Axillary treatment of patients with breast cancer and micrometastatic disease in the sentinel lymph node Our experience


COD: 04_2017_14_2665 Categorie: ,

Andrea Morlino, Giuseppe La Torre, Giuseppe Patitucci, Aldo Cammarota

Ann. Ital. Chir., 2017 88, 4: 360-364

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AIM: Since the introduction of the sentinel lymph node biopsy (SLNB) in patients with breast cancer, micrometastases
are detected frequently in the sln.
PATIENTS AND METHODS: Between July 2005 and June 2016, 1244 patients were submitted to surgery for breast cancer.
431 patients cT1-2 N0 underwent to sentinel lymph node (SLN) and micrometastases were found in 68 of 431
screen-detected patients. Nearly all patients with both micro and macrometastases had axillary lymph node dissection
RESULTS: The SLN was negative in 69% of patients (296 of 431), 121 patients (28%) instead turned positive for
lymph node metastases and in 14 patients (3%) were identified isolated tumor cells (ITC). SLN micrometastases were
detected in 15,7% of patients (68 of 431). All patients with micrometastases underwent a completion ALND. In 85%
of cases, therefore, the sentinel node with micrometastases was the only site of nodal disease. Neither loco-regional recurrences
or distant metastases occurred in any of the Patients with sln micrometastases.
DISCUSSION: There is considerable interest in foregoing axillary dissection (AD) when the sentinel node (SN) is positive
in early breast cancer, particularly when axillary involvement is minimal (micrometastases or isolated tumor cells). Several
trials are addressing the problem. In breast cancer patients survival is not affected by the presence of micrometastatic
lymph node involvement.
CONCLUSION: In our experience we always underwent to ALND all patients with micrometastases. In the light of the
results we observed our attitude no longer provides for the axillary lymphadenectomy.