الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In recent decades, there has been a paradigm shift in the management of axilla in breast cancer patients. Studies in recent years have found no significant difference in disease recurrence and overall survival in clinically node-negative breast cancer patients treated with SLNB alone Vs those treated with SLNB plus completion ALND.
This study aimed to assess the incidence of metastatic disease beyond the SLN in patients with clinically node-negative breast cancer.
This prospective single center study was conducted at the Surgical Oncology unit of the Alexandria Main University Hospital. Thirty-one female breast cancer patients with clinically node-negative axilla and had positive SLNB were included. Excluded from this study were patients post neoadjuvant chemotherapy, patients with previous axillary surgery and patients with negative SLNB. All patients had completion ALND after positive SLNB was detected by frozen section. Histopathologic assessment was done after completion ALND to detect metastasis beyond the SLNs. Univariate logistic regression analysis was done to identify clinicopathological features associated with non-SLNB metastasis.
A total of 31 female patients were enrolled. The mean age of the study population was 48 years. Five patients (16.1%) had a positive family history of breast cancer. The most frequent location of tumors was the upper outer breast quadrant (22/31, 70.9%). Most of the tumors (19/31) were T1 tumors. All the patients in our study had invasive ductal carcinoma. Macro-metastasis was identified in the SLN in 23 patients (74.2%) while 8 (25.8%) had micro-metastasis. No further disease was found on completion ALND in patients with micro-metastasis. And overall, no metastasis was detected in nodes beyond level I. The overall incidence of non-SLN metastasis was 58.1% (18/31) and incidence in macro-metastatic SLN was 78.3%. Patient age of ≥ 50 years was associated with higher likelihood of detecting non-SLN metastasis following completion ALND in our logistic regression analysis (p value=0.041, O.R=5.2, 95% C.I = 1.068 – 25.309). Presence of macro-metastasis (p value <0.001) and lympho-vascular invasion (p value = 0.001) showed significant association with metastasis to non-SLN compared to presence with micro-metastasis and no lympho-vascular metastasis respectively, on completion ALND.
The incidence of metastasis beyond the SLN was 58.1% in clinically node negative breast cancer patients. Our study demonstrated no further disease in patients with only micro-metastasis in the SLN and the patients with metastasis beyond the SLN had disease limited to level I axillary nodes. Patients aged ≥ 50 years were found to be more likely to have non-SLN metastasis when macro-metastasis was detected in SLNB. Our findings suggest that, in patients with only micro-metastasis in SLN, completion ALND could be avoided and for patients with larger metastasis size, especially when aged ≥ 50 years, removal of level I axillary nodes alone may be adequate.