title: Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database.
abstract: BACKGROUND
  Complete axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) remains the standard practice. As nodal surgery has long been considered a staging procedure without a clear survival benefit, the need for ALND in all patients is debatable. The purpose of this study was to examine differences in survival for patients undergoing SLNB alone versus SLNB with complete ALND.
  
  
  METHODS
  Patients with breast cancer who underwent SLNB and were found to have nodal metastases were identified from the Surveillance, Epidemiology, and End Results database (1998-2004). Clinicopathologic and outcomes data were examined for patients who underwent SLNB alone versus SLNB with ALND.
  
  
  RESULTS
  We identified 26,986 patients with disease-positive lymph nodes; 4,425 (16.4%) underwent SLNB alone, and 22,561 (83.6%) underwent SLNB with ALND. Patients were significantly more likely to undergo SLNB alone if they were older (median 59 years old) or if the tumor was low grade and estrogen receptor positive. From 1998 to 2004, the proportion of patients with micrometastasis in the sentinel lymph nodes who underwent SLNB alone increased from 21.0 to 37.8% (P < 0.001). At a median follow-up of 50 months, there were no statistically significant differences in overall survival (OS) between patients who underwent SLNB alone versus complete ALND.
  
  
  CONCLUSIONS
  There is an increasing trend toward omitting ALND in patients with micrometastatic nodal disease identified by SLNB. Compared with SLNB alone, completion ALND does not seem to be associated with improved survival for breast cancer patients with micrometastasis in the sentinel lymph nodes.
authors.affiliation: Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Yi
authors.forename: Sharon Hermes
authors.initials: SH
authors.lastname: Giordano
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mittendorf
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Rosa F
authors.initials: RF
authors.lastname: Hwang
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Loren
authors.initials: L
authors.lastname: Rourke
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000639:trends*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy / Q000639:trends*; D055815:Young Adult