In Selected Women with Breast Cancer and Positive Sentinel Lymph Node Metastases, Axillary Lymph Node Dissection May Not Be Needed

DynaMed Weekly Update - Volume 5, Issue 45

In a recent Weekly Update, the DynaMed Editors reported on a randomized trial with level 1 evidence showing that sentinel lymph node (SLN) resection alone is as effective as SLN resection plus axillary lymph node dissection (ALND) for women with node-negative invasive breast cancer. Another recent trial has compared SLN resection alone to SLN resection plus ALND in 856 women positive for SLN metastases. Women were randomized to have completion ALND or no ALND following a finding of metastatic disease in a SLN resection. Among the reasons for excluding patients from the trial were the presence of matted nodes, ? 3 SLNs with metastases, bilateral breast cancer, and gross extranodal disease at time of SLN resection. Comparing SLN resection alone vs. SLN resection plus ALND after median follow-up of 6.3 years, there were no significant differences in either local recurrence (1.8% vs. 3.6%) or regional recurrence (0.9% vs. 0.5%) (level 2 [mid-level] evidence). The trial was stopped early due to slow enrollment after enrolling only about half the calculated number of patients needed for 90% power (Ann Surg 2010 Sep;252(3):426).

For more information see the Breast cancer (female) topic in DynaMed.