Is a completion axillary dissection indicated for micrometastases in the sentinel lymph node?
Section snippets
Methods
Between June 1998 and March 2001, 227 breast cancer patients underwent SLNM at Grant Medical Center. Their charts were retrospectively reviewed for this study. All surgeries were performed by two fellowship trained surgical oncologists (BJSS, TAN) who had completed SLNM courses at the National Cancer Institute. Patients with palpable lymphadenopathy or neoadjuvant chemotherapy were excluded. All patients underwent intraparenchymal injection of 5 cc 1% isosulfan blue dye (Lymphazurin; U.S.
Results
Over a 33-month period, 227 patients were identified as candidates for SLNM at Grant Medical Center. One patient was excluded from this study owing to inability to identify the SLN. In the 226 remaining patients, 82 (36%) were found to have metastatic disease in the SLN. Of these patients, 15 (6.7%) had microscopic metastasis. The tumor histology of the 15 patients with micrometastatic disease in the SLN was as follows: 13 invasive ductal carcinoma, 1 invasive lobular carcinoma, and 1 mucinous
Comments
As SLNM evolves into the gold standard in the staging of breast cancer patients, many issues need to be addressed: optimal technique, learning curve, accuracy in neoadjuvant patients, accuracy in patients with previous breast or axillary surgery, reliability in repeat SLNM, and, of course, the need for CAD. Small tumor size and micrometastatic disease in the axilla may be able to predict the negative status of non-SLNs and avoidance of CAD [1], [2], [3].
Micrometastasis in the SLN has been
Conclusion
Micrometastases in the SLN is an issue that warrants further investigation as SLNM evolves into the standard of care for breast cancer management. Standardizations in techniques, definition, histologic staining, and pathologic reporting will need to be in place for the data to be of value.
This study suggests that micrometastasis in the SLN may be the sole site of disease in the axilla. Other studies have confirmed this finding, especially in the presence of small primary tumors and in the
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