Management of Sentinel Lymph Node (SLN) Positive Breast Cancer Patients

• Traditionally, axillary lymph node dissection (ALND) was performed in the setting of a positive Sentinel Lymph Node (SLN):
  • A paradigm shift occurred in 2010 following results of the ACOSOG Z0011 trial which challenged the traditional approach:
    • This trial definitively changed the management of SLN positive axillary metastases in patients with early-stage clinically node-negative breast cancer.
  • The Z0011 trial enrolled patients with:
    • Clinically node-negative
    • T1 or T2 early-stage breast cancer undergoing breast conservation therapy (BCT) and SLN dissection
    • With three or fewer positive SLNs as detected by hematoxylin and eosin (H&E) staining.
  • Critically important to this study was the requirement that:
    • All patients received postoperative whole breast radiation and chemotherapy as indicated.
  • Patients were randomized to completion axillary dissection versus no further axillary surgery.
  • At a median follow-up of 6.3 years:
    • There was no difference in overall survival:
      • ALND 91.9% vs. 92.5% in SLN-only (P = 0.24)
    • There was no difference in disease free survival at 5 years:
      • ALND 82.2% vs. 83.8% in SLN-only (P = 0.13)
    • There was no significant difference in local recurrence:
      • 3.6% of the ALND group versus 1.8% of the SLND-only group.
    • After ALND alone:
      • Ipsilateral axillary recurrence was identified in 0.5% of patients 
    • After SLNB alone:
      • Ipsilateral axillary recurrence was identified in 0.9%
  • Although this study closed early due to poor accrual:
    • Results suggest that in clinically node-negative patients with early-stage breast cancer who will receive whole breast radiotherapy and systemic adjuvant therapy as indicated, ALND does not confer an improved survival advantage:
      • In this setting SLN dissection alone for appropriate staging with completed adjuvant therapy may offer excellent regional control with decreased morbidity.
  • Since the publication of these practice-changing results,:
    • The Z0011 findings have been rapidly and widely adopted and are now considered standard practice.
    • It is important to note that these findings are not applicable to all patients including:
      • Those with locally advanced (T3 or T4) disease
      • Those who received neoadjuvant chemotherapy
      • Those undergoing mastectomy

Rodrigo Arrangoiz MS, MD, FACS a surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

• He is an expert in the management of breast cancer.

  • If you have any questions about the management of Sentinel Lymph Node (SLN) positive breast cancer patients please fill free to contact Dr. Arrangoiz.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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