From the Guidelines
Surgeons should aim to harvest at least 10 lymph nodes during an axillary lymph node dissection (ALND) for adequate oncologic evaluation, as this number is considered the minimum standard for a complete axillary dissection, particularly in breast cancer cases. This recommendation is based on the most recent and highest quality study, which emphasizes the importance of accurate cancer staging and determining the extent of lymphatic spread 1. A level I and II axillary dissection typically yields between 10-20 lymph nodes, while a more extensive level III dissection may yield up to 30 nodes.
- The number of nodes retrieved is crucial for accurate cancer staging and determining the extent of lymphatic spread.
- Inadequate sampling (fewer than 10 nodes) may lead to understaging of the disease and potentially inappropriate treatment decisions.
- The actual number of nodes harvested can vary based on individual patient anatomy, the extent of the dissection performed, the surgical technique used, and the thoroughness of the pathological examination.
- Surgeons should document the levels of axillary dissection performed and ensure careful handling of specimens to facilitate accurate node counting by pathologists. Other studies, such as 1 and 1, also support this recommendation, but 1 is the most recent and highest quality study, making it the basis for this recommendation.
From the Research
Recommended Number of Lymph Nodes for ALND
The recommended number of lymph nodes to be harvested during an axillary lymph node dissection (ALND) is:
- At least 10 lymph nodes, as stated in current guidelines 2
- Approximately 20 lymph nodes, as suggested by a study that found improved survival with this number of nodes retrieved 3
Factors Affecting Lymph Node Harvest
The number of lymph nodes harvested during ALND can be affected by:
- The surgeon performing the operation, with significant differences found between surgeons 2
- The use of neoadjuvant chemotherapy, which does not appear to affect the number of lymph nodes harvested 2
- The presence of metastatic lymph nodes, which does not appear to be correlated with the total number of lymph nodes harvested 2
Comparison with Sentinel Lymph Node Dissection
In comparison to sentinel lymph node dissection (SLND), ALND typically involves the removal of more lymph nodes:
- The median number of lymph nodes resected with SLND is 2, compared to 11 for ALND 4
- A significant proportion of patients undergoing SLND have fewer than 4 lymph nodes removed, which may not be sufficient for accurate axillary staging 4
Optimal Threshold for Sentinel Lymph Nodes
For SLNB, the optimal threshold number of sentinel lymph nodes to be removed for accurate axillary staging is:
- At least 4 sentinel lymph nodes, as suggested by a study that found improved accuracy with this number of nodes removed 5