Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2015; 6(1): 1-6
Published online Feb 10, 2015. doi: 10.5306/wjco.v6.i1.1
Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy
Ioannis A Voutsadakis, Silvana Spadafora
Ioannis A Voutsadakis, Silvana Spadafora, Division of Medical Oncology, Department of Internal Medicine, Sault Area Hospital, Sault Ste. Marie, Ontario ON P6B 0A8, Canada
Ioannis A Voutsadakis, Silvana Spadafora, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario ON P0M, Canada
Author contributions: Both authors contributed to this manuscript.
Conflict-of-interest: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ioannis A Voutsadakis, MD, PhD, Division of Medical Oncology, Department of Internal Medicine, Sault Area Hospital, 750 Great Northern Road, Sault Ste. Marie, Ontario ON P6B 0A8, Canada. ivoutsadakis@yahoo.com
Telephone: +1-705-7593434 Fax: +1-705-7593815
Received: August 16, 2014
Peer-review started: August 17, 2014
First decision: November 3, 2014
Revised: November 19, 2014
Accepted: December 3, 2014
Article in press: December 10, 2014
Published online: February 10, 2015
Processing time: 172 Days and 6.5 Hours
Abstract

The surgical treatment of localized breast cancer has become progressively less aggressive over the years. The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered.

Keywords: Tumor sub-types; Micro-metastatic; Node positive; Breast cancer; Axillary lymph node dissection; Macro-metastatic; Axillary recurrence

Core tip: Management of the axilla in breast cancer has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in sentinel lymph node negative patients. More recently, it has been proposed that lymph node dissection could be avoided even in patients with sentinel lymph node positive biopsies. The basis of such proposals is discussed here and caution is advised against a universal omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered.