Axillary surgery in node-positive breast cancer
• Current indications for performing axillary lymph node dissection.
• De-escalating axillary surgery strategies in node-positive
breast cancer.
• New concept for clinically node-positive breast cancer.
Long-term follow-up data from multicenter phase III
non-inferiority trials confirmed the safety of omission of axillary dissection
in selected patients with clinically node-negative, sentinel node-positive
breast cancer. Several ongoing trials investigate extended eligibility of the
Z0011 protocol in the adjuvant setting. De-escalation of axillary surgery in
patients with clinically node-positive breast cancer is currently limited to
the neoadjuvant setting, where the sentinel procedure is used to determine
nodal pathological complete response. Targeted axillary dissection lowers the
false-negative rate of the sentinel procedure, which, however, is consistently
associated with a very low risk of axillary recurrence in several recent
single-center series. Axillary dissection remains standard care in patients
with residual disease after neoadjuvant chemotherapy while the results of
Alliance A011202 are pending. The TAXIS trial investigates the role of tailored
axillary surgery in patients with clinically node-positive breast cancer, a
novel concept designed to selectively remove positive nodes in the adjuvant and
neoadjuvant setting.
