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No Axillary Lymph Node Dissection in Breast Cancer Patients with Sentinel Lymph Node Micrometastasis

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DOI: 10.4236/abcr.2014.31003    3,126 Downloads   6,792 Views  

ABSTRACT

Follow-up data of a series of 75 breast cancer patients with sentinel node (SN) micrometastases only (between 0.2 and 2 mm) and favorable histopathological features of the primary tumor (well-differentiated, T1 tumors without lymphovascular invasion) who refused completion axillary lymph node dissection (ALND) or who were unsuitable for surgery were assessed in order to detect the rate of axillary recurrence after an adjuvant chemoand/or hormonal adjuvant treatment was given. The great majority of patients (81.3%) did not undergo ALND due to the existence of favorable histopathologic factors while the rest were equally distributed among over 75-year-old women (10.6%) and patients at a high surgical risk due to comorbid conditions (9.3%). Sixty-six patients (88%) underwent conservative treatment (lumpectomy followed by adjuvant breast radiotherapy) while the remaining nine patients (12%) had total mastectomy; 72 out of 75 patients (96%) received some forms of adjuvant chemoand/or hormone-therapy. After a median follow-up of 38 months (range 12 - 84 months), nine out of 75 patients (12%) had a disease relapse, only one of them (1.3%) being affected by an axillary recurrence in the untreated axilla three years after primary surgery. On these grounds, completion ALND could be safely omitted in patients with SN micrometastasis and favorable histopathological characteristics of the primary neoplasm due to the very low rate of axillary recurrence with no detrimental effect on survival.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Gipponi, M. , Fregatti, P. , Murelli, F. , Meszaros, P. , Depaoli, F. , Margarino, C. , Baccini, P. , Gualco, M. and Friedman, D. (2014) No Axillary Lymph Node Dissection in Breast Cancer Patients with Sentinel Lymph Node Micrometastasis. Advances in Breast Cancer Research, 3, 12-16. doi: 10.4236/abcr.2014.31003.

