Is sentinel lymph node biopsy enough for axillary macrometastasis?

Abstract

Although omission of further treatment to axilla in clinical N0 T1-2 breast cancer patients with conserved breast and positive micrometastatic 1-2 sentinel lymph node(s) is relatively well established, optimal management of the axilla in macrometastatic disease is controversial. Z0011 (micro- and macromets), International Breast Cancer Study Group (IBCSG) 23-01 (micromets), and AMAROS (micro- and macromets) are randomized trials try to determine best management. According to Z0011 axillary lymph node dissection (ALND) isn’t necessary and sentinel lymph node dissection (SLND) could be the appropriate choice. IBCSG 23-01 not only further strengths this idea for the micrometastatic cases but also shows that quality of life could be improved with SLND. In Saint Gallen consensus report 2013, 73% of the experts state that avoiding full axillary clearance after 1-2 positive sentinel nodes is endorsed in situations of conservative surgery and radiotherapy (RT). AMAROS announced at ASC0 2013 Meeting and showed that both axillary RT and ALND were equally effective but less lymphedema with axillary RT. Although Z0011 changes the practice, details of radiotherapy fields have recently been announced at the San Antonio 2013 Meeting. In review of patients with evaluable detailed radiotherapy records, roughly 70% of them received some form of lymphatic RT. Hence, omission of further treatment to axilla with macrometastatic sentinel lymph node isn’t appropriate and either ALND or axillary RT can be an effective options treating patients but with less lymphedema in RT arm. It’s still not clear whether these suggestions could be applicable to the patients treated with mastectomy.

Externally peer-reviewed.

Concept - M.F., H.K.; Design - M.F., H.K.; Supervision - M.F., H.K.; Data Collection and/or Processing - M.F., M.T., H.K.; Analysis and/or Interpretation - M.F., H.K.; Literature Review - M.F., M.T., H.K.; Writer - M.F.; Critical Review - M.F., H.K.

No conflict of interest was declared by the authors.

The authors declared that this study has received no financial support.