Published: 2019-08-28

Axillary dissection versus non dissection in negative sentinel node biopsy patients

Hossam Abd Ellatif Abo Elkasem, Ahmed Abdel Kahaar Aldardeer


Background: The goal of this series was to compare performing axillary clearance versus none performing in patients with node biopsy negative.

Methods: This study included 114 patients had breast cancer , presented with breast mass no enlarged axillary node either clinically or radiologically and all patients had negative sentinel lymph node intraoperatively those patients presented to Sohag Cancer Center and General Surgery Department Sohag, Egypt during the period of May 2018 to May 2019. Analysis of the clinical presentation, grade of breast cancer and radiological findings was done. All patients with above mentioned criteria were fitted for the study.

Results: A total of 114 patients, all of them had sentinel lymph node negative, axillary dissection done in 55 patients of them while 59 patients had no dissection. We divided the patients in our series into group A (with axillary dissection) and group B with non-dissection; in group A 27 (49.1%) patients had lymphoedema on post-operative follow up while in group B none of patients complained from lymphoedema. Numbness was found in 11 (20%) patients among group A patients, while in group B none of patients complained from numbness. On follow up of seroma we discovered that in group A all the patients had seroma while in group B only 9 (15.3%) patients had seroma. None of our 114 patients either with or without dissection had recurrence on follow up period.

Conclusions: Clearance of the axilla in sentinel node negative patients has no significant difference in overall survival but also increased rates of lymphoedema, seroma and haematoma. 


Breast cancer, Axillary clearance, Sentinel node biopsy, Lymphoedema

Full Text:



Sugie T, Sawada T, Tagaya N, Kinoshita T, Yamagami K, Suwa H, et al. Indocyanine green fluorescence in comparison to blue dye methods in detection of sentinel lymph nodes in early-stage breast cancer. Annals Surg Oncol. 2013;20(7):2213-8.‏

Gary LH, Giuliano AE, Somerfield MR, Benson AB, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703-20.‏

Kirby IB, Copeland EM, Klimberg S. History of the therapy of breast cancer. Breast. 2018;5:1-19.‏

Hunt KK, Yi M, Mittendorf EA, Guerrero C, Babiera GV, Bedrosian I, et al. After neoadjuvant chemotherapy doing sentinel lymph node surgery is considered accurate and reduces the need for dissection of the axilla in patients with breast cancer. Annals Surg. 2009;250(4):558-66.‏

Howard S. American Society of Breast Surgeons presidential address: could quality measures impede quality care?. Annals Surg Oncol. 2012;19(10):3125-30.‏

Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2014;32(13):1365-83.‏

Maimone S. Handbook of breast MRI. In: Jeremy P, ed. New York, NY: Cambridge University Press; 2012: 230.‏

Recht A, COmen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and society of surgical oncology focused guideline update. Practical Radiat Oncol. 2016;6(6):219-34.‏

Wishart GC, Loh SW, Jones L, Benson JR. A feasibility study (ICG-10) of indocyanine green (ICG) fluorescence mapping for sentinel lymph node detection in early breast cancer. Eur J Surg Oncol. 2012;38(8):651-6.‏

Galanzha E, Kokoska MS, Shashkov EV, Kim JW, Tuchin TV, Zharov VP. In vivo fiber‐based multicolor photoacoustic detection and photothermal purging of metastasis in sentinel lymph nodes targeted by nanoparticles. J Biophotonics. 2009;2:528-39.‏

Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297-305.‏

Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426.‏

Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303-10.‏

Schipper RJ, Moossdorff M, Nelemans PJ, Nieuwenhuijzen GA, de Vries B, Strobbe LJ, et al. A model to predict pathologic complete response of axillary lymph nodes to neoadjuvant chemo (immuno) therapy in patients with clinically node-positive breast cancer. Clin Breast Cancer. 2014;14(5):315-22.‏

Gabor C. Sentinel node biopsy and nodal staging. Breast Cancer, a heterogeneous disease entity. Dordrecht: Springer; 2011: 149-183.