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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2010

01-10-2010 | American Society of Breast Surgeons

Trends in and Outcomes from Sentinel Lymph Node Biopsy (SLNB) Alone vs. SLNB with Axillary Lymph Node Dissection for Node-Positive Breast Cancer Patients: Experience from the SEER Database

Authors: Min Yi, MD, Sharon Hermes Giordano, MD, Funda Meric-Bernstam, MD, Elizabeth A. Mittendorf, MD, Henry M. Kuerer, MD, PhD, Rosa F. Hwang, MD, Isabelle Bedrosian, MD, Loren Rourke, MD, Kelly K. Hunt, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2010

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Abstract

Background

Complete axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) remains the standard practice. As nodal surgery has long been considered a staging procedure without a clear survival benefit, the need for ALND in all patients is debatable. The purpose of this study was to examine differences in survival for patients undergoing SLNB alone versus SLNB with complete ALND.

Methods

Patients with breast cancer who underwent SLNB and were found to have nodal metastases were identified from the Surveillance, Epidemiology, and End Results database (1998–2004). Clinicopathologic and outcomes data were examined for patients who underwent SLNB alone versus SLNB with ALND.

Results

We identified 26,986 patients with disease-positive lymph nodes; 4,425 (16.4%) underwent SLNB alone, and 22,561 (83.6%) underwent SLNB with ALND. Patients were significantly more likely to undergo SLNB alone if they were older (median 59 years old) or if the tumor was low grade and estrogen receptor positive. From 1998 to 2004, the proportion of patients with micrometastasis in the sentinel lymph nodes who underwent SLNB alone increased from 21.0 to 37.8% (P < 0.001). At a median follow-up of 50 months, there were no statistically significant differences in overall survival (OS) between patients who underwent SLNB alone versus complete ALND.

Conclusions

There is an increasing trend toward omitting ALND in patients with micrometastatic nodal disease identified by SLNB. Compared with SLNB alone, completion ALND does not seem to be associated with improved survival for breast cancer patients with micrometastasis in the sentinel lymph nodes.
Literature
1.
Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. Am J Ophthalmol. 2000;130:688.CrossRefPubMed
2.
Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.CrossRefPubMed
3.
4.
Guenther JM, Hansen NM, DiFronzo LA, et al. Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes. Arch Surg. 2003;138:52–6.CrossRefPubMed
5.
Jeruss JS, Winchester DJ, Sener SF, et al. Axillary recurrence after sentinel node biopsy. Ann Surg Oncol. 2005;12:34–40.CrossRefPubMed
6.
Chu KU, Turner RR, Hansen NM, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg. 1999;229:536–41.CrossRefPubMed
7.
Hwang RF, Gonzalez-Angulo AM, Yi M, et al. Low locoregional failure rates in selected breast cancer patients with tumor-positive sentinel lymph nodes who do not undergo completion axillary dissection. Cancer. 2007;110:723–30.CrossRefPubMed
8.
Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10:1140–51.CrossRefPubMed
9.
Fant JS, Grant MD, Knox SM, et al. Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol. 2003;10:126–30.CrossRefPubMed
10.
Grube BJ, Giuliano AE. Observation of the breast cancer patient with a tumor-positive sentinel node: implications of the ACOSOG Z0011 trial. Semin Surg Oncol. 2001;20:230–7.CrossRefPubMed
11.
Moore MP, Kinne DW. Axillary lymphadenectomy: a diagnostic and therapeutic procedure. J Surg Oncol. 1997;66:2–6.CrossRefPubMed
12.
13.
14.
Leitch AM, McCall L, Beitsch P. Factors influencing accrual to ACOSOG Z0011, a randomized phase III trial of axillary dissection vs observation for sentinel node positive breast cancer (abstract 601). J Clin Oncol. 2006;24(Suppl):28s.
15.
16.
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;27:2946–53.CrossRefPubMed
17.
Leggett MD, Chen SL, Schneider PD, Martinez SR. Prognostic value of lymph node yield and metastatic lymph node ratio in medullary thyroid carcinoma. Ann Surg Oncol. 2008;15:2493–9.CrossRefPubMed
18.
Martinez SR, Robbins AS, Meyers FJ, et al. Racial and ethnic differences in treatment and survival among adults with primary extremity soft-tissue sarcoma. Cancer. 2008;112:1162–8.CrossRefPubMed
19.
Chen SL, Martinez SR. The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. Am J Surg. 2008;196:495–9.CrossRefPubMed
20.
Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 6th ed. New York: Springer, 2009. p. 223–40.
21.
McMasters KM, Giuliano AE, Ross MI, et al. Sentinel-lymph-node biopsy for breast cancer—not yet the standard of care. N Engl J Med. 1998;339:990–5.CrossRefPubMed
22.
Cserni G, Gregori D, Merletti F, et al. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg. 2004;91:1245–52.CrossRefPubMed
23.
Katz A, Smith BL, Golshan M, et al. Nomogram for the prediction of having four or more involved nodes for sentinel lymph node-positive breast cancer. J Clin Oncol. 2008;26:2093–8.CrossRefPubMed
24.
Naik AM, Fey J, Gemignani M, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240:462–8.CrossRefPubMed
25.
Straver ME, Meijnen P, van Tienhoven G, et al. Role of axillary clearance after a tumor-positive sentinel node in the administration of adjuvant therapy in early breast cancer. J Clin Oncol. 2010;28:731–7.
26.
Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.PubMed
27.
Morrow M. Patterns of care with a positive sentinel node: echoes of an opportunity missed. Ann Surg Oncol. 2009;16:2429–30.CrossRefPubMed
28.
Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887–92.CrossRefPubMed
29.
Winchester DP, Trabanino L, Lopez MJ. (2005) The evolution of surgery for breast cancer. Surg Oncol Clin N Am. 14:479–98, vi.CrossRefPubMed
Metadata
Title
Trends in and Outcomes from Sentinel Lymph Node Biopsy (SLNB) Alone vs. SLNB with Axillary Lymph Node Dissection for Node-Positive Breast Cancer Patients: Experience from the SEER Database
Authors
Min Yi, MD
Sharon Hermes Giordano, MD
Funda Meric-Bernstam, MD
Elizabeth A. Mittendorf, MD
Henry M. Kuerer, MD, PhD
Rosa F. Hwang, MD
Isabelle Bedrosian, MD
Loren Rourke, MD
Kelly K. Hunt, MD
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1253-3

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