Stage migration in breast cancer: surgical decisions concerning isolated tumour cells and micro-metastases in the sentinel lymph node

Widt-Levert, Louise de; Tjan‐Heijnen, Vivianne C. G.; Bult, Peter; Ruers, Theo J.M.; Wobbes, Theo

doi:10.1053/ejso.2002.1401

Cited by 33 publications

(12 citation statements)

References 23 publications

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“…Although axillary lymph node dissection (ALND) is still standard of care in any case of SLN metastasis [2][3][4][5][6][7][8], there is an ongoing debate about the necessity for complete ALND in every patient with metastatic SLN, especially in those with little risk of additional disease since 40-60% of patients have no disease in axillary lymph node other than SLN itself [1,9,10]. These patients, therefore, are unlikely to benefit from further surgery that results in a longer period of hospitalization, higher costs and higher postoperative morbidity [11].…”

Section: Introductionmentioning

confidence: 99%

The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population

Klar

Jochmann

Foeldi

et al. 2008

Breast Cancer Res Treat

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The MSKCC nomogram did not provide a reliable predictive model in our study population. However, the likelihood of SLN metastasis correlated with the presumed risk factors and no obvious differences between the MSKCC population and our population could be seen. In order to achieve interinstitutional reproducibility, standardization of surgical procedure and of the pathological assessment of the SLN is desirable.

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Section: Introductionmentioning

confidence: 99%

The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population

Klar

Jochmann

Foeldi

et al. 2008

Breast Cancer Res Treat

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“…Regarding SLN micrometastases and relation to clinical outcome, there is limited data based on retrospective examination by IHC of the SLN (9). Patients with ITC are recommended adjuvant treatment as node-negative patients (2), whereas the role of ALND in this group of patients is still under debate since the risk of additional axillary nodal involvement is yet not clarified (10, 11,12,13).…”

Section: Introductionmentioning

confidence: 99%

Determination of sentinel lymph node (SLN) status in primary breast cancer by prospective use of immunohistochemistry increases the rate of micrometastases and isolated tumour cells: Analysis of 174 patients after SLN biopsy

Rydén¹,

Chebil²,

Sjöström³

et al. 2007

European Journal of Surgical Oncology (EJSO)

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“…10 This increase could have an important effect on the treatment of patients. 11,12 Based on the Dutch treatment guidelines, most patients with small tumours and negative nodes will not be treated with adjuvant therapy, while patients staged with metastases will receive adjuvant treatment. It is not yet clear whether patients with micrometastases should be treated as node positive or negative.…”

Section: Introductionmentioning

confidence: 99%

Introduction of sentinel node biopsy and stage migration of breast cancer

Loo

Bezemer

Hennipman

et al. 2006

European Journal of Surgical Oncology (EJSO)

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Aim: The purpose of this study was to examine in a large population based group of breast cancer patients treated in a regular care setting whether the introduction of the Sentinel Node Biopsy (SNB) led to detection of a higher percentage of patients with positive regional lymph nodes. Methods: The study includes 3665 early breast cancer patients, aged 30e85 years, diagnosed in the period 1997-2002 and registered at the Regional Cancer Registry of the Comprehensive Cancer Centre Middle Netherlands. During this period the SNB was introduced. The outcome of staging was compared for groups staged with or without SNB. A logistic regression model was used to adjust for age, calendar period and tumour size. Results: Overall a quarter of all patients over the period 1997e2002 underwent a SNB as method of lymphatic staging. The use of SNB clearly increased over time: from 2% in 1998 to 65% in 2002. The percentage node positive patients also rose significantly; before introduction of the SNB 30% of all patients were diagnosed with positive lymph nodes, and after SNB introduction this percentage was 40%. The increase is largely explained by the increase of patients diagnosed with only micrometastases. Adjustment did not change the results. Conclusion: In conclusion, introduction of the SNB in early breast cancer led to significant upstaging of breast cancer patients treated in a regular care setting, due to the detection of more micrometastases. Since the relevance of micrometastases for long term survival is not yet known, this upstaging potentially led to over treatment of patients. On the other side, for some patients axillary lymph node dissection was prevented by the SNB procedure, preventing comorbidity.

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Stage migration in breast cancer: surgical decisions concerning isolated tumour cells and micro-metastases in the sentinel lymph node

Cited by 33 publications

References 23 publications

The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population

The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population

Determination of sentinel lymph node (SLN) status in primary breast cancer by prospective use of immunohistochemistry increases the rate of micrometastases and isolated tumour cells: Analysis of 174 patients after SLN biopsy

Introduction of sentinel node biopsy and stage migration of breast cancer

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