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Optimizing Axillary Management in Clinical T1-2N0 Mastectomy Patients with Positive Sentinel Lymph Nodes
Olga Kantor1,2, Jessica Means1, Samantha Grossmith1
1Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Annals of Surgical Oncology
|September 1, 2021
Summary
Omitting intraoperative sentinel lymph node (SLN) evaluation in mastectomy patients with early-stage breast cancer who are candidates for postmastectomy radiation therapy (PMRT) reduced axillary lymph node dissection (ALND) rates without impacting oncologic outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Management
Background:
- The AMAROS trial results prompted a need to optimize axillary lymph node dissection (ALND) or postmastectomy radiation therapy (PMRT) + axillary radiation (AxRT) utilization.
- Focus on cT1-2N0 patients with 1-2 positive sentinel lymph nodes (SLNs) after mastectomy.
Purpose of the Study:
- To optimize axillary treatment strategies for specific breast cancer patient groups.
- To evaluate the impact of omitting intraoperative SLN evaluation on ALND and PMRT utilization.
Main Methods:
- Implemented a protocol to omit intraoperative SLN evaluation for select mastectomy patients (cT1-2N0) likely to receive PMRT if SLNs were positive.
- Prospectively evaluated axillary management, complications, and oncologic outcomes in patients with 1-2 positive SLNs.
Main Results:
- Protocol compliance was high (72% omission of intraoperative SLN evaluation).
- Protocol adherence led to significantly lower rates of ALND (8% vs. 24%) and ALND + PMRT (9% vs. 41%).
- No significant differences in regional recurrences, distant recurrences, disease-free survival, or complication rates were observed between ALND and PMRT + AxRT groups.
Conclusions:
- Omitting intraoperative SLN evaluation in eligible cT1-2N0 mastectomy patients effectively reduces ALND and ALND + PMRT utilization.
- This strategy minimizes invasive procedures without compromising short-term oncologic outcomes or complication rates.
