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Related Experiment Videos

Unnecessary axillary node dissections in the sentinel lymph node era.

Mattia Intra1, Nicole Rotmensz, Denise Mattar

  • 1Division of Breast Surgery, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy. mattia.intra@ieo.it

European Journal of Cancer (Oxford, England : 1990)
|October 13, 2007
PubMed
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Axillary lymph node dissection (ALND) is often unnecessary for breast cancer patients with uninvolved lymph nodes. Efforts should focus on expanding sentinel lymph node biopsy (SNB) indications to avoid non-metastatic axillary staging.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Sentinel lymph node biopsy (SNB) has become standard for staging the axilla in invasive breast cancer.
  • Axillary lymph node dissection (ALND) is typically reserved for cases with confirmed nodal metastasis.

Purpose of the Study:

  • To evaluate the rate and reasons for 'unnecessary' ALND in patients not selected for SNB.
  • To assess trends in 'unnecessary' ALND over time with evolving SNB indications.

Main Methods:

  • Retrospective analysis of 10,031 invasive breast cancer patients operated between January 2000 and August 2005.
  • Identification of patients undergoing 'direct ALND' without prior SNB and analysis of reasons for exclusion from SNB.

Main Results:

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  • Out of 3487 patients undergoing 'direct ALND', 18% had no axillary metastasis.
  • Frequent reasons for 'unnecessary ALND' included suspicious nodes, neoadjuvant therapy, large tumor size, multifocality, and prior biopsy.
  • The rate of 'unnecessary ALND' decreased from 26% in 2000 to 9% in 2005.

Conclusions:

  • A significant proportion of patients undergo 'unnecessary ALND', highlighting the need to optimize SNB selection criteria.
  • Expanding SNB indications can further reduce the number of patients undergoing non-therapeutic ALND.