Positive lymph nodes do not metastasize

Engel, Jutta; Emeny, Rebecca T.; Hölzel, Dieter

doi:10.1007/s10555-011-9343-7

Cited by 53 publications

(63 citation statements)

References 78 publications

(83 reference statements)

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“…However, this therapeutic function of SLNB seems superfluous, because recent evidence demonstrates that no risk of metastasis emerges from positive lymph nodes [7]. …”

Section: From the View Of The Epidemiologistmentioning

confidence: 99%

“…That means, for large tumors, the SLN is the ‘oldest' one, but not significantly larger than the ‘youngest' lymph node itself. Thus, the primary tumor sequentially affects the lymph nodes, and there seems to be a growth limitation in the macroscopic sector [7]. …”

Section: From the View Of The Epidemiologistmentioning

confidence: 99%

“…Also, a pre-metastatic niche, which can be formed only from the primary tumor, seems to be necessary [27]. The process of metastasis is complex and starts from the primary tumor, not from positive lymph nodes [7,28,29]. …”

Section: From the View Of The Epidemiologistmentioning

confidence: 99%

See 2 more Smart Citations

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Reimer

Engel²,

Schmidt

et al. 2018

Breast Care

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Local treatment of the axilla in clinically node-negative (cN0) early breast cancer patients with routine sentinel lymph node biopsy (SLNB) is debated for various reasons: i) pN staging information may not be necessary for the postoperative treatment decision regarding adjuvant systemic therapy in the great majority of patients; ii) the SLNB-positive rate is declining below 20% in specialized breast centers; iii) albeit being a minimally invasive procedure, SLNB causes a significant reduction in quality of life in 23% of patients; and iv) previous randomized trials from the pre-SLNB era did not show a disadvantage for patients without axillary surgery with regard to overall survival. These data support the hypothesis that avoiding axillary treatment in patients with clinically and sonographically unsuspicious lymph nodes seems to be a safe option, although omitting axillary surgery may increase the risk of locoregional recurrence. Currently, the information regarding node-positive status is essential to guide postoperative treatment such as systemic or radiation therapies in a non-negligible minority of patients. Three ongoing prospective European trials (SOUND, INSEMA, BOOG 2013-08) with axillary observation alone versus SLNB in cN0 patients and primary breast-conserving surgery have the objective to evaluate oncologic safety when omitting SLNB.

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“…However, this therapeutic function of SLNB seems superfluous, because recent evidence demonstrates that no risk of metastasis emerges from positive lymph nodes [7]. …”

Section: From the View Of The Epidemiologistmentioning

confidence: 99%

Section: From the View Of The Epidemiologistmentioning

confidence: 99%

See 1 more Smart Citation

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Reimer

Engel²,

Schmidt

et al. 2018

Breast Care

Self Cite

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“…We agree that in spite of these violations, the non-inferiority of SNB compared to ALND is corroborated, nonetheless without supporting the assumption that positive SN have no impact on prognosis [2]. The reverse has been recently indicated by the results of a subgroup analysis of the NSABP-B 32 trial which was originally also designed to evaluate whether SLND alone was equivalent to complete ALND, albeit in primarily SN-negative women.…”

mentioning

confidence: 71%

How nescience may obscure evidence

et al. 2014

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limitations of the study were recognized and let to some critical comments [7], current guidelines [8,14] rapidly adopted the omission of ALND in these selected patients.Unreckoned insights about the quality of evidence generated by the Z0011-trial were provided by a recent publication on behalf of the Alliance for Clinical Trials in Oncology by Jagsi et al. Briefly, the study [3] (published in 2011) comprised 891 women from 115 institutions with a clinically negative axilla who underwent sentinel node dissection (SLND), revealing 1-2 pathologically affected nodes. Tumor characteristics were pT1 (70 %) or pT2 invasive carcinomas, mostly ER +, well-differentiated tumors. Patients were randomized to either axillary dissection (ALND) or During the last decade, treatment trends for early breast cancer have been fluctuating between opposite extremes. More aggressive regional nodal irradiation (RNI) has been suggested by several recent studies [10,17], on the other side, the previously unquestioned dogma of axillary dissection as an important part of breast cancer management was gradually abandoned in favor of sentinel node dissection (SLND). While consensus was rapidly achieved for pathologically negative SN, the management of patients with one or two positive SN remained controversial up to the first publication of a randomized study of the American College of Surgeons Oncology Group [3] which specifically addressed the outcome of such patients with ALND vs. none. Even though Editorial on Jagsi et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial.

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“…If this were possible, it would identify a subgroup of small tumours with no lymph node involvement that still have a poor prognosis. In addition, currently the idea that local lymph node dissection is not significant for further survival is under considerable discussion [10]. …”

Section: Discussionmentioning

confidence: 99%

Long-Term Analysis of Ab-2 (Clone SN3b) Immunoreactivity as a Prognostic Factor in Breast Carcinoma

2015

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Background: CD24 expression has been described as a significant prognostic factor in multiple solid tumours. Most of these studies have, however, been undertaken using the Ab-2 antibody (clone SN3b), which detects a CD24-associated carbohydrate, and not the CD24 protein itself. Although its biological identity remains unclear, its prognostic significance means that detection of this carbohydrate may, nonetheless, be clinically relevant. Methods: 133 breast carcinomas were selected (pT1-2 pN0-2 M0, no secondary carcinoma, no contralateral carcinoma) from a previous SN3b expression study on a larger cohort of breast carcinomas. After updating data on follow-up observations, we carried out univariate and multivariate analysis of the prognostic significance of SN3b for total and breast cancer-specific survival. Results: A statistically significant correlation between cytoplasmic SN3b immunoreactivity and positive node status was found. Cytoplasmic SN3b also has node status-independent prognostic significance. Total survival exhibits a statistically significant dependency on cytoplasmic SN3b even for pN0 cases. Conclusion: The independent prognostic value of CD24 as detected by Ab-2/clone SN3b could replace the diagnostic axillary dissection in breast carcinoma patients if this was confirmed in further studies. Also, clarifying the exact epitope of this interesting antibody is more than warranted.

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Positive lymph nodes do not metastasize

Cited by 53 publications

References 78 publications

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery

How nescience may obscure evidence

Long-Term Analysis of Ab-2 (Clone SN3b) Immunoreactivity as a Prognostic Factor in Breast Carcinoma

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