Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy

Abstract

The surgical treatment of localized breast cancer has become progressively less aggressive over the years. The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered.

External Validation of the SERC Trial Population: Comparison with the Multicenter French Cohort, the Swedish and SENOMIC Trial Populations for Breast Cancer Patients with Sentinel Node Micro-Metastasis

“…In the ACOSOG Z011, inequalities between patients were in the favor of the SLN group with a higher rate of micro-metastases in the SLN group. The tumor burden in the study was lower than anticipated and the patients in real life who meet the eligibility criteria have higher chances of having additional positive nodes [ 15 ]. Axillary recurrences were not an endpoint and a significant amount had unknown nodal status [ 4 ].…”

“…Both of the above cited trials induced important changes in clinical practice by eliminating the indications of ALND in patients presenting micro-metastases and patients presenting less than two SLN macro-metastases; however, the extrapolation of these results to the general population has been questioned. Both trials closed prematurely [ 11 ], did not achieve full patient accrual, presented lower numbers of events compared to what was expected, and the majority of patients included had favorable tumor prognostic features [ 4 , 12 , 13 , 14 , 15 , 16 ].…”

Análise De Expressão Gênica Na Identificação De Potenciais Marcadores Preditivos Em Neoplasias Malignas Mamárias

“…Sabe-se que a identificação de marcadores preditivos em câncer de mama poderá poupar mulheres com baixo risco de metástase em linfonodos de se submeterem a procedimentos cirúrgicos desnecessários, como a dissecação dos linfonodos axilares (DLN) (VOUTSADAKIS et al, 2015). Contudo, a maioria dos trabalhos de expressão gênica avalia somente o potencial prognóstico dos genes, enquanto uma quantidade reduzida analisa o poder preditivo de genes em amostras de neoplasias primárias e metástases de linfonodos em câncer de mama (BERTUCI et al, 2000;HUANG et al, 2003;ABBA et al, 2007;FENG et al, 2007;WANG et al, 2013;VALENTE et al, 2014;CHEN et al, 2017;PAULA et al, 2017).…”

The Sentinel Node with Isolated Breast Tumor Cells or Micrometastases. Benefits and Risks of Axillary Dissection

“…Research in the area of ALN management in breast cancer tends to advocate a more personalised approach based on axillary tumor burden and biology of the cancer (26). The future role of ALND may increasingly be to treat locally persistent or recurrent disease, not to prevent it (27).…”