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Axillary Lymph Node Dissection in Breast Cancer Patients with Sentinel Lymph Node Micrometastases
Sentinel lymph node (sN) biopsy followed by axillary lymph node dissection ( ALND ) in tumor-positive sN has already been confirmed as a safe and accurate procedure for the surgical management of patients with small (< 2 cm) breast cancer. Noteworthy, in 38% to 67% of node-positive patients, the only tumor-involved lymph node is the sN so that most of these patients would not benefit by ALND. Literature data suggest that patients with a very low risk of non-sN metastasis are those with sN micrometastases, primary breast tumors measuring less than 2 cm, and without lymphovascular invasion. Actually, in a series of 116 patients with sN micrometastases undergoing ALND, both univariate test of association between clinical and histopathologic features and non-sN status and logistic regression analysis confirmed that primary tumor size and lymphovascular invasion were significant predictors of non-sN status. Notably, no patient with sN micrometastases and pT1a-T1b breast cancer had non-sN metastases so that they could be spared an unnecessary ALND with the inherent postoperative morbidity, although an adequate adjuvant treatment and a regular follow-up should be scheduled within a prospective clinical trial.
Reference:
Marco Gipponi Patologia Chirurgica Gastroenterologica, Azienda Ospedaliera Universitaria, Ospedale San Martino, Genoa, Italy
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