Does the presence of sentinel lymph node macrometastases in breast cancer patients require axillary lymph node dissection?—Single‐center analysis

• Published in: The breast journal Vol. 24; no. 5; pp. 724 - 729
• Main Authors: Nowikiewicz, Tomasz, Zegarski, Wojciech, Pagacz, Konrad, Nowacki, Maciej, Morawiec‐Sztandera, Alina, Głowacka‐Mrotek, Iwona, Sowa, Magdalena, Biedka, Marta, Kołacińska, Agnieszka
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2018
• Subjects: ACOSOG Z0011; Breast cancer; Dissection; Lymph; macrometastasis; sentinel lymph node biopsy; surgical treatment; breast cancer; surgical treatment; sentinel lymph node biopsy; macrometastasis; ACOSOG Z0011
• ISSN: 1075-122X; 1524-4741
• DOI: 10.1111/tbj.12997

According to the current guidelines on treatment of breast cancer patients, identification of metastases in the sentinel lymph node (SLN (+)) is not an absolute indication for necessary axillary lymph node dissection (ALND). In our study, we present long‐term outcomes of treatment among SLN(+) patients referred for conservative treatment, for example, no further ALND. A total of 3145 breast cancer patients subjected to sentinel lymph node biopsy (SLNB) between November 2008 and June 2015. SLN metastases were identified in 719 patients (22.9%). Locoregional recurrences and distant metastases as endpoints were distinquished. The mean follow‐up time for patients after ALND was 36.2 months (6‐74 months); 18.8 months (6‐38 months) for patients with SLN macrometastases without ALND; and 34.0 months (6‐74 months) for patients with micrometastases. Adjuvant ALND was performed in 626 of SLN(+) patients. Conservative treatment was applied in the remaining 93 cases. Among SLN(+) patients without adjuvant ALND, there was one case of recurrence (1.07%). In the group of patients without SLN, metastases recurrence was noted in 32 patients (1.32%). Among SLN(+) patients diagnosed with macrometastases, recurrence concerned 2.01% of analyzed cases (all subjected to ALND). Lack of radical surgical treatment in SLN(+) breast cancer patients did not lead to worsening long‐term outcomes. In the occurrence of macrometastases to the sentinel lymph node, abandoning completion axillary lymph node dissection might be a reasonable option. However, it would require continuation of current research, preferably involving a clinical trial.