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Updated: Feb 3, 2026
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Omission of Axillary Lymph Node Dissection in Early-Stage Breast Cancer With Limited Sentinel Lymph Node Metastasis:
Changzai Li1, Pan Zhang2, Jiaxing Wang3
1Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Breast Cancer Molecular Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Oncological Surgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China.
Background:
Whether axillary lymph node dissection (ALND) can be safely omitted clinically node-negative (cN0) breast cancer with limited sentinel lymph (SLN) metastasis remains uncertain, particularly after mastectomy.
Methods:
This retrospective cohort included women with T1-T2 cN0 breast cancer and positive SLN between 2015 and 2020. Patents underwent sentinel lymph node biopsy (SLNB) alone or ALND. Propensity score matching (1:1, nearest neighbor, caliper 0.02 on logit) balanced age, T stage, tumor grade, vascular invasion, number of positive SLNs, ER/PR/HER2, Ki-67, surgery type, chemotherapy, and radiotherapy. Kaplan-Meier and Cox regression estimated overall survival (OS) recurrence-free survival (RFS).
Results:
Of 1244 patients screened, 1038 were analyzed (577 ALND, 461 SLNB alone; median follow-up 68 months), After matching (283 pairs), 5-year OS was 97.1% (95% CI, 95.0-99.3) for ALND and 96.1% (93.8-98.5) for SLNB alone. Five-year RFS was 96.8% (94.7-99.0) versus 97.0% (94.9-99.0). No statistically significant difference was found in OS (HR, 1.14, 95% CI, 0.51-2.54, P = .75) and RFS (HR, 0.86, 95% CI, 0.36-2.05, P = .74) between the ALND and SLNB alone. Findings were consistent among patients with 1 to 3 positive SLNs, regardless of surgery type. All 22 patients with 4 to 6 positive SLNs underwent ALND, precluding comparison.
Conclusion:
In cN0 breast cancer patients with 1 to 3 positive SLNs, omitting ALND did not compromise OS or RFS after mastectomy or breast-conserving surgery. These results support broader application of de-escalated axillary surgery while prospective validation for higher nodal burden remains necessary.
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