Abstract P3-03-37: A clinical evaluation of performing total axillary lymph node clearance in breast cancer patients after positive sentinel lymph node biopsy in light of the ZOO11 randomised control trial, based at one centre in the UK
Authors: Saeed S , Javadzadeh S , Clark S , Kirupakaran A , Ullah MZ , Aggarwal S , Frecker PB 
Published: May 2019

Abstract
Introduction
Axillary nodal involvement is a poor prognostic indicator in breast cancer1. Sentinel lymph node biopsy (SLNB) is known to have a &gt;95% rate for identification of nodal metastatic spread, its use has significantly reduced common complications of total axillary lymph node clearance (TALNC)1. However, a recent large American study (ZOO11 RCT)2 demonstrated that in cases of 1- 2 positive sentinel lymph nodes (SLN) in patients with T1/T2 tumours, conservative management is non- inferior to TALNC and does not impact on the 10 year survival rate2. In this retrospective study we have analysed a cohort of patients from our centre to clinically evaluate the need for TALNC in patients who have 1-2 positive SLN.
Methods
Retrospective analysis of histopathology data within our centre identified 1100 patients who had a breast surgery procedure recorded between 2012- 2017. Patients were excluded from this original data set due to duplication of results, lack of electronic patient records as well as coding for non breast surgery related procedures. This left a total of 774 patients. A data collection tool was used to identify and record those patients who had SLNB performed. We recorded the number of nodes yielded as well as the number found to be positive for both SLNB and TALNC.
Results
From 774 patients 47.5% (368) patients had SLNB performed. The remaining 52.6% (407) patients had a core biopsy, no biopsy or radiological identification of lymphatic spread. A total of 82% (635) patients had TALNC. There were 30.4% patients who had a TALNC based on positive SLNB. The percentage of patients who had TALNC that yielded positive lymph nodes was 13.2%. There were 9.56% (74) patients with only 1-2 positive SLN excised that went on to have TALNC. There were 6.71% patients who had only 1 positive SLN (mean no. of nodes removed = 2.3) and 2.84% patients with 2 positive SLN (mean no. of nodes removed = 3.2). Interestingly there were 2 patients who had 0 positive SLN but had TALNC.
Conclusion
Our study demonstrates that the number of patients who had SLNB performed with only 1-2 positive nodes identified and then went on the have a TALNC, was very low (9.56%). It brings in to question whether performing a TALNC on this cohort of patients is a necessary routine procedure. Especially given that the ZOO11 RCT demonstrated no difference in 10 year survival (in a similar group of patients) between TALNC vs no TALNC, with both groups receiving radiotherapy post operatively. We could possibly suggest that a change in routine management for patients with only 1-2 positive SLN is that they do not undergo further operative TALNC but proceed straight to radiotherapy treatment.
Bibliography
1. Zahoor S, Haji A, Battoo A, Qurieshi M, Mir W, Shah M. Sentinel Lymph Node Biopsy in Breast Cancer: A Clinical Review and Update. Journal of Breast Cancer. 2017;20(3):217-227.
2. Giuliano AE, Ballman KV, McCall L, et al. 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(10):918-926.
Citation Format: Saeed S, Javadzadeh S, Clark S, Kirupakaran A, Ullah MZ, Aggarwal S, Frecker PB. A clinical evaluation of performing total axillary lymph node clearance in breast cancer patients after positive sentinel lymph node biopsy in light of the ZOO11 randomised control trial, based at one centre in the UK [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-37.