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Basu A, Mondal J, Swetha B, Chakrabarty S, Ghosh D, Gangopadhyay S, Mandal B. Patient-Reported Shoulder Morbidity and Fatigue among Breast Cancer Survivors: An Insight from a Tertiary Care Cancer Hospital. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_257_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm, shoulder stiffness, arm pain, and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospitals. Aims: The aim was to evaluate the predictive factors of arm and shoulder morbidity and fatigue among breast cancer survivors. Settings and Design: This was a retrospective analysis based on a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire, and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34, and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy and radiotherapy to axilla were statistically significantly (P = 0.04 and 0.01, respectively) associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs.
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Affiliation(s)
- Abhishek Basu
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Janmenjoy Mondal
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Bhukya Swetha
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Shinjini Chakrabarty
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Debjit Ghosh
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Subhendu Gangopadhyay
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Bidyut Mandal
- Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India
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Combi F, Andreotti A, Gambini A, Palma E, Papi S, Biroli A, Zaccarelli S, Ficarra G, Tazzioli G. Application of OSNA Nomogram in Patients With Macrometastatic Sentinel Lymph Node: A Retrospective Assessment of Accuracy. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211014796. [PMID: 33994790 PMCID: PMC8113365 DOI: 10.1177/11782234211014796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Introduction: Almost 50% to 70% of patients who undergo axillary lymph node dissection (ALND) because of a single metastatic sentinel lymph node (SLN) have no further metastatic nodes at the axillary histology. On these grounds, the one-step nucleic acid amplification (OSNA) nomogram was designed and validated. As a mathematical model, calculated through tumor size (expressed in millimeters) and CK19 mRNA copy number, it is thought to predict nonsentinel lymph node (NSLN) status. The aim of the study is to verify the diagnostic accuracy of the OSNA nomogram in a group of patients with macrometastatic SLN, with a retrospective analysis. Methods: The OSNA nomogram was retrospectively applied to a group of 66 patients with macrometastatic SLN who underwent ALND. The result of the final histology of the axillary cavity was compared to the nomogram prediction. We calculated the prevalence of NSLN metastasis in patients who underwent ALND, sensitivity and specificity, negative and positive predictive value of the nomogram. Results: In patients with macrometastasis in SLN, the prevalence of patients with metastatic NSLN was 45%. The sensitivity of the nomogram was excellent (90%). The specificity was low (36%). Positive predictive value amounted to 54%, while negative predictive value was good (81%). Conclusions: These results suggest that the OSNA nomogram is a valid instrument that can help choose the best surgical strategy for the treatment of axillary cavity. The mathematical model is useful to avoid surgery in a selected group of patients because it accurately predicts NSLN status.
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Affiliation(s)
- Francesca Combi
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Francesca Combi, Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena (MO), Italy. Emails: ;
| | - Alessia Andreotti
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Anna Gambini
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Enza Palma
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Simona Papi
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
| | - Alice Biroli
- Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Guido Ficarra
- Department of Pathology, University Hospital of Modena, Modena, Italy
| | - Giovanni Tazzioli
- Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy
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Wang L, Li J, Qiao J, Guo X, Bian X, Guo L, Liu Z, Lu Z. Establishment of a model for predicting sentinel lymph node metastasis in early breast cancer based on contrast-enhanced ultrasound and clinicopathological features. Gland Surg 2021; 10:1701-1712. [PMID: 34164314 DOI: 10.21037/gs-21-245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sentinel lymph node (SLN) biopsy (SLNB) is the standard procedure for axillary staging in clinically node-negative (cN0) breast cancer patients. However, the positive rate of SLNs among cN0 stage patients is 26-35%. The identification of appropriate candidates for SLNB is quite challenging. This study aimed to establish and verify a predictive model of SLN metastasis using contrast-enhanced ultrasound (CEUS) and other clinicopathological indicators. Methods The clinicopathological data of 224 patients who had undergone SLNB at the Affiliated Cancer Hospital of Zhengzhou University from June 2018 to July 2019 were analyzed retrospectively. The risk prediction model of SLN metastasis was established by logistic regression analysis. According to the β value of each variable in the model, a risk score system of SLN metastasis was established and verified using the internal population. The predictive model was prospectively applied to 73 patients from July 2019 to September 2019 to evaluate the clinical value of the model in patients with early breast cancer. Results Multivariate analysis confirmed that body mass index (BMI), SLN aspect ratio of CEUS mode, SLN aspect ratio of mammography, lympho-vascular invasion, and cytokeratin (CK)5/6 were independent risk factors for SLN metastasis. A scoring system was established according to the above risk factors, and a receiver operating characteristic (ROC) curve was drawn. After internal- and external verification, a corrected ROC curve was drawn, respectively. The ROC curve of the modeling group, internal verification group, and external verification group was 0.9075 (95% CI: 0.8616-0.9534), 0.8766 (95% CI: 0.8192-0.9341), and 0.8505 (95% CI: 0.7333-0.9676), respectively. Conclusions We constructed and verified a prediction model of SLN metastasis in early breast cancer. The model has a specific predictive value for preoperative evaluation of SLN status.
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Affiliation(s)
- Lina Wang
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Juntao Li
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Jianghua Qiao
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Xiaoxia Guo
- Department of Ultrasound, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Xiaolin Bian
- Department of Ultrasound, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Lanwei Guo
- Henan Office for Cancer Control and Research, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Zhenzhen Liu
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Zhenduo Lu
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
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Hartmann S, Stachs A, Gerber B, Knauerhase H, Kamin F, Kundt G, Reimer T. Lost clips after targeted lymph node biopsy in breast cancer patients: Follow-up of the CLIP-study. Eur J Surg Oncol 2021; 47:1907-1912. [PMID: 33962833 DOI: 10.1016/j.ejso.2021.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Clipping and selective removal of axillary lymph nodes in breast cancer patients presenting with initially node-positive disease and achieving a nodal downstaging after primary systemic therapy is a less invasive method for axillary staging. An imaging guided localization and successful extirpation of these clipped lymph nodes is not possible in all patients. To date no follow-up data regarding patients with lost clips are available. MATERIAL AND METHODS The oncological outcome of all participants of the CLIP-study and the results of postoperative axillary imaging in those patients with unproven clip resection are presented. RESULTS A total of thirty patients were included into the pilot study. In ten of these patients (33%) the removal of the clipped axillary lymph node could not be verified by intraoperative radiograph. Postoperative imaging did not find lost clips in eight of these ten patients (80%). The lost clip was detected in two patients after surgery (20%), by mammography in one patient during routine follow-up and by computed tomography scan in one patient before radiotherapy. After a median follow-up of 40 months, 26 (87%) patients were still alive. Seven patients (23%) developed distant recurrent disease. No local or axillary recurrences were observed. CONCLUSION Lost clips were detected by postoperative imaging only in a minority of patients. The impact of lost clips on axillary recurrences in breast cancer patients is still unclear and should be further clarified in larger, multicentric trials.
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Affiliation(s)
- Steffi Hartmann
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Hellen Knauerhase
- Department of Radiotherapy and Radiation Oncology, University of Rostock, Rostock, Germany
| | - Frank Kamin
- Department of Pathology, Klinikum Südstadt, Rostock, Germany
| | - Günther Kundt
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University of Rostock, Rostock, Germany
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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Evaluation of Late Postural Complications in Breast Cancer Patients Undergoing Breast-Conserving Therapy in Relation to the Type of Axillary Intervention-Cross-Sectional Study. J Clin Med 2021; 10:jcm10071432. [PMID: 33916060 PMCID: PMC8036801 DOI: 10.3390/jcm10071432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of the study was to evaluate posture in patients undergoing breast-conserving therapy (BCT) in relation to the type of surgical intervention to the axilla. Methods: The study was conducted on patients who had undergone breast-conserving surgical treatment for breast cancer 5–6 years earlier. In 54 patients, BCT+ALND (axillary lymph node dissection) was performed, while 63 patients were subjected to BCT+SLND (sentinel lymph node dissection). The control group consisted of 54 females. The study was conducted using digital postural assessment. Results: No statistically significant differences were observed with respect to the parameters between the BCT+SLNB and BCT+ALND groups (p > 0.05). However, the differences were highly significant between the CG (control group) and the studied groups (BCT+ALND, BCT+SLNB) for the following parameters: BETA angle of thoracolumbar spine inclination (p = 0.002), GAMMA angle of thoracic spine inclination (p = 0.0044), TKA (thoracic kyphosis angle) (p < 0.0001) and shoulder level inclination (p = 0.0004). The BCT+ALND patients were characterized by higher dependency of raised shoulder (p = 0.0028) and inferior angle of the scapula (p = 0.00018) on the operated side compared to BCT+SLNB patients. Conclusions: Postural imbalance occurs independent of the type of axillary intervention. Disturbances within the upper torso (abnormal position of shoulders and inferior angles of scapulae) are more pronounced in patients after ALND.
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Shinzato JY, Serra KP, Eugeni C, Cabello C, Cardoso-Filho C, Zeferino LC. Potential Impact of the Z0011 Trial on the Omission of Axillary Dissection: A Retrospective Cohort Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:297-303. [PMID: 33784760 PMCID: PMC10183926 DOI: 10.1055/s-0041-1725052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. METHODS A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. RESULTS A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded from the study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes and met the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). CONCLUSION The ACOSOG Z0011 trial criteria can be applied to a select group of SLN-positive patients, reducing the costs and morbidities of breast cancer surgery.
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Affiliation(s)
- Julia Yoriko Shinzato
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Katia Piton Serra
- Gynecology and Obstetrics Department, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil
| | - Caroline Eugeni
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cesar Cabello
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cassio Cardoso-Filho
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Luís Carlos Zeferino
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Davis J, Boughey JC, Hoskin TL, Day CN, Cheville JC, Piltin MA, Hieken TJ. Locoregional Management of the Axilla in Mastectomy Patients with One or Two Positive Sentinel Nodes: The Role of Intraoperative Pathology. Clin Breast Cancer 2021; 21:458-465. [PMID: 33839043 DOI: 10.1016/j.clbc.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Controversy exists regarding optimal management of the axilla in clinically node-negative (cN0) mastectomy patients with one or two positive sentinel lymph nodes (+SLNs). We evaluated the influence of frozen-section pathology on axillary management and recurrence. PATIENTS AND METHODS We studied cN0 breast cancer patients treated from 2008 to 2018 with mastectomy and SLN surgery with one or two +SLNs. Patients with one or two +SLNs identified on frozen-section intraoperatively (FS+SLN) were compared to those with one or two +SLNs not detected by frozen section (FS-SLN). Recurrence rates were estimated using the Kaplan-Meier method. RESULTS Of 2295 cN0 mastectomy patients, 338 patients had one or two +SLNs: 108 (32%) FS-SLN and 230 (68%) FS+SLN. In the FS+SLN cases, completion axillary lymph node dissection (cALND) was more frequent (97% vs. 39%; P < .001), and median SLN metastasis size (5 vs. 1.3 mm; P < .001) and likelihood of positive non-SLNs (31% vs. 14%; P = .02) were greater compared with FS-SLN cases. Across all 338 patients, 40% had SLN surgery alone, and 47% of cALND patients received post-mastectomy radiation therapy (PMRT). At a median follow-up of 61 months, no axillary recurrences were observed among FS-SLN patients. Among FS+SLN patients, 97% proceeded to cALND but 49% avoided PMRT; three regional nodal recurrences were observed (all in patients treated with cALND, of whom two received PMRT). CONCLUSION Mastectomy patients with one or two FS+SLNs have a higher nodal disease burden than FS-SLN patients. The majority of FS+SLN patients underwent cALND, and 51% received PMRT with very low 5-year regional nodal recurrence rates. A substantial proportion of FS-SLN patients successfully avoided both cALND and PMRT. Frozen-section pathology analysis can guide de-escalation of axillary management.
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Affiliation(s)
| | | | - Tanya L Hoskin
- Department of Health Science Research and Clinical Statistics
| | - Courtney N Day
- Department of Health Science Research and Clinical Statistics
| | - John C Cheville
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
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Malter W, Eichler C, Hanstein B, Mallmann P, Holtschmidt J. First Reported Use of Radiofrequency Identification (RFID) Technique for Targeted Excision of Suspicious Axillary Lymph Nodes in Early Stage Breast Cancer - Evaluation of Feasibility and Review of Current Recommendations. In Vivo 2021; 34:1207-1213. [PMID: 32354911 DOI: 10.21873/invivo.11894] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM The purpose of this study was to evaluate, whether radio frequency identification (RFID) labeling of axillary lymph nodes (LNs) for the use of targeted resection is feasible in primary breast cancer patients with suspicious LNs. PATIENTS AND METHODS We analyzed 10 consecutive patients where RFID technique was used for intraoperative detection of suspicious LNs without preceding neoadjuvant chemotherapy (NACT). We compared the specifics of these procedures to 10 consecutive sentinel lymph node biopsies (SLNB) in the cN0 situation. RESULTS Intraoperative detection rate (DR) for the RFID-labeled target lymph node (TLN) was 100%. Perioperative complications were infrequent and comparable to SLNB. Average time for location of the RFID labeled TLN was quicker than for the SLN. In 71.4% the chip bearing TLN equaled a SLN. CONCLUSION The use of the RFID technique for intraoperative localization of axillary LNs for targeted excision seems feasible. RFID technique for targeted axillary dissection (TAD) following NACT should be investigated in a prospective manner.
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Affiliation(s)
- Wolfram Malter
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bettina Hanstein
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Johannes Holtschmidt
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
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Mele A, Fan B, Pardo J, Emhoff I, Beight L, Serres SK, Singhal D, Magrini L, James TA. Axillary lymph node dissection in the era of immediate lymphatic reconstruction: Considerations for the breast surgeon. J Surg Oncol 2021; 123:842-845. [PMID: 33524160 DOI: 10.1002/jso.26355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/20/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandra Mele
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Betty Fan
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jaime Pardo
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Isha Emhoff
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Leah Beight
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Stephanie K Serres
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dhruv Singhal
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Leo Magrini
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ted A James
- Breast Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Shi Z, Wang X, Qiu P, Liu Y, Zhao T, Sun X, Chen P, Wang C, Zhang Z, Cong B, Wang Y. Predictive factors of pathologically node-negative disease for HER2 positive and triple-negative breast cancer after neoadjuvant therapy. Gland Surg 2021; 10:166-174. [PMID: 33633973 DOI: 10.21037/gs-20-573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background With the improvement of the efficacy of neoadjuvant therapy (NAT) that is guided by molecular subtypes, the rate of pathologically node-negative disease after NAT (ypN0) is increasing for HER2 positive (HER2+) and triple-negative (TN) breast cancer patients. The necessity of axillary surgery for patients with high ypN0 has been questioned. This study aimed to identify patients among HER2+ and TN breast cancer with low risk for axillary metastases after NAT, and, perhaps, they are suitable for selective elimination of axillary surgery staging. Methods From January 2010 to August 2018, 865 breast cancer patients who underwent NAT were included in this retrospective clinical study, and 184 patients (21.3%,184/865) suffered from TN and HER2+ breast cancer and received full-course NAT. The correlation among clinicopathological characteristics of HER2+ and TN breast cancer and ypN0 were analyzed. Results Among the 184 HER2+ and TN breast cancer patients, tumor staging, lymph node staging and Ki-67 before NAT, clinically node-negative disease after NAT (ycN0), and breast radiologic and pathologic complete response (bpCR) were correlated with ypN0 (P<0.05). Lymph node staging before NAT (OR =0.363, P<0.001), ycN0 (OR =4.995, P<0.001) and bpCR (OR =11.285, P<0.001) were the independent effects of ypN0. The ypN0 rate after NAT in cN0/1 patients with bpCR and ycN0 (97.6%, 40/41) was significantly higher than that in cN2/3 patients (62.5%, 10/16) (P<0.001). Among the 37 patients with initial nodal ultrasonography showing cN0 disease, 17 of 17 (100.0%) with and 18 of 20 (90.0%) without bpCR had no evidence of residual nodal disease (P=0.178). Among the 42 patients with cN1 to ycN0, 23 of 24 (95.8%) with and 10 of 18 (55.6%) without bpCR had no evidence of residual nodal disease (P<0.001). Patients without bpCR had a relative risk for nodal residual metastases of 10.560 (95% CI: 2.720-41.003; P<0.001) compared with those with bpCR in cN1 group. Conclusions In terms of HER2+ and TN breast cancer patients, clinical lymph node staging before NAT, ycN0 and bpCR were the independent predictors of ypN0. bpCR was highly correlated with nodal status after NAT. The risk of axillary lymph nodes residual metastases after NAT in the patients of bpCR with cN0 and cN1 to ycN0 was less than 5%, thus making it possible to selectively avoid axillary surgery.
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Affiliation(s)
- Zhiqiang Shi
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Xueer Wang
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Pengfei Qiu
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Yanbing Liu
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Tong Zhao
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Xiao Sun
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Peng Chen
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Chunjian Wang
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Zhaopeng Zhang
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Binbin Cong
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Yongsheng Wang
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
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Magnoni F, Veronesi P. Sentinel node biopsy in conservative surgery for breast cancer: a changing role in clinical practice. MINERVA CHIR 2020; 75:386-391. [DOI: 10.23736/s0026-4733.20.08481-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yoon CI, Ahn SG, Kim D, Choi JE, Bae SJ, Cha CH, Park S, Jeong J. Repeat Sentinel Lymph Node Biopsy for Ipsilateral Breast Tumor Recurrence After Breast Conserving Surgery With Sentinel Lymph Node Biopsy: Pooled Analysis Using Data From a Systematic Review and Two Institutions. Front Oncol 2020; 10:518568. [PMID: 33072563 PMCID: PMC7538804 DOI: 10.3389/fonc.2020.518568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction: Best surgical approach of axillary staging remains controversial in locally recurrent breast cancer. We evaluated the reliability of repeat sentinel lymph node biopsy (reSLNB) in patients with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) with sentinel lymph node biopsy (SLNB) in terms of identification rate (IR) and false negative rate (FNR). To address the FNR, we identified patients who underwent sequential axillary lymph node dissection (ALND) after reSLNB. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library were conducted to identify patient-level data from articles. We searched for data of patients who underwent BCS with SLNB for primary breast cancer and who underwent sequential ALND after reSLNB due to local recurrence. Patients data was also identified by the same criteria at two institutions. Results: In total, 197 peer-reviewed publications were obtained, of which 20 included patients who met the eligibility criteria. Data from 464 patients were collected. From the two institutions, 31 patients were identified. A total of 495 patients were pooled. The IR of reSLNB was 71.9% (356/495). To address the FNR of reSLNB, 171 patients who underwent ALND after reSLNB were identified. The FNR and accuracy of reSLNB were 9.4% (5/53) and 97.1% (165/170), respectively. Conclusion: Our pooled data analysis showed that the FNR of reSLNB is lower than 10%, indicating that this operation is a reliable axillary surgery in patients with IBTR after they underwent BCS.
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Affiliation(s)
- Chang Ik Yoon
- Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Seoul, Seoul, South Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dooreh Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Eun Choi
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Hwan Cha
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Soeun Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Nielsen Moody A, Cox K, Haigh I, Chen Y, Sharma N. Does Contrast Enhanced Ultrasound (CEUS) of Normal/Benign Axillary Lymph Nodes in Patients with Breast Cancer Identify Significant Axillary Nodal Burden? Eur J Radiol 2020; 132:109311. [PMID: 33017774 DOI: 10.1016/j.ejrad.2020.109311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Contrast enhanced ultrasound (CEUS) of the axilla allows preoperative identification and biopsy of the sentinel lymph node. Our aims were to evaluate the accuracy of the CEUS procedure for identifying axillary lymph node metastases preoperatively and compare the volume of axillary metastases in patients with malignant versus benign CEUS guided core biopsy at end of primary surgical treatment. METHODS Retrospective analysis of prospectively collected data on patients with breast cancer with normal axillary ultrasound or benign axillary FNAC undergoing preoperatively CEUS guided sentinel lymph node biopsy between 2013 and 2018. RESULTS SLN was successfully identified by CEUS in 186 (90.7%) of patients with definitive diagnosis obtained in 163 (87.6%). Overall sensitivity was 55.77%, but significantly higher for high volume disease (77.78%) than for low volume disease (32.00%, odds ratio = 7.44, 95% CI = 2.16 to 25.62, p = .001) Specificity was 100%. NPV was 82.84% overall, 86.72% for low volume disease and 94.87 % for high volume disease. 72.4% of patients with initial malignant CEUS guided SLN core biopsy had two or more macrometastases at end of surgical treatment compared to 4.47% of patients with initial benign CEUS guided core biopsy. CONCLUSION When disease was present, CEUS guided sentinel lymph node core biopsy identify nodal metastases in 55.77% of patients with normal axillary grey scale ultrasound. This study suggests that the likelihood of extensive axillary disease at end of surgical treatment is low with an initial benign CEUS guided SLN core biopsy.
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Affiliation(s)
- Anne Nielsen Moody
- Breast Radiology, Breast Imaging Department, St James's University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK.
| | - Karina Cox
- Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Maidstone, Kent, UK
| | - Isobel Haigh
- Breast Radiology, Breast Imaging Department, St James's University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Yan Chen
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Nisha Sharma
- Breast Radiology, Breast Imaging Department, St James's University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK
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Breast radiologic complete response is associated with favorable survival outcomes after neoadjuvant chemotherapy in breast cancer. Eur J Surg Oncol 2020; 47:232-239. [PMID: 33213958 DOI: 10.1016/j.ejso.2020.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/04/2020] [Accepted: 08/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the accuracy of radiologic complete response (rCR) in predicting pathologic complete response (pCR), and determine whether rCR is a predictor of favorable survival outcomes. MATERIALS AND METHODS We retrospectively reviewed breast cancer patients treated with neoadjuvant chemotherapy (NAC) followed by surgery from September 2007 to June 2016. Breast lesions and axillary nodes were measured by MRI and categorized into either disappeared (breast rCR) or residual disease (breast non-rCR) and either normalized (axillary rCR) or abnormal findings (axillary non-rCR) in the axillary nodes. Correlation between rCR and pCR were compared using Cohen's Kappa statistics, and the recurrence-free survival (RFS) and overall survival (OS) rates were calculated by the Kaplan-Meier method. RESULTS Out of the 1017 eligible patients, 287 (28.2%) achieved breast pCR, 165 (16.2%) achieved breast rCR, 529 (52.0%) had axillary pCR, and 274 (26.9%) achieved axillary rCR. The correlation between a breast rCR and pCR showed a Cohen's Kappa value of 0.459, and between axillary rCR and pCR, the value was 0.384. During a median follow-up time of 48.0 months, the 5-year RFS rates were 90.6% for breast rCR, and 69.2% for breast non-rCR. The 5-year RFS rates were 82.3% for axillary rCR, and 68.8% for axillary non-rCR. Patients without breast rCR had a 2.4-fold significant increase in the risk of recurrence (p = 0.004) compared to patients with breast rCR. CONCLUSION Although rCR correlated with pCR by only moderate to fair degrees, breast rCR was a strong predictor for a favorable RFS outcome.
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Sun J, Henry DA, Carr MJ, Yazdankhahkenary A, Laronga C, Lee MC, Hoover SJ, Sun W, Czerniecki BJ, Khakpour N, Kiluk JV. Feasibility of Axillary Lymph Node Localization and Excision Using Radar Reflector Localization. Clin Breast Cancer 2020; 21:e189-e193. [PMID: 32893094 DOI: 10.1016/j.clbc.2020.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) is commonly used for patients with clinically detected nodal metastases. Sentinel lymph node biopsy (SLNB) after NAC is feasible. Excision of biopsy-proven positive lymph nodes in addition to SLNB, termed targeted axillary dissection (TAD), decreases the false-negative rate of SLNB alone. Positive nodes can be marked with radar reflector-localization (RRL) clips. We report our institutional experience with RRL-guided TAD and demonstrate its safety and feasibility. PATIENTS AND METHODS We performed an institutional review board-approved retrospective review of consecutive clinically node-positive female patients with breast cancer treated with NAC and RRL-guided TAD between January 2017 and September 2019. Clinicopathologic and treatment data were collected; descriptive statistics are reported. RESULTS Forty-five patients were analyzed; the median age was 55 years (range, 20-72 years), and the median body mass index was 27.2 kg/m2 (range, 16.5-40.4 kg/m2). All patients received NAC, primary breast surgery, and TAD. All clinically detected nodal metastases were confirmed with percutaneous biopsy and marked with a biopsy clip. RRL clips were implanted a median of 8 days (range, 1-167 days) prior to surgery; all were retrieved without complications. The RRL node was identified as the sentinel lymph node in 36 (80%) patients. Twenty-five patients had positive nodes, of which 24 were identified by RRL node excision, and 1 (4%) patient had a positive node identified by SLNB but not RRL. Over a median follow-up time of 29.6 months, 5 patients recurred (1 local, 4 distant). CONCLUSIONS RRL-guided TAD after NAC is safe and feasible. This technique allows for adequate assessment of the nodal basin and helps confirm excision of the previously biopsied positive axillary node.
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Affiliation(s)
- James Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL; Present affiliation: Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Danielle A Henry
- Breast Care Center, Orlando Health - UF Health Cancer Center, Orlando, FL
| | - Michael J Carr
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | - Adel Yazdankhahkenary
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL; Present affiliation: Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Catherine Lee
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | - Susan J Hoover
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | - Weihong Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | | | | | - John V Kiluk
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL.
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Mittendorf EA, Bellon JR, King TA. Regional Nodal Management in Patients With Clinically Node-Negative Breast Cancer Undergoing Upfront Surgery. J Clin Oncol 2020; 38:2273-2280. [PMID: 32442075 DOI: 10.1200/jco.19.02891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Jennifer R Bellon
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA.,Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
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Zhang W, Xu J, Wang K, Tang XJ, Liang H, He JJ. Independent risk factors for axillary lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes. BMC WOMENS HEALTH 2020; 20:143. [PMID: 32646416 PMCID: PMC7350751 DOI: 10.1186/s12905-020-01004-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/26/2020] [Indexed: 12/24/2022]
Abstract
Background The benefit of axillary lymph node dissection (ALND) in breast cancer patients with one or two positive sentinel lymph nodes (SLNs) remains inconclusive. The purpose of this study was to identify risk factors independently associated with axillary lymph node (ALN) metastasis. Methods We retrospectively analyzed data from 389 Chinese breast cancer patients with one or two positive SLNs who underwent ALND. Univariate and multivariate logistic regression analyses were performed to identify ALN metastasis-associated risk factors. Results Among the 389 patients, 174 (44.7%) had ALN metastasis, while 215 (55.3%) showed no evidence of ALN metastasis. Univariate analysis revealed significant differences in age (< 60 or ≥ 60 years), human epidermal growth factor receptor-2 (Her-2) status, and the ratio of positive to total SLNs between the ALN metastasis and non-metastasis groups (P < 0.05). The multivariate analysis indicated that age, the ratio of positive to total SLNs, and occupations were significantly different between the two groups. Lastly, younger age (< 60 years), a higher ratio of positive to total SLNs, and manual labor jobs were independently associated with ALN metastasis (P < 0.05). Conclusions The risk of ALN metastasis in breast cancer patients with one or two positive SLNs can be further increased by younger age, manual labor jobs, and a high ratio of positive to total SLNs. Our findings may also aid in identifying which patients with one or two positive SLNs may not require ALND.
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Affiliation(s)
- Wei Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Jing Xu
- Department of Geriatric Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Ke Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Xiao-Jiang Tang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Hua Liang
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jian-Jun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China.
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Kim YG, Song IH, Lee H, Kim S, Yang DH, Kim N, Shin D, Yoo Y, Lee K, Kim D, Jung H, Cho H, Lee H, Kim T, Choi JH, Seo C, Han SI, Lee YJ, Lee YS, Yoo HR, Lee Y, Park JH, Oh S, Gong G. Challenge for Diagnostic Assessment of Deep Learning Algorithm for Metastases Classification in Sentinel Lymph Nodes on Frozen Tissue Section Digital Slides in Women with Breast Cancer. Cancer Res Treat 2020; 52:1103-1111. [PMID: 32599974 PMCID: PMC7577824 DOI: 10.4143/crt.2020.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Assessing the status of metastasis in sentinel lymph nodes (SLNs) by pathologists is an essential task for the accurate staging of breast cancer. However, histopathological evaluation of SLNs by a pathologist is not easy and is a tedious and time-consuming task. The purpose of this study is to review a challenge competition (HeLP 2018) to develop automated solutions for the classification of metastases in hematoxylin and eosin–stained frozen tissue sections of SLNs in breast cancer patients. Materials and Methods A total of 297 digital slides were obtained from frozen SLN sections, which include post–neoadjuvant cases (n = 144, 48.5%) in Asan Medical Center, South Korea. The slides were divided into training, development, and validation sets. All of the imaging datasets have been manually segmented by expert pathologists. A total of 10 participants were allowed to use the Kakao challenge platform for 6 weeks with two P40 GPUs. The algorithms were assessed in terms of the area under receiver operating characteristic curve (AUC). Results The top three teams showed 0.986, 0.985, and 0.945 AUCs for the development set and 0.805, 0.776, and 0.765 AUCs for the validation set. Micrometastatic tumors, neoadjuvant systemic therapy, invasive lobular carcinoma, and histologic grade 3 were associated with lower diagnostic accuracy. Conclusion In a challenge competition, accurate deep learning algorithms have been developed, which can be helpful in making frozen diagnosis of intraoperative SLN biopsy. Whether this approach has clinical utility will require evaluation in a clinical setting.
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Affiliation(s)
- Young-Gon Kim
- Department of Biomedical Engineering, Asan Institute of Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Hye Song
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunna Lee
- Health Innovation Big Data Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Korea
| | - Sungchul Kim
- Department of Biomedical Engineering, Asan Institute of Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Kyowoon Lee
- Department of Computer Science and Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Dahye Kim
- Image Laboratory, School of Computer Science and Engineering, ChungAng University, Seoul, Korea
| | | | | | | | - Taeu Kim
- Department of Business Management and Convergence Software, Sogang University, Seoul, Korea
| | - Jong Hyun Choi
- Data Science & Business Analytics Lab, School of Industrial Management Engineering, College of Engineering, Korea University, Seoul, Korea
| | | | - Seong Il Han
- Software Graduate Program, School of Computing, College of Engineering, Korea Advanced Institute of Science and Technology, Seoul, Korea
| | - Young Je Lee
- Department of Biomedical Engineering, Yonsei University, Seoul, Korea
| | - Young Seo Lee
- Department of Social Studies Education, College of Education, Ewha Womans University, Seoul, Korea
| | - Hyung-Ryun Yoo
- Department of Math, University of Kwangwoon, Seoul, Korea
| | - Yongju Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Jeong Hwan Park
- Department of Pathology, Seoul National University College of Medicine and SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University College of Medicine and SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Besic N, Smrekar J, Strazisar B. Chronic adverse effects after an axillary lymphadenectomy in breast cancer patients after administering weaker and stronger postoperative analgesia: results of a prospective double-blind randomized study. Breast Cancer Res Treat 2020; 182:655-663. [PMID: 32557338 DOI: 10.1007/s10549-020-05713-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to compare the rate of chronic adverse effects after a weaker and stronger postoperative analgesia. METHODS A prospective double-blind randomized study included 117 breast cancer patients receiving tramadol for pain relief for 4 weeks after an axillary lymphadenectomy from 2015 to 2018. Patients with a larger dose received 75/650 mg of tramadol with paracetamol every 8 h and a group with a lower dose received 37.5/325 mg of tramadol with paracetamol every 8 h from the 2nd to the 29th postoperative day. 1 year after surgery, patients were evaluated for the presence of neuropathic pain, chronic pain, arm symptoms and lymphedema. RESULTS There was a trend for a lower rate of neuropathic pain after stronger analgesia in comparison to weaker analgesia (p = 0.059). Chronic pain was present in 18% of patients 1 year after the lymphadenectomy. There was no difference in the rate of chronic pain after stronger and weaker postoperative analgesia. Patients had less arm symptoms after a stronger analgesia than after a weaker analgesia (p = 0.02). Furthermore, there was a trend for a lower rate of lymphedema of the forearm after a stronger analgesia than after a lower analgesia (p = 0.078). CONCLUSIONS The patients who received a stronger postoperative analgesia had less arm symptoms and a better quality of life in comparison to patients who received a weaker analgesia. The patients who received a stronger postoperative analgesia had a statistical trend for less neuropathic pain in comparison to patients who received a weaker analgesia.
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Affiliation(s)
- Nikola Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, 1000, Ljubljana, Slovenia.
| | - Jaka Smrekar
- Faculty of Mathematics and Physics, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Branka Strazisar
- Department of Anesthesiology, Institute of Oncology, Zaloska 2, 1000, Ljubljana, Slovenia
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Tan H, Wu Y, Bao F, Zhou J, Wan J, Tian J, Lin Y, Wang M. Mammography-based radiomics nomogram: a potential biomarker to predict axillary lymph node metastasis in breast cancer. Br J Radiol 2020; 93:20191019. [PMID: 32401540 PMCID: PMC7336077 DOI: 10.1259/bjr.20191019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To establish a radiomics nomogram by integrating clinical risk factors and radiomics features extracted from digital mammography (MG) images for pre-operative prediction of axillary lymph node (ALN) metastasis in breast cancer. METHODS 216 patients with breast cancer lesions confirmed by surgical excision pathology were divided into the primary cohort (n = 144) and validation cohort (n = 72). Radiomics features were extracted from craniocaudal (CC) view of mammograms, and radiomics features selection were performed using the methods of ANOVA F-value and least absolute shrinkage and selection operator; then a radiomics signature was constructed with the method of support vector machine. Multivariate logistic regression analysis was used to establish a radiomics nomogram based on the combination of radiomics signature and clinical factors. The C-index and calibration curves were derived based on the regression analysis both in the primary and validation cohorts. RESULTS 95 of 216 patients were confirmed with ALN metastasis by pathology, and 52 cases were diagnosed as ALN metastasis based on MG-reported criteria. The sensitivity, specificity, accuracy and AUC (area under the receiver operating characteristic curve of MG-reported criteria were 42.7%, 90.8%, 24.1% and 0.666 (95% confidence interval: 0.591-0.741]. The radiomics nomogram, comprising progesterone receptor status, molecular subtype and radiomics signature, showed good calibration and better favorite performance for the metastatic ALN detection (AUC 0.883 and 0.863 in the primary and validation cohorts) than each independent clinical features (AUC 0.707 and 0.657 in the primary and validation cohorts) and radiomics signature (AUC 0.876 and 0.862 in the primary and validation cohorts). CONCLUSION The MG-based radiomics nomogram could be used as a non-invasive and reliable tool in predicting ALN metastasis and may facilitate to assist clinicians for pre-operative decision-making. ADVANCES IN KNOWLEDGE ALN status remains among the most important breast cancer prognostic factors and is essential for making treatment decisions. However, the value of detecting metastatic ALN by MG is very limited. The studies on pre-operative ALN metastasis prediction using the method of MG-based radiomics in breast cancer are very few. Therefore, we studied whether MG-based radiomics nomogram could be used as a predictive biomarker for the detection of metastatic ALN.
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Affiliation(s)
- Hongna Tan
- Department of Radiology, Henan Provincial People's Hospital & Imaging Diagnosis of Neurological Diseases and Research Laboratory of Henan Province & People's Hospital of Zhengzhou University, Henan, China, 450003
| | - Yaping Wu
- Department of Radiology, Henan Provincial People's Hospital & Imaging Diagnosis of Neurological Diseases and Research Laboratory of Henan Province & People's Hospital of Zhengzhou University, Henan, China, 450003
| | - Fengchang Bao
- Department of Hematology, Henan Provincial People's Hospital & People's Hospital of Zhengzhou University, Henan, China, 450003
| | - Jing Zhou
- Department of Radiology, Henan Provincial People's Hospital & Imaging Diagnosis of Neurological Diseases and Research Laboratory of Henan Province & People's Hospital of Zhengzhou University, Henan, China, 450003
| | - Jianzhong Wan
- Collaborative Innovation Center for Internet Healthcare & School of Software, Zhengzhou University, Zhengzhou, Henan, China, 450052
| | - Jie Tian
- Institute of Automation, Chinese Academy of Sciences, Beijing, China, 100190
| | - Yusong Lin
- Collaborative Innovation Center for Internet Healthcare & School of Software, Zhengzhou University, Zhengzhou, Henan, China, 450052
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital & Imaging Diagnosis of Neurological Diseases and Research Laboratory of Henan Province & People's Hospital of Zhengzhou University, Henan, China, 450003
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Arisio R, Borella F, Porpiglia M, Durando A, Bellino R, Bau MG, DE Sanctis C, Danese S, Benedetto C, Katsaros D. Axillary Dissection vs. no Axillary Dissection in Breast Cancer Patients With Positive Sentinel Lymph Node: A Single Institution Experience. In Vivo 2020; 33:1941-1947. [PMID: 31662523 DOI: 10.21873/invivo.11689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Axillary surgery of breast cancer patients is undergoing a paradigm shift, as axillary lymph node dissection's (ALND) usefulness is being questioned in the treatment of patients with tumor-positive sentinel lymph node biopsy (SLNB). The aim of this study was to investigate the overall survival (OS) and relapse-free survival (RFS) of patients with positive SLNB treated with ALND or not. PATIENTS AND METHODS We investigated 617 consecutive patients with cN0 operable breast cancer with positive SLNB undergoing mastectomy or conservative surgery. A total of 406 patients underwent ALND and 211 were managed expectantly. RESULTS No significant difference in OS and RFS was found between the two groups. The incidence of loco-regional recurrence in the SLNB-only group and the ALND group was low and not significant. CONCLUSION The type of breast cancer surgery and the omission of ALND does not improve OS or RSF rate in cases with metastatic SLN.
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Affiliation(s)
- Riccardo Arisio
- Department of Surgical Sciences, Sant'Anna Hospital, Turin, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mauro Porpiglia
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy.,Breast Unit, Sant'Anna Hospital, Turin, Italy
| | - Antonio Durando
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 2, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Roberto Bellino
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 2, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maria Grazia Bau
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 3, Sant'Anna Hospital, Turin, Italy
| | - Corrado DE Sanctis
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 3, Sant'Anna Hospital, Turin, Italy
| | - Saverio Danese
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 4, Sant'Anna Hospital, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Dionyssios Katsaros
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy .,Breast Unit, Sant'Anna Hospital, Turin, Italy
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Preda T, McGrath R, Bingham J, Fawcett A, O'Dea C, Bochner M, Gill PG, Kollias J. How much does axillary ultrasound contribute in women undergoing breast-conserving surgery with no palpable axillary nodes? ANZ J Surg 2020; 90:1146-1150. [PMID: 31957192 DOI: 10.1111/ans.15680] [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: 02/02/2019] [Revised: 11/18/2019] [Accepted: 11/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The primary objective was evaluation of axillary ultrasound (AxUS) in preoperative staging of patients with invasive carcinoma undergoing breast-conserving surgery. METHODS This is a retrospective, observational cohort study of patients with clinically node-negative (cN0) biopsy-proven invasive breast carcinoma undergoing breast-conserving surgery between January 2011 and December 2014 who underwent AxUS with fine needle aspiration (FNA) biopsy of sonographically abnormal lymph nodes. Patient records were reviewed. RESULTS A total of 713 cases were analysed. Four hundred and thirty-three patients underwent formal preoperative AxUS; 100 underwent biopsy for abnormal findings. Of these, 32 had positive FNA biopsy result and underwent level II axillary dissection (axillary lymph node dissection (ALND)). Thirty were T1-2 tumours with AxUS scan/FNA demonstrating sensitivity of 25.2%, specificity of 100%, positive predictive value of 100% and negative predictive value of 76.6%. Forty-six patients had a positive sentinel lymph node (SLN) biopsy and axillary dissection. 34.8% of T1 tumours, 47.8% of T2 tumours and 100% of T3 tumours had further positive nodes. The average number of nodes involved per axilla was 1.8 for the T1 group, 4.1 for the T2 group and 4.6 in the T3 group. Macrometastases were a more common finding than micrometastases for all T stages undergoing ALND. A suspicious preoperative AxUS result was significantly associated with positive SLN. Other risk factors for positive SLN biopsy were oestrogen receptor positivity and lymphovascular invasion. CONCLUSION AxUS identifies patients with high nodal burdens justifying immediate ALND. AxUS did not adversely affect women with histologically negative sentinel nodes. Three percent may have been overtreated.
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Affiliation(s)
- Tamara Preda
- Department of Breast and Endocrine Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Rachel McGrath
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Janne Bingham
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Alexandra Fawcett
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Chloe O'Dea
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Melissa Bochner
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Grantley Gill
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - James Kollias
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
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Zou J, Wang X, Yang Z, Yang X, Wang C, Sun L, Wang W, Wang Y, Nie J. The application of methylene blue coloration technique in axillary lymph node dissection of breast cancer. Transl Cancer Res 2019; 8:2781-2790. [PMID: 35117035 PMCID: PMC8797960 DOI: 10.21037/tcr.2019.10.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022]
Abstract
Background To analyze the associated factors that affect the coloration of methylene blue (MB) in axillary lymph node dissection (ALND) of patients with breast cancer and to explore the tracer effect of MB in high axillary lymph node metastasis, to guide surgical treatment. Methods We recruited 170 patients who underwent ALND, all of them were injected MB before operation. We analyzed the relationships between the clinical factors of age, body mass index (BMI), molecular typing, TNM staging, neoadjuvant chemotherapy, injection time and position and the MB coloration by univariate and multivariate analyses. A total of 84 cases were selected for observation of the application value of MB during intervention involving the lymph nodes upper axillary vein. Results Of 170 cases, 138 cases (81.17%) were colored. Univariate analysis showed that significant differences were observed between differing BMI’s (χ2=24.074, P<0.0001) and injection times (χ2=41.207, P<0.0001). Multivariate analysis showed that injection time (P=0.016) was the clinical factor associated with MB coloration. More than 60 minutes before surgery and MB injection, the possibility of methylene blue colored was 0.088 times higher than 10 minutes (P=0.010, 95% CI, 0.014, 0.554). MB was used to track the lymph node upper axillary vein with a sensitivity of 12.5%, a specificity of 100%, a false negative rate of 87.50%, and a false positive rate of 0; the kappa coefficient was 0.051 (χ2=0.679, P=0.404). Conclusions Among the clinical factors, MB coloration was worse more than 60 minutes before ALND. Using the technology of MB color, lymph nodes can be clearly identified. It has great guiding value for the doctors who learn the operation initially. However, it is still prudent to use MB for high lymph node dissection.
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Affiliation(s)
- Jieya Zou
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Xiaoqi Wang
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Zhuangqing Yang
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Xiaojuan Yang
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Chang'an Wang
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Lifei Sun
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Wenhuan Wang
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Yue Wang
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Jianyun Nie
- Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
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Preliminary study of real-time three-dimensional contrast-enhanced ultrasound of sentinel lymph nodes in breast cancer. Eur Radiol 2019; 30:1426-1435. [PMID: 31776739 DOI: 10.1007/s00330-019-06494-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/31/2019] [Accepted: 10/03/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the clinical value of real-time three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the detection of sentinel lymph nodes (SLNs) and drainage lymphatics in breast cancer patients. METHOD The prospective study was performed in women with pathology-confirmed T1/2 breast cancer between June 2016 and December 2017 who underwent sentinel lymph node biopsy and 3D-CEUS. The number, size, location, enhancement pattern of SLNs, and the lymphatic drainage patterns were reviewed. The routes, location of SLNs, and lymph channels (LCs) on the surface were marked. All patients underwent blue dye-guided sentinel lymph node biopsy (SLNB) finally. RESULTS According to the postoperative pathology findings and the blue dye staining of the lymphatic drainage routes, there are six patterns of lymphatic drainage routes and the coincidence rate of the 3D-CEUS was 97.4%; the sensitivity, specificity, positive predictive value, negative predictive value, the LN detection rate, and the correct diagnosis rate of the 3D-CEUS were 75%, 93.0%, 81.8%, 89.9%, 95.3%, and 87.7%, respectively. CONCLUSION 3D-CEUS is a new feasible and useful approach to detect the SLNs and LCs. 3D-CEUS can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes. KEY POINTS • The three-dimensional contrast-enhanced ultrasound can detect the sentinel lymph nodes. • The three-dimensional contrast-enhanced ultrasound can show the stereo direction of sentinel lymph nodes and lymph drainage routes. • The three-dimensional contrast-enhanced ultrasound can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes.
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Taruno K, Kurita T, Kuwahata A, Yanagihara K, Enokido K, Katayose Y, Nakamura S, Takei H, Sekino M, Kusakabe M. Multicenter clinical trial on sentinel lymph node biopsy using superparamagnetic iron oxide nanoparticles and a novel handheld magnetic probe. J Surg Oncol 2019; 120:1391-1396. [DOI: 10.1002/jso.25747] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Kanae Taruno
- Department of Breast Surgical OncologyShowa University School of MedicineTokyo Japan
| | - Tomoko Kurita
- Department of Breast SurgeryNippon Medical School HospitalTokyo Japan
| | - Akihiko Kuwahata
- Department of Electrical Engineering and Information Systems, Graduate School of EngineeringThe University of TokyoTokyo Japan
| | - Keiko Yanagihara
- Department of Breast SurgeryNippon Medical School HospitalTokyo Japan
| | - Katsutoshi Enokido
- Department of Breast Surgical Oncology, Showa University School of MedicineFujigaoka HospitalYokohama Kanagawa Japan
| | | | - Seigo Nakamura
- Department of Breast Surgical OncologyShowa University School of MedicineTokyo Japan
- The Department of Breast Cancer, Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin China
| | - Hiroyuki Takei
- Department of Breast Surgical Oncology, Showa University School of MedicineFujigaoka HospitalYokohama Kanagawa Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of EngineeringThe University of TokyoTokyo Japan
| | - Moriaki Kusakabe
- Research Center for Food Safety, Graduate School of Agricultural and Life SciencesThe University of TokyoTokyo Japan
- Department of Medical DeviceMatrix Cell Research Institute IncUshiku Ibaraki Japan
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Bekelman JE, Lu H, Pugh S, Baker K, Berg CD, Berrington de González A, Braunstein LZ, Bosch W, Chauhan C, Ellenberg S, Fang LC, Freedman GM, Hahn EA, Haffty BG, Khan AJ, Jimenez RB, Kesslering C, Ky B, Lee C, Lu HM, Mishra MV, Mullins CD, Mutter RW, Nagda S, Pankuch M, Powell SN, Prior FW, Schupak K, Taghian AG, Wilkinson JB, MacDonald SM, Cahlon O. Pragmatic randomised clinical trial of proton versus photon therapy for patients with non-metastatic breast cancer: the Radiotherapy Comparative Effectiveness (RadComp) Consortium trial protocol. BMJ Open 2019; 9:e025556. [PMID: 31619413 PMCID: PMC6797426 DOI: 10.1136/bmjopen-2018-025556] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/07/2019] [Accepted: 07/26/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION A broad range of stakeholders have called for randomised evidence on the potential clinical benefits and harms of proton therapy, a type of radiation therapy, for patients with breast cancer. Radiation therapy is an important component of curative treatment, reducing cancer recurrence and extending survival. Compared with photon therapy, the international treatment standard, proton therapy reduces incidental radiation to the heart. Our overall objective is to evaluate whether the differences between proton and photon therapy cardiac radiation dose distributions lead to meaningful reductions in cardiac morbidity and mortality after treatment for breast cancer. METHODS We are conducting a large scale, multicentre pragmatic randomised clinical trial for patients with breast cancer who will be followed longitudinally for cardiovascular morbidity and mortality, health-related quality of life and cancer control outcomes. A total of 1278 patients with non-metastatic breast cancer will be randomly allocated to receive either photon or proton therapy. The primary outcomes are major cardiovascular events, defined as myocardial infarction, coronary revascularisation, cardiovascular death or hospitalisation for unstable angina, heart failure, valvular disease, arrhythmia or pericardial disease. Secondary endpoints are urgent or unanticipated outpatient or emergency room visits for heart failure, arrhythmia, valvular disease or pericardial disease. The Radiotherapy Comparative Effectiveness (RadComp) Clinical Events Centre will conduct centralised, blinded adjudication of primary outcome events. ETHICS AND DISSEMINATION The RadComp trial has been approved by the institutional review boards of all participating sites. Recruitment began in February 2016. Current version of the protocol is A3, dated 08 November 2018. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement efforts and presentation to the public via lay media outlets. TRIAL REGISTRATION NUMBER NCT02603341.
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Affiliation(s)
- Justin E Bekelman
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hien Lu
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephanie Pugh
- American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Kaysee Baker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Walter Bosch
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Susan Ellenberg
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Gary M Freedman
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
| | - B G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Atif J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Bonnie Ky
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hsiao-Ming Lu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - C Daniel Mullins
- PHSR, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Suneel Nagda
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Pankuch
- Northwestern Medicine Chicago Proton Center, Warrenville, Illinois, USA
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Fred W Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Karen Schupak
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
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Morency D, Dumitra S, Parvez E, Martel K, Basik M, Robidoux A, Poirier B, Holloway CMB, Gaboury L, Sideris L, Meterissian S, Boileau JF. Axillary Lymph Node Ultrasound Following Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: Results from the SN FNAC Study. Ann Surg Oncol 2019; 26:4337-4345. [PMID: 31605348 DOI: 10.1245/s10434-019-07809-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The sentinel node biopsy following neoadjuvant chemotherapy (SN FNAC) study has shown that in node-positive (N+) breast cancer, sentinel node biopsy (SNB) can be performed following neoadjuvant chemotherapy (NAC), with a low false negative rate (FNR = 8.4%). A secondary endpoint of the SN FNAC study was to determine whether axillary ultrasound (AxUS) could predict axillary pathological complete response (ypN0) and increase the accuracy of SNB. METHODS The SN FNAC trial is a study of patients with biopsy-proven N+ breast cancer who underwent SNB followed by completion node dissection. All patients had AxUS following NAC and the axillary nodes were classified as either positive (AxUS+) or negative (AxUS-). AxUS was compared with the final axillary pathology results. RESULTS There was no statistical difference in the baseline characteristics of patients with AxUS+ versus those with AxUS-. Overall, 82.5% (47/57) of AxUS+ patients had residual positive lymph nodes (ypN+) at surgery and 53.8% (42/78) of AxUS- patients had ypN+. Post NAC AxUS sensitivity was 52.8%, specificity 78.3%, and negative predictive value 46.2%. AxUS FNR was 47.2%, versus 8.4% for SNB. If post-NAC AxUS- was used to select patients for SNB, FNR would decrease from 8.4 to 2.7%. However, using post-NAC AxUS in addition to SNB as an indication for ALND would have led to unnecessary ALND in 7.8% of all patients. CONCLUSION AxUS is not appropriate as a standalone staging procedure, and SNB itself is sufficient to assess the axilla post NAC in patients who present with N+ breast cancer.
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Affiliation(s)
- Dominique Morency
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - Sinziana Dumitra
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - Elena Parvez
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - Karyne Martel
- Hopital de Saint-Jerome CISSS St-Jerome, Saint-Jerome, QC, Canada
| | - Mark Basik
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - André Robidoux
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Brigitte Poirier
- Centre des maladies du sein HSS CHU de Quebec, Universite Laval, Quebec, QC, Canada
| | - Claire M B Holloway
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Louis Gaboury
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Lucas Sideris
- Hopital Maisonneuve-Rosemont, Universite de Montreal, Montreal, QC, Canada
| | | | - Jean-François Boileau
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada.
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Morrow M, Jagsi R, McLeod MC, Shumway D, Katz SJ. Surgeon Attitudes Toward the Omission of Axillary Dissection in Early Breast Cancer. JAMA Oncol 2019; 4:1511-1516. [PMID: 30003237 DOI: 10.1001/jamaoncol.2018.1908] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance The American College of Surgeons Oncology Group (ACOSOG) Z0011 study demonstrated the safety of sentinel node biopsy alone in clinically node-negative women with metastases in 1 or 2 sentinel nodes treated with breast conservation. Little is known about surgeon perspectives regarding when axillary lymph node dissection (ALND) can be omitted. Objectives To determine surgeon acceptance of ACOSOG Z0011 findings, identify characteristics associated with acceptance of ACOSOG Z0011 results, and examine the association between acceptance of the Society of Surgical Oncology and American Society for Radiation Oncology negative margin of no ink on tumor and surgeon preference for ALND. Design, Setting, and Participants A survey was sent to 488 surgeons treating a population-based sample of women with early-stage breast cancer (N = 5080). The study was conducted from July 1, 2013, to August 31, 2015. Main Outcomes and Measures Surgeons were categorized as having low, intermediate, or high propensity for ALND according to the outer quartiles of ALND scale distribution. A multivariable linear regression model was used to confirm independent associations. Results Of the 488 surgeons invited to participate, 376 (77.0%) responded and 359 provided complete information regarding propensity for ALND derived from 5 clinical scenarios. Mean surgeon age was 53.7 (range, 31-80) years; 277 (73.7%) were male; 142 (37.8%) treated 20 or fewer breast cancers annually and 108 (28.7%) treated more than 50. One hundred seventy-five (49.0%) recommended ALND for 1 macrometastasis. Of low-propensity surgeons who recommended ALND, only 1 (1.1%) approved ALND for any nodal metastases compared with 69 (38.6%) and 85 (95.5%) of selective and high-propensity surgeons (P < .001), respectively. In multivariable analysis, lower ALND propensity was significantly associated with higher breast cancer volume (21-50: -0.19; 95% CI, -0.39 to 0.02; >51: -0.48; 95% CI, -0.71 to -0.24; P < .001), recommendation of a minimal margin width (1-5 mm: -0.10; 95% CI, -0.43 to 0.22; no ink on tumor: -0.53; 95% CI, -0.82 to -0.24; P < .001), participation in a multidisciplinary tumor board (1%-9%: -0.25; 95% CI, -0.55 to 0.05; >9%: -0.37; 95% CI, -0.63 to -0.11; P = .02), and Los Angeles Surveillance, Epidemiology, and End Results site (-0.18; 95% CI, -0.35 to -0.01; P = .04). Conclusions and Relevance This study shows substantial variation in surgeon acceptance of more limited surgery for breast cancer, which is associated with higher breast cancer volume and multidisciplinary interactions, suggesting the potential for overtreatment of many patients and the need for education targeting lower-volume breast surgeons.
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - M Chandler McLeod
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - Dean Shumway
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Steven J Katz
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
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Serquiz N, Moro L, Menossi CA, Almeida NR, Baccarin G, de Paiva Silva GR, Shinzato JY, Derchain S, Jales RM. Perinodal fibrosis developed after ultrasonography-guided core-needle biopsy of a contrast-enhanced ultrasound-detected sentinel axillary node interferes with subsequent surgical sentinel node dissection. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:445-452. [PMID: 31359458 DOI: 10.1002/jcu.22765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/13/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate perinodal fibrosis after 14-gauge staging core-needle biopsy (CNB) of the axillary sentinel lymph node (SLN) identified using contrast-enhanced ultrasonography (CEUS) and its interference with subsequent surgical SLN dissection in breast cancer patients. METHODS Frequencies or means of main clinical, sonographic, pathological, and surgical characteristics were calculated. We also compared patient groups with and without perinodal pathological fibrosis. RESULTS Forty-eight patients who underwent CEUS + CNB and axillary surgery were eligible for this cross-sectional study. Axillary surgical specimens showed perinodal fibrosis in 9/48 (18.7%) patients. Interference with SLN dissection was reported in 4/48 (8.3%) patients (two hematomas, three abnormal palpation findings, and four difficult dissections). The overall surgical detection rate of SLN was 43/48 (89.6%). In the majority of cases, perinodal fibrosis was described as moderate (4/9 [44.4%]) or severe (4/9 [44.4%]). The mean time elapsed between CEUS + CNB and axillary dissection was shorter in patients with perinodal fibrosis (P = .04). Interference with SLN dissection was only reported in patients with perinodal fibrosis (P < .001). Surgical SLN detection was successful in all nine cases in which perinodal pathological fibrosis or interference with SLN dissection was reported. CONCLUSION Perinodal fibrosis may impair the surgical SLN dissection in early stage breast cancer patients who were staged using CEUS + CNB using a14-gauge needle.
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Affiliation(s)
- Nicoli Serquiz
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Luciano Moro
- Department of Radiology, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos A Menossi
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Natalie R Almeida
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Gabrielle Baccarin
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Geisilene R de Paiva Silva
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Julia Y Shinzato
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Rodrigo M Jales
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
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Chen HY, Tsai HH, Tam KW, Huang TW. Effects of photobiomodualtion therapy on breast cancer-related lymphoedema: A systematic review and meta-analysis of randomised controlled trials. Complement Ther Med 2019; 47:102200. [PMID: 31780036 DOI: 10.1016/j.ctim.2019.102200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Lymphoedema characterised by the persistent accumulation of the interstitial fluid in peripheral tissues post breast cancer treatments. Photobiomodualtion therapy (PBMT) is widely used as supportive care in patients with breast cancer or breast cancer-related lymphoedema (BCRL). This systematic review and meta-analysis analysed the effectiveness and safety of PBMT for the treatment of BCRL. METHOD PubMed, EMBASE, PEDro, SCOPUS, CINAHL, and Cochrane Central Register of Controlled Trials were searched for RCTs on PBMT published before July 2019. Randomised controlled trials (RCTs) that evaluated the efficacy of PBMT on BCRL were included. The primary outcome was the arm circumference or volume, and secondary outcomes were grip strength and pain scores. This study is registered with PROSPERO (number CRD 42018102107). RESULTS We reviewed nine RCTs that included 316 patients and six studies for mata-analysis. We found no significant difference in the reduction of the arm circumference or arm volume after treatment, one month, and three month follow-up between the PBMT and control groups. Studies revealed no significant differences in the reduction in grip strength and pain scores at 0, 1, 2, and 3 month between the PBMT and control groups. CONCLUSIONS Although PBMT demonstrated a slight improvement in reducing arm circumference and arm volume, the results of our meta-analysis did not show significant benefits in relieving of lymphoedema. Further trials are needed to recruit more participants, and to evaluate the long-term efficacy and safety of PBMT in management of breast cancer-related lymphoedema.
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Affiliation(s)
- Hsuan-Yu Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of General Medicine, Chang Chung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Hsuan Tsai
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsai-Wei Huang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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81
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Li H, Jun Z, Zhi-Cheng G, Xiang Q. Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer. J Int Med Res 2019; 47:4841-4853. [PMID: 31507208 PMCID: PMC6833398 DOI: 10.1177/0300060519827413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective This study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer. Methods A total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB. Results The identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively. Conclusions SLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.
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Affiliation(s)
- Huang Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Breast Surgery Ward No. 3, The Affiliated Tumor Hospital of Shanxi Medical University, Shanxi Tumor Hospital, Taiyuan, Shanxi, China
| | - Zhang Jun
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ge Zhi-Cheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qu Xiang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Bundred N, Todd C, Morris J, Keeley V, Purushotham A, Bagust A, Foden P, Bramley M, Riches K. Individualising breast cancer treatment to improve survival and minimise complications in older women: a research programme including the PLACE RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundOver 44,000 women are diagnosed with breast cancer annually in the UK. The research comprised three workstreams (WSs) focused on older women.Maximising survivalWS1 – to identify the role of older women’s and surgeons’ preferences in cancer treatment decisions and whether comorbidity or fitness for surgery has an impact on survival.Minimising complicationsWS2 – to assess multifrequency bioimpedance (BEA) compared with perometry in identifying women predisposed to develop lymphoedema after axillary node clearance (ANC) surgery. WS3 – to assess, in women at risk of lymphoedema, whether or not applying compression garments prevents the onset of lymphoedema.DesignWS1 – a prospective, consecutive cohort of surgical consultations with women aged ≥ 70 years with operable breast cancer. Interviews and questionnaire surveys of surgeons’ and women’s perceptions of responsibility for treatment decisions (Controlled Preference Score), effects related to survival and secondary outcomes. WS2 – women undergoing ANC for cancer in 21 UK centres underwent baseline and subsequent BEA, and perometer arm measurements and quality-of-life (QoL) assessments. WS3 – a randomised controlled trial testing standard versus applying graduated compression garments to the affected arm, for 1 year, in WS2 patients developing arm swelling.SettingBreast outpatient clinics in hospitals with specialist lymphoedema clinics.ParticipantsWS1 – patients aged ≥ 70 years with newly diagnosed, operable, invasive breast cancer. WS2 – women with node-positive cancer scheduled to undergo ANC. WS3 – WS2 participants developing a 4–9% increase in arm volume.InterventionsWS1 – observational study. WS2 – observational study. WS3 – application of graduated compression garments to affected arm, compared with standard management, for 1 year.OutcomesWS1 – self-report and clinically assessed health, QoL, complications and survival. WS2 – perometer and bioimpedance spectroscopy (BIS) measurements, QoL and health utility; and sensitivity and specificity of BIS for detecting lymphoedema compared with perometer arm measurements; in addition, a health economics assessment was performed. WS3 – time to the development of lymphoedema [≥ 10% relative arm-volume increase (RAVI)] from randomisation.ResultsWS1 – overall, 910 women were recruited, but numbers in the substudies differ depending on consent/eligibility. In a study of patient/surgeon choice, 83.0% [95% confidence interval (CI) 80.4% to 85.6%] had surgery. Adjusting for health and choice, only women aged > 85 years had reduced odds of surgery [odds ratio (OR) 0.18, 95%CI 0.07 to 0.44]. Patient role in treatment decisions made no difference to receipt of surgery. A qualitative study of women who did not have surgery identified three groups: ‘patient declined’, ‘patient considered’ and ‘surgeon decided’. In a survival substudy, adjusting for tumour stage, comorbidity and functional status, women undergoing surgery had one-third the hazard of dying from cancer. Serious complications from surgery were low and not predicted by older age. In a substudy of the effect of surgical decision-making on HRQoL, 59 (26%) received preferred treatment decision-making style. In multivariate analyses, change in HRQoL was associated neither with congruence (p = 0.133) nor with receipt of surgery (p = 0.841). In a substudy of receipt of chemotherapy in women aged ≥ 65 years, adjusting for tumour characteristics, health measures and choice, women aged ≥ 75 years had reduced odds of chemotherapy (OR 0.06, 95%CI 0.02 to 0.16). WS2 – lymphoedema by 24 months was detected in 21.4% of women by perometry (24.4% sleeve application) and in 39.4% by BIS. Perometer and BIS measurements correlated at 6 months (r = 0.61). Specificity for sleeve application was greater for perometry (94% CI 93% to 96%) at 24 months, as was a positive predictive value of 59% (95% CI 48% to 68%). Lymphoedema diagnosis reduced QoL scores. Sleeve application in the absence of RAVI of > 9% did not improve QoL or symptoms. A composite definition of lymphoedema was developed, comprising a 9% cut-off point for perometer and self-reported considerable swelling. Diagnostic accuracy was ≥ 94% at 6, 12 and 24 months. WS3 – the PLACE (Prevention of Lymphoedema After Clearance of External compression) trial recruited 143 patients, but recruitment was slow and closed early on the advice of the Independent Data Monitoring Committee. A qualitative substudy identified a number of barriers to recruitment.ConclusionsHalf of older patients felt that they influenced decisions about their treatment. No relationship between decision preference being fulfilled and HRQoL in elderly patients diagnosed with cancer occurred, and older age did not predict complications. Primary surgery reduced the hazard of dying of cancer by two-thirds, independent of age, health and tumour characteristics. Women aged ≥ 75 years have reduced odds of receiving chemotherapy. Lymphoedema (along with a BMI of > 30 kg/m2, cigarette smoking and chemotherapy) reduces QoL. Changes in arm volume of > 9% predicted lymphoedema requiring and benefiting from sleeve application. The PLACE trial qualitative work provides a number of insights into problems of recruitment that were specific to this trial (stigma of compression garments) but that are also generalisable to other RCTs.LimitationsBoth WS1 and WS2 were large, multicentre, UK cohort, observational studies. The WS3 PLACE trial has not reported yet but closed with approximately half of the patients originally planned.Future workResearch producing objective measures for sleeve prescription in the NHS is required.Trial registrationCurrent Controlled Trials ISRCTN48880939.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 7, No. 5. See the NIHR Journals Library website for further project information. Additional support for WS1 came from a Breast Cancer Campaign Grant and a NIHR Postdoctoral Fellowship. ImpediMed (Carslbad, CA, USA;www.impedimed.com) provided bioimpedance L-Dex®machines and electrodes for the study and Sigvaris provided the external compression garments free of charge for the (PLACE) trial.
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Affiliation(s)
- Nigel Bundred
- Department of Academic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Julie Morris
- Department of Academic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Clinical Trials Co-ordination Unit, The Christie NHS Foundation Trust, Manchester, UK
| | - Vaughan Keeley
- Department of Palliative Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | - Adrian Bagust
- Management School, University of Liverpool, Liverpool, UK
| | - Philip Foden
- Department of Academic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maria Bramley
- Oncology Research, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Katie Riches
- Department of Palliative Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
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Shi ZQ, Qiu PF, Liu YB, Cong BB, Zhao T, Chen P, Wang CJ, Zhang ZP, Sun X, Wang YS. Neo-adjuvant chemotherapy and axillary de-escalation management for patients with clinically node-negative breast cancer. Breast J 2019; 25:1154-1159. [PMID: 31332886 DOI: 10.1111/tbj.13422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
This study aimed to explore the optimal time of sentinel lymph node biopsy (SLNB) and neo-adjuvant chemotherapy (NAC) and to assess the feasibility of selective elimination of axillary surgery after NAC in clinically node-negative (cN0) patients. From April 2010 to August 2018, 845 patients undergoing surgery after NAC were included in this retrospective study to analyze the correlation between different clinicopathological characteristics of cN0 patients and negative axillary lymph node after NAC (ypN0). Among the 148 cN0 patients, 83.1% (123/148) were ypN0. The rates of ypN0 in patients with hormone receptor positive (HR+)/HER2-, HR+/HER2+, HR-/HER2+, and triple-negative (TN) breast cancer were 75.4% (46/61), 82.6% (19/23), 85.2% (23/27), and 94.6% (35/37), respectively (P < 0.001). The rates of ypN0 in TN and HER2+ patients were 94.6% and 95.5%, which were significantly higher than that in HR+/HER2- patients (P < 0.05). Molecular subtypes, clinical stage, radiologic complete response, and pathologic complete response (bpCR) of the breast tumor correlated with ypN0 after full-course NAC (P < 0.05). Molecular subtypes (OR = 2.374, P = 0.033), clinical stage (OR = 0.320, P = 0.029), and bpCR (OR = 0.454, P = 0.012) were independent predictors for ypN0. The optimal time of SLNB and NAC in cN0 patients might be different among different molecular subtypes: it would be preferable to perform SLNB prior to NAC for HR+/HER2- patients, and SLNB after NAC for TN and HER2+ patients to reduce the risk of axillary lymph node dissection. In view of the high ypN0 rate in cN0 patients, axillary surgical staging might be selectively eliminated, especially for HER2+ and TN patients.
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Affiliation(s)
- Zhi-Qiang Shi
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peng-Fei Qiu
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan-Bing Liu
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Bin-Bin Cong
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
| | - Tong Zhao
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Peng Chen
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Chun-Jian Wang
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Zhao-Peng Zhang
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Xiao Sun
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Yong-Sheng Wang
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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Decreasing rates of axillary lymph node dissections over time: Implications for surgical resident exposure and operative skills development. Am J Surg 2019; 218:786-791. [PMID: 31350006 DOI: 10.1016/j.amjsurg.2019.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/23/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy has supplanted axillary lymph node dissection (ALND) in clinically node-negative breast cancer and select node-positive disease. We hypothesized a decreasing rate of both ALND and resident exposure over time. METHODS We identified women with clinical Stage I-III breast cancer in the National Cancer Data Base (2004-2014). Adjusted multivariate logistic regression was used to estimate the effect of various factors on receipt of ALND. Yearly procedural rates for residents were extracted from surgical case log reports for comparison against procedural rates. RESULTS 1,131,363 patients were identified; 255,306 received ALND, 876,057 underwent non-ALND management. ALND rates declined from 2004 (32%) to 2014 (16%, p < 0.001), with the largest decline occurring between 2010 and 2011 (24%-20%). After adjustment, this effect was maintained, with ALND rates decreasing with each additional year (OR = 0.90, 95% CI 0.89-0.90). Resident procedure volumes similarly declined from 1999 to 2017 (p < 0.001). CONCLUSIONS Significant declines in both ALND rates and procedural volume in residency may impact outcomes, as ALNDs are being performed in ever more challenging oncologic scenarios by potentially less-experienced surgeons.
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85
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Kuemmel S, Holtschmidt J, Gerber B, Von der Assen A, Heil J, Thill M, Krug D, Schem C, Denkert C, Lubitz J, Blohmer JU, Reinisch M, Hötzeldt M, Seither F, Nekljudova V, Schwidde I, Uhrhan K, Von Minckwitz G, Rezai M, Mulowski J, Loibl S, Kuehn T. Prospective, Multicenter, Randomized Phase III Trial Evaluating the Impact of Lymphoscintigraphy as Part of Sentinel Node Biopsy in Early Breast Cancer: SenSzi (GBG80) Trial. J Clin Oncol 2019; 37:1490-1498. [DOI: 10.1200/jco.18.02092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current work was to clarify whether a preoperative lymphoscintigraphy (LSG) enhances staging accuracy of sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS In a prospective, multicenter, randomized phase III trial, patients with cN0 early breast cancer or extensive/high-grade ductal carcinoma in situ planned for standard radioactive-labeled colloid LSG with subsequent SLNB were randomly assigned 1:1 to receive SLNB either with knowledge of the LSG findings or without. As the false-negative rate of SLNB correlates with the number of resected sentinel lymph nodes (SLNs), our primary end point was the mean number of histologically detected SLNs per patient. One thousand one hundred two evaluable patients were necessary to demonstrate noninferiority of SLNB without LSG. Stratified one-sided 95% CI for the difference (without LSG − with LSG) in the mean number of histologically detected SLNs had to be greater than −0.27 (10% noninferiority margin). Stratification was performed according to tumor focality and trial site. Additional predefined secondary end points (rates of node-positive patients and of completion axillary lymph node dissection) were analyzed to rule out differences in the reliable detection of nodal metastases. RESULTS Between May 2014 and October 2015, 1,198 patients were randomly assigned in 23 German and Swiss breast centers. Modified intention-to-treat analysis (n = 1,163) showed a mean number of histologically detected SLNs of 2.21 with LSG and 2.26 without LSG (difference 0.05; stratified 95% CI, −0.18 to infinity), thus establishing noninferiority of omitting preoperative LSG. Secondary end points displayed no statistically significant differences. CONCLUSION We show that SLNB is equally effective irrespective of the surgeon’s knowledge of preoperative LSG results. SLNB without LSG will speed up the preoperative workflow and reduce cost.
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Affiliation(s)
| | | | | | | | - Joerg Heil
- University Hospital Heidelberg, Heidelberg, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - David Krug
- University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Schem
- University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- Mammazentrum Hamburg, Hamburg, Germany
| | | | | | | | - Mattea Reinisch
- Kliniken Essen-Mitte, Essen, Germany
- German Breast Group, Neu-Isenburg, Germany
| | | | | | | | - Ilka Schwidde
- Die Frauenärztinnen Mülheim an der Ruhr, Mülheim, Germany
| | - Klara Uhrhan
- Zentrum für Nuklearmedizin und Molekulare Bildgebung Essen, Essen, Germany
| | | | - Mahdi Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf, Germany
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Chrischilles EA, Riley D, Letuchy E, Koehler L, Neuner J, Jernigan C, Gryzlak B, Segal N, McDowell B, Smith B, Sugg SL, Armer JM, Lizarraga IM. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat 2019; 175:675-689. [PMID: 30852760 PMCID: PMC6534523 DOI: 10.1007/s10549-019-05184-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL. METHODS Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener. RESULTS Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction. CONCLUSIONS A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
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Affiliation(s)
- Elizabeth A Chrischilles
- University of Iowa College of Public Health, Iowa City, IA, USA.
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA.
- College of Public Health, University of Iowa, S424 CPHB, 145 N. Riverside Dr., Iowa City, IA, 52242-2007, USA.
| | - Danielle Riley
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Elena Letuchy
- University of Iowa College of Public Health, Iowa City, IA, USA
| | | | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brian Gryzlak
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Neil Segal
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley McDowell
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Brian Smith
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Sonia L Sugg
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Ingrid M Lizarraga
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
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87
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Verbelen H, Tjalma W, Meirte J, Gebruers N. Long-term morbidity after a negative sentinel node in breast cancer patients. Eur J Cancer Care (Engl) 2019; 28:e13077. [PMID: 31050088 DOI: 10.1111/ecc.13077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/26/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Morbidity after sentinel lymph node biopsy is often underestimated. The aim of this study was to inventory arm and shoulder complaints in sentinel node-negative breast cancer patients post-surgery after long-term follow-up. METHODS Sentinel node-negative breast cancer patients with at least 2 years of follow-up after surgery were included in this study. Self-reported arm and shoulder morbidities were assessed using a survey. Patients (n = 126) were asked if they ever developed complaints, if these complaints were still present and whether they were ever treated for these complaints. RESULTS After a mean follow-up of 55.5 months (range 25-86 months), the prevalence of the self-reported arm and shoulder complaints was 25.8% for pain, 12.0% for numbness, 6.4% for paraesthesias, 7.1% for lymphedema, 8.0% for axillary web syndrome, 26.2% for loss of strength and 19.5% for limitations in range of motion. About 38.1% of the patients were treated by a physical therapist concerning the experienced complaints after SLNB. CONCLUSION Up to 7 years post-surgery a considerable amount of sentinel node-negative patients still suffer from arm and shoulder complaints. These complaints affect the activities of daily living. Therefore, more research is needed regarding the value of early detection and treatment of these complaints.
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Affiliation(s)
- Hanne Verbelen
- Department of Rehabilitation Sciences and Physiotherapy REVAKI-MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic Antwerp, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Oedema Clinic, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jill Meirte
- Department of Rehabilitation Sciences and Physiotherapy REVAKI-MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy REVAKI-MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Oedema Clinic, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Tandra P, Kallam A, Krishnamurthy J. Identification and Management of Lymphedema in Patients With Breast Cancer. J Oncol Pract 2019; 15:255-262. [DOI: 10.1200/jop.18.00141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Breast cancer–related lymphedema (BCRL) is a potentially debilitating and often irreversible complication of breast cancer treatment. Risk of BCRL is proportional to the extent of axillary surgery and radiation. Other risk factors include obesity and infections. Given the 5-year survival rate of 90% and its potential impact on the quality of life of survivors of breast cancer, BCRL has become a significant financial burden on the health care system. Minimizing axillary surgery and radiation has been proven to reduce the risk of BCRL. Comprehensive multidisciplinary assessment at the time of initial diagnosis; early referral to physical therapy after surgery; and patient education regarding weight loss, skin, and nail care are cornerstones of the management of early-stage lymphedema. End-stage lymphedema may benefit from referral to a plastic surgeon specializing in lymphedema surgery. In this review, we attempt to review the incidence, risk factors, staging, prevention, and management of this complication of breast cancer treatment. We also describe our multidisciplinary approach for the prevention of this complication at the time of initial diagnosis.
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89
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Lorek A, Stojčev Z, Zarębski W, Kowalczyk M, Szyluk K. Analysis of Postoperative Complications After 303 Sentinel Lymph Node Identification Procedures Using the SentiMag® Method in Breast Cancer Patients. Med Sci Monit 2019; 25:3154-3160. [PMID: 31032820 PMCID: PMC6503749 DOI: 10.12659/msm.912758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The objective of this paper was to assess the complications following sentinel lymph node biopsy (SLNB) in breast cancer patients using the SentiMag® method. Material/Methods The study material consisted of 368 patients who had received the SLNB procedure in combination with wide local excision (WLE), simple mastectomy or who had an autonomous SLNB procedure in the period from January 2014 to September 2017. The final study group consisted of 303 patients who attended follow-up consultations. Results Sensory disturbances in the arm occurred in 12 patients (9.9%), including 3 patients (1.5%) after WLE and 9 patients (8.4%) after simple mastectomy. Restricted mobility in the upper limb was experienced by 9 patients (7.1%), including 3 patients (1.5%) after WLE and 6 patients (5.6%) after simple mastectomy. Minimal-degree lymphedema developed in 9 patients (7.5%), including 2 patients (1%) after WLE and 7 patients (6.5%) after simple mastectomy. A significant correlation was demonstrated between the incidence of these complications and the number of lymph nodes dissected. A significantly higher incidence of paresthesia and lymphedema was revealed for simple mastectomy with SLNB when compared to WLE with SLNB. Discolorations upon tracer administration were observed in 47 patients (15.5%). Conclusions SentiMag® is a safe sentinel lymph node identification method used in breast cancer and has a low risk of complications. The rate of complications increases together with the number of dissected lymph nodes and the extent of the surgery. The possibility of temporary discolorations on the skin should be communicated to the patients explicitly prior to surgery.
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Affiliation(s)
- Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, Katowice, Poland
| | - Zoran Stojčev
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, Katowice, Poland
| | - Wojciech Zarębski
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marek Kowalczyk
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, Katowice, Poland
| | - Karol Szyluk
- Department VI of Trauma and Orthopaedics, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland
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90
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Zhang X, Wang X, Zhang B, Yang S, Liu D. Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials. Acupunct Med 2019; 37:16-24. [PMID: 30845813 DOI: 10.1136/acupmed-2018-011668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Breast cancer-related lymphoedema (BCRL) is a common complication after breast cancer treatment. We investigated whether acupuncture could be used to manage limb oedema in women after breast cancer surgery. METHODS The Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and four Chinese databases were electronically searched for papers published through November 2017. Randomised controlled trials (RCTs) of acupuncture for BCRL were included. RESULTS In total, six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. Two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001). Two other studies used the effectiveness index to assess the arm and found a significant difference between the acupuncture and control groups (WMD 23.34, 95% CI 10.74 to 35.94; P<0.001). The fifth study used bioelectrical impedance spectroscopy to assess lymphoedema at several points on the arm before and after acupuncture; this study also reported a significant reduction in lymphoedema. The sixth study reported no significant difference in bioimpedance between the groups. CONCLUSIONS The present meta-analysis and systematic review suggests that acupuncture is effective at reducing BCRL in patients after breast cancer treatment.
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Affiliation(s)
- Xinyan Zhang
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
| | - Xiuli Wang
- 2 Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Bingyan Zhang
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
| | - Sa Yang
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
| | - Dongling Liu
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
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91
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Rupp J, Hadamitzky C, Henkenberens C, Christiansen H, Steinmann D, Bruns F. Frequency and risk factors for arm lymphedema after multimodal breast-conserving treatment of nodal positive breast Cancer - a long-term observation. Radiat Oncol 2019; 14:39. [PMID: 30845971 PMCID: PMC6407279 DOI: 10.1186/s13014-019-1243-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/25/2019] [Indexed: 01/11/2023] Open
Abstract
Background Arm-lymphedema is a major complication after breast cancer. Recent studies demonstrate the validity of predicting Breast Cancer Related Lymphedema (BCRL) by self-reports. We aimed to investigate the rate of BCRL and its risk factors in the long-term using self-reported symptoms. Methods Data was collected from 385 patients who underwent multimodal therapy for nodal positive breast cancer, including breast conserving surgery, axillary dissection, and local or locoregional radiotherapy. Two validated questionnaires were used for the survey of BCRL (i.e. LBCQ-D and SDBC-D). These were analysed collectively with retrospective data of our medical records. Results 23.5% (n = 43) suffered a permanent BCRL (stage II-III) after a median follow-up time of 10.1 years (4.9–15.9 years); further 11.5% (n = 23) reported at least one episode of reversible BCRL (Stage 0-I) during the follow-up time. 87.1% of the patients with lymphedema developed this condition in the first two years. Adjuvant chemotherapy was a significant risk factor for the appearance of BCRL (p = 0.001; 95%-CI 7.7–10.2). Conclusions Breast cancer survivors face a high risk of BCRL, particularly if axillary dissection was carried out. Almost 90% of BCRL occurred during the first two years after radiotherapy. Self-report of symptoms seems to be a suitable instrument of early detection of BCRL.
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Affiliation(s)
- Julia Rupp
- Department of Radiation Oncology, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany.,Department of Gynecology and Obstetrics, DIAKOVERE Hospital Henriettenstift, Hannover, Germany
| | - Catarina Hadamitzky
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.,Practice for Lympho-Vascular Diseases, Bahnhofstraße 12, Hannover, Germany
| | - Christoph Henkenberens
- Department of Radiation Oncology, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Hans Christiansen
- Department of Radiation Oncology, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Diana Steinmann
- Department of Radiation Oncology, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Frank Bruns
- Department of Radiation Oncology, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
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92
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Li J, Ma W, Jiang X, Cui C, Wang H, Chen J, Nie R, Wu Y, Li L. Development and Validation of Nomograms Predictive of Axillary Nodal Status to Guide Surgical Decision-Making in Early-Stage Breast Cancer. J Cancer 2019; 10:1263-1274. [PMID: 30854136 PMCID: PMC6400691 DOI: 10.7150/jca.32386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose: To develop and validate nomogram models using noninvasive imaging parameters with related clinical variables to predict the extent of axillary nodal involvement and stratify treatment options based on the essential cut-offs for axillary surgery according to the ACOSOG Z0011 criteria. Materials and Methods: From May 2007 to December 2017, 1799 patients who underwent preoperative breast and axillary magnetic resonance imaging (MRI) were retrospectively studied. Patients with data on axillary ultrasonography (AUS) were enrolled. The MRI images were interpreted according to Breast Imaging Reporting and Data system (BI-RADS). Using logistic regression analyses, nomograms were developed to visualize the associations between the predictors and each lymph node (LN) status endpoint. Predictive performance was assessed based on the area under the receiver operating characteristic curve (AUC). Bootstrap resampling was performed for internal validation. Goodness-of-fit of the models was evaluated using the Hosmer-Lemeshow test. Results: Of 397 early breast cancer patients, 200 (50.4%) had disease-free axilla, 119 (30.0%) had 1 or 2 positive LNs, and 78 (19.6%) had ≥3 positive LNs. Patient age, MRI features (mass margin, LN margin, presence/absence of LN hilum, and LN symmetry/asymmetry), and AUS descriptors (presence of cortical thickening or hilum) were identified as predictors of nodal disease. Nomograms with these predictors showed good calibration and discrimination; the AUC was 0.809 for negative axillary node (N0) vs. any LN metastasis, 0.749 for 1 or 2 involved nodes vs. N0, and 0.874 for ≥3 nodes vs. ≤2 metastatic nodes. The predictive ability of the 3 nomograms with additional pathological variables was significantly greater. Conclusion: The nomograms could predict the extent of ALN metastasis and facilitate decision-making preoperatively.
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Affiliation(s)
- Jiao Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Weimei Ma
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Xinhua Jiang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Chunyan Cui
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Hongli Wang
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jiewen Chen
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Runcong Nie
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Yaopan Wu
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Li Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
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93
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Karampelias V, Koukouras D, Tzorakoleftherakis E, Mariolis-Sapsakos T, Chrysikos D. Breast cancer section analysis correlates with sentinel lymph node biopsies: Precision and topographic anatomy. Breast Dis 2019; 38:1-5. [PMID: 30829609 DOI: 10.3233/bd-180355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The mainstream treatment of breast cancer is radical mastectomy accompanied with Axillary Lymph Node Dissection (ALND). Lately, more conservative methods accompanied by adjuvant radiotherapy have been gradually replacing radical modalities. The Sentinel Lymph Node Biopsy (SLNB) has been considered such a valuable alternative to surgery conservative approach. OBJECTIVE To assess the agreement between SLNB in breast cancer patients and pathology results following ALND and to provide correlation between the sentinel lymph nodes (SLN) anatomical topography and biopsy positivity according to SLNBs. METHODS Two hundred female breast cancer patients (31 to 83 years of age) underwent partial or simple mastectomy with or without subsequent ALND. All patients were randomized against selection criteria and underwent SLNB. RESULTS In a set of 200 patients, 96.3% presented identical results between SLNB and pathology. 36% of them were confirmed with positive SLN through both approaches. Regarding the SLN topographic anatomical position, 67.3% of samples were located in the front axillary position, 24.5% in the front thoracic position, whereas 6.1% was located in the central axillary position. CONCLUSIONS The correlation between the SLN topographic anatomical position and the pathology results, revealed that the majority of the SLN accumulates in the front axillary region. A larger patient population will statistically support this association.
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Affiliation(s)
| | | | | | - Theodoros Mariolis-Sapsakos
- Department of 1st Propaedeutic Surgery, University of Athens, Medical School, Hippokratio Hospital, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of 1st Propaedeutic Surgery, University of Athens, Medical School, Hippokratio Hospital, Athens, Greece
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94
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Evans A, Whelehan P, Warwick V, Purdie C, Pitsinis V, Brown D, Thompson A, Macaskill EJ. Percutaneous sentinel node removal using a vacuum-assisted needle biopsy in women with breast cancer: a feasibility and acceptability study. Clin Radiol 2018; 74:216-219. [PMID: 30528598 DOI: 10.1016/j.crad.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
AIMS To assess the feasibility and acceptability of large-gauge percutaneous removal of the axillary sentinel lymph node (SLN) using dual gamma probe and ultrasound guidance. MATERIALS AND METHODS Technetium nanocolloid was administered the day before surgery. On the day of surgery, potential SLNs were identified with gamma probe and ultrasound scanning. A 7 G vacuum-assisted biopsy (VAB) device was inserted percutaneously deep to the target node and the node(s) removed. The gamma probe was used to confirm removal of radiolabelled tissue. At surgery, any residual radiolabelled or blue nodes were removed. Morbidity was assessed via (1) a pain questionnaire immediately after the percutaneous procedure, (2) relevant items from the FACT B+4 questionnaire 7-10 days after surgery, and (3) case note review 1 month after surgery. RESULTS Twenty-two patients consented and 20 patients underwent the procedure. Radiolabelled nodal tissue was obtained in 18/20 (90%). The mean procedure time was 11 minutes. Four of 18 patients had metastatic disease identified in the VAB excision tissue with 100% sensitivity for axillary metastasis. At axillary surgery, additional intact SLN or fragments were found in 14 patients. No additional metastatic disease was found at surgery. One patient suffered a pneumothorax during instillation of local anaesthetic. The median pain score was 10/100 by visual analogue scale. Immediate post-procedure haematoma was common (14 of 20) and prolonged manual compression frequent. CONCLUSION VAB removal of sentinel nodes using dual scanning is feasible. Although preliminary sensitivity and specificity levels are encouraging, complications may discourage widespread implementation.
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Affiliation(s)
- A Evans
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - P Whelehan
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - V Warwick
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - C Purdie
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - V Pitsinis
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - D Brown
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - A Thompson
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - E J Macaskill
- breast unit, University of Dundee, Mailbox 4, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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95
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Henke G, Knauer M, Ribi K, Hayoz S, Gérard MA, Ruhstaller T, Zwahlen DR, Muenst S, Ackerknecht M, Hawle H, Fitzal F, Gnant M, Mátrai Z, Ballardini B, Gyr A, Kurzeder C, Weber WP. Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial. Trials 2018; 19:667. [PMID: 30514362 PMCID: PMC6278139 DOI: 10.1186/s13063-018-3021-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022] Open
Abstract
Background Complete lymph node removal through conventional axillary dissection (ALND) has been standard treatment for breast cancer patients for almost a century. In the 1990s, however, and in parallel with the advent of the sentinel lymph node (SLN) procedure, ALND came under increasing scrutiny due to its association with significant patient morbidity. Several studies have since provided evidence to suggest omission of ALND, often in favor of axillary radiation, in selected clinically node-negative, SLN-positive patients, thus supporting the current trend in clinical practice. Clinically node-positive patients, by contrast, continue to undergo ALND in many cases, if only for the lack of studies re-assessing the indication for ALND in these patients. Hence, there is a need for a clinical trial to evaluate the optimal treatment for clinically node-positive breast cancer patients in terms of surgery and radiotherapy. The TAXIS trial is designed to fill this gap by examining in particular the value of tailored axillary surgery (TAS), a new technique for selectively removing positive lymph nodes. Methods In this international, multicenter, phase-III, non-inferiority, randomized controlled trial (RCT), including 34 study sites from four different countries, we plan to randomize 1500 patients to either receive TAS followed by ALND and regional nodal irradiation excluding the dissected axilla, or receive TAS followed by regional nodal irradiation including the full axilla. All patients undergo adjuvant whole-breast irradiation after breast-conserving surgery and chest-wall irradiation after mastectomy. The main objective of the trial is to test the hypothesis that treatment with TAS and axillary radiotherapy is non-inferior to ALND in terms of disease-free survival of clinically node-positive breast cancer patients in the era of effective systemic therapy and extended regional nodal irradiation. The trial was activated on 31 July 2018 and the first patient was randomized on 7 August 2018. Discussion Designed to test the hypothesis that TAS is non-inferior to ALND in terms of curing patients and preventing recurrences, yet is significantly superior in reducing patient morbidity, this trial may establish a new worldwide treatment standard in breast cancer surgery. If found to be non-inferior to standard treatment, TAS may significantly contribute to reduce morbidity in breast cancer patients by avoiding surgical overtreatment. Trial registration ClinicalTrials.gov, ID: NCT03513614. Registered on 1 May 2018. www.kofam.ch, ID: NCT03513614. Registered on 17 June 2018. EudraCT No.: 2018–000372-14. Electronic supplementary material The online version of this article (10.1186/s13063-018-3021-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, Rorschacher Strasse 95, 9007, St.Gallen, Switzerland
| | - Michael Knauer
- Breast Center, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Karin Ribi
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland.,IBCSG Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland
| | - Stefanie Hayoz
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland
| | | | - Thomas Ruhstaller
- Breast Center, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Graubünden Cantonal Hospital, Loestrasse 170, 7000, Chur, Switzerland
| | - Simone Muenst
- Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Markus Ackerknecht
- Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Hanne Hawle
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Breast Health Center, Comprehensive Cancer Center Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Gnant
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Breast Health Center, Comprehensive Cancer Center Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Zoltan Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary
| | | | - Andreas Gyr
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
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96
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de Gregorio A, Widschwendter P, Albrecht S, de Gregorio N, Friedl TWP, Huober J, Janni W, Ebner FK. Axillary Surgery in Breast Cancer Patients Treated with Breast-Conserving Surgery at German Breast Cancer Centers Within the Last 14 Years - Comparison of a University Center and a Community Hospital. Geburtshilfe Frauenheilkd 2018; 78:1138-1145. [PMID: 30498281 PMCID: PMC6255741 DOI: 10.1055/a-0750-1880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/12/2022] Open
Abstract
Background
Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade.
Methods
Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U-BCC) and the community hospital Dachau (D-BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data.
Results
The average annual rate of sentinel node biopsy (SNB) was 85.5% and 87.2% in Ulm and Dachau, respectively. SNB was performed more precisely at the U-BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (r
s
= − 0.82; p < 0.001) and Dachau (r
s
= − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U-BCC (r
s
= − 0.76; p = 0.002) while it remained stable in D-BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1% preZ0011 and 14.4% postZ0011; p < 0.001) in Ulm.
Conclusion
Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U-BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D-BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.
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Affiliation(s)
- Amelie de Gregorio
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Peter Widschwendter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Susanne Albrecht
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | | | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Florian K Ebner
- Department of Gynecology and Obstetrics, Helios Hospital Amper, Dachau, Germany
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97
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Prevalence of shoulder morbidity after treatment for breast Cancer in South Africa. Support Care Cancer 2018; 27:2591-2598. [PMID: 30456720 DOI: 10.1007/s00520-018-4540-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death among women, representing a considerable public health burden in South Africa and other low-middle income countries. Short- and long-term complications of these treatments include shoulder morbidities such as pain, decreased range of motion, tightness, weakness, pain, numbness and lymphoedema and may be present for up to 6 years post-treatment. An understanding of baseline demographic and clinical risk factors can guide rehabilitation and management strategies for high-risk patients. The aims of this study were to quantify the burden of shoulder pain and disability in a tertiary academic hospital in Cape Town, South Africa, and identify potential risk factors for the development of shoulder morbidity. METHODS This study was a cross-sectional analysis of the prevalence of shoulder pain and dysfunction in women attending their post-treatment annual follow-up visit for unilateral breast carcinoma. RESULTS Three in four patients reported a presence of any pain or disability while only 9% experienced severe pain and disability. Multivariable ordinal logistic regression analysis identified race, side, axillary surgery, chemotherapy and age as significant predictors of pain and chemotherapy a significant predictor of disability. CONCLUSION The substantial burden of shoulder morbidity in this population represents a significant public health burden. The use of identified clinical and demographic characteristics may guide in the development of survivorship programmes incorporating surveillance and management of these high-risk patients.
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98
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Sentinel lymph node biopsy mapped with methylene blue dye alone in patients with breast cancer: A systematic review and meta-analysis. PLoS One 2018; 13:e0204364. [PMID: 30235340 PMCID: PMC6147575 DOI: 10.1371/journal.pone.0204364] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background Methylene blue dye is easy to obtain in developing countries and can be used in sentinel lymph node mapping for breast cancer. However, the accuracy of methylene blue alone for sentinel lymph node mapping in breast cancer has not been well defined. In this study, we collected data to assess the feasibility and accuracy of sentinel lymph node biopsy mapped with methylene blue alone in patients with breast cancer. Methods We searched the PubMed, EMBASE, and Cochrane Library databases from January 1, 1993, to March 31, 2018. Selected studies had to have a defined group of patients with breast cancer in which MBD alone was used as the mapping technique for SNB. Results 18 studies were included in this study. The combined identification rate was 91% [95% confidence interval (CI): 88%-94%, I2 = 68.3%], and the false negative rate was 13% (95% CI: 9%-18%, I2 = 36.7%). The pooled sensitivity, negative predictive value, and accuracy rate were 87% (95% CI: 82%-91%, I2 = 37.5%), 91% (95% CI: 87%-93%, I2 = 32.4%) and 94% (95% CI: 92%-96%, I2 = 29%), respectively. Conclusions This meta-analysis found that mapping sentinel lymph node locations with methylene blue dye alone results in an acceptable identification rate but an excessive false negative rate according to the American Society of Breast Surgeons’ recommendations. Caution is warranted when using methylene blue dye alone as the mapping method for sentinel lymph node biopsy.
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99
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Castaneda CA, Rebaza P, Castillo M, Gomez HL, De La Cruz M, Calderon G, Dunstan J, Cotrina JM, Abugattas J, Vidaurre T. Critical review of axillary recurrence in early breast cancer. Crit Rev Oncol Hematol 2018; 129:146-152. [PMID: 30097233 DOI: 10.1016/j.critrevonc.2018.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/20/2018] [Accepted: 06/18/2018] [Indexed: 01/07/2023] Open
Abstract
Around 2% of early breast cancer cases treated with axillary lymph node dissection (ALND) underwent axillary recurrence (AR) and it has a deleterious effect in prognosis. Different scenarios have incorporated Sentinel Lymph Node (SLN) Biopsy (SLNB) instead of ALND as part of the standard treatment and more effective systemic treatment has also been incorporated in routine management after first curative surgery and after regional recurrence. However, there is concern about the effect of SLNB alone over AR risk and how to predict and treat AR. SLN biopsy (SLNB) has been largely accepted as a valid option for SLN-negative cases, and recent prospective studies have demonstrated that it is also safe for some SLN-positive cases and both scenarios carry low AR rates. Different studies have identified clinicopathological factors related to aggressiveness as well as high-risk molecular signatures can predict the development of locoregional recurrence. Other publications have evaluated factors affecting prognosis after AR and find that time between initial treatment and AR as well as tumor aggressive behavior influence patient survival. Retrospective and prospective studies indicate that treatment of AR should include local and systemic treatment for a limited time.
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Affiliation(s)
- Carlos A Castaneda
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Research Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru.
| | - Pamela Rebaza
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Miluska Castillo
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Henry L Gomez
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Miguel De La Cruz
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Gabriela Calderon
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Jorge Dunstan
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Jose Manuel Cotrina
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Julio Abugattas
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Tatiana Vidaurre
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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Hoffner M, Ohlin K, Svensson B, Manjer J, Hansson E, Troëng T, Brorson H. Liposuction Gives Complete Reduction of Arm Lymphedema following Breast Cancer Treatment-A 5-year Prospective Study in 105 Patients without Recurrence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1912. [PMID: 30324078 PMCID: PMC6181505 DOI: 10.1097/gox.0000000000001912] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Arm lymphedema is a well-recognized complication after breast cancer surgery that negatively impacts patients' quality of life, both physiologically and psychologically. Lymph stasis and inflammation result in excess formation of adipose tissue, which makes removal of the deposited subcutaneous fat necessary to eliminate the excess volume. Liposuction, combined with postoperative controlled compression therapy (CCT), is the only treatment that gives complete reduction of the excess volume. The aim of this study was to evaluate the 5-year results after liposuction in combination with CCT. METHODS Patients consecutively operated on between 1993 and 2012 were identified from the lymphedema registry, comprising all patients with nonpitting lymphedema treated with liposuction and CCT in our department. Standardized forms were used to collect pre-, peri-, and postoperative data. RESULTS One hundred five women with nonpitting edema were treated. The mean interval between the breast cancer operation and lymphedema start was 2.9 ± 5.0 years, the mean duration of lymphedema was 10 ± 7.4 years, and the preoperative mean excess volume was 1,573 ± 645 ml. The mean volume aspirated was 1,831 ± 599 ml. Postoperative mean reduction 5 years postoperatively was 117% ± 26% as compared with the healthy arm. CONCLUSION Liposuction is an effective method for the treatment of chronic, nonpitting, arm lymphedema resistant to conservative treatment. The volume reduction remains complete after 5 years.
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Affiliation(s)
- Mattias Hoffner
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Surgery, Blekinge Hospital, Karlskrona, Sweden
| | - Karin Ohlin
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Barbro Svensson
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jonas Manjer
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Emma Hansson
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Troëng
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Brorson
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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