Original scientific paper
https://doi.org/10.20471/LO.2021.49.02-03.07
Axillary lymph node dissection could be omitted in the breast cancer patients with a limited sentinel lymph node involvement following neoadjuvant systemic treatment
Ana Car-Peterko
orcid.org/0000-0003-3148-0126
; Department of General Surgery and Surgical Oncology, Clinical Hospital Centre Rijeka, Rijeka Croatia
Manuela Avirović
orcid.org/0000-0002-6601-7521
; Department of General Pathology and Pathologic Anatomy, University of Rijeka, Faculty of Medicine, Rijeka, Croatia
Petra Valković-Zujić
orcid.org/0000-0003-4029-5432
; Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
Koraljka Rajković-Molek
; Clinical Department of Pathology and Cytology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
Ingrid Belac-Lovasić
; Department of Radiotherapy and Oncology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
Franjo Lovasić
; Department of General Surgery and Surgical Oncology, Clinical Hospital Centre Rijeka, Rijeka Croatia
Abstract
Background: In modern breast cancer management, SLNB is a standard of care. For the patients with limited sentinel lymph node involvement in the upfront surgery setting, ALND can be safely omitted. However, for any sentinel node metastasis detected following neoadjuvant systemic treatment (NST), ALND is still considered a mandatory procedure.
Patients and methods: Present retrospective analysis has included all breast cancer patients submitted to surgery following NST in Clinical Hospital Centre (CHC) Rijeka in the period from 2017 till 2020.
Results: SLNB was performed in 151 of 222 consecutive patients, and sentinel node metastasis was detected in 49 cases. The risk of non-sentinel lymph node involvement in sentinel node-positive patients was 34.7%, but exclusively for cases with macro-metastatic disease detected in the sentinel node. In addition, for the patients diagnosed with clinically uninvolved axilla, the risk of ypN2-3 status was only 2.8%.
Conclusions: ALND following NST is overtreatment in 65.3% of sentinel node-positive patients. Axillary irradiation with the omission of ALND should be considered for the sentinel-positive patients with only micro-metastatic disease detected in the sentinel node following neoadjuvant chemotherapy, as well as for those with low volume macro metastatic disease, diagnosed with the uninvolved axilla.
Keywords
breast cancer; neoadjuvant chemotherapy; sentinel lymph node biopsy
Hrčak ID:
267879
URI
Publication date:
22.12.2021.
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