Is It Possible to Reduce Even More Need for Axillary Dissection?

Abstract

It has always been disappointing to receive a histology report after an axillary dissection (ALND) saying that the only positive lymph node was the sentinel lymph node (SLN). It is for this reason that there have been many efforts to create the best predictive model in order to avoid non sentinel node dissection and in fact there are in use many of them with a reasonable success rate. The publication of the multicenter study by Giuliano et al. showed a disease free survival and overall survival rate equal between patients with positive SLN with or without axillary dissection in a large group of patients. Breast surgeons around the world have long before been interested in reducing even more the need for axillary lymph node dissection, so they easily grasped the chance of those results and applied them in their practice. Objections have been expressed regarding the integrity of the study methods and the results which make the need for a second study to confirm those results absolutely necessary.

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Pechlivanides, G. , Vassilarou, D. and Vassilaros, S. (2013) Is It Possible to Reduce Even More Need for Axillary Dissection?. Advances in Breast Cancer Research, 2, 44-50. doi: 10.4236/abcr.2013.22008.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] A. E. Giuliano, K. K. Hunt, K. V. Ballman, P. D. Beitsch, P. W. Whitworth, P. W. Blumencranz, A. M. Leitch, S. Saha, L. M. McCall and M. Morrow, “Axillary Dissection vs No Axillary Dissection in Women with Invasive Breast Cancer Andsentinel Node Metastasis: A Randomized Clinical Trial,” JAMA, Vol. 305, No. 6, 2011, pp. 569-575. doi:10.1001/jama.2011.90
[2] B. Gerber, K. Heintze, J. Stubert, M. Dieterich, S. Hartmann, A. Stachs and T. Reimer, “Axillary Lymph Node Dissection in Early-Stage Invasive Breast Cancer: Is It Still Standard Today?” Breast Cancer Research and Treatment, Vol. 128, No. 3, 2011, pp. 613-624. doi:10.1007/s10549-011-1532-0
[3] G. Martelli, P. Boracchi, M. De Palo, S. Pilotti, S. Oriana, R. Zucali, et al., “A Randomized Trial Comparing Axillary Dissection to No Axillary Dissectionin Older Patients with T1N0 Breast Cancer: Results after 5 Years of Follow-Up,” Ann Surgery, Vol. 242, No. 1, 2005, pp. 1-6. doi:10.1097/01.sla.0000167759.15670.14
[4] International Breast Cancer Study Group, C. M. Rudenstam, D. Zahrieh, J. F. Forbes, D. Crivellari, S. B. Holmberg, P. Rey, D. Dent, I. Campbell, J. Bernhard, K. N. Price, M. Castiglione-Gertsch, A. Goldhirsch, R. D. Gelber and A. S. Coates, “Randomized Trial Comparing Axillary Clearance versus No Axillary Clearance in Older Patients with Breast Cancer: First Results of International Breast Cancer Study Group Trial 10-93,” Journal of Clinical Oncology, Vol. 24, No. 3, 2006, pp. 337-344. doi:10.1200/JCO.2005.01.5784
[5] U. Veronesi, R. Orecchia, S. Zurrida, et al., “Avoiding Axillary Dissection in Breast Cancer Surgery: A Randomized Trial to Assess the Role of Axillary Radiotherapy,” Annals of Oncology, Vol. 16, No. 3, 2005, pp. 383-388. doi:10.1093/annonc/mdi089
[6] G. Martelli, R. Miceli, M. G. Daidone, G. Vetrella, A. M. Cerrotta, D. Piromalli and R. Agresti, “Axillary Dissection versus No Axillary Dissection in Elderly Patients with Breast Cancer and No Palpable Axillary Nodes: Results after 15 Years of Follow-Up,” Annals of Surgical Oncology, Vol. 18, No. 1, 2011, pp. 25-33. doi:10.1245/s10434-010-1217-7
[7] A. E. Giuliano, L. McCall, P. Beitsch, P. W. Whitworth, P. Blumencranz, A. M. Leitch, S. Saha, K. K. Hunt, M. Morrow and K. Ballman, “Locoregional Recurrence after Sentinel Lymph Node Dissection with or without Axillary Dissection in Patients with Sentinel Lymph Node Metastases: The American College of Surgeons Oncology Group Z0011 Randomized Trial,” Annals of Surgery, Vol. 252, No. 3, 2010, pp. 426-432.
