Is a completion axillary dissection indicated for micrometastases in the sentinel lymph node?
Section snippets
Methods
Between June 1998 and March 2001, 227 breast cancer patients underwent SLNM at Grant Medical Center. Their charts were retrospectively reviewed for this study. All surgeries were performed by two fellowship trained surgical oncologists (BJSS, TAN) who had completed SLNM courses at the National Cancer Institute. Patients with palpable lymphadenopathy or neoadjuvant chemotherapy were excluded. All patients underwent intraparenchymal injection of 5 cc 1% isosulfan blue dye (Lymphazurin; U.S.
Results
Over a 33-month period, 227 patients were identified as candidates for SLNM at Grant Medical Center. One patient was excluded from this study owing to inability to identify the SLN. In the 226 remaining patients, 82 (36%) were found to have metastatic disease in the SLN. Of these patients, 15 (6.7%) had microscopic metastasis. The tumor histology of the 15 patients with micrometastatic disease in the SLN was as follows: 13 invasive ductal carcinoma, 1 invasive lobular carcinoma, and 1 mucinous
Comments
As SLNM evolves into the gold standard in the staging of breast cancer patients, many issues need to be addressed: optimal technique, learning curve, accuracy in neoadjuvant patients, accuracy in patients with previous breast or axillary surgery, reliability in repeat SLNM, and, of course, the need for CAD. Small tumor size and micrometastatic disease in the axilla may be able to predict the negative status of non-SLNs and avoidance of CAD [1], [2], [3].
Micrometastasis in the SLN has been
Conclusion
Micrometastases in the SLN is an issue that warrants further investigation as SLNM evolves into the standard of care for breast cancer management. Standardizations in techniques, definition, histologic staining, and pathologic reporting will need to be in place for the data to be of value.
This study suggests that micrometastasis in the SLN may be the sole site of disease in the axilla. Other studies have confirmed this finding, especially in the presence of small primary tumors and in the
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Cited by (68)
The evolving role of axillary lymph node dissection in the modern era of breast cancer management
2012, Surgical OncologyCitation Excerpt :The role of ALND in the SLN micrometastatic setting is also controversial. However, based on published retrospective and prospective data, the rate of axillary recurrence rate in SLN micrometastases (i.e. greater than 0.02 mm and less than 0.2 mm) varies from 0 to 3% in patients receiving adjuvant therapies [14–17]. This is acceptable given the local failure rate of ALND is 0–2% [18].
Sentinel lymph node micrometastasis in human breast cancer: An update
2011, Surgical OncologyCitation Excerpt :Many studies showed that SLN MM is associated with increased frequency of non-SLN involvement (0–57%). However, the majority of these studies were observational ones that lack patients follow-up [12,23,31,41–43,45,46,49,51–58,62,63,65,111,130] and small number of patients making it impossible to draw conclusions on the significance of non-SLN tumour involvement. Of interest, two studies published in 2008 have followed SLN MM patients for a reasonable time.
Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN
2011, European Journal of Surgical OncologyCitation Excerpt :One study was excluded because it was also a meta-analysis of predictive factors.88 Five studies were excluded because of the presumed overlap of the dataset with another study.14,26,27,89,90 Thus, 56 studies, published between January 1999 and June 2009 were included in this meta-analysis (Table 1).9–13,15,17–23,25,28–40,91–118
Axillary Management
2011, Early Diagnosis and Treatment of Cancer Series: Breast Cancer