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Campisi C, Soluri A, Stella S, Valenti G, Scopinaro F. Intraoperative Sentinel Node Detection by an Innovative Imaging Probe. TUMORI JOURNAL 2018; 88:S56-8. [PMID: 12369557 DOI: 10.1177/030089160208800348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraoperative tumor detection has been used in many applications, and today the sentinel node technique is a widely employed surgical procedure in breast cancer. Different detector systems are employed but several problems have been reported in clinical practice, in particular the difficulty to accurately detect the sentinel node within the axillary soft tissue. The problem is even greater for abdominal and thoracic tumors. We propose an innovative Imaging Probe (IP) able to visualize on a monitor the primary tumor and secondary lesions, if appropriately radiolabeled. The IP can be optimally applied for minimally invasive surgery in breast cancer treatment, and a preliminary experience related to 15 patients and 20 sentinel nodes is reported here. We compared the results obtained with the IP to those obtained with an Anger camera and a traditional scintillation detector, and found them to be very promising. In particular the surgeon's work is greatly facilitated by direct visual guidance instead of a generic acoustic signal.
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Affiliation(s)
- C Campisi
- Institute of Biomedical Technologies, National Research Council, Rome.
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2
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Ballal DS, Rakshit SH, Somashekhar SP, Arunkumar N. Evaluation of Intraoperative Frozen Section with Final Histopathology Results for Sentinel Lymph Node Biopsy in Breast Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Multivariate Preoperative and Intraoperative Predictors of Postmastectomy Radiation Therapy in Patients for Whom Immediate Breast Reconstruction Is Planned. Plast Reconstr Surg 2017; 139:599e-605e. [DOI: 10.1097/prs.0000000000003052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Somashekhar SP, Naikoo ZA, Zaveri SS, Holla S, Chandra S, Mishra S, Parameswaran RV. Intraoperative Frozen Section Evaluation of Sentinel Lymph Nodes in Breast Carcinoma: Single-Institution Indian Experience. Indian J Surg 2015; 77:335-40. [PMID: 26730021 PMCID: PMC4692900 DOI: 10.1007/s12262-013-0827-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 01/15/2013] [Indexed: 12/17/2022] Open
Abstract
Sentinel lymph node biopsy is an established way of predicting axillary nodal metastasis in early breast cancer. Intraoperative frozen sections (FS) of sentinel lymph nodes (SLNs) can be used to detect metastatic disease, allowing immediate axillary lymph node dissection. The purpose of this study was to evaluate the accuracy of intraoperative frozen sections in evaluation of sentinel lymph nodes in cases of breast cancer. Between March 2006 and August 2010, a total of 164 patients with clinically node-negative operable breast cancer were subjected to sentinel lymph node biopsy of axillary lymph nodes using preoperative peritumoral injection of radioactive colloid and methylene blue. Intraoperative identification of sentinel nodes was done using a handheld gamma probe and identification of blue-stained nodes. The nodes were sent for frozen section examination. The results of frozen section were compared with the final histopathology. Out of the 164 cases, metastases were detected in SLN by frozen section in 38 cases. There were three false-negative cases (all showing micrometastasis on final histopathology). FS had sensitivity of 92.6 %, specificity of 100 %, and overall accuracy of 98.1 %. The positive predictive value was 100 %, and the negative predictive value was 97.6 %. FS for diagnosis of metastasis of SLNs is reliable. Patients with negative SLNs by the FS diagnosis can avoid reoperation for axillary lymph node dissection. However, FS may fail to detect micrometastases, especially in cases with small tumors.
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Affiliation(s)
- S. P. Somashekhar
- />Dept. of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, # 98, HAL Airport road, Bangalore, India
| | - Zahoor Ahmed Naikoo
- />Dept. of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, # 98, HAL Airport road, Bangalore, India
| | - Shabber S. Zaveri
- />Dept. of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, # 98, HAL Airport road, Bangalore, India
| | - Soumya Holla
- />Dept. of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, # 98, HAL Airport road, Bangalore, India
| | - Suresh Chandra
- />Department of Pathology, Manipal Hospital, # 98, HAL Airport road, Bangalore, India
| | - Suniti Mishra
- />Department of Pathology, Manipal Hospital, # 98, HAL Airport road, Bangalore, India
| | - R. V. Parameswaran
- />Department of Nuclear Medicine, Manipal Hospital, # 98, HAL Airport road, Bangalore, India
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Tian P, Zhang W, Zhao H, Lei Y, Cui L, Zhang Y, Xu Z. Intraoperative detection of sentinel lymph node metastases in breast carcinoma by Fourier transform infrared spectroscopy. Br J Surg 2015. [PMID: 26198697 DOI: 10.1002/bjs.9882] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Sentinel lymph node (SLN) biopsy is a routine surgical staging procedure in clinically lymph node-negative breast cancer. Fourier transform infrared (FTIR) spectroscopy, a technique based on the biochemical composition of the tissue, has previously been found to be capable of differentiating between normal and malignant tissue. The aim of the present study was to explore the intraoperative use of FTIR spectroscopy for rapidly identifying metastatic SLNs, and distinguishing between metastatic and non-metastatic tissue.
