The Adventure of Axillary Treatment in Early Stage Breast Cancer

Abstract

Axillary lymph node dissection (ALND) which was an essential part of breast cancer treatment and the gold standard in evaluation of the status of axillary lymph node had notorious with increased arm morbidity and reduction of quality of life. Sentinel lymph node biopsy (SLNB) accurately stages the axilla in early breast cancer and ALND is omitted in SLNB negative patients. In patients with positive SLNB the omission of ALND with or without replacement of axillary radiotherapy has also been recommended by guidelines. The neoadjuvant chemotherapy (NAC) which has been increasingly used for large breast cancers to downstage the tumours for allowing breast conserving surgery and decreasing mastectomy rate has also been used in axillary node positive patients to reduce the need for ALND. The issues surrounding the treatment of axilla in patients treated with NAC; application and false negative rate of SLNB, number of identified sentinel lymph nodes, and axillary radiotherapy instead of ALND are currently the discussed and practiced hot topics. The quests for decreasing arm morbidity without compromising outcome in breast cancer treatment which have begun with the invention of SLNB continue for axilla conserving surgery. This article reviews the adventure of axillary treatment in breast cancer patients treated with or without NAC.

Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery

“…However, given that in contemporaneous practice, axillary clearance is no longer recommended for diagnostic purposes (as SLNB is equivalent in the efficacy of cancer treatment but with far less morbidity), 5,56 such a comparison is not possible for ICG. Nevertheless, the accuracy of ICG could be assessed by performing a trial whereby patients due to undergo axillary clearance for node-positive disease first undergo an SLNB with ICG.…”

Thematic trends and knowledge structure map of sentinel lymph node biopsy for breast cancer: a bibliometric analysis from 2010 to 2019

“…The presence of disease in the lymph nodes is a component of breast cancer staging and an important prognostic indicator that helps direct local and systemic therapies ( 32 ). ALND is an essential part of breast cancer treatment, however, it is notorious for increased arm morbidity and decreased quality of life ( 33 ). SLNB was initially pioneered for staging melanoma in 1994 and has become the new standard of care for patients with clinically node negative invasive breast cancer ( 34 , 35 ).…”

Leczenie przedoperacyjne chorych na raka piersi i jego wpływ na postępowanie operacyjne oraz radioterapeutyczne (część 2.)

“…Postoperative nipple necrosis was found in 3.3% of patients after a surgery [32,46]. Complications after NSM / SSM and IBR occurred in 7.5-47.3% of treated patients [51,[68][69][70], while local recurrence was found in 3.2-5.3% of cases [32,46]. Postoperative complications were not associated with NAT but with body mass index (BMI), smoking, adjuvant radiotherapy, and concurrent ALND [28,[45][46][47].…”

“…No differences were observed in loco-regional recurrence, DFS and OS in patients with cN0 cancer (pN0) who underwent only SLNB as compared to those qualified for ALND. The rate of regional recurrences was at 1% [66,68]. Therefore, for cN0 patients, SLNB is recommended after NAT [18,19,60,69,70].…”