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  • Review Article
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Is axillary lymph node clearance required in node-positive breast cancer?

Nature Reviews Clinical Oncology volume 12, pages 55–61 (2015)Cite this article

Subjects

Key Points

  • Axillary micrometastases require no further axillary treatment after SNB for patients with early stage breast cancer

  • After positive sentinel node biopsy, axillary irradiation provides equivalent regional control to nodal clearance in early breast cancer

  • Less morbidity (especially lymphoedema) is seen after axillary radiotherapy

  • Axillary dissection can be safely omitted in patients with more than two positive sentinel nodes after breast-conserving surgery, provided whole-breast radiation therapy is planned

Abstract

Although the majority of patients with breast cancer have clinically negative axillary nodes at preoperative assessment, around 15–20% of these women will have metastatic disease within the lymph nodes at operative sentinel node biopsy, and additional selective treatment to the axilla might be required. Local treatment to the axilla can include axillary node clearance or axillary radiotherapy. The recent results of the American College of Surgeons Oncology Group Z0011 trial suggested that some women would be safe from recurrence without further axillary treatment if they have less than three involved sentinel nodes, with no extracapsular spread. We review the evidence base for management of the axilla after detection of a positive sentinel node, discuss the evidence for why micrometastatic disease requires systemic but not axillary therapy, and present data suggesting that axillary irradiation for macrometastases gives equivalent control to axillary node clearance, but causes less morbidity such as lymphoedema. Ongoing trials will confirm whether any further therapy can be omitted for all patients with low volume, sentinel-node macrometastases.

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Author information

Authors and Affiliations

  1. Department of Academic Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, Manchester, UK

    Nigel J. Bundred & Nicola L. P. Barnes

  2. Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 100CX, Netherlands

    Emiel Rutgers

  3. Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 100CX, Netherlands

    Mila Donker

Authors
  1. Nigel J. Bundred
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  4. Mila Donker
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All authors made substantial contributions to all stages of the preparation of the manuscript for submission.

Corresponding author

Correspondence to Nigel J. Bundred.

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The authors declare no competing financial interests.

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Bundred, N., Barnes, N., Rutgers, E. et al. Is axillary lymph node clearance required in node-positive breast cancer?. Nat Rev Clin Oncol 12, 55–61 (2015). https://doi.org/10.1038/nrclinonc.2014.188

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