THERAPEUTIC EFFECT OF SENTINEL LYMPHADENECTOMY IN TL BREAST-CANCER

Objective: To evaluate whether the tumor status of the sentinel lymph node (SN) would alter the systemic adjuvant therapy administered to pa tients with T1 breast cancer. Design and Patients: Consecutive breast cancer patients (tumors less than or equal to 2 cm) who underwent succ essful sentinel lymphadenectomy. Main Outcome Measures: Metastatic tum or in the SN, primary tumor size, recommendations for systemic adjuvan t therapy before and after histopathologic evaluation of the SN, and a ctual systemic adjuvant therapy received by the patient. Results: Of 1 42 total patients, 14 had T1a tumors; 35, T1b; and 93, T1c. Recommenda tions for systemic adjuvant therapy were initially determined solely b y primary tumor characteristics and menopausal status. These recommend ations were compared with recommendations for systemic adjuvant therap y based on tumor characteristics, menopausal status, and SN status; an d then were compared with actual systemic adjuvant therapy received by the patient. Among the 118 patients with T1a, T1b, and favorable (pos itive estrogen or progesterone receptors and a low S-phase percentage with respect to DNA content) T1c tumors, 15 (37.5%) of 40 premenopausa l patients and 20 (25.6%) of 78 postmenopausal patients became candida tes for chemotherapy when examination of the SN revealed axillary meta stasis; chemotherapy was actually administered to all 15 premenopausal patients but to only 6 postmenopausal patients. In the remaining 24 p atients with unfavorable T1c tumors, SN status did not change the reco mmendation for chemotherapy but may have altered the choice of specifi c chemotherapeutic agents. Conclusions: Identification of tumor-involv ed SN may alter systemic adjuvant therapy in patients with T1a, T1b, a nd favorable T1c tumors and may potentially change the type or dose of chemotherapeutic agents given to patients with unfavorable T1c tumors . Surgical axillary staging Of the axilla remains an essential part of breast cancer management and should not be abandoned.