Lymphatic mapping and sentinel node biopsy in breast cancer

McIntosh, Stuart; Purushotham, Arnie

doi:10.1046/j.1365-2168.1998.00934.x

Cited by 83 publications

(38 citation statements)

References 103 publications

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“…Axillary clearance remains the standard surgical procedure for early breast cancer, despite the option of axillary node sampling (Steele et al, 1985) and the advent of sentinel node biopsy (McIntosh and Purushotham, 1998). Although it is possible to discharge patients early without a wound drain in situ (Purushotham et al, 2002), this has not become standard practice.…”

Section: Discussionmentioning

confidence: 99%

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

et al. 2004

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Patients with breast cancer who require axillary clearance traditionally remain in hospital until their wound drains are removed. Early discharge has been shown to improve clinical outcomes, but there has been little assessment of the psychosocial and financial impact of early discharge on patients, carers and the health service. This study aimed to evaluate the effectiveness of a nurse-led model of early discharge from hospital. Main outcome measures were quality of life and carer burden. Secondary outcomes included patient satisfaction, arm morbidity, impact on community nurses, health service costs, surgical cancellations and in-patient nursing dependency. A total of 108 patients undergoing axillary clearance with mastectomy or wide local excision for breast cancer were randomised to nurse-led early discharge or conventional stay. Nurse-led early discharge had no adverse effects on quality of life or patient satisfaction, had little effect on carer burden, improved communication between primary and secondary care, reduced cancellations and was safely implemented in a mixed rural/urban setting. In total, 40% of eligible patients agreed to take part. Nonparticipants were significantly older, more likely to live alone and had lower emotional well being before surgery. This study provides further evidence of the benefits of early discharge from hospital following axillary clearance for breast cancer. However, if given the choice, most patients prefer to stay in hospital until their wound drains are removed.

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Section: Discussionmentioning

confidence: 99%

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

et al. 2004

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“…More recently, sentinel lymph node biopsy (SLNB) has been proposed as an alternative method for staging the axilla in women who have early breast cancer with clinically node negative axillae (Giuliano et al, 1994;Veronesi et al, 1997;McIntosh and Purushotham, 1998;Veronesi et al, 1999;Veronesi et al, 2003). The SLN is the first lymph node to receive lymphatic drainage from a tumour.…”

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confidence: 99%

The value of immunohistochemistry in sentinel lymph node histopathology in breast cancer

et al. 2005

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The optimal protocol for the histopathological examination of sentinel lymph nodes (SLNs) in breast cancer has not been determined. The value of more detailed examination using immunohistochemistry (IHC) is controversial. A total of 476 SLNs from 216 patients were reviewed. Sentinel lymph nodes were sectioned at three levels at 100 mm intervals and stained with haematoxylin and eosin (H&E). If the H&E sections showed no evidence of metastasis, then the three serial sections were stained with a murine monoclonal anti-cytokeratin antibody (CAM 5.2). Metastatic deposits were classified as macrometastasis (42.0 mm), micrometastasis (0.2 -2.0 mm) or isolated tumour cells (ITC, o0.2 mm). Of the 216 patients, 56 (26%) had metastasis as identified by H&E. Immunohistochemistry detected metastatic deposits in a further nine patients (4%), of whom four (2%) had micrometastasis and five (2%) had ITC only. Those cases with micrometastases were all, on review, visible on the H&E sections. Immunohistochemistry detects only a small proportion of metastasis in SLNs. All metastatic deposits identified by IHC were either micrometastasis or ITC. Until the prognostic significance of these deposits has been determined, IHC may be of limited value in the histopathological examination of SLNs.

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“…The results of these major studies (including the very small number of cases with failed SND mapping) and the reported overviews of the SND approach 11,13,17 were used to produce a weighted average for the sensitivity of SND to use in the model. Using this method of compositing, a sensitivity of approximately 0.92 was estimated for SND.…”

Section: -10mentioning

confidence: 99%

“…The details of the SND procedure have been well documented and a variety of techniques have been used and continue to be developed. [5][6][7][8][9][10][11][12][13][14][15][16][17] By assessing the status of the first echelon draining lymph node (i.e., the "sentinel" lymph node) of the primary tumor, SND identifies patients who require an AND. However, caution is warranted because the false-negative (FN) rate for SND, albeit small, may have an impact on survival.…”

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confidence: 99%

Sentinel lymph node versus axillary lymph node dissection for early‐stage breast carcinoma

Jani

Basu

Heimann

et al. 2003

Cancer

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The selectivity of reactions on active patches over those on a partially active carrier surface is investigated for patch‐covered spheres. The effects of relevant parameters including patch and carrier reactivities, patch coverage, patch size, and patch separation state are studied. The selectivity is found to increase with increasing relative dominance of the patch reactivity over the carrier reactivity and patch coverage, as expected. Interestingly, it also increases with decreasing patch size and increasing patch separations. Decrease in patch size creates more patch–carrier interfaces and thus enhances the competition effectiveness of the patches against the carrier surface. With respect to the patch separation state, more complete utilization of the patches is achieved for well‐separated patches and thus enhances the selectivity toward the patches. © 2007 American Institute of Chemical Engineers AIChE J 2007

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Lymphatic mapping and sentinel node biopsy in breast cancer

Cited by 83 publications

References 103 publications

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

The value of immunohistochemistry in sentinel lymph node histopathology in breast cancer

Sentinel lymph node versus axillary lymph node dissection for early‐stage breast carcinoma

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