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Vlastos G, Verkooijen HM. Minimally invasive approaches for diagnosis and treatment of early-stage breast cancer. Oncologist 2007; 12:1-10. [PMID: 17227896 DOI: 10.1634/theoncologist.12-1-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Breast cancer management has been evolving toward minimally invasive approaches. Image-guided percutaneous biopsy techniques provide accurate histologic diagnosis without the need for surgical biopsy. Breast conservation therapy has become the treatment standard for early-stage breast cancer. Sentinel lymph node biopsy is a new procedure that can predict axillary lymph node status without the need of axillary lymph node dissection. The next challenge is to treat primary tumors without surgery. For this purpose, several new minimally invasive procedures, including radiofrequency ablation, interstitial laser ablation, focused ultrasound ablation, and cryotherapy, are currently under development and may offer effective tumor management and provide treatment options that are psychologically and cosmetically more acceptable to the patients than are traditional surgical therapies. In this review, we give an overview of minimally invasive approaches for the diagnostic and therapeutic management of early-stage breast cancer.
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Affiliation(s)
- Georges Vlastos
- Geneva University Hospitals, Department of Gynecology and Obstetrics, Division of Gynecology, Senology and Surgical Gynecologic Oncology Unit, 30 Boulevard de la Cluse, 1211 Geneva 14, Switzerland.
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Krynyckyi BR, Shafir MK, Kim SC, Kim DW, Travis A, Moadel RM, Kim CK. Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:25. [PMID: 16277655 PMCID: PMC1308847 DOI: 10.1186/1477-7800-2-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 12/28/2022]
Abstract
Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).
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Affiliation(s)
- Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Michail K Shafir
- Department of Surgery, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Dong Wook Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Arlene Travis
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Renee M Moadel
- Department of Nuclear Medicine, Albert Einstein College of Medicine of Yeshiva University, and the Montefiore Medical Center, Bronx, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
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