Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe

A long term follow-up analysis

Hans Torrenga, Hans Fabry, Joost R M Van Der Sijp, Paul J. Van Diest, Rik Pijpers, Sybren Meijer, Omgo E. Nieweg

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the rate of axillary recurrences in sentinel node (SN) negative breast cancer patients without further axillary lymph node dissection (ALND). Patients and Methods: Between October 1994 and November 1999, all SN negative breast cancer patients who did not underwent complete ALND were enrolled in this prospective study. SN biopsy was performed by using the triple technique which combines preoperative lymphoscintigraphy, intraoperative use of blue dye, and a handheld gamma probe to visualize and localize the SN. SNs were examined by standard hematoxylin and eosin (H&E) staining and immunohistochemistry (IHC). During the first year after surgery all patients underwent clinical examination at 3 monthly intervals. This follow-up interval was prolonged to 6 month after the first year. Results: From the 104 patients, 93 (89%) underwent breast-conserving therapy; all remaining patients were treated by modified radical mastectomy. In 91 cases a ductal carcinoma and in 13 cases a lobular carcinoma was diagnosed. One SN was removed in 80, two SNs in 18, and three SNs in 2 patients. Twenty patients received systemic therapy based on age and primary tumor characteristics. After a median follow-up of 57 month only one axillary recurrence was observed. During follow-up three patients developed distant metastases. One of these patient with metastases to the bone is alive with evidence of disease. The remaining two patients died 9 and 19 month after surgery. Conclusions: Our long term follow-up results indicate that survival is excellent (98%) and local axillary control is adequate (99%) after omitting ALND in a group of 104 SN negative breast cancer patients.

Original languageEnglish (US)
Pages (from-to)4-8
Number of pages5
JournalJournal of Surgical Oncology
Volume88
Issue number1
DOIs
StatePublished - Oct 1 2004
Externally publishedYes

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Lymph Node Excision
Breast Neoplasms
cyhalothrin
Neoplasm Metastasis
Modified Radical Mastectomy
Lymphoscintigraphy
Lobular Carcinoma
Recurrence
Ductal Carcinoma
Hematoxylin
Eosine Yellowish-(YS)
Breast
Coloring Agents
Immunohistochemistry
Prospective Studies
Staining and Labeling
Biopsy
Bone and Bones

Keywords

  • Breast neoplasm
  • Follow-up study
  • Recurrence
  • Sentinel lymph node biopsy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Torrenga, H., Fabry, H., Van Der Sijp, J. R. M., Van Diest, P. J., Pijpers, R., Meijer, S., & Nieweg, O. E. (2004). Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: A long term follow-up analysis. Journal of Surgical Oncology, 88(1), 4-8. https://doi.org/10.1002/jso.20101

Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe : A long term follow-up analysis. / Torrenga, Hans; Fabry, Hans; Van Der Sijp, Joost R M; Van Diest, Paul J.; Pijpers, Rik; Meijer, Sybren; Nieweg, Omgo E.

In: Journal of Surgical Oncology, Vol. 88, No. 1, 01.10.2004, p. 4-8.

Research output: Contribution to journalArticle

Torrenga, H, Fabry, H, Van Der Sijp, JRM, Van Diest, PJ, Pijpers, R, Meijer, S & Nieweg, OE 2004, 'Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: A long term follow-up analysis', Journal of Surgical Oncology, vol. 88, no. 1, pp. 4-8. https://doi.org/10.1002/jso.20101
Torrenga, Hans ; Fabry, Hans ; Van Der Sijp, Joost R M ; Van Diest, Paul J. ; Pijpers, Rik ; Meijer, Sybren ; Nieweg, Omgo E. / Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe : A long term follow-up analysis. In: Journal of Surgical Oncology. 2004 ; Vol. 88, No. 1. pp. 4-8.
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abstract = "Purpose: To evaluate the rate of axillary recurrences in sentinel node (SN) negative breast cancer patients without further axillary lymph node dissection (ALND). Patients and Methods: Between October 1994 and November 1999, all SN negative breast cancer patients who did not underwent complete ALND were enrolled in this prospective study. SN biopsy was performed by using the triple technique which combines preoperative lymphoscintigraphy, intraoperative use of blue dye, and a handheld gamma probe to visualize and localize the SN. SNs were examined by standard hematoxylin and eosin (H&E) staining and immunohistochemistry (IHC). During the first year after surgery all patients underwent clinical examination at 3 monthly intervals. This follow-up interval was prolonged to 6 month after the first year. Results: From the 104 patients, 93 (89{\%}) underwent breast-conserving therapy; all remaining patients were treated by modified radical mastectomy. In 91 cases a ductal carcinoma and in 13 cases a lobular carcinoma was diagnosed. One SN was removed in 80, two SNs in 18, and three SNs in 2 patients. Twenty patients received systemic therapy based on age and primary tumor characteristics. After a median follow-up of 57 month only one axillary recurrence was observed. During follow-up three patients developed distant metastases. One of these patient with metastases to the bone is alive with evidence of disease. The remaining two patients died 9 and 19 month after surgery. Conclusions: Our long term follow-up results indicate that survival is excellent (98{\%}) and local axillary control is adequate (99{\%}) after omitting ALND in a group of 104 SN negative breast cancer patients.",
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AB - Purpose: To evaluate the rate of axillary recurrences in sentinel node (SN) negative breast cancer patients without further axillary lymph node dissection (ALND). Patients and Methods: Between October 1994 and November 1999, all SN negative breast cancer patients who did not underwent complete ALND were enrolled in this prospective study. SN biopsy was performed by using the triple technique which combines preoperative lymphoscintigraphy, intraoperative use of blue dye, and a handheld gamma probe to visualize and localize the SN. SNs were examined by standard hematoxylin and eosin (H&E) staining and immunohistochemistry (IHC). During the first year after surgery all patients underwent clinical examination at 3 monthly intervals. This follow-up interval was prolonged to 6 month after the first year. Results: From the 104 patients, 93 (89%) underwent breast-conserving therapy; all remaining patients were treated by modified radical mastectomy. In 91 cases a ductal carcinoma and in 13 cases a lobular carcinoma was diagnosed. One SN was removed in 80, two SNs in 18, and three SNs in 2 patients. Twenty patients received systemic therapy based on age and primary tumor characteristics. After a median follow-up of 57 month only one axillary recurrence was observed. During follow-up three patients developed distant metastases. One of these patient with metastases to the bone is alive with evidence of disease. The remaining two patients died 9 and 19 month after surgery. Conclusions: Our long term follow-up results indicate that survival is excellent (98%) and local axillary control is adequate (99%) after omitting ALND in a group of 104 SN negative breast cancer patients.

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