Avoidance of axillary lymph node dissection in breast cancer patients with metastatic sentinel node - a pilot study
Abstract
Studying metastatic involvement of nonsentinel lymph nodes depending on metastatic involvement of sentinel nodes (SN) in breast cancer considering histopathology of the tumour as well admits avoidance of axillary lymph node dissection (ALND) by metastatic SN with postoperative radiotherapy and systemic oncological treatment for tumours less than 2cm, grade 1, low proliferative activity, hormonal dependent, without expresion HER2/neu and with micrometastasis in 1-2 SN. It has been shown that unfavourable tumours (pT2, G3, high proliferative activity) and macromatastasis in 1-2 SN as well doesn't have to be followed by ALND.
Metastatic lymph nodes is evidently bad prognostic factor, but there is no evidence that ALND in metastatic SN improves disease free interval (DFI) and overal survival (OS). In contrary there is a group of women without ALND with longer DFI and OS due to postoperative radiotherapy and systemic oncological treatment.
Scientific guidelines for avoidance ALND in metastatic SN need more prospective large studies. Nowadays it is admitted to avoid ALND individually if the complex treatment is headed by oncologist.