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Omission of axillary lymph node dissection in breast cancer patients with micrometastasis or isolated tumor cells in sentinel lymph nodes: a 12-year experience in a tertiary breast unit

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Abstract

Introduction

After the IBCSG 23–01 trial, our breast center no longer performed axillary lymph node dissection (ALND) after detection of isolated tumor cells (ITC) or micrometastasis in the sentinel lymph nodes (SLN). A recent study suggested that up to half of the patients with micrometastasis in the SLN could benefit from ALND in terms of disease-free survival (DFS) and overall survival (OS).

Methods

This retrospective, unicentric, study analyzed 261 consecutive cT1-3 cN0 breast cancer patients with ITC or micrometastasis in their SLN. Primary objective was comparison of ALND vs. SLN biopsy (SLNB) with regard to DFS and OS. Secondary objectives included analysis of factors associated with an increased rate of locoregional recurrence (LRR), distant metastasis (DM) and metachronous contralateral breast cancer (MCBC).

Results

DFS events occurred in 19 patients (7.3%) and 14 patients died (5.4%). Median follow-up time was 78 months. 251 patients (96.2%) had micrometastasis in their SLN. There was no difference in the OS or DFS of ALND vs. SLNB patients. History of previous contralateral breast cancer and WBI were associated with an increased and decreased rate of LRR, respectively. Larger tumor size was associated with an increased rate of DM. Non-ductal histological types were associated with an increased rate of MCBC.

Discussion

Avoiding ALND may be safe in pN1mi/pN0(i+) patients. Besides, we strongly encourage clinicians to develop their own follow-up protocols based on the best available evidence, to rapidly identify and treat breast cancer recurrence.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available in accordance with University Hospital Center of São João Data Protection requirements.

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Funding

The authors declare that no funds, grants or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Faculty of Medicine, University of Porto, Porto, Portugal

    Nuno Sousa & Bárbara Peleteiro

  2. Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal

    Bárbara Peleteiro & José Luis Fougo

  3. Institute of Public Health, EPI Unit, University of Porto, Porto, Portugal

    Bárbara Peleteiro

  4. Laboratory for Integrative and Translational Research in Population Health, University of Porto, Porto, Portugal

    Bárbara Peleteiro

  5. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

    José Luis Fougo

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  1. Nuno Sousa
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Contributions

Study concept: JLF; NS; study design: JLF; NS; BP; data acquisition: JLF; NS; BP; quality control of data and algorithms: BP; data analysis and interpretation: JLF; BP; NS; statistical analysis: NS; BP; manuscript preparation: NS; manuscript editing: BP; JLF; manuscript review: BP; JLF.

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Correspondence to Nuno Sousa.

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The study was approved by the conjoint Ethics Committee of University Hospital Center of São João and Faculty of Medicine of Porto University—project number 306/2022.

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Sousa, N., Peleteiro, B. & Fougo, J.L. Omission of axillary lymph node dissection in breast cancer patients with micrometastasis or isolated tumor cells in sentinel lymph nodes: a 12-year experience in a tertiary breast unit. J Cancer Res Clin Oncol 150, 1 (2024). https://doi.org/10.1007/s00432-023-05513-4

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