The Management of Axillary Lymph Nodes in Breast Cancer - A Retrospective Single-Centre Study (original) (raw)
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Patterns of Axillary Surgical Care for Breast Cancer in the Era of Sentinel Lymph Node Biopsy
Annals of Surgical Oncology, 2009
Background. Population-based overall patterns of surgical management of the axilla in women with operable breast cancer during the era of adoption of sentinel lymph node biopsy (SLNB) were studied. Methods. Women with operable breast carcinoma residing in 14 geographic areas of the Surveillance, Epidemiology, and End Results (SEER) cancer registries (1998-2004, n = 239,661) were assessed for axillary surgical patterns of care. Results. Use of SLNB increased from 11 to 59%. Use of no axillary surgery decreased from 14 to 6.6%. In pathologic node-negative women, use of axillary lymph node dissection (ALND) decreased from 94 to 36%. Independent factors most associated with failure to receive SLNB included diagnosis year (
Cancer, 2002
BACKGROUND. There are no data available from randomized controlled trials that compare the efficacy of sentinel lymph node (SLN) biopsy with Level I/II axillary lymph node dissection (ALND) in patients with breast carcinoma. We performed a formal decision analysis to determine whether SLN biopsy is appropriate, compared with ALND, for patients with T1, T2, and T3 tumors and to quantify the relative value of these two procedures in the management of patients with breast carcinoma. METHODS. All clinically relevant outcomes were modeled for both SLN biopsy and ALND. The probabilities of complications and outcomes were derived using data from the University of Louisville Breast Cancer Sentinel Lymph Node Study and from extensive review of previous studies. Utilities were assigned by the authors, incorporating values from the literature whenever possible. RESULTS. The expected utility of SLN biopsy was higher than the expected utility for ALND for T1 and T2 tumors that were 4.0 cm or smaller. There was no clear preference for either procedure with tumors that were larger than 4.0 cm. The T1 and T2 results were robust to sensitivity analysis. CONCLUSIONS. The results of this decision analysis suggest that SLN biopsy is preferred over ALND for patients with breast tumors that are 4.0 cm or smaller. Patients should be aware of the potential for false-negative results in SLN biopsy, but this risk is outweighed by the decreased morbidity associated with the proce
Breast Cancer, 2010
Background It is currently unclear which patients with breast cancer with sentinel lymph node (SLN) metastases do not need axillary lymph node dissection (ALND). Patients and methods A cohort of 1,132 women who had unilateral invasive breast cancer with clinically negative nodes or nodes suspicious for metastasis, were intraoperatively diagnosed as having negative SLNs, and did not undergo an immediate ALND. Our intraoperative histological investigation uses H&E staining of a frozen section from a maximum cut surface of each SLN. Of these 1,132 women, 132 (11.7%) were postoperatively diagnosed as having positive SLNs, which classifies them as having an intraoperative, false-negative SLN biopsy (SLNB). Patient and tumor characteristics, treatment methods, and the prognoses of these patients were investigated and compared with the remaining 1,000 patients who were negative for SLNB.
The role of axillary lymph node dissection in breast cancer management
Breast Cancer, 1997
Although it is generally accepted that axillary dissection provides no survival advantage in patients with breast cancer, it is commonly regarded as a reliable method of assessing nodal status and treating regional disease. However, it is time to consider eliminating routine axillary dissection in patients who are clinically nodenegative. A sentinel lymph node biopsy may assess axillary nodal status while obviating a full axillary dissection. At present, axillary dissection remains the standard approach for the surgical management of all patients with invasive carcinoma of the breast, regardless of tumor size or patient age, though it is unnecessary for patients with small intraductal carcinomas.
Sentinel Lymph Node Biopsy and Axillary Dissection in Breast Cancer: Results in a Large Series
JNCI Journal of the National Cancer Institute, 1999
Background: Axillary lymph node dissection is an established component of the surgical treatment of breast cancer, and is an important procedure in cancer staging; however, it is associated with unpleasant side effects. We have investigated a radioactive tracerguided procedure that facilitates identification, removal, and pathologic examination of the sentinel lymph node (i.e., the lymph node first receiving lymphatic fluid from the area of the breast containing the tumor) to predict the status of the axilla and to assess the safety of foregoing axillary dissection if the sentinel lymph node shows no involvement. Methods: We injected 5-10 MBq of 99m Tc-labeled colloidal particles of human albumin peritumorally in 376 consecutive patients with breast cancer who were enrolled at the European Institute of Oncology during the period from March 1996 through March 1998. The sentinel lymph node in each case was visualized by lymphoscintigraphy, and its general location was marked on the overlying skin. During breast surgery, the sentinel lymph node was identified for removal by monitoring the acoustic signal from a hand-held gamma ray-detecting probe. Total axillary dissection was then carried out. The pathologic status of the sentinel lymph node was compared with that of the whole axilla. Results: The sentinel lymph node was identified in 371 (98.7%) of the 376 patients and accurately predicted the state of the axilla in 359 (95.5%) of the patients, with 12 false-negative findings (6.7%; 95% confidence interval = 3.5%-11.4%)
The Breast, 2007
Introduction: In many countries sentinel node biopsy (SNB) has become the standard of care in breast cancer based on a large number of observational studies but without results from prospective randomized trials. The goal of our study was to evaluate the oncological safety of the SNB in breast cancer in a multicenter, nonrandomized setting with comparable groups. Patients and methods: Between 1996/05 and 2004/11, 2942 patients from 14 departments in Austria with unicentric, unilateral, invasive disease without neoadjuvant therapy were collected in a database. The recommendations of the Austrian Sentinel Node Study Group were to complete a training period (phase I) with 50 cases of SNB followed by axillary lymph node dissection (ALND) to prove a detection rate of X90% and a false-negative rate of p5%. In the executing period (phase II), SNB was followed by ALND only if the sentinel node (SN) contained metastases. We compared the results on disease-free survival, local recurrence rates, distant recurrence rates and overall survival of both groups. Cases from phases I and II generated groups I (n ¼ 671) and 2 (n ¼ 2271 cases), respectively.
Panacea Journal of Medical Sciences, 2023
Abstract Introduction: Sentinel lymph node biopsy (SLNB) has become standard to stage the axilla in cases of clinically and Ultrasound negative axilla avoiding unnecessary axillary Lymph node dissection which is associated with higher morbidity in patients Objective: 1. The Primary objective is to preoperatively detect axillary metastasis in USG confirmed node negative axilla and perform Sentinel Lymph node Biopsy, 2. To negate the need for axillary lymph node dissection and biopsy in the treatment of breast cancer patients with sentinel node negative Materials and Methods: A total number of 80 patients with core needle biopsy proved were subjected to USG of Breast and axilla. The patients who had suspicious features in USG axilla were subjected to USG Guided FNAC. The patient having positive (metastasis) over USG guided FNAC were subjected to ALND and those patients with USG guided FNAC Negative and Normal USG Axilla i.e. No suspicious over USG were subjected to SLNB using blue dye. The SLNB negative cases were followed up with Adjuvant Chemotherapy and every 3months in combination with sonography of the breast and the axilla. Mammograms, X-ray and abdominal sonography performed annually. Results: All 80 biopsy proven patients were subjected to USG. From which 32 patients had suspicious of metastatic deposits which were subjected to USG Guided FNAC. Rest 48 patients Normal Axilla. From 32 suspicious patients undergone USG Guided FNAC 15 showed deposits in Axilla which were subjected to ALND. Rest 17 Negative under USG guided FNAC along with 48 Normal Axilla patients were subjected to blue dye SLNB i.e., Total of 65 cases. i). From these 65 cases which undergone SLNB 4 cases (23.5%) showed metastatic deposit in USG guided FNAC Negative cases (17 total cases) and 8 cases (16.6%) showed metastatic deposit in USG Normal Axilla (48 Total cases) in frozen section. Which brings total SLNB of 18.4% (12 out of 65 cases). ii). These 12 cases were subjected to Axillary Lymph node dissection. The Final HPE study showed 100% metastatic deposits. iii). Remaining 53 cases were followed up for a period of 12 months. No local or Axillary recurrence could be observed in 53 patients who underwent SLNB without ALND. Conclusion: Short term results were very promising with combination of USG along with SLNB without ALND in SLNB negative cases and holds a strong future perspective. Keywords: Sentinel Lymph node biopys, FNAC
Axillary vs Sentinel Lymph Node Dissection for Invasive Breast Cancer
JAMA, 2011
and colleagues stated that "Axillary recurrence is usually an early event, occurring at a median of 14.8 months in [the National Surgical Adjuvant Breast and Bowel Project] B04 [trial]; in that trial, only 7 of 68 axillary recurrences occurred more than 5 years after study entry." 1,2 The authors then argued that, after a median follow-up of 6.3 years, further follow-up of patients in the American College of Surgeons Oncology Group Z0011 trial would not substantially alter the results of their study. Yet the authors ignored the fact that the risk of breast cancer recurrence is not only time-dependent but also dependent on tumor estrogen receptor (ER) status. Patients with ER-negative tumors have a much greater risk of recurrence during the initial 7 years following breast cancer diagnosis than those with ER-positive tumors, who have a greater risk of recurrence after that period (ie, the hazard curves for ER-negative and ER-positive tumors cross at approximately 7 years following initial diagnosis). 3 In Z0011, approximately 82% of the tumors were ER positive, which is greater than the proportion of ER-positive tumors in the current US population. 3 Furthermore, the proportion of patients with ER-positive tumors has increased in recent years, so patients in B04 likely had a higher proportion of ERnegative tumors. 4 Patients enrolled in B04 would therefore most likely have a higher risk of early recurrences, while those in Z0011 would have a higher risk of later recurrences. Consequently, further follow-up of patients enrolled in Z0011 is required before any meaningful conclusions can be drawn concerning the effect of sentinel lymph node dissection (SLND) alone vs axillary lymph node dissection (ALND) in patients with sentinel node metastasis.