Sentinel lymph node dissection provides similar local-regional control compared to axillary dissection in patients with node negative breast cancer

Abstract

588 Background: Recent studies have documented low axillary recurrence rates in breast cancer patients undergoing axillary sentinel lymph node dissection (SLND). The purpose of this study was to compare axillary control rates in patients staged with SLND versus complete axillary lymph node dissection (ALND). Methods: 1597 patients with T1-T4 N0 M0 breast cancer, node negative by H&E, were identified from prospective databases of two institutions from 1994 to 2003. All patients had mastectomy or breast conservation combined with either SLND followed by ALND as part of a training protocol or SLND alone. Factors evaluated included tumor size, nuclear grade, ER, PR, HER-2/neu, lymphovascular invasion (LVI), and the number of nodes removed. Results: Of 1597 node negative patients, 1334 underwent SLND alone and 263 had SLND with ALND. There were no significant differences in T stage, LVI, ER, PR, HER-2/neu, nuclear grade, or surgical procedure between the two groups. Significantly more patients in the ALND group received systemic chemotherapy (p<0.05), but there was no difference in use of endocrine therapy. A median of 2.0 SLN and 0 non-SLN were removed in the SLND group versus 2.0 SLN and 15 non-SLN in the ALND group. At a median follow-up of 28 months (range 3–119 mos), 40 patients (2.5%) had local-regional or distant disease. There were no differences in disease-free and overall survival between the SLND and ALND groups at a median follow-up time of 26 mos and 53 mos, respectively. Specifically, four patients (0.25%) developed axillary recurrence, 2 in the SLND group (0.15%) and 2 in the ALND group (0.76%). Axillary recurrences in the SLND group were noted at 27 and 32 mos versus 55 and 61 mos in the ALND group. Conclusions: SLND alone appears to provide similar axillary control compared to ALND in node negative breast cancer patients. Long-term follow-up is needed to determine if the low axillary failure rates seen with SLND alone are durable. No significant financial relationships to disclose.