scholarly journals Lymph Node Surgery - Stepwise Retirement for the Breast Surgeon?

Breast Care ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 282-286 ◽  
Author(s):  
Julia Landin ◽  
Walter P. Weber
Keyword(s):  
Lymph Node ◽  
Randomized Trials ◽  
Standard Of Care ◽  
Evidence Based ◽  
Axillary Lymph ◽  
Regional Nodal Irradiation ◽  
Axillary Surgery ◽  
Randomized Controlled ◽  
Breast Surgeon ◽  
Conflicting Evidence

Axillary lymph node dissection (ALND) has been standard of care for all patients with breast cancer until the 1990s. The stepwise retreat of breast surgeons from the axilla began after the introduction of the sentinel lymph node procedure. The evidence based clinical trend toward the omission of ALND has advanced to include patients with affected nodes, and several ongoing randomized controlled trials are evaluating the remaining indications for ALND. Conflicting with this trend toward less axillary surgery, indication and extent of regional nodal irradiation are currently broadened, equally supported by evidence from randomized trials. The present review summarizes this conflicting evidence, presents ongoing trials, and discusses the current and future optimal regional management of patients with affected nodes.

scholarly journals The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

2020 ◽  
Author(s):  
Na Liu ◽  
Liu Yang ◽  
Xinle Wang ◽  
Meiqi Wang ◽  
Ruoyang Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
Histological Grade ◽  
False Negative ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Ki 67 ◽  
Axillary Surgery

Abstract Background: Axillary lymph node dissection can be avoided in early stage breast cancer patients with negative sentinel lymph node biopsy. However, the possibility of avoiding axillary surgery in patients without axillary lymph node metastasis (ALNM) by preoperative imaging is still under exploration. Thus, the objectives of this study were to investigate the high-risk factors of false negative of ALNM diagnosed by preoperative ultrasound (US) and to find out who could be avoided axillary surgery in the US negative ALNM patients.Methods: This study retrospectively analyzed 3,361 patients with primary early breast cancer diagnosed in the Breast Center of the Fourth Hospital of Hebei Medical University from January 2010 to December 2012. All patients had undergone routine preoperative US and then axillary lymph node dissected. This study investigated the clinicopathological features of axillary lymph node (ALN) negative patients diagnosed by preoperative US and its correlation with prognosis. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 2,357 patients. Results: The sensitivity, specificity and accuracy of axillary US in this cohort were 66.24%, 76.62% and 73.87%. The proportion of patients in the false negative group was higher than that in true negative in the group of age < 50 years old (P = 0.002), tumor size > 2cm (P = 0.008), estrogen receptor (ER) positive (P = 0.005), progesterone receptor (PR) high expression (P = 0.007), nuclear-associated antigen Ki-67 (Ki-67) >20% (P = 0.030), visible vascular tumor thrombus (P < 0.001) and histological grade>2 (P < 0.001). Prognostic analysis of false negative and true negative ultrasonographic diagnosis of ALN metastasis: when ALNM was not found by preoperative ultrasound, there was no significant difference in patients with ALNM≤3 compared with patients without lymph node metastasis in patients of age ≥ 50 years old, tumor size ≤ 2cm, Ki-67 ≤ 20%, or histological grade ≤ 2. Conclusion: The surgery of ALN may be avoided for the preoperative US diagnosed ALNs negative in early breast cancer patients who had advanced age, small tumor size, low expression of Ki-67 and low histological grade.

scholarly journals Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer–Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial

2020 ◽  
Vol 38 (29) ◽  
pp. 3430-3438 ◽  
Author(s):  
George E. Naoum ◽  
Sacha Roberts ◽  
Cheryl L. Brunelle ◽  
Amy M. Shui ◽  
Laura Salama ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Locoregional Control ◽  
Long Term Results ◽  
Axillary Lymph ◽  
Axillary Surgery ◽  
Breast Cancer Related Lymphedema ◽  
The Impact ◽  
Screening Trial

PURPOSE To independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer–related lymphedema (BCRL) rates in patients with breast cancer. PATIENTS AND METHODS From 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a ≥ 10% relative increase in arm volume arising > 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival. RESULTS The cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively). CONCLUSION Although RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.

Locoregional Therapy in Breast Cancer

2009 ◽  
Vol 05 (01) ◽  
pp. 45
Author(s):  
Lorenzo Livi ◽  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Local Control ◽  
Breast Conservation ◽  
Standard Of Care ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
Axillary Lymph ◽  
Breast Irradiation ◽  
Axillary Lymph Node Metastases

Breast cancer is the most common cancer in women. In 2004, estimates were that about 215,990 women and approximately 1,500 men in the US would be diagnosed with invasive breast cancer. Surgery and radiotherapy, either alone or combined, remain the most effective techniques to treat cancer. Surgical procedures have been clearly defined by several randomised clinical trials that demonstrated equivalent survival with breast-conservation surgery combined with radiotherapy versus mastectomy. In the last few years, in order to avoid the risk of lymphoedema caused by axillary dissection, in patients free from axillary lymph node metastases sentinel lymph node biopsy has been widely accepted as a standard of care. The use of whole-breast irradiation with or without a boost is the standard of care at present. The value of adding nodal irradiation to the breast irradiation is unproven. Local control is influenced not only by treatment modalities but also by screening programmes, allowing the possibility of identifying smaller and smaller lesions. Nowadays, local control for breast cancer is a fundamental part of treatment. The surgical approach is tailored towards conservation of the breast and good-looking cosmesis, while radiotherapy is tailored towards reduction of treated volume to reduce damage and to spare time and cost.

Are there disparities in the utilization of sentinel lymph node biopsies in patients with breast cancer?

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 117-117
Author(s):  
Archana Radhakrishnan ◽  
Paula Silverman ◽  
Robert R. Shenk ◽  
Cheryl L. Thompson
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Racial Differences ◽  
Early Stage ◽  
Medical Center ◽  
Standard Of Care ◽  
Axillary Staging ◽  
Axillary Lymph ◽  
Medical Centers

117 Background: Racial disparities in outcomes continue to persist amongst breast cancer (BC) patients (pts). Standard of care for the surgical evaluation of early BC has changed from axillary lymph node dissection being recommended for axillary staging to sentinel lymph node biopsy (SLNB) for clinically node-negative pts. SLNB, however, can be deferred if findings would not alter treatment plans. The goal of this study is to determine if SLNB rates differ by race, age, insurer, community vs academic setting or surgeon. Causes contributing to disparities will be considered. Methods: Pts undergoing primary surgery for early stage BC from 2010-2011 at our academic teaching hospital and two affiliated community medical centers were identified from the tumor registry. Data abstracted included demographics, insurance type, medical center and surgeon. For pts without SLNB, clinical information was confirmed with medical record review. Unadjusted comparison of factors for pts who did and did not have SLNB was evaluated with a t-test or chi square test. Logistic regression modeling assessed significance of demographic and clinical factors predicting SLNB. Results: 499 pts were identified; 114 (23%) were black, 373 (75%) white, and 12 (2%) others/unknown race. SLNB was performed in 443 (89%) of total pts, without racial differences (86% of black and 89% of white pts (p=0.31) had SLNB). Average age of pts who had SLNB was younger (60.4) than those who did not (76.3) (p<0.01). As compared to those with managed care insurance (97%) or Medicaid (91%), only 78% of Medicare pts had SLNB (p<0.01). There was no statistical difference in SLNB rates between academic and community medical centers or by surgeon. Chart review determined that the standard of care was met in 55/56 pts who did not have SLNB; reasons for no SLNB include advanced age (range 79-95), in-breast recurrences, and positive nodes pre-operatively. Conclusions: Utilization rates of SLNB did not differ between black and white BC pts. Differences were seen based on age and insurer. Although only 89% of pts had SLNB, careful evaluation for reasons reveals medically appropriate treatment in almost all cases. These results suggest cautionary interpretation of large database findings.

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