Trends in axillary surgery and clinical outcomes among breast cancer patients with sentinel node metastasis

Gou, Zongchao; Xiao, Lu; He, Mengting; Yu, Luoting

doi:10.1016/j.breast.2022.02.014

Cited by 10 publications

(12 citation statements)

References 40 publications

(59 reference statements)

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“…Interestingly, surgical de-escalation is considered an option beyond patients fulfilling Z0011 criteria: in 2016, 21% of patients with 3-5 metastatic nodes did not undergo completion ALND. In this patient group, however, omitting ALND was reported to be associated with decreased survival [49].…”

Section: Tablementioning

confidence: 66%

“…Based on the results from the Z0011 and AMAROS data and updated guidelines recommendations, most surgeons quickly adopted the "no completion ALND" policy into their clinical practice. Recently, an analysis of the SEER database showed that the percentage of patients undergoing SLNB alone increased from 22% in 2000 to 81% in 2016 for patients with 1-2 metastatic nodes [49]. Interestingly, surgical de-escalation is considered an option beyond patients fulfilling Z0011 criteria: in 2016, 21% of patients with 3-5 metastatic nodes did not undergo completion ALND.…”

Section: Tablementioning

confidence: 99%

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Real de-escalation or escalation in disguise?

Banys‐Paluchowski¹,

Rubio²,

Ditsch³

et al. 2023

The Breast

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Section: Tablementioning

confidence: 66%

Section: Tablementioning

confidence: 99%

Real de-escalation or escalation in disguise?

Banys‐Paluchowski¹,

Rubio²,

Ditsch³

et al. 2023

The Breast

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“…In patients with a diagnosis of breast cancer and axillary lymph node involvement, it is as important to determine the optimal technique to quantify the tumor burden as it is to select the most effective treatment. In a recent retrospective review of the Surveillance, Epidemiology and End Results (SEER) program database by Gou et al, in patients with 3 affected SNs, survival was better with axillary lymph node dissection than with sentinel lymph node biopsy alone (22). Prospective studies should define the role of axillary lymph node dissection, radiotherapy, or both together, in the treatment of axillary node involvement, which could change depending on axillary tumor load (23).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial

Vernet-Tomas¹,

Argudo²,

Jimenez³

et al. 2023

Gland Surg

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Background: Some studies suggested that the patients included in the Z0011 trial may represent patients with ultrasound-negative axillary nodes and axillary invasion diagnosed by sentinel node (SN) biopsy.Nevertheless, the National Comprehensive Cancer Network (NCCN) guidelines recommend SN mapping if 1 or 2 suspicious lymph nodes are identified on axillary ultrasound (AU). The aim of this preliminary phase of the Multimodal Targeted Axillary Surgery (MUTAS) trial was to establish the accuracy of SN mapping in patients with axillary involvement undergoing upfront surgery.Methods: Between September 2019 and March 2022, we recruited patients with biopsy-proven metastatic axillary nodes and upfront surgery from a single center. We performed SN mapping in these patients before the surgical intervention, which included axillary lymph node dissection. The biopsy-proven metastatic node, SNs and the remaining axillary nodes were excised separately. SN status was considered representative of the status of the remaining axillary nodes. We calculated the sensitivity, specificity, negative predictive value and positive predictive value of the SN, overall and in patients with palpable nodes, in those with non-palpable nodes and an AU leading to diagnosis of axillary involvement, in those with 1 or 2 suspicious nodes on AU, and in patients with a single suspicious node on AU. We evaluated clinical, imaging and pathology features as predictors of the status of the remaining axillary nodes, false-negatives, and false-positives. Results:We included 25 patients in this phase. The false-negative rate of SN mapping was 28% overall, 21.42% for patients with palpable nodes, 36.36% for patients with non-palpable nodes and an AU diagnosis of axillary involvement, 28.75% for those with 1 or 2 suspicious nodes on AU, and 15.38% in patients with a single suspicious node on AU. The negative predictive value was highest in patients with a single suspicious node on AU (75%). The only significant predictive factor was that FN showed a higher Ki67 index score.Conclusions: In this study, SN mapping was not reliable in patients with biopsy-proven metastatic axillary

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“…Sentinel lymph node biopsy (SLNB) has been gradually performed on patients with early‐stage breast cancer since 1994 and has been demonstrated as the standard staging method for patients with breast cancer and clinically negative axillae 3,4 . The Z0011 trial further validated the safety of SLNB in patients with one to two positive sentinel lymph nodes; therefore, SLNB was applied in more cases than ALND 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…3,4 The Z0011 trial further validated the safety of SLNB in patients with one to two positive sentinel lymph nodes; therefore, SLNB was applied in more cases than ALND. 5,6 In recent decades, lumpectomy plus radiation and SLNB have been used as surgical approaches for those with primary early-stage breast cancer. 7,8 Nevertheless, approximately 14.3% to 20% will develop local recurrences that necessitate reoperation.…”

Section: Introductionmentioning

confidence: 99%

Is repeat sentinel lymph node biopsy possible for surgical axillary staging among patients with ipsilateral breast tumor recurrence?

Xiao

et al. 2023

Cancer

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Background: There is a lack of studies assessing the survival of repeat sentinel lymph node biopsy (rSLNB) versus axillary lymph node dissection (ALND) for surgical axillary staging among patients with ipsilateral breast tumor recurrence (IBTR). Methods:We retrospectively identified patients with IBTR from the Surveillance, Epidemiology, and End Results database from 2000 to 2017. The primary outcome was overall survival (OS) between the rSLNB and ALND groups.Results: Of the 2141 women with IBTR after lumpectomy and SLNB, 524 did not receive surgical axillary staging (nonsurgery group) and 1617 patients who did undergo axilla surgery received either rSLNB or ALND as axillary staging (1268 with rSLNB and 349 with ALND). The 10-year OS rates were 61.9% for the nonsurgery and 73.8% for axilla surgery groups (p = .001). In the 1:1 matched cohorts, the 10year OS rates were 61.4% for the nonsurgery and 69.1% for axilla surgery groups (p = .072). After adjusting for other factors, axillary surgery treatment of IBTR was an independent favorable factor for OS (hazard ratio [HR], 0.71; 95% CI, 0.56-0.90; p = .004). Within the axilla surgery group, rSLNB presented a comparable 10-year OS to the ALND cohort (log-rank test p = .054). Multivariate Cox analysis, as well as subgroup analysis, showed that rSLNB had a similar benefit to ALND (10-year OS;

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Trends in axillary surgery and clinical outcomes among breast cancer patients with sentinel node metastasis

Cited by 10 publications

References 40 publications

Real de-escalation or escalation in disguise?

Real de-escalation or escalation in disguise?

Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial

Is repeat sentinel lymph node biopsy possible for surgical axillary staging among patients with ipsilateral breast tumor recurrence?

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