Quantifying the number of lymph nodes identified in one-stage versus two-stage axillary dissection in breast cancer

Damgaard, Olaf E.; Jensen, Maj‐Britt; Kroman, Niels; Tvedskov, Tove Filtenborg

doi:10.1016/j.breast.2012.03.009

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…The two-step operation with delayed ALND has similar long-term morbidity but a longer operative time [ 28 , 29 ]. The number of lymph nodes identified is slightly reduced in delayed ALND patients, but without clinical significance, and the risk of lymphedema is similar between delayed and immediate ALND [ 30 , 31 ]. The major risk of delayed ALND for FNSN patients is perioperative and anesthesia-related distress, especially in elderly patients [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

et al. 2021

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Background Sentinel lymph node biopsy (SLNB) is the standard approach for the axillary region in early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes in intraoperative frozen sections (FNSN) using real-world data. Methods A case–control study with a 1:3 ratio was conducted. FNSN was determined when sentinel nodes (SNs) were negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections. Results A total of 20 FNSN cases and 60 matched controls from 333 SLNB patients were enrolled between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between the FNSN and control groups. The FNSN patients had larger tumor sizes on preoperative mammography (P = 0.033) and more lymphatic tumor emboli on core biopsy (P < 0.001). Four FNSN patients had metastasis in nonrelevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in nonrelevant SNs were recognized in two patients. All FNSN patients underwent a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed breast cancer recurrence. The disease-free survival, breast cancer-specific survival, and overall survival in FNSN were not inferior to those in controls. Conclusions Patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, the outcomes of FNSN patients after completing ALND were noninferior to those without SN metastasis. ALND provides a correct staging for patients with metastasis in nonsentinel axillary lymph nodes.

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Section: Discussionmentioning

confidence: 99%

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

et al. 2021

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“…The two-step operation with delayed ALND has similar long-term morbidity but with a longer operative time (21,22). The number of lymph nodes identi ed is slightly reduced in delayed ALND patients without clinical signi cance, and the risk of lymphedema is similar between delayed and immediate ALND (23,24). The major risk from delayed ALND for FNSN patients comes from perioperative and anesthesia-related distress, especially in elderly patients (25,26).…”

Section: Discussionmentioning

confidence: 99%

False-Negative Frozen Section of Sentinel Nodes in Early Breast Cancer Patients

Loh

Lee

Chen

et al. 2021

Preprint

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Background: Sentinel lymph node biopsy (SLNB) is the standard approach of the axillary region for early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes of intraoperative frozen section (FNSNs) in real-world data.Methods: A case–control study with a 1:3 ratio was conducted. FNSN was diagnosed when sentinel nodes (SNs) are negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections.Results: A total of 20 FNSN cases and 60 matched controls were enrolled from 333 SLNB patients between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had larger tumor sizes in preoperative mammography (P = 0.033) and more lymphatic tumor emboli in core biopsy (P < 0.001). Four FNSN patients had metastasis in the non-relevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from the FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in non-relevant SNs were recognized in two patients. All FNSN patients received a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were not inferior to the controls.Conclusions: The patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, outcomes of FNSN patients after completing ALND were noninferior to those without metastasis in SNs. ALND provides a correct diagnosis of patients with metastasis in non-sentinel axillary lymph nodes.

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“…The two-step operation with delayed ALND has similar long-term morbidity but with a longer operative time [27,28]. The number of lymph nodes identified is slightly reduced in delayed ALND patients without clinical significance and the risk of lymphedema is similar between delayed and immediate ALND [29,30]. The major risk from delayed ALND for FNSN patients comes from perioperative and anesthesiarelated distress, especially in elderly patients [31,32].…”

Section: Discussionmentioning

confidence: 99%

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

Loh

Lee

Chen

et al. 2020

Preprint

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Background Sentinel lymph node biopsy (SLNB) is standard approach of axillary region for early breast cancer patients with clinically negative node. The present study investigated patients with false-negative sentinel nodes (FNSN) of intraoperative frozen section.Methods A case-control study with 1:3 ratio was conducted. FNSN was diagnosed as negative sentinel nodes (SNs) in frozen sections, but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) blocks. Control was defined no metastasis of SNs in both frozen and FFPE sections.Results Total 20 FNSN cases and 60 matched-controls were enrolled from 333 SLNB patients between April 1, 2005 and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had a larger tumor size in preoperative mammography and more lymphatic tumor emboli in core biopsy (P-value 0.033 and < 0.001, respectively). Four FNSN patients had metastasis in the non-relevant SNs. Other 16 FNSN patients had results of benign lymphoid hyperplasia of SNs in frozen sections and metastasis in FFPE blocks. Micrometastasis (less than 2 mm) was detected in seven of 16 patients and metastases in non-sentinel nodes was recognized in two of 16 patients. All FNSN patients received second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were non-inferior than controls.Conclusion Outcomes of FNSN patients after completing ALND was non-inferior to those without metastasis in SNs. ALND improved survival of patients with metastasis non-sentinel ALNs. However, omitting ALND had no effect for those have only micrometastasis in SNs.

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Quantifying the number of lymph nodes identified in one-stage versus two-stage axillary dissection in breast cancer

Abstract: The number of lymph nodes identified in breast cancer patients is slightly reduced if delayed ALND is performed. However, the difference is small and considered to be without clinical significance.

Cited by 6 publications

References 16 publications

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

False-Negative Frozen Section of Sentinel Nodes in Early Breast Cancer Patients

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

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