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Li C, Zhang P, Lv J, Dong W, Hu B, Zhang J, Zhu H. Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis. Front Oncol 2024; 13:1320867. [PMID: 38260843 PMCID: PMC10800700 DOI: 10.3389/fonc.2023.1320867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
Background The omission of axillary lymph node dissection (ALND) or axillary radiation (AxRT) remains controversial in patients with clinical node-negative early breast cancer and a positive sentinel lymph node. Methods We conducted a comprehensive review by searching PubMed, Embase, Web of Science, and Cochrane databases (up to November 2023). Our primary outcomes were overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and axillary recurrence (AR). Results We included 26 studies encompassing 145,548 women with clinical node-negative early breast cancer and positive sentinel lymph node. Pooled data revealed no significant differences between ALND and sentinel lymph node biopsy (SLNB) alone in terms of OS (hazard ratio [HR]0.99, 95% confidence interval [CI] 0.91-1.08, p=0.84), DFS (HR 1.04, 95% CI 0.90-1.19, p=0.61), LRR (HR 0.76, 95% CI 0.45-1.20, p=0.31), and AR (HR 1.01, 95% CI 0.99-1.03, p=0.35). Similarly, no significant differences were observed between AxRT and SLNB alone for OS (HR 0.57, 95% CI 0.32-1.02, p=0.06) and DFS (HR 0.52, 95% CI 0.26-1.05, p=0.07). When comparing AxRT and ALND, a trend towards higher OS was observed the AxRT group (HR 0.08, 95% CI 0.67-1.15), but the difference did not reach statistical significance (p=0.35, I2 = 0%). Additionally, no significant differences significance observed for DFS or AR (p=0.13 and p=0.73, respectively) between the AxRT and ALND groups. Conclusion Our findings suggest that survival and recurrence rates are not inferior in patients with clinical node-negative early breast cancer and a positive sentinel lymph node who receive SLNB alone compared to those undergoing ALND or AxRT.
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Affiliation(s)
- Changzai Li
- Department of Oncological Surgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Pan Zhang
- College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, Hebei, China
| | - Jie Lv
- Department of Oncological Surgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Wei Dong
- Department of Oncological Surgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Baoshan Hu
- Department of Oncological Surgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Jinji Zhang
- Department of Oncological Surgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Hongcheng Zhu
- Department of Oncological Surgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
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Chen F, Li X, Lin X, Chen L, Lin Z, Wu H, Chen J. Can Axillary Lymph Node Dissection be Omitted in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes Undergoing Mastectomy? A Systematic Review and Meta-Analysis of Real-World Evidence. World J Surg 2023; 47:2446-2456. [PMID: 37249632 DOI: 10.1007/s00268-023-07072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The omission of axillary lymph node dissection (ALND) in patients with breast cancer who have metastatic sentinel lymph nodes (SLNs) undergoing mastectomy remains controversial. This meta-analysis explored the clinicopathological factors affecting the selection of ALND and the influences of ALND on survival outcomes in patients receiving mastectomy with positive SLNs. METHODS Eligible studies published prior to 31 December 2022 were selected by searching the Embase, Web of Science and PubMed databases. Pooled analyses were performed using the number of events for clinicopathological parameters and HRs with 95% CIs for survival outcomes including disease-free survival (DFS), overall survival (OS), distant recurrence-free survival (DRFS) and locoregional recurrence-free survival (LRFS). RESULTS A total of 10 retrospective studies enrolling only breast cancer patients with limited SLN metastases (no more than 3 positive SLNs or micrometastatic SLNs) undergoing mastectomy were included. Performing ALND in mastectomy patients who had limited SLN metastases was significantly correlated with invasive ductal carcinomas, larger tumors, lymphovascular invasion, higher tumor grade, macrometastatic SLNs, more positive SLNs, extranodal extension, positive surgical margins, negative ER, administration of adjuvant chemotherapy and nonwhite race (P < 0.05). However, performing ALND did not result in significantly longer OS, DFS, LRFS or DRFS (P > 0.05) in these patients. CONCLUSION The present meta-analysis indicated that ALND may be safely avoided in patients with breast cancer who had limited SLN metastases undergoing mastectomy. Further well-designed randomized clinical trials are warranted to validate our results.
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Affiliation(s)
- Fulong Chen
- Department of Breast Surgery, Yangjiang People's Hospital (Affiliated Yangjiang Hospital of Guangdong Medical University), No. 42 of Dongshan Road, Jiangcheng District, Yangjiang, 529500, China
| | - Xiaowen Li
- Department of Breast Surgery, Yangjiang People's Hospital (Affiliated Yangjiang Hospital of Guangdong Medical University), No. 42 of Dongshan Road, Jiangcheng District, Yangjiang, 529500, China
| | - Xianjun Lin
- Department of Breast Surgery, Yangjiang People's Hospital (Affiliated Yangjiang Hospital of Guangdong Medical University), No. 42 of Dongshan Road, Jiangcheng District, Yangjiang, 529500, China
| | - Lijia Chen
- Department of Breast Surgery, Yangjiang People's Hospital (Affiliated Yangjiang Hospital of Guangdong Medical University), No. 42 of Dongshan Road, Jiangcheng District, Yangjiang, 529500, China
| | - Zhaoling Lin
- Department of Breast Surgery, Yangjiang People's Hospital (Affiliated Yangjiang Hospital of Guangdong Medical University), No. 42 of Dongshan Road, Jiangcheng District, Yangjiang, 529500, China
| | - Hao Wu
- Department of Breast Surgery, Yangjiang People's Hospital (Affiliated Yangjiang Hospital of Guangdong Medical University), No. 42 of Dongshan Road, Jiangcheng District, Yangjiang, 529500, China
| | - Jishang Chen
- Department of Breast Surgery, Yangjiang People's Hospital (Affiliated Yangjiang Hospital of Guangdong Medical University), No. 42 of Dongshan Road, Jiangcheng District, Yangjiang, 529500, China.
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Fan YJ, Li JC, Zhu DM, Zhu HL, Zhao Y, Zhu XB, Wu G, Bai TT. Efficacy and safety comparison between axillary lymph node dissection with no axillary surgery in patients with sentinel node-positive breast cancer: a systematic review and meta-analysis. BMC Surg 2023; 23:209. [PMID: 37495945 PMCID: PMC10369839 DOI: 10.1186/s12893-023-02101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/07/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to study the evidence on the efficacy and safety of omitting axillary lymph node dissection (ALND) for patients with clinically node-negative but sentinel lymph node (SLN)-positive breast cancer using all the available evidence. METHODS The Embase, Medline, and Cochrane Library databases were searched through February 25, 2023. Original trials that compared only the sentinel lymph node biopsy (SLNB) with ALND as the control group for patients with clinically node-negative but SLN-positive breast cancer were included. The primary outcomes were axillary recurrence rate, total recurrence rate, disease-free survival (DFS), and overall survival (OS). Meta-analyses were performed to compare the odds ratio (OR) in rates and the hazard ratios (HR) in time-to-event outcomes between both interventions. Based on different study designs, tools in the revised Cochrane risk of bias tool were used for randomized trials and the risk of bias in nonrandomized studies of interventions to assess the risk of bias for each included article. Funnel plots and Egger's test were used for the publication's bias assessment. RESULTS In total, 30 reports from 26 studies were included in the systematic review (9 reports of RCTs, 21 reports of retrospective cohort studies). According to our analysis, omitting ALND in patients with clinically node-negative but SLN-positive breast cancer had a similar axillary recurrence rate (OR = 0.95, 95% confidence interval (CI): 0.76-1.20), DFS (HR = 1.02, 95% CI: 0.89-1.16), and OS (HR = 0.97, 95% CI: 0.92-1.03), but caused a significantly lower incidence of adverse events and benefited in locoregional recurrence rate (OR = 0.76, 95% CI: 0.59-0.97) compared with ALND. CONCLUSION For patients with clinically node-negative but SLN-positive breast cancer (no matter the number of the positive SLN), this review showed that SLNB alone had a similar axillary recurrence rate, DFS, and OS, but caused a significantly lower incidence of adverse events and showed a benefit for the locoregional recurrence compared with ALND. An OS benefit was found in the Macro subset that used SLNB alone versus complete ALND. Therefore, omitting ALND is feasible in this setting. TRIAL REGISTRATION CRD 42023397963.
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Affiliation(s)
- Yu-Jia Fan
- Thyroid & Breast Surgery Department,, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, P. R. China
| | - Jin-Cheng Li
- Department of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, P. R. China.
| | - De-Miao Zhu
- Department of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, P. R. China
| | - Hai-Long Zhu
- Department of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, P. R. China
| | - Yi Zhao
- Department of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, P. R. China
| | - Xin-Bing Zhu
- Department of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, P. R. China
| | - Gang Wu
- Department of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, P. R. China
| | - Ting-Ting Bai
- Department of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, P. R. China
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Xiang K, Chen J, Min Y, Chen H, Yang J, Hu D, Han Y, Yin G, Feng Y. A multi-dimensional nomogram to predict non-sentinel lymph node metastases in T1-2HR+ breast cancer. Front Endocrinol (Lausanne) 2023; 14:1121394. [PMID: 37476497 PMCID: PMC10354643 DOI: 10.3389/fendo.2023.1121394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Axillary lymph node dissection (ALND) could be omitted for T1-2 breast cancer patients with 1-2 positive sentinel lymph node (SLN) after breast-conserving surgery when radiation is planned. However, whether ALND could be replaced by radiation in patients with 1-3 positive SLNs when no more non-SLN metastasis were observed after mastectomy are still controversial. The aim of our study was to develop and validate a nomogram for predicting the possibility of non-SLN metastasis in T1-2 and hormone receptor (HR) positive breast cancer patients with 1-3 positive SLNs after mastectomy. Methods We retrospectively reviewed and analyzed the data including the basic information, preoperative sonographic characteristics, and pathological features in breast cancer patients with 1-3 positive SLNs in our medical center between Jan 2016 and Dec 2021. The Chi-square, Fisher's exact test, and t test were used for comparison of categorical and qualitative variables among patients with or without non-SLN metastasis. Univariate and multivariate logistic regression were used to determine the risk factors for non-SLN metastasis. These predictors were used to build the nomogram. The C-index and area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of the model. Results A total of 49 in 107 (45.8%) patients were identified with non-SLN metastasis. In multivariate analysis, four variables including younger age, lower estrogen receptor (ER) expression, higher histological score, and cortex thickening of the lymph nodes were determined to be significantly associated with non-SLN metastasis. An individualized nomogram was consequently established with a favorable C-index of 0.822 and verified via two internal validation cohorts. Conclusions The current study developed a nomogram predicting non-SLN metastasis for T1-2 and HR+ breast cancer with 1-3 positive SLNs after mastectomy and found that patients in the high-risk group exhibited worse relapse-free survival. The novel nomogram may further help surgeons to determine whether ALND could be omitted when 1-3 positive SLNs were observed in T1-2 and HR+ breast cancer patients.
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Affiliation(s)
- Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Min
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Chen
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaxin Yang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuling Han
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guobing Yin
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Axilla lymph node dissection can be safely omitted in patients with 1-2 positive sentinel nodes receiving mastectomy: a large multi-institutional study and a systemic meta-analysis. Breast Cancer Res Treat 2022; 196:129-141. [PMID: 36076127 DOI: 10.1007/s10549-022-06727-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/26/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aimed to evaluate whether axillary lymph node dissection (ALND) can be omitted in patients with 1-2 positive sentinel lymph nodes (SLNs) who received total mastectomy (TM). METHODS Consecutive breast cancer patients with 1-2 positive SLNs were retrospectively reviewed from a multi-institutional database. Patients were divided into sentinel lymph node biopsy (SLNB) group and ALND group. Administration of adjuvant chemotherapy and survival were compared between groups. To further verify the results, a meta-analysis was also conducted. RESULTS Among the 1161 enrolled patients, 893 (76.9%) received ALND and 268 (23.1%) underwent SLNB alone. Administration of chemotherapy was comparable between the two groups (91.1% vs. 90.6%, P = 0.798), which was consistent in TM (P = 0.638) and BCS cohort (P = 0.576). After a median follow-up of 36 months, no significant difference was observed between the two groups in recurrence-free survival (P = 0.583) regardless of surgery of breast. During further meta-analysis, 13 out of 4733 relative studies reported the association of axillary surgery and disease-free survival (DFS) or overall survival (OS) in 1-2 positive SLNs patients. Pooled analysis showed no difference in adjusted DFS (HR 0.84, 95% CI 0.70-1.02) or OS (HR 1.02, 95% CI 0.93-1.11) between SLNB and ALND groups. Survival benefit of ALND remained non-significant after restricting the analysis in four studies with patients only receiving BCS, or in three studies with patients only receiving TM. CONCLUSION Further ALND does not impact adjuvant chemotherapy administration or disease outcome in breast cancer patients with 1-2 positive SLNs treated with TM.
