what is the journal?

The Journal of the American

Medical Association
JAMA
 what is the reputation of the
journal? is it indexed? what is
the impact factor?
publisher?
Highly Reputed and Indexed journal.
Impact Factor in 2014 was 35.289.
Publisher-
American Medical Association(United
States)
 TITLE:-

AXILLARY DISSECTION VS NO AXILLARY

DISSECTION IN WOMEN WITH
INVASIVE BREAST CANCER AND
SENTINEL NODE METASTASIS
 Authors? who are they?
Armando E. Giuliano, MD, Kelly K.
Hunt, MD, Karla V. Ballman, PhD ,
Peter D. Beitsch, MD Pat W.
Whitworth, MD , Peter W.
Blumencranz, MD A. Marilyn Leitch,
MD Sukamal Saha, MD Linda M.
McCall, MS, Monica Morrow, MD.
Armando E. Giuliano and Monica
Morrow are well known authorities in
Breast Cancer.
 INTRODUCTION
Axillary lymph node dissection (ALND)
has been part of breast cancer surgery.
ALND, carries an indisputable and often
unacceptable risk of complications such
as seroma, infection, and lymphedema.
Sentinel lymph node dissection (SLND)
was therefore developed to accurately
stage tumor draining axillary nodes with
less morbidity than ALND.
 Methodology
Multicentre Randomized Clinical Trial
Patient characteristic:
Adult woman with IDC 5 cm or less.
No palpable lymphadenopathy.
metastatic SLN
Ineligble if 3 or more SLN metastasis or
matted or gross extra-nodal invasion.
All patients underwent lumpectomy and
tangential whole-breast irradiation
 Study Design and Treatment:
Before randomization, all women
underwent SLND.
stratified according
to age (50 and 50 years),
estrogen-receptor status,
tumor size (1 cm or < 1 cm and 2
cm, or < 2 cm and >2 cm).
They are randomly assigned to ALND
and only SLND.
 Study End Points
The primary end point - overall
survival, defined as the time from
randomization until death from any
cause.

The secondary end point- disease

free survival.
 RESULTS
Clinical and tumor characteristics were
similar between 445 patients randomized
to ALND and 446 randomized to SLND
alone.
At a median follow-up of 6.3 years (last
follow-up, March 4, 2010).
5-year overall survival was 91.8% with
ALND and 92.5% with SLND alone;
5-year disease-free survival was 82.2%
with ALND and 83.9% with SLND alone.
 DISCUSSION
ALND did not significantly affect overall or
disease-free survival of patients with clinical
T1-T2 breast cancer and a positive SLN who
were treated with lumpectomy, adjuvant
systemic therapy, and tangential-field whole
breast radiation therapy.
The hazard ratio for treatment-related
overall survival was 0.79 without adjustment
and 0.87 after adjusting for age and
adjuvant therapy indicates non inferiority of
SLND alone.
 CONCLUSION
limited SLN metastatic breast cancer
treated with breast conservation and
systemic therapy, the use of SLND
alone compared with ALND did not
result in inferior survival.
 what have we learnt new?
For BCS , SLN metastasis <3 nodes,
only SLND is sufficient, No further
ALND required.
Because ALND after SLND does not
have the superior survival benefit,
but has more complications.
will it change your practice?
No it will not change my practice.
Because it is the result of one centre
experience.
No extensive data available.
should we implement this practice?

We will not implement this practice.

As it is one centre experience.
But in our institution, proper follow
up after BCS is difficult.
Number of Patient is also limited.
 what are the drawbacks of this
study?
No of patient.
Follow up period less, only 6.3 yrs