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Cipolla C, Galvano A, Vieni S, Saputo F, Lupo S, Latteri M, Graceffa G, Valerio MR. Effects of the number of removed lymph nodes on survival outcome in patients with sentinel node-negative breast cancer. World J Surg Oncol 2021; 19:306. [PMID: 34666764 PMCID: PMC8524859 DOI: 10.1186/s12957-021-02418-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sentinel lymph node biopsy is the gold standard surgical technique for axillary staging in patients with clinically node-negative. However, it is still uncertain what is the optimal number of sentinel lymph nodes (SLNs) to be removed to reduce the false-negative rate. The aim of this study was to investigate whether patients with a single negative SLN have a worse prognosis than those with two or more negative SLNs. METHODS A retrospective review was conducted on a large series of SLN-negative breast cancer patients. Survival outcomes and regional recurrence rate were evaluated according to the number of removed SLNs. Secondly, the contribution of different adjuvant therapies on disease-free survival was explored. Statistical analysis included the chi-square, Wilcoxon-Mann-Whitney test, and Kaplan-Meier survival analysis. RESULTS A total of 1080 patients were included in the study. A first group consisted of 328 patients in whom a single SLN was retrieved, and a second group consisted of 752 patients in whom two or more SLNs were retrieved. There was no relevant difference in median DFS (64.9 vs 41.4) for SLN = 1 vs SLN > 1 groups (HR 0.76, CI 95% 0.39-1.46; p = 0.38). A statistically significant difference in mDFS was showed only for HT-treated patients who were SLN = 1 if compared to SLN > 1 (100.6 months versus 35.3 months). CONCLUSIONS There is likely a relationship between the number of resected SNL and mDFS. Our results, however, showed no relevant difference in median DFS for SLN = 1 vs SLN > 1 group, except for a subset of the patients treated with hormone therapy.
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Affiliation(s)
- Calogero Cipolla
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy.
| | - Antonio Galvano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy
| | - Salvatore Vieni
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy
| | - Federica Saputo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy
| | - Simona Lupo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy
| | - Mario Latteri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy
| | - Giuseppa Graceffa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy
| | - Maria Rosaria Valerio
- Department of Surgical, Oncological and Oral Sciences, University of Palermo (Italy), A.O.U.P. "P. Giaccone" University Hospital, Via del Vespro 129, 90127, Palermo, Italy
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Sharma N, Pinto A, Notghi A, Sintler M. Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time? Indian J Surg 2015; 77:1480-3. [PMID: 27011606 PMCID: PMC4775584 DOI: 10.1007/s12262-013-0994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 10/10/2013] [Indexed: 10/26/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) remains the gold standard for assessing axillary node status in breast cancer. Preoperative scintigrams have been used to identify the sentinel lymph node (SLN); however, their use is controversial. Studies suggest they add little to successful SLN detection in theatre, immediately prior to node excision. They have been associated with high false negatives, time expense, patient dissatisfaction, and unnecessary costs. The aim of the present study was to evaluate the diagnostic accuracy of scintigrams in comparison to intraoperative SLN identification techniques. This study included all patients undergoing a SLNB for breast cancer from April 2010 to 2011. Scintigram reports, operation notes, and histology results were analyzed. Mann-Whitney U and chi-squared tests were used for statistical analysis of data. Two hundred nineteen female patients with a median age of 59.6 years (24.0-89.9 years) were included in this study. Scintigram was performed in 185 and not in 34 patients due to time constraints. Combined γ-probe and Isosulfan blue dye for SLN detection (intraoperative methods) have an identification rate of 98.2 % (p = 0.005), compared to 92.4 % (p = 0.088) from scintigrams alone. Scintigrams confer no additional advantage to the operating surgeon for successful SLN detection and excision in theatre. Intraoperative SLN identification is more accurate and reliable. Routine scintigram use is unjustified and should be withdrawn from current practice.
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Affiliation(s)
- N. Sharma
- />Royal Shrewsbury Hospital, Shrewsbury, UK
| | - A. Pinto
- />Royal Wolverhampton Hospital Trusts, Wolverhampton, UK
| | - A. Notghi
- />Sandwell and West Birmingham Hospital Trusts, Birmingham, UK
| | - M. Sintler
- />Sandwell and West Birmingham Hospital Trusts, Birmingham, UK
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Abstract
Previous studies have shown that an increased number of axillary lymph nodes with metastatic involvement is associated with nonvisualization of lymph nodes during lymphoscintigraphy. We report a case of nonvisualization of the sentinel node during lymphoscintigraphy in a female with advanced breast cancer to support this association. Although many factors can affect visualization of the sentinel node during lymphoscintigraphy, the presence of advanced metastatic disease involving the lymphatic system must always be considered.
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Krynyckyi BR, Shafir MK, Kim SC, Kim DW, Travis A, Moadel RM, Kim CK. Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:25. [PMID: 16277655 PMCID: PMC1308847 DOI: 10.1186/1477-7800-2-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 12/28/2022]
Abstract
Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).
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Affiliation(s)
- Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Michail K Shafir
- Department of Surgery, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Dong Wook Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Arlene Travis
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Renee M Moadel
- Department of Nuclear Medicine, Albert Einstein College of Medicine of Yeshiva University, and the Montefiore Medical Center, Bronx, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
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Krynyckyi BR, Kim SC, Kim CK. Preoperative lymphoscintigraphy and triangulated patient body marking are important parts of the sentinel node process in breast cancer. World J Surg Oncol 2005; 3:56. [PMID: 16120218 PMCID: PMC1215530 DOI: 10.1186/1477-7819-3-56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 08/24/2005] [Indexed: 11/11/2022] Open
Affiliation(s)
- Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
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