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4314 The Impact of Axillary Surgery on Recurrence-Free Survival in Invasive Lobular Carcinoma (ILC) of the Breast

Published online by Cambridge University Press:  29 July 2020

Mary Kathryn Reed Abel
Affiliation:
University of California, San Francisco
Jasmine Wong
Affiliation:
University of California, San Francisco
Michael Alvarado
Affiliation:
University of California, San Francisco
Cheryl Ewing
Affiliation:
University of California, San Francisco
Laura J. Esserman
Affiliation:
University of California, San Francisco
Catherine Park
Affiliation:
University of California, San Francisco
Rita A. Mukhtar
Affiliation:
University of California, San Francisco
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Abstract

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OBJECTIVES/GOALS: Clinical trials demonstrate that axillary lymph node dissection (ALND) is unnecessary for most breast cancer patients with 1-3 involved nodes, but whether this is true for those with ILC is unknown. We evaluate the impact of ALND on recurrence-free survival (RFS) in ILC and 1-3 positive nodes. METHODS/STUDY POPULATION: We performed a retrospective cross-sectional analysis of patients with ILC treated between 1992-2019 at our institution. All patients received either sentinel lymph node biopsy (SLNB) or ALND and underwent either breast conservation surgery (BCS) or mastectomy. The primary outcome was RFS, defined as the absence of locoregional or distant recurrence. RESULTS/ANTICIPATED RESULTS: Of 496 cases, 250 (50.4%) underwent BCS, and 246 (49.6%) underwent mastectomy. A total of 93% of patients were hormone receptor positive, and 89% had low or intermediate grade disease. Among patients with 1-3 positive nodes, there was no significant difference in 5- and 10-year RFS based on receipt of ALND for both BCS and mastectomy cohorts. Using a multivariate model, we found no association between ALND and RFS overall (HR = 0.98, 95% CI 0.36-2.7, p>0.20) and among those with 1-3 positive nodes (HR = 0.60, 95% CI 0.12-3.4, p>0.20). DISCUSSION/SIGNIFICANCE OF IMPACT: These findings support the safety of omitting ALND in patients with ILC and 1-3 positive nodes, regardless of whether they receive BCS or mastectomy. Further studies of axillary management in ILC, including imaging tools to predict nodal involvement and response to therapy, are warranted.

Type
Clinical Epidemiology/Clinical Trial
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Association for Clinical and Translational Science 2020