TY - JOUR
T1 - Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes
AU - Guenther, J. Michael
AU - Hansen, Nora M.
AU - DiFronzo, L. Andrew
AU - Giuliano, Armando E.
AU - Collins, J. Craig
AU - Grube, Baiba L.
AU - O'Connell, Theodore X.
PY - 2003/1/1
Y1 - 2003/1/1
N2 - Hypothesis: Sentinel node (SN) biopsy for breast can cer enhances staging sensitivity, often demonstrating only micrometastases (<2 mm) or isolated, keratin positive cells. When SN metastasis is present, the value of additional axillary dissection is unclear and not all patients benefit from axillary lymph node dissection (ALND). Design: Prospective cohort study, median 32-month fol low-up. Setting: Multidisciplinary breast cancer centers. Patients: Forty-six women having SN metastases diagnosed between May 1, 1996, and September 1, 2001, who refused ALND or were recommended to omit ALND ow ing to serious comorbid conditions. Interventions: Isosulfan blue dye-directed SN biopsy. Axillary lymph node dissection was not per formed. Standard breast irradiation was given. Adjuvant systemic therapy was provided as determined by an oncologist. Interval clinical evaluation was performed. Main Outcome Measure: Axillary and systemic failure rates. Results: Mean patient age was 61.6 years (age range, 36-92 years). Mean tumor size was 1.65 cm (range, 0.4-5.5 cm). Thirty-five (76%) of 46 tumors were ductal carcinomas and 39 (87%) of 45 were estrogen receptor-positive. A mean of 2.6 SNs were identified (median, 2; range, 1-7). Thirty-nine patients (85%) had a single positive SN; the remaining 7 patients (15%) had 2 positive SNs. Seven patients (15%) had macrometastases (>2 mm); 16 (35%) had micrometastases (<2 mm); and 23 (50%) had cellular metastases. Only 16 positive SNs (35%) were seen on hematoxylin-eosin staining, while 30 SNs (65%) had positive immunohistochemical staining. There have been no axillary recurrences. One patient (2%) developed distant metastases during follow-up (range, 4-61 months). Conclusions: Patients with SN metastases who did not have ALND had a low incidence of regional failure. To confirm this observation, we suggest that patients with SN metastases are ideal candidates for trials evaluating the necessity of ALND.
AB - Hypothesis: Sentinel node (SN) biopsy for breast can cer enhances staging sensitivity, often demonstrating only micrometastases (<2 mm) or isolated, keratin positive cells. When SN metastasis is present, the value of additional axillary dissection is unclear and not all patients benefit from axillary lymph node dissection (ALND). Design: Prospective cohort study, median 32-month fol low-up. Setting: Multidisciplinary breast cancer centers. Patients: Forty-six women having SN metastases diagnosed between May 1, 1996, and September 1, 2001, who refused ALND or were recommended to omit ALND ow ing to serious comorbid conditions. Interventions: Isosulfan blue dye-directed SN biopsy. Axillary lymph node dissection was not per formed. Standard breast irradiation was given. Adjuvant systemic therapy was provided as determined by an oncologist. Interval clinical evaluation was performed. Main Outcome Measure: Axillary and systemic failure rates. Results: Mean patient age was 61.6 years (age range, 36-92 years). Mean tumor size was 1.65 cm (range, 0.4-5.5 cm). Thirty-five (76%) of 46 tumors were ductal carcinomas and 39 (87%) of 45 were estrogen receptor-positive. A mean of 2.6 SNs were identified (median, 2; range, 1-7). Thirty-nine patients (85%) had a single positive SN; the remaining 7 patients (15%) had 2 positive SNs. Seven patients (15%) had macrometastases (>2 mm); 16 (35%) had micrometastases (<2 mm); and 23 (50%) had cellular metastases. Only 16 positive SNs (35%) were seen on hematoxylin-eosin staining, while 30 SNs (65%) had positive immunohistochemical staining. There have been no axillary recurrences. One patient (2%) developed distant metastases during follow-up (range, 4-61 months). Conclusions: Patients with SN metastases who did not have ALND had a low incidence of regional failure. To confirm this observation, we suggest that patients with SN metastases are ideal candidates for trials evaluating the necessity of ALND.
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U2 - 10.1001/archsurg.138.1.52
DO - 10.1001/archsurg.138.1.52
M3 - Article
C2 - 12511150
AN - SCOPUS:0037223824
SN - 2168-6254
VL - 138
SP - 52
EP - 56
JO - JAMA Surgery
JF - JAMA Surgery
IS - 1
ER -
