Level I axillary dissection in patients with breast cancer and tumor-involved sentinel lymph node after NAC is not sufficient for adequate nodal staging
Jan Žatecký1-3
, Oldřich Coufal1,4, Miloš Holánek5,6, Otakar Kubala7,8, Markéta Kepičová8, Jiří Gatěk9, Milan Lerch3, Matúš Peteja2,3
1Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
2The Institute of Paramedical Health Studies, Silesian University, Opava, Czech Republic
3Department of Surgery, Silesian Hospital in Opava, Opava, Czech Republic
4Department of Surgical Oncology, Masaryk University, Brno, Czech Republic
5Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
6Department of Comprehensive Cancer Care, Masaryk University, Brno, Czech Republic
7Department of Surgical Studies, University of Ostrava, Ostrava, Czech Republic
8Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
9Department of Surgery, EUC Clinic Zlín, Zlín, Czech Republic
Abstract
Objective: The purpose of the study was to investigate the oncological sufficiency of level I axillary dissection for adequate histological nodal staging (ypN) in patients with breast cancer and tumor-involved sentinel lymph node (SLN) after neoadjuvant chemotherapy (NAC).
Material and Methods: A prospective multicentre pilot study took place from 01.01.2018 to 30.11.2020 in three mammary centres in the Czech Republic in patients with breast cancer after NAC (NCT03556397). Patients in the cohort with positive histological frozen section of SLN were indicated to separate axillary dissection of levels I and II.
Results: Sixty-one patients with breast cancer after NAC were included in the study according to inclusion and exclusion criteria. Twelve patients with breast cancer and tumour involved SLN after NAC were further included in the analysis. Two (16.7%) patients had positive non-sentinel lymph nodes in level I only, one (8.3%) patient had positive lymph nodes in level II only, and seven (58.3%) patients had positive lymph nodes in both levels. Level I axillary dissection in a patient with tumour involved SLN after NAC would have resulted in understaging in five (41.7%) patients, mostly ypN1 instead of ypN2.
Conclusion: According to our pilot result, level I axillary dissection is not sufficient in terms of adequate histological nodal staging in breast cancer patients after NAC, and level II axillary dissection should not be omitted.
Keywords: Breast cancer, sentinel lymph node biopsy, neoadjuvant chemotherapy, axillary dissection, level I axillary dissection
Cite this article as: Žatecký J, Coufal O, Holánek M, Kubala O, Kepičová M, Gatěk J, et al. Level I axillary dissection in patients with breast cancer and tumor-involved sentinel lymph node after NAC is not sufficient for adequate nodal staging. Turk J Surg 2023; 39 (1): 1-6.
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Faculty of Medicine, University of Ostrava (12/2018, 26.3.2018), by the Ethics Committee of University Hospital Ostrava (1031/2017, 23.11.2017), by the Ethics Committee of Silesian Hospital in Opava (298/2017, 14.11.2017) and by the Ethics Committee of EUC Clinic Zlín (13/2020, 27.4.2020). All patients participating in the study signed consent to participate.
Externally peer-reviewed.
Concept - JT, OC, MH, OK; Design - JZ, OC, OK; Supervision - OC, OK, ML, MP; Fundings - MP, OC, MK; Materials - JZ, OC, MK, JG; Data Collection and/ or Processing - JZ, MK, JG; Analysis and/or Interpretation - JZ, OC, OK; Literature Search - JZ, MH, OC, ML; Writing Manuscript - JZ, MH, OC; Critical Reviews - JG, MP, ML.
The authors have no conflicts of interest to declare.
Supported by MH CZ – DRO (MMCI, 00209805) and by the Student Grant Competition of Specific University Research of the University of Ostrava (SGS04 / LF / 2018-2019).