J Breast Cancer.  2018 Sep;21(3):306-314. 10.4048/jbc.2018.21.e44.

Comparative Study between Sentinel Lymph Node Biopsy and Axillary Dissection in Patients with One or Two Lymph Node Metastases

• Lee J
• Choi JE
• Kim SJ
• Lee SB
• Seong MK
• Jeong J
• Yoon CS
• Kim BK
• Sun WY
• The Korean Breast Cancer Society

• KMID: 2421371
• DOI: http://doi.org/10.4048/jbc.2018.21.e44

Abstract

PURPOSE
Sentinel lymph node biopsy (SLNB) is a standard axillary surgery in early breast cancer. If the SLNB result is positive, subsequent axillary lymph node dissection (ALND) is a routine procedure. In 2011, the American College of Surgeons Oncology Group Z0011 trial revealed that ALND may not be necessary in early breast cancer with one or two positive sentinel lymph nodes. The purpose of this study was to compare outcomes among Korean patients with one or two positive axillary lymph nodes in the final pathology who did and did not undergo ALND.
METHODS
A total of 131,717 patients from the Korea Breast Cancer Society registry database received breast cancer surgery from January 1995 to December 2014. Inclusion criteria were T stage 1 or 2, one or two positive lymph nodes, and having received breast-conserving surgery (BCS), whole breast radiation therapy, and no neoadjuvant therapy. We analyzed the differences in disease-specific survival (DSS) and overall survival (OS) between patients who received SLNB only and those who underwent SLNB+ALND.
RESULTS
A total 4,442 patients met the inclusion criteria, with 1,268 (28.6%) in the SLNB group and 3,174 (71.4%) in the SLNB+ALND group. There were no differences in DSS and OS between the two groups (p=0.378 and p=0.925, respectively). The number of patients who underwent SLNB alone for one or two positive lymph nodes increased continuously from 2004 to 2014.
CONCLUSION
Korean patients with early breast cancer and 1 or 2 positive axillary lymph nodes who received BCS plus SLNB showed no significant difference in DSS and OS regardless of whether they received ALND. The findings of this retrospective study demonstrate that omitting ALND can be considered when treating selected patients with early breast cancer who have one or two positive lymph nodes.

Keyword

Breast neoplasms; Lymphatic metastasis; Sentinel lymph node biopsy; Survival

MeSH Terms

Breast
Breast Neoplasms
Humans
Korea
Lymph Node Excision
Lymph Nodes*
Lymphatic Metastasis
Mastectomy, Segmental
Neoadjuvant Therapy
Neoplasm Metastasis*
Pathology
Retrospective Studies
Sentinel Lymph Node Biopsy*
Surgeons

Figure

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  Figure 1 Selection and categorization of patients with one or two positive axillary lymph nodes in the study cohort.SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection.

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  Figure 2 Survival outcomes by sentinel lymph node biopsy (SLNB) versus SLNB+axillary lymph node dissection (ALND) in early breast cancer. (A) Disease-specific survival. (B) Overall survival.

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  Figure 3 Disease-specific survival and overall survival according to molecular subtype. (A) Luminal A-like. (B) Luminal B-like. (C) Triple-negative. (D) HER2-enriched.SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection; HER2=human epidermal growth factor receptor 2. *Luminal B-like and HER2-enriched type has no disease-related death.

• 

  Figure 4 Annual incidence of sentinel lymph node biopsy (SLNB) versus SLNB+axillary lymph node dissection (ALND) in patients with one or two positive axillary lymph nodes.

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