The Axillary Nodal Harvest in Breast Cancer Surgery Is Unchanged by Sentinel Node Biopsy or the Timing of Surgery

Introduction. Patients with a positive sentinel lymph node biopsy may undergo delayed completion axillary dissection. Where intraoperative analysis is available, immediate completion axillary dissection can be performed. Alternatively, patients may undergo primary axillary dissection for breast cancer, historically or when preoperative assessment suggests axillary metastases. This study aims to determine if there is a difference in the total number of lymph nodes or the number of metastatic nodes harvested between the 3 possible approaches. Methods. Three consecutive comparable groups of 50 consecutive patients who underwent axillary dissection in each of the above contexts were identified from the Portsmouth Breast Unit Database. Patient demographics, clinicopathological variables, and surgical treatment were recorded. The total pathological nodal count and the number of metastatic nodes were compared between the groups. Results. There were no differences in clinico-pathological features between the three groups for all features studied with the exception of breast surgical procedure ( ). There were no differences in total nodal harvest ( ) or in the number of positive nodes harvested ( ) between the three groups. Conclusion. The three approaches to axillary clearance yield equivalent nodal harvests, suggesting oncological equivalence and robustness of surgical technique. 1. Introduction The role of axillary surgery in breast cancer is to stage the axilla and in those with lymph node metastases to treat the axilla with axillary clearance [1]. Adequate axillary dissection is important in node-positive patients both to ensure removal of all involved nodes to optimise local control and to obtain the maximum prognostic information [2]. When staging the axilla, an additional goal, particularly in node-negative patients, is to minimise morbidity. Various strategies for doing so have been developed, the most recent being dual localisation sentinel lymph node biopsy (SLNB). This has been recommended by the United Kingdom National Institute for Health and Clinical Excellence as the “preferred technique” for staging the axilla in radiologically or cytologically (where tested) node-negative patients [3]. If SLNB analysis demonstrates metastasis to the axilla, it is recommended that patients undergo axillary clearance [4]. Traditionally, sentinel lymph nodes are analysed histologically, and patients who are found to have metastases in these nodes often undergo a delayed completion axillary dissection (dALND) after a delay when the histological result is available.