A further survey of surgical management of the axilla in UK breast cancer patients

INTRODUCTION The aims of this study were to investigate the practice of axillary lymph node management within different units throughout the UK, and to assess changes in practice since our previous survey in 2004. SUBJECTS AND METHODS A structured questionnaire was sent to 350 members of the British Association of Surgical Oncology. RESULTS There were 177 replies from respondents who managed more than 100 patients a year with breast cancer. Of these: 12 did not perform axillary ultrasound at all in their centre; 17 (10%) employed axillary node clearance (ANC) on all patients; 122(69%) performed sentinel node biopsy (SNB) with dual localisation; and 111 respondents had attended the New Start Course. Radioisotope was most frequently injected 2 h or more before operation. Just 13 surgeons were convinced of the value of dissecting internal mammary nodes visualised on a scan. Reasons for not using dual localisation included lack of nuclear medicine facilities, no local ARSAC licence holder, no probe, and no funding. Sixty-six surgeons stated that, if they had an ARSAC licence and could inject the radioactivity in theatre, this would be a major improvement. In addition, 83 (47%) did not perform SLNB in patients receiving neo-adjuvant chemotherapy. CONCLUSIONS Despite significant changes since 2004, substantial variation remains in management of the axilla. A number of surgeons are practicing outwith current guidelines.

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Magnetic Seed (Magseed) Localisation in Breast Cancer Surgery: A Multicentre Clinical Trial

Breast Care ◽

10.1159/000510380 ◽

2020 ◽

pp. 1-6

Author(s):

Jan Žatecký ◽

Otakar Kubala ◽

Oldřich Coufal ◽

Markéta Kepičová ◽

Adéla Faridová ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Surgical Oncology ◽

Breast Tumour ◽

Axillary Node ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Magnetic Marker ◽

Magnetic Seeds

Introduction: The aim of this study was to evaluate the accuracy and reliability of the Magseed magnetic marker in breast cancer surgery. Methods: Thirty-nine patients with 41 implanted Magseeds undergoing surgical treatment in 3 surgical oncology departments were included in the retrospective trial to study pilot use of the Magseed magnetic marker in the Czech Republic for localisation of breast tumours or pathological axillary nodes in breast cancer patients. Results: Thirty-four breast cancer and 7 pathological lymph node localisations were performed by Magseed implantation. No placement failures, or perioperative detection failures of Magseeds were observed (0/41, 0.0%), but one case of Magseed migration was present (1/41, 2.4%). All magnetic seeds were successfully retrieved (41/41, 100.0%). Negative margins were achieved in 29 of 34 (85.3%) breast tumour localisations by Magseed. Conclusion: Magseed is a reliable marker for breast tumour and pathological axillary node localisation in breast cancer patients. Magseed is comparable to conventional localisation methods in terms of oncosurgical radicality and safety.

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The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial

European Journal of Cancer ◽

10.1016/s0959-8049(99)00133-1 ◽

1999 ◽

Vol 35 (9) ◽

pp. 1320-1325 ◽

Cited By ~ 256

Author(s):

U Veronesi ◽

E Marubini ◽

L Mariani ◽

P Valagussa ◽

R Zucali

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Randomised Trial ◽

Breast Cancer Patients ◽

Internal Mammary Nodes ◽

Internal Mammary

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Prognosis of Breast Cancer Patients after Mastectomy and Dissection of Internal Mammary Nodes

Annals of Surgery ◽

10.1097/00000658-198512000-00007 ◽

1985 ◽

Vol 202 (6) ◽

pp. 702-707 ◽

Cited By ~ 259

Author(s):

UMBERTO VERONESI ◽

NATALE CASCINELLI ◽

MARCO GRECO ◽

ROSARIA BUFALINO ◽

ALBERTO MORABITO ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Breast Cancer Patients ◽

Internal Mammary Nodes ◽

Internal Mammary

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Internal Mammary Nodes in Breast Cancer: Diagnosis and Implications for Patient Management—A Systematic Review

Journal of Clinical Oncology ◽

10.1200/jco.2008.17.4862 ◽

2008 ◽

Vol 26 (30) ◽

pp. 4981-4989 ◽

Cited By ~ 160

Author(s):

Ronald C. Chen ◽

Nancy U. Lin ◽

Mehra Golshan ◽

Jay R. Harris ◽

Jennifer R. Bellon

Keyword(s):

