Lymphadenectomy (lymph node dissection)

Overview

• Breast cancer, the axilla: NICE NG101 (1.4.11) says to offer axillary node clearance to people whose preoperative ultrasound-guided needle biopsy proved lymph node metastases, (1.4.12) to offer further axillary treatment (clearance or radiotherapy) after a sentinel node biopsy showing 1 or more macrometastasis, (1.4.13) to discuss the benefits and risks of no further treatment with women who have 1 or 2 macrometastases after breast-conserving surgery and have been advised to have whole-breast radiotherapy with systemic therapy, (1.4.14) not to offer further treatment for micrometastases alone, and (1.4.15) to classify isolated tumour cells as lymph node-negative.
• Radiotherapy instead of clearance: in the 10-year analysis of AMAROS, 1,425 patients with a positive sentinel node were randomised to axillary lymph node dissection (744) or axillary radiotherapy (681); the 10-year cumulative axillary recurrence was 0.93 percent after dissection and 1.82 percent after radiotherapy, with no difference in overall or disease-free survival, and lymphoedema at 5 years was 24.5 percent after dissection against 11.9 percent after radiotherapy.
• Leaving the axilla alone after a positive sentinel node: in ACOSOG Z0011, 891 women with T1 or T2 cancer, no palpable adenopathy and 1 or 2 positive sentinel nodes, all having lumpectomy with tangential whole-breast radiotherapy, had a 10-year overall survival of 86.3 percent with sentinel node dissection alone against 83.6 percent with axillary dissection (non-inferior). In SENOMAC, 2,540 patients in the per-protocol analysis with 1 or 2 sentinel-node macrometastases, about 90 percent of whom had nodal radiotherapy, had a 5-year recurrence-free survival of 89.7 percent without completion dissection against 88.7 percent with it.