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Yang H, Sun Y, Wang P, Qiao J, Wang C, Liu Z. The Impact of Sentinel Lymph Node Biopsy on Female Patients With T3-4c Breast Cancer and 1-2 Positive Lymph Nodes: A Population-Based Cohort Study. Clin Breast Cancer 2024; 24:e126-e137.e3. [PMID: 38114365 DOI: 10.1016/j.clbc.2023.11.004] [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: 10/21/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE This study aimed to evaluate the efficacy of sentinel lymph node biopsy (SLNB) in patients diagnosed with cT3-4c breast cancer with no more than 2 positive sentinel lymph nodes. METHODS Using data from the Surveillance, Epidemiology, and End Results (SEER) database, this retrospective study identified patients diagnosed with T3-4c breast cancer between 2010 and 2015. These patients were then categorized into 2 groups: the SLNB group, which underwent examination of 1-5 regional lymph nodes and the axillary lymph node dissection (ALND) group, which underwent examination of ≥10 regional lymph nodes. Propensity score matching analysis was used to assess the efficacy of SLNB in cT3-4c patients. RESULTS A total of 1139 patients were included in the analysis, with 423 and 716 patients in the SLNB and ALND groups, respectively. The 10-year overall survival (OS) and breast cancer-specific survival (BCSS) rates in the SLNB group were 66.1% and 76.3%, respectively, compared with 66.0% and 73.8%, respectively. Statistical analysis revealed no significant differences between the 2 groups in terms of OS (HR = 1.00, 95% CI = 0.80-1.25, P = .997) and BCSS (HR = 1.08, 95% CI = 0.83-1.41, P = .551). Even after 1:1 propensity score matching, there were no significant differences in OS (HR = 0.87, 95% CI = 0.65-1.16, P = .341) and BCSS (HR = 0.82, 95% CI = 0.59-1.16, P = .266) between the 2 groups. CONCLUSION This study demonstrates that SLNB does not adversely affect the survival of cT3-4c breast cancer patients with 1-2 sentinel lymph node metastases.
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Affiliation(s)
- Hanzhao Yang
- Department of Breast Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yadong Sun
- Department of Breast Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Peili Wang
- Department of Breast Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jianghua Qiao
- Department of Breast Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Chengzheng Wang
- Department of Breast Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Zhenzhen Liu
- Department of Breast Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
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Verreck EEF, van Steenhoven JEC, Kuijer A, van Maaren MC, Simons JM, Siesling S, van Dalen T. Trends of Axillary Treatment in Sentinel Node-Positive Breast Cancer Patients Undergoing Mastectomy. Ann Surg Oncol 2023; 30:5623-5632. [PMID: 37225832 PMCID: PMC10409658 DOI: 10.1245/s10434-023-13568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The ACOSOG-Z0011- and the AMAROS-trial obviated the need for axillary surgery in most sentinel node-positive (SLN+) breast cancer patients undergoing breast-conserving surgery (BCS). Data for patients who undergo mastectomy is scarce. The purpose of this study was to investigate patterns of axillary treatment in SLN+ patients treated by mastectomy in the years after the publication of landmark studies regarding axillary treatment in SLN+ breast cancer patients undergoing BCS. METHODS This was a population-based study in cT1-3N0M0 breast cancer patients treated by mastectomy and staged as SLN+ between 2009 and 2018. The performance of an axillary lymph node dissection (ALND) and/or administration of postmastectomy radiotherapy (PMRT) were primary outcomes and were studied over time. RESULTS The study included 10,633 patients. The frequency of ALND performance decreased from 78% in 2009 to 10% in 2018, whereas PMRT increased from 4 to 49% (P < 0.001). In ≥N1a patients, ALND performance decreased from 93 to 20%, whereas PMRT increased to 70% (P < 0.001). In N1mi and N0itc patients, ALND was abandoned during the study period, whereas PMRT increased to 38% and 13% respectively (P < 0.001), respectively. Age, tumor subtype, N-stage, and hospital type affected the likelihood that patients underwent ALND. CONCLUSIONS In this study in SLN+ breast cancer patients undergoing mastectomy, use of ALND decreased drastically over time. By the end of 2018 most ≥N1a patients received PMRT as the only adjuvant axillary treatment, whereas the majority of N1mi and N0itc patients received no additional treatment.
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Affiliation(s)
| | - Julia E C van Steenhoven
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anne Kuijer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marissa C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Janine M Simons
- Department of Radiotherapy, Erasmus MC, Rotterdam, The Netherlands
- GROW school for oncology and reproduction, MUMC+, Maastricht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Huang Z, Wu Z, Zou QQ, Xie YJ, Li LH, Huang YP, Wu FM, Huang D, Pan YH, Yang JR. Risk factors of non-sentinel lymph node metastasis in breast cancer with 1-2 sentinel lymph node macrometastases underwent total mastectomy: a case-control study. World J Surg Oncol 2023; 21:125. [PMID: 37024930 PMCID: PMC10077622 DOI: 10.1186/s12957-023-02888-z] [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: 09/22/2022] [Accepted: 01/09/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The randomized trials which include ACOSOG Z0011 and IBCSG 23-01 had found that the survival rates were not different in patients with cT1/2N0 and 1-2 sentinel lymph node (SLN)-positive, macro/micrometastases who underwent breast-conserving therapy, and micrometastases who underwent total mastectomy (TM), when axillary lymph node dissection (ALND) was omitted. However, for patients with cT1/2N0 and 1-2 SLN macrometastases who underwent TM; there was still insufficient evidence from clinical studies to support whether ALND can be exempted. This study aimed to investigate the risk factors of non-sentinel lymph node (nSLN) metastasis in breast cancer patients with 1-2 SLN macrometastases undergoing TM. METHODS The clinicopathological data of 1491 breast cancer patients who underwent TM and SLNB from January 2017 to February 2022 were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for nSLN metastasis. RESULTS A total of 273 patients with 1-2 SLN macrometastases who underwent TM were enrolled. Postoperative pathological data showed that 35.2% patients had nSLN metastasis. The results of multivariate analysis indicated that tumor size (TS) (P = 0.002; OR: 1.051; 95% CI: 1.019-1.084) and ratio of SLN macrometastases (P = 0.0001; OR: 12.597: 95% CI: 4.302-36.890) were the independent risk factors for nSLN metastasis in breast cancer patients with 1-2 SLN macrometastases that underwent TM. The ROC curve analysis suggested that when TS ≤22 mm and ratio of SLN macrometastases ≤0.33, the incidence of nSLN metastasis could be reduced to 17.1%. CONCLUSIONS The breast cancer patients with cT1/2N0 stage, undergoing TM and 1-2 SLN macrometastases, when the TS ≤22 mm and macrometastatic SLN does not exceed 1/3 of the total number of detected SLN, the incidence of nSLN metastasis is significantly reduced, but whether ALND can be exempted needs further exploration.
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Affiliation(s)
- Zhen Huang
- Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China
| | - Zhe Wu
- Department of Gynaecology, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Quan-Qing Zou
- Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China
| | - Yu-Jie Xie
- Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China
| | - Li-Hui Li
- Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China
| | - Yan-Ping Huang
- Department of Breast Surgery, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Feng-Ming Wu
- Department of Breast Surgery, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Dong Huang
- Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China
| | - Yin-Hua Pan
- Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China
| | - Jian-Rong Yang
- Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China.
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Guo Q, Dong Z, Jiang L, Zhang L, Li Z, Wang D. Assessing Whether Morphological Changes in Axillary Lymph Node Have Already Occurred Prior to Metastasis in Breast Cancer Patients by Ultrasound. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111674. [PMID: 36422213 PMCID: PMC9695007 DOI: 10.3390/medicina58111674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Whether the morphological changes in axillary lymph node (ALN) have occurred prior to metastasis remains unclear in breast cancer (BC) patients. The aim of this study is to investigate the influence of BC for the morphology of non-metastasis ALN (N−) and, further, to improve the performance of ultrasound (US) examination for metastasis ALN (N+). Materials and Methods: In this retrospective study, 653 patients with breast mass were enrolled and divided into normal group of 202 patients with benign breast tumor, N− group of 233 BC patients with negative ALN and N+ group of 218 BC patients with positive ALN. US features of ALN were evaluated and analyzed according to long (L) and short (S) diameter, the (L/S) axis ratio, cortical thickness, lymph node edge, replaced hilum and color Doppler flow imaging (CDFI). Results: ALN US features of short diameter, replaced hilum, cortical thickness and CDFI have significant statistical differences in N− group comparing with normal group and N+ group, respectively (p < 0.05). Conclusions: Therefore, BC can affect ALN and lead to US morphological changes whether lymph node metastasis is present, which reduces the sensitivity of axillary US. The combination of US and other examination methods should be applied to improve the diagnostic performance of N+.
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Affiliation(s)
- Qiang Guo
- Department of Ultrasound Medicine, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, China
- Correspondence: ; Tel.: +86-(189)-3081-7376
| | - Zhiwu Dong
- Department of Laboratory Medicine, Jinshan Branch of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201599, China
| | - Lixin Jiang
- Department of Ultrasound in Medicine, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201599, China
| | - Lei Zhang
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Ziyao Li
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Dongmo Wang
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
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Xu J, Li J. A model for the early identification of sentinel lymph node metastasis in patients with breast cancer based on contrast‑enhanced ultrasound and clinical features. Oncol Lett 2022; 24:378. [PMID: 36238843 PMCID: PMC9494614 DOI: 10.3892/ol.2022.13498] [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: 02/14/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to establish a model for the early identification of sentinel lymph node (SLN) metastasis in patients with breast cancer (BC). The SLN metastasis predictive model was established with a retrospective training set of 365 patients with BC and was re-evaluated using a prospective validation set of 402 patients with BC. The multivariable analysis indicated that the tumor diameter [odds ratio (OR), 1.189; 95% confidence interval (CI), 1.124-1.257; P<0.001], menopause (OR, 1.011; 95% CI, 0.603-1.436; P<0.001), estrogen receptor (ER) expression (OR, 3.199; 95% CI, 1.077-6.567; P=0.043) and contrast-enhanced ultrasonography (CEUS) type (OR, 10.563; 95% CI, 6.890-28.372; P<0.001) were independent predictors of SLN status in patients with BC. The SLN metastasis predictive model was as follows: (0.173 × tumor diameter)-(4.490 × menopause) + (2.322 × ER) + (5.445 × CEUS type)-1.9521. In the training set, the model was highly sensitive (83.6%) and specific (94.3%) for the early identification of SLN metastasis. Similarly, in the validation set, the model was highly sensitive (70.4%) and specific (89.5%) for the early identification of SLN metastasis in patients with BC. Overall, in the present study, a model was successfully established to predict SLN metastasis in patients with BC that includes tumor diameter, menopausal status, ER expression and CEUS detection.
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Affiliation(s)
- Juan Xu
- Department of Interventional Ultrasound, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Junzhi Li
- Department of Interventional Ultrasound, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
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Chen ST, Lai HW, Wu WP, Chen ST, Liao CY, Wu HK, Chen DR, Mok CW. The impact of body mass index (BMI) on MRI diagnostic performance and surgical management for axillary lymph node in breast cancer. World J Surg Oncol 2022; 20:45. [PMID: 35193599 PMCID: PMC8864912 DOI: 10.1186/s12957-022-02520-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background We hypothesized that different BMI might have different impact on pre-operative MRI axillary lymph node (ALN) prediction accuracy and thereby subsequent surgical lymph node management. The aim of this study is to evaluate the effect of BMI on presentation, surgical treatment, and MRI performance characteristics of breast cancer with the main focus on ALN metastasis evaluation. Methods The medical records of patients with primary invasive breast cancer who had pre-operative breast MRI and underwent surgical resection were retrospectively reviewed. They were categorized into 3 groups in this study: underweight (BMI < 18.5), normal (BMI of 18.5 to 24), and overweight (BMI > 24). Patients’ characteristics, surgical management, and MRI performance for axillary evaluation between the 3 groups were compared. Results A total of 2084 invasive breast cancer patients with a mean age of 53.4 ± 11.2 years were included. Overweight women had a higher rate of breast conserving surgery (56.7% vs. 54.5% and 52.1%) and initial axillary lymph node dissection (15.9% vs. 12.2% and 8.5%) if compared to normal and underweight women. Although the post-operative ALN positive rates were similar between the 3 groups, overweight women were significantly found to have more axillary metastasis on MRI compared with normal and underweight women (50.2% vs 37.7% and 18.3%). There was lower accuracy in terms of MRI prediction in overweight women (65.1%) than in normal and underweight women (67.8% and 76.1%). Conclusion Our findings suggest that BMI may influence the diagnostic performance on MRI on ALN involvement and the surgical management of the axilla in overweight to obese women with breast cancer.
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Affiliation(s)
- Shu-Tian Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital-Chiayi Branch, Chiayi, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Wen Lai
- Chang Gung University College of Medicine, Taoyuan City, Taiwan. .,Endoscopy & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan. .,Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan. .,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. .,Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan. .,Kaohsiung Medical University, Kaohsiung, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Wen-Pei Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chiung-Ying Liao
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hwa-Koon Wu
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chi Wei Mok
- Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore, Singapore
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Peyroteo M, Canotilho R, Margarida Correia A, Baía C, Ribeiro C, Reis P, de Sousa A. Predictive factors of non-sentinel lymph node disease in breast cancer patients with positive sentinel lymph node. Cir Esp 2022; 100:81-87. [PMID: 35123939 DOI: 10.1016/j.cireng.2022.01.003] [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: 10/17/2020] [Accepted: 11/16/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Management of positive sentinel lymph node biopsy (SLNB) in breast cancer remains a matter of debate. Our aim was to evaluate the incidence and identify predictive factors of non-sentinel lymph node metastases. METHODS Retrospective review of all cN0 breast cancer patients treated between January 2013 and December 2017, with positive SLNB that were submitted to ALND. RESULTS Of the 328 patients included, the majority of tumors were cT1 or cT2, with lymphovascular invasion in 58.4% of cases. The mean isolated nodes in SLNB was 2.7, with a mean of 1.6 positive nodes, 60.7% with extracapsular extension. Regarding ALND, a mean of 13.9 nodes were isolated, with a mean of 2.1 positive nodes. There was no residual disease in the ALND in 50.9% of patients, with 18.9% having ≥4 positive nodes. In the multivariate analysis, lymphovascular invasion, extracapsular extension in SLN, largest SLN metastases size (>10 mm) and ratio of positive SNL (>50%) were independent predictors of non-sentinel lymph node metastases. These four factors were used to build a non-pondered score to predict the probability of a positive ALND after a positive SLNB. The AUC of the model was 0.69 and 81% of patients with score = 0 and 65.6% with score = 1 had no additional disease in ALND. CONCLUSION The absence of non-sentinel lymph node metastases in the majority of patients with 1-2 positive SLN with low risk score questions the need of ALND in this population. The identified predictive factors may help select patients in which ALND can be omitted.
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Affiliation(s)
- Mariana Peyroteo
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal.
| | - Rita Canotilho
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Ana Margarida Correia
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Catarina Baía
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Cátia Ribeiro
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Paulo Reis
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Abreu de Sousa
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
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8
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Peyroteo M, Canotilho R, Correia AM, Baía C, Ribeiro C, Reis P, de Sousa A. Predictive factors of non-sentinel lymph node disease in breast cancer patients with positive sentinel lymph node. Cir Esp 2020; 100:S0009-739X(20)30386-9. [PMID: 33358014 DOI: 10.1016/j.ciresp.2020.11.012] [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: 10/17/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Management of positive sentinel lymph node biopsy (SLNB) in breast cancer remains a matter of debate. Our aim was to evaluate the incidence and identify predictive factors of non-sentinel lymph node metastases. METHODS Retrospective review of all cN0 breast cancer patients treated between January 2013 and December 2017, with positive SLNB that were submitted to ALND. RESULTS Of the 328 patients included, the majority of tumors were cT1 or cT2, with lymphovascular invasion in 58.4% of cases. The mean isolated nodes in SLNB was 2.7, with a mean of 1.6 positive nodes, 60.7% with extracapsular extension. Regarding ALND, a mean of 13.9 nodes were isolated, with a mean of 2.1 positive nodes. There was no residual disease in the ALND in 50.9% of patients, with 18.9% having ≥ four positive nodes. In the multivariate analysis, lymphovascular invasion, extracapsular extension in SLN, largest SLN metastases size (>10 mm) and ratio of positive SNL (> 50%) were independent predictors of non-sentinel lymph node metastases. These four factors were used to build a non-pondered score to predict the probability of a positive ALND after a positive SLNB. The AUC of the model was 0.69 and 81% of patients with score = 0 and 65.6% with score = 1 had no additional disease in ALND. CONCLUSION The absence of non-sentinel lymph node metastases in the majority of patients with 1-2 positive SLN with low risk score questions the need of ALND in this population. The identified predictive factors may help select patients in which ALND can be omitted.
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Affiliation(s)
- Mariana Peyroteo
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal.
| | - Rita Canotilho
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Ana Margarida Correia
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Catarina Baía
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Cátia Ribeiro
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Paulo Reis
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Abreu de Sousa
- Surgical Oncology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
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9
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Riedel F, Heil J, Feisst M, Moderow M, von Au A, Domschke C, Michel L, Schaefgen B, Golatta M, Hennigs A. Analyzing non-sentinel axillary metastases in patients with T3-T4 cN0 early breast cancer and tumor-involved sentinel lymph nodes undergoing breast-conserving therapy or mastectomy. Breast Cancer Res Treat 2020; 184:627-636. [PMID: 32816190 PMCID: PMC7599150 DOI: 10.1007/s10549-020-05876-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/10/2020] [Indexed: 11/12/2022]
Abstract
Purpose In the ACOSOG Z0011 trial, completing axillary lymph node dissection (cALND) did not benefit patients with T1–T2 cN0 early breast cancer and 1–2 positive sentinel lymph nodes (SLN) undergoing breast-conserving surgery (BCT). This paper reports cALND rates in the clinical routine for patients who had higher (T3–T4) tumor stages and/or underwent mastectomy but otherwise met the ACOSOG Z0011 eligibility criteria. Aim of this study is to determine cALND time trends and non-sentinel axillary metastases (NSAM) rates to estimate occult axillary tumor burden. Methods Data were included from patients treated in 179 German breast cancer centers between 2008 and 2015. Time-trend rates were analyzed for cALND of patients with T3–T4 tumors separated for BCT and mastectomy and regarding presence of axillary macrometastases or micrometastases. Results Data were available for 188,909 patients, of whom 19,009 were identified with 1–2 positive SLN. Those 19,009 patients were separated into 4 cohorts: (1) Patients with T1–T2 tumors receiving BCT (ACOSOG Z0011 eligible; n = 13,741), (2) T1–T2 with mastectomy (n = 4093), (3) T3–T4 with BCT (n = 269), (4) T3–T4 with mastectomy (n = 906). Among patients with T3–T4 tumors, cALND rates declined from 2008 to 2015: from 88.2 to 62.6% for patients receiving mastectomy and from 96.6 to 58.1% in patients receiving BCT. Overall rates for any NSAM after cALND for cohorts 1–4 were 33.4%, 42.3%, 46.9%, 58.8%, respectively. Conclusions The cALND rates have decreased substantially in routine care in patients with ‘extended’ ACOSOG Z0011 eligibility criteria. Axillary tumor burden is higher in these patients than in the ACOSOG Z0011 trial.
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Affiliation(s)
- Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Mareike Moderow
- West German Breast Center GmbH, Bahlenstr. 180, 40589, Düsseldorf, Germany
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Laura Michel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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10
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Mathias BJ, Sun J, Sun W, Zhou JM, Fulp WJ, Laronga C, Lee MC, Kiluk JV. Surgeon Bias in the Management of Positive Sentinel Lymph Nodes. Clin Breast Cancer 2020; 21:74-79. [PMID: 32917535 DOI: 10.1016/j.clbc.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The standard of care for clinically node-negative (cN0) patients following positive sentinel lymph node biopsy (SLNB) was completion axillary lymph node dissection (CALND). Publication of ACOSOG Z0011 in 2010 changed this standard for patients undergoing lumpectomy. Clinicians have since expanded this practice to mastectomy patients, and ongoing prospective studies are seeking to validate this practice. Here, we evaluate patient and tumor characteristics that led surgeons to forego a second surgery for CALND in cN0 mastectomy patients with positive SLNB. PATIENTS AND METHODS A single institution, retrospective review of cN0 patients with invasive primary breast cancer and positive SLNB from 2010 to 2016 was performed. Patients with T4 disease, positive preoperative axillary biopsy, prior neoadjuvant therapy or axillary surgery were excluded. Patients with positive SLNB undergoing CALND were compared with patients for whom CALND was omitted. Statistical analysis was performed using Kruskal-Wallis tests for continuous variables and χ2 tests or Fischer exact tests for categorical variables. RESULTS Of 259 patients with positive SLNB, 180 (69.4%) patients underwent mastectomy. CALND was performed at the time of mastectomy in 54 (30%) patients, at time of second operation in 22 (12.2%) patients, and not performed in 104 (57%) patients. Delayed CALND was significantly associated with younger age, larger tumors, increased number of positive sentinel nodes, invasive lobular carcinoma, extranodal extension, and lymphovascular invasion. CONCLUSIONS The management of cN0 patients with positive SLNB that do not meet ACOSOG Z0011 criteria is evolving and is influenced by tumor and patient characteristics in an attempt to balance the morbidity of CALND with the low rate of local regional recurrence.
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Affiliation(s)
| | - James Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Weihong Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Christine Laronga
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - M Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - John V Kiluk
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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