Locoregional Management of the Axilla in Mastectomy Patients with One or Two Positive Sentinel Nodes: The Role of Intraoperative Pathology

Autor: John C. Cheville, John M. Davis, Courtney N. Day, Mara A. Piltin, Judy C. Boughey, Tanya L. Hoskin, Tina J. Hieken
Rok vydání: 2021
Předmět:
Zdroj: Clinical Breast Cancer. 21:458-465
ISSN: 1526-8209
Popis: Tailoring axillary surgery to disease burden has occurred for patients treated with breast-conserving surgery, but limited data exist for patients treated with mastectomy, thus most of these patients who are clinically node-negative but found to be pathologically node-positive are treated with axillary dissection. From 2295 clinically node-negative mastectomy patients treated at our institution 2008-2018, we studied 338 with 1-2 positive sentinel nodes. Patients with a positive sentinel node identified on intraoperative frozen section pathology had a higher nodal disease burden. 66 of 108 patients (61%) whose nodal disease was identified only on permanent section pathology were treated with sentinel node surgery without axillary dissection with no 5-year regional nodal recurrences. This approach permits tailoring axillary surgery in most clinically node-negative mastectomy patients whilst avoiding a second operation. Introduction : Controversy exists regarding optimal management of the axilla in clinically node-negative (cN0) mastectomy patients with 1-2 positive sentinel nodes (+SLNs). We evaluated the influence of frozen section pathology on axillary management and recurrence. Materials and Methods : We studied cN0 breast cancer patients treated 2008-2018 with mastectomy and SLN surgery with 1-2+SLNs. Patients with 1-2+SLNs identified on frozen section intraoperatively (FS+SLN) were compared to those with 1-2+SLNs not detected by frozen section (FS–SLN). Recurrence rates were estimated using the Kaplan-Meier method. Results : Of 2295 cN0 mastectomy patients, 338 had 1-2+SLNs: 108 (32%) FS-SLN and 230 (68%) FS+SLN. In FS+SLN cases, completion axillary dissection (cALND) was more frequent (97% versus 39%, p Conclusions : Mastectomy patients with 1-2 FS+SLNs have a higher nodal disease burden than FS-SLN patients. The majority of FS+SLN patients underwent cALND and 52% received PMRT with very low 5-year regional nodal recurrence rates. A substantial proportion of FS-SLN patients successfully avoided both cALND and PMRT. Frozen section pathology analysis can guide de-escalation of axillary management.
Databáze: OpenAIRE
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