title: Can axillary node dissection be safely omitted in the elderly? A retrospective study on axillary management of early breast cancer in older women.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) is a minimally invasive technique to stage the axillary lymph node status. The burden of nodal metastasis is of great concern, as the clinical relevance and therapeutic implications of pN1mi and pN0(i+) in the sentinel lymph node (SLN) remain a matter of debate.
  
  
  METHODS
  We examined the pathological features of 901 patients above the age of 65 presenting with clinical T1-T2 N0M0 breast tumours (<3 cm), detecting tumours related to llary non-sentinel node (NSN) metastases when the SLN was minimally involved.
  
  
  RESULTS
  A total of 270 patients underwent complete axillary lymph node dissection (cALND) after their SLNB specimen tested positive for macrometastasis, micrometastasis and isolated tumour cells (ITCs). Seventy-six patients were diagnosed with micrometastatic disease pN1mi (27.5%), whilst ITCs (pN0i+) were detected in seven patients (2.5%). NSNs were found to be involved in two patients (2.6%) with micrometastases at the SLN. No further metastatic disease was detected in NSNs when the SLN contained ITCs. At a median follow-up period of 5.8 years, no axillary recurrence was observed among pN1mi and pN0(i+) patients. Lobular histotype, multicentricity and lymphovascular invasion were found to be associated with NSN involvement.
  
  
  CONCLUSIONS
  The results from our case series are supported by IBCSG 23-01 level 1 evidence, which demonstrated a local recurrence rate of 1% in 'minimally involved not-surgical treated axilla'.
  
  
  CONCLUSIONS
  Based on current evidence, we spare well-informed and consenting patients from further axillary surgery when the SLN is minimally involved in early breast cancer within an agreed protocol, whilst scheduling adjuvant treatment based on the patients' primary tumour characteristics.
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: emanuelaexpo@hotmail.it.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Esposito
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: vivianasollazzo@hotmail.com.
authors.forename: Viviana
authors.initials: V
authors.lastname: Sollazzo
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: rosadimicco@alice.it.
authors.forename: Rosa
authors.initials: R
authors.lastname: Di Micco
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: mariacervotti@alice.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Cervotti
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: gaetano.luglio@gmail.com.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Luglio
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: gbenassa@unina.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Benassai
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: pasqualedoc@gmail.com.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mozzillo
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: stefanoperrotta.s@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Perrotta
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: vin_des@hotmail.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Desiato
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: bramato@unina.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: forestie@unina.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: glimite@unina.it.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Limite
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007558:Italy; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*
keywords: Early breast cancer; Micrometastases; Sentinel node biopsy