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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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Díaz-Expósito R, Martí-Bonmatí L, Burgués O, Casáns-Tormo I, Bermejo-de Las Heras B, Julve-Parreño A, Caballero-Garate A. Selective sentinel node biopsy after intratumour administration of radiotracer in breast cancer patients treated with neoadjuvant chemotherapy in relation to the level of tumour response. Rev Esp Med Nucl Imagen Mol 2016; 35:358-364. [PMID: 27246292 DOI: 10.1016/j.remn.2016.04.005] [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: 02/10/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective was to analyse the accuracy of the sentinel node biopsy, taking into consideration the scintigraphy detection rate after the intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy. MATERIALS AND METHODS The study included 60 patients with a diagnosis of invasive breast carcinoma, stage T1-T3, who received treatment with neoadjuvant chemotherapy, and were subsequently subjected to breast surgery and sentinel node biopsy after intra-tumour administration of the radiopharmaceutical. RESULTS Scintigraphic detection of some sentinel node was achieved in 55/60 patients (91.6%). When those cases that received a second injection of the radiopharmaceutical, performed peri-areolarly due to a lack of tracer migration, were excluded, the detection rate dropped to 70% (42/60). When the detection of sentinel node, or its absence, was compared in those 42 patients, no differences were found with age, laterality-location of the lesion, size pre- and post-neoadjuvant chemotherapy, histological grade, or immunohistochemical profile. There were significant differences when comparing the groups according to the degree of pathological tumour response, both with the Miller-Payne system (non-detection 44.4%-detection 16.7%, p = 0.003) as well as the residual cancer burden (72.2%-28.6%, p<0.01). CONCLUSIONS The scintigraphic detection of the sentinel node after intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy was below the optimal value, and sometimes a further, peri-areolar, injection was necessary, probably in relation to an alteration in the lymphatic drainage pathways. There was a significant inverse relationship between the detection of the sentinel node and level of pathological tumour response.
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Affiliation(s)
- R Díaz-Expósito
- Facultativo especialista, Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - L Martí-Bonmatí
- Facultativo especialista, Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - O Burgués
- Facultativo especialista, Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, España
| | - I Casáns-Tormo
- Facultativo especialista, Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España
| | - B Bermejo-de Las Heras
- Facultativo especialista, Servicio de Oncología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Julve-Parreño
- Facultativo especialista, Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Caballero-Garate
- Facultativo especialista, Servicio de Cirugía General, Hospital Clínico Universitario de Valencia, Valencia, España
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Selective sentinel node biopsy after intratumour administration of radiotracer in breast cancer patients treated with neoadjuvant chemotherapy in relation to the level of tumor response. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Axillary pathologic response after neoadjuvant chemotherapy in locally advanced breast cancer with axillary involvement. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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[Axillary pathologic response after neoadjuvant chemotherapy in locally advanced breast cancer with axillary involvement]. Rev Esp Med Nucl Imagen Mol 2015; 34:230-5. [PMID: 25743035 DOI: 10.1016/j.remn.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/20/2022]
Abstract
AIM To compare axillary involvement (N+) at initial staging in locally advanced breast cancer (LABC) with axillary lymphadenectomy histologic results after neoadjuvant chemotherapy treatment (NeoChemo). MATERIAL AND METHODS Retrospective study between November 2011 and September 2013 of LABC cases treated with neoadjuvant chemotherapy based on docetaxel (associated with trastuzumab in HER2 positive cases and carboplatin/adriamycin in HER2 negative cases). Those clinically or radiologically suspected cases of axillary involvement were histologically confirmed. When there was no suspicion of axillary involvement, sentinel lymph node radioguided biopsy (SLNRB) was performed using intradermal injection of (99m)Tc-nanocolloid albumin prior to neoadjuvant treatment. Axillary lymphadenectomy after NeoChemo was undertaken in all cases with positive axilla. Final pathologic response was classified as complete (pCR) when there was no evidence of tumoral disease and as non-pathologic complete response (no pCR) in the opposite case. RESULTS A total of 346 patients treated with docetaxel were reviewed, identifying 105 LABC. Axillary involvement at initial staging was detected in 70 (67%) before starting NeoChemo. From these 70, 73% (n=51) were N+ (fine needle biopsy and/or biopsy) and the remaining 19 (27%) were occult N+ detected by SLNRB. Axillary lymphadenectomy detected pCR in 56% (39/70), increasing up to 84% pCR when initial N+ status was reached using SNLB. On the other hand, when N+ was detected using fine needle biopsy/lymph biopsy, pCR was only 45%. CONCLUSION More than 50% of women affected by locally advanced breast cancer with tumoral axillary involvement at initial diagnosis present free metastatic axilla after therapeutic neoadjuvant chemotherapy effect. This increases up to almost 90% in case of occult metastatic axilla detected with sentinel node biopsy prior starting neoadjuvant chemotherapy.
