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Published in: Current Oncology Reports 1/2011

01-02-2011

The Need for Axillary Dissection in Patients with Positive Axillary Sentinel Lymph Nodes

Authors: Randal L. Croshaw, Kathleen M. Erb, Hilary M. Shapiro-Wright, Thomas B. Julian

Published in: Current Oncology Reports | Issue 1/2011

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Abstract

The need for completion axillary dissection after a positive sentinel node biopsy continues to be challenged. In the 2 years since we last reviewed this subject, a number of authors have shared their experiences about micrometastatic disease and isolated tumor cells, opining both for and against axillary treatment. Data from the ACOSOG Z0011 trial and other small studies do not appear to support the use of completion axillary dissection even for macro-metastatic disease in patients with clinically node-negative (N0) disease. While existing guidelines still recommend axillary dissection for patients with clinically positive nodes, even when conversion to clinically negative disease following neoadjuvant chemotherapy has occurred, this concept is being questioned in ACOSOG Z1071 and in several other recent small trials. The surgical approach to the treatment of breast cancer continues to move away from the traditional Halstedian concept.
Literature
1.
go back to reference Fisher B, Redmond C, Fisher ER, et al.: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 1985, 312:674–681.CrossRefPubMed Fisher B, Redmond C, Fisher ER, et al.: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 1985, 312:674–681.CrossRefPubMed
2.
go back to reference Krag DN, Stewart JA, Julian TB, et al.: Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomized phase III trial. Lancet Oncol 2007, 8:881–888.CrossRefPubMed Krag DN, Stewart JA, Julian TB, et al.: Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomized phase III trial. Lancet Oncol 2007, 8:881–888.CrossRefPubMed
3.
go back to reference Kiluk JV, Ly QP, Santillan AA, et al.: Erratum to: Axillary recurrence rate following negative sentinel node biopsy for invasive breast cancer: long-term follow-up. Ann Surg Oncol 2010, 17:552–557.CrossRefPubMed Kiluk JV, Ly QP, Santillan AA, et al.: Erratum to: Axillary recurrence rate following negative sentinel node biopsy for invasive breast cancer: long-term follow-up. Ann Surg Oncol 2010, 17:552–557.CrossRefPubMed
4.
go back to reference Veronesi U, Galimberti V, Paganelli G, et al.: Axillary metastases in breast cancer patients with negative sentinel nodes: a follow-up of 3548 cases. Eur J Cancer 2009, 45:1381–1388.CrossRefPubMed Veronesi U, Galimberti V, Paganelli G, et al.: Axillary metastases in breast cancer patients with negative sentinel nodes: a follow-up of 3548 cases. Eur J Cancer 2009, 45:1381–1388.CrossRefPubMed
5.
go back to reference Ashikaga T, Krag DN, Land SR, et al.: Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 2010, 102:111–118.CrossRefPubMed Ashikaga T, Krag DN, Land SR, et al.: Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 2010, 102:111–118.CrossRefPubMed
6.
go back to reference •• Giuliano AE, McCall LM, Beitsch PD, et al.: ACOSOG Z0011: a randomized trial of axillary node dissection in women with clinical T1-2 N0 M0 breast cancer who have a positive sentinel node. J Clin Oncol 2010, 28(Suppl):abstr CRA506. This study reports on a large phase 3 trial to date revealing no benefit of axillary node dissection for patients with clinically node negative but pathologically positive sentinel nodes. •• Giuliano AE, McCall LM, Beitsch PD, et al.: ACOSOG Z0011: a randomized trial of axillary node dissection in women with clinical T1-2 N0 M0 breast cancer who have a positive sentinel node. J Clin Oncol 2010, 28(Suppl):abstr CRA506. This study reports on a large phase 3 trial to date revealing no benefit of axillary node dissection for patients with clinically node negative but pathologically positive sentinel nodes.
7.
go back to reference Martelli: A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: Results after 5 years of follow-up. Ann Surg 2005, 242:1–9.CrossRefPubMed Martelli: A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: Results after 5 years of follow-up. Ann Surg 2005, 242:1–9.CrossRefPubMed
8.
go back to reference Taras AR, Hendrickson NA, Lowe KA, et al.: Recurrence rates in breast cancer patients with false-negative intraoperative evaluation of sentinel lymph nodes. Am J Surg 2010, 199:625–628.CrossRefPubMed Taras AR, Hendrickson NA, Lowe KA, et al.: Recurrence rates in breast cancer patients with false-negative intraoperative evaluation of sentinel lymph nodes. Am J Surg 2010, 199:625–628.CrossRefPubMed
9.
go back to reference Takei H, Kurosumi M, Yoshida T, et al.: Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies. Breast Cancer 2010, 17:9–16.CrossRefPubMed Takei H, Kurosumi M, Yoshida T, et al.: Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies. Breast Cancer 2010, 17:9–16.CrossRefPubMed
10.
go back to reference Bilimoria KY, Bentrem DJ, Hansen NM, et al.: Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol 2009, 27:2946–2953.CrossRefPubMed Bilimoria KY, Bentrem DJ, Hansen NM, et al.: Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol 2009, 27:2946–2953.CrossRefPubMed
11.
go back to reference Fisher ER, Palekar A, Rockette H, et al.: Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol No. 4) V. Significance of axillary nodal micro-and macrometastases. Cancer 1978, 42:2032–2038.CrossRefPubMed Fisher ER, Palekar A, Rockette H, et al.: Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol No. 4) V. Significance of axillary nodal micro-and macrometastases. Cancer 1978, 42:2032–2038.CrossRefPubMed
12.
go back to reference Kuijt GP, Voogd AC, van de Poll-Franse LV, et al.: The prognostic significance of axillary lymph-node micrometastases in breast cancer patients. Eur J Surg Oncol 2005, 31:500–505CrossRefPubMed Kuijt GP, Voogd AC, van de Poll-Franse LV, et al.: The prognostic significance of axillary lymph-node micrometastases in breast cancer patients. Eur J Surg Oncol 2005, 31:500–505CrossRefPubMed
13.
go back to reference • Reed J, Rosman M, Verbanac KM, et al.: Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg 2009, 208:333–340. The rate of distant recurrence is reported at 4.9 years and reveals increased recurrence risk in patients with isolated tumor cells, micrometastases, and macrometastases in sentinel nodes.CrossRefPubMed • Reed J, Rosman M, Verbanac KM, et al.: Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg 2009, 208:333–340. The rate of distant recurrence is reported at 4.9 years and reveals increased recurrence risk in patients with isolated tumor cells, micrometastases, and macrometastases in sentinel nodes.CrossRefPubMed
14.
go back to reference • Truong PT, Lesperance M, Li KH, et al.: Micrometastatic node-positive breast cancer: Long-term outcomes and identification of high-risk subsets in a large population-based series. Ann Surg Oncol 2010, 17:2138–2146. This study reports on a large number of patients with N0, N1mi, or N1 disease for 10 years, and reveals statistically significant prognostic information.CrossRefPubMed • Truong PT, Lesperance M, Li KH, et al.: Micrometastatic node-positive breast cancer: Long-term outcomes and identification of high-risk subsets in a large population-based series. Ann Surg Oncol 2010, 17:2138–2146. This study reports on a large number of patients with N0, N1mi, or N1 disease for 10 years, and reveals statistically significant prognostic information.CrossRefPubMed
15.
go back to reference Maibenco DC, Dombi GW, Kau TY, et al.: Significance of micrometastases on the survival of women with T1 breast cancer. Cancer 2006, 107:1234–1239CrossRefPubMed Maibenco DC, Dombi GW, Kau TY, et al.: Significance of micrometastases on the survival of women with T1 breast cancer. Cancer 2006, 107:1234–1239CrossRefPubMed
16.
go back to reference Chen SL, Hoehne FM, Giuliano AE: The prognostic significant of micrometastases in breast cancer: A SEER population-based analysis. Ann Surg Oncol 2007, 14:3378–3384.CrossRefPubMed Chen SL, Hoehne FM, Giuliano AE: The prognostic significant of micrometastases in breast cancer: A SEER population-based analysis. Ann Surg Oncol 2007, 14:3378–3384.CrossRefPubMed
17.
go back to reference De Boer M, Van Dijck JA, Bult P, et al.: Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. J Natl Cancer Inst 2010, 102:410–425.CrossRefPubMed De Boer M, Van Dijck JA, Bult P, et al.: Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. J Natl Cancer Inst 2010, 102:410–425.CrossRefPubMed
20.
go back to reference Rescigno J, Zampell J, Axelrod D: Patterns of axillary surgical care for breast cancer in the era of sentinel lymph node biopsy. Ann Surg Oncol 2009, 16:687–696.CrossRefPubMed Rescigno J, Zampell J, Axelrod D: Patterns of axillary surgical care for breast cancer in the era of sentinel lymph node biopsy. Ann Surg Oncol 2009, 16:687–696.CrossRefPubMed
21.
