Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer Center

O’Hea, Brian; Hill, A. D. K.; El-Shirbiny, Ayda M.; Yeh, Samuel D. J.; Rosen, Paul Peter; Coit, Daniel G.; Borgen, Patrick I.; Cody, Hiram S.

doi:10.1016/s1072-7515(98)00060-x

Cited by 405 publications

(220 citation statements)

References 9 publications

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“…Sentinel lymph node biopsy is a minimally invasive surgical procedure with significant lower morbidity than ALND (Peintinger et al, 2003;Schijven et al, 2003). The accuracy of SLNB for axillary staging has been confirmed in many studies (Krag et al, 1993;Giuliano et al, 1994Giuliano et al, , 1997Krag et al, 1998;O'Hea et al, 1998;Nieweg et al, 2001). The long-term outcome of SLNB without ALND has not yet been evaluated and prospective randomised trials comparing SLNB alone vs SLNB plus ALND in SLN-negative patients as the American NSABP-B 32 trial or the European ALMANAC trial are in the recruitment phase.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining 60 -70% with negative axillary lymph nodes may thus have an unnecessary ALND and suffer from minor to major short-and long-term morbidity of ALND. Many studies have shown that SLNB can identify axillary lymph node involvement in most patients (Krag et al, 1993(Krag et al, , 1998Giuliano et al, 1994Giuliano et al, , 1997O'Hea et al, 1998;Nieweg et al, 2001). The aim of this study was to evaluate the rate of axillary recurrences in SLN-negative patients after SLNB alone, without further ALND.…”

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confidence: 99%

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200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

Reitsamer

Peintinger²,

Prokop

et al. 2004

Br J Cancer

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The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V s ) and technetium 99m-labelled albumin (Nanocoll s ). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 months. The absence of axillary recurrences after SLNB without ALND in SLNnegative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

Reitsamer

Peintinger²,

Prokop

et al. 2004

Br J Cancer

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“…Some of the technical aspects outlined above can explain the large differences in the reported incidence of non-axillary sentinel nodes (Uren et al, 1995;Roumen et al, 1997;Borgstein et al, 1998;Chatterjee et al, 1998;O'Hea et al, 1998;Reuhl et al, 1998;Rubio et al, 1998;Snider et al, 1998;Hill et al, 1999;Liberman et al, 1999;Miner et al, 1999;Imoto et al, 2000). Three studies concern results of biopsy of non-axillary sentinel nodes in a substantial number of patients Johnson et al, 2000;Zurrida et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients

et al. 2002

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The purpose of this study was to evaluate the occurrence of lymphatic drainage to non-axillary sentinel nodes and to determine the implications of this phenomenon. A total of 549 breast cancer patients underwent lymphoscintigraphy after intratumoural injection of 99m Tc-nanocolloid. The sentinel node was intraoperatively identified with the aid of intratumoural administered patent blue dye and a gamma-ray detection probe. Histopathological examination of sentinel nodes included step-sectioning at six levels and immunohistochemical staining. A sentinel node outside level I or II of the axilla was found in 149 patients (27%): internal mammary sentinel nodes in 86 patients, other non-axillary sentinel nodes in 44 and both internal mammary and other non-axillary sentinel nodes in nineteen patients. The intra-operative identification rate was 80%. Internal mammary metastases were found in seventeen patients and metastases in other non-axillary sentinel nodes in ten patients. Staging improved in 13% of patients with non-axillary sentinel lymph nodes and their treatment strategy was changed in 17%. A small proportion of clinically node negative breast cancer patients can be staged more precisely by biopsy of sentinel nodes outside level I and II of the axilla, resulting in additional decision criteria for postoperative regional or systemic therapy.

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“…Studies with patent blue alone have shown a detection rate of 60 to 75% at the beginning of the learning curve. 19,29 For various reasons, we decided that all patients with invasive carcinomas should be included in the study, even cases lacking conventional indication for sentinel lymph node. This would allow a greater number of cases to be included, providing the team with a better training opportunity and conferring greater statistical power to the analysis.…”

Section: Figurementioning

confidence: 99%

A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients

Paulinelli

Freitas‐Junior

Rahal

et al. 2017

Rev. Assoc. Med. Bras.

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Introduction:Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis. Objective: The two dyes were compared regarding detection of the sentinel lymph node (SLN). Method: A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded. Results: Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0.18). The time and degree of difficulty involved in identifying the SLN were similar in both groups. There were no complications or allergies. Conclusion: Methylene blue performed as well as patent blue in identifying the SLN in breast cancer patients.

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Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer Center

Cited by 405 publications

References 9 publications

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients

A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients

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