Indication of the axillary lymph node dissection in micrometastatic lymph node involvement of breast cancer

Czech version

Authors: Milan Šimánek ¹; Václav Abrahám ²; Josef Hruška ³
Authors‘ workplace: Oddělení nukleární medicíny ¹; Onkologické oddělení ²; Chirurgické oddělení Nemocnice Pelhřimov p. o., ČR ³
Published in: NuklMed 2015;4:4-7
Category: Original Article

Overview

Introduction:
Axillary lymph node dissection (ALND) is clearly recommended only for 3 or more positive sentinel lymph nodes today. It is not indicated for a negative sentinel lymph nodes and presence of only isolated tumor cells. The benefit of ALND is further investigated in patients with less than 3 positive sentinel nodes and/or with micrometastatic involment only.

Aim:
To assess the indication of the ALND when the micrometastatic involvement of sentinel node of breast cancer is detected.

Methods:
Biopsy of sentinel lymph nodes with periareolar application of radiopharmaceutical Sentiscint. 265 patients, 82 of them with positive sentinel lymph nodes, 17 with micrometastatic involvement only, 4 with the combination of micrometastatic and macrometastatic involvement in two different sentinel lymph nodes. The ALND was performed in 7 patients with only micrometastatic involvement and in all 4 patients with a combination of micrometastatic and macrometastatic sentinel lymph node involvement. Patients were then monitored for 41 months in average.

Results:
At least two sentinel lymph nodes were removed in all patients. Only negative lymph nodes were found in axilla after ALND in 7 patients with isolated micrometastatic involvement of SLN and at least one other negative node. No axillary recurrence has been detected during the follow-up period in the remaining 10 patients. Metastatic axillary lymph nodes were found after ALND at half of the patients with a combination of micrometastatic and macrometastatic involvement of various SLN.

Conclusion:
It is not possible to predict the axillary lymph node status when only one sentinel lymph node with the micrometastatic involvement is removed and to stop ALND. But if we find at least one other negative lymph node next to isolated micrometastatic involvement of SLN, the risk of axillary lymph node metastases is small and we do not have to indicate ALND.

Key words:
breast cancer, sentinel lymph nodes, micrometastases

Sources

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Labels

Nuclear medicine Radiodiagnostics Radiotherapy

Role of sentinel node in breast cancer

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Article was published in

Nuclear Medicine

2015 Issue 1