Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer

Jansen, Liesbeth; Doting, M. H. E.; Rutgers, Emiel J. T.; Vries, Jakob de; Olmos, Renato A. Valdés; Nieweg, Omgo E.

doi:10.1046/j.1365-2168.2000.01437.x

Cited by 132 publications

(80 citation statements)

References 30 publications

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“…These patients are described in detail separately. 13 The sentinel lymph node was identified during the operation in 126 patients (93%). A total of 224 sentinel lymph nodes was harvested, with an average of 1.7 sentinel lymph nodes per patient (range, 1-4).…”

Section: Resultsmentioning

confidence: 99%

Lymphatic mapping with intralesional tracer administration in breast carcinoma patients

Doting

Jansen

Nieweg

et al. 2000

Cancer

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Section: Resultsmentioning

confidence: 99%

Lymphatic mapping with intralesional tracer administration in breast carcinoma patients

Doting

Jansen

Nieweg

et al. 2000

Cancer

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“…Esta técnica é baseada no princípio do envolvimento progressivo dos linfonodos axilares pelas células tumorais, sendo a axila o principal local de acometimento linfonodal metastático. O LS fora da axila pode ocorrer em até 16,8% dos casos, porém o impacto clínico é limitado, modificando a conduta em apenas 3% dos casos 13 .…”

Section: Discussionunclassified

“…Em publicações baseadas em bancos de dados, a ocorrência do linfonodo IM varia de 0,6 14 a 2% 8,11 e a ocorrência do LS-IM na ordem de 0,2 10 a 2,6% 13 . Por outro lado, a prevalência desse achado na anatomia patológica é de 1 a 28% 7, 15 .…”

Section: Discussionunclassified

Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora?

Vieira¹,

Viviani²,

Ferreira³

et al. 2012

Rev. Bras. Ginecol. Obstet.

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ResumoA pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS) extra-axilar e intramamário (IM) ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação. AbstractThe sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM) sentinel lymph node (SLN) occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

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“…The prognostic value of IM lymph node involvement alone is similar to the value of axillary lymph node involvement (Noguchi et al, 1993;Veronesi et al, 1999). However, the importance of finding a non-axillary sentinel node will mainly be dependent on it being the only involved node which occurs in less than 10% of cases where the IM nodes are involved (Donegan, 1977;Jansen et al, 2000). A small proportion of axillary node negative patients have IM node metastases but today, we are not able to predict which patients these are.…”

mentioning

confidence: 99%

“…The lack of interest in the IM node means that many surgeons today have no experience of the procedure nor have they had to deal with the complications of the procedure such as haemo-or pneumothorax (Bembenek and Schlag, 2000). However, a few studies have shown that non-axillary sentinel node biopsy can be performed with few side effects and a relatively high success ratio (Jansen et al, 2000;Noguchi et al, 2000;Dupont et al, 2001) although this has to be confirmed in other centres and countries.…”

mentioning

confidence: 99%

Will early detection of non-axillary sentinel nodes affect treatment decisions?

Wärnberg

Bundred

2002

Br J Cancer

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Axillary lymph node involvement is the best prognostic factor for breast cancer survival. Staging breast cancers by axillary dissection remains standard management and is part of the UK national guidelines for breast cancer treatment. In the presence of involved axillary lymph nodes best treatment has been shown to be axillary clearance (Fentiman and Mansell, 1991), but clearly for women whose nodes are uninvolved avoidance of morbidity is optimal and this will be achieved by minimal dissection of the axilla. Thus, for node-negative women the introduction of the sentinel node biopsy technique may revolutionise the approach to the axilla. These will be women with mammographic screen detected small well and moderately differentiated tumours (Hadjiloucas and Bundred, 2000). The impact of sentinel node biopsy in women who have symptomatic large tumours is unproven, and around half of these women will require a second procedure to clear their axilla or radiotherapy as treatment. Even for those women found to have involved sentinel lymph nodes the ability to use early systemic chemotherapy followed by axillary clearance or radiotherapy may provide long-term survival gains. Sentinel node biopsy should not, however, become routine practice until randomised controlled trials have proven its benefit and safety in reducing morbidity. Several randomised controlled trials (including ALMANAC) are currently underway. British Journal of Cancer (2002) Sentinel node lymphoscintigraphy leads to the visualisation of hot radioactive nodes in sites other than the axilla in about 13% of all cases (range 2 -35% in series using different injection techniques) (Cserni and Szekeres, 2001). Tanis and co-workers in this issue of the Journal report the detection of non-axillary sentinel nodes and its impact on treatment. Earlier studies where internal mammary (IM) lymph node dissection has been performed have shown IM node involvement in about 23% of breast cancer patients (Cserni and Szekeres, 2001). In the study by Tanis et al (this issue) the proportion of detected non-axillary node metastases was about 5% among all patients, which is similar to findings in other studies where lymphoscintigraphy has been used (Cserni and Szekeres, 2001;Dupont et al, 2001). Only patients with a visualised non-axillary sentinel node were biopsied but this low proportion of metastases might also reflect that breast cancer is detected at an earlier stage today. The proportion of involved nodes was 20 -25% among those patients who underwent an IM or other nonaxillary sentinel node biopsy.Centrally and medially located tumours have been reported to have a higher proportion of IM lymph node metastases compared to lateral tumours (Manji, 1982). However, in the overview of series undergoing extended radical mastectomy (Cserni and Szekeres, 2001) the range of IM lymph node involvement was 13.3 -35.3% in lateral tumours and 19.5 -32.6% in central and medial tumours. Tumour location alone is therefore not a reliable indicator of risk for IM lymph node metastases (Ur...

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Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer

Cited by 132 publications

References 30 publications

Lymphatic mapping with intralesional tracer administration in breast carcinoma patients

Lymphatic mapping with intralesional tracer administration in breast carcinoma patients

Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora?

Will early detection of non-axillary sentinel nodes affect treatment decisions?

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