Axillary lymph node dissection: Dead or still alive?

Beck, Anna; Morrow, Monica

doi:10.1016/j.breast.2023.01.009

Cited by 8 publications

(12 citation statements)

References 56 publications

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“…The use of de-escalation strategies for lymph node surgery after NAC in early-stage breast cancer patients has recently been under debate. 18 , 19 After Tadros et al . 20 reported in a single-institution study that breast pCR is highly correlated with nodal status after NAC, Barron et al .…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of pathological nodal burden after neoadjuvant chemotherapy in initially cN0-1 breast cancer patients: a dual-center, 10-year survival analysis

Maimaitiaili,

Fan,

Zhang

et al. 2024

Ther Adv Med Oncol

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Background: There is an interest in performing de-escalating axillary surgery after neoadjuvant chemotherapy (NAC). However, the significance of residual axillary node disease after NAC has not been well studied. Objectives: To investigate the pathological residual axillary lymph node tumor burden (ypN) of patients with initial clinical nodal stage cN0-1 breast cancer after NAC and determine its prognostic value. Design: Initial cN0-1 breast cancer patients who received NAC followed by axillary surgery at the First Hospital of Jilin University and the First Affiliated Hospital of Xi’an Jiaotong University between January 2011 and December 2019 were included. Methods: Survival outcomes were compared according to different clinical and pathological stage and nodal response to NAC. The main outcomes were disease-free survival (DFS) and overall survival (OS). Factors associated with survival were defined by Cox regression analysis. Results: A total of 911 patients were included, among whom 260 had cN0 and 651 had cN1 tumors. After NAC, 410 patients were ypN0, and another 501 were ypN+. The median follow-up time was 63 months. There was no significant difference in DFS or OS between the cN0 and cN1 groups in hormone receptor positive (HR+)/human epidermal growth factor receptor 2 positive (HER2+) and HR−/HER2− subtypes; instead, ypN status was significantly related to DFS and OS. In HR+/HER2− subtype, both cN and ypN stages did not show significant survival differences, but the ypN number and the nodal response to NAC showed significant prognostic value ( p < 0.05). Among HR−/HER2+ patients, all cN status, ypN status, ypN number, and nodal response were significantly associated with survival ( p < 0.05). Furthermore, tumor biology, axillary surgery, ypN status, pathological tumor size, and radiotherapy were independent prognostic factors for DFS and OS. Conclusion: The ypN status after NAC provide more prognostic information than the initial cN stage in cN0-1 patients, and the surgical axillary staging after NAC may have high clinical value.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of pathological nodal burden after neoadjuvant chemotherapy in initially cN0-1 breast cancer patients: a dual-center, 10-year survival analysis

Maimaitiaili,

Fan,

Zhang

et al. 2024

Ther Adv Med Oncol

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“…ALND has conventionally been performed to establish local control in cN+ patients with a heavy axillary tumor burden [9]. In fact, for cN+ patients, beyond ALND, options are still limited.…”

Section: Neoadjuvant Chemotherapy (Nac) For Cn+ Patientsmentioning

confidence: 99%

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

Noguchi,

Inokuchi,

Yokoi-Noguchi

et al. 2023

Cancers

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Axillary lymph node dissection (ALND) has been associated with postoperative morbidities, including arm lymphedema, shoulder dysfunction, and paresthesia. Sentinel lymph node (SLN) biopsy emerged as a method to assess axillary nodal status and possibly obviate the need for ALND in patients with clinically node-negative (cN0) breast cancer. The majority of breast cancer patients are eligible for SLN biopsy only, so ALND can be avoided. However, there are subsets of patients in whom ALND cannot be eliminated. ALND is still needed in patients with three or more positive SLNs or those with gross extranodal or matted nodal disease. Moreover, ALND has conventionally been performed to establish local control in clinically node-positive (cN+) patients with a heavy axillary tumor burden. The sole method to avoid ALND is through neoadjuvant chemotherapy (NAC). Recently, various forms of conservative axillary surgery have been developed in order to minimize arm lymphedema without increasing axillary recurrence. In the era of effective multimodality therapy, conventional ALND may not be necessary in either cN0 or cN+ patients. Further studies with a longer follow-up period are needed to determine the safety of conservative axillary surgery.

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“…However, ALND results in significant morbidity, such as lymphedema, seroma formation, arm weakness, decreased shoulder range of motion, and neurological changes [ 10 ]. However, axillary lymph node clearance remains the standard of care for patients with locally advanced breast cancer, inflammatory breast carcinoma (T4d disease), patients with a positive sentinel lymph node (T3 tumours, ≥3 positive sentinel nodes), and patients scheduled for a mastectomy [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Is Sentinel Lymph Node Biopsy a Viable Alternative to Axillary Lymph Node Dissection in Breast Carcinoma Patients Who Have Received Neo-Adjuvant Chemotherapy?

Sulthana,

Singh

2024

Cureus

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Background Sentinel lymph node biopsy (SLNB) is based on the hypothesis that lymph from a primary solid neoplasm drains into one or more sentinel nodes, which are the first nodes at risk for harbouring occult metastatic disease. Sentinel lymph node biopsy has replaced axillary lymph node dissection (ALND) as the standard method for axillary staging in clinically node-negative patients. It avoids the complications associated with ALND and allows assessment of nodal status in patients with clinically node-negative breast cancer. Aims and objectives The aim of this study is to determine the false negative rate and identification rate of SLNB in breast cancer patients who received neoadjuvant chemotherapy (NACT). Materials and methods We conducted a hospital-based prospective study that included 19 patients who presented with early breast cancer and were node-positive. Post NACT, intraoperatively, methylene blue and radiocolloid dye were injected in the subareolar region. During the surgery, the blue and hot nodes identified were dissected, sent for frozen section analysis, and subsequently submitted for histopathological evaluation. This was followed by a standard-level I/II/III axillary clearance with histopathological examination. Results The false-negative rate of SLNB is 25%. Sentinel lymph node biopsy was more accurate with stage II than stage III tumours, and in patients who downstaged from stage II to any stage following NACT, it was more accurate than downstaging from stage III. The average number of sentinel nodes identified was 1.9, with the maximum being seven and the minimum being one. A total of 25 sentinel lymph nodes were identified in 13 patients, with an identification rate of 68.42%. Conclusions The main clinicopathological factors that influence the false negative rate of SLNB after NACT are axillary lymph node status, stage of the tumour at presentation, and tumour downstaging. For patients for whom sentinel nodes cannot be harvested, ALND should be done.

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Axillary lymph node dissection: Dead or still alive?

Cited by 8 publications

References 56 publications

Prognostic value of pathological nodal burden after neoadjuvant chemotherapy in initially cN0-1 breast cancer patients: a dual-center, 10-year survival analysis

Prognostic value of pathological nodal burden after neoadjuvant chemotherapy in initially cN0-1 breast cancer patients: a dual-center, 10-year survival analysis

Conservative Axillary Surgery May Prevent Arm Lymphedema without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

Is Sentinel Lymph Node Biopsy a Viable Alternative to Axillary Lymph Node Dissection in Breast Carcinoma Patients Who Have Received Neo-Adjuvant Chemotherapy?

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