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2005, Number 6

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Cir Cir 2005; 73 (6)

Lymphatic mapping and sentinel lymph node biopsies in order to avoid axilar dissection in early breast cancer

Barroso-Bravo S, Zarco-Espinosa G, Alvarado-Cabrero I, Valenzuela-Flores AG, Pichardo-Romero P, Rodríguez-Cuevas AS

Language: Spanish
References: 39
Page: 437-441
PDF size: 86.14 Kb.


ABSTRACT

Objective: To present the characteristics of women with early breast cancer and clinically negative ganglia who were submitted to LM and SLNB in order to select the positive cases for axilar dissection and to identify the negative cases.
Material and methods: Cases included patients who attended the Breast Tumor Service of the Oncology Hospital of the National Medical Center of the Mexican Social Security Institute from March 1, 2002 to April 30, 2004. Women with early breast cancer and clinically negative ganglia (N0) were included, without previous treatment and without previous biopsies. All cases were submitted to LM and SLNB with patent blue or double-blue technique and gamma probe. The lymph nodes were evaluated histopathologically and negative or positive results were considered, in order to determine whether or not to undertake the axilar dissection. No cases were excluded.
Results: Sixty cases were reviewed with an average age of 51 years. The average size of the ganglia was 1.9 cm, with stages EC-0: 9 %, EC-I: 33 %, EC-IIA: 58 %. Sentinel lymph nodes were found in 100 % and 95 ganglions were dissected, for an average of 1.6 per procedure. The histopathology was definitive in 19 women with metastasis (32 %) and in 41 women with negative ganglia (68 %). The results of transoperative histopathology were correlated with the histopathology report (one false positive case and six false negative cases), sensitivity of 68.4 %, specificity of 97.5 %, positive predictive value 92.8 % and negative predictive value 86.9 %.
Conclusions: LM and SLNB avoided radical axilar dissection in 68 % of the cases and reduced the cost in 10 % of the cases.


REFERENCES

  1. Derossis AM, Fey J, Young H, Yeh SD, Heerdt AS, Petrek J, Vanzee KJ, Montgomery LL, Burgen PI, Cady HS 3rd. A trend analysis of the relative value of blue dye and isotope localization in 2,000 consecutive cases of sentinel node biopsy for breast cancer. J Am Coll Surg 2001;193(5):473-478.

  2. 2. Tafra L, Lannin D, Swanson MS, Van Eyk JJ, Verbanac KM, Chua AN, Ng PC, et al. Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg 2001;233(1):51-59.

  3. 3. O’Hea BJ, Hill AD, El-Shirbiny AM, et al. Sentinel lymph node biopsy in breast cancer: initial experience of Memorial Sloan Kettering Cancer Center. J Am Coll Surg 1998;186:423-427.

  4. 4. Miltenburg DM, Miller C, Karamlou TB, Brunicardi FC. Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res 1999;84:138-142.

  5. 5. Schwartz GF, Giuliano AE, Veronesi U. Proceeding of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer 2002;13;2542-2551.

  6. 6. Hsueh EC, Hansen N, Giuliano AE. Intraoperative lymphatic mapping and sentinel lymph node dissection in breast cancer. CA Cancer J Clin 2000;50:579.

  7. 7. Borgstein PS, Meijer S, Pijpers RJ, Van Diest PJ. Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method. Ann Surg 2000;232(1): 81-89.

  8. 8. Giuliano AE, Jones RC, Brennan M, Stetman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997;15:2345-2350.

  9. 9. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer. A multicenter validation study. N Engl J Med 1998;339:941-946.

  10. 10. Cox CE, Pendes S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patient with breast cancer. Ann Surg 1998;227:645-653.

  11. 11. De Gicco C, Cremonesi M, Luimi A, et al. Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer. J Nucl Med 1998;39:2080-2084.

  12. 12. Flett MM, Going JJ, Stanton PD, Cooke TG. Sentinel node localization in patients with breast cancer. Br J Surg 1998;85:991-993.

  13. 13. Maffali L, Sturn E, Roselli M, Fontanelli R, Pauwels E, Bombardieri E. State of the art of sentinel node biopsy in oncology. Tumori 2000;86(4):263-272.

  14. 14. Veronesi U, Galimberti V, Zurrida S, Pigatto F, Veronesi D, Robertson C, et al. Sentinel lymph node biopsy as an indicator for axillary dissection in early breast cancer. Eur J Cancer 2001;37:454-458.

  15. 15. Bland KI, Scott-Conner CE, Menck H, Winchester DP. Axillary dissection in breast-conserving surgery for stage I and II breast cancer: a national cancer database study of patterns of omission and implications for survival. J Am Coll Surg 1999;188:586-595.

  16. 16. Orr RK. The impact of prophylactic axillary node dissection on breast cancer survival: a Bayesian metaanalysis. Ann Surg Oncol 1999;6:109-116.

