Sentinel lymphadenectomy for breast cancer: experience with 180 consecutive patients: efficacy of filtered Technetium 99m sulphur colloid with overnight migration time11No competing interests declared.

Winchester, David J.; Sener, Stephen F.; Perlman, Reid; Goldschmidt, Robert; Motykie, G. D.; Martz, Carole Hennessy; Rabbitt, Sarah; Brenin, David R.; Stull, Margaret A.; Moulthrop, J M

doi:10.1016/s1072-7515(99)00060-5

Cited by 114 publications

(57 citation statements)

References 12 publications

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“…Initial studies of sentinel lymphadenectomy for patients with breast carcinoma confirmed that the status of the sentinel lymph node(s) was an accurate predictor of the presence of metastatic disease in the axillary lymph nodes. [1][2][3][4][5][6][7] Thus, patients with negative sentinel lymph nodes were spared the morbidity of axillary dissection.…”

Section: Resultsmentioning

confidence: 99%

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Lymphedema after sentinel lymphadenectomy for breast carcinoma

Sener

Winchester

Martz

et al. 2001

Cancer

193

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Section: Resultsmentioning

confidence: 99%

“…in late 1996 as a pilot validation study at the authors' institution. 7 After informed consent was obtained, patients were enrolled in a protocol approved by the Institutional Review Board. Data regarding patient characteristics and treatment variables were collected concurrently in a computerized data base.…”

Section: Methodsmentioning

confidence: 99%

Lymphedema after sentinel lymphadenectomy for breast carcinoma

Sener

Winchester

Martz

et al. 2001

Cancer

193

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“…1,2 The introduction of sentinel lymph node biopsy (SLNB) into the armamentarium of breast cancer management denotes progression in the understanding of this disease and has permitted a less extensive and less morbid surgical option for many patients. [3][4][5][6][7] Furthermore, the SLNB technique allows for a more precise pathologic evaluation of nodal disease to more accurately stage the axilla. 8 At many medical centers, a preliminary intraoperative pathologic analysis is performed on SLNs through frozen section or touch imprint cytology (TIC).…”

Section: Conclusion Tic Is Cost Effective For Assessing Sln Metastamentioning

confidence: 99%

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Jeruss¹,

Hunt²,

Xing³

et al. 2006

Cancer

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BACKGROUND.Sentinel lymph nodes (SLNs) are generally evaluated postoperatively, requiring 5–7 days for assessment. SLNs can also be evaluated intraoperatively by using touch imprint cytology (TIC), thus providing the surgeon immediate feedback and allowing for concurrent completion node dissection (CND) for positive SLNs. The authors hypothesized that TIC, when compared with standard postoperative SLN assessment alone, would permit a cost‐effective evaluation of SLNs in patients with clinically node‐negative breast cancer.METHODS.A decision‐analysis model was created to compare TIC with standard postoperative SLN assessment alone. Sensitivity and specificity of TIC were determined prospectively from 342 patients who underwent SLN biopsy assessed by both techniques. Short‐term health states associated with surgical staging were defined, and utilities were estimated using EuroQol‐5D. Base‐case analysis was performed to estimate quality‐adjusted life years and the incremental cost‐effectiveness ratio. Sensitivity analyses were performed to examine stability of model parameters.RESULTS.For each tumor stage, TIC was cost effective, and for patients with larger tumors (T3 and T4), TIC was the dominant strategy. The analysis was robust to changes in sensitivity and specificity of TIC, prevalence of metastasis, probability of complications, and cost. However, when utility associated with standard SLN assessment was 0.9 or greater, this became the preferred strategy.CONCLUSIONS.TIC is cost effective for assessing SLN metastasis intraoperatively. For patients with larger tumors, it is not only more effective, but also less costly than standard SLN assessment alone. TIC may be particularly useful for patients who experience significant anxiety while awaiting results of standard SLN assessment. Cancer 2006. © 2006 American Cancer Society.

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“…While it is well documented that this technique accurately predicts axillary node status in over 90% of the cases, [1][2][3][4][5][6][7][8] there are many relevant clinical decisions and surgical practices that have not been completely standardized. These include: (a) immediate complete axillary dissection based on sentinel node status at intraoperative consult vs complete axillary dissection as part of a second surgical procedure; (b) clinical value of complete axillary dissection following sentinel node micrometastasis; [9][10][11] (c) clinical significance of tumor deposits less than 0.2 mm in size, detected either by hematoxylin and eosin (H&E), immunohistochemistry, or cytology alone; 12,13 (d) the best intraoperative consult detection method for metastatic disease (frozen section vs cytology); [14][15][16][17][18] (e) the definition of sentinel node micrometastatic disease at intraoperative consult; and (f) when to stop evaluating sentinel nodes in the presence of possible micrometastasis at intraoperative consult.…”

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confidence: 99%

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

et al. 2005

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The decision whether to proceed with complete axillary node dissection based on sentinel node status is clear for patients with negative or macrometastatic disease. However, the course of action based on sentinel node micrometastasis remains controversial. We reviewed 358 cases from 6/1999 to 7/2003. All sentinel nodes were evaluated at three levels by frozen section, touch preparation, and scrape preparation. Micrometastasis was defined as tumor deposits between 0.2 and 2 mm. Size, grade, and lymphvascular invasion of the primary tumor, as well as number, status, size of metastatic disease, and presence of extranodal capsular extension of sentinel and nonsentinel nodes were recorded. Of the 358 cases, 89 had positive sentinel nodes, 29 of which represented micrometastases. Only one (3%) of the 29 cases contained a nonsentinel node with macrometastasis. In 60 of the 89 cases sentinel nodes contained macrometastases. Of these, 38 cases (63%) had metastatic tumor in nonsentinel nodes. Intraoperative consult was performed in 53 of the 89 cases with positive sentinel nodes. Only 1 of the 19 (5%) intraoperative consult cases with micrometastatic sentinel nodes had positive nonsentinel nodes, while 21 of 34 (62%) of macrometastatic sentinel nodes at intraoperative consult had tumor in nonsentinel nodes. No single variable studied discriminated between micro-vs macrometastatic disease. At intraoperative consult, macrometastatic disease was present in all three diagnostic preparations, while diagnostic material in micrometastatic sentinel nodes was usually present in only one modality. This analysis suggests that the risk of finding tumor in nonsentinel nodes differs significantly between cases with micro (3%)-vs macro (63%)-metastatic disease in sentinel nodes. This holds true for cases assessed by intraoperative consult. Considering the known morbidity of complete axillary dissection, assessments of risk vs benefit of undertaking this procedure should be performed on a case-by-case basis in patients with sentinel node micrometastases. Modern Pathology (2005) 18, 762-768, advance online publication, 11 March 2005; doi:10.1038/modpathol.3800394Keywords: axillary node dissection; breast cancer; intraoperative consult; macrometastasis; micrometastasis; nonsentinel node; sentinel node Sentinel node mapping for patients with breast cancer and clinically negative axilla has become the standard of care in many cancer centers. While it is well documented that this technique accurately predicts axillary node status in over 90% of the cases, 1-8 there are many relevant clinical decisions and surgical practices that have not been completely standardized. These include: (a) immediate complete axillary dissection based on sentinel node status at intraoperative consult vs complete axillary dissection as part of a second surgical procedure; (b) clinical value of complete axillary dissection following sentinel node micrometastasis; 9-11 (c) clinical significance of tumor deposits less than 0.2 mm in size, detected either by hematoxyli...

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Sentinel lymphadenectomy for breast cancer: experience with 180 consecutive patients: efficacy of filtered Technetium 99m sulphur colloid with overnight migration time11No competing interests declared.

Cited by 114 publications

References 12 publications

Lymphedema after sentinel lymphadenectomy for breast carcinoma

Lymphedema after sentinel lymphadenectomy for breast carcinoma

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

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