Ann Surg Treat Res.  2023 Jul;105(1):10-19. 10.4174/astr.2023.105.1.10.

Trends of axillary surgery in breast cancer patients with axillary lymph node metastasis: a comprehensive single-center retrospective study

• Kim YJ
• Kim HJ
• Chung SY
• Lee SK
• Chae BJ
• Yu J
• Lee JE
• Kim SW
• Nam SJ
• Ryu JM

• KMID: 2544598
• DOI: http://doi.org/10.4174/astr.2023.105.1.10

Abstract

Purpose
Based on the results of previous trials, de-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) has increased in patients with axillary lymph node (ALN) metastasis at presentation. This study aimed to review the trends of axillary surgery by time period and molecular subtype in patients with ALN metastasis.
Methods
We analyzed the rates of sentinel lymph node biopsy (SLNB) and ALN dissection (ALND) based on time period and subtype. The time period was divided into 3 subperiods to determine the rate of axillary surgery type over time (period 1, from 2009 to 2012; period 2, from 2013 to 2016; and period 3, from 2017 to July 2019).
Results
From 2009 to July 2019, 2,525 breast cancer patients underwent surgery. Based on subtype, the ALND rate of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2–) disease decreased by 13.0% from period 1 to period 3 (period 1, 99.4%; period 2, 97.5%; and period 3, 86.4%; P < 0.001). Conversely, the ALND rate in HR+/HER2+, HR–/HER2+, and triple-negative breast cancer (TNBC) significantly decreased by 43.7%, 48.8%, and 35.2% in period 1, period 2, and period 3, respectively (P < 0.001). In the patient group receiving NAC, HR+/HER2– had a significantly higher ALND rate (84.1%) than HR+/HER2+, HR–/HER2+, and TNBC (60.8%, 62.3%, and 70.7%, respectively; P < 0.001).
Conclusion
The SLNB rate in patients with ALN metastasis has increased over time. However, the ALND rate in HR+/ HER2– was significantly higher than in other subtypes.

Keyword

Lymphatic metastasis; Breast neoplasms; Neoadjuvant chemotherapy; Sentinel lymph node biopsy

Figure

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  Fig. 1 Axillary surgery based on subtype. SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; TNBC, triple-negative breast cancer.

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  Fig. 2 Axillary surgery in each subtype based on NAC status and time period. (A) Period 1, from 2009 to 2012. (B) Period 2, from 2013 to 2016. (C) Period 3, from 2017 to July 2019. NAC, neoadjuvant chemotherapy; SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; TNBC, triple-negative breast cancer.

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  Fig. 3 Axillary surgery in each subtype based on neoadjuvant chemotherapy status. NAC, neoadjuvant chemotherapy; SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; TNBC, triple-negative breast cancer.

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  Fig. 4 Axillary surgery in each subtype based on time period. HR, hormone receptor; HER2, human epidermal growth factor receptor 2; SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection; TNBC, triple-negative breast cancer.

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