  17. 17. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63:181.

  18. 18. Aitken RJ, Gayes MN, Rodsen A, et al. Arm morbidity within a trial of mastectomy and either node sample with selective radiotherapy or axillary clearance. Br J Surg 1989;76:568-571.

  19. 19. Liljegren G, Holmberg L. Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomized trial Uppsala-Orebro Breast Cancer Study Group. Eur J Cancer 1997;33:193-199.

  20. 20. Ivens D, Hoe AL, Podd TJ, Hamillton CR, Taylor I, Roy GT. Assessment of morbidity from complete axillary dissection. Br J Cancer 1992;66:136.

  21. 21. Kissing MW, Guerci de lla Rovere G, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer. Br J Cancer 1986;73:580.

  22. 22. Estourgie SH, Nieweg OE, Valdes Olmos RA, Rutgers EJ, Kroon BB. Lymphatic drainage patterns from the breast. Ann Surg 2004;239: 232-237.

  23. 23. Uren RF, Howman-Giles R, and Renwick SB, et al. Lymphatic mapping of the breast: locating the sentinel lymph nodes. World J Surg 2001;25:789-793.

  24. 24. Byrd DR, Dunnwald LK, Mankoff DA, et al. Internal mammary lymph node drainage using patterns in patients with breast cancer documented by breast lymphoscintigraphy. Ann Surg Oncol 2001; 8:234-240.

  25. 25. Ross MI. Sentinel node dissection in early-stage breast cancer: ongoing prospective randomized trials in the USA. Ann Surg Oncol 2001;9(suppl):77S-81S.

  26. 26. Krag DN, Julian TB, Harlow SP, Weaver DL, Ashikaga T, Bryant J, Single RM, Wolmark N. NSABP-32: Phase III, randomized trial comparing axillary resection with sentinel lymph node dissection: a description of the trial. Ann Surg Oncol 2004;11(3):208S-210S.

  27. 27. Grantley Gill P. Sentinel lymph node biopsy versus axillary clearance in operable breast cancer: the RACS SNAC trial, a multicenter randomized trial of the Royal Australian College of Surgeons (RACS) section of breast surgery, in collaboration with the national health and medical research council clinical trial center. Ann Surg Oncol 2004;11(3):216S-221S.

  28. 28. Motomura K, Komoike Y, Nagumo S, Kasugai T, Hasegawa Y, Inaji H, Nagachi S, Kojama H. Sentinel node biopsy to avoid axillary lymph node dissection in breast cancer. Breast Cancer 2002;9(4):337-343.

  29. 29. Reumen RM, Kuijt GP, Liem IH, van Beek M. Tretament of 100 patients with sentinel node negative breast cancer without further axillary dissection. Br J Surg 2001;88(12):1639-1643.

  30. 30. Giuliano AE, Haigh PI, Brennan MB, Hansen NM, Kelley MC, Ye W, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 2000;18:2553-2559.

  31. 31. Orr RK, Hoehn JL, Nananda FC. The learning curve for sentinel node biopsy in breast cancer. Practical considerations. Arch Surg 1999;134(7):764-767.

  32. 32. Hill ADK, Tran KN, Akhurst T, et al. Lesson learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999;229:528-535.

  33. 33. Marioni G, Erba P, Villa G, Gipponi M, Boni G, Button F, Castagnola F, Paganelli G, Strauss HW. Lymphoscintigraphic and intraoperative detection of the sentinel lymph node in breast cancer patients: the nuclear medicine perspective. J Surg Oncol 2004;85(3):112-122.

  34. 34. Turner RR, Giuliano AE, Hoon DS, et al. Pathologic examination of sentinel lymph node for breast carcinoma. World J Surg 2001;25:798-805.

  35. 35. Kollias J, Gill PG, Chatterton B, Raymond W, Collins PJ. Sentinel node biopsy in breast cancer: recommendations for surgeon, pathologists, nuclear physicians and radiologists in Australia and New Zealand. Aust NZ J Surg 2000;70(2):132-136.

  36. 36. Silverstain MJ, Chaban AB, Friedman P, et al. Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg 2001;25:767-772.

  37. 37. Mullenix PS, Carter PL, Martin MJ, Steele SR, Scoll CL, Walts MJ, Beitter AL. Predictive value intraoperative touch preparation analysis of sentinel lymph nodes for axillary metastases in breast cancer. Am J Surg 2003;185(5):420-424.

  38. 38. Shirov SA, Creager AJ, Geisinger K, Perrier N, Sheen P, Levine EA. Intraoperative analysis of sentinel lymph nodes by imprint cytology for cancer of the breast. Am J Surg 2002;184;424-427.

  39. 39. Krag D. Minimal invasive staging for breast cancer: clinical experience with sentinel lymph node biopsy. Semin Oncol 2001;28(3):221-228




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