Comparison of Sentinel Lymph Node Biopsy Alone and Completion Axillary Lymph Node Dissection for Node-Positive Breast Cancer

Abstract

Compared with SLNB alone, completion ALND does not appear to improve outcomes for breast cancer patients with microscopic nodal metastases; however, there was a nonsignificant trend toward better outcomes with completion ALND for those with macroscopic disease.

Intraoperative molecular assay for sentinel lymph node metastases in early stage breast cancer

“…The risk of further nonsentinel lymph node involvement was reported to be approximately 15% to 20% in patients with sentinel lymph node micrometastasis detected by histological examination [25][26][27][28][29] ; however, it remains controversial whether completion axillary lymph node dissection is needed for patients with sentinel lymph node micrometastasis [30][31][32][33][34] or micrometastasis has a prognostic impact. 2,19,21,35,36 One of the reasons for these controversies is that the conventional histopathological examination is not standardized, and its ability to measure accurate total metastatic volume in a lymph node, particularly for low-volume metastases, is limited.…”

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

“…Invasive lobular 4 (13) 21 (13) 13 (20) 6 (15) 5 (25) Select studies of patients with positive SLN and who did not undergo ALND have demonstrated low regional recurrence rates in the setting of adjuvant systemic therapy and RT (Table 5). 1,[5][6][7][8][9][10][11][12][13][14]28 Those series differed with respect to the length of median follow-up, the definition of a positive SLN, reasons for omitting ALND, and the receipt of systemic therapy. Although several of those reports 1,5,7,11 described the RT fields used, none reported treatment outcomes stratified by RT field design.…”

“…Methods of enhanced pathologic assessment of the SLN node have resulted in the increased detection of small-volume (micrometastases and isolated tumor cells) SLN metastases. 1,2 Nomograms that identify patients at low risk for additional lymph node metastases have guided the selection of patients for SLNB alone, 3 leading to a nationwide decline in the performance of completion axillary dissection (cALND). 1 These trends are reflected at our own institution, where cALND rates between 1998 to 2008 decreased from 85% to 73%.…”

“…1,2 Nomograms that identify patients at low risk for additional lymph node metastases have guided the selection of patients for SLNB alone, 3 leading to a nationwide decline in the performance of completion axillary dissection (cALND). 1 These trends are reflected at our own institution, where cALND rates between 1998 to 2008 decreased from 85% to 73%. 4 The recent publications of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial confirmed the low axillary recurrence rates observed in multiple studies of SLN-positive patients who did not undergo cALND and extended those observations to patients with macrometastases.…”

“…4 The recent publications of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial confirmed the low axillary recurrence rates observed in multiple studies of SLN-positive patients who did not undergo cALND and extended those observations to patients with macrometastases. 1,[5][6][7][8][9][10][11][12][13][14][15] The results suggested that SLNB alone in patients with early stage breast cancer who have low tumor burden in the SLNs, the receipt of adjuvant radiotherapy (RT) and systemic therapy is adequate for locoregional control. 14 Although the ACOSOG Z0011 protocol specified that all patients receive standard tangent field irradiation to the whole breast, details of the RT were not published, raising the question of whether the low regional recurrence rates observed in Z0011 were caused by the treatment of a portion of the axilla with the tangent fields 16 or by radiation oncologists opting to use high tangents to improve axillary coverage.…”