Incidence of nodes in completion mastectomy specimens following breast conservation and axillary clearance

Khonji, N.; Edwards, Richard E.; Sweetland, Helen; Monypenny, I.; Mansel, Robert E.; Webster, David

doi:10.1046/j.1365-2168.2002.02203.x

Cited by 6 publications

(6 citation statements)

References 4 publications

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“…Others, however, believe that positive IntraMSLNs do not necessarily predict AxLN metastasis and that the decision on axillary surgical management should by individualized. 11,16,27,34 Our study showed that positive IntraMLNs are good predictor of AxLNs involvement by metastasis (Table 3 and Figure 3). The correlation between the status of positive IntraMLNs and positive AxLNs was significant (Figures 1 and 2, Table 5).…”

Section: Discussionmentioning

confidence: 58%

“…This depends on how vigorous and meticulous the radiological or pathologic examination methods were carried out and on the detection methods employed. 1,[5][6][7]10,14,[17][18][19]27,28 The overall prevalence of positive IntraMLNs is 27% (Table 1). Postoperative pathologic examination was a better methodology to detect IntraMLNs (53% detection rate) than preoperative methods (48%; Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen studies were included for systematic review (Table 1). 1,3,4,6,7,10,11,13,14,16,20,21,[23][24][25][26][27][28] Twelve studies with sufficient data on the AxLN status were included in the meta-analysis for the relationship between the IntraMLNs status and the AxLN status (Table 3). 3,4,[9][10][11]13,14,16,20,24,25,28 Three studies with sufficient clinical data were included in the meta-analysis for the relationship between the intraMLNs status and clinical survival (Table 4).…”

Section: Description Of Studiesmentioning

confidence: 99%

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The Significance of Intramammary Lymph Nodes in Breast Cancer

et al. 2012

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Intramammary lymph nodes (IntraMLNs) are frequent mostly benign incidental findings. However, they are clinically important because they can be the primary sites of metastasis and sentinel lymph nodes. Literature data regarding the clinical significance of IntraMLNs metastasis, however, remains controversial. This study aimed to perform a systematic review and meta-analysis to better define the prognostic value of positive IntraMLNs in patients with breast cancer. A systematic review of the literature without date restrictions was conducted. Five electronic medical databases were searched, and a hand-search of the reference lists of the collected articles was also performed. Studies with sufficient and relevant pathologic and clinical survival data were included. Other studies with insufficient data or normal findings were excluded. This study found 18 studies eligible for systematic review, 3 of which were eligible for outcome meta-analysis. IntraMLNs metastases were strongly correlated with axillary lymph nodes involvement. Positive IntraMLNs are reliable predictors of axillary lymph node involvement and therefore a guide for further surgical management of the axillary nodes. Even though it could be concluded that IntraMLNs metastasis is an independent predictor of outcome, this meta-analysis was limited because of the scarcity of data and the inconsistencies and heterogeneity of the outcome studies.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

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The Significance of Intramammary Lymph Nodes in Breast Cancer

et al. 2012

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“…2 Moreover, when adjuvant therapy includes radiotherapy (RT) to the breast or chest wall, the lower axilla may be treated as it is often included in the tangential irradiation field, and some lower level axillary nodes may be removed at mastectomy. 3 This hypothesis is supported by the Z11 trial 4 that showed that ANC may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and receiving whole breast RT. Axillary recurrence was low, and there were no clear differences between the two groups (ANC 0.5% vs no ANC 0.9%) at 6.3 years.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 95%

POSNOC—POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes

et al. 2021

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IntroductionACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence.Methods and analysisPOSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 1:1 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel node biopsy, with or without extranodal extension. In the intervention group women receive adjuvant therapy alone, in the standard care group they receive ANC or axillary RT. In both groups women receive adjuvant therapy, according to local guidelines. This includes systemic therapy and, if indicated, RT to breast or chest wall. The UK Radiotherapy Trials Quality Assurance Group manages the in-built radiotherapy quality assurance programme. Primary endpoint is 5-year axillary recurrence. Secondary outcomes are arm morbidity assessed by Lymphoedema and Breast Cancer Questionnaire and QuickDASH questionnaires; quality of life and anxiety as assessed with FACT B+4 and State/Trait Anxiety Inventory questionnaires, respectively; other oncological outcomes; economic evaluation using EQ-5D-5L. Target sample size is 1900. Primary analysis is per protocol. Recruitment started on 1 August 2014 and as of 9 June 2021, 1866 participants have been randomised.Ethics and disseminationProtocol was approved by the National Research Ethics Service Committee East Midlands—Nottingham 2 (REC reference: 13/EM/0459). Results will be submitted for publication in peer-reviewed journals.Trial registration numberISRCTN54765244; NCT0240168Cite Now

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“…Most patients receive adjuvant systemic therapy and we now have molecular determinants of prognosis and predictors of treatment benefit. Moreover, the lower axilla is treated inadvertently in all patients as it is included in the irradiation field during whole breast radiotherapy, or some lower level axillary nodes are included in the mastectomy specimen [11]. …”

Section: Introductionmentioning

confidence: 99%

Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol

2013

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BackgroundFor patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients. With improvements in adjuvant therapy, routine axillary treatment may no longer offer any overall advantage.ObjectivesTo assess the short and long term benefits and adverse effects of routine axillary treatment (axillary lymph node clearance or axillary radiotherapy) for patients with lymph node positive early-stage breast cancer.Methods/DesignCriteria for potentially eligibility for the study will be that the participants are men and women with early breast cancer and lymph nodes with metastasis. The study compares either axillary treatment with no axillary treatment, or axillary node clearance with axillary radiotherapy, and the study is a randomized trial. Primary outcomes are axillary recurrence, disease-free and overall survival. Secondary outcomes include breast or chest wall recurrence, distant metastasis, time to axillary recurrence, axillary recurrence-free survival, arm morbidity, quality of life and health economic costs. The search strategy will include the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform (ICTRP) search portal. Two independent reviewers will assess studies for inclusion in the review, assess study quality and extract data. Characteristics of included studies will be described. Meta-analysis will be conducted using ReVman software.CommentThis review addresses an important clinical question, and results will inform clinical practice and health care policy.

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Incidence of nodes in completion mastectomy specimens following breast conservation and axillary clearance

Cited by 6 publications

References 4 publications

The Significance of Intramammary Lymph Nodes in Breast Cancer

The Significance of Intramammary Lymph Nodes in Breast Cancer

POSNOC—POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes

Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol

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