Axillary lymph node dissection in pT1 breast cancer: a retrospective analysis of 315 patients and review of the literature.

Axillary lymph node status and pathologic features of the primary tumor are used to predict the prognosis and select appropriate adjuvant therapy for individual patients with breast cancer. The goal of our study is to identify a group of breast cancer patients who would not benefit from axillary dissection. We researched medical literature and conducted retrospective analyses of 315 consecutive postmenopausal women with breast tumors under 2.0 cm in diameter (pT1) in relation to the extent of axillary lymph node involvement. None of the 39 patients with pT1a tumors had axillary lymph node metastases (ALNM). Of the remaining 276 patients, the ALNM rate in the subgroup pT1b and grading 1 was 5.9%. As expected, the frequency of positive lymph nodes increased the larger the tumor and the higher the grading. Our data corresponds with some of the literature reviewed, although the percentage of axillary involvement described, especially in the subgroup of pT1a tumors, varies within a wide range (0-28%). Our data indicates that it is unlikely that invasive breast cancer pT1a (< or = 0.5 cm) is associated with axillary lymph node metastases in women older than 50 years. The authors conclude that the parameter tumor size, combined with age, can help to assess the risk for axillary lymph node metastases.