[8] R. A. Mohammed, A. Green, S. El Shikh, et al., “Prognostic Significance of Vascular Endothelial Cell Growth Factors-A, -C and -D in Breast Cancer and Their Relationship with Angioand Lymphangiogenesis,” British Journal of Cancer, Vol. 96, No. 7, 2007, pp. 1092-1100. doi:10.1038/sj. bjc.6603678
[9] Y. Nakamura, H. Yasuoka, M. Tsujimoto, et al., “Lymph Vessel Density Correlates with Nodal Status, VEGF-C Expression, and Prognosis in Breast Cancer,” Breast Cancer Research and Treatment, Vol. 91, No. 2, 2005, pp. 125-132. doi:10.1007/s10549-004-5783-x
[10] S. J. Aitken, J. S. Thomas, S. P. Langdon, et al., “Quantitative Analysis of Changes in ER, PR and HER2 Expression in Primary Breast Cancer and Paired Nodal Metastases,” Annals of Oncology, Vol. 21, No. 6, 2010, pp. 1254-1261. doi:10.1093/annonc/mdp427
[11] A. Avril, G. Le BouEdec, G. Lorimier, J. M. Classe, C. Tunonde-Lara, S. Giard, G. MacGrogan, M. Debled, S. Mathoulin-Pélissier and L. Mauriac, “Phase III Randomized Equivalence Trial of Early Breast Cancer Treatments with or without Axillary Clearance in Post-Menopausal Patients Results after 5 Years of Follow-Up,” European Journal of Surgical Oncology, Vol. 37, No. 7, 2011, pp. 563-570. doi:10.1016/j. ejso.2011.04.008
[12] S. A. Valente, G. M. Levine, M. J. Silverstein, J. A. Rayhanabad, J. G. Weng-Grumley, L. Ji, D. R. Holmes, R. Sposto and S. F. Sener, “Accuracy of Predicting Axillary Lymph Node Positivity by Physical Examination, Mammography, Ultrasonography, and Magnetic Resonance Imaging,” Annals of Surgical Oncology, Vol. 19, No. 6, 2012, pp. 1825-1830. doi:10.1245/s10434-011-2200-7
[13] M. Pamilo, M. Soiva and E. M. Lavast, “Real-Time Ultrasound, Axillary Mammography, and Clinical Examination in the Detection of Axillary Lymph Node Metastases in Breast Cancer Patients,” Journal of Ultrasound in Medicine, Vol. 8, No. 3, 1989, pp. 115-120.
[14] K. A. Kvistad, J. Rydland, H. B. Smethurst, S. Lundgren, H. E. Fjosne and O. Haraldseth, “Axillary Lymph Node Metastases in Breast Cancer: Preoperative Detection with Dynamic Contrast-Enhanced MRI,” European Radiology, Vol. 10, No. 9, 2000, pp. 1464-1471. doi:10.1007/s003300000370
[15] B. P. Baruah, A. Goyal, P. Young, A. G. Douglas-Jones and R. E. Mansel, “Axillary Node Staging by Ultrasonography and Fine-Needle Aspiration Cytology in Patients with Breast Cancer,” British Journal of Surgery, Vol. 97, No. 5, 2010, pp. 680-683. doi:10.1002/bjs.6964
[16] A. García Fernández, M. Fraile, N. Giménez, A. ReNe, M. Torras, L. Canales, J. Torres, I. Barco, S. González, E. Veloso, C. González, L. Cirera and A. Pessarrodona, “Use of Axillary Ultrasound, Ultrasound-Fine Needle Aspiration Biopsy and Magnetic Resonance Imaging in the Preoperative Triage of Breast Cancer Patients Considered for Sentinel Node Biopsy,” Ultrasound in Medicine & Biology, Vol. 37, No. 1, 2011, pp. 16-22. doi:10.1016/j.ultrasmedbio.2010.10.011
[17] M. B. Mainiero, C. M. Cinelli, S. L. Koelliker, T. A. Graves and M. A. Chung, “Axillary Ultrasound and FineNeedle Aspiration in the Preoperative Evaluation of the Breast Cancer Patient: An Algorithm Based on Tumor Size and Lymph Node Appearance,” American Journal of Roentgenology, Vol. 195, No. 5, 2010, pp. 1261-1267. doi:10.2214/AJR.10.4414
[18] N. Cho, W. K. Moon, W. Han, I. A. Park, J. Cho and D. Y. Noh, “Preoperative Sonographic Classification of Axillary Lymph Nodes in Patients with Breast Cancer: Node-to-Node Correlation with Surgical Histology and Sentinel Node Biopsy Results,” American Journal of Roentgenology, Vol. 193, No. 6, 2009, pp. 1731-1737. doi:10.2214/AJR.09.3122
[19] I. Steppan, D. Reimer, E. Müller-Holzner, C. Marth, F. Aigner, F. Frauscher, T. Frede and A. G. Zeimet, “Breast Cancer in Women: Evaluation of Benign and Malignant Axillary Lymph Nodes with Contrast-Enhanced Ultrasound,” Ultraschall in der Medizin, Vol. 31, No. 1, 2010, pp. 63-67. doi:10.1055/s-0028-1109847
[20] I. J. Robertson, F. Hand and M. R. Kell, “FDG-PET/CT in the Staging of Local/Regional Metastases in Breast Cancer,” Breast, Vol. 20, No. 6, 2011, pp. 491-494. doi:10.1016/j.breast.2011.07.002
[21] S. E. Harnan, K. L. Cooper, Y. Meng, S. E. Ward, P. Fitzgerald, D. Papaioannou, C. Ingram, E. Lorenz, I. D. Wilkinson and L. Wyld, “Magnetic Resonance for Assessment of Axillary Lymph Node Status in Early Breast Cancer: A Systematic Review and Meta-Analysis,” European Journal of Surgical Oncology, Vol. 37, No. 11, 2011, pp. 928-936. doi:10.1016/j.ejso.2011.07.007
[22] E. Botteri, V. Bagnardi, A. Goldhirsch, et al., “Axillary Lymph Node Involvement in Women with Breast Cancer: Does It Depend on Age?” Clinical Breast Cancer, Vol. 10, No. 4, 2010, pp. 318-321. doi:10.3816/CBC.2010.n.042
[23] H. Kennecke, R. Yerushalmi, R. Woods, et al., “Metastatic Behavior of Breast Cancer Subtypes,” Journal of Clinical Oncology, Vol. 28, No. 20, 2010, pp. 3271-3277. doi:10.1200/JCO.2009.25.9820
[24] K. D. Voduc, M. C. Cheang, S. Tyldesley, et al., “Breast Cancer Subtypes and the Risk of Local and Regional Relapse,” Journal of Clinical Oncology, Vol. 28, No. 10, 2010, pp 1684-1691. doi:10.1200/JCO.2009.24.9284
[25] M. J. van de Vijver, Y. D. He, L. J. van’t Veer, et al., “A Gene-Expression Signature as a Predictor of Survival in Breast Cancer,” The New England Journal of Medicine, Vol. 347, No. 25, 2002, pp. 1999-2009. doi:10.1056/NEJMoa021967
