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May 29, 2020 07:50AM
I would not follow anyone's "feeling" about this. There are quite a few recent studies that discourage the removal of many lymph nodes in patients with few positive nodes as there is a much higher risk of issues (particularly lymphedema) later. Here are a few:
"Women without SLNB metastases should not receive ALND. In patients with micro- or macrometastasis on SLNB, axillary radiotherapy successfully replaces the ALND. The arm morbidity rate was significantly lower in patients with positive SLNB treated with breast surgery and radiotherapy for three axillary levels and/or to the whole breast. Axillary dissection could safely be omitted in patients with 1, 2 metastatic nodes on SLNB and without extranodal extension who undergo BCS and whole breast radiotherapy or in patients with metastatic nodes on SLNB who underwent BCS or mastectomy and have adjuvant radiotherapy for the all three axillary levels, the supraclavicular fossa, and ± mammaria interna and/or the whole breast or chest wall."
"Among women with T1 or T2 invasive primary breast cancer, no palpable axillary adenopathy, and 1 or 2 sentinel lymph nodes containing metastases, 10-year overall survival for patients treated with sentinel lymph node dissection alone was noninferior to overall survival for those treated with axillary lymph node dissection. These findings do not support routine use of axillary lymph node dissection in this patient population based on 10-year outcomes."
"Axillary recurrence after 10 years in patients with a tumor-positive SNB who were treated with ART is extremely rare and not significantly different from patients who were treated with ALND."
Age at dx: 45. Oncotype, left-side tumor: 9. Right side had multifocal IDC and "extensive" LCIS. Isolated tumor cells in 1 right-side node.
3/27/2015, IDC, Left, 2cm, Stage IIA, Grade 1, 0/3 nodes, ER+/PR+, HER2- (FISH)
4/27/2015, IDC, Right, 1cm, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH)
6/1/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right
6/1/2015 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
8/28/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
12/4/2015 Reconstruction (left): Fat grafting, Nipple reconstruction; Reconstruction (right): Fat grafting, Nipple reconstruction