CADONOT: Comparing axillary dissection or not in breast cancer surgery
Introduction: Sentinel lymph node biopsy (SLNB) is the gold standard for the axillary evaluation of clinically node-negative early breast cancer. The ACOSOG Z0011 study demonstrated the safety of omitting axillary dissection for limited SLNB disease, with other trials confirming SLNB alone or with a...
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Elsevier
2025-06-01
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| Series: | Breast |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977625004709 |
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| author | André Mattar Marcelo Antonini Francisco Pimentel Cavalcante Felipe Zerwes Eduardo de Camargo Millen Fabricio Palermo Brenelli Antônio Luiz Frasson Patrícia Carvalho Baruel Lucas Miyake Okumura Leonardo Ribeiro Soares Marcelo Madeira Marina Diógenes Teixeira Andressa Gonçalves Amorim Larissa Chrispim de Oliveira Marcellus do Nascimento Moreira Ramos Gil Facina Ruffo de Freitas Junior Henrique Lima Couto Sabrina Monteiro Rondelo Renata Montarroyos Leite Renata Arakelian Luiz Henrique Gebrim Juliana Monte Real |
| author_facet | André Mattar Marcelo Antonini Francisco Pimentel Cavalcante Felipe Zerwes Eduardo de Camargo Millen Fabricio Palermo Brenelli Antônio Luiz Frasson Patrícia Carvalho Baruel Lucas Miyake Okumura Leonardo Ribeiro Soares Marcelo Madeira Marina Diógenes Teixeira Andressa Gonçalves Amorim Larissa Chrispim de Oliveira Marcellus do Nascimento Moreira Ramos Gil Facina Ruffo de Freitas Junior Henrique Lima Couto Sabrina Monteiro Rondelo Renata Montarroyos Leite Renata Arakelian Luiz Henrique Gebrim Juliana Monte Real |
| author_sort | André Mattar |
| collection | DOAJ |
| description | Introduction: Sentinel lymph node biopsy (SLNB) is the gold standard for the axillary evaluation of clinically node-negative early breast cancer. The ACOSOG Z0011 study demonstrated the safety of omitting axillary dissection for limited SLNB disease, with other trials confirming SLNB alone or with axillary radiotherapy (AR) as non-inferior. Methods: We followed PRISMA guidelines and registered at PROSPERO. Using Medline, Embase, and Cochrane, we reviewed randomized controlled trials (2010–2024). Outcomes, including 5-, 8-, and 10-year OS, DFS, recurrence rates, and lymphedema, were analyzed with R software and assessed for bias (Cochrane RoB) and evidence quality (GRADE). The focus was ALND vs. SLNB, alone or with AR, in cT1-T3 BC with 1–2 metastatic SLNs. Results: Thirteen articles from seven randomized controlled trials (RCTs) were included, covering 7338 women with a follow-up period of 2.8–10 years. SLNB was associated with a 65 % lower risk of lymphedema than ALND, with no significant differences in the 5-, 8-, or 10-year OS, DFS, or recurrence rates. A meta-analysis comparing micrometastasis and macrometastasis showed no impact on outcomes, indicating that ALND may be unnecessary in either case. Recurrence rates also did not differ between SLNB and ALND, reinforcing SLNB's significantly lower lymphedema risk of SLNB. Conclusions: This systematic review and meta-analysis support SLNB as a safe and effective alternative to ALND in early-stage BC with 1–2 positive SLNs, providing comparable survival and recurrence outcomes, with fewer complications. |
| format | Article |
| id | doaj-art-91f4f47e9bfd443eaded3f828fefdd9f |
| institution | OA Journals |
| issn | 1532-3080 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj-art-91f4f47e9bfd443eaded3f828fefdd9f2025-08-20T02:30:55ZengElsevierBreast1532-30802025-06-018110445310.1016/j.breast.2025.104453CADONOT: Comparing axillary dissection or not in breast cancer surgeryAndré Mattar0Marcelo Antonini1Francisco Pimentel Cavalcante2Felipe Zerwes3Eduardo de Camargo Millen4Fabricio Palermo Brenelli5Antônio Luiz Frasson6Patrícia Carvalho Baruel7Lucas Miyake Okumura8Leonardo Ribeiro Soares9Marcelo Madeira10Marina Diógenes Teixeira11Andressa Gonçalves Amorim12Larissa Chrispim de Oliveira13Marcellus do Nascimento Moreira Ramos14Gil Facina15Ruffo de Freitas Junior16Henrique Lima Couto17Sabrina Monteiro Rondelo18Renata Montarroyos Leite19Renata Arakelian20Luiz Henrique Gebrim21Juliana Monte Real22Hospital da Mulher - SP, São Paulo, SP, Brazil; BBREAST: Brazilian Breast Association Team, Brazil; Corresponding author. BBREAST: Brazilian Breast Association Team, Brazil.BBREAST: Brazilian Breast Association Team, Brazil; Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, SP, Brazil; Hospital do Servidor Público Estadual – Francisco Morato de Oliveira, São Paulo, SP, BrazilBBREAST: Brazilian Breast Association Team, Brazil; Hospital Geral de Fortaleza, Fortaleza, CE, BrazilBBREAST: Brazilian Breast Association Team, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, São Paulo, RS, Brazil; Grupo Oncoclínicas, Porto Alegre, RS, BrazilBBREAST: Brazilian Breast Association Team, Brazil; Américas Oncologia, Rio de Janeiro, RJ, BrazilBBREAST: Brazilian Breast Association Team, Brazil; Universidade Estadual de Campinas, Campinas, SP, BrazilBBREAST: Brazilian Breast Association Team, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, BrazilVerde Health Care Consultancy, São Paulo, SP, BrazilValue ArchTech, São Paulo, SP, BrazilUniversidade Federal de Goiás, Goiania, GO, BrazilFaculdade de Medicina do Hospital Albert Einstein, São Paulo, SP, BrazilHospital da Mulher - SP, São Paulo, SP, BrazilHospital da Mulher - SP, São Paulo, SP, BrazilHospital da Mulher - SP, São Paulo, SP, BrazilHospital da Mulher - SP, São Paulo, SP, BrazilUniversidade Federal de São Paulo, São Paulo, SP, BrazilCORA Advanced Center for Breast Cancer Diagnosis, Federal University of Goias, Goiania, GO, BrazilRedimama - Redimasto, Belo Horizonte, MG, BrazilHospital da Mulher - SP, São Paulo, SP, BrazilOncoclínicas, Sergipe, SE, Brazil; Universidade Federal de Sergipe, Sergipe, SE, BrazilHospital da Mulher - SP, São Paulo, SP, Brazil; DASA Oncologia, São Paulo, SP, BrazilHospital Beneficência Portuguesa de São Paulo, São Paulo, SP, BrazilHospital do Servidor Público Estadual – Francisco Morato de Oliveira, São Paulo, SP, BrazilIntroduction: Sentinel lymph node biopsy (SLNB) is the gold standard for the axillary evaluation of clinically node-negative early breast cancer. The ACOSOG Z0011 study demonstrated the safety of omitting axillary dissection for limited SLNB disease, with other trials confirming SLNB alone or with axillary radiotherapy (AR) as non-inferior. Methods: We followed PRISMA guidelines and registered at PROSPERO. Using Medline, Embase, and Cochrane, we reviewed randomized controlled trials (2010–2024). Outcomes, including 5-, 8-, and 10-year OS, DFS, recurrence rates, and lymphedema, were analyzed with R software and assessed for bias (Cochrane RoB) and evidence quality (GRADE). The focus was ALND vs. SLNB, alone or with AR, in cT1-T3 BC with 1–2 metastatic SLNs. Results: Thirteen articles from seven randomized controlled trials (RCTs) were included, covering 7338 women with a follow-up period of 2.8–10 years. SLNB was associated with a 65 % lower risk of lymphedema than ALND, with no significant differences in the 5-, 8-, or 10-year OS, DFS, or recurrence rates. A meta-analysis comparing micrometastasis and macrometastasis showed no impact on outcomes, indicating that ALND may be unnecessary in either case. Recurrence rates also did not differ between SLNB and ALND, reinforcing SLNB's significantly lower lymphedema risk of SLNB. Conclusions: This systematic review and meta-analysis support SLNB as a safe and effective alternative to ALND in early-stage BC with 1–2 positive SLNs, providing comparable survival and recurrence outcomes, with fewer complications.http://www.sciencedirect.com/science/article/pii/S0960977625004709Sentinel lymph node biopsyAxillary lymph node dissectionBreast cancerBreast neoplasmMastectomySegmental mastectomy |
| spellingShingle | André Mattar Marcelo Antonini Francisco Pimentel Cavalcante Felipe Zerwes Eduardo de Camargo Millen Fabricio Palermo Brenelli Antônio Luiz Frasson Patrícia Carvalho Baruel Lucas Miyake Okumura Leonardo Ribeiro Soares Marcelo Madeira Marina Diógenes Teixeira Andressa Gonçalves Amorim Larissa Chrispim de Oliveira Marcellus do Nascimento Moreira Ramos Gil Facina Ruffo de Freitas Junior Henrique Lima Couto Sabrina Monteiro Rondelo Renata Montarroyos Leite Renata Arakelian Luiz Henrique Gebrim Juliana Monte Real CADONOT: Comparing axillary dissection or not in breast cancer surgery Breast Sentinel lymph node biopsy Axillary lymph node dissection Breast cancer Breast neoplasm Mastectomy Segmental mastectomy |
| title | CADONOT: Comparing axillary dissection or not in breast cancer surgery |
| title_full | CADONOT: Comparing axillary dissection or not in breast cancer surgery |
| title_fullStr | CADONOT: Comparing axillary dissection or not in breast cancer surgery |
| title_full_unstemmed | CADONOT: Comparing axillary dissection or not in breast cancer surgery |
| title_short | CADONOT: Comparing axillary dissection or not in breast cancer surgery |
| title_sort | cadonot comparing axillary dissection or not in breast cancer surgery |
| topic | Sentinel lymph node biopsy Axillary lymph node dissection Breast cancer Breast neoplasm Mastectomy Segmental mastectomy |
| url | http://www.sciencedirect.com/science/article/pii/S0960977625004709 |
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