Anaphylaxis-induced myocardial depression treated with amrinone (original) (raw)
Position Statement on Management of the Axilla in Patients With Invasive Breast Cancer
Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) for the staging of clinically node-negative breast cancer patients, demonstrating equivalent survival to ALND for lymph node–negative patients 1 while resulting in reduced morbidity. 2 For the majority of patients with pathologically positive SLNs, completion ALND is recommended by the American Society of Clinical Oncology Guidelines and the National Comprehensive Cancer Network (NCCN). 3,4 However, recent data from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial suggest that ALND may be omitted in selected patients with 1 or 2 positive SLNs. 5,6 In the ACOSOG Z0011 trial, 813 patients with clinical T1-2 node-negative tumors who were found to have hematoxylin and eosin (H&E)-positive SLNs were randomized to ALND vs no further axillary surgery. Patients with palpable lymph nodes or clinical T3 tumors were not eligible for this study. The protocol mandated the use of standard whole-breast radiation without an axillary field. Patients with >3 positive SLNs were excluded from the study. The trial was closed early due to poor accrual with an enrollment of only 47% of the targeted 1900 patients. It still showed equivalent results between the 2 treatment arms for loco-regional failure and survival. At 6.3 years' follow-up, no differences were found between the 2 groups in the rates of axillary recurrence (0.5% vs 0.9%), in-breast recurrence (3.6% vs 1.9%), or overall locoregional recurrence (4.1% vs 2.8%, P = 0.53). 5 Disease-free and overall survival were similar (82.2% vs 83.8% and 91.9% vs 92.5%) between the groups. 6 The majority of women in this trial were older than 50 years (64%), had clinical T1 tumors (68%), had ER-positive tumors (77%), had only 1 positive SLN (60%), received whole-breast radiation (89%), and received systemic therapy (96%: 58% adjuvant chemotherapy and 46% adjuvant hormonal therapy). Forty percent of patients had micrometastases or isolated tumor cells and 60% had macrometastases in the sentinel nodes. Additional positive axillary nodes were found in 27.3% of the ALND patients. This study excluded patients undergoing mastectomy and patients receiving neoadjuvant chemotherapy.
Geburtshilfe und Frauenheilkunde, 2012
The prognosis of breast cancer is most heavily influenced by the status of the axillary nodes. Until a few years ago, this knowledge was gained through radical axillary lymph node clearance. In the meantime, sentinel lymph node clearance has become an established part of the surgical treatment of breast cancer. With the development of this procedure, the morbidity caused by axillary dissection has been reduced significantly. Although comprehensive prospective, randomised data regarding the safe use of the sentinel concept are only now available, the focus currently, however, is on the question of whether in the case of positive sentinel lymph nodes, an axillary dissection can be done away with altogether without having any negative impact on the risk of loco-regional recurrence or on progression-free survival and overall survival. The results of the American ACOSOG-Z001 study have changed the fundamental perspective of this. In this study on the advantages of axillary dissection following the confirmation of tumour tissue in the sentinel lymph nodes, there were no statistically significant advantages from axillary dissection for women with a favourable overall risk profile who had received radiotherapy and systemic therapy. If this concept takes hold, the surgical treatment of node-positive breast cancer, at least in the axilla, would be reduced to a minimum, and the focus of treatment would in future lie more on the systemic treatment of this condition. As part of an interdisciplinary consensus meeting, a standardised approach for Austria with regard to this question was decided upon. Zusammenfassung ! Die Prognose des Mammakarzinoms wird durch den axillären Lymphknotenstatus am stärksten beeinflusst. Dieses Wissen wurde noch bis vor wenigen Jahren durch die radikale axilläre Lymphonodektomie erlangt. Inzwischen ist die Sentinel-Lymphonodektomie etablierter Bestandteil in der operativen Behandlung des Mammakarzinoms geworden. Durch die Entwicklung dieses Verfahrens konnte die Morbidität, die durch eine axilläre Dissektion verursacht wird, wesentlich reduziert werden. Wenngleich erst jetzt umfassende prospektiv randomisierte Daten zur sicheren Anwendung des Sentinel-Konzepts vorliegen, geht es aktuell jedoch bereits um die Frage, ob bei positivem Sentinel-Lymphknoten auf eine Axilladissektion (AD) gänzlich verzichtet werden kann, ohne das Risiko für ein lokoregionäres Rezidiv oder das progressionsfreie Überleben und Gesamtüberleben negativ zu beeinflussen. Die Ergebnisse der amerikanischen ACOSOG-Z0011-Studie haben die grundlegende Betrachtungsweise verändert. In dieser Studie zum Vorteil der Axilladissektion nach Tumornachweis im Sentinel-Lymphknoten ergaben sich für die Patientinnen mit günstigem Gesamtrisikoprofil und applizierter Strahlentherapie und systemischer Therapie keine statistisch signifikanten Vorteile durch die Axilladissektion. Setzt sich dieses Konzept durch, wäre die operative Versorgung des nodalpositiven Mammakarzinoms zumindest in der Axilla auf ein Minimum reduziert und der Fokus der Behandlung läge zukünftig mehr in der systemischen Behandlung dieser Erkrankung. Im Rahmen eines interdisziplinären Konsensus-Meetings wurde eine einheitliche Vorgehensweise für Österreich diese Fragestellung betreffend beschlossen.
Breast Cancer Patients Treated Without Axillary Surgery
Annals of Surgery, 2000
Background: It has recently been reported that, using axillary reverse mapping (ARM), the lymphatics from the arm can be spared to reduce the incidence of breast-cancer-related lymphoedema (BCRL). The aim of this study was to assess the feasibility of selective axillary dissection (SAD) after using ARM and partially preserving arm drainage, and to assess the occurrence of BCRL. Methods: Using a radioisotope and lymphoscintigraphy, ARM was performed in 60 patients scheduled for SAD, who were subsequently divided for the purpose of comparing the BCRL rates into: group A, comprising 45 patients who successfully underwent SAD with a residual lymphatic hot spot; and group B with 15 whose hot nodes were removed as is normally the case during complete axillary lymph node dissection (ALND). Results: SAD was feasible in 75% of the 60 patients. SAD was completed successfully in 19 of the first 30 patients, and in 26 of the second 30 patients ( p ¼ 0.072). The median follow-up was 16 months (6e36), during which 9 patients developed a BCRL, 4 in group A (9%) and 5 in group B (33%); p ¼ 0.035. None of the patients had nodal relapses during the follow-up. Conclusions: Using a radioisotope enables an effective and safe SAD in a large proportion of patients. There was evidence of a trend to suggest a learning curve. The rate of BCRL after SAD was less than one third of the rate recorded after ALND, a result that should encourage the development of the former technique.
Surgical management of axilla: controversy and care
International Surgery Journal, 2019
Surgery for cancer of the breast was pioneered by William S. Halstead, who advocated en bloc removal of the breast, axillary nodes and part of the chest wall. Called the radical mastectomy, this procedure became the unquestionable path that generations of surgeons followed with diligence. Although it often resulted in significant morbidities, it increased the 20 years survival rate from 10 to 50%. Axillary node involvement is the single most important prognostic variable in patients with breast cancer. It was established that when the axillary lymph nodes came out ABSTRACT Background: Surgical staging of the axilla has traditionally provided the best prognostic information about breast cancer. However, the morbidity of a complete axillary clearance outweighs the therapeutic and prognostic benefits of the procedure. Authors observed the types of axillary lymph node dissection (ALND) performed in authors' institute and the magnitude of morbidities of a complete ALND. Methods: This observational study was conducted at the Cancer Institute of Himalayan Institute of Medical Sciences for a period of one year. Sequelae of ALND was observed at 1, 3 and 6 months in all female patients undergoing axillary dissection as part of surgery for breast cancer. Results: Out of 150 patients 53 (35.33%) presented with locally advanced disease, and 84 (56%) had palpable axillary nodes. All patients with palpable nodes underwent level II-III dissection. 32 patients underwent sentinel node dissection using blue dye only. Tumour size correlated positively with grade of tumour (r =0.36, P <0.001) and number of positive lymph nodes (r = 0.34; P <0.001). There was significant difference in incidence of lymphedema at 6 months in patients who underwent level III dissection (27.38%) as opposed to those who did not (8.92 %) (p <0.05). The incidence of seroma was also more at 1 month in these patients (57.14%) vs (39.28%), (p <0.05). Post-operative pain/ wound infection/Restriction of motion were not statistically significant. Conclusions: Higher stages of presentation require higher levels of axillary dissection. Unwarranted dissection can be avoided by tailoring the surgery during initial clinical assessment.
European Journal of Cancer, 2013
The German, Austrian and Swiss (D.A.CH) Societies of Senology gathered together in 2012 to address dwelling questions regarding axillary clearance in breast cancer patients. The Consensus Panel consisted of 14 members of these societies and included surgical oncologists, gynaecologists, pathologists and radiotherapists. With regard to omitting axillary lymph node dissection in sentinel lymph node macrometastases, the Panel consensually accepted this option for low-risk patients only. A simple majority voted against extending radiotherapy to the axilla after omitting axillary dissection in N1 disease. Consensus was yielded for the use of axillary ultrasound and prospective registers for such patients in the course of follow-up. The questions regarding neoadjuvant therapy and the timing of sentinel lymph node biopsy failed to yield consensus, yet both options (before or after) are possible in clinically node-negative disease.
The Risk Factors of Lymphedema in Breast Cancer Patients Post Axillary Clearance
Surgical Science, 2022
Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30-60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both.