{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:00:44Z","timestamp":1792677644333,"version":"4.5.0"},"reference-count":50,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,8]]},"abstract":"\n Context.\u2014<\/jats:bold>\n Results of the American College of Surgeons Oncology Group Z0011 trial showed that patients with early-stage breast cancer and limited sentinel node metastasis treated with breast conservation and systemic therapy did not benefit from axillary lymph node dissection. Subsequently, most pathology departments have likely seen a decrease in frozen section diagnosis of sentinel lymph nodes.\n <\/jats:p>\n \n Objective.\u2014<\/jats:bold>\n To determine the effect of the Z0011 trial on pathology practice and to examine the utility of intraoperative sentinel lymph node evaluation for this subset of patients.\n <\/jats:p>\n \n Design.\u2014<\/jats:bold>\n Pathology reports from cases of primary breast cancer that met Z0011 clinical criteria and were initially treated with lumpectomy and sentinel lymph node biopsy from 2009 to 2015 were collected. Clinicopathologic data were recorded.\n <\/jats:p>\n \n Results.\u2014<\/jats:bold>\n Sentinel lymph node biopsies sent for frozen section diagnosis occurred in 22 of 22 cases (100%) in 2009 and 15 of 22 cases (68%) in 2010 during the pre-Z0011 years, and in 3 of 151 cases (2%) collected in 2011 through 2015, considered to be post-Z0011 years. Of the 151 post-Z0011 cases, 28 (19%) had sentinel lymph nodes with metastasis, and 147 (97%) were spared axillary lymph node dissection.\n <\/jats:p>\n \n Conclusions.\u2014<\/jats:bold>\n Following Z0011, intraoperative sentinel lymph node evaluation has significantly decreased at our institution. Prior to surgery, all patients had clinically node-negative disease. After sentinel lymph node evaluation, 97% (147 of 151) of the patients were spared axillary lymph node dissection. Therefore, routine frozen section diagnosis for sentinel lymph node biopsies can be avoided in these patients.\n <\/jats:p>","DOI":"10.5858\/arpa.2015-0296-oa","type":"journal-article","created":{"date-parts":[[2015,12,30]],"date-time":"2015-12-30T18:32:05Z","timestamp":1451500325000},"page":"830-835","source":"Crossref","is-referenced-by-count":36,"title":["Decline in Frozen Section Diagnosis for Axillary Sentinel Lymph Nodes as a Result of the American College of Surgeons Oncology Group Z0011 Trial"],"prefix":"10.5858","volume":"140","author":[{"given":"Julie Anne","family":"Bishop","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihong","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Ajkay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Ann G.","family":"Sanders","sequence":"additional","affiliation":[{"name":"From the Department of Pathology & Laboratory Medicine (Drs Sanders, Bishop, and Sun) and the Department of Surgery (Dr Ajkay), University of Louisville Hospital, Louisville, Kentucky. Dr Sun is now with the Department of Pathology, SUNY, University of Buffalo at Buffalo, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"key":"i1543-2165-140-8-830-b01","series-title":"Robbins and Cotran Pathologic Basis of Disease","first-page":"1065","article-title":"The breast","author":"Lester \n SC.","year":"2015","unstructured":"Lester \n SC. \n \n \n The breast. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 8th ed.Philadelphia, PA: Elsevier\/Saunders; 2015:1065\u20131095."},{"issue":"6","key":"i1543-2165-140-8-830-b02","series-title":"N Engl J Med","first-page":"546","article-title":"A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer","volume":"349","author":"Veronesi \n U,","year":"2003","unstructured":"Veronesi \n U, \n \n \n Paganelli \n G, \n \n \n Viale \n G, \n \n et al. \n A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349(6):546\u2013553."},{"issue":"6","key":"i1543-2165-140-8-830-b03","series-title":"JAMA","first-page":"569","article-title":"Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial","volume":"305","author":"Giuliano \n AE,","year":"2011","unstructured":"Giuliano \n AE, \n \n \n Hunt \n KK, \n \n \n Ballman \n KV, \n \n et al. \n Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569\u2013575."