Impact of omission of completion axillary lymph node dissection (cALND) or axillary radiotherapy (ax RT) in breast cancer patients with micrometastases (pN1mi) or isolated tumor cells (pN0[i+]) in the sentinel lymph node (SN): Results from the MIRROR study

Tjan-Heijnen, V. C. G.; Pepels, M.J.A.E.; Boer, M. de; Borm, GF; Dijck, J. A. van; Deurzen, Carolien Hm van; Adang, E. M.; Menke-Pluymers, Marian B. E.; Diest, Paul J. van; Bult, Peter

doi:10.1200/jco.2009.27.18s.cra506

Cited by 14 publications

(9 citation statements)

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“…In contrast, some other authors suggest that these results must be interpreted with great caution [36], because data used in the Z10-study were obtained from a cancer registry and did not undergo a central pathology review, and did not separate the microscopic disease into ITCs and micrometastasis. Moreover, a large Dutch population study, found a significantly higher 5-year axillary recurrence rate by the omission of CALND or axillary radiotherapy in patients with sentinel node micrometastasis [37]. All patients with ITCs or micrometastasis in our study population underwent CALND because the future role of ITCs and micrometastases was unknown, although ITCs are not currently considered to be an effective metastatic form [38].…”

Section: Discussionmentioning

confidence: 84%

Nine years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1,050 Cases

Bernardi¹,

Bertozzi²,

Londero

et al. 2012

World j. surg.

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Section: Discussionmentioning

confidence: 84%

Nine years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1,050 Cases

Bernardi¹,

Bertozzi²,

Londero

et al. 2012

World j. surg.

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“…Of note, the MSKCC reported that in patients identified with a positive SN by H&E examination, the ARR was 5% at a median follow-up of 23 months, even though these were highly selected patients [67]. In a cohort study from The Netherlands (the MIRROR study), patients with SN micrometastases (0.2-2.0 mm) who did not undergo a completion ALND were also shown to have an increased risk of axillary recurrence of 5% at 5 years follow-up [84].…”

Section: Discussionmentioning

confidence: 95%

Safety of avoiding routine use of axillary dissection in early stage breast cancer: a systematic review

Pepels

Vestjens

Boer

et al. 2010

Breast Cancer Res Treat

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Purpose Physicians are moving away from routine axillary lymph node dissection (ALND) in clinically node-negative breast cancer. We conducted a systemic review on the safety of this policy.Methods Pubmed and Cochrane library were searched for. Sixty-eight studies were included: studies of clinically node-negative patients in the pre-sentinel node (SN) era; observational studies of SN-negative patients, without ALND; comparative studies of SN-negative patients, with a non-ALND and an ALND group; SN-positive studies, of patients without ALND. Primary endpoint was the pooled axillary recurrence rate (ARR) of each category; secondary endpoint was overall survival (OS) rates. ResultsIn pre-SN studies, with larger tumors and less systemic therapy, ARR without ALND after 5 to 10 years follow-up was 12-18%, with 5% reduced OS. In the observational SN-negative studies, with median follow-up of 36 months, the pooled ARR was 0.6% (95%CI 0.6-0.8). In the comparative SN-negative studies, pooled ARR was 0.4% (95%CI 0.2-0.6) without ALND versus 0.3% (95%CI 0.1-0.6) with ALND at 31 and 47 months, respectively, and no survival disadvantage. In SNpositive studies, ARR was up to 1.7% (95%CI 1.0-2.7) at 30 months. For patients with an H&E positive SN the ARR without ALND was 5% after 23 months, which may imply rates as high as 13% and 18% after 5 and 8 years.Conclusion This systematic review confirms the safety of omitting ALND in SNnegative patients. There is a potential role for avoiding ALND in selected SN-positive patients, but eligibility criteria and the role of systemic therapy need further to be elucidated. M. Pepels et al.

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“…Dans l'étude hollandaise MIRROR, en cas de micrométastase du ganglion sentinelle, le taux de récidive axillaire à cinq ans était de 5 % en l'absence de curage axillaire [32]. Dans l'étude de la National Cancer Data Base, avec 97 314 patientes chez qui le ganglion sentinelle était envahi, une biopsie des ganglions sans curage a été réalisée chez 20,8 % des patientes [33].…”

Section: Récidive Axillaireunclassified

Traitement régional des cancers du sein en cas de micrométastase ganglionnaire axillaire

Houvenaeghel

Cohen

Jauffret-Fara

et al. 2015

Cancer/Radiothérapie

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Impact of omission of completion axillary lymph node dissection (cALND) or axillary radiotherapy (ax RT) in breast cancer patients with micrometastases (pN1mi) or isolated tumor cells (pN0[i+]) in the sentinel lymph node (SN): Results from the MIRROR study

Cited by 14 publications

References 0 publications

Nine years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1,050 Cases

Nine years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1,050 Cases

Safety of avoiding routine use of axillary dissection in early stage breast cancer: a systematic review

Traitement régional des cancers du sein en cas de micrométastase ganglionnaire axillaire

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