Axe the ax dissection.

Top Line: Women with clinically node negative breast cancer generally don't need full axillary dissections.
The Study: A year ago, we got the 10 year results from the Z0011 trial showing that omitting an axillary dissection was non-inferior for women with 1-2 sentinel node metastases. In IBCSG 23-01, women with ≤ cT2N0 and patholoigic axillary nodal micrometastases (< 2 mm or isolated tumor cells) were randomized +/- subsequent axillary dissection followed by routine adjuvant care. Now we have these 10 year outcomes that confirm omitting an axillary dissection results in non-inferior disease-free and overall survival. An interesting side note is that all women were enrolled pre-op so we learn the rate of sentinel node micromets among clinically node-negative women is roughly 14%. Isolated axillary recurrences were rare and similar between groups: 2% without versus 1% with a completion dissection. Rate of breast cancer events were exactly the same (16%), and the primary patterns of failure were distant (~10%), local (~3%), and contralateral breast (~3%). Lymphedema, on the other hand, was significantly lower without dissection (3% versus 13%).
Bottom Line: The omission of axillary lymph node dissection in women with macro or micrometastases forfeits no breast cancer or survival outcomes and affords less toxicity. | Galimberti, Lancet Oncol 2018


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