Axillary recurrence after a tumor-positive sentinel lymph node biopsy without axillary treatment: a review of the literature.
BACKGROUND
Sentinel lymph node biopsy (SLNB) has become standard of care as a staging procedure in patients with invasive breast cancer. A positive SLNB allows completion axillary lymph node dissection (cALND) to be performed. The axillary recurrence rate (ARR) after cALND in patients with positive SLNB is low. Recently, several studies have reported a similar low ARR when cALND is not performed. This review aims to determine the ARR when cALND is omitted in SLNB-positive patients.


METHODS
A literature search was performed in the PubMed database with the search terms "breast cancer," "sentinel lymph node biopsy," "axillary" and "recurrence." Articles with data regarding follow-up of patients with SLNB-positive breast cancer were identified. To be eligible, patients should not have received cALND and ARR should be reported.


RESULTS
Thirty articles were analyzed. This resulted in 7,151 patients with SLNB-positive breast cancer in whom a cALND was omitted (median follow-up of 45 months, range 1-142 months). Overall, 41 patients developed an axillary recurrence. 27 studies described 3,468 patients with micrometastases in the SLNB, of whom 10 (0.3 %) developed an axillary recurrence. ARR varied between 0 and 3.7 %. Sixteen studies described 3,268 patients with macrometastases, 24 (0.7 %) axillary recurrences were seen. ARR varied between 0 and 7.1 %. Details regarding type of surgery and adjuvant treatment were lacking in the majority of studies.


CONCLUSIONS
ARR appears to be low in SLNB-positive patients even when a cALND is not performed. Withholding cALND may be safe in breast cancer selected patients such as those with isolated tumor cells or micrometastatic disease.
Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. clairefrancissen@hotmail.com
Claire M T P
CM
Francissen
Pim J M
PJ
Dings
Thijs
T
van Dalen
Luc J A
LJ
Strobbe
Hanneke W M
HW
van Laarhoven
Johannes H W
JH
de Wilt
D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D015201:Meta-Analysis as Topic; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D012196:Review Literature as Topic; D021701:Sentinel Lymph Node Biopsy