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Lim GH, Alcantara VS, Allen JC, Saffari SE, Tan VKM, Tan KTB, Ngaserin S, Tan SM, Leong LCH, Wong FY. Long-Term Oncologic Outcomes of Omitting Axillary Surgery in Breast Cancer Patients with Chest Wall Recurrence after Mastectomy. Cancers (Basel) 2024; 16:2699. [PMID: 39123428 PMCID: PMC11312264 DOI: 10.3390/cancers16152699] [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: 06/07/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The management of the axilla in breast cancer patients with isolated chest wall recurrence (CWR) after mastectomy remains controversial. Although sentinel lymph node biopsy (SLNB) for restaging is feasible, its role is unclear. We aimed to determine if the omission of axillary restaging surgery in female patients with operable presumably isolated CWRs could result in an increased risk of second recurrences. METHODS In this retrospective multicentre study, patients who developed CWRs were reviewed. We excluded patients with suspected or concomitant regional/distant metastases, bilateral cancers and patients without CWR surgery. Patients' demographics, pathological data and subsequent recurrences were collected from a prospective database and were compared between patients with axillary lymph node dissection (ALND) and/or SLNB versus no axillary operation at CWR. FINDINGS A total of 194 patients with CWRs were eligible. The median age at CWR was 56.0 (IQR 47.0-67.0) years old. At recurrence, 8 (4.1%), 5 (2.6%) and 181 (93.3%) patients had ALND, SLNB and no axillary operation, respectively. Patients with no axillary surgery during CWR were associated with, at primary cancer, a lower incidence of ductal carcinoma in situ as diagnosis (p = 0.007) and older age (p = 0.022). Subsequent ipsilateral axillary (p = 0.768) and second recurrences (p = 0.061) were not statistically different between patients with and without axillary surgery at CWR on median follow-up of 59.5 (IQR 27.3-105) months. INTERPRETATION In patients without evidence of concomitant regional or distant metastasis at CWR diagnosis, omission of axillary restaging surgery was not associated with an increased ipsilateral axillary or second recurrences on long-term follow-up.
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Affiliation(s)
- Geok Hoon Lim
- Breast Department, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
- Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore 168582, Singapore (S.N.)
| | - Veronica Siton Alcantara
- Breast Department, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
- SingHealth Duke-NUS Breast Centre, Singapore 168582, Singapore (S.N.)
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| | - Veronique Kiak Mien Tan
- SingHealth Duke-NUS Breast Centre, Singapore 168582, Singapore (S.N.)
- Department of Breast Surgery, Singapore General Hospital, Singapore 544886, Singapore
- Division of Surgery and Surgical Oncology, National Cancer Centre, Singapore 168583, Singapore
| | - Kiat Tee Benita Tan
- SingHealth Duke-NUS Breast Centre, Singapore 168582, Singapore (S.N.)
- Department of Breast Surgery, Singapore General Hospital, Singapore 544886, Singapore
- Division of Surgery and Surgical Oncology, National Cancer Centre, Singapore 168583, Singapore
- Breast Service, Department of Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Sabrina Ngaserin
- SingHealth Duke-NUS Breast Centre, Singapore 168582, Singapore (S.N.)
- Breast Service, Department of Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Su Ming Tan
- SingHealth Duke-NUS Breast Centre, Singapore 168582, Singapore (S.N.)
- Division of Breast Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - Lester Chee Hao Leong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore 169608, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre, Singapore 168583, Singapore
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2
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Weber WP, Hanson SE, Wong DE, Heidinger M, Montagna G, Cafferty FH, Kirby AM, Coles CE. Personalizing Locoregional Therapy in Patients With Breast Cancer in 2024: Tailoring Axillary Surgery, Escalating Lymphatic Surgery, and Implementing Evidence-Based Hypofractionated Radiotherapy. Am Soc Clin Oncol Educ Book 2024; 44:e438776. [PMID: 38815195 DOI: 10.1200/edbk_438776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The management of axillary lymph nodes in breast cancer is continually evolving. Recent data now support omitting axillary lymph node dissection (ALND) in most patients with metastases in up to two sentinel lymph nodes (SLNs) during upfront surgery and those with residual isolated tumor cells after neoadjuvant chemotherapy (NACT). In the upfront surgery setting, ALND is still indicated, however, in patients with clinically node-positive breast cancer or more than two positive SLNs and, after NACT, in case of residual micrometastases and macrometastases. Omission of the sentinel lymph node biopsy (SLNB) can be considered in many postmenopausal patients with small luminal breast cancer, particularly when axillary ultrasound is negative. Several randomized controlled trials (RCTs) are currently aiming at eliminating the remaining indications for ALND and also establishing omission of SLNB in a broader patient population. The movement to deescalate axillary staging is in part because of the association between ALND and lymphedema, which is swelling of an extremity because of lymphatic damage and obstructed lymphatic drainage. To reduce the risk of developing this condition, patients undergoing ALND can undergo reverse mapping of the axilla and immediate reconstruction or bypass of the lymphatics from the involved extremity. Decongestion and compression are the foundation of conservative treatment for established lymphedema, while lymphovenous bypass and lymph node transfer are surgical procedures to address the physiologic dysfunction. Radiotherapy is an essential component of breast locoregional therapy: more than three decades of radiation research has optimized treatment according to patient's risk of local recurrence while substantially reducing the number of treatment visits. High-quality RCTs have shown the efficacy and safety of hypofractionation-more than 2Gy radiation dose per treatment (fraction)-significantly reducing the burden of radiotherapy treatment for many patients with breast cancer. In 2024, guidelines recommend no more than 15-16 fractions for whole-breast and nodal radiotherapy, with some recommending five fractions for whole-breast radiotherapy. In addition, simultaneous integrated boost (SIB) has been shown to be noninferior to sequential boost with regards to ipsilateral breast tumor recurrence with similar or reduced long-term side effects, also reducing overall treatment length. Further RCTs are underway investigating other indications for five fractions, including SIB and regional node irradiation, such that, in future, it may be possible for the majority of breast radiotherapy patients to be treated with a 1-week course. This manuscript serves to outline the latest updates on axillary surgical staging, lymphatic surgery, and evidence-based radiotherapy in the treatment of breast cancer.
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Affiliation(s)
- Walter Paul Weber
- Breast Clinic, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Summer E Hanson
- Plastic and Reconstructive Surgery, The University of Chicago Medicine and Biological Sciences Division, Chicago, IL
| | - Daniel E Wong
- Plastic and Reconstructive Surgery, The University of Chicago Medicine and Biological Sciences Division, Chicago, IL
| | - Martin Heidinger
- Breast Clinic, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fay H Cafferty
- Institute of Cancer Research Clinical Trials and Statistics Unit, London, United Kingdom
| | - Anna M Kirby
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
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3
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Mokhtech M, Knowlton CA. Bilateral Breast Cancer With Contralateral Axillary Metastasis Warrants Aggressive Treatment: Let's Go for It! Int J Radiat Oncol Biol Phys 2023; 117:527-528. [PMID: 37739602 DOI: 10.1016/j.ijrobp.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Meriem Mokhtech
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Christin A Knowlton
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
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4
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McDuff SGR, Blitzblau RC. Postoperative Comprehensive Radiation with Curative Intent. Int J Radiat Oncol Biol Phys 2022; 113:491-492. [PMID: 35777391 DOI: 10.1016/j.ijrobp.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/25/2022]
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5
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Haarsma R, van Loevezijn AA, Donswijk ML, Scholten AN, Vrancken Peeters MTFD, van Duijnhoven FH. Added value of repeat sentinel lymph node biopsy in FDG-PET/CT node-negative patients with ipsilateral breast cancer recurrence. Breast Cancer Res Treat 2022; 194:617-627. [PMID: 35727380 DOI: 10.1007/s10549-022-06654-9] [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: 03/22/2022] [Accepted: 06/05/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Repeat sentinel lymph node biopsy (rSLNB) has been suggested for axillary staging in clinically node-negative (cN0) patients with ipsilateral breast tumor recurrence (IBTR). Although rSLNB is technically feasible in this group of patients, the clinical value has not been established. We aimed to assess the added value of rSLNB in cN0 patients with IBTR who underwent optimal clinical staging with FDG-PET/CT. METHODS This retrospective single-center cohort study included 119 patients with IBTR-staged cT1-4N0M0 with FDG-PET/CT who underwent rSLNB between 2006 and 2020. Overall recurrence-free survival (RFS) and overall survival (OS) were calculated for subgroups with tumor-positive, tumor negative, and unsuccessful rSLNB. RESULTS rSLNB was successful in 79 (66%) of the 119 included patients, of whom 70 (59%) had a tumor negative and 9 (8%) a tumor-positive rSLNB; rSLNB was unsuccessful in the remaining 40 (34%) patients. Patients with a tumor-positive rSLNB had poorer overall 5-year RFS compared to patients with a tumor negative or unsuccessful rSLNB (44% vs. 86% vs. 90%, p = 0.004). Although patients with a tumor-positive rSLNB had worse RFS, the 10-year OS was comparable to a tumor negative or unsuccessful rSLNB (89% vs. 89% vs. 95%, p = 0.701). CONCLUSION The incidence of a tumor-positive rSLNB in patients with a negative FDG-PET/CT is low and does not change survival. Therefore, in cN0 patients with IBTR who underwent optimal clinical staging with FDG-PET/CT, we support a patient- and tumor-tailored treatment strategy in which rSLNB may be omitted.
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Affiliation(s)
- R Haarsma
- Department of Surgical Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Plesnmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - A A van Loevezijn
- Department of Surgical Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Plesnmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Department of Surgical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - A N Scholten
- Department of Radiotherapy, Netherlands Cancer Institute- Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - M T F D Vrancken Peeters
- Department of Surgical Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Plesnmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Department of Surgical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - F H van Duijnhoven
- Department of Surgical Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Plesnmanlaan 121, 1066CX, Amsterdam, The Netherlands.
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6
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Song MW, Ki SY, Lim HS, Lee HJ, Lee JS, Yoon JH. Axillary metastasis from occult breast cancer and synchronous contralateral breast cancer initially suspected to be cancer with contralateral axillary metastasis: a case report. BMC Womens Health 2021; 21:418. [PMID: 34920718 PMCID: PMC8684161 DOI: 10.1186/s12905-021-01569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Initial detection of axillary metastasis without known ipsilateral breast cancer could be a challenging diagnostic problem. Four options could be considered for the primary site of the malignancy: ipsilateral occult breast cancer, contralateral breast cancer, tumors in other distant organs, and primary axillary malignancy itself. Although breast cancer is known as the most common primary cancer of axillary metastasis, both occult breast cancer and breast cancer with contralateral axillary metastasis (CAM) are rare.
Case presentation
A 63-year-old woman presented with palpable right axillary metastasis, and a tiny contralateral breast cancer was detected by breast magnetic resonance imaging. No lesion was found in the ipsilateral right breast and contralateral left axillary region. Both right axillary metastasis and contralateral breast cancer were positive for estrogen receptor. The diagnostic issue was to determine whether the axillary metastasis was derived from the contralateral breast cancer or not. Right axillary dissection and left breast conserving surgery were performed. The final diagnosis was occult breast cancer that presented with axillary lymph node metastasis and early-stage synchronous contralateral breast cancer, based on clinical evidence and postoperative pathologic results. After surgery, systemic treatment and whole breast irradiation were administered. No recurrence or metastasis was observed 15 months postoperatively.
Conclusion
For accurate diagnosis of axillary metastasis without detectable ipsilateral breast cancer, multifaceted diagnostic approach considering clinical, radiological, and pathological evidences is required.
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7
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Vicini E, Leonardi MC, Fontana SKR, Pagan E, Bagnardi V, Gilardi L, Cardillo A, Rafaniello Raviele P, Sargenti M, Morigi C, Intra M, Veronesi P, Galimberti V. How to Perform Repeat Sentinel Node Biopsy Safely After a Previous Mastectomy: Technical Features and Oncologic Outcomes. Ann Surg Oncol 2021; 29:1750-1760. [PMID: 34750715 DOI: 10.1245/s10434-021-10986-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/05/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The latest National Comprehensive Cancer Network Breast Cancer Guidelines still discourage repeat sentinel node biopsy (SNB) after mastectomy, and the largest multicentric study available reports only 35 cases in the absence of previous axillary dissection (AD). METHODS From January 2003 to November 2018, 89 patients of the European Institute of Oncology with local recurrence of breast cancer after mastectomy, free of distant metastases, with a clinically negative axilla and a negative axillary ultrasound, in absence of AD, underwent lymphatic mapping before wide local excision. RESULTS During surgery, SNB was successful for 99% of the patients, with 14% being metastatic. Additional metastatic nodes removed by AD after a positive sentinel node occurred in 82% of cases. After a medium follow-up period of 3.7 years, the overall survival rate was 96.7%, and the disease-free survival rate was 84.4%. No axillary relapse after AD was recorded. One patient who refused human epidermal growth factor receptor 2 (HER2)-targeted treatment experienced ipsilateral axillary recurrence after a negative repeat SNB. The first axillary level was never directly irradiated because all the patients with positive repeat SNB underwent AD. For invasive luminal-like HER2-negative recurrences, the metastatic sentinel node was significantly associated with the choice to prescribe adjuvant chemotherapy (p = 0.003). CONCLUSIONS In specialized centers, repeat axillary SNB for patients with local recurrence after mastectomy in the absence of previous AD can represent a safe option for detection and removal of occult axillary disease that would otherwise not be excised/irradiated to achieve better local control and could possibly influence the choice of adjuvant treatments.
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Affiliation(s)
- Elisa Vicini
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.
| | | | | | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Cardillo
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Manuela Sargenti
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Consuelo Morigi
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
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8
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Nash AL, Thomas SM, Plichta JK, Fayanju OM, Hwang ES, Greenup RA, Rosenberger LH. Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer? Ann Surg Oncol 2021; 28:5544-5552. [PMID: 34287787 DOI: 10.1245/s10434-021-10461-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contralateral axillary nodal metastases (CAM) is classified as stage IV disease, although many centers treat CAM with curative intent. We hypothesized that patients with CAM, treated with multimodality therapy, would have improved overall survival (OS) versus patients with distant metastatic disease (M1) and similar OS to those with locally advanced breast cancer (LABC). METHODS Using the NCDB (2004-2016), we categorized adult patients with node-positive breast cancer into three study groups: LABC, CAM, and M1. Kaplan-Meier curves were used to visualize the unadjusted OS. Cox proportional hazards models were used to estimate the association of study group with OS. RESULTS A total of 94,487 patients were identified: 122 with CAM, 12,325 with LABC, and 82,040 with M1 (median follow-up 63.6 months). LABC and CAM patients had similar histology and rates of chemotherapy and endocrine therapy receipt. However, the CAM group had significantly larger tumors, more estrogen-receptor expression, higher T-stage, and more mastectomies than the LABC group. Compared with M1 patients, CAM patients were more likely to have grade 3 and cT4 tumors. Patients with CAM and LABC had similar 5-year unadjusted OS and significantly improved OS vs M1 patients. After adjustment, LABC and CAM patients continued to have similar OS and better OS vs M1 patients. CONCLUSIONS CAM patients who receive multi-modal therapy with curative intent may have OS more comparable to LABC patients than M1 patients. Out data support a reevaluation of whether CAM should remain classified as M1, as N3 may better reflect disease prognosis and treatment goals.
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Affiliation(s)
- Amanda L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute, Duke University, Durham, NC, USA.
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9
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Akita S, Yamaji Y, Tokumoto H, Tezuka T, Ogata H, Kosaka K, Kanai M, Kuriyama M, Mitsukawa N. Where does subcutaneous lymph from the chest wall flow into after mastectomy? J Plast Reconstr Aesthet Surg 2021; 74:2856-2862. [PMID: 34020906 DOI: 10.1016/j.bjps.2021.03.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Changes of the lymph flow from the chest wall after mastectomy and sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (Ax) has yet to be understood. This study aimed to investigate the effect of axillary surgery on lymphatic flow from the chest wall in patients who have undergone mastectomy, including those have undergone breast reconstruction and vascularized lymph node transfer (VLNT). METHODS Following mastectomy in 100 breasts, the directions of lymph flow from the chest wall was compared between the SLNB omission, SLNB, Ax, and Ax followed by VLNT groups using indocyanine green (ICG) lymphography in cross-sectional study. Lymph flow on the deep epigastric artery perforator (DIEP) flap was also investigated. RESULTS Lymph flow directing to the ipsilateral axilla was observed more frequently after SLNB than Ax (48% vs. 12.5%; p = 0.005); however, no significant difference was observed in the frequency of contralateral axillary route adoption between them (8% vs. 15%; p = 0.65). In the VLNT group, lymph flow to the ipsilateral axilla was not observed at a significantly higher frequency than in the Ax group (12.5% vs. 12.5%, p = 1.00). On the transferred DIEP flap, the lymph flowed anterograde or retrograde parallel to the anatomic course of the lymphatic vessels. CONCLUSION To visualize the direction of lymph flow of the chest following mastectomy, ICG lymphography may be useful to discern the direction in which malignant neoplasms, including lymphoma, are transported and to plan for lymph flow restoration.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Yoshihisa Yamaji
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Chiba, Japan
| | - Takafumi Tezuka
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideyuki Ogata
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Kosaka
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiko Kanai
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Motone Kuriyama
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Shinyurigaoka General Hospital, Kawasaki, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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10
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Maseki H, Takayama S, Yoshida M, Nakadaira U, Watase C, Shiino S, Murata T, Jimbo K, Suto A. A case of lymph node dissection for contralateral axillary lymph node metastasis of ipsilateral breast tumor recurrence after identifying the primary lymphatic drainage by lymphoscintigraphy. Int Cancer Conf J 2021; 10:154-158. [PMID: 33786290 PMCID: PMC7947167 DOI: 10.1007/s13691-021-00470-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022] Open
Abstract
We report a case of total mastectomy and contralateral axillary lymph node dissection (ALND) in a patient with ipsilateral breast tumor recurrence (IBTR) and contralateral axillary lymph node metastasis (ALNM), with lymphoscintigraphy, confirming that the primary lymphatic flow was directed to the contralateral ALNM. The patient in the present case study is a 63-year-old woman. At the age of 46 years, the patient underwent lumpectomy and sentinel lymph node biopsy (SLNB) for left breast cancer. After surgery, she underwent whole-breast irradiation and hormone therapy (tamoxifen) for 5 years. On follow-up, she did not have recurrence. When she underwent breast ultrasound examination at the 17-year checkup after the initial surgery, she was diagnosed with tumor recurrence in the left conserved breast and with contralateral ALNM, without distant metastasis to any other organ. When re-SLNB is performed in patients with IBTR, the primary lymphatic flow is directed toward a lymph node other than the ipsilateral axillary lymph node (ALN). Therefore, it is necessary to discuss whether or not the contralateral ALNM in our case should be treated as stage IV. Therefore, we performed ALND after confirming that the primary lymphatic flow was directed toward the contralateral ALN as observed on lymphoscintigraphy and considering the contralateral ALNM as a localized lesion. Lymphoscintigraphy and intraoperative fluorescence imaging aid in the identification of the primary lymphatic flow. Lymph node metastases beyond the altered primary lymphatic flow are treated as localized lesions, and aggressive surgery is expected to be effective. There is a need to formulate guidelines on the treatment of IBTR considering changes in primary lymphatic flow.
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Affiliation(s)
- Haruhi Maseki
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Shin Takayama
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Uta Nakadaira
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Chikashi Watase
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Sho Shiino
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Takeshi Murata
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Kenjiro Jimbo
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Akihiko Suto
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
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11
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Guru SD, Hoskin TL, Whaley DH, Nathan MA, Jakub JW. Repeat Sentinel Lymph Node Surgery in Recurrent Breast Cancer: Peritumoral vs. Periareolar Injections. Clin Breast Cancer 2021; 21:466-476. [PMID: 33736936 DOI: 10.1016/j.clbc.2021.02.004] [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: 11/24/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the setting of recurrent cancer, there is no standard methodology regarding the technical aspects of repeat sentinel lymph node (rSLN) surgery. We analyzed our institutional experience with attempted rSLN surgery to determine the optimal injection technique. MATERIALS AND METHODS Single site, retrospective review of patients with prior lumpectomy for breast cancer who presented with recurrent or new ipsilateral breast cancer and underwent attempt at rSLN surgery from 2008 to 2017. Patients with prior mastectomy or no prior ipsilateral axillary operation were excluded. RESULTS A total of 141 patients were included; 103 (73%) underwent successful rSLN biopsy procedure. Lymphoscintigraphy showed aberrant drainage in 32 (26%). Periareolar (PA) injection resulted in failed mapping in 23/99 (23%) and aberrant drainage in 25/85 (29%). By comparison, peritumoral (PT) injection had a 14/38 (37%) incidence of failed mapping and 7/37 (19%) aberrant drainage (P = .11 and .23, respectively). Of the patients with successful sentinel lymph node (SLN) biopsy procedure via PA injection, 11/76 (14%) were positive for metastatic disease as compared with 2/24 (8%) in PT injection. Sixteen patients had lymph node metastases; 13 (81%) were SLNs, including 3 positive aberrant SLNs. Five-year regional recurrence rates were 11.4% (95% confidence interval, 0%-21.5%) and 0% for PA and PT injection techniques, respectively. CONCLUSION PA and PT injections had a similar incidence of SLN identification and aberrant drainage. Preoperative lymphoscintigraphy is beneficial in patients with recurrent breast cancer given the higher incidence of aberrant drainage in this population. Patients who underwent PA injections had a higher incidence of regional recurrences but this difference was not statistically significant.
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Affiliation(s)
| | - Tanya L Hoskin
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Dana H Whaley
- Department of Diagnostic Radiology-Breast Imaging, Mayo Clinic, Rochester, MN
| | - Mark A Nathan
- Department of Diagnostic Radiology-Nuclear Medicine, Mayo Clinic, Rochester, MN
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12
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Wu S, Xin Z, Sui D, Ou Z, Bai H, Zhu S, Wang X, Zhang J. Development and validation of a nomogram to predict drainage duration in patients with breast cancer treated with modified radical mastectomy. Sci Rep 2021; 11:2533. [PMID: 33510284 PMCID: PMC7843610 DOI: 10.1038/s41598-021-82073-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/13/2021] [Indexed: 12/29/2022] Open
Abstract
Appropriate drainage duration is vital for the postoperative rehabilitation of patients with breast cancer (BC) undergoing modified radical mastectomy (MRM). To provide better and individualized postoperative management for these patients, this study explored independent predictors of postoperative drainage duration in patients with BC. This was a single-center retrospective cohort study. Patients diagnosed with BC and treated with MRM from May 2016 to April 2020 were randomly divided into training (n = 729) and validation (n = 243) cohorts. Univariate and multivariate Cox analyses revealed that the body mass index, serum albumin level, hypertension, number of total dissected axillary lymph nodes, and ratio of positive axillary lymph nodes were independent predictors of postoperative drainage duration in the training cohort. Based on independent predictors, a nomogram was constructed to predict the median postoperative drainage duration and the probability of retaining the suction drain during this period. This nomogram had good concordance and discrimination both in the training and validation cohorts and could effectively predict the probability of retaining the suction drain during drainage, thus assisting clinicians in predicting postoperative drainage duration and providing individualized postoperative management for patients with BC.
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Affiliation(s)
- Song Wu
- Department of Thyroid and Breast Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Zechang Xin
- Dalian Medical University, Dalian, Liaoning, China
| | - Daxing Sui
- Dalian Medical University, Dalian, Liaoning, China
| | - Zhengli Ou
- Dalian Medical University, Dalian, Liaoning, China
| | - Haotian Bai
- Dalian Medical University, Dalian, Liaoning, China
| | - Shenzhen Zhu
- Dalian Medical University, Dalian, Liaoning, China
| | - Xueying Wang
- Department of Thyroid and Breast Surgery, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou University Medical Academy, Yangzhou, 225001, Jiangsu, China
| | - Jiaxin Zhang
- Department of Thyroid and Breast Surgery, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou University Medical Academy, Yangzhou, 225001, Jiangsu, China.
