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Shah C, Hobbs BP, Vicini F, Al-Hilli Z, Manyam BV, Verma V, Jia X, Goldstein N, Recht A. The Diminishing Impact of Margin Definitions and Width on Local Recurrence Rates following Breast-Conserving Therapy for Early-Stage Invasive Cancer: A Meta-Analysis. Ann Surg Oncol 2020; 27:4628-4636. [PMID: 32712894 DOI: 10.1245/s10434-020-08878-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal tumor-free margin definition and width following breast-conserving therapy (BCT) for early-stage invasive cancers has been evaluated in previous meta-analyses and guidelines. We performed an updated meta-analysis to assess how improvements in treatment over time have affected the impact of margins on local recurrence (LR) rates over time. METHODS A systematic literature review identified 38 eligible studies comprising 54,502 patients treated between 1968 and 2010. Inclusion criteria included patients treated with BCT and minimum follow-up of 50 months, pathologic definitions of margin status explicitly stated, and LR data in relation to margin status. Data were pooled using a Bayesian logistic regression model to evaluate the risk of LR in relation to both margin status and study enrollment periods. RESULTS Median follow-up was 7.25 years. Absolute LR rates decreased over time for each margin width cohort, with maximum differences between negative margin groups of less than 1% for the most recent enrollment period. However, relative rates of LR between different margin groups remained stable over time. CONCLUSIONS With an additional 22,000 patients compared with the previous meta-analysis, this updated meta-analysis supports the consensus guideline of "no tumor on ink" for the majority of patients. Additionally, while concerns exist regarding a benefit with wider margins from previous studies, the analysis demonstrates the impact of margin width on LR rates has declined substantially over time, with very small differences between the narrowest and widest margin groups in the most recent cohort. Hence, older studies appear to have limited value to inform current management guidelines.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Brian P Hobbs
- Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Frank Vicini
- 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI, USA
| | - Zahraa Al-Hilli
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bindu V Manyam
- Department of Radiation Oncology, Alleghany Health Network, Pittsburgh, PA, USA
| | - Vivek Verma
- Department of Radiation Oncology, Alleghany Health Network, Pittsburgh, PA, USA
| | - Xuefei Jia
- Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Catheter-based delineation of lumpectomy cavity for accurate target definition in partial-breast irradiation with multicatheter interstitial brachytherapy. J Contemp Brachytherapy 2019; 11:108-115. [PMID: 31139218 PMCID: PMC6536147 DOI: 10.5114/jcb.2019.84504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/03/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose In partial-breast irradiation (PBI), accurate lumpectomy cavity (LC) delineation is critical. Seroma-based delineation (SBD) using computed tomography (CT) with clips remains uncertain, causing an expansion of the LC and planning target volume (PTV). In catheter-based delineation (CBD), the implanted catheters were used as reference markers for LC delineation in multicatheter interstitial brachytherapy (MIB). Material and methods Between October 2008 and October 2018, 513 patients who underwent MIB-PBI were examined. In CBD, anatomical relations of LC to catheters were recorded. In randomly selected 22 CBD cases, the LC volume and PTV were retrospectively recontoured on SBD, and the relationship between the contribution of CBD and cavity visuality was evaluated. The LC volume and PTV before and after the introduction of CBD were compared. Results The mean LC volumes based on SBD and CBD were 19.1 cm3 and 14.1 cm3, respectively (p < 0.001). The mean PTVs based on SBD and CBD were 47.9 cm3 and 35.7 cm3, respectively (p < 0.0001). More reductions in the LC volume (5.1 cm3) (p < 0.05) and PTV (7.7 cm3) (p = 0.13) were observed in the poorly visible LC than in the visible LC. The LC volume and PTV before the introduction of CBD (n = 411) were compared with those after introduction (n = 102). Significant reductions were observed in the LC volume (5.9 cm3) (p < 0.0001) after the introduction of CBD; moreover, PTV tended to be reduced (3.9 cm3) (p = 0.17). Conclusions CBD may help to establish the standardized procedure for MIB-PBI and prevent unnecessary radiation exposure to the normal breast tissue.
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Tanabe M, Iwase T, Okumura Y, Yoshida A, Masuda N, Nakatsukasa K, Shien T, Tanaka S, Komoike Y, Taguchi T, Arima N, Nishimura R, Inaji H, Ishitobi M. Local recurrence risk after previous salvage mastectomy. Eur J Surg Oncol 2016; 42:980-5. [PMID: 27055945 DOI: 10.1016/j.ejso.2016.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Breast-conserving surgery is a standard treatment for early breast cancer. For ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery, salvage mastectomy is the current standard surgical procedure. However, it is not rare for patients with IBTR who have received salvage mastectomy to develop local recurrence. In this study, we examined the risk factors of local recurrence after salvage mastectomy for IBTR. PATIENTS AND METHODS A total of 118 consecutive patients who had histologically confirmed IBTR without distant metastases and underwent salvage mastectomy without irradiation for IBTR between 1989 and 2008 were included from eight institutions in Japan. The risk factors of local recurrence were assessed. RESULTS The median follow-up period from salvage mastectomy for IBTR was 4.6 years. Patients with pN2 or higher on diagnosis of the primary tumor showed significantly poorer local recurrence-free survival than those with pN0 or pN1 at primary tumor (p < 0.001). Multivariate analysis showed that the lymph node status of the primary tumor was a significantly independent predictive factor of local recurrence-free survival (p = 0.02). CONCLUSION The lymph node status of the primary tumor might be a predictive factor of local recurrence-free survival after salvage mastectomy for IBTR. Further research and validation studies are needed. (UMIN-CTR number UMIN000008136).
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Affiliation(s)
- M Tanabe
- Dept. of Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Iwase
- Dept. of Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Okumura
- Dept. of Breast & Endocrine Surgery, Kumamoto City Hospital, Kumamoto, Japan
| | - A Yoshida
- Dept. of Breast Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - N Masuda
- Dept. of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - K Nakatsukasa
- Dept. of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Shien
- Dept. of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - S Tanaka
- Section of Breast and Endocrine Surgery, Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Y Komoike
- Dept. of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - T Taguchi
- Dept. of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - N Arima
- Dept. of Pathology, Kumamoto City Hospital, Kumamoto, Japan
| | - R Nishimura
- Dept. of Breast & Endocrine Surgery, Kumamoto City Hospital, Kumamoto, Japan
| | - H Inaji
- Dept. of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - M Ishitobi
- Dept. of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
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Osako T, Nishimura R, Nishiyama Y, Okumura Y, Tashima R, Nakano M, Fujisue M, Toyozumi Y, Arima N. Efficacy of intraoperative entire-circumferential frozen section analysis of lumpectomy margins during breast-conserving surgery for breast cancer. Int J Clin Oncol 2015; 20:1093-101. [PMID: 25855313 DOI: 10.1007/s10147-015-0827-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/31/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intraoperative frozen section analysis of the surgical margins during breast-conserving surgery (BCS) for breast cancer can reliably achieve clear surgical margins and prevent re-operations. The aim of this study was to assess intraoperative entire-circumferential frozen section analysis (IEFSA) of the lumpectomy margins during BCS. METHODS A total of 1029 patients who underwent BCS with IEFSA between June 2007 and July 2013 were available for assessment. The inner surfaces of the shaved lumpectomy margins were examined as frozen sections during BCS. The margins were defined as positive when the cancer cells were present within 5 mm from the edge of the outermost margins of the specimens. RESULTS Out of 1029 patients, 312 patients (30.3 %) had positive margins after the initial lumpectomy and underwent additional resections during BCS. Fourteen patients (1.4 %) underwent mastectomy following the results of additional resections during the first surgery. Of 1015 patients who completed BCS, 60 patients (5.9 %) were found to have positive margins in the final pathology. One patient (0.1 %) underwent re-operation after BCS while the residual diseases of the other 59 patients were judged to be minimal. Of the 312 patients who were judged to have positive margins after the initial lumpectomy with IEFSA, 53 patients (16.9 %) were found to have negative margins in the final pathology. At a median follow-up time of 54.1 months, one patient (0.1 %) had a recurrence of breast cancer in the preserved breast. CONCLUSION IEFSA is useful for preventing the need for re-operation and local recurrence after BCS.
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Affiliation(s)
- Tomofumi Osako
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan.
| | - Reiki Nishimura
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Yasuyuki Nishiyama
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Yasuhiro Okumura
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Rumiko Tashima
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Masahiro Nakano
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Mamiko Fujisue
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Yasuo Toyozumi
- Department of Pathology, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
| | - Nobuyuki Arima
- Department of Pathology, Kumamoto City Hospital, 1-1-60 Kotoh, Higashi-ku, Kumamoto, 862-8605, Japan
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Makita M, Sakai T, Ogiya A, Kitagawa D, Morizono H, Miyagi Y, Iijima K, Iwase T. Optimal surveillance for postoperative metastasis in breast cancer patients. Breast Cancer 2014; 23:286-94. [PMID: 25294313 DOI: 10.1007/s12282-014-0571-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/23/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To establish an optimal surveillance schedule after surgery for breast cancer, patients included in an institutional database were retrospectively investigated with respect to the first metastatic site and timing of recurrence. PATIENTS AND METHODS We investigated 11,676 pT1-4pN0-2M0 breast cancer patients treated from 1985 to 2009 and followed up until June 2014. Our surveillance protocol included physician visits and examinations with bone scans, liver echography, chest roentgenography and laboratory tests. We evaluated the liver, bones, lungs and pleura as surveillance covering sites (SCS) in addition to parameters such as time points exceeding 80 % with respect to the accumulated percentage of patients of recurrence and the number of surveillance per one recurrence (NSR), calculated by dividing the number of patients at risk of recurrence at the start of a particular time frame by the number of patients of recurrence at SCS within that period. RESULTS There were a total of 1,962 recurrent patients, including 601 patients with locoregional recurrence, nine patients with recurrence in the opposite breast, 1,349 patients with recurrence at distant sites and three unknown patients. The number of patients with the bones, lungs, liver and pleura as the first site of recurrence was 447, 324, 144 and 69, respectively, and 72.9 % of the distant metastatic lesions belonged to SCS. The five-year overall survival rate after recurrence among the patients with single recurrent site was longer than that observed among the patients with multiple sites of recurrence (43.3 vs 25.3 %; p < 0.0001). In addition, more than 80 % of the patients of liver metastasis were detected within 5 years after surgery, while 80 % of the patients of pleura metastasis were detected within 10 years. The NSR was below 200 for the 10-year period, as was the NSR of the patients with lymph node metastasis and a positive hormone receptor status. In contrast, the NSR of the patients with a negative hormone receptor status was above 200 after 5 years. CONCLUSIONS In this study, the prognosis of the patients with a single site of recurrence was superior to that of the patients with multiple sites. Curable patients with distant metastases included those with single metastatic sites. The optimal surveillance schedule should be established taking into consideration that the incidence of metastasis differs among metastatic sites during follow-up.
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Affiliation(s)
- Masujiro Makita
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takehiko Sakai
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akiko Ogiya
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Dai Kitagawa
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hidetomo Morizono
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yumi Miyagi
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kotaro Iijima
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takuji Iwase
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 2014; 21:717-30. [PMID: 24473640 DOI: 10.1245/s10434-014-3480-5] [Citation(s) in RCA: 307] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We systematically review the evidence on surgical margins in BCT for invasive breast cancer to support the development of clinical guidelines. METHODS Study-level meta-analysis of studies reporting local recurrence (LR) data relative to final microscopic margin status and the threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression. RESULTS Based on 33 studies (LR in 1,506 of 28,162), the odds of LR were associated with margin status [model 1: odds ratio (OR) 1.96 for positive/close vs negative; model 2: OR 1.74 for close vs. negative, 2.44 for positive vs. negative; (P < 0.001 both models)] but not with margin distance [model 1: >0 mm vs. 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.12); and model 2: 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.90)], adjusting for study median follow-up time. There was little to no statistical evidence that the odds of LR decreased as the distance for declaring negative margins increased, adjusting for follow-up time [model 1: 1 mm (OR 1.0, referent), 2 mm (OR 0.95), 5 mm (OR 0.65), P = 0.21 for trend; and model 2: 1 mm (OR 1.0, referent), 2 mm (OR 0.91), 5 mm (OR 0.77), P = 0.58 for trend]. Adjustment for covariates, such as use of endocrine therapy or median-year of recruitment, did not change the findings. CONCLUSIONS Meta-analysis confirms that negative margins reduce the odds of LR; however, increasing the distance for defining negative margins is not significantly associated with reduced odds of LR, allowing for follow-up time. Adoption of wider relative to narrower margin widths to declare negative margins is unlikely to have a substantial additional benefit for long-term local control in BCT.
