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Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis

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Abstract

Purpose

The ACOSOG Z0011 trial demonstrated that axillary lymph node dissection (ALND) is unnecessary in select patients with cT1-2N0 tumors undergoing breast-conserving therapy with 1–2 positive sentinel lymph nodes (SLNs). However, patients with preoperatively confirmed ALN metastasis were not included and may be subjected to unnecessary ALND. The aim of this study is to identify patients who can be considered for ALND omission when the preoperative ALN biopsy results are positive.

Methods

Breast cancer patients who underwent preoperative ALN biopsy and primary surgery were retrospectively reviewed. Among patients with positive ALN biopsy results, clinicopathological and imaging characteristics were compared according to LN disease burden (1–2 positive LNs vs. ≥ 3 positive LNs).

Results

A total of 542 patients were included in the analysis. Among them, 225 (41.5%) patients had a preoperative positive ALN biopsy. More than 40% of the patients (n = 99, 44.0%) with a positive biopsy had only 1–2 positive ALNs. The association between nodal burden and imaging factors was strongest when ≥ 2 suspicious LNs were identified on PET/CT images (HR 8.795, 95% CI 4.756 to 13.262). More than one imaging modality showing ≥ 2 suspicious LNs was also strongly correlated with ≥ 3 positive ALNs (HR 5.148, 95% CI 2.881 to 9.200).

Conclusions

Nearly half of patients with a preoperative biopsy-proven ALN metastasis had only 1–2 positive LNs on ALND. Patients meeting ACOSOG Z0011 criteria with only one suspicious LN on PET/CT or those presenting with few abnormal ALNs on only one imaging modality appear appropriate for SLNB and consideration of ALND omission.

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Funding

This work was supported by the Basic Science Research Program of the National Research Foundation funded by the Ministry of Education [2017R1D1A1B03033486 to B.J.C.].

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Authors and Affiliations

  1. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Tae-Kyung Yoo, Juneyoung Ahn & Woo-Chan Park

  2. Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Tae-Kyung Yoo

  3. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Bong Joo Kang & Sung Hun Kim

  4. Division of Breast-Thyroid Surgery, Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Gyeonggi-do, 14647, Republic of Korea

    Byung Joo Song

  5. Department of Surgery, Samsung Medical Center, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea

    Byung Joo Chae

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  1. Tae-Kyung Yoo
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Correspondence to Byung Joo Chae.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This study was approved by the institutional review board of Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea (IRB no. KC18RESI0614), and the need to obtain informed consent was waived.

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Yoo, TK., Kang, B.J., Kim, S.H. et al. Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis. Breast Cancer Res Treat 181, 403–409 (2020). https://doi.org/10.1007/s10549-020-05636-z

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  • DOI: https://doi.org/10.1007/s10549-020-05636-z

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