The publication of these trials has resulted in changes in practice for a majority of surgeons according to a survey 3. Both aforementioned studies showed that patients with limited sentinel lymph node metastasis who were treated with BCS, whole breast radiation therapy, and adjuvant systemic treatment, could be spared an ALND without compromising locoregional control or survival.Īdditionally, omission of ALND in patients with cN1 disease who are found to be ypN0 after neoadjuvant chemotherapy has shown acceptable results throughout several trials (ACOSOGZ1071, SENTINA, and SN-FNAC). The results of this trial show that in patients with only micrometastases in the sentinel nodes, ALND is not needed. A recent randomized controlled trial confirmed the oncologic safety of omitting complete ALND for micro-metastasis-positive SLNB (IBCSG 23-01 ). The result of the ACOSOGZ0011 trial showed that ALND was not needed in women with early breast cancer with only one or two sentinel node metastases who would receive whole breast radiation as part of breast-conserving surgery 2. Some studies have also been focused on the safe omission of complete ALND when the axillary nodes contain micro or macro-metastasis. There has been a distinct trend for limiting the extent of axillary surgery to avoid the side effects from axillary lymph node dissection (ALND), which is known to be associated with a higher morbidity, prolonged hospitalization, and impairment of quality of life. Intraoperative frozen section analysis of sentinel lymph node has been shown to be accurate for the evaluation of axillary lymph node metastasis with high sensitivity and specificity 1. Over recent decades, the sentinel lymph node biopsy (SLNB) has been validated by several studies and has become the standard management for patients with clinically node-negative primary invasive breast cancer. SLNB might be a possible option for ALND in patients with breast cancer who have limited axillary node metastasis after NAC without compromising survival outcomes. After the propensity score matching, no significant statistical differences were observed in 5-year ARFS, DMFS, OS, and BCSS between the SLNB only group and ALND group. Univariate and multivariate analyses revealed no statistically significant differences between the two groups for ARFS, DMFS, OS, and BCSS. The median follow-up period was 71 months. We compared axillary recurrence-free survival (ARFS), distant metastasis-free survival (DMFS), overall survival (OS), and breast cancer-free survival (BCSS) according to the surgical method. After matching, we included 98 patients in each SLNB only group and ALND group respectively. Patients were matched for baseline characteristics. SLNB was performed for patients with good responders to NAC with limited nodal burden. Patients who had either micrometastasis or macrometastasis in 1 or 2 node(s) were included. General indications for ALND included prominent nodes detected clinically before NAC, evident macrometastasis on multiple nodes during SLNB. The patients received NAC at AMC between 20. We included 324 patients who had undergone axillary surgery with either sentinel lymph node biopsy (SLNB) only or ALND. This was a single institution retrospective study of patients with ypN1 from Asan Medical Center (AMC). We analyzed the long-term results of these patients according to axillary surgical methods using propensity score matching (PSM) to clarify whether omission of axillary lymph node dissection (ALND) is oncologically safe. For residual N1 nodal disease following neoadjuvant chemotherapy (NAC) for patients with breast cancer, the optimal local therapy for axilla is an evolving area.
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