Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases

TLDR

Sentinel lymph node dissection has replaced axillary dissection for node‑negative breast cancer, but completion axillary dissection remains the standard for patients with tumor‑positive sentinel nodes, and few studies have examined outcomes when axillary dissection is omitted. The study reports local and regional recurrence data from the ACOSOG Z0011 trial, which randomized patients with sentinel node metastases to either axillary dissection after sentinel node dissection or sentinel node dissection alone. In this prospective trial, 446 patients received sentinel node dissection alone and 445 received sentinel node dissection plus axillary dissection; the groups were comparable in age, tumor characteristics, and adjuvant therapy, and recurrence was evaluated over a median follow‑up of 6.3 years. At 6.3 years, there were no statistically significant differences in local or regional recurrence between the two groups, indicating that sentinel node dissection alone can provide excellent regional control and may be reasonable for selected early‑stage breast cancer patients.

Abstract

Sentinel lymph node dissection (SLND) has eliminated the need for axillary dissection (ALND) in patients whose sentinel node (SN) is tumor-free. However, completion ALND for patients with tumor-involved SNs remains the standard to achieve locoregional control. Few studies have examined the outcome of patients who do not undergo ALND for positive SNs. We now report local and regional recurrence information from the American College of Surgeons Oncology Group Z0011 trial.American College of Surgeons Oncology Group Z0011 was a prospective trial examining survival of patients with SN metastases detected by standard H and E, who were randomized to undergo ALND after SLND versus SLND alone without specific axillary treatment. Locoregional recurrence was evaluated.There were 446 patients randomized to SLND alone and 445 to SLND + ALND. Patients in the 2 groups were similar with respect to age, Bloom-Richardson score, estrogen receptor status, use of adjuvant systemic therapy, tumor type, T stage, and tumor size. Patients randomized to SLND + ALND had a median of 17 axillary nodes removed compared with a median of only 2 SN removed with SLND alone (P < 0.001). ALND also removed more positive lymph nodes (P < 0.001). At a median follow-up time of 6.3 years, there were no statistically significant differences in local recurrence (P = 0.11) or regional recurrence (P = 0.45) between the 2 groups.Despite the potential for residual axillary disease after SLND, SLND without ALND can offer excellent regional control and may be reasonable management for selected patients with early-stage breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.