Axillary Recurrence Rate After Negative Sentinel Node Biopsy in Breast Cancer

Bergkvist, Leif; Boniface, Jana de; Jönsson, Per‐Ebbe; Ingvar, Christian; Liljegren, G; Frisell, Jan

doi:10.1097/sla.0b013e318153ff40

Cited by 84 publications

(38 citation statements)

References 35 publications

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“…Langer et al [34] revealed 96% of patients with ITC from SLN biopsy undergoing delayed ALND to have specimens free of macro-metastases and without benefit of ALND. SLN ITCpositive patients who did not receive ALND were shown to have a relapse rate between 0 and 3.6% [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Hirche

Murawa

Mohr

et al. 2010

Breast Cancer Res Treat

215

150

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Background: Sentinel lymph node (SLN) biopsy is a selective approach to axillary staging of breast cancer with reduced morbidity. Current detection methods including radioisotope and blue dye show good results but some drawbacks are remaining. Indocyanine green (ICG) fluorescence detection was evaluated as a new method for SLN biopsy in breast cancer allowing both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLN. Methods: Forty-three women with clinically node negative breast cancer received subareolar injection of ICG for fluorescence detection of SLN. All patients underwent either planned axillary lymph node dissection (ALND) with SLN biopsy or selective SLN biopsy to determine need for ALND. Clinical feasibility, detection rate, sensitivity, and axillary recurrence after isolated SLN biopsy were analyzed. Results: Overall ICG fluorescence imaging identified 2.0 SLN in average in 42 of 43 patients (detection rate: 97.7%). Metastatic involvement of the SLN was found in 17 of 18 nodal positive patients by conventional histopathology (sensitivity: 94.4%). Immunohistochemistry revealed isolated tumor cells in five further cases. There was only one false-negative case in 43 patients (5.6%). In 17 of 23 overall nodal positive patients, the SLN was the only positive lymph node. After a median follow-up of 4.7 years none of the patients presented with axillary recurrence. Conclusion: ICG fluorescence imaging is a new method for SLN biopsy in breast cancer with acceptable sensitivity and specificity comparable to conventional methods. One advantage of this technique is that it allows transcutaneous visualization of lymphatic vessels and intraoperative lymph node detection without radioisotope.Keywords Sentinel lymph node biopsy Á Breast cancer Á Indocyanine green (ICG) Á Fluorescence imaging Á Surgery Abbreviations ALND Axillary lymph node dissection ICG Indocyanine green SLN Sentinel lymph node

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Section: Discussionmentioning

confidence: 99%

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Hirche

Murawa

Mohr

et al. 2010

Breast Cancer Res Treat

215

150

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“…15 Table 3 summarizes the recurrence rates of publications with at least 500 patients. [14][15][16][17][18][19][20][21][22] An interesting note should be made of the meta-analysis in that only one paper had follow-up longer than 5 years (65 months). 23 The recurrence rate in this group was higher than in a majority of the papers published in the past (2.68%).…”

Section: P-valuementioning

confidence: 99%

Erratum to: Axillary Recurrence Rate Following Negative Sentinel Node Biopsy for Invasive Breast Cancer: Long-Term Follow-Up

Kiluk

Santillan

et al. 2009

Ann Surg Oncol

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Objective. Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) as the staging procedure for breast cancer. SLN biopsy causes less morbidity and is more cost effective than complete ALND. Lymphatic mapping and SLN biopsy have a low false-negative rate, but long-term outcomes in large consecutive series of patients are unavailable. Methods. Retrospective review of a prospectively accrued institutional breast cancer database was performed. The initial mapping of 1,528 patients with invasive breast cancer that demonstrated negative sentinel node biopsy and no axillary dissection in 1,530 cases between January 1995 and June 2003 were collated and reviewed to achieve a long-term follow-up. These 1,528 patients were reviewed for follow-up time, local recurrences, distant metastases, and survival. Results. A total of 1,530 consecutively mapped invasive breast cancer cases had negative SLN biopsy and no ALND. The mean invasive tumor size of was 1.40 cm. Of patients, 1,212 (79.2%) underwent lumpectomy and 318 (20.8%) underwent mastectomy. Median follow-up was 63 months (range 0.1-144 months). There have been 4 (0.26%) cases presenting with local axillary recurrences, 54 (3.53%) cases presenting with local recurrences in the ipsilateral breast/chest wall, and 24 (1.57%) cases presenting with distant metastases. Conclusion. These data confirm that SLN biopsy is an effective and safe alternative to ALND for detection of nodal metastases in patients with invasive breast cancer and validates its use as the standard tool for nodal staging.The status of the axillary nodal basin is one of the most important prognostic indicators for recurrence and survival in patients with breast cancer.1,2 Until the introduction of sentinel node mapping in the early 1990 s, the standard operation for staging the axilla involved level I and II axillary nodal dissection. This operation provided maximum local control of cancer while providing valuable staging information that guided additional treatment choices and provided prognostic information for patients and clinicians alike. Unfortunately, the advantages of axillary dissection did not come without significant morbidity. Acute and chronic lymphedema, paresthesia and pain from intercostal and intercostal-brachial nerve injury, and seromas from axillary dissections made the ramifications of this surgery some of the most significant complaints relating to breast cancer treatment. As screening mammography and breast cancer awareness increased, the percentage of patients with positive lymph nodes decreased to approximately 30%. 4 As a result, 70% of patients with breast cancer were taking on the The online version of the original article can be found under

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“…The axillary surgery, either by axillary lymph-node dissection (ALND) or by sentinel lymph-node dissection is an important procedure in the surgical treatment of breast cancer, allowing a prognostic purpose, reducing recurrence and contributing to plan an appropriate adjuvant therapy program [1][2][3][4][5]. Axillary surgery also has post-operative morbidity including early and long term complications as bleeding, infection at the operation site, axillary web syndrome (AWS), arm or shoulder weakness and motion restriction, swelling, numbness, pain and lymphedema [6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Axillary web syndrome after axillary dissection in breast cancer: a prospective study

Torres-Lacomba

Moral

Zazo

et al. 2009

Breast Cancer Res Treat

102

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International audienceThe axillary web syndrome is a self-limiting and frequently overlooked cause of significant morbidity in the early post-operative period after breast cancer axillary surgery, which is characterized by axillary pain that runs down the medial arm, limited shoulder range of motion affecting mainly shoulder abduction, and cords of subcutaneous tissue extending from axilla into the medial arm, made visible or palpable and painful by shoulder abduction. We evaluated the incidence of axillary web syndrome after axillary lymph-node dissection. Altogether 116 patients who underwent axillary lymph-node dissection were assessed for axillary web syndrome. Range of shoulder abduction, pain, and the subjective feeling of tightness along the arm were recorded. Axillary web syndrome was found in 56 patients, which means an incidence of 48.3% (CI95%: 38.9, 57.7). Axillary web syndrome is a significant self-limited cause of morbidity of axillary surgery ocurring not only in the early post-operative period

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Axillary Recurrence Rate After Negative Sentinel Node Biopsy in Breast Cancer

Cited by 84 publications

References 35 publications

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Erratum to: Axillary Recurrence Rate Following Negative Sentinel Node Biopsy for Invasive Breast Cancer: Long-Term Follow-Up

Axillary web syndrome after axillary dissection in breast cancer: a prospective study

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