Development of sentinel node targeting technique in breast cancer patients

Dn, Krag; Ashikaga, Takamaru; Harlow, Seth P.; Dl, Weaver

doi:10.1016/s0899-7071(98)00038-2

Cited by 12 publications

(17 citation statements)

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“…Increasing the volume of tracer injected can increase the rate of successful identification of sentinel nodes to 100 percent, according to a report from one institution. 20 Increased volume, which increases the count rate of sentinel nodes (unpublished data), makes the nodes more readily apparent and should lower the false negative rate when the lesion is in the lateral half of the breast. Vital dyes that provide a visual aid [24][25][26] may be complementary to probeguided surgery and lower the false negative rate.…”

Section: Discussionmentioning

confidence: 99%

“…15 Alex and Krag described direct localization of sentinel nodes with radioactive tracers and a handheld gamma probe, demonstrating in an animal model that the radioactive-tracer and blue-dye methods were equally effective in locating lymph nodes. 16 Be-The New Eng land Jour nal of Medicine cause the preliminary results with radioactive tracers were encouraging in patients with melanoma 17,18 and patients with breast cancer, 19,20 we conducted a study in 11 centers to evaluate this method of identifying sentinel nodes in patients with breast cancer.…”

Section: Conclusion Biopsy Of Sentinel Nodes Can Predictmentioning

confidence: 99%

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The Sentinel Node in Breast Cancer — A Multicenter Validation Study

et al. 1998

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Section: Discussionmentioning

confidence: 99%

Section: Conclusion Biopsy Of Sentinel Nodes Can Predictmentioning

confidence: 99%

The Sentinel Node in Breast Cancer — A Multicenter Validation Study

et al. 1998

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“…In 1994 Giuliano et al (12) described SLN mapping in breast cancer using isosulfan blue dye. Subsequently sentinel lymphadenectomy was tested in breast cancer by Krag et al (23) using 99 Tc sulfur colloid. Many early studies, including a previous report from our institution (16), compared the accuracy of SLNB with conventional ALND, in which conventional ALND was performed in all patients following initial SLNB.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer

2003

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Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both 99Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty-three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty-three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (p = 0.036) and the presence of lymphatic/vascular invasion (LVI) (p = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (p = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER-2/neu and p53 status, S-phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section ...

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“…Therefore it is likely that the false‐negative rate is in part due to the inability to identify the appropriate SLN(s) correctly in all cases. Improvements in technique56, 57 may lower the false‐negative rate; however, it is highly unlikely that all false‐negative cases will be eliminated. Axillary lymph node disease can be reduced or in some cases eliminated with chemotherapy58 or radiation 59, 60.…”

Section: Discussionmentioning

confidence: 99%

Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma

Weaver

Krag

Ashikaga

et al. 2000

Cancer

210

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BACKGROUND Axillary lymph node status is a powerful prognostic factor in breast carcinoma; however, complications after axillary lymph node dissection are common. Sentinel lymph node biopsy is an alternative staging procedure. The sentinel lymph node postulate is that tumor cells migrating from the primary tumor colonize one or a few lymph nodes before colonizing subsequent lymph nodes. To validate this hypothesis, the distribution of occult and nonoccult metastases in sentinel and nonsentinel lymph nodes was evaluated. METHODS Original pathology material was reviewed from 431 patients enrolled on a multicenter validation study of sentinel lymph node biopsy in breast carcinoma patients. Paraffin embedded tissue blocks of sentinel and nonsentinel lymph nodes were obtained for 214 lymph node negative patients. Additional sections from 100 and 200 μm deeper into the paraffin block were examined for the presence of occult metastatic carcinoma. Both routine and cytokeratin immunohistochemical stains were employed. RESULTS Metastases were identified in 15.9% of sentinel lymph nodes and 4.2% of nonsentinel lymph nodes (odds ratio [OR] 4.3[ P < 0.001]; 95% confidence interval [95% CI], 3.5–5.4). Occult metastases were identified in 4.09% of sentinel lymph nodes and 0.35% of nonsentinel lymph nodes (OR 12.3 [P < 0.001]; 95% CI, 5.6–28.6). The overall case conversion rate was 10.3%. All the occult metastases identified were ≤ 1 mm in greatest individual dimension. The likelihood (OR) of metastases in nonsentinel lymph nodes was 13.4 times higher for sentinel lymph node positive than for sentinel lymph node negative patients (P < 0.001; 95% CI, 6.7–28.1). CONCLUSIONS The distribution of occult and nonoccult metastases in axillary lymph nodes validates the sentinel lymph node hypothesis. In addition, pathology review of cases confirmed the authors' previously reported finding that the sentinel lymph nodes are predictive of the final axillary lymph node status. Occult metastatic disease is more likely to be identified in sentinel lymph nodes, allowing future studies to focus attention on one or a few sentinel lymph nodes. However, the relation between occult metastatic disease in sentinel lymph nodes, disease free survival, and overall survival must be evaluated prior to endorsing the intensive analysis of sentinel lymph nodes in routine practice. [See editorial on pages 971–7, this issue.] Cancer 2000;88:1099–1107. © 2000 American Cancer Society.

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Development of sentinel node targeting technique in breast cancer patients

Cited by 12 publications

References 0 publications

The Sentinel Node in Breast Cancer — A Multicenter Validation Study

The Sentinel Node in Breast Cancer — A Multicenter Validation Study

Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer

Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma

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