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Axillary dissection in women with sentinel node metastasis

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2510 (Published 16 May 2011) Cite this as: BMJ 2011;342:d2510

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Axillary dissection in women with sentinel node metastasis

I agree with much of what Rescigno and Axelrod write but disagree
totally with the statement "ALND remains necessary for women who have
tumours larger than 5cm, those who require mastectomy, or when partial
breast radiation is planned". This advice is incorrect and outdated.

Sentinel lymph node biopsy works in patients with larger tumours and can
be performed either at the same time as mastectomy or during mastectomy1.
Patients with tumours larger than 5mm or who require mastectomy whose
sentinel lymph nodes are negative do NOT require axillary lymph node
dissection. Similarly for those suitable for partial breast radiation
whose sentinel lymph nodes are negative do NOT require axillary lymph node
dissection. Rescigno and Axelrod also state that axillary lymph node
dissection might be beneficial to determine the absolute benefits of
chemotherapy on the basis of the number of axillary nodes affected. There
is evidence from the AMAROS randomised study that completion axillary
lymph node dissection does not need to be performed to accurately assess
the need for chemotherapy2. An article on such an important surgical topic
as axillary lymph node dissection should have included an author who is a
surgeon and who has a thorough understanding of the current literature.

There are serious errors in this article and these need to be clarified
prominently in the Journal urgently.

1.SLN Biopsy for large and/or multicentric breast cancers: Should we
worry? Cody H. Eur J Surg Oncol. 2011 May;37(5):386-7

2.Role of Axillary Clearance After a Tumor-Positive Sentinel Node in
the Administration of Adjuvant Therapy in Early Breast Cancer. Straver M,
Meijnen P, Tienhoven G et al. J Clin Oncol. 2010 Feb 10;28(5):731-7

Competing interests: No competing interests

07 July 2011
J Michael Dixon
Professor of Surgery & Consultant Surgeon
Edinburgh Breast Unit