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Matsuzuka T, Tsukahara K, Yoshimoto S, Chikamatsu K, Shiotani A, Oze I, Murakami Y, Shinozaki T, Enoki Y, Ohba S, Kawakita D, Hanai N, Koide Y, Sawabe M, Nakata Y, Fukuda Y, Nishikawa D, Takano G, Kimura T, Oguri K, Hirakawa H, Hasegawa Y. Predictive factors for dissection-free sentinel node micrometastases in early oral squamous cell carcinoma. Sci Rep 2023; 13:6188. [PMID: 37061623 PMCID: PMC10105758 DOI: 10.1038/s41598-023-33218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
This sentinel node (SN) biopsy trial aimed to assess its effectiveness in identifying predictive factors of micrometastases and to determine whether elective neck dissection is necessary in oral squamous cell carcinoma. This retrospective study included 55 patients from three previous trials, with positive SNs. The relationship between the sizes of the metastatic focus and metastasis in non-sentinel node (NSN) was investigated. Four of the 55 largest metastatic focus were isolated tumor cells, and the remaining 51 were ranged from 0.2 to 15 mm, with a median of 2.6 mm. The difference of prevalence between 46 negative- and 9 positive-NSN was statistically significant with regard to age, long diameter of primary site and number of cases with regional recurrence. In comparing the size of largest metastatic focus dividing the number of positive SN, with metastaic focus range of < 3.0 mm in one-positive SN group, there were 18 (33%) negative-NSN and no positive-NSN. Regarding prognosis, 3-year overall survival rate of this group (n = 18) and other (n = 37) were 94% and 73% (p = 0.04), and 3-year recurrence free survival rate of this group and other were 94% and 51% (p = 0.03), respectively. Absolutely a further prospective clinical trial would be needed, micrometastases may be defined as solitary SN metastasis with < 3.0 mm of metastatic focus, and approximately 33% of neck dissections could be avoided using these criteria.
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Affiliation(s)
- Takashi Matsuzuka
- Department of Head and Neck Surgery - Otorhinolaryngology, Asahi University Hospital, 3-23 Hashimotocou, Gifu, 500-8523, Japan.
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuaki Chikamatsu
- Department of Otolaryngology Head and Neck Surgery, Gunma University School of Medicine, Maebashi, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Yoshiko Murakami
- Department of Diagnostic Pathology, Nagoya Medical Center, Nagoya, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuichiro Enoki
- Department of Head and Neck Oncology / Ear, Nose and Throat, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shinichi Ohba
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Koide
- Department of Otolaryngology Head and Neck Surgery, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Michi Sawabe
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Nakata
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Yujiro Fukuda
- Department of Otolaryngology Head and Neck Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Daisuke Nishikawa
- Department of Otorhinolaryngology, Kindai University Nara Hospital, Nara, Japan
| | - Gaku Takano
- Department of Otorhinolaryngology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Takahiro Kimura
- Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Keisuke Oguri
- Department of Otorhinolaryngology, Konan Kosei Hospital, Konan, Japan
| | - Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of the Ryukyus Faculty of Medicine, Okinawa, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery - Otorhinolaryngology, Asahi University Hospital, 3-23 Hashimotocou, Gifu, 500-8523, Japan
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de Oliveira-Junior I, Nahas EAP, Cherem AC, Nahas-Neto J, Vieira RADC. Sentinel Lymph Node Biopsy in T3 and T4b Breast Cancer Patients: Analysis in a Tertiary Cancer Hospital and Systematic Literature Review. Breast Care (Basel) 2021; 16:27-35. [PMID: 33716629 DOI: 10.1159/000504693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Breast cancer represents the most common type of cancer among women in the world. The presence and extent of axillary lymph node involvement represent an important prognostic factor. Sentinel lymph node biopsy (SLNB) is currently accepted for T1 and T2 with negative axillae (N0); however, many patients with T3-T4b tumors with N0 are often submitted to unnecessarily axillary lymph node dissection. Materials and Methods This is a retrospective, observational study of patients treated for breast cancer between 2008 and 2015, with T3/T4b tumors and N0, who underwent SLNB. A systematic review of the literature was also carried out in 5 bases. Results We analyzed 73 patients, and SLNB was negative for macrometastasis in 60.3% of the cases. With a mean follow-up of 45 months, no ipsilateral axillary local recurrence was observed. In the systematic review, only 7 articles presented data for analysis. Grouping these studies with the present series, the rate of N0 was 32.1% for T3 and 61.0% for T4b; grouping all studies (T3 and T4b n = 431) the rate was 32.5%. Conclusions SLNB in T3/T4b tumors is a feasible and safe procedure from the oncological point of view, as it has not been associated with ipsilateral axillary relapse.
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Affiliation(s)
- Idam de Oliveira-Junior
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil
| | - Eliana Aguiar Petri Nahas
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Gynecology, Obstetrics and Mastology, Botucatu School of Medicine, UNESP, Botucatu, Brazil
| | | | - Jorge Nahas-Neto
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Gynecology, Obstetrics and Mastology, Botucatu School of Medicine, UNESP, Botucatu, Brazil
| | - René Aloisio da Costa Vieira
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil.,Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil
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Kaidar-Person O, Offersen BV, Boersma LJ, de Ruysscher D, Tramm T, Kühn T, Gentilini O, Mátrai Z, Poortmans P. A multidisciplinary view of mastectomy and breast reconstruction: Understanding the challenges. Breast 2021; 56:42-52. [PMID: 33610903 PMCID: PMC7905468 DOI: 10.1016/j.breast.2021.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
The current review paper was written in collaboration with breast cancer surgeons from the European Breast Cancer Research Association of Surgical Trialists (EUBREAST), a breast pathologist from the Danish Breast Cancer Group (DBCG), and representatives from the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer course. Herein we summarize the different mastectomies and reconstruction procedures and define high-risk anatomical areas for breast cancer recurrences, to further specify the challenges in the surgical procedure, histopathological evaluation, and target volumes in case of postmastectomy irradiation, as recommended by the ESTRO guidelines according to the surgical procedure. The paper has original figures and illustrations for all disciplines for in-depth understanding of the differences between the procedures. Mastectomy techniques and reconstruction evolved to improve cosmetic outcomes. Different techniques maybe associated with different amount of residual breast tissue. More data is needed to estimate who are the patients at risk for residual disease or recurrence. Multidisciplinary work needed to individualise treatment for optimal oncological outcomes while maintaining the significant improvements in achieving better cosmesis for these patients.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, At Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands.
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Liesbeth J Boersma
- GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Dirk de Ruysscher
- GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | - Oreste Gentilini
- Breast Surgery Unit, San Raffaele University Hospital, Milan, Italy
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, 1122, Budapest, Ráth György U 7, Hungary
| | - Philip Poortmans
- Iridium Kankernetwerk, 2610, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, 2610, Wilrijk-Antwerp, Belgium
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Zhu C, Qi X, Zhou X, Nie X, Gu Y. Sulfatase 2 facilitates lymphangiogenesis in breast cancer by regulating VEGF-D. Oncol Rep 2016; 36:3161-3171. [PMID: 27748846 PMCID: PMC5112611 DOI: 10.3892/or.2016.5143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/01/2016] [Indexed: 12/27/2022] Open
Abstract
In our previous studies, sulfatase 2 (Sulf2) was found to upregulate vascular endothelial growth factor-D (VEGF-D) expression in breast cancer. As VEGF-D plays an important role in lymphangiogenesis, we hypothesized that Sulf2 facilitates lymphangiogenesis in breast cancer by regulating VEGF-D. To evaluate the functions of Sulf2 on lymphangiogenesis in breast cancer, proliferation, apoptosis, cell cycle, cell mobility and tube-formation of lymphatic endothelial cells (LECs) were measured in vitro. Lymphangiogenesis in nude mouse ears and breast cancer xenografts were examined in vivo. Furthermore, the expression levels of related signaling pathway genes were screened and verified in LECs. We found that Sulf2 significantly increased the mobility and tube formation of the LECs, inhibited cisplatin-induced LEC apoptosis, but had no effect on cell proliferation and the cell cycle. Moreover, recombinant Sulf2 (rSulf2) combined with VEGF-D further promoted the proliferation, cell cycle, mobility and tube-like structure formation in the LECs, and at the same time inhibited cisplatin-induced apoptosis especially in the late stage. Sulf2 also significantly increased the density of lymphatic vessels in mouse ears and breast cancer xenografts in vivo. AKT1 was also shown to be upregulated and activated by Sulf2. Our results confirmed that Sulf2 facilitated lymphangiogenesis in breast cancer cells by regulating VEGF-D and that the AKT1-related signaling pathway was involved.
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Affiliation(s)
- Chenfang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Affiliated with Shanghai Jiaotong University, School of Medicine, Shanghai 200011, P.R. China
| | - Xiaoliang Qi
- Department of General Surgery, Shanghai Ninth People's Hospital, Affiliated with Shanghai Jiaotong University, School of Medicine, Shanghai 200011, P.R. China
| | - Xin Zhou
- Department of Surgery, George Washington University, Washington, DC 20052, USA
| | - Xin Nie
- Department of General Surgery, Shanghai Ninth People's Hospital, Affiliated with Shanghai Jiaotong University, School of Medicine, Shanghai 200011, P.R. China
| | - Yan Gu
- Department of General Surgery, Shanghai Ninth People's Hospital, Affiliated with Shanghai Jiaotong University, School of Medicine, Shanghai 200011, P.R. China
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Yamada K, Ogata A, Kaise H, Oda M, Kimura F, Komatsu S, Nakamura Y, Hosonaga M, Matsumura M, Kawate T, Miyahara K, Kawai Y, Ueda A, Teraoka S, Kohno N. Accuracy and validity of sentinel lymph node biopsy for breast cancer using a photosensitizer: 8-year follow-up. Lasers Surg Med 2013; 45:558-63. [PMID: 24114757 DOI: 10.1002/lsm.22183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE We evaluated an alternative procedure for sentinel lymph node biopsy (SLNB) for breast cancer after approval of the study by the Ethics Committee of Tokyo Medical University Hospital in 2004. We examined the efficacy and safety of SLNB using the photosensitizer talaporfin sodium (Laserphyrin®, Meiji Seika Pharma, Tokoyo, Japan), compared with current methods. STUDY DESIGN/PATIENTS AND METHODS The study included 21 breast cancer patients (Japanese women; median age, 54 years; range, 35-75). All patients received a breast cancer operation combined with SLNB between June 2004 and May 2005. Three milliliters of talaporfin solution was locally injected into the subareolar region just before the operation. We attempted to identify a sentinel lymph node (SLN) that exhibited fluorescence and was consistent with a radioisotope (RI) localization technique. Our purpose was to verify the accuracy and validity of the talaporfin fluorescence imaging method after 8 years of application. RESULTS There was no consistent correlation between fluorescence and pathological SLN metastasis, although all four cases of pathological SLN metastasis revealed positive fluorescence. In some cases in which we could not identify SLNs by the RI technique, we could identify SLNs using talaporfin. The method using talaporfin did not adversely affect the patients after the operation, even the chronic renal failure patient. After 8 years, all patients are alive, and none had lymph node recurrence. Side effects were not observed. CONCLUSION SLNB using the photosensitizer talaporfin sodium in breast cancer patients is considered to be useful as complementary to other current methods. We could evaluate the accuracy and validity of this method 8 years after all of the procedures were performed. In the future, a large-scale clinical study with statistical analyses should be conducted.
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Affiliation(s)
- Kimito Yamada
- Department of Breast Oncology, Tokyo Medical University Hospital, Tokyo, Japan
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Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg 2013; 70:103-10. [PMID: 21862916 DOI: 10.1097/sap.0b013e31822ed5ce] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We conducted a retrospective survey of American Society of Plastic Surgeons to ascertain the current trends in breast reconstruction (BR). METHODS Surveys were sent to 2250 active American Society of Plastic Surgeons members by e-mail with a cover letter including the link using Survey Monkey for the year 2010. In all, 489 surveys (a response rate of 21.7%) were returned. Three hundred fifty-eight surveys from respondents performing BR in their practices were included in the study. The survey included questions on surgeon demographics, practice characteristics, BR after mastectomy, number of BR per year, type and timing of BR, use of acellular dermal matrix, reconstructive choices in the setting of previous irradiation and in patients requiring postmastectomy radiation therapy, timing of contralateral breast surgery, fat grafting, techniques used for nipple-areola reconstruction, the complications, and physician satisfaction and physician reported patient satisfaction. Returned responses were tabulated and assessed. RESULTS After prophylactic mastectomy, 16% of BRs were performed. In all, 81.2% of plastic surgeons predominantly performed immediate BR. In patients requiring postmastectomy radiation therapy, 81% did not perform immediate BR. Regardless of practice setting and laterality of reconstruction, 82.7% of respondents predominantly performed implant-based BR. Half of the plastic surgeons performing prosthetic BR used acellular dermal matrix. Only 14% of plastic surgeons predominantly performed autologous BR. Surgeons in solo, plastic surgery group practices, and multispecialty group practices preferred implant-based BR for both unilateral and bilateral cases more frequently than those in academic practices (P < 0.05). Overall, plastic surgeons in academic settings preferred autologous BR more frequently than those in other practice locations (P < 0.05). Of total respondents, 64.8% did not perform microsurgical BR at all; 28% reported performing deep inferior epigastric perforator flap BR. Pedicled transverse rectus abdominis myocutaneous flap was the most often used option for unilateral autologous reconstruction, whereas deep inferior epigastric perforator flap was the most commonly used technique for bilateral BR. The overall complication rate reported by respondents was 11%. CONCLUSION The survey provides an insight to the current trends in BR practice with respect to surgeon and practice setting characteristics. Although not necessarily the correct best practices, the survey does demonstrate a likely portrayal of what is being practiced in the United States in the area of BR.
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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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Takei H, Yoshida T, Kurosumi M, Inoue K, Matsumoto H, Hayashi Y, Higuchi T, Uchida S, Ninomiya J, Kubo K, Oba H, Nagai S, Tabei T. Sentinel lymph node biopsy after neoadjuvant chemotherapy predicts pathological axillary lymph node status in breast cancer patients with clinically positive axillary lymph nodes at presentation. Int J Clin Oncol 2012; 18:547-53. [PMID: 22588780 DOI: 10.1007/s10147-012-0418-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 04/19/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND It is still controversial whether axillary lymph node (ALN) dissection (ALND) can be omitted after negative sentinel lymph node (SLN) biopsy (SLNB) in breast cancer (BC) patients with clinically positive ALNs at presentation treated with neoadjuvant chemotherapy (NAC). The study aim was to analyze whether SLNB could be useful in these patients. METHODS In a retrospective study, eligible patients were women with invasive BC with clinically positive ALNs at presentation, treated with NAC then a total or partial mastectomy, with an intraoperative histological examination of SLNs and non-SLNs suspicious for metastasis followed by ALND. Non-SLNs suspicious for metastasis were defined as hard or large nodes located in the same level of the axilla where clinically positive ALNs had been initially identified. The results of SLNB and clinicopathological characteristics were analyzed for correlation with pathological ALN status. RESULTS In a consecutive series of 105 women with 107 BC cases, 81 (75.7 %) had at least 1 SLN, and the remaining 26 (24.3 %) had at least 1 non-SLN suspicious for metastasis. The intraoperative (or final) histological examination of these nodes revealed that the false-negative (FN) rate and accuracy were 8.2 (or 6.3) % and 95.1 (or 96.3) %, respectively. Estrogen receptor status at presentation, pathological tumor response, lymphovascular invasion after NAC, and NAC regimen were correlated with pathological ALN status. CONCLUSION The histological examination of SLNs and that of non-SLNs suspicious for metastasis are useful for predicting pathological ALN status in BC patients with clinically positive ALNs at presentation who are treated with NAC.
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Affiliation(s)
- Hiroyuki Takei
- Division of Breast Surgery, Saitama Cancer Center, 818 Komuro Ina, Kita-Adachi, Saitama, 362-0806, Japan.
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Eldweny H, Alkhaldy K, Alsaleh N, Abdulsamad M, Abbas A, Hamad A, Mounib S, Essam T, Kukawski P, Bobin JY, Oteifa M, Amanguono H, Abulhoda F, Usmani S, Elbasmy A. Predictors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node (Pilot study). J Egypt Natl Canc Inst 2012; 24:23-30. [PMID: 23587229 DOI: 10.1016/j.jnci.2011.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 11/29/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Sentinel Lymph Node Biopsy (SLNB) procedure was found to be an accurate method of staging the axilla in patients with early stage breast cancer. The standard of care for breast cancer patients with positive SLN metastasis includes complete Axillary Lymph Node Dissection (ALND). However, in 40-70% of patients, the SLN is the only involved axillary node. Factors predicting non SLN metastasis should be identified in order to define subgroups of patients with positive SLN in whom the axilla may be staged by SLNB alone. OBJECTIVES To identify the factors predicting metastatic involvement of the non-SLNs in breast cancer patients having SLN metastasis. PATIENTS AND METHODS Data were collected and analyzed from 80 patients with early stage invasive breast cancer (T1, T2, N0, M0) who underwent SLNB at the Surgical Oncology Department, Kuwait Cancer Control Center (KCCC) between November 2004 and February 2009. SLNB was performed using a combined technique (radioactive colloid, and blue dye) in the majority of cases. In some cases, only one technique was used. Complete ALND was performed in the case of failure of SLN identification and in patients with positive SLN. Multiple variables (patient, tumor, and SLN characteristics) were tested as possible predictors of nonsentinel lymph node metastasis. RESULTS The mean age of patients at diagnosis was 46.6years. The median tumor size was 2cm. The SLN identification rate was 96.2% (77 out of 80 patients). The SLN was positive in 24 patients (31%), and half of these showed evidence of capsular invasion. The median number of SLNs removed was two. The median number of positive SLNs was one. The incidence of non-SLN metastasis associated with positive SLN was 50% (12 out of 24 patients). Lymphovascular invasion was found to be the only factor associated with non-SLN metastases. In addition, two trends were observed, though they did not reach the statistical significance: the first is that the majority of patients having capsular invasion of the SLN (8 out of 12 patients, 67%) had positive non-SLN metastasis, and the second is that the patients having more than one SLN metastasis were more likely to have non-SLN metastasis (4 out of 5, 80%). CONCLUSION In the current pilot study, only the lymphovascular invasion in the area of the primary tumor was found to be significantly related to the nonsentinel lymph node metastasis. There was a tendency toward higher incidence of nonsentinel lymph node metastasis associated with the number of positive SLN and capsular invasion of SLN, though this did not reach the statistical significance. This could be attributed to the small number of patients recruited. Further evaluation of the predictors of nonsentinel lymph node metastasis on a larger number of patients is required. The validation of these predictors in prospective studies may enable approximately half of early stage breast cancer patients with positive SLN to be staged with SLNB alone while avoiding the morbidity of unnecessary ALND.
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Affiliation(s)
- Hany Eldweny
- Department of Surgical Oncology, Kuwait Cancer Control Center, Kuwait
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McGhan L, Dueck A, Gray R, Wasif N, McCullough A, Pockaj B. The changing landscape of axillary surgery: Which breast cancer patients may still benefit from complete axillary lymph node dissection? J Surg Oncol 2011; 106:254-9. [DOI: 10.1002/jso.22131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/04/2011] [Indexed: 01/17/2023]
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Pechlivanides G, Vassilaros D, Tsimpanis A, Apostolopoulou A, Vasilaros S. Sentinel node biopsy for breast cancer patients: issues for discussion and our practice. PATHOLOGY RESEARCH INTERNATIONAL 2010; 2011:109712. [PMID: 21234361 PMCID: PMC3018621 DOI: 10.4061/2011/109712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 12/09/2010] [Indexed: 11/20/2022]
Abstract
Sentinel node biopsy has been established for several years now as a standard procedure of breast cancer surgery, but there are several variations of the indications and the technique used. This paper provides information regarding several issues of debate for its application as are the selection criteria, the application to patients with multifocal/multicentric breast cancer or DCIS, postneoadjuvant chemotherapy, the necessary number of nodes to be biopsied, the need for lymphoscintigraphy, the technique for frozen section, the factors that may predict nonsentinel nodes (NSNs) involvement, the value of micrometastasis and isolated tumour cells, the internal mammary chain sentinel nodes, and finally the axillary recurrence after SLNB. Our view for these issues is included together with our experience of 430 SLNBs.
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Affiliation(s)
- Georgios Pechlivanides
- "Prolipsis" Diagnostic Center, Breast Unit, 88A Mihalacopoulou Street, 11528 Athens, Greece
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Fehm T, Helms G, Banys M, Kühn T. Management of the axilla for ipsilateral breast cancer recurrence after previous sentinel lymph node biopsy and breast conserving therapy. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10397-010-0616-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Webster JD, Dennis MM, Dervisis N, Heller J, Bacon NJ, Bergman PJ, Bienzle D, Cassali G, Castagnaro M, Cullen J, Esplin DG, Peña L, Goldschmidt MH, Hahn KA, Henry CJ, Hellmén E, Kamstock D, Kirpensteijn J, Kitchell BE, Amorim RL, Lenz SD, Lipscomb TP, McEntee M, McGill LD, McKnight CA, McManus PM, Moore AS, Moore PF, Moroff SD, Nakayama H, Northrup NC, Sarli G, Scase T, Sorenmo K, Schulman FY, Shoieb AM, Smedley RC, Spangler WL, Teske E, Thamm DH, Valli VE, Vernau W, Euler HV, Withrow SJ, Weisbrode SE, Yager J, Kiupel M. Recommended Guidelines for the Conduct and Evaluation of Prognostic Studies in Veterinary Oncology. Vet Pathol 2010; 48:7-18. [DOI: 10.1177/0300985810377187] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. D. Webster
- Molecular Pathology Unit, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - M. M. Dennis
- Faculty of Veterinary Science, University of Sydney, Camden, New South Wales, Australia
| | - N. Dervisis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - J. Heller
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - N. J. Bacon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | | | - D. Bienzle
- Department of Pathobiology, University of Guelph, Guelph, Ontario, Canada
| | - G. Cassali
- Department of General Pathology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - M. Castagnaro
- Department of Public Health, Comparative Pathology, and Veterinary Hygiene, University of Padua, Padua, Italy
| | - J. Cullen
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | | | - L. Peña
- Department of Animal Medicine, Surgery and Pathology, Veterinary School, University Complutense of Madrid, Madrid, Spain
| | - M. H. Goldschmidt
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - K. A. Hahn
- Hill’s Pet Nutrition, Inc, Topeka, Kansas
| | - C. J. Henry
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - E. Hellmén
- Department of Anatomy, Physiology, and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - D. Kamstock
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - J. Kirpensteijn
- Department of Companion Animal Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - B. E. Kitchell
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - R. L. Amorim
- Department of Veterinary Clinics, Veterinary Medical School, UNESP, Sao Paulo State University, Botucatu, Sao Paulo, Brazil
| | - S. D. Lenz
- Depatment of Comparative Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - T. P. Lipscomb
- Department of Veterinary Pathology, Armed Forces Institute of Pathology, Washington, DC
| | - M. McEntee
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | | | | | | | - A. S. Moore
- Faculty of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - P. F. Moore
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, California
| | | | - H. Nakayama
- Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
| | - N. C. Northrup
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - G. Sarli
- Department of Veterinary Public Health and Animal Pathology, Faculty of Veterinary Medicine, University of Bologna, Bologna, Italy
| | - T. Scase
- Bridge Pathology Ltd, Bristol, United Kingdom
| | - K. Sorenmo
- Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - F. Y. Schulman
- Department of Veterinary Pathology, Armed Forces Institute of Pathology, Washington, DC
| | - A. M. Shoieb
- Pfizer, Drug Safety and Research Development, Sandwich, United Kingdom
| | - R. C. Smedley
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | | | - E. Teske
- Department of Companion Animal Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - D. H. Thamm
- Animal Cancer Center, Colorado State University, Fort Collins, Colorado
| | - V. E. Valli
- VDx Veterinary Diagnostics, Davis, California
| | - W. Vernau
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, California
| | - H. von Euler
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - S. J. Withrow
- Animal Cancer Center, Colorado State University, Fort Collins, Colorado
| | - S. E. Weisbrode
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - J. Yager
- Yager-Best Histovet, Guelph, Ontario, Canada
| | - M. Kiupel
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
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Carvalho S, Mourão Netto M, Lima E, Pimentel A, Makdissi F, Osório C, Maciel M, Iyeyasu H, Collins J, Fontes C, Perina A, Soares F. Sentinel node biopsy in breast cancer: results in a large series. Braz J Med Biol Res 2010; 43:593-9. [DOI: 10.1590/s0100-879x2010007500048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 05/06/2010] [Indexed: 11/22/2022] Open
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Takei H, Kurosumi M, Yoshida T, Ishikawa Y, Hayashi Y, Ninomiya J, Tozuka K, Oba H, Inoue K, Nagai S, Saito Y, Kazumoto T, Saitoh JI, Tabei T. Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies. Breast Cancer 2009; 17:9-16. [PMID: 19701679 DOI: 10.1007/s12282-009-0154-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 06/08/2009] [Indexed: 01/17/2023]
Abstract
BACKGROUND It is currently unclear which patients with breast cancer with sentinel lymph node (SLN) metastases do not need axillary lymph node dissection (ALND). PATIENTS AND METHODS A cohort of 1,132 women who had unilateral invasive breast cancer with clinically negative nodes or nodes suspicious for metastasis, were intraoperatively diagnosed as having negative SLNs, and did not undergo an immediate ALND. Our intraoperative histological investigation uses H&E staining of a frozen section from a maximum cut surface of each SLN. Of these 1,132 women, 132 (11.7%) were postoperatively diagnosed as having positive SLNs, which classifies them as having an intraoperative, false-negative SLN biopsy (SLNB). Patient and tumor characteristics, treatment methods, and the prognoses of these patients were investigated and compared with the remaining 1,000 patients who were negative for SLNB. RESULTS Of the 132 patients with intraoperative, false-negative SLNB, none underwent a further ALND. With a median follow-up period of 58.1 months, none of these patients exhibited recurrence in the axillary nodes. Their recurrence-free survival rates were not statistically different from those of patients with negative SLNB. CONCLUSIONS ALND can be avoided in most patients with breast cancer with intraoperative, false-negative SLNB.
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Positive sentinel lymph node biopsy predicts the number of metastatic axillary nodes of breast cancer. Breast 2009; 18:244-7. [PMID: 19559610 DOI: 10.1016/j.breast.2009.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 03/29/2009] [Accepted: 05/24/2009] [Indexed: 02/06/2023] Open
Abstract
It remains to be clarified whether a positive sentinel lymph node biopsy (SLNB) can predict the number of metastatic axillary nodes. This study examined a consecutive series of women with unilateral invasive breast cancer who underwent axillary lymph node dissection after an intra-operative positive SLNB. The numbers of positive and negative sentinel lymph nodes (SLNs) were analyzed for a likelihood of pN1a, pN2a, and pN3a diseases as per the UICC TNM classification. Of the 368 study patients, 165 (45%) had one positive SLN and one or more negative SLNs. This result represented the most common combination of positive and negative SLNs. It was also the most predictive indicator (93%) of pN1a disease and the least predictive indicator (7% or 0%) of pN2a or pN3a disease, respectively. The numbers of positive and negative SLNs can predict the number of metastatic axillary nodes in breast cancer patients.
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17
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Advantage of sentinel lymph node biopsy before neoadjuvant chemotherapy in breast cancer treatment. Surg Today 2009; 39:374-80. [DOI: 10.1007/s00595-008-3880-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 11/04/2008] [Indexed: 01/05/2023]
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18
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Britton P, Provenzano E, Barter S, Gaskarth M, Goud A, Moyle P, Sinnatamby R, Wallis M, Benson J, Forouhi P, Wishart G. Ultrasound guided percutaneous axillary lymph node core biopsy: How often is the sentinel lymph node being biopsied? Breast 2009; 18:13-6. [DOI: 10.1016/j.breast.2008.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 09/03/2008] [Accepted: 09/10/2008] [Indexed: 10/21/2022] Open
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19
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Bergkvist L. Resolving the controversies surrounding lymphatic mapping in breast cancer. Future Oncol 2008; 4:681-8. [DOI: 10.2217/14796694.4.5.681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Sentinel lymph node biopsy has rapidly become the standard of care in the primary treatment of breast cancer. Most of the initially identified potential contraindications towards the procedure, such as nonpalpability, large tumor size, pregnancy and being previously operated in the breast or axilla, have been ruled out, whereas multifocality represents an unsolved problem. There is no consensus about the best use of the technique in patients receiving neoadjuvant treatment. There is no place for sentinel lymph node biopsy in pure ductal carcinoma in situ, but it can be used for large high-grade in situ cancer diagnosed through core biopsy, especially if a mastectomy is planned. Morbidity is low, and the recurrence rates reported so far are reassuring. However, long-term results are lacking, and results from ongoing randomized trials are awaited.
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Affiliation(s)
- Leif Bergkvist
- Department of Surgery and Center for Clinical Research, Uppsala Universitet Central Hospital, SE 72189 Västerås, Sweden
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20
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Cox CE, Cox JM, Ramos D, Meade TL. Intramammary sentinel lymph nodes: what is the clinical significance? Ann Surg Oncol 2008; 15:1273-4. [PMID: 18322759 PMCID: PMC2277455 DOI: 10.1245/s10434-007-9769-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 11/26/2007] [Indexed: 11/18/2022]
Affiliation(s)
- Charles E. Cox
- Department of Surgery at the Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, Florida USA
| | - John M. Cox
- Department of Surgery at the Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, Florida USA
| | - Daniel Ramos
- Department of Surgery at the Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, Florida USA
| | - Tammi L. Meade
- Department of Surgery at the Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, Florida USA
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