Axilla management in sentinel node positive breast cancer patients at Mater Dei Hospital : an audit and literature review

Abstract

BACKGROUND: In breast cancer patients with a positive SLN, surgical axillary clearance and axillary radiation therapy (ART) provide comparable locoregional control and survival, according to a 10-year follow-up of the large European Organisation for Research and Treatment of Cancer AMAROS trial. ART has the advantage of causing less complications with significantly lower rates of lymphoedema. The aim of this audit is to review clinical practice of axillary management of breast cancer patients in Malta following identification of positive SLN and compare results with international criteria. The possibility of de-escalating therapy might improve the morbidity of our patients without compromising their outcomes.

METHODS: A retrospective and quantitative analysis of 329 breast cancer patients who underwent an axillary SLN procedure at Mater Dei Hospital (MDH) between January 2019 and 2020 was performed. The inclusion criteria were patient demographics, pre-/post-operative staging, tumour size, and treatment given. Data was analysed and compared to International randomised trials. The San Matteo Criteria based on the AMAROS trial, were reviewed, and used as a standard and compared to local practice.

RESULTS: 329 patients were analysed, of which 284 patients fulfilled the inclusion criteria. 70 patients had a positive SLN with 74% having one SLN positive, of which 40% underwent ALND, 6% had ART, 2% refused ART and 52% received no treatment. 26% had 2 positive SLNs of which 44% underwent ALND, none received ART and 56% received no treatment in those with two positive SLN. Patients with more than 2 positive SLNs were excluded.

CONCLUSION: We have determined that ALND is the accepted management for breast cancer patients with positive SLN in MDH. ART should be considered as a more favourable treatment option in patients with positive SLN being treated as it provides comparable results with significantly lower morbidity than ALND.