Outcome in breast cancer managed without an initial axillary lymph node dissection

Abstract

Purpose: The role of an elective axillary lymph node dissection (AxLND) in the initial management of patients with early stage breast cancer has recently become controversial. The objective of this current study is to review the reasons as to why patients from a single institution were managed without an initial AxLND and their outcome in terms of survival and recurrence rates. Materials and methods: A retrospective analysis was conducted on 126 women referred to the Princess Margaret Hospital with the diagnosis of breast cancer who did not undergo an initial AxLND. Results: The median age of this population was 69 years, with the vast majority (93%) being post-menopausal. Fifty-seven patients had T 1 tumors and the remainder had T 2–3 tumors. Adjuvant radiation therapy to the breast was administered to 65 patients and systemic adjuvant treatment was administered to 24 patients. In approximately one-third of these cases, the reasons cited for not performing an AxLND were related to the patient's age, a medical contraindication, or the patient's choice. The 5-year actuarial cause-specific survival was 92%; the local breast relapse-free rate (RFR) was 85% and the axillary RFR was 86%. No patients in this study experienced debilitating symptoms from their axillary disease. Only 16 patients underwent a subsequent AxLND, with the lymph nodes being pathologically uninvolved in six of these patients. Conclusion: This study supports the concept that, in selected patients, adopting an approach of a delayed AxLND does not appear to compromise the patients' outcome, with only 13% of patients requiring a subsequent AxLND.