Abstract
The purpose of this study was to evaluate pathologic lymph node metastasis in breast cancer with cytology-proven axillary metastasis. This study was designed prospectively. We performed axillary lymph node dissections (ALND) after lymphatic mapping by near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG). We evaluated 72 breast cancer patients with cytology-proven axillary metastasis by curative surgery at the Samsung Medical Center between May of 2016 and December of 2017. Among the 72 patients with cytology-proven axillary metastasis, 14 of 39 patients (35.9%) with one or two sentinel lymph nodes containing metastases were metastasized to post-sentinel lymph node. Thirteen of fourteen patients had additional non-sentinel lymph node metastases, seven of thirteen patients also had additional level II lymph node metastases, and one patient had only one additional level II lymph node metastasis. Of T1 or T2 stage patients, 10 of 33 patients (30.3%) with one or two sentinel lymph nodes containing metastases were metastasized to post-sentinel lymph node. Even in patients without SLN metastasis, 50% of the patients had at least three LN metastases, and 40% in the T1 or T2 stage patients. Sentinel lymph node biopsy without ALND might be not safe for patients with cytology-proven axillary metastasis.
Highlights
Nodal status is the primary prognostic indicator in breast cancer, and it is important for determining treatment [1]
Recent studies have found that axillary lymph node dissection (ALND) was unnecessary for patients with nonpalpable axillary lymph nodes (LN) with one or two positive sentinel lymph nodes (SLN) [2,3,4]
The American College of Surgeons Oncology Group (ACOSOG) did not conduct a preoperative axillary ultrasound (US) [3] in its Z0011 trial; in many medical centers, preoperative axillary US is standard procedure for breast cancer patients and axillary US-guided LN needle biopsy is implemented for suspicious LNs
Summary
Nodal status is the primary prognostic indicator in breast cancer, and it is important for determining treatment [1]. The American College of Surgeons Oncology Group (ACOSOG) did not conduct a preoperative axillary ultrasound (US) [3] in its Z0011 trial; in many medical centers, preoperative axillary US is standard procedure for breast cancer patients and axillary US-guided LN needle biopsy is implemented for suspicious LNs. Generally, ALND is required in breast cancer patients with cytology-proven axillary metastasis; a recent study demonstrated that a positive US-guided LN needle biopsy in breast cancer may be conducted with a sentinel lymph node biopsy (SLNB) [5]. If patients with cytology-proven axillary metastasis have one to two sentinel lymph node metastases and are omitted ALND, the existence of other axillary metastases cannot be confirmed. The purpose of this study was to evaluate pathologic lymph node metastasis in breast cancer with cytology-proven axillary metastases
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