title: Completion axillary dissection can safely be omitted in screen detected breast cancer patients with micrometastases. A decade's experience from a single institution.
abstract: BACKGROUND
  The need for completion axillary lymph node dissection (ALND) in breast cancer patients with micrometastases in the sentinel nodes (SNs) is controversial. The aim of this retrospective observational study is to determine if the method of detection of early breast cancer is predictive for additional positive nodes in patients with micrometastases in the SNs.
  
  
  METHODS
  Between 2001 and 2011 a total of 1993 women with primary unilateral breast cancer had surgery at Skåne University Hospital, Lund. Of 1993 patients, 1458 had an SN biopsy and nearly all patients with micro- and macrometastases had ALND.
  
  
  RESULTS
  Micrometastases defined as >0.2 mm/>200 cells and ≤2.0 mm were found in 62 of 757 screen-detected patients and in 81 of 701 patients with symptomatic breast cancer. Only 3 of the screen-detected patients with micrometastases, all with tumour size >15 mm (range 18-39 mm), had metastases in the completion ALND whereas this was found in 18 of the symptomatic patients with micrometastases (p = 0.01), (tumour size, range 10-30 mm). Logistic regression analysis adjusted for method of detection, tumour size and histological grade showed 5 times higher odds for further metastases in ALND in patients with symptomatic presentation vs. screen-detected breast cancer.
  
  
  CONCLUSIONS
  Despite the small number of patients with micrometastases in this large cohort of breast cancer patients, these results support the contention that completion ALND can safely be omitted in screen-detected breast cancer patients with micrometastases in the SNs.
authors.affiliation: Department of Pathology, Skåne University Hospital, Lund, Sweden. Dorthe.grabau@skane.se
authors.forename: D
authors.initials: D
authors.lastname: Grabau
authors.forename: L
authors.initials: L
authors.lastname: Dihge
authors.forename: M
authors.initials: M
authors.lastname: Fernö
authors.forename: C
authors.initials: C
authors.lastname: Ingvar
authors.forename: L
authors.initials: L
authors.lastname: Rydén
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000556:secondary / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008327:Mammography; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D061206:Neoplasm Micrometastasis; D049451:Nomograms; D016017:Odds Ratio; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
chemical_list: D014408:Biomarkers, Tumor