Making our Way out of the Axilla: A Look at De-Escalation in Axillary Therapy

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33. https://doi.org/10.1016/s1470-2045(10)70207-2.

Article  PubMed  PubMed Central  Google Scholar 

Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg. 2010;251(4):595–600. https://doi.org/10.1097/SLA.0b013e3181c0e92a.

Article  PubMed  Google Scholar 

Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA. 2017;318(10):918–26. https://doi.org/10.1001/jama.2017.11470.

Article  PubMed  PubMed Central  Google Scholar 

Bartels SAL, Donker M, Poncet C, Sauvé N, Straver ME, van de Velde CJH, et al. Radiotherapy or surgery of the axilla after a positive Sentinel node in breast cancer: 10-Year results of the randomized controlled EORTC 10981–22023 AMAROS trial. J Clin Oncol. 2023;41(12):2159–65. https://doi.org/10.1200/jco.22.01565.

Article  CAS  PubMed  Google Scholar 

de Boniface J, Filtenborg Tvedskov T, Rydén L, Szulkin R, Reimer T, Kühn T, et al. Omitting axillary dissection in breast cancer with sentinel-node metastases. N Engl J Med. 2024;390(13):1163–75. https://doi.org/10.1056/NEJMoa2313487.

Article  PubMed  Google Scholar 

Isik A, Soran A, Grasi A, Barry N, Sezgin E. Lymphedema after sentinel lymph node biopsy: who is at risk? Lymphat Res Biol. 2022;20(2):160–3. https://doi.org/10.1089/lrb.2020.0093.

Article  CAS  PubMed  Google Scholar 

Temple LK, Baron R, Cody HS 3rd, Fey JV, Thaler HT, Borgen PI, et al. Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women. Ann Surg Oncol. 2002;9(7):654–62. https://doi.org/10.1007/bf02574481.

Article  PubMed  Google Scholar 

Rudenstam CM, Zahrieh D, Forbes JF, Crivellari D, Holmberg SB, Rey P, et al. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of international breast cancer study group trial 10–93. J Clin Oncol. 2006;24(3):337–44. https://doi.org/10.1200/jco.2005.01.5784.

Article  PubMed  Google Scholar 

Martelli G, Miceli R, Daidone MG, Vetrella G, Cerrotta AM, Piromalli D, et al. Axillary dissection versus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol. 2011;18(1):125–33. https://doi.org/10.1245/s10434-010-1217-7.

Article  PubMed  Google Scholar 

Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31(19):2382–7. https://doi.org/10.1200/jco.2012.45.2615.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Society of Surgical Oncology. SSO: Five Things Physicians and Patients Should Question.: https://www.surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf (2020). Accessed 11/10/2024.

Sun J, Mathias BJ, Sun W, Fulp WJ, Zhou JM, Laronga C, et al. Is it wise to omit sentinel node biopsy in elderly patients with breast cancer? Ann Surg Oncol. 2021;28(1):320–9. https://doi.org/10.1245/s10434-020-08759-1.

Article  CAS  PubMed  Google Scholar 

Thompson J, Le J, Hop A, Melnik M, Paulson J, Wright GP. Impact of choosing wisely recommendations on Sentinel lymph node biopsy and postoperative radiation rates in women over age 70 years with Hormone-Positive breast cancer. Ann Surg Oncol. 2021;28(10):5716–22. https://doi.org/10.1245/s10434-021-10460-w.

Article  PubMed  Google Scholar 

Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16(3):266–73. https://doi.org/10.1016/s1470-2045(14)71221-5.

Article  PubMed  Google Scholar 

Gentilini OD, Botteri E, Sangalli C, Galimberti V, Porpiglia M, Agresti R, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023;9(11):1557–64. https://doi.org/10.1001/jamaoncol.2023.3759.

Article  PubMed  PubMed Central  Google Scholar 

Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, et al. 21-gene assay to inform chemotherapy benefit in node-positive breast cancer. N Engl J Med. 2021;385(25):2336–47. https://doi.org/10.1056/NEJMoa2108873.

Article  CAS  PubMed  PubMed Central  Google Scholar 

van Roozendaal LM, Vane MLG, van Dalen T, van der Hage JA, Strobbe LJA, Boersma LJ, et al. Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up: a Dutch randomized controlled multicentre trial (BOOG 2013-08). BMC Cancer. 2017;17(1):459. https://doi.org/10.1186/s12885-017-3443-x.

Article  PubMed  PubMed Central  Google Scholar 

Jung JG, Ahn SH, Lee S, Kim EK, Ryu JM, Park S, et al. No axillary surgical treatment for lymph node-negative patients after ultra-sonography [NAUTILUS]: protocol of a prospective randomized clinical trial. BMC Cancer. 2022;22(1):189. https://doi.org/10.1186/s12885-022-09273-1.

Article  PubMed  PubMed Central  Google Scholar 

Reimer T, Stachs A, Veselinovic K, Kühn T, Heil J, Polata S, et al. Axillary surgery in breast cancer — primary results of the INSEMA trial. N Engl J Med. 2025;392:1051–64. https://doi.org/10.1056/NEJMoa2412063.

Article  PubMed  Google Scholar 

Fentiman IS. 8. The dilemma of in situ carcinoma of the breast. Int J Clin Pract. 2001;55(10):680–3.

Article  CAS  PubMed  Google Scholar 

Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96(6):443–8. https://doi.org/10.1093/jnci/djh069.

Article  PubMed  Google Scholar 

Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478–88. https://doi.org/10.1093/jnci/djr027.

Article  PubMed  PubMed Central  Google Scholar 

Silverstein MJ, Rosser RJ, Gierson ED, Waisman JR, Gamagami P, Hoffman RS, et al. Axillary lymph node dissection for intraductal breast carcinoma–is it indicated? Cancer. 1987;59(10):1819–24. https://doi.org/10.1002/1097-0142(19870515)59:10%3C1819::aid-cncr2820591023%3E3.0.co;2-v.

Article  CAS  PubMed  Google Scholar 

Chavez de Paz Villanueva C, Bonev V, Senthil M, Solomon N, Reeves ME, Garberoglio CA, et al. Factors associated with underestimation of invasive cancer in patients with ductal carcinoma in situ: precautions for active surveillance. JAMA Surg. 2017;152(11):1007–14. https://doi.org/10.1001/jamasurg.2017.2181.

Article  PubMed  PubMed Central  Google Scholar 

Davey MG, O’Flaherty C, Cleere EF, Nohilly A, Phelan J, Ronane E, et al. Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis. BJS Open. 2022. https://doi.org/10.1093/bjsopen/zrac022.

Article  PubMed  PubMed Central  Google Scholar 

El Hage Chehade H, Headon H, Wazir U, Abtar H, Kasem A, Mokbel K. Is sentinel lymph node biopsy indicated in patients with a diagnosis of ductal carcinoma in situ? A systematic literature review and meta-analysis. Am J Surg. 2017;213(1):171–80. https://doi.org/10.1016/j.amjsurg.2016.04.019.

Article  PubMed  Google Scholar 

Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365–83. https://doi.org/10.1200/jco.2013.54.1177.

Article  PubMed  Google Scholar 

Douek M, Klaase J, Monypenny I, Kothari A, Zechmeister K, Brown D, et al. Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG multicentre trial. Ann Surg Oncol. 2014;21(4):1237–45. https://doi.org/10.1245/s10434-013-3379-6.

Article  PubMed 

Comments (0)

No login
gif