AXILLARY LYMPH NODE DISSECTION IN INVASIVE BREAST CANCER PATIENTS AT CHARLOTTE MAXEKE JOHANNESBURG ACADEMIC HOSPITAL AND CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL.

BACKGROUND: Axillary lymph node dissection (ALND) carries a high morbidity and sentinel node biopsy has become the standard of care in node-negative disease. Patients in our setting are assessed as node-positive on the basis of physical examination and axillary ultrasound and will undergo ALND without prior biopsy. The administration of neoadjuvant chemotherapy (NACT) may downstage the axilla and offer opportunities for axilla-sparing surgery.

METHOD: This retrospective cohort study included all female patients older than 18 years of age who underwent axillary surgery in the breast units at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital from March 2013 to March 2015. Odds ratios (OR) were calculated for a node-negative ALND after NACT and in the absence of axillary biopsy prior to surgery.

RESULTS: We included 509 eligible patients and 391 underwent ALND (76.8%). A total of 99 patients (25.3%) had a node-negative ALND. Amongst these, 47 (47.5%) had received NACT. The risk of a node-negative ALND was not significantly increased when compared to patients who had primary surgery (OR 1.02). Only 41 of the 509 patients (10.5%) had preoperative pathological confirmation of nodal involvement. Patients with preoperative biopsy of the axilla were at reduced risk (OR 0.58) for node-negative ALND.

CONCLUSION: Of our ALNDs, 25.3% were node-negative. Contributing factors include the lack of preoperative pathological confirmation of nodal involvement. Routine biopsy of suspicious nodes should be introduced in our clinical practice. NACT did not increase the risk. There is a need to specifically evaluate the impact of HIV status on axillary management.