scholarly journals Effects of the Number of Removed Lymph Nodes on Survival Outcome in Patients With Sentinel Node-negative Breast Cancer.

2021 ◽  
Author(s):  
Calogero Cipolla ◽  
Antonio Galvano ◽  
Salvatore Vieni ◽  
Federica Saputo ◽  
Simona Lupo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
False Negative ◽  
False Negative Rate ◽  
Optimal Number ◽  
Breast Cancer Patients ◽  
Chi Square ◽  
Relevant Difference ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background It is still uncertain what is the optimal number of sentinel lymph nodes (SLN) to be removed to reduce the false negative rate. The aim of this study was to investigate whether patients with a single negative SLN have a worse prognosis than those with two or more negative SLNs.Methods A retrospective review was conducted on a large series of SLN-negative breast cancer patients. Survival outcomes were evaluated according to the number of removed SLNs. Statistical analysis included Chi-square, Wilcoxon Mann Whitney test and Kaplan–Meier survival analysis.Results There was no relevant difference in median DFS (64.9 vs 41.4) for SLN=1 vs SLN>1 groups (HR 0.76, CI 95% 0.39 – 1.46; p = 0.38). A statistically significant difference in mDFS was showed only for HT treated patients who were SLN= 1 if compared to SLN>1 (100.6 months versus 35.3 months). Conclusions Our results showed no relevant difference in median DFS for SLN=1 vs SLN>1 group, except for a subset of the patients treated with hormone therapy.

scholarly journals Effects of the number of removed lymph nodes on survival outcome in patients with sentinel node-negative breast cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Calogero Cipolla ◽  
Antonio Galvano ◽  
Salvatore Vieni ◽  
Federica Saputo ◽  
Simona Lupo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
False Negative ◽  
False Negative Rate ◽  
Disease Free Survival ◽  
Axillary Staging ◽  
Breast Cancer Patients ◽  
Node Negative ◽  
Relevant Difference ◽  
Significant Difference

Abstract Background Sentinel lymph node biopsy is the gold standard surgical technique for axillary staging in patients with clinically node-negative. However, it is still uncertain what is the optimal number of sentinel lymph nodes (SLNs) to be removed to reduce the false-negative rate. The aim of this study was to investigate whether patients with a single negative SLN have a worse prognosis than those with two or more negative SLNs. Methods A retrospective review was conducted on a large series of SLN-negative breast cancer patients. Survival outcomes and regional recurrence rate were evaluated according to the number of removed SLNs. Secondly, the contribution of different adjuvant therapies on disease-free survival was explored. Statistical analysis included the chi-square, Wilcoxon–Mann–Whitney test, and Kaplan–Meier survival analysis. Results A total of 1080 patients were included in the study. A first group consisted of 328 patients in whom a single SLN was retrieved, and a second group consisted of 752 patients in whom two or more SLNs were retrieved. There was no relevant difference in median DFS (64.9 vs 41.4) for SLN = 1 vs SLN > 1 groups (HR 0.76, CI 95% 0.39–1.46; p = 0.38). A statistically significant difference in mDFS was showed only for HT-treated patients who were SLN = 1 if compared to SLN > 1 (100.6 months versus 35.3 months). Conclusions There is likely a relationship between the number of resected SNL and mDFS. Our results, however, showed no relevant difference in median DFS for SLN = 1 vs SLN > 1 group, except for a subset of the patients treated with hormone therapy.

scholarly journals Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer

2019 ◽  
Vol 47 (10) ◽  
pp. 4841-4853 ◽  
Author(s):  
Huang Li ◽  
Zhang Jun ◽  
Ge Zhi-Cheng ◽  
Qu Xiang
Keyword(s):  
Breast Cancer ◽  
Methylene Blue ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
False Negative ◽  
False Negative Rate ◽  
Blue Dye ◽  
Methylene Blue Dye ◽  
Clinicopathological Factors

Objective This study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer. Methods A total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB. Results The identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively. Conclusions SLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.

The optimal number of lymph nodes removed in maximizing the survival of breast cancer patients

2014 ◽  
Author(s):  
Lim Fong Peng ◽  
Nur Aishah Taib ◽  
Ibrahim Mohamed ◽  
Noorizam Daud
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Optimal Number ◽  
Breast Cancer Patients

Phase II study of preoperative chemotherapy versus standard postoperative chemotherapy in HR-negative HER2-positive breast cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12118-e12118
Author(s):  
Meng Xiu ◽  
Pin Zhang
Keyword(s):  
Breast Cancer ◽  
Preoperative Chemotherapy ◽  
Postoperative Chemotherapy ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Her2 Breast Cancer ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Risk Patients

e12118 Background: HR-/HER2+ breast cancer is a subtype with aggressive characteristic and poor survival. More clinical evidence are needed for choice of therapeutic strategies. Methods: Patients with T1-3N0-3M0 received preoperative chemotherapy (PTX 175 mg/m2, CBP AUC 4, q2w*6) combined with trastuzumab (2mg/kg qw) or standard postoperative chemotherapy such as ddAC-PH, AC-PH, TCH. The primary endpoint was RFS. Results: 86 patients were enrolled, 43 received preoperative chemotherapy (pre arm) and the other 43 received postoperative chemotherapy (post arm). There was no significant difference in baseline between the two arms. 22.1% of patients were stage IIA, 25.6% IIB, 34.9% IIIA, and 18.6% IIIC. At a median follow-up of 33.4 months, 16 patients had relapsed (pre arm 8, post arm 8). The median time from diagnosis to relapse was 22.8 months (7.1-49.2) and 23.8 months (11.4-37.4) in pre and post arm. Kaplan-Meier survival analysis estimated that the 3-year RFS were similar (pre vs post: 73.4% vs 75.4%, p= 0.631). Only 1 death occurred in post arm. Table showed that in subgroups, there was no statistical difference in risk of recurrence between pre and post arms. In pre arm, ORR was 97.7% clinically, and pCR (ypT0/TisN0) was 39.0%. No patients achieved pCR relapsed, and the residual invasive lesions indicated poor prognosis. Table showed that Neo-Bioscore 4-5 was related to recurrence event significantly ( p= 0.021). The rate of breast-conserving in pre arm was higher (19.5% vs 9.3%), and PCb regiments every 2 weeks had similar adverse effects with standard chemotherapy, and less patients had dose reductions (18.6% vs 25.6%). Conclusions: Preoperative chemotherapy versus standard postoperative chemotherapy results in similar RFS among HR-/HER2+ patients. Preoperative chemotherapy can identify prognosis of patients early by Neo-Bioscore and adjuvant therapy should be strengthened for high-risk patients. PCb every 2 weeks combined with trastuzumab can be an option of preoperative therapy for HER2+ breast cancer. Clinical trial information: NCT02934828. [Table: see text]

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.

Incidence of febrile neutropenia with use of docetaxel plus cyclophosphamide (TC) for breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12073-e12073 ◽  
Author(s):  
Kiran Patel ◽  
Brenda Diergaarde ◽  
Adam Brufsky ◽  
Rachel Catherine Jankowitz ◽  
Barry C. Lembersky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Febrile Neutropenia ◽  
Standard Dose ◽  
Age At Diagnosis ◽  
High Rate ◽  
Hormonal Status ◽  
Breast Cancer Patients ◽  
Chi Square ◽  
Logistic Regression Models ◽  
Significant Difference

e12073 Background: Incidence of febrile neutropenia (FN) is reported as 5% in breast cancer patients receiving TC (Jones et al., JCO 2006), which would not justify the usage of prophylactic granulocyte colony stimulating factors (G-CSF). We previously showed that the incidence of FN may be as high as 23% in a small study. (N = 130, Soni et al., ASCO 2011). In the current study, we determined the incidence of FN in a larger cohort (N = 415), and evaluated the usage of G-CSF and its relation to FN, age, stage, and hormonal status. Methods: We retrospectively reviewed the electronic medical records from patients diagnosed with breast cancer who received at least one standard dose cycle of adjuvant TC between 2010-2016 at a university-based breast oncology practice. Chi-square or Fisher’s exact tests were used to assess differences between groups. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multiple logistic regression models. Results: We identified in total 415 patients who received adjuvant TC. Median age at diagnosis was 58 (range: 25-86), the majority had stage I or II (N = 382; 92.1%) disease, and 315 (75.9%) were ER+, 277 (66.8%) PR+, 42 (10.1%) HER2+, 22 (5.3%) triple-positive, and 81 (19.5%) triple-negative. Prophylactic G-CSF was utilized in 247 patients (59.5%), and unknown for 43 (10.4%). Overall 39 (9.4%) patients experienced febrile neutropenia. Incidence of FN among those receiving G-CSF was 4.5% versus 17.6% among those who did not (p < 0.001). Use of G-CSF significantly lowered risk of FN, OR (95%CI): 0.20 (0.10-0.43) adjusted for age at diagnosis and stage. Use of G-CSF on incidence of FN did not differ significantly by age, stage, or hormonal status. Conclusions: Our data confirms a high rate of FN in patients receiving TC without G-CSF prophylaxis. Our institutional high rate of G-CSF use ( > 50%) reduced the incidence of FN to 4.5% and the observed significant difference in FN incidence between the non G-CSF group and G-CSF group suggests that prophylaxis may be considered when administering TC. Age, stage, and hormonal status do not seem to affect the usage of G-CSF or incidence of FN in our population.

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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