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The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients

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Abstract

Several independent randomized controlled trials are initiated to investigate whether sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients with negative axillary ultrasound findings, who are treated with breast conserving therapy. A consequence of omitting sentinel lymph node biopsy is absence of pathological lymph node status information. We aimed to investigate the impact of omitting sentinel lymph node biopsy on adjuvant systemic treatment recommendations. Data from all consecutive patients with invasive breast cancer and negative axillary ultrasound findings treated with breast conserving therapy and sentinel lymph node biopsy between 2008 and 2012 were collected from a prospective database. Two methods, Adjuvant! Online and the Dutch breast cancer guideline 2012, were used to determine the adjuvant systemic treatment recommendations of every patient. At first, each patient was considered to be lymph node negative, and secondly the patients’ true pathological lymph node status was used. A total of 303 patients were consecutively included. Pathological lymph node status was pN0 in 72.3 %, pN0(i+) in 12.9 %, pN1mi+ in 5.6 %, pN1 in 7.3 %, and pN2 in 2.0 % of the patients. The decision to recommend adjuvant systemic treatment changed due to the pathological lymph node status in 1.0 % of the patients (3/303) when using Adjuvant! Online and in 3.6 % (11/303) when using the 2012 Dutch breast cancer guideline. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients with negative axillary ultrasound findings treated with breast conserving therapy is limited. The safety of omitting the sentinel lymph node biopsy should be confirmed by the initiated randomized controlled trials.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    L. M. van Roozendaal, R. J. Schipper, C. M. Haekens & M. L. Smidt

  2. Division of Pathology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    K. K. B. T. Van de Vijver

  3. Division of Radiology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    M. B. I. Lobbes

  4. Division of Medical Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands

    V. C. G. Tjan-Heijnen & M. de Boer

  5. GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands

    L. M. van Roozendaal, R. J. Schipper, M. B. I. Lobbes, V. C. G. Tjan-Heijnen, M. de Boer & M. L. Smidt

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  1. L. M. van Roozendaal
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  7. M. de Boer
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Correspondence to L. M. van Roozendaal.

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L.M. van Roozendaal and R.J. Schipper have contributed equally to the study.

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van Roozendaal, L.M., Schipper, R.J., Van de Vijver, K.K.B.T. et al. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients. Breast Cancer Res Treat 143, 469–476 (2014). https://doi.org/10.1007/s10549-013-2822-5

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