Less Invasive Surgery Appears Safe in Node+ Breast Cancer

TOPLINE:

Patients with clinically node-negative breast cancer after neoadjuvant chemotherapy demonstrated low axillary and locoregional recurrence rates after sentinel lymph node biopsy (SLNB) or targeted axillary dissection.

METHODOLOGY:

• More conservative treatment options for women with node-positive breast cancer include SLNB and targeted axillary dissection. However, data comparing patient outcomes after targeted axillary dissection and SLNB remain limited.
• Researchers conducted a subgroup analysis of the prospective, multicenter NEOSENTITURK MF-1803 study involving patients with clinically node-positive breast cancer who were downstaged to node-negative disease following neoadjuvant chemotherapy.
• A total of 976 participants (median age, 46 years) underwent either SLNB alone (n = 620) or targeted axillary dissection alone (n = 356), with mapping performed using single tracer (69.8%) or dual tracer (30.2%) procedures.
• The primary outcomes included axillary or locoregional recurrence rates as well as disease-free survival (DFS) and disease-specific survival. The mean follow-up was 38.9 months.
• Most participants underwent mapping with blue dye alone (66.1%). Patients who underwent targeted axillary dissection (vs SLNB) were more likely to undergo mapping using the dual approach (44.1% vs 22.3%).

TAKEAWAY:

• The researchers found no significant differences in axillary, locoregional, and regional recurrence rates between the groups. Compared with those who had targeted axillary dissection, patients who underwent SLNB had similarly low rates of ipsilateral axillary recurrence (0.3% vs 0.3%), locoregional recurrence (1.1% vs 0.6%, respectively; P = .50), and regional recurrence (0.6% vs 0.3%, respectively; P = .66).
• Patients who received targeted axillary dissection had a lower systemic recurrence rate compared with those who underwent SLNB (3.4% vs 5.8%; P = .09) and a slightly higher 5-year DFS rate (94.9% vs 92.6%; P = .07), but the differences were also not statistically significant.
• Advanced clinical nodal stage (cN2-3) and nonluminal tumor characteristics were associated with lower 5-year disease-specific survival rates that were statistically significant — cN1 (98.7%) vs cN2-3 (96.8%) and luminal (98.9%) vs nonluminal (96.9%).
• Initial clinical tumor stage, pathologic complete response, and use of blue dye alone did not affect the outcomes.

IN PRACTICE:

“Our findings from the short-term follow-up suggest axillary and locoregional recurrences at very low rates” in a select group of patients after either SLNB or targeted axillary dissection without axillary lymph node dissection, regardless of the SLN pathologic findings, the authors wrote. “Whether [targeted axillary dissection] might provide a clear survival advantage compared with SLNB remains to be proven in studies with longer follow-up.”

SOURCE:

The study, led by Neslihan Cabıoğlu, MD, PhD, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, was published online in JAMA Surgery.

LIMITATIONS:

Limitations were nonrandomized design and short follow-up. Additionally, advanced disease stages among patients in the SLNB group could have influenced outcomes. Differences in the lymph node ratios between the groups could have affected result interpretation.

DISCLOSURES:

The authors did not disclose any funding information. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.