1
|
Bessa JDF, Novita GG, Testa L, Freitas-Junior R, Marta GN. Is my patient an appropriate candidate for sentinel node biopsy? Less axillary surgery, for the right patients. Critical review and grades of recommendation. Surg Oncol 2024; 54:102064. [PMID: 38518660 DOI: 10.1016/j.suronc.2024.102064] [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: 06/22/2023] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION While general conclusions of historical trials are widely recognized, the nuances regarding precise indications of Sentinel Node Biopsy (SNB) in breast cancer in complex clinical scenarios often remain a source of debate and require further elucidation. METHODS Two reviewers (JFB and GNM) independently searched electronic databases for studies including SNB as the main intervention. Filters were applied to retrieve only clinical trials (randomized or experimental non-randomized); non-oncological outcomes were excluded. The selected studies were considered to construct a narrative review focused on inclusion criteria and survival outcomes, followed by recommendations. RESULTS Fourteen (n = 14) trials were selected, including eleven (n = 11) randomized trials for upfront surgery, and three (n = 3) single-group clinical trials for surgery following neoadjuvant therapy. All trials for upfront surgery provided long-term survival data for SNB, that was equivalent or non-inferior to axillary dissection, in tumors without palpable adenopathy (caution for larger T3 and T4 tumors) - Grade of recommendation: A. In tumors up to 5 cm, complete axillary dissection is not necessary if up to two sentinel nodes are positive for macrometastasis, and radiation therapy is planned - Grade of recommendation: A. If there are more than two sentinel nodes positive for macrometastasis, or a positive node other than the sentinel one, complete axillary dissection is recommended - Grade of recommendation: A. Following neoadjuvant chemotherapy, considering 10% as an acceptable false negative rate, SNB might be offered for cN0 patients who have remained negative, and for cN1 (caution for cN2) patients become clinically negative; complete axillary dissection might not be necessary if at least two sentinel lymph nodes are retrieved, and there is no residual disease - Grade of recommendation: B. CONCLUSION SNB can be performed in most cases of clinically negative nodes. After neoadjuvant chemotherapy, SNB is feasible and may have acceptable performance for cN0 and cN1 tumors, although prospective survival data is still awaited.
Collapse
Affiliation(s)
| | | | - Laura Testa
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
| | | | | |
Collapse
|
2
|
Yu M, Liu Y, Huang Z, Zhu Q, Huang Y. The Feasibility and Reliability of Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Breast Cancer Patients With Negative Axillary Lymph Nodes-A Meta-analysis. Breast Cancer (Auckl) 2024; 18:11782234241255856. [PMID: 38826850 PMCID: PMC11141228 DOI: 10.1177/11782234241255856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background The application of sentinel lymph node biopsy (SLNB) has expanded from early breast cancer to locally advanced breast cancer with neoadjuvant chemotherapy (NAC). For patients with negative axillary lymph nodes, performing SLNB before or after NAC remains controversial. Objectives To evaluate the diagnostic feasibility and reliability of SLNB after NAC in breast cancer patients with negative axillary nodes at initial diagnosis. Design To calculate pooled identification rate (IR) and false negative rate (FNR) of SLNB after NAC on breast cancer patients with initially negative axillary nodes by enrolling relevant studies and perform subgroup analysis by the type of tracer and the number of biopsied sentinel lymph nodes in average. Data sources and methods The PubMed, Embase, Cochrane, Web of Science, and Scopus databases from January 1, 2002, to March 1, 2022, were searched for studies. The QUADAS-2 tool and MINORS item were employed to evaluate the quality of the included studies. I2 and Q tests were used to evaluate the heterogeneity among the studies. Random-effects model and fixed-effects model were employed to calculate the pooled IR, FNR, and 95% confidence interval (CI). Publication bias was evaluated, and sensitivity analysis was performed. Subgroup analysis was performed according to the type of tracer (single/double) and the number of biopsied sentinel lymph nodes in average (⩽2/>2). Results A total of 21 studies covering 1716 patients were enrolled in this study (IR = 93%, 95% CI = 90-96; FNR = 8%, 95% CI = 6-11). Conclusion The SLNB after NAC can serve as a feasible and reliable approach in breast cancer patients with negative axillary lymph node. In our study, no significant impact of tracer was found on the IR and FNR of SLNB, and the number of biopsy nodes >2 leads to the decreased FNR of SLNB.
Collapse
Affiliation(s)
| | | | | | - Qingqing Zhu
- Department of Breast and Thyroid Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yong Huang
- Department of Breast and Thyroid Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
3
|
Sulthana R, Singh A. Is Sentinel Lymph Node Biopsy a Viable Alternative to Axillary Lymph Node Dissection in Breast Carcinoma Patients Who Have Received Neo-Adjuvant Chemotherapy? Cureus 2024; 16:e52698. [PMID: 38384601 PMCID: PMC10879841 DOI: 10.7759/cureus.52698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Background Sentinel lymph node biopsy (SLNB) is based on the hypothesis that lymph from a primary solid neoplasm drains into one or more sentinel nodes, which are the first nodes at risk for harbouring occult metastatic disease. Sentinel lymph node biopsy has replaced axillary lymph node dissection (ALND) as the standard method for axillary staging in clinically node-negative patients. It avoids the complications associated with ALND and allows assessment of nodal status in patients with clinically node-negative breast cancer. Aims and objectives The aim of this study is to determine the false negative rate and identification rate of SLNB in breast cancer patients who received neoadjuvant chemotherapy (NACT). Materials and methods We conducted a hospital-based prospective study that included 19 patients who presented with early breast cancer and were node-positive. Post NACT, intraoperatively, methylene blue and radiocolloid dye were injected in the subareolar region. During the surgery, the blue and hot nodes identified were dissected, sent for frozen section analysis, and subsequently submitted for histopathological evaluation. This was followed by a standard-level I/II/III axillary clearance with histopathological examination. Results The false-negative rate of SLNB is 25%. Sentinel lymph node biopsy was more accurate with stage II than stage III tumours, and in patients who downstaged from stage II to any stage following NACT, it was more accurate than downstaging from stage III. The average number of sentinel nodes identified was 1.9, with the maximum being seven and the minimum being one. A total of 25 sentinel lymph nodes were identified in 13 patients, with an identification rate of 68.42%. Conclusions The main clinicopathological factors that influence the false negative rate of SLNB after NACT are axillary lymph node status, stage of the tumour at presentation, and tumour downstaging. For patients for whom sentinel nodes cannot be harvested, ALND should be done.
Collapse
Affiliation(s)
- Rehena Sulthana
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Akshita Singh
- General Surgery and Breast Oncology, Narayana Health City, Bangalore, IND
| |
Collapse
|
4
|
Boughey JC, Yu H, Dugan CL, Piltin MA, Postlewait L, Son JD, Edmiston KK, Godellas CV, Lee MC, Carr MJ, Tonneson JE, Crown A, Lancaster RB, Woriax HE, Ewing CA, Chau HS, Patterson AK, Wong JM, Alvarado MD, Yang RL, Chan TW, Sheade JB, Ahrendt GM, Larson KE, Switalla K, Tuttle TM, Tchou JC, Rao R, Tamirisa N, Singh P, Gould RE, Terando A, Sauder C, Hewitt K, Chiba A, Esserman LJ, Mukhtar RA. Changes in Surgical Management of the Axilla Over 11 Years - Report on More Than 1500 Breast Cancer Patients Treated with Neoadjuvant Chemotherapy on the Prospective I-SPY2 Trial. Ann Surg Oncol 2023; 30:6401-6410. [PMID: 37380911 DOI: 10.1245/s10434-023-13759-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Axillary surgery after neoadjuvant chemotherapy (NAC) is becoming less extensive. We evaluated the evolution of axillary surgery after NAC on the multi-institutional I-SPY2 prospective trial. METHODS We examined annual rates of sentinel lymph node (SLN) surgery with resection of clipped node, if present), axillary lymph node dissection (ALND), and SLN and ALND in patients enrolled in I-SPY2 from January 1, 2011 to December 31, 2021 by clinical N status at diagnosis and pathologic N status at surgery. Cochran-Armitage trend tests were calculated to evaluate patterns over time. RESULTS Of 1578 patients, 973 patients (61.7%) had SLN-only, 136 (8.6%) had SLN and ALND, and 469 (29.7%) had ALND-only. In the cN0 group, ALND-only decreased from 20% in 2011 to 6.25% in 2021 (p = 0.0078) and SLN-only increased from 70.0% to 87.5% (p = 0.0020). This was even more striking in patients with clinically node-positive (cN+) disease at diagnosis, where ALND-only decreased from 70.7% to 29.4% (p < 0.0001) and SLN-only significantly increased from 14.6% to 56.5% (p < 0.0001). This change was significant across subtypes (HR-/HER2-, HR+/HER2-, and HER2+). Among pathologically node-positive (pN+) patients after NAC (n = 525) ALND-only decreased from 69.0% to 39.2% (p < 0.0001) and SLN-only increased from 6.9% to 39.2% (p < 0.0001). CONCLUSIONS Use of ALND after NAC has significantly decreased over the past decade. This is most pronounced in cN+ disease at diagnosis with an increase in the use of SLN surgery after NAC. Additionally, in pN+ disease after NAC, there has been a decrease in use of completion ALND, a practice pattern change that precedes results from clinical trials.
