ReviewSentinel lymph node micrometastasis in human breast cancer: An update
Highlights
► The presence of SLN MM is an indicator of poorer prognosis in breast cancer. ► Use of adjuvant therapy in SLN MM patients is associated with improved survival. ► Complete axillary dissection may be safely omitted in patients with SLN MM. ► The optimal management of SLN MM is yet to conclude.
Section snippets
Introduction & background
The axillary lymph node (ALN) status at the time of diagnosis is the most powerful predictor of survival in breast cancer (BC) patients [1], [2]. In addition, decisions regarding adjuvant therapies are largely influenced by lymph node status. Axillary lymph node dissection (ALND) remains the gold standard, it provides accurate staging information and local control of the disease; however, the morbidity of this procedure can be high. The sentinel lymph node biopsy (SLNB) has now been confirmed
Search methodology
MEDLINE and PubMed were used to search for relevant articles. Articles identified using the key words “breast cancer” or “sentinel lymph node” or “axillary lymph node” or “lymph node” and “micrometastasis” or “micrometastasis” or “micro metastasis” or “micro metastases” or “micro-metastasis” or “micro-metastases" and “adjuvant therapy” and “evidence” or “prognosis” or “morbidity” or “mortality” or “recurrence” or “ failure” or “survival”. Studies identified were screened for those that focused
The clinical significance of axillary micrometastasis
Published studies have reported divergent and conflicting results regarding the significance and implications of ALN MM in general and SLN MM in particular [14]. Clinical outcome such as overall survival, disease-free survival, loco-regional recurrence and distant metastasis have been evaluated. Furthermore, in patients with SLN MM studies examined the incidence of non-SLN involvement. In the following, we evaluate the incidence of non-SLN metastatic involvement in patients with SLN MM and its
Discussion
The management of breast cancer patients has witnessed dramatic changes in the last two decades. Early diagnosis, breast conserving surgery, the advent of SLNB and advances in adjuvant therapies have replaced old practices. One of the key drivers of this change has been an improved understanding of the natural history and tumour biology of BC. Now, the biological model that considers BC as a systemic disease with disseminated MM at the time of diagnosis [87] is considered an acceptable way of
Conclusion
The latest published evidence suggests that the SLN MM is likely to have significant prognostic implications in early-stage BC. There is a growing body of evidence that patients with SLN MM have a poorer prognosis than those who are SLN negative. SLN MM is likely to be associated with non-SLN involvement some of which are macro-metastatic foci. In the absence of level 1 evidence, decisions about the management options of patients with SLN MM should be taken in the context of risk estimate
Conflict of interest statement
The authors declare that they have no competing interests.
References (134)
- et al.
Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial
Lancet Oncol
(2007) - et al.
Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study
Lancet Oncol
(2006) - et al.
Introduction of sentinel node biopsy and stage migration of breast cancer
Eur J Surg Oncol
(2006) Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer
Eur J Surg Oncol
(2008)- et al.
The value of intraoperative frozen section examination of sentinel lymph nodes in breast cancer
Eur J Surg Oncol
(2009) - et al.
Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines
Eur J Cancer
(2003) - et al.
Role of immunohistochemical detection of lymph-node metastases in management of breast cancer
Lancet
(1999) - et al.
Comparison of pathologist-detected and automated computer-assisted image analysis detected sentinel lymph node micrometastases in breast cancer
Mod Pathol
(2003) - et al.
Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection
Mod Pathol
(2005) - et al.
Axillary lymph-node dissection for positive sentinel nodes in breast cancer patients
Eur J Surg Oncol
(2002)