Mythilidevi Sappa1, Ravichandra Matcha2
ALND after breast cancer surgery is associated with considerable morbidity. We hypothesised- 1) The morbidity in patients undergoing SLN biopsy only is significantly lower compared with those after SLN and completion ALND level I and II; and 2) The intermediate survival rates, local and axillary recurrence rates were significantly equivalent in both the groups.
MATERIALS AND METHODS
Patients with early stage breast cancer (pT1 and pT2 ≤3 cm, cN0) were included between April 2010 and April 2016 in this prospective single centre study. All patients underwent SLN biopsy. In all patients with SLN macrometastases and most patients with SLN micrometastases (43 of 68) or isolated tumour cells (11 of 19), a completion ALND was performed. Postoperative morbidity was assessed based on a standardised protocol.
SLN biopsy alone was performed in 449 patients, whereas 210 patients underwent SLN and completion ALND. The median follow-ups were 31.0 and 29.5 months for the SLN and SLN and completion ALND groups, respectively. Intermediate-term follow-up information was available from 635 of 659 patients (96.4%) of enrolled patients. The following results were found in the SLN versus SLN and completion ALND group- Presence of lymphoedema (3.5% vs. 19.1%, P <0.0001), impaired shoulder range of motion (3.5% vs. 11.3%, P <0.0001), shoulder/arm pain (8.1% vs. 21.1%, P <0.0001) and numbness (10.9% vs. 37.7%, P <0.0001).
CONCLUSION The morbidity after SLN biopsy alone is not negligible, but significantly lower compared with ALND. The intermediate survival rates, local and axillary recurrence rates were equivalent in SLNB only and SLNB plus completion ALND groups.