The IBCSG 23-01 and AMAROS trial both reported that axillary lymph node dissection (ALND) did not change survival rates in breast cancer patients with positive nodes detected by sentinel lymph node biopsy (SLNB). The aim of this study was to determine whether patients with mastectomy and false-negative frozen section in SLNB could forgo ALND.
This is a retrospective study of cN0 patients diagnosed with primary invasive breast cancer who were treated by mastectomy and SLNB at FUSCC between January 2011 and December 2013. Patients with false-negative frozen section in SLNB were separated by the following management in axillary into non-ALND group (non-process or radiation only) and ALND group.
A total of 212 patients were included, 86 and 126 patients in non-ALND and ALND group, respectively. The positive rate of non-SLNs was 15.87% (20/126) in ALND group. We found that patients with larger tumor size (>2cm) (OR 1.989, P=0.030) and multifocal lesions (OR 3.542, P=0.029) tended to receive ALND. The positivity of non-SLNs in ALND group was associated with SLN macrometastasis (OR 3.551, P=0.043) and lymphovascular invasion (OR 6.158, P=0.003). Also, removing more SLNs (≥3) was related to negativity in non-SLNs in these patients (OR 0.255, P=0.016). After a median follow-up of 55.83 months, the disease-free survival (DFS) and overall survival (OS) of the two groups were similar (P=0.427 and 0.742, respectively). In subgroup analysis, we found that 108 patients who met the inclusive criteria of IBCSG 23-01 trial had similar DFS and OS between non-ALND and ALND group (P=0.938 and 1.000, respectively). Also, in 130 patients who met the criteria of AMAROS trial, whether receiving ALND or radiation only had no significant difference in both DFS and OS (P=0.332 and 0.147, respectively).
ALND can be carefully omitted in breast cancer patients with mastectomy and false-negative frozen section in SLNB. SLNB is relatively sufficient in patients who meet the criteria of IBCSG 23-01 trial, and radiation is as effective as ALND in patients who meet the criteria of AMAROS trial for both DFS and OS.