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Brown S, Kokosis G, Graziano FD, Haran O, Smith-Montes E, Zivanovic O, Ariyan CE, Coit DG, Coriddi M, Mehrara BJ, Dayan JH. Immediate Lymphatic Reconstruction with Vascularized Omentum Lymph Node Transplant: Reducing the Risk of Both Painful Contracture and Lymphedema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5747. [PMID: 38645629 PMCID: PMC11029981 DOI: 10.1097/gox.0000000000005747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/06/2024] [Indexed: 04/23/2024]
Abstract
Patients undergoing extensive lymph node dissection and radiation are at high risk for not only lymphedema but also painful contracture. In a standard lymphadenectomy, immediate lymphatic reconstruction using a lymphovenous bypass is effective in reconstructing the lymphatic defect. However, a more aggressive nodal clearance leaves the patient with a large cavity and skeletonized neurovascular structures, often resulting in severe contracture, pain, cosmetic deformity, and venous stricture. Adjuvant radiotherapy to the nodal bed can lead to severe and permanent disability despite physical therapy. Typically, these patients are referred to us after the fact, where surgery will rarely restore the patient to normal function. In an effort to avoid lymphedema and contracture, we have been reconstructing both the lymphatic and soft tissue defect during lymphadenectomy, using vascularized omentum lymphatic transplant (VOLT). A total of 13 patients underwent immediate reconstruction with VOLT at the time of axillary (n = 8; 61.5%) or groin (n = 5; 38.5%) dissection. No postoperative complications were observed. The mean follow-up time was 15.1 ± 12.5 months. Only one lower extremity patient developed mild lymphedema (11% volume differential), with excellent scores in validated patient-reported outcomes. All patients maintained full range of motion with no pain. None of the 13 patients required a compression garment. Immediate lymphatic reconstruction with VOLT is a promising procedure for minimizing the risk of lymphedema and contracture in the highest risk patients undergoing particularly extensive lymph node dissection and radiotherapy.
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Affiliation(s)
- Stav Brown
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - George Kokosis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, RUSH Medical College, Chicago, Ill
| | - Francis D. Graziano
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Oriana Haran
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Elizabeth Smith-Montes
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Oliver Zivanovic
- Division of Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Charlotte E. Ariyan
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Daniel G. Coit
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Michelle Coriddi
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Babak J. Mehrara
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Joseph H. Dayan
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
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McNeely ML, Courneya KS, Al Onazi MM, Wharton S, Wang Q, Dickau L, Vallance JK, Culos-Reed SN, Matthews CE, Yang L, Friedenreich CM. Upper Limb Morbidity in Newly Diagnosed Individuals After Unilateral Surgery for Breast Cancer: Baseline Results from the AMBER Cohort Study. Ann Surg Oncol 2023; 30:8389-8397. [PMID: 37755568 DOI: 10.1245/s10434-023-14316-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE We aimed to examine potential associations between post-surgical upper limb morbidity and demographic, medical, surgical, and health-related fitness variables in newly diagnosed individuals with breast cancer. METHODS Participants were recruited between 2012 and 2019. Objective measures of health-related fitness, body composition, shoulder range of motion, axillary web syndrome, and lymphedema were performed within 3 months of breast cancer surgery, and prior to or at the start of adjuvant cancer treatment. RESULTS Upper limb morbidity was identified in 54% of participants and was associated with poorer upper limb function and higher pain. Multivariable logistic regression analysis identified mastectomy versus breast-conserving surgery (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65-4.65), axillary lymph node dissection versus sentinel lymph node dissection (OR 2.67, 95% CI 1.73-4.10), earlier versus later time from surgery (OR 1.58, 95% CI 1.15-2.18), and younger versus older age (OR 1.01, 95% CI 1.00-1.03) as significantly associated with a higher odds of upper limb morbidity, while mastectomy (OR 1.57, 95% CI 1.10-2.25), axillary lymph node dissection (OR 2.20, 95% CI 1.34-3.60), lower muscular endurance (OR 1.10, 95% CI 1.01-1.16) and higher percentage body fat (OR 1.04, 95% CI 1.00-1.07) were significantly associated with higher odds of moderate or greater morbidity severity. CONCLUSIONS Upper limb morbidity is common in individuals after breast cancer surgery prior to adjuvant cancer treatment. Health-related fitness variables were associated with severity of upper limb morbidity. Findings may facilitate prospective surveillance of individuals at higher risk of developing upper limb morbidity.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
- Supportive Care Services, Cancer Care Alberta, Edmonton, AB, Canada.
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Wharton
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Qinggang Wang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Leanne Dickau
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jeffrey K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD, USA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Yuan C, Xu G, Zhan X, Xie M, Luo M, She L, Xue Y. Molybdenum target mammography-based prediction model for metastasis of axillary sentinel lymph node in early-stage breast cancer. Medicine (Baltimore) 2023; 102:e35672. [PMID: 37861524 PMCID: PMC10589595 DOI: 10.1097/md.0000000000035672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Sentinel lymph node (SLN) status is closely related to axillary lymph node metastasis in breast cancer. However, SLN biopsy has certain limitations due to invasiveness and diagnostic efficiency. This study aimed to develop a model to predict the risk of axillary SLN metastasis in early-stage breast cancer based on mammography, a noninvasive, cost-effective, and potential complementary way. Herein, 649 patients with early-stage breast cancer (cT1-T2) who received SLN biopsy were assigned to the training cohort (n = 487) and the validation cohort (n = 162). A prediction model based on specific characteristics of tumor mass in mammography was developed and validated with R software. The performance of model was evaluated by receiver operating characteristic curve, calibration plot, and decision curve analysis. Tumor margins, spicular structures, calcification, and tumor size were independent predictors of SLN metastasis (all P < .05). A nomogram showed a satisfactory performance with an AUC of 0.829 (95% CI = 0.792-0.865) in the training cohort and an AUC of 0.825 (95% CI = 0.763-0.888) in validation cohort. The consistency between model-predicted results and actual observations showed great Hosmer-Lemeshow goodness-of-fit (P = .104). Patients could benefit from clinical decisions guided by the present model within the threshold probabilities of 6% to 84%. The prediction model for axillary SLN metastasis showed satisfactory discrimination, calibration abilities, and wide clinical practicability. These findings suggest that our prediction model based on mammography characteristics is a reliable tool for predicting SLN metastasis in patients with early-stage breast cancer.
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Affiliation(s)
- Caixing Yuan
- Department of Radiology, Affiliated Hospital of Putian College, Putian, China
| | - Guolin Xu
- Department of Radiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Xiangmei Zhan
- Department of Radiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Min Xie
- Department of Radiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Mingcong Luo
- Department of Radiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Lilan She
- Department of Radiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Yunjing Xue
- Department of Radiology, Affiliated Hospital of Putian College, Putian, Fujian, China
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Morrow M. Is Axillary Staging Obsolete in Early Breast Cancer? Surg Oncol Clin N Am 2023; 32:675-691. [PMID: 37714636 DOI: 10.1016/j.soc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
This article reviews the incidence of nodal metastases in early-stage breast cancer and the need for axillary staging to maintain local control in the axilla or to determine the need for adjuvant systemic therapy across the spectrum of patients with breast cancer, and reviews clinical trials addressing this question. At present, sentinel lymph node biopsy should be omitted in women age ≥70 years with cT1-2 N0, HR+/HER2- cancers. The importance of nodal status in selecting patients for radiotherapy remains the main reason for axillary staging in younger postmenopausal women with cT1-2N0, HR+/HER2- cancers.
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
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Balbaloglu H, Tasdoven I, Karadeniz Cakmak G. Can inflammatory indices predict sentinel lymph node status in patients with early-stage breast cancer? Medicine (Baltimore) 2023; 102:e34808. [PMID: 37603529 PMCID: PMC10443763 DOI: 10.1097/md.0000000000034808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
Breast cancer research has focused on the early detection and treatment of breast cancer. Axillary lymph node status is essential for primary breast cancer staging, recurrence, and survival. The current quest for precision medicine is to identify predictive markers that offer the advantage of individualized treatment options. This study aimed to investigate the value of inflammatory indices in predicting positive sentinel nodes in breast cancer. We studied 602 patients with early-stage breast cancer who underwent sentinel lymph node biopsies (SLNB) at the Bülent Ecevit University General Surgery Clinic. We obtained data, including the clinical and demographic characteristics of the patients, such as age, histological type, and sentinel lymph nodes. Neutrophil, lymphocyte, platelet, and monocyte counts were obtained from preoperative complete blood count test data from the patient registry. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory index (SII), and sentinel lymph node biopsy were analyzed. Sentinel LAP was negative in 391 (65%) patients and positive in 211 (35%). In the receiver operating characteristic curve analysis, no significant difference was found between SLNB positivity and negativity in terms of NLR, PLR, LMR, or SII. In contrast to previous research, NLR, PLR, LMR, or SII did not affect SLNB positivity prediction in our study.
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Affiliation(s)
- Hakan Balbaloglu
- Bulent Ecevit University, School of Medicine, Department of General Surgery, Zonguldak, Turkey
| | - Ilhan Tasdoven
- Bulent Ecevit University, School of Medicine, Department of General Surgery, Zonguldak, Turkey
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Wu X, Guo Y, Sa Y, Song Y, Li X, Lv Y, Xing D, Sun Y, Cong Y, Yu H, Jiang W. Contrast-Enhanced Spectral Mammography-Based Prediction of Non-Sentinel Lymph Node Metastasis and Axillary Tumor Burden in Patients With Breast Cancer. Front Oncol 2022; 12:823897. [PMID: 35615151 PMCID: PMC9125761 DOI: 10.3389/fonc.2022.823897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo establish and evaluate non-invasive models for estimating the risk of non-sentinel lymph node (NSLN) metastasis and axillary tumor burden among breast cancer patients with 1–2 positive sentinel lymph nodes (SLNs).Materials and MethodsBreast cancer patients with 1–2 positive SLNs who underwent axillary lymph node dissection (ALND) and contrast-enhanced spectral mammography (CESM) examination were enrolled between 2018 and 2021. CESM-based radiomics and deep learning features of tumors were extracted. The correlation analysis, least absolute shrinkage and selection operator (LASSO), and analysis of variance (ANOVA) were used for further feature selection. Models based on the selected features and clinical risk factors were constructed with multivariate logistic regression. Finally, two radiomics nomograms were proposed for predicting NSLN metastasis and the probability of high axillary tumor burden.ResultsA total of 182 patients [53.13 years ± 10.03 (standard deviation)] were included. For predicting the NSLN metastasis status, the radiomics nomogram built by 5 selected radiomics features and 3 clinical risk factors including the number of positive SLNs, ratio of positive SLNs, and lymphovascular invasion (LVI), achieved the area under the receiver operating characteristic curve (AUC) of 0.85 [95% confidence interval (CI): 0.71–0.99] in the testing set and 0.82 (95% CI: 0.67–0.97) in the temporal validation cohort. For predicting the high axillary tumor burden, the AUC values of the developed radiomics nomogram are 0.82 (95% CI: 0.66–0.97) in the testing set and 0.77 (95% CI: 0.62–0.93) in the temporal validation cohort.DiscussionCESM images contain useful information for predicting NSLN metastasis and axillary tumor burden of breast cancer patients. Radiomics can inspire the potential of CESM images to identify lymph node metastasis and improve predictive performance.