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13
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Kabra V, Aggarwal R, Vardhan S, Singh M, Khandelwal R, Jain S, Sahani S, Saini S, Deo N, Kaul R, Parikh PM, Aggarwal S. Practical consensus recommendations regarding the management of sentinel lymph node issues in early breast cancer. South Asian J Cancer 2020; 7:132-136. [PMID: 29721480 PMCID: PMC5909291 DOI: 10.4103/sajc.sajc_120_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Axillary lymph node involvement is a very important poor prognostic factor in the clinical staging and management of breast cancer patients. Traditionally, axillary lymph node dissection (ALND) has been used for determining the status of the axillary lymph nodes. More recently the sentinel lymph node biopsy (SLNB) procedure has gained wider acceptance as the standard of care, having the advantage of being less invasivewhile providing good accuracy. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of the two different procedures and other issues in patients with early breast cancer for the benefit of community oncologists.
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Affiliation(s)
- Vedant Kabra
- Department of Surgical Oncology, Manipal Super Specialty Hospital, New Delhi, India
| | - R Aggarwal
- Department of Surgical Oncology, Medanta Hospital, Gurugram, Haryana, India
| | - S Vardhan
- Department of Surgical Oncology, Mool Chand Hospital, New Delhi, India
| | - M Singh
- Department of Surgical Oncology, Fortis Hospital, New Delhi, India
| | - R Khandelwal
- Department of Surgical Oncology, W Pratiksha Hospital, Gurugram, Haryana, India
| | - S Jain
- Department of Surgical Oncology, DMCH Cancer Care Centre, Ludhiana, Punjab, India
| | - S Sahani
- Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - S Saini
- Department of Surgical Oncology, Jolly Grant Himalayan Institute, Dehradun, Uttarakhand, India
| | - N Deo
- Department of Surgical Oncology, Amit Jaggi Memorial Hospital, Agra, Uttar Pradesh, India
| | - R Kaul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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14
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Walstra CJEF, Schipper RJ, Poodt IGM, Maaskant-Braat AJG, Luiten EJT, Vrancken Peeters MJTFD, Smidt ML, Degreef E, Voogd AC, Nieuwenhuijzen GAP. Multifocality in ipsilateral breast tumor recurrence - A study in ablative specimens. Eur J Surg Oncol 2020; 46:1471-1476. [PMID: 32402507 DOI: 10.1016/j.ejso.2020.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/24/2020] [Accepted: 04/17/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The incidence and clinical significance of multifocality in ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) are unclear. With growing interest in repeat BCT, this information has become of importance. This study aimed to gain insight in the incidence of multifocality in IBTR, to identify patient- and tumor-related predicting factors and to investigate the prognostic significance of multifocality. METHODS Two hundred and fifteen patients were included in this analysis. All had an IBTR after BCT and were treated by salvage mastectomy and appropriate adjuvant therapy. Predictive tumor- and patient-related factors for multifocality in IBTR were identified using X2 test and univariate logistic regression analyses. Prognostic outcomes were calculated using Kaplan Meier analysis and compared using the log rank test. RESULTS Multifocality was present in 50 (22.9%) of IBTR mastectomy specimens. Axillary positivity in IBTR was significantly associated with multifocality in IBTR. Chest wall re-recurrences occurred more often after multifocal IBTR (14% versus 7% after unifocal IBTR, p = 0.120). Regional re-recurrences did not differ significantly between unifocal and multifocal IBTR (8% vs. 6%, p = 0.773). Distant metastasis after salvage surgery occurred more frequently after multifocal IBTR (15% vs. 24%, p = 0.122). Overall survival was 132 months after unifocal IBTR and 112 months after multifocal IBTR (p = 0.197). CONCLUSION The prevalence of multifocality in IBTR is higher than in primary breast cancer. Axillary positivity in IBTR was associated with a multifocal IBTR. Chest wall re-recurrences and distant metastasis were, although not statistically significant, more prevalent after multifocal IBTR.
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Affiliation(s)
| | | | - Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands
| | | | | | | | - Marjolein L Smidt
- Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands
| | - Ellen Degreef
- Department of Pathology, Catharina Hospital Eindhoven, the Netherlands
| | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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15
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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
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16
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Sentinel lymph node biopsy following previous axillary surgery in recurrent breast cancer. Eur J Surg Oncol 2019; 45:1835-1838. [DOI: 10.1016/j.ejso.2019.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 11/20/2022] Open
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17
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Sato A, Sakai T, Iwase T, Kano F, Kimura K, Ogiya A, Koizumi M, Tanabe M, Horii R, Akiyama F, Ueno T, Ohno S. Altered lymphatic drainage patterns in re-operative sentinel lymph node biopsy for ipsilateral breast tumor recurrence. Radiat Oncol 2019; 14:159. [PMID: 31477153 PMCID: PMC6720389 DOI: 10.1186/s13014-019-1367-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/22/2019] [Indexed: 01/21/2023] Open
Abstract
Background This study aimed to evaluate the impact of previous local treatment on lymphatic drainage patterns in ipsilateral breast tumor recurrence (IBTR) based on our data on re-operative sentinel lymph node biopsy (re-SLNB) for IBTR. Methods Between April 2005 and December 2016, re-SLNB using lymphoscintigraphy with Tc-99 m phytate was performed in 136 patients with cN0 IBTR. Patients were categorized into two groups: the AX group included 55 patients with previous axillary lymph node dissection; the non-AX group included 69 patients with previous SLNB and 12 patients with no axillary surgery. The whole breast irradiation (RT) after initial surgery had performed in 17 patients in the AX group and 27 patients in the non-AX group. Results Lymphatic drainage was visualized in 80% of the AX group and 95% of the non-AX group (P < 0.01). The visualization rate of lymphatic drainage was associated with the number of removed lymph nodes in prior surgery. In the non-AX group, lymphatic drainage was visualized in 96% of patients without RT and 93% with RT. Lymphatic drainage was observed at the ipsilateral axilla in 98% of patients without RT and in 64% with RT (P < 0.0001). Aberrant drainage was significantly more common in patients with RT than without RT (60% vs. 19%, P < 0.001); it was observed mostly to the contralateral axilla (52% vs. 2%, P < 0.0001). In the AX group, patients with previous RT showed decreased lymphatic drainage to the ipsilateral axilla compared to those without RT (29% vs. 63%, P < 0.05) and increased aberrant drainage to the contralateral axilla (64% vs. 5%, P < 0.0001). Conclusion Lymphatic drainage patterns altered in re-SLNB in patients with IBTR and previous ALND and RT were associated with alterations in lymphatic drainage patterns.
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Affiliation(s)
- Ayaka Sato
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.,Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takehiko Sakai
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takuji Iwase
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Fumiko Kano
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Kiyomi Kimura
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.,Division of Gene regulation, Institute of Advanced Medical Research, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akiko Ogiya
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Mitsuru Koizumi
- Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Horii
- Department of Pathology, Clinicopathology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.,Division of Pathology, Clinicopathology Center, The Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Futoshi Akiyama
- Division of Pathology, Clinicopathology Center, The Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takayuki Ueno
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Shinji Ohno
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
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18
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Al-Hilli Z, Grobmyer SR. Management Strategies for Locally Recurrent Breast Cancer: Redo-Lumpectomy, Redo-Sentinel Node Biopsy, Redo-Radiation. Ann Surg Oncol 2019; 26:3018-3024. [DOI: 10.1245/s10434-019-07545-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/27/2022]
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19
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Jakub JW. Sentinel Lymph Node Biopsy for Ipsilateral Breast Tumor Recurrence, Technically Feasible but Influence on Oncologic Outcomes Yet to be Completely Defined. Ann Surg Oncol 2019; 26:2319-2321. [DOI: 10.1245/s10434-019-07356-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 02/06/2023]
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20
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Poodt IGM, Schipper RJ, de Greef BTA, Vugts G, Maaskant-Braat AJG, Jansen FH, Wyndaele DNJ, Voogd AC, Nieuwenhuijzen GAP. Screening for distant metastases in patients with ipsilateral breast tumor recurrence: the impact of different imaging modalities on distant recurrence-free interval. Breast Cancer Res Treat 2019; 175:419-428. [PMID: 30955183 PMCID: PMC6533220 DOI: 10.1007/s10549-019-05205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
Purpose In patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with 18F-FDG PET-CT or no imaging at all. Methods This study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used. Results Of the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with 18F-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N = 168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as first event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the different staging methods had no significant impact on the DRFI. Conclusions This study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically significant impact of the different imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using 18F-FDG PET-CT over conventional imaging techniques. Electronic supplementary material The online version of this article (10.1007/s10549-019-05205-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Bianca T A de Greef
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Dirk N J Wyndaele
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands.,Utrecht Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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21
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Poodt IGM, Walstra CJEF, Vugts G, Maaskant-Braat AJG, Voogd AC, Schipper RJ, Nieuwenhuijzen GAP. Low Risk of Development of a Regional Recurrence After an Unsuccessful Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence. Ann Surg Oncol 2019; 26:2417-2427. [PMID: 30850903 DOI: 10.1245/s10434-019-07272-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unlike sentinel lymph node biopsy (SLNB) in the primary setting, the repeat SLNB (rSLNB) in patients with ipsilateral breast tumor recurrence (IBTR) is challenging, because it is difficult to visualize and/or harvest a sentinel lymph node in every patient. Regional treatments options and safety in terms of regional disease control after such an unsuccessful rSLNB remain unclear. This study assesses factors associated with the performance of axillary lymph node dissection (ALND) after unsuccessful rSLNB and evaluates the occurrence of regional recurrences. METHODS Data were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 239 patients, the rSLNB was unsuccessful, of whom 60 patients underwent ipsilateral ALND. RESULTS A shorter time interval between primary treatment and IBTR, and a primary negative SLNB were significantly associated with a higher probability to be treated with ALND after unsuccessful rSLNB (P < 0.001). The 5-year regional-recurrence rate was 0.0% in the ALND group compared with 3.7% in the group treated without ALND (P = 0.113). Of the 179 patients treated without ALND, after a median follow-up of 5.1 years (range 0.3-13.2), 7 (3.9%) developed a regional recurrence as first event after unsuccessful rSLNB. None of the seven recurrences occurred in the ipsilateral axilla. Univariable analysis showed no factors associated with regional recurrence as first event after unsuccessful rSLNB (P > 0.05). CONCLUSIONS The present study demonstrates that the risk of regional recurrence in patients with an IBTR and an unsuccessful rSLNB is negligible, irrespective of the use of ALND. This suggests that there is no need for additional treatment of the axilla after an unsuccessful rSLNB.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands.
| | - Coco J E F Walstra
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands
| | | | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands
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Tejera Hernández AA, Vega Benítez VM, Rocca Cardenas JC, Gutiérrez Giner MI, Díaz Chico JC, Hernández Hernández JR. Factors predicting local relapse and survival in patients treated with surgery for breast cancer. Asian J Surg 2018; 42:755-760. [PMID: 30529008 DOI: 10.1016/j.asjsur.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Assessment of local relapse in patients treated with surgery for breast cancer. MATERIALS AND METHODS This observational study included 673 patients treated with surgery for breast cancer between 2005 and 2010, who were monitored for a 7-year minimum follow-up period. The study was concluded on 2017 and yielded a total of 31 cases of local relapse. RESULTS 4.6% of patients presented local relapse, most of them during the first 3 years of follow-up; 45% of patients with local relapse subsequently presented the disease at distant points. The association between the occurrence of local relapse and later onset of the disease at distant points was significant. The Kaplan-Meier survival analysis revealed that negative results for the presence of progesterone receptors, the use of neoadjuvant chemotherapy and the presence of the disease at distant points were factors that significantly influenced patient survival. CONCLUSIONS Almost half of the patients suffering relapse subsequently present the disease at distant points. Certain factors increase the aggressiveness of the disease, predict higher risk of relapse and determine its prognosis.
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Affiliation(s)
- Ana Alicia Tejera Hernández
- Universidad de Las Palmas de Gran Canaria, Calle Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Las Palmas, Spain; General Surgery Department, Complejo Hospitalario Universitario Insular Materno Infantil, Av. Marítima del Sur, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Víctor Manuel Vega Benítez
- Universidad de Las Palmas de Gran Canaria, Calle Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Las Palmas, Spain; General Surgery Department, Complejo Hospitalario Universitario Insular Materno Infantil, Av. Marítima del Sur, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Carlos Rocca Cardenas
- Universidad de Las Palmas de Gran Canaria, Calle Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Las Palmas, Spain; Physical Medicine and Rehabilitation Department, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35010, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - María Isabel Gutiérrez Giner
- Universidad de Las Palmas de Gran Canaria, Calle Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Las Palmas, Spain; General Surgery Department, Complejo Hospitalario Universitario Insular Materno Infantil, Av. Marítima del Sur, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Carlos Díaz Chico
- Universidad de Las Palmas de Gran Canaria, Calle Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Ramón Hernández Hernández
- Universidad de Las Palmas de Gran Canaria, Calle Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Las Palmas, Spain; General Surgery Department, Complejo Hospitalario Universitario Insular Materno Infantil, Av. Marítima del Sur, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
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Strazzanti A, Gangi S, Trovato C, Pacini N, Basile F. Contralateral lymph node metastasis in a woman with new primary breast cancer: Systemic desease or locoregional diffusion? Int J Surg Case Rep 2018; 53:400-402. [PMID: 30567054 PMCID: PMC6259044 DOI: 10.1016/j.ijscr.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Contralateral axillary lymph node metastases (CAMs) in patients with breast cancer are rare (Daoud et al., 1998); however, CAMs may be already detected at the time of primary breast cancer diagnosis (synchronous CAM) or after a previous treatment of breast cancer as a recurrence if not as an ipsilateral breast recurrence (IBR) (metasynchronous CAM) (Zhou and Richir, 2013). The involvement of the contralateral axilla could be caused by a systemic disease (stage IV), a regional metastasis from a new occult primary tumor (T0N1, stage II) or a breast cancer recurrence It may also arise from a locally advanced disease in a patient who has suffered from a primary breast cancer. PRESENTATION OF CASE This report focuses on the case of a 50-year-old woman who has developed a new primary breast cancer, breast skin invasion and CAMs. DISCUSSION We intend to show that an altered lymphatic drainage may result from CAMs; in fact, patients who have previously undergone axillary lymph node dissection (ALND) are more likely to develop contralateral lymph drainage (Maaskant-Braat et al., 2013). CONCLUSION Along with that, we want to support the theory that CAMs should be treated with curative intent rather than as a stage IV disease, as we believe that CAMs are due to a locoregional extension of the disease.
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Affiliation(s)
- Angela Strazzanti
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, Surgery Catania, 95124, Sicily, Italy.
| | - Santi Gangi
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, General Surgery Catania, 95124, Sicily, Italy
| | - Claudio Trovato
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, General Surgery Catania, 95124, Sicily, Italy
| | - Nicola Pacini
- Azienda Sanitaria Provinciale di Reggio Calabria, Biochemistry Reggio Calabria, 89125, Calabria, Italy
| | - Francesco Basile
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, General Surgery Catania, 95124, Sicily, Italy
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Chkheidze R, Sanders MAG, Haley B, Leitch AM, Sahoo S. Isolated Contralateral Axillary Lymph Node Involvement in Breast Cancer Represents a Locally Advanced Disease Not Distant Metastases. Clin Breast Cancer 2018; 18:298-304. [DOI: 10.1016/j.clbc.2017.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/17/2017] [Accepted: 10/31/2017] [Indexed: 12/11/2022]
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Wong SM, Golshan M. Management of In-Breast Tumor Recurrence. Ann Surg Oncol 2018; 25:2846-2851. [PMID: 29947005 DOI: 10.1245/s10434-018-6605-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Indexed: 12/16/2022]
Abstract
The management of isolated in-breast tumor recurrence is complex, requiring careful consideration of prior local therapies to plan future multimodality treatment. Options for surgical management have evolved from standard salvage mastectomy with axillary clearance and now include repeat breast conservation with axillary staging in select patients. Reattempting sentinel lymph node biopsy may avoid the morbidity of extensive axillary surgery and has been shown to be feasible in clinically node-negative patients with oncologically safe outcomes. In the adjuvant setting, partial breast irradiation has emerged as a valuable means to improve local control rates with limited associated toxicity and acceptable overall cosmesis. Furthermore, results from prospective trials are now available to support the use of chemotherapy in hormone-receptor negative subgroups, which is associated with improvements in long-term, disease-free, and overall survival.
