scholarly journals Predictors of Nonsentinel Nodal Involvement to Aid Intraoperative Decision Making in Breast Cancer Patients with Positive Sentinel Lymph Nodes

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
Ern Yu Tan ◽  
Bernard Ho ◽  
Juliana J. C. Chen ◽  
Pey Woei Ho ◽  
Christine Teo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Positive Sentinel Lymph Node ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Nodal Involvement ◽  
Node Dissection ◽  
Positive Slns ◽  
Mskcc Nomogram

Background. Up to 60% of patients with a positive sentinel lymph node (SLN) have no additional nodal involvement and do not benefit from completion axillary lymph node dissection (ALND). We aim to identify factors predicting for non-SLN involvement and to validate the MSKCC nomogram and Tenon score in our population. Methods. Retrospective review was performed of 110 consecutive patients with positive SLNs who underwent ALND over an 8-year period. Results. Fifty patients (45%) had non-SLN involvement. Non-SLN involvement correlated positively with the number of positive SLNs (P=0.04), macrometastasis (P=0.01), and inversely with the total number of SLNs harvested (P=0.03). The MSKCC nomogram and Tenon score both failed to perform as previously reported. Conclusions. The MSKCC nomogram and Tenon score have limited value in our practice. Instead, we identified three independent predictors, which are more relevant in guiding the intraoperative decision for ALND.

scholarly journals Radiation Field Design in the ACOSOG Z0011 (Alliance) Trial

2014 ◽  
Vol 32 (32) ◽  
pp. 3600-3606 ◽  
Author(s):  
Reshma Jagsi ◽  
Manjeet Chadha ◽  
Janaki Moni ◽  
Karla Ballman ◽  
Fran Laurie ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Nodal Involvement ◽  
Node Dissection ◽  
Acosog Z0011 ◽  
Significant Difference ◽  
Low Volume

Purpose ACOSOG Z0011 established that axillary lymph node dissection (ALND) is unnecessary in patients with breast cancer with one to two positive sentinel lymph nodes (SLNs) who undergo lumpectomy, radiotherapy (RT), and systemic therapy. We sought to ascertain RT coverage of the regional nodes in that trial. Methods We evaluated case report forms completed 18 months after enrollment. From 2012 to 2013, we collected all available detailed RT records for central review. Results Among 605 patients with completed case report forms, 89% received whole-breast RT. Of these, 89 (15%) were recorded as also receiving treatment to the supraclavicular region. Detailed RT records were obtained for 228 patients, of whom 185 (81.1%) received tangent-only treatment. Among 142 with sufficient records to evaluate tangent height, high tangents (cranial tangent border ≤ 2 cm from humeral head) were used in 50% of patients (33 of 66) randomly assigned to ALND and 52.6% (40 of 76) randomly assigned to SLND. Of the 228 patients with records reviewed, 43 (18.9%) received directed regional nodal RT using ≥ three fields: 22 in the ALND arm and 21 in the SLND arm. Those receiving directed nodal RT had greater nodal involvement (P < .001) than those who did not. Overall, there was no significant difference between treatment arms in the use of protocol-prohibited nodal fields. Conclusion Most patients treated in Z0011 received tangential RT alone, and some received no RT at all. Some patients received directed nodal irradiation via a third field. Further research is necessary to determine the optimal RT approach in patients with low-volume axillary disease treated with SLND alone.

scholarly journals EARLY COMPLICATIONS AFTER RADICAL OPERATIONS IN BREAST CANCER PATIENTS

2020 ◽  
Vol 1 ◽  
pp. 3-9
Author(s):  
Yuri Vinnyk ◽  
Vadym Vlasenko ◽  
Anna Baranova
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Wound Infection ◽  
Cancer Patients ◽  
Lymph Node Dissection ◽  
Early Period ◽  
Radical Mastectomy ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Dissection

Breast cancer is one of the most common malignancies in women. In many cases, a major component of complex treatment for breast cancer is surgery - radical mastectomy or radical breast resection. The aim of the work – to investigate the frequency and structure of complications after radical surgery with dissection of axillary lymph nodes in breast cancer patients. Material and methods. The baseline and surgical results of 147 women with breast cancer who underwent radical mastectomy or radical breast resection with lymph node dissection were analysed. Results. Complications in the early period after surgery for breast cancer were found in 76 (51.7 %), including postoperative extremity edema in 60 (40.8 %); lymphorrhea – in 37 (25.2 %), seroma – in 33 (22.4 %); wound infection in 18 (12.2 %), necrosis of the wound edges – in 15 (10.2 %) patients. Correlation of postoperative edema with almost all other complications was found, lymphorrhea and seroma were most associated with swelling and with each other; necrosis of edges with postoperative edema. Wound infection was significantly associated with lymphorrhea. Patients' age, stage of disease, and immunohistochemical type of tumour did not affect the development of complications. With increasing BMI, the incidence of complications increased significantly (χ2=9.530; p=0.009). The tendency to decrease the frequency of complications during reconstructive surgery was revealed (42.6 % versus 58.1 %, p=0.064), and adjuvant radiotherapy, on the contrary, contributed to the increase of complications (57.8 % versus 43.8 %, p=0.090). Conclusion. Radical operations with lymph node dissection in patients with breast cancer are characterized by a high frequency of early postoperative complications, mainly associated with disorders of lymphatic outflow, which indicates the need for a set of measures of preoperative preparation, improvement of surgical technique.

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