title: Axillary lymph node dissection in patients  with breast cancer and sentinel lymph node micrometastasis or isolated tumor cells:  is it necessary?
abstract: OBJECTIVE
  Sentinel lymph node biopsy is the standard method for axillary lymph node staging in patients with early stage breast cancer. The aim of the study was to evaluate the necessity of axillary lymph node dissection in patients with breast cancer and sentinel lymph node micrometastasis or isolated tumor cells.
  
  
  METHODS
  Sentinel lymph node biopsy was performed in 136 patients for breast cancer staging: 16 of them (11.7%) were found to have micrometastasis or isolated tumor cells and underwent axillary lymph node dissection. Micrometastases were considered when tumor invasion was ≤ 2 mm and >0.2 mm in diameter and isolated tumor cells when detected alone or in clusters of <0.2 mm in diameter. The dissection of the three axillary lymph node levels of Berg was performed in all cases.
  
  
  RESULTS
  Two patients (12.5%) presented isolated tumor cells and 14 (87.5%) micrometastasis in the sentinel lymph node. Among them, 25% presented nonsentinel axillary lymph node tumor invasion, whereas 75% had no further nodal involvement.
  
  
  CONCLUSIONS
  Results suggest that micrometastasis or isolated tumor cells of the sentinel lymph node represent the only site of cancer involvement of the axilla, especially in patients with early breast tumors, and that axillary lymph node dissection may be unnecessary in these cases and represent an overtreatment.
authors: Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy. f.attene@uniss.it
authors: Federico
authors: F
authors: Attene
authors: Panagiotis
authors: P
authors: Paliogiannis
authors: Fabrizio
authors: F
authors: Scognamillo
authors: Emilio
authors: E
authors: Trignano
authors: Carlo
authors: C
authors: Pala
authors: Mario
authors: M
authors: Trignano
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy