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Cheng-Yen Lai J, Yang MS, Lu KW, Yu L, Liou WZ, Wang KL. The role of sentinel lymph node biopsy in early-stage cervical cancer: A systematic review. Taiwan J Obstet Gynecol 2018; 57:627-635. [DOI: 10.1016/j.tjog.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 10/28/2022] Open
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2
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Axillary Recurrence Rate in Patients with Breast Cancer and Negative Sentinel Lymph Node Biopsy. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.8330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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3
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Management of axilla in breast cancer – The saga continues. Breast 2015; 24:343-53. [DOI: 10.1016/j.breast.2015.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/13/2015] [Accepted: 03/22/2015] [Indexed: 02/06/2023] Open
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4
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The Value of Isosulfan Blue Dye in Addition to Isotope Scanning in the Identification of the Sentinel Lymph Node in Breast Cancer Patients With a Positive Lymphoscintigraphy. Ann Surg 2015; 262:243-8. [DOI: 10.1097/sla.0000000000001213] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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5
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Choudhury M, Agrawal S, Pujani M, Thomas S, Pujani M. Immunohistochemical detection of axillary lymph node micrometastases in node negative breast cancer patients using cytokeratin and epithelial membrane antigen. South Asian J Cancer 2015; 4:28-31. [PMID: 25839017 PMCID: PMC4382779 DOI: 10.4103/2278-330x.149946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: The study was conducted to detect occult metastases in lymph node negative breast cancer patients using cytokeratin (CK) and epithelial membrane antigen (EMA) immunohistochemistry (IHC) and correlate this with primary tumor size and grade. Materials and Methods: A total of 32 cases including 12 prospective and 20 retrospective cases of axillary lymph node negative breast cancer were studied. CK and EMA IHC were performed to detect micrometastases. Results: Axillary lymph node metastases were detected in 18.75% of previously node negative cases using CK and EMA IHC. CK was found to be more sensitive for detection of metastases compared to EMA. A highly significant correlation was observed between tumor grade and axillary lymph node metastases detected by CK and EMA. However, no significant correlation was found between tumor size and axillary lymph node metastases detected by IHC. Conclusion: In the present study, there was an increase of 18.75% in the occult metastases detection rate using CK and EMA. To conclude, IHC detection of occult metastases should be done using CK in all axillary node negative cases, especially in T1 and T2 stage tumors.
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Affiliation(s)
- Monisha Choudhury
- Department of Pathology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Sapna Agrawal
- Department of Pathology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Mukta Pujani
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Shaji Thomas
- Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Meenu Pujani
- Department of Pathology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
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6
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Bircan HY, Ozcelik U, Koc B, Kemik O, Demirag A. Cutaneous necrosis as a result of isosulphane blue injection in mammarian sentinel lymph node mapping: report of two cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:79-81. [PMID: 25187747 PMCID: PMC4133033 DOI: 10.4137/ccrep.s16784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/04/2014] [Accepted: 06/09/2014] [Indexed: 11/16/2022]
Abstract
Skin-sparing mastectomy with sentinel lymph node biopsy (SLNB) and synchronous breast reconstruction are widely used in breast cancer surgery nowadays. Difficulties in feeling confident in this technique and postoperative surgical complications are the major obstacles against the widespread usage of this technique. Compared with the other surgical techniques, the complications are hard to treat. Cutaneous necrosis because of methylene blue used for sentinel lymph node mapping in patients who underwent skin-sparing mastectomy and SLNB is already reported in the literature. We present here two cases with cutaneous necrosis because of isosulphane blue injection after skin-sparing mastectomy and SLNB as a rare complication of dye injection.
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Affiliation(s)
- Huseyin Y Bircan
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
| | - Umit Ozcelik
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
| | - Bora Koc
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
| | - Ozgur Kemik
- Department of Surgery, Yuzuncu Yil Universitesi, Medical Faculty, Van, Turkey
| | - Alp Demirag
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
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7
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Özdemir A, Mayir B, Demirbakan K, Oygür N. Efficacy of Methylene Blue in Sentinel Lymph Node Biopsy for Early Breast Cancer. THE JOURNAL OF BREAST HEALTH 2014; 10:88-91. [PMID: 28331650 DOI: 10.5152/tjbh.2014.1914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/04/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Sentinel lymph node biopsy is the recommended approach in the evaluation of axilla during breast cancer surgery. In this study, results of patients who underwent methylene blue sentinel lymph node biopsy were evaluated. MATERIALS AND METHODS The study included 32 female patients with T1 and T2 tumors. 5 ml of 1% methylene blue was injected into the peritumoral area or around the cavity. The axillary sentinel lymph node was found and removed, and then axillary dissection was performed. The sentinel lymph node and axillary dissection specimen were histopathologically examined and the results were compared. RESULTS The sentinel lymph node was found in 30 (94%) patients. Lymph node metastasis was not observed in 17 patients in both the sentinel lymph node and axilla. Two patients had metastasis in the axilla although this was not detected in sentinel lymph node. Eleven patients had metastasis both in the sentinel lymph node and in the axilla. The accuracy rate was 93%, and the false negativity rate was identified as 15%. CONCLUSION Sentinel lymph node biopsy by methylene blue is a method that can be applied with high accuracy. Methylene blue can be considered as an alternative to isosulphane blue in sentinel lymph node biopsy.
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Affiliation(s)
- Altan Özdemir
- Department of General Surgery, Bucak State Hospital, Burdur, Turkey
| | - Burhan Mayir
- Department of General Surgery, Antalya Education and Research Hospital, Antalya, Turkey
| | - Kenan Demirbakan
- Department of General Surgery, Gaziantep 25 Aralık State Hospital, Gaziantep, Turkey
| | - Nezihi Oygür
- Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
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8
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Guzijan A, Babić B, Gojković Z, Gajanin R, Ćulum J, Grahovac D. Sentinel lymph node biopsy in breast cancer: Validation study and comparison of lymphatic mapping techniques. SCRIPTA MEDICA 2014. [DOI: 10.5937/scrimed1402056g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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9
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The accuracy of sentinel node biopsy in breast cancer patients with the history of previous surgical biopsy of the primary lesion: Systematic review and meta-analysis of the literature. Eur J Surg Oncol 2012; 38:95-109. [DOI: 10.1016/j.ejso.2011.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 10/25/2011] [Accepted: 11/15/2011] [Indexed: 11/19/2022] Open
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10
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A Randomized Clinical Trial on Sentinel Lymph Node Biopsy Versus Axillary Lymph Node Dissection in Breast Cancer. Ann Surg 2008; 247:207-13. [DOI: 10.1097/sla.0b013e31812e6a73] [Citation(s) in RCA: 248] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Delpech Y, Coutant C, Morel O, Uzan S, Daraï E, Barranger E. La recherche du ganglion sentinelle dans le cancer de l'endomètre a-t-elle un intérêt? ACTA ACUST UNITED AC 2007; 35:618-24. [PMID: 17572131 DOI: 10.1016/j.gyobfe.2007.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 03/01/2007] [Indexed: 11/18/2022]
Abstract
In cancer research, regional lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy. The sentinel node procedure, which has emerged to reduce morbidity of extensive lymphadenectomy, remains a major step in the surgical management of various cancers. Sentinel node procedure has become a standard technique for the determination of the nodal stage of the disease in patients with melanoma, vulvar cancer and in breast cancer. In endometrial cancer, the sentinel node biopsy is still at the stage of feasibility. In this article, we review the technical aspects, results, clinical implications and limitations of sentinel node procedure in endometrial cancers.
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Affiliation(s)
- Y Delpech
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France
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12
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Lerch L, Donald JC, Olivotto IA, Lesperance M, van der Westhuizen N, Rusnak C, Biberdorf D, Ross A, Hayashi A. Measuring surgeon performance of sentinel lymph node biopsy in breast cancer treatment by cumulative sum analysis. Am J Surg 2007; 193:556-9; discussion 560. [PMID: 17434354 DOI: 10.1016/j.amjsurg.2007.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 01/29/2007] [Accepted: 01/29/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study was performed to determine if surgeons' performance of sentinel lymph node biopsy (SLNB) for breast cancer varied with time and to devise a method to continuously evaluate that performance. METHODS We retrospectively examined the SLNB experience of 13 community surgeons performing 765 SLNBs and 579 concomitant axillary dissections. False-negative rates (FNRs) were assessed for individuals and cohorts defined by caseload. Performance with time was assessed using cumulative sum (CUSUM) analysis. RESULTS Overall, the SLN identification rate was 94.3%, and FNR was 5.3%. Each surgeon demonstrated variation in identification rate and/or FNR with time. CUSUM analysis provided an effective means to demonstrate when surgeon variation breached performance standards. CONCLUSIONS Surgeon performance of SLNB varied with time, independent of case load. CUSUM may prove to be a useful statistical tool to evaluate performance before adopting stand-alone SLNB.
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Affiliation(s)
- Lindsey Lerch
- Department of Surgery, Vancouver Island Health Authority, 302-2020 Richmond Road, Victoria, British Columbia, Canada V8R 6R5
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Schüle J, Frisell J, Ingvar C, Bergkvist L. Sentinel node biopsy for breast cancer larger than 3 cm in diameter. Br J Surg 2007; 94:948-51. [PMID: 17436338 DOI: 10.1002/bjs.5713] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Sentinel node biopsy (SNB) is a standard staging procedure in early breast cancer. Its suitability for larger tumours has been questioned. This study evaluated the reliability of SNB in women with invasive breast cancer larger than 3 cm in diameter who were clinically axillary node negative.
Methods
Some 109 women with a tumour larger than 3 cm on pathological analysis were identified from the Swedish prospective SNB database. They were included if a completion axillary clearance was planned, regardless of SNB results.
Results
The sentinel node detection rate was 103 (94·5 per cent) of 109. The overall false-negative rate was eight (13 per cent) of 64. Although a preoperative diagnosis of multifocal tumour was an exclusion criterion, 16 such cases were revealed on postoperative pathological examination. The false-negative rate in this subgroup was higher than that in women with a unifocal tumour (four (31 per cent) of 13 versus four (8 per cent) of 51; P = 0·012). No other significant predictors of a false-negative sentinel node biopsy were identified.
Conclusion
SNB is feasible in patients with unifocal breast tumours larger than 3 cm. When large tumour size coincides with multifocality, however, the false-negative rate seems to be increased and a completion axillary clearance should be considered even if the SNB is negative.
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Affiliation(s)
- J Schüle
- Department of Surgery and Centre for Clinical Research Uppsala University, Central Hospital, Västerås, Sweden.
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Gagliardi A, Wright FC, Quan ML, McCready D. Evaluating the organization and delivery of breast cancer services: use of performance measures to identify knowledge gaps. Breast Cancer Res Treat 2006; 103:131-48. [PMID: 17077995 DOI: 10.1007/s10549-006-9359-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 07/31/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This paper identifies gaps in our knowledge about the quality of breast cancer care in Canada to understand where programs and resources are required to enhance health services and research capacity. METHODS A modified Delphi approach was employed involving a 15-member multidisciplinary panel of health professionals and two rounds of rating followed by deliberation to develop evidence- and consensus-based performance measures. A literature search for Canadian health services research in breast cancer was conducted based on the indicator topics. Eligible articles were identified in indexed databases of medical literature and funded research from 1995 to 2006. RESULTS The multidisciplinary panel selected 34 indicators spanning access to services, patient outcomes, diagnosis and staging, surgery, adjuvant therapy, pathology, and follow-up care. A total of 78 articles (66 quantitative; 12 exploratory) on these topics were reviewed. Apart from two aspects of care (communication of treatment options, supportive care), the yield of Canadian breast cancer health services research did not increase subsequent to a review conducted 10 years ago which recommended greater efforts in this area. CONCLUSIONS Research involving quantitative and qualitative methods is needed to increase our understanding about the organization and delivery of services for breast cancer diagnosis, treatment and follow-up care. Since it is unclear how to balance competing research demands, innovative strategies are required to assemble resources for health services research on breast cancer. This could include the promotion of partnerships between researchers and policy-makers across jurisdictions, and the pooling of resources between organizations, regions or networks.