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Affiliation(s)
- Nehmat Houssami
- Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia,
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Hattori M, Nishimura S, Tada K, Koyama M, Akiyama F, Ito Y, Iwase T. Reoperative sentinel lymph node biopsy for ipsilateral breast tumor recurrence after previous axillary lymph node dissection: Report of a case. Surg Today 2011; 41:247-50. [DOI: 10.1007/s00595-009-4241-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 10/05/2009] [Indexed: 10/18/2022]
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Yoshida T, Takei H, Kurosumi M, Ninomiya J, Ishikawa Y, Hayashi Y, Tozuka K, Oba H, Kawanowa K, Inoue K, Tabei T. True Recurrences and New Primary Tumors Have Different Clinical Features in Invasive Breast Cancer Patients with Ipsilateral Breast Tumor Relapse After Breast-Conserving Treatment. Breast J 2010; 16:127-33. [DOI: 10.1111/j.1524-4741.2009.00884.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sirohi B, Leary A, Johnston SRD. Ipsilateral breast tumor recurrence: is there any evidence for benefit of further systemic therapy? Breast J 2009; 15:268-78. [PMID: 19645782 DOI: 10.1111/j.1524-4741.2009.00716.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To date, there are no standard guidelines for treating patients with ipsilateral breast tumor recurrence (IBTR). Current practice is to resect the recurrence with a radical intent followed possibly by radiotherapy if the patient has not received this before, but the role of further adjuvant medical (hormone or chemotherapy) therapy remains undefined. Currently Phase III trials are underway to answer this question. In this review, we will focus on published data relating to IBTR and discuss recent trials. The results from the Phase III trials will not be available for sometime. At the time of IBTR, it is reasonable to change the endocrine therapy with indirect evidence from sequencing of impact on outcome. There is currently no conclusive evidence to suggest that further adjuvant chemotherapy post loco-regional recurrence impacts on survival, though the use of noncross-resistant chemotherapy drugs may make sense in those at highest risk. Biopsy at IBTR is helpful to distinguish whether it is a true recurrence or a new primary tumor and receptor phenotyping may be helpful for HER2. Future trials in IBTR need to address the following issues: to be able to distinguish between true recurrence and new primary (consensus required on definitions); pathologic processing relating to margins needs to be standardized (1 or 5 mm wide specimens); documentation of the pattern of IBTR in relation to each histopathologic subtype and methods used for pathologic examination by centers. Regional nodal recurrence including supraclavicular node recurrence is not dealt with in this review.
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Affiliation(s)
- Bhawna Sirohi
- Breast Unit, Royal Marsden NHS Foundation Trust, Surrey, UK
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Ipsilateral breast tumor relapse after breast conserving surgery in women with breast cancer. Breast 2009; 18:238-43. [DOI: 10.1016/j.breast.2009.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 05/07/2009] [Accepted: 06/17/2009] [Indexed: 12/11/2022] Open
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Koizumi M, Koyama M, Tada K, Nishimura S, Miyagi Y, Makita M, Yoshimoto M, Iwase T, Horii R, Akiyama F, Saga T. The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol 2008; 34:365-8. [PMID: 17532172 DOI: 10.1016/j.ejso.2007.04.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 04/18/2007] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Sentinel lymph node biopsy (SNB) has been a standard technique in early breast cancer. However, it is not clear that the SNB procedure can be applied to second breast cancer or recurrence occurring in the previously treated breast. The purpose of this study was to clarify the feasibility of the SNB procedure in breast cancer occurring in the previously treated breast, and to investigate the factors related to altered lymphatic flow. PATIENTS AND METHODS Between April 2004 and December 2006, 1490 patients underwent the breast SNB procedure. Among them, 31 patients had a history of previous treatments in the same breast. Recent excision biopsy cases were not included in this group. All patients had previous breast-conserving surgery in the same breast. Sixteen patients had axillary dissection, 3 had SNB, and 12 had no axillary treatment. Ten patients had received radiation therapy to the breast and axilla. Visualization of axillary nodes, internal mammary nodes and contralateral axillary nodes was evaluated and compared with pathological results. RESULTS Axillary nodes were visualized in 23 patients, internal mammary nodes in 7 patients, and contralateral axillary nodes in 7 patients. The patients with previous axillary dissection exhibited altered lymph node distribution, but did not show involvement of contralateral axillary nodes. Visualization of contralateral axillary nodes occurred in 7 of the 10 patients with previous irradiation to breast irrespective of axillary dissection. Twenty-eight patients underwent SNB, 4 of whom showed cancer-positive nodes. Three patients were cancer-positive in non-ipsilateral axillary nodes (one patient showed positive opposite axillary node and two patients showed positive internal mammary nodes). CONCLUSION Previous axillary dissection or irradiation to the breast greatly influences lymphatic flow. Irradiation to the breast may be a strong factor for the visualization of contralateral axillary nodes. Despite the frequent alteration of lymphatic flow, SNB seems to be feasible in secondary or recurrent breast cancer patients.
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Affiliation(s)
- M Koizumi
- Diagnostic Imaging Group, Institute for Molecular Imaging, National Institutes of Radiological Sciences, Chiba, Japan.
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