TITLE:
Early Results of Omitting Completion Axillary Lymph Node Dissection in Sentinel Lymph Node Metastasis-Positive Breast Cancer Patients
AUTHORS:
Junko Honda, Hisashi Matsuoka, Chieko Hirose, Taeko Nagao, Takahiro Yoshida, Masako Takahashi, Issei Imoto, Mitsunori Sasa
KEYWORDS:
Axillary Lymph Node Dissection; Breast Cancer; Sentinel Node Biopsy
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.2 No.4,
September
9,
2013
ABSTRACT: 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.