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How Do I Deal With the Axilla in Patients With a Positive Sentinel Lymph Node?

  • Breast Cancer (Carla Falkson, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Optimal management of the axilla in a patient with a positive sentinel node biopsy is not yet defined.

These patients usually have Breast Conserving Surgery and receive adjuvant systemic therapy and whole breast radiation.

Treatment options for the axilla include:

  • no further surgery with or without radiation

  • completion axillary nodal dissection with or without radiation

Radiation options in addition to whole breast radiation include

  • axillary and supraclavicular nodal irradiation

  • regional nodal irradiationincludes supraclavicular and internal mammary nodes

Completion axillary dissection has been standard practice in patients with positive sentinel nodes.

  • the number of involved nodes provides prognostic information.

  • theoretically improves local control, but may be obviated by systemic chemotherapy.

but

  • avoidance of dissection may not adversely affect locoregional control or survival.

  • dissection has significant morbidity so safe avoidance is desirable.

There is little worldwide concordance on the use of radiation:

  • whole breast radiation (commonly used after breast conserving surgery) may radiate the lower axilla

  • supraclavicular radiation is most commonly recommended for patients with four or more nodes but may confer a survival benefit on patients with lower risk disease.

  • adding nodal irradiation reduces local recurrence with only modest toxicity.

Adjuvant systemic therapy provides a survival benefit for patients with nodal disease. Most will receive cytostatic chemotherapy containing an anthracycline and a taxane. Hormone therapy is appropriate for estrogen receptor positive disease. The extent to which systemic therapy controls microscopic nodal disease is unknown. Node positive patients should generally receive adjuvant chemotherapy.

A small group of patients benefit from specific nodal therapy. Further studies are needed to better identify these patients.

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  1. Department of Oncology, Queen’s University and CCSEO at Kingston General Hospital, 75 King St W, K7L 5P9, Kingston, Ontario, Canada

    Conrad B. Falkson MBCHB FCRad(Onc)(SA) FRCPC

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Correspondence to Conrad B. Falkson MBCHB FCRad(Onc)(SA) FRCPC.

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Falkson, C.B. How Do I Deal With the Axilla in Patients With a Positive Sentinel Lymph Node?. Curr. Treat. Options in Oncol. 12, 389–402 (2011). https://doi.org/10.1007/s11864-011-0170-4

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