1
|
Magnoni F, Corso G, Gilardi L, Pagan E, Massari G, Girardi A, Ghidinelli F, Bagnardi V, Galimberti V, Grana CM, Veronesi P. Does failed mapping predict sentinel lymph node metastasis in cN0 breast cancer? Future Oncol 2021; 18:193-204. [PMID: 34882010 DOI: 10.2217/fon-2021-0470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: The clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) is unknown. The authors sought to determine the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Patients & methods: A total of 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively studied. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Results: Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Conclusion: Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.
Collapse
Affiliation(s)
- Francesca Magnoni
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Giovanni Corso
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy.,Departmentof Oncology & Hemato-Oncology, University of Milan, Milan, 20122, Italy
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milano, 20141, Italy
| | - Eleonora Pagan
- Department of Statistics & Quantitative Methods, University of Milan-Bicocca, Milan, 20126, Italy
| | - Giulia Massari
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Antonia Girardi
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | | | - Vincenzo Bagnardi
- Department of Statistics & Quantitative Methods, University of Milan-Bicocca, Milan, 20126, Italy
| | - Viviana Galimberti
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milano, 20141, Italy
| | - Paolo Veronesi
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy.,Departmentof Oncology & Hemato-Oncology, University of Milan, Milan, 20122, Italy
| |
Collapse
|
2
|
Tsai LW, Lee YH, Lo C, Lien HC, Wang MY, Jan IS, Yen RF, Hu FC, Huang CS. Factors predicting one or two sentinel lymph nodes to be accepted for sentinel lymph node biopsy alone after neoadjuvant therapy in initially node-positive breast cancer patients. Surg Oncol 2021; 39:101667. [PMID: 34673474 DOI: 10.1016/j.suronc.2021.101667] [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: 06/19/2021] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current guidelines recommend harvesting ≥3 sentinel nodes if sentinel lymph node biopsy (SLNB) alone is considered after neoadjuvant therapy (NAT) for initially node-positive (cN+) breast cancer. We attempted to investigate factors predicting one or two sentinel lymph nodes harvested to be accepted for SLNB alone after NAT in initially cN + patients. METHODS Overall, 157 patients who received NAT (clinically T1-3/N1-2/M0) and underwent SLNB were identified from a prospectively maintained database. Significant factors were identified using a multiple logistic regression model. RESULTS The overall SLN identification rate was 83.4%. Failed SLN identification was associated with a 2-day protocol using a single tracer (odds ratio: 0.331 [95% confidence interval {CI}: 0.132-0.830], p = 0.018), age >52 years (0.345 [0.131-0.913], p = 0.032), and lobular histology (0.156 [0.026-0.944], p = 0.043). The overall false-negative SLNB rate was 14.7%. Its increased risk was associated with radioactivity count >530 for any SLN during SLNB (96.4 [4.00-2320], p = 0.005), age ≥57 years (34.2 [1.92-610], p = 0.016), and taxane use (105 [1.02-10700], p = 0.049); its decreased risk was associated with more harvested SLNs (0.191 [0.054-0.669], p = 0.01) and dual tracers (0.101 [0.012-0.843], p = 0.034). A predictive model using these factors achieved an area under the curve of 0.935 (95% CI: 0.878-0.991). CONCLUSION When taxane was administered during NAT, the false-negative rate was predicted at <5% for patients aged <57 years, if 1-2 SLNs were harvested using dual tracers, and when the count of every SLN was lower than 530 after NAT in cN + breast cancer.
