The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients

Abstract

Several independent randomized controlled trials are initiated to investigate whether sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients with negative axillary ultrasound findings, who are treated with breast conserving therapy. A consequence of omitting sentinel lymph node biopsy is absence of pathological lymph node status information. We aimed to investigate the impact of omitting sentinel lymph node biopsy on adjuvant systemic treatment recommendations. Data from all consecutive patients with invasive breast cancer and negative axillary ultrasound findings treated with breast conserving therapy and sentinel lymph node biopsy between 2008 and 2012 were collected from a prospective database. Two methods, Adjuvant! Online and the Dutch breast cancer guideline 2012, were used to determine the adjuvant systemic treatment recommendations of every patient. At first, each patient was considered to be lymph node negative, and secondly the patients' true pathological lymph node status was used. A total of 303 patients were consecutively included. Pathological lymph node status was pN0 in 72.3 %, pN0(i+) in 12.9 %, pN1mi+ in 5.6 %, pN1 in 7.3 %, and pN2 in 2.0 % of the patients. The decision to recommend adjuvant systemic treatment changed due to the pathological lymph node status in 1.0 % of the patients (3/303) when using Adjuvant! Online and in 3.6 % (11/303) when using the 2012 Dutch breast cancer guideline. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients with negative axillary ultrasound findings treated with breast conserving therapy is limited. The safety of omitting the sentinel lymph node biopsy should be confirmed by the initiated randomized controlled trials.

Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up: a Dutch randomized controlled multicentre trial (BOOG 2013-08)

“…Primary systemic therapy can eradicate lymph node metastases with a reported pathologic complete response rates of 20–40% [20–23]. Lack of knowledge on the pathological lymph node status is nowadays hardly influencing systemic therapy indication [24]. Low RR rates in the ACOSOG Z0011 (and IBCSG 23–01) trial might be due to whole breast irradiation (WBI) following lumpectomy [25–28].…”

Differentiating axillary lymph node metastasis in invasive breast cancer patients: A comparison of radiomic signatures from multiparametric breast MR sequences

“…I N BREAST CANCER PATIENTS, axillary lymph node metastasis is an important prognostic factor, and it is also critical for determining whether an adjuvant systemic chemotherapy or postoperative radiation is needed. [1][2][3] Axillary lymph node (ALN) metastasis may be clinically confirmed by ultrasound-guided fineneedle aspiration (US-FNA) or lymph node dissection. For patients with confirmed ALN metastasis, axillary lymph node dissection (ALND) is the standard method for axillary lymph node staging.…”

“…4 However, both ALND and SLND are invasive, with potential complications of lymphedema, seroma, infection, hematoma, and arm pain. 4 It would be beneficial to determine axillary lymph node status preoperatively to reduce unnecessary lymph node dissection [1][2][3][4] and patient distress.…”

Diagnostic Performance of Dedicated Axillary T2- and Diffusion-weighted MR Imaging for Nodal Staging in Breast Cancer

“…However, three randomized controlled trials showed that regional control or overall survival was not affected by omission of axillary treatment in the case of sentinel lymph node metastasis (3)(4)(5). Also, the effect of the detection of a single axillary metastasis on adjuvant systemic treatment appears limited (6). Consequently, the need for the detection of every single small lymph node metastasis Implication for Patient Care n The diagnostic performance of dedicated axillary T2-and diffusion-weighted MR imaging for nodal staging in patients with breast cancer is insufficient to replace sentinel lymph node biopsy in clinical practice.…”