Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses

Abstract

Traditionally, women with node-positive operable breast cancer have received complete axillary lymph node dissection (ALND), which is associated with significant morbidity, but recently less invasive alternatives have been explored. We conducted a systematic review of randomised controlled trials assessing alternative approaches to axillary surgery in patients with pathologically-confirmed sentinel node-positive operable breast cancer. We searched on 16/3/15 the Specialized Register of the Cochrane Breast Cancer group; CENTRAL; MEDLINE; PreMEDLINE; EMBASE; WHO International Clinical Trials Registry Portal; ClinicalTrials.gov; conference proceedings from ASCO and the San Antonio Breast Cancer meetings; checked reference lists and contacted authors to identify relevant studies. Double, independent study sifting, extraction, appraisal and summarising were undertaken using standard Cochrane Collaboration methodology. We included three studies (2020 patients) comparing ALND with sentinel lymph node dissection (SLND) to SLND alone, and two studies (1899 patients) comparing ALND to axillary radiotherapy (aRT). No differences in survival or recurrence were observed between ALND and SLND or aRT, but morbidity may have been increased in ALND, and all the results were subject to different biases, such as recruitment bias, performance bias, and outcome-reporting bias. Whilst it is encouraging that there appears to be no adverse effect on recurrence or survival, it will be appropriate to confirm these findings and provide additional data confirming quality of life effects and long term outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-1712-9) contains supplementary material, which is available to authorized users.

Lymphoscintigraphy detecting alterations of upper limb lymphatic flow following early sentinel lymph node biopsy in breast cancer

“…An SLNB in patients submitted to early-stage breast cancer treatment is a strategy to minimize the risk of morbidities associated with therapy, primarily upper limb lymphedema 3,4,50. Currently, the decrease in practice of ALND after positive SLN for micrometastases or an isolated tumor suggests that ALND is more prognostic than therapeutic 51–53.…”

“…An SLNB in patients submitted to early-stage breast cancer treatment is a strategy to minimize the risk of morbidities associated with therapy, primarily upper limb lymphedema. 3 , 4 , 50 Currently, the decrease in practice of ALND after positive SLN for micrometastases or an isolated tumor suggests that ALND is more prognostic than therapeutic. 51 – 53 Although SLNB reduces the risk of developing lymphedema, other factors, including disruption of arm lymphatic vessels 37 , 38 and obesity, 38 , 39 may lead to the onset of this condition, especially when associated with adjuvant radiation therapy.…”

Oxygénothérapie hyperbare et radiothérapie : entre mythe et réalité

“…Schmidt-Hansen et al ont réalisé une méta-analyse des essais comparant un curage axillaire et une radiothérapie de l'aire ganglionnaire axillaire, chez des patientes atteintes d'un cancer du sein opéré avec ganglion sentinelle atteint [19]. Ils ont montré un taux de rechute identique entre les deux cas, mais une morbidité supé-rieure en cas de curage ganglionnaire chirurgical.…”

Imaging and pathology features to predict axillary tumor load in breast cancer

“…When the ACOSOG Z0011 and AMAROS trials were conducted, several breast units stopped performing axillary lymph node dissection (ALND) in patients with one or two affected sentinel lymph nodes (SLN) as these studies proved that ALND was not superior to direct or indirect axillary irradiation . Since these trials were conducted, several systematic reviews and meta‐analyses have supported this data …”

“…1,2 Since these trials were conducted, several systematic reviews and meta-analyses have supported this data. 3,4 On the other hand, a recent meta-analysis of randomized trials of ALND versus no ALND showed an improvement in overall survival (OS) and disease-free survival (DFS) in patients who underwent ALND. 5 Importantly, a randomized trial also reported that irradiation of lymph node areas improved DFS and distant DFS.…”