Annals of Surgical Oncology

, Volume 17, Issue 4, pp 1063–1068

Predictors of Completion Axillary Lymph Node Dissection in Patients With Immunohistochemical Metastases to the Sentinel Lymph Node in Breast Cancer

Authors

  • Matthew S. Pugliese
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
  • Amer K. Karam
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
  • Meier Hsu
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
  • Michelle M. Stempel
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
  • Sujata M. Patil
    • Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer Center
  • Alice Y. Ho
    • Department of Radiation OncologyMemorial Sloan-Kettering Cancer Center
  • Tiffany A. Traina
    • Department of MedicineMemorial Sloan-Kettering Cancer Center
  • Kimberly J. Van Zee
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
  • Hiram S. CodyIII
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
  • Monica Morrow
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
    • Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center
Breast Oncology

DOI: 10.1245/s10434-009-0834-5

Cite this article as:
Pugliese, M.S., Karam, A.K., Hsu, M. et al. Ann Surg Oncol (2010) 17: 1063. doi:10.1245/s10434-009-0834-5

Abstract

Background

Axillary lymph node dissection (ALND) in patients with immunohistochemistry (IHC)-determined metastases to the sentinel lymph node (SLN) is controversial. The goal of this study was to examine factors associated with ALND in IHC-only patients.

Methods

Retrospective review of an institutional SLN database from July 1997 to July 2003 was performed. We compared sociodemographic, pathologic, and therapeutic variables between IHC-only patients who had SLN biopsy alone and those that had ALND.

Results

Our study group consisted of 171 patients with IHC-only metastases to the SLN. Young age, estrogen receptor negative status, high Memorial Sloan-Kettering Cancer Center nomogram score, and chemotherapy were associated with ALND. Among patients who had ALND (n = 95), 18% had a positive non-SLN. Rates of systemic therapy were similar between those with and without positive non-SLNs at ALND. No axillary recurrences were observed in this series with a median follow-up of 6.4 years. The percentage of patients who were recurrence-free after 5 years was 97% (95% confidence interval, 92.1–98.6).

Conclusions

On the basis of our findings and the lack of prospective randomized data, the practice of selectively limiting ALND to IHC-only patients thought to be at high risk and to patients for whom the identification of additional positive nodes may change systemic therapy recommendations seems to be a safe and reasonable approach.

Copyright information

© Society of Surgical Oncology 2009