Lymphatic Mapping and Sentinel Node Biopsy in the Patient With Breast Cancer

Albertini, John J.; Lyman, Gary H.; Cox, Charles E.; Yeatman, Tim; Balducci, L.; Ku, Nini K.; Shivers, Steven C.; Berman, Claudia G.; Wells, Karen; Rapaport, D; Shons, Alan R.; Horton, John; Greenberg, Harvey; Nicosia, Santo V.; Clark, Robert A.; Cantor, Alan; Reintgen, Douglas S.

doi:10.1001/jama.1996.03540220042028

Cited by 1,084 publications

(458 citation statements)

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“…Therefore, a tumour-free sentinel lymph node implies the absence of lymph node metastases in the entire lymphatic basin. This sentinel node concept had been previously confirmed by H&E examinations, immunohistochemical study and nonquantitative RT -PCR assays (Giuliano et al, 1994;Albertini et al, 1996;Veronesi et al, 1997;Krag et al, 1998;Kataoka et al, 2000;Manzotti et al, 2001;Branagan et al, 2002;Ishida et al, 2002).…”

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confidence: 62%

“…In addition, no post-PCR manipulations are required with this method, and quantification and calculation of the results are all automated. Currently, many investigators reported sentinel lymph node biopsy for the diagnosis of axillary lymph node metastases from breast cancer (Giuliano et al, 1994;Albertini et al, 1996;Veronesi et al, 1997;Krag et al, 1998). The sentinel lymph node is the first lymph node to receive drainage from the primary tumours in early stage cancers (Morton et al, 1992).…”

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confidence: 99%

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Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

et al. 2003

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We have established a highly sensitive and quantitative reverse transcriptase -polymerase chain reaction (RT -PCR) method to detect axillary lymph node metastases of breast cancer. Amplifying cytokeratin 19 (CK19) mRNA transcripts using real-time TaqMan PCR made it possible to quantify axillary metastatic burden. Metastases in 358 axillary lymph nodes obtained from 23 breast cancers of 22 patients were investigated by conventional haematoxylin and eosin (H&E) staining, immunohistochemical staining and quantitative RT -PCR assay. The detection rates of axillary lymph node metastasis using H&E staining, immunohistochemistry and RT -PCR assay were 4.5, 5.9 and 13.1%, respectively. RT -PCR assay was the most sensitive of these three methods for detecting lymph node metastases. Cytokeratin 19 mRNA expression values of both histologically and immunohistochemically positive lymph nodes were significantly higher than the values for lymph nodes judged to be negative by both histological and immunohistochemical methods (Po0.0001), and those of histologically negative, but immunohistochemically positive lymph nodes were significantly higher than the values for lymph nodes judged to be negative by both histological and immunohistochemical methods (Po0.0001). Furthermore, metastatic rates of sentinel nodes were higher than the rates of nonsentinel lymph nodes as measured by all three methods. These results indicate that quantitative RT -PCR assay is a sensitive and reliable method for detecting lymph node metastasis. Furthermore, quantification of metastases in sentinel lymph nodes by quantitative RT -PCR assay may be useful to assess the entire axillary burden of breast cancer patients.

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confidence: 62%

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confidence: 99%

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

et al. 2003

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“…[1][2][3] The technique identifies a sentinel lymph node or nodes in the axilla of a patient with breast carcinoma using a vital dye or radionuclide. If the sentinel lymph node is negative for malignancy, the patient can forego regular axillary lymph node dissection, since the probability that the additional dissected lymph nodes will contain metastatic tumor when the sentinel node is negative is about 5%.…”

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Frozen section diagnosis for axillary sentinel lymph nodes: the first six years

Mitchell

2005

Modern Pathology

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Intraoperative frozen section of axillary lymph nodes for the detection of metastatic breast cancer has been controversial because of the labor-intensive techniques necessary to obtain a highly sensitive test, and because of the uncertain significance of frequently detected submicrometastatic carcinoma. In total, 874 consecutive axillary sentinel lymph node cases examined by intraoperative frozen section over a 6-year period were reviewed retrospectively. Frozen section had a sensitivity of 60% and was 100% specific, but when cases with submicrometastatic tumor cells were considered negative, the sensitivity rose to 83%. Rare cases were called 'atypical' on frozen section; almost all of these cases were negative for carcinoma on permanent sections.

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“…20 In patients with positive SLNs, axillary dissection remained standard practice, despite the finding that the SLNs were the only involved lymph nodes in 40% to 60% of patients. [21][22][23][24][25][26][27] The rationale for completion axillary dissection was based on 2 assumptions: 1) the presence of tumor-containing SLNs signifies potential residual tumor in the remaining the axillary lymph nodes, and 2) these lymph nodes require removal to prevent progression to clinically manifest axillary recurrence. Invasive lobular 4 (13) 21 (13) 13 (20) 6 (15) 5 (25) Select studies of patients with positive SLN and who did not undergo ALND have demonstrated low regional recurrence rates in the setting of adjuvant systemic therapy and RT (Table 5).…”

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confidence: 99%

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

Setton

Cody

Tan

et al. 2011

Cancer

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BACKGROUND: Randomized data suggest that axillary clearance is not necessary in select, clinically lymph nodenegative women with positive sentinel lymph node (SLN) biopsies (SLNBs) who undergo breast-conserving surgery or receive whole-breast radiotherapy and systemic therapy. The additional value of axillary radiotherapy in these patients is unknown. METHODS: The authors identified 326 patients with positive SLNBs who underwent breast-conserving surgery without axillary lymph node dissection from 1997 to 2009. SLN tumor deposits measured 0.2 mm in 58% of patients, 0.3 to 2.0 mm in 35% of patients, and >2 mm in 7% Patients. Ninety-three percent of patients received adjuvant radiotherapy. Radiation fields were categorized as standard tangents, high tangents, comprehensive (tangents plus supraclavicular), or partial breast to reflect coverage of the axilla. Standard tangents included both prone and supine positions. Regional failure was defined as recurrence in the ipsilateral supraclavicular, axillary, or internal mammary lymph nodes. RESULTS: The median follow-up was 55 months (range, 1-158 months). The 4-year rates of regional control, local control, disease-free survival, and overall survival were 99%, 98%, 95%, and 91%, respectively. Three patients had regional recurrences. Two of those patients received adjuvant radiotherapy with standard supine tangents, and 1 patient did not receive radiotherapy. No regional recurrences occurred among 66 patients who received radiotherapy in the prone position. CONCLUSIONS: Regional control was high (99% at 4 years) in patients who had low-volume SLN disease who did not undergo axillary dissection, regardless of whether the axilla was irradiated. Whole-breast radiation alone, including in the prone position, is sufficient treatment after breast-conserving surgery for select patients with tumor-containing SLNs who omit axillary dissection.

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Lymphatic Mapping and Sentinel Node Biopsy in the Patient With Breast Cancer

Cited by 1,084 publications

References 32 publications

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

Frozen section diagnosis for axillary sentinel lymph nodes: the first six years

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

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