Axillary dissection of level I and II lymph nodes is important in breast cancer classification

Axelsson, C. K.; Mouridsen, Henning T.; Zedeler, Karin

doi:10.1016/0959-8049(92)90534-9

Cited by 254 publications

(142 citation statements)

References 13 publications

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“…Traditional level I and II ALND requires that ≥10 lymph nodes be provided for pathologic evaluation to accurately stage the axilla. 15,16 ALND should be extended to include level III nodes only if gross disease is apparent in the level II and III nodes. In the absence of gross disease in level II nodes, lymph node dissection should include tissue inferior to the axillary vein from the latissimus dorsi muscle laterally to the medial border of the pectoralis minor muscle (level I and II) (see BINV-D; page 440).…”

Section: Nccn Recommendationsmentioning

confidence: 99%

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Gradishar¹,

Anderson

Balassanian

et al. 2017

J Natl Compr Canc Netw

396

346

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These NCCN Guidelines Insights highlight the important updates/changes to the surgical axillary staging, radiation therapy, and systemic therapy recommendations for hormone receptor-positive disease in the 1.2017 version of the NCCN Guidelines for Breast Cancer. This report summarizes these updates and discusses the rationale behind them. Updates on new drug approvals, not available at press time, can be found in the most recent version of these guidelines at NCCN.org.

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Section: Nccn Recommendationsmentioning

confidence: 99%

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Gradishar¹,

Anderson

Balassanian

et al. 2017

J Natl Compr Canc Netw

396

346

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“…2,3 There is general agreement that the Level I and II lymph nodes located lateral to and deep to the pectoralis minor muscle should be removed for accurate staging and to reduce axillary recurrence. [15][16][17][18][19][20][21] A study of 13,851 patients registered by the Danish Breast Cancer Cooperative Group suggests that the number of lymph nodes removed with Level I and II dissection should be at least 10 to exclude misclassification of patients with positive lymph nodes as lymph node-negative. 16 In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04 study, the estimate of quantitative lymph node status (1-3 vs. Ն 4 positive lymph nodes) was more reliable when at least 10 lymph nodes were removed.…”

Section: Lrrmentioning

confidence: 99%

“…[15][16][17][18][19][20][21] A study of 13,851 patients registered by the Danish Breast Cancer Cooperative Group suggests that the number of lymph nodes removed with Level I and II dissection should be at least 10 to exclude misclassification of patients with positive lymph nodes as lymph node-negative. 16 In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04 study, the estimate of quantitative lymph node status (1-3 vs. Ն 4 positive lymph nodes) was more reliable when at least 10 lymph nodes were removed. 15,22 Accordingly, the higher LRR rates in the Danish randomized trials, compared with other series, have been attributed to limited axillary surgery removing a median of 7 lymph nodes, 4,5 potentially compromising staging accuracy and regional disease control.…”

Section: Lrrmentioning

confidence: 99%

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Truong

Berthelet

Lee

et al. 2005

Cancer

126

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BACKGROUNDAdjuvant therapy for women with T1–T2 breast carcinoma and 1–3 positive lymph nodes is controversial due to discrepancies in reported baseline locoregional recurrence (LRR) risks. This inconsistency has been attributed to variations in lymph node staging techniques, which have yielded different numbers of dissected lymph nodes. The current study evaluated the prognostic impact of the percentage of positive/dissected lymph nodes on recurrence and survival in women with one to three positive lymph nodes.METHODSThe study cohort was comprised of 542 women with pathologic T1–T2 breast carcinoma who had 1–3 positive lymph nodes and who had undergone mastectomy and received adjuvant systemic therapy without radiotherapy. Ten‐year Kaplan–Meier (KM) LRR, distant recurrence (DR), and overall survival (OS) rates stratified by the number of positive lymph nodes, the number of dissected lymph nodes, and the percentage of positive lymph nodes were examined using different cut‐off levels. Multivariate analysis was performed to evaluate the prognostic significance of the percentage of positive lymph nodes in disease recurrence and survival.RESULTSThe median follow‐up was 7.5 years. LRR, DR, and OS rates correlated significantly with the number of positive lymph nodes and the percentage of positive lymph nodes, but not with the number of dissected lymph nodes. The cut‐off level at which the most significant difference in LRR was observed was 25% positive lymph nodes (the 10‐year KM LRR rates were 13.9% and 36.7% in women with ≤ 25% and > 25% positive lymph nodes, respectively; P < 0.0001). Higher DR rates and lower OS rates were observed among patients who had > 25% positive lymph nodes compared with patients who had ≤ 25% positive lymph nodes (DR: 53.0% vs. 30.3%, respectively; P < 0.0001; OS: 43.4% vs. 62.6%, respectively; P < 0.0001). In the multivariate analysis, the percentage of positive lymph nodes and the histologic grade were significant, independent factors associated with LRR, DR, and OS.CONCLUSIONSThe presence of > 25% positive lymph nodes was an adverse prognostic factor in patients with 1–3 positive nodes and may be used to identify patients at high risks of postmastectomy locoregional and distant recurrence who may benefit with adjuvant radiotherapy and more aggressive systemic therapy regimens. Cancer 2005. © 2005 American Cancer Society.

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“…Nodal yield is a surrogate marker for quality of the accuracy of ALND as a staging procedure and of the completeness of ALND when used for therapeutic purposes: yields of over 10 nodes are accepted as indicating an adequate dissection [15 ]. It is reassuring to establish that ,despite a heavy nodal burden in the pALND group, nodal yield is unaffected.…”

Section: Determinants Of Nodal Yield and Adequacy Of Node Retrievalmentioning

confidence: 99%

Axillary nodal yields: A comparison between primary clearance and completion clearance after sentinel lymph node biopsy in the management of breast cancer

Chakravorty

Sanmugalingam

Shrestha

et al. 2011

European Journal of Surgical Oncology (EJSO)

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International audienceAxillary nodal status is the most important prognostic indicator which in turn influences adjuvant therapy and long term outcomes. The aim of this study was to compare total nodal yields from primary axillary lymph node dissection (pALND) with completion ALND after a cancer positive SLNB: either concurrently (cALND) following intra-operative assessment (IOA) of the SLN's or as a delayed procedure (dALND) when the SLN was found to be cancer positive on post operative histological examination

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Axillary dissection of level I and II lymph nodes is important in breast cancer classification

Cited by 254 publications

References 13 publications

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Axillary nodal yields: A comparison between primary clearance and completion clearance after sentinel lymph node biopsy in the management of breast cancer

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