Axillary lymph node dissection for patients with invasive breast cancer at Charlotte Maxeke and Chris Hani Baragwanath Academic Hospitals

Keywords: axillary lymph node dissection, invasive breast cancer, Charlotte Maxeke Johannesburg Academic Hospital, Chris Hani Baragwanath Academic Hospital

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) patients.This study aims to evaluate the application of SLNB and axillary lymph node dissection (ALND) and the associated risk factors for node-negative ALND in our units.

Methods: We included female patients with primary breast cancer who underwent axillary surgery in the breast units at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital from March 2013 to March 2015. Univariate and multivariable logistic regression models were used to determine factors associated with pathological node-negative (pN0) ALND.

Results: 505 patients were included and 344 patients were staged clinically node-positive (68.1%), 161 (31.9%) were assessed as clinically node-negative and deemed eligible for SLNB. Sensitivity of clinical nodal staging was 85.9% with a positive predictive value of 76.5%. The majority of patients (313, 61.9%) underwent primary surgery while 192 (38.1%) underwent surgery after NACT. We performed 118 SLNBs and 387 ALNDs of which 97 were pathologically node-negative. Risk was not increased after NACT (OR 1.06, p = 0.790). We identified a significant risk in patients with triple-negative and 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 25.06%. In our cohort a significantly higher risk was found in hormone receptor-negative tumours. Preoperative nodal assessment needs to be optimised and include pathological confirmation. SLNB needs to be extended to patients after NACT despite resource-constraints.

Author Biographies

C Groenewald, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, South Africa

H Cubasch, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, South Africa

A Mannell, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, South Africa

O Ayeni, University of the Witwatersrand

Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa

S Nietz, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, South Africa

Published
2019-11-04
How to Cite
Groenewald, C., Cubasch, H., Mannell, A., Ayeni, O., & Nietz, S. (2019). Axillary lymph node dissection for patients with invasive breast cancer at Charlotte Maxeke and Chris Hani Baragwanath Academic Hospitals. South African Journal of Surgery, 57(4), 18-24. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3007
Section
General Surgery