Collapse
Affiliation(s)
- Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Hongmei Yu
- Quantum Leap Healthcare Collaborative, San Francisco, CA, USA
| | | | - Mara A Piltin
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lauren Postlewait
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer D Son
- Ourisman Breast Center, MedStar Georgetown University, Washington, DC, USA
| | - Kirsten K Edmiston
- Department of Surgery, University of Virginia, Inova Campus, Fairfax, VA, USA
| | | | - Marie C Lee
- Division of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Michael J Carr
- Department of Breast Surgery, Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer E Tonneson
- Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Angelena Crown
- True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | - Rachel B Lancaster
- Division of Surgical Oncology, The University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Hannah E Woriax
- Division of Surgical Oncology, Duke University of School of Medicine, Durham, NC, USA
| | - Cheryl A Ewing
- Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | | | - Anne K Patterson
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Jasmine M Wong
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Michael D Alvarado
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Rachel L Yang
- Department of Surgery, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Theresa W Chan
- Department of Breast Surgical Oncology, Ironwood Cancer and Research Centers, Scottsdale, AZ, USA
| | - Jori B Sheade
- Division of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Gretchen M Ahrendt
- Division of Surgical Oncology, University of Colorado Denver - Anschutz Medical Campus, Boulder, CO, USA
| | - Kelsey E Larson
- Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Kayla Switalla
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Julia C Tchou
- Department of Breast Surgery Research, Penn Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Roshni Rao
- Division of Breast Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Nina Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Puneet Singh
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebekah E Gould
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alicia Terando
- Division of Surgical Oncology, Department of Surgery, Huntington Cancer Center/Cedars Sinai Cancer, Pasadena, CA, USA
| | - Candice Sauder
- Department of Surgery, UC Davis Health Comprehensive Cancer Center, Sacramento, CA, USA
| | - Kelly Hewitt
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Laura J Esserman
- Departments of Surgery and Radiology, UCSF, San Francisco, CA, USA
| | | |
Collapse
|
5
|
Surgical Planning after Neoadjuvant Treatment in Breast Cancer: A Multimodality Imaging-Based Approach Focused on MRI. Cancers (Basel) 2023; 15:cancers15051439. [PMID: 36900231 PMCID: PMC10001061 DOI: 10.3390/cancers15051439] [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: 01/10/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Neoadjuvant chemotherapy (NACT) today represents a cornerstone in the treatment of locally advanced breast cancer and highly chemo-sensitive tumors at early stages, increasing the possibilities of performing more conservative treatments and improving long term outcomes. Imaging has a fundamental role in the staging and prediction of the response to NACT, thus aiding surgical planning and avoiding overtreatment. In this review, we first examine and compare the role of conventional and advanced imaging techniques in preoperative T Staging after NACT and in the evaluation of lymph node involvement. In the second part, we analyze the different surgical approaches, discussing the role of axillary surgery, as well as the possibility of non-operative management after-NACT, which has been the subject of recent trials. Finally, we focus on emerging techniques that will change the diagnostic assessment of breast cancer in the near future.
Collapse
|
6
|
Axillary ultrasound after neoadjuvant therapy reduces the false-negative rate of sentinel lymph node biopsy in patients with cytologically node-positive breast cancer. Breast Cancer Res Treat 2023; 197:515-523. [PMID: 36513955 DOI: 10.1007/s10549-022-06817-8] [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: 08/15/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to determine whether post-neoadjuvant therapy (NAT) axillary ultrasound (AUS) could reduce the false-negative rate (FNR) of sentinel lymph node biopsy (SLNB). We also performed subgroup analyses to identify the appropriate patient for SLNB. METHODS A total of 220 patients with cytologically proven axillary node-positive breast cancer who underwent both SLNB and axillary lymph node dissection (ALND) after NAT were included. We calculated the FNR of SLNB. In the case of post-NAT AUS results available, AUS was classified as negative or positive. Then the FNR of post-NAT AUS combined with SLNB was evaluated. Subgroup analyses based on the number of sentinel lymph nodes removed, molecular subtypes, and the clinical N stage were also performed. RESULTS The overall axillary lymph node pathological complete response rate was 45.5% (100/220). The FNR of SLNB alone was 15.8% (95%CI: 9.2 to 22.5%). Post-NAT AUS results were available for 181 patients. When combined negative post-NAT AUS results and SLNB, the FNR was reduced to 7.5% (95%CI: 2.4 to 12.7%). Subgroup analyses of the FNR for SLNB alone and negative post-NAT AUS combined with SLNB were shown as follows: in cases patients with less than three sentinel lymph nodes (SLNs) and at least three SLNs removed, the FNR was decreased from 24.5 to 13.2%, and 9.0 to 5.0%, respectively. The FNR was decreased from 20.8 to 10.5% in HR+/HER2+subgroup, 21.4 to 16.7% in HR-/HER2+subgroup, 15.9 to 7.0% in HR+/HER2- subgroup, and 0% in HR-/HER2- subgroup, respectively. For cN1 patients, the FNR was decreased from 18.1 to 12.1% while 17.1 to 3.6% for cN2 patients and 0% for cN3 patients. CONCLUSION Using negative post-NAT AUS may help to decrease the FNR and improve patient selection for SLNB.
Collapse
|
7
|
Lin SQ, Vo NP, Yen YC, Tam KW. Outcomes of Sentinel Node Biopsy for Women with Breast Cancer After Neoadjuvant Therapy: Systematic Review and Meta-Analysis of Real-World Data. Ann Surg Oncol 2022; 29:3038-3049. [PMID: 35018590 DOI: 10.1245/s10434-021-11297-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence on the accuracy of sentinel lymph node biopsy (SLNB) after neoadjuvant therapy (NAT) for patients with breast cancer is inconclusive. This study reviewed the real-world data to determine the acceptability of SLNB after NAT. METHODS The study searched for articles in the PubMed, EMBASE, and Cochrane Library databases. The primary outcomes were the identification rate for sentinel lymph nodes (SLNs) and the false-negative rate (FNR) for SLNB. The study also evaluated the FNR in subgroups defined by tumor stage, nodal stage, hormone receptor status, human epidermal growth factor receptor-2 status, tumor response, mapping technique, and number of SLNs removed. RESULTS The study retrieved 61 prospective and 18 retrospective studies with 10,680 initially cN± patients. The pooled estimate of the identification rate was 0.906 (95 % confidence interval [CI], 0.891-0.922), and the pooled FNR was 0.118 (95 % CI, 0.103-0.133). In subgroup analysis, the FNR was significantly higher for the patients with estrogen receptor (ER)-negative status and fewer than three SLNs removed. The FNR did not differ significantly between the patients with and those without complete tumor response. Among the patients with initial clinical negative axillary lymph nodes, the incidence of node metastasis was 26.8 % (275/1041) after NAT. CONCLUSION Real-world evidence indicates that the FNR of SLNB after NAT in breast cancer is 11.8 %, exceeding only slightly the commonly adopted threshold of 10 %. The FNR is significantly higher for patients with ER-negative status and removal of fewer than three SLNs. Using a dual tracer and removing at least three SLNs may increase the accuracy of SLNB after NAT.
Collapse
Affiliation(s)
- Shi-Qian Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Nguyen-Phong Vo
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-based Health Care, Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. .,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
8
|
Sentinel lymph node mapping in breast cancer patients following neoadjuvant chemotherapy: systematic review and meta-analysis about head to head comparison of cN0 and cN + patients. Breast Cancer 2021; 29:50-64. [PMID: 34341902 DOI: 10.1007/s12282-021-01280-7] [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: 03/31/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The effectiveness of sentinel lymph node (SLN) mapping and biopsy following neoadjuvant chemotherapy (NAC) in axillary lymph node staging of breast cancer (BCa) patients with initial clinical node positive status (cN +) compared to clinical node negative status (cN0) is not yet known. The aim of this meta-analysis was to compare the accuracy of SLN mapping following NAC in cN + and cN0 BCa patients. METHODS PubMed and Scopus were comprehensively reviewed to retrieve all the studies that performed SLN mapping/biopsy and standard axillary lymph node dissection on cN0 and cN + BCa patients following NAC. Pooled detection and false negative rates for N0 and N + patients including 95% confidence interval values (95% CI) were evaluated. Odds ratio (OR) and risk difference (RD) of SLN detection failure and false negative results were compared between two groups. RESULTS A total of 27 articles were included for SLN detection rate evaluation and 17 for false negative assessment. The OR and RD of detection failure in N + group compared with N0 group following NAC were 2.22 (p = 0.00, 95% CI 1.4-3.4) and 4% (p = 0.00, 95% CI 2-6%), respectively. The OR and RD of false negative rate were 1.6 (p = 0.01, 95% CI 1-2.6) and 8% (p = 0.02, 95% CI 1-14%), respectively. CONCLUSION SLN mapping in BCa patients following NAC shows high risk of detection failure and high false negative rate of SLN biopsy in cN + patients. In comparison with cN0 BCa patients, SLN mapping and biopsy after NAC was associated with almost two times higher odds of detection failure and false negative results in cN + patients; therefore, this method should not be recommended in this group of patients.
Collapse
|
9
|
Brackstone M, Baldassarre FG, Perera FE, Cil T, Chavez Mac Gregor M, Dayes IS, Engel J, Horton JK, King TA, Kornecki A, George R, SenGupta SK, Spears PA, Eisen AF. Management of the Axilla in Early-Stage Breast Cancer: Ontario Health (Cancer Care Ontario) and ASCO Guideline. J Clin Oncol 2021; 39:3056-3082. [PMID: 34279999 DOI: 10.1200/jco.21.00934] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide recommendations on the best strategies for the management and on the best timing and treatment (surgical and radiotherapeutic) of the axilla for patients with early-stage breast cancer. METHODS Ontario Health (Cancer Care Ontario) and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature. RESULTS This guideline endorsed two recommendations of the ASCO 2017 guideline for the use of sentinel lymph node biopsy in patients with early-stage breast cancer and expanded on that guideline with recommendations for radiotherapy interventions, timing of staging after neoadjuvant chemotherapy (NAC), and mapping modalities. Overall, the ASCO 2017 guideline, seven high-quality systematic reviews, 54 unique studies, and 65 corollary trials formed the evidentiary basis of this guideline. RECOMMENDATIONS Recommendations are issued for each of the objectives of this guideline: (1) To determine which patients with early-stage breast cancer require axillary staging, (2) to determine whether any further axillary treatment is indicated for women with early-stage breast cancer who did not receive NAC and are sentinel lymph node-negative at diagnosis, (3) to determine which axillary strategy is indicated for women with early-stage breast cancer who did not receive NAC and are pathologically sentinel lymph node-positive at diagnosis (after a clinically node-negative presentation), (4) to determine what axillary treatment is indicated and what the best timing of axillary treatment for women with early-stage breast cancer is when NAC is used, and (5) to determine which are the best methods for identifying sentinel nodes.Additional information is available at www.asco.org/breast-cancer-guidelines.
Collapse
Affiliation(s)
| | | | | | - Tulin Cil
- University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | - Ian S Dayes
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Jay Engel
- Cancer Center of Southeastern Ontario, Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Tari A King
- Dana Farber/Brigham & Women's Cancer Center, Boston, MA
| | | | - Ralph George
- Division of General Surgery, St Michael's Hospital, CIBC Breast Centre, Toronto, Ontario, Canada
| | - Sandip K SenGupta
- Pathology Department, Kingston General Hospital, Kingston, Ontario, Canada
| | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Andrea F Eisen
- University of Toronto, Odette Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Kim WH, Kim HJ, Kim SH, Jung JH, Park HY, Lee J, Kim WW, Park JY, Chae YS, Lee SJ. Ultrasound-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy with clip and activated charcoal in breast cancer patients: a feasibility study. BMC Cancer 2019; 19:859. [PMID: 31470821 PMCID: PMC6716853 DOI: 10.1186/s12885-019-6095-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/26/2019] [Indexed: 12/26/2022] Open
Abstract
Background We report on our experience of ultrasound (US)-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy (NAC) with clip and activated charcoal to guide axillary surgery in breast cancer patients. Methods Between November 2017 and May 2018, a dual-localization procedure was performed under US guidance for the most suspicious axillary nodes noted at initial staging (before NAC, with clip) and restaging (after NAC, with activated charcoal) in 28 cytologically proven node-positive breast cancer patients. Patients underwent axillary sampling or dissection, which involved removing not only the sentinel nodes (SNs), but also clipped nodes (CNs) and tattooed nodes (TNs). Success (or failure) rates of biopsies of SNs, CNs, and TNs and inter-nodal concordance rates were determined. Sensitivities for the individual and combined biopsies were calculated. Results SN biopsy failed in four patients (14%), whereas the CN biopsy failed in one patient (4%). All TNs were identified in the surgical field. Concordance rates were 79% for CNs–TNs, 63% for CNs–SNs, and 58% for TNs–SNs. Sensitivity for SN, CN, and TN biopsy was 73%, 67%, and 67%, respectively. Sensitivity was 80% for any combination of biopsies (SN plus CN, SN plus TN, SN plus CN plus TN). Conclusions US-guided dual-localization of axillary nodes before and after NAC with clip and activated charcoal was a feasible approach that might facilitate more reliable nodal staging with less-invasive strategies in node-positive breast cancer patients.
Collapse
Affiliation(s)
- Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea.
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Yee Soo Chae
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Soo Jung Lee
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| |
Collapse
|
11
|
Shirzadi A, Mahmoodzadeh H, Qorbani M. Assessment of sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer in two subgroups: Initially node negative and node positive converted to node negative - A systemic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2019; 24:18. [PMID: 30988686 PMCID: PMC6421883 DOI: 10.4103/jrms.jrms_127_18] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/10/2018] [Accepted: 12/16/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with breast cancer, but the reliability of sentinel lymph node biopsy (SLNB) following chemotherapy is in doubt. In this meta-analysis, we aimed to evaluate studies that examine the results of SLNB after NAC to assess identification rate (IR) and false-negative rate (FNR). MATERIALS AND METHODS Systemic searches were performed in the PubMed, ISI Web of Sciences, Scopus, and Cochrane databases from January 1, 2000, to November 30, 2016, for studies of SLNB after NAC for breast cancer and followed by axillary lymph node (LN) dissection in two subgroups: initially node negative and node positive converted to node negative. Two reviewers independently review quality of included studies. A random-effects model was used to pool IR and FNR with 95% confidence intervals (CI), and heterogeneity among studies was assessed by I 2 and Q-test. RESULTS A total of 23 studies with 1521 patients in the initially node-negative subgroup and 13 studies with 1088 patients in the node-positive converted to node-negative subgroup, were included in this meta-analysis with IR and FNR of 94% (95% CI: 92-96) and 7% (95% CI: 5-9) in the initially node-negative subgroup and 89% (95% CI: 85-94) and 13% (95% CI: 7-18) in the node-positive converted to node-negative subgroup, respectively. CONCLUSION Our meta-analysis showed acceptable IR and FNR in initially node-negative group and it seems feasible in these patients, but these parameters did not reach to predefined value in node-positive converted to node-negative group, and thus, it is not recommended in these patients.