Breast Cancer ◽

Survival Benefit ◽

Randomized Trials ◽

Radical Mastectomy ◽

Tumor Control ◽

Breast Cancer Patients ◽

Term Survival ◽

Cardiac Morbidity ◽

Internal Mammary Nodes ◽

Internal Mammary

The management of internal mammary nodes (IMNs) in breast cancer is controversial. Surgical series from the 1950s showed that one third of breast cancer patients had IMN involvement, with a higher risk in patients with medial tumors and/or positive axillary nodes. IMN metastasis has similar prognostic importance as axillary nodal involvement. However, after three randomized trials showed no survival benefit from extended mastectomy compared with radical or modified radical mastectomy, IMN dissection was largely abandoned. Recently, lymphoscintigraphy studies have renewed interest in IMN evaluation. Approximately one fifth of internal mammary sentinel nodes are pathologic, although most centers do not perform IMN biopsies because of concerns about morbidity and lack of established survival benefit. In addition, results from randomized trials testing the value of postmastectomy irradiation and a meta-analysis of 78 randomized trials have provided high levels of evidence that local-regional tumor control is associated with long-term survival improvements. This benefit was limited to trials that used systemic therapy, which was not routinely administered in the earlier surgical studies, although the contribution from IMN treatment is unclear. IMN irradiation has also been shown to cause increased cardiac morbidity. Before mature results from current randomized trials assessing the benefit of IMN irradiation become available, lymphoscintigraphy may be used to help guide decisions regarding systemic and local-regional treatment. However, even in patients with visualized primary IMN drainage, the potential benefit of treatment should be balanced against the risk of added morbidity.

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82 Inverse planning dynamic multibeam IMRT — a promising treatment technique in improving outcomes in left breast cancer patients with internal mammary nodes involvement — clinical implementation

Radiotherapy and Oncology ◽

10.1016/s0167-8140(05)80243-9 ◽

2005 ◽

Vol 76 ◽

pp. S25

Author(s):

C. Popescu ◽

I. Olivotto ◽

F. Cao ◽

L. Salter ◽

W. Beckham

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Left Breast ◽

Treatment Technique ◽

Breast Cancer Patients ◽

Clinical Implementation ◽

Inverse Planning ◽

Internal Mammary Nodes ◽

Internal Mammary ◽

Promising Treatment

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Ultrasound-Guided Fine-Needle Aspiration Biopsy of Internal Mammary Nodes: Technique and Preliminary Results in Breast Cancer Patients

American Journal of Roentgenology ◽

10.2214/ajr.13.11148 ◽

2014 ◽

Vol 203 (2) ◽

pp. W213-W220 ◽

Cited By ~ 11

Author(s):

Bruno D. Fornage ◽

Basak E. Dogan ◽

Nour Sneige ◽

Gregg A. Staerkel

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Breast Cancer Patients ◽

Ultrasound Guided ◽

Fine Needle ◽

Internal Mammary Nodes ◽

Internal Mammary

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TP8.1.1 Does ultrasound quantification of suspicious axillary nodes correlate with pathological results?

British Journal of Surgery ◽

10.1093/bjs/znab362.066 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Muhammad Abdullah

Keyword(s):

Breast Cancer ◽

Fast Track ◽

Axillary Node ◽

Retrospective Data ◽

Breast Cancer Patients ◽

Axillary Ultrasound ◽

Axillary Nodes ◽

Axillary Node Clearance ◽

Ultrasound Findings ◽

Abnormal Node

Abstract Aims Fast-track axillary node clearance (ANC) leads to overtreatment of axilla. Improved quantification by axillary US (AUS) is suggested to avoid unnecessary ANC and proceed with ANC or SLNB based on the number of abnormal axillary nodes. This retrospective study was aimed to evaluate whether ANC can be omitted based on AUS quantification in patients with low axillary burden. Methods Retrospective data of breast cancer patients who underwent ANC following a positive pre-operative axillary nodal biopsy between 1 January 2017 and 31 December 2018 were included in this study. The patients who received neoadjuvant chemotherapy, those having ANC following positive SLNB and those with axillary recurrence were excluded. The histopathology results of ANC were correlated with axillary ultrasound findings. Results 45 patients underwent fast-track ANC following positive axillary core biopsy. On pre-operative AUS, 18 of these patients were reported to have a single abnormal node, while 8 had two abnormal nodes and 19 patients had multiple abnormal nodes. The comparison of the number of metastatic nodes following ANC, and the reported abnormal nodes on pre-operative AUS, showed that 57.3% of patients with 1 – 2 abnormal nodes on AUS had 3 or more metastatic nodes and 26.3% of patients with multiple abnormal nodes on AUS had 1 – 2 metastatic nodes following ANC. Conclusions The quantification of the axillary burden with pre-operative AUS does not correlate with the number of metastatic axillary nodes. The reported relevant axillary burden on AUS is not sufficiently specific to form the basis of omission of ANC.

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