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Affiliation(s)
- Xiaoqian Wu
- Department of Biomedical Engineering, School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Yu Guo
- Department of Biomedical Engineering, School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Yu Sa
- Department of Biomedical Engineering, School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Yipeng Song
- Department of Radiotherapy, Yantai Yuhuangding Hospital, Yantai, China
| | - Xinghua Li
- Department of Radiotherapy, Yantai Yuhuangding Hospital, Yantai, China
| | - Yongbin Lv
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Dong Xing
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yan Sun
- Department of Otorhinolaryngology–Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Yizi Cong
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Wei Jiang, ; Yizi Cong, ; Hui Yu,
| | - Hui Yu
- Department of Biomedical Engineering, School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- *Correspondence: Wei Jiang, ; Yizi Cong, ; Hui Yu,
| | - Wei Jiang
- Department of Biomedical Engineering, School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Department of Radiotherapy, Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Wei Jiang, ; Yizi Cong, ; Hui Yu,
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Lorek A, Steinhof-Radwańska K, Zarębski W, Lorek J, Stojčev Z, Zych J, Syrkiewicz A, Niemiec P, Szyluk K. Comparative Analysis of Postoperative Complications of Sentinel Node Identification Using the SentiMag ® Method and the Use of a Radiotracer in Patients with Breast Cancer. Curr Oncol 2022; 29:2887-2894. [PMID: 35621625 PMCID: PMC9139760 DOI: 10.3390/curroncol29050235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: The purpose of the study was a retrospective, comparative assessment of complications of the surgical sentinel node biopsy (SNB) procedure in breast cancer using the radiotracer method and the SentiMag® method on groups of patients after 3.5 years of use. (2) Methods: The material was a group of 345 patients with primary surgical breast cancer who underwent the SNB procedure with the use of a radiotracer in combination with wide local excision (WLE), simple amputation (SA) with SNB and an independent SNB procedure in the period from May 2018 to January 2021 in the Department of Oncological Surgery. Of the patients who were monitored in the Hospital Outpatient Clinic, 300 were enrolled. The analyzed group was compared in terms of the occurrence of the same complications with the group of 303 patients also operated on in our center in the period from January 2014 to September 2017, in which SN identification was performed using the SentiMag® method. (3) Results: The most common complications found were sensation disorders in the arm, which occurred in 16 (14.1%) patients using the radiotracer method, SentiMag®-11 (9.9%). By comparing the complication rate between the methods with the radiotracer (n = 300) and SentiMag® (n = 303), no significant differences were found. (4) Conclusions: Sentinel node (SN) identification using the radiotracer method and the SentiMag® method are comparable diagnostic methods in breast cancer, with a low risk of complications.
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Affiliation(s)
- Andrzej Lorek
- Department of Oncological Surgery, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland;
| | - Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Wojciech Zarębski
- Department of Oncological Surgery, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland;
| | - Joanna Lorek
- Department of Surgery, Ludwig Rydygier Hospital sp. z.o.o., 31-826 Krakow, Poland;
| | - Zoran Stojčev
- Teaching Department of Oncology and Breast Diseases, Central Teaching Hospital of the Ministry of Internal Affairs and Administration, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jacek Zych
- Medical Faculty, Medical University of Silesia in Katowice, 40-514 Katowice, Poland; (J.Z.); (A.S.)
| | - Aleksandra Syrkiewicz
- Medical Faculty, Medical University of Silesia in Katowice, 40-514 Katowice, Poland; (J.Z.); (A.S.)
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 KatowiSce, Poland;
- Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, 41-940 Piekary Śląskie, Poland
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Qiu Y, Zhang X, Wu Z, Wu S, Yang Z, Wang D, Le H, Mao J, Dai G, Tian X, Zhou R, Huang J, Hu L, Shen J. MRI-Based Radiomics Nomogram: Prediction of Axillary Non-Sentinel Lymph Node Metastasis in Patients With Sentinel Lymph Node-Positive Breast Cancer. Front Oncol 2022; 12:811347. [PMID: 35296027 PMCID: PMC8920306 DOI: 10.3389/fonc.2022.811347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Overtreatment of axillary lymph node dissection (ALND) may occur in patients with axillary positive sentinel lymph node (SLN) but negative non-SLN (NSLN). Developing a magnetic resonance imaging (MRI)-based radiomics nomogram to predict axillary NSLN metastasis in patients with SLN-positive breast cancer could effectively decrease the probability of overtreatment and optimize a personalized axillary surgical strategy. Methods This retrospective study included 285 patients with positive SLN breast cancer. Fifty five of them had metastatic NSLNs and 230 had non-metastatic NSLNs. MRI-based radiomic features of primary tumors were extracted and MRI morphologic findings of the primary tumor and axillary lymph nodes were assessed. Four models, namely, a radiomics signature, an MRI-clinical nomogram, and two MRI-clinical-radiomics nomograms were established based on MRI morphologic findings, clinicopathologic characteristics, and MRI-based radiomic features to predict the NSLN status. The optimal predictors in each model were selected using the 5-fold cross-validation (CV) method. Their predictive performances were determined by the receiver operating characteristic (ROC) curves analysis. The area under the curves (AUCs) of different models was compared by the Delong test. Their discrimination capability, calibration curve, and clinical usefulness were also assessed. Results The 5-fold CV analysis showed that the AUCs ranged from 0.770 to 0.847 for the radiomics signature, from 0.720 to 0.824 for the MRI-clinical nomogram, from 0.843 to 0.932 for the MRI-clinical-radiomics nomogram. The optimal predictive factors in the radiomics signature, MRI-clinical nomogram, and MRI-clinical-radiomics nomogram were one texture feature of diffusion-weighted imaging (DWI), two clinicopathologic features together with one MRI morphologic finding, and the DWI-based texture feature together with the two clinicopathologic features plus the one MRI morphologic finding, respectively. The MRI-clinical-radiomics nomogram with CA 15-3 included achieved the highest AUC compared with the radiomics signature (0.868 vs. 0.806, P <0.001) and MRI-clinical nomogram (0.868 vs. 0.761; P <0.001). In addition, the MRI-clinical-radiomics nomogram without CA 15-3 showed a higher performance than that of the radiomics signature (AUC, 0.852 vs. 0.806, P = 0.016) and the MRI-clinical nomogram (AUC, 0.852 vs. 0.761, P = 0.007). The MRI-clinical-radiomics nomograms showed good discrimination and good calibration. Decision curve analysis demonstrated that the MRI-clinical-radiomics nomograms were clinically useful. Conclusion The MRI-clinical-radiomics nomograms developed in our study showed high predictive performance, which can be used to predict the axillary NSLN status in SLN-positive breast cancer patients before surgery.
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Affiliation(s)
- Ya Qiu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
- Department of Radiology, the First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Xiang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Zhiyuan Wu
- School of Public Health, Capital Medical University, Beijing, China
| | - Shiji Wu
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Ultrasound, the First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Zehong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Dongye Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Hongbo Le
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Jiaji Mao
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Guochao Dai
- Department of Radiology, the First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Xuwei Tian
- Department of Radiology, the First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Renbing Zhou
- Department of Radiology, the First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Jiayi Huang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Lanxin Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Guangzhou, China
- *Correspondence: Jun Shen,
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Zeng R, Zhang X, Zheng C, Du JH, Gao Z, Jun W, Shen J, Lu Y. Decoupling convolution network for characterizing the metastatic lymph nodes of breast cancer patients. Med Phys 2021; 48:3679-3690. [PMID: 33825207 DOI: 10.1002/mp.14876] [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: 05/08/2020] [Revised: 02/15/2021] [Accepted: 03/29/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The dual-energy computed tomography (DECT) technique is an emerging imaging tool that can better characterize material features and has the potential to be a noninvasive means of predicting lymph node metastasis. The purpose of this study was to establish a DECT-specified quantitative approach based on a neural network to characterize the sentinel lymph node (SLN). METHODS With IRB approval, we retrospectively collected a total of 229 patients (100/229 metastasis) with biopsy proven breast cancer in this study. The chest and axillary spectral CT examinations were performed prior to the axillary lymph node (ALN) surgery. A decoupling convolution network with 11 ROIs from sequential keV (40 to 140 keV with 10 keV increment) was proposed to explicitly extract the spectral and spatial features in a DECT to predict the lymph node status. Focal loss was introduced as the loss function. The metric of the slope of the spectral Hounsfield unit curve measured at the venous phase was used as the baseline approach in comparison to our approach. In additional, a logistic model with radiomic features was also compared to our approach. The area under ROC curve (AUC) was used as the figure of merit to evaluate the classification performance. RESULTS By introducing spectral convolution and focal loss, AUC on test set could be improved by 0.15 and 0.01 separately. Compared to the slope of the spectral curve with the average AUC of 0.611 and radiomic model with AUC of 0.825, the proposed approach demonstrates a considerably better performance, with test set AUC value of 0.837, by using decoupling spectral and spatial convolution together with focal loss function. CONCLUSIONS We presented a new decoupling neural network based quantification method for DECT analysis, which might have potential as a noninvasive tool to predict metastasis lymph node status for breast cancer in clinical practice.
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Affiliation(s)
- Rutong Zeng
- School of Mathematics, Sun Yat-sen University, Guangzhou, 510275, P.R. China.,Guangdong Province Key Laboratory of Computational Science, Sun Yat-sen University, Guangzhou, 510275, P.R. China
| | - Xiang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, P.R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, P.R. China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, P.R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, P.R. China
| | - Jin-Hong Du
- School of Mathematics, Sun Yat-sen University, Guangzhou, 510275, P.R. China
| | - Zixiong Gao
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, 510275, P.R. China
| | - Wei Jun
- Perception Vision Medical Technology, Inc, Guangzhou, 510275, P.R. China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, P.R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, P.R. China
| | - Yao Lu
- Guangdong Province Key Laboratory of Computational Science, Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, 510275, P.R. China.,Shanghai University of Medicine & Health Sciences, Shanghai, 201218, P.R. China
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10
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Evaluation of Late Postural Complications in Breast Cancer Patients Undergoing Breast-Conserving Therapy in Relation to the Type of Axillary Intervention-Cross-Sectional Study. J Clin Med 2021; 10:jcm10071432. [PMID: 33916060 PMCID: PMC8036801 DOI: 10.3390/jcm10071432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of the study was to evaluate posture in patients undergoing breast-conserving therapy (BCT) in relation to the type of surgical intervention to the axilla. Methods: The study was conducted on patients who had undergone breast-conserving surgical treatment for breast cancer 5–6 years earlier. In 54 patients, BCT+ALND (axillary lymph node dissection) was performed, while 63 patients were subjected to BCT+SLND (sentinel lymph node dissection). The control group consisted of 54 females. The study was conducted using digital postural assessment. Results: No statistically significant differences were observed with respect to the parameters between the BCT+SLNB and BCT+ALND groups (p > 0.05). However, the differences were highly significant between the CG (control group) and the studied groups (BCT+ALND, BCT+SLNB) for the following parameters: BETA angle of thoracolumbar spine inclination (p = 0.002), GAMMA angle of thoracic spine inclination (p = 0.0044), TKA (thoracic kyphosis angle) (p < 0.0001) and shoulder level inclination (p = 0.0004). The BCT+ALND patients were characterized by higher dependency of raised shoulder (p = 0.0028) and inferior angle of the scapula (p = 0.00018) on the operated side compared to BCT+SLNB patients. Conclusions: Postural imbalance occurs independent of the type of axillary intervention. Disturbances within the upper torso (abnormal position of shoulders and inferior angles of scapulae) are more pronounced in patients after ALND.
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11
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Zhang X, Yang Z, Cui W, Zheng C, Li H, Li Y, Lu L, Mao J, Zeng W, Yang X, Zheng J, Shen J. Preoperative prediction of axillary sentinel lymph node burden with multiparametric MRI-based radiomics nomogram in early-stage breast cancer. Eur Radiol 2021; 31:5924-5939. [PMID: 33569620 DOI: 10.1007/s00330-020-07674-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To develop and validate a multiparametric MRI-based radiomics nomogram for pretreatment predicting the axillary sentinel lymph node (SLN) burden in early-stage breast cancer. METHODS A total of 230 women with early-stage invasive breast cancer were retrospectively analyzed. A radiomics signature was constructed based on preoperative multiparametric MRI from the training dataset (n = 126) of center 1, then tested in the validation cohort (n = 42) from center 1 and an external test cohort (n = 62) from center 2. Multivariable logistic regression was applied to develop a radiomics nomogram incorporating radiomics signature and predictive clinical and radiological features. The radiomics nomogram's performance was evaluated by its discrimination, calibration, and clinical use and was compared with MRI-based descriptors of primary breast tumor. RESULTS The constructed radiomics nomogram incorporating radiomics signature and MRI-determined axillary lymph node (ALN) burden showed a good calibration and outperformed the MRI-determined ALN burden alone for predicting SLN burden (area under the curve [AUC]: 0.82 vs. 0.68 [p < 0.001] in training cohort; 0.81 vs. 0.68 in validation cohort [p = 0.04]; and 0.81 vs. 0.58 [p = 0.001] in test cohort). Compared with the MRI-based breast tumor combined descriptors, the radiomics nomogram achieved a higher AUC in test cohort (0.81 vs. 0.58, p = 0.005) and a comparable AUC in training (0.82 vs. 0.73, p = 0.15) and validation (0.81 vs. 0.65, p = 0.31) cohorts. CONCLUSION A multiparametric MRI-based radiomics nomogram can be used for preoperative prediction of the SLN burden in early-stage breast cancer. KEY POINTS • Radiomics nomogram incorporating radiomics signature and MRI-determined ALN burden outperforms the MRI-determined ALN burden alone for predicting SLN burden in early-stage breast cancer. • Radiomics nomogram might have a better predictive ability than the MRI-based breast tumor combined descriptors. • Multiparametric MRI-based radiomics nomogram can be used as a non-invasive tool for preoperative predicting of SLN burden in patients with early-stage breast cancer.
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Affiliation(s)
- Xiang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China
| | - Zehong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China
| | - Wenju Cui
- Medical Imaging Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88 Keling Road, Suzhou, 215163, People's Republic of China.,Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, No. 99 Shangda Road, Shanghai, 200444, People's Republic of China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China
| | - Haojiang Li
- Department of Radiology, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Yudong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China
| | - Liejing Lu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China
| | - Jiaji Mao
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China
| | - Weike Zeng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China
| | - Xiaodong Yang
- Medical Imaging Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88 Keling Road, Suzhou, 215163, People's Republic of China
| | - Jian Zheng
- Medical Imaging Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88 Keling Road, Suzhou, 215163, People's Republic of China.
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China. .,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, People's Republic of China.
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12
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Vafa S, Zarrati M, Malakootinejad M, Totmaj AS, Zayeri F, Salehi M, Sanati V, Haghighat S. Calorie restriction and synbiotics effect on quality of life and edema reduction in breast cancer-related lymphedema, a clinical trial. Breast 2020; 54:37-45. [PMID: 32898787 PMCID: PMC7486474 DOI: 10.1016/j.breast.2020.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/24/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little evidence exists regarding the clinical value of synbiotics in the management of post-treatment complications of breast cancer especially breast cancer-related lymphedema (BCRL). This study aimed to investigate the effects of synbiotic supplementation along with calorie restriction on quality of life and edema volume in patients with BCRL. METHODS This randomized, placebo-controlled, clinical trial was conducted on 135 overweight and obese women with BCRL aged 18-65 years old. Participants were randomly allocated to receive a calorie-restricted diet plus 109 CFU synbiotic supplement (CRS group; n = 45) or placebo (CRP group; n = 45), daily for 10 weeks. Also, a control group (n = 45) with no intervention was included in the trial. All of the participants received Complete Decongestive Therapy for lymphedema treatment. The quality of life score, edema volume and body mass index (BMI) were measured at baseline and end of the trial. RESULTS A total of 121 subjects completed the trial. CRS group showed a significant decrease in the total quality of life score (P = 0.004), and it's psychosocial (P = 0.022) and functional (P = 0.002) domain scores, as well as edema volume (P = 0.002) and BMI (P < 0.001) in comparison to the control. However, there were no significant differences in changes in trial outcomes between the CRS and CRP groups. CONCLUSION Synbiotic supplementation along with a low-calorie diet was effective in quality of life, edema volume, and BMI improvement; mostly due to low-calorie diet. It seems that adding a dietitian consultation on the lymphedema management strategy may provide a better result in lymphedema control.
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Affiliation(s)
- Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Marjan Malakootinejad
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Saneei Totmaj
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Proteomics Research Center and Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Health, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Sanati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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13
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Ostos-Díaz B, Casuso-Holgado MJ, Muñoz-Fernández MJ, Carazo AF, Martín-Valero R, Medrano-Sánchez EM. Early Physical Rehabilitation after Sentinel Lymph Node Biopsy in Breast Cancer: Is It Feasible and Safe? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228382. [PMID: 33198359 PMCID: PMC7697742 DOI: 10.3390/ijerph17228382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
Abstract
The primary purpose of this research was to investigate the feasibility and safety of delivering an early supervised physical therapy intervention to women after sentinel lymph node biopsy (SLNB); furthermore, we aimed to provide explorative data on its effects. This was a single-site feasibility study. Pre- and post-evaluation was conducted from baseline to follow-up at 6 months. Primary outcomes were participant recruitment, participant retention, compliance with the intervention, and safety. Secondary outcomes were shoulder range of motion, handgrip strength, upper limb pain and disability, scar recovery, quality of life, and the incidence of axillary web syndrome (AWS) and/or lymphoedema. A total of 43 participants (mean age 55.37 years) completed the trial and the follow-up period. A total of 91% of women who met the inclusion criteria agreed to participate, and the adherence rate was 80%. No adverse events were reported. Incidence of AWS was 9.3%, and there was no incidence of lymphoedema at 6 months. Our results support that this intervention is feasible and safe. The results presented in this study also provide preliminary evidence for the use of a rehabilitation program as a supportive intervention after SLNB, but future research on effectiveness is needed.
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Affiliation(s)
- Beatriz Ostos-Díaz
- Department of Physiotherapy, University of Sevilla, 41009 Sevilla, Spain; (B.O.-D.); (M.J.M.-F.)
| | - María Jesús Casuso-Holgado
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
- Correspondence: ; Tel.: +34-95-448-65-21; Fax: +34-95-448-65-27
| | | | - Ana F. Carazo
- Department of Economy, Quantitative Methods and Economy History, Pablo de Olavide University, 41013 Sevilla, Spain;
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Málaga, Spain;
| | - Esther M. Medrano-Sánchez
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
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14
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Lee SB, Gwark SC, Kang CM, Sohn G, Kim J, Chung IY, Lee JW, Kim HJ, Ko BS, Ahn SH, Kim W, Do J, Jeon JY, Kim J, Um E, in Yoon T, Jung SU, Han M, Son BH. The effects of poloxamer and sodium alginate mixture (Guardix-SG®) on range of motion after axillary lymph node dissection: A single-center, prospective, randomized, double-blind pilot study. PLoS One 2020; 15:e0238284. [PMID: 32966294 PMCID: PMC7510996 DOI: 10.1371/journal.pone.0238284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/11/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Restricted shoulder mobility is a major upper extremity dysfunction associated with lower quality of life and disability after breast cancer surgery. We hypothesized that a poloxamer and sodium alginate mixture (Guardix-SG®) applied after axillary lymph node dissection (ALND) would significantly improve shoulder range of motion (ROM) in patients with breast cancer. METHODS We conducted a double-blind, randomized, prospective study to evaluate the clinical efficacy and safety of Guardix-SG® for the prevention of upper extremity dysfunction after ALND. The primary outcome measure was shoulder ROM at baseline (T0) and 3 (T1), 6 (T2), and 12 months (T3) after surgery. Secondary outcome measures were the Disabilities of the Arm, Shoulder, and Hand score(DASH), pain associated with movement, which was assessed using a numeric rating scale, and lymphedema assessed using body composition analyzer. RESULTS A total of 83 women with breast cancer were randomly assigned to either the Guardix-SG® group or the control group. In the Guardix-SG® group (n = 37), Guardix-SG® was applied to the axillary region after ALND. In the control group (n = 46), ALND was performed without using Guardix-SG®. Comparing ROM for shoulder flexion before surgery (178.2°) and 12 months after surgery (172.3°), that was restored 12 months after surgery in the Guardix-SG® group, and there was no statistically significant difference between that at before surgery and 12 months after surgery (p = 0.182). No adverse effect was observed in either group. CONCLUSIONS The results of this study have shown that Guardix-SG® help improve shoulder ROM without causing adverse effects in patients who underwent breast cancer surgery. However, there was no statistically significant difference from the control group. A further large-scale study is needed to obtain a more conclusive conclusion. TRIAL REGISTRATION CRISKCT0003386; https://cris.nih.go.kr (20181207).
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Affiliation(s)
- Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-chan Gwark
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Min Kang
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Guiyun Sohn
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Kim
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Junghwa Do
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jinsung Kim
- Division of Breast Surgery, Department of Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Eunhae Um
- Department of Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Tae in Yoon
- Division of Breast Surgery, Department of Surgery, Dongnam institute of Radiological and medical science, Busan, Korea
| | - Sung-ui Jung
- Division of Breast Surgery, Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
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15
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De Groef A, De Vrieze T, Dams L, Penen F, Van der Gucht E, Van Assche B, Verhaeghe V, Devoogdt N. Reliability and validity of a Dutch Lymphoedema Questionnaire: Cross-cultural validation of the Norman Questionnaire. Eur J Cancer Care (Engl) 2020; 29:e13242. [PMID: 32410258 DOI: 10.1111/ecc.13242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/05/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To perform the cross-cultural validation process of the Dutch Norman Questionnaire (NQ), a questionnaire for the detection and characterisation of breast-cancer related lymphoedema (BCRL) using self-reported signs and symptoms. METHODS Test-retest reliability and construct (including convergent, divergent and known-groups validity), face and content validity were examined in breast cancer patients with (n = 30) and without (n = 30) lymphoedema. For concurrent validity, first, agreement between the diagnostic item of the NQ and a clinical diagnosis were analysed. Second, correlations between NQ scores and clinical arm volume assessment were tested. RESULTS Test-retest reliability was found to be strong to very strong (ICC 0.79-0.96) in the lymphoedema group and moderate to very strong ( ICC 0.64-0.99) in the non-lymphoedema group. Seventeen out of 20 hypotheses on convergent and divergent validity were accepted. There was good face, content and known-groups validity as well. For concurrent validity, agreement between evaluation methods was only 0.462. Moderate correlations were found between 6 out of 9 symptom scores (r = 0.422-0.630) of the NQ and clinical assessment. CONCLUSION The Dutch NQ is a reliable and valid questionnaire for the characterisation of BCRL using self-reported signs and symptoms. Only moderate agreement for the detection of BCRL was found.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Frauke Penen
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Brecht Van Assche
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Vincent Verhaeghe
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphoedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
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16
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Li H, Jun Z, Zhi-Cheng G, Xiang Q. Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer. J Int Med Res 2019; 47:4841-4853. [PMID: 31507208 PMCID: PMC6833398 DOI: 10.1177/0300060519827413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective This study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer. Methods A total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB. Results The identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively. Conclusions SLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.
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Affiliation(s)
- Huang Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Breast Surgery Ward No. 3, The Affiliated Tumor Hospital of Shanxi Medical University, Shanxi Tumor Hospital, Taiyuan, Shanxi, China
| | - Zhang Jun
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ge Zhi-Cheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qu Xiang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Chrischilles EA, Riley D, Letuchy E, Koehler L, Neuner J, Jernigan C, Gryzlak B, Segal N, McDowell B, Smith B, Sugg SL, Armer JM, Lizarraga IM. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat 2019; 175:675-689. [PMID: 30852760 PMCID: PMC6534523 DOI: 10.1007/s10549-019-05184-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL. METHODS Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener. RESULTS Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction. CONCLUSIONS A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
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Affiliation(s)
- Elizabeth A Chrischilles
- University of Iowa College of Public Health, Iowa City, IA, USA.
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA.
- College of Public Health, University of Iowa, S424 CPHB, 145 N. Riverside Dr., Iowa City, IA, 52242-2007, USA.
| | - Danielle Riley
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Elena Letuchy
- University of Iowa College of Public Health, Iowa City, IA, USA
| | | | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brian Gryzlak
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Neil Segal
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley McDowell
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Brian Smith
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Sonia L Sugg
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Ingrid M Lizarraga
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Navaei M, Haghighat S, Janani L, Vafa S, Saneei Totmaj A, Raji Lahiji M, Emamat H, Salehi Z, Amirinejad A, Izad M, Zarrati M. The Effects of Synbiotic Supplementation on Antioxidant Capacity and Arm Volumes in Survivors of Breast Cancer-Related Lymphedema. Nutr Cancer 2019; 72:62-73. [PMID: 31135225 DOI: 10.1080/01635581.2019.1616781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background and Aims: Synbiotics found to be beneficial in breast cancer survivors (BCSs) through its antioxidant properties. The aim of this study was to assess the effects of synbiotic supplementation on edema volume and some oxidative markers among obese and overweight patients with BCRL.Method: This randomized double-blind, placebo-controlled trial was conducted on 88 overweight and obese BCSs aged 18-65 years. All the subjects were given a specified low-calorie diet (LCD) and were randomly assigned into two groups to intake 109 CFU/day synbiotic supplement (n = 44) or placebo (n = 44) for 10 wk. Edema volume and serum total antioxidant capacity (TAC), malondialdehyde (MDA), glutathione peroxidase (GPx), and superoxide dismutase (SOD) concentration were measured at baseline and after the 10-wk intervention.Results: Ten-wk supplementation with synbiotics leads to a significant reduction in serum MDA levels (P = 0.001) and an increase in serum SOD concentration (P = 0.007) compared to placebo. No significant changes were observed in serum GPx, TAC, and edema volume between groups.Conclusion: Our findings reveal that 10-wk synbiotic supplementation along with a LCD program-reduced serum MDA levels and elevate the activity of SOD in overweight and obese patients with BCRL. However, its effect on serum GPx, TAC, and edema volume was not significant.
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Affiliation(s)
- Mehraban Navaei
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran Iran
| | - Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran
| | - Ali Saneei Totmaj
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran
| | - Mahsa Raji Lahiji
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran
| | - Hadi Emamat
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Salehi
- Immunology Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Amirinejad
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran
| | - Maryam Izad
- Immunology Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran
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Verbelen H, Tjalma W, Meirte J, Gebruers N. Long-term morbidity after a negative sentinel node in breast cancer patients. Eur J Cancer Care (Engl) 2019; 28:e13077. [PMID: 31050088 DOI: 10.1111/ecc.13077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/26/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Morbidity after sentinel lymph node biopsy is often underestimated. The aim of this study was to inventory arm and shoulder complaints in sentinel node-negative breast cancer patients post-surgery after long-term follow-up. METHODS Sentinel node-negative breast cancer patients with at least 2 years of follow-up after surgery were included in this study. Self-reported arm and shoulder morbidities were assessed using a survey. Patients (n = 126) were asked if they ever developed complaints, if these complaints were still present and whether they were ever treated for these complaints. RESULTS After a mean follow-up of 55.5 months (range 25-86 months), the prevalence of the self-reported arm and shoulder complaints was 25.8% for pain, 12.0% for numbness, 6.4% for paraesthesias, 7.1% for lymphedema, 8.0% for axillary web syndrome, 26.2% for loss of strength and 19.5% for limitations in range of motion. About 38.1% of the patients were treated by a physical therapist concerning the experienced complaints after SLNB. CONCLUSION Up to 7 years post-surgery a considerable amount of sentinel node-negative patients still suffer from arm and shoulder complaints. These complaints affect the activities of daily living. Therefore, more research is needed regarding the value of early detection and treatment of these complaints.
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Affiliation(s)
- Hanne Verbelen
- Department of Rehabilitation Sciences and Physiotherapy REVAKI-MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic Antwerp, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Oedema Clinic, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jill Meirte
- Department of Rehabilitation Sciences and Physiotherapy REVAKI-MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy REVAKI-MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Oedema Clinic, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Upper-Limb Morbidity in Patients Undergoing a Rehabilitation Program After Breast Cancer Surgery: A 10-Year Follow-up Study. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Falco M, Masojć B, Byrski T, Kram A. The diameter of metastasis in positive sentinel lymph node biopsy affects axillary tumor load in early breast cancer. Asia Pac J Clin Oncol 2019; 15:121-127. [PMID: 30761763 DOI: 10.1111/ajco.13113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/20/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Omission of axillary lymph node dissection (ALND) after positive sentinel lymph biopsy (SLNB) has become a standard procedure for breast cancer patients with one or two metastatic lymph nodes. Here the aim was model development for selection for ALND. MATERIAL AND METHODS We analyzed 323 positive SLNB breast cancer patients, who afterwards underwent ALND. In 126 (39%), there were positive additional axillary lymph nodes. Specimens of resected lymph nodes were scanned and the volumes of tumors (expressed as diameter in mm) were calculated. The maximal diameter of metastasis in the sentinel lymph nodes (SLNDmax ) and axillary lymph nodes (ALNDsum ) indicated tumor load in the resected lymph nodes. ALNDsum higher or equal to 5 mm was defined as high and present in 62 patients (21%). RESULTS Risk factors for high ALNDsum were primary tumor diameter (P = 0.0092), histopathological type (P = 0.0173), number of positive SLNs (P = 0.0012), type of metastasis (P = 0.0025), molecular type (P = 0.0037), SLNDmax (P = 0.0001), and Her-2 status (P = 0.0093). Independent variables for high ALNDsum were SLNDmax (P < 0.0001), number of positive SLNs (P = 0.0237) and primary tumor diameter (P = 0.0296). CONCLUSIONS Twenty-one percent patients with positive SLNB are at risk of high ALNDsum . SLNDmax is the strong predictive factor for high ALNDsum after positive ALND.
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Affiliation(s)
- Michał Falco
- Radiation Oncology Department, West Pomeranian Oncology Center, Szczecin, Poland
| | - Bartłomiej Masojć
- Radiation Oncology Department, West Pomeranian Oncology Center, Szczecin, Poland
| | - Tomasz Byrski
- Department of Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Kram
- Pathology Department, West Pomeranian Oncology Center, Szczecin, Poland
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Li J, Ma W, Jiang X, Cui C, Wang H, Chen J, Nie R, Wu Y, Li L. Development and Validation of Nomograms Predictive of Axillary Nodal Status to Guide Surgical Decision-Making in Early-Stage Breast Cancer. J Cancer 2019; 10:1263-1274. [PMID: 30854136 PMCID: PMC6400691 DOI: 10.7150/jca.32386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose: To develop and validate nomogram models using noninvasive imaging parameters with related clinical variables to predict the extent of axillary nodal involvement and stratify treatment options based on the essential cut-offs for axillary surgery according to the ACOSOG Z0011 criteria. Materials and Methods: From May 2007 to December 2017, 1799 patients who underwent preoperative breast and axillary magnetic resonance imaging (MRI) were retrospectively studied. Patients with data on axillary ultrasonography (AUS) were enrolled. The MRI images were interpreted according to Breast Imaging Reporting and Data system (BI-RADS). Using logistic regression analyses, nomograms were developed to visualize the associations between the predictors and each lymph node (LN) status endpoint. Predictive performance was assessed based on the area under the receiver operating characteristic curve (AUC). Bootstrap resampling was performed for internal validation. Goodness-of-fit of the models was evaluated using the Hosmer-Lemeshow test. Results: Of 397 early breast cancer patients, 200 (50.4%) had disease-free axilla, 119 (30.0%) had 1 or 2 positive LNs, and 78 (19.6%) had ≥3 positive LNs. Patient age, MRI features (mass margin, LN margin, presence/absence of LN hilum, and LN symmetry/asymmetry), and AUS descriptors (presence of cortical thickening or hilum) were identified as predictors of nodal disease. Nomograms with these predictors showed good calibration and discrimination; the AUC was 0.809 for negative axillary node (N0) vs. any LN metastasis, 0.749 for 1 or 2 involved nodes vs. N0, and 0.874 for ≥3 nodes vs. ≤2 metastatic nodes. The predictive ability of the 3 nomograms with additional pathological variables was significantly greater. Conclusion: The nomograms could predict the extent of ALN metastasis and facilitate decision-making preoperatively.
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Affiliation(s)
- Jiao Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Weimei Ma
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Xinhua Jiang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Chunyan Cui
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Hongli Wang
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jiewen Chen
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Runcong Nie
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Yaopan Wu
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Li Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
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Evaluation of distant sequelae of breast cancer treatment among patients after breast-conserving surgery depending on the type of intervention in the axillary fossa. Contemp Oncol (Pozn) 2018; 22:240-246. [PMID: 30783388 PMCID: PMC6377421 DOI: 10.5114/wo.2018.82643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022] Open
Abstract
Aim of the study The goal of this work was to assess upper-limb sequelae among patients undergoing breast-conserving therapy (BCT) for breast cancer 5-6 years after the surgical procedure. Material and methods A controlled clinical study was conducted on 128 patients who had undergone surgery 5-6 years prior. BCT + ALND (axillary lymph node dissection) was performed in 58 patients and 69 underwent BCT + SLND (sentinel lymph node dissection). Patients declared active participation in physiotherapy. The following parameters were assessed in studied subjects: range of motion in the shoulder joint, superficial sensation, upper limb circumference, skin sensation, and presence of winged scapula sign. Results Five to six years after BCT, patients who had undergone BCT + ALND presented with significantly poorer outcomes concerning upper limb range of motion on the operated side compared to the BCT + SLND group with regard to the following features: flexion (p = 0.00004), external rotation (p = 0.0292), and internal rotation (p = 0.0448). However, no statistically significant differences were noted between compared groups with regard to upper limb circumference and sensation disturbances. Statistically significant differences between limb on the operated side (operated limb - OL) vs. contralateral limb (healthy limb - HL) were noted in the BCT + SLND group with regard to the range of motion in extension (p = 0.0004), external rotation (p = 0.0055), and internal rotation (p < 0.0001), as well as the occurrence of winged scapula sign (p < 0.0001) and sensation disturbances (p < 0.0001). Conclusions Our study demonstrated that both procedures are not free of distant sequelae, although the BCT + ALND group is more frequently affected.
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The effect of training interventions on physical performance, quality of life, and fatigue in patients receiving breast cancer treatment: a systematic review. Support Care Cancer 2018; 27:109-122. [PMID: 30302542 DOI: 10.1007/s00520-018-4490-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/02/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The primary purpose of this systematic review is to structure the available evidence concerning physical exercise programs and their effects on (1) physical performance outcomes, (2) experienced fatigue, and (3) quality of life (QoL) in patients during the initial treatment for breast cancer. DATA SOURCES A systematic literature search, based upon the PRISMA guideline, up to January 1, 2018, was performed using four databases (Web of Science, Cochrane Library for Clinical Trials, PubMed, and Medline). STUDY SELECTION Inclusion criteria were as follows: (1) adults > 18 years; (2) patients with breast cancer undergoing initial treatment; (3) interventions with the aim to influence the patient's physical activity, QoL, or fatigue; (4) randomized controlled trials (RCTs) of all ages. The selected studies were scored for methodological quality, and data concerning physical performance, QoL, and fatigue were extracted. Twenty-eight RCTs were included. DATA EXTRACTION Different treatment modalities during initial treatment were identified (radiation therapy, chemotherapy, and combination therapy), as well as different types of physical training interventions (cardiovascular endurance exercise, strengthening programs, or a combination of both). Therefore, the results were clustered with regard to the above-mentioned grouping; extracting every relevant outcome related to physical performance (6 MWT or VO2peak; grip/muscle strength), QoL (questionnaires), and fatigue (questionnaires). DATA SYNTHESIS Different training programs (endurance, resistance, or a combination of both) were found. These programs were applied during different phases of initial treatment. Some programs were supervised while others were home based. Overall, most training interventions provided an improvement in physical performance and a decrease in perceived fatigue. QoL was the outcome variable least susceptible to improvement. CONCLUSION Different types of exercise programs are available for rehabilitation purposes of breast cancer patients during adjuvant therapy. Overall resistance training or resistance training in combination with CV endurance training provides the best results, especially on physical performance and perceived fatigue.
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Dong LF, Xu SY, Long JP, Wan F, Chen YD. Role of number of sentinel nodes in predicting non-sentinel node metastasis in breast cancer. J Int Med Res 2018; 46:828-835. [PMID: 29441833 PMCID: PMC5971514 DOI: 10.1177/0300060517729589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of the present study was to determine how many sentinel lymph nodes (SLNs) are appropriate for predicting non-SLN metastasis in breast cancer. Methods The association between clinicopathological features and non-SLN metastasis was retrospectively analyzed in 472 patients who underwent axillary lymph node dissection (ALND) following SLN biopsy. Another 251 patients who underwent only SLN biopsy without ALND were analyzed and followed up for 2 years. Results A large tumor size, positive SLN, and HER-2 positivity were independent predictors of non-SLN metastasis. There were significant differences in non-SLN metastasis between patients with one negative SLN and patients with an absence of negative SLNs. There was no significant difference in non-SLN metastasis between patients with one negative SLN and two or more negative SLNs. The recurrence-free survival rate for patients who did not undergo ALND was 99.6% (245/246). Conclusion Surgeons should ensure that the number of SLNs obtained is appropriate. The presence of one negative SLN is enough in SLN biopsy. Considering the invasiveness of the surgery, two or more negative SLNs may be unnecessary.
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Affiliation(s)
- Li-Feng Dong
- 1 Department of Breast, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shu-Ying Xu
- 2 Physical Examination Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jing-Pei Long
- 1 Department of Breast, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Wan
- 1 Department of Breast, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi-Ding Chen
- 3 Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Cremades M, Torres M, Solà M, Navinés J, Pascual I, Mariscal A, Caballero A, Castellà E, Luna MÁ, Julián JF. Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients. Cir Esp 2017; 95:536-541. [PMID: 29033071 DOI: 10.1016/j.ciresp.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. METHODS An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. RESULTS SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. CONCLUSION The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique.
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Affiliation(s)
- Manel Cremades
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España.
| | - Mireia Torres
- Cirugía General y Digestiva, Hospital General de Catalunya, Sant Cugat del Vallés, España
| | - Montse Solà
- Medicina Nuclear, Hospital Germans Trias i Pujol, Badalona
| | - Jordi Navinés
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | - Icíar Pascual
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | | | - Albert Caballero
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | - Eva Castellà
- Anatomía Patológica, Hospital Germans Trias i Pujol, Badalona, España
| | - Miguel Ángel Luna
- Ginecología y Obstetricia, Hospital Germans Trias i Pujol, Badalona, España
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Kozak D, Głowacka-Mrotek I, Nowikiewicz T, Siedlecki Z, Hagner W, Sowa M, Zegarski W. Analysis of Undesirable Sequelae of Sentinel Node Surgery in Breast Cancer Patients - a Prospective Cohort Study. Pathol Oncol Res 2017; 24:891-897. [PMID: 28918579 PMCID: PMC6132823 DOI: 10.1007/s12253-017-0306-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 09/04/2017] [Indexed: 12/02/2022]
Abstract
Use of sentinel lymph node biopsy limits the frequency and severity of sequelae of surgical treatment. However, the procedure itself may not be completely free of complications. The goal of this work was to analyze prospectively the occurrence of undesirable sequelae in patients undergoing sentinel lymph node biopsy as an isolated intervention in the axillary fossa. This prospective observational study was conducted on a group of 104 women. Patients were examined on five occasions: one day before the procedure, one day after the procedure, one month, three months, and six months after the procedure. At every stage of the study they were assessed for tactile sensation, range of motion in the shoulder joint, upper limb circumference, sensation abnormalities, winged scapula sign, and pain severity according to Visual Analogue Scale (VAS). In the study group we observed statistically significant differences, such as limited mobility in the shoulder joint (p ≤ 0.01), gradual increase in limb circumference on the operated side (p < 0.01) and pain (p ≤ 0.01). Despite relatively low invasiveness of the procedure, sentinel lymph node biopsy is not entirely devoid of the risk of undesirable sequelae.
