Underuse of Axillary Dissection for the Management of Sentinel Node Micrometastases in Breast Cancer

(59.6%) underwent ALND. In the latter group, histopathologic examination of nonsentinel nodes upstaged 18.6% of cases to N1, 2.2% to N2, and 0.1% to N3 disease.Multivariateanalysisusinglogisticregressionshowed that age younger than 66 years (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.56-2.04), high tumor grade(OR,1.22;95%CI,1.07-1.40),andtumorsizelarger than 2 cm (OR, 1.16; 95% CI, 1.01-1.32) were predictive of ALND. Predictors of upstaging were infiltrating lobularhistology(OR,1.23;95%CI,1.00-1.51),T2stage (OR, 1.38; 95% CI, 1.14-1.67), T3 stage (OR, 3.66; 95% CI,1.70-7.90),andnumberofnodesexamined(OR,1.04; 95% CI, 1.03-1.05). Conclusions: Only 60% of patients with SNMM from breast cancer are treated according to American Society ofClinicalOncologyguidelines.Nodalstagingbasedonly on sentinel node biopsy may underestimate the extent of nodal disease in 20.9% of cases. Surgical management of SNMM should be standardized.