[26] A. Goldhirsch, W. C. Wood, A. S. Coates, R. D. Gelber, B. Thurlimann and H. J. Senn, “Strategies for Subtypes—Dealing with the Diversity of Breast Cancer: Highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011,” Annals of Oncology, Vol. 22, No. 8, 2011, pp. 1736-1747. doi:10.1093/annonc/mdr304
[27] P. Karlsson, B. F. Cole, B. H. Chua, K. N. Price, J. Lindtner, J. P. Collins, A. Kovács, B. Thürlimann, D. Crivellari, M. Castiglione-Gertsch, J. F. Forbes, R. D. Gelber, A. Goldhirsch and G. Gruber, for the International Breast Cancer Study Group, “Patterns and Risk Factors for Locoregional Failures after Mastectomy for Breast Cancer: An International Breast Cancer Study Group Report,” Annals of Oncology, Vol. 23, No. 11, 2012, pp. 2852-2858. doi:10.1093/annonc/mds118
[28] B. Fisher, J. H. Jeong, S. Anderson, et al., “Twenty-FiveYear Follow-Up of a Randomized Trial Comparing Radical Mastectomy, Total Mastectomy, and Total Mastectomy Followed by Irradiation,” The New England Journal of Medicine, Vol. 347, 2002, pp. 567-575. doi:10.1056/NEJMoa020128
[29] S. Latosinsky, T. S. Berrang, C. S. Cutter, R. George, I. Olivotto, T. B. Julian, A. Hayashi, C. Baliski, R. L. Croshaw, K. M. Erb and J. Chen, “CAGS and ACS Evidence Based Reviews in Surgery 40. Axillary Dissection versus No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis,” Canadian Journal of Surgery, Vol. 55, No. 1, 2012, pp. 66-69.
[30] T. J. Whelan, I. A. Olivotto, I. Ackerman, et al., “NCICCTG MA20: An Intergroup Trial of Regional Nodal Irradiation in Early Breast Cancer,” Journal of Clinical Oncology, Vol. 29, No. 15, 2011, Article ID: LBA1003.
[31] M. E. Straver, P. Meijnen, G. van Tienhoven, et al., “Sentinel Node Identification Rate and Nodal Involvement in the EORTC 10981-22023 AMAROS Trial,” Annals of Surgical Oncology, Vol. 17, No. 7, 2010, pp 1854-1861. doi:10.1245/s10434-010-0945-z
[32] W. P. Weber, M. Barry, M. M. Stempel, M. J. Junqueira, A. A. Eaton, S. M. Patil, M. Morrow and H. S. Cody 3rd, “A 10-Year Trend Analysis of Sentinel Lymph Node Frozen Section and Completion Axillary Dissection for Breast Cancer: Are These Procedures Becoming Obsolete?” Annals of Surgical Oncology, Vol. 19, No. 1, 2012, pp. 225-232. doi:10.1245/s10434-011-1823-z
[33] I. van den Hoven, G. P. Kuijt, A. C. Voogd and R. M. H. Roumen, “High Intersystem Variability for the Prediction of Additional Axillary Non-Sentinel Lymph Node Involvement in Individual Patients with Sentinel NodePositive Breast Cancer,” Annals of Surgical Oncology, Vol 19, No. 6, 2012, pp. 1841-1849. doi:10.1245/s10434-011-2169-2
[34] T. S. Berrang, M. Lesperance, P. T. Truong, C. Walter, A. H. Hayashi and I. A. Olivotto, “Which Prediction Models Best Identify Additional Axillary Disease after a Positive Sentinel Node Biopsy for Breast Cancer?” Breast Cancer Research and Treatment, Vol. 133, No. 2, 2012, pp 695-702. doi:10.1007/s10549-012-1991-y
[35] A. E. Giuliano, M. Morrow, S. Duggal and T. B. Julian, “Should ACOSOG Z0011 Change Practice with Respect to Axillary Lymph Node Dissection for a Positive Sentinel Lymph Node Biopsy in Breast Cancer?” Clinical and Experimental Metastasis, Vol. 29, No. 7, 2012, pp. 687-692. doi:10.1007/s10 585-012-9515-z

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