Axillary Recurrence in Breast Cancer Patients with Isolated Tumor Cells in the Sentinel Lymph Node [AJCC N0(i+)]

Background. Completion axillary lymph node dissection (CALND) is controversial in patients with sentinel lymph node (SLN) metastases <= 0.2 mm [N0 (i+)]. Our goal was to characterize patients with SLN isolated tumor cells regarding surgical management and axillary recurrence. Materials and Methods. An Institutional Review Board (IRB)-approved retrospective chart review identified 677 consecutive patients with positive SLN biopsy for breast cancer between October 1997 and June 2004, and NO(i+) patients were identified. Clinicopathologic characteristics, predicted probability of nonsentinel node disease, axillary surgery, and recurrences were recorded. Results. Of 81 patients with SLN NO(i+) metastasis, 31 underwent CALND and 50 did not. The two groups of patients showed no statistical differences in tumor size, stage, grade, number of SLNs removed, and number of positive SLNs. Predicted probability of additional axillary metastasis was somewhat higher among those who underwent CALND compared with those who did not. Patients undergoing CALND were significantly younger than those who did not (mean age 50 vs. 57, P = 0.01). Of the 31 patients with CALND, 4 (12.9%) had additional nodal metastases. Radiation to nodal fields was administered to 8 patients in the CALND group (25.8%) and to 7 in the group without axillary dissection (14.0%, P = 0.44). No axillary recurrences were noted at a median follow-up of 38 months. Conclusion. Among breast cancer patients with SLN isolated tumor cells, a small percentage have additional metastasis in other axillary nodes. However, the risk of axillary recurrence appears low in those who do not undergo CALND.