A Positive Sentinel Lymph Node Biopsy (SLNB) Mean Axillary Lymph Node Dissection (ALND)

• A patient with early breast cancer diagnosis who underwent breast conserving surgery and had one out of two SLN positive for metastatic disease but without extra-capsular extension:
  • Should this patient undergo ALND?
    • The risk of finding additional lymph node metastases in this clinical scenario:
      • Is approximately 27%
  • The standard approach has been to recommend ALND when sentinel nodes are positive:
    • However, the results from ACOSOG Z0011 have changed this practice in node-positive women with T1 to T2 breast cancer treated with breast conservation:
      • This study randomized patients found to have 1 to 2 histologically positive SLNs to no further axillary surgery versus ALND
      • Most patients received whole-breast radiotherapy and systemic therapy
      • At a median follow-up of 6.3 years:
        • The investigators found no significant difference in:
          • Local regional control, overall survival, or disease-free survival between those who received ALND and those who did not
      • Regional recurrence rates were less than 1% in both groups
  • The results of ACOSOG Z0011 were practice changing:
    • As the study emphasized that effective systemic therapy and radiation therapy coupled with less-extensive surgery provided equivalent local control and survival to aggressive axillary surgery in clinically node-negative patients with metastases in 1 or 2 SLNs
  • There is no evidence that removal of additional lymph nodes is beneficial
• A positive sentinel node:
  • Is no longer an indication for ALND in the setting of breast conservation when no more than 2 nodes are involved

• REFERENCES
  1. Caudle AS, Cupp JA, Kuerer HM. Management of axillary disease. Surg Oncol Clin N Am. 2014;23:473-486. doi: 10.1016/j.soc.2014.03.007. Epub 2014 Apr 13. http://www.ncbi.nlm.nih.gov/pubmed/24882346
  2. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569-575. doi: 10.1001/jama.2011.90. http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2011.90

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

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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