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Affiliation(s)
- A Gagliardi
- General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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15
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Martin RCG, Chagpar A, Scoggins CR, Edwards MJ, Hagendoorn L, Stromberg AJ, McMasters KM. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg 2005; 241:1005-12; discussion 1012-5. [PMID: 15912050 PMCID: PMC1359077 DOI: 10.1097/01.sla.0000165200.32722.02] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY BACKGROUND DATA Previous studies have suggested a variety of factors that may affect the false negative (FN) rate for sentinel lymph node (SLN) biopsy in breast cancer. Because FN results are relatively rare, no prior studies have had sufficient sample size to allow detailed statistical analysis of factors predicting FN results. METHODS Patients with clinical stage T1-2, N0 invasive breast cancer were enrolled in a prospective, multicenter study. All patients underwent SLN biopsy, followed by planned completion axillary dissection regardless of the SLN results, to assess the FN rate. SLN biopsy was performed using radioactive colloid injection in combination with isosulfan blue dye in 94% of cases. Dermal, subdermal, peritumoral, or subareolar radioactive colloid injection techniques were used at the discretion of each institution. Univariate and multivariate analyses were performed to identify factors associated with a FN result. RESULTS SLNs were identified in 3870 of 4117 patients (94%). There were 1243 true positive, 2521 true negative, and 106 FN results. Age, histologic subtype, the number of non-SLN removed, tumor palpability, type of breast biopsy, and SLN injection technique were not significant factors. On multivariate analysis, tumor size <2.5 cm, upper outer quadrant tumor location, removal of only a single SLN, minimal surgeon experience, presence of a single positive axillary LN, and use of immunohistochemistry (IHC) for SLN analysis were independently associated with an increased risk of FN results. CONCLUSIONS Surgeon experience, tumor size and location, and the number of SLN removed are preoperative and intraoperative factors that independently predict the risk of a FN result. In contrast to suggestions from other smaller studies, age does not affect the likelihood of a FN result; a lesser, rather than greater, number of positive axillary nodes was associated with an increased likelihood of a FN result; and IHC analysis of the SLN increases, rather than decreases, the risk of FN results.
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Affiliation(s)
- Robert C G Martin
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, Kentucky 40202, USA
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16
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Smidt ML, Janssen CMM, Kuster DM, Bruggink EDM, Strobbe LJA. Axillary recurrence after a negative sentinel node biopsy for breast cancer: incidence and clinical significance. Ann Surg Oncol 2005; 12:29-33. [PMID: 15827775 DOI: 10.1007/s10434-004-1166-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) carries the inherent risk of approximately 5% false-negative sampling. Undetected tumor-positive nodes of clinical importance are those that lead to axillary recurrence. This survey aims at clarifying the extent of this problem in current practice and literature. METHODS In a regional teaching hospital, 696 consecutive breast cancer patients underwent SLNB between January 1998 and July 2003, and data were entered in a prospective database. PubMed and the Cochrane library were searched for a systematic review of the literature. Thirteen studies dealt with the follow-up of a cohort of sentinel lymph node (SLN)-negative patients or presented a case report. RESULTS The SLN identification rate was 97.1%. The SLN was tumor free in 439 (65%) of the 676 patients. After a median follow-up of 26 months, axillary recurrence was detected in 2 of 439 patients 4 and 27 months after the SLNB. The incidence of clinically apparent false-negative SLNB is .46%. The systematic review resulted in 3184 SLNB-negative patients with a median follow-up of 25 months. Axillary recurrence occurred in eight patients after a median of 21 months. The axillary recurrence rate in the literature is .25%. One third of these patients present with synchronous systemic metastases. CONCLUSIONS Axillary recurrences after a negative SLNB occur, but at a much lower rate than would be expected on the basis of historical figures and the false-negative SLN findings. The natural history of axillary relapse after negative SLNB resembles the locoregional recurrence of breast cancer.
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Affiliation(s)
- Marjolein L Smidt
- Department of Surgical Oncology, C22, Canisius Wilhelmina Hospital, PO Box 9015, 6500, GS Nijmegen, The Netherlands.
