Axillary lymph node dissection in sentinel node positive breast cancer: is it necessary?

Abstract

PURPOSE OF REVIEW: Sentinel lymph node biopsy (SLNB) has become a gold standard procedure for axillary lymph node evaluation in clinically node-negative patients. In those patients with positive SLNB, completion axillary lymph node dissection (ALND) has been routely performed. Recent clinical trials suggest that ALND is not necessary in some cases, even when the sentinel lymph node (SLN) is positive. The appropriate conditions under which ALND may be eliminated are defined in this review. RECENT FINDINGS: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial studied the impact of SLNB alone versus completion axillary node dissection (AND) on survival in clinically node-negative breast cancer patients undergoing partial mastectomy and whole breast irradiation who were found to have a positive SLN on pathological evaluation. Results of this study showed no survival advantage for complete AND in patients with one or two positive SLNs. In other words, those patients appeared to be treated safely without completion AND. SUMMARY: Despite the small sample size and limited stastical power and the relatively short median follow up for ACOSOG Z0011, many breast cancer teams no longer believe it mandatory to perform axillary dissection for patients with one or two positive SLNs. The results of other prospective randomized trials called After Mapping of the Axilla: Radiotherapy Or Surgery study and International Breast Cancer Study Group trial 23-01 study will be available soon, and may further change the confidence with which ALND is performed or eliminated.