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Patrick Borgen, MD, chair, Department of Surgery, director, Breast Center, Maimonides Medical Center, discusses important factors of deciding which patients with breast cancer need axillary lymph node dissection.
Patrick Borgen, MD, chair, Department of Surgery, director, Breast Cancer, Maimonides Medical Center, discusses important factors of deciding which patients with breast cancer require axillary lymph node dissection (ALND).
Under the current guidelines, Borgen says, this applies to patients who are undergoing breast conservation therapy with radiation. That doesn’t necessarily mean it won’t apply to patients undergoing a mastectomy, since some of those patients also receive radiation therapy. Borgen said he uses findings from the ACOSOG Z0011 trial, which indicated there was no difference in outcome in forgoing ALND, to decide which patients would benefit from the procedure. This patient population included women with clinical T1/T2 invasive breast cancer, no palpable adenopathy, and 1 to 2 sentinel lymph nodes containing metastases. For these patients, Borgen says he wouldn’t be compelled to perform an ALND.
However, there are some patients where an ALND might still be necessary. For example, a 35-year-old Caribbean-American woman with triple-negative breast cancer who has cancer in her lymph nodes and is undergoing a mastectomy would be a candidate.