Axillary lymph node dissection for patients with invasive breast cancer at Charlotte Maxeke Johannesburg academic hospital and Chris Hani Baragwanath academic hospital
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Date
2019
Authors
Groenewald, C
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Abstract
Background: The extent of axillary surgery correlates with its morbidity and sentinel
lymph node biopsy (SLNB) has become the standard of care in clinically node-negative
(cN0) breast cancer patients.
Objectives: This study aims to 1) evaluate the application of SLNB and axillary lymph
node dissection (ALND) and determine the prevalence of pathological node negative
(pN0) ALND’s and 2) determine the factors associated with pN0 ALND outcome in two
Johannesburg breast units.
Methods: We included female patients with primary breast cancer who underwent
axillary surgery in the breast units at Charlotte Maxeke Johannesburg Academic
Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH) from
March 2013 to March 2015. Univariate and multivariable logistic regression models were
used to determine factors associated with pN0 ALND.
Results: Five hundred and five patients were included and 344 patients (68.1%) were
staged clinically node-positive (cN1), 161 patients (31.9%) were assessed as cN0 and
deemed eligible for SLNB. Sensitivity of clinical nodal staging was 85.9% with a positive
predictive value (PPV) of 76.5%. The majority of patients (313, 61.9%) underwent
primary surgery while 192 patients (38.1%) underwent surgery after Neoadjuvant
chemotherapy (NACT). We performed 118 SLNBs and 387 ALNDs. There were 97 pN0
ALND’s and of all the SLNB’s and ALND’s, a total of 199 were pN0 tumours.
Risk was not increased after NACT (OR 1.06, p=0.790). We identified a significant risk
in patients with triple-negative and Human epidermal growth factor-2 (HER-2) enriched
subtypes compared to hormone receptor-positive patients (OR 3.05, 95% CI: 1.6-5.7,
p=0.001 and OR 2.25, 95% CI: 1.1-4.8, p=0.035).
Conclusions: The prevalence of pN0 ALND was 25.1%. Hormone receptor negative
tumours were associated with a higher pN0 ALND outcome as compared to luminal
cancers.
Preoperative nodal assessment needs to be optimised and include pathological
confirmation. SLNB needs to be extended to patients after NACT despite resourceconstraints.
Description
A Research Report submitted to the Faculty of Health Science, University of
Witwatersrand, in fulfillment of the requirements for the degree of Masters in Surgery
(Mmed in Surgery)
Johannesburg 2019
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Citation
Groenewald, Carolette (2019) Axillary lumph node dissection for patients with invasive breast cancer at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/29623>