Predictors of completion axillary lymph node dissection in patients with immunohistochemical metastases to the sentinel lymph node in breast cancer.

Abstract

BACKGROUND:

Axillary lymph node dissection (ALND) in patients with immunohistochemistry (IHC)-determined metastases to the sentinel lymph node (SLN) is controversial. The goal of this study was to examine factors associated with ALND in IHC-only patients.

METHODS:

Retrospective review of an institutional SLN database from July 1997 to July 2003 was performed. We compared sociodemographic, pathologic, and therapeutic variables between IHC-only patients who had SLN biopsy alone and those that had ALND.

RESULTS:

Our study group consisted of 171 patients with IHC-only metastases to the SLN. Young age, estrogen receptor negative status, high Memorial Sloan-Kettering Cancer Center nomogram score, and chemotherapy were associated with ALND. Among patients who had ALND (n = 95), 18% had a positive non-SLN. Rates of systemic therapy were similar between those with and without positive non-SLNs at ALND. No axillary recurrences were observed in this series with a median follow-up of 6.4 years. The percentage of patients who were recurrence-free after 5 years was 97% (95% confidence interval, 92.1-98.6).

CONCLUSIONS:

On the basis of our findings and the lack of prospective randomized data, the practice of selectively limiting ALND to IHC-only patients thought to be at high risk and to patients for whom the identification of additional positive nodes may change systemic therapy recommendations seems to be a safe and reasonable approach.

• Authors: Matthew S Pugliese, Amer K Karam, Meier Hsu, Michelle M Stempel, Sujata M Patil, Alice Y Ho, Tiffany A Traina, Kimberly J Van Zee, Hiram S Cody 3rd, Monica Morrow, Mary L Gemignani
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 17 Issue 4 Pg. 1063-8 (Apr 2010) ISSN: 1534-4681 [Electronic] United States
• PMID: 20033325 (Publication Type: Journal Article)

Chemical References

• Receptors, Estrogen
• Receptors, Progesterone
• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adult
• Aged
• Aged, 80 and over
• Axilla
• Breast Neoplasms (metabolism, pathology, surgery)
• Carcinoma, Ductal, Breast (metabolism, pathology, surgery)
• Carcinoma, Lobular (metabolism, pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Immunoenzyme Techniques
• Lymph Node Excision
• Lymphatic Metastasis
• Middle Aged
• Neoplasm Recurrence, Local (metabolism, pathology, surgery)
• Prospective Studies
• Receptor, ErbB-2 (metabolism)
• Receptors, Estrogen (metabolism)
• Receptors, Progesterone (metabolism)
• Retrospective Studies
• Sentinel Lymph Node Biopsy
• Survival Rate
• Treatment Outcome