Is axillary lymph node dissection necessary for positive preoperative aspiration cytology lymph node results?

• Published in: European journal of surgical oncology 2020-04, Vol.46 (4), p.504-510
• Main Authors: Horváth, Z., Paszt, A., Simonka, Z., Látos, M., Kaizer, L., Hamar, S., Vörös, A., Ormándi, K., Fejes, Z., Lázár, G.
• Format: Article
• Language: English
• Subjects: Axillary lymph node dissection; Axillary metastasis; Breast cancer; Neoadjuvant therapy
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2019.10.043

Based on international guidelines, axillary lymph node dissection (ALND) is recommended in cases of breast cancer if preoperative examinations confirm axillary metastasis. We examined which set of preoperative parameters might render ALND unnecessary. Preoperative examinations (axillary ultrasound and aspiration cytology) confirmed axillary metastasis in 190 cases out of 2671 patients with breast cancer; primary ALN dissection was performed on these patients with or without prior neoadjuvant therapy. The clinicopathological results were analysed to determine which parameter might predict the presence of no more than 2 or 3 metastatic ALNs. The final histological examination confirmed 1–3 metastatic lymph nodes in ALND samples in 116 cases and over 3 metastatic lymph nodes in 74 cases. For patients receiving neoadjuvant therapy (59 out of the 190 cases), if the size of the primary tumour was 2 cm or smaller and/or the metastatic ALN was 15 mm or smaller, then the patient was likely to have no more than 3 positive ALNs (stage N0–1 disease) (p