 |
|
Axillary Dissection Is Not Required for All Patients With Breast Cancer and Positive Sentinel Nodes
J. Michael Guenther, MD;
Nora M. Hansen, MD;
L. Andrew DiFronzo, MD;
Armando E. Giuliano, MD;
J. Craig Collins, MD;
Baiba L. Grube, MD;
Theodore X. O'Connell, MD
Arch Surg. 2003;138:52-56.
Hypothesis Sentinel node (SN) biopsy for breast cancer enhances staging sensitivity, often demonstrating only micrometastases (<2 mm) or isolated, keratin-positive cells. When SN metastasis is present, the value of additional axillary dissection is unclear and not all patients benefit from axillary lymph node dissection (ALND).
Design Prospective cohort study, median 32-month follow-up.
Setting Multidisciplinary breast cancer centers.
Patients Forty-six women having SN metastases diagnosed between May 1, 1996, and September 1, 2001, who refused ALND or were recommended to omit ALND owing to serious comorbid conditions.
Interventions Isosulfan blue dye–directed SN biopsy. Axillary lymph node dissection was not performed. Standard breast irradiation was given. Adjuvant systemic therapy was provided as determined by an oncologist. Interval clinical evaluation was performed.
Main Outcome Measure Axillary and systemic failure rates.
Results Mean patient age was 61.6 years (age range, 36-92 years). Mean tumor size was 1.65 cm (range, 0.4-5.5 cm). Thirty-five (76%) of 46 tumors were ductal carcinomas and 39 (87%) of 45 were estrogen receptor–positive. A mean of 2.6 SNs were identified (median, 2; range, 1-7). Thirty-nine patients (85%) had a single positive SN; the remaining 7 patients (15%) had 2 positive SNs. Seven patients (15%) had macrometastases (>2 mm); 16 (35%) had micrometastases (<2 mm); and 23 (50%) had cellular metastases. Only 16 positive SNs (35%) were seen on hematoxylin-eosin staining, while 30 SNs (65%) had positive immunohistochemical staining. There have been no axillary recurrences. One patient (2%) developed distant metastases during follow-up (range, 4-61 months).
Conclusions Patients with SN metastases who did not have ALND had a low incidence of regional failure. To confirm this observation, we suggest that patients with SN metastases are ideal candidates for trials evaluating the necessity of ALND.
From the Kaiser Los Angeles Medical Center, Los Angeles, Calif (Drs Guenther, DiFronzo, Collins, and O'Connell), and the Joyce Eisenberg Keefer Breast Center at St John's Hospital, Santa Monica, Calif (Drs Hansen, Giuliano, and Grube).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Comparison of Sentinel Lymph Node Biopsy Alone and Completion Axillary Lymph Node Dissection for Node-Positive Breast Cancer
Bilimoria et al.
JCO 2009;27:2946-2953.
ABSTRACT
| FULL TEXT
Non-Sentinel Lymph Node Metastases Associated With Isolated Breast Cancer Cells in the Sentinel Node
van Deurzen et al.
JNCI J Natl Cancer Inst 2008;100:1574-1580.
ABSTRACT
| FULL TEXT
Breast Sentinel Lymph Node Dissection Before Preoperative Chemotherapy
Grube et al.
Arch Surg 2008;143:692-700.
ABSTRACT
| FULL TEXT
Sentinel Node Biopsy: Interpretation and Management of Patients With Immunohistochemistry-Positive Sentinel Nodes and Those With Micrometastases
Rutgers
JCO 2008;26:698-702.
ABSTRACT
| FULL TEXT
A Multidisciplinary Approach to the Management of Breast Cancer, Part 1: Prevention and Diagnosis
Pruthi et al.
Mayo Clin Proc. 2007;82:999-1012.
ABSTRACT
| FULL TEXT
Surgeon Characteristics and Variations in Treatment for Early-Stage Breast Cancer
Gilligan et al.
Arch Surg 2007;142:17-22.
ABSTRACT
| FULL TEXT
Application of intraoperative ultrasound to nonsentinel node assessment in primary breast cancer.
Hsu et al.
Clin. Cancer Res. 2006;12:3746-3753.
ABSTRACT
| FULL TEXT
An evaluation of molecular markers for improved detection of breast cancer metastases in sentinel nodes.
Abdul-Rasool et al.
J. Clin. Pathol. 2006;59:289-297.
ABSTRACT
| FULL TEXT
Comprehensive Examination of Sentinel Lymph Node in Breast Cancer: A Solution Without a Problem?
Falconieri et al.
INT J SURG PATHOL 2006;14:1-8.
ABSTRACT
Case 35-2005 -- A 56-Year-Old Woman with Breast Cancer and Isolated Tumor Cells in a Sentinel Lymph Node
Davidson et al.
NEJM 2005;353:2177-2185.
FULL TEXT
Lymphatic Mapping and Sentinel Lymph Node Biopsy for Breast Cancer Patients
Newman
J Oncol Pract 2005;1:130-133.
FULL TEXT
American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer
Lyman et al.
JCO 2005;23:7703-7720.
ABSTRACT
| FULL TEXT
Patients With Breast Cancer and Positive Sentinel Nodes: Axillary Dissection or Axillary Radiotherapy?
Zippel and Papa
Arch Surg 2003;138:1159-1159.
FULL TEXT
|
