Detection and significance of axillary lymph node micrometastases Book Section
| Authors: | Pilewskie, M.; Cody, H. S. 3rd |
| Editors: | Bland, K. I.; Copeland, E. M. 3rd; Klimberg, V. S.; Gradishar, W. J.; White, J.; Korourian, S. |
| Article/Chapter Title: | Detection and significance of axillary lymph node micrometastases |
| Abstract: | In determining breast cancer prognosis, axillary lymph node (ALN) status has been, to date, the single best prognostic factor. Despite this, the outcome for good-prognosis breast cancer is not uniformly favorable, and as many as 30% of ALN-negative patients die of distant metastases despite adequate local therapy. It is logical to suspect that more intensive surveillance for subclinical regional or systemic disease might uncover this metastatic potential, and for patients with breast cancer, this search has focused on three sites: the ALN, the bone marrow, and the peripheral blood. This chapter focuses on the identification, significance, and surgical management of occult metastases in the ALN recognizing a shifting paradigm regarding both the clinical significance and the appropriate surgical management for women with micrometastatic nodal disease. A large body of retrospective literature consistently reports the identification of occult micrometastases among patients who are ALN negative by routine examination with mixed results regarding the prognostic significance of these findings. More recently, the significance and surgical management of ALN micrometastases have been reevaluated in the era of sentinel lymph node biopsy and routine use of systemic therapy. We now have definitive prospective studies, the American College of Surgeons Oncology Group (ACOSOG) Z0010 and National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32, which show that routine use of immunohistochemical staining is no longer justified for additional evaluation of negative sentinel lymph nodes by standard evaluation, and two randomized trials showing that for many patients with SLN micrometastases, ALND is no longer needed. Looking ahead, genomic profiling for both prognostication and prediction of response to therapy may ultimately trump conventional histopathology, challenging the necessity of lymph node staging altogether. © 2018 Elsevier Inc. All rights reserved. |
| Keywords: | sentinel lymph node; breast cancer; axillary lymph node; occult metastases |
| Book Title: | The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed |
| ISBN: | 978-0-323-35955-9 |
| Publisher: | Elsevier Inc. |
| Publication Place: | Philadelphia, PA |
| Date Published: | 2018-01-01 |
| Start Page: | 631 |
| End Page: | 636.e2 |
| Language: | English |
| DOI: | 10.1016/b978-0-323-35955-9.00043-x |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Book Chapter: 43 -- Export Date: 1 November 2018 -- Source: Scopus |
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