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Fernandez-Gonzalez S, Falo C, Pla MJ, Campos M, Ortega-Exposito C, Ortega R, Vicente M, Petit A, Bosch-Schips J, Bajen MT, Reyes G, Martínez E, González-Viguera J, Peñafiel J, Stradella A, Pernas S, Ponce J, Garcia-Tejedor A. Sentinel lymph node biopsy before and after neoadjuvant chemotherapy in cN0 breast cancer patients: impact on axillary morbidity and survival-a propensity score cohort study. Breast Cancer Res Treat 2024:10.1007/s10549-024-07274-1. [PMID: 38635082 DOI: 10.1007/s10549-024-07274-1] [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: 11/26/2023] [Accepted: 01/30/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE In patients with clinically lymph node-negative (cN0) breast cancer, performing sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) has been preferentially embraced in comparison to before NACT. However, survival outcomes associated with both strategies remain understudied. We aimed to compare the axillary lymphadenectomy (ALND) rate, disease-free survival (DFS), and overall survival (OS), between two strategies. METHODS We included 310 patients in a retrospective observational study. SNLB was performed before NACT from December 2006 to April 2014 (107 cases) and after NACT from May 2014 to May 2020 (203 patients). An inverse probability of treatment weighting (IPTW) method was applied to homogenize both groups. Hazard ratios (HR) and odd ratios (OR) are reported with 95% confidence intervals (95%CI). RESULTS The lymphadenectomy rate was 29.9% before NACT and 7.4% after NACT (p < 0.001), with an OR of 5.35 95%CI (2.7-10.4); p = .002. After 4 years of follow-up, SLNB after NACT was associated with lower risk for DFS, HR 0.42 95%CI (0.17-1.06); p = 0.066 and better OS, HR 0.21 CI 95% (0.07-0.67); p = 0.009 than SLNB before NACT. After multivariate analysis, independent adverse prognostic factors for OS included SLNB before NACT, HR 3.095 95%CI (2.323-4.123), clinical nonresponse to NACT, HR 1.702 95% CI (1.012-2.861), and small tumors (cT1) with high proliferation index, HR 1.889 95% (1.195-2.985). CONCLUSION Performing SLNB before NACT results in more ALND and has no benefit for patient survival. These findings support discontinuing the practice of SLNB before NACT in patients with cN0 breast cancer.
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Affiliation(s)
- Sergi Fernandez-Gonzalez
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Feixa Llarga, s/n, 08907, l'Hospitalet de Llobregat, Spain.
| | - Catalina Falo
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Idibell, Barcelona, Spain
| | - Maria J Pla
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Miriam Campos
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Carlos Ortega-Exposito
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Raul Ortega
- Department of Radiology, Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Maria Vicente
- Department of Radiology, Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Ana Petit
- Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Jan Bosch-Schips
- Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Maria Teresa Bajen
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Gabriel Reyes
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Evelyn Martínez
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Barcelona, Spain
| | - Javier González-Viguera
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Barcelona, Spain
| | - Judith Peñafiel
- Biostatistics Unit, Institut d'Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Spain
| | - Agostina Stradella
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Idibell, Barcelona, Spain
| | - Sonia Pernas
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Idibell, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Amparo Garcia-Tejedor
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
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2
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Casella D, Fusario D, Neri A. New safer management for breast cancer patients who need neoadjuvant therapy during SARS-COVID pandemic. Breast Dis 2021; 41:1-3. [PMID: 34219707 DOI: 10.3233/bd-210007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frails patients as oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggest to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.
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Affiliation(s)
| | | | - Alessandro Neri
- Azienda Ospedaliero-Universitaria Senese, Siena, Italy.,University of Siena, Siena, Italy
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3
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Parmar V, Nair NS, Vanmali V, Hawaldar RW, Siddique S, Shet T, Desai S, Rangarajan V, Patil A, Gupta S, Badwe RA. Sentinel Node Biopsy Versus Low Axillary Sampling in Predicting Nodal Status of Postchemotherapy Axilla in Women With Breast Cancer. JCO Glob Oncol 2020; 6:1546-1553. [PMID: 33074737 PMCID: PMC7605370 DOI: 10.1200/go.20.00246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We tested low axillary sampling (LAS) and sentinel node biopsy (SNB) performed in the same patient to predict axillary nodal status post-neoadjuvant chemotherapy (NACT) in women undergoing elective breast surgery, clinically N0 after NACT. PATIENTS AND METHODS A total of 751 women clinically node negative post-NACT underwent LAS (excision of lymph node [LN] and fat below first intercostobrachial nerve). Of these women, 730 also underwent SNB by dual technique (methylene blue plus radioisotope). SNB (defined as targeted plus palpable LNs) and LAS specimens were distinctly examined for metastasis. All patients underwent completion axillary lymph node dissection. Post-NACT, 290 (38.6%) of 751 women had residual positive lymph nodes on pathology. RESULTS The median clinical tumor size was 5 cm (range, 1-15 cm), and 533 (71%) of patients were N1 or N2 at presentation. Targeted sentinel node (SN) identification was 85.7% (626 of 730; median, two LNs); SN with palpable nodes was found in 95.2% (695 of 730; median, five LNs); LAS node was identified in 98.5% (740 of 751; median, seven LNs). In all but one case, the SN was found within the LAS specimen. The false negative rate (FNR) of SNB (blue, hot, and adjacent palpable nodes) was 19.7% (47 of 238; one-sided 95% CI upper limit, 24.0), compared with an FNR of 9.9% for LAS (29 of 292; one-sided 95% CI upper limit, 12.8; P < .001). If SNB was confined to blue/hot node, excluding adjacent palpable nodes, the FNR was 31.6% (74 of 234; one-sided 95% CI upper limit, 36.6). The FNR could be brought down to < 8.8% if three or more LNs were identified by LAS. CONCLUSION LAS is superior to SNB in identification rate, FNR, and negative predictive value in predicting node-negative axilla post-NACT. LAS can be safely used to predict negative axilla with < 10% chance of leaving residual disease.
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Affiliation(s)
- Vani Parmar
- Department of Breast Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nita S. Nair
- Department of Breast Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vaibhav Vanmali
- Breast Cancer Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rohini W. Hawaldar
- Breast Cancer Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shabina Siddique
- Breast Cancer Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tanuja Shet
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sangeeta Desai
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Venkatesh Rangarajan
- Nuclear Medicine Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Asawari Patil
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A. Badwe
- Department of Breast Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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4
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Tardieu A, Mesnard C, Margueritte F, Mollard J, Lacorre A, Aubard Y, Deluche E, Gauthier T. [Risk of axillary recurrence after sentinel lymph node biopsy before neoadjuvant chemotherapy in breast cancer]. ACTA ACUST UNITED AC 2018; 46:509-513. [PMID: 29776842 DOI: 10.1016/j.gofs.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In case of large breast cancer, neoadjuvant chemotherapy (NAC) can be performed to reduce the size of the tumor and thus perform a conservative surgery. The place of the sentinel lymph node biopsy (SLNB) in case of NAC is still debated. The main aim of this study is to assess the risk of axillary recurrence after negative SLNB before NAC. METHODS It is a retrospective, observational and uni-centric study. We included 18 to 80-year-old patients with unilateral breast cancer requiring a NAC and with a negative SLNB before NAC. Our primary endpoint was axillary recurrence. RESULTS Between August 2006 and October 2016, 64 patients had a negative GS performing before a NAC and did not benefit from axillary dissection after NAC. The average duration of follow-up was 37 months. During our follow-up, we did not find any cases of axillary recurrence. CONCLUSION This study supports the reliability of lymph node status assessment using the SLNB before CNA.
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Affiliation(s)
- A Tardieu
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France.
| | - C Mesnard
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France
| | - F Margueritte
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France
| | - J Mollard
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France
| | - A Lacorre
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Aubard
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France
| | - E Deluche
- Département d'oncologie médicale, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France
| | - T Gauthier
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Dominique-Larrey, 87000 Limoges, France; UMR-1248, faculté de médecine, rue du docteur-Marcland, 87000 Limoges, France
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5
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Piñero A, Giménez J, Vidal-Sicart S, Intra M. Selective Sentinel Lymph Node Biopsy and Primary Systemic Therapy in Breast Cancer. TUMORI JOURNAL 2018; 96:17-23. [DOI: 10.1177/030089161009600103] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Sentinel lymph node biopsy has become an ordinary method for breast cancer staging. Neoadjuvant chemotherapy has been considered one of the contraindications for sentinel lymph node biopsy due to potential secondary fibrosis and lymphatic distortion. Timing and influence on sentinel lymph node biopsy result by primary systemic therapy are current and controversial topics. Methods and study design The experience in the medical literature is reviewed. A search was performed in the following databases: Medline (through Pubmed), EMBASE, Tripdatabase and Cochrane Library, between January 1998 and December 2008. Results and conclusions After analyzing the conclusions from 42 series and waiting for the end of related prospective trials, it could be concluded that sentinel lymph node biopsy is a useful diagnostic tool that should be integrated in the algorithm for the management of breast cancer patients when primary systemic therapy is needed.
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Affiliation(s)
- Antonio Piñero
- Department of Surgery, “Virgen de la Arrixaca” University Hospital, Murcia
| | - Julia Giménez
- Department of Surgery, Valencian Institute of Oncology Foundation, Valencia
| | | | - Mattia Intra
- Division di Senologia, European Institute of Oncology, Milan, Italy
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6
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Vaz MMOLL, de Jesus Guirro RR, Carrara HHA, Montezuma T, Perez CS, de Oliveira Guirro EC. Alteration of Blood Circulation in the Upper Limb Before and After Surgery for Breast Cancer Associated with Axillary Lymph Node Dissection or Sentinel Lymph Node Biopsy. Lymphat Res Biol 2017; 15:343-348. [PMID: 28956696 DOI: 10.1089/lrb.2017.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This aim of this study was to assess and compare arterial and venous circulation in women with axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) before and after breast cancer surgery. METHODS AND RESULTS Fifty-two women took part in the study, divided into three groups: those undergoing ALND at levels I, II, and III (ALNDG), with mean age of 56.29 ± 10.85 years old; those undergoing sentinel lymph node biopsy (SLNBG), with mean age of 57.7 ± 7.07 years old; and controls without diagnosis of breast cancer (CG), with mean age of 53.92 ± 8.85 years old. Maximum venous and arterial flow velocities in upper limbs were assessed before and after surgical treatment for breast cancer by means of Doppler ultrasonography (Nicolet Vascular Versalab SE®). Data normality was assessed by using the Shapiro-Wilk's test, with normally distributed variables being analyzed with analysis of variance (ANOVA) and post hoc Tukey's test or t-test. For variables with non-normal distribution, Kruskal-Wallis' test and post hoc Dunn's test were used at p < 0.05. There was significant difference in the maximum blood flow velocities, both venous (ALNDG) and arterial (SLNBG). CONCLUSION The results suggest that ALND and SLNB can interfere with the upper limp blood circulation.
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Affiliation(s)
- Maíta M O L L Vaz
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Hélio Humberto Angotti Carrara
- 2 Postgraduate Program in Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Thais Montezuma
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Carla Silva Perez
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
| | - Elaine Caldeira de Oliveira Guirro
- 1 Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto, Brazil
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7
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Pilewskie M, Morrow M. Axillary Nodal Management Following Neoadjuvant Chemotherapy: A Review. JAMA Oncol 2017; 3:549-555. [PMID: 27918753 DOI: 10.1001/jamaoncol.2016.4163] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance The increasing use of neoadjuvant chemotherapy (NAC) for operable breast cancer has raised questions about optimal local therapy for the axilla. Observations Sentinel lymph node biopsy (SLNB) after NAC in patients presenting with clinically negative nodes has an accuracy similar to upfront SLNB and reduces the need for axillary lymph node dissection compared with SLNB prior to NAC. In patients presenting with node-positive disease, clinical trials demonstrate that SLNB after NAC is accurate when 3 or more sentinel nodes are obtained, but long-term outcomes are lacking. The relative importance of pre- and post-NAC stage in predicting risk of locoregional recurrence remains an area of controversy. Conclusions and Relevance Neoadjuvant chemotherapy reduces the need for axillary lymph node dissection, and SLNB is an accurate method of determining nodal status after NAC.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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8
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Garcia-Tejedor A, Falo C, Quetglas C, Soler T, Marqueta B, Ortega R, Gil-Gil M, Pernas S, Fernandez-Montolí E, Pla MJ, Guma A, Bajen M, Benitez A, Eraso A, Campos M, Petit A, Ponce J. Feasibility, accuracy and prognosis of sentinel lymph node biopsy before neoadjuvant therapy in breast cancer. A prospective study. Int J Surg 2017; 39:141-147. [DOI: 10.1016/j.ijsu.2017.01.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/20/2017] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
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9
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Zetterlund L, Celebioglu F, Axelsson R, de Boniface J, Frisell J. Swedish prospective multicenter trial on the accuracy and clinical relevance of sentinel lymph node biopsy before neoadjuvant systemic therapy in breast cancer. Breast Cancer Res Treat 2017; 163:93-101. [PMID: 28213781 PMCID: PMC5387013 DOI: 10.1007/s10549-017-4163-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 02/06/2023]
Abstract
Purpose The timing of sentinel lymph node biopsy (SLNB) in the context of neoadjuvant systemic therapy (NAST) in breast cancer is still controversial. SLNB before NAST has been evaluated in few single-institution studies in which axillary lymph node dissection (ALND), however, was commonly not performed in case of a negative SLNB. We investigated the potential clinical relevance of SLNB before NAST by performing ALND in all patients after NAST. Methods This national multicenter trial prospectively enrolled clinically node-negative breast cancer patients planned for NAST at 13 recruiting Swedish hospitals between October 2010 and December 2015. SLNB before NAST was followed by ALND after NAST in all individuals. Repeat SLNB after NAST was encouraged but not mandatory. Results SLNB before NAST was performed in 224 patients. The identification rate was 100% (224/224). The proportion of patients with a negative SLNB before NAST but positive axillary lymph nodes after NAST was 7.4% (nine of 121 patients, 95% CI 4.0–13.5). Among those with a positive SLNB before NAST, 23.2% (86/112) had further positive lymph nodes after NAST. Conclusions In clinically node-negative patients, SLNB before NAST is highly reliable. With this sequence, ALND and regional radiotherapy can be safely omitted in patients with a negative SLNB provided good clinical response to NAST. Additionally, SLNB-positive patients upfront will receive correct nodal staging unaffected by NAST and be consequently offered adjuvant locoregional treatment according to current guidelines pending the results of ongoing randomized trials.
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Affiliation(s)
- Linda Zetterlund
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Department of Surgery, Södersjukhuset, Stockholm, 118 83, Sweden.
| | - Fuat Celebioglu
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, 118 83, Sweden
| | - Rimma Axelsson
- Department of Clinical Science, Intervention and Technology, Division of Radiography, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, 141 86, Sweden
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Capio St Göran's Hospital, Stockholm, 112 81, Sweden
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Solna, 171 76, Sweden
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10
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Pinder SE, Rakha EA, Purdie CA, Bartlett JMS, Francis A, Stein RC, Thompson AM, Shaaban AM. Macroscopic handling and reporting of breast cancer specimens pre- and post-neoadjuvant chemotherapy treatment: review of pathological issues and suggested approaches. Histopathology 2015; 67:279-93. [PMID: 25585651 DOI: 10.1111/his.12649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Neoadjuvant chemotherapy (NACT) is used increasingly in the treatment of invasive breast cancer and presents challenges for the pathologist in the handling and interpretation of tissues. Potential issues include pathological identification and localization of the residual tumour site; how best to assess pathological response (given the diversity of scoring systems described); the timing and assessment of axillary node biopsy; and the value of retesting any residual tumour for dissonance between core biopsy and post-treatment residual cancer cells for biomarker expression such as oestrogen and progesterone receptors and human epidermal growth factor receptor 2 (HER2). The role of the pathologist is critical in modern NACT approaches to breast cancer and is likely to remain challenging as novel agents and newer biomarkers become available. In this manuscript we review these issues and describe some practical approaches to handling and reporting these samples in the routine histopathology laboratory.
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Affiliation(s)
- Sarah E Pinder
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Colin A Purdie
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | - Robert C Stein
- University College London Hospitals and Medical School, London, UK
| | - Alastair M Thompson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abeer M Shaaban
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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11
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Choy N, Lipson J, Porter C, Ozawa M, Kieryn A, Pal S, Kao J, Trinh L, Wheeler A, Ikeda D, Jensen K, Allison K, Wapnir I. Initial Results with Preoperative Tattooing of Biopsied Axillary Lymph Nodes and Correlation to Sentinel Lymph Nodes in Breast Cancer Patients. Ann Surg Oncol 2014; 22:377-82. [DOI: 10.1245/s10434-014-4034-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Indexed: 11/18/2022]
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12
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Is imaging the future of axillary staging in breast cancer? Eur Radiol 2013; 24:288-93. [PMID: 24037250 DOI: 10.1007/s00330-013-3009-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/02/2013] [Accepted: 08/18/2013] [Indexed: 12/13/2022]
Abstract
Axillary management in patients with breast cancer has become much less invasive with the introduction of sentinel lymph node biopsy (SLNB). However, over 70 % of SLNBs are negative, questioning the generic use of this invasive procedure. Emerging evidence indicates that breast cancer patients with a low axillary burden of disease do not benefit from axillary lymph node dissection (ALND). Non-invasive techniques such as paramagnetic iron oxide contrast-enhanced magnetic resonance imaging (MRI) may provide genuine alternatives to axillary staging and should be evaluated within clinical trials. Selective axillary surgery could then be offered based on imaging findings and for therapeutic intent. This non-operative approach would reduce morbidity further and facilitate interpretation of follow-up imaging. Key Points • Modern imaging and biopsy greatly help the axillary staging of breast cancer. • Superparamagnetic iron oxide (SPIO)-enhanced MRI offers a further advance. • Sentinel lymph node biopsy may become redundant with SPIO-enhanced MRI. • Selective therapeutic axillary surgery should be based upon preoperative imaging findings.
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13
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Darko Z, Miroslav G, Marija Z, Tomislav R, Dejan N, Nebojsa I. Physical examination: the first step in sophisticated diagnostic path of breast cancer. World J Surg 2013; 37:2252-3. [PMID: 23604342 DOI: 10.1007/s00268-013-2057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer. AJR Am J Roentgenol 2012; 199:465-70. [PMID: 22826414 DOI: 10.2214/ajr.11.7702] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether sentinel lymph nodes (SLNs) that undergo targeted needle biopsy after identification by contrast-enhanced ultrasound (CEUS) using intradermally injected microbubbles results in more node-positive breast cancer patients being diagnosed preoperatively. Furthermore, we sought to determine whether the addition of CEUS to gray-scale sonography of the axilla reduces the number of patients having axillary lymph node (ALN) dissection as a second procedure. SUBJECTS AND METHODS Intradermal microbubble injection was performed in 136 breast cancer patients who had no abnormal ALNs on routine gray-scale axillary sonography. When an enhancing ALN was visualized, percutaneous sonography-guided fine-needle aspiration cytology or core needle biopsy was performed. Depending on the biopsy results, patients underwent SLN biopsy or ALN dissection. If the putative SLN biopsy was positive or a biopsy tract was seen in the excised SLN, the procedure was defined as successful. RESULTS SLNs were identified and biopsied in 126 of the 136 cases (93%). Seventeen patients had positive sonography-guided biopsy results (13%) and were treated with immediate ALN dissection. In seven patients, the biopsied node was the only positive node. The remaining 109 patients underwent SLN biopsy. In nine cases (8%), a positive lymph node was identified. Four of these false-negative cases had only micrometastases. CONCLUSION SLNs can be identified and biopsied using CEUS to increase the accuracy of preoperative axillary staging. If the needle biopsy result is negative, conventional SLN biopsy is indicated.
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Is optimal timing of sentinel lymph node biopsy before neoadjuvant chemotherapy in patients with breast cancer? A literature review. Surg Oncol 2012; 21:252-6. [PMID: 22819780 DOI: 10.1016/j.suronc.2012.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 06/17/2012] [Accepted: 06/25/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Twenty five percent of women with breast cancer who undergo preoperative chemotherapy do not have axillary metastases. These patients need to withstand sentinel lymph node biopsy (SLNB). The optimal timing of SLNB in patients with neoadjuvant chemotherapy has not yet been defined. METHODS We systematically reviewed the literature for studies concerning the efficacy of sentinel lymph node biopsy before neoadjeuvant chemotherapy. A literature search was performed for the years 1993 through 2011 using the databases MEDLINE and EMBASE. Data that assessed the reliability of sentinel lymph node biopsy before chemotherapy were collected. RESULTS We identified 10 high-quality studies from 387 papers, which are analyzed further in this review. The identification rates reported ranged from 97% to 100%. The sensitivities of sentinel lymph node biopsy were 100%, and the false negative rates were 0%. Use an isotope combined with blue dye was associated with a higher probability of identification than that of using an isotope or blue dye alone (99.5% vs 98.5%). Only two studies compared data based on different timing for the sentinel lymph node biopsy. They achieved a lower false negative rate (0% vs 15.8%) and higher success rate (100% vs 81%) in patients with sentinel lymph node biopsy prior to neoadjuvant chemotherapy. CONCLUSION Sentinel lymph node biopsy prior to chemotherapy potentially gives a more accurate evaluation of axillary status, because it is unaffected by any previous therapeutic intervention.
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Tausch C, Steger GG, Haid A, Jakesz R, Fridrik MA, Reitsamer R, Pöstlberger S, Lang A, Gnant M, Greil R. Sentinel Node Biopsy After Primary Chemotherapy in Breast Cancer: A Note of Caution from Results of ABCSG-14. Breast J 2011; 17:230-8. [DOI: 10.1111/j.1524-4741.2011.01073.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Shimazu K, Noguchi S. Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer. Surg Today 2011; 41:311-6. [DOI: 10.1007/s00595-010-4404-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 06/17/2010] [Indexed: 11/30/2022]
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Muñoz M, Pahisa J, Xavier Caparrós F, Vidal-Sicart S. Ganglio centinela y neoadyuvancia en cáncer de mama. ACTA ACUST UNITED AC 2010; 29:319-20. [DOI: 10.1016/j.remn.2010.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
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Taxane-based chemotherapy enhances response to neoadjuvant treatment for stage II and III breast cancer. Med Oncol 2010; 28 Suppl 1:S65-9. [PMID: 20953738 DOI: 10.1007/s12032-010-9711-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
Abstract
Reducing primary tumor volume is the main role of neoadjuvant chemotherapy for breast cancer. We evaluated the benefit of adding docetaxel to anthracyclin as neoadjuvant therapy. This study is a retrospective cohort analysis comparing the efficacy of neoadjuvant chemotherapy in patients subjected to docetaxel and epirubicin or 5-fluoruracil, epirubicin and cyclophosphamide combinations (DE and FEC group, respectively). The mean number of chemotherapy delivered was similar in both groups (P = 0.8). A total of 316 patients were treated (151 in FEC group and 165 in DE group). Primary endpoint was the clinical and pathological response to therapy. Breast conserving surgery rate was compared. In T1/2 staged patients, the complete clinical response rate was 7.5% in FEC group and 32% in DE group (P = 0.002), and the breast conserving surgery rate was 72 and 73% in FEC and DE groups, respectively (P = 0.9). In the subset of patients staged as T3 and T4a-c, objective response was higher in DE group (P < 0.0001 and P = 0.008, respectively). Breast conserving surgery rate was 38 and 63% in FEC and DE groups, respectively, in T3 staged patients and, 20.5 and 37% in T4a-c staged patients (P = 0.003 and 0.08). Despite the similar number of chemotherapy cycles delivered in both groups, the presence of microscopic axillary lymph node involvement after chemotherapy was less frequent in DE group. Neoadjuvant chemotherapy with DE combination is more effective in terms of clinical and pathological response propitiating higher breast conserving surgery rate than FEC combination in stage II and III breast cancer.