Methods
Freshly removed SLNs from patients with breast cancer were analysed. Samples were measured by FTIR spectroscopy before histopathological diagnosis. The FTIR spectrum of each sample identified ten bands from 2000 to 900 cm−1. The peak position, intensity and full width at half maximum of each absorbent band were measured, and the relative intensity ratios calculated. Canonical discriminant analysis was performed to discriminate between metastatic and non-metastatic samples.
Results
A total of 149 SLNs were removed from 49 patients. Histopathological examination confirmed 38 metastatic and 111 non-metastatic SLNs. Eighteen of 29 parameters were significantly different between the metastatic and non-metastatic SLNs. Five parameters were selected as independent factors to form discriminant functions. The sensitivity, specificity and accuracy of this method were 94·7, 90·1 and 91·3 per cent respectively. The accuracy of histological analysis of frozen sections was 100 per cent.
Conclusion
FTIR spectroscopy is a promising technique for the real-time diagnosis of SLN metastasis during breast cancer surgery. Surgical relevanceSentinel lymph node (SLN) biopsy is a highly accurate predictor of overall axillary status and has become the standard in disease staging in clinically node-negative breast cancer. A rapid and accurate intraoperative assessment of metastatic spread to the SLN provides the necessary information for the surgeon to proceed with immediate axillary dissection.The results of this research indicate that Fourier transform infrared (FTIR) spectroscopy is a rapid, accurate, non-destructive and cost-effective molecular method that can be used to detect SLN metastasis during surgery.FTIR analysis could be useful for the intraoperative diagnosis of lymph node metastases at large institutions, thereby reducing the workload of pathologists, as well as in regions lacking pathologists such as in developing countries.
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Affiliation(s)
- P Tian
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - W Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - H Zhao
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Y Lei
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - L Cui
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Y Zhang
- College of Chemistry and Molecular Engineering, Peking University, Beijing, China
| | - Z Xu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
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Standardized processing of native tissue in breast pathology. Recent Results Cancer Res 2015; 199:45-53. [PMID: 25636428 DOI: 10.1007/978-3-319-13957-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In breast surgery, replacement of intraoperative frozen section by core needle and vacuum biopsies hampers collections of unfixed breast specimens. We practice immediate intraoperative macroscopic analysis of resection margins and vacuum-cooling of breast specimens to enable native tissue asservation for assessment of biological markers and tissue banking of tumor tissue. In addition, slicing of native tissue before formalin fixation guarantees a standardized and uniform fixation. Starting in 2013, more than 350 breast specimens were processed as native specimens in the Institute of Pathology of Hannover Medical School. Breast specimens with an invasive carcinoma and request of an intraoperative resection margin assessment were processed with an immediate intraoperative pathological analysis. All other breast specimens without assessment of an intraoperative resection margin were vacuum-fixed processed. In all cases, native tissue for biomarker analyses and tumor banking could be preserved.
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Chagpar AB, McMasters KM. Sentinel lymph node biopsy for breast cancer: from investigational procedure to standard practice. Expert Rev Anticancer Ther 2014; 4:903-12. [PMID: 15485323 DOI: 10.1586/14737140.4.5.903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node biopsy, popularized in melanoma, has revolutionized the management of breast cancer. While the morbidity associated with axillary node dissection was once thought to be a requisite risk in order to appropriately stage the axilla, large validation studies have demonstrated that sentinel lymph node biopsy is a minimally invasive technique that can accurately predict nodal status. This technique has become an accepted practice in many centers, but there remain many controversies surrounding the technique itself, the pathologic evaluation of the sentinel node and the optimal management of patients with minimal nodal disease. The historic roots of this technique are discussed, along with the controversial issues surrounding the technique and the clinical trials that are currently ongoing.
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Affiliation(s)
- Anees B Chagpar
- Division of Surgical Oncology, University of Louisville, KY 40202, USA.
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Moatasim A, Mujtaba S, Faridi N. Intraoperative frozen section analysis of sentinel lymph nodes in breast carcinoma patients in a tertiary hospital in Pakistan. Int J Surg 2013; 11:253-8. [PMID: 23354316 DOI: 10.1016/j.ijsu.2013.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 01/14/2013] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
Abstract
Intraoperative evaluation of sentinel lymph nodes has become routine in many units that manage early breast carcinoma. The procedure is associated with minimal morbidity and can be cost effective, avoiding re operation and reducing hospital stay as an axillary clearance can be performed under the same anesthetic after a positive intraoperative diagnosis without awaiting conventional paraffin histology. In negative cases extensive axillary lymph node dissection and its associated side effects can be avoided altogether. With careful patient selection, the expertise of surgeons and pathologists can increase the sensitivity and specificity of the technique with a reduction in false negatives. A number of international studies have established the usefulness of intraoperative sentinel lymph node evaluation. However, no local study has assessed the accuracy of frozen section in evaluating sentinel lymph node biopsy. The purpose of our study was to compare the two techniques (frozen section versus conventional paraffin histology) of the sentinel lymph node examination and to present our local data highlighting its usefulness and pitfalls, comparing the results with those in published studies. From the results obtained, we strongly recommend intraoperative assessment of the sentinel lymph nodes in breast carcinoma patients; frozen section microscopy can be a reliable and accurate technique in the hands of an experienced histopathologist.
