Are Clinically Node-Negative Patients with a Positive Preoperative Axillary Lymph Node Biopsy Appropriate Candidates for Sentinel Lymph Node Biopsy?

Regina Matar-Ujvary ¹, Varadan Sevilimedu ², Monica Morrow ³

⁰Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Annals of Surgical Oncology +

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October 11, 2024

View abstract on PubMed

Summary

Most breast cancer patients with detected lymph node metastases need sentinel lymph node biopsy (SLNB) rather than axillary lymph node dissection (ALND). Over 70% had fewer than 3 positive SLNs, avoiding further surgery.

Area Of Science

Oncology
Surgical Oncology
Breast Cancer Research

Background

Controversy exists regarding the management of cN0 breast cancer patients with image-detected nodal metastases.
Options include sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), or neoadjuvant chemotherapy (NAC).
This study investigates the need for ALND in patients undergoing upfront surgery after a positive lymph node biopsy.

Purpose Of The Study

To determine the frequency of ALND requirement in patients with clinically node-negative (cN0) breast cancer and positive lymph node biopsy.
To identify predictive factors for having three or more positive sentinel lymph nodes (SLNs).

Main Methods

A prospective database of patients with cT1-2N0 breast cancer and positive lymph node biopsy (2014-2022) was analyzed.
Patients receiving NAC were excluded.
Clinicopathologic characteristics were compared between those with 1-2 positive SLNs and those with ≥3 positive SLNs.

Main Results

Of 90 eligible patients, 73% had 1-2 positive SLNs and 27% had ≥3 positive SLNs.
Factors associated with ≥3 positive SLNs included >1 abnormal lymph node on imaging (OR 4.36), microscopic extracapsular extension (OR 3.83), and a higher number of SLNs removed (OR 1.42).
No significant differences were observed in BMI, tumor size, histology, grade, multifocality, lymphovascular invasion, or receptor status.

Conclusions

Over 70% of women with cT1-2 breast cancer and image-detected nodal metastases had fewer than 3 positive SLNs, thus not requiring ALND.
Frozen section analysis during SLNB may be considered for patients with multiple abnormal lymph nodes on imaging to potentially avoid repeat surgeries.

Keywords:

Axilla Breast cancer Clinically node-negative Early-stage breast cancer Needle biopsy Sentinel lymph node biopsy