Guidelines for Sentinel Node Biopsy and Lymphatic Mapping of Patients With Breast Cancer

Cox, Charles E.; Pendas, Solange; Cox, John M.; Joseph, Emmanuella; Shons, Alan R.; Yeatman, Timothy J.; Ku, Ni Ni; Lyman, Gary H.; Berman, Claudia G.; Haddad, F.; Reintgen, Douglas S.

doi:10.1097/00000658-199805000-00005

Cited by 570 publications

(284 citation statements)

References 14 publications

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“…The positive SLN rate was high in patients with a locally advanced cancer in the contralateral breast. Sentinel lymph node biopsy has been shown to be feasible and safe for staging the axilla in patients with breast cancer, [25][26][27] which provides more accurate lymph node staging and avoids the morbidity associated with a complete ALND, which has a high rate of complications, including lymphedema, pain, numbness and limited shoulder movement. Moreover, most patients have negative SLNs at the time of prophylactic mastectomy, and performing ALND in these patients would expose them to the associated complications with no apparent benefit.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

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Background: Prophylactic mastectomy is performed to decrease the risk of breast cancer in women at high risk for the disease. The benefit of sentinel lymph node biopsy (SLNB) at the time of prophylactic mastectomy is controversial, and we performed a meta-analysis of the reported data to assess that benefit. Methods:We searched MEDLINE, EMBASE and the Cochrane Library databases from January 1993 to December 2009 for studies on patients who underwent SLNB at the time of prophylactic mastectomy. Two reviewers independently evaluated all the identified papers, and only retrospective studies were included. We used a mixedeffect model to combine data. Results:We included 6 studies in this review, comprising a total study population of 1251 patients who underwent 1343 prophylactic mastectomies. Of these 1343 pooled prophylactic mastectomies, the rate of occult invasive cancer (21 cases) was 1.7% (95% confidence interval [CI] 1.1%-2.5%), and the rate of positive SLNs (23 cases) was 1.9% (95% CI 1.2%-2.6%). In all, 36 cases (2.8%, 95% CI 2.0%-3.8%) led to a significant change in surgical management as a result of SLNB at the time of prophylactic mastectomy. In 17 cases, patients with negative SLNs were found to have invasive cancer at the time of prophylactic mastectomy and avoided axillary lymph node dissection (ALND). In 19 cases, patients with positive SLNBs were found not to have invasive cancer at the time of prophylactic mastectomy and needed a subsequent ALND. Of the 23 cases with positive SLNs, about half the patients had locally advanced disease in the contralateral breast. Conclusion:Sentinel lymph node biopsy is not suitable for all patients undergoing prophylactic mastectomy, but it may be suitable for patients with contralateral, locally advanced breast cancer.Contexte : La mastectomie prophylactique vise à réduire le risque de cancer du sein chez les femmes à risque élevé. L'avantage de la biopsie du ganglion lymphatique sentinelle (BGLS) au moment de la mastectomie prophylactique suscite la controverse et nous avons procédé à une méta-analyse des données qui ont fait l'objet de rapports afin d'évaluer l'avantage en question. Méthodes :Nous avons cherché dans les bases de données MEDLINE, EMBASE et la Bibliothèque Cochrane, de janvier 1993 à décembre 2009, des études portant sur des patientes qui ont subi une BGLS au moment de la mastectomie prophylactique. Deux examinateurs ont évalué indépendamment toutes les études repérées et nous avons inclus seulement les études rétrospectives. Nous avons utilisé un modèle à effets mixtes pour combiner les données.Résultats : Nous avons inclus dans cette analyse 6 études regroupant une population totale de 1251 patientes qui ont subi 1343 mastectomies prophylactiques. Parmi ces 1343 mastectomies prophylactiques regroupées, le taux de cancer envahissant occulte (21 cas) s'est établi à 1,7 % (intervalle de confiance [IC] à 95 %, 1,1 %-2,5 %) et le taux de GLS positifs (23 cas) a atteint 1,9 % (IC à 95 %, 1,2 %-2,6 %). Au total, les constatations dans 36 cas (2,8 %, IC ...

