Open AccessCan We Avoid Axillary Lymph Node Dissection (ALND) in Patients with 1–2 Positive Sentinel/Low Axillary Lymph Nodes (SLN/LAS+) in the Indian Setting?
Author(s) -
Asha Reddy,
Nita Nair,
Smruti Mokal,
Vani Parmar,
Tanuja Shet,
Rima Pathak,
Garvit Chitkara,
Purvi Thakkar,
Shalaka Joshi,
Rajendra Badwe
Publication year - 2021
Publication title -
indian journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 16
eISSN - 0976-6952
pISSN - 0975-7651
DOI - 10.1007/s13193-021-01297-6
Subject(s) - medicine , axillary lymph node dissection , axilla , breast cancer , micrometastasis , population , cohort , sentinel lymph node , surgery , cancer , environmental health
The ACOSOG Z0011 study, heralded as a "practice changing" trial, suggested that women with T1-2 breast cancer with 1-2 SLN+, undergoing breast conservation therapy, need not be offered further ALND. However, whether these results are applicable to all women in the Indian setting, it remains debatable. A retrospective audit of all cN0 operated from 2013 to 2018 was conducted. We analyzed the percentage of additional LN positive (LN+) in the ALND group and compared it to the ACOZOG Z11 trial. Of the 2350 cN0 with EBC who underwent LAS, 687 (29%) had positive lymph nodes on final histopathology. Five hundred ninety-seven (86.9%) patients had 1-2 LN+, 40 (5.8%) patients had 3 LN+, and 50 (7.3%) had 4 or more nodes positive. Demographic features in the ACOSOG Z11 are different from those in our study, looking at ACOZOG Z11 versus our cohort-median pT 1.7 cm versus 3 cm, 45% micrometastasis versus 99.16% macrometastasis, and 28-30% grade 3 tumors versus 73.7%. In our cohort 31.82% of the 1-2 LN positive had additional LN+ on ALND. Keeping in mind the difference in clinicopathological features between our cohort and that of ACOZOG Z0011 and that 31.82% of women had additional LN+ on ALND, it may not be appropriate to apply the results of the ACOSOG Z0011 trial directly to our general population. Possibly, only a select subset of patients who match the trial population of the ACOSOG Z11 could be offered observation of the axilla and validated nomograms can be used to identify high-risk patients.