Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: A long term follow‐up analysis

Torrenga, Hans; Fabry, Hans; Sijp, Joost R.M. van der; Diest, Paul J. van; Pijpers, Rik; Meijer, Sybren

doi:10.1002/jso.20101

Cited by 64 publications

(26 citation statements)

References 17 publications

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“…16 Many programs now routinely accept a negative SLN as accurate, and these patients are spared the morbidity of the completion ALND. Several studies with long-term follow-up [17][18][19][20] are now reporting excellent results with this strategy, as well as improved quality of life. The SLN biopsy therefore screens newly diagnosed breast cancer patients for nodal metastases, and only SLN-positive patients proceed to undergo completion ALND.…”

Section: A K Rivers Et Almentioning

confidence: 99%

Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

et al. 2006

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Background:The survival benefit of a completion axillary lymph node dissection (ALND) in patients after removal of a metastatic sentinel lymph node (SLN) is uncertain and is under study in ongoing clinical trials. The completion ALND remains necessary, however, for the identification of cases with at least four metastatic lymph nodes, in which extended-field locoregional and/or postmastectomy radiation will be recommended. Our goal was evaluate clinicopathologic features that might serve as surrogates for determining which patients with a positive SLN are likely or unlikely to belong to this high-risk subset.Methods: Records were reviewed for 285 patients from 2 comprehensive cancer centers who underwent completion ALND after resection of a metastatic SLN from 1995 to 2002. Clinicopathologic features were analyzed by univariate and multivariate logistic regression. Fortyone cases (14%) were found to have at least four positive nodes after ALND.Results: FisherÕs exact test revealed the following features to be significantly (P < .05) associated with having four or more nodal metastases: tumor size >2 cm, lymphovascular invasion, an increasing ratio of positive SLNs to the total number of resected SLNs, extranodal extension, and the size of the SLN metastasis. Patients whose largest SLN metastasis was <2 mm had only a 1.4% risk of having four or more metastatic nodes (P < .0001).Conclusions: We conclude that patients with SLN micrometastases face an extremely low likelihood of having extensive nodal disease on completion ALND. Patients with larger primary tumors, lymphovascular invasion, and extranodal extension are more likely to have ALND findings that will affect their cancer management.

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Section: A K Rivers Et Almentioning

confidence: 99%

Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

et al. 2006

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“…Estudios observacionales a partir de largas series de pacientes muestran unos porcentajes de recurrencia axilar muy bajos, es el caso de Veronesi y col 20 [24][25][26] que señalan que en pacientes sin LA tras BSGC negativa la recurrencia axilar es mucho más baja de lo que cabría esperar en base a los resultados de ganglios centinelas falsos negativos.…”

Section: Discussionunclassified

Ganglio centinela en cáncer de mama: biopsia selectiva comparada con linfadenectomía axilar. Seguimiento a largo plazo

Goñi

Lozano

Estébanez

et al. 2009

Anales Sis San Navarra

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ResUmenFundamento. La biopsia selectiva del ganglio centinela (BSGC) ha reemplazado a la linfadenectomía axilar (LA), como procedimiento de elección, en el estadiaje del cán-cer de mama en estadios iniciales y axila clínicamente negativa. El objetivo de este trabajo es comparar la supervivencia global y libre de eventos de aquellas pacientes a las que se realizó, en el periodo de validación de la técnica, BSGC seguida de LA respecto a las que se practicó BSGC y LA si el ganglio centinela (GC) presentaba metástasis. material y métodos. Se han incluido 148 pacientes, 81 pertenecientes al periodo de validación y 67 al grupo de aplicación clínica. El radiocoloide se administró intraperitumoralmente, obteniéndose imágenes hasta la visualización del GC, posteriormente en la intervención quirúrgica se procedió a su identificación y extirpación.Resultados. En el grupo de validación, la eficacia de la técnica ha sido del 92,5%, la sensibilidad del 95,6% y la tasa de falsos negativos del 4%. De las 81 pacientes, 75 se encuentran libres de enfermedad (92,6%). De las 67 pacientes pertenecientes al grupo de aplicación clínica, 63 (94%) viven libres de enfermedad. Ninguna paciente ha presentado recurrencia ganglionar axilar.Conclusiones. En la validación de la técnica hemos obtenido unos valores que se hallan dentro de las exigencias de calidad generalmente aceptadas. Con una media de seguimiento de 6 años no hemos observado recurrencia axilar en ninguno de los dos grupos. No existe diferencia estadísticamente significativa en la supervivencia global y libre de eventos entre ambos grupos.Palabras clave. Ganglio centinela. Cáncer de mama. Linfogammagrafía. Supervivencia global. Supervivencia libre de enfermedad. aBsTRaCTBackground. Selective biopsy of the sentinel ganglion (SBSG) has replaced axillary lymphadectomy (AL) as the procedure of choice in staging breast cancer in its initial stages and in clinically negative axilla. The aim of this study is to compare global event-free survival of those patients subjected to SBSG followed by AL, during the period of validation of the technique, with respect to those subjected to SBSG and AL if the sentinel ganglion (SG) showed metastasis. methods. One hundred and forty-eight patients were included, 81 belonging to the period of validation and 67 to the clinical application group. Radiocoloid was administered intraperitumorally, obtaining images up until the visualisation of the SG; its identification and extirpation were carried out subsequently in the surgical intervention.Results. The efficacy of the technique in the validation group was 92.5%, sensitivity was 95.6% and the rate of false negatives was 4%. Of the 81 patients, 75 are free of disease (92.6%). Of the 67 patients belonging to the clinical application group, 63 (94%) are free of disease. No patient has presented axillary ganglion recurrence. Conclusion.In the validation of the technique we obtained values that fall within the demands of generally accepted quality. With an average follow up of 6 years we did not observe ...

