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Geburtshilfe Frauenheilkd 2012; 72(4): 293-298
DOI: 10.1055/s-0031-1298441
Review
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Axillary Dissection in the Case of Positive Sentinel Lymph Nodes: Results of the Innsbruck Consensus Conference

Axilladissektion bei positivem Sentinel-Lymphknoten: Ergebnisse Innsbrucker Konsensuskonferenz
M. Hubalek
1   Department of Womenʼs Health, Clin. Dept. of Gynaecology and Obstetrics, Innsbruck, Austria
,
R. Bartsch
3   University Department of Internal Medicine I, Breast Health Centre MUW/AKH, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
,
M. Gnant
2   University Department of Surgery, Breast Health Centre MUW/AKH, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
,
K. S. Kapp
4   University Department of Radiotherapy/Radio-Oncology, Graz, Austria
,
A. Lang
5   Feldkirch State Hospital, Dept. of Internal Medicine, Haematology and Medical Oncology, Feldkirch, Austria
,
S. Lax
6   Graz West State Hospital, Institute of Pathology, Graz, Austria
,
P. Lukas
7   University Department of Radiotherapy/Radio-Oncology, Innsbruck, Austria
,
W. Neunteufel
8   Dornbirn Hospital, Department of Gynaecology and Obstetrics, Dornbirn, Austria
,
G. Pristauz
9   University Department of Gynaecology and Obstetrics, Clinical Department of Gynaecology, Graz, Austria
,
R. Reitsamer
10   St. Johanns-Spital/State Womenʼs Hospital, University Department of Specialist Gynaecology, Salzburg, Austria
,
P. Sandbichler
11   St.Vinzenz Hospital, Department of Surgery, Zams, Austria
,
P. Schrenk
12   Linz City Hospital, Dept. of Surgery II, Breast Competence Centre, Linz, Austria
,
C. Singer
14   Clinical Department of General Gynaecology and Gynaecological Oncology, Medical University of Vienna, Vienna, Austria
,
K. Tamussino
9   University Department of Gynaecology and Obstetrics, Clinical Department of Gynaecology, Graz, Austria
,
J. Tschmelitsch
13   Hospital of the Merciful Brothers, Surgical Department, St. Veit/Glan, Austria
,
A. G. Zeimet
1   Department of Womenʼs Health, Clin. Dept. of Gynaecology and Obstetrics, Innsbruck, Austria
,
C. Marth
1   Department of Womenʼs Health, Clin. Dept. of Gynaecology and Obstetrics, Innsbruck, Austria
› Author Affiliations
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Publication History

Publication Date:
09 May 2012 (online)

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Abstract

The prognosis of breast cancer is most heavily influenced by the status of the axillary nodes. Until a few years ago, this knowledge was gained through radical axillary lymph node clearance. In the meantime, sentinel lymph node clearance has become an established part of the surgical treatment of breast cancer. With the development of this procedure, the morbidity caused by axillary dissection has been reduced significantly. Although comprehensive prospective, randomised data regarding the safe use of the sentinel concept are only now available, the focus currently, however, is on the question of whether in the case of positive sentinel lymph nodes, an axillary dissection can be done away with altogether without having any negative impact on the risk of loco-regional recurrence or on progression-free survival and overall survival. The results of the American ACOSOG-Z001 study have changed the fundamental perspective of this. In this study on the advantages of axillary dissection following the confirmation of tumour tissue in the sentinel lymph nodes, there were no statistically significant advantages from axillary dissection for women with a favourable overall risk profile who had received radiotherapy and systemic therapy. If this concept takes hold, the surgical treatment of node-positive breast cancer, at least in the axilla, would be reduced to a minimum, and the focus of treatment would in future lie more on the systemic treatment of this condition. As part of an interdisciplinary consensus meeting, a standardised approach for Austria with regard to this question was decided upon.

Zusammenfassung

Die Prognose des Mammakarzinoms wird durch den axillären Lymphknotenstatus am stärksten beeinflusst. Dieses Wissen wurde noch bis vor wenigen Jahren durch die radikale axilläre Lymphonodektomie erlangt. Inzwischen ist die Sentinel-Lymphonodektomie etablierter Bestandteil in der operativen Behandlung des Mammakarzinoms geworden. Durch die Entwicklung dieses Verfahrens konnte die Morbidität, die durch eine axilläre Dissektion verursacht wird, wesentlich reduziert werden. Wenngleich erst jetzt umfassende prospektiv randomisierte Daten zur sicheren Anwendung des Sentinel-Konzepts vorliegen, geht es aktuell jedoch bereits um die Frage, ob bei positivem Sentinel-Lymphknoten auf eine Axilladissektion (AD) gänzlich verzichtet werden kann, ohne das Risiko für ein lokoregionäres Rezidiv oder das progressionsfreie Überleben und Gesamtüberleben negativ zu beeinflussen. Die Ergebnisse der amerikanischen ACOSOG-Z0011-Studie haben die grundlegende Betrachtungsweise verändert. In dieser Studie zum Vorteil der Axilladissektion nach Tumornachweis im Sentinel-Lymphknoten ergaben sich für die Patientinnen mit günstigem Gesamtrisikoprofil und applizierter Strahlentherapie und systemischer Therapie keine statistisch signifikanten Vorteile durch die Axilladissektion. Setzt sich dieses Konzept durch, wäre die operative Versorgung des nodal-positiven Mammakarzinoms zumindest in der Axilla auf ein Minimum reduziert und der Fokus der Behandlung läge zukünftig mehr in der systemischen Behandlung dieser Erkrankung. Im Rahmen eines interdisziplinären Konsensus-Meetings wurde eine einheitliche Vorgehensweise für Österreich diese Fragestellung betreffend beschlossen.

Key words

sentinel lymph node - axillary dissection - ACOSOG-Z0011 - breast cancer

Schlüsselwörter

Sentinel-Lymphknoten - Axilladissektion - ACOSOG-Z0011 - Brustkrebs

Supporting Information

 

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