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Güth U, Elfgen C, Zadeh SN, Meier S, Varga Z, Tinguely M, Papassotiropoulos B, Däster K, Tausch CJ. The impact of intraoperative frozen section in patients with clinically node-negative breast cancer (cN0/ycN0) who received neoadjuvant systemic therapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1423-1428. [PMID: 37183046 DOI: 10.1016/j.ejso.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND When surgical axillary staging reveals residual metastatic deposits in breast cancer (BC) patients who had received neoadjuvant chemotherapy (NACT), axillary lymphonodectomy is indicated. In this study, we investigate whether it is reasonable to perform intraoperative frozen section (FS) of the removed sentinel lymph nodes (SLNs) in cases where NACT had been administered in patients who had a clinically negative nodal status at the time of diagnosis. PATIENTS AND METHODS We analyzed data from 101 BCE patients with 103 carcinomas who were diagnosed between 2014 and 2021 and met the above-mentioned criteria. RESULTS In three cases (2.8% of the study group), histologically active tumor tissue was detected in the removed axillary LNs. Discontinuation of therapy/the use of a low-dose NACT regimen was a significant factor for positive LNs (p = 0.02) at the subsequent surgical procedure; tumor progression during therapy approached borderline significance (p = 0.058). Among patients who had completed NACT with the planned standard dose regimen, and in which the primary tumors showed a response to therapy (n = 94), only one case had histologically detected residual metastases in the SLNs. CONCLUSIONS Certified breast centers aim to improve the outcome of the patients. However, these specialized centers should also focus on economic aspects. This means that diagnostic and therapeutic procedures should be continuously critically reviewed in order to avoid unnecessary expenses. In BC patients with clinically node negative disease who completed NACT as planned and in which the tumor showed a good response to therapy, time consuming and costly FS of the SLNs removed should be omitted.
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Affiliation(s)
- Uwe Güth
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland; University of Basel, Faculty of Medicine, Klingelbergstrasse 61, CH-4056, Basel, Switzerland.
| | - Constanze Elfgen
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland; University of Witten/Herdecke, Faculty of Medicine, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany
| | - Shadi Najaf Zadeh
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Simon Meier
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Zsuzsanna Varga
- Institute of Pathology and Molecular Pathology, University Hospital of Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland
| | - Marianne Tinguely
- Institute of Pathology Enge, Hardturmstrasse 133, CH-8055, Zurich, Switzerland; University of Zurich, Medical Faculty, Pestalozzistrasse 3, CH-8032, Zurich, Switzerland
| | - Bärbel Papassotiropoulos
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Kavitha Däster
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
| | - Christoph J Tausch
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, CH-8008, Zurich, Switzerland; University of Basel, Faculty of Medicine, Klingelbergstrasse 61, CH-4056, Basel, Switzerland
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Greene LR, Wilkinson D. The role of general nuclear medicine in breast cancer. J Med Radiat Sci 2015; 62:54-65. [PMID: 26229668 PMCID: PMC4364807 DOI: 10.1002/jmrs.97] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/08/2015] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
The rising incidence of breast cancer worldwide has prompted many improvements to current care. Routine nuclear medicine is a major contributor to a full gamut of clinical studies such as early lesion detection and stratification; guiding, monitoring, and predicting response to therapy; and monitoring progression, recurrence or metastases. Developments in instrumentation such as the high-resolution dedicated breast device coupled with the diagnostic versatility of conventional cameras have reinserted nuclear medicine as a valuable tool in the broader clinical setting. This review outlines the role of general nuclear medicine, concluding that targeted radiopharmaceuticals and versatile instrumentation position nuclear medicine as a powerful modality for patients with breast cancer.
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Affiliation(s)
- Lacey R Greene
- Faculty of Science, Charles Sturt University Wagga Wagga, New South Wales, Australia
| | - Deborah Wilkinson
- Faculty of Health, Wheeling Jesuit University Wheeling, West Virginia
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Sadeghi R, Alesheikh G, Zakavi SR, Fattahi A, Abdollahi A, Assadi M, Jangjoo A, Keshtgar M. Added value of blue dye injection in sentinel node biopsy of breast cancer patients: do all patients need blue dye? Int J Surg 2014; 12:325-8. [PMID: 24486686 DOI: 10.1016/j.ijsu.2014.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/10/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the current study, we evaluated the incremental value of blue dye injection in sentinel node mapping of early breast cancer patients. We specially considered the experience of the surgeons and lymphoscintigraphy results in this regard. METHODS 605 patients with early stage breast cancer were retrospectively evaluated in the study. Patients underwent sentinel node mapping using combined radiotracer and blue dye techniques. Lymphoscintiraphy was also performed for 590 patients. Blue dye, radioisotope, and overall success rates in identifying the sentinel lymph node were evaluated in different patient groups. The benefit of blue dye and radioisotope in identifying the sentinel lymph nodes was also evaluated. RESULTS Marginal benefits of both blue dye and isotope for overall sentinel node detection as well as pathologically involved sentinel nodes were statistically higher in inexperienced surgeons and in patients with sentinel node visualization failure. In the patients with sentinel node visualization on lymphoscintigraphy, 6 sentinel nodes were detected by blue dye only. All these six nodes were harvested by inexperienced surgeons. On the other hand 8 sentinel nodes were detected by dye only in the patients with sentinel node non-visualization. All these nodes were harvested by experienced surgeons. CONCLUSIONS The use of blue dye should be reserved for inexperienced surgeons during their learning phase and for those patients in whom lymphoscintigraphy failed to show any uptake in the axilla.
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Affiliation(s)
- Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ghazaleh Alesheikh
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asiehsadat Fattahi
- Minimally Invasive and Endoscopic Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Minimally Invasive and Endoscopic Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Assadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammed Keshtgar
- Consultant Surgical Oncologist, Royal Free Hospital and University College, London, UK
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