Axillary lymph node dissection could be omitted in the breast cancer patients with a limited sentinel lymph node involvement following neoadjuvant systemic treatment

Abstract

Background: In modern breast cancer management, SLNB is a standard of care. For the patients with limited sentinel lymph node involvement in the upfront surgery setting, ALND can be safely omitted. However, for any sentinel node metastasis detected following neoadjuvant systemic treatment (NST), ALND is still considered a mandatory procedure. Patients and methods: Present retrospective analysis has included all breast cancer patients submitted to surgery following NST in Clinical Hospital Centre (CHC) Rijeka in the period from 2017 till 2020. Results: SLNB was performed in 151 of 222 consecutive patients, and sentinel node metastasis was detected in 49 cases. The risk of non-sentinel lymph node involvement in sentinel node-positive patients was 34.7%, but exclusively for cases with macro-metastatic disease detected in the sentinel node. In addition, for the patients diagnosed with clinically uninvolved axilla, the risk of ypN2-3 status was only 2.8%. Conclusions: ALND following NST is overtreatment in 65.3% of sentinel node-positive patients. Axillary irradiation with the omission of ALND should be considered for the sentinel-positive patients with only micro-metastatic disease detected in the sentinel node following neoadjuvant chemotherapy, as well as for those with low volume macro metastatic disease, diagnosed with the uninvolved axilla.

Keywords

• breast cancer
• neoadjuvant chemotherapy
• sentinel lymph node biopsy