Halsted Revisited: Internal Mammary Sentinel Lymph Node Biopsy in Breast Cancer

Ent, F.W.C. van der; Kengen, R.A.M.; Pol, H.A.G. van der; Povel, J. A. C. M.; Stroeken, Harry J. G.; Hoofwijk, A. G. M.

doi:10.1097/00000658-200107000-00012

Cited by 184 publications

(99 citation statements)

References 33 publications

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“…The SLNs in previous studies were found in the axilla, internal mammary, and supraclavicular nodes. But the frequency of extraaxillary SLNs including internal mammary nodes was slightly lower than in previous studies (10.76% vs. 17%-56% and 8.34% vs. 10%-40%, respectively) (32)(33)(34)(35).…”

Section: Discussioncontrasting

confidence: 59%

Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Wang

Lin

et al. 2016

J Nucl Med

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The metastatic status of sentinel lymph nodes (SLNs) might be the most important prognostic factor in breast cancer. In this paper, we report to our knowledge the first study of 99m Tc-rituximab as a radiotracer for imaging of SLNs using lymphoscintigraphy in both preoperative and intraoperative breast cancer patients. Methods: 99m Tcrituximab was designed as an SLN tracer targeting the CD20 antigen, which expresses extensively in LNs. A retrospective study was performed on 2,317 patients with primary breast cancer who underwent lymphoscintigraphy and sentinel lymph node biopsy (SLNB). Before imaging, all patients were administered a preoperative peritumoral injection of 37 MBq of 99m Tc-rituximab. Results: 99m Tc-rituximab was synthesized in both high radiolabeling yield and high radiochemical purity (.95%), with molecular integrity and immune activity well maintained. The initial study of 100 breast cancer patients showed that the success rate of SLN lymphoscintigraphy by injection of 99m Tc-rituximab, as compared with SLNB, was 100%, and the sensitivity, specificity, accuracy, and false negative rate were 97.4%, 100%, 98.0%, and 2.60%, respectively. Of the following 2,217 patients studied, the success rate of lymphoscintigraphy and SLNB was 98.8% and 99.9%, and the average number of SLN was 1.78 (range, 1-10) and 2.85 (range, 1-15). Age was an independent predictor of the number of SLNs identified by lymphoscintigraphy and intraoperative handheld γ-probe (P , 0.05), and other factors-such as sex, imaging time, primary tumor site, histopathologic subtype, clinical T stage, and immunochemistry-were not (P . 0.05). However, the SLN metastatic rates were different in patients with different histopathologic subtype, clinical T stage, and immunochemistry (P , 0.05). Conclusion: Here we report the first study of the new radiotracer 99m Tc-rituximab for breast cancer lymphoscintigraphy. This tracer showed great feasibility, safety, and effectiveness for SLN mapping in breast cancer patients.

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Section: Discussioncontrasting

confidence: 59%

Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Wang

Lin

et al. 2016

J Nucl Med

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“…This was followed by IM-SLNB whenever lymphoscintigraphy highlighted IMC drainage. The IM-SLNB technique, based on the IM-SLNB method described by van der Ent [19] can usually be performed using the mastectomy incision. In breast conserving operations, a small additional horizontal incision (2.5-3 cm) over the desired interspace was used to sample IMSLNs.…”

Section: Dmentioning

confidence: 99%

“…Metastases exclusively situated in the IM node, without concurrent axillary metastases, occur in 2-11% of patients [85]. A larger axillary metastatic load may represent a higher risk of IMC metastasis [1], and the total number of involved nodes in the two regions together may likewise be important from a prognostic aspect, but this is currently very difficult to assess, as IMC-LND is not part of the standard treatment of breast carcinoma [22].…”

Section: Internal Mammary Sentinel Lymph Node Biopsy In Breast Cancermentioning

confidence: 99%

“…Adjuvant chemotherapeutic treatment and IMC irradiation is however indicated when a tumor-positive IMC lymph node is found [96]. IM-SLNB may be associated with some additional morbidity in about 3-10 % of the cases, according to the literature: pleural lesions or injury of the IM artery [1,19,78]. Recovery is usually uneventful in the case of pleural lesions, after simple vacuum drainage.…”

Section: Internal Mammary Sentinel Lymph Node Biopsy In Breast Cancermentioning

confidence: 99%

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Current issues in breast surgery

Maráz¹

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“…Of these 14 cases, 10 had positive axillary nodes at the same time, confirming again that axillary node positivity in the case of drainage to IMN is a strong predictive factor for IMN metastasis. Van der Ent et al 36 investigated internal mammary chain metastasis in 256 patients. This paper reported IMN metastasis in 26.8% (11/41).…”

Section: Factors Associated With Imn Drainage and Metastasismentioning

confidence: 99%

Internal mammary node management in breast cancer. A review

Vrána¹,

Gatěk²,

Cwiertka³

et al. 2013

BIOMED PAP

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Background. Internal mammary nodes visualized during sentinel node biopsy for breast cancer, remain an unresolved management issue. Further, both internal mammary node (IMN) radiotherapy and biopsy have attendant risks and hence should be used with caution. The purpose of this review is to highlight the available data and evidence. Methods and Results. A PubMed database from 1960 to 2012 using key words: internal mammary nodes, breast cancer radiotherapy planning, adjuvant radiotherapy, sentinel node biopsy in breast cancer and selected publications on the significance of internal mammary nodes in breast cancer treatment, published data and approaches used. We found 14513 relevant papers and we selected 30 that clearly investigated the management of internal mammary nodes during sentinel node search. We focused on the incidence of IMN metastasis (6 papers), risk factors associated with IMN drainage (9 reports), management of IMN and the impact on disease free and overall patient survival (15 papers). Conclusions. The evidence for breast cancer axillary nodes management is good but the data for other draining nodes such as internal mammary nodes are far less conclusive and further research is needed.

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Halsted Revisited: Internal Mammary Sentinel Lymph Node Biopsy in Breast Cancer

Abstract: Internal mammary sentinel node biopsy is feasible without serious additional complications. It improves nodal staging in breast cancer by identifying higher-risk subgroups with internal mammary nodal metastases, which might benefit from altered adjuvant treatment regimens.

Cited by 184 publications

References 33 publications

Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Current issues in breast surgery

Internal mammary node management in breast cancer. A review

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Halsted Revisited: Internal Mammary Sentinel Lymph Node Biopsy in Breast Cancer

Abstract: Internal mammary sentinel node biopsy is feasible without serious additional complications. It improves nodal staging in breast cancer by identifying higher-risk subgroups with internal mammary nodal metastases, which might benefit from altered adjuvant treatment regimens.

Cited by 184 publications

References 33 publications

Clinical Evaluation of 99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Clinical Evaluation of 99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Current issues in breast surgery

Internal mammary node management in breast cancer. A review

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Resources

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Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients