Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis
| Autor: | Tae-Kyung Yoo, Byung Joo Chae, Sung Hun Kim, Juneyoung Ahn, Byung Joo Song, Bong Joo Kang, Woo Chan Park |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Axillary Lymph Node Biopsy Cancer Research medicine.medical_specialty Receptor ErbB-2 Breast Neoplasms Lymph node metastasis Mastectomy Segmental Metastasis 03 medical and health sciences 0302 clinical medicine Breast cancer Positron Emission Tomography Computed Tomography Biopsy Medicine Humans Acosog z0011 Retrospective Studies medicine.diagnostic_test business.industry Sentinel Lymph Node Biopsy Carcinoma Ductal Breast Axillary Lymph Node Dissection Middle Aged medicine.disease Prognosis Carcinoma Lobular 030104 developmental biology Oncology Receptors Estrogen 030220 oncology & carcinogenesis Lymphatic Metastasis Axilla Lymph Node Excision Female Radiology Lymph Lymph Nodes business Receptors Progesterone Follow-Up Studies |
| Zdroj: | Breast cancer research and treatment. 181(2) |
| ISSN: | 1573-7217 |
| Popis: | The ACOSOG Z0011 trial demonstrated that axillary lymph node dissection (ALND) is unnecessary in select patients with cT1-2N0 tumors undergoing breast-conserving therapy with 1–2 positive sentinel lymph nodes (SLNs). However, patients with preoperatively confirmed ALN metastasis were not included and may be subjected to unnecessary ALND. The aim of this study is to identify patients who can be considered for ALND omission when the preoperative ALN biopsy results are positive. Breast cancer patients who underwent preoperative ALN biopsy and primary surgery were retrospectively reviewed. Among patients with positive ALN biopsy results, clinicopathological and imaging characteristics were compared according to LN disease burden (1–2 positive LNs vs. ≥ 3 positive LNs). A total of 542 patients were included in the analysis. Among them, 225 (41.5%) patients had a preoperative positive ALN biopsy. More than 40% of the patients (n = 99, 44.0%) with a positive biopsy had only 1–2 positive ALNs. The association between nodal burden and imaging factors was strongest when ≥ 2 suspicious LNs were identified on PET/CT images (HR 8.795, 95% CI 4.756 to 13.262). More than one imaging modality showing ≥ 2 suspicious LNs was also strongly correlated with ≥ 3 positive ALNs (HR 5.148, 95% CI 2.881 to 9.200). Nearly half of patients with a preoperative biopsy-proven ALN metastasis had only 1–2 positive LNs on ALND. Patients meeting ACOSOG Z0011 criteria with only one suspicious LN on PET/CT or those presenting with few abnormal ALNs on only one imaging modality appear appropriate for SLNB and consideration of ALND omission. |
| Databáze: | OpenAIRE |
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