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Affiliation(s)
- Stephanie M Wong
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Mehra Golshan
- Department of Surgery, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
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26
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Yüksel E, Duman D, Yeniay L, Ulukaya S. Severe decrease in SpO 2 and methemoglobinemia following subareolar isosulfan blue administration and clinical relevance. Turk J Surg 2018; 34:74-76. [PMID: 29756115 DOI: 10.5152/turkjsurg.2017.3137] [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: 03/12/2015] [Accepted: 12/13/2015] [Indexed: 11/22/2022]
Abstract
The level of axillary lymph node involvement in breast cancer is a critical decision factor for adjuvant therapy and the most important indicator of prognosis and survival. Sentinel lymph node biopsy is a minimally invasive technique with low morbidity in axillary staging of breast cancer. Radiocolloid substances (Technetium-99m) and/or blue dyes such as methylene blue or isosulfan blue are used during sentinel lymph node biopsy. Isosulfan blue stain is frequently used in sentinel lymph node biopsy and rarely causes complications. The present case report presents a severe decrease in SpO2 due to methemoglobinemia following isosulfan blue administration as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old, 77 kg, ASA II female case who underwent sentinel lymph node biopsy under general anesthesia.
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Affiliation(s)
- Esra Yüksel
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Dilek Duman
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Levent Yeniay
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Sezgin Ulukaya
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
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Poodt IGM, Vugts G, Maaskant-Braat AJG, Schipper RJ, Voogd AC, Nieuwenhuijzen GAP. Risk of Regional Recurrence After Negative Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence. Ann Surg Oncol 2018; 25:1312-1321. [PMID: 29497910 PMCID: PMC5891565 DOI: 10.1245/s10434-018-6384-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 01/17/2023]
Abstract
Background Repeat sentinel lymph node biopsy (rSLNB) has increasingly been used in patients with ipsilateral breast tumor recurrence (IBTR). The safety in terms of regional disease control after this procedure remains unclear. This study evaluates occurrence of regional recurrence as first event in patients with IBTR and negative rSLNB, treated without additional lymph node dissection. Patients and Methods Data were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 201 patients, tumor-negative rSLNB was obtained without performing additional lymph node dissections. Results With median follow-up of 4.7 (range 0.9–12.7) years, regional recurrence occurred after median time of 3.0 (range 0.4–6.7) years in 4.5% (N = 9) of patients as first event after IBTR and rSLNB. In four of these nine patients, the site of recurrence was in concordance with the anatomical location of rSLNB. Two of the nine recurrences were reported in the ipsilateral axilla, resulting in an ipsilateral axillary regional recurrence rate of 1.0%. In the other seven patients, regional recurrence occurred in aberrant basins. Univariable analysis showed that triple-negative IBTR and lower amount of radioactive-labeled tracer (99mtechnetium) used during rSLNB were associated with developing regional recurrence as first event after negative rSLNB (P < 0.05). Conclusions The risk of developing regional recurrence after negative rSLNB is low. The low relapse rate supports the safety of rSLNB as primary nodal staging tool in IBTR. The time has come for clinical guidelines to adopt rSLNB as axillary staging tool in patients with IBTR. Electronic supplementary material The online version of this article (10.1245/s10434-018-6384-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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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.
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Chand AR, Ziauddin MF, Tang SC. Can Locoregionally Recurrent Breast Cancer Be Cured? Clin Breast Cancer 2017; 17:326-335. [PMID: 28365334 DOI: 10.1016/j.clbc.2017.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/22/2017] [Accepted: 02/23/2017] [Indexed: 11/15/2022]
Abstract
Locoregional recurrence (LRR) of breast cancer can occur after multidisciplinary treatment of a primary breast cancer. With modern multidisciplinary breast cancer treatment, the incidence of isolated LRR is decreasing. Improvements in systemic therapy are driving the decrease in LRR. LRR does still occur, however. LRR reflects biology of the cancer, as does systemic recurrence. LRR of breast cancer is frequently associated with systemic disease recurrence and poor prognosis. Given this associated poor prognosis, historically, it has been unclear whether patients with LRR would benefit from aggressive therapy with curative intent. Findings in retrospective studies suggest that prognosis for patients with LRR is not universally poor, and some patients may benefit from aggressive locoregional and systemic therapy. The challenge remains to assess prognosis and appropriately treat patients with locoregional breast cancer recurrence.
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Affiliation(s)
- Arati Rani Chand
- Division of Hematology/Oncology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA
| | - M Firdos Ziauddin
- Department of Surgery, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA
| | - Shou-Ching Tang
- Division of Hematology/Oncology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA; Tianjin Medical University Cancer Institute and Hospital, Tianjin, PR China.
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30
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Surgical Treatment of Local Recurrence in Breast Cancer Patients. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Borrelli P, Donswijk ML, Stokkel MP, Teixeira SC, van Tinteren H, Rutgers EJT, Valdés Olmos RA. Contribution of SPECT/CT for sentinel node localization in patients with ipsilateral breast cancer relapse. Eur J Nucl Med Mol Imaging 2016; 44:630-637. [PMID: 27787592 PMCID: PMC5323474 DOI: 10.1007/s00259-016-3545-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023]
Abstract
Background In recent years repeat sentinel node (SN) biopsy has been proven to be feasible in local breast cancer recurrence (LBCR). However, in these patients SNs outside the ipsilateral axilla are frequently observed. This study evaluates the contribution of SPECT/CT for SN localization and surgical adjustment in LBCR patients. Methods SN biopsy was performed in 122 LBCR patients (median age 60.5 years, range 24–87), enrolled from August 2006 to July 2015. Median disease-free time lapse was 109.5 months (range 9–365). Axillary lymph node dissection (ALND) had previously been performed in 55 patients, SN biopsy in 44, both techniques in 13 and fine-needle aspiration in 10. Primary breast cancer treatment included radiotherapy in 104 patients (85.3 %) and chemotherapy in 40 (32.8 %). Preoperative lymphatic mapping, using planar scintigraphy (PS) and SPECT/CT included report of SN location according to lymph node territory. In case of a territorial PS-SPECT/CT mismatch, surgery was adjusted according to SPECT/CT findings. Results SPECT/CT SN visualization rate was higher than PS (53.3 % vs. 43.4 %, p n.s.) with, in total, 19 additional SN (118 vs. 99, p n.s.). PS-SPECT/CT territory mismatch, found in 60 % (39/65) of patients with SN visualization, led to surgical adjustment in 21.3 % (26/122) of patients. The SN procedure was finally performed in 104 patients resulting in a 65.7 % surgical retrieval rate with a total of 132 removed SNs (1.86/patient). SN metastases were found in 17/71 patients (23.9 %), in 16 of them (94 %) in ipsilateral basins outside the axilla or in the contralateral axilla. Conclusion Using SPECT/CT there is a trend to visualize more SNs in LBCR, providing at the same time important anatomical information to adjust intraoperative SN procedures. The addition of SPECT/CT to the standard imaging protocol may lead to better staging mainly in patients presenting drainage outside the ipsilateral axilla.
