Sentinel Node Biopsy Alone for Node-Positive Breast Cancer: 12-Year Experience at a Single Institution

Spiguel, Lisa; Yao, Katharine; Winchester, David J.; Gorchow, Addie; Du, Hongwu; Sener, Stephen F.; Martz, Brigid; Turk, Mary; Barrera, Ermilo; Winchester, David P.

doi:10.1016/j.jamcollsurg.2011.03.034

Cited by 19 publications

(6 citation statements)

References 38 publications

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“…Our analysis of those data showed a 1.2% incidence rate for axillary recurrence in N0 breast cancer patients who underwent only SNB. That recurrence rate is comparable to the rates reported by others [12, [14][15][16], and we think that it sufficiently guarantees safety in regard to axillary recurrence. In addition, we found no statistically significant differences between the status of SN metastasis and the site of recurrence, although the axillary recurrence rate was slightly higher in patients who had been SNB-positive.…”

Section: Discussionsupporting

confidence: 89%

Early Results of Omitting Completion Axillary Lymph Node Dissection in Sentinel Lymph Node Metastasis-Positive Breast Cancer Patients

Honda¹,

Matsuoka²,

Hirose³

et al. 2013

ABCR

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Background: We investigated the early results of omitting completion axillary lymph node dissection (ALND) for axillary node metastasis-negative (N0), sentinel node (SN) metastasis-positive breast cancer patients. Patients and Methods: 489 patients had invasive N0 breast cancer treated without completion ALND, regardless of their SN metastasis status. Analyses included the associations between the SN metastasis status, clinicopathological findings and recurrence, between recurrence and clinicopathological findings, and recurrence-free survival. Results: 430 patients were SN biopsy (SNB)-negative, and 59 were SNB-positive. The SNB-positive patients received significantly more potent adjuvant therapy than the SNB-negative patients. Median follow-up was 3.7 years, and the axillary node recurrence was seen in 6 patients (1.2%) and recurrence in 21 patients. The SN status showed no associations with the clinicopathological findings or recurrence. Univariate analysis showed recurrence was associated with absence of hormonal therapy, ER-negative, PgR-negative, HER2-positive or triple-negative (TNBC) disease, a tumor ≥2.1 cm and higher nuclear grade. Multivariate analysis showed recurrence was associated with absence of hormonal therapy and a tumor ≥2.1 cm. Cox proportional hazards model showed recurrence was extremely early in ER-negative and TNBC patients. Conclusion: Completion ALND can be skipped in N0 breast cancer patients even if they are SNB-positive, but adjuvant therapy is essential.

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Section: Discussionsupporting

confidence: 89%

Early Results of Omitting Completion Axillary Lymph Node Dissection in Sentinel Lymph Node Metastasis-Positive Breast Cancer Patients

Honda¹,

Matsuoka²,

Hirose³

et al. 2013

ABCR

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“…Retrospective analyses have, however, evaluated the outcomes of BC patients selected for mastectomy with omission of ALND, despite one to two SLN macrometastases 15 , 17 , 22 – 27 . Gao et al .…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients undergoing mastectomy with one to two metastatic sentinel lymph nodes: sub-analysis of the SINODAR-ONE multicentre randomized clinical trial and reopening of enrolment

Tinterri

Canavese

Gatzemeier

et al. 2023

British Journal of Surgery

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Background The initial results of the SINODAR-ONE randomized clinical trial reported that patients with T1–2 breast cancer and one to two macrometastatic sentinel lymph nodes treated with breast-conserving surgery, sentinel lymph node biopsy only, and adjuvant therapy did not present worse 3-year survival, regional recurrence, or distant recurrence rates compared with those treated with axillary lymph node dissection. To extend the recommendation of axillary lymph node dissection omission even in patients treated with mastectomy, a sub-analysis of the SINODAR-ONE trial is presented here. Methods Patients with T1–2 breast cancer and no more than two metastatic sentinel lymph nodes undergoing mastectomy were analysed. After sentinel lymph node biopsy, patients were randomly assigned to receive either axillary lymph node dissection followed by adjuvant treatment (standard arm) or adjuvant treatment alone (experimental arm). The primary endpoint was overall survival. The secondary endpoint was recurrence-free survival. Results A total of 218 patients were treated with mastectomy; 111 were randomly assigned to the axillary lymph node dissection group and 107 to the sentinel lymph node biopsy-only group. At a median follow-up of 33.0 months, there were three deaths (two deaths in the axillary lymph node dissection group and one death in the sentinel lymph node biopsy-only group). There were five recurrences in each treatment arm. No axillary lymph node recurrence was observed. The 5-year overall survival rates were 97.8 and 98.7 per cent in the axillary lymph node dissection treatment arm and the sentinel lymph node biopsy-only treatment arm, respectively (P = 0.597). The 5-year recurrence-free survival rates were 95.7 and 94.1 per cent in the axillary lymph node dissection treatment arm and the sentinel lymph node biopsy treatment arm, respectively (P = 0.821). Conclusion In patients with T1–2 breast cancer and one to two macrometastatic sentinel lymph nodes treated with mastectomy, the overall survival and recurrence-free survival rates of patients treated with sentinel lymph node biopsy only were not inferior to those treated with axillary lymph node dissection. To strengthen the conclusion of the trial, the enrolment of patients treated with mastectomy was reopened as a single-arm experimental study. Registration number NCT05160324 (http://www.clinicaltrials.gov)

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“…They performed a retrospective review of women with stage 1 to 3 breast cancer and found that survival curves showed no significant difference in recurrence-free survival between the sentinel biopsy only group and axillary dissection group. Spiguel et al (15) performed a retrospective analysis of a sentinel node-positive group staged as N1micro or N1. Their study included 123 node-positive patients who underwent SLNB alone with no completion axillary dissection for invasive breast cancer, among which approximately 30% of the patients underwent mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Could axillary lymph node dissection be omitted in the mastectomy patient with tumor positive sentinel node?

et al. 2023

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BackgroundRecent data from the ACOSOG Z0011 trial suggest that axillary lymph node dissection (ALND) may not be necessary for patients with positive sentinel lymph node biopsy (SLNB) receiving breast-conserving surgery (BCS) with irradiation. However, consensus statements and guidelines have recommended that patients undergoing mastectomy with tumor-positive sentinel node undergo completion ALND. In this study, we compared the locoregional recurrence rate of patients with tumor-positive sentinel nodes among three groups: mastectomy with SLNB, mastectomy with ALND and BCS with SLNB.MethodWe identified 6,163 women with invasive breast cancer who underwent surgical resection at our institution between January 2000 and December 2011. Clinicopathologic data obtained from the prospectively collected medical database were analyzed retrospectively. Among the patients with sentinel node positive, mastectomy with SLNB was performed in 39 cases, mastectomy with ALND in 181 cases, and BCS with SLNB in 165 cases. The primary end point was the loco-regional recurrence rate.ResultsClinicopathologic characteristics were similar among the groups. There were no cases of loco-regional recurrence in the sentinel groups. At a median follow-up of 61.0 months (last follow-up May 2013), the loco-regional recurrence rate of each group was 0% for BCS with SLNB and mastectomy with SLNB only, and 1.7% for mastectomy with ALND (p=0.182).ConclusionIn our study, there was no significant difference in loco-regional recurrence rates between groups. This result lends weight to the argument that SLNB without ALND may be a reasonable management for selected patients with appropriate surgery and adjuvant systemic therapy.

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Sentinel Node Biopsy Alone for Node-Positive Breast Cancer: 12-Year Experience at a Single Institution

Cited by 19 publications

References 38 publications

Early Results of Omitting Completion Axillary Lymph Node Dissection in Sentinel Lymph Node Metastasis-Positive Breast Cancer Patients

Early Results of Omitting Completion Axillary Lymph Node Dissection in Sentinel Lymph Node Metastasis-Positive Breast Cancer Patients

Sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients undergoing mastectomy with one to two metastatic sentinel lymph nodes: sub-analysis of the SINODAR-ONE multicentre randomized clinical trial and reopening of enrolment

Could axillary lymph node dissection be omitted in the mastectomy patient with tumor positive sentinel node?

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