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Bear HD. Neoadjuvant Chemotherapy for Operable Breast Cancer: Individualizing Locoregional and Systemic Therapy. Surg Oncol Clin N Am 2010; 19:607-26. [DOI: 10.1016/j.soc.2010.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Sabel MS. Sentinel lymph node biopsy before or after neoadjuvant chemotherapy: pros and cons. Surg Oncol Clin N Am 2010; 19:519-38. [PMID: 20620925 DOI: 10.1016/j.soc.2010.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This article summarizes the relative pros and cons surrounding the timing of sentinel lymph node (SLN) biopsy in patients undergoing neoadjuvant chemotherapy. Several institutions initiated prospective trials of SLN biopsy performed after neoadjuvant chemotherapy in conjunction with a completion axillary lymph node dissection, with the goal of ultimately showing that SLN biopsy could be safely and accurately performed after the patient completed systemic therapy. Other institutions adopted a policy of performing SLN biopsy before initiation of chemotherapy. This avoided the issue surrounding the accuracy of SLN biopsy after chemotherapy and potentially provided information that might influence adjuvant therapy decisions. This article addresses the clinical questions regarding the 2 approaches including the accuracy of the procedure and the prognostic information gleaned.
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Affiliation(s)
- Michael S Sabel
- Department of Surgery, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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22
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Schwartz GF, Tannebaum JE, Jernigan AM, Palazzo JP. Axillary sentinel lymph node biopsy after neoadjuvant chemotherapy for carcinoma of the breast. Cancer 2010; 116:1243-51. [PMID: 20087958 DOI: 10.1002/cncr.24887] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The timing and accuracy of axillary sentinel lymph node biopsy (SLNB) in patients who are receiving neoadjuvant chemotherapy (NACT) for breast cancer are controversial. To examine the accuracy of SLNB after NACT, the authors performed SLNB after chemotherapy on all of patients who received NACT at their institution starting in January 1997. METHODS Seventy-nine women who underwent NACT between 1997 and 2008 comprised this study and were divided as follows: 4 women had stage I disease, 60 women had stage II disease, and 15 women had stage III disease, including 10 women who had multicentric disease. Thirty-nine women (49.4%) had clinical evidence of axillary metastasis (N1-N2) at the time of diagnosis. The regimen, the duration of treatment, and the number of cycles of NACT depended on clinical response. The choice of breast conservation therapy or mastectomy was based on the patient's response to treatment and patient preference. All patients underwent SLNB after NACT. RESULTS Seventy-three patients underwent breast conservation therapy, and 6 patients underwent mastectomy. Sentinel lymph nodes were identified in 98.7% of patients (in 1 patient, SLNB failed to capture 1 proven axillary metastasis), and 29 patients underwent full axillary lymph node dissection. Fourteen patients (17.7%) had no residual carcinoma (invasive or ductal carcinoma in situ) in their breast, 5 patients (6.3%) had residual ductal carcinoma in situ (only), and 60 patients (75.9%) had residual invasive carcinoma. One false-negative SLNB was reported in the group of 23 patients who underwent full axillary dissection after a negative SLNB. No patient had a subsequent axillary recurrence. CONCLUSIONS SLNB after NACT was feasible in virtually all patients and accurately selected patients who required complete level I and II axillary dissection. NACT frequently downstaged the axilla, converting patients with N1-N2 lymph node status to N0 status and also avoiding full axillary dissection in these patients.
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Affiliation(s)
- Gordon F Schwartz
- Department of Surgery, Thomas Jefferson University and Hospitals, Philadelphia, PA, USA.
