Refusal of Breast Surgery in Patients With Breast Cancer With a Clinical Complete Response (cCR) After Neoadjuvant Systemic Therapy and a Confirmed Pathological Complete Response (pCR) Using Vacuum-assisted Biopsy (VAB) and Sentinel Lymph Node Biopsy (SLNB)

2020 ◽  
Author(s):  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Pathological Complete Response ◽  
Breast Surgery ◽  
Complete Response ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Neoadjuvant Systemic Therapy

scholarly journals Avoiding Axillary Sentinel Lymph Node Biopsy after Neoadjuvant Systemic Therapy in Breast Cancer: Rationale for the Prospective, Multicentric EUBREAST-01 Trial

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3698
Author(s):  
Toralf Reimer ◽  
Aenne Glass ◽  
Edoardo Botteri ◽  
Sibylle Loibl ◽  
Oreste D. Gentilini
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Systemic Therapy ◽  
Lymph Node Biopsy ◽  
Biological Behavior ◽  
Axillary Surgery ◽  
Node Biopsy ◽  
Neoadjuvant Systemic Therapy

Currently, axillary surgery for breast cancer is considered only as staging procedure, since the risk of developing metastasis depends on the biological behavior of the primary. The postsurgical therapy should be considered on the basis of biologic tumor characteristics rather than nodal involvement. Improvements in systemic treatments for breast cancer have increased the rates of pathologic complete response (pCR) in patients receiving neoadjuvant systemic therapy (NAST), offering the opportunity to de-escalate surgery in patients who have a pCR. European Breast Cancer Research Association of Surgical Trialists (EUBREAST)-01 is a clinical trial in which only patients with the highest likelihood of having a pCR after NAST (triple-negative or HER2-positive breast cancer) will be included and type of surgery will be defined according to the response to NAST rather than on the classical T (for tumor size in the breast) and N (for axillary lymph node involvement) status. In the discussed trial, axillary surgery will be eliminated completely (no axillary sentinel lymph node biopsy) for initially clinical node-negative (cN0) patients with radiologic complete remission and a breast pCR in the lumpectomy specimen. The trial design is a multicenter single-arm study with a limited number of patients (n = 267), which might give practice-changing results in a short period of time, sparing the time and the costs of a randomized comparison.

Evaluation of sentinel lymph node biopsy after previous breast surgery for breast cancer: GATA study

The Breast ◽  
2016 ◽  
Vol 28 ◽  
pp. 54-59 ◽  
Author(s):  
C. Renaudeau ◽  
C. Lefebvre-Lacoeuille ◽  
L. Campion ◽  
F. Dravet ◽  
P. Descamps ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Breast Surgery ◽  
Lymph Node Biopsy ◽  
Node Biopsy

scholarly journals Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy

2021 ◽  
pp. 1-12
Author(s):  
S. Salinas-Huertas ◽  
A. Luzardo-González ◽  
S. Vázquez-Gallego ◽  
S. Pernas ◽  
C. Falo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Breast Surgery ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Axillary Radiotherapy

INTRODUCTION: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1–54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS: Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92–18.16) and 3.9 (1.60–9.49) respectively. CONCLUSIONS: The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment.

scholarly journals Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy. It Is Worth To Decide!

2016 ◽  
Vol 26 (5) ◽  
pp. 84-87
Author(s):  
Agnė Čižauskaitė ◽  
Donatas Petrauskas ◽  
Dainius Šimčikas ◽  
Alvydas Česas
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Neoadjuvant Chemotherapy ◽  
Breast Surgery ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Biopsy

Objective. To evaluate the predictable percentage of patients that could be eligible for sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in Klaipeda University Hospital Breast Surgery Department. Background. Although SLNB is a standard staging method for axillar node status assessment for early- stage clinically lymph node (LN) negative breast cancer patients, SLNB after NAC is still controversial. Axillary lymph node dissection (ALND) still remains standard accepted surgical approach for patients following NAC regardless of primary LN status. ALND is associated with significant morbidity and complications. NAC is now used with increasing frequency not only for locally advanced but also for early-stage breast cancer and optimal indications for SLNB after NAC are required. Methods. 163 cases with breast cancer treated by NAC were enrolled in this study. After NAC all patients at the time of definitive breast surgery, underwent ALND. Results. Before NAC, clinical LN status was negative in 21 cases (13%) and positive in 141 (87%). When evaluated postoperatively, pN0 in clinically LN negative group was detected in 21 patients (100%). Meanwhile in clinically LN positive group, pN0 was 63 (44.7%) and pN+ 78 (55.3%) of cases. Conclusions. SLNB should always be performed before or after NAC in clinically LN negative patients. Optimal technique should be chosen in node- positive patients to assure the success of the procedure.

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