An axillary lymph node dissection (ALND) is a procedure used in certain cases of breast cancer where the tumors have spread to the lymph nodes around your underarms (axilla). This procedure may be recommended following the results of a sentinel lymph node biopsy.
What is an axillary lymph node dissection?
An axillary lymph node dissection (ALND) is a procedure used in certain cases of breast cancer where the tumors have spread to the lymph nodes around your underarms (axilla). This procedure may be recommended following the results of a sentinel lymph node biopsy.
What happens during a lymph node dissection?
If you have a modified radical mastectomy, the lymph node dissection usually occurs in the same operation. If you have a lumpectomy, the lymph node dissection may occur at the same time or in a later operation. Once the surgeon removes the nodes, a pathologist will examine them carefully for signs of cancer.
What is axillary lymphadenectomy?
Axillary lymphadenectomy, or axillary dissection, is a procedure where a surgeon dissects out the lymph nodes within the axilla en bloc. This is done most commonly for cancer workups and treatment.
Why are axillary lymph nodes removed during breast cancer metastasis?
Early theories of breast-cancer metastasis held that cancer cells that had broken free from the main tumor would first travel through these lymph nodes on their way to other organs. That led doctors to believe that removing the axillary lymph nodes could reduce the risk of both cancer recurrence and metastases.
When is axillary dissection needed?
Axillary dissection is advocated for all patients who complete neoadjuvant treatment to down-stage the breast tumor, except when sentinel node biopsy is negative and undertaken prior to the neoadjuvant treatment.
When is axillary node dissection indicated?
Axillary lymph node dissection (ALND) ALND is usually done at the same time as a mastectomy or breast-conserving surgery (BCS), but it can be done in a second operation. ALND may be needed: If a previous SLNB has shown 3 or more of the underarm lymph nodes have cancer cells.
Is axillary lymph node dissection necessary?
Nearly 10 years of follow-up from a large clinical trial have confirmed that axillary dissection is not necessary in patients with early breast cancer and a minimal or moderate tumor burden in the sentinel nodes.
What is the purpose of axillary node dissection?
Axillary lymph node dissection (ALND) is a procedure to remove these lymph nodes. ALND happens after cancer cells are found during a sentinel lymph node biopsy. ALND can remove lymph nodes located above, below or directly underneath a muscle that runs along the side of the upper chest.
Is axillary lymph node dissection necessary after a positive sentinel lymph node biopsy?
Background: A positive sentinel lymph node has traditionally required subsequent axillary dissection. Over time, the paradigm has shifted to omit axillary dissection, if possible.
Is axillary lymph node dissection a major surgery?
What's the recovery like for an axillary lymph node dissection? ALND is considered major surgery, which requires home care before you resume your normal activities. You may experience swelling for up to a week after surgery, with full recovery expected within 4 to 6 weeks.
Who needs axillary lymph node dissection?
An axillary lymph node dissection (ALND) is performed with the primary breast procedure (eg, lumpectomy or mastectomy) in patients who have: Locally advanced (T3-T4; N0-2) or inflammatory breast cancer.
What are the signs that you have a cancerous lymph node?
SymptomsPainless swelling of lymph nodes in your neck, armpits or groin.Persistent fatigue.Fever.Night sweats.Shortness of breath.Unexplained weight loss.Itchy skin.
How long does it take to heal from lymph node removal in armpit?
You will probably be able to go back to work or your normal routine in 3 to 6 weeks. It will also depend on the type of work you do and any further treatment. You may be able to take showers (unless you have a drain in your incision) 24 to 48 hours after surgery. Pat the cut (incision) dry.
What is a suspicious axillary lymph node?
Suspicious lymph nodes of the axilla seen on ultrasound rarely indicate occult breast cancer but show a variety of other malignancies and generalised infectious disease requiring further treatment. Fine needle aspiration and/or core needle biopsy are both sufficient methods for clarification in the majority of cases.
How many lymph nodes are removed during axillary dissection?
Based on the doctor's physical exam and other information, the surgeon will generally remove between five and thirty nodes during a traditional axillary dissection.
Why do lymph nodes get dissected?
A lymph node dissection is surgery to remove an area of lymph nodes. It is done to remove lymph nodes that have cancer and other lymph nodes when there is a very high chance that the cancer may spread there. It is also called a lymphadenectomy. The lymph nodes are part of the lymphatic system.
Why do lymph nodes get dissected?
A lymph node dissection is surgery to remove an area of lymph nodes. It is done to remove lymph nodes that have cancer and other lymph nodes when there is a very high chance that the cancer may spread there. It is also called a lymphadenectomy. The lymph nodes are part of the lymphatic system.
What is the difference between sentinel lymph node biopsy and axillary lymph node dissection?
Axillary dissection, sentinel node biopsy and risk of lymphedema. Axillary dissection removes more axillary lymph nodes than a sentinel node biopsy does. Because it disrupts more of the normal tissue in the underarm area, axillary dissection is more likely to affect arm function and cause lymphedema.
What is the major complication of axillary dissection?
Axillary complications after surgery for breast carcinoma are well recognized and include wound infections, lymphedema of the arm, limitation of arm movement, lymphangitis, and arm numbness.
What is level 2 axillary dissection?
Level II – This level of dissection removes affected tissues in the middle part of the pectoralis minor muscle. Level III – This level involves the most aggressive dissection of the three and removes all the lymph nodes from the axilla.
How to dissect axillary vein?
The patient's axilla is prepped and draped in the usual sterile fashion. The patient is supine with the arm of the affected side at 90 to 100 degrees of abduction on an arm board. The landmark used superficially for the axillary incision is the inferior axillary hair line. An oblique incision is made, and electrocautery is typically used to dissect through the subcutaneous tissue to access the axillary fat pad once the clavipectoral fascia is incised. Once this is identified, many surgeons will identify the axillary vein and begin dissection inferior to this. Retraction is used to elevate the pectoralis muscles to dissect out the level two lymph nodes. Typically, most of this dissection can be performed bluntly. The axillary specimen is usually removed en bloc. The cavity is examined, and hemostasis is achieved as necessary, taking care to not injure any of the surrounding nerves or major vessels. A small drain may be left in place, with the exit point at a site other than the incision. The drain is sutured in place. The axillary incision is closed based on surgeon preference. Some sort of compressive dressing can be used postoperatively to provide some support and decrease seroma formation in addition to the drain. [10]
What is axillary lymphadenectomy?
Axillary lymphadenectomy, or axillary dissection, is a procedure where a surgeon dissects out the lymph nodes within the axilla en bloc. This is done most commonly for cancer workups and treatment. This procedure used to be done widely, but it is done much more selectively in recent years with advances in early detection and treatment, as well as numerous studies showing no increased benefit to this procedure in certain circumstances. The most common disease process that this is done for is breast cancer. While the focus of this article will be on breast cancer, it is important to note that sentinel lymph node biopsy and axillary lymphadenectomy can be performed for lung cancer and melanoma as well.[1]
Why do we do a sentinel node biopsy?
Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.
What are the complications of axillary lymphadenectomy?
Typical complications with any surgery include infection and bleeding. Complications specific to this procedure include temporarily decreased range of motion of the shoulder, hematoma, lymphedema, lymphocele, lymphatic fibrosis, lymphangiosarcoma, injury to vasculature, or nerves within the region, or axillary vein thrombosis. Drains are placed commonly after this procedure, and while not a complication in itself, prolonged need for the drain can be a complication. Typically after an axillary lymphadenectomy is performed, there is not a need for additional surgery in the same region, unless there is an axillary recurrence in the future. [11]
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What is the role of a breast cancer team?
These teams are crucial in formulating plans during breast tumor boards and in the aftercare of these patients for survivorship planning. Being up to date in all aspects of these specialties provides for the best patient care, improved patient outcomes, and overall enhances the team's performance when taking care of these patients.
Do you need a radiotracer for axillary lymph node biopsy?
This includes the patients with possible axillary dissection during a sentinel lymph node biopsy procedure, in addition to patients who had a planned axillary lymphadenectomy. Radiotracer and/or lymphazurin/methylene blue are not necessary for this procedure but may have been used if the initial procedure was a sentinel lymph node biopsy that was converted to axillary dissection. [9]
What should be included in an operative report?
