Torrenga H et al. (2004) Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: a long term follow-up analysis. J Surg Oncol 88: 4–8

Axillary lymph node dissection (ALND) is now commonly omitted in sentinel node (SN)-negative breast cancer patients. Although this approach avoids ALND-associated morbidity, its safety depends on the accuracy of the SN biopsy. Torrenga and colleagues have evaluated the long-term rate of axillary recurrences in patients treated in this way.

The prospective study included 104 SN-negative breast cancer patients. All patients had undergone SN biopsy by the triple technique (preoperative lymphoscintigraphy, intraoperative use of blue dye, and localization of the SN using a handheld gamma probe). Since H&E staining and immunohistochemistry of the harvested SNs showed no tumor, no further ALND was performed. Patients were treated with breast-conserving therapy or modified radical mastectomy, plus systemic therapy in some cases. The women were followed up every 3 months for the first year and 6-monthly thereafter.

During the follow-up period (median 57 months), only one local axillary recurrence was recorded. Three further patients developed distant metastases (in bone, brain and lung) and two of these patients died. The overall survival and disease-free survival rates were therefore 98% and 97%, respectively, whereas the local control rate was 99%.

The authors conclude that omitting ALND did not appear to have compromised local control or survival in these SN-negative patients, after more than 4 years' follow-up.