Low axillary sampling in clinically node-negative operable breast cancer

Area of Science:

• Oncology
• Surgical Pathology
• Global Health

Background:

• Sentinel node biopsy (SNB) is standard for axillary staging in node-negative breast cancer.
• High costs and radiocolloid requirements limit SNB in developing countries.
• Low axillary sampling (LAS) is proposed as an accessible alternative.

Purpose of the Study:

• To validate anatomically guided low axillary sampling as a reliable alternative to SNB.
• To assess the feasibility and accuracy of LAS in a developing country context.

Main Methods:

• Anatomically guided LAS involved removing lower level I axillary fat and lymph nodes.
• The method's accuracy was confirmed by subsequent complete axillary clearance in all participants.
• 355 women with clinically node-negative operable breast cancer were included.

Main Results:

• Lymph nodes were successfully identified in all 355 patients using LAS.
• The median number of nodes retrieved was 5, with an overall positivity rate of 32.1%.
• A 5-node LAS had an 8.8% false-negative rate (FNR); a 6-node LAS achieved an FNR of 1.5% with 95% sensitivity, comparable to SNB.

Conclusions:

• Low axillary sampling is a low-cost, reliable alternative for axillary staging in clinically node-negative breast cancer.
• A 6-node LAS provides excellent accuracy, comparable to SNB, making it suitable for resource-limited settings.