Collapse
Affiliation(s)
- Li-Wei Tsai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chiao Lo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Yang Wang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Fu-Chang Hu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
3
|
Nowikiewicz T, Głowacka‐Mrotek I, Tarkowska M, Nowikiewicz M, Zegarski W. Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis. Breast J 2020; 26:873-881. [DOI: 10.1111/tbj.13769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Tomasz Nowikiewicz
- Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
- Department of Clinical Breast Cancer and Reconstructive Surgery Oncology Centre Bydgoszcz Poland
| | - Iwona Głowacka‐Mrotek
- Department of Rehabilitation Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Magdalena Tarkowska
- Department of Physiotherapy Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Magdalena Nowikiewicz
- Student Scientific Society – Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Wojciech Zegarski
- Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| |
Collapse
|
4
|
Hellingman D, de Wit-van der Veen BJ, Wan OY, van der Ploeg IM, Rutgers EJT, Stokkel MPM. Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes. J Surg Oncol 2018; 119:421-429. [DOI: 10.1002/jso.25339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Daan Hellingman
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Berlinda J de Wit-van der Veen
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Oi Yan Wan
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Iris M van der Ploeg
- Department of Surgical Oncology; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Emiel J. Th. Rutgers
- Department of Surgical Oncology; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Marcel P. M. Stokkel
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| |
Collapse
|
5
|
Non-visualized sentinel nodes in breast cancer patients; prevalence, risk factors, and prognosis. Breast Cancer Res Treat 2017; 167:147-156. [PMID: 28861665 DOI: 10.1007/s10549-017-4483-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evidence and consensus is lacking in international guidelines regarding axillary treatment recommendations for patients in whom a sentinel lymph node (SLN) cannot be visualized (non-vSLN) during the sentinel node procedure. In this study we aimed to determine the prevalence of non-vSLNs in a Dutch population of breast cancer patients and to examine predictors and survival rate for non-vSLN. METHODS A nationwide, retrospective, population-based study was performed including 116,920 patients with invasive breast cancer who underwent a SLN procedure in the Netherlands between January 2005 and December 2013. RESULTS Of the 76,472 clinically negative patients who underwent a SLN procedure, 1924 patients (2.5%) had a non-vSLN, of whom 1552 (80.7%) underwent an ALND. Multivariate analysis showed predictive factors for non-vSLN: older age (p < 0.001), diagnosis in the period 2005-2009 (p < 0.001), larger tumor size (p = 0.003), and extensive nodal involvement (p < 0.001). Multivariate survival analysis showed a significantly worse survival (HR 1.18, 95% CI 1.03-1.34, p = 0.015) for non-vSLNs patients. However, in the non-vSLN group, an ALND was not statistically significantly associated with a better survival (HR 0.96, 95% CI 0.53-1.75, p = 0.891). CONCLUSION Patients with non-vSLNs had less favorable disease characteristics and a worse survival compared to patients with a visualized SLN. Performing an ALND was not associated with a significantly better survival in patients with non-vSLNs. However, further research on the necessity of axillary treatment in this specific patient group is required.
Collapse
|
6
|
Thangarajah F, Malter W, Hamacher S, Schmidt M, Krämer S, Mallmann P, Kirn V. Predictors of sentinel lymph node metastases in breast cancer-radioactivity and Ki-67. Breast 2016; 30:87-91. [DOI: 10.1016/j.breast.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/29/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022] Open
|
7
|
Breast cancer lymphoscintigraphy: Factors associated with sentinel lymph node non visualization. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Vugts G, Maaskant-Braat AJG, Voogd AC, van Riet YEA, Roumen RMH, Luiten EJT, Rutgers EJT, Wyndaele D, Rutten HJT, Nieuwenhuijzen GAP. Improving the Success Rate of Repeat Sentinel Node Biopsy in Recurrent Breast Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S529-35. [DOI: 10.1245/s10434-015-4787-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Indexed: 11/18/2022]
|
9
|
