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Evidence summaries

Axillary Treatment for Operable Primary Breast Cancer

Sentinel lymph node biopsy or axillary sampling (lesser axillary surgery) appears to be as effective as full axillary surgery in operable primary breast cancer in terms of mortality. Level of evidence: "B"

Comment: The quality of evidence is downgraded by imprecise results (few outcome events).

Summary

A Cochrane review [Abstract] 1 included 26 studies with operable primary breast cancer.

No axillary surgery versus axillary lymph node dissection (ALND) (10 trials, n=3 849): There were no important differences between overall survival although no axillary surgery increased the risk of locoregional recurrence but also decreased the risk of lymphoedema (table T1).

Axillary sampling versus ALND (6 trials, n=1 559): There was similar effectiveness in terms of overall survival but it was unclear whether axillary sampling led to increased risk of local recurrence (table T2).

Sentinel lymph node biopsy (SLNB) versus ALND (7 trials, n=9 426): There was similar overall survival (table T3). Differences in local recurrence, locoregional recurrence and distant metastasis were uncertain.

No axillary surgery compared with full axillary surgery (ALND)

OutcomesRelative effect(95% CI)Assumed risk - Control - Full axillary surgeryCorresponding risk - Intervention - No axillary surgery (95% CI)No of participants(studies) Quality of evidence
All-cause mortality at 5 yearsHR 1.06 (0.96 to 1.17)92% overall survival92% overall survival (91% to 93%)3 849(10) Moderate
Locoregional recurrence at 5 yearsHR 2.35 (1.91 to 2.89)86% locoregional recurrence-free survival71% locoregional recurrence-free survival (66% to 76%)20 863(5) Moderate
Lymphoedema: Increase in arm circumference Follow-up: 1 or more yearsOR 0.31 (0.23 to 0.43)236 per 100087 per 1000(66 to 117)1 714(4) Low
Arm or shoulder movement impairmentFollow-up: 1 or more yearsOR 0.72 (0.49 to 1.05)91 per 100067 per 1000(47 to 95)1495(5) Very low

Axillary sampling compared with full axillary surgery (ALND)

OutcomesRelative effect(95% CI)Assumed risk - Control - Full axillary surgeryCorresponding risk - Intervention - Axillary sampling (95% CI)No of participants(studies) Quality of evidence
All-cause mortality at 5 yearsHR 0.94 (0.73 to 1.21)82% overall survival83% overall survival (79% to 87%)967(3) Low
Local recurrence at 5 yearsHR 1.41 (0.94 to 2.12)85% local recurrence-free survival80% local recurrence free survival (71% to 86%)1 404(3) Low

Sentinel node biopsy (SLNB) compared with full axillary surgery (ALND)

OutcomesRelative effect(95% CI)Assumed risk - Control - Full axillary surgeryCorresponding risk - Intervention - Sentinel node biopsy (95% CI)No of participants(studies) Quality of evidence
All-cause mortality at 5 yearsHR 1.05 (0.89 to 1.25)96% overall survival96% overall survival (95% to 96%)6 352(3) Moderate
Lymphoedema (subjective): Follow-up: 1 yearOR 0.33 (0.15 to 0.86)132 per 100048 per 1000(22 to 115)815(3) Low
Subjective arm movement impairmentFollow-up: 1 yearOR 0.38 (0.22 to 0.67)100 per 100040 per 1000(24 to 69)877(2) Very low
NumbnessFollow-up: 1 yearOR 0.43 (0.34 to 0.54)346 per 1000185 per 1000(152 to 222)1 799(3) Moderate

Clinical comments

Note

Date of latest search: 12 March 2015

    References

    • Bromham N, Schmidt-Hansen M, Astin M et al. Axillary treatment for operable primary breast cancer. Cochrane Database Syst Rev 2017;(1):CD004561. [PubMed]

Primary/Secondary Keywords