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Affiliation(s)
- Pablo Borrelli
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Nuclear Medicine, Medical Imaging Clinical Area, Hospital La Fe, Valencia, Spain
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marcel P Stokkel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Suzana C Teixeira
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Harm van Tinteren
- Department of Biometrics, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Emiel J Th Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Renato A Valdés Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Karanlik H, Ozgur I, Kilic B, Fathalizadeh A, Sanli Y, Onder S, Saip P, Sen F, Gulluoglu BM. Sentinel lymph node biopsy and aberrant lymphatic drainage in recurrent breast cancer: Findings likely to change treatment decisions. J Surg Oncol 2016; 114:796-802. [PMID: 27778360 DOI: 10.1002/jso.24423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/14/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES It is not clear whether sentinel lymph node biopsy (SLNB) can be applied to patients with a second breast cancer or recurrence occurring at previously treated breast. The purpose of this study was to assess the feasibility of SLNB procedure in patients with recurrent breast cancer. METHODS Patients with non-metastatic recurrent N0 breast cancer at ipsilateral breast were included. Patients were grouped according to their initial breast, axilla, and overall surgery. Presence of drainage and its pattern as well as SLNB success rate and overall axillary involvement rates were assessed. Findings were compared. RESULTS Out of 75 patients, mean age was 52.5 years and disease-free interval was 82 (9-312) months. Lymphatic drainage was successful in 42 (56%) patients. Drainage positivity was more frequent in patients who were previously treated with SLNB (82.6%) than in patients who underwent axillary lymph node dissection (ALND) (44.2%; P = 0,002). Aberrant lymphatic drainage was detected in 64.3% of drainage positive patients. Success rate of reoperative SLNB was 92.9%. Adjuvant treatment plan was altered in 12 (16%) patients. In 15 patients, negative SLNB prevented axillary dissection. CONCLUSIONS Reoperative SLNB seems to be technically feasible in N0 recurrent breast cancer patients. It may further avoid unnecessary ALND and lead changes in adjuvant treatment plans. J. Surg. Oncol. 2016;114:796-802. © 2016 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hasan Karanlik
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey.
| | - Ilker Ozgur
- Department of General Surgery, Acibadem International Hospital, Istanbul, Turkey
| | - Berkay Kilic
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Alisan Fathalizadeh
- Department of General Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Fatma Sen
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Bahadir M Gulluoglu
- Breast Surgery Unit, Department of General Surgery, Marmara University Hospital, Pendik, Istanbul, Turkey
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Repeat sentinel lymph node procedure in patients with recurrent vulvar squamous cell carcinoma is feasible. Gynecol Oncol 2016; 140:415-9. [DOI: 10.1016/j.ygyno.2016.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
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Johnson J, Esserman L, Ewing C, Alvarado M, Park C, Fowble B. Sentinel Lymph Node Mapping in Post-Mastectomy Chest Wall Recurrences: Influence on Radiation Treatment Fields and Outcome. Ann Surg Oncol 2015; 23:715-21. [PMID: 26714943 DOI: 10.1245/s10434-015-4971-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Invasive chest wall recurrences (CWR) following mastectomy are typically treated with surgical excision, radiation therapy (RT) to the chest wall and supraclavicular (SCV) region, and appropriate systemic therapy. Repeat axillary surgery is not routinely performed if the axilla is clinically negative. We evaluated sentinel node biopsy (SNB) in patients with an isolated invasive CWR, for identification and biopsy rates, non-axillary drainage, and clinical implications for radiation fields and outcome. METHODS Between 2008 and 2013, 12/19 women with an isolated invasive CWR had sentinel node (SN) mapping with Tc99m. Median age was 53 years, and 92% (11/12) had initial path N0 disease. All had prior SNB, with axillary dissection in one patient. RESULTS Overall, 83% (10/12) had successful mapping, with 70% (7/10) having an axillary SN. Ninety percent (9/10) had successful axillary node biopsy, with one patient having positive nodes. SCV RT was omitted in those with negative axillary nodes. With a median follow-up of 4.6 years from recurrence, there have been no SCV recurrences and no instances of lymphedema. CONCLUSIONS SNB is possible in women with an isolated CWR with acceptable identification and biopsy rates. Omission of routine irradiation of the SCV region has not jeopardized regional control and results in decreased morbidity.
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Affiliation(s)
- Julian Johnson
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Esserman
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Cheryl Ewing
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Park
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Barbara Fowble
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA.
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Vugts G, Maaskant-Braat AJG, Voogd AC, van Riet YEA, Luiten EJT, Rutgers EJT, Rutten HJT, Roumen RMH, Nieuwenhuijzen GAP. Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer. Breast Cancer Res Treat 2015; 153:549-56. [DOI: 10.1007/s10549-015-3571-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
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Matsumoto A, Jinno H, Nakamura T, Saito J, Takahashi M, Hayashida T, Kameyama K, Kitagawa Y. Technical feasibility of sentinel lymph node biopsy in patients with ipsilateral breast tumor recurrence and previous axillary surgery. Int J Surg 2015; 22:28-31. [PMID: 26278666 DOI: 10.1016/j.ijsu.2015.07.709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/14/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The role of sentinel lymph node biopsy (SLNB) in patients with ipsilateral breast tumor recurrence (IBTR) remains to be elucidated. The aim of this study was to evaluate feasibility and validity of SLNB in patients with IBTR. METHODS A prospective database of 1172 patients with clinically node-negative breast cancer who underwent SLNB from January 2005 to December 2013 at Keio University Hospital was analyzed and 35 patients with IBTR underwent SLNB. Sentinel lymph nodes (SLNs) were detected using a combined method of blue dye and radioisotope or indocyanine green fluorescence in cases with failure of identification by blue dye and radioisotope. RESULTS Twenty-two patients had previous SLNB, eight had previous axillary lymph node dissection (ALND), and five had no previous axillary surgery. Overall, SLNs were successfully identified in 28 (80.0%) of 35 patients. The identification rate in patients with previous SLNB, ALND and no axillary surgery was 81.8% (18/22), 75% (6/8) and 80% (4/5), respectively (P = 0.52). Aberrant drainage outside the ipsilateral axilla was found more frequently in patients with previous ALND compared with SLNB and no axillary treatment (37.5% vs. 4.5% vs. 0%, P = 0.048). No axillary recurrence was observed after median follow-up of 40.3 months from the second surgery for IBTR. CONCLUSIONS SLNB is a technically feasible and valid procedure for staging and treatment of regional lymph nodes in patients with IBTR.
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Affiliation(s)
- Akiko Matsumoto
- Department of Surgery, Inagi Municipal Hospital, 1171 Ohmaru, Inagi, Tokyo, 206-0801, Japan
| | - Hiromitsu Jinno
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.
| | - Tetsuya Nakamura
- Department of Surgery, Inagi Municipal Hospital, 1171 Ohmaru, Inagi, Tokyo, 206-0801, Japan
| | - Junichi Saito
- Department of Surgery, Inagi Municipal Hospital, 1171 Ohmaru, Inagi, Tokyo, 206-0801, Japan
| | - Maiko Takahashi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Tetsu Hayashida
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kaori Kameyama
- Division of Pathological Diagnosis, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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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]
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Contralateral lymph node recurrence in breast cancer: Regional event rather than distant metastatic disease. A systematic review of the literature. Eur J Surg Oncol 2015; 41:1128-36. [PMID: 26108737 DOI: 10.1016/j.ejso.2015.05.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/04/2015] [Accepted: 05/27/2015] [Indexed: 11/21/2022] Open
Abstract
AIMS After treatment for breast cancer, some patients experience a contralateral lymph node recurrence (CLNR). Traditionally, contralateral nodes are considered a distant site. However, aberrant lymph drainage after previous surgery is common. This might indicate that CLNR is a regional event. This study aimed to review the literature to determine prognosis after CLNR. METHODS PubMed was searched up until July 2014. Articles on CLNR with or without ipsilateral breast tumour recurrence (IBTR), and repeat sentinel node (SN) studies reporting on positive contralateral nodes were included. Exclusion criteria were synchronous contralateral breast cancer and synchronous distant events. RESULTS 24 articles were included, describing 48 patients. Of these 48, 26 patients had an isolated CLNR, 7 IBTR and clinically detected CLNR, and 15 IBTR with a positive contralateral repeat SN. Isolated CLNR occurred earlier (45.9 months) than IBTR with CLNR (126.6 months, p < 0.001) or with a positive contralateral repeat SN (217.2, p = 0.02). Surgical treatment was described for 38 patients, and consisted of axillary lymph node dissection for 34 (89.5%). Information on adjuvant therapy was available for 27 patients, 21 (77.8%) received chemotherapy. Follow-up information after CLNR was available for 23 patients (47.9%). Mean follow-up was 50.3 months. Overall survival and disease-free survival were 82.6% [95% CI 67.1-98.1] and 65.2% [45.7-84.7] respectively at last follow-up. CONCLUSIONS Although observed in a small population, the survival of CLNR is not comparable to distant disease. Most patients received locoregional and systemic treatment suggesting a curative approach. This indicates that CLNR should be regarded as a regional event.
