Omission of axillary dissection after a positive sentinel lymph-node: Implications in the multidisciplinary treatment of operable breast cancer.
Omission of axillary dissection in women with breast cancer and one or two positive sentinel-node biopsy is a major advancement in the management of this disease. Supported by a sound rationale and confirmed by prospective, randomized trials, omission of axillary dissection is now recommended in women who have undergone breast conserving surgery and who are candidate to adjuvant radiotherapy. Because breast cancer is best managed in the context of a multidisciplinary team, this surgical shift in the paradigm is expected to have implications that extend also to the other specialties involved in the team. In fact, the full evaluation of the axillary tumor burden has been historically considered an essential part of tumor staging and the absolute number of involved node critical information to tailor post-surgical treatments. Lack of this information in a patient with axillary involvement documented by a positive sentinel lymph-node biopsy may represent a challenge when deciding on further, post-surgical treatments. This review will address the critical aspects and the potential implications of omission of axillary dissection in the context of the multidisciplinary breast team.
Gynecological Oncology, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy.
Riccardo
R
Ponzone
University of Turin, Medical School, Turin, Italy.
Fiorella
F
Ruatta
Radiation Therapy, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy.
Marco
M
Gatti
Department of Medical Sciences, University of Turin, Italy.
Isabella
I
Castellano
Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy.
Elena
E
Geuna
University of Turin, Medical School, Turin, Italy.
Giulia
G
Amato
Gynecological Oncology, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy.
Franziska
F
Kubatzki
Gynecological Oncology, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy.
Paola
P
Sgandurra
University of Turin, Medical School, Turin, Italy; Surgical Pathology, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy.
Anna
A
Sapino
Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy. Electronic address: filippo.montemurro@ircc.it.
Filippo
F
Montemurro
D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
Breast cancer; Chemotherapy; Multidisciplinary breast team; Prognosis; Radiotherapy; Sentinel lymph-node biopsy