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Dämmrich M, Thomssen C, Hillemanns P, Kreipe H. [Intraoperative pathological rapid investigations in breast surgery]. DER PATHOLOGE 2012; 33:424-9. [PMID: 22918528 DOI: 10.1007/s00292-012-1596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In breast surgery intraoperative frozen sections for the diagnosis of malignancy has lost impact and has largely been replaced by preoperative core needle biopsies. Nevertheless, there is still need for immediate pathological investigation of native breast tissue during surgery due to three reasons: (1) macroscopic and microscopic evaluation of resection margins, (2) the histological analysis of sentinel lymph nodes in order to circumvent secondary axillary surgery and (3) the preparation of native tissue for tumor banking or measurement of biomarkers. Because histology provides only a facultative component of immediate pathological examination of breast specimens during surgery, the term frozen section does not seem to be appropriate anymore. Intraoperative evaluation of resection specimens by pathologists provides surgically relevant information immediately, guarantees standardized preparation and fixation of specimens and enables tissue banking of native tissue for assessment of biological markers.
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Affiliation(s)
- M Dämmrich
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Liu LC, Lang JE, Lu Y, Roe D, Hwang SE, Ewing CA, Esserman LJ, Morita E, Treseler P, Leong SP. Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients. Cancer 2010; 117:250-8. [DOI: 10.1002/cncr.25606] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 06/23/2010] [Accepted: 07/19/2010] [Indexed: 11/10/2022]
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Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer. Br J Cancer 2009; 102:181-7. [PMID: 19997107 PMCID: PMC2813735 DOI: 10.1038/sj.bjc.6605470] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT–PCR) has produced encouraging results, the more discriminating markers remain to be identified. Methods: Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT–PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC. Results: SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (P<0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (P<0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases. Conclusion: PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT–PCR.
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Horvath JW, Barnett GE, Jimenez RE, Young DC, Povoski SP. Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma. World J Surg Oncol 2009; 7:34. [PMID: 19317888 PMCID: PMC2667517 DOI: 10.1186/1477-7819-7-34] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 03/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is the standard of care for the surgical assessment of the axilla during breast cancer surgery. However, the diagnostic accuracy of intraoperative frozen section analysis for confirming metastatic involvement of SLNs in cases of invasive lobular carcinoma (ILC) versus that of invasive ductal carcinoma (IDC) has generated controversy secondary to a frequently low-grade cytologic appearance and an often discohesive pattern displayed by metastatic lymph nodes in ILC. In the current report, we present a comparison of intraoperative frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. METHODS We evaluated the results of 131 consecutive cases of ILC from 1997 to 2008 and 133 cases of IDC (selected by a random sequence generator program) from amongst 1163 consecutive cases of IDC from the same time period. All cases had at least one SLN that had both intraoperative frozen section analysis and confirmatory permanent section analysis performed. RESULTS No statistically significant difference was found in the sensitivity (67% vs. 75%, P = 0.385), specificity (100% vs. 100%), accuracy (86% vs. 92%, P = 0.172), false negative rate (33% vs. 25%, P = 0.385), negative predictive value (81% vs. 89%, P = 0.158), and positive predictive value (100% vs. 100%) for frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. CONCLUSION Since there was no statistically significant difference in sensitivity, specificity, accuracy, false negative rate, negative predictive value, and positive predictive value between frozen section analysis of SLNs for patients with ILC and IDC, the clinical accuracy of confirming metastatic involvement of SLNs on frozen section analysis for ILC should not be considered inferior to the clinical accuracy for IDC. Therefore, frozen section analysis of all SLNs during breast cancer surgery in patients with ILC should remain the standard of care in order to reduce the risk of the need of a later, separate axillary lymph node dissection.
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Affiliation(s)
- James W Horvath
- Department of Pathology, The Ohio State University, Columbus, Ohio 43210, USA
| | - Gary E Barnett
- Department of Pathology, The Ohio State University, Columbus, Ohio 43210, USA
| | - Rafael E Jimenez
- Department of Pathology, The Ohio State University, Columbus, Ohio 43210, USA
| | - Donn C Young
- Center for Biostatistics, The Ohio State University, Columbus, Ohio 43210, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA
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Schwartz GF, Krill LS, Palazzo JP, Dasgupta A. Value of Intraoperative Examination of Axillary Sentinel Nodes in Carcinoma of the Breast. J Am Coll Surg 2008; 207:758-62. [DOI: 10.1016/j.jamcollsurg.2008.06.341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Revised: 06/24/2008] [Accepted: 06/25/2008] [Indexed: 11/26/2022]
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Accuracy of frozen section of sentinel lymph nodes: a prospective analysis of 659 breast cancer patients of the Swiss multicenter study. Breast Cancer Res Treat 2008; 113:129-36. [DOI: 10.1007/s10549-008-9911-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 01/16/2008] [Indexed: 11/25/2022]
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Purdie CA. Sentinel lymph node biopsy: Review of the literature and guidelines for pathological handling and reporting. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cdip.2006.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Somasundar P, Gass J, Steinhoff M, Koeliker S, Dizon D, Cady B, Taneja C. Role of ultrasound-guided axillary fine-needle aspiration in the management of invasive breast cancer. Am J Surg 2006; 192:458-61. [PMID: 16978949 DOI: 10.1016/j.amjsurg.2006.06.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 06/20/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous studies from Women & Infants' Hospital have reported the accuracy of ultrasound-guided fine-needle aspiration biopsy examination of axillary lymph nodes (USFNAB) for locally advanced breast cancer. The aim of this article is to report our further experience with USFNAB in staging the axilla and determining its affect on management decisions. METHODS We performed a retrospective review of prospectively collected data between January 1998 and June 2005. RESULTS A total of 220 patients underwent USFNAB for breast cancer. Of these, 52 were excluded. Of the 168 remaining patients, 79 had positive and 89 had negative USFNAB results. A total of 107 (63%) patients underwent primary surgery and 61 (37%) patients underwent neoadjuvant chemotherapy. In these patients, the sensitivity and specificity of USFNAB was 35% and 96% for T1, and 67% and 100% for T2, respectively. CONCLUSIONS The high specificity of USFNAB could safely eliminate sentinel lymph node biopsy examination before axillary lymph node dissection, particularly in T2 lesions.
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Affiliation(s)
- Ponnandai Somasundar
- Department of Surgical Oncology, Roger Williams Hospital/Boston University Medical Center, 825 Chalkstone Ave., Providence, RI 02908, USA
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Lee IK, Lee HD, Jeong J, Park BW, Jung WH, Hong SW, Oh KK, Ryu YH. Intraoperative examination of sentinel lymph nodes by immunohistochemical staining in patients with breast cancer. Eur J Surg Oncol 2006; 32:405-9. [PMID: 16524688 DOI: 10.1016/j.ejso.2006.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 01/26/2006] [Indexed: 10/24/2022] Open
Abstract
AIM To performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (CK-IHC) staining of the SLN removed during the operation of breast cancer patients. STUDY DESIGN Between December 2002 and March 2004, 62 patients with T1 and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. Eighty-nine sentinel lymph nodes (mean number, 1.44) were biopsied and first examined by hematoxylin-eosin (H&E) stained frozen section. All the tumour free sentinel lymph nodes by H&E stained frozen section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50, Novocastra Lab., Newcastle, UK) during the operations. RESULTS Rapid IHC staining revealed seven positive sentinel lymph nodes that were negative for metastasis by H&E staining. This study showed a sensitivity of 92.86%, a specificity of 100%, an accuracy of 98.9%, and a negative predictive value of 98.7%. CONCLUSIONS The intraoperative examination of sentinel lymph nodes is an accurate and effective way of predicting the axillary lymph node status of patients with breast cancers.
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Affiliation(s)
- I-K Lee
- Department of Surgery, MizMedi Hospital, Seoul, South Korea
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Michy T, Le Bouëdec G, Mishellany F, Penault-Llorca F, Dauplat J. [Is there still a place for extemporaneous exam in breast cancer?]. ACTA ACUST UNITED AC 2006; 34:115-9. [PMID: 16483825 DOI: 10.1016/j.gyobfe.2005.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 12/05/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The rise of preoperative diagnosis thanks to new methods of micro and macrobiopsy and the development of sentinel lymph node have dramatically modified the surgical management of patients with breast tumor. The purpose of this study is to know if extemporaneous exams still have a place in the management of breast cancer. PATIENTS AND METHODS Retrospective study which compares the qualitiative evolution of frozen sections in breast tumor at Jean-Perrin center before the practice of percutaneous strereotaxic biopsy and after the training of sentinel lymph node operative biopsy. RESULTS The results were in favour of a different distribution of anatomocytopathological activity with a decrease of frozen section in breast tumor and an increase of cytological imprints on sentinel nodes. DISCUSSION AND CONCLUSION The interest of histologic preoperative diagnosis and the failure of consensus in the sentinel lymph node just leave a restrictive position to frozen section in breast cancer.
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Affiliation(s)
- T Michy
- Service de chirurgie carcinologique, centre Jean-Perrin, place Henri-Dunant, 63000 Clermont-Ferrand, France.
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Elsheikh MN, Rinaldo A, Hamakawa H, Mahfouz ME, Rodrigo JP, Brennan J, Devaney KO, Grandis JR, Ferlito A. Importance of molecular analysis in detecting cervical lymph node metastasis in head and neck squamous cell carcinoma. Head Neck 2006; 28:842-9. [PMID: 16691557 DOI: 10.1002/hed.20368] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Because of the impact of nodal status on treatment and survival in squamous cell carcinoma of the head and neck, accurate staging of cervical lymph nodes is critical. This article explores the value of molecular analyses in the detection of cervical lymph node metastasis. METHODS A review of the literature was carried out and combined with our own experience regarding the role of molecular analyses in detecting cervical lymph node metastasis. RESULTS Few studies have demonstrated the diagnostic and prognostic relevance of molecular analysis in detecting tumor cells in lymph nodes. Nodal staging was improved by the use of molecular techniques; when compared with histopathologic examination, however, the small sample size of these studies did not allow definitive conclusions. CONCLUSIONS Molecular analysis is exquisitely sensitive in detecting very small cancer deposits within lymph nodes. It provides an oncologic basis that may be used to guide therapy and influence outcomes. It should be recommended for diagnostic use in controlled studies of patients without evidence of lymph node metastasis on routine hematoxylin-eosin-stained sections. The clinical significance of these types of metastases, however, must be determined with carefully designed and controlled prospective clinical trials.
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Affiliation(s)
- Mohamed N Elsheikh
- Department of Otolaryngology-Head and Neck Surgery, Tanta University, Tanta, Egypt
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Leikola JP, Toivonen TS, Krogerus LA, von Smitten KAJ, Leidenius MHK. Rapid immunohistochemistry enhances the intraoperative diagnosis of sentinel lymph node metastases in invasive lobular breast carcinoma. Cancer 2005; 104:14-9. [PMID: 15929120 DOI: 10.1002/cncr.21133] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The sensitivity of the intraoperative diagnosis of sentinel lymph node (SLN) micrometastases and the metastases of invasive lobular carcinoma (ILC) is low. The goal of the current study was to assess whether the use of intraoperative, rapid immunohistochistochemistry (IHC) enhances the intraoperative detection of micrometastases and metastases of ILC. METHODS The sensitivity of the intraoperative diagnosis of SLN metastasis was evaluated in 438 patients when using rapid IHC with a cytokeratin biomarker. The results were compared with those obtained for 557 patients without rapid IHC but with conventional staining. RESULTS For patients with ILC, the sensitivity of the intraoperative diagnosis was 87% (45 of 52) in the IHC group and 66% (39 of 59) in the non-IHC group (P = 0.02). The sensitivity of the intraoperative diagnosis was similar for patients with other types of invasive cancer regardless of the use of rapid IHC. However, rapid IHC enhanced marginally the intraoperative diagnosis of the smallest micrometastases, isolated tumor cells (P = 0.06). CONCLUSIONS Rapid IHC with cytokeratin labeling enhanced the intraoperative diagnosis of SLN metastases in patients with ILC. It may also improve the intraoperative diagnosis of micrometastases.
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Veronesi U, Orecchia R, Zurrida S, Galimberti V, Luini A, Veronesi P, Gatti G, D'Aiuto G, Cataliotti L, Paolucci R, Piccolo P, Massaioli N, Sismondi P, Rulli A, Lo Sardo F, Recalcati A, Terribile D, Acerbi A, Rotmensz N, Maisonneuve P. Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy. Ann Oncol 2005; 16:383-8. [PMID: 15668261 DOI: 10.1093/annonc/mdi089] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. PATIENTS AND METHODS From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. RESULTS After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms. CONCLUSIONS This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.
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Affiliation(s)
- U Veronesi
- Division of Senology, European Institute of Oncology, Via G. Ripamonti 435, 20141 Milan, Italy.
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22
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Aubard Y, Mollard J, Fermeaux V. Comment éviter les aléas de l’examen extemporané du ganglion sentinelle dans le cancer du sein ? ACTA ACUST UNITED AC 2004; 32:981-4. [PMID: 15567689 DOI: 10.1016/j.gyobfe.2004.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 09/24/2004] [Indexed: 11/22/2022]
Abstract
The sentinel lymph node procedure is now admitted by many teams for axillary evaluation in the early stage of breast cancer. The classical technique consists in an intraoperative examination of the sentinel lymph node under general anaesthesia during tumorectomy, deciding whether or not complete axillary lymphadenectomy must be done. Intraoperative examination seems to us to have a poor predictive value. In the case of a false positive, the surgeon would perform lymphadenectomy unnecessarily, while a false negative would mean that the patient would have to be re-operated for lymphadenectomy once the definitive results have become available. For all these reasons, we propose the detection of the sentinel lymph node under local anaesthesia and to await its definitive analysis before carrying out tumorectomy on the patient and axillary lymphadenectomy if necessary under general anesthesia. Hence, we consider that the best way to avoid the uncertainties of an intraoperative examination of the sentinel lymph node is not to carry out intraoperative examinations.
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Affiliation(s)
- Y Aubard
- Service de gynécologie-obstétrique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
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23
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Fortunato L, Amini M, Farina M, Rapacchietta S, Costarelli L, Piro FR, Alessi G, Pompili P, Bianca S, Vitelli CE. Intraoperative Examination of Sentinel Nodes in Breast Cancer: Is the Glass Half Full or Half Empty? Ann Surg Oncol 2004; 11:1005-10. [PMID: 15525830 DOI: 10.1245/aso.2004.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intraoperative identification of positive sentinel lymph nodes in patients with breast cancer may avoid a return to the operating room. METHODS In a group of 402 consecutive patients with primary breast cancer who underwent sentinel lymph node biopsy, an intraoperative examination (IE) was obtained in 236 cases either by frozen section (FS; n = 68) or by touch preparation cytology (TP; n = 168). RESULTS IE had an accuracy of 89% (209 of 236), but it identified only 52 of 77 positive cases (sensitivity, 68%). There were 25 false-negative cases (13.7%), of which 7 were macrometastases and 18 by micrometastases (P < .001). Six macrometastases were missed by TP and one by FS (P = .9). There were two false-positive cases (3.7%). Overall, 48 (20%) of 236 patients avoided a delayed return to the operating room for a completion lymphadenectomy because of IE findings. This occurred in 10% of patients with tumors <1 cm in diameter, in 20% of those with tumors between 1 and 2 cm, and in 34% of those with tumors >2 cm in diameter (P = .05). The cost savings for the Italian Health System amounted to 198,040 (US$223,794) in these patients. CONCLUSIONS IE has acceptable sensitivity for lymph node macrometastases, but it is a weak tool for diagnosing micrometastases. FS and TP are roughly equivalent. IE allows management changes, because approximately 20% of all patients are expected to undergo synchronous axillary dissection, and it is particularly helpful in T2 patients. This may allow substantial cost savings for the health-care system.
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Affiliation(s)
- Lucio Fortunato
- Departments of General amd Surgical Oncology, Ospedale MG Vannini, Via Acqua Bullicante 4, 00177 Rome, Italy.
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Abstract
The paradigm shift in the assessment of the axilla in breast surgery has evoked specific clinical issues. In a population where breast cancer is diagnosed early and service screening mammography is applied, the chance for a woman to be free of lymph node metastases is approximately 60%. Currently, there are three ongoing and one published randomized series on sentinel node lymphadenectomy in Europe, comprising more than 100 patients. These studies address the important issues of morbidity, quality of life and long-term outcome measures such as survival and recurrence.
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Affiliation(s)
- Kerstin Sandelin
- Department of Surgical Sciences, Karolinska University Hospital, Stockholm, Sweden.
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Hamakawa H, Onishi A, Sumida T, Terakado N, Hino S, Nakashiro KI, Shintani S. Intraoperative real-time genetic diagnosis for sentinel node navigation surgery. Int J Oral Maxillofac Surg 2004; 33:670-5. [PMID: 15337180 DOI: 10.1016/j.ijom.2004.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2004] [Indexed: 10/26/2022]
Abstract
Sentinel node navigation surgery (SNNS) has received considerable attention for its role in deciding whether to perform neck dissection in patients with early oral cancer. However, diagnostic accuracy and its intraoperative availability of results remain important concerns. First, we shortened the examination time required for genetic diagnosis. Second, we assessed the quality of the extracted mRNA. Third, 10 patients with early N0 oral cancer underwent SNNS, using our new technique for genetic diagnosis to determine whether neck dissection was required. The examination time of our one-step reverse-transcriptase polymerase chain reaction method using a minicolumn and LightCycler was successfully shortened to 2 h, permitting intraoperative genetic diagnosis. The extracted mRNA was of high quality. Six sentinel nodes in four patients were diagnosed to be metastatic on genetic diagnosis; these patients underwent neck dissection. The other six patients avoided unnecessary surgery. We conclude that intraoperative genetic diagnosis of micrometastasis holds promise of being a sensitive method that can be used to support SNNS.
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Affiliation(s)
- H Hamakawa
- Department of Oral & Maxillofacial Surgery, Ehime University School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime 791-0295, Japan.
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26
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Merson M, Fenaroli P, Gianatti A, Virotta G, Giuliano LG, Bonasegale A, Bambina S, Pericotti S, Guerra U, Tondini C. Sentinel node biopsy in the surgical management of breast cancer: experience in a general hospital with a dedicated surgical team. Breast 2004; 13:200-5. [PMID: 15177422 DOI: 10.1016/j.breast.2004.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2003] [Revised: 11/25/2003] [Accepted: 01/20/2004] [Indexed: 10/26/2022] Open
Abstract
The aims of this study were to analyse the feasibility and accuracy of the sentinel lymph node biopsy (SLNB) procedure as performed in a general hospital compared with the literature results; to report on the organizational aspects of planning surgical time with higher accuracy of pathological analysis; and to verify that there is a real advantage of SLNB in the surgical management of breast cancer. From October 1999 to September 2000, 371 consecutive patients with T1-2N0 breast lesions underwent SLNB. The immunoscintigraphic method of sentinel node identification was the main one used, the blue dye method being used only when the lymphoscintigraphic method was unsuccessful in identifying sentinel nodes. SLNB was done under either general or local anaesthesia, depending on how the surgical procedure was organized and clinically planned. SLNB was successful in 99% of these T1-2N0 breast cancer cases, and in 71% no metastases were found in the sentinel node. In 47% of cases with axillary metastasis only the sentinel node was involved. Nodal involvement was not present in any case of microinvasive or in situ carcinoma. In T1 cancers nodal involvement was present in 21%; in T2 cases the corresponding rate reached 51%. The results obtained with the SLNB procedure at Bergamo Hospital are similar to the literature data. When a dedicated surgical team, the nuclear medicine department and the pathology department work together, a general hospital can provide breast cancer patients with appropriate surgical treatment.
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Affiliation(s)
- M Merson
- Breast Cancer Unit, Ospedali Riuniti, Largo Barozzi 1, 24128 Bergamo, Italy.
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Torrenga H, Meijer S, Fabry H, van der Sijp J. Sentinel node biopsy in breast cancer patients: triple technique as a routine procedure. Ann Surg Oncol 2004; 11:231S-5S. [PMID: 15023758 DOI: 10.1007/bf02523635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Since its introduction in the early 1990s, the sentinel node (SN) concept in breast cancer has been validated by many studies. Because SN biopsy in breast cancer enables the identification of node-negative axillae, the potential morbidity of an axillary lymph node dissection (ALND) can be avoided. The SN procedure is still surrounded by many variables and uncertainties, such as the clinical relevance of micrometastases. However, the main goal is to avoid unnecessary ALND in node-negative breast cancer patients. Sufficient clinical data are available to achieve this goal by incorporating the SN procedure into routine clinical practice. The ultimate safety of the applied technique will be determined by the number of axillary recurrences during long-term follow-up. Preoperative lymphoscintigraphy and intraoperative use of both blue dye and a hand-held gamma probe-the triple technique-has been applied at our institute since early 1994.
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Affiliation(s)
- Hans Torrenga
- Department of Surgical Oncology, VU Medical Center, Amsterdam, The Netherlands
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Chao C, Abell T, Martin RC, Mcmasters KM. Intraoperative Frozen Section of Sentinel Nodes: A Formal Decision Analysis. Am Surg 2004. [DOI: 10.1177/000313480407000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients’ quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to choose FS versus PS should be based on individual patient risk and preference because the decision analysis indicated that these two options are equivalent with respect to patient quality of life.
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Affiliation(s)
- Celia Chao
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Troy Abell
- Abell Research Consulting, Ouray, Colorado, and the
| | - Robert C.G. Martin
- Division of Surgical Oncology, J. Graham Brown Cancer Center, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kelly M. Mcmasters
- Division of Surgical Oncology, J. Graham Brown Cancer Center, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Bedrosian I, Bedi D, Kuerer HM, Fornage BD, Harker L, Ross MI, Ames FC, Krishnamurthy S, Edeiken-Monroe BS, Meric F, Feig BW, Akins J, Singletary SE, Mirza NQ, Hunt KK. Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol 2004; 10:1025-30. [PMID: 14597440 DOI: 10.1245/aso.2003.12.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Ultrasonography and fine-needle aspiration (FNA) are used to evaluate the breast and regional nodes in breast cancer patients. We sought to identify factors influencing the sensitivity of ultrasonography for detection of nodal metastasis. METHODS Patients with a clinically negative axilla who underwent axillary ultrasonography and sentinel lymph node biopsy were included. RESULTS Of 208 patients, axillary ultrasonography was negative in 180 (86%) and suspicious or indeterminate in 28 (14%). FNA was performed in 22 patients whose findings were indeterminate or suspicious, and 3 were positive for malignancy. Final pathological examinations revealed positive nodes in 53 patients: 39 (22%) of 180 with negative ultrasonographic findings and 14 (50%) of 28 with indeterminate or suspicious ultrasonographic findings (P =.001). Excisional biopsy was more common for patients with indeterminate or suspicious findings on preoperative ultrasonography (P =.038). There were no significant differences in tumor size, histological features, size of nodal metastasis, or number of positive nodes between patients whose ultrasonography findings were negative and those whose findings were indeterminate or suspicious. CONCLUSIONS Ultrasonographically suggested nodal metastasis is associated with the finding of nodal disease on final pathological examination. No significant clinicopathologic criteria were found to impact sensitivity of ultrasonography; however, excisional biopsy for diagnosis may be a confounding variable in subsequent axillary ultrasonography.
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Affiliation(s)
- Isabelle Bedrosian
- Departments of Surgical Oncology,The University of Texas M D Anderson Cancer Center, Houston, Texas 77030, USA
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Leidenius MHK, Krogerus LA, Toivonen TS, Von Smitten KJA. The feasibility of intraoperative diagnosis of sentinel lymph node metastases in breast cancer. J Surg Oncol 2003; 84:68-73. [PMID: 14502779 DOI: 10.1002/jso.10296] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the study was to analyse in detail the feasibility of intraoperative assessment of sentinel lymph nodes in breast cancer. METHODS Altogether 139 consecutive breast cancer patients with metastases in axillary sentinel nodes were included in a prospective study. A combination of imprint cytology and frozen section was used as the method of intraoperative diagnosis of sentinel node metastases. The definite postoperative evaluation of the sentinel nodes was taken as the gold standard. RESULTS The overall sensitivity of intraoperative diagnosis was 83%, reaching 81% if the intraoperative assessment had been limited to the two first retrieved sentinel nodes. False negative (FN) findings were more common in connection with invasive lobular carcinoma (28%) than with invasive ductal carcinoma (8%) (P < 0.01) as well as in connection with micro-metastases, in 38% of the cases, compared to the larger metastases, 6% (P < 0.00005). CONCLUSIONS Intraoperative examination of sentinel lymph nodes enables breast surgery, axillary staging, and treatment in the same operation in a substantial proportion of breast cancer patients. Hospital costs as well as workload in the pathology laboratory may be reduced, limiting the intraoperative assessment to the two first retrieved nodes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Feasibility Studies
- Humans
- Intraoperative Period
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Staging
- Prospective Studies
- Sensitivity and Specificity
- Sentinel Lymph Node Biopsy
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Liang R, Craik J, Juhasz ES, Harman CR. Imprint cytology versus frozen section: intraoperative analysis of sentinel lymph nodes in breast cancer. ANZ J Surg 2003; 73:597-9. [PMID: 12887528 DOI: 10.1046/j.1445-2197.2003.02728.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intraoperative analysis of the sentinel node status in breast cancer adds the benefit of proceeding to axillary dissection at the same time as the primary breast operation, without the need for a second trip to theatre. However, the method of intra-operative analysis must be both rapid and accurate for use in this setting. METHODS A prospective series of 20 consecutive patients in one hospital who underwent sentinel node biopsy was performed. Intraoperative evaluation by imprint cytology and frozen section was compared with the final histopathological results. The time taken for both procedures was recorded. RESULTS A total of 21 sentinel node procedures was performed. The sentinel node was found in 20 procedures (95%). The average time to perform intraoperative pathological analysis was 17 min (range: 5-35 min). Of the eight positive sentinel nodes, five were positive on imprint cytology alone and five were positive on frozen section alone (62.5% accuracy). The statistical false negative rate was 18.8% and the 'false reassurance rate' (patients with an initially negative node that was subsequently positive on formal histology who required a second trip to theatre for axillary dissection) was 37.5%. All patients with a negative sentinel node had a negative axilla. CONCLUSIONS Intraoperative analysis of sentinel lymph nodes in breast cancer can be performed quickly. Imprint cytology and frozen section show comparable accuracy in predicting sentinel node status.
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Affiliation(s)
- Rhea Liang
- Department of Surgery North Shore Hospital, Auckland, New Zealand.
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van Berlo CLH, Hess DA, Nijhuis PAH, Leys E, Gerritsen HAM, Schapers RFM. Ambulatory sentinel node biopsy under local anaesthesia for patients with early breast cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2003; 29:383-5. [PMID: 12711294 DOI: 10.1053/ejso.2002.1420] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Sentinel lymph node biopsy (SLNB) may permit reliable identification of patients with axillary node involvement. The aim of this study was to report our experience with this procedure under local anaesthesia. METHODS One hundred and sixty-two patients underwent a sentinel node procedure under local anaesthesia without sedation. The SLN was identified by (99m)Tc-nano-colloid and patent blue. Immediate histopathologic examination and immunohistochemistry was performed. Patients with positive SLNs proceded to axillary dissection under general anaesthesia. RESULTS In all 162 patients the SLN ('s) were found using blue dye and gamma-probe. The SLN was positive in 55/162 patients (34%). Five of these were detected using immunohistochemistry only. CONCLUSIONS A 100% detection rate of sentinel nodes in early breast cancer harvested under local anaesthesia was achieved without serious morbidity. This allows the surgeon to select preoperatively the treatment given to the patient.
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Affiliation(s)
- C L H van Berlo
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands.
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Affiliation(s)
- David R McCready
- epartment of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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Zurrida S, Orecchia R, Galimberti V, Luini A, Giannetti I, Ballardini B, Amadori A, Veronesi G, Veronesi U. Axillary radiotherapy instead of axillary dissection: a randomized trial. Italian Oncological Senology Group. Ann Surg Oncol 2002; 9:156-60. [PMID: 11888872 DOI: 10.1007/bf02557367] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgical dissection of the axilla is a standard part of the treatment of breast cancer but, by itself, does not improve prognosis; furthermore, most patients with small-sized breast cancer and a clinically uninvolved axilla never develop axillary metastases. We evaluated disease-free and overall survival in patients with early breast cancer treated by breast-conservation surgery without dissection of axillary lymph nodes, receiving or not receiving axillary radiotherapy (RT). METHODS From 1995 to 1998, 435 patients older than 45 years with breast cancer up to 1.2 cm were randomized, 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. RESULTS After a follow-up of 28 to 68 months (median, 42 months), two women (1%) in the no axillary treatment group and one (.5%) in the axillary RT group developed axillary metastases. Rates of distant metastases and local treatment failure were also very low, and 5-year overall survival was 99%. CONCLUSIONS After a mean of 46 months of follow-up, our results indicate that axillary dissection can be safely avoided in patients with very small invasive carcinomas and a clinically negative axilla. Whether axillary RT should be added can be assessed only by longer follow-up.
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Affiliation(s)
- Stefano Zurrida
- Department of Senology, European Institute of Oncology, Milan, Italy.
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35
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Sentinel node biopsy in the breast cancer: Possibility of the avoidance of axillary node dissection. ARCHIVE OF ONCOLOGY 2002. [DOI: 10.2298/aoo0203192g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
(Conclusion) This researching, and many others, indicates that in certain patients (especially T1a and T1b), under precise criteria, when SN metastases are not present, axillary dissection in the breast cancer (10, 22) and all its consequences (lymphoedeama, numbness, pain, limited movement in the shoulder joint) could be avoided. We should remember that nowadays at least 50% of women undergo axillary nodes dissection within the breast cancer operative treatment because of histopathologically negative nodes.
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