Can Axillary Lymph Node Dissection Be Safely Omitted for Early-Stage Breast Cancer Patients with Sentinel Lymph Node Micrometastasis?

Excerpt

This study presents data that we have been anxiously awaiting. It adds to a slowly growing body of evidence that axillary lymph node dissection (ALND) may be omitted in select groups of node-positive patients. Many of us prefer not to perform ALND when only micrometastases are identified in sentinel lymph nodes (SLNs), especially when it often involves returning to the operating room. It is already the standard of care to omit ALND for patients who have SLNs positive only by immunohistochemistry (IHC). There are now tools available, such as the Memorial Sloan-Kettering nomogram, that use tumor size, grade, number of positive SLNs, method of detection, estrogen status, and presence of lymphovascular invasion to determine the risk of finding additional positive axillary nodes if ALND is performed.1 Numerous studies have demonstrated a worse prognosis associated with axillary micrometastasis.2‐5 However, these studies are retrospective, and some evaluated ALNDs performed before the era of routine SLN biopsies. What is most interesting about this study is that it prospectively evaluated the omission of ALND for micrometastasis, and it has the longest follow-up available in the literature for such patients. …