References

[1] A. E. Giuliano, P. I. Haigh, M. B. Brennan, N. M. Hansen, M. C. Kelley, W. Ye, E. C. Glass and R. R. Turner, “Prospective Observational Study of Sentinel Lymphadenectomy without Further Axillary Dissection in Patients with Sentinel Node-Negative Breast Cancer,” Journal of Clinical Oncology, Vol. 18, No. 13, 2000, pp. 2553-2559.
[2] U. Veronesi, G. Paganelli, G. Viale, A. Luini, S. Zurrida, V. Galimberti, M. Intra, P. Veronesi, P. Maisonneuve, G. Gatti, G. Mazzarol, C. De Cicco, G. Manfredi and J. R. Fernández, “Sentinel-Lymph-Node Biopsy as a Staging Procedure in Breast Cancer: Update of a Randomize Controlled Study,” Lancet Oncology, Vol. 7, No. 12, 2006, pp. 983-990. http://dx.doi.org/10.1016/S1470-2045(06) 70947-0
[3] G. Canavese, A. Catturich, C. Vecchio, D. Tomei, M. Gipponi, G. Villa, F. Carli, P. Bruzzi and B. Dozin, “Sentinel Node Biopsy Compared with Complete Axillary Dissection for Staging Early Breast Cancer with Clinically Negative Nodes: Results of Randomized Trial,” Annals of Oncology, Vol. 20, No. 6, 2009, pp. 1001-1007. http://dx.doi.org/10.1093/annonc/mdn746
[4] G. Cserni, D. Gregori, F. Merletti, A. Sapino, M. P. Mano, A. Ponti, S. Sandrucci, B. Baltás and G. Bussolati, “Meta-Analysis of Non-Sentinel Node Metastases Associated with Micrometastatic Sentinel Nodes in Breast Cancer,” British Journal of Surgery, Vol. 91, No. 10, 2004, pp. 1245-1252. http://dx.doi.org/10.1002/bjs.4725
[5] G. Houvenaeghel, C. Nos, S. Giard, H. Mignotte, B. Esterni, J. Jacquemier, M. Buttarelli, J. M. Classe, M. Cohen, P. Rouanet, F. Penault Llorca, P. Bonnier, F. Marchal, J. R. Garbay, J. Fraisse, P. Martel, E. Fondrinier, C. Tunon de Lara and J. F. Rodier, “A Nomogram Predictive of Non-Sentinel Lymph Node Involvement in Breast Cancer Patients with a Sentinel Lymph Node Micrometastasis,” EJSO, Vol. 35, No. 11, 2009, pp. 690-695. http://dx.doi.org/10.1016/j.ejso.2008.10.003
[6] M. Gipponi, G. Canavese, R. Lionetto, A. Catturich, C. Vecchio, A. Sapino, D. Friedman and F. Cafiero, “The Role of Axillary Lymph Node Dissection in Breast Cancer Patients with Sentinel Lymph Node Micrometastases,” European Journal of Surgical Oncology, Vol. 32, No. 2, 2006, pp. 143-147. http://dx.doi.org/10.1016/j.ejso.2005.10.003
[7] K. Y. Bilimoria, D. J. Bentrem, N. M. Hansen, K. P. Bethke, A. W. Rademaker, C. Y. Ko, D. P. Winchester and D. J. Winchester, “Comparison of Sentinel Lymph Node Biopsy Alone and Completion Axillary Lymph Node Dissection for Node-Positive Breast Cancer,” Journal of Clinical Oncology, Vol. 27, No. 18, 2009, pp. 2946-2953. http://dx.doi.org/10.1200/JCO.2008.19.5750
[8] A. E. Giuliano, L. McCall, P. Beitsch, P. W. Whitworth, P. Blumencranz, A. M. Leitch, S. Saha, K. K. Hunt, M. Morrow and K. Ballman, “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,” Annals of Surgery, Vol. 252, No. 3, 2010, pp. 426-432.
[9] A. E. Giuliano, K. K. Hunt, K. V. Ballman, P. D. Beitsch, P. W. Whitworth, P. W. Blumencranz, A. M. Leitch, S. Saha, L. M. McCall and M. Morrow, “Axillary Dissection vs No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial,” JAMA, Vol. 305, No. 6, 2011, pp. 569-575. http://dx.doi.org/10.1001/jama.2011.90
[10] S. Arnaud, G. Houvenaeghel, V. Moutardier, M. Butarelli, M. Martino, A. Tallet, A. C. Braud, J. Jacquemier, C. Julian-Reynier and I. Brenot-Rossi, “Patients’ and Surgeons’ Perspectives on Axillary Surgery for Breast Cancer,” EJSO, Vol. 30, No. 7, 2004, pp. 735-743. http://dx.doi.org/10.1016/j.ejso. 2004.05.007
[11] R. E. Mansel, L. Fallowfield, M. Kissin, A. Goyal, R. G. Newcombe, J. M. Dixon, C. Yiangou, K. Horgan, N. Bundred, I. Monypenny, D. England, M. Sibbering, T. I. Abdullah, L. Barr, U. Chetty, D. H. Sinnett, A. Fleissig, D. Clarke and P. J. Ell, “Randomized Multicenter Trial of Sentinel Node Biopsy versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC Trial,” Journal of the National Cancer Institute, Vol. 98, No. 9, 2006, pp. 599-609. http://dx.doi.org/10.1016/j.ejso.2004.05.007
[12] S. Latosinsky, K. Dabbs, F. Moffat, S. Latosinsky, K. Dabbs, F. Moffat and Canadian Association of General Surgeons and American College of Surgeons Evidence-Based Reviews in Surgery, “Quality-of-Life Outcomes with Sentinel Node Biopsy versus Standard Axillary Treatment in Patients with Operable Breast Cancer. Randomized Multicenter Trial of Sentinel Node Biopsy versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC Trial,” Canadian Journal of Surgery, Vol. 51, 2008, pp. 483-485.