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Affiliation(s)
- Dominika Kozak
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Iwona Głowacka-Mrotek
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094, Bydgoszcz, Poland.
| | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Zygmunt Siedlecki
- Department of Neurosurgery, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Wojciech Hagner
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094, Bydgoszcz, Poland
| | - Magdalena Sowa
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Department of Laser Therapy and Physiotherapy, Collegium Medicum of the Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, Tjalma W. Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: A best practice guideline. Eur J Obstet Gynecol Reprod Biol 2017; 216:245-253. [DOI: 10.1016/j.ejogrb.2017.07.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/02/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
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Zhang J, Li X, Huang R, Feng WL, Kong YN, Xu F, Zhao L, Song QK, Li J, Zhang BN, Fan JH, Qiao YL, Xie XM, Zheng S, He JJ, Wang K. A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: A nationwide, multicenter, 10-year epidemiological study. Oncotarget 2017; 8:35311-35325. [PMID: 27852049 PMCID: PMC5471057 DOI: 10.18632/oncotarget.13330] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/26/2016] [Indexed: 01/17/2023] Open
Abstract
Axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) alone may lead to postoperative complications. Among patients with positive ALN in the preoperative examination, approximately 40% patients do not have SLN metastasis. Herein, we aimed to develop a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. We retrospectively analyzed the clinicopathological features of 4211 female patients with breast cancer who were diagnosed in seven breast cancer centers representing entire China, over 10 years (1999-2008). The patients were randomly categorized into a training cohort or validation cohort (3:1 ratio). Multivariate logistic regression analysis was performed for 1869 patients with complete information on the study variables. Age at diagnosis, tumor size, tumor quadrant, clinical nodal status, local invasion status, pathological type, and molecular subtypes were the independent predictors of ALN metastasis. The nomogram was then developed using the seven variables. Further, it was subsequently validated in 642 patients with complete data on variables in the validation cohort. Coefficient of determination (R²) and the area under the receiver-operating characteristic (ROC) curve (AUC) were calculated to be 0.979 and 0.7007, showing good calibration and discrimination of the model, respectively. The false-negative rates of the nomogram were 0 and 6.9% for the predicted risk cut-off values of 14.03% and 20%, respectively. Therefore, when the predicted risk is less than 20%, SLNB may be avoided. After further validation in various patient populations, this model may support increasingly limited axillary surgery in breast cancer.
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Affiliation(s)
- Jian Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Xiao Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Rong Huang
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Wei-Liang Feng
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R. China
| | - Ya-Nan Kong
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Feng Xu
- Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, Changsha, P.R. China
| | - Lin Zhao
- Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, P.R. China
| | - Qing-Kun Song
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jing Li
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Bao-Ning Zhang
- Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Shan Zheng
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jian-Jun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Ke Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
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Głowacka-Mrotek I, Sowa M, Siedlecki Z, Nowikiewicz T, Hagner W, Zegarski W. Evaluation of changes to foot shape in females 5 years after mastectomy: a case-control study. Breast Cancer Res Treat 2017; 163:287-294. [PMID: 28271310 PMCID: PMC5410211 DOI: 10.1007/s10549-017-4183-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 12/04/2022]
Abstract
Purpose The aim of this study was to evaluate changes in foot shape of women 5 years after undergoing breast amputation. Methods Evaluation of foot shape was performed using a non-invasive device for computer analysis of the plantar surface of the foot. Obtained results were compared between feet on the healthy breast side (F1) and on the amputated breast side (F2). Results 128 women aged 63.60 ± 8.83, 5–6 years after breast amputation were enrolled in this case–control study. Weight bearing on the lower extremity on the amputated breast side (F1) compared with the healthy breast side (F2) showed statistically significant differences (p < 0.01). Patients put more weight onto the healthy breast side. No statistically significant difference was found with regard to F1 and F2 foot length (p = 0.4239), as well as BETA (p = 0.4470) and GAMMA (p = 0.4566) angles. Highly statistically significant differences were noted with respect to foot width, ALPHA angle, and Sztriter–Godunov index—higher values were observed on the healthy breast side (p < 0.001). Highly statistically significant differences were also noted while comparing Clark’s angles, higher values being observed on the operated breast side (p < 0.001). Conclusions Differences in foot shape on the healthy breast side and amputated breast side constitute a long-term negative consequence of mastectomy, and can be caused by unbalanced weight put on feet on the healthy breast side compared to the amputated breast side.
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Affiliation(s)
- Iwona Głowacka-Mrotek
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Marii Curie-Skłodowskiej 9 Street, 85-094, Bydgoszcz, Poland.
| | - Magdalena Sowa
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.,Department of Laser Therapy and Physiotherapy, Collegium Medicum of the Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Zygmunt Siedlecki
- Department of Neurosurgery, Collegium Medicum of the Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Wojciech Hagner
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Marii Curie-Skłodowskiej 9 Street, 85-094, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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Sarri AJ, Dias R, Laurienzo CE, Gonçalves MCP, Dias DS, Moriguchi SM. Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer. Onco Targets Ther 2017; 10:1451-1457. [PMID: 28331338 PMCID: PMC5348076 DOI: 10.2147/ott.s117830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Compare the lymphatic flow in the arm after breast cancer surgery and axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) using lymphos-cintigraphy (LS). PATIENTS AND METHODS A cross-sectional study with 39 women >18 years who underwent surgical treatment for unilateral breast cancer and manipulation of the axillary lymph node chain through either ALND or SLNB, with subsequent comparison of the lymphatic flow of the arm by LS. The variables analyzed were the area reached by the lymphatic flow in the upper limb and the sites and number of lymph nodes identified in the ALND or SLNB groups visualized in the three phases of LS acquisition (immediate dynamic and static images, delayed scan images). For all analyses, the level of significance was set at 5%. RESULTS There was a significant difference between the ALND and SLNB groups, with predominant visualization of lymphatic flow and/or lymph nodes in the arm and axilla (P=0.01) and extra-axillary lymph nodes (P<0.01) in the ALND group. There was no significant difference in the total number of lymph nodes identified between the two groups. However, there was a significant difference in the distribution of lymph nodes in these groups. The cubital lymph node was more often visualized in the immediate dynamic images in the ALND group (P=0.004), while the axillary lymph nodes were more often identified in the delayed scan images of the SLNB group (P<0.01). The deltopectoral lymph node was only identified in the ALND group, but with no significant difference. CONCLUSION The lymphatic flow from the axilla was redirected to alternative extra-axillary routes in the ALND group.
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Affiliation(s)
- Almir José Sarri
- Department of Physical Therapy, Barretos Cancer Hospital, Barretos
| | - Rogério Dias
- Department of Obstetrics, Gynaecology and Mastology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu
| | | | | | - Daniel Spadoto Dias
- Department of Obstetrics, Gynaecology and Mastology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu
| | - Sonia Marta Moriguchi
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
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Wariss BR, Costa RM, Pereira ACPR, Koifman RJ, Bergmann A. Axillary web syndrome is not a risk factor for lymphoedema after 10 years of follow-up. Support Care Cancer 2016; 25:465-470. [PMID: 27704260 DOI: 10.1007/s00520-016-3424-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/19/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the association between axillary web syndrome and the development of lymphoedema after 10 years of follow-up. METHODOLOGY A prospective observational study in a hospital cohort of women diagnosed with breast cancer and treated at a referral centre for cancer. Patients were followed according to the routine of the hospital's physical therapy service. In addition, a review of medical records was conducted for the period between 5 and 10 years of follow-up. Data on patient characteristics, treatment, tumour and postoperative complications were collected. RESULTS In all, 964 patients were included, mostly <65 years old (75 %) and classified as being overweight (68 %). Disease was diagnosed as being up to stage IIA in 54.9 % of the cases; 65.1% underwent mastectomy and 83.8% had total axillary dissection. As adjuvant treatment, 61 % underwent chemotherapy, 63.5 % radiotherapy and 68 % hormone therapy. Among surgical complications, 62.6 % of patients had seroma, 40.7 % had necrosis, 35.9 % axillary web syndrome and 31.4 % lymphoedema. There was no association between axillary web syndrome and the development of lymphoedema (OR = 0.87, 95 % CI 0.65 to 1.15, p = 0.329). CONCLUSION The occurrence of axillary web syndrome was not a risk factor for lymphoedema after 10 years of follow-up.
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Teguh DN, Bol Raap R, Struikmans H, Verhoef C, Koppert LB, Koole A, Huang Y, van Hulst RA. Hyperbaric oxygen therapy for late radiation-induced tissue toxicity: prospectively patient-reported outcome measures in breast cancer patients. Radiat Oncol 2016; 11:130. [PMID: 27682427 PMCID: PMC5041335 DOI: 10.1186/s13014-016-0700-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/13/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction This study examines patient reported outcome measures of women undergoing hyperbaric oxygen treatment (HBOT) after breast-conserving therapy. Method Included were 57 women treated with HBOT for late radiation-induced tissue toxicity (LRITT) referred in the period January 2014-December 2015. HBOT consisted of (on average) 47 sessions. In total, 80 min of 100 % O2 was administered under increased pressure of 2.4 ATA. Quality of life was assessed before and after treatment using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23, and a NRS pain score. Results Fifty-seven women were available for evaluation before and after treatment. Before HBOT, patients had severe complaints of pain in the arm/shoulder (46 %), swollen arm/hand (14 %), difficulty to raise arm or move it sideways (45 %), pain in the area of the affected breast (67 %), swollen area of the affected breast (45 %), oversensitivity of the affected breast (54 %), and skin problems on/in the area of the affected breast (32 %); post HBOT, severe complaints were still experienced in 17, 7, 22, 15, 13, 15, and 11 % of the women, respectively. Differences were all significant. The NRS pain score improved at least 1 point (range 0–10) in 81 % of the patients (p < 0.05). Conclusion In these breast cancer patients treated with HBOT for LRITT, the patient-reported outcomes were positive and improvements were observed. HBOT was a well-tolerated treatment for LRITT and its side-effects were both minimal and reversible.
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Affiliation(s)
- David N Teguh
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands. .,Department of Surgery/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - René Bol Raap
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands
| | - Henk Struikmans
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands.,Radiotherapy Centre West, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Cees Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arne Koole
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands
| | - Yadi Huang
- University of Leuven, Leuven, The Netherlands
| | - Rob A van Hulst
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands.,Department of Anesthesiology/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Han C, Yang L, Zuo W. A mini-review on factors and countermeasures associated with false-negative sentinel lymph node biopsies in breast cancer. Chin J Cancer Res 2016; 28:370-6. [PMID: 27478323 PMCID: PMC4949283 DOI: 10.21147/j.issn.1000-9604.2016.03.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a new surgical technique for local axillary lymph nodes (ALNs) of breast cancer. Large-scale clinical trials have confirmed that undergoing SLNB and ALN dissection (ALND) showed no significant difference for sentinel lymph node (SLN)-negative patients in terms of disease-free survival, overall survival and recurrence-free survival. However, false-negative results are still the main concern of physicians as well as patients who undergo SLNB instead of ALND. The American Society of Breast Surgeons established a task force to suggest acceptable standards for SLNB. In 2000, the task force recommended that the identification rate for SLNB be 85% or higher and the false-negative rate be 5% or lower. This review focuses on clinical factors (tumor volume, multifocal/multi-center cancers, neoadjuvant chemotherapy and skip metastasis), tracer techniques and pathological factors affecting SLNB and explores methods for reducing the false-negative rate.
