Breast cancer (BC) has emerged as a commonest cancer in India. There is a shift of transition from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB). Recently SLNB is emerging as an option following neoadjuvant chemotherapy (NACT). To formulate policies for ALN management, we present our experience of the pattern of ALN involvement among Indian BC patients and also to assess the scope of SLNB among LABC patients.
This study is conducted in a tertiary care center, North India. A prospective breast cancer computerized data base was created and data captured from 1992 to 2020. A total of 4186 ALNDs done were analyzed and 1998 ALNDs were done in LABC patients.
Mean age was 48.5years. Stage-wise distribution where ALND was done is 5.16% in stage I, 41.92% in stage II, 47.73% in stage III and 4.06% in stage IV. Pathologic node positivity was seen in 55.75% patients and node negativity in 44.24% patients. Among 1998 LABC patients analyzed, 47.49% patients received NACT and 52.5% patients had upfront surgery. Among patients who received NACT, pathologic node positivity was seen in 59.95% patients and 40.04% had pathologic complete response (pCR) in nodes. This shows NACT improves node-negative status. Among NACT group, 53.78% patients were node negative with cN0, 39.74% patients with cN1, 35.22% patients with cN2 and 38.46% patients with cN3.
This study is one of the largest ALND series in LMIC. Overall lymph node positivity rates among Indian breast cancer patients are high due to heavy nodal burden disease at presentation. Results indicate that de-escalation of axilla from ALND to SLNB is feasible in approximately 40% undergoing NACT.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.