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Sentinel Lymph Node and Axillary Dissection

  • Hisham Fansa
  • Christoph Heitmann
Chapter

Abstract

The removal of axillary lymph nodes is nowadays used more for the diagnosis and initiation of adjuvant measures. Surgical therapy can only be one of many approaches to lymph node infiltration caused by cancer. Since the removal of axillary lymph nodes can lead to high morbidity and ultimately the survival rate is not improved by an aggressive lymph node dissection, the removal of sentinel lymph nodes has become popular. The sentinel lymph node (SLN) is the lymph node that is the first filter station in the drainage of the breast. If the lymph node is tumour-free, no further measures are necessary. If the lymph node is affected by macrometastasis, axillary dissection should take place as a follow-up intervention. The frozen section test has proven to be sufficiently safe in our hands. After frozen section examination, the axillary dissection can be performed in the same procedure in case of infiltration. If a frozen section examination is not possible or if a metastasis appears later in the workup, the axillary dissection must be carried out in a second operation. Isolated tumour cells and micrometastases in the SLN are not an indication for axillary lymphadenectomy.

Literature

  1. 1.
    Bromham N, Schmidt-Hansen M, Astin M, Hasler E, Reed MW. Axillary treatment for operable primary breast cancer. Cochrane Database Syst Rev. 2017;1:CD004561.  https://doi.org/10.1002/14651858. CrossRefPubMedGoogle Scholar
  2. 2.
    Crane-Okada R, Wascher RA, Elashoff D, Giuliano AE. Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Ann Surg Oncol. 2008;15:1996–2005.CrossRefGoogle Scholar
  3. 3.
    Del Bianco P, Zavagno G, Burelli P, Scalco G, Barutta L, Carraro P, Pietrarota P, Meneghini G, Morbin T, Tacchetti G, Pecoraro P, Belardinelli V, De Salvo GL. GIVOM Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for Breast cancer patients: results of the sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol. 2008;34:508–13.CrossRefGoogle Scholar
  4. 4.
    Fleissig A, Fallowfield LJ, Langridge CI, Johnson L, Newcombe RG, Dixon JM, Kissin M, Mansel RE. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95:279–93.CrossRefGoogle Scholar
  5. 5.
    Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, Saha S, Hunt KK, Morrow M, Ballman K. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, Ollila DW, Hansen NM, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Morrow M. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA. 2017;318:918–26.CrossRefGoogle Scholar
  7. 7.
    Intra M, Viale G, Vila J, Grana CM, Toesca A, Gentilini O, Galimberti V, Veronesi P, Luini A, Rotmensz N, Bagnardi V, Mattar D, Colleoni M. Second axillary sentinel lymph node biopsy for breast tumour recurrence: experience of the European Institute of Oncology. Ann Surg Oncol. 2015;22:2372–7.CrossRefGoogle Scholar
  8. 8.
    Janni W, Kühn T, Schwentner L, Kreienberg R, Fehm T, Wöckel A. Sentinel node biopsy and axillary dissection in breast cancer: the evidence and its limits. Dtsch Arztebl Int. 2014;111:244–9.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, Lebeau A, Liedtke C, von Minckwitz G, Nekljudova V, Schmatloch S, Schrenk P, Staebler A, Untch M. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609–18.CrossRefGoogle Scholar
  10. 10.
    Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, Ashikaga T, Weaver DL, Mamounas EP, Jalovec LM, Frazier TG, Noyes RD, Robidoux A, Scarth HM, Wolmark N. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.CrossRefGoogle Scholar
  11. 11.
    Russo L, Betancourt L, Romero G, Godoy A, Bergamo L, Delgado R, Ruiz Á, Gutiérrez M, Salas E, Puzzi M. Frozen section evaluation of sentinel lymph nodes in breast carcinoma: a retrospective analysis. Ecancermedicalscience. 2017;11:774.  https://doi.org/10.3332/ecancer.2017.774.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Tucker NS, Cyr AE, Ademuyiwa FO, Tabchy A, George K, Sharma PK, Jin LX, Sanati S, Aft R, Gao F, Margenthaler JA, Gillanders WE. Axillary ultrasound accurately excludes clinically significant lymph node disease in patients with early stage breast cancer. Ann Surg. 2016;264:1098–102.CrossRefGoogle Scholar
  13. 13.
    Zuber M, Oertli D, Marti WR, Kocher T, Wildisen A, Berclaz G, Köchli OR, Harder F. Für die Arbeitsgruppe FMH Guideline Mammakarzinom. FMH Guideline. Axillachirurgie beim Mammakarzinom Schweiz Ärztezeitung. 2003;84:1967–73.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Hisham Fansa
    • 1
    • 2
    • 3
  • Christoph Heitmann
    • 4
  1. 1.Department of Plastic, Reconstructive and Aesthetic SurgeryKlinikum BielefeldGermany
  2. 2.Center for Aesthetic Plastic Surgery and Reconstructive Breast SurgeryMunichGermany
  3. 3.Center for Aesthetic Plastic Surgery and Reconstructive Breast SurgeryZurichSwitzerland
  4. 4.Practice for Plastic SurgeryMunichGermany

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