When tiny breast cancer deposits are found in sentinel lymph nodes, how often does further armpit surgery find more disease?

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The abstract lists Royal Berkshire Hospital in Reading, Berkshire, and John Radcliffe Hospital in Oxford, Oxfordshire, UK. It describes axillary lymph node status as the most important prognostic indicator influencing adjuvant therapy. Sentinel lymph node biopsy (SLNB) was the standard procedure for staging the axilla, and axillary node clearance (ANC) was the standard when lymph node metastases were found. The study aimed to assess how many lymph nodes were positive at ANC after a positive SLNB or a positive biopsy following clinical or ultrasound assessment.

In this retrospective review, researchers identified patients who underwent ANC between January 2008 and December 2009 and collected lymph node yields from SLNB and ANC, clinical-pathological parameters, and treatment details. There were three groups: patients with micrometastases on SLNB, patients with macrometastases on SLNB, and patients with positive axillary lymph nodes on clinical/ultrasound-guided biopsy.

A total of 170 ANC procedures were performed over the two-year period. More than 40% of patients with macrometastases on SLNB had additional positive lymph nodes at ANC. In contrast, 8% of patients with micrometastases had residual axillary disease (p<0.001, Fisher's exact test). Completion ANC provided no additional information that altered adjuvant treatment in patients with micrometastases.

The authors concluded that completion ANC had a limited role in patients with micrometastases on SLNB and that this finding was likely to affect the management of early breast cancer.