},{"issue":"9","key":"i1543-2165-140-8-830-b04","series-title":"Ann Surg Oncol","first-page":"2407","article-title":"Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial","volume":"18","author":"Caudle \n AS,","year":"2011","unstructured":"Caudle \n AS, \n \n \n Hunt \n KK, \n \n \n Kuerer \n HM, \n \n et al. \n Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol. 2011;18(9):2407\u20132412."},{"issue":"10","key":"i1543-2165-140-8-830-b05","series-title":"Ann Surg Oncol","first-page":"3144","article-title":"American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns","volume":"19","author":"Caudle \n AS,","year":"2012","unstructured":"Caudle \n AS, \n \n \n Hunt \n KK, \n \n \n Tucker \n SL, \n \n et al. \n American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19(10):3144\u20133151."},{"issue":"1","key":"i1543-2165-140-8-830-b06","series-title":"J Am Coll Surg","first-page":"105","article-title":"Impact of the american college of surgeons oncology group Z0011 criteria applied to a contemporary patient population","volume":"216","author":"Yi \n M,","year":"2013","unstructured":"Yi \n M, \n \n \n Kuerer \n HM, \n \n \n Mittendorf \n EA, \n \n et al. \n Impact of the american college of surgeons oncology group Z0011 criteria applied to a contemporary patient population. J Am Coll Surg. 2013;216(1):105\u2013113."},{"issue":"32","key":"i1543-2165-140-8-830-b07","series-title":"J Clin Oncol","first-page":"3583","article-title":"New information prompts old question: is sentinel lymph node sampling equivalent to axillary lymph node dissection?","volume":"32","author":"Zellars \n RC.","year":"2014","unstructured":"Zellars \n RC. \n \n \n New information prompts old question: is sentinel lymph node sampling equivalent to axillary lymph node dissection?\n J Clin Oncol. 2014;32(32):3583\u20133585."},{"issue":"13","key":"i1543-2165-140-8-830-b08","series-title":"J Clin Oncol","first-page":"1365","article-title":"Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update","volume":"32","author":"Lyman \n GH,","year":"2014","unstructured":"Lyman \n GH, \n \n \n Temin \n S, \n \n \n Edge \n SB, \n \n et al. \n Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365\u20131383."},{"issue":"4","key":"i1543-2165-140-8-830-b09","series-title":"Lancet Oncol","first-page":"297","article-title":"Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial","volume":"14","author":"Galimberti \n V,","year":"2013","unstructured":"Galimberti \n V, \n \n \n Cole \n BF, \n \n \n Zurrida \n S, \n \n et al. \n Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297\u2013305."},{"issue":"13","key":"i1543-2165-140-8-830-b10","series-title":"Ann Surg Oncol","first-page":"4145","article-title":"Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on clinical management of the axilla in older breast cancer patients: a SEER-medicare analysis","volume":"20","author":"Caretta-Weyer \n H,","year":"2013","unstructured":"Caretta-Weyer \n H, \n \n \n Greenberg \n CG, \n \n \n Wilke \n LG, \n \n et al. \n Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on clinical management of the axilla in older breast cancer patients: a SEER-medicare analysis. Ann Surg Oncol. 2013;20(13):4145\u20134152."},{"issue":"10","key":"i1543-2165-140-8-830-b11","series-title":"Ann Surg Oncol","first-page":"3152","article-title":"Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons","volume":"19","author":"Gainer \n SM,","year":"2012","unstructured":"Gainer \n SM, \n \n \n Hunt \n KK, \n \n \n Beitsch \n P, \n \n \n Caudle \n AS, \n \n \n Mittendorf \n EA, \n \n \n Lucci \n A. \n \n \n Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons. Ann Surg Oncol. 2012;19(10):3152\u20133158."},{"issue":"2","key":"i1543-2165-140-8-830-b12","series-title":"Am J Surg","first-page":"240","article-title":"Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system","volume":"209","author":"Wright \n GP,","year":"2015","unstructured":"Wright \n GP, \n \n \n Mater \n ME, \n \n \n Sobel \n HL, \n \n et al. \n Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system. Am J Surg. 2015;209(2):240\u2013245."},{"issue":"3","key":"i1543-2165-140-8-830-b13","series-title":"Ann Surg","first-page":"426","article-title":"Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial","volume":"252","author":"Giuliano \n AE,","year":"2010","unstructured":"Giuliano \n AE, \n \n \n McCall \n L, \n \n \n Beitsch \n P, \n \n et al. \n Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426\u2013432; discussion 432\u2013423."},{"issue":"5","key":"i1543-2165-140-8-830-b14","series-title":"N Engl J Med","first-page":"412","article-title":"Effect of occult metastases on survival in node-negative breast cancer","volume":"364","author":"Weaver \n DL,","year":"2011","unstructured":"Weaver \n DL, \n \n \n Ashikaga \n T, \n \n \n Krag \n DN, \n \n et al. \n Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364(5):412\u2013421."},{"issue":"7","key":"i1543-2165-140-8-830-b15","series-title":"Arch Pathol Lab Med","first-page":"966","article-title":"Prognostic factors in breast cancer: College of American Pathologists Consensus Statement 1999","volume":"124","author":"Fitzgibbons \n PL,","year":"2000","unstructured":"Fitzgibbons \n PL, \n \n \n Page \n DL, \n \n \n Weaver \n D, \n \n et al. \n Prognostic factors in breast cancer: College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000;124(7):966\u2013978."},{"issue":"suppl 2","key":"i1543-2165-140-8-830-b16","series-title":"Mod Pathol","first-page":"S26","article-title":"Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale","volume":"23","author":"Weaver \n DL.","year":"2010","unstructured":"Weaver \n DL. \n \n \n Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale. Mod Pathol. 2010;23(suppl 2):S26\u2013S32."},{"issue":"9804","key":"i1543-2165-140-8-830-b17","series-title":"Lancet","first-page":"1707","article-title":"Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials","volume":"378","author":"Early Breast Cancer Trialists' Collaborative Group (EBCTCG)","year":"2011","unstructured":"Early Breast Cancer Trialists' Collaborative Group (EBCTCG)\n , Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707\u20131716."},{"issue":"9935","key":"i1543-2165-140-8-830-b18","series-title":"Lancet","first-page":"2127","article-title":"Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials","volume":"383","author":"Early Breast Cancer Trialists' Collaborative Group (EBCTCG)","year":"2014","unstructured":"Early Breast Cancer Trialists' Collaborative Group (EBCTCG)\n , McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127\u20132135."},{"issue":"12","key":"i1543-2165-140-8-830-b19","series-title":"Lancet Oncol","first-page":"1303","article-title":"Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial","volume":"15","author":"Donker \n M,","year":"2014","unstructured":"Donker \n M, \n \n \n van Tienhoven \n G, \n \n \n Straver \n ME, \n \n et al. \n Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303\u20131310."},{"issue":"10","key":"i1543-2165-140-8-830-b20","series-title":"Arch Pathol Lab Med","first-page":"1288","article-title":"Metastatic tumor volume and extranodal tumor extension: clinical significance in patients with stage II breast cancer","volume":"139","author":"Drinka \n E,","year":"2015","unstructured":"Drinka \n E, \n \n \n Allen \n P, \n \n \n McBride \n A, \n \n \n Buchholz \n T, \n \n \n Sahin \n A. \n \n \n Metastatic tumor volume and extranodal tumor extension: clinical significance in patients with stage II breast cancer. Arch Pathol Lab Med. 2015;139(10):1288\u20131294."},{"issue":"5","key":"i1543-2165-140-8-830-b21","series-title":"Ann Surg","first-page":"607","article-title":"Extracapsular extension of the sentinel lymph node metastasis: a predictor of nonsentinel node tumor burden","volume":"237","author":"Stitzenberg \n KB,","year":"2003","unstructured":"Stitzenberg \n KB, \n \n \n Meyer \n AA, \n \n \n Stern \n SL, \n \n et al. \n Extracapsular extension of the sentinel lymph node metastasis: a predictor of nonsentinel node tumor burden. Ann Surg. 2003;237(5):607\u2013612; discussion 612\u2013603."},{"issue":"11","key":"i1543-2165-140-8-830-b22","series-title":"Eur J Cancer","first-page":"1731","article-title":"Group AT. Predictors of non-sentinel lymph node metastasis in breast cancer patients","volume":"40","author":"Goyal \n A,","year":"2004","unstructured":"Goyal \n A, \n \n \n Douglas-Jones \n A, \n \n \n Newcombe \n RG, \n \n \n Mansel \n RE, \n \n \n Group AT. Predictors of non-sentinel lymph node metastasis in breast cancer patients. Eur J Cancer. 2004;40(11):1731\u20131737."