The sentinel node biopsy after previous breast surgery: preliminary results on 543 patients treated at the European Institute of Oncology

Luini, Alberto; Galimberti, Viviana; Gatti, Giovanna; Arnone, Paolo; Vento, Anna Rita; Trifirò, Giuseppe; Viale, Giuseppe; Rotmensz, Nicole; Fernández, J.R. García-Talavera; Gilardi, Daniela; Paganelli, Giovanni

doi:10.1007/s10549-004-1719-8

Cited by 81 publications

(35 citation statements)

References 19 publications

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“…They found that the sentinel node was negative in 70.4 % of cases, and only three cases developed axillary recurrence during follow-up. The sentinel node was identified in 99 % of cases [17].…”

Section: Slnb Post Breast Surgerymentioning

confidence: 99%

What Is a False Negative Sentinel Node Biopsy: Definition, Reasons and Ways to Minimize It?

2016

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Sentinel node biopsy helps in assessing the involvement of axillary lymph node without the morbidity of full axillary lymph node dissection, namely arm and shoulder pain, paraesthesia and lymphoedema. The various methods described in the literature identify the sentinel lymph nodes in approximately 96 % of cases and associated with a false negativity rate of 5 to 10 %. A false negative sentinel node is defined as the proportion of cases in whom sentinel node biopsy is reported as negative, but the rest of axillary lymph node(s) harbours cancer cells. The possible causes of a false negative sentinel lymph node may be because of blocked lymphatics either by cancer cells or following fibrosis of previous surgery/radiotherapy, and an alternative pathway opens draining the blue dye or isotope to another uninvolved node. The other reasons may be two lymphatic pathways for a tumour area, the one opening to a superficial node and the other in deep nodes. Sometimes, lymphatics do not relay into a node but traverse it going to a higher node. In some patients, the microscopic focus of metastasis inside a lymph node is so small-micrometastasis (i.e. between 0.2 and 2 mm) or isolated tumour cells (i.e. less than 0.2 mm) that is missed by the pathologist. The purpose of this review is to clear some fears lurking in the mind of most surgeons about the false negative sentinel lymph node (FNSLN).

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Section: Slnb Post Breast Surgerymentioning

confidence: 99%

What Is a False Negative Sentinel Node Biopsy: Definition, Reasons and Ways to Minimize It?

2016

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“…First, SLNB should not be performed for patients with pure DCIS because of its non-invasive biological behavior [1] . Second, a SLNB will be unnecessary in the majority of patients with a preoperative image-guided CNB diagnosis of DCIS because the final postoperative histology will only contain pure DCIS and will not contain any invasive disease [2,19] . Third, although SLNB is a less morbid surgical procedure compared with ALND, it is also associated with complications [7,8] .…”

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Alameer¹,

Nefaie²,

Johani³

et al. 2016

WJCO

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AIM:To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS). METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) Al-Ameer AY et al . SNLB in clinically detected DCIS of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an imageguided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive. RESULTS:Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%.CONCLUSION: SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy. Core tip: While most ductal carcinoma in situ (DCIS) cases present with a radiologically detected abnormality, our sample represented a rare group of ductal carcinoma which was detected clinically. This study had a specific objective to determine the indications for sentinel lymph node in clinically detected DCIS. There are very few studies worldwide tracking this specific group, and there is no screening program in our community for breast cancer. This study will help communities who have no screening program to put protocols in place for such a specific group of patients.

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“…They can, thus, provide a "useful map" of lymphatic drainage in cases where there is likely to have been disruption to the former. Luini et al looked at patients who have had previous breast surgery and found a scintigram that had a SLN detection rate of 99 % [14]. Birdwell et al found no difference between SLN identification in women who underwent prior excisional biopsy of breast tissue.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time?

et al. 2013

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Sentinel lymph node biopsy (SLNB) remains the gold standard for assessing axillary node status in breast cancer. Preoperative scintigrams have been used to identify the sentinel lymph node (SLN); however, their use is controversial. Studies suggest they add little to successful SLN detection in theatre, immediately prior to node excision. They have been associated with high false negatives, time expense, patient dissatisfaction, and unnecessary costs. The aim of the present study was to evaluate the diagnostic accuracy of scintigrams in comparison to intraoperative SLN identification techniques. This study included all patients undergoing a SLNB for breast cancer from April 2010 to 2011. Scintigram reports, operation notes, and histology results were analyzed. Mann-Whitney U and chi-squared tests were used for statistical analysis of data. Two hundred nineteen female patients with a median age of 59.6 years (24.0-89.9 years) were included in this study. Scintigram was performed in 185 and not in 34 patients due to time constraints. Combined γ-probe and Isosulfan blue dye for SLN detection (intraoperative methods) have an identification rate of 98.2 % (p =0.005), compared to 92.4 % (p =0.088) from scintigrams alone. Scintigrams confer no additional advantage to the operating surgeon for successful SLN detection and excision in theatre. Intraoperative SLN identification is more accurate and reliable. Routine scintigram use is unjustified and should be withdrawn from current practice.

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The sentinel node biopsy after previous breast surgery: preliminary results on 543 patients treated at the European Institute of Oncology

Abstract: SLNB accuracy after a previous breast biopsy is comparable with the results obtained in validation studies. SLNB after a previous breast biopsy can be considered a standard procedure. Lymphoscintigraphy identifies the sentinel node in 99% of patients.

Cited by 81 publications

References 19 publications

What Is a False Negative Sentinel Node Biopsy: Definition, Reasons and Ways to Minimize It?

What Is a False Negative Sentinel Node Biopsy: Definition, Reasons and Ways to Minimize It?

Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time?

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