![]() However, the current accepted practice is to perform a full ALND when the sentinel node finding is positive. Women who have negative sentinel node findings do not have to undergo a full ALND. Sentinel node biopsy has proved to be an important tool in sparing a large population of women with breast cancer from a full axillary lymph node dissection (ALND). Most patients with stages I and II breast cancer do not have axillary lymph node metastasis. 11 - 14 Other complications such as neuropathies, seromas, and wound infections also affect a significant number of patients. Arm lymphedema is one of the major complications of axillary dissection, particularly when patients also undergo radiation therapy. 6 - 10 However, axillary dissection is not without morbidity. 1 - 5 With the advent of sentinel node biopsy, a similar shift in the paradigm to minimal axillary surgery is also evolving in the management of axillary disease in breast cancer.īecause axillary lymph node involvement is the most important prognostic factor in patients with breast cancer, the status of the axilla is an essential component of staging in patients with breast cancer. Several large multicenter trials have established that lumpectomy followed by radiation therapy, or breast conservation, is no different in terms of overall survival than mastectomy. However, pending results of larger clinical trials, full axillary lymph node dissection is still recommended for patients with sentinel lymph node metastases.ĭuring the past 3 decades, the surgical management of breast cancer has changed significantly. ![]() These findings may ultimately spare patients a full axillary lymph node dissection. 37).Ĭonclusions Although primary tumor size and micrometastases correlate with the status of the NSLNs, extranodal extension is the most important independent predictor of NSLN metastasis. The number of sentinel nodes removed also had no bearing on the status of the NSLNs ( P =. Lymphovascular invasion was not associated with positive NSLN findings ( P =. When all factors were included in a logistic regression analysis, the significant predictor of NSLN metastasis was extranodal extension ( P =. ![]() The presence of micrometastasis was associated with negative NSLN findings. Results In a univariate analysis, size of the primary tumor and extranodal extension were associated with having positive NSLN findings. Main Outcome Measures Sentinel node metastasis, NSLN metastasis, tumor size and stage, lymphovacular invasion, micrometastasis, extronodal extension, histological tumor characteristics, and number of sentinel nodes removed. ![]() Intervention Completion axillary lymph node dissection and definitive therapy. Patients Four hundred seven consecutive patients at a single institution who underwent sentinel lymph node dissection as part of breast conservation or mastectomy with biopsy-proved cancer. ![]() Hypothesis The presence of nonsentinel lymph node (NSLN) metastasis after having a positive sentinel lymph node dissection finding is associated with tumor size and stage, the presence of lymphovascular invasion, micrometastasis, and extranodal extension.
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