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  Vol. 137 No. 10, October 2002 TABLE OF CONTENTS
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The Time Has Come to Change the Algorithm for the Surgical Management of Early Breast Cancer

Nora M. Hansen, MD; Baiba J. Grube, MD; Armando E. Giuliano, MD

Arch Surg. 2002;137:1131-1135.

Hypothesis  If the sentinel lymph nodes (SNs) draining a primary invasive breast cancer are free of tumor, then axillary lymph node dissection is not necessary for management of disease.

Design and Intervention  In July 2000, we reported our initial experience of a small cohort of patients who underwent axillary lymph node dissection only if their SNs were involved with metastases. We now report outcome data for all patients who underwent breast conservation and sentinel lymph node dissection without completion axillary lymph node dissection between October 1, 1995, and April 30, 1999.

Setting  Tertiary breast referral center.

Patients  Two hundred thirty-eight patients whose SN staining results were negative for tumor by both hematoxylin-eosin and imunohistochemical stains. Median age was 58.4 years. Most patients (85%) had a T1 tumor; 15% had a T2 tumor. Most (86%) had infiltrating ductal carcinoma with or without extensive ductal carcinoma in situ; 10% had invasive lobular cancer.

Results  At a median follow-up of 38.9 months (range, 6-69 months), we found no axillary recurrences, and 98.3% of patients are alive without evidence of disease. Three patients have died of causes not related to breast cancer. Four patients are alive with metastatic disease but have not developed axillary recurrences.

Conclusions  Sentinel lymph node dissection is a safe and efficacious treatment option for patients with early breast cancer. It provides excellent regional control and is associated with excellent survival. A multicenter trial such as the American College of Surgeons Oncology Group Z0010 is needed to corroborate findings of this single-institution study.


From the Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute at St John's Health Center, Santa Monica, Calif.


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This Month in Archives of Surgery
Arch Surg. 2002;137(10):1094.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Survival Outcomes in Node-Negative Breast Cancer Patients Evaluated With Complete Axillary Node Dissection Versus Sentinel Lymph Node Biopsy
Cox et al.
Ann. Surg. Oncol. 2006;13:708-711.
ABSTRACT | FULL TEXT  





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