[13] R. W. Carlson, D. C. Allred, B. O. Anderson, H. J. Burstein, W. B. Carter, S. B. Edge, J. K. Erban, W. B. Farrar, L. J. Goldstein, W. J. Gradishar, D. F. Hayes, C. A. Hudis, M. Jahanzeb, K. Kiel, B. M. Ljung, P. K. Marcom, I. A. Mayer, B. McCormick, L. M. Nabell, L. J. Pierce, E. C. Reed, M. L. Smith, G. Somlo, R. L. Theriault, N. S. Topham, J. H. Ward, E. P. Winer and A. C. Wolff, “NCCN Breast Cancer Clinical Practice Guidelines Panel: Breast Cancer. Clinical Practice Guidelines in Oncology,” Journal of the National Comprehensive Cancer Network, Vol. 7, 2009, pp. 122-192.
[14] H. S. Cody and N. Houssami, “Axillary Management in Breast Cancer: What’s New for 2012?” Breast, Vol. 21, No. 3, 2012, pp. 411-415. http://dx.doi.org/10.1016/j.breast.2012.01.011
[15] AIOM, “Linee Guida Neoplasie Della Mammella,” 2006.
[16] M. Gipponi, C. Bassetti, G. Canavese, A. Catturich, C. Di Somma, C. Vecchio, G. Nicolò, F. Schenone, D. Tomei and F. Cafiero, “Sentinel Lymph Node as a New Marker for Therapeutic Planning in Breast Cancer Patients,” Journal of Surgical Oncology, Vol. 85, No. 3, 2004, pp. 102-111. http://dx.doi.org/ 10.1002/jso.20022
[17] F. L. Greene, D. L. Page, A. G. Fleming and C. M. Balch, Eds., “AJCC Cancer Staging Handbook,” Springer, New York, 2002.
[18] U. Veronesi, G. Paganelli, G. Viale, A. Luini, S. Zurrida, V. Galimberti, M. Intra, P. Veronesi, C. Robertson, P. Maisonneuve, G. Renne, C. DeCicco, F. De Lucia and R. Gennari, “A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast Cancer,” New England Journal of Medicine, Vol. 349, No. 6, 2003, pp. 546-553. http://dx.doi.org/10.1056/NEJMoa012782
[19] R. E. Mansel, L. Fallowfield, M. Kissin, A. Goyal, R. G. Newcombe, J. M. Dixon, C. Yiangou, K. Horgan, N. Bundred, I. Monypenny, D. England, M. Sibbering, T. I. Abdullah, L. Barr, U. Chetty, D. H. Sinnett, A. Fleissig, D. Clarke and P. J. Ell, “Randomized Multicenter Trial of Sentinel Node Biopsy versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC Trial,” Journal of the National Cancer Institute, Vol. 98, No. 9, 2006, pp. 599-609. http://dx.doi.org/10.1093/jnci/djj158
[20] A. E. Giuliano, “Sentinel Lymphadenectomy in Primary Breast Carcinoma: An Alternative to Routine Axillary Dissection,” Journal of Surgical Oncology, Vol. 62, No. 2, 1996, pp. 75-77.
http://dx.doi.org/10.1002/(SICI)1096-9098(199606)62:2<75::AID-JSO1>3.0.CO;2-N
[21] P. J. Borgstein, R. Pijpers, E. F. Comans, P. J. van Dieast, R. P. Boom and S. Maijers, “Sentinel Lymph Node Biopsy in Breast Cancer: Guidelines and Pitfalls of Lymphoscintigraphy and Gamma Probe Detection,” Journal of the American College of Surgeons, Vol. 186, No. 3, 1998, pp. 275-283.
http://dx.doi.org/10.1016/S1072-7515(98)00011-8
[22] J. M. Barnwell, M. A. Arredondo, D. Kollmorgen, J. F. Gibbs, D. Lamonica, W. Carson, P. Zhang, J. Winston and S. B. Edge, “Sentinel Lymph Node Biopsy in Breast Cancer,” Annals of Surgical Oncology, Vol. 5, No. 2, 1998, pp. 126-130. http://dx.doi.org/10.1007/BF02303845
[23] A. Salem, “Sentinel Lymph Node Biopsy in Breast Cancer: A Comprehensive Literature Review,” Journal of Surgical Education, Vol. 66, No. 5, 2009, pp. 267-275. http://dx.doi.org/10.1016/j.jsurg. 2009.07.011
[24] D. J. Dabbs, M. Fung, D. Landsittel, K. McManus and R. Johnson, “Sentinel Lymph Node Micrometastasis as a Predictor of Axillary Tumor Burden,” Breast Journal, Vol. 10, No. 2, 2004, pp. 101-105. http://dx.doi.org/10.1111/j.1075-122X.2004.21280.x
[25] A. Goldhirsch, W. C. Wood, A. S. Coates, R. D. Gelber, B. Thürlimann and H.-J. Senn, “Strategies for Subtypes— Dealing with the Diversity of Breast Cancer: Highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011,” Annals of Oncology, Vol. 22, No. 8, 2011, pp. 1736-1747. http://dx.doi.org/10.1093/annonc/mdr304
[26] B. Fisher, S. Anderson, J. Bryant, R. G. Margolese, M. Deutsch, E. R. Fisher, J. H. Jeong and N. Wolmark, “Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy Plus Irradiation for the Treatment of Invasive Breast Cancer,” New England Journal of Medicine, Vol. 347, No. 16, 2002, pp. 1233-1241. http://dx.doi.org/10.1056/NEJMoa022152
[27] International Brest Cancer Study Group, “Randomized trial Comparing Axillary Clearance versus No Axillary Clearance in Older Patients with Breast Cancer: First Results of International Breast Cancer Study Group Trial 10-93,” Journal of Clinical Oncology, Vol. 24, No. 3, 2006, pp. 337-344.
http://dx.doi.org/10.1200/JCO.2005.01.5784
[28] M. Solá, J. A. Alberro, M. Fraile, P. Santesteban, M. Ramos, R. Fabregas, A. Moral, B. Ballester and S. Vidal, “Complete Axillary Lymph Node Dissection versus Clinical Follow-Up in Breast Cancer Patients with Sentinel Node Micrometastasis: Final Results from the Multicenter Clinical Trial AATRM 048/13/2000,” Annals of Surgical Oncology, Vol. 20, No. 1, 2013, pp. 120-127. http://dx.doi.org/10. 1245/s10434-012-2569-y

  
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