title: Completion axillary lymph node dissection not required for regional control in patients with breast cancer who have micrometastases in a sentinel node.
abstract: OBJECTIVE
  Completion axillary lymph node dissection (ALND) is not required for regional control in patients with metastases in the sentinel lymph node (SLN).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Urban teaching hospital.
  
  
  METHODS
  Fifty patients with breast cancer who underwent breast-conserving surgery, had an SLN positive for metastasis, and did not undergo completion ALND.
  
  
  METHODS
  Breast-conserving surgery with SLN biopsy, breast irradiation, and systemic therapy.
  
  
  METHODS
  Locoregional and distant recurrence and survival.
  
  
  RESULTS
  The mean patient age was 57 years (range, 29-83 years). The mean tumor size was 1.9 cm (range, 0.4-5 cm). The mean number of positive nodes was 1.3 (median, 1; range, 1-2). Fourteen patients (30%) had macrometastases (>2 mm), and 33 patients (71%) had micrometastases. The mean duration of follow-up was 82 months (median, 79 months; range, 6-142 months). One patient with an SLN micrometastasis (1 of 33; 3%) and 1 patient with an SLN macrometastasis (1 of 14; 7%) developed an axillary recurrence with distant metastasis at 84 months and 28 months, respectively. There was 1 death (2%) not related to breast cancer.
  
  
  CONCLUSIONS
  Patients with SLN metastases who do not undergo ALND have a low incidence of regional recurrence. Axillary lymph node dissection is not necessary for regional control in patients with micrometastatic disease.
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles Medical Center, 4760 Sunset Blvd, 3rd Floor, Los Angeles, CA 90027, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Yegiyants
authors.forename: Lina M
authors.initials: LM
authors.lastname: Romero
authors.forename: Philip I
authors.initials: PI
authors.lastname: Haigh
authors.forename: L Andrew
authors.initials: LA
authors.lastname: DiFronzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D019564:Unnecessary Procedures