},{"issue":"9","key":"i1543-2165-140-8-830-b23","series-title":"Ann Surg Oncol","first-page":"2897","article-title":"The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1-T2 breast cancer","volume":"21","author":"Gooch \n J,","year":"2014","unstructured":"Gooch \n J, \n \n \n King \n TA, \n \n \n Eaton \n A, \n \n et al. \n The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1-T2 breast cancer. Ann Surg Oncol. 2014;21(9):2897\u20132903."},{"key":"i1543-2165-140-8-830-b24","series-title":"National Library of Medicine Web site","article-title":"Standard or comprehensive radiation therapy in treating patients with early-stage breast cancer previously treated with chemotherapy and surgery","year":"2015","unstructured":"National Surgical Adjuvant Breast and Bowel Project. Standard or comprehensive radiation therapy in treating patients with early-stage breast cancer previously treated with chemotherapy and surgery. National Library of Medicine Web site. https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01872975. NLM identifier: NCT01872975. AccessedNovember2,2015."},{"key":"i1543-2165-140-8-830-b25","series-title":"National Library of Medicine Web site","article-title":"Comparison of axillary lymph node dissection with axillary radiation for patients with node-positive breast cancer treated with chemotherapy","year":"2015","unstructured":"Alliance for Clinical Trials in Oncology. Comparison of axillary lymph node dissection with axillary radiation for patients with node-positive breast cancer treated with chemotherapy. National Library of Medicine Web site. https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01901094. NLM identifier: NCT01901094. AccessedNovember2,2015."},{"key":"i1543-2165-140-8-830-b01","series-title":"Robbins and Cotran Pathologic Basis of Disease","first-page":"1065","article-title":"The breast","author":"Lester \n SC.","year":"2015","unstructured":"Lester \n SC. \n \n \n The breast. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 8th ed.Philadelphia, PA: Elsevier\/Saunders; 2015:1065\u20131095."},{"issue":"6","key":"i1543-2165-140-8-830-b02","series-title":"N Engl J Med","first-page":"546","article-title":"A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer","volume":"349","author":"Veronesi \n U,","year":"2003","unstructured":"Veronesi \n U, \n \n \n Paganelli \n G, \n \n \n Viale \n G, \n \n et al. \n A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349(6):546\u2013553."},{"issue":"6","key":"i1543-2165-140-8-830-b03","series-title":"JAMA","first-page":"569","article-title":"Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial","volume":"305","author":"Giuliano \n AE,","year":"2011","unstructured":"Giuliano \n AE, \n \n \n Hunt \n KK, \n \n \n Ballman \n KV, \n \n et al. \n Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569\u2013575."},{"issue":"9","key":"i1543-2165-140-8-830-b04","series-title":"Ann Surg Oncol","first-page":"2407","article-title":"Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial","volume":"18","author":"Caudle \n AS,","year":"2011","unstructured":"Caudle \n AS, \n \n \n Hunt \n KK, \n \n \n Kuerer \n HM, \n \n et al. \n Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol. 2011;18(9):2407\u20132412."},{"issue":"10","key":"i1543-2165-140-8-830-b05","series-title":"Ann Surg Oncol","first-page":"3144","article-title":"American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns","volume":"19","author":"Caudle \n AS,","year":"2012","unstructured":"Caudle \n AS, \n \n \n Hunt \n KK, \n \n \n Tucker \n SL, \n \n et al. \n American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19(10):3144\u20133151."},{"issue":"1","key":"i1543-2165-140-8-830-b06","series-title":"J Am Coll Surg","first-page":"105","article-title":"Impact of the american college of surgeons oncology group Z0011 criteria applied to a contemporary patient population","volume":"216","author":"Yi \n M,","year":"2013","unstructured":"Yi \n M, \n \n \n Kuerer \n HM, \n \n \n Mittendorf \n EA, \n \n et al. \n Impact of the american college of surgeons oncology group Z0011 criteria applied to a contemporary patient population. J Am Coll Surg. 2013;216(1):105\u2013113."