Predictors of Completion Axillary Lymph Node Dissection in Patients With Immunohistochemical Metastases to the Sentinel Lymph Node in Breast Cancer
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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.
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.
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).
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.
- Adair F, Berg J, Joubert L, et al. Long-term followup of breast cancer patients: the 30-year report. Cancer. 1974;33:1145–50. CrossRef
- NIH Consensus Conference (1991) Treatment of early-stage breast cancer. JAMA. 265:391–5. CrossRef
- Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39:456–66. CrossRef
- Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8. CrossRef
- Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2:335–9. CrossRef
- McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26:5213–9. CrossRef
- McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol. 2008;26:5220–6. CrossRef
- Silverstein MJ, Lagios MD, Recht A, et al. Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg. 2005;201:586–97. CrossRef
- Dowlatshahi K, Fan M, Snider HC, et al. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer. 1997;80:1188–97. CrossRef
- Cote RJ, Peterson HF, Chaiwun B, et al. Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast Cancer Study Group. Lancet. 1999;354(9182):896–900.
- Tan LK, Giri D, Hummer AJ, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol. 2008;26:1803–9. CrossRef
- Cody HS 3rd, Fey J, Akhurst T, et al. Complementarity of blue dye and isotope in sentinel node localization for breast cancer: univariate and multivariate analysis of 966 procedures. Ann Surg Oncol. 2001;8:13–9. CrossRef
- Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291:2441–7. CrossRef
- Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10:1140–51. CrossRef
- Czerniecki BJ, Scheff AM, Callans LS, et al. Immunohistochemistry with pancytokeratins improves the sensitivity of sentinel lymph node biopsy in patients with breast carcinoma. Cancer. 1999;85:1098–103. CrossRef
- Schreiber RH, Pendas S, Ku NN, et al. Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node. Ann Surg Oncol. 1999;6:95–101. CrossRef
- Teng S, Dupont E, McCann C, et al. Do cytokeratin-positive-only sentinel lymph nodes warrant complete axillary lymph node dissection in patients with invasive breast cancer? Am Surg. 2000;66:574–8.
- Singletary E. Early-stage invasive breast cancer: isolated tumor cells in axillary lymph nodes, peripheral blood, and bone marrow. Gen Surg News. 2006;33:17–20.
- Gray RJ, Pockaj BA, Conley CR. Sentinel lymph node metastases detected by immunohistochemistry only do not mandate complete axillary lymph node dissection in breast cancer. Ann Surg Oncol. 2004;11:1056–60. CrossRef
- Jakub JW, Diaz NM, Ebert MD, et al. Completion axillary lymph node dissection minimizes the likelihood of false negatives for patients with invasive breast carcinoma and cytokeratin positive only sentinel lymph nodes. Am J Surg. 2002;184:302–6. CrossRef
- Early Breast Cancer Trialists’ Collaborative Group. Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet. 1998;352(9132):930–42.
- Chu KU, Turner RR, Hansen NM, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg. 1999;229:536–41. CrossRef
- Freneaux P, Nos C, Vincent-Salomon A, et al. Histological detection of minimal metastatic involvement in axillary sentinel nodes: a rational basis for a sensitive methodology usable in daily practice. Mod Pathol. 2002;15:641–6. CrossRef
- Marin C, Mathelin C, Neuville A, et al. Sentinel lymph node biopsy with micrometastases in breast cancer: histological data and surgical implications. About a series of 201 axillary dissections after peroperative sentinel node identification. Bull Cancer. 2003;90:459–65.
- Abdessalam SF, Zervos EE, Prasad M, et al. Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg. 2001;182:316–20. CrossRef
- Bergkvist L, Frisell J, Liljegren G, et al. Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancer. Br J Surg. 2001;88:1644–8. CrossRef
- Mignotte H, Treilleux I, Faure C, et al. Axillary lymph-node dissection for positive sentinel nodes in breast cancer patients. Eur J Surg Oncol. 2002;28:623–6. CrossRef
- Cserni G, Gregori D, Merletti F, et al. Meta-analysis of non–sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg. 2004;91:1245–52. CrossRef
- van Deurzen CH, de Boer M, Monninkhof EM, et al. Non–sentinel lymph node metastases associated with isolated breast cancer cells in the sentinel node. J Natl Cancer Inst. 2008;100:1574–80. CrossRef
- Calhoun KE, Hansen NM, Turner RR, et al. Nonsentinel node metastases in breast cancer patients with isolated tumor cells in the sentinel node: implications for completion axillary node dissection. Am J Surg. 2005;190:588–91. CrossRef
- Langer I, Marti WR, Guller U, et al. Axillary recurrence rate in breast cancer patients with negative sentinel lymph node (SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg. 2005;241:152–8.
- Predictors of Completion Axillary Lymph Node Dissection in Patients With Immunohistochemical Metastases to the Sentinel Lymph Node in Breast Cancer
Annals of Surgical Oncology
Volume 17, Issue 4 , pp 1063-1068
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- 1. Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- 2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- 3. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- 4. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA