[Strategies in case of metastatic sentinel lymph node in breast cancer]
- PMID: 31699399
- DOI: 10.1016/j.bulcan.2019.09.005
[Strategies in case of metastatic sentinel lymph node in breast cancer]
Abstract
Management strategy of micro or macro metastatic sentinel lymph node(s) (SLNs) in breast cancer has dramatically changed over the past ten years and the publication of five randomized trials results: ACOSOG Z0011, IBCSG 23-01, and AATRM comparing axillary lymph node dissection (ALND) versus SLNs biopsy alone; and AMAROS and OTOASOR comparing ALND versus axillary radiotherapy. Despite methodological limitations of several of these trials, notably ACOSOG Z0011, the international recommendations (ASCO, NCCN) and the expert consensus of St Gallen do not recommend the performance of a complementary ALND in case of macro or micro metastatic SLN, if all ACOSOG Z0011 inclusion criteria are met. Moreover, in the context of a mastectomy, with one or two positive SLN and a wall irradiation indication, an axillary radiotherapy can be proposed as an alternative to ALND. Additionally, ALND is also indicated in extracapsular involvement or when three or more SLNs are metastatic. This change in strategy led to a significant decrease on the number of ALNDs performed and resulted on the abandon of SLNs extemporaneous examination. In France, there are no national recommendations on axillary management in the context of SLN involvement. Moreover, a multitude of different local guidelines, led to very heterogeneous practices in our country. The next evolution on axillary management strategy will be the implementation of a SLNs procedure after neoadjuvant chemotherapy (NAC) for patients with lymph node involvement proven before NAC and for whom NAC has allowed axillary downstaging.
Keywords: Abstention du curage axillaire; Alternative for axillary lymph node dissection; Axillary radiotherapy; Breast cancer; Cancer du sein; Ganglion sentinelle; Radiothérapie axillaire; Sentinel lymph node.
Copyright © 2019. Published by Elsevier Masson SAS.
Similar articles
-
Omitting axillary lymph node dissection after positive sentinel lymph node in the post-Z0011 era: Compliance with NCCN and ASCO clinical guidelines and Z0011 criteria in a large prospective cohort.Bull Cancer. 2022 Mar;109(3):268-279. doi: 10.1016/j.bulcan.2021.09.018. Epub 2021 Nov 24. Bull Cancer. 2022. PMID: 34838310
-
[Axillary management in breast cancer: The French practice versus recommendations in the post-2011 era].J Gynecol Obstet Biol Reprod (Paris). 2016 May;45(5):451-8. doi: 10.1016/j.jgyn.2016.01.008. Epub 2016 Mar 14. J Gynecol Obstet Biol Reprod (Paris). 2016. PMID: 26989008 French.
-
Role of frozen section in sentinel lymph node biopsy for breast cancer in the era of the ACOSOG Z0011 and IBCSG 23-10 trials.Surgeon. 2018 Aug;16(4):232-236. doi: 10.1016/j.surge.2017.11.003. Epub 2018 Jan 9. Surgeon. 2018. PMID: 29329752
-
[Sentinel node and breast cancer: A state-of-the-art in 2019].Gynecol Obstet Fertil Senol. 2019 Jun;47(6):522-526. doi: 10.1016/j.gofs.2019.04.002. Epub 2019 Apr 5. Gynecol Obstet Fertil Senol. 2019. PMID: 30959186 Review. French.
-
[Therapeutic de-escalation in breast cancer surgery].Bull Cancer. 2021 Dec;108(12):1145-1154. doi: 10.1016/j.bulcan.2021.06.017. Epub 2021 Oct 14. Bull Cancer. 2021. PMID: 34656300 Review. French.
Cited by
-
Axillary Surgical Attitude Changing with Retrospective Application of ACOSOG Z0011 Eligible Criteria: An Institutional Evaluation.Eur J Breast Health. 2023 Oct 1;19(4):318-324. doi: 10.4274/ejbh.galenos.2023.2023-6-4. eCollection 2023 Oct. Eur J Breast Health. 2023. PMID: 37795004 Free PMC article.
-
Sentinel Lymph Node in Non-Small Cell Lung Cancer: Assessment of Feasibility and Safety by Near-Infrared Fluorescence Imaging and Clinical Consequences.J Pers Med. 2022 Dec 30;13(1):90. doi: 10.3390/jpm13010090. J Pers Med. 2022. PMID: 36675751 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous