Use of axillary lymph node dissection (ALND) in patients with micrometastatic breast cancer

O’Donoghue, Cristina; Sun, Weihong; Zhou, Junmin; Ma, Zhenjun; Laronga, Christine; Lee, Marie Catherine

doi:10.1016/j.jss.2017.03.039

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…In this study, 54.1% of the patients had one to two SLNs removed, which was similar to previous research [ 26 , 30 , 36 ]. Moreover, the median and range of SLNs in our study were also consistent with previous research [ 17 , 24 , 26 , 27 , 29 , 30 , 36 ]. However, two studies showed both a higher median number and wider range [ 37 , 38 ].…”

Section: Discussionsupporting

confidence: 93%

“…However, two studies showed both a higher median number and wider range [ 37 , 38 ]. Regarding the micrometastatic SLNs, most studies have indicated an extremely high percentage of one and two positive SLNs [ 17 , 24 , 30 , 39 ], and several studies selected one as a cut-off point [ 36 , 37 , 40 ] without demonstrating additional details concerning the low quantity; other studies have shown no more than two invaded [ 25 , 27 , 29 ]. The relative small probability to discover three micrometastases in SLNs was caused by the low number of SLN examinations.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Significance of Further Axillary Dissection in Breast Cancer Patients with Micrometastases & the Number of Micrometastases: a SEER Population-Based Analysis

Lin

2018

Future Sci. OA

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Aim:To investigate the benefits of axillary dissection in patients with micrometastases.Methods:A review of data from the Surveillance, Epidemiology, and End Results database was performed from 2004 to 2013. Kaplan–Meier curves, Cox regression models, and propensity score matching were utilized to comprehensively evaluate the cohort.Results:Multivariate analysis after propensity score matching showed that patients with one to two micrometastases did not substantially benefit from axillary lymph node dissection in breast cancer-specific survival (p = 0.725). However, a subgroup analysis indicated that axillary dissection may benefit estrogen receptor-negative patients. Moreover, patients who carried three micrometastases had a significantly lower crude hazard ratio in breast cancer-specific survival.Conclusion:Axillary lymph node dissection may have advantages in high-risk micrometastatic patients. Patients with three micrometastases should be treated with caution.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Further Axillary Dissection in Breast Cancer Patients with Micrometastases & the Number of Micrometastases: a SEER Population-Based Analysis

Lin

2018

Future Sci. OA

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“…Particularly after the introduction of SLNB, the use of ALND in the management of breast cancer declined dramatically since SLNB proved to be a non-inferior staging procedure [10][11][12][13][14]. Furthermore, cALND as a standard procedure after a positive SLNB became a matter of debate since it showed no survival benefit [4,5,8,15]. Recently, axillary radiotherapy has been introduced as an alternative treatment to the axilla after a positive SLNB [4,16].…”

Section: Discussionmentioning

confidence: 99%

The Dilemma After an Unforeseen Positive Sentinel Node in Primary Breast Cancer: Is Completion Axillary Dissection Necessary?

Bekkum

Kraima

Westenend³

et al. 2020

World j. surg.

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Background In the majority of cases, the sentinel node is the only positive node in the axilla and completion ALND (cALND) is a futile procedure. However, refraining from cALND will lead to less accurate staging and, possibly, undertreatment. To help resolve this dilemma, we examined the clinical value of cALND in staging and determining adjuvant treatment. Methods In a retrospective cohort, all consecutive patients over a five‐year period with primary breast cancer who received ALND were identified and grouped based on timing of ALND. Total nodal yield and positive lymph nodes were defined and factors with possible impact identified. In the case of cALND, N‐status upstaging and possible impact on adjuvant treatment were studied in detail. Results A total of 280 patients were selected of whom 204 underwent primary ALND (pALND) and 76 cALND. pALND resulted in a significantly higher total nodal yield and more positive nodes when compared to cALND (p = 0.003, and p < 0.001, respectively). Neoadjuvant chemotherapy (NAC) had no effect on total nodal yield (p = 0.413), but resulted in fewer positive nodes (p < 0.001). Due to the results of cALND, only 11 patients (14%) had upstaging of N‐status. All these patients were advised more extensive adjuvant radiotherapy. Conclusion In the majority of patients, cALND does not lead to upstaging. cALND should be performed only after a careful discussion with the patient about the pros and cons of this procedure, and most probably only in the presence of multiple risk factors for axillary disease in the absence of systemic therapy.