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

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“…25 Although mostly very accurate, unfortunately there are still some disadvantages of the currently-used procedure. The use of the tracer can be logistically complicated when administered a day before the operation by a nuclear medicine physician.…”

Section: Dyes and Probes That Accumulate In The Sentinel Lymph Nodementioning

confidence: 99%

The use of fluorescent dyes and probes in surgical oncology

Velde

Veerman

Subramaniam

et al. 2010

European Journal of Surgical Oncology (EJSO)

128

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Aims and background: Improved visualization of surgical targets inside of the patient helps to improve radical resection of the tumor while sparing healthy surrounding tissue. In order to achieve an image, optical contrast must be generated by properties intrinsic to the tissue, or require the attachment of special visualization labels to the tumor. In this overview the current status of the clinical use of fluorescent dyes and probes are reviewed. Methods:In this review, all experimental and clinical studies concerning fluorescent imaging were included. In addition, in the search for the optimal fluorescent imaging modality, all characteristics of a fluorescent dye were described. Findings and Conclusions:Although the technique of imaging through fluorescence sounds promising and several animal models show efficacy, official approval of these agents for further clinical evaluation, is eagerly awaited.

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“…Previous studies have shown that SLN visualization in patients with breast cancer is influenced by several factors, including procedural variation and patient factors such as age, body mass index (BMI), tumor size, and metastasis to the SLN [12][13][14]. Lee et al [15] studied predicting nonsentinel lymph node metastasis in patients with breast cancer using sentinel lymphoscintigraphy.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Value of Hybrid Sentinel Lymphoscintigraphy to Predict Metastatic Sentinel Lymph Nodes in Breast Cancer

Kim

et al. 2014

Nucl Med Mol Imaging

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Purpose Hybrid imaging techniques can provide functional and anatomical information about sentinel lymph nodes in breast cancer. Our aim in this study was to evaluate which imaging parameters on hybrid sentinel lymphoscintigraphy predicted metastatic involvement of sentinel lymph nodes (SLNs) in patients with breast cancer. Methods Among 56 patients who underwent conventional sentinel lymphoscintigraphy, 45 patients (age, 53.1±9.5 years) underwent hybrid sentinel lymphoscintigraphy using a singlephoton emission computed tomography (SPECT)/computed tomography (CT) gamma camera. On hybrid SPECT/CT images, we compared the shape and size (long-to-short axis [L/S] ratio) of the SLN, and SLN/periareolar injection site (S/P) count ratio between metastatic and non-metastatic SLNs. Metastatic involvement of sentinel lymph nodes was confirmed by pathological biopsy. Results Pathological biopsy revealed that 21 patients (46.7 %) had metastatic SLNs, while 24 (53.3 %) had non-metastatic SLNs. In the 21 patients with metastatic SLNs, the SLN was mostly round (57.1 %) or had an eccentric cortical rim (38.1 %). Of 24 patients with non-metastatic SLNs, 13 patients (54.1 %) had an SLN with a C-shape rim or eccentric cortex. L/S ratio was 2.04 for metastatic SLNs and 2.38 for non-metastatic SLNs. Seven (33 %) patients had T1 primary tumors and 14 (66 %) had T2 primary tumors in the metastatic SLN group. In contrast, 18 (75 %) patients had T1 primary tumors and six (25 %) had T2 tumors in the non-metastatic SLN group. S/P count ratio was significantly lower in the metastatic SLN group than the non-metastatic SLN group for those patients with a T1 primary tumor (p=0.007). Conclusions Hybrid SPECT/CT offers the physiologic data of SPECT together with the anatomic data of CT in a single image. This hybrid imaging improved the anatomic localization of SLNs in breast cancer patients and predicted the metastatic involvement of SLNs in the subgroup of breast cancer patients with T1 primary tumors.

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Guidelines for Sentinel Node Biopsy and Lymphatic Mapping of Patients With Breast Cancer

Cited by 570 publications

References 14 publications

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

The use of fluorescent dyes and probes in surgical oncology

The Clinical Value of Hybrid Sentinel Lymphoscintigraphy to Predict Metastatic Sentinel Lymph Nodes in Breast Cancer

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