Management and results of treatment of breast cancer patients having sentinel lymph node micrometastases

Abstract

According to current therapeutic guidelines, finding micrometastases in the sentinel node (SLN) of a patient with non-advanced breast cancer is not an absolute indication for adjuvant axillary lymph node dissection (ALND). This work presents our experiences regarding this clinical problem. 1071 breast cancer patients were referred for sentinel node biopsy between January 2004 and December 2011. Metastases were found in 245 of the removed lymph nodes. In 49 patients lymph node changes turned out to be micrometastases or isolated tumor cells (ITC). ALND was performed in 38 cases of sentinel node micrometastases or ICTs. In three patients involvement of other axillary lymph nodes was found in the studied tissue material (7.9% vs. 37.9% for metastases >2mm). The remaining patients with micrometastases in the SLN (11/49) were treated conservatively. No local axillary recurrences or neoplastic metastases were found in this group of patients with SLN micrometastases. Mean follow-up period in patients who had undergone ALND was 18.0 months (4 to 60 months) and 21.4 months (9-40 months) in patients without ALND. Non-radical surgical treatment in the presence of SLN micrometastases in patients with non-advanced breast cancer does not lead to therapeutic failure (local axillary recurrences, distant metastases). Obtaining favorable outcomes of conservative treatment in the analyzed group of patients does not require additional modification of the adjuvant therapy.