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Challenges in Identifying Sentinel Lymph Nodes in Early Breast Cancer Patients: Should We Opt for Standard Axillary
1Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Purpose:
Assessing the metastatic status of axillary lymph nodes is critical in breast cancer to determine disease progression and guide treatment. Axillary lymph node dissection (ALND) is performed when sentinel lymph nodes (SLNs) are undetectable; however, this can lead to overtreatment and complications. This study investigated whether limited axillary lymph node dissection (L-ALND) provides outcomes comparable to those of standard axillary lymph node dissection (S-ALND) in patients with early stage breast cancer.
Methods:
Medical records of 2,461 patients were reviewed, focusing on 304 cases with undetectable SLNs. After excluding those with three or more metastatic nodes, 217 patients with early-stage disease were analyzed. They were classified into L-ALND (≤ 9 nodes removed) and S-ALND (≥ 10 nodes removed) groups.
Results:
The L-ALND group had a lower local recurrence rate (1.6% vs. 3.4%) and fewer complications than the S-ALND group. Similarly, the five- and ten-year recurrence-free survival rates were higher in the L-ALND group than in the S-ALND group (95.0% vs. 89.1% and 94.2% vs. 49.5%). Factors affecting recurrence included the ALND type (S-ALND vs. L-ALND), type of operation, and tumor subtype. The incidence of lymphedema was also lower in the L-ALND group than in the S-ALND group (4.8% vs. 10.3%).
Conclusion:
L-ALND offers outcomes comparable to S-ALND in early-stage breast cancer, reducing complications without compromising oncological outcomes.
