Kowsi Murugappan
Royal Brisbane & Women’s Hospital, Australia
Title: Importance of ALND: 8-year Retrospective Analysis of a Tertiary Breast Surgical Unit
Biography
Biography: Kowsi Murugappan
Abstract
Introduction
Following the release of the ACOSOG Z0011 trial debate exists as to which patients with a positive sentinel lymph node biopsy (SLNB) should proceed to axillary lymph node dissection (ALND). We aim to identify predictors of positive non-sentinel lymph nodes in these patients.
Methods
All patients undergoing a Level I-III ALND for breast cancer between January 2008-December 2016 at the Royal Brisbane & Women’s Hospital were identified through an established database maintained by the Breast & Endocrine Surgery Unit. Ethics approval was obtained to conduct this retrospective review.
Results
A total of 887 patients underwent SLNB for breast cancer during the study period. Of these, 179 (20.2%) progressed to a level I-III ALND. 67 patients had positive non-sentinel axillary nodes representing 37.4% of patients undergoing ALND. Level III nodes were positive in 18% of patients. Lymphovascular invasion was present in 59% of patients with a positive non-sentinel lymph node as opposed to 39% of patients with a negative ALND (p = 0.01). Additionally, Grade 3 tumours accounted for 40% of patients with positive non-sentinel lymph nodes in comparison to 25% of patients who were negative (P = 0.03). T stage, ER status, PR status and HER-2 status did not affect risk of non-sentinel disease
Conclusion
Axillary clearance remains an important therapeutic approach for management of axillary disease in breast cancer. Following a positive sentinel lymph node biopsy patients with lymphovascular invasion and grade 3 tumours should proceed to a Level I-III ALND given their increased risk of non-sentinel lymph node disease.