The clinical impact of the application of a Clinical Decision Rule to a population of Sentinel Node Positive Breast Cancer patients.

Abstract

Background and Objectives: The sentinel node (SN) concept allowed the selection of pN+ breast cancer (BC) patients to undergo complete axillary dissection (AD). However, the majority do not have additional axillary nodes involved. Therefore, some centres developed clinical decision rules (CDR), based on clinical and pathology variables, to assist in the decision to perform AD. The aim of our study was to evaluate the CDR of the Breast Center of the Centro Hospitalar Universitário São João in Porto (CHUSJ) and to compare its results with the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial criteria. Methods: We performed a retrospective analysis of a consecutive series of SN-positive BC patients, treated between 2012 and 2019. Results: Among the 418 included patients, 173 (41.4%) were submitted to AD and 245 (58.6%) were spared. In the group submitted to AD, additional positive non-sentinel nodes (NSN) were found in 89 patients (51.4%). In the group spared to AD, two patients (0.8%) had an axillary lymph node recurrence. Conclusions: In BC patients with a positive SN, applying the CHUSJ-CDR reduced the rate of AD to 41.4%, lowering arm and shoulder morbidity caused by this invasive procedure while maintaining a reduced probability of regional recurrence.