BACKGROUND: Controversy exists regarding axillary dissection (ALND) for sentinel node (SLN) metastases detected as isolated tumor cells (ITC). We hypothesized that the number of positive non-SLNs is low and ALND is unnecessary for most patients with ITC. METHODS: From 1995 to 1999, 634 breast cancer patients underwent SLND. SLNs were examined using immunohistochemistry if hematoxylin and eosin was negative. ALND was recommended for ITC-positive SLNs. RESULTS: Seventy-eight patients (12.3%) with ITC-positive SLNs were offered ALND. Sixty-one consented, whereas 17 refused. Fifty-eight (95.1%) had negative non-SLNs. Three (4.9%) had non-SLN metastases. One patient (1.6%) had macrometastatic disease, whereas 2 (3.3%) had micrometastases. No ITC-only-positive SLN patient experienced axillary recurrence. CONCLUSIONS: When ALND was performed for ITC, 1.6% of non-SLNs harbored macrometastases and 3.3% had micrometastases. When ALND was not performed, axillary recurrence was not seen. The low risk of non-SLN disease in this study fails to support the routine use of ALND for ITC-positive SLNs.
BACKGROUND: Controversy exists regarding axillary dissection (ALND) for sentinel node (SLN) metastases detected as isolated tumor cells (ITC). We hypothesized that the number of positive non-SLNs is low and ALND is unnecessary for most patients with ITC. METHODS: From 1995 to 1999, 634 breast cancerpatients underwent SLND. SLNs were examined using immunohistochemistry if hematoxylin and eosin was negative. ALND was recommended for ITC-positive SLNs. RESULTS: Seventy-eight patients (12.3%) with ITC-positive SLNs were offered ALND. Sixty-one consented, whereas 17 refused. Fifty-eight (95.1%) had negative non-SLNs. Three (4.9%) had non-SLN metastases. One patient (1.6%) had macrometastatic disease, whereas 2 (3.3%) had micrometastases. No ITC-only-positive SLN patient experienced axillary recurrence. CONCLUSIONS: When ALND was performed for ITC, 1.6% of non-SLNs harbored macrometastases and 3.3% had micrometastases. When ALND was not performed, axillary recurrence was not seen. The low risk of non-SLN disease in this study fails to support the routine use of ALND for ITC-positive SLNs.
Authors: Gábor Cserni; Simonetta Bianchi; Vania Vezzosi; Riccardo Arisio; Rita Bori; Johannes L Peterse; Anna Sapino; Isabella Castellano; Maria Drijkoningen; Janina Kulka; Vincenzo Eusebi; Maria P Foschini; Jean-Pierre Bellocq; Cristi Marin; Sten Thorstenson; Isabel Amendoeira; Angelika Reiner-Concin; Thomas Decker; Manuela Lacerda; Paulo Figueiredo; Gábor Fejes Journal: Pathol Oncol Res Date: 2007-03-27 Impact factor: 3.201
Authors: Carolien H M van Deurzen; Maaike de Boer; Evelyn M Monninkhof; Peter Bult; Elsken van der Wall; Vivianne C G Tjan-Heijnen; Paul J van Diest Journal: J Natl Cancer Inst Date: 2008-11-11 Impact factor: 13.506
Authors: Claire M T P Francissen; Pim J M Dings; Thijs van Dalen; Luc J A Strobbe; Hanneke W M van Laarhoven; Johannes H W de Wilt Journal: Ann Surg Oncol Date: 2012-08-14 Impact factor: 5.344
Authors: Holbrook E Kohrt; Richard A Olshen; Honnie R Bermas; William H Goodson; Douglas J Wood; Solomon Henry; Robert V Rouse; Lisa Bailey; Vicki J Philben; Frederick M Dirbas; Jocelyn J Dunn; Denise L Johnson; Irene L Wapnir; Robert W Carlson; Frank E Stockdale; Nora M Hansen; Stefanie S Jeffrey Journal: BMC Cancer Date: 2008-03-04 Impact factor: 4.430