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Nascimento JHF, Vieira ATS, Souza Filho BM, Tomaz SC, Delgado Bocanegra RE, Melo Costa VS, Johnson LFP, Gusmão-Cunha A, Silva Neto MM, Andrade AB. Breast cancer in Brazil: Screening program and surgical approach. Cancer Epidemiol 2021; 73:101970. [PMID: 34216956 DOI: 10.1016/j.canep.2021.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Screening mammography for breast cancer (BC) is a current strategy that reduces the mortality of BC by up to 30 %. Although mastectomy has been an important component of treatment for decades, conservative surgery (lumpectomy) has become the gold-standard approach for most cases, yet it depends on early detection of the BC. METHODS This was an epidemiological study performed through DATASUS (2010-2018). We evaluated the temporal trend of screening mammograms, deaths from BC, and surgical procedures at national, regional and state levels. Statistical analysis was performed on VassarStat®-Website for Statistical Computation (Vassar College, New York, USA) and the R-software (R Foundation, v.4.0.3). RESULTS During 2010-2018 there were 67,392 oncological mastectomies and 48,567 lumpectomies in Brazil's health system. Mastectomies decreased in the Northeast (-3.67 % ± 0.43 per year) and in Bahia state (-3.58 % ± 0.24 per year). Lumpectomies increased in Brazil (median 2.19 (-9.6 to 20.96)), the Northeast (median -12.07 (-25.8 to 9.43)) and Bahia (median 0.16 (-29.1 to 1.9)). Also, screening mammograms increased in Brazil (3.29 % ± 0.43), the Northeast (6.36 % ± 0.49) and Bahia (5.51 % ± 0.31), with 35,317,728 exams during this period. Deaths from BC increased annually in Brazil (+4.13 % ± 0.86), the Northeast (+4.76 % ± 1.45) and Bahia (+5.65 % ± 0.83). CONCLUSION The number of mammograms related to the screening program increased in the years 2010-2018 in Brazil. Furthermore, we identified an increase in lumpectomies as opposed to mastectomies, and this approach is associated with a reduction in hospitalization days by almost a half, which in turn might result in a cost decrease and probably an earlier return to work.
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Affiliation(s)
| | | | | | | | | | | | | | - André Gusmão-Cunha
- Department of Life Sciences, Universidade do Estado da Bahia (UNEB), Salvador, BA, Brazil
| | | | - André Bouzas Andrade
- Department of Life Sciences, Universidade do Estado da Bahia (UNEB), Salvador, BA, Brazil; Hospital Santa Izabel (HSI), Salvador, BA, Brazil.
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Shiono S, Shibata SC, Kabata D, Shintani A, Ikeda T, Fujino Y. Comparison of 1-year recurrence-free survival between sevoflurane and propofol use for general anesthesia management in primary breast cancer surgery. J Anesth 2020; 34:694-701. [DOI: 10.1007/s00540-020-02806-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/31/2020] [Indexed: 12/19/2022]
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Chang YW, Lee HY, Lee CM, Jung SP, Kim WY, Woo SU, Lee JB, Son GS. Sentinel lymph node detection using fluorescein and blue light-emitting diodes in patients with breast carcinoma: A single-center prospective study. Asian J Surg 2020; 43:220-226. [DOI: 10.1016/j.asjsur.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/02/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
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Werutsky G, Nunes P, Barrios C. Locally advanced breast cancer in Brazil: current status and future perspectives. Ecancermedicalscience 2019; 13:895. [PMID: 30792812 PMCID: PMC6372296 DOI: 10.3332/ecancer.2019.895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most frequent cancer and the main cause of cancer deaths among women worldwide and in Brazil. A high proportion of patients are diagnosed with locally advanced breast cancer (LABC) in Brazil, mainly due to limited coverage of screening programmes. A disparity in the access to optimal treatment is evident between the public and private health systems which impact patient outcomes. Clinical research is an opportunity for patients, institutions and investigators and therefore should be facilitated through a better regulatory environment. In a country facing a trend of increasing BC incidence for the next years, it is critical to improve BC screening and incorporate new medicines and devices into the public health system to control the burden of LABC.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group, Porto Alegre 90619-900, Brazil.,Department of Medical Oncology, Hospital São Lucas PUCRS, Porto Alegre 90619-900, Brazil
| | - Paulo Nunes
- Latin American Cooperative Oncology Group, Porto Alegre 90619-900, Brazil.,Department of Medical Oncology, Hospital São Lucas PUCRS, Porto Alegre 90619-900, Brazil
| | - Carlos Barrios
- Latin American Cooperative Oncology Group, Porto Alegre 90619-900, Brazil.,Department of Medical Oncology, Hospital São Lucas PUCRS, Porto Alegre 90619-900, Brazil
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DE Aguiar PHW, Aquino RGFDE, Alves MM, Correia JMS, Oliveira ALDES, Viana AB, Pinheiro LGP. Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer. ACTA ACUST UNITED AC 2017; 44:612-618. [PMID: 29267558 DOI: 10.1590/0100-69912017006013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/17/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. METHODS clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. RESULTS identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. CONCLUSION autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.
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Affiliation(s)
| | - Ranniere Gurgel Furtado DE Aquino
- - Federal University of Ceará, Medical Surgical Sciences Post-Graduate Program, Fortaleza, CE, Brazil.,- Fortaleza University School of Medicine, Fortaleza, CE, Brazil
| | - Mayara Maia Alves
- - Federal University of Ceará, Biotechnology Post-Graduate Program (RENORBIO), Fortaleza, CE, Brazil
| | | | | | - Antônio Brazil Viana
- - Ceará Federal University, Walter Cantídio University Hospital, Fortaleza, CE, Brazil
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Agrawal SK, Shenoy SS, Nalawade N, Datta SS, Roy S, Chatterjee S, Arun I, Ahmed R. Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer: Applicability and Clinical Relevance in a Non-screened Population. Indian J Surg Oncol 2017; 9:312-317. [PMID: 30287989 DOI: 10.1007/s13193-017-0695-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022] Open
Abstract
Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer: Applicability and Clinical Relevance in a Non-screened Population: sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as standard of care for management of early breast cancer. This study assessed our SLNB program against 11 published quality indicators (QIs). All breast cancer patients who underwent SLNB in our centre from June 2013-Dec 2015 were included. Clinical, pathological and follow-up data were extracted from the institutional REDCap data system. Analysis was done with SPSS 23. Following validation, 234 patients had SLNB, always performed along with primary surgery. Identification rate was 95.3% and > 1 SLN was identified in 72% of patients. SLNB positivity was 33%, of these, 100% underwent ALND. Overall 91% of QI eligible patients underwent SLNB. No ineligible patients (T4) underwent SLNB. For the patients who had radio colloid, injection criteria were met for 100%. Pathological evaluation and reporting criteria were met for 100% of patients. There were no axillary recurrences in a median follow-up of 2 years. 7.6% patients had SLN negative on frozen section but positive on final histology. 7.2% of patients with clinical negative nodes had pN2 disease in final histopathology report after surgery. Sixty percent of patients who had completion ALND had only positive SLN. This study supports the applicability of published QI of SLNB in a non-screened cohort of early breast cancer patients. Although QI were useful, modification based on patient characteristics and resource availability may be needed. These indicators can be used as audit tools to improve the overall accuracy of the procedure.
