Completion axillary lymph node dissection (ALND) is the recommended procedure in patients with a positive sentinel lymph node biopsy (SLNB), yet most of them harbor no metastatic lymph nodes beyond SLN (non-SLNs) in the axillary basin. Although a few models or nomograms for predicting the non-SLNs metastases have been proposed to identify good candidates for omitting ALND after a positive SLNB, the ones which include histopathological variables may not be practical because such findings are available only after surgery.The aim of this study was to develop a simple rule predictive of no metastases to non-SLN that may assist in shared decision making on adding oromitting ALND.
Among 357 patients with Tis or T1-T3N0M0 primary breast cancer who underwent SLNB from January 2002 to December 2012, 68 patients (19%) with positive SLNB received additional ALND. Numbers of harvested and positive lymph nodes as well as tumor size were correlated with the ALND negative rate.
49 patients (72%) had no metastases to non-SLN. The median numbers of removed and positive SLNs were 2 (range 1-12) and 1 (range 1–3), respectively. The median tumor size was1.7cm (range 0.3 -9.0). ALND negative rate was 91% (95%CI: 82–100%) for patients who had only one positive node among 2 or more harvested SLNs, while the rate was 53% (95%CI: 36–70%) for those other SLNB results. Tumor size was not associated with ALND negative rate.
Patients with only one SLN positive who have 2 or more SLNs biopsied may be candidates for omitting additional ALND, given that appropriate adjuvant local and systemic therapies are delivered.
Clinical trial identification
All authors have declared no conflicts of interest.