Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection

Schulze, Tobias; Mucke, Jörg; Markwardt, J.; Schlag, Peter M.; Bembenek, A.

doi:10.1002/jso.20406

Cited by 133 publications

(101 citation statements)

References 40 publications

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“…The SN procedure is already proven to be accurate and costeffective, related to a marked improvement in postoperative morbidity, in different types of cancer such as breast and vulvar (31)(32)(33). However, in patients with a complex adnexal mass, the SN procedure should be performed before the diagnosis EOC can be made on the basis of a frozen section.…”

Section: Discussionmentioning

confidence: 99%

The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

et al. 2014

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Few sentinel node (SN) studies in ovarian cancer have been reported, mainly because of the risk of tumor dissemination associated with the injection of tracers into the ovarian cortex. To our knowledge, the injection of tracers into the ovarian ligaments has not been explored. The aim of this study was to determine the feasibility of the SN procedure in ovarian cancer with tracer injection into the ovarian ligaments and to establish whether the procedure is safe for the healthcare workers. Methods: The study included patients who were at high risk of ovarian malignancy. Blue dye and radioactive colloid were injected into the proper ovarian ligament and suspensory ligament of the ovary. To measure professional radiation exposure, ring dose meters were worn by the surgeon, theater nurse, and pathologist during 3 procedures. Results: An SN procedure was performed in 21 patients, and at least 1 SN location was identified in all patients using the γ probe before retroperitoneal exploration. SNs were located in the paraaortic and paracaval regions only in 67% of the patients, in the pelvic region only in 9%, and in both the paraaortic/paracaval and the pelvic regions in 24%. All but 2 SNs were found on the ipsilateral side. In 6 patients who underwent retroperitoneal exploration, 1-4 SNs were identified using the γ probe and resected. Blue-stained SNs were detected in 2 patients. Positive SNs were detected in 1 patient with lymph node metastases. The amount of radiation exposure to the surgeon, theater nurse, and pathologist did not exceed the safe limit. Conclusion: The identification of SNs in all cases suggests that the SN procedure performed by injection of tracers in the ovarian ligaments is feasible and promising. The procedure is safe for the involved personnel. Further investigation is necessary to determine the clinical application of this new technique.

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Section: Discussionmentioning

confidence: 99%

The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

et al. 2014

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“…It has the advantages of being the simplest, cheapest and most reliably reproducible method of objective assessment of lymphedema. However, in the reported studies using this method the point of measurement as well as the differences between both arms considered as significant lymph edema vary significantly [10,34].…”

Section: Discussionmentioning

confidence: 99%

Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer

Pillai

Sharma

Ahmed

et al. 2010

Indian J Surg Oncol

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Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer. 1. To ascertain the incidence of lymphedema in a hospital based population (in patients undergoing axillary dissection for breast cancer. 2. To determine the clinicoepidemilogical factors associated with the occurrence of lymphedema in these patients. For all patients undergoing axillary dissection, arm measurements were taken in the pre-& post-operative period from at least 3 sites; one in the arm, forearm and wrist (points fixed in reference to fixed bony landmarks). Patients included in this study were followed up for at least 12 months. Circumference difference of more than 5% was taken as mild lymphedema; more than 10% as moderate lymphedema and more than 15% as severe lymphedema. Data was analyzed using SPSS 11.0 statistical software. Of the 231 patients in this study mean age was 51.2 years, majority were housewives (71.9%) and postmenopausal (58.5%). Modified radical mastectomy (MRM), was performed on 203 (87.9%) patients. 57.2% patients had positive lymph nodes. The mean number of positive nodes was 6.52. Majority of the patients received chemo and radio therapy. Overall incidence of lymphedema was 41.1%. The definition of 5-10% increase as mild lymphedema may be a bit severe as in most patients with this increase, lymphedema is not clinically apparent. The incidence of moderate and severe lymphedema in our series is only 7.4%. The incidence of clinically significant lymphedema (moderate to severe lymphedema & symptomatic mild lymphedema) was 16.8%. Only axillary irradiation and pathological nodal status (pN3) emerged as significant risk factors for lymphedema development on multivariate analysis. Lymphedema once established is difficult to treat. Combination of axillary dissection with radiation and more nodal positivity seems to predispose to lymphedema. Prevention by means of sentinel node biopsy in early cases, good surgical technique, arm care post surgery, exercises and massage therapy may help reducing the incidence and/or severity.

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“…Complete lymph node dissections are frequently associated with significant morbidity. Combining diagnostic advantages with decreased morbidity (1,2), the sentinel lymph node (SLN) procedure represents one of the most recent advances in surgical oncology. It consists of the identification and removal of SLNs, which are lymph nodes that receive lymphatic drainage directly from the primary tumor.…”

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confidence: 99%

Precise Localization of Sentinel Lymph Nodes and Estimation of Their Depth Using a Prototype Intraoperative Mini -Camera in Patients with Breast Cancer

Mathelin

Salvador²,

Huss³

et al. 2007

Journal of Nuclear Medicine

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The aim of this study was to evaluate the ability of a prototype intraoperative mini g-camera, the CarolIReS, with a 50 · 50 mm field of view, to precisely localize sentinel lymph nodes (SLNs) and to determine their depth in a series of patients with infiltrative breast cancer requiring SLN excision. Methods: With the use of phantoms, the broadness of the signal of an acquired projection was shown to linearly depend on its distance from the collimator. A preclinical ex vivo study of 25 excised SLNs demonstrated that SLN size did not influence depth estimation. The minimum activity threshold for successful use of the proposed method was determined. After a preoperative radioisotope injection and lymphoscintigraphy, the SLN was localized in a series of 11 patients using both the mini g-camera and a g-probe. During surgery, a ruler was used to measure the depth of all SLNs before their excision. Results: Using the measured linear dependence of image broadness, we found that the expected SLN anatomic depth was compatible with its measured depth during surgery. Conclusion: This study showed that the mini g-camera efficiently estimated the location of SLNs in 3 dimensions.Key Words: breast cancer; lymphoscintigraphy; intraoperative gamma-camera; sentinel lymph node; CarolIReS Mostt ypes of lymphophile cancers require assessment of regional lymph nodes for staging the tumor, determining prognosis, and devising therapeutic strategies. Complete lymph node dissections are frequently associated with significant morbidity. Combining diagnostic advantages with decreased morbidity (1,2), the sentinel lymph node (SLN) procedure represents one of the most recent advances in surgical oncology. It consists of the identification and removal of SLNs, which are lymph nodes that receive lymphatic drainage directly from the primary tumor. The SLN procedure is now a widely accepted method of lymph node staging for selected cases of invasive breast cancer (3,4) and cutaneous melanoma (5). The concept is also being evaluated in numerous other types of cancer, including pelvic gynecologic (vulval, cervical, and endometrial) (6-9), prostate (10), colon (11), gastric (12) and thyroid (13) cancer. In all cases, successful adaptation of the SLN procedure implies that the operator has a high identification rate and a low false-negative rate. For SLN identification, in addition to the peroperative injection of a blue dye, a 99m Tc-radiomarked colloidal solution is generally injected the day before or the day of the surgery and 2 planar scintigraphic images are taken in a nuclear medicine department. In a recent metaanalysis (14) including 69 trials and 8,059 patients with low-risk breast cancer, the proportion of patients with successfully mapped SLNs ranged from 41% to 100%, with more than 50% of the studies reporting a rate under 90%. The false-negative rate ranged from 0% to 29%, averaging 7.3% overall. Significant inverse correlations were observed between the false-negative rate and the proportion of patients with successfully mapped SLN...

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Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection

Cited by 133 publications

References 40 publications

The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer

Precise Localization of Sentinel Lymph Nodes and Estimation of Their Depth Using a Prototype Intraoperative Mini -Camera in Patients with Breast Cancer

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