Towards optimal management of the axilla in the context of a positive sentinel node biopsy in early breast cancer (original) (raw)
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Controversial Indications for Sentinel Lymph Node Biopsy in Breast Cancer Patients
BioMed Research International, 2015
Sentinel lymph node biopsy (SLNB) emerged in the 1990s as a new technique in the surgical management of the axilla for patients with early breast cancer, resulting in lower complication rates and better quality of life than axillary lymph node dissection (ALND). Today SLNB is firmly established in the armamentarium of clinicians treating breast cancer, but several questions remain. The goal of this paper is to review recent work addressing 4 questions that have been the subject of debate in the use of SLNB in the past few years: (a) What is the implication of finding micrometastases in the sentinel nodes? (b) Is ALND necessary in all patients who have a positive SLNB? (c) How accurate is SLNB after neoadjuvant therapy? (d) Can SLNB be used to stage the axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery?
Management of the axilla in early stage breast cancer: will sentinel node biopsy end the debate?
1999
PURPOSE To provide recommendations on the best strategies for the management and on the best timing and treatment (surgical and radiotherapeutic) of the axilla for patients with early-stage breast cancer. METHODS Ontario Health (Cancer Care Ontario) and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature. RESULTS This guideline endorsed two recommendations of the ASCO 2017 guideline for the use of sentinel lymph node biopsy in patients with early-stage breast cancer and expanded on that guideline with recommendations for radiotherapy interventions, timing of staging after neoadjuvant chemotherapy (NAC), and mapping modalities. Overall, the ASCO 2017 guideline, seven high-quality systematic reviews, 54 unique studies, and 65 corollary trials formed the evidentiary basis of this guideline. RECOMMENDATIONS Recommendations are issued for each of the objectives of this guideline: (1) To determine which patients with early-stage breast cancer require axillary staging, (2) to determine whether any further axillary treatment is indicated for women with early-stage breast cancer who did not receive NAC and are sentinel lymph node-negative at diagnosis, (3) to determine which axillary strategy is indicated for women with earlystage breast cancer who did not receive NAC and are pathologically sentinel lymph node-positive at diagnosis (after a clinically node-negative presentation), (4) to determine what axillary treatment is indicated and what the best timing of axillary treatment for women with early-stage breast cancer is when NAC is used, and (5) to determine which are the best methods for identifying sentinel nodes.
European Journal of Nuclear Medicine and Molecular Imaging, 2008
Purpose To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer. Methods In the period 2001–2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique (99mTc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located. Results Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43–44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla. Conclusion The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue.
International seminars in surgical oncology : ISSO, 2005
Axillary clearance provides important prognostic information but is associated with significant morbidity. Sentinel node biopsy can provide staging .141 patients with node negative early breast cancers-tumour size less than 1.5 cm measured clinically or by imaging had guided axillary sampling (sentinel lymph node biopsy in combination with axillary sampling). Four node axillary sampling improved the detection rate of axillary node metastases by 13.6% as compared to blue dye sentinel node biopsy alone. Positive sampled nodes strongly indicated the likelihood of further metastatic being revealed by axillary dissection (67%). Negative sampled nodes in combination with a positive sentinel node biopsy were associated with a much lower rate of further nodal involvement in the axillary clearance (8%).
The Value of Sentinel Lymph Node Biopsy in Determining Optimal Therapy for Breast Cancer
American Journal of Cancer, 2002
Axillary lymph node dissection (ALND) is typically a standard part of the care of patients with breast cancer. It offers the most precise information about prognosis, controls potential metastatic disease in the axilla, and may provide a small survival advantage. Unfortunately, the procedure is expensive, uncomfortable, and associated with potential long term morbidity. Sentinel node biopsy (SNB) has been proposed as a minimally invasive method for axillary staging, with avoidance of full ALND in those cases (the majority) where the sentinel node is histologically negative. When done by experienced surgeons, the sentinel node is identified in at least 95% of cases, with a minimal (<5%) false negative rate. Immunohistochemistry may be performed selectively on the sentinel node, and upstages up to 20% of putative node negative patients. Nevertheless, SNB has a significant learning curve, with inexperienced surgeons identifying a sentinel node less frequently (in 60 to 80% of cases) with more false negatives. Use of SNB by inexperienced surgeons may lead to undertreatment (not using chemotherapy and/or hormonal therapy) and possible axillary recurrence. SNB is gradually replacing ALND as the standard of care for patients with the early stage of breast cancer, but the clinician must be aware of local surgeon and institution experience. Until each surgical team has documented their expertise with SNB, full ALND should be considered the local standard of care.
Introduction: For patients with clinically negative axilla, sentinel lymph node biopsy (SLNB) is the standard method for axillary staging Because the SLBNs are the only positive nodes in approximately 40-70% of patients with pathologically proven positive axillae after completion axillary lymph node dissection (ALND), the treatment of patients with a positive SLBN has been reconsidered and the development of predictive tools that select the patients whom routine ALND could be avoided safely. Purpose: to characterize the patients in whom completion ALND can be avoided in spite of positive SLNB. Patients and methods: This retrospective study included all patients who had SLNB at The characteristics of the special group with positive SLNB and node-negative upon completion ALND were studied. Results: out of 66 patients with clinically negative axillae, SLNB was negative in 36 patients, with no more ALND, J Cancer Sci Clin Ther 2020; 4 (1): 001-014 Journal of Cancer Science and Clinical Therapeutics 2 and SLNB was positive in 30 patients for whom completion ALND was done, and revealed that 63.4% (19 out of 30 patients) had no other positive nodes after completion ALND. Conclusion: In patients with clinically negative axillae and positive sentinel SLNB, A combination of multiple predictive parameters as, the number of positive SLNs, the ratio between metastatic SLNs and total number of SLN retrieved, extracapsular invasion, and lymphovascular invasion were significant predictors for the risk of non-SLN involvement and can identify the patients with positive SLNB for whom routine ALND could be safely avoided.
World Journal of Surgical Oncology, 2013
BackgroundGenerally, sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI).MethodsA prospectively maintained database of 767 breast cancer patients enrolled between January 2006 and December 2009 was reviewed. All patients were offered preoperative breast ultrasound, magnetic resonance imaging, and positron emission tomography scanning. SI patients were regarded as those for whom preoperative imaging was “suspicious for axillary LN metastasis” and NSI as “non-suspicious for axillary LN metastasis” on preoperative imaging techniques. Patients were subgrouped by presence of SI and types of axillary operation, and analyzed.ResultsFor 323 patients who received SLNB, there was no statistically significant difference in axillary re...
JNCI Journal of the National Cancer Institute, 2006
Background: Sentinel lymph node biopsy in women with operable breast cancer is routinely used in some countries for staging the axilla despite limited data from randomized trials on morbidity and mortality outcomes. We conducted a multicenter randomized trial to compare quality-of-life outcomes between patients with clinically node-negative invasive breast cancer who received sentinel lymph node biopsy and patients who received standard axillary treatment. Methods: The primary outcome measures were arm and shoulder morbidity and quality of life. From November 1999 to October 2003, 1031 patients were randomly assigned to undergo sentinel lymph node biopsy (n = 515) or standard axillary surgery (n = 516). Patients with sentinel lymph node metastases proceeded to delayed axillary clearance or received axillary radiotherapy (depending on the protocol at the treating institution). Intention-to-treat analyses of data at 1, 3, 6, and 12 months after surgery are presented. All statistical tests were two-sided. Results: The relative risks of any lymphedema and sensory loss for the sentinel lymph node biopsy group compared with the standard axillary treatment group at 12 months were 0.37 (95% confi dence interval [CI] = 0.23 to 0.60; absolute rates: 5% versus 13%) and 0.37 (95% CI = 0.27 to 0.50; absolute rates: 11% versus 31%), respectively. Drain usage, length of hospital stay, and time to resumption of normal day-to-day activities after surgery were statistically signifi cantly lower in the sentinel lymph node biopsy group (all P <.001), and axillary operative time was reduced ( P = .055). Overall patient-recorded quality of life and arm functioning scores were statistically signifi cantly better in the sentinel lymph node biopsy group throughout (all P ≤ .003). These benefi ts were seen with no increase in anxiety levels in the sentinel lymph node biopsy group ( P >.05). Conclusion: Sentinel lymph node biopsy is associated with reduced arm morbidity and better quality of life than standard axillary treatment and should be the treatment of choice for patients who have early-stage breast cancer with clinically negative nodes. [J Natl Cancer Inst 2006;98:599 -609] Affi liations of authors: