Value of axillary dissection in addition to lumpectomy and radiotherapy in early breast cancer

Cabanes, P.-A.; Salmon, R; Vilcoq, J.R.; Durand, Jean‐Claude; Fourquet, A.; Gautier, C.; Asselain, Bernard

doi:10.1016/0140-6736(92)91591-u

Cited by 268 publications

(95 citation statements)

References 14 publications

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“…Traditionally, axillary lymph node status has been evaluated by routine axillary lymph node dissection accompanying lumpectomy or mastectomy specimens. Axillary lymph node dissection is used to obtain precise staging data, provide local control for patients with metastatic breast carcinoma and for selection of adjuvant therapy (5)(6)(7)(8)(9)(10)(11). Unfortunately, the only patients who are likely to derive therapeutic benefit from axillary lymph node dissection are those with positive nodes, approximately 40% of those undergoing axillary dissection (12)(13)(14)(15)(16).…”

Section: Abstract: Breast Carcinoma Cytopathology Imprint Metastatmentioning

confidence: 99%

Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology

et al. 2002

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Background: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both frozen sectioning and intraoperative imprint cytology are used for rapid intraoperative sentinel lymph node evaluation at many institutions. The purpose of this study is to evaluate experience with imprint cytology for intraoperative evaluation of sentinel lymph nodes in patients with breast cancer. Methods: A retrospective review of the intraoperative imprint cytology results of 678 sentinel lymph node mappings for breast carcinoma was performed. Sentinel nodes were evaluated intraoperatively by either bisecting or slicing the sentinel node into 4 mm sections. Imprints were made of each cut surface and stained with H&E and/or Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Intraoperative imprint cytology results were compared with final histologic results. Results: The sensitivity of imprint cytology was 53%, specificity was 98%, positive predictive value was 94%, negative predictive value was 82% and accuracy was 84%. The sensitivity for detecting macrometastases ( more than 2mm) was significantly better than for detecting micrometastases (<2 mm), 81 versus 21%, respectively (P < 00001). Conclusions: The sensitivity and

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Section: Abstract: Breast Carcinoma Cytopathology Imprint Metastatmentioning

confidence: 99%

Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology

et al. 2002

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“…Irradiation of the axillary lymph nodes is also an option for regional treatment. Axillary radiation and surgery have provided equivalent local control in early breast cancer patients [3,4]. Randomised trials to evaluate the efficacy and toxicity of surgical or radiotherapeutic management of axilla with positive sentinel lymph node biopsy have been planned, and the results are pending [5].…”

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confidence: 99%

Coverage of axillary lymph nodes with high tangential fields in breast radiotherapy

Alço

Igdem²,

Ercan³

et al. 2010

BJR

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ABSTRACT. The aim of this study is to evaluate the coverage of axillary nodal volumes with high tangent fields (HTF) in breast radiotherapy and to determine the utility of customised blocking. The treatment plans of 30 consecutive patients with early breast cancer were evaluated. The prescription dose was 50 Gy to the whole breast. Axillary level I-II lymph node volumes were delineated and the cranial border of the tangential fields was set just below the humeral head to create HTF. Dose-volume histograms (DVH) were used to calculate the doses received by axillary nodal volumes. In a second planning set, HTF were modified with multileaf collimators (MLC-HTF) to obtain an adequate dose coverage of axillary nodes. The mean doses of the axillary nodes, the ipsilateral lung and heart were compared between the two plans (HTF vs MLC-HTF) using a paired sample t-test. The doses received by 95% of the breast volumes were not significantly different for the two plans. The doses received by 95% of the level I and II axillary volumes were 16.79 Gy and 11.59 Gy, respectively, for HTF, increasing to 47.2 Gy and 45.03 Gy, respectively, for MLC-HTF. Mean lung doses and per cent volume of the ipsilateral lung receiving 20 Gy (V20) were also increased from 6.47 Gy and 10.47%, respectively, for HTF, to 9.56 Gy and 16.77%, respectively, for MLC-HTF. Our results suggest that HTF do not adequately cover the level I and II axillary lymph node regions. Modification of HTF with MLC is necessary to obtain an adequate coverage of axillary levels without compromising healthy tissue in the majority of the patients. Sentinel lymph node (SLN) biopsy for clinically nodenegative breast cancer has become the standard approach for the surgical evaluation of the axilla [1,2]. If the final pathology report reveals metastatic involvement of the sentinel lymph node(s), then axillary lymph node dissection (ALND) is considered. Irradiation of the axillary lymph nodes is also an option for regional treatment. Axillary radiation and surgery have provided equivalent local control in early breast cancer patients [3,4]. Randomised trials to evaluate the efficacy and toxicity of surgical or radiotherapeutic management of axilla with positive sentinel lymph node biopsy have been planned, and the results are pending [5]. Irradiation of the axilla can be performed via separate anteriorposterior fields; alternatively a portion of the axilla (the most likely levels I and II) can be covered by the tangential fields; Irradiating the lower levels of the axilla through tangential fields is considered to be more practical. In the era of CT-based three dimensional (3D) radiotherapy planning, however, concerns have been raised about the adequacy of coverage of the axillary levels in the tangential fields [6][7][8][9][10].In this study, we evaluated the coverage of the axillary nodal levels administered using modified high tangential fields in patients without axillary dissection and the effect of this modification on the doses received by the ipsilateral lung. Methods ...

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“…62 A randomized, prospective study has demonstrated that axillary dissection provides a survival benefit. 60 In patients randomized to dissection, less axillary recurrences, visceral metastases, and supraclavicular metastases were noted. A retrospective analysis correlated improved survival with increased extent of the axillary dissection.…”

Section: Axillary Lymph Nodesmentioning

confidence: 99%

“…For example, surgery has a significant impact on recommendations for adjuvant therapy, affords excellent local control of the axilla, and has been proven to have a survival benefit. 60,61 At present no other modality achieves all of these goals. Primary radiation therapy to the axilla may in the future be proven to provide longterm local control, but to date limited short-term results have been reported.…”

Section: Axillary Lymph Nodesmentioning

confidence: 99%

The surgical management of primary invasive breast cancer

Moore

Kinne

1995

CA: A Cancer Journal for Clinicians

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IntroductionBreast cancer accounts for about 17 percent of all female noncutaneous malignancies, and it is estimated that worldwide in 1994 more than 850,000 new cases of breast cancer were diagnosed and about 250,000 people died. In 1995 in the United States, it is estimated that 183,400 new cases of breast cancer will be diagnosed and 46,240 people will die. 1Although these numbers seem staggering, a positive trend toward earlier diagnosis of breast cancer has occurred. About 75 percent of newly diagnosed breast cancers in 1993 were stage I or II, and about two thirds of all breast cancer were node negative.2 Stage I and II cancers are by convention grouped together as early-stage breast cancer, while in situ cancers are grouped separately.The treatment of operable primary breast cancer has also undergone a remarkable evolution in the past several decades. The standard operative procedure has changed from the radical mastectomy to the modified radical mastectomy, and the use of breast-conserving treatment is increasing. Radical mastectomy is no longer the only available option for potentially curative treatment of early-stage breast cancer. Survival for Early-Stage Breast CancerSurvival for patients with early-stage breast cancer treated with mastectomy alone is excellent, but varies by stage and quantitative nodal involvement.3 A recent study by Rosen et al 4 provided longterm follow-up of patients treated primarily by modified radical mastectomy. Patients with small tumors and no lymph node involvement (stage I, tumor less than 1.0 cm in widest diameter) had a 10-year disease-free survival rate of 91 percent and a 20-year disease-free survival rate of 88 percent. When all patients with stage I lesions were included, the 10-year and 20-year disease-free survival rates were 83 and 79 percent, respectively. Thus, survival for these patients was excellent, and most attrition occurred within the first decade.Lymph node involvement, however, had a profound impact on survival. Patients with stage IIA cancer (T1N1) with one involved lymph node had a 10-year disease-free survival rate of 71 percent and a 20-year disease-free survival rate of 66 percent. If two to four lymph nodes were involved, 10-year and 20-year disease-free survival rates were 62 and 56 percent, respectively. For patients with more than four involved lymph nodes, 10-year and 20-year disease-free survival rates were 47 and 43 percent, respectively.The long-term survival rates in the paper by Adair et al 3 reflect the impact of local-regional care alone, primarily with mastectomy, in an era prior to adjuvant systemic therapy. The primary and often only therapy was radical mastectomy.C A C a n c e r J C l i n 1 9 9 5 ; 4 5 : 2 7 9 -2 8 8

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Value of axillary dissection in addition to lumpectomy and radiotherapy in early breast cancer

Cited by 268 publications

References 14 publications

Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology

Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology

Coverage of axillary lymph nodes with high tangential fields in breast radiotherapy

The surgical management of primary invasive breast cancer

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