CADONOT: Comparing axillary dissection or not in breast cancer surgery

CADONOT: Comparing axillary dissection or not in breast cancer surgery

Introduction: Sentinel lymph node biopsy (SLNB) is the gold standard for the axillary evaluation of clinically node-negative early breast cancer. The ACOSOG Z0011 study demonstrated the safety of omitting axillary dissection for limited SLNB disease, with other trials confirming SLNB alone or with a...

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Main Authors: André Mattar, Marcelo Antonini, Francisco Pimentel Cavalcante, Felipe Zerwes, Eduardo de Camargo Millen, Fabricio Palermo Brenelli, Antônio Luiz Frasson, Patrícia Carvalho Baruel, Lucas Miyake Okumura, Leonardo Ribeiro Soares, Marcelo Madeira, Marina Diógenes Teixeira, Andressa Gonçalves Amorim, Larissa Chrispim de Oliveira, Marcellus do Nascimento Moreira Ramos, Gil Facina, Ruffo de Freitas Junior, Henrique Lima Couto, Sabrina Monteiro Rondelo, Renata Montarroyos Leite, Renata Arakelian, Luiz Henrique Gebrim, Juliana Monte Real
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Breast
Subjects:
Sentinel lymph node biopsy
Axillary lymph node dissection
Breast cancer
Breast neoplasm
Mastectomy
Segmental mastectomy
Online Access:http://www.sciencedirect.com/science/article/pii/S0960977625004709
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Summary:Introduction: Sentinel lymph node biopsy (SLNB) is the gold standard for the axillary evaluation of clinically node-negative early breast cancer. The ACOSOG Z0011 study demonstrated the safety of omitting axillary dissection for limited SLNB disease, with other trials confirming SLNB alone or with axillary radiotherapy (AR) as non-inferior. Methods: We followed PRISMA guidelines and registered at PROSPERO. Using Medline, Embase, and Cochrane, we reviewed randomized controlled trials (2010–2024). Outcomes, including 5-, 8-, and 10-year OS, DFS, recurrence rates, and lymphedema, were analyzed with R software and assessed for bias (Cochrane RoB) and evidence quality (GRADE). The focus was ALND vs. SLNB, alone or with AR, in cT1-T3 BC with 1–2 metastatic SLNs. Results: Thirteen articles from seven randomized controlled trials (RCTs) were included, covering 7338 women with a follow-up period of 2.8–10 years. SLNB was associated with a 65 % lower risk of lymphedema than ALND, with no significant differences in the 5-, 8-, or 10-year OS, DFS, or recurrence rates. A meta-analysis comparing micrometastasis and macrometastasis showed no impact on outcomes, indicating that ALND may be unnecessary in either case. Recurrence rates also did not differ between SLNB and ALND, reinforcing SLNB's significantly lower lymphedema risk of SLNB. Conclusions: This systematic review and meta-analysis support SLNB as a safe and effective alternative to ALND in early-stage BC with 1–2 positive SLNs, providing comparable survival and recurrence outcomes, with fewer complications.
ISSN:1532-3080

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