scholarly journals Impact of the ACOSOG Z0011 Trial on Surgical Practice in Asian Patients: Comparison of Trends in Axillary Surgery for Breast Cancer Between Korean and Dutch Cohorts

2021 ◽  
Author(s):  
CHIHWAN CHA ◽  
Eun Young Kim ◽  
Sung Yong Kim ◽  
Jai Min Ryu ◽  
Min Ho Park ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conserving Surgery ◽  
Lymphatic Invasion ◽  
Downward Trend ◽  
Axillary Lymph ◽  
Annual Percent Change ◽  
Axillary Surgery ◽  
Z0011 Trial ◽  
The Impact ◽  
Dutch Cohort

Abstract PurposeSince the publication of the Z0011 trial, practice-changing clinical guidelines for breast surgery have been developed. Although recent studies confirmed the feasibility of the Z0011 strategy in Asian populations, there has been no study on the trends of axillary surgery in Asian cohort. This study aimed to investigate the time trend of axillary surgery for breast cancer in Korea and compare it with that in Dutch cohort to understand the impact of the Z0011 trial.MethodsWe collected prospectively constructed data from the nationwide Korean Breast Cancer Registry (KBCR). We identified patients who underwent sentinel node biopsy followed by breast-conserving surgery from 2011 to 2018 and were found to have pathological stage T1-2N1-3M0 disease. Regression analyses were performed to compare the downward trend of axillary lymph node dissection (ALND) in our cohort with that previously reported in a Dutch cohort.Results From KBCR data, 7,478 patients met the inclusion criteria. The proportion of ALND significantly decreased from 2011 (76.6%) to 2018 (47.5%). Multivariate analysis revealed that earlier year at diagnosis, larger tumor size, and lymphatic invasion were associated with a higher odds ratio of performing ALND. Compared to Dutch cohort, the downward trend of ALND in Korea was significantly more gradual (annual percent change: 30.1% vs. 5.8%, P < 0.001).ConclusionsThis study demonstrated a downward trend of ALND in Korean patients with breast cancer. However, the rate of decrease was significantly slower than that in Dutch cohort, indicating the need to spread the Z0011 strategy in Asia.

scholarly journals Axillary surgery in breast cancer patients treated with breast-conserving surgery at german breast cancer centers within the last 14 years – comparison of a university center and a community hospital

2019 ◽  
Vol 16 (01) ◽  
pp. 59-66
Author(s):  
Amelie de Gregorio ◽  
Peter Widschwendter ◽  
Susanne Albrecht ◽  
Nikolaus de Gregorio ◽  
Thomas Friedl ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Community Hospital ◽  
Breast Conserving Surgery ◽  
University Hospital ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
University Hospitals ◽  
Cancer Centers ◽  
Axillary Surgery ◽  
Over Time

Abstract Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade. Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U‑BCC) and the community hospital Dachau (D‑BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data. Results The average annual rate of sentinel node biopsy (SNB) was 85.5 % and 87.2 % in Ulm and Dachau, respectively. SNB was performed more precisely at the U‑BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (rs = − 0.82; p < 0.001) and Dachau (rs = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U‑BCC (rs = − 0.76; p = 0.002) while it remained stable in D‑BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1 % pre Z0011 and 14.4 % postZ0011; p < 0.001) in Ulm. Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U‑BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D‑BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.

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.

scholarly journals Potential Impact of the Z0011 Trial on the Omission of Axillary Dissection: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Julia Yoriko Shinzato ◽  
Katia Piton Serra ◽  
Caroline Eugeni ◽  
Cesar Cabello ◽  
Cassio Cardoso-Filho ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Acosog Z0011 ◽  
Number Of Patients ◽  
Z0011 Trial

Abstract Objective To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. Methods A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. Results A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded from the study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes and met the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). Conclusion The ACOSOG Z0011 trial criteria can be applied to a select group of SLN-positive patients, reducing the costs and morbidities of breast cancer surgery.

scholarly journals Axillary Surgery in Breast Cancer Patients Treated with Breast-Conserving Surgery at German Breast Cancer Centers Within the Last 14 Years – Comparison of a University Center and a Community Hospital

2018 ◽  
Vol 78 (11) ◽  
pp. 1138-1145 ◽  
Author(s):  
Amelie de Gregorio ◽  
Peter Widschwendter ◽  
Susanne Albrecht ◽  
Nikolaus de Gregorio ◽  
Thomas Friedl ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Community Hospital ◽  
Breast Conserving Surgery ◽  
University Hospital ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
University Hospitals ◽  
Cancer Centers ◽  
Axillary Surgery ◽  
Over Time

Abstract Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade. Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U-BCC) and the community hospital Dachau (D-BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data. Results The average annual rate of sentinel node biopsy (SNB) was 85.5% and 87.2% in Ulm and Dachau, respectively. SNB was performed more precisely at the U-BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (rs = − 0.82; p < 0.001) and Dachau (rs = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U-BCC (rs = − 0.76; p = 0.002) while it remained stable in D-BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1% preZ0011 and 14.4% postZ0011; p < 0.001) in Ulm. Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U-BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D-BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.

scholarly journals Upper Arm Disability after Axillary Surgery for Early Breast Cancer

2020 ◽  
Vol 17 (3) ◽  
pp. 99-102
Author(s):  
Karen Mbaabu ◽  
Ronald Wasike
Keyword(s):  
Breast Cancer ◽  
Upper Extremity ◽  
Early Breast Cancer ◽  
Surgical Removal ◽  
Dash Score ◽  
Axillary Lymph ◽  
Upper Arm ◽  
Cancer Data ◽  
Axillary Surgery ◽  
The Impact

Background: The treatment of early breast cancer includes surgical removal of the tumor and evaluation of axillary lymph nodes. Axillary lymph node surgery is associated with upper arm morbidity. The impact of this upper arm limitation has a direct effect on the patient’s quality of life. Objectives: To quantify the symptoms of upper extremity disability, and identify correlations between severity of symptoms and type of axillary surgery. Methods: An observational study of 2 groups of patients who had undergone surgery for breast cancer. Data were collected using the DASH® questionnaire and analyzed using SPSS v13®. Results: All 102 participants reported upper extremity symptoms. The mean DASH score for all participants was 51.7. Participants in the retrospective arm had a higher DASH score of 53; those in the prospective arm had a score of 47.3. Conclusion: There was no correlation between severity of symptoms and type of axillary surgery performed. Targeted rehabilitation services should be implemented after the primary surgery. Keywords: Early breast cancer, Axillary dissection, DASH score, Upper arm disability

scholarly journals Breast Angiosarcoma with a Preoperative Diagnosis of Late Recurrence of Breast Cancer: A Case Report

2021 ◽  
pp. 604-609
Author(s):  
Rika Kouhashi ◽  
Shinichiro Kashiwagi ◽  
Yuka Asano ◽  
Tamami Morisaki ◽  
Sae Ishihara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Preoperative Diagnosis ◽  
Vascular Endothelial Cells ◽  
Interstitial Fibrosis ◽  
Late Recurrence ◽  
Breast Conserving Surgery ◽  
Surrounding Tissue ◽  
Axillary Lymph ◽  
Elevated Lesion ◽  
The Right

Angiosarcoma is a malignant mesenchymal tumor characterized by the presence of vascular endothelial cells. Although rare, angiosarcoma developing in the mammary glands has a poor prognosis. We report a case of breast angiosarcoma with a preoperative diagnosis of late recurrence of breast cancer. A 78-year-old woman noticed a tumor in her right breast and visited our hospital. The patient had undergone breast-conserving surgery and axillary lymph node dissection from the right breast 12 years before the visit. The tumor was diagnosed as T4bN0M0, stage IIIB. Anastrozole was administered as postoperative adjuvant therapy for 5 years; the patient also received 50-Gy whole-breast radiation therapy after surgery. Physical examination during her visit revealed an elevated lesion with blue purpura around the nipple in the right breast. We performed breast ultrasound and detected a well-defined 19.6 × 16.4 × 10.7 mm hypoechoic tumor in the left subareolar area. The patient underwent core needle biopsy (CNB). Based on the CNB specimen findings, she was suspected to experience late local recurrence after surgery. Therefore, she underwent total mastectomy after breast-conserving surgery. A dark-red tumor sized 18 × 12 mm was found in a specimen from the nipple. The pathological diagnosis of the specimen revealed short spindle-shaped tumor cells with strong nuclear pleomorphism and a significant interstitial fibrosis. Immunohistochemistry using D2-40 and CD31 antibodies showed irregular luminal proliferation at the anastomosis, infiltration into the surrounding tissue, and massive necrosis, thereby leading to the diagnosis of breast angiosarcoma. We have reported a case of breast angiosarcoma with a preoperative diagnosis of late recurrence of breast cancer.

scholarly journals The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy

2015 ◽  
Vol 112 (4) ◽  
pp. 636-643 ◽  
Author(s):  
E J Bantema-Joppe ◽  
G H de Bock ◽  
M Woltman-van Iersel ◽  
D M Busz ◽  
A V Ranchor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Breast Conserving Surgery ◽  
The Impact

scholarly journals Is It Contralateral Axillary Metastasis or Occult Breast Cancer: A Confusing Case Report

2015 ◽  
Vol 8 (3) ◽  
pp. 498-502 ◽  
Author(s):  
Yong Gi Son ◽  
Woon Won Kim ◽  
Ki Hoon Kim ◽  
Jin Soo Kim
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Growth Factor Receptor ◽  
Immunohistochemical Analysis ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Lymph Node Biopsy ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Axillary Metastasis

We report the case of a 43-year-old woman with primary left breast cancer presenting metastatic lymphadenopathy in the contralateral axilla. This patient represents a diagnostic and therapeutic challenge because primary breast cancer, occult contralateral breast cancer, and extra-mammary primary lesion can all be the source of the contralateral axillary metastasis. Left breast-conserving surgery, left sentinel lymph node biopsy, right breast mass excision, and right axillary lymph node dissection were performed. Immunohistochemical analysis revealed that the left breast cancer specimen was positive for estrogen receptor (ER) and progesterone receptor (PR), but negative for human epidermal growth factor receptor 2 (HER2). In contrast, the right axillary lymphadenopathy specimen was negative for ER and PR, but positive for HER2. Further investigation revealed no evidence of occult primary cancers or extra-mammary tumors. After surgical intervention, the patient was treated with adjuvant chemotherapy, adjuvant radiation therapy, and targeted therapy with trastuzumab. Two years after diagnosis, she is free of disease and presently being treated with tamoxifen.

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.

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