No stage migration due to the introduction of the sentinel node procedure: a population-based study

Axillary lymph node dissection (ALND) is associated with significant morbidity, whilst sentinel node biopsy (SNB) has the potential to minimize complications in the management of breast cancer. The aim of this study was to systematically appraise the outcome of SNB when compared to ALND. A comprehensive search for published trials examining outcomes after SNB for breast cancer was performed using medline and cross-referencing available data. Each study was reviewed and data extracted. Primary outcomes were nodal positivity and surgery-related morbidity. A total of 9,608 patients were identified from trials comparing ALND and SNB. The overall rate of axillary lymph node positivity for those with no clinically palpable nodes was 28.8% for ALND and 27.6% for SNB (OR = 1.00, 95% CI = 0.86-1.17, P = 0.956), though there was a trend for superior detection of metastatic disease with SNB when this was compared with ALND alone (OR = 1.22, 95% CI = 0.95-1.57, P = 0.122). Patients who undergo SNB are significantly less likely to suffer post-operative morbidity relative to ALND: risk of infection (OR = 0.58, 95% CI = 0.42-0.80, P = 0.0011), seroma (OR = 0.40, 95% CI = 0.31-0.51, P = 0.0071), arm swelling (OR = 0.30, 95% CI = 0.14-0.66, P = 0.0028) and numbness (OR = 0.25, 95% CI = 0.1-0.59, P = 0.0018).SNB is at least equivalent to ALND in detecting metastatic disease in the axilla. SNB is the optimum approach in terms of morbidity for the assessment of axillary metastasis in clinically node negative breast cancer.

Section: Discussionmentioning

confidence: 99%

Outcome of axillary staging in early breast cancer: a meta-analysis

Kell

Burke

Barry

et al. 2010

“…Recent studies showed a 4.3-10% increase among patients diagnosed with micrometastatic disease in the sentinel node as well [9,10]. This increase led to stage migration after adjustment for the simultaneous, favorable trend in tumor size [9]. A discussion followed on prognostic significance and possible need for additional systemic and regional treatment.…”

Section: Introductionmentioning

confidence: 99%

Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study

Maaskant‐Braat

Poll‐Franse

Voogd

et al. 2010

To cite this version:Adriana J. Maaskant-Braat, Lonneke V. Poll-Franse, Adri C. Voogd, Jan Willem W. Coebergh, Rudi M. Roumen, et al.. Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study. Breast Cancer Research and Treatment, Springer Verlag, 2010, 127 (1), pp.195-203 and pN0(i+): (HR 0.4 (95% CI, 0.14-1.3)) and neither was the case after additional adjustment for adjuvant systemic therapy. Our practice based study showed that the presence of sentinel node micrometastases in breast cancer patients has hardly any impact on breast cancer overall survival during the first years after diagnosis.

“…Patients who underwent SLN biopsy with a negative SLN have an improved disease-free and overall survival compared with node negative axillary lymph node dissection (ALND) patients [4,5]. The reason for this observation is clearly the more extensive histopathologic workup of lymph nodes resulting in a more accurate axillary staging, a reduced rate of false-negative results and stage migration [6,7]. SLN biopsy has been reported to result in an increased quality of life with reduced morbidity, but especially younger patients after isolated SLN biopsy with early breast cancer showed greater procedure-associated levels of anxiety [8].…”

Section: Introductionmentioning

confidence: 99%

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Hirche

Murawa

Mohr

et al. 2010

211

150

Background: Sentinel lymph node (SLN) biopsy is a selective approach to axillary staging of breast cancer with reduced morbidity. Current detection methods including radioisotope and blue dye show good results but some drawbacks are remaining. Indocyanine green (ICG) fluorescence detection was evaluated as a new method for SLN biopsy in breast cancer allowing both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLN. Methods: Forty-three women with clinically node negative breast cancer received subareolar injection of ICG for fluorescence detection of SLN. All patients underwent either planned axillary lymph node dissection (ALND) with SLN biopsy or selective SLN biopsy to determine need for ALND. Clinical feasibility, detection rate, sensitivity, and axillary recurrence after isolated SLN biopsy were analyzed. Results: Overall ICG fluorescence imaging identified 2.0 SLN in average in 42 of 43 patients (detection rate: 97.7%). Metastatic involvement of the SLN was found in 17 of 18 nodal positive patients by conventional histopathology (sensitivity: 94.4%). Immunohistochemistry revealed isolated tumor cells in five further cases. There was only one false-negative case in 43 patients (5.6%). In 17 of 23 overall nodal positive patients, the SLN was the only positive lymph node. After a median follow-up of 4.7 years none of the patients presented with axillary recurrence. Conclusion: ICG fluorescence imaging is a new method for SLN biopsy in breast cancer with acceptable sensitivity and specificity comparable to conventional methods. One advantage of this technique is that it allows transcutaneous visualization of lymphatic vessels and intraoperative lymph node detection without radioisotope.Keywords Sentinel lymph node biopsy Á Breast cancer Á Indocyanine green (ICG) Á Fluorescence imaging Á Surgery Abbreviations ALND Axillary lymph node dissection ICG Indocyanine green SLN Sentinel lymph node