The role of sentinel lymph node biopsy in women undergoing prophylactic mastectomy

Dupont, Elisabeth; Kuhn, M. Ann; McCann, C.R.; Salud, Chris; Spanton, Janet L; Cox, Charles E.

doi:10.1016/s0002-9610(00)00458-x

Cited by 77 publications

(49 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, in the only prospective study we found in our search, 18 the benefit rate was greater (7%). In this study, 2 patients with negative SLNs in whom invasive cancer was identified in prophylactic mastectomy specimens were able to avoid ALND.…”

Section: Discussionmentioning

confidence: 56%

“…After full-text review of the 42 relevant studies, we identified 8 studies that met our first 2 inclusion criteria. Of these studies, the data of 1 study 16 were updated by McLaughlin and colleagues 17 in 2008, and 1 study 18 was prospective, leaving 6 studies for inclusion in our analysis. The data were extracted from these 6 studies 17,[19][20][21][22][23] (Fig.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

View full text Add to dashboard Cite

Background: Prophylactic mastectomy is performed to decrease the risk of breast cancer in women at high risk for the disease. The benefit of sentinel lymph node biopsy (SLNB) at the time of prophylactic mastectomy is controversial, and we performed a meta-analysis of the reported data to assess that benefit. Methods:We searched MEDLINE, EMBASE and the Cochrane Library databases from January 1993 to December 2009 for studies on patients who underwent SLNB at the time of prophylactic mastectomy. Two reviewers independently evaluated all the identified papers, and only retrospective studies were included. We used a mixedeffect model to combine data. Results:We included 6 studies in this review, comprising a total study population of 1251 patients who underwent 1343 prophylactic mastectomies. Of these 1343 pooled prophylactic mastectomies, the rate of occult invasive cancer (21 cases) was 1.7% (95% confidence interval [CI] 1.1%-2.5%), and the rate of positive SLNs (23 cases) was 1.9% (95% CI 1.2%-2.6%). In all, 36 cases (2.8%, 95% CI 2.0%-3.8%) led to a significant change in surgical management as a result of SLNB at the time of prophylactic mastectomy. In 17 cases, patients with negative SLNs were found to have invasive cancer at the time of prophylactic mastectomy and avoided axillary lymph node dissection (ALND). In 19 cases, patients with positive SLNBs were found not to have invasive cancer at the time of prophylactic mastectomy and needed a subsequent ALND. Of the 23 cases with positive SLNs, about half the patients had locally advanced disease in the contralateral breast. Conclusion:Sentinel lymph node biopsy is not suitable for all patients undergoing prophylactic mastectomy, but it may be suitable for patients with contralateral, locally advanced breast cancer.Contexte : La mastectomie prophylactique vise à réduire le risque de cancer du sein chez les femmes à risque élevé. L'avantage de la biopsie du ganglion lymphatique sentinelle (BGLS) au moment de la mastectomie prophylactique suscite la controverse et nous avons procédé à une méta-analyse des données qui ont fait l'objet de rapports afin d'évaluer l'avantage en question. Méthodes :Nous avons cherché dans les bases de données MEDLINE, EMBASE et la Bibliothèque Cochrane, de janvier 1993 à décembre 2009, des études portant sur des patientes qui ont subi une BGLS au moment de la mastectomie prophylactique. Deux examinateurs ont évalué indépendamment toutes les études repérées et nous avons inclus seulement les études rétrospectives. Nous avons utilisé un modèle à effets mixtes pour combiner les données.Résultats : Nous avons inclus dans cette analyse 6 études regroupant une population totale de 1251 patientes qui ont subi 1343 mastectomies prophylactiques. Parmi ces 1343 mastectomies prophylactiques regroupées, le taux de cancer envahissant occulte (21 cas) s'est établi à 1,7 % (intervalle de confiance [IC] à 95 %, 1,1 %-2,5 %) et le taux de GLS positifs (23 cas) a atteint 1,9 % (IC à 95 %, 1,2 %-2,6 %). Au total, les constatations dans 36 cas (2,8 %, IC ...