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Affiliation(s)
| | | | - Nikhil Nalawade
- 1Department of Breast Oncosurgery, Tata Medical Center, Kolkata, India
| | | | - Soumendranath Roy
- 3Department of Nuclear Medicine, Tata Medical Center, Kolkata, India
| | - Sanjoy Chatterjee
- 4Department of Clinical Oncology, Tata Medical Center, Kolkata, India
| | - Indu Arun
- 5Department of Pathology, Tata Medical Center, Kolkata, India
| | - Rosina Ahmed
- 1Department of Breast Oncosurgery, Tata Medical Center, Kolkata, India
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Zhang X, Li Y, Zhou Y, Mao F, Lin Y, Guan J, Sun Q. Diagnostic Performance of Indocyanine Green-Guided Sentinel Lymph Node Biopsy in Breast Cancer: A Meta-Analysis. PLoS One 2016; 11:e0155597. [PMID: 27280407 PMCID: PMC4900647 DOI: 10.1371/journal.pone.0155597] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/29/2016] [Indexed: 01/24/2023] Open
Abstract
Background The diagnostic performance of indocyanine green (ICG) fluorescence-guided sentinel lymph node biopsy (SLNB) for the presence of metastases in breast cancer remains unclear. Objective We performed a meta-analysis to investigate the diagnostic performance of ICG-guided SLNB. Methods Eligible studies were identified from searches of the databases PubMed and EMBASE up to September 2015. Studies that reported the detection rate of ICG fluorescence-guided SLNB with full axillary lymph node dissection and histological or immunohistochemical examinations were included. A meta-analysis was performed to generate pooled detection rate, sensitivity, specificity, false negative rate, diagnostic odds ratio (DOR) and a summary receiver operator characteristic curve (SROC). Results Nineteen published studies were included to generate a pooled detection rate, comprising 2594 patients. The pooled detection rate was 0.98 (95% confidence interval [CI], 0.96–0.99). Six studies finally met the criteria for meta-analysis, which yielded a pooled sensitivity of 0.92 (95% CI, 0.85–0.96), specificity 1 (95% CI, 0.97–1), and DOR 311.47 (95% CI, 84.11–1153.39). The area under the SROC was 0.9758. No publication bias was found. Conclusion ICG fluorescence-guided SLNB is viable for detection of lymph node metastases in breast cancer. Large-scale randomized multi-center trials are necessary to confirm our results.
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Affiliation(s)
- Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jinghong Guan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
- * E-mail:
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Vasques PHD, Alves MM, Aquino RGFD, Torres RVA, Bezerra JLM, Brasileiro LP, Pinheiro LGP. Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer. Acta Cir Bras 2015; 30:785-90. [DOI: 10.1590/s0102-865020150110000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
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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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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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How to identify patients with increased risk of breast cancer relapse? Appl Immunohistochem Mol Morphol 2015; 22:488-97. [PMID: 23958543 DOI: 10.1097/pai.0b013e3182915951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A cohort of 362 breast cancer patients had subtype classification accomplished using 4 immunohistochemical markers: luminal A (ER or PR positive, HER2 negative, Ki-67<14%), luminal B (ER or PR positive, HER2 negative, Ki-67≥14%), luminal HER2 (ER or PR positive, HER2 positive), HER2 enriched (ER or PR negative, HER2 positive) or triple negative (ER, PR, and HER2 negative). Multivariable Cox analysis was used to determine the risk of local (LR) or distant (DR) relapse associated with the intrinsic subtypes, adjusting for standard clinicopathologic factors. There have been a total of 124 recurrences. Triple-negative patients were associated with increased risk of LR. Luminal B subtype showed statistical tendency (P=0.053) to LR. For patients undergoing breast conservation surgery, luminal B and HER2-enriched subtypes demonstrated an increased risk to LR, and this was statistically significant on multivariable analysis. After mastectomy, there was no statistical difference between subtypes of LR or DR on multivariable analysis. Luminal A tumors are associated with a low risk of LR or DR. Despite the existence of gene expression profiling, in the current study we demonstrate that analysis of 4 immunohistochemical markers is equally effective and less expensive alternative to identify higher recurrence risk patients.
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Parvez E, Hodgson N, Cornacchi SD, Ramsaroop A, Gordon M, Farrokhyar F, Porter G, Quan ML, Wright F, Lovrics PJ. Survey of American and Canadian general surgeons' perceptions of margin status and practice patterns for breast conserving surgery. Breast J 2014; 20:481-8. [PMID: 24966093 DOI: 10.1111/tbj.12299] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although breast conservation surgery (BCS) is commonly performed, several aspects of the procedure remain controversial. We undertook a cross-sectional survey to compare Canadian (CDN) and American (AM) general surgeons' reported BCS practice patterns to better understand the cross-border differences in early-stage breast cancer surgery care. A modified Dillman Method survey was mailed to 1,447 AM and 1,443 CDN surgeons. Factors evaluated included preoperative assessment, margin definition, surgical techniques, and re-excision practices. The response rate was 26% and 51% for AM and CDN surgeons, respectively. There was variation in use of preoperative core biopsies. American surgeons required wider margins for invasive cancer and ductal carcinoma in situ, and more often recommend re-excision for invasive cancer with 1 and 2 mm margins (p < 0.05). There was also variability in surgical techniques used for intraoperative margin assessment. Wide variation in BCS practice was observed, with some of this variability related to surgeon country.
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Affiliation(s)
- Elena Parvez
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Thill M, Kurylcio A, Welter R, van Haasteren V, Grosse B, Berclaz G, Polkowski W, Hauser N. The Central-European SentiMag study: sentinel lymph node biopsy with superparamagnetic iron oxide (SPIO) vs. radioisotope. Breast 2014; 23:175-9. [PMID: 24484967 DOI: 10.1016/j.breast.2014.01.004] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/24/2013] [Accepted: 01/05/2014] [Indexed: 12/11/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is the standard surgical procedure for the axilla in early node-negative breast cancer. To date, the "gold standard" to localize the sentinel lymph node (SLN) is the radiotracer (99m)Tc with or without blue dye. The aim of this study was to evaluate potential equivalency of the new SentiMag(®) technique in comparison to the "gold standard". Within this prospective, multicentric and multinational non-inferiority study including 150 patients (99m)Tc was compared with the magnetic technique, using superparamagnetic iron oxide particles (SPIOs, Sienna+(®)) for localization of SLNs. The results showed a detection rate per patient of 97.3% (146/150) for (99m)Tc vs. 98.0% (147/150) for Sienna+(®) with a similar average number of removed SLNs per patient and a higher per patient malignancy detection rate for the SPIO tracer. We obtained convincing results that magnetic SLNB can be performed easily, safely and equivalently well in comparison to the radiotracer method.
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Affiliation(s)
- Marc Thill
- Department of Gynaecology and Obstetrics, Breast Cancer Centre, Agaplesion Markus Hospital, Frankfurt, Germany.
| | - Andrzej Kurylcio
- Department of Surgical Oncology, Medical University of Lublin, Poland
| | - Rebekka Welter
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Centre, Kantonsspital Baden, Baden, Switzerland
| | - Viviana van Haasteren
- Department of Gynaecology and Obstetrics, Breast Cancer Centre, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Britta Grosse
- Department of Gynaecology and Obstetrics, Breast Cancer Centre, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Gilles Berclaz
- Breast Centre Bern, Engeriedspital, Lindenhofgruppe, Bern, Switzerland
| | | | - Nik Hauser
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Centre, Kantonsspital Baden, Baden, Switzerland
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Forget P, Bentin C, Machiels JP, Berliere M, Coulie PG, De Kock M. Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery. Br J Anaesth 2014; 113 Suppl 1:i82-7. [PMID: 24464611 DOI: 10.1093/bja/aet464] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and better outcome after mastectomy and lung surgery for cancer has been recently suggested. In a retrospective analysis, we investigated the association between intraoperative NSAIDs use in conservative breast cancer surgery and breast cancer disease-free survival (DFS). Similarly, we also evaluated the association between breast cancer DFS and preoperative neutrophil:lymphocyte ratio (NLR). METHODS A retrospective analysis of a single-centre cohort was performed in breast cancer patients (n=720) with uni- and multivariate analyses, using a Cox regression model. RESULTS In conservative breast cancer surgery, the intraoperative use of NSAIDs (ketorolac or diclofenac) was associated with an improved DFS {hazard ratio (HR)=0.57 [95% confidence interval (CI): 0.37-0.89], P=0.01} and an improved overall survival (OS) [HR=0.35 (95% CI: 0.17-0.70), P=0.03]. In these patients, an NLR >3.3 (identified by a receiver-operating characteristic curve) was associated with a shorter DFS [HR=1.99 (95% CI: 1.16-3.41), P=0.01] and OS [HR=2.35 (95% CI: 1.02-5.43), P=0.046]. CONCLUSIONS Intraoperative NSAIDs and higher preoperative NLR are associated with improved outcome in conservative breast cancer surgery. Prospective, randomized trials to evaluate if these associations are causal are warranted.
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Affiliation(s)
| | | | - J P Machiels
- Department of Medical Oncology, Institut de Recherche Clinique et Expérimentale (pôle MIRO), Université catholique de Louvain, Brussels, Belgium
| | | | - P G Coulie
- de Duve Institute, Université catholique de Louvain, Brussels, Belgium
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Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.09.004] [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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16
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Forget P, Machiels JP, Coulie PG, Berliere M, Poncelet AJ, Tombal B, Stainier A, Legrand C, Canon JL, Kremer Y, De Kock M. Neutrophil:lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery. Ann Surg Oncol 2013; 20 Suppl 3:S650-60. [PMID: 23884751 DOI: 10.1245/s10434-013-3136-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Inflammation is associated with a worse outcome in cancer and neutrophil:lymphocyte ratio (NLR) is a strong prognostic value. In cancer, nonsteroidal anti-inflammatory drugs (NSAIDs) could be of interest. We investigated the prognostic significance of NLR and the impact of intraoperative NSAIDs in cancer surgeries. METHODS We performed an observational study in early breast, kidney, and lung cancers (357, 227, and 255 patients) with uni- and multivariate analyses (Cox model). RESULTS In breast cancer (Centre 1), NLR ≥ 4 is associated with a higher risk of relapse (hazards ratio (HR) = 2.41; 95 % confidence interval (CI) 1.01-5.76; P = 0.048). In breast cancer (Centre 2), NLR ≥ 3 is associated with a higher risk of relapse (HR = 4.6; 95 % CI 1.09-19.1; P = 0.04) and higher mortality (HR = 4.0; 95 % CI 1.12-14.3; P = 0.03). In kidney cancer, NLR ≥ 5 is associated with a higher risk of relapse (HR = 1.63; 95 % CI 1.00-2.66; P = 0.05) and higher mortality (HR = 1.67; 95 % CI 1.0-2.81; P = 0.05). In lung cancer, NLR ≥ 5 is associated with higher mortality (HR = 1.45; 95 % CI 1.02-2.06; P = 0.04). The intraoperative use of NSAIDs in breast cancer patients (Centre 1) is associated with a reduced recurrence rate (HR = 0.17; 95 % CI 0.04-0.43; P = 0.0002) and a lower mortality (HR = 0.25; 95 % CI 1.08-0.75; P = 0.01). NSAIDs use at the beginning of the surgery is independently associated with a lower metastases risk after lung cancer surgery (HR = 0.16; 95 % CI 0.04-0.63; P = 0.009). Ketorolac use is independently associated with longer survival (HR = 0.55; 95 % CI 0.31-0.95; P = 0.03). CONCLUSIONS In these cohorts, these analyses show that NLR is a strong perioperative prognosis factor for breast, lung, and kidney cancers. In this context, intraoperative NSAIDs administration could be associated with a better outcome.
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Affiliation(s)
- Patrice Forget
- Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium,
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Goñi Gironés E, Vicente García F, Serra Arbeloa P, Estébanez Estébanez C, Calvo Benito A, Rodrigo Rincón I, Camarero Salazar A, Martínez Lozano ME. [Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera]. Rev Esp Med Nucl Imagen Mol 2013; 32:343-9. [PMID: 23597424 DOI: 10.1016/j.remn.2013.02.008] [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: 01/22/2013] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
AIM To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. MATERIAL AND METHODS A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. RESULTS The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). CONCLUSIONS The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role.
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Affiliation(s)
- E Goñi Gironés
- Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, España.
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Retsky M, Demicheli R, Hrushesky WJM, Forget P, De Kock M, Gukas I, Rogers RA, Baum M, Sukhatme V, Vaidya JS. Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs: new findings and a review. Curr Med Chem 2013; 20:4163-76. [PMID: 23992307 PMCID: PMC3831877 DOI: 10.2174/09298673113209990250] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/26/2013] [Accepted: 03/31/2013] [Indexed: 12/21/2022]
Abstract
To explain a bimodal pattern of hazard of relapse among early stage breast cancer patients identified in multiple databases, we proposed that late relapses result from steady stochastic progressions from single dormant malignant cells to avascular micrometastases and then on to growing deposits. However in order to explain early relapses, we had to postulate that something happens at about the time of surgery to provoke sudden exits from dormant phases to active growth and then to detection. Most relapses in breast cancer are in the early category. Recent data from Forget et al. suggest an unexpected mechanism. They retrospectively studied results from 327 consecutive breast cancer patients comparing various perioperative analgesics and anesthetics in one Belgian hospital and one surgeon. Patients were treated with mastectomy and conventional adjuvant therapy. Relapse hazard updated Sept 2011 are presented. A common Non-Steroidal Anti-Inflammatory Drug (NSAID) analgesic used in surgery produced far superior disease-free survival in the first 5 years after surgery. The expected prominent early relapse events in months 9-18 are reduced 5-fold. If this observation holds up to further scrutiny, it could mean that the simple use of this safe, inexpensive and effective anti-inflammatory agent at surgery might eliminate early relapses. Transient systemic inflammation accompanying surgery could facilitate angiogenesis of dormant micrometastases, proliferation of dormant single cells, and seeding of circulating cancer stem cells (perhaps in part released from bone marrow) resulting in early relapse and could have been effectively blocked by the perioperative anti-inflammatory agent.
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Affiliation(s)
- Michael Retsky
- Harvard School of Public Health, BLDG I, Rm 1311, 665 Huntington, Ave, Boston, MA 02115, USA.
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Lovrics PJ, Gordon M, Cornacchi SD, Farrokhyar F, Ramsaroop A, Hodgson N, Quan ML, Wright F, Porter G. Practice patterns and perceptions of margin status for breast conserving surgery for breast carcinoma: National Survey of Canadian General Surgeons. Breast 2012; 21:730-4. [DOI: 10.1016/j.breast.2012.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/16/2012] [Accepted: 07/29/2012] [Indexed: 11/26/2022] Open
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Hirano A, Kamimura M, Ogura K, Kim N, Hattori A, Setoguchi Y, Okubo F, Inoue H, Miyamoto R, Kinoshita J, Fujibayashi M, Shimizu T. A comparison of indocyanine green fluorescence imaging plus blue dye and blue dye alone for sentinel node navigation surgery in breast cancer patients. Ann Surg Oncol 2012; 19:4112-6. [PMID: 22782671 DOI: 10.1245/s10434-012-2478-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate two methods of sentinel node navigation surgery (SNNS) using blue dye with and without indocyanine green (ICG) fluorescence imaging (FI) to determine the usefulness of combined ICG and blue dye. METHODS Between 2005 and 2010, a total of 501 patients underwent SNNS in our hospital. Detection of sentinel lymph node (SLN) was performed with sulfan blue (SB) alone until 2008 and with a combination of SB and ICG-FI since 2009. ICG 5 mg and SB 15 mg were injected in the subareolar region, and FI was obtained by a fluorescence imaging device. RESULTS We attempted to identify SLNs in 393 patients by SB alone and in 108 patients by a combination of SB and FI. The mean number of SLNs detected was 1.6 (0-5) for SB alone and 2.2 (1-6) for the combination method. The SLN identification rate was 95.7 % for SB alone and 100 % for the combination method so that the combination was significantly superior to SB in terms of the identification rate (p = 0.0037). In patients who received the combination method, detection of SLN was made through only SB in 1 patient, only ICG in 8 patients, and both in 99 patients. Lymph node metastasis was found in 56 patients with SB alone and in 16 patients with the combination method. Recurrence of an axillary node was observed in 3 patients (0.8 %) with SB alone and in no patients with the combination method. CONCLUSIONS ICG-FI is a useful method and is especially recommended in cases where no radiotracers are available.
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Affiliation(s)
- Akira Hirano
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Nishiogu 2-1-10, Arakawa-ku, Tokyo 116-8567, Japan.
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Stordeur S, Vrijens F, Devriese S, Beirens K, Van Eycken E, Vlayen J. Developing and measuring a set of process and outcome indicators for breast cancer. Breast 2012; 21:253-60. [DOI: 10.1016/j.breast.2011.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/05/2011] [Accepted: 10/12/2011] [Indexed: 11/17/2022] Open
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Waters PS, Piggott RP, McDermott AM, Sweeney KJ, Kerin MJ. The impact of international guidelines on breast cancer management. BREAST CANCER MANAGEMENT 2012. [DOI: 10.2217/bmt.12.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY In Europe, breast cancer is the most common type of cancer among women and has an annual incidence of 2000 new cases per 1,050,000. Over the past two decades, there has been a massive increase in breast cancer diagnosis, and the therapeutic strategies have changed with increasing knowledge. Most breast cancer programs are now integrated into either national or international cancer networks, and there has been a trend towards development of consensus conferences and guidelines. With this greater understanding and the publication of initial treatment guidelines in the latter half of the 1980s, there has been a reduction in associated mortality rates. Increased experience has led to vast changes in practice, requiring guidelines to constantly evolve with research findings. This leads one to question the concept of guidelines and their ability to be correct and up to date for the treatment of individual patients with breast cancer.
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Affiliation(s)
- Peadar S Waters
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Robert P Piggott
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Ailbhe M McDermott
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Karl J Sweeney
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
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Eggemann H, Ignatov A, Krocker J, Neuss K, Elling D, John J, Costa SD. Comparative study of surgical margins and cosmetic outcome in lumpectomy versus segmental resection in breast cancer. Eur Surg Res 2011; 47:231-9. [PMID: 22056494 DOI: 10.1159/000333090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/20/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present retrospective study was to compare two breast-conserving techniques, segmental resection and standard lumpectomy, for the treatment of breast cancer regarding their oncological safety. Quality of life aspects were evaluated by assessing the respective postsurgical cosmetic results. PATIENTS AND METHODS 190 women with breast cancer located in the superior and lateral quadrant were included in the study. Sixty patients were treated with segmental resection (group 1), whereas 130 underwent standard lumpectomy (group 2). Tumor sizes were determined and excised tissue specimens were analyzed for positive or negative resection margins. Patients were given a 16-item questionnaire for the postsurgical self-assessment of the cosmetic outcome. RESULTS No statistically significant difference was found concerning the number of positive resection margins between the groups (25 vs. 30%, p = 0.46). Exceptions were ventral margins, which predominated in group 2 (p = 0.016). Group 1 revealed a significantly larger maximum tumor size with negative margins as compared to group 2 (26.6 vs. 17.0 mm). General satisfaction with the cosmetic results was comparable between groups. CONCLUSIONS Segmental resection surgery, as a method of breast conservation therapy, can be used to treat larger breast lesions as compared to standard lumpectomy.
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Affiliation(s)
- H Eggemann
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, Magdeburg, Germany.
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25
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Wang Z, Wu LC, Chen JQ. Sentinel lymph node biopsy compared with axillary lymph node dissection in early breast cancer: a meta-analysis. Breast Cancer Res Treat 2011; 129:675-89. [DOI: 10.1007/s10549-011-1665-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/28/2011] [Indexed: 11/30/2022]
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Dickson-Witmer D, Bleznak AD, Kennedy JS, Stewart AK, Palis BE, Bailey L, Laidley AL, Penman EJ. Breast Cancer Care in the Community: Challenges, Opportunities, and Outcomes. Surg Oncol Clin N Am 2011; 20:555-80, ix. [DOI: 10.1016/j.soc.2011.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The relationship between quality and cost during the perioperative breast cancer episode of care. Breast 2010; 19:289-96. [DOI: 10.1016/j.breast.2010.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Wells BJ, Najjar H, Wright FC, Holloway CMB, Fraser N, McCready D, Quan ML. Measuring the quality of sentinel lymph node biopsy in breast cancer using newly developed quality indicators: a feasibility study. Ann Surg Oncol 2010; 18:78-85. [PMID: 20625839 DOI: 10.1245/s10434-010-1190-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Indexed: 01/01/2023]
Abstract
BACKGROUND Measurement of the quality of sentinel lymph node biopsy (SLNB) has not been reported beyond the false-negative rate and sentinel lymph node identification rate. This study's purpose is to determine the feasibility of measuring 11 quality indicators (QIs) that were recently developed using a modified Delphi process. METHODS All patients who underwent SLNB for breast cancer at a tertiary health-care center from January 1st 2005 to December 31st 2007 were identified using a SLNB registry. Patient charts were reviewed retrospectively and the QIs were abstracted. RESULTS Nine of the 11 QIs were measurable: 7 required chart-level abstraction, 2 were confirmed at an institutional level, and 2 were immeasurable due to registry limitations. Of the 497 identified patients, 13 patients had failed SLNB, resulting in 484 SLNBs. The axillary positivity rate was 19%. The method of SLN identification was reported in 97% of cases, and in 388 (80%) more than one SLN was removed. All SLNs were serially sectioned according to protocol, though only 102 (21%) of pathology reports explicitly stated the cancer stage. Nearly all SLNBs were performed alongside the primary breast surgery. Among SLN-positive patients: 78 (87%) underwent axillary lymph node dissection, 10 patients refused, and chart data were missing in 2 others. No "ineligible" patients had SLNB. CONCLUSION Measurement of newly developed QIs for SLNB is feasible for abstraction from inpatient charts at a single institution. These QIs can provide baseline measures for ongoing quality assessment of SLNB using hospital chart review.
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Affiliation(s)
- Bryan J Wells
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.
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Temple WJ, Francis WP, Tamano E, Dabbs K, Mack LA, Fields A. Synoptic surgical reporting for breast cancer surgery: an innovation in knowledge translation. Am J Surg 2010; 199:770-5. [DOI: 10.1016/j.amjsurg.2009.07.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 11/17/2022]
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Forget P, Vandenhende J, Berliere M, Machiels JP, Nussbaum B, Legrand C, De Kock M. Do intraoperative analgesics influence breast cancer recurrence after mastectomy? A retrospective analysis. Anesth Analg 2010; 110:1630-5. [PMID: 20435950 DOI: 10.1213/ane.0b013e3181d2ad07] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Whether intraoperative analgesics have an impact on postoperative cancer recurrence is unknown. Some investigations suggest that the opioids could favor relapse and that regional analgesia and nonsteroidal antiinflammatory drugs could improve cancer prognosis. We retrospectively reviewed our series of breast cancer surgery patients. METHODS This retrospective study included 327 consecutive women who underwent mastectomy with axillary dissection for breast cancer. The main objective was to compare the incidence of cancer recurrence among patients who received different analgesics during surgery. RESULTS Perioperative characteristics, cancer prognostic factors, and the length of surgery were comparable regardless of the analgesics administered. Univariate and multivariate analyses showed a lower cancer recurrence rate when ketorolac was given before surgery (P = 0.019). Other analgesics (sufentanil, ketamine, and clonidine) were not associated with a significant reduction in cancer recurrence rates in our series. CONCLUSION This retrospective analysis suggests that intraoperative administration of ketorolac decreases the risk of breast cancer relapse compared with other analgesícs.
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Affiliation(s)
- Patrice Forget
- Department of Anesthesiology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
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Abstract
The role of the breast cancer surgeon has changed from one with performance of one operation, to a position in which the surgeon is the patient's initial contact, leader of a multidisciplinary team, the clinical leader who ensures that the patient receives the most appropriate breast cancer treatment and then also receives follow up and surveillance services. Breast conservation rates, patient satisfaction rates, clear margins, use of oncoplastic surgical techniques, appropriate referral to other consultants, clinical trial referral, and survival rates are all higher when patients are cared for by breast-focused surgeons. This new role requires greater time both before and after surgery to provide the proper planning and care for these patients. Women with breast cancer should have access to these dedicated breast-focused surgeons. Recognition of this expanding responsibility and reimbursement for this time and expertise is needed so that women with breast cancer can be offered the highest quality of care.
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ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat 2010; 121:373-8. [PMID: 20140704 DOI: 10.1007/s10549-010-0760-z] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/19/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is a selective approach to axillary staging of breast cancer with reduced morbidity. Current detection methods including radioisotope and blue dye show good results but some drawbacks are remaining. Indocyanine green (ICG) fluorescence detection was evaluated as a new method for SLN biopsy in breast cancer allowing both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLN. METHODS Forty-three women with clinically node negative breast cancer received subareolar injection of ICG for fluorescence detection of SLN. All patients underwent either planned axillary lymph node dissection (ALND) with SLN biopsy or selective SLN biopsy to determine need for ALND. Clinical feasibility, detection rate, sensitivity, and axillary recurrence after isolated SLN biopsy were analyzed. RESULTS Overall ICG fluorescence imaging identified 2.0 SLN in average in 42 of 43 patients (detection rate: 97.7%). Metastatic involvement of the SLN was found in 17 of 18 nodal positive patients by conventional histopathology (sensitivity: 94.4%). Immunohistochemistry revealed isolated tumor cells in five further cases. There was only one false-negative case in 43 patients (5.6%). In 17 of 23 overall nodal positive patients, the SLN was the only positive lymph node. After a median follow-up of 4.7 years none of the patients presented with axillary recurrence. CONCLUSION ICG fluorescence imaging is a new method for SLN biopsy in breast cancer with acceptable sensitivity and specificity comparable to conventional methods. One advantage of this technique is that it allows transcutaneous visualization of lymphatic vessels and intraoperative lymph node detection without radioisotope.
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Capdet J, Martel P, Charitansky H, Lim Y, Ferron G, Battle L, Landier A, Mery E, Zerdoub S, Roche H, Querleu D. Factors predicting the sentinel node metastases in T1 breast cancer tumor:An analysis of 1416 cases. Eur J Surg Oncol 2009; 35:1245-9. [DOI: 10.1016/j.ejso.2009.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/28/2009] [Accepted: 06/02/2009] [Indexed: 11/17/2022] Open
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The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer. Am J Surg 2009; 197:740-6. [DOI: 10.1016/j.amjsurg.2008.03.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Revised: 03/21/2008] [Accepted: 03/21/2008] [Indexed: 01/10/2023]
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Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer 2009; 9:108. [PMID: 19356240 PMCID: PMC2679762 DOI: 10.1186/1471-2407-9-108] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 04/08/2009] [Indexed: 11/17/2022] Open
Abstract
Background One of the basic prerequisites for generating evidence-based data is the availability of classification systems. Attempts to date to classify breast cancer operations have focussed on specific problems, e.g. the avoidance of secondary corrective surgery for surgical defects, rather than taking a generic approach. Methods Starting from an existing, simpler empirical scheme based on the complexity of breast surgical procedures, which was used in-house primarily in operative report-writing, a novel classification of ablative and breast-conserving procedures initially needed to be developed and elaborated systematically. To obtain proof of principle, a prospectively planned analysis of patient records for all major breast cancer-related operations performed at our breast centre in 2005 and 2006 was conducted using the new classification. Data were analysed using basic descriptive statistics such as frequency tables. Results A novel two-type, six-tier classification system comprising 12 main categories, 13 subcategories and 39 sub-subcategories of oncological, oncoplastic and reconstructive breast cancer-related surgery was successfully developed. Our system permitted unequivocal classification, without exception, of all 1225 procedures performed in 1166 breast cancer patients in 2005 and 2006. Conclusion Breast cancer-related surgical procedures can be generically classified according to their surgical complexity. Analysis of all major procedures performed at our breast centre during the study period provides proof of principle for this novel classification system. We envisage various applications for this classification, including uses in randomised clinical trials, guideline development, specialist surgical training, continuing professional development as well as quality of care and public health research.
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Affiliation(s)
- Jürgen Hoffmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany.
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Bae YT. Oncoplastic Breast Surgery. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.10.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young-tae Bae
- Division of Breast Surgery, Pusan National University College of Medicine, Korea.
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Thorat MA, Rangole A, Nadkarni MS, Parmar V, Badwe RA. Revision surgery for breast cancer. Cancer 2008; 113:2347-52. [DOI: 10.1002/cncr.23839] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Reitsamer R, Menzel C, Glueck S, Hitzl W, Peintinger F. Predictors of Mastectomy in a Certified Breast Center The Surgeon is an Independent Risk Factor. Breast J 2008; 14:324-9. [DOI: 10.1111/j.1524-4741.2008.00592.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kirby RM, Basit A, Nguyen QT, Jaipersad A, Billingham R. Three stage axillary lymphatic massage optimizes sentinel lymph node localisation using blue dye. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2007; 4:30. [PMID: 18154682 PMCID: PMC2248582 DOI: 10.1186/1477-7800-4-30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 12/22/2007] [Indexed: 11/10/2022]
Abstract
Aims This paper describes a simple technique of axillary and breast massage which improves the successful identification of blue sentinel nodes using patent blue dye alone. Methods Patent blue dye was injected in the subdermal part of the retroaroelar area in 167 patients having surgical treatment for invasive breast cancer. Three stage axillary lymphatic massage was performed prior to making the axillary incision for sentinel lymph node biopsy. All patients had completion axillary sampling or clearance. Results A blue lymphatic duct leading to lymph nodes of the first drainage was identified in 163 (97%) of the patients. Results are compared with 168 patients who had sentinel lymph node biopsy using blue dye without axillary massage. Allergic reactions were observed in four patients (1.2%). Conclusion Three stage axillary lymphatic massage improves the successful identification of a blue sentinel lymph node in breast cancer patients.
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Affiliation(s)
- Robert M Kirby
- Breast Unit, University Hospital of North Staffordshire, Keele University, Stoke-on-Trent, UK.
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Hussein O, El-Nahhas W, El-Saed A, Denewer A. Video-assisted axillary surgery for cancer: Non-randomized comparison with conventional techniques. Breast 2007; 16:513-9. [PMID: 17532217 DOI: 10.1016/j.breast.2007.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 03/08/2007] [Accepted: 03/25/2007] [Indexed: 01/22/2023] Open
Abstract
Endoscopic techniques have been introduced in most of surgical disciplines including surgery for breast cancer. However, there is shortage of evidence-based guidelines and oncological outcome data. We present a controlled trial of endoscopic axillary surgery for breast cancer with mid-term oncologic results. Fifty cases of axilloscopy for sentinel node biopsy, axillary sampling or full axillary dissection were included. Sentinel node biopsy was accomplished with the blue dye technique. Full axillary dissection was performed with a three-port approach with gas insufflation without liposuction. Endoscopic axillary dissection significantly lowered duration of drainage and operative blood loss. Lymph node harvest with endoscopic approach was significantly lower than with open procedure. One case developed axillary recurrence. Endoscopic sentinel node biopsy yielded identification rate of 80%. Current data do not justify the oncological safety of resectional endoscopic procedures. Endoscopically assisted axillary cancer surgery is technically feasible. The technique is valuable to maximize utility of blue dye method for sentinel lymphadenectomy in areas with no access to radio-guided surgery.
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Affiliation(s)
- Osama Hussein
- Department of Surgery, Mansoura University Cancer Center, Mansoura University, Mansoura 35516, Egypt.
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de Kok M, Scholte RW, Sixma HJ, van der Weijden T, Spijkers KF, van de Velde CJH, Roukema JA, van der Ent FW, Bell AVRJ, von Meyenfeldt MF. The patient’s perspective of the quality of breast cancer care. Eur J Cancer 2007; 43:1257-64. [PMID: 17467266 DOI: 10.1016/j.ejca.2007.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 03/06/2007] [Accepted: 03/08/2007] [Indexed: 11/20/2022]
Abstract
Quality of care is often described by professionals. However, in this study breast cancer patients participated in developing an instrument that reflects quality of care from the patient's perspective. Through focus groups and concept mapping patients' ideas on determinants of good quality of care were generated and categorised according to similarity and importance. Information from eight focus group interviews with a total of 72 participants yielded 221 quality of care aspects. Following reduction, 81 aspects were used for categorisation during six concept mapping sessions with 67 participants. After analysis, 55 aspects remained grouped into six clusters. This study was conducted with a large number of breast cancer patients, undergoing the full range of treatment modalities, in different hospitals, in different areas in the Netherlands. Therefore, this set of quality of care indicators can be considered valid and suitable for the evaluation of breast cancer care as experienced by patients.
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Affiliation(s)
- Mascha de Kok
- Department of Surgery, University Hospital Maastricht, P. Debeyelaan 25, 6229 HX, Maastricht, The Netherlands.
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Giacalone PL, Dubon O, Roger P, El Gareh N, Rihaoui S, Daurés JP. Doughnut mastopexy lumpectomy versus standard lumpectomy in breast cancer surgery: A prospective study. Eur J Surg Oncol 2007; 33:301-6. [PMID: 17110076 DOI: 10.1016/j.ejso.2006.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 09/15/2006] [Indexed: 10/23/2022] Open
Abstract
AIMS Doughnut mastopexy lumpectomy (DML) is a unique breast resection in which a tissue segment is removed and the breast reshaped through a periareolar incision. The present prospective investigation compares DML and standard lumpectomy (SL) in relation to surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. METHODS 127 patients with breast cancer were offered the choice between two conservative surgical approaches: doughnut mastopexy lumpectomy (DML group, n=39) or standard lumpectomy (SL group, n=88). The groups were comparable for radiological tumour size, tumour location within the breast, histological size, and pT category. Comparison was performed in term of surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. RESULTS The patients undergoing DML were younger than the patients who chose SL. In the DML group, the skin incision was 3-fold longer than in the SL group but was obtained with a final scar located around the nipple areola complex without further postoperative complications. The average volume of the breast specimen was higher in the DML group compared with SL group. The clinician assessment of cosmetic outcome reported a higher rate of acceptable result in the DML group than in the SL group. However, patient's assessment did not show difference of cosmetic satisfaction between groups. CONCLUSION Our comparative study indicates that DML may be a useful alternative to SL not only in terms of accurate breast tissue resection but also in term of cosmetic results.
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Affiliation(s)
- P L Giacalone
- Oncology Unit, Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, 371 rue du Doyen Gaston Giraud, Herault, 34295 Montpellier Cedex 5, France.
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Axelsson CK, Mouridsen HT, Düring M, Møller S. Axillary staging during surgery for breast cancer. Br J Surg 2007; 94:304-9. [PMID: 17262756 DOI: 10.1002/bjs.5599] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Axillary lymph node status remains the single most important prognostic parameter in patients with breast cancer. In approximately half of operations sentinel lymph node biopsy cannot be employed and axillary dissection is indicated. Retrieval of ten nodes has hitherto been considered sufficient, but it remains questionable whether the removal of more lymph nodes might improve staging.
Methods
Data from 31 679 breast cancer operations in Denmark were analysed.
Results
The number of axillary lymph nodes retrieved was an independent and strong predictor of node positivity. The more lymph nodes retrieved, the better the staging of the disease; this was evident for all sizes of tumour. Dissection of 20 or more nodes rather than ten to 14 increased the probability of node positivity from 14·2 to 25·9 per cent for 1–5-mm tumours, from 38·6 to 47·9 per cent for 11–20-mm tumours, and from 80·6 to 90·0 per cent for tumours with diameter greater than 50 mm.
Conclusion
The number of metastatic lymph nodes increased as more nodes were retrieved. These findings underline the need for high-quality specialist surgical and pathological services in breast cancer treatment.
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Affiliation(s)
- C K Axelsson
- Department F of Breast Surgery, University Hospital at Herlev, Herlev, Denmark.
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Yildirim E, Berberoglu U. Lymph Node Ratio is More Valuable than Level III Involvement for Prediction of Outcome in Node-Positive Breast Carcinoma Patients. World J Surg 2007; 31:276-89. [PMID: 17219275 DOI: 10.1007/s00268-006-0487-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND We examined the relationship between different expressions of positive axillary lymph nodes (PN) and the outcomes of node-positive breast carcinoma patients to determine the best predictor(s) among these expressions and to assess whether anatomic high level involvement is an independent prognostic factor. STUDY DESIGN In this retrospective study, the primary endpoints were distant recurrence (DR), locoregional recurrences (LRR), and disease-free survival (DFS). Univariate and multivariate prognostic factor analyses were carried out using survival and regression methods in the data of 704 patients with PN. RESULTS In multivariate analysis, the number of PN, ratio of PN, log odds of PN, and level III (L-III) involvement, separately, were significant factors for DR in addition to age, tumor size, and lymphovascular invasion (LVI). In the final model including all expressions of nodal involvement, age (continuous P = 0.001; hazard ratio [HR]: 0.98; 95% confidence Interval [95% CI]: 0.96-0.99), tumor size (continuous: P < 0.0001; HR: 1.3; 95% CI, 1.2-1.5), LVI (yes vs. no: P = 0.005; HR: 1.6; 95% CI, 1.2-2.2), and ratio of PN (continuous: P = 0.02; HR: 1.03; 95% CI, 1.01-1.06) were the independent prognostic factors for DR. For LRR, ratio of PN (continuous: P = 0.001; HR: 1.02; 95% CI, 1.01-1.03) was the most important factor in addition to age (continuous: P = 0.02; HR: 0.98; 95% CI, 0.97-0.99) and tumor size (continuous: P = 0.04; HR: 1.3; 95% CI, 1.1-1.6). When patients were stratified by number categories of PN (1-3 vs. 4-9 vs. >/= 10), there was no difference between DFSs of patients with and without L-III involvement. In contrast, when patients were stratified by L-III involvement, DFSs according to the number categories were statistically different. CONCLUSIONS Ratio of PN was more valuable than number of PN for predicting outcome in node-positive breast carcinoma patients. Level III involvement was not an independent prognostic indicator either for locoregional or for distant recurrences.
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Affiliation(s)
- Emin Yildirim
- Ankara Oncology Training and Research Hospital, Ankara, Turkey.
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Ferrari A, Rovera F, Dionigi P, Limonta G, Marelli M, Besana Ciani I, Bianchi V, Vanoli C, Dionigi R. Sentinel lymph node biopsy as the new standard of care in the surgical treatment for breast cancer. Expert Rev Anticancer Ther 2007; 6:1503-15. [PMID: 17069533 DOI: 10.1586/14737140.6.10.1503] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
During the recent years, based on the results of validation studies, the sentinel lymph node biopsy has replaced routine axillary dissection as the new standard of care in early breast cancer. The technique represents a minimally invasive, highly accurate method for axillary staging, which could spare approximately 65-70% of patients unnecessary axillary dissection and its related morbidity. Several technical and clinical controversies have been raised during the development of this new technique; the authors review the most important issues, some questions have already been answered and others are still under debate. As far as the technical aspects are concerned, mapping techniques, appropriate surgical training, options for pathological examination of sentinel lymph nodes and the issue of nonaxillary sentinel lymph nodes are discussed. An update on clinical controversies demonstrates that factors such as large tumor size, palpable axillary nodes, multifocality and multicentricity, previous breast and axillary surgery, and pregnancy are no longer regarded as absolute contraindications for sentinel lymph node biopsy. Feasibility, accuracy and timing of sentinel lymph node biopsy in patients undergoing neoadjuvant chemotherapy remain unsolved issues, as well as the indication of the technique for some subgroups of in situ lesions. Finally, one of the most attractive open forums for debate will be discussed: whether or not completion of axillary dissection in the case of positive SLN is always required.
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Affiliation(s)
- Alberta Ferrari
- University of Insubria, Department of Surgical Sciences, Viale Borri 57, 21100 Varese, Italy.
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de Hullu JA, van der Zee AGJ. Surgery and radiotherapy in vulvar cancer. Crit Rev Oncol Hematol 2006; 60:38-58. [PMID: 16829120 DOI: 10.1016/j.critrevonc.2006.02.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 01/30/2006] [Accepted: 02/28/2006] [Indexed: 12/01/2022] Open
Abstract
The majority of patients with vulvar cancer have squamous cell carcinomas (SCC). The cornerstone of the treatment is surgery. Radical vulvectomy with "en bloc" inguinofemoral lymphadenectomy has led to a favorable prognosis but with impressive morbidity. Nowadays, treatment is more individualized with wide local excision with uni- or bilateral inguinofemoral lymphadenectomy via separate incisions as the standard treatment for early stage patients with SCC of the vulva with depth of invasion >1 mm without suspicious groins. In case of more than one intranodal lymph node metastasis and/or extranodal growth, postoperative radiotherapy on the groins and pelvis is warranted. Until now there is a limited role for primary radiotherapy on the vulva and/or groins in early stage disease. The sentinel lymph node (SLN) procedure with the combined technique (preoperative lymphoscintigraphy with a radioactive tracer and intraoperative blue dye) is a promising staging technique for patients with early stage vulvar cancer. The safety of clinical implementation of the SLN procedure and the role of additional histopathological techniques of the SLNs need to be further investigated before its wide-scale application. Patients with advanced vulvar cancer are difficult to treat. One of the problems in patients with locally advanced vulvar cancer is the high incidence of concomitant bulky lymph nodes in the groin(s). Ultraradical surgery in case of resectable disease will lead to impressive morbidity because of the exenterative-type procedure. (Chemo)radiation with or without surgery should be regarded as the first choice for patients with locally advanced vulvar cancer only when primary surgery will necessitate performance of a stoma. Further studies are needed to determine the optimal combined modality treatment in these patients. Due to the fact that vulvar cancer is a rare disease, further clinical studies will only be possible, when international collaborative groups will join forces in order to perform clinical trials, in which different treatment options such as SLN procedure, primary radiotherapy on the groins and multimodality treatment for advanced disease will be investigated.
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Affiliation(s)
- J A de Hullu
- Department of Gynaecologic Oncology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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