Avoidance of axillary dissection in cN0 breast cancer patients with metastatic sentinel lymph node(s) using ACOSOG Z-0011 criteria: Is it appropriate for Indian patients?

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 62-62
Author(s):  
Gaurav Agarwal ◽  
Sanjay Gambhir ◽  
Punita Lal ◽  
Narendra Krishnani ◽  
Sendhil Rajan
Keyword(s):  
False Negative ◽  
Study Cohort ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Single Institution ◽  
Data Set ◽  
Entire Study ◽  
Acosog Z0011 ◽  
Tangential Field ◽  
Z0011 Trial

62 Background: A relatively newer algorithm for surgical management of axilla, where axillary node dissection (ALND) is avoided in cN0 EBC patients with 1 to 2 metastatic sentinel nodes (SLN) is now widely practiced in North America. ASCO & NCCN guidelines, and St Gallen consensus statement too have endorsed this strategy. This algorithm, based on the ACOSOG-Z0011 trial results has evoked quite a debate in India too. Concerns relating the quality of Z0011 data and its wide applicability persist. On the other hand, avoidance of ALND and its morbidity seems attractive to the oncologists and patients. In a single institution validation SLN Biopsy (SLNB) data-set, we evaluated the applicability of the “Z0011 strategy” to know its impact on an Indian patient cohort. Methods: In a prospective data-set of 120 cN0 EBC patients (mean age 51.1 years, T1 = 14, T2 = 106, mean tumor size 3.8 cm, 51.7% ER/PR+) who underwent validation SLNB (ALND irrespective of SLNB histology), such patients who fulfilled the selection criteria of ACOSOG-Z0011, i.e. those who underwent BCS and tangential field whole breast irradiation, and 1-2 metastatic SLNs were identified. Results: 66 (55%) of the 120 patients underwent BCS and tangential field whole breast irradiation. Of the 25 out of 66 patients with metastatic SLNs, 5 patients had 3 or more metastatic SLNs, and 2 had extra-nodal spread, thus not fitting the Z0011 criteria. Thus only 18 patients (15% of entire study cohort, and 27.3% of those undergoing BCS) with 1 to 2 metastatic SLNs were eligible for avoidance of ALND based Z0011 criteria. Of these 18 eligible patients, 7 (38.9%) had non-sentinel metastatic nodes. These 7, and the 3 with false negative SLNs could be seen as being left with undertreated axillae. Conclusions: In Indian context, where the majority of patients have large tumors and many opt for mastectomy, avoidance of ALND in presence of metastatic SLNs can be offered to a small proportion of patients. In a single institution validation SLNB data-set, only 15% patients qualified for avoidance of ALND using the Z0011 trial criteria. Besides, avoidance of ALND would have left 8.3% patients potentially undertreated in the axilla.

scholarly journals Multimodal imaging for clinical target volume definition in prone whole-breast irradiation: a single institution experience

2017 ◽  
Vol 6 (2) ◽  
pp. 61-69
Author(s):  
Alessandra Huscher ◽  
Dina Santus ◽  
Alberto Soregaroli ◽  
Stefano Mutti ◽  
Gabriele Levrini ◽  
...  
Keyword(s):  
Multimodal Imaging ◽  
Clinical Target Volume ◽  
Target Volume ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Single Institution ◽  
Target Volume Definition

Patient-reported outcomes of catheter-based accelerated partial breast brachytherapy and whole breast irradiation, a single institution experience

2018 ◽  
Vol 169 (1) ◽  
pp. 189-196 ◽  
Author(s):  
Krishan R. Jethwa ◽  
Mohamed M. Kahila ◽  
Kristin C. Mara ◽  
William S. Harmsen ◽  
David M. Routman ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Single Institution ◽  
Breast Brachytherapy ◽  
Patient Reported

OC-0469 inter-institute variability of kb-models for whole breast irradiation with tangential field

2021 ◽  
Vol 161 ◽  
pp. S355-S356
Author(s):  
A. Tudda ◽  
R. castriconi ◽  
E. cagni ◽  
G. benecchi ◽  
F. dusi ◽  
...  
Keyword(s):  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Tangential Field

Diagnostic Value of a Carpal Tunnel Corticosteroid Injection in Patients with Negative Electrodiagnostic Studies

2020 ◽  
Author(s):  
Brian M. Katt ◽  
Casey Imbergamo ◽  
Fortunato Padua ◽  
Joseph Leider ◽  
Daniel Fletcher ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Carpal Tunnel Release ◽  
False Negative ◽  
False Negative Rate ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Symptom Improvement ◽  
Study Cohort ◽  
Chi Square Analysis

Abstract Introduction There is a known false negative rate when using electrodiagnostic studies (EDS) to diagnose carpal tunnel syndrome (CTS). This can pose a management dilemma for patients with signs and symptoms that correlate with CTS but normal EDS. While corticosteroid injection into the carpal tunnel has been used in this setting for diagnostic purposes, there is little data in the literature supporting this practice. The purpose of this study is to evaluate the prognostic value of a carpal tunnel corticosteroid injection in patients with a normal electrodiagnostic study but exhibiting signs and symptoms suggestive of carpal tunnel, who proceed with a carpal tunnel release. Materials and Methods The group included 34 patients presenting to an academic orthopedic practice over the years 2010 to 2019 who had negative EDS, a carpal tunnel corticosteroid injection, and a carpal tunnel release. One patient (2.9%), where the response to the corticosteroid injection was not documented, was excluded from the study, yielding a study cohort of 33 patients. Three patients had bilateral disease, yielding 36 hands for evaluation. Statistical analysis was performed using Chi-square analysis for nonparametric data. Results Thirty-two hands (88.9%) demonstrated complete or partial relief of neuropathic symptoms after the corticosteroid injection, while four (11.1%) did not experience any improvement. Thirty-one hands (86.1%) had symptom improvement following surgery, compared with five (13.9%) which did not. Of the 32 hands that demonstrated relief following the injection, 29 hands (90.6%) improved after surgery. Of the four hands that did not demonstrate relief after the injection, two (50%) improved after surgery. This difference was statistically significant (p = 0.03). Conclusion Patients diagnosed with a high index of suspicion for CTS do well with operative intervention despite a normal electrodiagnostic test if they have had a positive response to a preoperative injection. The injection can provide reassurance to both the patient and surgeon before proceeding to surgery. Although patients with a normal electrodiagnostic test and no response to cortisone can still do well with surgical intervention, the surgeon should carefully review both the history and physical examination as surgical success may decrease when both diagnostic tests are negative. Performing a corticosteroid injection is an additional diagnostic tool to consider in the management of patients with CTS and normal electrodiagnostic testing.

Sign in / Sign up

Export Citation Format

Share Document