Omitting Axilla Lymphadenectomy Even by Positive Sentinel Lymph Node: A Change in Breast Cancer Treatment Practice

Evaluation of: Giuliano AE, Hunt KK, Ballman KV et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305, 569–575 (2011). Sentinel lymph node biopsy (SLNB) has been a reliable technique to accurately predict the axilla node status in women with breast cancer with clinically negative lymph nodes. Based on predictive accuracy evidence from large-scale clinical trials, SLNB has become the current standard of care in breast cancer, preventing unnecessary axilla lymph node dissection and its related adverse events in patients who test negative with SLNB. Now a Phase III randomized trial provides evidence that avoiding axilla lymphadenectomy in patients with positive SLNB does not increase locoregional recurrence or mortality. In this article the benefits, risks and selection criteria to safely prevent axilla lymphadenectomy even by positive SLNB are discussed. Moreover, limitations of this practice-changing trial are described with emphasis on caution in patient selection.