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Wang X, Gao Y, Yang X, Kong X, Wang Z, Fang Y, Wang J. Omitting ALND Is Not Safe for a Cohort of Early-Stage Breast Cancer Patients with 1-2 SLNs Macro-Metastases and Breast-Conserving Therapy: A Single-Center Retrospective Study. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1262-1268. [PMID: 33083292 PMCID: PMC7548499 DOI: 10.18502/ijph.v49i7.3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Omitting axillary lymph node dissection (ALND) is recommended for early-stage breast cancer patients with 1–2 sentinel lymph nodes (SLNs) macro-metastases and breast-conserving therapy. However, it is not safe for part of patients, so it is significant to find risk factors and develop a predictive model of non-SLNs metastases in breast cancer patients with 1–2 SLNs macro-metastases and breast-conserving therapy. Methods: This retrospective study enrolled 228 breast cancer patients with 1–2 SLNs macro-metastases who underwent ALND and breast-conserving surgery between Jan 2012 and Dec 2017 at Cancer Hospital Chinese Academy of Medical Sciences. Chi-square test and backward stepwise binary logistic regression were used to find factors that influenced non-SLN metastases, then a predictive model was formulated and obtained its area under the curve. Results: Tumor pathologic invasion size, number of positive SLNs and ALN status on imaging was associated with non-SLNs metastases. The predictive model was also formulated based on these three factors to assess and the area under the curve of model was 0.708. Conclusion: We developed a predictive model to assess the high-risk cohort of patients of non-SLNs metastases which can be an auxiliary tool for doctors.
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Affiliation(s)
- Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yinqi Gao
- Department of Oncology, Capital Medical University Electric Power Teaching Hospital, Beijing, 100073, China
| | - Xue Yang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zixing Wang
- School of Basic Medical Sciences, Jining Medical University, Jining, 272067, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Profiles of Immune Infiltration and Prognostic Immunoscore in Lung Adenocarcinoma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5858092. [PMID: 32596334 PMCID: PMC7301220 DOI: 10.1155/2020/5858092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/14/2020] [Indexed: 12/26/2022]
Abstract
Lung tissue is abundant with immune cells that form a powerful first defense against exotic particles and microbes. The malignant phenotype of lung adenocarcinoma (LUAD) is defined not only by intrinsic tumor cells but also by tumor-infiltrating immune cells (TIICs) recruited to the immune microenvironment. Understanding more about the immune microenvironment of LUAD could function in sorting out patients more likely with high risk and benefit from immunotherapy. Twenty-two types of TIICs were estimated based on large public LUAD cohorts from the TCGA and GEO datasets using the CIBERSORT algorithm. Then principal component analysis (PCA), meta-analysis, and single-sample gene set enrichment analysis (ssGSEA) were used to measure and evaluate the specific immune responses and relative mechanisms. Moreover, an immunoscore model based on the percent of immune cells was constructed via the univariate and multivariate Cox regression models, which provided an in-depth overview of the LUAD immune microenvironment and shed light on the immune regulatory mechanism. The differential expression genes (DEGs) were acquired based on the immunoscore model, and prognostic immune-related genes were further identified. GSEA and the protein–protein interaction network (PPI) further revealed that these genes were mostly enriched in many immune-related biological processes. It is hoped that this immune landscape could provide a more accurate understanding for LUAD development and tumor immune therapy.