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“…A number of trials have confirmed that the incidence of upper limb edema, numbness, pain, paresthesia, shoulder joint mobility disorder and other complications in SLNB patients is significantly lower than that of ALND, which improves the quality of life of patients. [8,9] In the 8th edition of the American Joint Committee on Cancer (AJCC) [10] breast cancer staging, the number of SLNs was less than 6, and SLN footnote “sn” could not be used if there were more than 6. But the minimum number of SLNs is not specified.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and prognosis of sentinel lymph node metastasis in breast-conserving breast cancer: A retrospective study based on the SEER database

Liu,

Chen,

Cao

et al. 2024

Medicine

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At present, the risk factors and prognosis of sentinel lymph node metastasis (SLNM) are analyzed based on the study of axillary lymph node metastasis, but whether there is a difference between the two is unclear. Therefore, an accurate and appropriate predictive model needs to be proposed to evaluate patients undergoing sentinel lymph node biopsy (SLNB) for breast cancer. We selected 16983 women with breast cancer from the Surveillance Epidemiology and End Results (SEER) database. They were randomly assigned to two cohorts, one for development (n = 11891) and one for validation (n = 5092). multi-factor logistics regression was used to distinguish risk factors affecting SLNM. The potential prognostic factors were identified using the COX regression analysis. The hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for all results. Multiple Cox models are included in the nomogram, with a critical P value of .05. In order to evaluate the model’s performance, Concordance index and receiver operating characteristic curves were used. Six independent risk factors affecting SLNM were screened out from the Logistic regression, including tumor location, number of regional lymph nodes (2-5), ER positive, PR positive, tumor size (T2-3), and histological grade (Grade II-III) are independent risk factors for SLNM in patients (P < .05). Eight prognostic factors were screened out in the multivariate COX regression analysis (P < .05): Age: Age 60 to 79 years, Age ≥ 80 years; Race; Histological grading: Grade II, Grade III; No radiotherapy; Tumor size: T2, T3; ER positive:, sentinel lymph node positive, married. Histological grade, tumor location, T stage, ER status, PR status and the number of SLNB are significantly correlated with axillary SLNM. Age, ethnicity, histological grade, radiotherapy, tumor size, ER status, SLN status, and marital status were independent risk factors for Breast cancer specific survival (BCSS). Moreover, the survival rate of patients with 3 positive SLNs was not significantly different from that with one or two positive SLNs, We concluded that patients with stage N1 breast cancer were exempt from axillary lymph node dissection, which is worthy of further study.

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Use of axillary lymph node dissection (ALND) in patients with micrometastatic breast cancer

Abstract: Given that the risk of lymphedema after ALND ranges between 20%-53%, the morbidity of ALND may far exceed the likelihood of detecting further nodal involvement in women with micrometastatic disease: 7.1% in this series.

Cited by 9 publications

References 25 publications

Prognostic Significance of Further Axillary Dissection in Breast Cancer Patients with Micrometastases & the Number of Micrometastases: a SEER Population-Based Analysis

Prognostic Significance of Further Axillary Dissection in Breast Cancer Patients with Micrometastases & the Number of Micrometastases: a SEER Population-Based Analysis

The Dilemma After an Unforeseen Positive Sentinel Node in Primary Breast Cancer: Is Completion Axillary Dissection Necessary?

Risk factors and prognosis of sentinel lymph node metastasis in breast-conserving breast cancer: A retrospective study based on the SEER database

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