Can we avoid axillary dissection in the micrometastatic sentinel node in breast cancer?

There is considerable interest in foregoing axillary dissection (AD) when the sentinel node (SN) is positive in early breast cancer, particularly when involvement is minimal (micrometastases or isolated tumor cells). To address this issue we analyzed outcomes in patients with a single micrometastati...

Full description

Saved in:
Bibliographic Details
Published in:Breast cancer research and treatment 2012-02, Vol.131 (3), p.819-825
Main Authors: Galimberti, Viviana, Botteri, Edoardo, Chifu, Camelia, Gentilini, Oreste, Luini, Alberto, Intra, Mattia, Baratella, Paola, Sargenti, Manuela, Zurrida, Stefano, Veronesi, Paolo, Rotmensz, Nicole, Viale, Giuseppe, Sonzogni, Angelica, Colleoni, Marco, Veronesi, Umberto
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis
Axilla
Biological and medical sciences
Breast cancer
Breast Neoplasms - epidemiology
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Cancer research
Cancer therapies
Care and treatment
Development and progression
Female
Gynecology. Andrology. Obstetrics
Humans
Incidence
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis
Lymphatic system
Mammary gland diseases
Medical sciences
Medicine
Medicine & Public Health
Metastasis
Middle Aged
Neoplasm Grading
Neoplasm Micrometastasis - pathology
Neoplasm Staging
Oncology
Preclinical Study
Retrospective Studies
Sentinel Lymph Node Biopsy
Surgery
Survival Analysis
Toy industry
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:There is considerable interest in foregoing axillary dissection (AD) when the sentinel node (SN) is positive in early breast cancer, particularly when involvement is minimal (micrometastases or isolated tumor cells). To address this issue we analyzed outcomes in patients with a single micrometastatic SN who did not receive AD. We selected 377 consecutive patients treated at the European Institute of Oncology between 1999 and 2007 for invasive breast cancer. Classical and competing risks survival analyses were performed to estimate prognostic factors for axillary recurrence, first events and overall survival. Median age was 53 years (range 26–80); median follow-up was 5 years (range 1–9). Most (91.8%) patients received conservative surgery; 209 (55.4%) had only one SN (range 1–8). Five-year overall survival was 97.3%. There were 10 local events, 2 simultaneous local and axillary events, 6 axillary recurrences and 12 distant events. The cumulative incidence of axillary recurrence was 1.6% (95% CI 0.7–3.3). By multivariable analysis, tumor size and grade were significantly associated with axillary recurrence. The high five-year survival and low cumulative incidence of axillary recurrence in this cohort provide justification for the increasingly common practice of foregoing AD in women with minimal SN involvement, and suggest in particular that AD can safely be avoided in women with small, low-grade tumors. Nevertheless, a subset of patients might be at high risk of developing overt axillary disease and efforts should be made to identify such patients by ancillary analyses of the results of ongoing or recently published clinical trials.
ISSN:0167-6806
1573-7217
DOI:10.1007/s10549-011-1486-2