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Shahar KH, Buchholz TA, Delpassand E, Sahin AA, Ross MI, Ames FC, Kuerer HM, Feig BW, Meric-Bernstam F, Babiera GV, Singletary SE, Akins JS, Mirza NQ, Hunt KK. Lower and central tumor location correlates with lymphoscintigraphy drainage to the internal mammary lymph nodes in breast carcinoma. Cancer 2005; 103:1323-9. [PMID: 15726547 DOI: 10.1002/cncr.20914] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Radiation to the internal mammary chain (IMC) may be indicated for breast carcinoma patients with positive axillary sentinel lymph nodes (SLNs) and lymphoscintigraphic evidence of drainage to the IMC. The purpose of this study was to identify predictors of IMC drainage in patients with positive axillary SLNs. METHODS The records of 297 breast carcinoma patients with positive axillary SLNs and preoperative lymphoscintigraphy were reviewed between 1995 and 2002. Radiolabeled colloid was injected peritumorally with lymphoscintigraphy performed 30-60 minutes later. Drainage to the regional nodes of 279 patients was seen on lymphoscintigraphy. Associations among patient and tumor-related factors and drainage to the IMC were examined. RESULTS Drainage to the IMC on lymphoscintigraphy was seen in 63 patients (21%). IMC drainage only occurred in 4 patients, and 59 patients had both axillary and IMC drainage. The only variable that correlated with IMC drainage was tumor location (P = 0.017). Rates of drainage to the IMC were 14.1% for upper outer quadrant (n = 128), 16.7% for upper inner quadrant (n = 30), 31.6% for lower outer quadrant (n = 19), 42.9% for lower inner quadrant (n = 14), and 28.4% for central tumors (n = 88). IMC drainage rates differed significantly between upper and lower tumors (lower 36.4% vs. central 28.4% vs. upper 14.6%, P = 0.003) but not between medial and lateral tumors (medial 25.0% vs. central 28.4% vs. lateral 16.3%, P = 0.077). CONCLUSIONS Patients with tumors in the lower or central breast and positive axillary SLNs have increased incidence of drainage to the IMC. Preoperative lymphoscintigraphy can help to define the nodal basins at risk for harboring disease.
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Affiliation(s)
- Karen H Shahar
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Barone JE, Tucker JB, Perez JM, Odom SR, Ghevariya V. Evidence-Based Medicine Applied to Sentinel Lymph Node Biopsy in Patients with Breast Cancer. Am Surg 2005. [DOI: 10.1177/000313480507100113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sentinel lymph node biopsy (SLNB) has not been examined using the principles of evidence-based medicine (EBM). Specifically, likelihood ratios have not been used to assess the validity of SLNB. The Surveillance, Epidemiology, and End Results (SEER) public database of the National Cancer Institute was used to establish the baseline or pretest probability of finding a positive lymph axillary node for each stage of breast cancer. Rates of false negative results of SLNB for all breast cancer stages were determined from the surgical literature. Positive and negative likelihood ratios (LR) were calculated. For each stage of breast cancer, the Bayesian nomogram was used to find the post-test probability of missing a metastatic axillary node when the SLN was negative. The SEER database of 213,292 female patients with breast cancer yielded the following rates of positivity of axillary lymph nodes for each breast tumor size: T1a, 7.8 per cent; T1b, 13.3 per cent; T1c, 28.5 per cent; T2, 50.2 per cent; T3, 70.1 per cent. The combined data from 13 published studies of SLNB (6444 successful SLNBs) demonstrated a false negative rate of 8.5 per cent. The LR of a negative test is 0.086. According to the nomogram, the chances of missing a positive node for stage of cancer are as follows: T1a, 0.7 per cent; T1b, 1.5 per cent; T1c, 3.0 per cent; T2, 7 per cent; T3, 18 per cent. The risk of missing a positive axillary node can accurately be estimated for each stage of breast cancer using the LR, which is much more useful than the simple false negative rate. Surgeons should use this information when deciding whether to perform SLNB and in their informed consent discussions.
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Affiliation(s)
- James E. Barone
- Department of Surgery, Lincoln Medical and Mental Health Center, Bronx, New York
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Coelho-Oliveira A, Rocha ACP, Gutfilen B, Pessoa MCP, Fonseca LMBD. Identificação do linfonodo sentinela no câncer de mama com injeção subdérmica periareolar em quatro pontos do radiofármaco. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000400004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Este estudo visa identificar o linfonodo sentinela por meio da injeção exclusiva de radiofármaco periareolar subdérmico em quatro pontos, independente da topografia do tumor. A biópsia do linfonodo sentinela diminui a morbidade no estadiamento da axila. Foram realizadas 57 biópsias do linfonodo sentinela, em pacientes com câncer de mama, prospectivamente, em dois grupos: grupo A (25 pacientes) e grupo B (32 pacientes). Realizamos a injeção do radiofármaco peritumoral no grupo A, e nova técnica periareolar em quatro pontos no grupo B. A biópsia do linfonodo sentinela foi estudada por "imprint" citológico e hematoxilina e eosina, seguida de linfadenectomia axilar no grupo A e nos casos positivos do grupo B. No grupo A foram identificados 88% (22/25) de linfonodos sentinelas, não houve falso-negativo, com sensibilidade e especificidade de 100%; no grupo B foram identificados 96% (31/32) de linfonodos sentinelas e valor preditivo positivo de 100%. O número de linfonodos sentinelas variou de 1 a 7, moda de 1 e média de 2,7, a área de maior captação variou de 10 a 100 vezes. A injeção periareolar em quatro pontos se apresenta como bom método no mapeamento linfático para identificação do linfonodo sentinela. A padronização deste sítio pode ser o de escolha para identificação do linfonodo sentinela, sendo necessário maior número de casos para confirmação destes achados.
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Benoit L, Arnould L, Collin F, Fraisse J, Cuisenier J, Chauffert B. Concurrent lymphoma and metastatic breast carcinoma in the axillary, confounding sentinel lymph-node biopsy. Eur J Surg Oncol 2004; 30:462-3. [PMID: 15063904 DOI: 10.1016/j.ejso.2003.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2003] [Indexed: 10/26/2022] Open
Abstract
We describe the case of a female patient who presented with the concurrence of two tumors, breast cancer and low grade lymphoma, in different nodes but in the same axillary lymphatic site. The sentinel node biopsy procedure for the detection of carcinoma cells in two well-identified sentinel nodes which had been colonised by lymphoplasmocytic cells was negative. Tumor collision lead to a mistake in the appropriate staging of the breast tumor by sentinel lymph-node biopsy. We believe that sentinel lymph-node biopsy should be avoided in cases of lymphoma.
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Affiliation(s)
- L Benoit
- Service de Chirurgie, Centre G-F Leclerc, 1 rue du Pr. Marion, B P 77980, Dijon cedex 21079, France.
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Lafrenière R. What’s new in general surgery: surgical oncology. J Am Coll Surg 2004; 198:966-88. [PMID: 15194080 DOI: 10.1016/j.jamcollsurg.2004.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 03/05/2004] [Indexed: 10/26/2022]
Affiliation(s)
- Rene Lafrenière
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Abstract
PURPOSE OF REVIEW Lymphatic mapping and sentinel node biopsy represent one of the most revolutionary advances in oncological surgery in recent years. In this review, the current state of sentinel node detection in gynaecological cancers and its use in vulvar and cervical cancer are assessed. RECENT FINDINGS Since the recent clinical application of sentinel node biopsy for melanomas and breast cancer, there has been extensive research on the implementation of this technique to most solid neoplasias. Studies on the feasibility of sentinel node biopsy in vulvar cancer have shown that the status of the sentinel node is an accurate predictor of the status of inguinal nodes. The clinical implementation of the procedure requires validation and is under investigation. In the last two years, several pilot studies on the feasibility of lymphatic mapping/sentinel node biopsy in cervical cancer have yielded promising results. There is minimal experience of its use in endometrial cancer. Detailed pathological study of a sentinel node biopsy with ultrastaging and immunohistochemical or polymerase chain reaction analyses can identify lymph node micrometastasis that conventional methods would identify as negative for metastatic disease. The best histopathological procedure for sentinel node biopsy, the clinical significance of micrometastases, and the appropriate management of such micrometastases are currently under investigation. SUMMARY Sentinel node biopsy is one of the main research interests in gynaecological oncological surgery. At present there are not enough data to permit modification of current treatment protocols. Large and multi-institutional trials are required in order to define the implementation of sentinel node biopsy in clinical practice with the objective of achieving safer and more conservative surgery.
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Affiliation(s)
- Aureli Torné
- Section of Gynaecological Oncology, Clinical Institute of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Zavagno G, De Salvo GL, Casara D, Del Bianco P, Rubello D, Meggiolaro F, Rossi CR, Pierobon M, Lise M. Sentinel node biopsy for breast cancer: is it already a standard of care? A survey of current practice in an Italian region. BMC Cancer 2004; 4:2. [PMID: 14736337 PMCID: PMC344740 DOI: 10.1186/1471-2407-4-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Accepted: 01/22/2004] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although sentinel node biopsy (SNB) is becoming the standard approach for axillary staging in patients with small breast cancer, criteria for patient selection and some technical aspects of the procedure have yet to be clearly defined. The aim of the present survey was therefore to investigate the way in which SNB is used by general surgeons working in the Veneto region, Italy. METHODS A 29-item questionnaire regarding various aspects of SNB practice was mailed to surgeons in charge of breast surgery in all the 56 surgical centres of the region. RESULTS The rate of response to the questionnaire was 82.1% (n = 46); 69.6% (n = 32) of the respondents routinely perform SNB in their clinical practice. Most of the interviewed surgeons (93.5%) expressed the belief that the acceptable false negative rate should be < or =5%. However, among the surgeons who perform SNB, only 34.4% performed more than 20 SNB during the learning phase. Indications are limited to tumours of < or =1 cm by 31.2% (n = 10) of respondents, < or =2 cm by 46.9% (n = 15) and < or =3 cm by 21.9% (n = 7). Almost all respondents (93.7%) agreed that a clinically positive axilla is a contraindication to SNB, while opinions differed widely concerning other potential contraindications. In most of the centres considered, SN identification is undertaken on the day before surgery using a subdermal injection of 30-50 MBq of 99mTc-albumin-nanocolloid followed by lymphoscintigraphy. CONCLUSIONS SNB is currently performed in the majority of hospitals in the Veneto region. However, the training phase and criteria used for patient selection differ from centre to centre. Certified training courses and shared guidelines are therefore highly desirable.
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Affiliation(s)
- Giorgio Zavagno
- University of Padova, Istituto di Clinica Chirurgica II – Padova (35128), Italy
| | - Gian Luca De Salvo
- Centro Oncologico Regionale, Ufficio di Epidemiologia Clinica – Padova (35128), Italy
| | - Dario Casara
- Azienda Ospedaliera di Padova, Medicina Nucleare II – Padova (35128), Italy
| | - Paola Del Bianco
- Centro Oncologico Regionale, Ufficio di Epidemiologia Clinica – Padova (35128), Italy
| | - Domenico Rubello
- Azienda Ospedaliera di Padova, Medicina Nucleare II – Padova (35128), Italy
| | - Fabrizio Meggiolaro
- University of Padova, Istituto di Clinica Chirurgica II – Padova (35128), Italy
| | | | - Mariaelena Pierobon
- University of Padova, Istituto di Clinica Chirurgica II – Padova (35128), Italy
| | - Mario Lise
- University of Padova, Istituto di Clinica Chirurgica II – Padova (35128), Italy
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Blanco Sáiz I, Moriyón Entrialgo C, Gómez Barquín R, Díez Esteban MA, Platero García D, Pelletán Fernández J, Alvarez Obregón R, Aira Delgado FJ. Localización del ganglio centinela en cáncer de mama. Inyección periareolar del radiocoloide. ACTA ACUST UNITED AC 2004; 23:95-101. [PMID: 15000939 DOI: 10.1016/s0212-6982(04)72262-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Traditional lymphadenectomy is being replaced by sentinel node biopsy in initial management of early stage breast cancer. The aim of this study was to validate the technique in our center, where we perform preoperative lymphoscintigraphy and intraoperative detection of sentinel node, after periareolar radiotracer and peritumoral blue dye injection. Sixty patients, breast cancer stages I and II, were included. Lymphatic mapping was performed the day before surgery, after the administration of 74 MBq 99mTc sulfur colloid in periareolar subdermal tissue. Surgical detection of sentinel node through gamma probe was followed by intraoperative and occasionally delayed biopsies. Finally, full axillary node dissection was completed. Lymphoscintigraphy identified sentinel node in 78% of the patients (47/60): 43 in axilla, 4 in internal mammary chain. Probe guided axillary detection was achieved in 88% (53/60): in every patient with axillar migration in scan, in 9/13 without imaged drainage and in 1/4 with internal mammary chain migration. Sensitivity of blue dye technique was 75% (45/60), the concordance between both procedures being high. Considering both, the overall success rate of surgical detection was 90% (54/60); if we exclude those patients who showed exclusive extraaxillar drainage, the success rate reaches 95%. Malignancy was found in 24% of sentinel nodes removed (13/54); it being the only metastatic axillary node in 4/13. No false negative sentinel nodes were found. Therefore, negative predictive value and accuracy were 100%. These results allow us to validate the technique in our center.
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Affiliation(s)
- I Blanco Sáiz
- Clínica de Medicina Nuclear Géminis, Gijon, Asturias
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