ABSTRACT
Background:
Current guidelines suggest that when performing axillary lymph node dissection for treatment of breast cancer, a minimum of 10 lymph nodes should be removed to allow for accurate pathologic staging to guide the treatment decision regarding the adjuvant treatment. The purpose of this study is to identify clinical and pathologic factors associated with retrieval of fewer than 10 lymph nodes in completion axillary lymph node dissection (CALND) performed for patients with breast cancer who had sentinel lymph node (SLN) metastasis.
Materials and Methods:
Patients with breast cancer who underwent SLN mapping and subsequent CALND at UPMC Magee-Womens Hospital were identified using the tumor registry database. Patients were divided into two groups according to the total number of nodes dissected. One group was comprised of patients in who had 10 or more lymph node dissection after SLN positivity while the other group comprised of the patients with fewer than 10 nodes dissected. We evaluated a number of clinical and pathological variables with their association with number of lymph nodes retrieved. These variables included patient age, timing of axillary surgery, neoadjuvant chemotherapy (NCT), tumor characteristics and SLN characteristics.
Results:
Three hundred seventy three patients underwent immediate or delayed completion level I-II axillary lymph node dissection after SLN biopsy demonstrated metastasis. The mean age of the patients was 53 (range 29-84) years. Fifty-four patients underwent NCT. Following SLN pathologic examination, immediate CALND was performed for 35.4% of patients and delayed CALND for 53.9% of all patients. By univariate analysis, following factors had significant association with dissection of fewer than 10 lymph nodes: NCT, tumor size, delayed CALND, and SLN micrometastases (p<0.05). By multivariate analysis, NCT and SLN micrometastases were significantly associated with retrieval of fewer than 10 lymph nodes.
Conclusion:
In patients who have undergone CALND after identification of SLN metastasis, we found NCT and SLN micrometastases were associated with dissection of fewer than 10 axillary lymph nodes.
