Sentinel Lymph Node Biopsy for Breast Cancer: A Suitable Alternative to Routine Axillary Dissection in Multi-Institutional Practice When Optimal Technique Is Used

McMasters, Kelly M.; Tuttle, Todd M.; Carlson, David J.; Brown, Charles S.; Noyes, R. Dirk; Glaser, R. M.; Vennekotter, Donald J.; Turk, Peter S.; Tate, Peter S.; Sardi, Armando; Cerrito, Patricia B.; Edwards, Michael J.

doi:10.1200/jco.2000.18.13.2560

Cited by 552 publications

(353 citation statements)

References 28 publications

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“…The overall accuracy and falsenegative rate of SLN biopsy performed in patients with early stage breast cancer have been validated by several large studies and range from 95% to 99% and from 8% to 12%, respectively. [44][45][46] The pathologic status of SLNs is a sensitive and specific predictor of non-SLN status in breast cancer patients. When SLNs are found to be negative for metastasis by thorough pathologic evaluation, complete dissection of axillary lymph nodes and its associated morbidities, including lymphedema and neuropathy, can be obviated.…”

Section: Early Stage Breast Cancermentioning

confidence: 99%

Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Krishnamurthy

2009

Cancer Cytopathology

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Staging of disease is routine in the evaluation of patients newly diagnosed with breast cancer. Assessment of palpable and/or nonpalpable locoregional lymph nodes is an important component of the initial staging.Ultrasound (US) is the favored imaging modality for the initial investigation of lymph nodes and results in a significant increase in the specificity of the overall evaluation when used in conjunction with fine-needle aspiration (FNA). This review provides a concise summary, based on published literature, of the current applications and future prospects of FNA biopsy of locoregional lymph nodes in the initial staging and subsequent surgical management of patients with breast cancer. Patients undergo either sentinel lymph node (SLN) biopsy or complete axillary lymph node dissection, based on whether the axillary lymph node status is determined to be negative or positive in the initial staging process. The status of lymph nodes in the supraclavicular, infraclavicular, and internal mammary regions provides more accurate staging information and also impacts subsequent surgical management. The identification and evaluation of intramammary lymph nodes can add value in the overall assessment of patients with breast cancer. The feasibility of noninvasive imaging modalities for SLN mapping in animal models has indicated a good potential for FNA biopsy in the subsequent investigation of SLNs identified noninvasively in humans. Staging of the malignant tumor is a routine component in the assessment of patients who are newly diagnosed with breast cancer. Breast cancer staging aids in the appropriate management of patients at each stage of disease and is useful in estimating the prognosis for a patient at a particular stage. The routine staging process includes taking a thorough history of the patient, physical examination, mammography, ultrasonography (US) of the breast and lymph node basins, computed tomography (CT) scan of the abdomen, bone scanning, and chest radiography. Cancer is assigned a clinical stage at the time of the initial diagnosis based on the findings of the physical examination, radiologic studies, and core needle biopsy (CNB) of the

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Section: Early Stage Breast Cancermentioning

confidence: 99%

Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Krishnamurthy

2009

Cancer Cytopathology

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“…Histological status of the sentinel lymph node is predictive of the status of the regional nodal basin and is used to determine which patients can be spared an axillary dissection [13][14][15]. When multiple sections are cut through histologically negative lymph node(s), approximately 25% of patients otherwise deemed node negative have histologic evidence of micrometastasis [8,[16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Promoter hypermethylation in sentinel lymph nodes as a marker for breast cancer recurrence

Carraway

Wang²,

Blackford

et al. 2008

Breast Cancer Res Treat

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Purpose-Promoter methylation of tumor suppressor genes in histologically negative sentinel lymph nodes (HNSN) of early stage breast cancer patients has not been extensively studied. This study evaluates the methylation frequency and pattern in HNSN to determine if detection of hypermethylation of one or more genes is associated with an increased recurrence risk in node negative breast cancer.Experimental design-In 1998, a prospective study of patients with early stage breast cancer and HNSN was initiated in order to correlate sentinel node analysis with clinical outcome. Nodal tissue was selected from 120 HNSN patients for methylation analysis in at least one and up to six sentinel nodes using a panel of nine genes. Corresponding primary breast tumors from 79 patients were also evaluated for hypermethylation. Methylation analysis was performed using nested Methylation Sensitive PCR (n-MSP). Logistical regression was used to evaluate the relationship between clinical recurrence and methylation status.Results-Over a median follow-up of 79 months, 13 of the 120 patients had clinical recurrence. Hypermethylation of genes was frequently observed in HNSN, but there was no correlation of methylation pattern and clinical recurrence. However, increased frequency of gene methylation of the primary tumor correlated with clinical recurrence.Conclusions-Although hypermethylation of multiple genes occurs frequently in HNSN of breast cancer patients, it is not associated with breast cancer recurrence in the first 7 years of clinical follow-up.

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“…Multiple clinical trials have demonstrated the feasibility and efficacy of lymphatic mapping and sentinel lymph node (SLN) biopsy in patients with operable breast cancer [50][51][52][53][54][55][56]. On average, the rate of false negative SLN biopsy is 8-10%.…”

Section: Sentinel Lymph Node Biopsymentioning

confidence: 99%

Recommendations for research priorities in breast cancer by the coalition of cancer cooperative groups scientific leadership council: imaging and local therapy

Sparano

Pisano

White

et al. 2009

Breast Cancer Res Treat

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Sentinel Lymph Node Biopsy for Breast Cancer: A Suitable Alternative to Routine Axillary Dissection in Multi-Institutional Practice When Optimal Technique Is Used

Cited by 552 publications

References 28 publications

Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Promoter hypermethylation in sentinel lymph nodes as a marker for breast cancer recurrence

Recommendations for research priorities in breast cancer by the coalition of cancer cooperative groups scientific leadership council: imaging and local therapy

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