title: Long-term follow-up of 5262 breast cancer patients with negative sentinel node and no axillary dissection confirms low rate of axillary disease.
abstract: OBJECTIVE
  It is established that axillary dissection (AD) can be safely avoided in breast cancer patients with a negative sentinel node (SN). In the present study we assessed whether the rate of axillary disease was sufficiently low on long term follow-up to consolidate the policy of AD avoidance.
  
  
  METHODS
  We retrospectively analysed data on 5262 consecutive primary breast cancer patients with clinically negative axilla and negative SN, treated from 1996 to 2006, who did not receive AD. We used univariate and multivariate analyses to assess the influence of patient and tumour characteristics on first events and survival. The primary endpoint was the development of axillary disease as first event.
  
  
  RESULTS
  After a median follow-up of 7.0 years (interquartile range 5.4-8.9 years) survival for the series was high (91.3%; 95% CI 90.3-92.3 at 10 years) and only 91 (1.7%) patients developed axillary disease as first event. Axillary disease was significantly more frequent in patients with the following characteristics: <35 years at diagnosis, tumour >1 cm, multifocality/multicentricity, G3, ductal histotype, Ki67 ≥ 30%, peritumoral vascular invasion, luminal B-like subtype, HER2 positivity, mastectomy, and not receiving radiotherapy.
  
  
  CONCLUSIONS
  Long-term follow-up of our large series confirms that axillary metastasis is infrequent when AD is omitted in SN-negative breast cancer patients, and has low impact on overall survival.
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy. Electronic address: Viviana.galimberti@ieo.it.
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Manika
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Maisonneuve
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Corso
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Salazar Moltrasio
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Intra
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Gentilini
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy; University of Milan School of Medicine, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Veronesi
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pagani
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Rossi
authors.affiliation: Department of Pathology, European Institute of Oncology, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bottiglieri
authors.affiliation: University of Milan School of Medicine, Milan, Italy; Department of Pathology, European Institute of Oncology, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Viale
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Rotmensz
authors.affiliation: Division of Nuclear Medicine, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: De Cicco
authors.affiliation: Division of Nuclear Medicine, Milan, Italy.
authors.forename: C M
authors.initials: CM
authors.lastname: Grana
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sangalli
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Luini
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy
keywords: Axillary disease; Axillary dissection; Breast cancer; Sentinel node biopsy