Breast Surgeons Live

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Session Title:
Axillary Management in T1/T2 cN1 ER+ Breast Cancer: Upfront Surgery (Z11) vs NAC With TAD
Date & Time:
October 12, 2022, 7:00 PM–7:57 PM ET
57 Minutes
CME Deadline:
October 12, 2023
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Target Audience:
At the end of this activity, participants will be able to:
  • Discuss the axillary management options for patients with T1/T2 cN1 ER+ breast cancer.
  • Understand the literature supporting the management options for patients with T1/T2 cN1 ER+ breast cancer.
For patients with ER+ breast cancer axillary management can be challenging. Patients undergoing upfront surgery with BCS with 1 or 2 positive SLNs can be candidates for omission of ALND. However, if treated with neoadjuvant chemotherapy, can ALND be omitted? This webinar will debate management of the axilla for ER+ breast cancer in this scenario.
Welcome and Introduction
Zahraa Al-Hilli, MD, FACS
Debate: Upfront Surgery (Z11) vs NAC With TAD
Marissa Howard-McNatt, MD, FACS; Jennifer Steiman, MD, FACS
Case Discussion
All Faculty
Moderator—Zahraa Al-Hilli, MD, FACS
Cleveland Clinic
Cleveland, OH
Marissa Howard-McNatt, MD, FACS
Wake Forest University Baptist School of Medicine
Winston-Salem, NC
Jennifer Steiman, MD, FACS
University of Pittsburgh Medical Center
Pittsburgh, PA
  • ASBrS Consensus Guideline on Axillary Management for Patients With In-Situ and Invasive Breast Cancer: A Concise Overview (Download PDF)
  • Giuliano AE, Ballman KV, McCall L, et al. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318(10):918–926. doi:10.1001/jama.2017.11470
  • Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy in Patients With Node-Positive Breast Cancer: The ACOSOG Z1071 (Alliance) Clinical Trial. JAMA. 2013;310(14):1455–1461. doi:10.1001/jama.2013.278932
  • Tseng J, Alban RF, Siegel E, Chung A, Giuliano AE, Amersi FF. Changes in utilization of axillary dissection in women with invasive breast cancer and sentinel node metastasis after the ACOSOG Z0011 trial. Breast J. 2021 Mar;27(3):216-221. doi: 10.1111/tbj.14191. Epub 2021 Feb 14. PMID: 33586201.
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