go back to reference Wasif N, Maggard MA, Ko CY, Giuliano AE: Underuse of axillary dissection for the management of sentinel node micrometastases in breast cancer. Arch Surg 2010, 145:161–166.CrossRefPubMed Wasif N, Maggard MA, Ko CY, Giuliano AE: Underuse of axillary dissection for the management of sentinel node micrometastases in breast cancer. Arch Surg 2010, 145:161–166.CrossRefPubMed
22.
go back to reference Wasif N, Ye X, Giuliano AE: Survey of ASCO members on management of sentinel node micrometastases in breast cancer: Variation in treatment recommendations according to specialty. Ann Surg Oncol 2009, 16:2442–2449.CrossRefPubMed Wasif N, Ye X, Giuliano AE: Survey of ASCO members on management of sentinel node micrometastases in breast cancer: Variation in treatment recommendations according to specialty. Ann Surg Oncol 2009, 16:2442–2449.CrossRefPubMed
23.
go back to reference • Cox CE, Kiluk JV, Riker AI, et al.: Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg 2008, 206:261–268. This study reports a difference in DFS and OS for patients with micrometastatic disease. However, it failed to show a benefit for axillary dissection in micrometastatic disease.CrossRefPubMed • Cox CE, Kiluk JV, Riker AI, et al.: Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg 2008, 206:261–268. This study reports a difference in DFS and OS for patients with micrometastatic disease. However, it failed to show a benefit for axillary dissection in micrometastatic disease.CrossRefPubMed
24.
go back to reference •• De Boer M, Van Deurzen CHM, Van Dijck JAAM, et al.: Micrometastasis or isolated tumor cells and the outcome of breast cancer. N Engl J Med 2009, 361:653–663. The DFS of patients with micrometastasis and isolated tumor cells based on adjuvant chemotherapy and the possible value of axillary dissection was discussed.CrossRefPubMed •• De Boer M, Van Deurzen CHM, Van Dijck JAAM, et al.: Micrometastasis or isolated tumor cells and the outcome of breast cancer. N Engl J Med 2009, 361:653–663. The DFS of patients with micrometastasis and isolated tumor cells based on adjuvant chemotherapy and the possible value of axillary dissection was discussed.CrossRefPubMed
25.
go back to reference Meretoja TJ, Vironen JH, Heikkila PS, Leidenius MH: Outcome of selected breast cancer patients with micrometastasis or isolated tumor cells in sentinel node biopsy and no completion axillary lymph node dissection. J Surg Oncol 2010, In press. Meretoja TJ, Vironen JH, Heikkila PS, Leidenius MH: Outcome of selected breast cancer patients with micrometastasis or isolated tumor cells in sentinel node biopsy and no completion axillary lymph node dissection. J Surg Oncol 2010, In press.
26.
go back to reference Yegiyants S, Romero LM, Haigh PI, DiFronzo LA: Completion axillary lymph node dissection not required for regional control in patients with breast cancer who have micrometastases in a sentinel node. Arch Surg 2010, 145:564–569.CrossRefPubMed Yegiyants S, Romero LM, Haigh PI, DiFronzo LA: Completion axillary lymph node dissection not required for regional control in patients with breast cancer who have micrometastases in a sentinel node. Arch Surg 2010, 145:564–569.CrossRefPubMed
27.
go back to reference Langer I, Guller U, Viehl CT, et al.: Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients: long-term outcomes of a prospective study. Ann Surg Oncol 2009, 16:3366–3374.CrossRefPubMed Langer I, Guller U, Viehl CT, et al.: Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients: long-term outcomes of a prospective study. Ann Surg Oncol 2009, 16:3366–3374.CrossRefPubMed
28.
go back to reference Pernas S, Gil M, Benitez A, et al.: Avoiding axillary treatment in sentinel lymph node micrometastases of breast cancer: a prospective analysis of axillary or distant recurrence. Ann Surg Oncol 2010, 17:772–777.CrossRefPubMed Pernas S, Gil M, Benitez A, et al.: Avoiding axillary treatment in sentinel lymph node micrometastases of breast cancer: a prospective analysis of axillary or distant recurrence. Ann Surg Oncol 2010, 17:772–777.CrossRefPubMed
29.
go back to reference Klauber-DeMore N, Ollila DW, Moore DT, et al.: Size of residual lymph node metastasis after preoperative chemotherapy in locally advanced breast cancer patients is prognostic. Ann Surg Oncol 2006,13:685–691.CrossRefPubMed Klauber-DeMore N, Ollila DW, Moore DT, et al.: Size of residual lymph node metastasis after preoperative chemotherapy in locally advanced breast cancer patients is prognostic. Ann Surg Oncol 2006,13:685–691.CrossRefPubMed
30.
