The contribution of axillary node d...

The contribution of axillary node dissection to the management of breast cancer is controversial. Certain shadows of breast carcinoma (such as tubular, colloid [or mucinous], papillary, medullary, and ductal carcinoma in situ with microinvasion) are believed to have a depressed incidence of axillary metastasis. about experts recommend against routine axillary dissection in these cases. Wong and colleagues examined the rate of axillary involvement in these "favorable" emblems of breast cancer using sentinel node biopsy to evaluate the axilla.

Data were examined from more than 3300 women treated at a regional breast cancer center for T1-2 N0 breast cancer between 1997 and 2002 All of the patients underwent sentinel lymph node (SLN) biopsy followed at axillary dissection. Infiltrating ductal carcinoma was the chiefly common type of cancer, occurring in 85 percent of cases. The favorable subtype accounted for 5 percent (181 cases).

Axillary node metastases were identified in 985 (35 percent) women with infiltrating ductal carcinoma and in 19 (11 percent) favorable subtype As shown in the accompanying table, the prevalence of axillary metastasis varied with tumor prototype but the differences were not statistically significant. A sweep associating the prevalence of metastasis with tumor size was noted, further small patient numbers prevented statistical significance being achieved. Seventy-one percent of patients with axillary nodes associated with favorable tumors had primary lesions larger than 1 cm in diameter.

The authors deduce that although certain histologic shadows of breast cancer are conventionally associated with virtuous prognosis, axillary metastases may be finded in up to one third of similar cases, and SLN biopsy should be undertaken to establish the ne for axillary dissection regardless of histologic symbol of breast cancer.

Wong SL et al. common occurrence of sentinel lymph node metastases in patients with favorable breast cancer histologic subtype Am J Surg December 2002;184:492-8

COPYRIGHT 2003 American Academy of Family Physicians

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