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de Boniface J, Frisell J, Bergkvist L, Andersson Y. Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation. Br J Surg 2018; 105:1607-1614. [PMID: 29926900 PMCID: PMC6220856 DOI: 10.1002/bjs.10889] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/22/2018] [Accepted: 04/08/2018] [Indexed: 01/18/2023]
Abstract
Background The prognostic equivalence between mastectomy and breast‐conserving surgery (BCS) followed by radiotherapy was shown in pivotal trials conducted decades ago. Since then, detection and treatment of breast cancer have improved substantially and recent retrospective analyses point towards a survival benefit for less extensive breast surgery. Evidence for the association of such survival data with locoregional recurrence rates is largely lacking. Methods The Swedish Multicentre Cohort Study prospectively included clinically node‐negative patients with breast cancer who had planned sentinel node biopsy between 2000 and 2004. Axillary lymph node dissection was undertaken only in patients with sentinel node metastases. For the present investigation, adjusted survival analyses were used to compare patients who underwent BCS and postoperative radiotherapy with those who received mastectomy without radiotherapy. Results Of 3518 patients in the Swedish Multicentre Cohort Study, 2767 were included in the present analysis; 2338 had BCS with postoperative radiotherapy and 429 had mastectomy without radiotherapy. Median follow‐up was 156 months. BCS followed by whole‐breast irradiation was superior to mastectomy without irradiation in terms of both overall survival (79·5 versus 64·3 per cent respectively at 13 years; P < 0·001) and breast cancer‐specific survival (90·5 versus 84·0 per cent at 13 years; P < 0·001). The local recurrence rate did not differ between the two groups. The axillary recurrence‐free survival rate at 13 years was significantly lower after mastectomy without irradiation (98·3 versus 96·2 per cent; P < 0·001). Conclusion The present data support the superiority of BCS with postoperative radiotherapy over mastectomy without radiotherapy. The axillary recurrence rate differed significantly, and could be one contributing factor in a complex explanatory model. Radiotherapy to lower axilla key?
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Affiliation(s)
- J de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Breast Centre, Capio St Göran's Hospital, Stockholm, Sweden
| | - J Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - L Bergkvist
- Centre for Clinical Research Uppsala University, Västmanland County Hospital, Västerås, Sweden.,Department of Surgery, Västmanland County Hospital, Västerås, Sweden
| | - Y Andersson
- Centre for Clinical Research Uppsala University, Västmanland County Hospital, Västerås, Sweden.,Department of Surgery, Västmanland County Hospital, Västerås, Sweden
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Fancellu A, Cottu P, Feo CF, Bertulu D, Giuliani G, Mulas S, Sanna V, Mura S, Madeddu G, Spanu A. Sentinel Node Biopsy in Early Breast Cancer: Lessons Learned from More than 1000 Cases at a Single Institution. TUMORI JOURNAL 2018; 98:413-20. [PMID: 23052155 DOI: 10.1177/030089161209800403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aims The aims of this paper are to report the development of sentinel node biopsy (SNB) in breast cancer at a single institution and to discuss the relevant issues on SNB still to be elucidated. Patients and methods From 1998 to 2010, 1021 SNBs with frozen section examination were carried out in patients with breast cancer. In the early period (1998–2002) SNB was always combined with axillary lymph node dissection (ALND). From 2002 onwards, only patients with a positive SNB result underwent ALND (late period). The characteristics of patients with infiltrating carcinoma (IC) and ductal carcinoma in situ (DCIS) and the histological status of the sentinel nodes were examined. The survival outcomes of node-negative patients were compared between patients submitted to SNB and ALND (ALND group) during the early period and patients who underwent only SNB during the late period (SNB group). Results The sentinel node was identified intraoperatively in 98.3% of cases. During the early period the overall accuracy of SNB was 97.0%. During the late period, 700 patients with IC and 140 with DCIS underwent SNB. In the IC group, 149 patients (21.3%) had sentinel node macrometastases and 36 (5.1%) micrometastases; of that subgroup, 21 underwent ALND and no other metastatic lymph nodes were found, and 15 underwent SNB only. Axillary recurrences were observed in 4 patients (0.77%) with negative SNB; none of these were among the patients with micrometastatic SNB. Two patients (1.4%) with DCIS had a positive SNB. In node-negative patients the 5-year overall survival was 96.7% in the ALND group and 96.5% in the SNB group (P = 0.63). The 5-year disease-free survival was 93.8% and 93.2% in the ALND and SNB groups, respectively (P = 0.77). Conclusions Overall and disease-free survival in patients with a negative SNB result and no further axillary surgery were equal to those in patients with negative ALND. Intraoperative assessment of the sentinel node in expert hands has a low false-negative rate and allows immediate ALND in patients with sentinel node metastases, avoiding the need for a second operation. ALND for sentinel node micrometastases may be safely omitted in most patients with early stage breast cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Silvia Mura
- Oncology Unit, University of Sassari, Sassari, Italy
| | | | - Angela Spanu
- Nuclear Medicine Unit, University of Sassari, Sassari, Italy
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Houvenaeghel G, Quilichini O, Cohen M, Reyal F, Classe JM, Mazouni C, Giard S, Carrabin N, Charitansky H, Darai E, Hudry D, Azuar P, Villet R, Gimbergues P, Tunon-DE-Lara C, Lambaudie E. Sentinel lymph node biopsy validation for large tumors. Int J Surg 2017; 48:275-280. [PMID: 29175020 DOI: 10.1016/j.ijsu.2017.10.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/06/2017] [Accepted: 10/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) remains under discussion for large size tumors. The aim of this work has been to study the false negative rate (FNR) of SLNB for large tumors and predictive factors of false negative (FN). MATERIALS AND METHODS A study of a multicentric cohort, involved patients presenting N0 breast cancer with a SLNB eventually completed by complementary axillary lymph node dissection (cALND). The main criteria were the FNR and the predictive factors of FN. RESULTS 12.415 patients were included: 748 with tumors ≥30 mm, 1101 with tumors >20 and < 30 mm and 10.566 with tumors ≤20 mm, with a cALND respectively for 501 patients (67%), 523 (62.1%) and 2775 (26.3%). The FNR were respectively: 3.05% (IC95%: 1.3-4.8) for tumors ≥30 mm*, 3.5% (1.8-5.2) for tumors >20 and < 30 mm*, 1.8% (1-2.4) for tumors ≤20 mm (p < 0.05) (*Not significant). At multivariate analysis, SN number harvested ≤2 (OR:2.0, p = 0.023) and tumor size >20 and < 30 mm (OR:2.07, p = 0.017) were significant predictive factors of FN, without significant value for tumor size ≥30 mm (OR:1.83, p = 0.073). CONCLUSION The FNR of SLNB was not higher amongst large size tumors compared to tumors of a smaller size. These results support the validation of SNLB for tumors up to 50 mm.
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Affiliation(s)
- Gilles Houvenaeghel
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, Site Timone, 25 Boulevard Jean Moulin, Marseille, France.
| | - Olivia Quilichini
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France.
| | - Monique Cohen
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France.
| | - Fabien Reyal
- Institut Curie, 26 rue d'Ulm, 75248 Paris Cedex 05, France; Hôpital René Huguenin, 35 rue Dailly, Saint Cloud, France.
| | - Jean-Marc Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France.
| | - Chafika Mazouni
- Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France.
| | - Sylvie Giard
- Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France.
| | | | | | - Emile Darai
- Hôpital Tenon, 4 rue de la Chine, Paris, France.
| | - Delphine Hudry
- Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France.
| | - Pierre Azuar
- Hôpital de Grasse, Chemin de Clavary, Grasse, France.
| | - Richard Villet
- Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France.
| | | | | | - Eric Lambaudie
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, Site Timone, 25 Boulevard Jean Moulin, Marseille, France.
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Yang Y, He Y, Fan Z, Ouyang T. Sentinel lymph node biopsy in Chinese patients with large operable breast cancer (≥4 cm): A decade's experience from a single institution. Breast 2017; 36:20-24. [PMID: 28869832 DOI: 10.1016/j.breast.2017.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Performing sentinel lymph node biopsy (SLNB) in patients with large operable breast cancer is still controversial. Our aim is to find whether or not performing SLNB is feasible and safety in Chinese patients with large operable breast cancer. METHODS We reviewed the data of patients in our center from 2003 to 2015, a series of 267 patients with large operable breast cancer (≥4 cm) who underwent SLNB were examined. All selected patients recieved preoperative axillary evaluation. RESULTS The successful rate for localizing SLNs was 96.3% (257 of 267). 31.1% (78 of 257) patients were found to have positive sentinel lymph nodes (SLN). The median follow-up was 52 months. 2.2% (4 of 179) SLN-negative patients developed axillary recurrence (AR) as first event. The 5-year axillary recurrence free survival in SLN-negative patients was 96.9% (95%CI, 93.8%-100%). Patients with suspicious nodes on ultrasonography (US) (P = 0.16) and undergoing breast conserving therapy (BCT) (P = 0.057) had a higher trend to be associated with AR. The 5-year recurrence free survival (RFS) was 86.1% (95%CI, 80.8%-93.0%) in SLN-negative patients and 76.3% (95%CI, 68.1%-90.1%) in SLN-positive patients (P = 0.246). CONCLUSIONS SLNB is feasible and safety in patients with large operable breast cancer who underwent preoperative axillary evaluation.
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Affiliation(s)
- Yang Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Cancer Prevention & Treatment Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yingjian He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Cancer Prevention & Treatment Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaoqing Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Cancer Prevention & Treatment Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Tao Ouyang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Cancer Prevention & Treatment Center, Peking University Cancer Hospital & Institute, Beijing 100142, China.
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5
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Swedish prospective multicenter trial evaluating sentinel lymph node biopsy after neoadjuvant systemic therapy in clinically node-positive breast cancer. Breast Cancer Res Treat 2017; 163:103-110. [PMID: 28224384 PMCID: PMC5387036 DOI: 10.1007/s10549-017-4164-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 02/06/2023]
Abstract
Purpose Patients with clinically node-positive breast cancer planned for neoadjuvant systemic therapy (NAST) may draw advantages from the nodal downstaging effect and reduce the extent of axillary surgery with sentinel lymph node biopsy (SLNB) performed after NAST. Since there are concerns about lower sentinel lymph node (SLN) detection and higher false-negative rates (FNR) in this setting, our aim was to define the accuracy of SLNB after NAST. Methods This Swedish national multicenter trial prospectively recruited 195 breast cancer patients from ten hospitals with T1–T4d biopsy-proven node-positive disease planned for NAST between October 1, 2010 and December 31, 2015. Clinically node-negative axillary status after NAST was not mandatory. SLNB was always attempted and followed by a completion axillary lymph node dissection (ALND). Results The SLN identification rate was 77.9% (152/195) but improved to 80.7% (138/171) with dual mapping. The median number of SLNs was two (range 1–5). A positive SLNB was found in 52% (79/152), almost 66% (52/79) of whom had additional positive non-sentinel lymph nodes. The overall pathologic nodal response rate was 33.3% (66/195). The overall FNR was 14.1% (13/92) but decreased to 4% (2/50) when only patients with two or more sentinel nodes were analyzed. Conclusions In biopsy-proven node-positive breast cancer, SLNB after NAST is feasible even though the identification rate is lower than in clinically node-negative patients. Since the overall FNR is unacceptably high, the omission of ALND should only be considered if two or more SLNs are identified.
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Zetterlund L, Celebioglu F, Axelsson R, de Boniface J, Frisell J. Swedish prospective multicenter trial on the accuracy and clinical relevance of sentinel lymph node biopsy before neoadjuvant systemic therapy in breast cancer. Breast Cancer Res Treat 2017; 163:93-101. [PMID: 28213781 PMCID: PMC5387013 DOI: 10.1007/s10549-017-4163-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 02/06/2023]
Abstract
Purpose The timing of sentinel lymph node biopsy (SLNB) in the context of neoadjuvant systemic therapy (NAST) in breast cancer is still controversial. SLNB before NAST has been evaluated in few single-institution studies in which axillary lymph node dissection (ALND), however, was commonly not performed in case of a negative SLNB. We investigated the potential clinical relevance of SLNB before NAST by performing ALND in all patients after NAST. Methods This national multicenter trial prospectively enrolled clinically node-negative breast cancer patients planned for NAST at 13 recruiting Swedish hospitals between October 2010 and December 2015. SLNB before NAST was followed by ALND after NAST in all individuals. Repeat SLNB after NAST was encouraged but not mandatory. Results SLNB before NAST was performed in 224 patients. The identification rate was 100% (224/224). The proportion of patients with a negative SLNB before NAST but positive axillary lymph nodes after NAST was 7.4% (nine of 121 patients, 95% CI 4.0–13.5). Among those with a positive SLNB before NAST, 23.2% (86/112) had further positive lymph nodes after NAST. Conclusions In clinically node-negative patients, SLNB before NAST is highly reliable. With this sequence, ALND and regional radiotherapy can be safely omitted in patients with a negative SLNB provided good clinical response to NAST. Additionally, SLNB-positive patients upfront will receive correct nodal staging unaffected by NAST and be consequently offered adjuvant locoregional treatment according to current guidelines pending the results of ongoing randomized trials.
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Affiliation(s)
- Linda Zetterlund
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Department of Surgery, Södersjukhuset, Stockholm, 118 83, Sweden.
| | - Fuat Celebioglu
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, 118 83, Sweden
| | - Rimma Axelsson
- Department of Clinical Science, Intervention and Technology, Division of Radiography, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, 141 86, Sweden
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Capio St Göran's Hospital, Stockholm, 112 81, Sweden
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Solna, 171 76, Sweden
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7
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de Boniface J, Frisell J, Bergkvist L, Andersson Y. Ten-year report on axillary recurrence after negative sentinel node biopsy for breast cancer from the Swedish Multicentre Cohort Study. Br J Surg 2017; 104:238-247. [PMID: 28052310 DOI: 10.1002/bjs.10411] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/26/2016] [Accepted: 09/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The omission of axillary lymph node dissection (ALND) in patients with breast cancer with a negative finding on sentinel node biopsy (SNB) has reduced arm morbidity substantially. Early follow-up reports have shown the rate of axillary recurrence to be significantly lower than expected, with a median false-negative rate of 7 per cent for SNB. Long-term follow-up is needed as recurrences may develop late. METHODS The Swedish Multicentre Cohort Study included 3518 women with breast cancer and a clinically negative axilla, in whom SNB was planned. ALND was performed only in patients with sentinel node metastasis. Twenty-six centres contributed to enrolment between September 2000 and January 2004. The primary endpoint was the axillary recurrence rate and the secondary endpoint was breast cancer-specific survival, calculated using Kaplan-Meier survival estimates. RESULTS Some 2216 sentinel node-negative patients with 2237 breast cancers were analysed. The median follow-up time was 126 (range 0-174) months. Isolated axillary recurrence was found in 35 patients (1·6 per cent). High histological grade and multifocal tumours were risk factors for axillary recurrence, whereas the removal of more than two sentinel nodes decreased the risk. Fourteen (40 per cent) of 35 patients died as a consequence of axillary recurrence. CONCLUSION The risk of axillary recurrence remains lower than expected after a negative finding on SNB at 10-year follow-up. Axillary recurrences may occur long after primary surgery, and lead to a significant risk of breast cancer death.
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Affiliation(s)
- J de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - L Bergkvist
- Centre for Clinical Research Uppsala University, Västmanland County Hospital, Västerås, Sweden.,Department of Surgery, Västmanland County Hospital, Västerås, Sweden
| | - Y Andersson
- Centre for Clinical Research Uppsala University, Västmanland County Hospital, Västerås, Sweden.,Department of Surgery, Västmanland County Hospital, Västerås, Sweden
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A Comparative Validation of Primary Surgical Versus Post-neo-adjuvant Chemotherapy Sentinel Lymph Node Biopsy for Stage III Breast Cancers. World J Surg 2015; 40:1583-9. [DOI: 10.1007/s00268-015-3222-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Abstract
OBJECTIVES To report our experience in sentinel lymph node biopsy (SLNB) in early breast cancer. METHODS This is a retrospective study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2005 and December 2014. There were 120 patients who underwent SLNB with frozen section examination. Data collected included the characteristics of patients, index tumor, and sentinel node (SN), SLNB results, axillary recurrence rate and SLNB morbidity. RESULTS There were 120 patients who had 123 cancers. Sentinel node was identified in 117 patients having 120 tumors (97.6% success rate). No SN was found intraoperatively in 3 patients. Frozen section results showed that 95 patients were SN negative, those patients had no immediate axillary lymph node dissection (ALND), whereas 25 patients were SN positive and subsequently had immediate ALND. Upon further examination of the 95 negative SN's by hematoxylin and eosin (H and E) and immunohistochemical staining for doubtful H and E cases, 10 turned out to have micrometastases (6 had delayed ALND and 4 had no further axillary surgery). Median follow up of patients was 35.5 months and the mean was 38.8 months. There was one axillary recurrence observed in the SN negative group. The morbidity of SLNB was minimal. CONCLUSION The obtainable results from our local experience in SLNB in breast cancer, concur with that seen in published similar literature in particular the axillary failure rate. Sentinel lymph node biopsy resulted in minimal morbidity.
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Affiliation(s)
- Abdulaziz A Alsaif
- Department of Surgery, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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10
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Patten DK, Zacharioudakis KE, Chauhan H, Cleator SJ, Hadjiminas DJ. Sentinel lymph node biopsy after neo-adjuvant chemotherapy in patients with breast cancer: Are the current false negative rates acceptable? Breast 2015; 24:318-20. [PMID: 25800381 DOI: 10.1016/j.breast.2015.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022] Open
Abstract
The advent of sentinel lymph node biopsy has revolutionised surgical management of axillary nodal disease in patients with breast cancer. Patients undergoing neo-adjuvant chemotherapy for large breast primary tumours may experience complete pathological response on a previously positive sentinel node whilst not eliminating the tumour from the other lymph nodes. Results from 2 large prospective cohort studies investigating sentinel lymph node biopsy after neo-adjuvant chemotherapy demonstrate a combined false negative rate of 12.6-14.2% and identification rate of 80-89% with the minimal acceptable false negative rate and identification rate being set at 10% and 90%, respectively. A false negative rate of 14% would have been classified as unacceptable when compared to the figures obtained by the pioneers of sentinel lymph node biopsy which was 5% or less.
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Affiliation(s)
- D K Patten
- Department of Breast and General Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK; Department of Surgery and Cancer, The Imperial Centre for Translational and Experimental Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK.
| | - K E Zacharioudakis
- Department of Breast and General Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - H Chauhan
- Department of Breast and General Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - S J Cleator
- Division of Cancer, Imperial College London, UK
| | - D J Hadjiminas
- Department of Breast and General Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK.