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Chung A, Giuliano A. Axillary Staging in the Neoadjuvant Setting. Ann Surg Oncol 2010; 17:2401-10. [DOI: 10.1245/s10434-010-1001-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Indexed: 02/05/2023]
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24
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Schwartz R. Revisión de la literatura para la actualización de los requisitos, requerimientos técnicos e indicaciones del linfonodo centinela axilar en cáncer de mama. Medwave 2010. [DOI: 10.5867/medwave.2010.01.4335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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25
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Parmar V, Badwe RA. Breast conservation in locally advanced breast cancer. Indian J Surg Oncol 2010; 1:3-7. [PMID: 22930610 DOI: 10.1007/s13193-010-0003-0] [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: 08/22/2009] [Accepted: 10/10/2009] [Indexed: 10/19/2022] Open
Abstract
Absence of breast cancer screening in India, lack of awareness in rural population, social inhibitions and poor socioeconomic status leads to a situation where a large proportion of women in India are still presenting with locally advanced breast cancer (LABC) at the time of initial diagnosis, although, there are relatively more of early stage cases detected in the metros and urban areas than maybe a decade ago. With advances in care and introduction of newer chemotherapeutic agents, it has now become feasible to offer neoadjuvant therapy with effective tumor downsizing, thus making it possible to even consider breast conservation surgery in select patients with locally advanced and unresectable disease at presentation. With reports suggesting apparent safety of the procedure, breast conservation treatment after chemotherapy is now being offered as routine care in most major centers for selective women with LABC. Multimodality therapy is the standard of care with neoadjuvant systemic therapy for all women with LABC.
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Sentinel lymphadenectomy for the staging of clinical axillary node-negative breast cancer before neoadjuvant chemotherapy. Eur J Surg Oncol 2009; 35:916-20. [DOI: 10.1016/j.ejso.2008.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/09/2008] [Accepted: 11/11/2008] [Indexed: 11/22/2022] Open
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Sentinel lymph node biopsy controversy: Before or after neoadjuvant chemotherapy. CURRENT BREAST CANCER REPORTS 2009. [DOI: 10.1007/s12609-009-0010-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Beatty JD, Precht LM, Lowe K, Atwood M. Axillary-conserving surgery is facilitated by neoadjuvant chemotherapy of breast cancer. Am J Surg 2009; 197:637-41; discussion 641-2. [DOI: 10.1016/j.amjsurg.2008.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 12/23/2008] [Accepted: 12/29/2008] [Indexed: 10/21/2022]
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Shenoy H, Peter M, Masannat Y, Dall B, Dodwell D, Horgan K. Practical advice on clinical decision making during neoadjuvant chemotherapy for primary breast cancer. Surg Oncol 2009; 18:65-71. [DOI: 10.1016/j.suronc.2008.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 06/29/2008] [Accepted: 07/11/2008] [Indexed: 11/25/2022]
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30
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Bergkvist L. Resolving the controversies surrounding lymphatic mapping in breast cancer. Future Oncol 2008; 4:681-8. [DOI: 10.2217/14796694.4.5.681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Sentinel lymph node biopsy has rapidly become the standard of care in the primary treatment of breast cancer. Most of the initially identified potential contraindications towards the procedure, such as nonpalpability, large tumor size, pregnancy and being previously operated in the breast or axilla, have been ruled out, whereas multifocality represents an unsolved problem. There is no consensus about the best use of the technique in patients receiving neoadjuvant treatment. There is no place for sentinel lymph node biopsy in pure ductal carcinoma in situ, but it can be used for large high-grade in situ cancer diagnosed through core biopsy, especially if a mastectomy is planned. Morbidity is low, and the recurrence rates reported so far are reassuring. However, long-term results are lacking, and results from ongoing randomized trials are awaited.
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Affiliation(s)
- Leif Bergkvist
- Department of Surgery and Center for Clinical Research, Uppsala Universitet Central Hospital, SE 72189 Västerås, Sweden
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31
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Kilbride KE, Lee MC, Nees AV, Cimmino VM, Diehl KM, Sabel MS, Hayes DF, Schott AF, Kleer CG, Chang AE, Newman LA. Axillary Staging Prior to Neoadjuvant Chemotherapy for Breast Cancer: Predictors of Recurrence. Ann Surg Oncol 2008; 15:3252-8. [DOI: 10.1245/s10434-008-0136-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 07/31/2008] [Accepted: 08/01/2008] [Indexed: 02/05/2023]
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Sentinel node mapping performed before preoperative chemotherapy may avoid axillary dissection in breast cancer patients with negative or micrometastatic sentinel nodes. Am J Surg 2008; 196:176-83. [DOI: 10.1016/j.amjsurg.2007.08.068] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 08/08/2007] [Accepted: 08/08/2007] [Indexed: 11/21/2022]
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Blanco I, Moriyón C, Santamaría L, Carrocera A, Díaz D, Lezana M, Álvarez R, Angulo J. Nuestra experiencia en la aplicación clínica de la biopsia del ganglio centinela en cáncer de mama. Cir Esp 2007; 82:352-7. [DOI: 10.1016/s0009-739x(07)71746-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Coutant C, Delpech Y, Morel O, Uzan S, Barranger E. [Sentinel node biopsy in invasive breast cancer in 2007]. ACTA ACUST UNITED AC 2007; 35:731-42. [PMID: 17706450 DOI: 10.1016/j.gyobfe.2007.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 04/20/2007] [Indexed: 11/26/2022]
Abstract
Sentinel lymph node (SN) biopsy for breast cancer has been introduced in the mid-1990s and it has now been performed on thousands of patients. This procedure has been rapidly adopted around the world by surgical specialists in clinical practice as a diagnostic procedure instead of the axillary lymph node dissection. The diffusion of the SN mapping in routine must be careful by respecting some principles of methodology and especially of training, in order to maintain its irreversible development. However, the advent of this mini-invasive technique revealed new questions, which the concept of the SN procedure raises: can we increase the current indications? Could axillary lymph node dissection be avoided in patients with metastatic SN? What is the morbidity of the biopsy of the SN? Which is the prognostic value of micrometastatis discovered by the diffusion of the ultra-stadification of the SNs? The GS procedure is a diagnostic method the reliability of which is now on accepted in its usual indications (tumours in place, small size breast tumour without palpable adenopathy). The value of the axillary dissection after metastatic SN is the subject of debates and controversies although axillary dissection remains recommended. So the use of scores or predictive nomograms is currently developed to select the patients being able not to justify of complementary axillary dissection, and seems promising.