Collapse
Affiliation(s)
- Alireza Shirzadi
- Non-Communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Habibollah Mahmoodzadeh
- Division of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
12
|
Lee SB, Yu JH, Park H, Kim HJ, Park SH, Chae BJ, Youn HJ, Jung SY, Kim EK, Jung YS, Son BH. Sentinel node biopsy after neoadjuvant chemotherapy for breast cancer with axillary node metastasis: A survey of clinical practice. Asian J Surg 2018; 42:314-319. [PMID: 30049563 DOI: 10.1016/j.asjsur.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/26/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A survey of breast surgeons was conducted to evaluate changes in clinical practice regarding sentinel node biopsy (SNB) among clinically node-negative patients after neoadjuvant chemotherapy for breast cancer with axillary node metastasis. METHODS We conducted two surveys among 252 members of the Korean Breast Cancer Society. The questionnaire comprised a case presentation and two associated questions. The case outlined a woman diagnosed with right breast cancer; core needle biopsy had confirmed invasive ductal carcinoma and tumor size was 4 cm on imaging examination. Fine needle aspiration examination for axillary lymph node enlargement showed metastatic carcinoma. The patient underwent neoadjuvant chemotherapy and tumor size was decreased by 2 cm; axillary lymph node enlargement was not observed on palpitation or imaging examination. Finally, the patient underwent breast conserving surgery. Survey recipients were asked: 1. Would you perform SNB in this patient? 2. If you perform SNB and no axillary node metastasis is seen, would you perform additional axillary lymph node dissection (ALND)? RESULTS The response rate was 28.2% (71/252) and 15.1% (38/252) in 2013 and 2017, respectively. For the first question, the SNB to ALND ratio increased significantly from 54% versus 46% in 2013 to 92% versus 8% in 2017 (p < 0.001). The proportion of surgeons performing no additional ALND versus additional ALND increased from 38% versus 54% in 2013 to 53% versus 37% in 2017, but did not reach statistical significance (p = 0.1). CONCLUSIONS These data show that application of SNB among clinically node-negative patients after neoadjuvant chemotherapy for breast cancer with node metastasis has increased among surgeons in Korea.
Collapse
Affiliation(s)
- Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jong-Han Yu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Heeseung Park
- Department of Breast Surgery, Busan Cancer, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Se Ho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Ju Chae
- Department of Surgery, College of Medicine, Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, South Korea
| | - So Youn Jung
- Center of Breast Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
| | - Eun Kyu Kim
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, South Korea
| | - Yong Sik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| |
Collapse
|
13
|
Dong LF, Xu SY, Long JP, Wan F, Chen YD. Role of number of sentinel nodes in predicting non-sentinel node metastasis in breast cancer. J Int Med Res 2018; 46:828-835. [PMID: 29441833 PMCID: PMC5971514 DOI: 10.1177/0300060517729589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of the present study was to determine how many sentinel lymph nodes (SLNs) are appropriate for predicting non-SLN metastasis in breast cancer. Methods The association between clinicopathological features and non-SLN metastasis was retrospectively analyzed in 472 patients who underwent axillary lymph node dissection (ALND) following SLN biopsy. Another 251 patients who underwent only SLN biopsy without ALND were analyzed and followed up for 2 years. Results A large tumor size, positive SLN, and HER-2 positivity were independent predictors of non-SLN metastasis. There were significant differences in non-SLN metastasis between patients with one negative SLN and patients with an absence of negative SLNs. There was no significant difference in non-SLN metastasis between patients with one negative SLN and two or more negative SLNs. The recurrence-free survival rate for patients who did not undergo ALND was 99.6% (245/246). Conclusion Surgeons should ensure that the number of SLNs obtained is appropriate. The presence of one negative SLN is enough in SLN biopsy. Considering the invasiveness of the surgery, two or more negative SLNs may be unnecessary.
Collapse
Affiliation(s)
- Li-Feng Dong
- 1 Department of Breast, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shu-Ying Xu
- 2 Physical Examination Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jing-Pei Long
- 1 Department of Breast, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Wan
- 1 Department of Breast, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi-Ding Chen
- 3 Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
14
|
Piñero A, Giménez J, Vidal-Sicart S, Intra M. Selective Sentinel Lymph Node Biopsy and Primary Systemic Therapy in Breast Cancer. TUMORI JOURNAL 2018; 96:17-23. [DOI: 10.1177/030089161009600103] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Sentinel lymph node biopsy has become an ordinary method for breast cancer staging. Neoadjuvant chemotherapy has been considered one of the contraindications for sentinel lymph node biopsy due to potential secondary fibrosis and lymphatic distortion. Timing and influence on sentinel lymph node biopsy result by primary systemic therapy are current and controversial topics. Methods and study design The experience in the medical literature is reviewed. A search was performed in the following databases: Medline (through Pubmed), EMBASE, Tripdatabase and Cochrane Library, between January 1998 and December 2008. Results and conclusions After analyzing the conclusions from 42 series and waiting for the end of related prospective trials, it could be concluded that sentinel lymph node biopsy is a useful diagnostic tool that should be integrated in the algorithm for the management of breast cancer patients when primary systemic therapy is needed.
Collapse
Affiliation(s)
- Antonio Piñero
- Department of Surgery, “Virgen de la Arrixaca” University Hospital, Murcia
| | - Julia Giménez
- Department of Surgery, Valencian Institute of Oncology Foundation, Valencia
| | | | - Mattia Intra
- Division di Senologia, European Institute of Oncology, Milan, Italy
| |
Collapse
|
15
|
Ruano Pérez R, Rebollo Aguirre A, García-Talavera San Miguel P, Díaz Expósito R, Vidal-Sicart S, Cordero García J, Carrera Salazar D, Rioja Martín M. Review of the role of the sentinel node biopsy in neoadjuvant chemotherapy in women with breast cancer and negative or positive axillary node at diagnosis. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Review of the role of the sentinel node biopsy in neoadjuvant chemotherapy in women with breast cancer and negative or positive axillary node at diagnosis. Rev Esp Med Nucl Imagen Mol 2017; 37:63-70. [PMID: 28869178 DOI: 10.1016/j.remn.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/04/2017] [Accepted: 06/29/2017] [Indexed: 02/06/2023]
Abstract
The role of the selective sentinel node biopsy (SNB) is increasing in relevance in breast cancer women with indication of neoadjuvant chemotherapy (NAC). The Radiosurgery Working Group of the SEMNIM is aware of the necessity of establishing the need for SNB before or after NAC, and also how to manage patients with axillary node-negative or node-positive. There is sufficient data to assess that the SNB with radioisotope techniques are feasible and safe in all these scenarios. An adequate axilla evaluation prior to surgery and the possibility of marking prior to NAC the nodes infiltrated must be the two main pillars to guarantee the success of the SNB. It has been shown that to incorporate the SNB in breast cancer women with indication of NAC increases the rate of a conservative treatment of the axilla that will be a clear benefit for these patients.
Collapse
|
17
|
Naidoo K, Pinder SE. Micro- and macro-metastasis in the axillary lymph node: A review. Surgeon 2017; 15:76-82. [DOI: 10.1016/j.surge.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
|
18
|
Carmon M, Olsha O, Gekhtman D, Nikitin I, Cohen Y, Messing M, Lioubashevsky N, Abu Dalo R, Hadar T, Golomb E. Detectability of Hygroscopic Clips Used in Breast Cancer Surgery. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:401-408. [PMID: 28039936 DOI: 10.7863/ultra.16.02053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
Sonographically detectable clips were introduced over the last decade. We retrospectively studied the rate and duration of sonographically detectable clip detectability in patients with breast cancer who had sonographically detectable clips inserted over a 2-year period. Nine of 26 patients had neoadjuvant chemotherapy, with all clips remaining detectable 140 to 187 days after insertion. Six of the 9 had intraoperative sonographic localization, with 1 reoperation (17%). Eleven additional patients with nonpalpable tumors and sonographically detectable clips had intraoperative sonographic localization with 1 reoperation (9%). In 1 patient, a sonographically detectable clip enabled intraoperative identification of a suspicious lymph node. There were no complications or clip migration. Sonographically detectable clips are helpful in breast cancer surgery with and without neoadjuvant chemotherapy, remaining detectable for many months and often averting preoperative localization and scheduling difficulties.
Collapse
Affiliation(s)
- Moshe Carmon
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Oded Olsha
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - David Gekhtman
- Breast Imaging Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Irena Nikitin
- Breast Imaging Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Yamin Cohen
- Hala: the Rachel Nash Jerusalem Comprehensive Breast Clinic, Jerusalem, Israel
| | - Michael Messing
- Hala: the Rachel Nash Jerusalem Comprehensive Breast Clinic, Jerusalem, Israel
| | | | - Ribhi Abu Dalo
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Tal Hadar
- Breast Health Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Eliahu Golomb
- Department of Pathology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| |
Collapse
|
19
|
Geng C, Chen X, Pan X, Li J. The Feasibility and Accuracy of Sentinel Lymph Node Biopsy in Initially Clinically Node-Negative Breast Cancer after Neoadjuvant Chemotherapy: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0162605. [PMID: 27606623 PMCID: PMC5015960 DOI: 10.1371/journal.pone.0162605] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/25/2016] [Indexed: 12/01/2022] Open
Abstract
Background With the increased use of neoadjuvant chemotherapy (NAC) in breast cancer, the timing of sentinel lymph node biopsy (SLNB) has become increasingly important. In this study, we aimed to evaluate the feasibility and accuracy of SLNB for initially clinically node-negative breast cancer after NAC by conducting a systematic review and meta-analysis. Methods We searched PubMed, Embase, and the Cochrane Library from January 1, 1993 to November 30, 2015 for studies on initially clinically node-negative breast cancer patients who underwent SLNB after NAC followed by axillary lymph node dissection (ALND). Results A total of 1,456 patients from 16 studies were included in this review. The pooled identification rate (IR) for SLNB was 96% [95% confidence interval (CI): 95%-97%], and the false negative rate (FNR) was 6% (95% CI: 3%-8%). The pooled sensitivity, negative predictive value (NPV) and accuracy rate (AR) were 94% (95% CI: 92%-97%, I2 = 27.5%), 98% (95% CI: 98%-99%, I2 = 42.7%) and 99% (95% CI: 99%-100%, I2 = 32.6%), respectively. In the subgroup analysis, no significant differences were found in either the IR of an SLNB when different mapping methods were used (P = 0.180) or in the FNR between studies with and without immunohistochemistry (IHC) staining (P = 0.241). Conclusion Based on current evidence, SLNB is technically feasible and accurate enough for axillary staging in initially clinically node-negative breast cancer patients after NAC.
Collapse
Affiliation(s)
- Chong Geng
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Xiao Chen
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Xiaohua Pan
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Jiyu Li
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
- * E-mail:
| |
Collapse
|
20
|
Han C, Yang L, Zuo W. A mini-review on factors and countermeasures associated with false-negative sentinel lymph node biopsies in breast cancer. Chin J Cancer Res 2016; 28:370-6. [PMID: 27478323 PMCID: PMC4949283 DOI: 10.21147/j.issn.1000-9604.2016.03.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a new surgical technique for local axillary lymph nodes (ALNs) of breast cancer. Large-scale clinical trials have confirmed that undergoing SLNB and ALN dissection (ALND) showed no significant difference for sentinel lymph node (SLN)-negative patients in terms of disease-free survival, overall survival and recurrence-free survival. However, false-negative results are still the main concern of physicians as well as patients who undergo SLNB instead of ALND. The American Society of Breast Surgeons established a task force to suggest acceptable standards for SLNB. In 2000, the task force recommended that the identification rate for SLNB be 85% or higher and the false-negative rate be 5% or lower. This review focuses on clinical factors (tumor volume, multifocal/multi-center cancers, neoadjuvant chemotherapy and skip metastasis), tracer techniques and pathological factors affecting SLNB and explores methods for reducing the false-negative rate.
Collapse
Affiliation(s)
- Chao Han
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Li Yang
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Wenshu Zuo
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| |
Collapse
|
21
|
Caudle AS, Kuerer HM. Targeting and limiting surgery for patients with node-positive breast cancer. BMC Med 2015; 13:149. [PMID: 26109042 PMCID: PMC4481081 DOI: 10.1186/s12916-015-0385-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/03/2015] [Indexed: 12/22/2022] Open
Abstract
The presence of axillary nodal metastases has a significant impact on locoregional and systemic treatment decisions. Historically, all node-positive patients underwent complete axillary lymph node dissection; however, this paradigm has changed over the last 10 years. The use of sentinel lymph node dissection has expanded from its initial role as a surgical staging procedure in clinically node-negative patients. Clinically node-negative patients with small volume disease found on sentinel lymph node dissection now commonly avoid more extensive axillary surgery. There is interest in expanding this role to node-positive patients who receive neoadjuvant chemotherapy as a way to restage the axilla in hopes of sparing women who convert to node-negative status from the morbidity of complete nodal clearance. While sentinel lymph node dissection alone may not accomplish this goal, there are novel techniques, such as targeted axillary dissection, that may now allow for reliable nodal staging after chemotherapy.
Collapse
Affiliation(s)
- Abigail S Caudle
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit1484, Houston, TX, 77230-1402, USA.
| | - Henry M Kuerer
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit1484, Houston, TX, 77230-1402, USA.
| |
Collapse
|
22
|
Kim JY, Kim MK, Lee JE, Jung Y, Bae SY, Lee SK, Kil WH, Kim SW, Kim KS, Nam SJ, Han S. Sentinel lymph node biopsy alone after neoadjuvant chemotherapy in patients with initial cytology-proven axillary node metastasis. J Breast Cancer 2015; 18:22-8. [PMID: 25834607 PMCID: PMC4381119 DOI: 10.4048/jbc.2015.18.1.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 03/03/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis. Methods From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results. Results At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050). Conclusion SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.
Collapse
Affiliation(s)
- Ji Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | | | - Jeong Eon Lee
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongsik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Soo Youn Bae
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Ho Kil
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Seok Jin Nam
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sehwan Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
23
|
Pinder SE, Rakha EA, Purdie CA, Bartlett JMS, Francis A, Stein RC, Thompson AM, Shaaban AM. Macroscopic handling and reporting of breast cancer specimens pre- and post-neoadjuvant chemotherapy treatment: review of pathological issues and suggested approaches. Histopathology 2015; 67:279-93. [PMID: 25585651 DOI: 10.1111/his.12649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Neoadjuvant chemotherapy (NACT) is used increasingly in the treatment of invasive breast cancer and presents challenges for the pathologist in the handling and interpretation of tissues. Potential issues include pathological identification and localization of the residual tumour site; how best to assess pathological response (given the diversity of scoring systems described); the timing and assessment of axillary node biopsy; and the value of retesting any residual tumour for dissonance between core biopsy and post-treatment residual cancer cells for biomarker expression such as oestrogen and progesterone receptors and human epidermal growth factor receptor 2 (HER2). The role of the pathologist is critical in modern NACT approaches to breast cancer and is likely to remain challenging as novel agents and newer biomarkers become available. In this manuscript we review these issues and describe some practical approaches to handling and reporting these samples in the routine histopathology laboratory.
Collapse
Affiliation(s)
- Sarah E Pinder
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Colin A Purdie
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | - Robert C Stein
- University College London Hospitals and Medical School, London, UK
| | - Alastair M Thompson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abeer M Shaaban
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | |
Collapse
|
24
|
Mamounas EP. Impact of neoadjuvant chemotherapy on locoregional surgical treatment of breast cancer. Ann Surg Oncol 2015; 22:1425-33. [PMID: 25727558 DOI: 10.1245/s10434-015-4406-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Indexed: 02/05/2023]
Abstract
Preoperative (neoadjuvant) chemotherapy (NC) has become the standard of care for patients with locally advanced breast cancer and is being increasingly used in those with large operable disease. Its main clinical advantages from a surgical therapy standpoint include the potential for conversion of patients requiring mastectomy to breast-conservation candidates, the potential for improving the cosmetic outcome following lumpectomy by decreasing the size of the primary breast tumor even if the patient is a lumpectomy candidate at presentation, and the potential for converting patients who present with positive axillary nodes and who would initially require axillary lymph node dissection to candidates for sentinel lymph node biopsy alone. Important steps are required from the time of diagnosis until the time of surgical resection to ensure successful locoregional therapy outcomes in patients treated with NC. They include accurate assessment of the location and extent of the primary breast tumor and determination of axillary nodal status before and after NC. This information is critical for successful execution of the surgical plan and to optimize the use of adjuvant radiotherapy following NC. In the future, development of more active neoadjuvant chemotherapy regimens and novel molecular and imaging techniques will undoubtedly lead to further individualization of breast cancer surgical management following NC, including the possibility of avoiding surgical resection in cases with a high likelihood of achieving a pathological complete response.
Collapse
|
25
|
Kida K, Ishikawa T, Yamada A, Shimizu D, Tanabe M, Sasaki T, Ichikawa Y, Endo I. A prospective feasibility study of sentinel node biopsy by modified Indigocarmine blue dye methods after neoadjuvant chemotherapy for breast cancer. Eur J Surg Oncol 2015; 41:566-70. [PMID: 25650249 DOI: 10.1016/j.ejso.2014.10.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/08/2014] [Accepted: 10/17/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although sentinel lymph node biopsy (SLNB) is a standard staging method for assessing nodal status of breast cancer patients, SLNB after neoadjuvant chemotherapy (NAC) remains controversial. The aim of this study was to validate the practicality and accuracy of SLNB by our modified Indigocarmine blue dye methods following NAC. METHODS One hundred consecutive cases with breast cancers treated by NAC were enrolled in this study. After NAC, all patients underwent SLNB performed by our modified Indigocarmine blue dye methods without radioisotope, followed by back-up axillary lymph node dissection (ALND). RESULTS Sentinel nodes (SNs) were identified in 94 cases (identification rate, 94%); the accuracy was 94.7% (89/94 cases); and the false negative rate (FNR) 13.5% (5/37 cases). For cases with vs. without clinically evident metastatic nodes before NAC, the identification rate was 92.4% (61/66 cases) vs. 97.1% (33/34 cases); the accuracy 91.8% (56/61 cases) vs. 97.0% (32/33 cases) and the FNR 16.1% (5/31 cases) vs. 0% (0/6 case), respectively. There were six patients without identified SNs, three of them had metastatic nodes. False negatives occurred in five cases; in four, fewer than two sentinel nodes had been removed. CONCLUSION Following NAC, the accuracy of SLNB by modified Indigocarmine blue dye methods is adequate compared with other tracers. In patients in whom no SNs have been identified, lymphatic metastasis is likely and therefore ALND is recommended. For patients with cN0 prior to NAC, SLNB by modified Indigocarmine blue dye methods is clinically feasible, though controversial for patients with positive nodes.
Collapse
Affiliation(s)
- K Kida
- Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
| | - T Ishikawa
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - A Yamada
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - D Shimizu
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - M Tanabe
- Department of Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - T Sasaki
- Department of Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Y Ichikawa
- Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - I Endo
- Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
26
|
|
27
|
Boileau JF, Poirier B, Basik M, Holloway CMB, Gaboury L, Sideris L, Meterissian S, Arnaout A, Brackstone M, McCready DR, Karp SE, Trop I, Lisbona A, Wright FC, Younan RJ, Provencher L, Patocskai E, Omeroglu A, Robidoux A. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol 2014; 33:258-64. [PMID: 25452445 DOI: 10.1200/jco.2014.55.7827] [Citation(s) in RCA: 516] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE An increasing proportion of patients (> 30%) with node-positive breast cancer will obtain an axillary pathologic complete response after neoadjuvant chemotherapy (NAC). If sentinel node (SN) biopsy (SNB) is accurate in this setting, completion node dissection (CND) morbidity could be avoided. PATIENTS AND METHODS In the prospective multicentric SN FNAC study, patients with biopsy-proven node-positive breast cancer (T0-3, N1-2) underwent both SNB and CND. Immunohistochemistry (IHC) use was mandatory, and SN metastases of any size, including isolated tumor cells (ypN0[i+], ≤ 0.2 mm), were considered positive. The optimal SNB identification rate (IR) ≥ 90% and false-negative rate (FNR) ≤ 10% were predetermined. RESULTS From March 2009 to December 2012, 153 patients were accrued to the study. The SNB IR was 87.6% (127 of 145; 95% CI, 82.2% to 93.0%), and the FNR was 8.4% (seven of 83; 95% CI, 2.4% to 14.4%). If SN ypN0(i+)s had been considered negative, the FNR would have increased to 13.3% (11 of 83; 95% CI, 6.0% to 20.6%). There was no correlation between size of SN metastases and rate of positive non-SNs. Using this method, 30.3% of patients could potentially avoid CND. CONCLUSION In biopsy-proven node-positive breast cancer after NAC, a low SNB FNR (8.4%) can be achieved with mandatory use of IHC. SN metastases of any size should be considered positive. The SNB IR was 87.6%, and in the presence of a technical failure, axillary node dissection should be performed. We recommend that SN evaluation with IHC be further evaluated before being included in future guidelines on the use of SNB after NAC in this setting.
Collapse
Affiliation(s)
- Jean-Francois Boileau
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
| | - Brigitte Poirier
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Mark Basik
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Claire M B Holloway
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Louis Gaboury
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Lucas Sideris
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Sarkis Meterissian
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Angel Arnaout
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Muriel Brackstone
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - David R McCready
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Stephen E Karp
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Isabelle Trop
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Andre Lisbona
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Frances C Wright
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Rami J Younan
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Louise Provencher
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Erica Patocskai
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Atilla Omeroglu
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| | - Andre Robidoux
- Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA
| |
Collapse
|
28
|
Ge WK, Yang B, Zuo WS, Zheng G, Dai YQ, Han C, Yang L, Zheng MZ. Sentinel lymph node biopsy does not apply to all axillary lymph node-positive breast cancer patients after neoadjuvant chemotherapy. Thorac Cancer 2014; 5:550-5. [PMID: 26767051 DOI: 10.1111/1759-7714.12131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuant chemotherapy (NAC) in breast cancer patients with confirmed axillary nodal metastases. METHODS We enrolled 51 patients with breast cancer who received NAC. All patients were proven to have axillary nodal metastases by histopathology biopsy prior to NAC. They all underwent SLNB before breast surgery, and complete axillary lymph node dissection immediately followed. RESULTS The identification rate for SLNB was 87.5% (84/96); the false negative rate was 24.5% (12/49). The clinicopathological factors were not significantly correlated with the identification and false negative rate of the SLNB. Lymphatic mapping, blue dye or radionuclide methods tended to decrease the identification rate of SLNB (P = 0.073). Clinical nodal status before NAC has a trend to increase the false-negative rates of the SLNB (P = 0.059). For patients with N1 clinical axillary lymph nodal status, the identification rate was 93.9%, and the false negative rate was 5.9%, compared with N2-3 patients with 73.9% and 38.9%, respectively. CONCLUSIONS SLNB is feasible for the patients whose axillary lymph nodal status before NAC is N1. However, for N2-3 patients, SLNB cannot be used as an infallible indicator of non-SLN status.
Collapse
Affiliation(s)
- Wen-Kai Ge
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Shandong Cancer Hospital Jinan, China; Department of Surgery II, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Jinan, China
| | - Ben Yang
- Department of Surgery II, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Jinan, China
| | - Wen-Shu Zuo
- Department of Surgery II, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Jinan, China
| | - Gang Zheng
- Department of Surgery II, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Jinan, China
| | - Ying-Qi Dai
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Shandong Cancer Hospital Jinan, China
| | - Chao Han
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Shandong Cancer Hospital Jinan, China
| | - Li Yang
- Department of Surgery II, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Jinan, China
| | - Mei-Zhu Zheng
- Department of Surgery II, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Jinan, China
| |
Collapse
|
29
|
Schipper RJ, Moossdorff M, Nelemans PJ, Nieuwenhuijzen GA, de Vries B, Strobbe LJ, Roumen RM, van den Berkmortel F, Tjan-Heijnen VC, Beets-Tan RG, Lobbes MB, Smidt ML. A Model to Predict Pathologic Complete Response of Axillary Lymph Nodes to Neoadjuvant Chemo(Immuno)Therapy in Patients With Clinically Node-Positive Breast Cancer. Clin Breast Cancer 2014; 14:315-22. [DOI: 10.1016/j.clbc.2013.12.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/31/2013] [Accepted: 12/31/2013] [Indexed: 01/29/2023]
|
30
|
|
31
|
Abstract
The development and wide acceptance of sentinel lymph node biopsy (SLNB) has profoundly affected the management of breast cancer. SLNB has spared the additional morbidity of axillary lymph node dissection (ALND) without compromising diagnostic accuracy and prognostic information in patients with clinically node-negative early-stage breast cancer. It has become an invaluable tool to clinicians to guide decisions regarding adjuvant treatment. The management of breast cancer continues to advance to more minimally invasive approaches, and the role of ALND is likely to become less important in the future.
Collapse
|
32
|
Murawa P, Murawa D, Adamczyk B, Połom K. Breast cancer: Actual methods of treatment and future trends. Rep Pract Oncol Radiother 2014; 19:165-72. [PMID: 24936340 DOI: 10.1016/j.rpor.2013.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/04/2013] [Indexed: 01/17/2023] Open
Abstract
The recent ten to twenty years have seen a substantial progress in the diagnosis and treatment of breast cancer. A rapid development of various curative options has led to the improvement of treatment outcomes, while paying more and more attention to the aspects of quality of life and cosmetic effect. In our publication, we wish to outline certain trends in the development of modern treatment of breast cancer. Among topics discussed are new forms of molecular diagnostics, new approach to the idea of sentinel node biopsy, as well as new techniques for delivery of medical procedures, the increasing use of nomograms, progress in the techniques of breast conservative treatment, modern approach to occult breast lesions, the increasing use of neoadjuvant treatment and intraoperative radiotherapy.
Collapse
Affiliation(s)
- Paweł Murawa
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland ; Cancer Pathology Department, Oncology Department, Poznań University of Medical Sciences, Poland
| | - Dawid Murawa
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland
| | - Beata Adamczyk
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland
| | - Karol Połom
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland
| |
Collapse
|
33
|
Intraoperative sentinel node biopsy by one-step nucleic acid amplification (OSNA) avoids axillary lymphadenectomy in women with breast cancer treated with neoadjuvant chemotherapy. Eur J Surg Oncol 2013; 39:873-9. [PMID: 23711734 DOI: 10.1016/j.ejso.2013.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 04/11/2013] [Accepted: 05/02/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is no evidence that supports the recommendation of sentinel lymph node biopsy (SLNB) in patients with breast cancer who have treated with neoadjuvant chemotherapy (NAC) to downsize tumors in order to allow breast conservation surgery, because NAC induces anatomical alterations of the lymphatic drainage. We evaluated the effectiveness of SLNB using intraoperative one-step nucleic acid amplification (OSNA) method to detect microscopic metastases or isolated tumor cells after NAC in patients with clinically negative axillary nodes at initial presentation. PATIENTS AND METHODS We evaluated in patients with breast cancer and clinically negative axilla at presentation, the effectiveness of SLNB by OSNA after NAC (71 patients) or prior to NAC (40 patients). RESULTS The rate of SLN identification was 100% in both groups. 17 women with SLNB prior to systemic treatment showed positive nodes (14 macrometastases and 3 micrometastases), and positive SLNB were detected in 15 women with SLNB after NAC, which were 14 macrometastases and 1 micrometastase. The negative predictive value of ultrasonography was 57.5% in patients with SLNB prior to neoadjuvant therapy and 78.9% in patients with chemotherapy followed by SLNB. CONCLUSIONS Intraoperative SLNB using OSNA in women with clinically negative axillary lymph nodes at initial presentation who received NAC could predict axillary status with high accuracy. Also it allows us to take decisions about the indication or not to perform an axillary dissection at the moment, thus avoiding delay in the administration of chemotherapy and benefiting the patients from a single surgical procedure.
Collapse
|
34
|
Park S, Park JM, Cho JH, Park HS, Kim SI, Park BW. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with cytologically proven node-positive breast cancer at diagnosis. Ann Surg Oncol 2013; 20:2858-65. [PMID: 23645483 DOI: 10.1245/s10434-013-2992-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND The performance of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NCT) was investigated in patients with locally advanced breast cancer (LABC). METHODS After NCT of 178 patients with cytology-proven axillary/supraclavicular nodes metastasis at the time of diagnosis, SLNB using radioisotope was performed including completion node dissection between 2008 and 2011. The detection rate, sensitivity, false negative rate (FNR), negative predictive value (NPV) and accuracy of SLNB were analyzed. RESULTS SLNB was successfully performed in 169 (94.9%) patients. Tumor nonresponse and extensive residual nodal disease were found to be significantly associated with detection failure of sentinel nodes. Sensitivity, FNR, NPV, and accuracy of SLNB were 78.0, 22.0, 75.8, and 87.0%, respectively, and a greater number of retrieved SLNs increased all four of these performance measures. Conversion to node-negative disease was achieved in 69 (40.8%) patients: 24% of patients with the luminal A subtype, 51.6% of patients with the luminal B, 51.7% of patients with the HER2-enriched, and 58.5% of patients with the triple-negative breast cancer (TNBC) subtype. Luminal B, HER2-enriched, and TNBC subtypes showed comparable responses to NCT; however, the TNBC subtype had a significantly better FNR and accuracy. CONCLUSIONS SLNB was found to be technically feasible, but its routine use was not recommended for LABCs after NCT. However, acceptable performance was noted for locally advanced TNBCs, and thus SLNB might be safely considered in these selected patients.
Collapse
Affiliation(s)
- Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
35
|
Fontein DBY, van de Water W, Mieog JSD, Liefers GJ, van de Velde CJH. Timing of the sentinel lymph node biopsy in breast cancer patients receiving neoadjuvant therapy - recommendations for clinical guidance. Eur J Surg Oncol 2013; 39:417-24. [PMID: 23473972 DOI: 10.1016/j.ejso.2013.02.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/10/2013] [Accepted: 02/01/2013] [Indexed: 12/20/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) is an increasingly important component in the treatment of both locally advanced and early-stage breast cancer. With this, a debate on the timing of the sentinel lymph node biopsy (SLNB) has emerged. At the end of the last century, the SLNB was introduced as an axillary staging modality, and this paper aims to further elucidate this issue in the context of NAC. We compiled available data on the SLNB after NAC and provide clinical guidance for timing the SLNB in this context. On the basis of our findings, we recommend that the SLNB can be performed after NAC in all cases. In patients with a clinically node-negative (cN0) status prior to NAC, the SLNB should be performed after NAC, and in case of a histologically confirmed negative SLNB, a completion axillary lymph node dissection (ALND) has no added value and can be omitted. In patients with clinically positive nodal involvement (cN+) prior to NAC, all axillary surgery can also be performed after NAC.
Collapse
Affiliation(s)
- Duveken B Y Fontein
- Leiden University Medical Center, Department of Surgery, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
36
|
Koolen BB, Valdés Olmos RA, Wesseling J, Vogel WV, Vincent AD, Gilhuijs KGA, Rodenhuis S, Rutgers EJT, Vrancken Peeters MJTFD. Early Assessment of Axillary Response with 18F-FDG PET/CT during Neoadjuvant Chemotherapy in Stage II–III Breast Cancer: Implications for Surgical Management of the Axilla. Ann Surg Oncol 2013; 20:2227-35. [DOI: 10.1245/s10434-013-2902-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Indexed: 12/14/2022]
|
37
|
Sentinel node biopsy for breast cancer: past, present, and future. Breast Cancer 2012; 22:212-20. [PMID: 23250812 DOI: 10.1007/s12282-012-0421-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/15/2012] [Indexed: 02/06/2023]
Abstract
Sentinel node biopsy has replaced axillary lymph node dissection as the standard of care in early breast cancers. Sentinel node biopsy represents a highly accurate and less-morbid axillary staging, which allows most patients to avoid unnecessary axillary lymph node dissection and its morbidity. This review provides information including several issues which are still under debate, such as clinical significance of micrometastases, avoidance of axillary lymph node dissection for patients with positive sentinel nodes, accuracy and timing of sentinel node biopsy in patients undergoing neoadjuvant chemotherapy, and how many sentinel nodes are sufficient for removal. Finally, a new topic is introduced: superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging for the detection of metastases in sentinel nodes localized by computed tomography (CT)-lymphography (CT-LG) in patients with breast cancer. SPIO-enhanced MR imaging is a useful method of detecting metastases in sentinel nodes localized by CT-LG in patients with breast cancer. Patients with clinically negative nodes may be spared even sentinel node biopsy when the sentinel node is diagnosed as disease free using SPIO-enhanced MR imaging.
Collapse
|
38
|
Pesek S, Ashikaga T, Krag LE, Krag D. The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis. World J Surg 2012; 36:2239-51. [PMID: 22569745 DOI: 10.1007/s00268-012-1623-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In sentinel node surgery for breast cancer, procedural accuracy is assessed by calculating the false-negative rate. It is important to measure this since there are potential adverse outcomes from missing node metastases. We performed a meta-analysis of published data to assess which method has achieved the lowest false-negative rate. METHODS We found 3,588 articles concerning sentinel nodes and breast cancer published from 1993 through mid-2011; 183 articles met our inclusion criteria. The studies described in these 183 articles included a total of 9,306 patients. We grouped the studies by injection material and injection location. The false-negative rates were analyzed according to these groupings and also by the year in which the articles were published. RESULTS There was significant variation related to injection material. The use of blue dye alone was associated with the highest false-negative rate. Inclusion of a radioactive tracer along with blue dye resulted in a significantly lower false-negative rate. Although there were variations in the false-negative rate according to injection location, none were significant. CONCLUSIONS The use of blue dye should be accompanied by a radioactive tracer to achieve a significantly lower false-negative rate. Location of injection did not have a significant impact on the false-negative rate. Given the limitations of acquiring appropriate data, the false-negative rate should not be used as a metric for training or quality control.
Collapse
Affiliation(s)
- Sarah Pesek
- University of Vermont College of Medicine, Burlington, VT 05405, USA
| | | | | | | |
Collapse
|
39
|
Koolen BB, Valdés Olmos RA, Elkhuizen PHM, Vogel WV, Vrancken Peeters MJTFD, Rodenhuis S, Rutgers EJT. Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy. Breast Cancer Res Treat 2012; 135:231-40. [PMID: 22872522 DOI: 10.1007/s10549-012-2179-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/17/2012] [Indexed: 12/12/2022]
Abstract
The optimal method for locoregional staging in patients treated with neoadjuvant chemotherapy (NAC), usually ultrasound (US) and pre- or post-chemotherapy sentinel lymph node biopsy (SLNB), remains subject of debate. The aim of this study was to assess the value of 18F-FDG PET/CT for detecting locoregional lymph node metastases in primary breast cancer patients scheduled for NAC. 311 breast cancer patients, scheduled for NAC, underwent PET/CT of the thorax in prone position with hanging breasts. A panel of four experienced reviewers examined PET/CT images, blinded for other diagnostic procedures. FDG uptake in locoregional nodes was determined qualitatively using a 4-point scale (0 = negative, 1 = questionable, 2 = moderately intense, and 3 = very intense). Results were compared with pathology obtained by US-guided fine needle aspiration or SLNB prior to NAC. All FDG-avid extra-axillary nodes were considered metastatic, based on the previously reported high positive predictive value of the technique. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-avid nodes for the detection of axillary metastases (score 2 or 3) were 82, 92, 98, 53, and 84 %, respectively. Of 28 patients with questionable axillary FDG uptake (score 1), 23 (82 %) were node-positive. Occult lymph node metastases in the internal mammary chain and periclavicular area were detected in 26 (8 %) and 32 (10 %) patients, respectively, resulting in changed regional radiotherapy planning in 50 (16 %) patients. In breast cancer patients scheduled for NAC, PET/CT renders pre-chemotherapy SLNB unnecessary in case of an FDG-avid axillary node, enables axillary response monitoring during or after NAC, and leads to changes in radiotherapy for a substantial number of patients because of detection of occult N3-disease. Based on these results, we recommend a PET/CT as a standard staging procedure in breast cancer patients scheduled for NAC.
Collapse
Affiliation(s)
- Bas B Koolen
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
40
|
Is There Still a Role for Axillary Dissection in Breast Cancer Surgery? CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
Chawla A, Hunt KK, Mittendorf EA. Surgical considerations in patients receiving neoadjuvant systemic therapy. Future Oncol 2012; 8:239-50. [PMID: 22409461 DOI: 10.2217/fon.12.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Neoadjuvant chemotherapy is being increasingly used in the treatment of patients presenting with early-stage, operable breast cancer. Neoadjuvant chemotherapy downsizes most tumors, allowing appropriately selected patients to undergo breast-conserving therapy. Management of the axilla in patients receiving neoadjuvant chemotherapy is dictated by whether patients present with clinically node-negative or node-positive disease. Patients with clinically node-negative disease can undergo sentinel lymph node dissection after neoadjuvant chemotherapy, with axillary lymph node dissection reserved for patients with a positive sentinel lymph node. For patients with clinically node-positive disease at presentation, the current standard of care is axillary lymph node dissection. An ongoing cooperative group trial is investigating the utility of sentinel lymph node surgery in the clinically node-positive population.
Collapse
Affiliation(s)
- Akhil Chawla
- Department of Surgery, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | | |
Collapse
|
42
|
Sbaity E, Jacobs LK. Surgical Considerations Following Preoperative Systemic Chemotherapy. CURRENT BREAST CANCER REPORTS 2011. [DOI: 10.1007/s12609-011-0057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
|
44
|
Twaddell WS, Wu PC, Verhage RJJ, Feith M, Ilson DH, Schuhmacher CP, Luketich JD, Brücher B, Vallböhmer D, Hofstetter WL, Krasna MJ, Kandioler D, Schneider PM, Wijnhoven BPL, Sontag SJ. Barrett's esophagus: treatments of adenocarcinomas II. Ann N Y Acad Sci 2011; 1232:265-91. [PMID: 21950818 DOI: 10.1111/j.1749-6632.2011.06056.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The following topics are explored in this collection of commentaries on treatments of adenocarcinomas related to Barrett's esophagus: the importance of intraoperative frozen sections of the margins for the detection of high dysplasia; the preferable way for sentinel node dissection; the current role of robotic surgery and of video-endoscopic approach; the value of the Siewert's classification of adenocarcinomas; the indications of two-step esophagectomy; the evaluation of pathological complete response; the role of PET scan in staging and response assessment; the role of p53 in the selection of adenocarcinomas patients; chemotherapy regimens for adenocarcinomas; the use of monoclonal antibodies in the control of cell proliferation; he attempt to define a stage-specific strategy, and the possible indications of selective therapy; and changes in mortality rates from esophageal cancer.
Collapse
Affiliation(s)
- William S Twaddell
- Anatomic Pathology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Sentinel Lymph Node Biopsy After Chemotherapy. CURRENT BREAST CANCER REPORTS 2011. [DOI: 10.1007/s12609-011-0040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Tausch C, Steger GG, Haid A, Jakesz R, Fridrik MA, Reitsamer R, Pöstlberger S, Lang A, Gnant M, Greil R. Sentinel Node Biopsy After Primary Chemotherapy in Breast Cancer: A Note of Caution from Results of ABCSG-14. Breast J 2011; 17:230-8. [DOI: 10.1111/j.1524-4741.2011.01073.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Pecha V, Kolarik D, Kozevnikova R, Hovorkova K, Hrabetova P, Halaska M, Sottner O, Trnkova M, Petruzelka L, Kolarova H. Sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy. Cancer 2011; 117:4606-16. [DOI: 10.1002/cncr.26102] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 01/09/2011] [Accepted: 01/27/2011] [Indexed: 11/06/2022]
|
48
|
Bear HD. Neoadjuvant Chemotherapy for Operable Breast Cancer: Individualizing Locoregional and Systemic Therapy. Surg Oncol Clin N Am 2010; 19:607-26. [DOI: 10.1016/j.soc.2010.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Ansari B, Boughey JC. Sentinel Lymph Node Surgery in Uncommon Clinical Circumstances. Surg Oncol Clin N Am 2010; 19:539-53. [DOI: 10.1016/j.soc.2010.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
50
|
Dixon J, Cody H. Role of sentinel node biopsy in patients having neoadjuvant chemotherapy. Eur J Surg Oncol 2010; 36:511-3. [DOI: 10.1016/j.ejso.2010.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 02/23/2010] [Accepted: 04/12/2010] [Indexed: 11/30/2022] Open
|