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11
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Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer. Its relation with molecular subtypes. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Ruano R, Ramos M, García-Talavera JR, Ramos T, Rosero AS, González-Orus JM, Sancho M. [Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer. Its relation with molecular subtypes]. Rev Esp Med Nucl Imagen Mol 2014; 33:340-5. [PMID: 24856234 DOI: 10.1016/j.remn.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the influence of the molecular subtype (MS) in the Sentinel Node Biopsy (SNB) technique after neoadjuvant chemotherapy (NAC) in women with locally advanced breast cancer (BC) and a complete axillary response (CR). MATERIAL AND METHODS A prospective study involving 70 patients with BC treated with NAC was carried out. An axillary lymph node dissection was performed in the first 48 patients (validation group: VG), and in case of micro- or macrometastases in the therapeutic application phase (therapy group:TG). Classified according to MS: 14 luminal A; 16 luminal B HER2-, 13 luminal B HER2+, 10HER2+ non-luminal, 17 triple-negative. RESULTS SNB was carried out in 98.6% of the cases, with only one false negative result in the VG (FN=2%). Molecular subtype did not affect SN detection. Despite the existence of axillary CR, statistically significant differences were found in the proportion of macrometastasis (16.7% vs. 35.7%, p=0.043) on comparing the pre-NAC cN0 and cN+. Breast tumor response to NAC varied among the different MS, this being lowest in luminal A (21.5%) and highest in non-luminal HER2+ group (80%). HER2+ and triple-negative were the groups with the best axillary histological response both when there was prior clinical involvement and when there was not. CONCLUSIONS Molecular subtype is a predictive factor of the degree of tumor response to NAC in breast cancer. However, it does not affect SNB detection and efficiency. SNB can also be used safely in women with prior node involvement as long as a complete clinical and radiological assessment is made of the node response to NAC.
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Affiliation(s)
- R Ruano
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España.
| | - M Ramos
- Unidad de Patología Mamaria, Hospital Universitario de Salamanca, Salamanca, España
| | - J R García-Talavera
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España
| | - T Ramos
- Unidad de Patología Mamaria, Hospital Universitario de Salamanca, Salamanca, España
| | - A S Rosero
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España
| | - J M González-Orus
- Unidad de Patología Mamaria, Hospital Universitario de Salamanca, Salamanca, España
| | - M Sancho
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
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13
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Beumer JD, Gill G, Campbell I, Wetzig N, Ung O, Farshid G, Uren R, Stockler M, Gebski V. Sentinel node biopsy and large (≥3 cm) breast cancer. ANZ J Surg 2013; 84:117-20. [DOI: 10.1111/ans.12139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jesse D. Beumer
- Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - Grantley Gill
- Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | | | - Neil Wetzig
- Wesley Medical Centre; Brisbane Queensland Australia
| | - Owen Ung
- New South Wales Breast Cancer Institute; Westmead Hospital; Sydney New South Wales Australia
| | | | - Roger Uren
- The Discipline of Medicine; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Martin Stockler
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
- Sydney Cancer Centre; Royal Prince Alfred and Concord Hospitals; Sydney New South Wales Australia
- Department of Medicine; University of Sydney; Sydney New South Wales Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
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14
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15
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Spillane AJ, Brennan ME. Accuracy of sentinel lymph node biopsy in large and multifocal/multicentric breast carcinoma--a systematic review. Eur J Surg Oncol 2011; 37:371-85. [PMID: 21292433 DOI: 10.1016/j.ejso.2011.01.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/31/2010] [Accepted: 01/10/2011] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND While sentinel lymph node biopsy (SLNB) is established in the management of small unifocal breast cancer its role in management of multifocal (MF), multicentric (MC) and larger tumors is still evolving. METHODS Medline was searched; studies meeting pre-determined criteria were included. Data were extracted and entered into evidence tables. RESULTS Twenty six studies met inclusion criteria and reported data on accuracy; no randomized trials were identified. For MF cancers (n = 314 cases), success rate for identification of an SLN was 86-94%, SLN positivity rate 42-59%, false negative rate (FNR) 0-33% and overall accuracy 78-100%. For MC (n = 294 cases): success rate 92-100%, SLN positivity rate 25-61%, FNR 4-8% and accuracy 96-100%. For 'multiple breast cancer' (studies combining MF/MC cases; n = 996 cases): success rate 92-100%, SLN positivity rate 12-63%, FNR 0-25%, and accuracy 82-100%. For larger tumors (n = 1912 cases): success rate 86-100%, SLN positivity rate 49-77%, FNR 3-18% and accuracy 85-98%. For MC/MF and larger cancers overall non-SLN positivity rates were up to 82%; axillary recurrence rates were low but seldom reported. CONCLUSION There are no randomized trials evaluating the safety of SLNB in MF/MC and larger breast cancers. Based on limited evidence, success rate and FNR appear to be similar to those for small unifocal cancers, however node positivity rates are higher and rates of non-SLN positivity are very high. Awareness of these issues is essential when recommending SLNB based axillary management for these higher-risk tumors.
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Affiliation(s)
- A J Spillane
- Breast and Surgical Oncology at The Poche Centre, 40 Rocklands Rd, North Sydney, NSW 2060, Australia.
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Schwartz R. Revisión de la literatura para la actualización de los requisitos, requerimientos técnicos e indicaciones del linfonodo centinela axilar en cáncer de mama. Medwave 2010. [DOI: 10.5867/medwave.2010.01.4335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sentinel lymphadenectomy for the staging of clinical axillary node-negative breast cancer before neoadjuvant chemotherapy. Eur J Surg Oncol 2009; 35:916-20. [DOI: 10.1016/j.ejso.2008.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/09/2008] [Accepted: 11/11/2008] [Indexed: 11/22/2022] Open
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Meretoja TJ, Leidenius MH, Heikkilä PS, Joensuu H. Sentinel node biopsy in breast cancer patients with large or multifocal tumors. Ann Surg Oncol 2009; 16:1148-55. [PMID: 19242761 DOI: 10.1245/s10434-009-0397-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 02/08/2009] [Indexed: 12/29/2022]
Abstract
BACKGROUND The axillary recurrence (AR) rate after negative sentinel node biopsy (SNB) in patients with high risk of axillary metastases is largely unknown. The aim of this study was to analyze the risk factors for isolated AR after negative SNB with special interest in large or multifocal tumors. METHODS A prospective SNB registry was analyzed for 2,408 invasive breast cancer patients operated between 2001 and 2007. No axillary clearance was performed in 1,309 cases with a negative SNB, including 1,138 small unifocal tumors, 121 small multifocal tumors, 48 large unifocal tumors, and 2 large multifocal tumors. RESULTS Six (0.5%) isolated AR were observed during a median follow-up of 43 months. Four (0.4%) patients with small unifocal tumors and two (1.6%) with small multifocal tumors had isolated AR (p = 0.179). None of the patients with large unifocal or multifocal tumors had isolated AR. Instead of tumor size and multifocality, estrogen receptor negativity (p < 0.001), nuclear grade III (p < 0.001), Her-2 status (p = 0.002), no radiotherapy (p = 0.005), and mastectomy (p = 0.005) were found to be associated with AR. CONCLUSIONS A remarkable proportion of patients with large unifocal tumors and small multifocal tumors may avoid unnecessary AC due to tumor negative SNB, without an excessive risk of AR.
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Affiliation(s)
- Tuomo J Meretoja
- Department of Gastrointestinal and General Surgery, Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
Biopsy of the sentinel lymph node now forms part of routine management in many centres dealing with early stage breast cancer. This article seeks to discuss developments over the past number of years and to summarise current practice.