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Real-time MRI navigated US: Role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US. Eur J Radiol 2014; 83:942-950. [DOI: 10.1016/j.ejrad.2014.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/24/2014] [Accepted: 03/01/2014] [Indexed: 11/21/2022]
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Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study. Cir Esp 2014; 93:23-9. [PMID: 24560631 DOI: 10.1016/j.ciresp.2014.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A controversial aspect of breast cancer management is the use of sentinel lymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P=0,002) in the negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients.
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Rebollo-Aguirre Á, Gallego-Peinado M, Sánchez-Sánchez R, Pastor-Pons E, García-García J, Chamorro-Santos C, Menjón-Beltrán S. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rebollo-Aguirre AC, Gallego-Peinado M, Sánchez-Sánchez R, Pastor-Pons E, García-García J, Chamorro-Santos CE, Menjón-Beltrán S. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis. Rev Esp Med Nucl Imagen Mol 2013; 32:240-5. [PMID: 23684711 DOI: 10.1016/j.remn.2013.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS A prospective study was performed from January 2008 to December 2012 in 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, and ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA). RESULTS Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without nanocolloid migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2. CONCLUSION SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy.
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Affiliation(s)
- A C Rebollo-Aguirre
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.
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Sentinel lymph node biopsy in patients with operable breast cancer treated with neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remnie.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rebollo-Aguirre AC, Gallego-Peinado M, Menjón-Beltrán S, García-García J, Pastor-Pons E, Chamorro-Santos CE, Ramos-Font C, Salamanca-Ballesteros A, Llamas-Elvira JM, Olea-Serrano N. Sentinel lymph node biopsy in patients with operable breast cancer treated with neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2011; 31:117-23. [PMID: 21676504 DOI: 10.1016/j.remn.2011.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 04/25/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
AIM To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in operable breast cancer patients treated with neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS Between January 2008-2011, 88 women, mean age 49.4 years, with infiltrating breast carcinoma, were studied prospectively. Patients were T1-3, N0-1, M0. Prior to surgery, the patients received chemotherapy (epirubicin/cyclophosphamide, docetaxel), and trastuzumab in Her2/neu-positive patients. Axillary status was established by physical examination, ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB, followed by complete axillary lymph node dissection (ALND). Sentinel lymph node (SLN) were examined by frozen sections, hematoxylin-eosin staining and immunohistochemical analysis or One Step Nucleic Acid Amplification (OSNA). RESULTS Mean tumor size: 3.5 cm. Histologic type: 69 invasive ductal, 16 invasive lobular and 3 others. Thirty seven patients had clinical/ultrasound node-positive at presentation. Clinical response of primary tumor to NAC: complete in 38, partial in 45, and stable disease in 5 patients. A pathological complete response was achieved in 25. All patients were clinically node-negative after NAC. SLN identification rate was 92.0%. Six of 7 patients in whom SLN was not found had clinical/ultrasound positive axilla before NAC. SLN accurately determined the axillary status in 96.5%. False negative rate was 8.3%. In 69.4% of patients, SLN was the only positive node. The mean number of SLN removed was 1.7 and nodes resected from the ALND were 13.2. CONCLUSION SLN biopsy after NAC can predict the axillary status with a high accuracy in patients with breast cancer, avoiding unnecessary ALND.
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Affiliation(s)
- A C Rebollo-Aguirre
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
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[Breast surgery after neoadjuvant chemotherapy]. Bull Cancer 2011; 98:19-24. [PMID: 21300601 DOI: 10.1684/bdc.2010.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this work is to specify surgical procedures for the breast and the axillary lymph node area after neoadjuvant chemotherapy. The extent of glandular resection was chosen using a rational based on the goals of neoadjuvant chemotherapy, the prognostical impact of response level and the evaluation of this response. The results of sentinel lymph node procedure before or after neoadjuvant chemotherapy are presented.
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Ganglio centinela y neoadyuvancia en cáncer de mama: en busca del mejor escenario. ACTA ACUST UNITED AC 2010; 29:316-8. [DOI: 10.1016/j.remn.2010.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 10/05/2010] [Accepted: 10/05/2010] [Indexed: 11/19/2022]
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