Review

Breast Cancer Research and Treatment

, Volume 128, Issue 3, pp 613-624

First online:

Axillary lymph node dissection in early-stage invasive breast cancer: is it still standard today?

  • Bernd GerberAffiliated withDepartment of Obstetrics and Gynecology, University of Rostock Email author 
  • , Kristin HeintzeAffiliated withDepartment of Obstetrics and Gynecology, University of Rostock
  • , Johannes StubertAffiliated withDepartment of Obstetrics and Gynecology, University of Rostock
  • , Max DieterichAffiliated withDepartment of Obstetrics and Gynecology, University of Rostock
  • , Steffi HartmannAffiliated withDepartment of Obstetrics and Gynecology, University of Rostock
  • , Angrit StachsAffiliated withDepartment of Obstetrics and Gynecology, University of Rostock
  • , Toralf ReimerAffiliated withDepartment of Obstetrics and Gynecology, University of Rostock

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Abstract

Evaluation of axillary lymph node status by sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection (ALND) are an inherent part of breast cancer treatment. Increased understanding of tumor biology has changed the prognostic and therapeutic impact of lymph node status. Non-invasive imaging techniques like axillary ultrasound, FDG-PET, or MRI revealed moderate sensitivity and high specificity in evaluation of lymph node status. Therefore, they are not sufficient for lymph node staging. Otherwise, the impact of remaining micrometastases and even macrometastases for prognosis and treatment decisions is overestimated. Considering tumor biology, the distinction of axillary metastases in isolated tumor cells (ITC, pN0(i+)); micrometastases (pN1mi), and macrometastases (pN1a) is not comprehensible. Increasing data support the thesis that remaining axillary metastases neither increase the axillary recurrence rate nor decrease overall survival. It is doubtful that axillary tumor cells are capable to complete the complex multistep metastatic process. If applied, axillary metastases are sensitive to systemic treatment and are targeted by postoperative tangential breast irradiation. Therefore, the controversy about the clinical relevance of tumor cell clusters or micrometastases in SLN is a sophisticated but not contemporary discussion. Currently, there is no indication for axillary surgery in elderly patients with favorable tumors and clinically tumor-free lymph nodes. Nonetheless, a rational and evidence-based approach to the management of clinically and sonographically N0 patients with planned breast-conserving surgery and limited tumor size is needed now.

Keywords

Breast cancer Axillary lymph nodes Dissection Sentinel Prognosis Metastases