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Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review of the Literature

ANNALS OF SURGICAL ONCOLOGY (2012)

Journal

ANNALS OF SURGICAL ONCOLOGY

Volume 19, Issue 13, Pages 4140-4149

Publisher

SPRINGER

DOI: 10.1245/s10434-012-2490-4

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Abstract

Sentinel lymph node biopsy (SLNB) has become standard of care as a staging procedure in patients with invasive breast cancer. A positive SLNB allows completion axillary lymph node dissection (cALND) to be performed. The axillary recurrence rate (ARR) after cALND in patients with positive SLNB is low. Recently, several studies have reported a similar low ARR when cALND is not performed. This review aims to determine the ARR when cALND is omitted in SLNB-positive patients. A literature search was performed in the PubMed database with the search terms breast cancer, sentinel lymph node biopsy, axillary and recurrence. Articles with data regarding follow-up of patients with SLNB-positive breast cancer were identified. To be eligible, patients should not have received cALND and ARR should be reported. Thirty articles were analyzed. This resulted in 7,151 patients with SLNB-positive breast cancer in whom a cALND was omitted (median follow-up of 45 months, range 1-142 months). Overall, 41 patients developed an axillary recurrence. 27 studies described 3,468 patients with micrometastases in the SLNB, of whom 10 (0.3 %) developed an axillary recurrence. ARR varied between 0 and 3.7 %. Sixteen studies described 3,268 patients with macrometastases, 24 (0.7 %) axillary recurrences were seen. ARR varied between 0 and 7.1 %. Details regarding type of surgery and adjuvant treatment were lacking in the majority of studies. ARR appears to be low in SLNB-positive patients even when a cALND is not performed. Withholding cALND may be safe in breast cancer selected patients such as those with isolated tumor cells or micrometastatic disease.

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Sentinel node involvement with or without completion axillary lymph node dissection: treatment and pathologic results of randomized SERC trial

Gilles Houvenaeghel, Monique Cohen, Pedro Raro, Jeremy De Troyer, Pierre Gimbergues, Christine Tunon de Lara, Vivien Ceccato, Veronique Vaini-Cowen, Christelle Faure-Virelizier, Frederic Marchal, Tristan Gauthier, Eva Jouve, Pierrick Theret, Claudia Regis, Philippe Gabelle, Julia Pernaut, Francesco Del Piano, Gauthier D'Halluin, Stephane Lantheaume, Emile Darai, Bassoodeo Beedassy, Caroline Dhainaut-Speyer, Xavier Martin, Sophie Girard, Richard Villet, Emilie Monrigal, Theophile Hoyek, Jean-Francois Le Brun, Pierre-Emmanuel Colombo, Agnes Tallet, Jean-Marie Boher

Summary: The study analyzed the treatment and pathological results of patients included in the SERC trial, a multicenter randomized non-inferiority phase-3 trial comparing completion axillary lymph node dissection (cALND) with sentinel lymph node biopsy alone in breast cancer patients. Patients with one or two involved sentinel nodes by micro- or macro-metastases may not require cALND, but further research is needed for those with more than two involved nodes.

NPJ BREAST CANCER (2021)