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Jo H, Lee EG, Song E, Han JH, Jung SY, Kang HS, Lee ES, Lee S. Comparison of clinical outcomes between sentinel lymph node biopsy and axillary lymph node dissection in a single-center Z0011-eligible breast cancer cohort. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2020; 16:18-24. [PMID: 36945308 PMCID: PMC9942717 DOI: 10.14216/kjco.20004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
Purpose The ACOSOG Z0011 trial has proven the oncological safety of sentinel lymph node biopsy (SLBx) for node negative breast cancer. Accordingly, treatment paradigm including axilla surgery was changed. We retrospectively reviewed breast cancer patients to evaluate the clinical effect of paradigm shift in breast cancer surgery after applying the Z0011 criteria. Methods All women who underwent breast-conserving surgery at the National Cancer Center between January 1, 2000, and December 31, 2015, were enrolled and classified according to the Z0011 criteria. The primary endpoint of the study was the disease-free survival rates, and the secondary was the adverse events, especially arm lymphedema. Results Total 361 patients were enrolled the study (271 axillary lymph node dissection [ALND] group, 90 SLBx group). After the Z0011 guideline was adopted in our institute, the use of ALND decreased, and lymph node sampling (removing only a few axillary lymph nodes) replaced ALND. The total mean number of retrieved nodes were more in ALND group (13.02) than SLBx group (3.43). However, there was no difference in the mean number of positive nodes between two groups (2.34 in ALND group vs. 1.12 in SLBx group, P=0.001). During follow-up, 25 patients experienced disease recurrence: 22 from the ALND group and three from the SLBx group. All of died seven patients were from the ALND group. The ALND group had more complications than the SLBx group (P=0.02). Arm edema occurred more frequently in the ALND group (29.5%) than in the SLBx group (5.6%), although without statistical significance (P=0.07). Conclusion In our study, we concluded that SLBx can be used safely in Z0011-eligible cohort without increased risk of locoregional recurrence. Moreover, we found that omission of ALND is favored to reduce some serious complications such as arm lymphedema.
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Affiliation(s)
- Heein Jo
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Eun-Gyeong Lee
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Eunjin Song
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Jai Hong Han
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - So-Youn Jung
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Han-Sung Kang
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Seeyoun Lee
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
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Wang XY, Wang JT, Guo T, Kong XY, Chen L, Zhai J, Gao YQ, Fang Y, Wang J. Risk factors and a predictive nomogram for non-sentinel lymph node metastases in Chinese breast cancer patients with one or two sentinel lymph node macrometastases and mastectomy. ACTA ACUST UNITED AC 2019; 26:e210-e215. [PMID: 31043829 DOI: 10.3747/co.26.4295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Two ongoing prospective randomized trials are evaluating whether omitting axillary lymph node dissection (alnd) in patients with breast cancer (bca) and sentinel lymph node (sln) macrometastases undergoing mastectomy is safe. Determining predictive risk factors for non-sln metastases and developing a model to predict the probability of those patients having non-sln metastases is also important. Methods This retrospective study enrolled 396 patients with bca and 1-2 slns with macrometastases who underwent alnd and mastectomy between January 2012 and December 2016. Factors influencing the non-sln metastases were determined, and a predictive nomogram was formulated. Performance of the nomogram was evaluated by its area under the curve (auc). Results We developed a predictive nomogram with an auc of 0.81 (cross-validation 95% confidence interval: 0.75 to 0.86) that included 4 factors (tumour size, histologic grade, and number of negative slns and axillary lymph nodes on imaging). Conclusions Our predictive nomogram assesses the risk of non-sln metastases in patients with bca and 1-2 sln macrometastases undergoing mastectomy.
