Manipulation of the Primary Breast Tumor and the Incidence of Sentinel Node Metastases From Invasive Breast Cancer

Hansen, Nora M.; Xing, Ya; Grube, Baiba J.; Giuliano, Armando E.

doi:10.1001/archsurg.139.6.634

Cited by 85 publications

(65 citation statements)

References 47 publications

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“…Our results do not confirm the findings of a recently published study, performed on a much smaller number of patients (Hansen et al, 2004), suggesting a positive association between needle biopsy and SLN metastases. Studies of SLN metastases must take into account all well-known predictive factors for axillary node metastases such as tumour size, clinical and histo-pathological criteria.…”

Section: Discussioncontrasting

confidence: 99%

The impact of preoperative breast biopsy on the risk of sentinel lymph node metastases: analysis of 2502 cases from the Austrian sentinel node biopsy study group

et al. 2004

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Preoperative breast biopsy might cause disaggregation of tumour cells and tumour cell spread. The purpose of this study was to investigate the impact of preoperative biopsy on the rate of metastases to the sentinel lymph node (SLN) of patients with primary breast cancer. We report the results of 2502 patients with primary breast cancer, who were operated, and a sentinel node biopsy was performed. The association of preoperative biopsy with the risk of SLN metastases was examined by regression analyses and tested for possible confounding well-known factors for axillary node metastases. In all, 1890 patients were available for final analyses; 1048 (55.4%) patients had a preoperative diagnosis performed by fine-needle aspiration or core biopsy; 641 (33.9%) patients had a positive SLN when conventional H&E and IHC staining was performed. Patients with preoperative breast biopsy showed a 1.37 times (95% CI, 1.13 -1.66) increased risk of SLN metastases on univariate analysis, but this result was not persistent when analysis was adjusted for other relevant factors for axillary node metastases, OR 1.09 (95% CI, 0.85 -1.40). In addition, subgroup analyses of the risk for occult micro metastases to the SLN (detected by IHC only) on H&E-negative cases also showed no increased risk associated with preoperative biopsy, OR 1.07 (95% CI, 0.69 -1.65). The conclusion, based on the present data, is that preoperative breast biopsy does not cause artificial tumour cell spread to the SLN, with possible negative impact on the prognosis of breast cancer.

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Section: Discussioncontrasting

confidence: 99%

The impact of preoperative breast biopsy on the risk of sentinel lymph node metastases: analysis of 2502 cases from the Austrian sentinel node biopsy study group

et al. 2004

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“…It is also noteworthy that several reports have identified associations between percutaneous biopsy of the primary tumour and SLN involvement with tumour, including MM [76,77]. Moore et al [78] found that the presence of MM was significantly related to the method of breast biopsy, however this relationship was only observed for IHC detected MM rather than those identified by HE staining.…”

Section: Discussionmentioning

confidence: 99%

The clinical significance of sentinel lymph node micrometastasis in breast cancer

Patani

Mokbel

2008

Breast Cancer Res Treat

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“…It is shown that ITC are more common in the SN after needle biopsy or manipulation of a breast tumor [10][11][12][13]. This is probably due to iatrogenic displacement of tumor cells.…”

Section: Introductionmentioning

confidence: 99%

“…Such a surgical excision may lead to a similar or even higher rate of ITC in the SN and it is not evident whether further ALND is indicated in these patients. So far, only few studies have addressed this subject and the results are controversial [12,13]. One study shows a lower incidence of SN metastases after surgical excision biopsy compared to needle biopsy [13], while another study shows that a surgical excision biopsy increases the incidence of SN metastases [12].…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic displacement of tumor cells to the sentinel node after surgical excision in primary breast cancer

Tvedskov

Jensen

Kroman

et al. 2011

Breast Cancer Res Treat

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Isolated tumor cells (ITC) are more common in the sentinel node (SN) after needle biopsy of a breast cancer, indicating iatrogenic displacement of tumor cells. We here investigate whether similar iatrogenic displacement occurs after surgical excision of a breast tumor. We compared the incidence of ITC in the SN of 414 breast cancer patients with recent surgical excision to a group of 16,960 patients without recent surgical procedure in a multivariate analysis by linking data from the Danish Breast Cancer Cooperative Group database and the Danish National Health Register. Moreover, the incidence of spread to non-SNs in patients with ITC in the SN after recent surgical excision was analyzed. We found an adjusted odds ratio on 3.73 (95% CI 2.57-5.43; P < 0.0001) for having ITC in the SN after surgical excision. The increase in ITC after surgical excision was especially seen in patients with ductal carcinomas (OR 4.66; 95% CI 3.03-7.19). None of the patients with ITC in SN after surgical excision had further spread to non-SNs compared to 12% in the group without recent surgical excision (P = 0.09). The nearly fourfold increase in ITC in the SN after surgical excision indicates that this procedure induces iatrogenic displacement of tumor cells. This displacement was more common in ductal carcinomas. We found no further dissemination to non-SNs in patients with ITC in the SN after recent surgical excision, and it is questioned whether these patients benefit from an axillary lymph node dissection.

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Manipulation of the Primary Breast Tumor and the Incidence of Sentinel Node Metastases From Invasive Breast Cancer

Abstract: The incidence of sentinel node (SN) metastases from invasive breast cancer might be affected by the technique used to obtain biopsy specimens from the primary tumor before sentinel lymph node dissection.

Cited by 85 publications

References 47 publications

The impact of preoperative breast biopsy on the risk of sentinel lymph node metastases: analysis of 2502 cases from the Austrian sentinel node biopsy study group

The impact of preoperative breast biopsy on the risk of sentinel lymph node metastases: analysis of 2502 cases from the Austrian sentinel node biopsy study group

The clinical significance of sentinel lymph node micrometastasis in breast cancer

Iatrogenic displacement of tumor cells to the sentinel node after surgical excision in primary breast cancer

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