Feasibility Of Avoiding Axillary Lymph Node Dissection In Stage ?/? Breast Cancer Patients With Sentinel Lymph Node Positive

Objective:At present,the axillary management of early breast cancer established by the status of sentinel lymph nodes(SLN)has become the standard treatment of breast cancer surgery:In patients with SLN-negative early breast cancer,axillary lymph node dissection(ALND)can generally be avoided,and whether SLN-positive patients can be exempted from ALND remains controversial.The purpose of this study was to compare the positive rates of axillary lymph nodes(ALN)between SLN(-),SLN(+)= 1,SLN(+)= 2 and SLN(+)?3 group to investigate the feasibility of avoiding ALND in stage I/II breast cancer patients with sentinel lymph node positive and find out the indications of SLN positive patients without ALND.Methods:The clinical and pathological data of 591 primary breast cancer patients from September 2014 to September 2016 at Tumor Hospital of Tianjin Medical University were collected and divided into SLN(-),SLN(+)= 1,SLN(+)= 2 and SLN(+)?3 group according to SLN status.All patients underwent ALND after SLNB.Finally,the positive rate of ALN in each group was compared.Results:1.A total of 591 patients were included in the study.All patients were successfully detected SLN,and the detection rate of SLN was 100%.A total of 1800 SLNs were detected and the median number of SLN was 3(1-7).Among them,there were 320 patients in SLN(-)group,and 820 SLNs were detected;there were 172 patients in SLN(+)= 1 group,and 540 SLNs were detected;there were 72 patients in SLN(+)=2 group,and 305 SLNs were detected;there were 27 patients in SLN(+)>3 group,and 135 SLNs were detected;Among the four groups,he median number of SLN was 3(1-7),3(1-6),4(2-6)and 5(3-7).2.ALN positive patients in SLN(-)group was 16 cases,the positive rate was 5%(16/320),that SLN false negative 16 cases,the false negative rate(FNR)was 5.0%,the accuracy rate was 95.0%.ALN-positive patients in SLN(+)=1,SLN(+)=2,and SLN(+)?3 group were 14,12 and 10 respectively,and the ALN positive rates were 8.1%(14/172),16.7%(12/72)and 37.0%(10/27)respectively.3?Univariate analysis showed that ALN metastasis was related to the diameter of primary tumors,the number of SLNs detected,the number of positive SLNs,and the status of ER and PR(all P<0.05).Multivariate analysis showed that ER positive(OR=4.577,95%CI 1.842?11.373),PR positive(OR=3.654,95%CI 1.413?9.448),the number of positive SLNs?2(OR=3.161,95%CI 1.358?7.359)and the number of SLNs detected? 2(OR= 14.35,95%CI 5.229?39.189)are independent risk factors for ALN metastasis(all P<0.05).4.The difference of ALN positive rate between each group was statistically significant(?2=38.232,P=0.000).There was no statistical difference in the positive rate of ALN between SLN(+)=1 group and SLN(-)group(?2=1.926,P=0.165).The ALN positive rate of SLN(+)=2 group was higher than that of SLN(-)group(?2=12.062,P=0.001)and SLN(+)=1 group(?2 = 3.876,P=0.049),and the difference in ALN positive rate was statistically significant.The ALN positive rate in the SLN(+)?3 group was significantly higher than that in the SLN(-)group(?2=32.939,P=0.000),SLN(+)=1 group(?2=15.751,P=0.000)and SLN(+)=2 group(?2=4.714,P=0.030),and the differences were statistically significant.Conclusion:Based on the above results,we suggest that in the decision-making of axillary surgical management of breast cancer,one SLN-positive patient may consider only SLNB without ALND,but two or more SLN-positive patients still recommend ALND routinely.This study provides a theoretical basis for the discovery of ALND-free indications for SLN-positive patients and the development of axillary management decisions.It can effectively avoid the complications such as lymphedema of upper limbs,limb numbness and pain in patients with ALND.The quality of life of the patients was improved.However,due to the small number of samples enrolled in this study,the exact conclusions need to be verified by more cases and higher levels of evidence-based basis.