},{"issue":"32","key":"i1543-2165-140-8-830-b07","series-title":"J Clin Oncol","first-page":"3583","article-title":"New information prompts old question: is sentinel lymph node sampling equivalent to axillary lymph node dissection?","volume":"32","author":"Zellars \n RC.","year":"2014","unstructured":"Zellars \n RC. \n \n \n New information prompts old question: is sentinel lymph node sampling equivalent to axillary lymph node dissection?\n J Clin Oncol. 2014;32(32):3583\u20133585."},{"issue":"13","key":"i1543-2165-140-8-830-b08","series-title":"J Clin Oncol","first-page":"1365","article-title":"Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update","volume":"32","author":"Lyman \n GH,","year":"2014","unstructured":"Lyman \n GH, \n \n \n Temin \n S, \n \n \n Edge \n SB, \n \n et al. \n Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365\u20131383."},{"issue":"4","key":"i1543-2165-140-8-830-b09","series-title":"Lancet Oncol","first-page":"297","article-title":"Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial","volume":"14","author":"Galimberti \n V,","year":"2013","unstructured":"Galimberti \n V, \n \n \n Cole \n BF, \n \n \n Zurrida \n S, \n \n et al. \n Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297\u2013305."},{"issue":"13","key":"i1543-2165-140-8-830-b10","series-title":"Ann Surg Oncol","first-page":"4145","article-title":"Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on clinical management of the axilla in older breast cancer patients: a SEER-medicare analysis","volume":"20","author":"Caretta-Weyer \n H,","year":"2013","unstructured":"Caretta-Weyer \n H, \n \n \n Greenberg \n CG, \n \n \n Wilke \n LG, \n \n et al. \n Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on clinical management of the axilla in older breast cancer patients: a SEER-medicare analysis. Ann Surg Oncol. 2013;20(13):4145\u20134152."},{"issue":"10","key":"i1543-2165-140-8-830-b11","series-title":"Ann Surg Oncol","first-page":"3152","article-title":"Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons","volume":"19","author":"Gainer \n SM,","year":"2012","unstructured":"Gainer \n SM, \n \n \n Hunt \n KK, \n \n \n Beitsch \n P, \n \n \n Caudle \n AS, \n \n \n Mittendorf \n EA, \n \n \n Lucci \n A. \n \n \n Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons. Ann Surg Oncol. 2012;19(10):3152\u20133158."},{"issue":"2","key":"i1543-2165-140-8-830-b12","series-title":"Am J Surg","first-page":"240","article-title":"Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system","volume":"209","author":"Wright \n GP,","year":"2015","unstructured":"Wright \n GP, \n \n \n Mater \n ME, \n \n \n Sobel \n HL, \n \n et al. \n Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system. Am J Surg. 2015;209(2):240\u2013245."},{"issue":"3","key":"i1543-2165-140-8-830-b13","series-title":"Ann Surg","first-page":"426","article-title":"Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial","volume":"252","author":"Giuliano \n AE,","year":"2010","unstructured":"Giuliano \n AE, \n \n \n McCall \n L, \n \n \n Beitsch \n P, \n \n et al. \n Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426\u2013432; discussion 432\u2013423."},{"issue":"5","key":"i1543-2165-140-8-830-b14","series-title":"N Engl J Med","first-page":"412","article-title":"Effect of occult metastases on survival in node-negative breast cancer","volume":"364","author":"Weaver \n DL,","year":"2011","unstructured":"Weaver \n DL, \n \n \n Ashikaga \n T, \n \n \n Krag \n DN, \n \n et al. \n Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364(5):412\u2013421."},{"issue":"7","key":"i1543-2165-140-8-830-b15","series-title":"Arch Pathol Lab Med","first-page":"966","article-title":"Prognostic factors in breast cancer: College of American Pathologists Consensus Statement 1999","volume":"124","author":"Fitzgibbons \n PL,","year":"2000","unstructured":"Fitzgibbons \n PL, \n \n \n Page \n DL, \n \n \n Weaver \n D, \n \n et al. \n Prognostic factors in breast cancer: College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000;124(7):966\u2013978."},{"issue":"suppl 2","key":"i1543-2165-140-8-830-b16","series-title":"Mod Pathol","first-page":"S26","article-title":"Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale","volume":"23","author":"Weaver \n DL.","year":"2010","unstructured":"Weaver \n DL. \n \n \n Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale. 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