Can axillary dissection be avoided in patients with sentinel lymph node metastasis?

Area of Science:

• Oncology
• Surgical Oncology
• Pathology

Background:

• The necessity of completion axillary dissection after identifying a positive sentinel lymph node (SLN) remains a subject of debate in oncological surgery.
• Accurate staging of lymph node metastasis is crucial for guiding treatment decisions in various cancers.

Purpose of the Study:

• To investigate predictors of non-sentinel lymph node (non-SLN) involvement in patients with a positive SLN.
• To evaluate whether specific patient or tumor characteristics could identify a subgroup of patients with positive SLNs who might not require completion axillary dissection.

Main Methods:

• A retrospective review of 1,133 patients who underwent SLN mapping was conducted.
• Statistical analyses, including frequency counts, Pearson chi-squared tests, and logistic regression, were used to assess associations between patient, tumor, and treatment characteristics and lymph node status.
• Predictors for positive SLNs and positive non-SLNs were analyzed.

Main Results:

• Of 1,148 SLN procedures, 367 (32%) were positive for metastasis.
• Factors significantly associated with non-SLN involvement in patients with a positive SLN included lymphovascular invasion (LVSI), increased number of positive SLNs, decreased number of negative SLNs, and larger metastasis size.
• No subgroup was definitively identified as having a negligible risk of non-SLN involvement, except potentially those with >=3 negative SLNs and metastasis <10 mm.

Conclusions:

• The study suggests that completion axillary dissection should not be omitted for any subgroup of patients with a positive SLN at this time.
• Further results from ongoing clinical trials are necessary to definitively determine the indications for completion axillary dissection.