Skip to main content
×
Home
    • Aa
    • Aa
  • Access

Should positive sentinel node cases have a further axillary dissection?

  • B. Cady (a1)
  • DOI: http://dx.doi.org/10.1017/S1470903106005049
  • Published online: 01 June 2006
Abstract

The treatment of lymph node metastasis in human cancers has been a source of controversy for many years. Several contemporary randomized trials indicate no survival advantage to performing axillary dissection in contrast to merely observing the axilla after invasive breast cancer. This assumption is confirmed since survival advantages cannot be demonstrated when comparing greater or lesser lymph node dissections or dissection vs. observation of regional lymph nodes in melanoma and breast cancer and all other epithelial cancers.

Many recent studies indicate that axillary metastases, when they do occur in this era of mammographic screening and small invasive cancers, demonstrate metastases in the axillary sentinel nodes only in from 20% to almost 100% depending on primary cancer size. For instance, in T1a and T1b cancers, 50–100% of lymph node metastases, infrequently discovered, are contained entirely within the sentinel nodes. In T2 cancers, this proportion is roughly 25–50%, and in T3 cancers it ranges from 20% to 40%. A number of recent articles have demonstrated no difference in survival and very little nodal recurrence when patients with positive sentinel nodes are not followed by axillary dissection although the axillary disease tends to be less advanced in observed compared to treated patients with axillary dissection. Nevertheless, basic principles have been reconfirmed in these reports.

It has also been shown in animal research that clones of particular metastatic site cells demonstrate organ specificity. Transplanted human breast cancers demonstrate specific homing abilities to selective distant metastatic organ sites such as lymph nodes, bone, lung, or even adrenal gland. Genetic profiles of the different clones of cells with high metastatic specificity are each unique. Thus it is assumed that lymph node specific metastatic cells (and other organ-site-specific cells) have no ability to lodge and grow in other metastatic sites; this has been demonstrated clinically in clinical trials previously mentioned.

Therefore, there is no benefit in performing subsequent axillary dissections even when the sentinel node biopsy is positive, because of: (1) very low risk (≤2%) of recurrent clinical nodal metastases, (2) the lack of impact on disease specific or overall survival, (3) most lymph node metastases are limited to the sentinel nodes, and (4) lymph node metastases are only indicators not governors of the distant metastases. The American College of Surgeons Oncology Group (ACOSOG) Z-11 Trial was designed to specifically address this point, but unfortunately was closed early because of poor accrual; nevertheless, 900 patients were enrolled and will be analyzed over time to address this point.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Should positive sentinel node cases have a further axillary dissection?
      Your Kindle email address
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Should positive sentinel node cases have a further axillary dissection?
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Should positive sentinel node cases have a further axillary dissection?
      Available formats
      ×
Copyright
Corresponding author
Correspondence to: B. Cady, MD, Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI 02903, USA. E-mail: bcady@usasurg.org; Tel: 401 4446158; Fax: 401 4446681
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Breast Cancer Online
  • ISSN: -
  • EISSN: 1470-9031
  • URL: /core/journals/breast-cancer-online
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: