Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy

Table 1 Trials discussed in this paper informing directly or indirectly on the question of completion of axillary lymph node dissection in patients with sentinel lymph node biopsy-positive breast cancer patients

Trial [Ref.]	Comment
ACOSOG Z0011[7]	The main randomized trial informing the clinical question
IBCSG 23-01[8]	Randomized trial in patients with micrometastatic only axillary disease
Yegiyants et al[14]	Small study of patients followed after micrometastases found in SLN biopsy
Martelli et al[15]	Randomized trial comparing ALND vs no surgery in older patients
IBCSG Trial 10-93[16]	Similar to reference 15
Avril et al[17]	Similar to references 15 and 16 but in a younger patient population
Louis-Sylvestre et al[19]	Randomized trial comparing ALND with axillary radiation treatment
Wang et al[21]	Retrospective SEER-based study in patients with lobular carcinomas

SLN: Sentinel lymph node; ALND: Axillary lymph node dissection; SEER: Surveillance, Epidemiology and End Results.

Table 2 Considerations for omission of completion axillary lymph node dissection in patients with positive sentinel lymph node

Axillary lymph node dissection may be omitted

T1 or T2 primary

One or two positive SLN without extra-capsular extension

Lumpectomy and conventional radiation therapy planned

ER and PR positive, Her2/Neu negative (equivalent to Luminal A) biology

Patient older than 65 yr old

Ductal histology

Axillary lymph node dissection should be the standard but omission could be discussed in an individualized basis

Patient younger than 65 yr old

Biology other than Luminal A

Lobular histology

Axillary lymph node dissection should be performed

T3, T4 or inflammatory primary

More than two positive SLN and/or extra-capsular extension

Mastectomy or unconventional radiation therapy planned

SLN: Sentinel lymph node.