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

  • Matthew S. Pugliese
  • Amer K. Karam
  • Meier Hsu
  • Michelle M. Stempel
  • Sujata M. Patil
  • Alice Y. Ho
  • Tiffany A. Traina
  • Kimberly J. Van Zee
  • Hiram S. CodyIII
  • Monica Morrow
  • Mary L. Gemignani
Breast Oncology

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.

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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Matthew S. Pugliese
    • 1
  • Amer K. Karam
    • 1
  • Meier Hsu
    • 1
  • Michelle M. Stempel
    • 1
  • Sujata M. Patil
    • 2
  • Alice Y. Ho
    • 3
  • Tiffany A. Traina
    • 4
  • Kimberly J. Van Zee
    • 1
  • Hiram S. CodyIII
    • 1
  • Monica Morrow
    • 1
  • Mary L. Gemignani
    • 1
  1. 1.Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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