The operative report should include all appropriate patient identifiers, the name of the operation, the type of anesthesia, and a succinct description of the clinical setting, indication for surgery, and operative findings. The steps of the operative procedure should be described in detail, noting in particular any complications and how they were managed. The presence of residual disease as well as the number/location/type of surgical drains should be noted. A copy of the operative report should go to all treating physicians and should be part of the permanent medical record. A plan for follow-up, including discussion of pathology results, wound care, drain management, and arm exercises should be part of the overall survivorship program.
What is ALND level?
The extent of ALND within the above boundaries is defined as level I (lateral to the pectoralis minor), level I-II (extending behind the minor), or level I-III (extending to the apex of the axilla, “Halsted’s ligament”), and should be based on tumor characteristics, patient anatomy, and intraoperative findings. ALND should be sufficient to remove all gross evidence of disease and should in general contain at least 10 nodes. Palpably suspicious Rotter’s (interpectoral) nodes should be removed if present. The pectoralis minor may be divided or excised to facilitate exposure and removal of gross disease at levels II and III. The long thoracic, thoracodorsal and medial pectoral nerves should be identified and, unless grossly involved by tumor, preserved. If anatomically suitable, the T2 (intercostobrachial) and T3 sensory nerves may be preserved at the discretion of the surgeon. Unresectable residual disease should be clipped to facilitate RT treatment planning.
What is ALND in breast surgery?
This American Society of Breast Surgeons (ASBrS) Performance and Practice Guideline summarizes the indications for and technique of axillary lymph node dissection (ALND). The Guideline reflects the consensus of a panel comprising members of the Education Committee, the Board of Directors and the Executive Committee, and is based on multiple sources from the peer-reviewed literature. This Guideline reflects what ASBrS considers to be optimal practice but may require modification based on the clinical circumstance, the physician’s judgment, the patient’s preference, and as scientific evidence continues to evolve.
Which vein is bounded by the axillary vein?
The axilla is bounded by the axillary vein superiorly, the serratus medially, the latissimus laterally, the clavipectoral fascia anteriorly and the subscapularis posteriorly. The inferior boundary of the axilla is less well-defined but should reach the axillary tail of the breast.
Is ALND needed for CN0?
ALND has largely been replaced by sentinel lymph node (SLN) biopsy for patients with cN0 breast cancer but is still required for a significant proportion of all breast cancer patients. Current indications for ALND are as follows:
What is a SLNB?
The trial, called ACOSOG Z0011, was designed to compare whether sentinel lymph node biopsy (SLNB) alone provided equivalent survival benefits to ALND after breast-conserving surgery among a subset of women who also received radiation and systemic therapy. The research team enrolled 891 participants into the study from 1999 to 2004.
How many women died from breast cancer after 10 years?
However, after 10 years of follow-up, the initial results held: only about 50 women had died from any cause in each group. Overall survival was 86.3% in the SLNB group and 83.6% in the ALND group.
What is the treatment for breast cancer?
Also, modern treatment for early-stage breast cancer typically includes radiation therapy —which targets some of the same lymph nodes—along with breast-conserving surgery, Dr. Giuliano added.
Where do axillary lymph nodes run?
The axillary lymph nodes run from the breast tissue into the armpit. Early theories of breast-cancer metastasis held that cancer cells that had broken free from the main tumor would first travel through these lymph nodes on their way to other organs. That led doctors to believe that removing the axillary lymph nodes could reduce the risk of both cancer recurrence and metastases.
What percentage of women have side effects from surgery?
Rates of negative side effects from surgery were much higher in the ALND group, with 70 percent of women experiencing wound infection, delayed healing, or pain compared with 25 percent of women in the SLNB-alone group. In addition, more women in the ALND group reported lymphedema. (The researchers reported complete data on side effects seen during the trial in a previous paper.)
Does removing axillary lymph nodes reduce cancer?
That led doctors to believe that removing the axillary lymph nodes could reduce the risk of both cancer recurrence and metastases. However, more-recent research has suggested that breast cancer may metastasize to other areas of the body through several different routes, explained Dr. Giuliano. Also, modern treatment for early-stage breast cancer ...
Can you skip axillary lymph node dissection?
The trial showed that women with early-stage breast cancer who have cancer cells in one or two sentinel lymph nodes can skip axillary lymph node dissection (ALND) after breast- conserving surgery without affecting their long-term survival.