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“…Naik y col 22 , en 2340 pacientes, encuentran 3 casos de recurrencia axilar (0,12%) y concluyen que es comparable a la LA. Así mismo, el metaanálisis realizado por van Der Ploeg y col 23 señala un 0,3% de recurrencia axilar, al que podemos añadir varios trabajos [24][25][26] que señalan que en pacientes sin LA tras BSGC negativa la recurrencia axilar es mucho más baja de lo que cabría esperar en base a los resultados de ganglios centinelas falsos negativos.…”

Section: Materials Y Métodosunclassified

Sentinel ganglion in breast cancer: selective biopsy compared with axillary lymphadectomy

Goñi

Lozano

Estébanez

et al. 2010

An Sist Sanit Navar

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Fundamento. La biopsia selectiva del ganglio centinela (BSGC) ha reemplazado a la linfadenectomía axilar (LA), como procedimiento de elección, en el estadiaje del cán-cer de mama en estadios iniciales y axila clínicamente negativa. El objetivo de este trabajo es comparar la supervivencia global y libre de eventos de aquellas pacientes a las que se realizó, en el periodo de validación de la técnica, BSGC seguida de LA respecto a las que se practicó BSGC y LA si el ganglio centinela (GC) presentaba metástasis. Material y métodos.Se han incluido 148 pacientes, 81 pertenecientes al periodo de validación y 67 al grupo de aplicación clínica. El radiocoloide se administró intraperitumoralmente, obteniéndose imágenes hasta la visualización del GC, posteriormente en la intervención quirúrgica se procedió a su identificación y extirpación.resultados. En el grupo de validación, la eficacia de la técnica ha sido del 92,5%, la sensibilidad del 95,6% y la tasa de falsos negativos del 4%. De las 81 pacientes, 75 se encuentran libres de enfermedad (92,6%). De las 67 pacientes pertenecientes al grupo de aplicación clínica, 63 (94%) viven libres de enfermedad. Ninguna paciente ha presentado recurrencia ganglionar axilar.conclusiones. En la validación de la técnica hemos obtenido unos valores que se hallan dentro de las exigencias de calidad generalmente aceptadas. Con una media de seguimiento de 6 años no hemos observado recurrencia axilar en ninguno de los dos grupos. No existe diferencia estadísticamente significativa en la supervivencia global y libre de eventos entre ambos grupos.Palabras clave. Ganglio centinela. Cáncer de mama. Linfogammagrafía. Supervivencia global. Supervivencia libre de enfermedad. aBstractBackground. Selective biopsy of the sentinel ganglion (SBSG) has replaced axillary lymphadectomy (AL) as the procedure of choice in staging breast cancer in its initial stages and in clinically negative axilla. The aim of this study is to compare global event-free survival of those patients subjected to SBSG followed by AL, during the period of validation of the technique, with respect to those subjected to SBSG and AL if the sentinel ganglion (SG) showed metastasis. Methods.One hundred and forty-eight patients were included, 81 belonging to the period of validation and 67 to the clinical application group. Radiocoloid was administered intraperitumorally, obtaining images up until the visualisation of the SG; its identification and extirpation were carried out subsequently in the surgical intervention.results. The efficacy of the technique in the validation group was 92.5%, sensitivity was 95.6% and the rate of false negatives was 4%. Of the 81 patients, 75 are free of disease (92.6%). Of the 67 patients belonging to the clinical application group, 63 (94%) are free of disease. No patient has presented axillary ganglion recurrence.conclusion. In the validation of the technique we obtained values that fall within the demands of generally accepted quality. With an average follow up of 6 years we did not observe axillary ...

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Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: A long term follow‐up analysis

Abstract: Our long term follow-up results indicate that survival is excellent (98%) and local axillary control is adequate (99%) after omitting ALND in a group of 104 SN negative breast cancer patients.

Cited by 64 publications

References 17 publications

Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

Ganglio centinela en cáncer de mama: biopsia selectiva comparada con linfadenectomía axilar. Seguimiento a largo plazo

Sentinel ganglion in breast cancer: selective biopsy compared with axillary lymphadectomy

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