Use of axillary lymph node dissection (ALND) in patients with micrometastatic breast cancer.

Abstract

BACKGROUND:

Sentinel lymph node (SLN) biopsy is the current prognostic tool for clinically node-negative breast cancer patients. If the SLN reveals macrometastasis, axillary lymph node dissection (ALND) is recommended. However, the use of ALND in patients with micrometastasis is debated. The objective of this study was to assess the utilization of ALND in the treatment of micrometastatic breast cancer.

METHODS:

An IRB approved, retrospective study of a pooled dataset of breast cancer patients with micrometastatic disease on SLN biopsy was performed. Patients diagnosed from 1999-2016 were identified via query of a single-institution National Comprehensive Cancer Network (NCCN) breast cancer database as well as a prospective tumor board.

RESULTS:

A total of 91 patients were diagnosed with micrometastatic nodal disease. The median age at diagnosis was 56 y (range: 31-85); median follow-up time was 47 mo (range: 0-203 mo). 42/91(46.2%) patients had ALND of which 37/42 (88.1%) were a second operation; 3/42(7.1%) patients had additional positive nodes found at ALND. 44/91 (48.4%) patients received radiation. 7/91 (7.7%) patients had a recurrence, 5/7 local, including one axillary (2.1%; patient declined ALND).

CONCLUSIONS:

Given that the risk of lymphedema after ALND ranges between 20%-53%, the morbidity of ALND may far exceed the likelihood of detecting further nodal involvement in women with micrometastatic disease: 7.1% in this series.

• Authors: Madison Collins, Cristina O'Donoghue, Weihong Sun, Jun-Min Zhou, Zhenjun Ma, Christine Laronga, Marie Catherine Lee
• Journal: The Journal of surgical research (J Surg Res) Vol. 215 Pg. 55-59 (07 2017) ISSN: 1095-8673 [Electronic] United States
• PMID: 28688661 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Axilla
• Breast Neoplasms (pathology, surgery)
• Carcinoma, Ductal, Breast (pathology, surgery)
• Carcinoma, Lobular (pathology, surgery)
• Female
• Florida
• Follow-Up Studies
• Humans
• Lymph Node Excision (statistics & numerical data)
• Lymphatic Metastasis
• Middle Aged
• Neoplasm Micrometastasis
• Practice Patterns, Physicians' (statistics & numerical data)
• Retrospective Studies
• Treatment Outcome