Axillary lymph node dissection in breast cancer patients after sentinel node biopsy

Jessing, Christina; Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis Møller; Tvedskov, Tove Filtenborg; Kroman, Niels

doi:10.1080/0284186x.2017.1401227

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…Statistical studies of cancer have revealed that breast cancer is one of the most common malignant carcinomas diagnosed and the seconding leading cause of cancer related‐death in women . Axillary lymph node metastasis is common in breast cancer patients, which also affects the treatment modality and surgical procedure . Axillary lymph node status of patients with breast cancer is usually assessed by sentinel lymph node biopsy (SLNB), core needle biopsy (CNB), or fine needle aspiration cytology (FNAC).…”

Section: Introductionmentioning

confidence: 99%

Axillary lymph node metastasis detection by magnetic resonance imaging in patients with breast cancer: A meta‐analysis

et al. 2018

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BackgroundThe study was conducted to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for the detection of axillary lymph node metastasis in patients with breast cancer.MethodsPubMed, Medline, Web of Science, Cochrane Embase, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases were searched for open published studies relevant to the use of MRI for the detection of axillary lymph node metastasis in breast cancer patients. The pooled diagnostic sensitivity, specificity, and the symmetric receiver operating characteristic (SROC) curve was calculated by combining the individual data extracted from 26 included studies.ResultsThe pooled diagnostic sensitivity and specificity of MRI to detect axillary lymph node metastasis in patients with breast cancer were 0.77 (95% confidence interval [CI] 0.75–0.80) and 0.90 (95% CI 0.89–0.91), respectively. The pooled positive and negative likelihood ratios were 7.67 (95% CI 5.09–11.53) and 0.23 (95% CI 0.17–0.32), respectively, by random effect method. The area under the SROC curve was 0.93 for MRI to detect axillary lymph node metastasis in breast cancer patients.ConclusionWith high sensitivity, specificity, and area under the curve, MRI is an effective method to differentiate metastatic axillary lymph node in breast cancer patients, which can provide useful information for surgical procedure selection.

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Section: Introductionmentioning

confidence: 99%

Axillary lymph node metastasis detection by magnetic resonance imaging in patients with breast cancer: A meta‐analysis

et al. 2018

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“…After results were reported from the ACOSOG Z0011 trial, it became clear that there had been virtually no control during the trial on details of the RT, so it was stated that ‘high tangents' after BCS were recommended [65]. Using modern RT techniques based on meticulous target volume delineation followed by conformal radiation treatment planning to ensure optimal dose homogeneity and as low a dose as possible to organs at risk, ‘high tangents' are not an option [59,60].…”

Section: The Radiation Therapy Perspectivementioning

confidence: 99%

“…In many countries, the shift from local RT to locoregional RT occurs when one macrometastasis is present in the axilla, and since locoregional RT per se causes more dose to heart and lungs and thereby increases the risk of serious late effects, it is very important to know for sure if a macrometastasis is present [61,62,63,64]. Highly specialized centers report positive SLNB in less than 20% of their patients; however, a nationwide evaluation of SLNB between 2010 and 2015 by the Danish Breast Cancer Group (DBCG) revealed macrometastases (not just positive nodes) in 21% of all SLNB, and in the group with sentinel macrometastases, 14% had pN2 disease and 6% had pN3 disease at ALND [37,64].…”

Section: The Radiation Therapy Perspectivementioning

confidence: 99%

“…Highly specialized centers report positive SLNB in less than 20% of their patients; however, a nationwide evaluation of SLNB between 2010 and 2015 by the Danish Breast Cancer Group (DBCG) revealed macrometastases (not just positive nodes) in 21% of all SLNB, and in the group with sentinel macrometastases, 14% had pN2 disease and 6% had pN3 disease at ALND [37,64]. Preoperative ultrasound was performed as part of the DBCG guideline.…”

Section: The Radiation Therapy Perspectivementioning

confidence: 99%

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Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Reimer

Engel²,

Schmidt

et al. 2018

Breast Care

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Local treatment of the axilla in clinically node-negative (cN0) early breast cancer patients with routine sentinel lymph node biopsy (SLNB) is debated for various reasons: i) pN staging information may not be necessary for the postoperative treatment decision regarding adjuvant systemic therapy in the great majority of patients; ii) the SLNB-positive rate is declining below 20% in specialized breast centers; iii) albeit being a minimally invasive procedure, SLNB causes a significant reduction in quality of life in 23% of patients; and iv) previous randomized trials from the pre-SLNB era did not show a disadvantage for patients without axillary surgery with regard to overall survival. These data support the hypothesis that avoiding axillary treatment in patients with clinically and sonographically unsuspicious lymph nodes seems to be a safe option, although omitting axillary surgery may increase the risk of locoregional recurrence. Currently, the information regarding node-positive status is essential to guide postoperative treatment such as systemic or radiation therapies in a non-negligible minority of patients. Three ongoing prospective European trials (SOUND, INSEMA, BOOG 2013-08) with axillary observation alone versus SLNB in cN0 patients and primary breast-conserving surgery have the objective to evaluate oncologic safety when omitting SLNB.

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“…It is likely that cN0 pN1(sn) patients can be spared from axillary dissection. Among 17,265 breast cancer patients treated in Denmark between 2010 and 2015, SLN biopsy was performed nationwide as part of the Danish Breast Cancer Group (DBCG) standard procedure which includes preoperative ultrasound [42]. Among these cN0 patients, 21% had one or more macrometastases in the SLN and therefore underwent axillary dissection.…”

Section: What Is the Best Management Of Cn0pn1(sn) Breast Cancer Patimentioning

confidence: 99%

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

et al. 2018

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Although the majority of breast cancer patients are clinically node-negative (cN0) at diagnosis, 15-20% will have a metastatic sentinel lymph node (SLN, pN1(sn)). While a less radical approach regarding axillary surgery in cN0 patients with a positive SLN biopsy is advocated, the limitations of 5 published trials on axillary management in pN1(sn) are discussed intensely in the literature and support the performance of ongoing validation and extension trials, especially considering the lack of data in the setting of mastectomy. As locoregional radiotherapy has a significant effect on both recurrence and survival, a standardization of locoregional radiotherapy in the situation of SLN biopsy alone in pN1(sn) patients has to be defined in the future, and de-escalation trials should embrace a truly multidisciplinary approach. This is also of utmost importance considering the fact that high-volume nodal disease requires an intensified adjuvant chemotherapy strategy to which patients omitting axillary dissection cannot be stratified. Finally, there is mounting evidence that the therapeutic role of extensive axillary surgery in low-volume nodal disease is negligible, and multidisciplinary and translational efforts must be undertaken to individualize treatment in order to gain a reasonable balance between necessary staging information and unnecessary treatment-related morbidity.

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Axillary lymph node dissection in breast cancer patients after sentinel node biopsy

Cited by 7 publications

References 21 publications

Axillary lymph node metastasis detection by magnetic resonance imaging in patients with breast cancer: A meta‐analysis

Axillary lymph node metastasis detection by magnetic resonance imaging in patients with breast cancer: A meta‐analysis

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

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