When is a completion axillary lymph node dissection necessary in the presence of a positive sentinel lymph node?
- Resource Type
- Authors
- Salena Bains; Hisham Hamed; Ian S. Fentiman; Olorunsola F. Agbaje; Michael Douek; Sarah E Pinder; Amalinda Suyoi; Ash Kothari; Arnie Purushotham
- Source
- European Journal of Cancer. 50:690-697
- Subject
- Cancer Research
medicine.medical_specialty
Axillary lymph nodes
Sentinel lymph node
Breast Neoplasms
medicine
Humans
Macrometastasis
Lymph node
Mastectomy
Sentinel Lymph Node Biopsy
business.industry
Micrometastasis
Axillary Lymph Node Dissection
Tumor Burden
Surgery
Axilla
medicine.anatomical_structure
Oncology
Lymphatic Metastasis
Lymph Node Excision
Female
Radiology
Lymph
Neoplasm Recurrence, Local
business
Follow-Up Studies
- Language
- ISSN
- 0959-8049
Background The management of the axilla in the presence of positive sentinel lymph node (SLN) remains controversial. Many centres forgo completion axillary lymph node dissection (cALND) in the presence of micrometastatic disease. The American College of Surgeons Oncology Group (ACOSOG) Z0011 trialists argue for extending this to macrometastasis. The aim of this study was to correlate tumour burden in SLNs with that in the residual lymph node basin to determine the likelihood of residual disease in patients with micro- and macrometastasis in the SLN. Methods Patients who underwent cALND following a positive SLN were analysed for histopathological features of the primary tumour and burden of axillary disease. Results Of 155 patients, 115 (74%) had macrometastases and 40 (26%) micrometastases in the SLNs. Residual axillary disease was detected in 55/155 (35%) patients with macrometastases and 4/40 (10%) with micrometastases. Generally, with increasing size of metastasis in the SLN there was an increasing risk of further disease in residual lymph nodes. Logistic regression analysis showed increased odds ratios for further disease for all groups when compared with the Conclusion Patients may be advised to forgo cALND where the SLN contains isolated tumour cells or micrometastasis. Recommendations for proceeding to cALND can be based on the size of metastasis in the SLN, which relates to the risk of further disease in the residual axillary lymph nodes and subsequent regional recurrence.