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Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 403] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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153
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Som D, Tak M, Setia M, Patil A, Sengupta A, Chilakapati CMK, Srivastava A, Parmar V, Nair N, Sarin R, Badwe R. A grid matrix-based Raman spectroscopic method to characterize different cell milieu in biopsied axillary sentinel lymph nodes of breast cancer patients. Lasers Med Sci 2015; 31:95-111. [DOI: 10.1007/s10103-015-1830-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
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154
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Di Filippo F, Giannarelli D, Bouteille C, Bernet L, Cano R, Cunnick G, Sapino A. Elaboration of a nomogram to predict non sentinel node status in breast cancer patients with positive sentinel node, intra-operatively assessed with one step nucleic acid amplification method. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:136. [PMID: 26538019 PMCID: PMC4632276 DOI: 10.1186/s13046-015-0246-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/19/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUNDS Tumor-positive sentinel node(SLN) biopsy results in a risk of nonsentinel node metastases in case of micro and macro metastases ranging from 20 to 50 %, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. Thus, the development of a mathematical model for predicting patient-specific risk of non sentinel node(NSLN) metastases is strongly warranted. METHODS The following parameters were recorded: CLINICAL hospital, age, medical record number Bio-pathological: tumor (T) size, grading (G), multifocality, histological type, LVI, ER-PR status, HER-2, ki67, molecular classification (luminal A, luminal B, HER2 like, triple negative) Sentinel and nonsentinel lymph node related: number of removed SLNs, number of positive and negative SLNs, copy number of positive sentinel nodes, ratio: number of positive SLNs to number of removed SLNs, number of removed and number of positive nodes after ALND. A total of 2460 patients have been included in the database. All the patients have been provided by the authors of this paper. RESULTS Multivariate logistic regression analysis demonstrated that only the number of a CK19 mRNA copies (p < 0.0001), T size (p < 0.0001) and LVI (p < 0.0001) were associated with NSN metastases. The discrimination of the model, quantified with the area under the receiver operating characteristics curve, was 0.71 (95 %, C.I. 0.69-0.73), thus confirming a good level of reliability. CONCLUSIONS The nomogram may be employed by the surgeon as a decision making tool on whether to perform an intraoperative axillary lymph node dissection on breast cancer patients with SLN positive. The large population employed and the standardized method of measuring the value of CK19 mRNA copies are appropiate prerequisites for a reliable nomogram.
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Affiliation(s)
- F Di Filippo
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00134, Rome, Italy.
| | - D Giannarelli
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00134, Rome, Italy.
| | | | - L Bernet
- Hospital de Xàtiva, Valencia, Spain.
| | - R Cano
- Hospital de Alzira, Valencia, Spain.
| | - G Cunnick
- Wycombe General Hospital, Buckinghamshire, England.
| | - A Sapino
- Istituto di Candiolo - IRCCS, Fpo-Ircc., Turin, Italy. .,Dept of Medical Sciences - University of Turin, Turin, Italy.
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155
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Fu MR, Axelrod D, Cleland CM, Qiu Z, Guth AA, Kleinman R, Scagliola J, Haber J. Symptom report in detecting breast cancer-related lymphedema. BREAST CANCER-TARGETS AND THERAPY 2015; 7:345-52. [PMID: 26527899 PMCID: PMC4621182 DOI: 10.2147/bctt.s87854] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.
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Affiliation(s)
- Mei R Fu
- College of Nursing, New York University, New York, NY, USA
| | - Deborah Axelrod
- Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY, USA
| | | | - Zeyuan Qiu
- Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ, USA
| | - Amber A Guth
- Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY, USA
| | - Robin Kleinman
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Joan Scagliola
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Judith Haber
- College of Nursing, New York University, New York, NY, USA
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156
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Ghilli M, Carretta E, Di Filippo F, Battaglia C, Fustaino L, Galanou I, Di Filippo S, Rucci P, Fantini MP, Roncella M. The superparamagnetic iron oxide tracer: a valid alternative in sentinel node biopsy for breast cancer treatment. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26365441 DOI: 10.1111/ecc.12385] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 02/06/2023]
Abstract
The European Union has determined that from 2016 breast cancer patients should be treated in Specialist Breast Units that achieve the minimum standards for the mandatory quality indicators as defined by Eusoma. The existing standard for axillary lymph node staging in breast cancer is sentinel node biopsy (SNB), performed using Technetium-sulphur colloid (99m Tc) alone or with blue dye. The major limits of radioisotope consist in the problems linked to radioactivity, in the shortage of tracer and nuclear medicine units. Among existing alternative tracers, SentiMag® , which uses superparamagnetic iron oxide particles, can represent a valid option for SNB. We conducted a paired, prospective, multicentre study to evaluate the non-inferiority of SentiMag® vs. 99m Tc. The primary end point was the detection rate (DR) per patient. The study sample consists of 193 women affected by breast carcinoma with negative axillary assessment. The concordance rate per patients between 99m Tc and SentiMag® was 97.9%. The DR per patient was 99.0% for 99m Tc and 97.9% for SentiMag® . SentiMag® appears to be non-inferior to the radiotracer and safe. While 99m Tc remains the standard, SentiMag® DR appears adequate after a minimum learning curve. In health care settings where nuclear medicine units are not available, SentiMag/Sienna+® allows effective treatment of breast cancer patients.
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Affiliation(s)
- M Ghilli
- Breast Cancer Center, University Hospital of Pisa, Via Roma, Pisa, Italy
| | - E Carretta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - F Di Filippo
- Department of General and Breast Surgery, Regina Elena National Tumour Institute, Roma, Italy
| | - C Battaglia
- Breast Surgery, Sanremo Civic Hospital, Sanremo, Italy
| | - L Fustaino
- Breast Cancer Center, University Hospital of Pisa, Via Roma, Pisa, Italy
| | - I Galanou
- Department of General and Breast Surgery, Regina Elena National Tumour Institute, Roma, Italy
| | - S Di Filippo
- Department of General and Breast Surgery, Regina Elena National Tumour Institute, Roma, Italy
| | - P Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - M P Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - M Roncella
- Breast Cancer Center, University Hospital of Pisa, Via Roma, Pisa, Italy
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157
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Kondo T, Hayashi N, Ohde S, Suzuki K, Yoshida A, Yagata H, Niikura N, Iwamoto T, Kida K, Murai M, Takahashi Y, Tsunoda H, Nakamura S, Yamauchi H. A model to predict upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ of the breast. J Surg Oncol 2015; 112:476-80. [DOI: 10.1002/jso.24037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/22/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Takafumi Kondo
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Naoki Hayashi
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Sachiko Ohde
- St. Luke's Life Science Institute Center for Clinical Epidemiology; Tokyo Japan
| | - Koyu Suzuki
- Departments of Pathology; St. Luke's International Hospital; Tokyo Japan
| | - Atsushi Yoshida
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Hiroshi Yagata
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Naoki Niikura
- Departments of Breast and Endocrine Surgery; Tokai University School of Medicine; Kanagawa Japan
| | - Takayuki Iwamoto
- Department of Gastroenterological Surgery and Surgical Oncology; Okayama University; Okayama Japan
| | - Kumiko Kida
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Michiko Murai
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Yuko Takahashi
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Hiroko Tsunoda
- Departments of Radiology; St. Luke's International Hospital; Tokyo Japan
| | - Seigo Nakamura
- Department of Surgery; Division of Breast Surgical Oncology; Showa University School of Medicine; Tokyo Japan
| | - Hideko Yamauchi
- Departments of Breast Surgical Oncology; St. Luke's International Hospital; Tokyo Japan
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158
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Abstract
OBJECTIVES To report our experience in sentinel lymph node biopsy (SLNB) in early breast cancer. METHODS This is a retrospective study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2005 and December 2014. There were 120 patients who underwent SLNB with frozen section examination. Data collected included the characteristics of patients, index tumor, and sentinel node (SN), SLNB results, axillary recurrence rate and SLNB morbidity. RESULTS There were 120 patients who had 123 cancers. Sentinel node was identified in 117 patients having 120 tumors (97.6% success rate). No SN was found intraoperatively in 3 patients. Frozen section results showed that 95 patients were SN negative, those patients had no immediate axillary lymph node dissection (ALND), whereas 25 patients were SN positive and subsequently had immediate ALND. Upon further examination of the 95 negative SN's by hematoxylin and eosin (H and E) and immunohistochemical staining for doubtful H and E cases, 10 turned out to have micrometastases (6 had delayed ALND and 4 had no further axillary surgery). Median follow up of patients was 35.5 months and the mean was 38.8 months. There was one axillary recurrence observed in the SN negative group. The morbidity of SLNB was minimal. CONCLUSION The obtainable results from our local experience in SLNB in breast cancer, concur with that seen in published similar literature in particular the axillary failure rate. Sentinel lymph node biopsy resulted in minimal morbidity.
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Affiliation(s)
- Abdulaziz A Alsaif
- Department of Surgery, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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159
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Aydoğan F, Arıkan AE, Aytaç E, Velidedeoğlu M, Yılmaz MH, Sager MS, Çelik V, Uras C. Sentinel lymph node biopsy under fluorescent indocyanin green guidance: Initial experience. ULUSAL CERRAHI DERGISI 2015; 32:50-3. [PMID: 26985159 DOI: 10.5152/ucd.2015.2832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/26/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Sentinel lymph node biopsy can be applied by using either blue dye or radionuclide method or both in breast cancer. Fluorescent imaging with indocyanine green is a new defined method. This study evaluates the applicability of sentinel lymph node biopsy via fluorescent indocyanine green. MATERIAL AND METHODS IC-VIEW (Pulsion Medical Systems AG, Munich, Germany) infrared visualization system was used for imaging. Two mL of indocyanine green was injected to visualize sentinel lymph nodes. After injection, subcutaneous lymphatics were traced and sentinel lymph nodes were found with simultaneous imaging. Sentinel lymph nodes were excised under fluorescent light guidance, and excised lymph nodes were examined histopathologically. Patients with sentinel lymph node metastases underwent axillary dissection. RESULTS Four patients with sentinel lymph node biopsy due to breast cancer were included in the study. Sentinel lymph nodes were visualized with indocyanine green in all patients. The median number of excised sentinel lymph node was 2 (2-3). Two patients with lymph node metastasis underwent axillary dissection. No metastasis was detected in lymph nodes other than the sentinel nodes in patients with axillary dissection. There was no complication during and after the operation related to the method. CONCLUSION According to our limited experience, sentinel lymph node biopsy under fluorescent indocyanine green guidance, which has an advantage of simultaneous visualization, is technically feasible.
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Affiliation(s)
- Fatih Aydoğan
- Department of General Surgery, Breast Diseases Service, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
| | - Akif Enes Arıkan
- Department of General Surgery, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
| | - Erman Aytaç
- Department of General Surgery, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
| | - Mehmet Velidedeoğlu
- Department of General Surgery, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
| | - Mehmet Halit Yılmaz
- Department of Radiology, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
| | - Muhammet Sait Sager
- Department of Nuclear Medicine, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
| | - Varol Çelik
- Department of General Surgery, Breast Diseases Service, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
| | - Cihan Uras
- Department of General Surgery, Breast Diseases Service, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
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160
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Navigation surgery for intraoperative sentinel lymph node detection using Indocyanine green (ICG) fluorescence real-time imaging in breast cancer. Breast Cancer Res Treat 2015; 153:337-44. [DOI: 10.1007/s10549-015-3542-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/10/2015] [Indexed: 12/31/2022]
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161
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Feldman S, Bansil H, Ascherman J, Grant R, Borden B, Henderson P, Ojo A, Taback B, Chen M, Ananthakrishnan P, Vaz A, Balci F, Divgi CR, Leung D, Rohde C. Single Institution Experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the Primary Prevention of Lymphedema. Ann Surg Oncol 2015. [DOI: 10.1245/s10434-015-4721-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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162
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Rahman M, Mohammed S. Breast cancer metastasis and the lymphatic system. Oncol Lett 2015; 10:1233-1239. [PMID: 26622656 DOI: 10.3892/ol.2015.3486] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/23/2015] [Indexed: 01/07/2023] Open
Abstract
Breast cancer remains the leading cause of cancer mortality worldwide, despite a significant decline in death rates due to early detection. The majority of cancer mortalities are due to the metastasis of tumor cells to other organs. Metastasis or tumor cell dissemination occurs via the hematogenous and lymphatic systems. For many carcinomas, the dissemination of tumor cells via lymphatic drainage of the tumor is the most common metastatic route. Such lymphatic drainage collects at the regional lymph nodes and the dissection and pathological examination of these nodes for lodged cancer cells is the gold standard procedure to detect metastasis. The present report provides an overview of the lymphatic system and its clinical significance as a prognostic factor, in addition to the interactions between the primary tumor and its microenvironment, and the influence of genomic subtypes on the resulting organ-specific pattern of tumor cell dissemination. It also examines the seemingly protracted asymptomatic period, during which the disseminated cells remain dormant, leading to the manifestation of metastasis decades after the successful treatment of the primary tumor.
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Affiliation(s)
- Munazzah Rahman
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA
| | - Sulma Mohammed
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA ; Purdue Center for Cancer Research, West Lafayette, IN 47907, USA ; Bindley Bioscience, Purdue Discovery Park, West Lafayette, IN 47907, USA
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163
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Hu Y, Shah P, Stukenborg GJ, Slingluff CL. Utility of sentinel lymph node biopsy for solitary dermal melanomas. J Surg Oncol 2015; 111:800-7. [PMID: 25712273 PMCID: PMC4436976 DOI: 10.1002/jso.23890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/02/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Solitary dermal melanoma (SDM) is melanoma confined to subcutaneous and/or dermal layers in the absence of a known primary cutaneous lesion. We hypothesized that sentinel node biopsy is an effective staging strategy for this rare disease. METHODS A Markov decision model was constructed to represent two management strategies for SDM: wide local excision followed by observation, and wide local excision followed by sentinel node biopsy. Utilities, likelihood of positive sentinel node biopsy, and cancer progression rates during a five year time horizon were assigned based on institutional data and a review of existing literature. Estimated costs were derived using Medicare reimbursements. RESULTS Excision followed by sentinel node biopsy provides greater utility, yielding 3.85 discounted quality-adjusted life years (dQALY) compared to 3.66 for excision alone. The incremental cost-effectiveness ratio for sentinel node biopsy is $19,102 per dQALY. Sensitivity analyzes demonstrated that observation is more cost-effective if greater than 23% of sentinel node biopsies are positive (16% reported), or if 5-year survival for observed patients is greater than 76% (69% reported). CONCLUSIONS Based on existing clinical evidence, sentinel node biopsy yields greater utility than excision alone and is cost-effective for patients presenting with solitary dermal melanoma.
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Affiliation(s)
- Yinin Hu
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Puja Shah
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - George J. Stukenborg
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Craig L. Slingluff
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
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164
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Houvenaeghel G, Cohen M, Jauffret-Fara C, Bannier M, Chéreau-Ewald É, Rua Ribeiro S, Lambaudie É. [Regional treatment for axillary lymph node micrometastases of breast cancer]. Cancer Radiother 2015; 19:276-83. [PMID: 26006761 DOI: 10.1016/j.canrad.2015.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/25/2015] [Indexed: 12/26/2022]
Abstract
In patients with breast cancer, axillary lymph node micrometastasis detection has been more frequent with a better definition since the introduction of the sentinel node procedure. In this review, we focus on pN1mi micrometastasis and review the literature in order to determine factors involved in making the decision of a regional treatment.
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Affiliation(s)
- G Houvenaeghel
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), BP 30059, 13009 Marseille cedex, France; Aix Marseille université, jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France.
| | - M Cohen
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), BP 30059, 13009 Marseille cedex, France; Aix Marseille université, jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - C Jauffret-Fara
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), BP 30059, 13009 Marseille cedex, France; Aix Marseille université, jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - M Bannier
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), BP 30059, 13009 Marseille cedex, France; Aix Marseille université, jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - É Chéreau-Ewald
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), BP 30059, 13009 Marseille cedex, France; Aix Marseille université, jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - S Rua Ribeiro
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), BP 30059, 13009 Marseille cedex, France; Aix Marseille université, jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - É Lambaudie
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), BP 30059, 13009 Marseille cedex, France; Aix Marseille université, jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
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Houvenaeghel G, Cohen M, Jauffret Fara C, Chéreau Ewald E, Bannier M, Rua Ribeiro S, Buttarelli M, Lambaudie E. [Sentinel lymph node-multicentric and multifocal tumors: a valid technique?]. ACTA ACUST UNITED AC 2015; 43:443-8. [PMID: 25986400 DOI: 10.1016/j.gyobfe.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/16/2015] [Indexed: 12/22/2022]
Abstract
Sentinel node biopsy without complementary axillary lymph node dissection was validated for T1-2 N0 unifocal breast cancer without previous treatment since several years. In the situation of multifocal multicentric breast tumors, this procedure was considered as a contraindication. The aim of this work was to analyse literature results to determine if sentinel lymph node biopsy can be considered as a valid option without complementary axillary lymph node dissection for negative sentinel lymph node.
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Affiliation(s)
- G Houvenaeghel
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - M Cohen
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - C Jauffret Fara
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - E Chéreau Ewald
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - M Bannier
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - S Rua Ribeiro
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - M Buttarelli
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - E Lambaudie
- Institut Paoli-Calmettes et CRCM, Aix-Marseille université, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
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166
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Harder H, Langridge C, Solis-Trapala I, Zammit C, Grant M, Rees D, Burkinshaw L, Jenkins V. Post-operative exercises after breast cancer surgery: Results of a RCT evaluating standard care versus standard care plus additional yoga exercise. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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167
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Moncayo VM, Aarsvold JN, Alazraki NP. Lymphoscintigraphy and Sentinel Nodes. J Nucl Med 2015; 56:901-7. [DOI: 10.2967/jnumed.114.141432] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/23/2015] [Indexed: 12/29/2022] Open
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Janni W, Kühn T, Schwentner L, Kreienberg R, Fehm T, Wöckel A. Sentinel node biopsy and axillary dissection in breast cancer: the evidence and its limits. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:244-9. [PMID: 24766712 DOI: 10.3238/arztebl.2014.0244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increasing evidence suggests that surgical removal of the axillary lymph nodes (axillary dissection, ALD) in early breast cancer yields no advantage in terms of either overall or disease-free survival, even in women with involvement of sentinel nodes. The optimal role of sentinel node biopsy (SNB) in neo-adjuvant therapy is currently under discussion. METHOD This review is based on a selective search in the Medline, EMBASE, Cochrane Library, and G.I.N. (Guidelines International Network) databases for relevant articles on the role of axillary dissection in node-positive breast cancer and the role of SNB in neo-adjuvant chemotherapy. RESULTS Although no single study provides adequate evidence, the available literature increasingly casts doubt on the putative therapeutic benefit of ALD as part of a multimodal treatment strategy for breast cancer. It is currently unclear what group of patients, if any, might benefit from ALD. Nor is any definitive judgment possible, from the available evidence, regarding the optimal role of SNB in neo-adjuvant therapy. The most recent evidence indicates that SNB after neo-adjuvant chemotherapy in ycN0 patients who had suspect lymph nodes before systemic treatment has a low rate of sensitivity. CONCLUSION Current evidence indicates that the radicality of lymph node surgery in the treatment of breast cancer can be reduced, even if the node status is positive.
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Affiliation(s)
- Wolfgang Janni
- Department of Obstetrics and Gynecology, Ulm University Medical Center, Department of Gynecology and Obstetrics, Hospital Esslingen, Department of Gynecology and Obstetrics, Düsseldorf University Hospital
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170
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Controversial indications for sentinel lymph node biopsy in breast cancer patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:405949. [PMID: 25821800 PMCID: PMC4363495 DOI: 10.1155/2015/405949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node biopsy (SLNB) emerged in the 1990s as a new technique in the surgical management of the axilla for patients with early breast cancer, resulting in lower complication rates and better quality of life than axillary lymph node dissection (ALND). Today SLNB is firmly established in the armamentarium of clinicians treating breast cancer, but several questions remain. The goal of this paper is to review recent work addressing 4 questions that have been the subject of debate in the use of SLNB in the past few years: (a) What is the implication of finding micrometastases in the sentinel nodes? (b) Is ALND necessary in all patients who have a positive SLNB? (c) How accurate is SLNB after neoadjuvant therapy? (d) Can SLNB be used to stage the axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery?
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171
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Free lymph node flap transfer and laser-assisted liposuction: a combined technique for the treatment of moderate upper limb lymphedema. Lasers Med Sci 2015; 30:1377-85. [DOI: 10.1007/s10103-015-1736-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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Joyce DP, Lowery AJ, McGrath-Soo LB, Downey E, Kelly L, O’Donoghue GT, Barry M, Hill ADK. Management of the axilla: has Z0011 had an impact? Ir J Med Sci 2015; 185:145-9. [DOI: 10.1007/s11845-015-1246-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
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Sackey H, Johansson H, Sandelin K, Liljegren G, MacLean G, Frisell J, Brandberg Y. Self-perceived, but not objective lymphoedema is associated with decreased long-term health-related quality of life after breast cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:577-84. [PMID: 25659877 DOI: 10.1016/j.ejso.2014.12.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 12/12/2014] [Accepted: 12/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The primary aim was to compare long-term health-related quality of life (HRQoL) in patients undergoing sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND), with or without axillary metastases. Secondary aims were to a) investigate agreement between objectively measured and self-reported lymphoedema and b) compare, with respect to HRQoL, women with objective arm lymphoedema without subjective ratings and those with no objective but subjective ratings of arm lymphoedema. METHODS The three study groups were defined by axillary surgery: 1) SLNB alone (N = 140), 2) ALND in patients without axillary metastases (N = 125) and 3) ALND in patients with axillary metastases (N = 155). Preoperatively, one and three years postoperatively arm volume was measured and questionnaires regarding self-perceived symptoms of arm lymphoedema and HRQoL were completed (The Swedish Short Form-36 Health Survey, SF-36). RESULTS Out of the original 516 who had axillary surgery, 420 (81%) completed the study. There were no statistically significant differences in HRQoL between the three study groups. No statistically significant agreement was found between self-perceived and objectively measured arm lymphoedema. Women without self-perceived arm lymphoedema, regardless of objective arm lymphoedema or not, scored higher on all eight SF-36 domains than those who reported self-perceived arm lymphoedema. CONCLUSION Women reporting self-perceived arm lymphoedema, regardless of objective lymphoedema or not, have a decreased long-term health-related quality of life. This indicates that more attention should be given to the subjective reports of symptom in order to better help these women.
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Affiliation(s)
- H Sackey
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - H Johansson
- Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - K Sandelin
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Göran Liljegren
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - G MacLean
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - J Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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174
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Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Health Related Quality of Life. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533010-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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175
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Chu QD, Kim RH. Early Breast Cancers. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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176
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Leveraging comparative effectiveness research to improve the quality of multidisciplinary care for breast cancer patients. Cancer Treat Res 2015; 164:15-30. [PMID: 25677016 DOI: 10.1007/978-3-319-12553-4_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer among women. To date, the use of efficacy randomized controlled trials (RCTs) in breast cancer have resulted in dramatic improvements in oncologic outcomes for this disease. However, not every question pertinent to breast cancer is amenable to such efficacy trials. This chapter will discuss some of the unique aspects of breast cancer that make efficacy RCTs challenging and/or impractical, how comparative effectiveness research can be used to address these issues, and identify several key questions which would benefit from ongoing comparative effectiveness research.
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McCann GA, Cohn DE, Jewell EL, Havrilesky LJ. Lymphatic mapping and sentinel lymph node dissection compared to complete lymphadenectomy in the management of early-stage vulvar cancer: A cost-utility analysis. Gynecol Oncol 2014; 136:300-4. [PMID: 25478927 DOI: 10.1016/j.ygyno.2014.11.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Sentinel lymph node biopsy (SLNB) is an acceptable method of evaluating groin lymph nodes in women with vulvar cancer. The purpose of this study is to assess the cost and effectiveness of SLNB compared to universal inguinofemoral lymphadenectomy (LND) for vulvar cancer. METHODS A modified Markov decision model was generated to compare two surgical approaches for newly diagnosed, early-stage vulvar cancer: (1) radical vulvectomy+LND and (2) radical vulvectomy+SLNB. Published data were used to estimate survival outcomes, probability of positive lymph nodes and lymphedema. Costs of surgery and radiation and lymphedema therapies were estimated from published data. Lymphedema's effect on quality of life (QOL) was extrapolated from other disease sites and assigned a utility score of 0.84. Multiple sensitivity analyses were performed. RESULTS SLNB was less costly ($13,449 versus $14,261) and more effective (4.16 quality-adjusted life years (QALYs) versus 4.00 QALYs) than LND. The model was sensitive to the impact of lymphedema on QOL. Unless the impact of lymphedema on QOL was minimal (utility score>0.975) SLNB dominated LND. Variations in the rate of positive SLNB and probability of lymphedema over clinically reasonable ranges did not alter the results. CONCLUSIONS SLNB is a cost-effective strategy for the treatment of newly diagnosed vulvar cancer, mainly due to the impact of lymphedema on QOL.
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Affiliation(s)
- Georgia A McCann
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Texas Health Science Center at San Antonio, United States.
| | - David E Cohn
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solve Research Institute, United States
| | - Elizabeth L Jewell
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, United States
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University, United States
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Soares EWS, Nagai HM, Bredt LC, da Cunha AD, Andrade RJ, Soares GVS. Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients. World J Surg Oncol 2014. [DOI: https:/doi.org/10.1186/1477-7819-12-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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179
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Lymphedema following breast cancer treatment and impact on quality of life: A review. Crit Rev Oncol Hematol 2014; 92:227-34. [DOI: 10.1016/j.critrevonc.2014.06.004] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/27/2014] [Accepted: 06/25/2014] [Indexed: 12/19/2022] Open
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180
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Fallowfield L, Jenkins V. Psychosocial/survivorship issues in breast cancer: are we doing better? J Natl Cancer Inst 2014; 107:335. [PMID: 25432407 DOI: 10.1093/jnci/dju335] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Modern breast cancer treatment offers many women greater prospects of cure or lengthier, good quality survival than was possible in the past. Advances include improved diagnostic and staging procedures, sophisticated onco-plastic surgery, enhanced radiotherapy techniques, and targeted systemic therapies. Much more attention has also been paid to cancer care delivery and access to specialist nurses, counsellors, support groups, and services provided by breast cancer charities. However, there are some concerns that these considerable improvements in treatment delivery and clinical outcomes have not led to similar benefits in the psychosocial, functional, and sexual well-being of women. The impact that non-life threatening, long-term iatrogenic harms of otherwise efficacious anticancer treatments has on patients is often overlooked; this is in part because of the emphasis given to physician-reported safety data in trials and the general exclusion of patient-reported outcomes (PROs). A failure to utilise reliable PRO measures has meant that some problems are underreported, which consequently has hampered much-needed research into ameliorative interventions. Systematic monitoring of quality of life-threatening side effects would permit early implementation of effective interventions and enhance long-term survivorship. Some examples of the pervasive difficulties that continue to affect survivors and evidence that certain interventions might help are provided in this commentary.
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Affiliation(s)
- Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, UK.
| | - Valerie Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, UK
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Haffty BG, Mahmoud O. The Evolution of Regional Nodal Irradiation in Breast Cancer. Breast J 2014; 21:32-41. [DOI: 10.1111/tbj.12351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bruce G. Haffty
- Department of Radiation Oncology; Rutgers Robert Wood Johnson Medical School; New Jersey Medical School and Cancer Institute of New Jersey; New Brunswick New Jersey
| | - Omar Mahmoud
- Department of Radiation Oncology; Rutgers Robert Wood Johnson Medical School; New Jersey Medical School and Cancer Institute of New Jersey; New Brunswick New Jersey
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Wyld L, Audisio RA, Poston GJ. The evolution of cancer surgery and future perspectives. Nat Rev Clin Oncol 2014; 12:115-24. [PMID: 25384943 DOI: 10.1038/nrclinonc.2014.191] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surgery is the oldest oncological discipline, dating back thousands of years. Prior to the advent of anaesthesia and antisepsis 150 years ago, only the brave, desperate, or ill-advised patient underwent surgery because cure rates were low, and morbidity and mortality high. However, since then, cancer surgery has flourished, driven by relentless technical innovation and research. Historically, the mantra of the cancer surgeon was that increasingly radical surgery would enhance cure rates. The past 50 years have seen a paradigm shift, with the realization that multimodal therapy, technological advances, and minimally invasive techniques can reduce the need for, or the detrimental effects of, radical surgery. Preservation of form, function, and quality of life, without compromising survival, is the new mantra. Today's surgeons, no longer the uneducated technicians of history, are highly trained medical professionals and together with oncologists, radiologists, scientists, anaesthetists and nurses, have made cancer surgeries routine, safe, and highly effective. This article will review the major advances that have underpinned this evolution.
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Affiliation(s)
- Lynda Wyld
- Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2RX, UK
| | - Riccardo A Audisio
- Department of Surgery, St Helens Teaching Hospital, University of Liverpool, St Helens, Merseyside WA9 3DA, UK
| | - Graeme J Poston
- Department of Surgery, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside L9 7AL, UK
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Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJH, Mansel RE, Cataliotti L, Westenberg AH, Klinkenbijl JHG, Orzalesi L, Bouma WH, van der Mijle HCJ, Nieuwenhuijzen GAP, Veltkamp SC, Slaets L, Duez NJ, de Graaf PW, van Dalen T, Marinelli A, Rijna H, Snoj M, Bundred NJ, Merkus JWS, Belkacemi Y, Petignat P, Schinagl DAX, Coens C, Messina CGM, Bogaerts J, Rutgers EJT. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014; 15:1303-10. [PMID: 25439688 PMCID: PMC4291166 DOI: 10.1016/s1470-2045(14)70460-7] [Citation(s) in RCA: 1122] [Impact Index Per Article: 112.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND If treatment of the axilla is indicated in patients with breast cancer who have a positive sentinel node, axillary lymph node dissection is the present standard. Although axillary lymph node dissection provides excellent regional control, it is associated with harmful side-effects. We aimed to assess whether axillary radiotherapy provides comparable regional control with fewer side-effects. METHODS Patients with T1-2 primary breast cancer and no palpable lymphadenopathy were enrolled in the randomised, multicentre, open-label, phase 3 non-inferiority EORTC 10981-22023 AMAROS trial. Patients were randomly assigned (1:1) by a computer-generated allocation schedule to receive either axillary lymph node dissection or axillary radiotherapy in case of a positive sentinel node, stratified by institution. The primary endpoint was non-inferiority of 5-year axillary recurrence, considered to be not more than 4% for the axillary radiotherapy group compared with an expected 2% in the axillary lymph node dissection group. Analyses were by intention to treat and per protocol. The AMAROS trial is registered with ClinicalTrials.gov, number NCT00014612. FINDINGS Between Feb 19, 2001, and April 29, 2010, 4823 patients were enrolled at 34 centres from nine European countries, of whom 4806 were eligible for randomisation. 2402 patients were randomly assigned to receive axillary lymph node dissection and 2404 to receive axillary radiotherapy. Of the 1425 patients with a positive sentinel node, 744 had been randomly assigned to axillary lymph node dissection and 681 to axillary radiotherapy; these patients constituted the intention-to-treat population. Median follow-up was 6·1 years (IQR 4·1-8·0) for the patients with positive sentinel lymph nodes. In the axillary lymph node dissection group, 220 (33%) of 672 patients who underwent axillary lymph node dissection had additional positive nodes. Axillary recurrence occurred in four of 744 patients in the axillary lymph node dissection group and seven of 681 in the axillary radiotherapy group. 5-year axillary recurrence was 0·43% (95% CI 0·00-0·92) after axillary lymph node dissection versus 1·19% (0·31-2·08) after axillary radiotherapy. The planned non-inferiority test was underpowered because of the low number of events. The one-sided 95% CI for the underpowered non-inferiority test on the hazard ratio was 0·00-5·27, with a non-inferiority margin of 2. Lymphoedema in the ipsilateral arm was noted significantly more often after axillary lymph node dissection than after axillary radiotherapy at 1 year, 3 years, and 5 years. INTERPRETATION Axillary lymph node dissection and axillary radiotherapy after a positive sentinel node provide excellent and comparable axillary control for patients with T1-2 primary breast cancer and no palpable lymphadenopathy. Axillary radiotherapy results in significantly less morbidity. FUNDING EORTC Charitable Trust.
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Affiliation(s)
- Mila Donker
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Marieke E Straver
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Philip Meijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | | | | | | | - Willem H Bouma
- Department of Surgery, Gelre Hospital, Apeldoorn, Netherlands
| | | | | | - Sanne C Veltkamp
- Department of Surgery, Amstelland Hospital, Amstelveen, Netherlands
| | - Leen Slaets
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Nicole J Duez
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Peter W de Graaf
- Department of Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Thijs van Dalen
- Department of Radiation Oncology, University Medical Center, Utrecht, Netherlands
| | - Andreas Marinelli
- Department of Surgery, Medical Center Haaglanden, Westeinde, Den Haag, Netherlands
| | - Herman Rijna
- Department of Surgery, Kennemer Gasthuis, Haarlem, Netherlands
| | - Marko Snoj
- Department of Surgery, Institute of Oncology, Ljubljana, Slovenia
| | - Nigel J Bundred
- Department of Surgery, Manchester University Hospital, Manchester, UK
| | - Jos W S Merkus
- Department of Surgery, Haga Hospital, Den Haag, Netherlands
| | - Yazid Belkacemi
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Patrick Petignat
- Division of Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Dominic A X Schinagl
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Carlo G M Messina
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan Bogaerts
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Emiel J T Rutgers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
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185
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Nothacker M, Muche-Borowski C, Kopp IB. [Measuring quality in the German Guideline Programme in Oncology (GGPO)—methodology and implementation]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:470-80. [PMID: 25523845 DOI: 10.1016/j.zefq.2014.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/24/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
Abstract
The German Guideline Programme in Oncology (GGPO) is a joint initiative between the German Cancer Society, the Association of the Scientific Medical Societies in Germany and German Cancer Aid. In accordance with the aims of the German National Cancer Plan, the GGPO supports the systematic development of high-quality guidelines. To enhance implementation and evaluation, the suggestion of performance measures (PMs) derived from guideline recommendations following a standardised methodology is obligatory within the GGPO. For this purpose, PM teams are convened representing the multidisciplinary guideline development groups including clinical experts, methodologists and patient representatives as well as those organisations that take an active part in and share responsibility for documentation and quality improvement, i.e., clinical cancer registries, certified cancer centres and, if appropriate, the institution responsible for external quality assurance according to the German Social Code (SGB). The primary selection criteria for PMs include strength of the underlying recommendation (strong, grade A), existing potential for improvement of care and measurability. The premises of data economy and standardised documentation are taken into account. Between May 2008 and July 2014, 12 guidelines with suggestions for 100 PMs have been published. The majority of the suggested performance measures is captured by the specific documentation requirements of the clinical cancer registries and certified cancer centres. This creates a solid basis for an active quality management and re-evaluation of the suggested PMs. In addition, the suspension of measures should be considered if improvement has been achieved on a broad scale and for a longer period in order to concentrate on a quality-oriented, economic documentation.
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Affiliation(s)
- Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement (IMWi), Marburg, Deutschland.
| | | | - Ina B Kopp
- AWMF-Institut für Medizinisches Wissensmanagement (IMWi), Marburg, Deutschland
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186
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Wetzig N, Gill PG, Zannino D, Stockler MR, Gebski V, Ung O, Campbell I, Simes RJ. Sentinel Lymph Node Based Management or Routine Axillary Clearance? Three-year Outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial. Ann Surg Oncol 2014; 22:17-23. [DOI: 10.1245/s10434-014-3928-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Indexed: 11/18/2022]
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187
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Langford R, Brown I, Vickery J, Mitchell K, Pritchard C, Creanor S. Study protocol for a double blind, randomised, placebo-controlled trial of continuous subpectoral local anaesthetic infusion for pain and shoulder function following mastectomy: SUB-pectoral Local anaesthetic Infusion following MastEctomy (SUBLIME) study. BMJ Open 2014; 4:e006318. [PMID: 25270861 PMCID: PMC4179566 DOI: 10.1136/bmjopen-2014-006318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Over 16 000 mastectomies are performed in England and Wales annually. Acute postoperative pain and nausea are common. The most frequently occurring long-term complications are chronic pain (up to 50%) and reduced shoulder function (reported at 35%). Regional techniques that improve acute postoperative pain relief may reduce the incidence of these complications. This study assesses the effectiveness of a 24-hour continuous local anaesthetic in the subpectoral plane in improving postoperative pain and quality of life in patients undergoing mastectomy. METHODS AND ANALYSIS This is a randomised, double blind, placebo-controlled, two-centre, parallel group trial in women undergoing mastectomy with or without axillary involvement. One hundred and sixty participants will be randomised in a 1:1 ratio to receive either 0.25% levobupivacaine or 0.9% saline by subpectoral infusion postoperatively for 24 h. All participants will be provided with an intravenous morphine patient-controlled analgesia (PCA) system. Participants will be followed-up for 24 h in hospital and at approximately 14 days and 6 months postoperatively. Joint primary outcome measures are total morphine consumption and total pain score (captured via patient-recorded visual analogue scale (VAS) 4 hourly) during the first 24 h postoperatively. Primary statistical analysis of total pain is based on the area under the curve of pain versus time graph. Secondary outcomes include PCA attempts in first 24 h; VAS pain scores and shoulder function by goniometry at 24 h, 14 days (approximately) and 6 months; Verbal Rating Scale pain scores in first 24 h; Brief Pain Inventory and Oxford Shoulder Score at 6 months; duration of hospital stay; incidence of postoperative nausea and vomiting; cost-effectiveness. ETHICS AND DISSEMINATION The study is approved by the South West England Research Ethics Committee (12/SW/0149). RESULTS will be published in a peer-reviewed journal and presented at local, national and international scientific meetings. TRIAL REGISTRATION ISRCTN46621916. EudraCT 2011-005775-16.
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Affiliation(s)
- R Langford
- Department of Anaesthesia, Royal Cornwall Hospital, Truro, UK
| | - I Brown
- Department of Surgery, Royal Cornwall Hospital, Truro, UK
| | - J Vickery
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - K Mitchell
- Department of Anaesthesia, Royal Cornwall Hospital, Truro, UK
| | - C Pritchard
- NIHR Research Design Service (South West), Truro, UK
| | - S Creanor
- Centre for Biostatistics, Bioinformatics & Biomarkers, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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188
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Komoike Y, Inokuchi M, Itoh T, Kitamura K, Kutomi G, Sakai T, Jinno H, Wada N, Ohsumi S, Mukai H. Japan Breast Cancer Society clinical practice guideline for surgical treatment of breast cancer. Breast Cancer 2014; 22:37-48. [PMID: 25091115 DOI: 10.1007/s12282-014-0558-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Yoshifumi Komoike
- Section of Breast and Endocrine Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 589-8511, Japan,
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189
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Mittendorf EA, Caudle AS, Yang W, Krishnamurthy S, Shaitelman S, Chavez-MacGregor M, Woodward WA, Bedrosian I, Kuerer HM, Hunt KK. Implementation of the american college of surgeons oncology group z1071 trial data in clinical practice: is there a way forward for sentinel lymph node dissection in clinically node-positive breast cancer patients treated with neoadjuvant chemotherapy? Ann Surg Oncol 2014; 21:2468-73. [PMID: 24841348 DOI: 10.1245/s10434-014-3775-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Indexed: 02/03/2023]
Abstract
For clinically node-positive breast cancer patients receiving neoadjuvant chemotherapy, approximately 40 % will be found to be pathologically node negative. The American College of Surgeons Oncology Group Z1071 trial was therefore conducted to evaluate sentinel lymph node dissection (SLND) in these patients. The trial's primary end point was to determine the false-negative rate (FNR) among patients with clinical N1 disease in whom at least 2 sentinel lymph nodes (SLNs) were identified. The FNR was 12.6 %, which exceeded the prespecified end point of 10.0 %. After data publication, our multidisciplinary team discussed the trial results and how we may incorporate the findings into clinical practice. Patient selection and surgical technique are critical. As an example, when dual tracer technique was used, the FNR was 10.8 %. Data from the trial presented at the San Antonio Breast Cancer Symposium suggested that the FNR could be improved if a clip was placed in the biopsy-proven positive lymph node and removal of that node during SLND was confirmed. Taking this into consideration, we have proposed an approach to surgical management of the axilla in clinically node-positive patients receiving neoadjuvant chemotherapy termed targeted axillary dissection (TAD). TAD involves placing a clip at the time a lymph node is determined to be positive. After completion of neoadjuvant chemotherapy, the clipped node is localized by using a wire or radioactive seed, and during the SLND procedure, all SLNs and the clipped node are removed. We are currently evaluating the efficacy of TAD in axillary staging after neoadjuvant chemotherapy.
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Affiliation(s)
- Elizabeth A Mittendorf
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
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190
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Fu Y, Chung D, Cao MA, Apple S, Chang H. Is axillary lymph node dissection necessary after sentinel lymph node biopsy in patients with mastectomy and pathological N1 breast cancer? Ann Surg Oncol 2014; 21:4109-23. [PMID: 25081336 DOI: 10.1245/s10434-014-3814-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial reported that axillary lymph node dissection (ALND) did not change the recurrence and overall survival (OS) rates in patients with lumpectomy and one to two positive nodes detected by sentinel lymph node biopsy (SLNB). The aim of this study was to determine whether patients with mastectomy and pathological N1 disease found by SLNB could forego ALND. MATERIALS AND METHODS This is a retrospective study of 214 patients diagnosed with primary invasive breast cancer who were treated by mastectomy and lymph node staging surgery (SLNB or ALND) at the Revlon/UCLA Breast Center between January 2002 and December 2010. Patients with pathological N1 disease were separated by their first nodal surgery into SLNB (subgroups: observation, radiation, and additional ALND with or without radiation) and ALND groups (subgroups: ALND with or without radiation). RESULTS After a median follow-up of 43.6 months, the OS and systemic relapse-free survival (RFS) rate of the radiation group and additional ALND group were significantly better than the observation group (p = 0.031 and 0.046, respectively). Human epidermal growth factor receptor 2 (HER2) expression was found to predict OS and patients' age, histological grade and HER2 expression predicted systemic recurrence. Compared with the SLNB group, pain (p = 0.021) and lymphedema (p = 0.043) occurred more frequently in the ALND group. CONCLUSION Radiation was as effective as ALND in patients with mastectomy and N1 disease for OS and RFS rates, yet radiation after SLNB had fewer side effects than ALND. SLNB followed by radiation could replace ALND in patients with mastectomy and pathological N1 breast cancer identified by SLNB.
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Affiliation(s)
- Yun Fu
- Department of Surgery, David Geffen School of Medicine, UCLA, Revlon/UCLA Breast Center, Los Angeles, California, USA
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191
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Caudle AS, Thompson AM. Less Remains Better: Morbidity After Axillary Surgery. Ann Surg Oncol 2014; 22:4-6. [DOI: 10.1245/s10434-014-3936-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Indexed: 01/20/2023]
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192
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An improved axillary staging system using the OSNA assay does not modify the therapeutic management of breast cancer patients. Sci Rep 2014; 4:5743. [PMID: 25034150 PMCID: PMC4102897 DOI: 10.1038/srep05743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/30/2014] [Indexed: 12/17/2022] Open
Abstract
The one-step nucleic acid amplification (OSNA) assay is a molecular procedure that can identify deposits of breast cancer (BC) cells in the sentinel lymph node (SLN). We examined the consistency of the OSNA assay with a classic hematoxylin-eosin (H&E)-based immunohistochemistry (IHC) study and evaluated how OSNA-based axillary staging might impact the therapeutic management of BC patients. SLN biopsy results were considered to be positive in 60 patients (40%) in the OSNA group (N = 148) and in 43 (28%) patients in the IHC cohort (N = 153, p = 0.023). There was no difference in the macrometastasis (22% for OSNA, 15% for H&E, p = 0.139) or micrometastasis (19% for OSNA, 13% for H&E, p = 0.166) rates, but we found statistically significant differences in the number of isolated tumor cells (1% for OSNA, 11% for H&E, p < 0.001). There were no differences in the administration rate of adjuvant systemic therapy between the OSNA (66% in the SLN(+) patients) and the H&E (74% in the SLN(+) patients) groups (p = 0.159). The OSNA assay allows for the detection of SLN metastases more precisely than conventional pathologic methods but does not alter the therapeutic management of SLN(+) BC patients.
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193
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Wang K, Ren Y, Huang R, He JJ, Feng WL, Kong YN, Xu F, Zhao L, Song QK, Li J, Zhang BN, Fan JH, Xie XM, Zheng S, Qiao YL. Application of intraoperative frozen section examination in the management of female breast cancer in China: a nationwide, multicenter 10-year epidemiological study. World J Surg Oncol 2014; 12:225. [PMID: 25034137 PMCID: PMC4105393 DOI: 10.1186/1477-7819-12-225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 07/04/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intraoperative frozen section examination (IFSE) during breast cancer surgery can partly reflect the status of surgical treatment since the surgical method used directly determines the purpose of IFSE use in disease management. This study aims to investigate the application of, changing trends in, and factors influencing IFSE in the management of female breast cancer in China. METHODS We collected the sociodemographic and clinical data of 4,211 breast cancer patients between 1999 and 2008 and statistically analyzed these data using χ2 or Fisher's exact tests. RESULTS A total of 2,283 (54.22%) patients with breast cancer underwent IFSE. During the 10-year study period, IFSE use was associated with an increase in the number of sentinel lymph node biopsies (SLNB) and breast-conserving surgeries (BS) performed, with significant regional differences noted in this trend (P < 0.05). Patients' education, occupation, age, tumor size estimated by preoperative palpation, and the use of imaging examinations affected the purpose of IFSE use (P < 0.05). CONCLUSIONS Our results show that the purpose of IFSE in the surgical treatment of breast cancer in China is gradually approaching that in developed countries. We believe that policymakers must address the differences in breast cancer treatment based on the socioeconomic status of patients. Lastly, the use of IFSE for determining tumor characteristics should be avoided as far as possible, and patient education and breast cancer screening programs tailored to the Chinese population should be established. Our findings may guide the formulation of breast cancer control strategies in China and other low-income countries.
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Affiliation(s)
- Ke Wang
- Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong Universtiy, 277 Yanta West Road, Xi’an 710061, P.R. China
| | - Yu Ren
- Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong Universtiy, 277 Yanta West Road, Xi’an 710061, P.R. China
| | - Rong Huang
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jian-Jun He
- Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong Universtiy, 277 Yanta West Road, Xi’an 710061, P.R. China
| | - Wei-Liang Feng
- Department of Breast Surgery, Zhejiang Cancer Hospital, No. 38 Banshanqiao Guanji Road, Hangzhou 310022, P.R. China
| | - Ya-Nan Kong
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East, Guangzhou 510060, P.R. China
| | - Feng Xu
- Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, No. 139 Renminzhonglu, Changsha 410011, P.R. China
| | - Lin Zhao
- Department of Breast Surgery, Liaoning Cancer Hospital, No. 44 Xiaoyanhe Road, Dadong District, Shenyang 110041, P.R. China
| | - Qing-Kun Song
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Jing Li
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Bao-Ning Zhang
- Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East, Guangzhou 510060, P.R. China
| | - Shan Zheng
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, P.R. China
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194
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Neuner JM, Zokoe N, McGinley EL, Pezzin LE, Yen TWF, Schapira MM, Nattinger AB. Quality of life among a population-based cohort of older patients with breast cancer. Breast 2014; 23:609-16. [PMID: 25034932 DOI: 10.1016/j.breast.2014.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 05/06/2014] [Accepted: 06/05/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Growing numbers of older women receive adjuvant breast cancer therapies, but little is known about the long-term effects of current therapies upon health-related quality of life outside of clinical trials. METHODS A population-based cohort of postmenopausal women with incident breast cancer aged sixty-five and older was identified from Medicare claims from four states and followed over five years. General health-related quality of life (HRQOL) was assessed using the Medical Outcomes Study SF-12 Health Survey, and breast cancer-related HRQOL was assessed using the breast cancer subscale of the functional assessment of cancer therapy (FACT-B BCS). The association of HRQOL with sociodemographic variables, comorbidity, and breast cancer variables (stage, treatments, and treatment sequelae) was examined in longitudinal models. RESULTS Among the 3083 older breast cancer survivors, general HRQOL as measured by SF-12 mental and physical component scores was similar to norms for non-cancer populations, and remained stable throughout follow-up. Breast cancer treatments, including surgery and radiation, adjuvant hormonal therapy, and cytotoxic chemotherapy were not associated with worsened general health scores. A similar pattern was seen for breast cancer-related HRQOL scores, except that chemotherapy was associated with slightly worse scores. Lymphedema occurred in 17% of the cohort, and was strongly associated with all measures of HRQOL. Reductions in general HRQOL with lymphedema development were larger than those with an age increase of 10 years. CONCLUSIONS There is little association of breast cancer treatment with HRQOL in older breast cancer patients followed for up to five years, but the development of lymphedema is associated with substantial reductions in HRQOL.
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Affiliation(s)
- Joan M Neuner
- Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA.
| | - Nathan Zokoe
- Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Emily L McGinley
- Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Liliana E Pezzin
- Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Tina W F Yen
- Medical College of Wisconsin, Department of Surgical Oncology, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Marilyn M Schapira
- Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Ann B Nattinger
- Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
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195
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Tamaki K, Tamaki N, Kamada Y, Uehara K, Miyashita M, Sm Chan M, Ishida T, Ohuchi N, Sasano H. Non-invasive evaluation of axillary lymph node status in breast cancer patients using shear wave elastography. TOHOKU J EXP MED 2014; 231:211-6. [PMID: 24213140 DOI: 10.1620/tjem.231.211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Less invasive procedures are currently required to examine the axillary lymph node status. Shear wave elastography with acoustic radiation force impulse provides objective and reproducible quantification of the intrinsic property of the soft tissue. In this study, we measured shear wave velocity of the axillary lymph nodes of patients with breast cancer using Virtual Touch Tissue Quantification (VTTQ). The degree of lymph node metastasis was evaluated by measuring the expression level of cytokeratin 19 (CK19) mRNA, a specific marker for breast cancer cells. The one-step nucleic acid amplification (OSNA) was used to determine the copy number of CK19 mRNA in 149 lymph node specimens of 149 primary breast cancer patients. Axillary lymph node status according to OSNA (copy number/μl) were categorized as 0-249 copies (-), 250-5,000 copies (+), and copy number > 5,000 (++). A category (-) represents no metastasis in the axillary lymph node. There were 121 patients with OSNA-, 9 with OSNA+ and 19 with OSNA++. The average velocities according to OSNA categories were 1.64 ± 0.42 m/second for OSNA-, 2.25 ± 0.78 m/second for OSNA+, and 2.79 ± 0.98 m/second for OSNA++. There were significant differences in the shear wave velocity between OSNA- and OSNA+ (P = 0.040) or OSNA++ (P < 0.001). The most optimal cutoff velocity to distinguish benign from metastasis is 1.44 m/second, as determined using the receiver operating characteristic method. The shear wave velocity measured with VTTQ could provide clinically useful information about axillary lymph node metastasis in patients with primary breast cancer.
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196
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Heil J, Fuchs V, Golatta M, Schott S, Wallwiener M, Domschke C, Sinn P, Lux MP, Sohn C, Schütz F. Extent of primary breast cancer surgery: standards and individualized concepts. ACTA ACUST UNITED AC 2014; 7:364-9. [PMID: 24647774 DOI: 10.1159/000343976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.
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Affiliation(s)
- Joerg Heil
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Valerie Fuchs
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Michael Golatta
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Sarah Schott
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | | | | | - Peter Sinn
- Institut für Pathologie, Universität Heidelberg, Germany
| | - Michael P Lux
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Germany
| | - Christof Sohn
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Florian Schütz
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
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197
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[Sentinel node invasion: is it necessary to perform axillary lymph node dissection? Randomized trial SERC]. Bull Cancer 2014; 101:358-63. [PMID: 24793627 DOI: 10.1684/bdc.2014.1916] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Contribution of axillary lymph node dissection (ALND) is questioned for positive sentinel node (SN), micro-metastasis and isolated tumor cells but also for macro-metastasis. The aim of this work is to precise why a prospective randomized trial is necessary and the design of this trial. Why? For positive SN, the scientific level evidence appears insufficient for validation of ALND omission as a new standard. Rational is presented with non-sentinel node involved rate and number of NSL involved at complementary ALND, axillary recurrence rate, disease free survival rate and adjuvant treatment decision impact. How? The proposed Sentinelle Envahi et Randomisation du Curage (SERC) trial will randomly assign to observation only or complementary ALND with positive SN. The aim is to demonstrate the non-inferiority of ALND omission versus ALND.
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198
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Barrett J, Jenkins V, Farewell V, Menon U, Jacobs I, Kilkerr J, Ryan A, Langridge C, Fallowfield L. Psychological morbidity associated with ovarian cancer screening: results from more than 23 000 women in the randomised trial of ovarian cancer screening (UKCTOCS). BJOG 2014; 121:1071-9. [DOI: 10.1111/1471-0528.12870] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J Barrett
- Cardiovascular Epidemiology Unit; Department of Public Health & Primary Care; University of Cambridge; Cambridge UK
| | - V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - V Farewell
- Medical Research Council Biostatistics Unit; Institute of Public Health; Cambridge UK
| | - U Menon
- EGA Institute for Women's Health; University College London; London UK
| | - I Jacobs
- Faculty of Medical & Human Sciences; University of Manchester; Manchester UK
| | - J Kilkerr
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - A Ryan
- EGA Institute for Women's Health; University College London; London UK
| | - C Langridge
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
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Maráz R, Boross G, Pap-Szekeres J, Markó L, Rajtár M, Ambrózay É, Bori R, Cserni G. The role of sentinel node biopsy in male breast cancer. Breast Cancer 2014; 23:85-91. [DOI: 10.1007/s12282-014-0535-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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Reimer T, Hartmann S, Stachs A, Gerber B. Local treatment of the axilla in early breast cancer: concepts from the national surgical adjuvant breast and bowel project B-04 to the planned intergroup sentinel mamma trial. Breast Care (Basel) 2014; 9:87-95. [PMID: 24944550 PMCID: PMC4038316 DOI: 10.1159/000360411] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Local treatment of the axilla in clinically node-negative, early-stage breast cancer patients has been hotly debated after the release of the American College of Surgeons Oncology Group (ACOSOG) Z0011 findings. However, this review does not focus on the 'Z0011-eligible' patients alone, because this subgroup represents a minority of our patients undergoing breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). The following topics are discussed: axillary diagnostics, timing of axillary procedures in the neoadjuvant setting, long-term follow-up of SLNB trials, omission of axillary surgery in randomized trials, management of the involved axilla with low tumor volume, positive sentinel lymph nodes and BCS, involved sentinel lymph nodes and mastectomy, and axillary radiotherapy. Finally, the current innovative study concepts (i.e. Sentinel Node versus Observation after Axillary Ultrasound (SOUND) and Intergroup Sentinel Mamma (INSEMA)) including patients with axillary observation alone in clinically node-negative women are presented.
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Affiliation(s)
- Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Germany
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