This provides an opportunity to avoid extensive
axillary dissection and also to choose appropriate adjuvant treatment.
[29.] Caudle AS, Yang WT, Krishnamurthy S, et al Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: Implementation of targeted
axillary dissection. J Clin Oncol 2016;34(10):1072-1078.
Ballman et al., "
Axillary dissection vs no
axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial," JAMA, vol.
Can
axillary dissection be avoided in patients with sentinel lymph node metastasis?
In recent studies,
axillary dissection (not the mastectomy or quadrantectomy) has been demonstrated to be a risk factor for persistent pain after treatment and sensory disturbances compared with sentinel lymph node biopsy [6, 7,17].
Axillary dissection with mastectomy or BCT followed by appropriate adjuvant therapy is recommended.
Allergic reactions were reported in a randomised controlled trial from North America comparing sentinel node biopsy-based treatment with
axillary dissection in women with early breast cancer (4).
In a study of suction drains in patients who underwent breast surgery with
axillary dissection, Barwell et al reported that (1) seromas were associated with larger total drainage volumes, (2) keeping drains in for longer periods (drains were kept in for a median of 4 days) did not protect against seroma formation, and (3) prolonged suction drainage only delayed patient discharge.
Even women with positive sentinel lymph nodes can often be treated safely and effectively without further
axillary dissection, say researchers, after a trial suggested that aggressive removal of lymph nodes did not prevent recurrence or prolong survival.
Whilst SNB is the procedure of choice in clinically node-negative breast cancer, preoperative radiological staging of the axilla is important because
axillary dissection is the recommended treatment for those with axillary metastases, and because it is in cases where nodes are heavily infiltrated with tumour that SNB is most likely to produce a false-negative result.
The accepted treatment for early-stage breast cancer in women with breast implants--skin-sparing mastectomy with
axillary dissection and implant exchange followed by WBI--carries a 55% risk of capsular contracture due to the formation of collagenous scar tissue around the implant, Dr.
Subjects were 3,088 women aged 18-70 years who had been treated with
axillary dissection and total mastectomy or lumpectomy followed by radiation at seven medical centers between 1995 and 2000.