Is a completion axillary dissection indicated for micrometastases in the sentinel lymph node?

Liang, Wen; Sickle‐Santanello, Brenda J.; Nims, Thomas A.

doi:10.1016/s0002-9610(01)00738-3

Cited by 67 publications

(41 citation statements)

References 11 publications

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“…Indeed, few retrospective analyses on selected patients with SLN micrometastases without further ALND have suggested that this subset of patients will suffer from a higher incidence of regional recurrence or distant disease. This supports the theory that formal ALND may be omitted in these patients, thus reducing the potential associated short-and long-term complications (36)(37)(38). However, the design of a probe that is capable of processing high-energy gamma photons from positron emitters such as 18 F and using it intraoperatively with significant background radiation is highly challenging.…”

Section: Figure 2 Maximum Intensity Projection Of Positron-emission supporting

confidence: 60%

PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

Orsaria

Chiaravalloti

Fiorentini

et al. 2017

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Nuclear medicine has an essential and increasing role in the management of patients with breast cancer. Sentinel node detection has achieved reliability and, at present, it has an important place in clinical management. Even in the era of gene-expression profiling, nodal status remains one of the primary prognostic discriminants in patients with breast cancer, and is of great value as an independent predictor of distant disease development. Although several institutional case series have differed in patient selection, follow-up, type of surgery, and adjuvant therapies, they have consistently shown that the percentage of positive lymph nodes is a significant indicator of survival in women with axillary metastases on final pathology (1-5). The American Society of Clinical Oncology convened an Update Committee of experts to provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer (6). The need to perform axillary lymph node dissection (ALND) when SNB is positive and administration of contemporary adjuvant treatment including radiotherapy, chemotherapy, and hormonal therapy has been questioned in recent years. On the other hand, ongoing trials are testing whether node-positive patients can be spared chemotherapy, as qualifying indications increasingly rely on breast cancer biology for decision-making regarding adjuvant systemic treatment (7). In summary, sentinel node surgery represents the next major step in reducing the extent of surgical procedures, but despite the revolution of quality-conserving care, recent data collection and analyses of anatomical techniques suggest that exact lymphatic drainage of the breast is debatable (8). Different lymphatic patterns may help explain some important unresolved clinical problems, including different detection rates between studies and high false-negative rates of about 10% in multicenter randomized controlled trials (9). Further anatomical investigation and knowledge of the exact sentinel lymphatic channels will provide more information about patterns of breast cancer in order to improve surgical strategy, locoregional recurrence, and survival.

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Section: Figure 2 Maximum Intensity Projection Of Positron-emission supporting

confidence: 60%

PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

Orsaria

Chiaravalloti

Fiorentini

et al. 2017

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“…This is consistent with other studies that have found the presence of micrometastases to be the only important size factor in predicting further ALN involvement. 9 The median age of the CALND group was higher than that in the SLNB group, but this did not reach statistical significance. Although age alone is not a deterrent from performing further surgery, CALND has been shown to have little effect on survival in women older than 60 years.…”

Section: Discussionmentioning

confidence: 84%

“…8 Low locoregional recurrence rates have been reported in selected patients with positive SLNs who do not undergo CALND. 9 In particular, in the setting of microscopic SLN metastases, there appears to be no advantage to performing CALND. 2,10 Given the advantages for SLNB, Van Zee and colleagues 11 developed a nomogram to predict the likelihood of non-SLN metastases in patients with positive SLNs, which has been validated.…”

mentioning

confidence: 99%

Factors that determine whether a patient receives completion axillary lymph node dissection after a positive sentinel lymph node biopsy in breast cancer in British Columbia

et al. 2011

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Factors that determine whether a patient receives completion axillary lymph node dissection after a positive sentinel lymph node biopsy for breast cancer in British Columbia Background: Completion axillary lymph node dissection (CALND) is recommended in the setting of positive sentinel lymph node biopsy (SLNB) but is associated with a higher rate of postoperative complications. In this study, the characteristics and outcomes of patients who did and did not have CALND are compared. Methods:We identified all patients with breast cancer with positive sentinel lymph nodes (SLNs) who did not have concurrent CALND from 2003 to 2006 using a prospectively collected database (British Columbia Cancer Breast Outcomes database) and retrospective chart review. Patient and tumour characteristics were compared between those who received CALND and those who did not.Results: Among 185 patients with positive SLNs identified by SLNB, 90 had a CALND and 95 had no further surgical therapy. Patients who did not receive CALND had more sentinel nodes removed (p < 0.001), a lower percentage of positive SLNs (p < 0.001) and lower pathologic N stage (p = 0.044) than those who did receive CALND. The size of the breast lesion, size of the largest SLN deposit, estrogen receptor status, grade, lymphovascular invasion, histology and multifocality were not significantly different between groups. Sixty-two percent of women who did not have CALND received radiation to the axilla. Postoperative complication rates (including lymphedema) were higher in the CALND group (21%) compared with the SLNB group (7%). The rates of locoregional recurrence (1% in both groups) and systemic metastases (6% in the CALND group v. 8% in the SLNB group) were similar at 36 months' follow-up. Conclusion:Compared with women who had CALND, women who did not receive CALND had on average a lower N stage with 3 or more SLNs removed and less than 50% node positivity. Most of these women received radiation therapy to the axilla and had comparable recurrence rates to those who had CALND.Contexte : L'ablation des ganglions lymphatiques axillaires (AGLA) est recommandée lorsque la biopsie des ganglions lymphatiques sentinelles donne des résultats positifs, mais cette intervention est associée à un taux plus élevé de complications postopératoires que la seule biopsie. Cette étude a comparé les caractéristiques et les résultats chez les patientes qui ont subi une AGLA et chez celles qui n'ont pas subi cette intervention.

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“…Similarly, in a series of 27 patients followed up for 30 months, Fant et al [61] found no cases of axillary recurrence in those with SLN MM. In a smaller study including 15 patients with MM, 11 of which underwent ALND, no cases of local or systemic relapse were identified after a median follow-up of 13.5 months [62]. In a retrospective review, Rutledge et al [63] found that the risk of finding non-SLN positivity was significantly lower in patients with SLN MM (3%) compared to SLN macrometastasis (63%).…”

Section: Evidence Againstmentioning

confidence: 97%

The clinical significance of sentinel lymph node micrometastasis in breast cancer

Patani

Mokbel

2008

Breast Cancer Res Treat

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Is a completion axillary dissection indicated for micrometastases in the sentinel lymph node?

Cited by 67 publications

References 11 publications

PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

Factors that determine whether a patient receives completion axillary lymph node dissection after a positive sentinel lymph node biopsy in breast cancer in British Columbia

The clinical significance of sentinel lymph node micrometastasis in breast cancer

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