Multicentric Breast Cancer: A New Indication for Sentinel Node Biopsy—A Multi-Institutional Validation Study

2006 ◽  
Vol 24 (21) ◽  
pp. 3374-3380 ◽  
Author(s):  
Michael Knauer ◽  
Peter Konstantiniuk ◽  
Anton Haid ◽  
Etienne Wenzl ◽  
Michaela Riegler-Keil ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
False Negative ◽  
False Negative Rate ◽  
Breast Conserving Surgery ◽  
Axillary Lymph ◽  
Identification Rate ◽  
Multicentric Breast Cancer ◽  
Adequate Quality

Purpose Multicentric breast cancer has been considered to be a contraindication for sentinel node (SN) biopsy (SNB). In this prospective multi-institutional trial, SNB-feasibility and accuracy was evaluated in 142 patients with multicentric cancer from the Austrian Sentinel Node Study Group (ASNSG) and compared with data from 3,216 patients with unicentric cancer. Patients and Methods Between 1996 and 2004, 3,730 patients underwent SNB at 15 ASNSG-affiliated hospitals. Patient data were entered in a multicenter database. One hundred forty-two patients presented with multicentric invasive breast cancer and underwent SNB. Results Intraoperatively, a mean number of 1.67 SNs were excised (identification-rate, 91.5%). The incidence of SN metastases was 60.8% (79 of 130). This was confirmed by axillary lymph node dissection (ALND) in 125 patients. Of patients with positive SNs, 60.8% (48 of 79) showed involvement of nonsentinel nodes (NSNs), as did three patients with negative SNs (false-negative rate, 4.0). Sensitivity, negative predictive value, and overall accuracy were 96.0%, 93.3%, and 97.3%, respectively. Ninety-one percent of the patients underwent mastectomy, and 9% were treated with breast conserving surgery. None of the patients have shown axillary recurrence so far (mean follow-up, 28.8 months). Compared with 3,216 patients with unicentric cancer, there was a significantly higher rate of SN metastases as well as in NSNs, whereas there was no difference in detection and false-negative rates. Conclusion Multicentric breast cancer is a new indication for SNB without routine ALND in controlled trials. Given adequate quality control and an interdisciplinary teamwork of surgical, nuclear medicine, and pathology units, SNB is both feasible and accurate in this disease entity.

scholarly journals Breast Cancer Sentinel Node Detection: An Alternative Solution for Centers Lacking Nuclear Technology

Breast Care ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 265-268 ◽  
Author(s):  
Mahmoud A. Alhussini ◽  
Ahmed T. Awad ◽  
Mohamed H. Ashour ◽  
Ahmed Abdelateef ◽  
Haytham Fayed
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
False Negative ◽  
False Negative Rate ◽  
Surgical Oncology ◽  
Blue Dye ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Sentinel Node Detection ◽  
Identification Rate

Background: Sentinel lymph node (SLN) has become the gold standard for all cases with no axillary nodal metastasis. The combined radioisotope and blue dye technique is adopted in most centers. The lack of the technology for radioisotope in our institution encouraged us to study the feasibility of methylene blue (MB) for SLN detection in breast cancer patients admitted to Alexandria Surgical Oncology Unit. Methods: A total of 144 cases were subjected to SLN detection by injecting 2 ml of MB 1%. This was followed by standard axillary lymph node dissection. The safety and accuracy of MB as a tracer for detection of SLN were studied. Results: The identification rate was 93.15%. The number of SLN identified ranged from 1 to 8 nodes with a mean of 1.75 ± 1.17. The sensitivity of MB dye technique was 96.3%. The false negative rate was 3.7%. The negative predictive value was 97.6% and the accuracy was 98.5%. Conclusions: MB is a safe, reliable, cheap, and accurate alternative tracer for detection of SLN.

Sentinel Node Biopsy in Breast Cancer: The Experience of Brescia Civic Hospital

2000 ◽  
Vol 86 (4) ◽  
pp. 309-311 ◽  
Author(s):  
Claudio Pizzocaro ◽  
Pier Luigi Rossini ◽  
Arturo Terzi ◽  
Roberto Farfaglia ◽  
Laura Lazzari ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Negative Rate ◽  
Sentinel Node Concept ◽  
Hematoxylin Eosin

The accuracy of the sentinel node technique in the evaluation of axillary node involvement in breast cancer was evaluated in 83 consecutive patients with monofocal T1–2 carcinoma, who were clinically N0 and who underwent lymphoscintigraphy with 99mTc-colloid integrated with intraoperative sentinel node detection by a portable probe. Lymphoscintigraphy revealed at least one sentinel node in 75 patients (90.4%), always identified by the probe. In eight patients (9.6%) the sentinel node was detected neither by lymphoscintigraphy nor by the probe. All removed lymph nodes were analyzed by hematoxylin-eosin histology and the sentinel node by immunostaining. In 28/75 patients (37.3%) at least one metastatic axillary lymph node was detected; in 16 of the 28 N+ subjects (57%) only the sentinel node was positive. The false negative rate (sentinel node negative/other axillary lymph nodes positive) was 17.85% (5/28 patients). In 9/23 patients (39%) micrometastases were found in the sentinel node only. In conclusion, specific sentinel node positivity in 57% of cases supports the validity of the sentinel node concept. Moreover, nine patients would have been considered No by standard hematoxylin-eosin histology without sentinel node-aided immunostaining. A 17.8% false negative rate calls for caution in patients with negative sentinel nodes.

Study of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 104-104
Author(s):  
T. Kinoshita ◽  
T. Hojo ◽  
S. Asaga ◽  
J. Suzuki ◽  
K. Jimbo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Primary Tumor ◽  
Tumor Response ◽  
False Negative ◽  
False Negative Rate ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Identification Rate

104 Background: Despite the increasing use of both sentinel lymph node biopsy (SLNB) and preoperative chemotherapy (PST) in patients with operable breast cancer, there is still limited information on the feasibility and accuracy of SLNB following PST. In this study, the feasibility and accuracy of SLNB for breast cancer patients with clinically negative lymph nodes after PST were investigated. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical tumor/nodal status before PST were analyzed. Methods: Between 2003 and 2008, 200 patients with stage II and III breast cancer previously treated with PST were enrolled in this study. The eligible criteria for PST were (a) primary tumor > 3cm or (b) positive axillary lymph node status on initial examination. FNA biopsy was performed for clinically or ultrasonographically suspicious axillary lymph nodes. The patients then underwent SLNB, which involved a combination of intradermal injection over the tumor of radiocolloid and subareolar injection of blue dye. This was followed by Level I/II axillary lymph node dissection (ALND). Results: The median patient age was 49 years, and the median primary tumor size was 4.9 cm. The overall SLN identification rate was 94.5% (189 of 200). In 178/189 patients (94%) the SLN accurately predicted the axillary status. Eleven patients had a false-negative SLN biopsies, yielding a false-negative rate of 12.9%. There were no significant differences in the SLN identification rate according to tumor classifications before PST, the clinical nodal status before PST, the clinical tumor response after PST, or pathological response of the tumor after PST, although the SLN identification rate tended to be lower in patients with a T4 primary tumor. Conclusions: Our data and some reports suggested that SLNB was feasible method for axillary staging in breast cancer patients who received PST even in patients who initially with lymph node positive disease. However, false-negative rate of SLNB in patients with clinical and pathological complete tumor response tended to be higher than other group.

scholarly journals Ultrasound guided needle biopsy of axilla to evaluate nodal metastasis after preoperative systemic therapy in cohort of 106 breast cancers enriched with BRCA1/2 pathogenic variant carriers

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Baiba Līcīte ◽  
Arvīds Irmejs ◽  
Jeļena Maksimenko ◽  
Pēteris Loža ◽  
Genādijs Trofimovičs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Node ◽  
Pathogenic Variant ◽  
Axillary Lymph ◽  
Ultrasound Guided ◽  
Node Positive

Abstract Background Aim of the study is to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after preoperative systemic therapy (PST). Methods From January 2016 – October 2020 106 node positive stage IIA-IIIC breast cancer cases undergoing PST were included in the study. 18 (17 %) were carriers of pathogenic variant in BRCA1/2. After PST restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. In 72/106 cases axilla conserving surgery and in 34/106 cases axillary lymph node dissection (ALND) was performed. Results False Positive Rate (FPR) of FNAC after PST in whole cohort and BRCA1/2 positive subgroup is 8 and 0 % and False Negative Rate (FNR) – 43 and 18 % respectively. Overall Sensitivity − 55 %, specificity- 93 %, accuracy 70 %. Conclusion FNAC after PST has low FPR and is useful to predict residual axillary disease and to streamline surgical decision making regarding ALND both in BRCA1/2 positive and negative subgroups. FNR is high in overall cohort and FNAC alone are not able to predict ypCR and omission of further axillary surgery. However, FNAC performance in BRCA1/2 positive subgroup is more promising and further research with larger number of cases is necessary to confirm the results.

scholarly journals Sentinel Node Mapping for Breast Cancer: Current Situation

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sergi Vidal-Sicart ◽  
Renato Valdés Olmos
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Sentinel Node ◽  
False Negative ◽  
False Negative Rate ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Biopsy

Axillary node status is a major prognostic factor in early-stage disease. Traditional staging needs levels I and II axillary lymph node dissection. Axillary involvement is found in 10%–30% of patients with T1 (<2 cm) tumours. Sentinel lymph node biopsy is a minimal invasive method of checking the potential nodal involvement. It is based on the assumption of an orderly progression of lymph node invasion by metastatic cells from tumour site. Thus, when sentinel node is free of metastases the remaining nodes are free, too (with a false negative rate lesser than 5%). Moreover, Randomized trials demonstrated a marked reduction of complications associated with the sentinel lymph node biopsy when compared with axillary lymph node dissection. Currently, the sentinel node biopsy procedure is recognized as the standard treatment for stages I and II. In these stages, this approach has a positive node rate similar to those observed after lymphadenectomy, a significant decrease in morbidity and similar nodal relapse rates at 5 years. In this review, the indications and contraindications of the sentinel node biopsy are summarized and the methodological aspects discussed. Finally, the new technologic and histologic developments allow to develop a more accurate and refinate technique that can achieve virtually the identification of 100% of sentinel nodes and reduce the false negative rate.

scholarly journals RETROSPECTIVE ANALYSIS OF BREAST CANCER CASES AND SURGICAL TREATMENT IN A PERIOD OF TEN YEARS

2003 ◽  
Vol 40 (139) ◽  
pp. 112-119 ◽  
Author(s):  
Prakash Sayami ◽  
B M Singh ◽  
Y Singh ◽  
R Timila ◽  
U Shrestha ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Analysis ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Lymph ◽  
Duration Of Symptoms ◽  
Tubular Carcinoma ◽  
Advanced Stages

Retrospective analysis of 321 cases of breast cancer diagnosed in T. U Teaching Hospitalin a period of 10 years, from May, 1991 to April, 2000 was carried out. There were317 cases (98.8%) females and 4 cases males (1.2%). The youngest patient was 22year old female and oldest patient was 92 year old female. The most common agegroup according to frequency was in forties (34.6%) followed by in thirties (25.5 %).Mean duration of symptoms before coming to doctor was 8.3 months and mean size oftumor was 6 cm. Out of 317 females, 310(97.2%) were married and average numberof children was 3. Out of 289 cases diagnosed as malignancy with fine needle aspirationcytology (FNAC) 279 (96.5%) was also diagnosed as malignancy in biopsy and theremaining 10 cases as non malignant diseases were diagnosed as malignancy in biopsywith a false negative rate of 3.5%. The histological types of breast cancer cases wereInfiltrating Ductal Carcinoma 280 cases (87.2%), Medullary Carcinoma 11 cases(3.4%), Infiltrating Lobular Carcinoma 5 cases (1.6%), Mucinous Carcinoma 4 cases(1.2%), Sarcoma 4 cases (1.2%), Squamous Cell Carcinoma 4 cases (1.2%), PapillaryCarcinoma 3 cases (0.9%), Tubular Carcinoma 2 cases, Adenosquamous Carcinoma2 cases (0.6%), Intraductal Carcinoma 2 cases (0.6%) and Non-Hodgkins Lymphoma1 case. Out of 305 operated cases, the types of operation performed was ModifiedRadical Mastectomy in 208 cases (68 %) and palliative mastectomy in 72 cases (23.5%),only lumpectomy in 24 cases (7.9%) and others in 2 cases. Among 246 cases withavailable axillary lymph node biopsy, there was metastatic diseases in 146 cases (60%)of cases. The Breast cancer was diagnosed in advanced stages in 63% of cases. StageIIIA (24%), Stage IIIB (21.5%) and Stage IV (17.4%). Breast cancers were diagnosedin advanced stages in below 40 age group in 65 out of 90 cases (72.2 % ) comparedto137 out of 231 cases ( 59.3 % ) in above 40 age group.Key Words: Breast cancer, Advanced stage, FNAC, Surgery.

Where to look for sentinel node in breast cancer?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2560-2560
Author(s):  
Anton J. Scharl ◽  
Andreas Düran ◽  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Lymphatic Mapping ◽  
False Negative ◽  
False Negative Rate ◽  
Breast Cancer Patients ◽  
Standard Methods

2560 Background: It has been observed, that the caudal Axilla on the border to pectoralis muscle is predicive for the sentinel node. The sono-morphology of lymph nodes has been the subject of multiple publications, usually dealing with malignant melanoma. In the context of sentinel lymph node biopsy (SLNB) in breast cancer patients, the following study examines the feasibility of the sonographic differentiation of the Sentinel lymph node (SLN) from neighboring non-SLNs and whether sentinel-ultrasound-needle localization (SUN) is a useful addition or alternative to current methods of “lymphatic mapping”. Methods: During a prospective study performed from 1/2003 to 9/2005 including 404 breast cancer patients (Tis-T4), the SLNB was performed using patent blue+/- 99Tc-Nanocoll. In addition to and independent of this method, the axilla was sonographically examined for “reactive” lymph nodes n=180 pt. (Siemens Elegra 7.5 MHz). The “reactivity” of the nodes was quantified using an index , which allowed the comparison of adjacent nodes. The most “reactive” lymph node in the caudal axilla was identified as the “Ultrasound-Sentinel-Node”(US-SLN) and has been marked with a wire. Results: In 180 patients the SLN was localized using the standard methods as well as (SUN). The was no difference in detection rates of US-SLN and the standard methods in tumor-free nodes(SLN-). However, for patients with axillary metastases (SLN+) SUN provided superior detection rate (99,1%). The false-negative-rate was reduced from 10,7 % to 1,3%. This was attributed to the embolization of lymph vessels afferent to the metastasized (SLN+) node causing a bypass of the “lymphatic mapping” and inhibiting detection. Conclusions: The SUN–Method is comparable to “lymphatic mapping” in tumor free nodes (SLN -). If SLN is metastasized (SLN+) - SUN is superior to the standard methods in sensitivity and specificity (80%) and the false-negative-rate can be reduced. Systematic axilla sonography is an effective method for the SLN-Localisation, and offers an excellent method for quality control during SLNB.

A prospective study to evaluate the accuracy of axillary staging using ultrasound and USG-guided fine needle aspiration cytology in early breast cancer patients in a high-volume center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12060-e12060
Author(s):  
Rashpal Singh ◽  
Ekta Dhamija ◽  
SVS Deo ◽  
Sandeep Mathur ◽  
Sanjay Thulkar
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
False Negative ◽  
False Negative Rate ◽  
High Volume ◽  
Axillary Staging ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Developing Nation

e12060 Background: In breast cancer, axillary lymph node involvement directly impacts the patient survival and prognosis.Sentinel lymph node biopsy (SLNB) is a procedure of choice for axillary staging in early breast cancer. Currently, management options for axilla management are ALND & SLNB in node positive & in node negative respectively. In developing nation like India,where resource constraints, logistics issues and over burden health institutes create difficulty in managing patients, our study address this issue by implementing USG and USG-FNAC in early breast cancer patients in developing nation. Methods: All early breast cancer patients were screend by ultrasound axilla to categorise the nodes as suspicious or non suspicious. Suspicious nodes underwent USG & FNAC using vascualr pedicle based nodal mapping for node targeted on USG-FNAC, if node found to be positive, patient underwent ALND & negative node patients underwent SLNB.All non-suspicious nodes patient underwent SLNB. Final histopathology was taken as gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value, accuacy and false negative rate calculated for USG & USG-FNAC. Results: Total 100 patients included in which 58 were non-suspicious and 42 suspicious nodes on USG. Among suspicious group, 24 were positive on USG-FNAC & 18 were negative.In non suspicious SLNB done in all. False negative rate of USG & USG-FNAC was 38% and 17% respectively. Conclusions: Our study indicates the feasibility of USG & USG-FNAC in a high volume centre with good accuracy of around 70- 80%.Overall, 24 % of total patients can be taken up for ALND without performing SLNB.This study can guide us to utilize ultrasound and ultrasound-guided FNAC as a routine evaluation tool in the pre operative assessment of axillary lymph nodes in early breast cancer. Our study showed good and acceptable result (75%) in isolating and retrieving the targeted node by just following the Vascular pedicle based node mapping of axilla to locate the suspicious node without using any tagging or marking of node from where FNAC was performed. This finding can act as a good practicing tool in a busy high volume, logistics issue and and resource constraint hospitals.[Table: see text]

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