Axillary node interventions in breast cancer: a systematic review.

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Traditional axillary surgery for breast cancer is being re-evaluated based on recent clinical trial data.
• Understanding the role of axillary interventions is crucial for optimizing patient outcomes.

Purpose of the Study:

• To review evidence on axillary interventions (surgical and nonsurgical) in breast cancer treatment.
• To assess the impact of these interventions on recurrence, mortality, and morbidity.

Main Methods:

• A systematic literature search was conducted across multiple databases (Ovid MEDLINE, Cochrane).
• Included studies were clinical trials, observational studies, and meta-analyses with at least a 2-year follow-up.
• 1070 publications were reviewed, with 17 meeting final inclusion criteria.

Main Results:

• For breast-conserving therapy without palpable axillary nodes, complete axillary node dissection shows minimal benefit over sentinel node biopsy alone.
• Complete axillary node dissection offers no survival advantage and increases the risk of lymphedema (14%) compared to sentinel node biopsy.
• Sentinel node biopsy is effective for staging and guiding adjuvant therapy decisions.

Conclusions:

• Axillary node dissection is associated with more harm than benefit in select breast cancer patients undergoing breast-conserving therapy.
• Interventions should be tailored to individual patient profiles to balance disease control and minimize morbidity.
• Complete axillary node dissection is indicated for palpable or biopsy-proven metastases, positive sentinel nodes with mastectomy, or more than 3 positive sentinel nodes in breast-conserving therapy.