Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer

• Published in: European journal of surgical oncology Vol. 34; no. 2; pp. 129 - 134
• Main Author: Noguchi, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2008
• Subjects: Adult; Aged; Axilla; Axillary lymph node dissection; Biopsy, Needle; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Japan; Lymph Node Excision - standards; Lymph Node Excision - trends; Lymph Nodes - pathology; Lymph Nodes - surgery; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Patient Selection; Risk Assessment; Sentinel lymph node biopsy; Sentinel Lymph Node Biopsy - standards; Sentinel Lymph Node Biopsy - trends; Surgery; Survival Analysis; Treatment Outcome; Japan; EORTC; Breast cancer; ALMNAC; BCT; UICC; SLN; Sentinel lymph node biopsy; AJCC; ITC; Axillary lymph node dissection; NSABP; ACOSOG; ALND; breast-conserving treatment; American College of Surgeons Oncology Group; axillary lymphatic mapping against nodal clearance; National Surgical Adjuvant Breast and Bowel Project; sentinel lymph node; European Organisation for Research and Treatment of Cancer; isolated tumour cells; American Joint Committee on Cancer; International Union Against Cancer
• ISSN: 0748-7983; 1532-2157; 1532-2157
• DOI: 10.1016/j.ejso.2007.03.026

Currently, it is standard practice to avoid ALND in patients with negative SLN, whereas this procedure is mandated for those with positive SLN. However, there has been some debate regarding the necessity of complete ALND in all patients with positive SLN. This review article discusses the issues related to eliminating the need for ALND in selected patients with positive nodes. A review of the English language medical literature was performed using the MEDLINE database and cross-referencing major articles on the subject, focusing on the last 10 years. Currently, complete ALND is mandated in patients with SLN macrometastases as well as those with clinically positive nodes. It is not clear whether SLN biopsy is appropriate for axillary staging in patients with initially clinically positive nodes (N1) that become clinically node-negative (N0) after neoadjuvant chemotherapy. Although there is debate regarding whether ALND should be performed in patients with micrometastases in the SLN, it seems premature to abandon ALND in clinical practice. Moreover, it remains unclear whether it is appropriate to avoid complete ALND in patients with ITC-positive SLN alone. In the absence of data from randomised trials, the long-term impact of SLN biopsy alone on axillary recurrence and survival rate in patients with SLN micrometastases as well as those with ITC-positive SLN remains uncertain. These important issues must be determined by careful analysis of the results of ongoing clinical trials.