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.

scholarly journals Quality of Life After Sentinel Lymph Node Biopsy Versus Complete Axillary Lymph Node Dissection in Early Breast Cancer: A 3-Year Follow-up Study

Medicina ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 18
Author(s):  
Algirdas Boguševičius ◽  
Daiva Čepulienė
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Biopsy

Background and Objectives. The rating of life quality may belong to the method of surgical treatment: after the axillary lymph node dissection patients may suffer from arm symptoms; after sentinel lymph node biopsy women may highlight the anxiety about the success of radical treatment. The aim was to assess the influence of sentinel lymph node biopsy on the quality of life of the patients with early stage breast cancer compared with total axillary lymph node dissection. Material and Methods. In a prospective case-control study, 48 patients with early invasive breast cancer and no evidence of lymph nodes involvement underwent breast conserving surgery with sentinel lymph node biopsy. They were grouped as matched pairs with the patients who underwert axillary lymph node dissection, according to the age, TNM stage, localization, hormonal receptor status, and surgical characteristics. Quality of life was evaluated using the QLQ-C30 and QLQ-BR-23 questionnaires before surgery and after 1, 3, 6, 12, and 36 months. Results. The patients who underwent sentinel lymph node biopsy scored better on the emotional functioning, pain, sexual functioning, and future perspective scales in comparison with those who underwent axillary lymph node dissection. The score on the arm symptom scale remained significantly better in the sentinel lymph node biopsy group than the axillary lymph node dissection group within the overall follow-up period. Conclusions. The women who underwent sentinel lymph node biopsy experienced better quality of life than the patients who underwent axillary lymph node dissection.

scholarly journals Sentinel Lymph Nodes for Breast Carcinoma: A Paradigm Shift

2016 ◽  
Vol 140 (8) ◽  
pp. 791-798 ◽  
Author(s):  
Aoife Maguire ◽  
Edi Brogi
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Lymph Node Biopsy ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection

Context.—Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes.Objective.—To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes.Data Sources.—Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network.Conclusions.—The main goal of sentinel lymph node examination should be to detect all macrometastases (&gt;2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin–stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non–sentinel lymph node involvement. This information is important to decide on further axillary treatment.

scholarly journals Role of sentinel lymph node biopsy in assessing the cancer spread to axilla in early breast cancer

2016 ◽  
Vol 4 (1) ◽  
pp. 53
Author(s):  
Ashutosh Gumber ◽  
Manish Mudgal
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Biopsy

Background:Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to axillary lymph node dissection as a way to stage breast cancer in clinically node-negative patients. Objective of the study was to determine the safety and reliability of sentinel lymph node biopsy without axillary lymph node dissection (ALND) in early breast cancer patients.Methods: This prospective study was conducted in patients with operable breast cancer in a single surgical unit of our hospital. Patients with T1-T3 breast cancer with clinically negative axilla and patients with previous lumpectomy were included. All the patients had undergone complete axillary lymph node dissection after sentinel lymph node biopsy. All the specimens were sent separately for paraffin section histopathology.Results:Mean age of 35 female patients included was 54 years. SLN was identified in 94.29% cases and it could not be identified in 2 cases. SLN (96.97%) was most commonly identified at level I. Mean numbers of sentinel node and axillary node were 1.52 and 16.11 respectively. Study of SLN biopsy with methylene blue dye for staging the axilla was done with 81.25% sensitivity and 100% specificity. Positive predictive value was 100% and was able to negatively predict the axilla in 86.36% with an overall accuracy of staging of 96.97% and false negative rate of 18.75%.Conclusions:Sentinel lymph node biopsy without axillary lymph node dissection in sentinel lymph node negative breast cancers appears to be a safe and reliable procedure for determining the nodal status and ensuring the loco-regional control.

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