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October 2010

Micrometastasis and Axillary Dissection in Breast Cancer—Reply

Author Affiliations

Author Affiliations: Department of Surgery, John Wayne Cancer Institute at St John's Health Center, Santa Monica, California.

Arch Surg. 2010;145(10):1023. doi:10.1001/archsurg.2010.215

In reply

We thank Dr Badruddoja for his comments. We agree that management of sentinel node micrometastases (N1mic) should be standardized. However, whether the presence of N1mic disease in the lymph nodes has an adverse impact on disease-free breast cancer survival remains uncertain. Our group has reported conflicting findings concerning the implications of micrometastases in axillary nodes.1,2 Thus, the use of additional therapy following identification of sentinel node micrometastases is also uncertain. Currently, the recommendation for further care remains axillary dissection.3 Abandoning this standard should be done only when studies directly support the omission of further surgery. As acknowledged by the Consensus panel, “studies examining the success of alternative treatment approaches in preventing axillary recurrence in these patients have generally contained few patients or had short follow up, or both.”4 Data from trials ACOSOG Z0011 and ACOSOG Z0010 by the American College of Surgeons Oncology Group and NSABP B32 by the National Surgical Adjuvant Breast and Bowel Project, as well as other trials in progress, should help clarify the significance of micrometastases and the consequences of omitting axillary dissection for patients with N1mic disease.