Challenges in Identifying Sentinel Lymph Nodes in Early Breast Cancer Patients: Should We Opt for Standard Axillary...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Accurate assessment of axillary lymph node metastatic status is crucial for breast cancer staging and treatment planning.
• Standard axillary lymph node dissection (ALND) is often performed when sentinel lymph nodes (SLNs) are undetectable, but can lead to overtreatment and complications.
• Limited ALND (L-ALND) aims to reduce morbidity while maintaining oncological safety.

Purpose of the Study:

• To compare the oncological outcomes and complication rates of limited axillary lymph node dissection (L-ALND) versus standard axillary lymph node dissection (S-ALND) in early-stage breast cancer patients with undetectable SLNs.

Main Methods:

• Retrospective review of 2,461 patient records, focusing on 217 early-stage breast cancer patients with undetectable SLNs and fewer than three metastatic nodes.
• Patients were categorized into L-ALND (≤9 nodes removed) and S-ALND (≥10 nodes removed) groups.
• Comparison of local recurrence rates, recurrence-free survival, and complication incidence, including lymphedema.

Main Results:

• The L-ALND group exhibited a lower local recurrence rate (1.6% vs. 3.4%) and significantly fewer complications compared to the S-ALND group.
• Five- and ten-year recurrence-free survival rates were higher in the L-ALND group (95.0% vs 89.1% and 94.2% vs 49.5%, respectively).
• Lymphedema incidence was lower in the L-ALND group (4.8% vs. 10.3%).

Conclusions:

• Limited axillary lymph node dissection (L-ALND) provides oncological outcomes comparable to standard axillary lymph node dissection (S-ALND) in select early-stage breast cancer patients.
• L-ALND reduces the incidence of complications, such as lymphedema, without compromising cancer control.
• This suggests L-ALND is a viable and potentially preferable surgical option for patients with undetectable SLNs.