Is Sentinel Lymph Node Biopsy Alone Accurate for Breast Cancer Mastectomy? Results of a Cohort Study of 2,423 Patients

Gilles Houvenaeghel, Jean Marc Classe, Guillaume Blache, Chafika Mazouni, Fabien Reyal, Pierre Gimbergues, Emile Daraï, Anne Sophie Azuar, Pierre Emmanuel Colombo, Marie Bannier, Eric Lambaudie and Monique Cohen

Department of Surgical Oncology, Aix-Marseille University, Marseille, France Department of Surgical Oncology, Western Cancer Institute, Saint Herblain cedex, France Department of General Surgery, Gustave Roussy Institute, Villejuif, France Departement of Surgical Oncology, Curie Institute, Paris, France Department of Gynecology and Obstetrics, Hospital Tenon, Assistance Publique des Hôpitaux de Paris, France Department of Gynecology-Obstetrics, Pierre-et-Marie-Curie-Paris-6 University, Tenon Hospital, France Departement de Gynecology, Hospital Center De Grasse, France 8 Department of Surgical Oncology, Montpellier Cancer Institute (ICM), France

^*Correspondance to: Gilles Houvenaeghel 

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Abstract:

Background: Few patients with mastectomy and pN0(i+) or pN1mi Sentinel Node (SN) were included in randomized trial. To demonstrate SN biopsy accuracy for mastectomy. Methods: We examined results of SN among a multi-institutional cohort of patients, <=cT2-N0, who required total mastectomy, according to SN-status and complementary Axillary-LymphNode-Dissection (cALND) or not. We have analyzed involved Non-Sentinel-Node (NSN) rate at cALND, overall (OS) and Disease-Free Survival (DFS). Results: Among 2,423 patients we reported 1307 pN0(i-)SN, 120 pN0(i+)SN, 273 pN1mi SN and 723 pN1-macro-metastases-SN with cALND respectively in 24.5%, 73.3%, 82.4% and 93.1%. Median follow-up was 42.72 months. Among 320 patients with pN0(i-)SN we observed 35 NSN-macro-metastases (10.9%) and among 723 patients with SN-macro-metastases, cALND was omitted in 50 patients (6.9%): In multivariate analysis, OS and DFS were not significantly different according to cALND or not. Among 120 patients with pN0(i+)SN and 273 with pN1miSN, cALND were respectively omitted in 32 and 48 patients: Age, pT-size and SN-status were predictive of NSN-involvement. In multivariate analysis, post-mastectomy radiotherapy, regional nodal irradiation and adjuvant chemotherapy were significantly correlated to cALND and a significant lesser DFS rate was reported for patients without cALND (HR: 3.351, p: 0.004). Conclusion: SN biopsy appeared as an accurate procedure for axillary staging of breast cancer mastectomy for pN0-SN status. For pN1-macro-metastases it is not possible to propose to avoid cALND. When SN was involved by pN0(i+) or micro-metastases, omission of cALND is still controversial and should have a negative prognosis impact in relation with a down staging and under treatment.

Keywords:

Sentinel Node; Breast Cancer; Mastectomy

Cite the Article:

Houvenaeghel G, Classe JM, Blache G, Mazouni C, Reyal F, Gimbergues P, et al. Is Sentinel Lymph Node Biopsy Alone Accurate for Breast Cancer Mastectomy? Results of a Cohort Study of 2,423 Patients. Clin Oncol. 2020; 5: 1689.