go back to reference • Sakakibara M, Nagashima T, Kadowaki M, et al.: Clinical significance of axillary microresiduals after neoadjuvant chemotherapy in breast cancer patients with cytologically proven metastasis. Ann Surg Oncol 2009, 16:2470–2478. This article reported a statistical difference for DFS and OS in N1 patients who received neoadjuvant chemotherapy.CrossRefPubMed • Sakakibara M, Nagashima T, Kadowaki M, et al.: Clinical significance of axillary microresiduals after neoadjuvant chemotherapy in breast cancer patients with cytologically proven metastasis. Ann Surg Oncol 2009, 16:2470–2478. This article reported a statistical difference for DFS and OS in N1 patients who received neoadjuvant chemotherapy.CrossRefPubMed
31.
go back to reference Kuerer HM, Newman LA, Buzdar AU, et al.: Residual metastatic axillary lymph nodes following preoperative chemotherapy predict disease-free survival in patients with locally advanced breast cancer. Am J Surg 1998, 176:502–509.CrossRefPubMed Kuerer HM, Newman LA, Buzdar AU, et al.: Residual metastatic axillary lymph nodes following preoperative chemotherapy predict disease-free survival in patients with locally advanced breast cancer. Am J Surg 1998, 176:502–509.CrossRefPubMed
32.
go back to reference Kuerer HM, Sahin AA, Hunt KK, et al.: Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with preoperative chemotherapy. Ann Surg 1999, 230:72–78.CrossRefPubMed Kuerer HM, Sahin AA, Hunt KK, et al.: Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with preoperative chemotherapy. Ann Surg 1999, 230:72–78.CrossRefPubMed
33.
go back to reference Bear HD, Anderson S, Brown A, et al.: The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2003, 21:4165–4174.CrossRefPubMed Bear HD, Anderson S, Brown A, et al.: The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2003, 21:4165–4174.CrossRefPubMed
34.
go back to reference Straver ME, Rutgers EJ, Russell NS, et al.: Towards rational axillary treatment in relation to neoadjuvant therapy in breast cancer. Eur J Cancer 2009, 45:2284–2292.CrossRefPubMed Straver ME, Rutgers EJ, Russell NS, et al.: Towards rational axillary treatment in relation to neoadjuvant therapy in breast cancer. Eur J Cancer 2009, 45:2284–2292.CrossRefPubMed
35.
go back to reference • Classe JM, Bordes V, Campion L, et al.: Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J Clin Oncol 2009, 27:726–732. This is a small prospective study evaluating the success of SNB after neoadjuvant chemotherapy in patients with N0 and N1 disease.CrossRefPubMed • Classe JM, Bordes V, Campion L, et al.: Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J Clin Oncol 2009, 27:726–732. This is a small prospective study evaluating the success of SNB after neoadjuvant chemotherapy in patients with N0 and N1 disease.CrossRefPubMed
36.
go back to reference • Ozmen V, Unal ES, Muslumanoglu ME, et al.: Axillary sentinel node biopsy after neoadjuvant chemotherapy. Eur J Surg Oncol 2010, 36:23–29. This study provides evidence on the usefulness of SNB and intraoperative cytopathology to confirmed nodal disease and its prognostic value in patients following neoadjuvant chemotherapy.PubMed • Ozmen V, Unal ES, Muslumanoglu ME, et al.: Axillary sentinel node biopsy after neoadjuvant chemotherapy. Eur J Surg Oncol 2010, 36:23–29. This study provides evidence on the usefulness of SNB and intraoperative cytopathology to confirmed nodal disease and its prognostic value in patients following neoadjuvant chemotherapy.PubMed
37.
go back to reference • Schwartz GF, Tannebaum JE, Jernigan AM, Palazzo JP: Axillary sentinel lymph node biopsy after neoadjuvant chemotherapy for carcinoma of the breast. Cancer 2010, 116:1243–1251. This is a small retrospective study evaluating the authors’ experience with SNB after neoadjuvant chemotherapy.CrossRefPubMed • Schwartz GF, Tannebaum JE, Jernigan AM, Palazzo JP: Axillary sentinel lymph node biopsy after neoadjuvant chemotherapy for carcinoma of the breast. Cancer 2010, 116:1243–1251. This is a small retrospective study evaluating the authors’ experience with SNB after neoadjuvant chemotherapy.CrossRefPubMed
Metadata
Title
The Need for Axillary Dissection in Patients with Positive Axillary Sentinel Lymph Nodes
Authors
Randal L. Croshaw
Kathleen M. Erb
Hilary M. Shapiro-Wright
Thomas B. Julian
Publication date
01-02-2011
Publisher
Current Science Inc.
Published in
Current Oncology Reports / Issue 1/2011
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-010-0133-0

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