TITLE:
No Axillary Lymph Node Dissection in Breast Cancer Patients with Sentinel Lymph Node Micrometastasis
AUTHORS:
Marco Gipponi, Piero Fregatti, Federica Murelli, Paolo Meszaros, Francesca Depaoli, Cecilia Margarino, Paola Baccini, Marina Gualco, Daniele Friedman
KEYWORDS:
Sentinel Lymph Node; Axillary Lymph Node Dissection; Breast Cancer
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.3 No.1,
January
17,
2014
ABSTRACT: Follow-up data of
a series of 75 breast cancer patients with sentinel node (SN) micrometastases only (between 0.2 and 2 mm) and favorable
histopathological features of the primary tumor (well-differentiated, T1 tumors
without lymphovascular invasion) who refused completion axillary lymph node dissection (ALND) or who
were unsuitable for surgery were assessed in order to detect the rate of
axillary recurrence after an adjuvant chemoand/or hormonal adjuvant treatment
was given. The great majority
of patients (81.3%) did not undergo ALND due to the existence of favorable
histopathologic factors while the rest were equally distributed among over 75-year-old women (10.6%) and patients at a high surgical risk due to comorbid conditions
(9.3%). Sixty-six patients (88%) underwent conservative treatment (lumpectomy
followed by adjuvant breast radiotherapy) while the remaining nine patients
(12%) had total mastectomy; 72 out of 75 patients (96%) received some forms of adjuvant chemoand/or hormone-therapy. After
a median follow-up of 38 months (range 12 - 84 months), nine out of 75 patients (12%) had a disease relapse,
only one of them (1.3%) being affected by an axillary recurrence in the
untreated axilla three years after primary surgery. On these grounds, completion
ALND could be safely omitted in patients with SN micrometastasis and favorable
histopathological characteristics of the primary neoplasm due to the very low
rate of axillary recurrence with no detrimental effect on survival.