801
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Winter M, Gibson R, Ruszkiewicz A, Thompson SK, Thierry B. Beyond conventional pathology: Towards preoperative and intraoperative lymph node staging. Int J Cancer 2014; 136:743-51. [DOI: 10.1002/ijc.28742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/23/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Marnie Winter
- Ian Wark Research Institute; University of South Australia; Adelaide SA Australia
| | - Rachel Gibson
- Discipline of Anatomy and Pathology School of Medical Sciences; University of Adelaide; Adelaide SA Australia
| | | | - Sarah K. Thompson
- Department of Surgery Royal Adelaide Hospital and School of Health Sciences; University of South Australia; Adelaide SA Australia
| | - Benjamin Thierry
- Ian Wark Research Institute; University of South Australia; Adelaide SA Australia
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802
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Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study. Cir Esp 2014; 93:23-9. [PMID: 24560631 DOI: 10.1016/j.ciresp.2014.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A controversial aspect of breast cancer management is the use of sentinel lymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P=0,002) in the negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients.
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803
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Tiernan JP, Verghese ET, Nair A, Pathak S, Kim B, White J, Thygesen H, Horgan K, Hanby AM. Systematic review and meta-analysis of cytokeratin 19-based one-step nucleic acid amplification versus histopathology for sentinel lymph node assessment in breast cancer. Br J Surg 2014; 101:298-306. [DOI: 10.1002/bjs.9386] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 01/11/2023]
Abstract
Abstract
Background
One-step nucleic acid amplification (OSNA) is a new rapid assay for detecting breast cancer metastases during surgery, saving a second procedure for patients requiring an axillary clearance. Many centres in the UK and abroad have adopted OSNA in place of routine histopathology, despite no published meta-analysis. The aim of this systematic review and meta-analysis was to determine whether intraoperative OSNA for lymph node assessment is comparable to routine histopathology in the detection of clinically relevant metastases.
Methods
PubMed, Embase, Web of Knowledge and regional databases were searched for relevant studies published before December 2012. Included studies compared OSNA and standard histology using fresh lymph nodes that were assessed in a clearly defined systematic manner in accordance with the index study.
Results
Twelve eligible studies were identified that included 5057 lymph nodes from 2192 patients. Although meta-analysis using a random-effects model showed a similar overall proportion of macrometastases detected (429 of 3234 versus 432 of 3234; odds ratio 0·99, 95 per cent confidence interval 0·86 to 1·15), analysis of concordance showed that the pooled positive predictive value for detecting macrometastases was 0·79. This suggests that up to 21 per cent of patients found to have macrometastases using OSNA would have an axillary clearance when histology would have classified the deposits as non-macrometastases. Furthermore, analysis of data from the index publication showed that the range of cytokeratin 19 titres for tumours of a given volume is too wide to predict tumour size.
Conclusion
OSNA has an unacceptably low positive predictive value, leading to axillary clearances that would not be recommended if standard histology had been used to assess the sentinel node.
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Affiliation(s)
- J P Tiernan
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Surgery, St James's University Hospital, Leeds, UK
| | - E T Verghese
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Histopathology, St James's University Hospital, Leeds, UK
| | - A Nair
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Surgery, St James's University Hospital, Leeds, UK
| | - S Pathak
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Surgery, St James's University Hospital, Leeds, UK
| | - B Kim
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Surgery, St James's University Hospital, Leeds, UK
| | - J White
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Surgery, St James's University Hospital, Leeds, UK
| | - H Thygesen
- Statistics and Bioinformatics, Leeds Cancer Research UK Centre, St James's University Hospital, Leeds, UK
| | - K Horgan
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Surgery, St James's University Hospital, Leeds, UK
| | - A M Hanby
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Histopathology, St James's University Hospital, Leeds, UK
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804
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Omair M, Al-Azawi D, Mann GB. Sentinel node biopsy in breast cancer revisited. Surgeon 2014; 12:158-65. [PMID: 24548701 DOI: 10.1016/j.surge.2013.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/23/2013] [Accepted: 12/23/2013] [Indexed: 01/17/2023]
Abstract
The axilla has long been a focus of clinicians' attention in the management of breast cancer. The approach to the axilla has undergone dramatic changes over the last century, from radical and extended radical excisions, through the introduction of sentinel node biopsy for node negative patients to the current situation where selective management of those with nodal involvement is being introduced. The introduction of lymphatic mapping and sentinel node biopsy in the 1990's has been key to the major changes that have occurred. In less than 20 years it has moved from a hypothesis to a situation where it is the default approach to almost all clinically node negative patients and is being considered in other situations where axillary clearance was previously considered standard. This article reviews the development and introduction of sentinel node biopsy, its current uncertainties and limitations, and possible future developments.
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Affiliation(s)
- Mohammad Omair
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Dhafir Al-Azawi
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia; St James's Hospital, Trinity College, Dublin, Ireland
| | - Gregory Bruce Mann
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia; The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia.
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805
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Tvedskov TF, Meretoja TJ, Jensen MB, Leidenius M, Kroman N. Cross-validation of three predictive tools for non-sentinel node metastases in breast cancer patients with micrometastases or isolated tumor cells in the sentinel node. Eur J Surg Oncol 2014; 40:435-41. [PMID: 24534362 DOI: 10.1016/j.ejso.2014.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/14/2014] [Accepted: 01/23/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We cross-validated three existing models for the prediction of non-sentinel node metastases in patients with micrometastases or isolated tumor cells (ITC) in the sentinel node, developed in Danish and Finnish cohorts of breast cancer patients, to find the best model to identify patients who might benefit from further axillary treatment. MATERIAL AND METHOD Based on 484 Finnish breast cancer patients with micrometastases or ITC in sentinel node a model has been developed for the prediction of non-sentinel node metastases. Likewise, two separate models have been developed in 1577 Danish patients with micrometastases and 304 Danish patients with ITC, respectively. The models were cross-validated in the opposite cohort. RESULTS The Danish model for micrometatases was accurate when tested in the Finnish cohort, with a slight change in AUC from 0.64 to 0.63. The AUC of the Finnish model decreased from 0.68 to 0.58 when tested in the Danish cohort, and the AUC of the Danish model for ITC decreased from 0.73 to 0.52, when tested in the Finnish cohort. The Danish micrometastatic model identified 14-22% of the patients as high-risk patients with over 30% risk of non-sentinel node metastases while less than 1% was identified by the Finish model. In contrast, the Finish model predicted a much larger proportion of patients being in the low-risk group with less than 10% risk of non-sentinel node metastases. CONCLUSION The Danish model for micrometastases worked well in predicting high risk of non-sentinel node metastases and was accurate under external validation.
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Affiliation(s)
- T F Tvedskov
- Department of Breast Surgery, Copenhagen University Hospital, Afsnit 4124, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - T J Meretoja
- Breast Surgery Unit, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - M B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Afsnit 2501, Blegdamsvej 9, Copenhagen, Denmark
| | - M Leidenius
- Breast Surgery Unit, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - N Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Afsnit 4124, Blegdamsvej 9, 2100 Copenhagen, Denmark
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806
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Cserni G. Sentinel lymph node status and axillary lymph node dissection in the surgical treatment of breast cancer. Orv Hetil 2014; 155:203-15. [DOI: 10.1556/oh.2014.29816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Axillary lymph node dissection has been traditionally perceived as a therapeutic and a staging procedure and unselectively removes all axillary lymph nodes. There still remains some controversy as concerns the survival benefit associated with axillary clearance. Sentinel lymph node biopsy removes the most likely sites of regional metastases, the lymph nodes directly connected with the primary tumour. It allows a more accurate staging and a selective indication for clearing the axilla, restricting this to patients who may benefit of it. Axillary dissection was performed in all patients during the learning phase of sentinel lymphadenectomy, but later only patients with metastasis to a sentinel node underwent this operation. Currently, even some patients with minimal sentinel node involvement, including some with macrometastasis may skip axillary clearance. This review summarizes the changes that have occurred in the surgical management of the axilla, the evidences and controversies behind these changes, along with current recommendations. Orv. Hetil., 2014, 155(6), 203–215.
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Affiliation(s)
- Gábor Cserni
- Bács-Kiskun Megyei Kórház Patológiai Osztály Kecskemét Nyíri út 49. 6000
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Patológiai Intézet Szeged Állomás u. 2. 6725
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807
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Tvedskov TF, Jensen MB, Balslev E, Kroman N. Robust and validated models to predict high risk of non-sentinel node metastases in breast cancer patients with micrometastases or isolated tumor cells in the sentinel node. Acta Oncol 2014; 53:209-15. [PMID: 23772767 DOI: 10.3109/0284186x.2013.806993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Benefit from axillary lymph node dissection in sentinel node positive breast cancer patients is under debate. Based on data from 1820 Danish breast cancer patients operated in 2002-2008, we have developed two models to predict high risk of non-sentinel node metastases when micrometastases or isolated tumor cells are found in sentinel node. The aim of this study was to validate these models in an independent Danish dataset. MATERIAL AND METHODS We included 720 breast cancer patients with micrometastases and 180 with isolated tumor cells in sentinel node operated in 2009-2010 from the Danish Breast Cancer Cooperative Group database. Accuracy of the models was tested in this cohort by calculating area under the receiver operating characteristic curve (AUC) as well as sensitivity and specificity. RESULTS AUC for the model for patients with micrometastases was comparable to AUC in the original cohort: 0.63 and 0.64, respectively. The sensitivity and specificity for predicting risk of non-sentinel node metastases over 30% was 0.36 and 0.81, respectively, in the validation cohort. AUC for the model for patients with isolated tumor cells decreased from 0.73 in the original cohort to 0.60 in the validation cohort. When dividing patients with isolated tumor cells into high and low risk of non-sentinel node metastases according to number of risk factors present, 37% in the high-risk group had non-sentinel node metastases. Specificity and sensitivity was 0.48 and 0.88, respectively, in the validation cohort when using this cut-point. CONCLUSION In this independent dataset, the model for patients with micrometastases was robust with accuracy similar to the original cohort, while the model for patients with isolated tumor cells was less accurate. The models may be used to identify patients where axillary lymph node dissection should still be considered.
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Affiliation(s)
- Tove F Tvedskov
- Department of Breast Surgery, Copenhagen University Hospital , Copenhagen , Denmark
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808
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Use of Established Nomograms to Predict Non-Sentinel Lymph Node Metastasis. CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-013-0137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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809
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Bettington M, Lakhani SR, Ung OA. Is the one-step nucleic acid amplification assay better for intra-operative assessment of breast sentinel nodes? ANZ J Surg 2014; 84:725-9. [PMID: 24397867 DOI: 10.1111/ans.12497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intra-operative assessment of sentinel lymph nodes in breast cancer offers the opportunity to prevent two-stage surgical procedures. At our institution we employ touch imprint cytology (TIC), which lacks sensitivity. In this study we compare the one-step nucleic acid amplification (OSNA) assay to TIC. METHODS Imprints were taken from 63 lymph nodes from 35 patients. The lymph nodes were sectioned at 2-mm intervals and alternate slices submitted for either histology or OSNA assay, with histology as the reference standard. RESULTS Seven patients were histologically positive. Nine and five patients were positive by OSNA and TIC, respectively. Sensitivity, specificity, positive and negative predictive value for the OSNA assay were 85.7%, 85.7%, 63.6% and 96.6% and for TIC were 70.0%, 96.6%, 87.5% and 90.3%. CONCLUSION In this study OSNA had a higher sensitivity than TIC. Fewer patients assessed by the OSNA assay would have required a two-stage procedure. The OSNA assay appears to be a highly cost-effective method for providing rapid and reliable intra-operative assessment of sentinel lymph nodes.
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Affiliation(s)
- Mark Bettington
- Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Queensland, Australia
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810
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Abreu EB, Martinez P, Betancourt L, Romero G, Godoy A, Bergamo L. Treatment plan for breast cancer with sentinel node metastasis. Ecancermedicalscience 2014; 8:383. [PMID: 24478806 PMCID: PMC3892908 DOI: 10.3332/ecancer.2014.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Indexed: 01/07/2023] Open
Abstract
Lymph node involvement is considered to be one of the most important independent prognostic factors in breast cancer. In patients without palpable lymphadenopathies, the method of choice for determining this involvement is the sentinel lymph node biopsy. In the presence of macrometastases, the current standard is to perform axillary lymph node dissection in spite of the knowledge that the involvement of non-sentinel lymph nodes is approximately 50%. When lymph node involvement is micrometastasic, the decision as to whether or not to proceed with lymphadenectomy remains in dispute. We set out, on the basis of the current scientific evidence and our own experience, to create guidelines that allow us to individualise each case and decide whether or not to perform a lymphadenectomy. We will discuss the arguments that support our position.
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Affiliation(s)
- Efrén Bolívar Abreu
- Breast Pathology Department, Dr Luis Razetti Oncology Institute, Caracas, Venezuela
| | - Pedro Martinez
- Breast Pathology Department, Dr Luis Razetti Oncology Institute, Caracas, Venezuela
| | - Luis Betancourt
- Breast Pathology Department, Dr Luis Razetti Oncology Institute, Caracas, Venezuela
| | - Gabriel Romero
- Breast Pathology Department, Dr Luis Razetti Oncology Institute, Caracas, Venezuela
| | - Ali Godoy
- Breast Pathology Department, Dr Luis Razetti Oncology Institute, Caracas, Venezuela
| | - Laura Bergamo
- Breast Pathology Department, Dr Luis Razetti Oncology Institute, Caracas, Venezuela
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811
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van Roozendaal LM, Schipper RJ, Van de Vijver KKBT, Haekens CM, Lobbes MBI, Tjan-Heijnen VCG, de Boer M, Smidt ML. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients. Breast Cancer Res Treat 2014; 143:469-76. [PMID: 24390150 DOI: 10.1007/s10549-013-2822-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/20/2013] [Indexed: 11/28/2022]
Abstract
Several independent randomized controlled trials are initiated to investigate whether sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients with negative axillary ultrasound findings, who are treated with breast conserving therapy. A consequence of omitting sentinel lymph node biopsy is absence of pathological lymph node status information. We aimed to investigate the impact of omitting sentinel lymph node biopsy on adjuvant systemic treatment recommendations. Data from all consecutive patients with invasive breast cancer and negative axillary ultrasound findings treated with breast conserving therapy and sentinel lymph node biopsy between 2008 and 2012 were collected from a prospective database. Two methods, Adjuvant! Online and the Dutch breast cancer guideline 2012, were used to determine the adjuvant systemic treatment recommendations of every patient. At first, each patient was considered to be lymph node negative, and secondly the patients' true pathological lymph node status was used. A total of 303 patients were consecutively included. Pathological lymph node status was pN0 in 72.3 %, pN0(i+) in 12.9 %, pN1mi+ in 5.6 %, pN1 in 7.3 %, and pN2 in 2.0 % of the patients. The decision to recommend adjuvant systemic treatment changed due to the pathological lymph node status in 1.0 % of the patients (3/303) when using Adjuvant! Online and in 3.6 % (11/303) when using the 2012 Dutch breast cancer guideline. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients with negative axillary ultrasound findings treated with breast conserving therapy is limited. The safety of omitting the sentinel lymph node biopsy should be confirmed by the initiated randomized controlled trials.
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Affiliation(s)
- L M van Roozendaal
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands,
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812
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Guzijan A, Babić B, Gojković Z, Gajanin R, Ćulum J, Grahovac D. Sentinel lymph node biopsy in breast cancer: Validation study and comparison of lymphatic mapping techniques. SCRIPTA MEDICA 2014. [DOI: 10.5937/scrimed1402056g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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813
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Reply to letter: "effectiveness of sentinel lymph node intraoperative examination in 753 women with breast cancer: are we overtreating patients?". Ann Surg 2014; 259:e71. [PMID: 24374523 DOI: 10.1097/sla.0000000000000473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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814
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Niu J, Chong L, Wascher RA. What is the role of axillary lymph node dissection, if any, in breast cancer treatment? BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.13.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jiaxin Niu
- Department of Medical Oncology, Western Regional Medical Center at Cancer Treatment Centers of America, 14200 W. Celebrate Life Way, Goodyear, AZ 85338, USA
| | - Lanceford Chong
- Department of Radiation Oncology, Western Regional Medical Center at Cancer Treatment Centers of America, 14200 W. Celebrate Life Way, Goodyear, AZ 85338, USA
| | - Robert A Wascher
- Department of Surgical Oncology, Western Regional Medical Center at Cancer Treatment Centers of America, 14200 W. Celebrate Life Way, Goodyear, AZ 85338, USA
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815
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Sentinel lymph node biopsy in patients with microinvasive breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2014; 40:5-11. [DOI: 10.1016/j.ejso.2013.10.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 10/26/2013] [Accepted: 10/28/2013] [Indexed: 11/20/2022] Open
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816
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L’exploration et le traitement de la région axillaire des tumeurs infiltrantes du sein (RPC 2013). ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2337-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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817
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Chaudhry A, Williams S, Cook J, Jenkins M, Sohail M, Calder C, Winters ZE, Rayter Z. The real-time intra-operative evaluation of sentinel lymph nodes in breast cancer patients using One Step Nucleic Acid Amplification (OSNA) and implications for clinical decision-making. Eur J Surg Oncol 2013; 40:150-7. [PMID: 24378008 DOI: 10.1016/j.ejso.2013.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/29/2013] [Accepted: 12/06/2013] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION One Step Nucleic Acid Amplification (OSNA) method for the intraoperative analysis of sentinel lymph nodes (SLNs) in breast cancer, obviates a second operation to the axilla and thereby expedites progression to adjuvant therapy. Recent NICE guidelines have approved OSNA as a method of sentinel node diagnosis to support the above case.(1) METHOD: This is a single centre prospective cohort analysis of all patients undergoing breast cancer surgery including sentinel node biopsy from February 2010 to June 2012. Patients with negative SLN(s) on OSNA had no further axillary surgery. A validation phase was performed prior to using OSNA routinely. Those with micrometastases underwent a level 1 clearance, and >one SLN with macrometastases, underwent treatment by level 2 axillary dissection. The length of time from sentinel node retrieval to OSNA result was recorded. RESULTS Four hundred and forty nodes were analysed in 212 patients with a mean age of 55 years (range 24-98). The sensitivity and specificity of OSNA was 93% and 94% respectively in cases of macrometastases. The process required additional median anaesthesia time of 20 min (range -48 to +65 min). Non-sentinel node positivity was 5% and 48% for micrometastasis and macrometastasis respectively. CONCLUSION OSNA identified 62 of 212 patients with at least one positive sentinel node, thereby sparing 29% from a second procedure to clear the axilla subsequently. The median waiting time of 20 min for node results from completion of breast procedure is acceptable and allows for an efficient operating list. OSNA can be incorporated into routine practice and with improved methods of imaging preoperatively, can be an excellent adjunct to the breast cancer patient pathway of care.
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Affiliation(s)
- A Chaudhry
- Department of Breast Surgery, University Hospitals Bristol NHS Trust, United Kingdom.
| | - S Williams
- Department of Breast Surgery, University Hospitals Bristol NHS Trust, United Kingdom
| | - J Cook
- Department of Breast Surgery, University Hospitals Bristol NHS Trust, United Kingdom
| | - M Jenkins
- Department of Histopathology, University Hospitals Bristol NHS Trust, United Kingdom
| | - M Sohail
- Department of Histopathology, University Hospitals Bristol NHS Trust, United Kingdom
| | - C Calder
- Department of Histopathology, University Hospitals Bristol NHS Trust, United Kingdom
| | - Z E Winters
- Department of Breast Surgery, University Hospitals Bristol NHS Trust, United Kingdom; School of Clinical Sciences, University of Bristol, Level 7, Research and Teaching, United Kingdom
| | - Z Rayter
- Department of Breast Surgery, University Hospitals Bristol NHS Trust, United Kingdom
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818
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Mersich T, Faludi S, Ping O, Jóbaházi J, Szabó B, Dede K, Besznyák I, Bursics A. [Evolution of sentinel lymph node biopsy in breast cancer--axillary staging in the past 15 years at the Uzsoki Street Hospital]. Magy Seb 2013; 66:320-4. [PMID: 24333976 DOI: 10.1556/maseb.66.2013.6.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Sentinel biopsy technique was performed in Europe in 1996.It was a great improvement in the surgical treatment of breast cancer, it decreased the number of patients suffering from early and late morbidity following axillary lymph node dissection (ALND). In our paper we demonstrate the evolution of sentinel biopsy technique (SLNB), as well as the changes in our policy on axillary treatment in line with the European trends. METHODS The authors of this article give an overview and analyse the relevant literature concerning sentinel lymph node biopsy and data of patients on whom sentinel lymph node biopsy was performed from 01/01/2001 to 31/12/2012. RESULTS Between 2001 and 2013 we performed 3756 breast operations, 2742 of those were done for malignant disease. Altogether we performed 744 sentinel lymph node biopsies in the Uzsoki teaching Hospital. The proportion of SLNB patients is increasing, it was 24.6% between 2001-2006 and 29.2% between 2007-2012, respectively. The indication of SLNB is widening, there might be justification of the technique even by multifocal or multilocular disease, in male patients, after former breats surgery or even in pregnant patients. CONCLUSION Histological examination of sentinel lymph node and its effect on complex treatment of breats cancer may place the role of surgical axillary staging in a brand new aspect in the near future perhaps.
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Affiliation(s)
- Tamás Mersich
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Sándor Faludi
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Orsolya Ping
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Jenő Jóbaházi
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Balázs Szabó
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Kristóf Dede
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - István Besznyák
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Attila Bursics
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
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819
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Ahmed M, Douek M. What is the future of magnetic nanoparticles in the axillary management of breast cancer? Breast Cancer Res Treat 2013; 143:213-8. [DOI: 10.1007/s10549-013-2801-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/02/2013] [Indexed: 02/06/2023]
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820
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Mittendorf EA, King TA. Incorporating the Results of the American College of Surgeons Oncology Group Z0011 Trial into Clinical Practice. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0131-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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821
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Abstract
A therapeutic surgical de-escalation has been observed since many years with an actual prolongation for axillary lymph node area treatment. Axillary lymph node dissection (ALND) omission has been studied before and after validation of sentinel node (SN) biopsy procedure. A non-inferiority of ALND omission has been reported in case of non-involved SN. ALND omission has been studied in case of SN involvement without consensus in relation with scientific level of proof and with selective indications. The purpose of this work is to make a synthesis of the experiences on this subject then to envisage the current and future perspectives.
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822
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Spillane A. Why the results of the American College of Surgeons Oncology Group Z0011 Trial are so important. ANZ J Surg 2013; 83:893. [PMID: 24289048 DOI: 10.1111/ans.12385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Andrew Spillane
- Sydney Medical School, The University of Sydney, Sydney; Department of Breast and Surgical Oncology, The Mater Hospital, North Sydney; Department of Surgical Oncology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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823
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Santaballa A, De La Cueva H, Salvador C, García-Martínez AM, Guarín MJ, Lorente D, Palomar L, Aznar I, Dobón F, Bello P. Advantages of one step nucleic acid amplification (OSNA) whole node assay in sentinel lymph node (SLN) analysis in breast cancer. SPRINGERPLUS 2013; 2:542. [PMID: 24255842 PMCID: PMC3824711 DOI: 10.1186/2193-1801-2-542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this study is to present our first results of sentinel node analysis (SLN) by one step nucleic acid amplification (OSNA) in routine clinical practice in our centre and compare them with the results of classic histopathological analysis in a historical cohort from our same institution. METHODS 407 patients (total study population) with early breast cancer and no clinical nodal involvement underwent SLN biopsy in our institution. The SLN was analysed by OSNA in 164 biopsies. OSNA results were compared with the conventional histopathology study of 244 patients who had undergone SLN biopsy previously. The characteristics of the patients in both groups were evaluated and a comparison was made of the rate of metastases detected by both methods and of the surgical procedures needed in each group. We also investigated the state of non-sentinel lymph nodes if micrometastases where found in SLN. RESULTS SLN biopsy result was considered as positive in 45 patients (28%) in the OSNA group and in 58 in the historical group (24%). There was no difference in the rate of macrometastases (16,5% for OSNA, 20% for HE) but we found differences in the rate of micrometastases (11% for OSNA and 3,6% for HE p = 0.0007). Axillary lymphadenectomy (ALND) was performed in 43/45 cases in the OSNA group and in 51/58 of the historical group. In all patients diagnosed by OSNA, ALND was performed during the initial surgical procedure. In the historical cohort ALND was performed during the initial surgical procedure in 41 patients and in a second surgical procedure in 10 patients. Patients from both groups with micrometastases in the SLN had no metastases in other nodes when the ALND was performed. CONCLUSIONS OSNA analysis allows the detection of SLN metastases as precisely as conventional pathology with an increased detection of micrometastases. The OSNA method can reduce the need of a deferred lymphadenectomy.
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Affiliation(s)
- Ana Santaballa
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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824
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Ahmed SS, Thike AA, Iqbal J, Yong WS, Tan B, Madhukumar P, Ong KW, Ho GH, Wong CY, Tan PH. Sentinel lymph nodes with isolated tumour cells and micrometastases in breast cancer: clinical relevance and prognostic significance. J Clin Pathol 2013; 67:243-50. [DOI: 10.1136/jclinpath-2013-201771] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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825
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Wiznia LE, Lannin DR, Evans SB, Hofstatter EW, Horowitz NR, Killelea BK, Tsangaris TN, Chagpar AB. The number of lymph nodes dissected in breast cancer patients influences the accuracy of prognosis. Ann Surg Oncol 2013; 21:389-94. [PMID: 24132625 DOI: 10.1245/s10434-013-3308-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent trials have suggested that axillary node dissection may not be warranted in some breast cancer patients with one to two positive nodes. Given that lymph node ratio (LNR; number of positive lymph nodes divided by the total examined) has been shown to be a significant prognostic factor, we sought to determine whether the number of nodes removed in this low risk population predicted survival. METHODS The National Cancer Database is a comprehensive clinical surveillance resource capturing 70% of newly diagnosed malignancies in the United States; 309,216 breast cancer patients diagnosed between 1998 and 2005, with tumors ≤5 cm and one to two positive nodes, formed the cohort of interest. RESULTS Median age at diagnosis was 57 (range 18-90) years. Median tumor size was 2 (range 0.1-5) cm; 215,382 patients (69.7%) had one positive node, and 93,834 (30.3%) had two. The median number of lymph nodes examined was 11 (range 1-84). Patients were categorized into low (≤0.2), medium (0.21-0.65), or high (>0.65) LNR groups, with 228,822 (74%), 55,797 (18%), and 24,597 (8%) patients in each of these categories, respectively. Median follow-up was 54.1 months. Median overall survival (OS) for low, intermediate, and high LNR was 66.1, 61.1, and 56.5 months, respectively (p < 0.001). In a Cox model controlling for clinicopathologic and therapy covariates, LNR category remained a significant predictor of OS (p < 0.001). CONCLUSIONS LNR is an independent predictor of OS in a low-risk population with one to two positive nodes and tumors ≤5 cm. Therefore, the number of lymph nodes excised may influence prognostic stratification.
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Affiliation(s)
- Lauren E Wiznia
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA,
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826
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Noushi F, Spillane A, Uren R, Cooper R, Allwright S, Snook K, Gillet D, Pearce A, Gebski V. High discordance rates between sub-areolar and peri-tumoural breast lymphoscintigraphy. Eur J Surg Oncol 2013; 39:1053-60. [DOI: 10.1016/j.ejso.2013.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 03/31/2013] [Accepted: 06/06/2013] [Indexed: 02/06/2023] Open
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827
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Khavanin N, Gart MS, Berry T, Thornton B, Saha S, Kim JYS. Sentinel Lymph Node Biopsy Versus Axillary Lymphadenectomy in Patients Treated with Lumpectomy: An Analysis of Short-Term Outcomes. Ann Surg Oncol 2013; 21:74-80. [DOI: 10.1245/s10434-013-3248-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 12/30/2022]
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828
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Is imaging the future of axillary staging in breast cancer? Eur Radiol 2013; 24:288-93. [PMID: 24037250 DOI: 10.1007/s00330-013-3009-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/02/2013] [Accepted: 08/18/2013] [Indexed: 12/13/2022]
Abstract
Axillary management in patients with breast cancer has become much less invasive with the introduction of sentinel lymph node biopsy (SLNB). However, over 70 % of SLNBs are negative, questioning the generic use of this invasive procedure. Emerging evidence indicates that breast cancer patients with a low axillary burden of disease do not benefit from axillary lymph node dissection (ALND). Non-invasive techniques such as paramagnetic iron oxide contrast-enhanced magnetic resonance imaging (MRI) may provide genuine alternatives to axillary staging and should be evaluated within clinical trials. Selective axillary surgery could then be offered based on imaging findings and for therapeutic intent. This non-operative approach would reduce morbidity further and facilitate interpretation of follow-up imaging. Key Points • Modern imaging and biopsy greatly help the axillary staging of breast cancer. • Superparamagnetic iron oxide (SPIO)-enhanced MRI offers a further advance. • Sentinel lymph node biopsy may become redundant with SPIO-enhanced MRI. • Selective therapeutic axillary surgery should be based upon preoperative imaging findings.
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829
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Seow H, Bainbridge D, Bryant D. Palliative care programs for patients with breast cancer: the benefits of home-based care. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
SUMMARY Improving breast cancer care means enhancing end-of-life care with specialized palliative care services. Palliative care embodies a holistic approach to care that focuses on symptom management of individuals with incurable diseases, whereas end-of-life care specifically focuses on a period of time, such as the last 6 months of life, where a rapid state of decline is often evident. The purpose of this article is to explore the benefits and limitations of end-of-life care provided in the hospital and community settings, with an emphasis on the benefits of home-based care. A key strength of home-based palliative care is the ability to expand the reach of palliative care to more cancer patients beyond residential hospice or hospital settings, which are limited in bed availability. The essential features of quality end-of-life services, regardless of setting, are care that offers seamless transitions, around-the-clock access to the same providers and an interdisciplinary, whole-person approach.
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Affiliation(s)
- Hsien Seow
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, 699 Concession St, 4th Floor, Room 4-229, Hamilton, ON L8V 5C2, Canada
| | - Deanna Bryant
- Department of Oncology, McMaster University, 699 Concession St, 4th Floor, Room 4-229, Hamilton, ON L8V 5C2, Canada
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830
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Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, Senn HJ. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 2013; 24:2206-23. [PMID: 23917950 PMCID: PMC3755334 DOI: 10.1093/annonc/mdt303] [Citation(s) in RCA: 2455] [Impact Index Per Article: 223.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 02/07/2023] Open
Abstract
The 13th St Gallen International Breast Cancer Conference (2013) Expert Panel reviewed and endorsed substantial new evidence on aspects of the local and regional therapies for early breast cancer, supporting less extensive surgery to the axilla and shorter durations of radiation therapy. It refined its earlier approach to the classification and management of luminal disease in the absence of amplification or overexpression of the Human Epidermal growth factor Receptor 2 (HER2) oncogene, while retaining essentially unchanged recommendations for the systemic adjuvant therapy of HER2-positive and 'triple-negative' disease. The Panel again accepted that conventional clinico-pathological factors provided a surrogate subtype classification, while noting that in those areas of the world where multi-gene molecular assays are readily available many clinicians prefer to base chemotherapy decisions for patients with luminal disease on these genomic results rather than the surrogate subtype definitions. Several multi-gene molecular assays were recognized as providing accurate and reproducible prognostic information, and in some cases prediction of response to chemotherapy. Cost and availability preclude their application in many environments at the present time. Broad treatment recommendations are presented. Such recommendations do not imply that each Panel member agrees: indeed, among more than 100 questions, only one (trastuzumab duration) commanded 100% agreement. The various recommendations in fact carried differing degrees of support, as reflected in the nuanced wording of the text below and in the votes recorded in supplementary Appendix S1, available at Annals of Oncology online. Detailed decisions on treatment will as always involve clinical consideration of disease extent, host factors, patient preferences and social and economic constraints.
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Affiliation(s)
- A Goldhirsch
- International Breast Cancer Study Group, Division of Medical Oncology, European Institute of Oncology, Milan, Italy.
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831
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Senkus E, Kyriakides S, Penault-Llorca F, Poortmans P, Thompson A, Zackrisson S, Cardoso F. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi7-23. [PMID: 23970019 DOI: 10.1093/annonc/mdt284] [Citation(s) in RCA: 329] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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832
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Boughey JC. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy, by Dengel et al. Ann Surg Oncol 2013; 21:8-10. [PMID: 23975315 DOI: 10.1245/s10434-013-3201-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Indexed: 11/18/2022]
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833
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Dengel LT, Van Zee KJ, King TA, Stempel M, Cody HS, El-Tamer M, Gemignani ML, Sclafani LM, Sacchini VS, Heerdt AS, Plitas G, Junqueira M, Capko D, Patil S, Morrow M. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy. Ann Surg Oncol 2013; 21:22-7. [PMID: 23975314 DOI: 10.1245/s10434-013-3200-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The extent to which ACOSOG Z0011 findings are applicable to patients undergoing breast-conserving therapy (BCT) is uncertain. We prospectively assessed how often axillary dissection (ALND) was avoided in an unselected, consecutive patient cohort meeting Z0011 eligibility criteria and whether subgroups requiring ALND could be identified preoperatively. METHODS Patients with cT1,2cN0 breast cancer undergoing BCT were managed without ALND for metastases in <3 sentinel nodes (SNs) and no gross extracapsular extension (ECE). Patients with and without indications for ALND were compared using Fisher's exact and Wilcoxon rank sum tests. RESULTS From August 2010 to November 2012, 2,157 invasive cancer patients had BCT. A total of 380 had histologic nodal metastasis; 93 did not meet Z0011 criteria. Of 287 with ≥1 H&E-positive SN (209 macrometastases), 242 (84 %) had indications for SN only. ALND was indicated in 45 for ≥3 positive SNs (n = 29) or ECE (n = 16). The median number of SNs removed in the SN group was 3 versus 5 in the ALND group (p < 0.0001). Age, hormone receptor and HER2 status, and grade did not differ between groups; tumors were larger in the ALND group (p < 0.0001). Of ALND patients, 72 % had additional positive nodes (median = 1; range 1-19). No axillary recurrences have occurred (median follow-up, 13 months). CONCLUSIONS ALND was avoided in 84 % of a consecutive series of patients having BCT, suggesting that most patients meeting ACOSOG Z0011 eligibility have a low axillary tumor burden. Age, ER, and HER2 status were not predictive of ALND, and the criteria used for ALND (≥3 SNs, ECE) reliably identified patients at high risk for residual axillary disease.
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Affiliation(s)
- Lynn T Dengel
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
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834
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Galimberti V, Cole BF. Axillary versus sentinel-lymph-node dissection for micrometastatic breast cancer--authors' reply. Lancet Oncol 2013; 14:e251-2. [PMID: 23725705 DOI: 10.1016/s1470-2045(13)70241-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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835
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Stachs A, Göde K, Hartmann S, Stengel B, Nierling U, Dieterich M, Reimer T, Gerber B. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer - size of metastases as limiting factor. SPRINGERPLUS 2013; 2:350. [PMID: 23961414 PMCID: PMC3733074 DOI: 10.1186/2193-1801-2-350] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/02/2013] [Indexed: 11/10/2022]
Abstract
Since the performance of surgical procedures of the axilla in the treatment of early breast cancer is decreasing, the role of axillary ultrasound (AUS) as staging procedere has newly to be addressed. The aim of this study was to determine which patient or histopathological characteristics are related to false-negative AUS. In a retrospective study design data of 470 women with primary breast cancer were collected from patient charts and imaging and pathology records were reviewed. True positive and false negative axillary ultrasound groups were compared in terms of tumor size, histological subtype, grade, estrogen receptor (ER) and HER2 status, proliferation index, number and size of nodal metastases, extracapsular extension (ECE) and lymphovascular invasion (LVI). Of 470 patients, 166 (35%) were node positive, 79 of them with suspicious AUS. Factors associated with false negative AUS by univariate analysis were included in a multivariate model. By multivariate analysis, only size of nodal metastases was an independent factor for false negative AUS. In the sentinel lymph node biopsy (SLNB) subgroup, 45% of patients had nodal metastasis size less than or equal to 5 mm. In conclusion, AUS in preoperative staging of early stage breast cancer is limited by small size of metastases in a substantial number of patients. Prospective studies have to show whether small metastatic deposits leaving in patients in case of no axillary surgery have no negative effect on disease free and overall survival.
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Affiliation(s)
- Angrit Stachs
- Department of Gynecology and Obstetrics, University of Rostock, Südring 81, Rostock, 18059 Germany
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836
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Barranger E, Houvenaeghel G, Classe JM. [Axillary support in breast cancer: survey practice in France]. ACTA ACUST UNITED AC 2013; 41:433-6. [PMID: 23856585 DOI: 10.1016/j.gyobfe.2013.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 05/30/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To establish an inventory concerning the consistency of current medical practices in the management of axillary support for non-metastatic breast cancer since the publication of the ACOSOG-Z0011 randomized trial. PATIENTS AND METHODS A descriptive survey practice using a questionnaire sent by email was conducted in medical care teams for breast cancer. RESULTS Forty-eight medical teams across the French territory answered to the questionnaire. It has been noted that 72.9% of medical teams have said to consistently achieve an additional axillary lymph node dissection (ALND) in case of macrometastatic sentinel node (SN), 12.5% in case of micrometastatic SN and only 2.1% in isolated tumor cells SN. The majority of medical teams (61.9%) claimed they did not perform the procedure GS before or after neoadjuvant chemotherapy (NAC). The SN biopsy was performed in only 29.1% of teams before and 9% after NAC, outside study. Axillary irradiation was performed in case of macrometastatic SN without complementary by 27.1% of interviewed medical teams and by 4.1% in the case of micrometastic SN. DISCUSSION AND CONCLUSION This survey of practice in patients with breast cancer highlights the evolution of medical practice for the axillary management in France. It also illustrates the diversity of practices in medical teams and the significant compensatory increase in the expansion of radiation fields in patients with metastatic SN without additional ALND.
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Affiliation(s)
- E Barranger
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, université Paris-7, Paris, France.
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837
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Zurrida S, Bagnardi V, Curigliano G, Mastropasqua MG, Orecchia R, Disalvatore D, Greco M, Cataliotti L, D'Aiuto G, Talakhadze N, Goldhirsch A, Viale G. High Ki67 predicts unfavourable outcomes in early breast cancer patients with a clinically clear axilla who do not receive axillary dissection or axillary radiotherapy. Eur J Cancer 2013; 49:3083-92. [PMID: 23777741 DOI: 10.1016/j.ejca.2013.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/08/2013] [Accepted: 05/12/2013] [Indexed: 01/24/2023]
Abstract
AIM Axillary dissection is increasingly forgone in early breast cancer patients with a clinically negative axilla. The GRISO 053 randomised trial recruited 435 patients of age over 45 years, tumour ≤1.4 cm and clinically negative axilla, to assess the importance of axillary radiotherapy versus no axillary radiotherapy in patients not given axillary dissection. In the present study on a subgroup GRISO cases our aim was to assess the prognostic importance of tumour biological factors after more than 10 years of follow-up. METHODS We retrospectively assessed biological factors in a subgroup of 285 GRISO cases (145 given axillary radiotherapy; 140 not given axillary radiotherapy) with complete biologic, therapeutic and follow-up information, using multivariable Cox proportional hazards regression modelling. RESULTS Only 10-year cumulative incidence of distant metastasis was lower in the axillary radiotherapy (1%) than no axillary radiotherapy arm (7%) (p=0.037). Irrespective of study arm, hormone receptor positivity had significantly favourable effects on 10-year disease-free survival (DFS) and overall survival. human epidermal growth factor receptor 2 (HER2)-positive and triple-negative subtypes were associated with lower 10-year DFS (60% and 76%, respectively) than luminal A (96%) and B (91%) (p=0.001). Ten-year DFS for high (≥14%) Ki67 cancers was lower than for low Ki67 cancers (p=0.027); however, this effect was mainly confined to the no axillary radiotherapy arm. CONCLUDING STATEMENT For patients with clinically node-negative small breast cancer not given axillary dissection, 10-year DFS is worsened by HER2 positivity, triple-negative phenotype and high Ki67. Axillary radiotherapy counteracts the negative prognostic effect of high Ki67 in patients not receiving axillary dissection.
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Affiliation(s)
- S Zurrida
- Division of Senology, European Institute of Oncology, Milan, Italy; University of Milan, School of Medicine, Milan, Italy.
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838
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839
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Boyages J, Winch C. Axillary versus sentinel-lymph-node dissection for micrometastatic breast cancer. Lancet Oncol 2013; 14:e250-1. [DOI: 10.1016/s1470-2045(13)70218-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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840
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Abstract
Significant progress has been made in the surgical management of breast cancer. Most women diagnosed with early stage invasive breast cancer can now be managed with breast-conserving therapy to include a segmental mastectomy followed by radiation. Axillary lymph nodes are routinely assessed by sentinel lymph node biopsy. Axillary lymph node dissection is reserved for patients with documented nodal metastasis; however, here too progress has been made because a population of low-risk patients has been identified in whom a complete dissection is not required even in the setting of a positive sentinel lymph node. This article details the landmark clinical trials that have guided the surgical management of breast cancer.
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Affiliation(s)
- Dalliah M. Black
- Assistant Professor, Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, Tel: (713) 792-4236; Fax: (713) 792-0722
| | - Elizabeth A. Mittendorf
- Assistant Professor, Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, Tel: (713) 792-2362; Fax: (713) 792-0722
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841
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842
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Goldhirsch A, Castiglione-Gertsch M. Adjuvante systemtherapie des mammakarzinoms. Arch Gynecol Obstet 1995; 256:S93-S103. [PMID: 27696035 DOI: 10.1007/bf02201943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Goldhirsch
- Schweizerische Arbeitsgruppe für Klinische Krebsforschung (SAKK), Servizio Oncologico Cantonale, Ospedale Civico, CH-6900, Lugano, Switzerland
| | - M Castiglione-Gertsch
- Schweizerische Arbeitsgruppe für Klinische Krebsforschung (SAKK), Servizio Oncologico Cantonale, Ospedale Civico, CH-6900, Lugano, Switzerland
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