• Sara Yegiyants, Lina M Romero, Philip I Haigh, and L Andrew DiFronzo.
• Department of Surgery, Kaiser Permanente, Los Angeles Medical Center, 4760 Sunset Blvd, 3rd Floor, Los Angeles, CA 90027, USA.
• Arch Surg. 2010 Jun 1;145(6):564-9.

HypothesisCompletion axillary lymph node dissection (ALND) is not required for regional control in patients with metastases in the sentinel lymph node (SLN).DesignProspective cohort study.SettingUrban teaching hospital.PatientsFifty patients with breast cancer who underwent breast-conserving surgery, had an SLN positive for metastasis, and did not undergo completion ALND.InterventionsBreast-conserving surgery with SLN biopsy, breast irradiation, and systemic therapy.Main Outcome MeasuresLocoregional and distant recurrence and survival.ResultsThe mean patient age was 57 years (range, 29-83 years). The mean tumor size was 1.9 cm (range, 0.4-5 cm). The mean number of positive nodes was 1.3 (median, 1; range, 1-2). Fourteen patients (30%) had macrometastases (>2 mm), and 33 patients (71%) had micrometastases. The mean duration of follow-up was 82 months (median, 79 months; range, 6-142 months). One patient with an SLN micrometastasis (1 of 33; 3%) and 1 patient with an SLN macrometastasis (1 of 14; 7%) developed an axillary recurrence with distant metastasis at 84 months and 28 months, respectively. There was 1 death (2%) not related to breast cancer.ConclusionsPatients with SLN metastases who do not undergo ALND have a low incidence of regional recurrence. Axillary lymph node dissection is not necessary for regional control in patients with micrometastatic disease.

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