Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies

Takei, Hiroyuki; Kurosumi, Masafumi; Yoshida, Takashi; Ishikawa, Yuko; Hayashi, Yuji; Ninomiya, Jun; Tozuka, Katsunori; Oba, Hanako; Inoue, Kenichi; Nagai, Shigenori; Saito, Yoshihiro; Kazumoto, Tomoko; Saitoh, Jun‐ichi; Tabei, Toshio

doi:10.1007/s12282-009-0154-4

Cited by 20 publications

(18 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nowadays, sentinel lymph node biopsy (SLNB) has become an alternative procedure of ALND. SLNB presents a lower risk of significant operative morbidity but similar benefit, and has emerged as the milestone advance in the surgical management of early-stage primary breast cancer [28], [29]. In our hospital, the proportion of SLNB in the early breast cancer is relatively low (approximately 10%).…”

Section: Discussionmentioning

confidence: 93%

A Straightforward but Not Piecewise Relationship between Age and Lymph Node Status in Chinese Breast Cancer Patients

et al. 2010

PLoS ONE

View full text Add to dashboard Cite

PurposeTo investigate the relationship between age and axillary lymph node (LN) involvement in Chinese breast cancer patients, and to replicate a recently identified piecewise relationship between age and LN involvement.MethodsA dataset, consisting of 3,715 patients (with complete information on study variables) with operable breast cancer consecutively surgically treated between 1996 and 2006, was derived from the database of Shanghai Cancer Hospital. Univariate and multivariate logistic regression were employed to analyze the relationship between age and LN. We subsequently performed a similar analysis on another dataset including 1,832 consecutive patients treated between 2007 and 2008 to replicate our findings in the first dataset.ResultsA U-shaped relationship (previously observed in two European populations) between age and LN status failed to be replicated in our dataset of Chinese patients. Instead, we observed a linear rather than piecewise relationship. After multivariate adjustment, the linear relationship was still present. Moreover, the interaction between age and LN involvement was not modified by tumor size. The odds of LN involvement decreased by 1.5% for each year increase in age (OR 0.985, 95% CI 0.979–0.991, P<0.001). Breast cancer subtypes were also associated with LN status. Proportions of basal-like and ERBB2+ subtypes decreased with increasing age. The observations in the first dataset were successfully replicated in a second independent dataset.ConclusionWe confirmed a straightforward but not piecewise relationship between age and LN status in Chinese patients. The different pattern between Chinese and European elderly patients should be considered when making clinical decisions.

show abstract

Section: Discussionmentioning

confidence: 93%

A Straightforward but Not Piecewise Relationship between Age and Lymph Node Status in Chinese Breast Cancer Patients

et al. 2010

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Three research groups reported results from the same cohort in two or three different articles with a progressively longer follow-up or an increased group size. The articles with data reporting the longest follow-up were included 19–21. Therefore, 30 articles were eligible for analysis in this review 9,10,14–16,19–43…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported results from a nationwide database 10,22. All the other series were single center reports 9,10,14–16,19–43…”

Section: Resultsmentioning

confidence: 99%

Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review of the Literature

et al. 2012

View full text Add to dashboard Cite

BackgroundSentinel lymph node biopsy (SLNB) has become standard of care as a staging procedure in patients with invasive breast cancer. A positive SLNB allows completion axillary lymph node dissection (cALND) to be performed. The axillary recurrence rate (ARR) after cALND in patients with positive SLNB is low. Recently, several studies have reported a similar low ARR when cALND is not performed. This review aims to determine the ARR when cALND is omitted in SLNB-positive patients.MethodsA literature search was performed in the PubMed database with the search terms “breast cancer,” “sentinel lymph node biopsy,” “axillary” and “recurrence.” Articles with data regarding follow-up of patients with SLNB-positive breast cancer were identified. To be eligible, patients should not have received cALND and ARR should be reported.ResultsThirty articles were analyzed. This resulted in 7,151 patients with SLNB-positive breast cancer in whom a cALND was omitted (median follow-up of 45 months, range 1–142 months). Overall, 41 patients developed an axillary recurrence. 27 studies described 3,468 patients with micrometastases in the SLNB, of whom 10 (0.3 %) developed an axillary recurrence. ARR varied between 0 and 3.7 %. Sixteen studies described 3,268 patients with macrometastases, 24 (0.7 %) axillary recurrences were seen. ARR varied between 0 and 7.1 %. Details regarding type of surgery and adjuvant treatment were lacking in the majority of studies.ConclusionsARR appears to be low in SLNB-positive patients even when a cALND is not performed. Withholding cALND may be safe in breast cancer selected patients such as those with isolated tumor cells or micrometastatic disease.

show abstract

“…The sentinel node was successfully detected in 81.5% of N1 patients compared with 94.6% of N0 patients (P=0.008). The false-negative rate did not statistically differ, with 15% for N1 compared to 9 …”

Section: Managing the Axilla In Patients Receiving Neoadjuvant Chemotmentioning

confidence: 81%

“…Two recent small studies evaluating axillary dissection after a false-negative SNB failed to show an advantage for completion dissection in patients with clinically N0 breast cancer with regard to recurrence. However, in both of these studies, many of the patients who did not undergo completion axillary dissection did receive axillary radiation [8,9].…”

Section: Axillary Dissection For Macro-metastatic Diseasementioning

confidence: 99%

The Need for Axillary Dissection in Patients with Positive Axillary Sentinel Lymph Nodes

et al. 2010

View full text Add to dashboard Cite

The need for completion axillary dissection after a positive sentinel node biopsy continues to be challenged. In the 2 years since we last reviewed this subject, a number of authors have shared their experiences about micrometastatic disease and isolated tumor cells, opining both for and against axillary treatment. Data from the ACOSOG Z0011 trial and other small studies do not appear to support the use of completion axillary dissection even for macro-metastatic disease in patients with clinically node-negative (N0) disease. While existing guidelines still recommend axillary dissection for patients with clinically positive nodes, even when conversion to clinically negative disease following neoadjuvant chemotherapy has occurred, this concept is being questioned in ACOSOG Z1071 and in several other recent small trials. The surgical approach to the treatment of breast cancer continues to move away from the traditional Halstedian concept.

show abstract

Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies

Abstract: ALND can be avoided in most patients with breast cancer with intraoperative, false-negative SLNB.

Cited by 20 publications

References 37 publications

A Straightforward but Not Piecewise Relationship between Age and Lymph Node Status in Chinese Breast Cancer Patients

A Straightforward but Not Piecewise Relationship between Age and Lymph Node Status in Chinese Breast Cancer Patients

Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review of the Literature

The Need for Axillary Dissection in Patients with Positive Axillary Sentinel Lymph Nodes

Contact Info

Product

Resources

About