Twenty‐five years of change in the management of the axilla in breast cancer

Dixon, J. M.; Cartlidge, Christopher W. J.

doi:10.1111/tbj.13720

Cited by 14 publications

(9 citation statements)

References 29 publications

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“…Moreover, the addition of accessory sentinel nodes increased the mean number of sentinel nodes to 3.3 leading to the decrease of false negative rate to 4.9% which is around two times lower than in the NSABP B-32 study. Although no real consensus exists concerning the number of SLN to be excised, a common practice is to try to have an average number of nodes removed close to 3 (13). Indeed, Bonneau et al showed in 2015 an association between the excision of 3 sentinel nodes and improved survival outcomes in patient with breast cancer (14).…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node mapping with patent blue dye in patients with breast cancer: a retrospective single institution study

Olivier¹,

Courtois²,

Jossa³

et al. 2021

Gland Surg

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Background: Since the end of the last century, sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as standard of care for axillary staging in early breast cancer in patients without any clinical sign of axillary lymph node infiltration. The worldwide most frequently used mapping method consists in the injection of radioactive Technetium-99 isotope alone or in combination with blue dye.As a specific infrastructure and dedicated personnel are needed for the use of a radioactive tracer, the CHC in Liege (Belgium) decided to test the use of patent blue dye alone to detect sentinel lymph nodes in a large consecutive cohort of patients and compared the results with radioactive mapping methods and guidelines recommendations.Methods: Patent blue dye was used in 456 consecutive patients with early breast cancer who underwent conservative breast cancer surgery or radical mastectomy between 1/1/2000 and 31/12/2007 in a community hospital (CHC Liège, Belgium). After SLNB, an ALND was performed in each patient.Results: Sentinel lymph nodes were identified in 444 patients among the 456 patients evaluated by this mapping method during this time period, which represents a detection rate of 97.4%. Infiltrated lymph nodes were detected in 32.7% of patients (149/456) while in the 444 patients with sentinel lymph nodes identified and resected, 137 patients have at last one positive lymph node (30.9%). The false negative rate was 4.9% and the predictive negative value was 97.7% with the blue dye mapping method.Conclusions: In addition of the simplicity of the method and the large economic advantage, SNLB using blue dye alone showed a quite acceptable performance in our retrospective analysis concerning its ability to find the SLN as well as its reliability to remove the good ones.

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Section: Discussionmentioning

confidence: 99%

Sentinel lymph node mapping with patent blue dye in patients with breast cancer: a retrospective single institution study

Olivier¹,

Courtois²,

Jossa³

et al. 2021

Gland Surg

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“…Although it is relatively easier to manage this condition in a patient with only lymphadenopathy, such a condition that may develop after vaccination in a patient with newly diagnosed breast cancer can cause confusion in axillary staging, which is very important in breast cancer management, when the tumor is located in the same axilla as the breast tumor. ALN involvement in breast cancer patients negatively affects the prognosis of the disease and is an important factor that determines the clinical and surgical approach [ 11 , 12 ]. Assessment of ALN involvement in all newly diagnosed breast cancer patients is requisite.…”

Section: Discussionmentioning

confidence: 99%

Axillary Lymph Nodes in Breast Cancer Patients After COVID-19 Vaccine

et al. 2023

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One of the side effects of vaccines used to end the COVID-19 epidemic is non-specifically enlarged axillary lymph nodes. Such lymphadenopathy detected during clinical examination of breast cancer patients may require additional imaging or interventional procedures that should not normally be performed. This study has been designed to estimate the incidence of palpable enlarged axillary lymph node in breast cancer patients who had received COVID-19 vaccination in the past 3 months in the same arm as compared to those without vaccination. Breast cancer patients admitted to M.U. Medical Faculty Breast polyclinic between January 2021 and March 2022 were screened, and clinical staging was performed after thorough clinical examination. Among these patients with suspected enlarged axillary lymph node and those undergoing sentinel lymph node biopsy (SLNB), they were divided into two groups as vaccinated and unvaccinated. Age, menopausal status, tumor size, tumor location, surgery, pathology results, hormonal receptor status, and SLNB results were statistically compared with groups. There was no significant difference between groups in terms of age, menopause, tumor size, tumor location, surgery, pathological results, and hormone receptor status. The SLNB being reported as reactive only was 89.1% in the vaccinated group and 73.2% in the non-vaccinated group which was statistically significant different. Reactive lymph nodes were commonly found with an excess of 16% in patients who had received COVID-19 vaccination in the past 3 months. This required caution and additional examination of the axillary lymph nodes in this period.

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“…With the defects of Halsted's radical mastectomy and further extensive radical surgery, we cannot but turn back to modi ed radical surgery and breast conserving surgery and SLNB later. 3,6,8,[10][11][12] The development of this road has burned a series of painful imprint step by step in progress to minimally invasive and functional treatment.…”

Section: Discussionmentioning

confidence: 99%

15-year Follow-up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicentres, Randomized Controlled Trial

Luo

Cao

Guo

et al. 2020

Preprint

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Backgroud: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND).Methods：From January 1, 2003 to December 31, 2005,1027 patients with operable breast cancer were randomly assigned to two groups: MALND and CALND. 996 eligible patients were enrolled. The end points are disease free survival and overall survival.Results：The final cohort of 996 patients was followed for an average of 184 months. The distribution of all events was fairly similar between two groups of patients. The incidence of local in-breast events did not differ in a significant manner between two cohorts. Similarly, the rate of distant metastases was not significantly different with 30.0% in MLND and 32.6% in CALND. And no significant difference was observed in other primary tumor between two groups (p=0.46). Patients who remain alive with no event comprise a total of 37.2% in MALND and 35.4% in CALND. Other primary cancers and deaths from other causes were distributed equally between two groups. The 15-year disease-free survival rates were41.1 percent for the MALND group and 39.6 percent for the CALND group (p=0.79). MALND was found to be not inferior for overall survival (P =0.54). The 15-year overall survival rates were 49.5 percentafter MALND and 51.2 percentafter CALND (p=0.86). Probability of overall survival was not significantly different between two groups.Conclusions：MALND does not increase unfavorable events, and also does not affect the long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery.

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Twenty‐five years of change in the management of the axilla in breast cancer

Abstract: Sentinel lymph node (SLN) biopsy is now used worldwide. It has led to many changes in how we manage the axilla in patients with breast cancer. This review covers four areas of management of the axilla in breast cancer: assessing the clinically node-

Cited by 14 publications

References 29 publications

Sentinel lymph node mapping with patent blue dye in patients with breast cancer: a retrospective single institution study

Sentinel lymph node mapping with patent blue dye in patients with breast cancer: a retrospective single institution study

Axillary Lymph Nodes in Breast Cancer Patients After COVID-19 Vaccine

15-year Follow-up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicentres, Randomized Controlled Trial

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