Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer

Straver, Marieke E.; Meijnen, Philip; Tienhoven, Geertjan van; Velde, Cornelis J.H. van de; Mansel, Robert Edward; Bogaerts, Jan; Demonty, Gaston; Duez, Nicole; Cataliotti, Luigi; Klinkenbijl, Jean H. G.; Westenberg, Helen; Mijle, Hueb van der; Hurkmans, Coen; Rutgers, E.

doi:10.1200/jco.2008.21.7554

Cited by 165 publications

(94 citation statements)

References 27 publications

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“…In conclusion, the only indication for a SLNB in cN0 patients who undergo primary surgery is to identify 4 or more involved axillary lymph nodes in luminal-like breast carcinomas resulting in a clear indication for postoperative chemotherapy and RT. In the AMAROS trial and a Dutch population-based study, only 3 and 1.7%, respectively, of all luminal-like tumors in an SLNB cohort showed 4 or more involved axillary lymph nodes (≥stage pN2a) [34,35]. Hence, even here, the chances of added value from the SLNB concerning treatment changes are low.…”

Section: Surgeon's View: Pros and Cons For Slnbmentioning

confidence: 99%

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Reimer

Engel²,

Schmidt

et al. 2018

Breast Care

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Local treatment of the axilla in clinically node-negative (cN0) early breast cancer patients with routine sentinel lymph node biopsy (SLNB) is debated for various reasons: i) pN staging information may not be necessary for the postoperative treatment decision regarding adjuvant systemic therapy in the great majority of patients; ii) the SLNB-positive rate is declining below 20% in specialized breast centers; iii) albeit being a minimally invasive procedure, SLNB causes a significant reduction in quality of life in 23% of patients; and iv) previous randomized trials from the pre-SLNB era did not show a disadvantage for patients without axillary surgery with regard to overall survival. These data support the hypothesis that avoiding axillary treatment in patients with clinically and sonographically unsuspicious lymph nodes seems to be a safe option, although omitting axillary surgery may increase the risk of locoregional recurrence. Currently, the information regarding node-positive status is essential to guide postoperative treatment such as systemic or radiation therapies in a non-negligible minority of patients. Three ongoing prospective European trials (SOUND, INSEMA, BOOG 2013-08) with axillary observation alone versus SLNB in cN0 patients and primary breast-conserving surgery have the objective to evaluate oncologic safety when omitting SLNB.

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Section: Surgeon's View: Pros and Cons For Slnbmentioning

confidence: 99%

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Reimer

Engel²,

Schmidt

et al. 2018

Breast Care

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“…Micrometastases in regional LNs were associated with a reduced disease-free survival with early-stage breast cancer (8). To investigate differences in regional control, survival, and long-term morbidity between axillary LN dissection and radiation therapy, an international multicenter phase III trial was initiated in 2001, and is still ongoing (9).…”

Section: Breast Cancermentioning

confidence: 99%

Significance and Mechanism of Lymph Node Metastasis in Cancer Progression

Kawada

Taketo²

2011

Cancer Research

142

114

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The effect of local therapy, such as surgical lymph node (LN) dissection and radiotherapy, on the survival of cancer patients has been debated for decades. Several lines of recent clinical evidence support that LN metastasis plays significant roles in systemic dissemination of cancer cells, although the effects of surgical LN dissection on survival was downplayed historically because of controversial data. Molecular studies of LN metastasis suggest that the microenvironment within LNs, including chemokines and lymphangiogenesis, can mediate the metastatic spread to the sentinel LNs, and beyond. It has been shown that chemokine receptor CXCR3 is involved in LN metastasis, and its inhibition may improve patient prognosis. Although it remains to be determined whether local therapy is best pursued through LN dissection or through a combination of resection with radiation, prevention of regional metastases is an important goal in the treatment of cancer patients to achieve a better survival. Cancer Res; 71(4); 1214-8. Ó2011 AACR.

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“…This procedure yields the same staging power as axillary lymph node dissection with less complications and better quality of life [30]. This less invasive procedure is possible for several reasons: i) Removal of lymph nodes is performed for staging purposes and not with curative intent [31][32][33], therefore, the wellknown risk of having a false-negative result can be accepted and comprehended; ii) even if the false-negative risk can be generally quantified in about 6%, the occurrence of overt axillary lymph node metastases after a negative SLNB has been shown to be lower than expected, being 0.9% after a median follow-up of 48 months in a cohort of 3,548 patients [6]; iii) to date, the impact of the prognostic information of axillary lymph node status in the decision-making process is less important than in the past as the adjuvant treatment is becoming increasingly tailored towards the biological features of the disease rather than the risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Early Breast Cancer: The Experience of the European Institute of Oncology in Special Clinical Scenarios

et al. 2011

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Background: While axillary nodal status is still one of the most important prognostic factors in breast cancer, sentinel lymph node biopsy (SLNB) has evolved as a main procedure to strongly reduce postsurgical morbidity improving early and long-term quality of life. Material and Methods: Between 1996 and 2010, we performed 18,884 SLNBs for breast cancer, successfully confirming the validity of this technique and its positive impact on patients’ quality of life, even though decision-making processes for adjuvant treatment strongly depend on biological features. Results: This paper summarizes published data mainly collected in our institute considering special clinical scenarios such as ductal intraepithelial neoplasia, intramammary sentinel nodes, multicentric breast cancer, prior breast surgery, previous breast aesthetic surgery, second axillary SLNB, pregnant patients, primary chemotherapy, and male patients. Conclusions: In general, we believe that SLNB represents the standard procedure for axillary staging in virtually all clinical situations, even in those which were previously considered a contraindication for this procedure. At the moment, the only contraindication to SLNB is the presence of documented axillary metastases.

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Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer

Cited by 165 publications

References 27 publications

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Significance and Mechanism of Lymph Node Metastasis in Cancer Progression

Sentinel Lymph Node Biopsy in Early Breast Cancer: The Experience of the European Institute of Oncology in Special Clinical Scenarios

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