Completion axillary lymph node dissection can be avoid in patients with invasive breast cancer and sentinel lymph node micrometastases

BACKGROUND: The prognostic value of sentinel lymph node (SLN) micrometastases in invasive breast cancer patients isstill widely debated. Even if, in the absence of unequivocal guidelines, the axillary lynphadenectomy is not still performedin the routine clinical care of these patients.MATERIALS AND METHOD: We have retrospectively analyzed 897 patients with operable invasive breast cancer and clinicallynegative axillary lymph nodes underwent conservative surgery or total mastectomy with SLN biopsy. Two groupsof patients with SLN micrometastases and isolated tumor cells (ITC) were considered, the first one treated with completionaxillary dissection, the second one not followed by further surgical axillary procedure. The incidence of axillaryrecurrences has BEEN evaluated in both groups and only in the first group of patients the involvement of the remaininglymph nodes was analyzed.RESULTS: Micrometastases were found in 67 (7.4%) patients and ITC in 8 (0,9%) patients. 14 (20.9%) patients withmicrometastases and 1 (12.5%) patient with ITC underwent completion axillary dissection. 53 (79.1%) patients withmicrometastases and 7 (87.5%) with ITC didn’t receive further surgical axillary procedure. No axillary recurrences werefound during a median follow up of 65.7±8.69 months in both groups of patients.CONCLUSIONS: Based on the results and according to some recent randomized trials we can say that completion axillarydissection can be safely avoided when micrometastases are found in sentinel lymph nodes. It should be performed anyway,depending on the analysis of the biomedical profile of the tumor