One-year morbidity after sentinel node biopsy and breast surgery

Rönkä, R.; Smitten, Karl von; Tasmuth, Tiina; Leidenius, Marjut

doi:10.1016/j.breast.2004.09.010

Cited by 95 publications

(47 citation statements)

References 22 publications

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“…Second, a SLNB will be unnecessary in the majority of patients with a preoperative image-guided CNB diagnosis of DCIS because the final postoperative histology will only contain pure DCIS and will not contain any invasive disease [2,19] . Third, although SLNB is a less morbid surgical procedure compared with ALND, it is also associated with complications [7,8] . Fourth, SLNB can also lead to excessive and unnecessary treatment by providing misleading information about the axillary status.…”

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

“…Although SLNB is a less invasive procedure compared with axillary lymph node dissection (ALND), it is associated with a certain degree of morbidity and may lead to overdiagnosis and overtreatment [6] . Paresthesias, lymphedemas, and seromas have also been reported [7,8] . Therefore, the role of SLNB in DCIS is controversial and the indications for its use are not clear.…”

Section: Introductionmentioning

confidence: 97%

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Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Alameer¹,

Nefaie²,

Johani³

et al. 2016

WJCO

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AIM:To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS). METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) Al-Ameer AY et al . SNLB in clinically detected DCIS of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an imageguided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive. RESULTS:Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%.CONCLUSION: SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy. Core tip: While most ductal carcinoma in situ (DCIS) cases present with a radiologically detected abnormality, our sample represented a rare group of ductal carcinoma which was detected clinically. This study had a specific objective to determine the indications for sentinel lymph node in clinically detected DCIS. There are very few studies worldwide tracking this specific group, and there is no screening program in our community for breast cancer. This study will help communities who have no screening program to put protocols in place for such a specific group of patients.

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Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Alameer¹,

Nefaie²,

Johani³

et al. 2016

WJCO

View full text Add to dashboard Cite

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“…The degree of compression of soft tissues may vary between different examiners. When making arm volume measurements the volume of the contra-lateral side is an attractive internal control, but in fact may cause misleading results as there are natural differences according to handedness [40]. Comparisons of arm volume measurements over time may also be affected by changes in BMI, disuse atrophy on the operated side, exercise and treatments for arm swelling.…”

Section: Discussionmentioning

confidence: 99%

Comparing patients’ and clinicians’ assessment of outcomes in a randomised trial of sentinel node biopsy for breast cancer (the RACS SNAC trial)

Smith

Gill

Wetzig

et al. 2008

Breast Cancer Res Treat

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The RACS sentinel node biopsy versus axillary clearance (SNAC) trial compared sentinel-node-based management (SNBM) and axillary lymph-node dissection (ALND) for breast cancer. In this sub study, we sought to determine whether patient ratings of arm swelling, symptoms, function and disability or clinicians' measurements were most efficient at detecting differences between randomized groups, and therefore, which of these outcome measures would minimise the required sample sizes in future clinical trials. 324 women randomised to SNBM and 319 randomised to ALND were included. The primary endpoint of the trial was percentage increase in arm volume calculated from clinicians' measurements of arm circumference at 10 cm intervals. Secondary endpoints included reductions in range of motion and sensation (both measured by clinicians); and, patients' ratings of arm swelling, symptoms and quality of life, using the European Organisation for Research and Treatment of Cancer Breast Cancer Module (EORTC QLM-BR23), the body image after breast cancer questionnaire (BIBC) and the SNAC study specific scales (SSSS). The relative efficiency (RE, the squared ratio of the test statistics, with 95% confidence intervals calculated by bootstrapping) was used to compare these measures in detecting differences between the treatment groups. Patients' self-ratings of arm swelling were generally more efficient than clinicians' measurements of arm volume in detecting differences between treatment groups. The SSSS arm symptoms scale was the most efficient (RE = 7.1) The entire SSSS was slightly less so (RE = 4.6). Patients' ratings on single items were 3-5 times more efficient than clinicians' measurements. Primary endpoints based on patient-rated outcome measures could reduce the required sample size in future surgical trials.

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“…12,14,29,30 This too contributes to altered shoulder mechanics and lymph drainage. 12–14,31–33 Reliance on large muscles (lattisimus dorsi, trapezius) place considerable torque on the shoulder leading to bursitis, tendonitis, adhesive capsulitis, or premature osteoarthritic changes all of which can reduce ROM. 27,34 Compensation by smaller muscles (teres major and minor, supraspinatus, infraspinatus, subscapularis, rhomboideous major and minor muscles, and the serratus anterior) 35 can also create a situation of overuse, muscle fatigue and spasm.…”

Section: Introductionmentioning

confidence: 99%

Shoulder Impairment Before Breast Cancer Surgery

Flores

Dwyer

2014

Journal of Women's Health Physical Therapy

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Objective To compare pre- and post-operative shoulder active range of motion (AROM) values from female breast cancer survivors to population norm values for shoulder AROM; and to compare shoulder AROM differences pre- and post-surgery between female African American and White breast cancer survivors (BCA). Study design This pilot study used a convenience sample and longitudinal design measuring participants 2 times (T0 = baseline, after biopsy but within 2 weeks before BCA surgery; T1 = 2nd postoperative week). Background The U.S. has the largest BCA survivor population in history and yet the mortality burden remains highest among AA BCA survivors. AAs may also have greater burden of physical and functional side effects compared to whites and the general population. Methods and Measures The data were collected from a convenience sample (n = 33; nAA = 9, nW = 24) and included data on shoulder AROM, medical chart review for pre- and co-morbid conditions, and self-reported demographics and medical history. We used t-tests to compare sample AROM means to population norms. We then compared our sample across 2 timepoints (T0 = pre-surgery; T1 = 2 weeks post-surgery) using independent samples t-tests and repeated measures analysis of variance (p < .05) to compare AA to White sub-samples AROM means. Results African Americans had significantly less shoulder abduction (at T0) and flexion (at T1) than whites. However, 100% had significantly reduced AROM for all movements at T0 (prior to surgery but after biopsy) when compared to population norms. Conclusions The significant reduction in shoulder AROM after biopsy but before surgery points to a possible unmet need for early physical therapy intervention. Further research using randomized controlled trial design is recommended.

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One-year morbidity after sentinel node biopsy and breast surgery

Cited by 95 publications

References 22 publications

Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Comparing patients’ and clinicians’ assessment of outcomes in a randomised trial of sentinel node biopsy for breast cancer (the RACS SNAC trial)

Shoulder Impairment Before Breast Cancer Surgery

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