Abstract
Background
The standard of care for clinically node-negative (cN0) patients following positive
sentinel lymph node biopsy (SLNB) was completion axillary lymph node dissection (CALND).
Publication of ACOSOG Z0011 in 2010 changed this standard for patients undergoing
lumpectomy. Clinicians have since expanded this practice to mastectomy patients, and
ongoing prospective studies are seeking to validate this practice. Here, we evaluate
patient and tumor characteristics that led surgeons to forego a second surgery for
CALND in cN0 mastectomy patients with positive SLNB.
Patients and Methods
A single institution, retrospective review of cN0 patients with invasive primary breast
cancer and positive SLNB from 2010 to 2016 was performed. Patients with T4 disease,
positive preoperative axillary biopsy, prior neoadjuvant therapy or axillary surgery
were excluded. Patients with positive SLNB undergoing CALND were compared with patients
for whom CALND was omitted. Statistical analysis was performed using Kruskal-Wallis
tests for continuous variables and χ2 tests or Fischer exact tests for categorical variables.
Results
Of 259 patients with positive SLNB, 180 (69.4%) patients underwent mastectomy. CALND
was performed at the time of mastectomy in 54 (30%) patients, at time of second operation
in 22 (12.2%) patients, and not performed in 104 (57%) patients. Delayed CALND was
significantly associated with younger age, larger tumors, increased number of positive
sentinel nodes, invasive lobular carcinoma, extranodal extension, and lymphovascular
invasion.
Conclusions
The management of cN0 patients with positive SLNB that do not meet ACOSOG Z0011 criteria
is evolving and is influenced by tumor and patient characteristics in an attempt to
balance the morbidity of CALND with the low rate of local regional recurrence.
Keywords
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References
- Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial.Lancet Oncol. 2010; 11: 927-933
- Factors associated with local-regional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial.Ann Surg. 2012; 256: 428-436
- A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer.N Engl J Med. 2003; 349: 546-553
- Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial.Ann Surg. 2010; 252 (discussion: 432-3): 426-432
- Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial.Ann Surg. 2016; 264: 413-420
- Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial.JAMA. 2017; 318: 918-926
- National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology, Breast version 3.2018. 2018 (Available at:)
- Complete axillary lymph node dissection versus clinical follow up in breast cancer patients with sentinel node metastasis: final results from the multicentre clinical trial AATRM 048/13/2000.Ann Surg Oncol. 2013; 20: 120-127
- Micrometastases or isolated tumor cells and the outcome of breast cancer.N Engl J Med. 2009; 361: 653-663
- Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial.Lancet Oncol. 2013; 14: 297-305
- Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial.JAMA. 2011; 305: 569-575
- Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial.Lancet Oncol. 2014; 15: 1303-1310
- Characteristics and outcomes of sentinel node-positive breast cancer patients after total mastectomy without axillary-specific treatment.Ann Surg Oncol. 2012; 19: 3762-3770
- Outcomes of sentinel lymph node-positive breast cancer patients treated with mastectomy without axillary therapy.Ann Surg Oncol. 2017; 24: 652-659
- Outcomes with and without axillary node dissection for node-positive lumpectomy and mastectomy patients.Am J Surg. 2015; 210: 685-693
- Axillary lymph node dissection does not improve post-mastectomy overall or disease-free survival among breast cancer patients with 1-3 positive nodes.Cancer Res Treat. 2019; 51: 1011-1021
- Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial.BMC Cancer. 2017; 17: 379
- Disease recurrence in sentinel node-positive breast cancer patients forgoing axillary lymph node dissection.Ann Surg Oncol. 2012; 19: 3185-3191
- American Joint Committee on Cancer. Breast.in: Amin M.B. Edge S. Greene F. AJCC Cancer Staging Manual. 8th edition. Springer, New York, NY2017
- Breast Cancer protocol.(Available at:)www.cap.orgDate accessed: June 20, 2020
- Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: 10 year follow up results of the EORTC AMAROS trial (EORTC 10981/22023). [abstract].in: San Antonio Breast Cancer Symposium; December 6, 2018. SABCS, San Antonio, TX2018 (Abstract no. GS4-01)
- Evolution of the use of completion axillary lymph node dissection in patients with T1/2N0M0 breast cancer and tumour-involved sentinel lymph nodes undergoing mastectomy: a cohort study.Ann Surg Oncol. 2019; 26: 2435-2443
- Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements.J Clin Oncol. 2008; 26: 5213-5219
- Risk of lymphedema after mastectomy: potential benefit of applying ACOSOG Z0011 protocol to mastectomy patients.Breast Cancer Res Treat. 2014; 144: 71-77
- Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011.J Clin Oncol. 2007; 25: 3657-3663
- Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients.Br J Cancer. 2003; 89: 648-652
- Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer.Arch Surg. 2003; 138 (discussion: 487-8): 482-487
- Invasive lobular vs. ductal breast cancer: a stage-matched comparison of outcomes.Ann Surg Oncol. 2010; 17: 1862-1869
- Mammographic and ultrasound features of invasive lobular carcinoma of the breast.J Med Imaging Radiat Oncol. 2014; 58: 1-10
- Invasive lobular carcinoma: mammographic findings in a 10-year experience.Radiology. 1991; 178: 149-154
- Invasive lobular carcinoma of the breast: mammographic findings and extent of disease at diagnosis in 184 patients.AJR Am J Roentgenol. 1993; 161: 957-960
- Routine completion axillary lymph node dissection for positive sentinel nodes in patients undergoing mastectomy is not associated with improved local control.Am J Surg. 2013; 205: 581-584
- Protocol 14PRT/0519: POSNOC—POsitive Sentinel NOde-adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomized controlled trial of axillary treatment in women with early stage breast cancer who have metastases in one or two sentinel nodes (ISRCTN54765244); PI: Goyal A.(Available at:)http://www.thelancet.com/protocol-reviews/14PRT-0519Date accessed: July 1, 2019
Article info
Publication history
Published online: July 28, 2020
Accepted:
July 20,
2020
Received in revised form:
June 21,
2020
Received:
March 30,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