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Affiliation(s)
- X Y Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R.C
| | - J T Wang
- Department of Biostatistics, School of Public Health, Shandong University, Shandong, P.R.C
| | - T Guo
- Department of Breast Surgery, The First Hospital of Qiqihar, Qiqihar, P.R.C
| | - X Y Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R.C
| | - L Chen
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R.C
| | - J Zhai
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R.C
| | - Y Q Gao
- Department of Oncology, Beijing Electric Power Hospital, Capital Medical University, Beijing, P.R.C
| | - Y Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R.C
| | - J Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R.C
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Castaneda CA, Rebaza P, Castillo M, Gomez HL, De La Cruz M, Calderon G, Dunstan J, Cotrina JM, Abugattas J, Vidaurre T. Critical review of axillary recurrence in early breast cancer. Crit Rev Oncol Hematol 2018; 129:146-152. [PMID: 30097233 DOI: 10.1016/j.critrevonc.2018.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/20/2018] [Accepted: 06/18/2018] [Indexed: 01/07/2023] Open
Abstract
Around 2% of early breast cancer cases treated with axillary lymph node dissection (ALND) underwent axillary recurrence (AR) and it has a deleterious effect in prognosis. Different scenarios have incorporated Sentinel Lymph Node (SLN) Biopsy (SLNB) instead of ALND as part of the standard treatment and more effective systemic treatment has also been incorporated in routine management after first curative surgery and after regional recurrence. However, there is concern about the effect of SLNB alone over AR risk and how to predict and treat AR. SLN biopsy (SLNB) has been largely accepted as a valid option for SLN-negative cases, and recent prospective studies have demonstrated that it is also safe for some SLN-positive cases and both scenarios carry low AR rates. Different studies have identified clinicopathological factors related to aggressiveness as well as high-risk molecular signatures can predict the development of locoregional recurrence. Other publications have evaluated factors affecting prognosis after AR and find that time between initial treatment and AR as well as tumor aggressive behavior influence patient survival. Retrospective and prospective studies indicate that treatment of AR should include local and systemic treatment for a limited time.
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Affiliation(s)
- Carlos A Castaneda
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Research Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru.
| | - Pamela Rebaza
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Miluska Castillo
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Henry L Gomez
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Miguel De La Cruz
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Gabriela Calderon
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Jorge Dunstan
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Jose Manuel Cotrina
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Julio Abugattas
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Tatiana Vidaurre
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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Kim YG, Jeon YW, Ko BK, Sohn G, Kim EK, Moon BI, Youn HJ, Kim HA. Clinicopathologic Characteristics of Pregnancy-Associated Breast Cancer: Results of Analysis of a Nationwide Breast Cancer Registry Database. J Breast Cancer 2017; 20:264-269. [PMID: 28970852 PMCID: PMC5620441 DOI: 10.4048/jbc.2017.20.3.264] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/12/2017] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This study aimed to evaluate the clinicopathological characteristics of pregnancy-associated breast cancer (PABC) in comparison with non-pregnancy associated breast cancer (non-PABC). METHODS A total of 344 eligible patients with PABC were identified in the Korean Breast Cancer Society Registry database. PABC was defined as ductal carcinoma in situ, invasive ductal carcinoma, or invasive lobular carcinoma diagnosed during pregnancy or within 1 year after the birth of a child. Patients with non-PABC were selected from the same database using a 1:2 matching method. The matching variables were operation, age, and initial stage. RESULTS Patients with PABC had significantly lower survival rates than patient with non-PABC (10-year survival rate: PABC, 76.4%; non-PABC, 85.1%; p=0.011). PABC patients had higher histologic grade and were more frequently hormone receptor negative than non-PABC patients. Being overweight (body mass index [BMI], ≥23 kg/m2), early menarche (≤13 years), late age at first childbirth (≥30 years), and a family history of breast cancer were more common in the PABC group than in the non-PABC group. Multivariate analysis showed the following factors to be significantly associated with PABC (vs. non-PABC): early menarche (odds ratio [OR], 2.165; 95% confidence interval [CI], 1.566-2.994; p<0.001), late age at first childbirth (OR, 2.446; 95% CI, 1.722-3.473; p<0.001), and being overweight (OR, 1.389; 95% CI, 1.007-1.917; p=0.045). CONCLUSION Early menarche, late age at first childbirth, and BMI ≥23 kg/m2 were more associated with PABC than non-PABC.
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Affiliation(s)
- Yun Gyoung Kim
- Department of Surgery, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Ye Won Jeon
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Kyun Ko
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Guiyun Sohn
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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12
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Vieni S, Graceffa G, La Mendola R, Latteri S, Cordova A, Latteri MA, Cipolla C. Application of a predictive model of axillary lymph node status in patients with sentinel node metastasis from breast cancer. A retrospective cohort study. Int J Surg 2016; 35:58-63. [DOI: 10.1016/j.ijsu.2016.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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13
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Andreis D, Bonardi S, Allevi G, Aguggini S, Gussago F, Milani M, Strina C, Spada D, Ferrero G, Ungari M, Rocca A, Nanni O, Roviello G, Berruti A, Harris AL, Fox SB, Roviello F, Polom K, Bottini A, Generali D. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with T2 to T4, N0 and N1 breast cancer. Breast 2016; 29:55-61. [PMID: 27428471 DOI: 10.1016/j.breast.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Histological status of axillary lymph nodes is an important prognostic factor in patients receiving surgery for breast cancer (BC). Sentinel lymph node (SLN) biopsy (B) has rapidly replaced axillary lymph node dissection (ALND), and is now the standard of care for axillary staging in patients with clinically node-negative (N0) operable BC. The aim of this study is to compare pretreatment lymphoscintigraphy with a post primary systemic treatment (PST) scan in order to reduce the false-negative rates for SLNB. METHODS In this single-institution study we considered 170 consecutive T2-4 N0-1 M0 BC patients treated with anthracycline-based PST. At the time of incisional biopsy, we performed sentinel lymphatic mapping. After PST, all patients repeated lymphoscintigraphy with the same methodology. During definitive surgery we performed further sentinel lymphatic mapping, SLNB and ALND. RESULTS The SLN was removed in 158/170 patients giving an identification rate of 92.9% (95% confidence interval (CI) = 88.0-96.3%) and a false-negative rate of 14.0% (95% CI = 6.3-25.8%). SLNB revealed a sensitivity of 86.0% (95% CI = 74.2-93.7%), an accuracy of 94.9% (95% CI = 90.3-97.8%) and a negative predictive value of 92.7% (95% CI = 86.1-96.8%). CONCLUSION Identification rate, sensitivity and accuracy are in accordance with other studies on SLNB after PST, even after clinically negative node conversion following PST. This study confirms that diagnostic biopsy and neoadjuvant chemotherapy maintain breast lymphatic drainage unaltered.
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Affiliation(s)
- D Andreis
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - S Bonardi
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - G Allevi
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - S Aguggini
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - F Gussago
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - M Milani
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - C Strina
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - D Spada
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - G Ferrero
- U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - M Ungari
- U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - A Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - O Nanni
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - G Roviello
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Section of Pharmacology and University Center DIFF - Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124 Brescia, Italy
| | - A Berruti
- Oncologia Medica, Spedali Civili di Brescia, Università di Brescia, Italy
| | - A L Harris
- Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DS Oxford, UK
| | - S B Fox
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia
| | - F Roviello
- Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy
| | - K Polom
- Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy
| | - A Bottini
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - D Generali
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129 Trieste, Italy.
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Van Berckelaer C, Huizing M, Van Goethem M, Vervaecke A, Papadimitriou K, Verslegers I, Trinh BX, Van Dam P, Altintas S, Van den Wyngaert T, Huyghe I, Siozopoulou V, Tjalma WAA. Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money. Eur J Obstet Gynecol Reprod Biol 2016; 206:164-171. [PMID: 27697620 DOI: 10.1016/j.ejogrb.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 08/31/2016] [Accepted: 09/10/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging? DESIGN This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller. CONCLUSION Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general.
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Affiliation(s)
- Christophe Van Berckelaer
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Manon Huizing
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Mireille Van Goethem
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Andrew Vervaecke
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Konstantinos Papadimitriou
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Inge Verslegers
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Bich X Trinh
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Peter Van Dam
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Sevilay Altintas
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Tim Van den Wyngaert
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Ivan Huyghe
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Vasiliki Siozopoulou
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
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15
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Kenny TC, Dove J, Shabahang M, Woll N, Hunsinger M, Morgan A, Blansfield J. Widespread Implications of ACOSOG Z0011: Effect on Total Mastectomy Patients. Am Surg 2016. [DOI: 10.1177/000313481608200124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ACOSOG Z0011 trial demonstrated that axillary lymph node dissection (ALND) is not necessary for all breast cancer patients. Patients who underwent breast conservation surgery (BCS) or total mastectomy (TM) and met Z0011 criteria were identified and sorted into pre- and post-Z0011 cohorts. Four hundred ninety four patients had breast cancer surgery from July 2008 to February 2013. Of these, 255 were pre-Z0011 and 239 were post. Pre-Z0011, 14 patients met Z0011 inclusion criteria in BCS subgroup. ALND was performed in 10 of these patients (71%). Post-Z0011, 14 patients met inclusion criteria, only 1 received ALND (7%). The decrease in ALND rate was significant (p=0.001). Pre-Z0011, 28 patients in TM subgroup met extrapolated inclusion criteria, twenty-three of which received ALND (82%). Post-Z0011, 14 patients in TM subgroup met extrapolated criteria, five of which underwent ALND (36%). The decrease in rate of ALND was significant (p=0.005). This study demonstrates that the Z0011 trial significantly altered management of the axilla in all breast cancer patients with positive sentinel lymph nodes, not just those receiving BCS.
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Affiliation(s)
| | - James Dove
- Geisinger Medical Center, Danville, Pennsylvania
| | | | - Nicole Woll
- Geisinger Medical Center, Danville, Pennsylvania
| | | | - April Morgan
- Geisinger Medical Center, Danville, Pennsylvania
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16
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Li CZ, Zhang P, Li RW, Wu CT, Zhang XP, Zhu HC. Axillary lymph node dissection versus sentinel lymph node biopsy alone for early breast cancer with sentinel node metastasis: A meta-analysis. Eur J Surg Oncol 2015; 41:958-66. [PMID: 26054706 DOI: 10.1016/j.ejso.2015.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/21/2015] [Accepted: 05/06/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In early breast cancer patients with sentinel node metastasis, the effect of axillary lymph node dissection (ALND) is controversial. The purpose of this study is to compare the safety and efficacy of sentinel lymph node biopsy (SLNB) alone versus ALND in patients with early breast cancer and sentinel node metastasis. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases from 1965 to February 2014. All data were analyzed using Review Manager Software 5.2. RESULTS 12 studies, which included 130,575 patients from five randomized controlled trials and seven observational studies, met our inclusion criteria. 26,870 early breast cancer patients underwent SLNB alone and 103,705 underwent ALND. Patients underwent ALND had more paresthesia (risk ratio [RR] 0.26, 95% confidence interval [CI] 0.20-0.33; p < 0.01) and lymphedema (RR 0.28, 95% CI 0.20-0.41; p < 0.01) than those had SLNB alone. There were no significant differences in overall survival (hazard ratio [HR] 0.95, 95% CI 0.85-1.06; p = 0.35), disease-free survival (HR 1.00, 95% CI 0.98-1.02, p = 0.96), and locoregional recurrence (RR 0.92, 95% CI 0.59-1.44; p = 0.73). CONCLUSION Current evidence indicates that axillary dissection may be omitted in early breast cancer patients with sentinel lymph metastasis.
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Affiliation(s)
- C Z Li
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - P Zhang
- Nursing and Rehabilitation College, Hebei United University, Tangshan 063000, Hebei, China
| | - R W Li
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - C T Wu
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - X P Zhang
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - H C Zhu
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China.
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17
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Ratchaworapong K, Thanawut S, Yodavudh S, Chottanapund S. Rate of sentinel lymph node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand. ASIAN BIOMED 2014. [DOI: 10.5372/1905-7415.0804.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: The sentinel lymph node (SLN) is the first lymph node to receive lymphatic drainage from a primary breast tumor. If the SLN contains no metastatic tumor, then it is unlikely other lymph nodes will contain breast cancer metastasis. When the SLN does contains metastasis, an axillary lymph node dissection (ALND) is recommended to further stage the axilla and to maintain locoregional control. SLNs can be identified by using a dye, radioisotope, or combined techniques.
Objective: To determine the rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand, and factors that affect it.
Methods: This prospective study of 106 consecutive cases breast cancer enrolled 105 women (1 bilateral breast cancer case) between October 2011 and October 2013 at Charoenkrung Pracharak Hospital. Clinical and pathological features were analyzed for the effectiveness of SLN identification using isosulfan blue dye.
Results: The rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital was 92%. The method was safe and well tolerated in early-stage breast cancer patients.
Conclusion: The effectiveness of sentinel node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital is consistent with that shown in studies from other countries.
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Affiliation(s)
| | - Sarawut Thanawut
- Department of Surgery, Charoenkrung Pracharak Hospital, Thailand
| | - Sirisanpang Yodavudh
- Department of Pathology, Charoenkrung Pracharak Hospital, Bangkok 10120, Thailand
| | - Suthat Chottanapund
- Department of Surgery, Bamrasnaradura Infectious Diseases Institute, Nontaburi 10110, Thailand
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