show abstract

Section: Discussionmentioning

confidence: 56%

Section: Resultsmentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

View full text Add to dashboard Cite

show abstract

“…[21][22][23] Historically, occult carcinoma has been reported in up to 5% of PM specimens. 20 In the current series, occult carcinoma was identified in 13 of 163 PM specimens (8.0%), reflecting the "high-risk" nature of our patient population (Table 1). In four patients, however, preoperative MRI abnormalities were identified in the prophylactic breast, but not biopsied prior to PM.…”

mentioning

confidence: 59%

“…Arguments in favor of performing SLN biopsy with PM include the potential to spare patients the need for complete ALND when occult breast carcinoma is identified in the PM specimen, the finding that a significant proportion of patients have lymph nodes removed inadvertently with the tail of the breast during PM, and the ability to increase the rate of detection of occult breast carcinoma when metastatic lymph node disease is identified first. 20 Arguments against performing SLN biopsy with PM center on the small but defined risk of morbidity, including pain, sensory changes, lymphedema, and the risk of allergic reaction associated with the procedure. [21][22][23] Historically, occult carcinoma has been reported in up to 5% of PM specimens.…”

mentioning

confidence: 99%

Cytokeratin‐positive cells in sentinel lymph nodes in breast cancer are not random events

King

Ganaraj

Fey

et al. 2004

Cancer

View full text Add to dashboard Cite

BACKGROUNDThe incidence of immunohistochemistry (IHC)‐detected epithelial cell displacement in sentinel lymph node (SLN) biopsy is unknown. In the current study, we address this question by examining the pattern of SLN involvement in patients undergoing prophylactic mastectomy (PM) at Memorial Sloan‐Kettering Cancer Center (New York, NY).METHODSBetween January 1999 and January 2003, 5275 patients underwent SLN biopsy. Unilateral or bilateral PM with SLN biopsy was performed in 143 (2.7%) patients, representing 163 PM cases.RESULTSOccult carcinoma was identified in 13 of 163 (8.0%) PM specimens. Two patients with occult invasive carcinoma had positive SLNs (hematoxylin and eosin). In the remaining 150 PM cases without occult carcinoma (130 patients), 89% underwent IHC analysis of the SLNs. Of these 130 patients, 43 (33%) had one or more prior biopsies in their “cancer‐free” breast, a median of 43 days (range, 3–314 days) before PM. A total of 310 SLNs were examined by IHC (mean, 2.3 lymph nodes per PM case). Only 1 of 130 (0.8%) patients without occult carcinoma had an IHC‐positive SLN. This patient had Stage IIIC carcinoma of the contralateral breast. IHC‐positive SLNs were not identified in any of the 43 patients with a history of prior biopsy. Therefore, only 1 IHC‐positive SLN was detected in 310 (0.3%) lymph nodes examined.CONCLUSIONSIHC‐positive cells in SLNs are rare in the absence of cancer and are not the result of previous breast instrumentation. Although the prognostic significance of IHC‐positive cells remains controversial, the current study suggests that they are not random events. Cancer 2004. © 2004 American Cancer Society.

show abstract

“…Approximately 5% of patients will be found to have an incidental malignancy [44,45]. SLN biopsy is simple to perform at the time of mastectomy, with little added morbidity.…”

Section: Breastmentioning

confidence: 99%

Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

2003

View full text Add to dashboard Cite

Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. Morton first described the application of lymphatic mapping for melanoma only a decade ago, and this technique is now accepted as the standard of care. The application for lymphatic mapping and sentinel lymph node biopsy in breast cancer remains approximately 5 years behind its utilization in melanoma.This technique has the potential to be utilized in all solid tumors. The rapid assent of this technique in clinical practice is the result of multiple factors, including accuracy, decreased morbidity, and supplying the pathologist with only a few nodes to allow a more focused and sensitive pathologic evaluation. Despite the success and acceptance of lymphatic mapping, many controversies remain. We have attempted to clearly highlight these controversies in this review.

show abstract

The role of sentinel lymph node biopsy in women undergoing prophylactic mastectomy

Cited by 77 publications

References 18 publications

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Cytokeratin‐positive cells in sentinel lymph nodes in breast cancer are not random events

Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

Contact Info

Product

Resources

About