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Affiliation(s)
- Chao Han
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Li Yang
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Wenshu Zuo
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
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De Groef A, Van Kampen M, Tieto E, Schönweger P, Christiaens MR, Neven P, Geraerts I, Gebruers N, Devoogdt N. Arm lymphoedema and upper limb impairments in sentinel node-negative breast cancer patients: A one year follow-up study. Breast 2016; 29:102-8. [PMID: 27479040 DOI: 10.1016/j.breast.2016.07.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/24/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study is (1) to investigate the prevalence rate of arm lymphedema, pain, impaired shoulder range of motion, strength and shoulder function one year after a sentinel lymph node biopsy (SLNB) for breast cancer and (2) to determine predictive factors for these complications. METHODS A longitudinal study was performed. One hundred patients with a sentinel-lymph node negative breast cancer were included. All patients were measured before surgery and one year after. Arm lymphedema was measured with the perimeter, pain with the Visual Analogue Scale, shoulder range of motion with an inclinometer, strength with a handheld dynamometer and shoulder function with the Disability of Arm, Shoulder and Hand questionnaire. Patient-, breast cancer- and treatment-related variables were recorded. RESULTS One year after surgery 8% of sentinel node-negative breast cancer patients had developed arm lymphedema. Fifty percent of patients had pain, 30% had an impaired shoulder range of motion, 8% had a decreased handgrip strength and 49% had an impaired shoulder function. Pain, shoulder range of motion, strength and shoulder dysfunctions changed significantly over one year (p < 0.001). Higher Body Mass Index is a predictive variable for shoulder dysfunctions one year post-SLNB. CONCLUSIONS Prevalence rate of lymphedema and other upper limb impairments may not be underestimated after SLNB. Pain, shoulder range of motion, handgrip strength and shoulder function change significantly up to one year compared to preoperative values in sentinel node-negative breast cancer patients.
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Affiliation(s)
- An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium.
| | - Marijke Van Kampen
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Elena Tieto
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Petra Schönweger
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Marie-Rose Christiaens
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Oncology Department, Department of Surgical Oncology, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Nick Gebruers
- Univeristy of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
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Shoulder Strength Changes One Year After Axillary Lymph Node Dissection or Sentinel Lymph Node Biopsy in Patients With Breast Cancer. Arch Phys Med Rehabil 2016; 97:953-63. [DOI: 10.1016/j.apmr.2015.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 12/05/2015] [Accepted: 12/10/2015] [Indexed: 11/20/2022]
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Gebruers N, Tjalma WA. Clinical feasibility of Axillary Reverse Mapping and its influence on breast cancer related lymphedema: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 200:117-22. [DOI: 10.1016/j.ejogrb.2016.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/28/2016] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
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Han C, Yang B, Zuo WS, Liu YS, Zheng G, Yang L, Zheng MZ. Prospective study found that peripheral lymph node sampling reduced the false-negative rate of sentinel lymph node biopsy for breast cancer. CHINESE JOURNAL OF CANCER 2016; 35:35. [PMID: 27044285 PMCID: PMC4820923 DOI: 10.1186/s40880-016-0099-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
Background Although sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false-negative rate (FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND). The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node (PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of “skip metastasis” on the FNR of SLNB. Methods At Shandong Cancer Hospital Affiliated to Shandong University between March 1, 2012 and June 30, 2015, the sentinel lymph nodes (SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer. First, the SLNs were removed; then, the area surrounding the original SLNs was selected, and the visible lymph nodes in a field of 3–5 cm in diameter around the center (i.e., PLNs) were removed, avoiding damage to the structure of the breast. Finally, ALND was performed. The SLNs, PLNs, and remaining ALNs underwent pathologic examination, and the relationship between them was analyzed. Results The identification rate of SLNs in the 596 patients was 95.1% (567/596); the metastasis rate of ALNs was 33.7% (191/567); the FNR of pure SLNB was 9.9% (19/191); and after the SLNs and PLNs were eliminated, the FNR was 4.2% (8/191), which was significantly decreased compared with the FNR before removal of PLNs (P = 0.028). According to the detected number (N) of SLNs, the patients were divided into four groups of N = 1, 2, 3, and ≥4; the FNR in these groups was 19.6, 9.8, 7.3, and 2.3%, respectively. For the patients with ≤2 or ≤3 detected SLNs, the FNR after removal of PLNs was significantly decreased compared with that before removal of PLNs (N ≤ 2: 14.0% vs. 4.7%, P = 0.019; N ≤ 3: 12.2% vs. 4.7%, P = 0.021), whereas for patients with ≥4 detected SLNs, the decrease in FNR was not statistically significant (P = 1.000). In the entire cohorts, the “skip metastasis” rate was 2.5% (15/596); the FNR caused by “skip metastasis” was 2.1% (4/191). Conclusions The FNR of SLNB was associated with the number of SLNs. For patients with ≤3 detected SLNs, PLN sampling can reduce the FNR of SLNB to an acceptable level of less than 5%. Because of the existence of the “skip metastasis” and distinct metastasis patterns, the FNR of SLNB cannot be completely eliminated.
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Affiliation(s)
- Chao Han
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, 250022, Shandong, P.R. China.,Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Ben Yang
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Wen-Shu Zuo
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China.
| | - Yan-Song Liu
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Gang Zheng
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Li Yang
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Mei-Zhu Zheng
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
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Jeffe DB, Pérez M, Cole EF, Liu Y, Schootman M. The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients' Quality of Life Over 2-Year Follow-up. Ann Surg Oncol 2015; 23:735-43. [PMID: 26511265 DOI: 10.1245/s10434-015-4926-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND We examined the effects of surgery type and adjuvant chemotherapy on change in early-stage breast cancer patients' quality of life (QOL) over time. METHODS A cohort of 549 patients (33.5% ductal carcinoma in situ, 66.5% stages I/IIA) were interviewed a mean 6.1 weeks (Time1), and 6.2 (Time2), 12.3 (Time3), and 24.4 (Time4) months following definitive breast-conserving surgery (BCS) or mastectomy. QOL was measured using the total Functional Assessment of Cancer Therapy-Breast (FACT-B). Adjusting for demographic, psychosocial, and clinical variables, multiple linear regression models estimated the associations between QOL and each of surgery type, chemotherapy, and their 2-way interaction at each interview. Adjusted generalized estimating equation (GEE) models tested Time1-Time4 change in QOL. RESULTS At Time2, chemotherapy (P < .001) and BCS (P < .001) were independently associated with worse QOL in adjusted linear regression, and the adverse effect of chemotherapy was prominent among patients who received BCS compared with those who received mastectomy (P interaction = .031). In the GEE model, QOL significantly improved over time among patients who received BCS (P trend = .047), mastectomy (P trend = .024), and chemotherapy (P trend < .001), but not among patients who did not receive chemotherapy (P trend = .720). All patients completed adjuvant chemotherapy and radiation by Time3. Regardless of surgery type, patients receiving chemotherapy reported lower QOL following surgery, and QOL improved after completion of adjuvant treatment. CONCLUSIONS Chemotherapy had a short-term negative impact on QOL after definitive surgical treatment regardless of surgery type. QOL rebounded after completion of adjuvant treatment.
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Affiliation(s)
- Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. .,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA.
| | - Maria Pérez
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily F Cole
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Ying Liu
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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Gebruers N, Verbelen H, De Vrieze T, Coeck D, Tjalma W. Incidence and time path of lymphedema in sentinel node negative breast cancer patients: a systematic review. Arch Phys Med Rehabil 2015; 96:1131-9. [PMID: 25637862 DOI: 10.1016/j.apmr.2015.01.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically assess the incidence/prevalence and time path of lymphedema in patients with sentinel node-negative breast cancer. DATA SOURCES A systematic literature search up to November 2013 was performed using 4 different electronic databases: PubMed, Embase, Cochrane Clinical Trials, and Web of Science. STUDY SELECTION Inclusion criteria were as follows: (1) research studies that included breast cancer patients who were surgically treated using the sentinel lymph node biopsy (SLNB) technique; (2) sentinel node-negative patients; (3) studies that investigated lymphedema as a primary or secondary outcome; (4) data extraction for the incidence or time path of lymphedema was possible; and (5) publication date starting from January 1, 2001. Exclusion criteria were as follows: (1) reviews or case studies; (2) patients who had an SLNB followed by an axillary lymph node dissection (ALND); (3) results of ALND patients and SLNB patients not described separately; and (4) studies not written in English. DATA EXTRACTION After scoring the methodological quality of the selected studies, the crude data concerning the incidence of lymphedema were extracted. Data concerning the time points and the incidence of lymphedema were also extracted. DATA SYNTHESIS Twenty-eight articles were included, representing 9588 SLNB-negative patients. The overall incidence of lymphedema in patients with sentinel node-negative breast cancer ranged from 0% to 63.4%. The studies that have assessed lymphedema at predefined time points, instead of a mean follow-up time, demonstrated an incidence range at ≤3, 6, 12, 18, or >18 months postsurgery of 3.2% to 5%, 2% to 10%, 3% to 63.4%, 6.6% to 7%, and 6.9% to 8.2%, respectively. CONCLUSIONS In SLNB patients, lymphedema is still a problem, mostly occurring 6 to 12 months after surgery. Because of different assessments and criteria, there is a wide range in incidence. Clear definitions of lymphedema are absolutely necessary to tailor therapy.
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Affiliation(s)
- Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Hanne Verbelen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Dorith Coeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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In breast cancer patients sentinel lymph node metastasis characteristics predict further axillary involvement. Virchows Arch 2014; 465:15-24. [PMID: 24809673 DOI: 10.1007/s00428-014-1579-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/05/2014] [Accepted: 03/28/2014] [Indexed: 12/20/2022]
Abstract
The aim of the study was to correlate various primary tumor characteristics with lymph node status, to examine sentinel lymph node (SLN) metastasis size and non-SLN axillary involvement, to look for a cut-off size/number value possibly predicting additional axillary involvement with more accuracy and to examine the relationship of SLN metastasis size to overall survival. Of 301 patients who underwent SLN biopsy, 75 had positive SLNs. The size of the metastases was measured. For different size categories, association with the prevalence of non-SLN metastases was assessed. Associations between metastasis size and tumor characteristics and overall survival (OS) were studied. The prevalence of axillary lymph node (ALN) involvement was not significantly different between cases with micrometastasis or macrometastasis in SLNs (p = 0.124). However, for metastases larger than 6, 7, and 8 mm, the prevalence of ALN involvement was significantly higher (p = 0.046, 0.022, and 0.025). OS was significantly lower in SLN-positive than in SLN-negative cases (p = 0.0375). Primary tumor size larger than 20 mm was associated with a significantly higher incidence of SLN metastasis (p < 0.001), and primary tumor size over 26 mm was associated with additional positive non-SLN (p < 0.001). Higher mitotic index (≥ 7) in primary tumors was significantly (p < 0.001) associated with ALN involvement in SLN-positive cases, whereas higher Ki67 labeling index was not significantly correlated with SLN or ALN involvement. Lymphovascular invasion (LVI) in primary tumors was significantly correlated with SLN positivity (p < 0.001) but not with further ALN involvement or OS. Tumor size and LVI are predictive for SLN metastasis. Mitotic index, primary tumor size, and larger volume SLN involvement are determinants of further ALN involvement. SLN metastasis size over 6 mm is a strong predictor of further axillary involvement. OS is shorter in the presence of positive SLN.
