Can the sentinel lymph node technique affect decisions to offer internal mammary chain irradiation?

Bourre, J.C.; Payan, R.; Collomb, Delphine; Gallazzini-Crepin, C.; Calizzano, Alex; Desruet, Marie-Dominique; Pasquier, Dominique; Bolla, M.; Fagret, Daniel; Vuillez, Jean‐Philippe

doi:10.1007/s00259-008-1034-4

Cited by 32 publications

(15 citation statements)

References 36 publications

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“…We selected 6 studies that fulfilled the following criteria: a large number of patients, peritumoral or intratumoral tracer injection, internal mammary biopsy successfully achieved in most patients with internal mammary drainage, and axilla staged routinely independent of internal mammary status (47)(48)(49)(50)(51)(52).…”

Section: Probability Of Internal Mammary Involvement In Patients Withmentioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the factors influencing the false-negative rate of SNB in breast cancer; (2) the risks associated with the use of the technique in specific situations such as large tumors, multiple ipsilateral tumors, or the setting of neoadjuvant chemotherapy; and (3) the meaning of internal mammary drainage on lymphoscintigraphy in terms of risk of occult internal mammary involvement.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through March 2012.Axillary node status is a major prognostic factor in early breast cancer. Staging with sentinel node biopsy (SNB) leads to a substantial reduction in surgical morbidity. Recent multiinstitutional studies revealed SNB false-negative rates ranging from 5.5% to 16.7%, higher than the target (,5%) set by the 2005 guidelines of the American Society of Clinical Oncology. These alarming data point to the necessity of optimization. Dual mapping with radiotracer and blue dye, combining 2 different injection sites, and routinely using lymphoscintigraphy may improve accuracy. Factors associated with decreased sensitivity, such as prior excisional biopsy or neoadjuvant chemotherapy, should be recognized. The use of SNB in situations with a high prevalence of node positivity (large tumor, multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in patients with T1 tumor and up to 15% in patients with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. Patients combining internal mammary drainage with a positive axillary sentinel node have close to a 50% probability of internal mammary involvement. Lymphoscintigraphy might thus be helpful in selecting patients for whom internal mammary radiation has a high benefit-to-risk ratio.Key Words: sentinel node biopsy; breast cancer; micrometastases; lymphoscintigraphy; internal mammary node; radiation therapy; neoadjuvant chemotherapy Because imaging techniques have limited sensitivity, the axilla must be explored surgically. Traditional staging requires levels I and II axillary lymph node dissection (ALND) with 10 or more removed nodes (3). Axillary involvement is found in 10%-30% of patients with T1 (#2 cm) tumors, depending on size. This rate reaches 45% for small T2 tumors (2.1-3 cm) and 55%-70% for larger tumors (2,4). However, routine ALND carries the risk of lymphedema, sensory disturbances, and chr...

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Section: Probability Of Internal Mammary Involvement In Patients Withmentioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

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“…Overall, the incidence of IMLN metastasis among breast cancer patients has been estimated to be less than 3% [9,14]. Moreover, due to advances in SLN biopsy techniques along with the surgeon's experience, the success rate may increase over time; however, complications are currently encountered in approximately 4.6-8% of patients, which is slightly higher than the metastasis rate in IMSLN [8,9,14]. IMSLN excision is associated with technical issues such as a higher morbidity rate, a lower metastasis rate in IMSLN than complication incidence, and limited surgeon experience and technical skills.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Internal Mammary Lymph Node Detected by Lymphoscintigraphy in Early Breast Cancer

et al. 2012

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PurposeInternal mammary lymph node (IMLN) metastasis is an important prognostic indicator in breast cancer. However, the necessity of internal mammary sentinel lymph node biopsy for accurate staging, for choosing adjuvant treatment, and as a prognostic indicator, has remained controversial.MethodsFrom January 2001 to December 2006, 525 female breast cancer patients underwent radical surgery after preoperative lymphatic scintigraphy. We retrospectively analyzed the follow-up results, recurrences, and deaths of all patients.ResultsThere was no significant difference in the clinicopathological characteristics between the axilla and the IMLN groups. The median follow-up period was 118.8 months (range, 7-122 months) in the axilla group and 107.7 months (range, 14-108 months) in the IMLN group. During the median follow-up period, the breast cancer-related death rate in the axilla group was 3.6%, which was not significantly different from that of the IMLN group (1.3%) (p=0.484). The five-year survival rates did not differ between the two groups (p=0.306). The overall recurrence rate and the locoregional recurrence rate also did not differ between the two groups (p=0.835 and p=0.582, respectively). The recurrence rate of IMLN (both ipsilateral and contralateral) metastasis was very low, accounting for 0.5% in the axilla group and 1.3% in the IMLN group (p=0.416).ConclusionThe long-term follow-up results showed that there was no significant difference in both overall outcome and regional recurrence between the two groups. Therefore, the requirement for identification of nodal basins outside the axilla or IMLN sentinel biopsy should be reconsidered.

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“…The 2010 NCCN Clinical Practice Guidelines [29] recommend consideration of radiotherapy to IMNs for patients with node-positive breast cancer after mastectomy. IMSN biopsy could make it possible to personalize treatment for patients with stage cT1 breast cancer and thereby avoid needless internal mammary radiation therapy in a large number of patients (93.4%) [30]. In recent years, Veronesi et al [15] suggested an influence on survival from taking the results of IMN biopsy and giving IMN/supraclavicular radiotherapy for positive cases, and advocated the necessity of IMN biopsy.…”

Section: Discussionmentioning

confidence: 99%

Surgical Approach to Internal Mammary Sentinel Node Biopsy

Zhuang

Tian

et al. 2010

Journal of Investigative Surgery

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Can the sentinel lymph node technique affect decisions to offer internal mammary chain irradiation?

Cited by 32 publications

References 36 publications

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Long-Term Outcome of Internal Mammary Lymph Node Detected by Lymphoscintigraphy in Early Breast Cancer

Surgical Approach to Internal Mammary Sentinel Node Biopsy

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