The New England Journal of MedicineOmitting Axillary Dissection in Breast Cancer with Sentinel-Node Metastases

Redefining Surgical Norms: The Impact of Sentinel Node Biopsy on Breast Cancer Treatment

This recent study explores the efficacy of sentinel node biopsy compared to traditional axillary lymph node dissection in patients with clinically node-negative breast cancer. With a focus on recurrence-free survival rates, the research provides crucial insights that could influence future surgical decisions and treatment protocols in breast cancer management.

Key Points:

• The study was a noninferiority trial comparing sentinel node biopsy only versus completion axillary lymph node dissection in patients with clinically node-negative T1 to T3 breast cancer.
• Participants included 2,766 patients across five countries, with the per-protocol population consisting of 2,540 individuals.
• The primary endpoint was overall survival, with a specific focus on the secondary endpoint of recurrence-free survival.
• The 5-year recurrence-free survival rates were 89.7% in the sentinel-node biopsy–only group and 88.7% in the dissection group.
• A country-adjusted hazard ratio for recurrence or death was 0.89 (95% CI, 0.66 to 1.19), significantly below the prespecified noninferiority margin.
• The majority of patients in both groups received radiation therapy, including nodal target volumes, highlighting the integrated approach to treatment.
• This study’s findings suggest that omitting completion axillary lymph node dissection does not compromise recurrence-free survival in selected patients.
• The implications of these results could lead to a shift in surgical practice, potentially reducing the extent of surgery and associated morbidity in suitable patients.

HCN Medical Memo
The omission of completion axillary-lymph-node dissection was noninferior to more extensive surgery in sentinel-node macrometastases, suggesting a possible paradigm shift in the surgical management of breast cancer.

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