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Bergkvist L. Resolving the controversies surrounding lymphatic mapping in breast cancer. Future Oncol 2008; 4:681-8. [DOI: 10.2217/14796694.4.5.681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Sentinel lymph node biopsy has rapidly become the standard of care in the primary treatment of breast cancer. Most of the initially identified potential contraindications towards the procedure, such as nonpalpability, large tumor size, pregnancy and being previously operated in the breast or axilla, have been ruled out, whereas multifocality represents an unsolved problem. There is no consensus about the best use of the technique in patients receiving neoadjuvant treatment. There is no place for sentinel lymph node biopsy in pure ductal carcinoma in situ, but it can be used for large high-grade in situ cancer diagnosed through core biopsy, especially if a mastectomy is planned. Morbidity is low, and the recurrence rates reported so far are reassuring. However, long-term results are lacking, and results from ongoing randomized trials are awaited.
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Affiliation(s)
- Leif Bergkvist
- Department of Surgery and Center for Clinical Research, Uppsala Universitet Central Hospital, SE 72189 Västerås, Sweden
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Fortunato L, Mascaro A, Amini M, Farina M, Vitelli CE. Sentinel Lymph Node Biopsy in Breast Cancer. Surg Oncol Clin N Am 2008; 17:673-99, x. [DOI: 10.1016/j.soc.2008.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ali R, Hanly AM, Naughton P, Castineira CF, Landers R, Cahill RA, Watson RG. Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer. World J Surg Oncol 2008; 6:69. [PMID: 18582366 PMCID: PMC2443144 DOI: 10.1186/1477-7819-6-69] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 06/26/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maximisation of the potential of sentinel lymph node biopsy as a minimally invasive method of axillary staging requires sensitive intraoperative pathological analysis so that rates of re-operation for lymphatic metastases are minimised. The aim of this study was to describe the test parameters of the frozen section evaluation of sentinel node biopsy for breast cancer compared to the gold standard of standard permanent pathological evaluation at our institution. METHODS The accuracy of intraoperative frozen section (FS) of sentinel nodes was determined in 94 consecutive women undergoing surgery for clinically node negative, invasive breast cancer (37:T1 disease; 43:T2; 14:T3). Definitive evidence of lymphatic spread on FS indicated immediate level II axillary clearance while sentinel node "negativity" on intraoperative testing led to the operation being curtailed to allow formal H&E analysis of the remaining sentinel nodal tissue. RESULTS Intraoperative FS correctly predicted axillary involvement in 23/30 patients with lymphatic metastases (76% sensitivity rate) permitting definitive surgery to be completed at the index operation in 87 women (93%) overall. All SN found involved on FS were confirmed as harbouring tumour cells on subsequent formal specimen examination (100% specificity and positive predictive value) with 16 patients having additional non-sentinel nodes found also to contain tumour. Negative Predictive Values were highest in women with T1 tumours (97%) and lessened with more local advancement of disease (T2 rates: 86%; T3: 75%). Of those with falsely negative FS, three had only micrometastatic disease. CONCLUSION Intraoperative FS reliably evaluates the status of the sentinel node allowing most women complete their surgery in a single stage. Thus SN can be offered with increased confidence to those less likely to have negative axillae hence expanding the population of potential beneficiaries.
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Affiliation(s)
- Rohanna Ali
- Department of General Surgery, Waterford Regional Hospital, Waterford, Ireland.
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Ruano R, Ramos M, García-Talavera J, García Macías M, Martín de Arriba A, González-Orús J, Iglesias M, Serrano E. La biopsia del ganglio centinela en cáncer de mama de más de 3 cm y axila clínicamente negativa frente a la indicación estándar T1-T2 < 3 cm. ACTA ACUST UNITED AC 2008. [DOI: 10.1157/13121027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rutgers E. Sentinel-lymph-node biopsy in breast cancer. Lancet Oncol 2007; 8:854-5. [PMID: 17913650 DOI: 10.1016/s1470-2045(07)70288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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