scholarly journals Application of the ACOSOG Z0011 Criteria to Chinese Patients with Breast Cancer: A Prospective Study

2020 ◽  
Author(s):  
Yuan Peng ◽  
Miao Liu ◽  
Fuzhong Tong ◽  
Yingming Cao ◽  
Peng Liu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Lymph Node Biopsy ◽  
Chinese Patients ◽  
Regional Recurrence ◽  
Axillary Lymph ◽  
Eligibility Criteria ◽  
Acosog Z0011 ◽  
Local Regional Recurrence

Abstract Background: Although the ACOSOG Z0011 study showed axillary lymph node dissection (ALND) could be avoided in a specific population of sentinel lymph node positive patients, it’s not widely accepted by Chinese surgeons. We conducted a prospective single-arm study to confirm whether or not the results of Z0011 are applicable to Chinese patients. Methods: Patients conforming to the Z0011 criteria were prospectively enrolled at the Peking University People’s Hospital Breast Center from November 2014 to June 2019. Clinicopathological features of the study group were compared with the Z0011 study. Lymphedema after surgery, incidence of local-regional recurrence, and survival were analyzed. Results: One hundred forty-two patients who met Z0011 eligibility criteria were enrolled in this study; 115 had sentinel lymph node biopsy (SLNB) alone. When comparing with the Z0011 trial, younger patients were included (median age, 52 [26- 82] years vs 54 [25-90] years; P = 0.03). Among clinical T stage, tumor histology, hormone status, lymphovascular invasion, and the number of positive sentinel lymph nodes (SLNs), no statistically significant differences were observed. More patients received adjuvant chemotherapy and endocrine therapy (90.85% vs 58.0% and 80.99% vs 46.6% respectively, P < .001). A similar percentage of patients received radiotherapy, but more nodal radiotherapy procedures were carried out in our study (54.5% vs 16.9%). After median follow-up of 29 months, only 1 patient (0.9%) had ipsilateral breast tumor recurrence and no regional recurrence occurred. Conclusion: Our study showed that it is achievable to avoid ALND in patients eligible for Z0011 in China. Trial registration: ClinicalTrials Registered Number: NCT03606616. Registered 31 July 2018-Retrospectiverly registered, https://www.clinicaltrials.gov/ct2/show/NCT03606616?term=Wang+shu&draw=4&ra nk=21.

scholarly journals Application of the ACOSOG Z0011 criteria to Chinese patients with breast cancer: a prospective study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yuan Peng ◽  
Miao Liu ◽  
Xianan Li ◽  
Fuzhong Tong ◽  
Yingming Cao ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Lymph Node Biopsy ◽  
Chinese Patients ◽  
Regional Recurrence ◽  
Study Group ◽  
Axillary Lymph ◽  
Eligibility Criteria ◽  
Acosog Z0011

Abstract Background Although the ACOSOG Z0011 study showed that axillary lymph node dissection (ALND) could be avoided in a specific population of sentinel lymph node-positive patients, it is not widely accepted by Chinese surgeons. We conducted a prospective single-arm study to confirm whether or not the results of Z0011 are applicable to Chinese patients. Methods Patients conforming to the Z0011 criteria were prospectively enrolled at the Peking University People’s Hospital Breast Center from November 2014 to June 2019. The clinicopathological features of the study group were compared with those of the Z0011 study group. Lymphedema after surgery, the incidence of local-regional recurrence, and survival were analyzed. Results One hundred forty-two patients who met the Z0011 eligibility criteria were enrolled in this study; 115 underwent sentinel lymph node biopsy (SLNB) alone. Compared with the Z0011 trial, younger patients were included (median age, 52 [26–82] years vs 54 [25–90] years; P = 0.03). For clinical T stage, tumor histology, hormone status, lymphovascular invasion, and the number of positive sentinel lymph nodes (SLNs), no statistically significant differences were observed. More patients received adjuvant chemotherapy and endocrine therapy in this study (90.85% vs 58.0% and 80.99% vs 46.6% respectively, P <0.001). A similar percentage of patients received radiotherapy, but more nodal radiotherapy procedures were carried out in our study (54.5% vs 16.9%). After a median follow-up of 29 months, only 1 patient (0.9%) had ipsilateral breast tumor recurrence, and no regional recurrence occurred. Conclusion Our study showed that it is achievable to avoid ALND in patients eligible for Z0011 in China. Trial registration ClinicalTrials.gov. Registration number NCT03606616. Retrospectively registered on 31 July 2018.

scholarly journals Intraoperative evaluation of sentinel lymph node in the era of acosog z0011

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Vanessa Monteiro Sanvido ◽  
Simone Elias ◽  
Gil Facina ◽  
Afonso Celso Pinto Nazário
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Dissection ◽  
Conservative Surgery ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Exclusion Criteria ◽  
Acosog Z0011 ◽  
Intraoperative Evaluation

Introduction: Intraoperative evaluation of sentinel lymph node was routinely conducted to assess the presence or absence of metastasis and decide, during the same surgical procedure, whether to perform an axillary dissection, which would avoid a second surgical procedure. However, with the current recommendations for conservative axillary treatment, the role of the intraoperative assessment is questionable. Results of the American College of Surgeons Oncology Group Z0011 (ACOSOG Z0011) randomized trial allow skipping the axillary lymph node dissection in patients with two positive axillary sentinel lymph nodes treated with conservative surgery, which would also allow not performing the intraoperative evaluation of sentinel lymph node because the result would not change the surgical approach. However, the rate of axillary re-excision was not described for cases of ACOSOG Z0011 exclusion criteria after definite anatomopathological results. Objectives: To assess the rate of axillary retreatment in patients submitted to conservative breast surgery in the era of ACOSOG Z0011. Method: This is a retrospective cohort study of patients who had invasive breast carcinoma up to 5 cm, clinically negative axilla, and underwent conservative breast surgery and sentinel lymph node dissection from February 2008 to December 2018. Results: We evaluated 415 patients – 318 (76.7%) with negative sentinel lymph node, and 97 (23.3%) with positive. Among positive cases, 56 (57.8%) were treated with sentinel lymph node biopsy, and 41 (42.2%) were submitted to axillary lymph node dissection. Intraoperative evaluation occurred in 90.2% of cases prior to the publication of ACOSOG Z0011, decreasing to 30.8% after publication (p<0.00001). The rate of surgical re-excision due to ACOSOG Z0011 exclusion criteria was only 3.7%. The main causes were the presence of metastasis in three or more axillary lymph nodes or capsular extravasation. Conclusions: Intraoperative evaluation of sentinel lymph node substantially decreased in patients with early-stage breast carcinoma treated with conservative surgery and sentinel lymph node biopsy after implementing the axillary treatment proposed in the ACOSOG Z0011 guidelines, and the rate of axillary surgical retreatment due to exclusion criteria was minimal.

Reoperative sentinel lymph node biopsy for ipsilateral breast tumor recurrence after previous axillary lymph node dissection: Report of a case

Surgery Today ◽  
2011 ◽  
Vol 41 (2) ◽  
pp. 247-250 ◽  
Author(s):  
Masaya Hattori ◽  
Seiichiro Nishimura ◽  
Keiichiro Tada ◽  
Masamichi Koyama ◽  
Futoshi Akiyama ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Breast Tumor ◽  
Tumor Recurrence ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Ipsilateral Breast ◽  
Node Biopsy

Evaluating One Day versus Two Days Preoperative Lymphoscintigraphy Protocols for Sentinel Lymph Node Biopsy in Breast Cancer

2015 ◽  
Vol 81 (5) ◽  
pp. 454-457 ◽  
Author(s):  
Michael G. Mount ◽  
Nicholas R. White ◽  
Christophe L. Nguyen ◽  
Richard K. Orr ◽  
Robert B. Hird
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Axillary Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Node Biopsy ◽  
Node Negative Breast Cancer

Sentinel lymph node biopsy (SLNB) is used to detect axillary lymph node metastases in breast cancer. Preoperative radiocolloid injection with lymphoscintigraphy (PL) is performed before SLNB. Few comparisons between 1- and 2-day PL protocols exist. Opponents of a 2-day protocol have expressed concerns of radiotracer washout to nonsentinel nodes. Proponents cite lack of scheduling conflicts between PL and surgery. A total of 387 consecutive patients with clinically node-negative breast cancer underwent SLNB with PL. Lymphoscintigraphy images were obtained within 30 minutes of radio-colloid injection. Axillary lymph node dissection was performed if the sentinel lymph node (SLN) could not be identified. Data were collected regarding PL technique and results. In all, 212 patients were included in the 2-day PL group and 175 patients in the 1-day PL group. Lymphoscintigraphy identified an axillary sentinel node in 143/212 (67.5%) of patients in the 2-day group and 127/175 (72.5%) in the 1-day group ( P = 0.28). SLN was identified at surgery in 209/212 (98.6%) patients in the 2-day group and 174/175 (99.4%) in the 1-day group ( P = 0.41). An average of 3 SLN was found at surgery in the 2-day group compared with 3.15 in the 1-day group ( P = 0.43). SLN was positive for metastatic disease in 54/212 (25.5%) patients in the 2-day group compared with 40/175 (22.9%) in the 1-day group ( P = 0.55). A 2-day lymphoscintigraphy protocol allows reliable detection of the SLN, of positive SLN and equivalent SLN harvest compared with a 1-day protocol. The timing of radiocolloid injection before SLNB can be left at the discretion of the surgeon.

Cost comparison of two surgical strategies in the treatment of breast cancer: Sentinel lymph node biopsy versus axillary lymph node dissection

2004 ◽  
Vol 20 (4) ◽  
pp. 449-454 ◽  
Author(s):  
Lionel Perrier ◽  
Karima Nessah ◽  
Magali Morelle ◽  
Hervé Mignotte ◽  
Marie-Odile Carrère ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Medical Costs ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Direct Medical Costs ◽  
Node Biopsy

Objectives: The feasibility and accuracy of sentinel lymph node biopsy (SLNB) in the treatment of breast cancer is widely acknowledged today. The aim of our study was to compare the hospital-related costs of this strategy with those of conventional axillary lymph node dissection (ALND).Methods: A retrospective study was carried out to determine the total direct medical costs for each of the two medical strategies. Two patient samples (n=43 for ALND; n=48 for SLNB) were selected at random among breast cancer patients at the Centre Léon Bérard, a comprehensive cancer treatment center in Lyon, France. Costs related to ALND carried out after SLNB (either immediately or at a later date) were included in SLNB costs (n=18 of 48 patients).Results: Total direct medical costs were significantly different in the two groups (median 1,965.86€ versus 1,429.93€, p=0.0076, Mann-Whitney U-test). The total cost for SLNB decreased even further for patients who underwent SLNB alone (median, 1,301€). Despite the high cost of anatomic pathology examinations and nuclear medicine (both favorable to ALND), the difference in direct medical costs for the two strategies was primarily due to the length of hospitalization, which differs significantly depending on the technique used (9-day median for ALND versus 3 days for SLNB, p<0.0001).Conclusions: A lower morbidity rate is favorable to the generalization of SLNB, when the patient's clinical state allows for it. From an economic point of view, SLNB also seems to be preferred, particularly because our results confirm those found in two published studies concerning the cost of SLNB.

scholarly journals An AN OBSERVATIONAL STUDY OF SLN MAPPING IN PATIENTS OF LOCALLY ADVANCED BREAST CANCER FOLLOWING NCT

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Ankur Garg ◽  
Udbhav Kathpalia ◽  
Shweta Bansal ◽  
Manoj Andley ◽  
Sudipta Saha
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Lymph Node Biopsy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Biopsy ◽  
Neo Adjuvant Chemotherapy

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3) Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5) Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed.   Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy.   Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.

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