Ten years on: Axillary recurrence after negative sentinel node biopsy for breast cancer

This study investigated the long term risk of axillary (underarm lymph node) recurrence in breast cancer (BC) patients who were not treated with axillary lymph node dissection (ALND) following a negative sentinel node biopsy (SNB) result. The study concluded that the risk of axillary recurrence after 10 years was lower than expected after a negative SNB result. However, it was noted that axillary recurrence may take place many years after initial surgery.

ALND is a procedure commonly used in BC treatment in which the lymph nodes of the armpit are removed. The surgery is associated with a number of post-operative symptoms including swelling, pain and reduced movement in the arm area. The sentinel lymph nodes are the first nodes cancer may spread to. SNB is a procedure used to determine the spread of BC. Patients with a negative SNB result are often able to avoid ALND and the accompanying symptoms without an increased risk of axillary recurrence in the short term. It is not clear what effect avoiding ALND has on long-term recurrence risk.

This study examined the long-term risk of axillary recurrence in patients who did not undergo ALND.

This study involved 3518 women with node-negative invasive BC that was 3 cm or less. The final analysis included 2216 women with 2237 BCs. Patients underwent an annual clinical examination and mammography with an average follow-up time of 10.5 years.

Isolated axillary recurrence was seen in 1.6% of patients with a further 1% found to have local as well as axillary recurrence.  Patients with BC negative for the estrogen hormone receptor (ER) were found to develop axillary recurrence earlier (an average of 21.5 months) than those who are ER-positive (an average of 51 months).

Ten-year BC-specific survival (time from treatment until death due to breast cancer) was 94.3%. 85.4% of patients were disease free after 10 years.

The study concluded that at the 10-year follow up, the risk of axillary recurrence was lower than was expected after a negative SNB result. However, it was noted that axillary recurrence may take place many years after initial surgery.

Patients selected for a trial of this type are likely to have less aggressive or advanced disease, meaning the results may not be applicable to patients outside this group.

Discuss the pros and cons of ALND after a negative SNB result with your doctor.