Sentinel node biopsy for breast cancer may have little to offer four-node-samplers

Macmillan, R. Douglas; Barbera, David La; Hadjiminas, Dimitri; Rampaul, R.S.; Lee, A.H.S.; Pinder, Sarah; Ellis, Ian O.; Blamey, R.W.; Geraghty, James

doi:10.1016/s0959-8049(00)00367-1

Cited by 51 publications

(24 citation statements)

References 23 publications

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“…This increased to 50% when the 4 largest nodes in each patient were considered. Nodal sampling based on size alone, as advocated by some centres [28], cannot therefore be recommended.…”

Section: A C C E P T E D Article In Pressmentioning

confidence: 99%

A pilot study of dual-isotope lymphoscintigraphy for breast sentinel node biopsy comparing intradermal and intraparenchymal injection

Fowler

Solanki

Guenther

et al. 2009

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…This increased to 50% when the 4 largest nodes in each patient were considered. Nodal sampling based on size alone, as advocated by some centres [28], cannot therefore be recommended.…”

Section: A C C E P T E D Article In Pressmentioning

confidence: 99%

A pilot study of dual-isotope lymphoscintigraphy for breast sentinel node biopsy comparing intradermal and intraparenchymal injection

Fowler

Solanki

Guenther

et al. 2009

European Journal of Surgical Oncology (EJSO)

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“…This meta-analysis was based on 11 studies involving 24,757 persons with breast cancer [7,9,[14][15][16][17][18][19][20]. A total of 15 data sets were extracted from these studies.…”

Section: Description Of the Included Trialsmentioning

confidence: 99%

“…The characteristics of the included studies are summarized in Table 1. Five of these studies utilized conventional complete axillary dissection in conjunction with either mastectomy or conservation surgery [10,11,[14][15][16]; two studies utilized sentinel node biopsy followed by complete axillary dissection [7,17]. One of the conventional surgery studies subdivided the patients depending upon whether the primary tumor was pathologically T1 (2 cm or less in greatest dimension) or T2 (more than 2 cm but not more than 5 cm in greatest dimension) [11].…”

Section: Description Of the Included Trialsmentioning

confidence: 99%

Statistical kinematics of axillary nodal metastases in breast carcinoma

Kendal

2005

Clin Exp Metastasis

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The number of involved lymph nodes in individuals with breast cancer is highly variable, and of both prognostic and therapeutic importance. A statistical description for the frequency distribution of the numbers of involved nodes in an affected population could potentially reveal mechanisms of axillary metastasis, and eventually facilitate predictive models for tumor control and axillary sampling. A meta-analysis of 15 studies involving 24,757 axillary dissections was performed, including conventional dissections, sentinel node dissections and studies of occult metastases. Frequency histograms for the numbers of involved axillary lymph nodes from the populations were tested for clustering and they were fitted, as a first approximation, to a negative binomial distribution. Although the number of involved nodes per individual was quite variable, some individuals sustained more involved nodes than could be expected from a random (Poisson) distribution. The negative binomial distribution, however, provided acceptable descriptions for the distributions of involved nodes in all populations studied. Two mechanisms could explain these observations: (1) an apparent contagion model, where involved nodes seeded further nodal metastases, and (2) a spurious contagion model where the number of involved nodes per individual was randomly (Poisson) distributed and population heterogeneity accounted for the more severe cases. Both models were consistent with the hypothesis that the nodal metastasis is a chance event, with the probability of involvement greatest for nodes contiguous to the primary tumor and proportioned by lymphatic flow.

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“…node sampling or sentinel node biopsy (23,24). However, most of the published results come from single institutions, while results from the SEER come from more heterogeneous practices and consequently should not be interpreted as indicating four or five nodes as a prognostic cut-off.…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

Effect of the number of uninvolved nodes on survival in early breast cancer

Vinh‐Hung¹,

Cserni²,

Burzykowski³

et al. 2003

Oncol Rep

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Abstract.A high number of uninvolved axillary nodes was found by some authors to be associated with poor survival in node-negative breast cancer. We searched for confirmation and extend the investigation to node-positive cases, using population data from the SEER Program. Patients selected were women aged 40-69 years, diagnosed 1988-1997, T1-T2 breast cancer, undergoing axillary dissection with 4-35 nodes examined. Survivals were estimated by the product-limit method and were computed on pooled data. Results in nodenegative patients (n=37,519) showed a 5-year overall survival from 92% (95% confidence interval: 88-95%) with 4 uninvolved nodes, to 93% (87-98%) with 34 uninvolved nodes. In node-positive patients (n=16,978), the 5-year survival increased from 50% (44-56%) with 0 uninvolved nodes, to 91% (82-100%) with 30 uninvolved nodes. Survival graphs indicated an improvement or a plateau with higher number of uninvolved nodes. The graphs also suggested that the ratio of involved and uninvolved nodes might be correlated with survival. We conclude that there was no evidence of poor outcome associated with a high number of uninvolved nodes. The incidental finding that ratio-based characterization of node involvement might be a prognostic factor will be further investigated. IntroductionTumor draining lymph nodes can undergo hyperplasia, resulting in increases in the number and size of detectable lymph nodes. A high number of tumor free axillary lymph nodes might thus represent the effect of lymphangiogenic and lymph node development factors playing a role in tumor metastasis (1). In support of that hypothesis, Camp et al reported that axillary dissection yielding more than 20 nodes in node-negative breast cancer was associated with a poor survival (1) when compared with node-negative breast cancer patients having less than 20 nodes examined.The Surveillance, Epidemiology, and End Results (SEER) provides detailed data on nodal extent for cases diagnosed since 1988 (2). The objective of the present study is to examine the pattern of survival, whether or not there is supportive evidence in the SEER registries data that high numbers of uninvolved nodes (nneg) are indicators of poor outcome.If lymphogenic factors are involved in node-negative (N0) breast cancer, then it should be expected that these factors are also involved in node-positive (N + ) cases. Therefore, consistency requires that the role of nneg should be examined in both N0 and N + cases, taking into account the number of positive nodes (npos).Outline of this study and results of a multivariate analysis by proportional hazard models have been reported previously (3). The mortality hazard ratio associated with the number of uninvolved nodes was 0.990 (95% confidence interval: 0.983-0.996) in N0, and 0.970 (0.963-0.976) in N + , i.e. 1% risk reduction and 3% risk reduction per uninvolved node, respectively. These results argued against the role of uninvolved nodes as indicators of poor prognosis. The present report will focus on the visual display of data. W...

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Sentinel node biopsy for breast cancer may have little to offer four-node-samplers

Cited by 51 publications

References 23 publications

A pilot study of dual-isotope lymphoscintigraphy for breast sentinel node biopsy comparing intradermal and intraparenchymal injection

A pilot study of dual-isotope lymphoscintigraphy for breast sentinel node biopsy comparing intradermal and intraparenchymal injection

Statistical kinematics of axillary nodal metastases in breast carcinoma

Effect of the number of uninvolved nodes on survival in early breast cancer

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