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Verbelen H, Gebruers N, Eeckhout FM, Verlinden K, Tjalma W. Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review. Breast Cancer Res Treat 2014; 144:21-31. [PMID: 24496928 DOI: 10.1007/s10549-014-2846-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/18/2014] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to assess which shoulder and arm impairments are common in sentinel node-negative breast cancer patients and to describe the incidence and time course of these impairments. A systematic literature search was performed using different electronic databases until October 2013. Inclusion criteria were (1) research studies that included breast cancer patients surgically treated using the sentinel lymph node biopsy (SLNB) technique, (2) sentinel node-negative patients, and (3) studies that investigated morbidities of shoulder and/or arm. The exclusion criteria were (1) reviews or case studies, (2) patients who have had a SLNB followed by an axillary lymph node dissection (ALND), (3) results of ALND patients and SLNB patients were not described separately, and (4) no follow-up described. Thirty articles were included, representing 5,448 patients. Shoulder and arm impairments among sentinel node-negative patients are loss of mobility, loss of strength, pain, axillary web syndrome, and sensory disorders. Within the first month after SLNB, the morbidities with the highest incidence are decreased abduction (range 40.8-100 %), forward flexion of the shoulder (range 37-100 %), pain (range 3.4-56.6 %), and numbness (range 2-64 %). Morbidities with the highest incidence after 2 years are pain (range 5.6-51.1 %), numbness (range 5.1-51.1 %), loss of strength (range 0-57.7 %), decreased internal rotation (44.4 %), and decreased abduction (range 0-41.4 %). In conclusion, although the shoulder and arm impairments are less common after SLNB alone compared to ALND, they cannot be neglected. A considerable amount of patients still suffer from those impairments more than 2 years after surgery.
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Affiliation(s)
- Hanne Verbelen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium,
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Sagen A, Kaaresen R, Sandvik L, Thune I, Risberg MA. Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Arch Phys Med Rehabil 2014; 95:875-81. [PMID: 24389401 DOI: 10.1016/j.apmr.2013.12.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine upper limb physical function and adverse effects after axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) in patients with breast cancer to identify impairments that can inform rehabilitation strategies. DESIGN Prospective longitudinal cohort. Upper limb measurements were studied preoperatively and 2.5 years after breast cancer treatment. SETTING Hospital setting. PARTICIPANTS Two groups of patients with early-stage primary breast cancer (N=391): the ALND surgery group (mean age, 55±10y) and the SLNB group (mean age, 57±10y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Arm lymphedema (≥10% increased arm volume relative to control arm volume), grip strength (in kilograms), shoulder mobility, pain intensity during isometric shoulder abduction (on a 100-mm visual analog scale), and body mass index (kg/m(2)). Parametric/nonparametric tests were used for hypothesized changes and differences, and regression analysis was used for confounding factors. RESULTS We observed more adverse effects in women treated with ALND than with SLNB after 2.5 years (P<.05): arm lymphedema (17% vs 3%), grip strength reduction (12% vs 2%), and shoulder abduction-provoked pain (increase of 6% vs decrease of 50%). The adverse effects were similar for affected and control upper limbs for all outcomes except arm lymphedema, which occurred only on the affected side. CONCLUSIONS Adverse effects in both affected and control/unaffected upper limb were observed after 2.5-year follow-up in both ALND and SLNB groups, but a higher prevalence was observed in the ALND group. Thus, women going through ALND surgery may benefit from further postoperative physical therapy, including resistance and strength exercise, focusing on pain management.
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Affiliation(s)
- Aase Sagen
- Department of Cancer Treatment, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Rolf Kaaresen
- Department of Breast and Endocrine Surgery, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Leiv Sandvik
- Center of Epidemiology and Biostatistics, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Inger Thune
- Department of Cancer Treatment, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - May Arna Risberg
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Impact of sentinel node biopsy on long-term quality of life in breast cancer patients. Br J Cancer 2013; 109:2783-91. [PMID: 24169352 PMCID: PMC3844912 DOI: 10.1038/bjc.2013.658] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/20/2013] [Accepted: 10/01/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to assess long-term quality of life (QoL) over a period of 6 years in women with breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), or SLNB followed by ALND. METHODS The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)-C30 and the EORTC-QLQ-BR-23 questionnaires were used to assess QoL before surgery, just after surgery, 6, 12 and 72 months later. The longitudinal effect of surgical modalities on QoL was assessed with a mixed model analysis of variance for repeated measurements. RESULTS Five hundred and eighteen BC patients were initially included. The median follow-up was 6 years. During the follow-up, 61 patients died. None of the patients of the SLNB group developed lymphedema during follow-up and the relapse rate was similar in the different groups (P=0.62). Before surgery, global health status (P=0.52) and arm symptoms (BRAS) (P=0.99) QoL scores were similar whatever the surgical procedure. The BRAS score (P=0.0001) was better in the SLNB group 72 months after surgery. Moreover, during follow-up, patients treated with SLNB had lower arm symptoms scores than ALND patients and there was no difference for arm symptoms between patients treated with ALND and those treated with SLNB followed by complementary ALND. CONCLUSION Long-term follow-up showed that SLNB was associated with less morbidity than ALND.
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García Fernández A, Chabrera C, García Font M, Fraile M, Lain J, Barco I, González C, Gónzalez S, Reñe A, Veloso E, Cassadó J, Pessarrodona A, Giménez N. Positive versus negative sentinel nodes in early breast cancer patients: Axillary or loco-regional relapse and survival. A study spanning 2000–2012. Breast 2013; 22:902-7. [DOI: 10.1016/j.breast.2013.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/09/2013] [Accepted: 04/17/2013] [Indexed: 11/15/2022] Open
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Kootstra JJ, Dijkstra PU, Rietman H, de Vries J, Baas P, Geertzen JHB, Hoekstra HJ, Hoekstra-Weebers JEHM. A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Res Treat 2013; 139:125-34. [DOI: 10.1007/s10549-013-2509-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/27/2013] [Indexed: 02/06/2023]
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Andersen K, Jensen M, Tvedskov T, Kehlet H, Gärtner R, Kroman N. Persistent pain, sensory disturbances and functional impairment after immediate or delayed axillary lymph node dissection. Eur J Surg Oncol 2013; 39:31-5. [DOI: 10.1016/j.ejso.2012.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/17/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022] Open
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Belmonte R, Garin O, Segura M, Pont A, Escalada F, Ferrer M. Quality-of-life impact of sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:907-915. [PMID: 22999141 DOI: 10.1016/j.jval.2012.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 05/11/2012] [Accepted: 06/08/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Controversy about quality-of-life (QOL) benefits of sentinel lymph node biopsy (SLNB) versus axillary lymph node dissection (ALND) in patients with breast cancer remains. Our aim was to compare the impact of SLNB and ALND on QOL and arm symptoms of patients with early breast cancer, using generic (short form 36 health survey) and tumor site-specific (FACT-B+4) instruments. METHODS This was a prospective longitudinal observational study of 93 patients (64 SLNB, 29 ALND). Patients were evaluated presurgery and 1, 6, and 12 months postsurgery. Generalized estimation equation models were constructed to assess the effect of treatment on QOL. The relative risks of edema, dysesthesia, and heaviness were calculated comparing ALND to SLND. RESULTS Most patients presented T1 (67.7%) and underwent breast-conserving surgery (92.5%). At 12 months, the SLNB group presented deterioration on the FACT-B+4 Arm Scale (beta coefficient estimated a change of -1.6 score points; P < 0.01) while, compared with SLNB, the deterioration in the ALND group was almost 2 additional score points higher (P = 0.009). FACT-B+4 global summary and short form 36 health survey did not show statistically significant differences between groups. Relative risk of dysesthesia and subjective edema was higher for the ALND group than for the SLNB group (1.97 and 2.11 at month 12; P < 0.01). CONCLUSION These results confirm the benefit of SLNB due to its lower arm morbidity impact on QOL, compared with ALND. There are clinically relevant between-treatment differences in the Arm Scale of FACT-B+4, while there were no relevant differences in general well-being, measured with the disease-specific FACT-B+4 and the generic short form 36 health survey.
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Affiliation(s)
- Roser Belmonte
- Department Medicina Física i Rehabilitació, Hospital Mar-Esperança Parc de Salut Mar, Barcelona, Spain.
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McNeely ML, Binkley JM, Pusic AL, Campbell KL, Gabram S, Soballe PW. A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues. Cancer 2012; 118:2226-36. [PMID: 22488697 DOI: 10.1002/cncr.27468] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Appropriate and timely rehabilitation is vital in the recovery from breast cancer surgeries, including breast conserving surgery, mastectomy, axillary lymph node dissection (ALND), and breast reconstruction. This article describes the incidence, prevalence, risk factors and time course for early postoperative effects and the role of prospective surveillance as a rehabilitation strategy to prevent and mitigate them. The most common early postoperative effects include wound issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and seroma. Appropriate treatment is necessary to avoid delay in wound healing that may increase the risk of long-term morbidity, unduly postpone systemic and radiation therapy, and delay rehabilitation. The presence of upper quarter dysfunction (UQD), defined as restricted upper quarter mobility, pain, lymphedema, and impaired sensation and strength, has been reported in over half of survivors after treatment for breast cancer. Moreover, evidence suggests that survivors who undergo breast reconstruction may be at higher risk of UQD. Ensuring the survivor's optimum functioning in the early postoperative time period is critical in the overall recovery from breast cancer. The formal collection of objective measures along with patient-reported outcome measures is recommended for the early detection of postoperative morbidity. Prospective surveillance, including preoperative assessment and structured surveillance, allows for early identification and timely rehabilitation. Early evidence supports a prospective approach to address and minimize postoperative effects.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy and Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada.
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Revisiting the “10% rule” in breast cancer sentinel lymph node biopsy: an approach to minimize the number of sentinel lymph nodes removed. Am J Surg 2012; 203:623-627. [DOI: 10.1016/j.amjsurg.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/12/2012] [Accepted: 01/12/2012] [Indexed: 11/22/2022]
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