Oncological safety of skipping ALND in patients undergoing mastectomy for clinical N0, SLN-positive breast cancer

A retrospective study at two centers in South Korea investigated the oncological safety of skipping axillary lymph node dissection (ALND) in patients undergoing total mastectomy (TM) for early breast cancer (EBC) without palpable lymphadenopathy who had one or two positive sentinel lymph nodes at the time of surgery. Propensity score matching was performed between the sentinel lymph node biopsy (SLNB) alone group and the ALND group. With a median follow-up of 65.0 months, 5-year disease-free survival rate was 90.8% in the SLNB group and 93.9% in the ALND group (p=0.36), while 5-year ipsilateral locoregional recurrence-free survival (LRRFS) was 95.1% versus 98.3% (p=0.21). In the SLNB group, patients who received radiotherapy had better 5-year LRRFS rate compared to patients who did not receive radiotherapy (100% versus 92,9%; p=0,02). The authors conclude that SLNB alone was not inferior to ALND in patients undergoing TM for EBC and had one or two positive SLNs, while radiotherapy could decrease locoregional recurrence among patients who underwent SLNB alone.