Abstract 211P
Background
The IBCSG 23-01 and AMAROS trials both reported that axillary lymph node dissection (ALND) did not change survival rates in breast cancer patients with positive nodes detected by sentinel lymph node biopsy (SLNB). The aim of this study was to determine whether breast cancer patients with mastectomy and false-negative frozen section in SLNB could forgo ALND.
Methods
This is a retrospective study of node-negative (cN0) patients diagnosed with primary invasive breast cancer treated by mastectomy and SLNB at our institute between January 2011 and December 2015. Patients with false-negative frozen section in SLNB were separated by the following management of axillary lymph node dissection into non-ALND group (non-process or radiation only) and ALND group (with or without radiation).
Results
A total of 212 patients were included, 86 and 126 patients in the non-ALND and ALND group, respectively. The positive rate of non-SLNs was 15.87% (20/126) in the ALND group. In multivariate analysis, we found that patients with larger tumour size (>2cm) (OR 1.989, P=0.030) and multifocal lesions (OR 3.542, P=0.029) tended to receive ALND. The positivity of non-SLNs in the ALND group was associated with SLN macrometastasis (OR 3.551, P=0.043) and lymphovascular invasion (OR 6.158, P=0.003). Also, removing more SLNs (≥3) was related to negativity in non-SLNs in these patients (OR 0.255, P=0.016). After a median follow-up of 55.83 months, the DFS and OS of the two groups were similar (P=0.427 and 0.742). In subgroup analysis, we found that 108 patients who met the inclusion criteria for the IBCSG 23-01 trial had similar DFS and OS between non-ALND and ALND group (P=0.938 and 1.000). The positive rate of non-SLNs was 10.00% (6/60) in the ALND group. In addition, in 130 patients who met the inclusion criteria for the AMAROS trial, whether receiving ALND or radiation only, there was no significant difference in both DFS and OS (P=0.332 and 0.147). The positive rate of non-SLNs was 16.67% (20/120) in the ALND group.
Conclusions
ALND can be carefully omitted in breast cancer patients who have undergone mastectomy and false-negative frozen section in SLNB. SLNB is sufficient in patients who met the inclusion criteria for the IBCSG 23-01 trial, and radiation was as effective as ALND in patients who met the inclusion criteria of the AMAROS trial for both DFS and OS.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.