Predictors of completion axillary lymph node dissection in patients with immunohistochemical metastases to the sentinel lymph node in breast cancer Journal Article


Authors: Pugliese, M. S.; Karam, A. K.; Hsu, M.; Stempel, M. M.; Patil, S. M.; Ho, A. Y.; Traina, T. A.; Van Zee, K. J.; Cody, H. S. 3rd; Morrow, M.; Gemignani, M. L.
Article Title: Predictors of completion axillary lymph node dissection in patients with immunohistochemical metastases to the sentinel lymph node in breast cancer
Abstract: Background: Axillary lymph node dissection (ALND) in patients with immunohistochemistry (IHC)-determined metastases to the sentinel lymph node (SLN) is controversial. The goal of this study was to examine factors associated with ALND in IHC-only patients. Methods: Retrospective review of an institutional SLN database from July 1997 to July 2003 was performed. We compared sociodemographic, pathologic, and therapeutic variables between IHC-only patients who had SLN biopsy alone and those that had ALND. Results: Our study group consisted of 171 patients with IHC-only metastases to the SLN. Young age, estrogen receptor negative status, high Memorial Sloan-Kettering Cancer Center nomogram score, and chemotherapy were associated with ALND. Among patients who had ALND (n = 95), 18% had a positive non-SLN. Rates of systemic therapy were similar between those with and without positive non-SLNs at ALND. No axillary recurrences were observed in this series with a median follow-up of 6.4 years. The percentage of patients who were recurrence-free after 5 years was 97% (95% confidence interval, 92.1-98.6). Conclusions: On the basis of our findings and the lack of prospective randomized data, the practice of selectively limiting ALND to IHC-only patients thought to be at high risk and to patients for whom the identification of additional positive nodes may change systemic therapy recommendations seems to be a safe and reasonable approach. © 2009 Society of Surgical Oncology.
Keywords: immunohistochemistry; adult; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival rate; retrospective studies; major clinical study; histopathology; follow up; follow-up studies; lymph node metastasis; lymph node dissection; lymphatic metastasis; lymph node excision; prospective studies; sentinel lymph node biopsy; demography; neoplasm recurrence, local; breast cancer; tumor volume; epidermal growth factor receptor 2; breast neoplasms; retrospective study; risk factor; high risk patient; risk assessment; axillary lymph node; immunoenzyme techniques; predictive validity; comorbidity; receptor, erbb-2; receptors, estrogen; receptors, progesterone; axilla; estrogen receptor; progesterone receptor; carcinoma, ductal, breast; carcinoma, lobular
Journal Title: Annals of Surgical Oncology
Volume: 17
Issue: 4
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2010-04-01
Start Page: 1063
End Page: 1068
Language: English
DOI: 10.1245/s10434-009-0834-5
PUBMED: 20033325
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: ASONF" - "Source: Scopus"
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Citation Impact
MSK Authors
  1. Sujata Patil
    497 Patil
  2. Alice Yoosun Ho
    121 Ho
  3. Meier Hsu
    153 Hsu
  4. Monica Morrow
    648 Morrow
  5. Kimberly J Van Zee
    280 Van Zee
  6. Hiram S Cody III
    235 Cody
  7. Mary L Gemignani
    196 Gemignani
  8. Amer Karam Karam
    8 Karam
  9. Tiffany A Traina
    213 Traina
  10. Michelle Moccio Stempel
    153 Stempel