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Controversial indications for sentinel lymph node biopsy in breast cancer patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:405949. [PMID: 25821800 PMCID: PMC4363495 DOI: 10.1155/2015/405949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node biopsy (SLNB) emerged in the 1990s as a new technique in the surgical management of the axilla for patients with early breast cancer, resulting in lower complication rates and better quality of life than axillary lymph node dissection (ALND). Today SLNB is firmly established in the armamentarium of clinicians treating breast cancer, but several questions remain. The goal of this paper is to review recent work addressing 4 questions that have been the subject of debate in the use of SLNB in the past few years: (a) What is the implication of finding micrometastases in the sentinel nodes? (b) Is ALND necessary in all patients who have a positive SLNB? (c) How accurate is SLNB after neoadjuvant therapy? (d) Can SLNB be used to stage the axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery?
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Uth CC, Christensen MH, Oldenbourg MH, Kjær C, Garne JP, Teilum D, Kroman N, Tvedskov TF. Sentinel Lymph Node Dissection in Locally Recurrent Breast Cancer. Ann Surg Oncol 2015; 22:2526-31. [PMID: 25564177 DOI: 10.1245/s10434-014-4338-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to investigate the use of sentinel lymph node dissection (SLND) in the treatment of patients with locally recurrent breast cancer. METHODS A total of 147 patients with locally recurrent breast cancer were included from five different breast surgery departments in Denmark. Data on previous breast and axillary surgery, adjuvant treatment, second operation in the breast and axilla, and lymphoscintigraphy were collected retrospectively from the original patient files. RESULTS SLND after recurrence (SLNDAR) was successful in 72 of 144 patients (50 %). The detection rate was significantly higher after previous SLND (66 %) compared with previous ALND (34 %) [p = 0.0001]. Thirty-seven patients (51 %) who had previous SLND had a negative sentinel node. These patients could be spared an ALND. Six patients (8 %) who had a previous ALND had a metastatic sentinel node at recurrence; 17 % of patients had a sentinel node located outside the ipsilateral axilla; and eight patients with negative sentinel node at SLNDAR underwent completion ALND. None of these patients had metastases at completion ALND, corresponding to a false negative rate of 0 %. CONCLUSIONS SLNDAR seems to be a feasible procedure in locally recurrent breast cancer and can spare a clinically significant number of patients an unnecessary ALND and the following risk of sequelae. In patients who had previous ALND, SLNDAR identified metastases that would have been overlooked following the current guidelines. A large proportion of patients had aberrant drainage, suggesting a need for lymphoscintigraphy.
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Intra M, Viale G, Vila J, Grana CM, Toesca A, Gentilini O, Galimberti V, Veronesi P, Luini A, Rotmensz N, Bagnardi V, Mattar D, Colleoni M. Second Axillary Sentinel Lymph Node Biopsy for Breast Tumor Recurrence: Experience of the European Institute of Oncology. Ann Surg Oncol 2014; 22:2372-7. [DOI: 10.1245/s10434-014-4282-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Indexed: 11/18/2022]
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Zervoudis S, Iatrakis G, Tomara E, Bothou A, Papadopoulos G, Tsakiris G. Main controversies in breast cancer. World J Clin Oncol 2014; 5:359-73. [PMID: 25114851 PMCID: PMC4127607 DOI: 10.5306/wjco.v5.i3.359] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/07/2014] [Accepted: 05/13/2014] [Indexed: 02/06/2023] Open
Abstract
In this article, we have reviewed available evidence for diagnosis, treatment, and follow-up in female breast cancer (BC). Into daily clinical practice some controversies are occurred. Especially, in the diagnosis field, despite the fact that the optimal age in which screening mammography should start is a subject of intense controversy, there is a shift toward the beginning at the age of 40 although it is suggested that the net benefit is small for women aged 40 to 49 years. In addition, a promising tool in BC screening seems to be breast tomosynthesis. Other tools such as 3D ultrasound and shear wave elastography (SWE) are full of optimism in BC screening although ultrasonography is not yet a first-line screening method and there is insufficient evidence to recommend the systemic use of the SWE for BC screening. As for breast magnetic resonance imaging (MRI), even if it is useful in BC detection in women who have a strong family history of BC, it is not generally recommended as a screening tool. Moreover, based on the lack of randomized clinical trials showing a benefit of presurgical breast MRI in overall survival, it's integration into breast surgical operations remains debatable. Interestingly, in contrast to fine needle aspiration, core biopsy has gained popularity in presurgical diagnosis. Furthermore, after conservative surgery in patients with positive sentinel lymph nodes, the recent tendency is the shift from axillary dissection to axillary conserving strategies. While the accuracy of sentinel lymph node after neoadjuvant chemotherapy and second BC surgery remains controversial, more time is needed for evaluation and for determining the optimal interval between the two surgeries. Additionally, in the decision between immediate or delayed breast reconstruction, there is a tendency in the immediate use. In the prevention of BC, the controversial issue between tamoxifen and raloxifene becomes clear with raloxifene be more profitable through the toxicities of tamoxifen. However, the prevention of bone metastasis with bisphosphonates is still conflicting. Last but not least, in the follow-up of BC survivors, mammography, history and physical examination are the means of an early detection of BC recurrence. ed.
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Cordoba O, Perez-Ceresuela F, Espinosa-Bravo M, Cortadellas T, Esgueva A, Rodriguez-Revuelto R, Peg V, Reyes V, Xercavins J, Rubio IT. Detection of sentinel lymph node in breast cancer recurrence may change adjuvant treatment decision in patients with breast cancer recurrence and previous axillary surgery. Breast 2014; 23:460-5. [DOI: 10.1016/j.breast.2014.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 01/16/2014] [Accepted: 03/16/2014] [Indexed: 11/28/2022] Open
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Management of the clinically node-negative axilla in primary and locally recurrent breast cancer. Surg Oncol Clin N Am 2014; 23:463-71. [PMID: 24882345 DOI: 10.1016/j.soc.2014.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
For patients with primary breast cancer, nodal status remains a key determinant for overall prognosis. Sentinel lymph node biopsy (SLNB) has become standard care for staging patients who have clinically node-negative disease. However, a new dilemma has arisen: how to manage the clinically negative axilla in patients with ipsilateral breast tumor recurrences (IBTRs). Are outcomes in these patients improved with repeat SLNB? Although observational studies suggest SLNB is feasible in patients with IBTR and a clinically node-negative axilla, the overall impact on morality and local recurrence is not yet known as no randomized trials have addressed this issue.
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Ikeda T. Re-sentinel node biopsy after previous breast and axillary surgery. Surg Today 2013; 44:2015-21. [DOI: 10.1007/s00595-013-0783-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
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Lizarraga IM, Scott-Conner CEH, Muzahir S, Weigel RJ, Graham MM, Sugg SL. Management of Contralateral Axillary Sentinel Lymph Nodes Detected on Lymphoscintigraphy for Breast Cancer. Ann Surg Oncol 2013; 20:3317-22. [DOI: 10.1245/s10434-013-3151-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Indexed: 02/06/2023]
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