The current evidence-based practice in the multidisciplinary treatment of breast cancer includes axillary lymph node dissection (ALND) for women with clinically positive axilla lymph nodes and for clinically negative nodes those with positive sentinel lymph nodes (SLNs). Many surgeons perform also ALND by absence of macrometastases and presence of micrometastases in SLNs.
This standard practice appears that will be modified after the publication of two randomized clinical trials that can be considered as practice-changing trials. In the first study of the National Surgical Adjuvant Breast and Bowel Project (NSABP), the clinical significance of occult metastases in the SLNs was evaluated and in the second performed by the American College of Surgeons Oncology Group (ACOSOG) Z0011 Study the impact of ALND, even by positive SLNs for selected patients, on survival and loco-regional recurrence was assessed. In this review, based on the results of these two trials, I am focused on the possibility of translating the results of these trials into routine clinical practice and potential limitations and risks of these practice-changing approaches.
(Citation: Gastric & Breast Cancer 2011; 10(3): 187-191)