SLIDE 1
Anna Kaminski MD, Sara Yegiyants MD, J. Michael Guenther MD,
- L. Andrew DiFronzo MD
Introduction
- Sentinel Node Biopsy (SLNBx)
- Increases sensitivity of surgical staging
- Avoids ALND when negative
- Safe
Completion Axillary Lymph Node Dissection Is Not Required for - - PowerPoint PPT Presentation
Completion Axillary Lymph Node Dissection Is Not Required for - - PowerPoint PPT Presentation
Completion Axillary Lymph Node Dissection Is Not Required for Regional Control in Patients With Breast Cancer Who Have Micrometastasis in a Sentinel Node Anna Kaminski MD, Sara Yegiyants MD, J. Michael Guenther MD, L. Andrew DiFronzo MD
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SLIDE 3
Introduction
- ALND
- Completion ALND is standard of care
- ? In patients with cellular micrometastasis
- Complications
- Regional control?
- Survival benefit?
SLIDE 4
Aim of Study
- Is completion ALND needed for
regional control in patients with metastatic disease in SLN?
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Methods
- Retrospective (1997 - 2005)
- Patients underwent breast conserving surgery
with positive SLN
- Axillary observation per patient and clinician
preference
SLIDE 6
Methods
Variables
- Locoregional and distant recurrence
- Survival
- Treatment patterns
- Clinicopathologic variables
- Histologic subtype
- Stage
- Tumor grade
- Sentinel node characteristics
- Macromets (>2mm)
- Micromets (<2mm)
- Cellular (detected by IHC only)
SLIDE 7
Results
- Fifty patients with a positive SLN who
underwent axillary observation were identified
- Three patients were lost to follow-up and
excluded from analysis
- Patients did not undergo axillary radiation
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Patient Characteristics Total no. of patients 47 Age Mean 57 years Range 29 - 83
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Tumor Characteristics
Histologic Subtype
Invasive ductal 33 (70%) Invasive lobular 7(15%) Other 7(15%)
Initial tumor stage
T1a 1 (2.1%) T1b 8 (17%) T1c 22 (47%) T2 16 (34%)
Nuclear grade*
1 7 (15%) 2 25(53%) 3 11 (23%) * Not available for all patients
Mean tumor size – 1.9 cm Range – 0.4 to 5 cm
SLIDE 10
Tumor Characteristics
ER
Positive 43 (91%) Negative 4 (8.5%)
PR*
Positive 22 Negative 4
Her2Neu*
Positive 1 Negative 13
* Not available for all patients
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Sentinel Lymph Node Characteristics
- No. of SLNs identified
Median 2 Range 1-9
- No. of positive SLNs
Median 1 Range 1-2 Total size of SLN metastasis Median 2 mm Range 0.2-20 mm Type of SLN metastasis Macro (≥ 2 mm) 14 (30%) Micro(≤ 2 mm) 33 (70%) Cellular 17/33(51%)
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Treatment Patterns
All patients underwent whole breast irradiation, and 43 patients (92%) received systemic therapy
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Follow Up
- The mean duration of follow-up was 54
months (median 50, range 6 - 113)
- The mean duration of follow-up for
macrometastasis was 49 months (median 46, range 24 – 110)
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Survival, Recurrence, and Distant Metastasis
- One death
- One patient (2.1%) developed an axillary
recurrence
- 4mm metastasis in the SLN. ALND was
performed 28 months after the initial operation, and 13 of 21 nodes were involved by tumor
- Developed distant metastasis
SLIDE 15
Conclusions
- ALND is not necessary for regional control in
patients with micrometastatic disease
- Even in patients with macrometastatic disease
recurrence is low 1/14 (7%) with a mean follow up of 49 months
- Additional studies will be necessary to further define