© 2004 by Oxford University Press
© 2004 Oxford University Press
CORRESPONDENCE |
RESPONSE: Re: Influence of the New AJCC Breast Cancer Staging System on Sentinel Lymph Node Positivity and False-Negative Rates
Correspondence to: David R. McCready, MD, FRCSC, FACS, Breast Site Group, Princess Margaret Hospital, 610 University Ave., University of Toronto, Toronto, ON, Canada (e-mail: david.mccready{at}uhn.on.ca)
The comments from Dr. Atkins support our paper (1) and are appreciated. There is a general agreement that the American Joint Committee on Cancer (AJCC) staging system is appropriate and rational. Whether the current nodal classification will remain static once the prospectively gathered prognostic information from the National Surgical Adjuvant Breast and Bowel Project (NSABP) and American College of Surgeons clinical trials has been analyzed is speculative. Currently, most completion axillary lymphadenectomies for breast cancer are performed when the sentinel node is determined to be positive. The newest AJCC system changed what was once positive in terms of staging and prognosis—micrometastases less than 0.2 mm in diameter—to negative (pN0[i–/i+]). It seems reasonable to determine the impact of these new staging definitions on surgical issues because one may indeed question the need to perform a completion lymphadenectomy after resecting a sentinel node that contains isolated tumor cells but is staged as negative. We observed that some patients with sentinel nodal micrometastases less than 0.2 mm in diameter have coexisting, non–sentinel nodal macrometastases (1). Hence, these seemingly inconsequential deposits, from a prognostic and staging viewpoint, need to be considered when planning surgical intervention. Van Zee et al. (2) have published a novel method to help clinicians determine the risk of finding non–sentinel nodal metastases after diagnosing a sentinel node containing metastatic disease. Our paper provided data to conclude, as Dr. Atkins states, that "the new AJCC staging system...should not be used as a basis for changing protocols for axillary dissection after sentinel lymphadenectomy."
REFERENCES
1 McCready DR, Yong WS, Ng AK, Miller N, Done S, Youngson B. Influence of the new AJCC breast cancer staging system on sentinel lymph node positive and false negative rates. J Natl Cancer Inst 2004;96:873–5.
2 Van Zee KJ, Manasseh DM, Bevilacqua JL, Boolbol SK, Fey JV, Tan LK, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 2003;10:1140–51.
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J Natl Cancer Inst 2004 96: 1639.
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