Abstract
Commentary: Predictive Value of Preoperative Multidetector-Row Computed Tomography for Axillary Lymph Nodes Metastasis in Patients with Breast Cancer.
Highlights
It is clear from studies such as the ACOSOG Z0011 randomized controlled trial that a subset group of patients presenting with primary breast cancer with positive axillary lymph nodes at sentinel lymph node biopsy (SLNB) may be able to avoid an axillary lymph node dissection (ALND) with its associated morbidities (1)
Twentythree percent (23%) of patients with SLNB macrometastases and 36% of patients with SNB micrometastases did not have ALND. For both groups with small volume nodal disease, the axillary local recurrence rate and 5-year survival were unchanged from the group who had undergone ALND, the more extensive operation
The most rigorous evidence for a stratified approach comes from the ACOSOG Z0011 trial, a prospective randomized controlled trial in which 813 patients with SLNB histology results indicating axillary lymph node involved with metastatic disease, were randomized to ALND versus no further surgery
Summary
It is clear from studies such as the ACOSOG Z0011 randomized controlled trial that a subset group of patients presenting with primary breast cancer with positive (involved) axillary lymph nodes at sentinel lymph node biopsy (SLNB) may be able to avoid an axillary lymph node dissection (ALND) with its associated morbidities (1).In a retrospective cohort study, Bilimoria (2) reported on a series of 97,314 patients. It is clear from studies such as the ACOSOG Z0011 randomized controlled trial that a subset group of patients presenting with primary breast cancer with positive (involved) axillary lymph nodes at sentinel lymph node biopsy (SLNB) may be able to avoid an axillary lymph node dissection (ALND) with its associated morbidities (1).
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