Selection of Breast Cancer Patients for Omission of Axillary Lymph Node Surgery
Main Article Content
Abstract
The surgical procedure of complete axillary lymph node dissection, which initially included all the level I, II, and III nodes combined with a radical mastectomy in breast cancer patients, de-escalated to include only level I and II nodes with a modified radical mastectomy, leaving intact level III nodes. The sentinel node era, which began thirty years ago, allowed for removal of a small number of only level I nodes. The further decrease in the extent of node removal did not decrease the likelihood of curing patients with breast cancer. In addition, diminished axillary nodal surgery resulted in less complications, including less arm lymphedema. The latest advance is to use clinical, radiological, pathological, molecular, genetic, and other criteria to select breast cancer patients in whom all axillary nodal surgery can be avoided. In this review we summarize the current recommendations for axillary lymph node surgery, highlight and discuss the concomitant development of lymph node imaging, molecular genetic technologies, improved systemic and locoregional therapies, and more clearly elucidate the potential indications for omission of axillary nodal surgery.
Article Details
How to Cite
BUI, Jenny et al.
Selection of Breast Cancer Patients for Omission of Axillary Lymph Node Surgery.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5861>. Date accessed: 15 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5861.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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12. Veronesi U, Viale G, Paganelli G, et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg. 2010;251(4):595-600. doi:10.1097/SLA.0b01 3e3181c0e92a
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14. Fayanju OM, Ren Y, Greenup RA, et al. Extent of axillary surgery in inflammatory breast cancer: a survival analysis of 3500 patients. Breast Cancer Res Treat. 2020;180(1):207-217. doi:10.1007/s105 49-020-05529-1
15. Rehman S, Reddy CA, Tendulkar RD. Modern outcomes of inflammatory breast cancer. Int J Radiat Oncol. 2012;84(3):619-624. doi:10.1016/j.ijr obp.2012.01.030
16. Britton P, Moyle P, Benson JR, et al. Ultrasound of the axilla: where to look for the sentinel lymph node. Clin Radiol. 2010;65(5):373-376. doi:10.1016/j.crad.2010.01.013
17. Swinson C, Ravichandran D, Nayagam M, Allen S. Ultrasound and fine needle aspiration cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer. Eur J Surg Oncol EJSO. 2009;35(11):1152-1157. doi:10.1016/j.ejso.2009.03.008
18. Ha SM, Chae EY, Cha JH, Shin HJ, Choi WJ, Kim HH. Diagnostic performance of standard breast MR imaging compared to dedicated axillary MR imaging in the evaluation of axillary lymph node. BMC Med Imaging. 2020;20(1):45. doi:10.1186/s 12880-020-00449-4
19. Kuijs VJL, Moossdorff M, Schipper RJ, et al. The role of MRI in axillary lymph node imaging in breast cancer patients: a systematic review. Insights Imaging. 2015;6(2):203-215. doi:10.1007/s13244-015-0404-2
20. De Mooij CM, Sunen I, Mitea C, et al. Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients. Nucl Med Commun. 2020;41(10):995-1004. doi:10.1097/MNM.0000000000001254
21. Riegger C, Koeninger A, Hartung V, et al. Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients. Acta Radiol. 2012;53(10):1092-1098. doi:10.125 8/ar.2012.110635
22. Zheng H, Zhao R, Wang W, et al. The accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph nodes in women with breast cancer: a systematic review and meta-analysis. Front Oncol. 2023;13:11 66035. doi:10.3389/fonc.2023.1166035
23. Huang Y, Liu Y, Wang Y, et al. Quantitative analysis of shear wave elastic heterogeneity for prediction of lymphovascular invasion in breast cancer. Br J Radiol. 2021;94(1127):20210682. doi:10.1259/bjr.20210682
24. Schwartz T. At the speed of SOUND: the pace of change for axillary management in breast cancer. Ann Surg Oncol. 2024;31(5):2801-2803. doi:10.1245/s10434-024-15010-8
25. Zhang H, Sui X, Zhou S, Hu L, Huang X. Correlation of conventional ultrasound characteristics of breast tumors With axillary lymph node metastasis and Ki‐67 expression in patients with breast cancer. J Ultrasound Med. 2019;38(7):1833-1840. doi:10.1002/jum.14879
26. Kim WH, Kim HJ, Lee SM, et al. Preoperative axillary nodal staging with ultrasound and magnetic resonance imaging: predictive values of quantitative and semantic features. Br J Radiol. 2018;91(1092):2 0180507. doi:10.1259/bjr.20180507
27. Gentilini OD, Botteri E, Sangalli C, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023;9(11):1557. doi:10.1001/jamaoncol.2023.3759
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