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Affiliation(s)
- C Coutant
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, Cancer Est, université Pierre-et-Marie-Curie-Paris-VI, 4, rue de la Chine, 75020 Paris, France
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de Ferrater MB, Vidal-Sicart S, Zanón G, Martínez-Román S, Sanjuán A, Fernández PL, Velasco M, Pons F. Importance of Intramammary Node Resection in Breast Cancer Staging. Clin Nucl Med 2007; 32:572-3. [PMID: 17581352 DOI: 10.1097/rlu.0b013e3180646a31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Newman EA, Sabel MS, Nees AV, Schott A, Diehl KM, Cimmino VM, Chang AE, Kleer C, Hayes DF, Newman LA. Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation. Ann Surg Oncol 2007; 14:2946-52. [PMID: 17514407 DOI: 10.1245/s10434-007-9403-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 12/07/2006] [Indexed: 02/05/2023]
Abstract
BACKGROUND The optimal strategy for incorporating lymphatic mapping and sentinel lymph node biopsy into the management of breast cancer patients receiving neoadjuvant chemotherapy remains controversial. Previous studies of sentinel node biopsy performed following neoadjuvant chemotherapy have largely reported on patients whose prechemotherapy, pathologic axillary nodal status was unknown. We report findings using a novel comprehensive approach to axillary management of node-positive-patients receiving neoadjuvant chemotherapy. METHODS We evaluated 54 consecutive breast cancer patients with biopsy-proven axillary nodal metastases at the time of diagnosis that underwent lymphatic mapping with nodal biopsy as well as concomitant axillary lymph node dissection after receiving neoadjuvant chemotherapy. All cases were treated at a single comprehensive cancer center between 2001 and 2005. RESULTS The sentinel node identification rate after delivery of neoadjuvant chemotherapy was 98%. Thirty-six patients (66%) had residual axillary metastases (including eight patients that had undergone resection of metastatic sentinel nodes at the time of diagnosis), and in 12 cases (31%) the residual metastatic disease was limited to the sentinel lymph node. The final, post-neoadjuvant chemotherapy sentinel node was falsely negative in three cases (8.6%). The negative final sentinel node accurately identified patients with no residual axillary disease in 17 cases (32%). CONCLUSIONS Sentinel lymph node biopsy performed after the delivery of neoadjuvant chemotherapy in patients with documented nodal disease at presentation accurately identified cases that may have been downstaged to node-negative status and can spare this subset of patients (32%) from experiencing the morbidity of an axillary dissection.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Axilla
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Combined Modality Therapy
- Female
- Humans
- Lymph Node Excision
- Lymph Nodes/pathology
- Lymphatic Metastasis/pathology
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Staging
- Neoplasm, Residual/pathology
- Neoplasm, Residual/radiotherapy
- Neoplasm, Residual/surgery
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/radiotherapy
- Neoplasms, Multiple Primary/surgery
- Predictive Value of Tests
- Radiotherapy, Adjuvant
- Treatment Outcome
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Affiliation(s)
- Erika A Newman
- Department of Surgery, The University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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37
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Boughey JC, Hunt KK. Expanding the indications for sentinel lymph node surgery in breast cancer. Future Oncol 2007; 3:9-14. [PMID: 17280496 DOI: 10.2217/14796694.3.1.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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38
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Göhring UJ, Solomayer E. Primary Systemic Therapy in Breast Cancer. Breast Care (Basel) 2006. [DOI: 10.1159/000095008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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