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Published on: June 1, 2019
From Axillary Lymph Node Dissection to Sentinel Node Biopsy in Breast Cancer: A 23-Year Population-Based Large-Sample
Lucia Mangone1, Francesco Marinelli1, Isabella Bisceglia1
1Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Purpose:
Axillary surgery in breast cancer has progressively evolved over the past decades toward less invasive approaches.
Patients And Methods:
This population-based study analyzed 10,955 women diagnosed with invasive breast cancer between 2000 and 2022 in Reggio Emilia, Italy, to assess long-term trends in axillary management.
Results:
A marked decline in axillary lymph node dissection (ALND) was observed-from 47.9% in 2000-2004 to 18.1% in 2017-2022-with a parallel increase in sentinel lymph node biopsy (SLNB) from 43.8% to 74.7%. The shift was particularly pronounced in stage I tumors, where ALND dropped from 44.7% to 2.9%. Overall survival at 15 years was significantly higher in the SLNB group (78%) compared to the ALND group (72%). These results align with major clinical trials (e.g. ACOSOG Z0011, SINODAR-ONE), confirming their applicability in unselected populations. Although ALND remained more frequent in patients with larger tumors or undergoing mastectomy, its role has substantially diminished.
Conclusion:
Our findings reinforce the safety and effectiveness of conservative axillary approaches and reflect their successful implementation in real-world practice. Further research should address the impact of these trends on quality of life and incorporate additional data on radiotherapy and tumor biology to guide future surgical decision-making.
