Postoperative management of positive sentinel lymph node in patients with early invasive breast cancer [Impact de l'atteinte du ganglion sentinelle sur la stratégie thérapeutique des cancers du sein]

摘要

The status of the axillary lymph nodes is the most important prognostic factor in breast cancer. Positive sentinel lymph node may be divided into two categories: metastatic, that is, pN1, and minimal lymph node involvement, that is, pN1mi and pN0i+. Postoperative management of pN1 patients following SNB (sentinel node biopsy) is same as pN1 patients following axillary lymph node dissection, whereas postoperative management of pN1mi and pN0i+ patients is still debated, with a trend to do a complementary axillary lymph node dissection because of the risk of positive-non-SNB. This risk is evaluated approximately 1015% (reclassifying in pN1) and can modify irradiation fields and adjuvant systemic therapy. Recent papers concerning the prognosis of these patients are published since 2008. The size of node metastasis seems to be correlated with 5-year distant free metastasis survival as well as the 10-year overall survival and has been described as a decisive factor for adjuvant systemic therapy. Analysis of lymphatic dissemination remains necessary in the management of breast cancer, and analysis of minimal lymph node involvement gives the surgeons an opportunity to play a role in optimizing the postoperative treatment and the prognosis of our patients.