1. For women with invasive breast cancer and metastases to 1 or 2 sentinel lymph nodes, treatment with sentinel lymph node dissection alone was not inferior to those treated with sentinel lymph node dissection followed by axillary lymph node dissection.
2. The use of axillary lymph node dissection is not supported when metastases are found with sentinel lymph node sampling in this patient population.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Axillary lymph node dissection (ALND) for breast cancer was utilized to identify women with axillary nodal metastases, but has been largely replaced by sentinel lymph node dissection (SLND). It is an effective way of obtaining regional control of the disease, but is associated with complications such as lymphedema, numbness, and decreased upper-extremity range of motion. This study assessed the 10-year overall survival of women with sentinel lymph node metastases treated with breast-conserving therapy and SLND alone without ALND compared to SLND plus ALND. A total of 891 women were randomized to the two groups and the 10-year overall survival was not inferior in the SLND-alone group compared to the ALND group. Overall, this study suggests that axillary lymph node dissection may not be necessary when metastases are found with sentinel lymph node sampling. However, not all biologic subtypes were represented in large numbers
In-Depth [randomized controlled trial]: This study was a phase 3 randomized clinical trial from 1999 to 2004 at 115 academic and community sites, which looked at women with clinical T1 or T2 invasive breast cancer, no palpable axillary adenopathy, and 1 or 2 sentinel lymph nodes with metastases. Patients underwent lumpectomy, tangential whole-breast irradiation, and adjuvant systemic therapy. 891 were randomized to SLND alone or SLND plus ALND. At a median follow-up of 9.3 years, the 10 year-overall survival was 86.3% in the SLND alone group and 83.6% in the SLND plus ALND group (HR 0.86 [1-sided CI95% 0-1.16]; noninferiority p = 0.02). Between years 5 and 10, 1 regional recurrence was seen in the SLND alone group vs. none in the SLND plus ALND group. Ten-year regional recurrence did not differ significantly between the 2 groups.
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