Vaz SC, Silva Â, Sousa R, Ferreira TC, Esteves S, Carvalho IP, Ratão P, Daniel A, Salgado L. Breast cancer lymphoscintigraphy: Factors associated with sentinel lymph node non visualization. Rev Esp Med Nucl Imagen Mol 2015; 34:345-9. [PMID: 25986344 DOI: 10.1016/j.remn.2015.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/21/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate factors associated with non identification of the sentinel lymph node (SLN) in lymphoscintigraphy of breast cancer patients and analyze the relationship with SLN metastases. MATERIAL AND METHODS A single-center, cross-sectional and retrospective study was performed. Forty patients with lymphoscintigraphy without sentinel lymph node identification (negative lymphoscintigraphy - NL) were enrolled. The control group included 184 patients with SLN identification (positive lymphoscintigraphy - PL). Evaluated factors were age, body mass index (BMI), tumor size, histology, localization, preoperative breast lesion hookwire (harpoon) marking and SLN metastases. The statistical analysis was performed with uni- and multivariate logistic regression models and matched-pairs analysis. RESULTS Age (p=0.036) or having BMI (p=0.047) were the only factors significantly associated with NL. Being ≥60 years with a BMI ≥30 increased the odds of having a NL 2 and 3.8 times, respectively. Marking with hookwire seems to increase the likelihood of NL, but demonstrated statistical significance is lacking (p=0.087). The other tested variables did not affect the examination result. When controlling for age, BMI and marking with the harpoon, a significant association between lymph node metastization and NL was not found (p=0.565). CONCLUSIONS The most important factors related with non identification of SLN in the patients were age, BMI and marking with hook wire. However, only the first two had statistical importance. When these variables were controlled, no association was found between NL and axillary metastases.
Collapse
Affiliation(s)
- S C Vaz
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal.
| | - Â Silva
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - R Sousa
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - T C Ferreira
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - S Esteves
- Clinical Research Unit of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - I P Carvalho
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - P Ratão
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - A Daniel
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - L Salgado
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| |
Collapse
|
10
|
Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Goñi Gironés E, Vicente García F, Serra Arbeloa P, Estébanez Estébanez C, Calvo Benito A, Rodrigo Rincón I, Camarero Salazar A, Martínez Lozano ME. [Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera]. Rev Esp Med Nucl Imagen Mol 2013; 32:343-9. [PMID: 23597424 DOI: 10.1016/j.remn.2013.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
AIM To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. MATERIAL AND METHODS A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. RESULTS The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). CONCLUSIONS The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role.
Collapse
Affiliation(s)
- E Goñi Gironés
- Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, España.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Kohl Schwartz A, Leo C, Rufibach K, Varga Z, Fink D, Gabriel N. Does increased tumor burden of sentinel nodes in breast cancer affect detection procedure? Eur J Surg Oncol 2013; 39:266-72. [DOI: 10.1016/j.ejso.2012.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/03/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
|
13
|
Cheng G, Kurita S, Torigian DA, Alavi A. Current status of sentinel lymph-node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging 2010; 38:562-75. [PMID: 20700739 DOI: 10.1007/s00259-010-1577-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 07/18/2010] [Indexed: 12/17/2022]
Abstract
Axillary node status is the most important prognostic indicator for patients with invasive breast cancer. Sentinel lymph-node biopsy (SLNB) is widely accepted and the preferred procedure for identifying lymph-node metastasis. SLNB allows focused excision and pathological examination of the most likely axillary lymph nodes to receive tumor metastases while avoiding morbidities associated with complete axillary nodal dissection. Since its introduction in the early 1990s, the process of SLNB has undergone continual modification and refinement; however, the procedure varies between institutions and controversies remain. In this review, we examine the technical issues that influence the success of lymph node mapping, discuss the controversies, and summarize the indications and contraindications for axillary node mapping and biopsy in clinical practice.
Collapse
Affiliation(s)
- Gang Cheng
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | | | |
Collapse
|
14
|
Meretoja TJ, Joensuu H, Heikkilä PS, Leidenius MH. Safety of sentinel node biopsy in breast cancer patients who receive a second radioisotope injection after visualization failure in lymphoscintigraphy. J Surg Oncol 2010; 102:649-55. [DOI: 10.1002/jso.21637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|