Omission of axillary lymph node dissection in early-stage breast cancer with positive sentinel lymph node biopsy
Update of evidence and therapeutic approach at the National Cancer Institute of Colombia
DOI:
https://doi.org/10.35509/01239015.749Keywords:
Breast neoplasms, sentinel lymph node, lymph node dissection, adjuvant radiotherapyAbstract
In breast cancer, the sentinel lymph node (SLN) is the first node to receive lymphatic drainage from the breast area containing the tumor, and is able to predict the status of the other axillary nodes. In recent years, multiple studies have shown the little impact of axillary lymph node dissection (ALND) in terms of disease-free survival (DFS) and overall survival (OS), which in turn has made it possible to establish criteria to omit axillary lymphadenectomy in patients with earlystage breast cancer. Women with infiltrating breast cancer and T1 and T2 tumors, and with clinically negative axilla, are candidates for SLN biopsy. If the SLN is positive, axillary dissection can be omitted only if the following requirements are
met: 1) surgical management of the primary tumor with conservative surgery or mastectomy, 2) negative surgical resection
margins for malignancy, and 3) SLN pathology report showing up to two sentinel nodes positive for micro- or macrometastasis, without extracapsular extension or with an extracapsular extension <=2 mm. Additionally, it is important to provide postoperative radiotherapy with high tangential fields to the whole breast or chest wall, and to the lower axillary region (a large part of axillary levels I and II), as well as the best adjuvant systemic treatment according to tumor biology.
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