Annals of Surgical Oncology

, Volume 19, Issue 12, pp 3755–3761 | Cite as

Omission of Axillary Dissection after a Positive Sentinel Node Dissection may Influence Adjuvant Chemotherapy Indications in Operable Breast Cancer Patients

  • Filippo Montemurro
  • Furio Maggiorotto
  • Giorgio Valabrega
  • Franziska Kubatzki
  • Valentina Rossi
  • Alessandra Magistris
  • Francesco Marocco
  • Marco Gatti
  • Ivana Sarotto
  • Massimo Aglietta
  • Riccardo Ponzone
Breast Oncology



This study was designed to evaluate how the omission of axillary dissection would have altered the indication for adjuvant chemotherapy (ACT) in patients with early breast cancer submitted to conservative surgery with one or two positive sentinel lymph nodes (SLNs).


We identified 321 women in our institutional database who fulfilled the characteristics. All underwent completion axillary lymph node dissection (AD). Each case was blindly reviewed by our breast team in two rounds, and the total number of positive lymph nodes was disclosed only in the second. At each round, the panel chose between: (1) recommend, (2) discuss, (3) do not recommend ACT. Changes between round 1 and 2 were studied by the marginal homogeneity test. Exploratory logistic regression analyses were performed to study predictors of non-SLN involvement and of changes in the indication for ACT.


AD revealed non-SLNs metastases in 96 patients (30 %). Fifty-two patients (16 %) had their initial indication changed at round 2 (p < 0.001). Most of the changes were toward ACT (83 %), and all except two occurred in patients with immunohistochemically defined luminal A and luminal B/HER2-negative tumors. In these two subgroups, a Ki67 above the median value (21 %) was the only independent predictor of no change in the indication to ACT at round 2.


Omission of AD in patients with one or two positive SLNs may change the indication to ACT in a significant proportion of patients with hormone receptor-positive/HER2-negative tumors. All implications should be taken into account before abandoning AD, including a possible biologically tailored surgical approach.


Axillary Dissection Axillary Dissection Ipsilateral Breast Tumor Recurrence Sentinel Lymph Node Dissection Completion Axillary Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.




Supplementary material

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Supplementary material 1 (DOCX 11 kb)
10434_2012_2505_MOESM2_ESM.docx (19 kb)
Supplementary material 2 (DOCX 18 kb)


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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Filippo Montemurro
    • 1
    • 2
  • Furio Maggiorotto
    • 3
  • Giorgio Valabrega
    • 2
  • Franziska Kubatzki
    • 3
  • Valentina Rossi
    • 2
  • Alessandra Magistris
    • 3
  • Francesco Marocco
    • 3
  • Marco Gatti
    • 4
  • Ivana Sarotto
    • 5
  • Massimo Aglietta
    • 2
  • Riccardo Ponzone
    • 3
  1. 1.Unit of Investigative Clinical Oncology (INCO)Institute for Cancer Research and TreatmentCandioloItaly
  2. 2.Division of Medical OncologyInstitute for Cancer Research and TreatmentCandioloItaly
  3. 3.Division of Gynecological OncologyInstitute for Cancer Research and TreatmentCandioloItaly
  4. 4.Division of RadiotherapyInstitute for Cancer Research and TreatmentCandioloItaly
  5. 5.Division of PathologyInstitute for Cancer Research and TreatmentCandioloItaly

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