Differences in Sentinel Lymph Node Pathology Protocols Lead to Differences in Surgical Strategy in Breast Cancer Patients

Bolster, Marieke J.; Bult, Peter; Schapers, R.F.M.; Meijer, Jos W. R.; Strobbe, Luc J. A.; Berlo, C.L.H. van; Klinkenbijl, Jean H. G.; Peer, Petronella G. M.; Wobbes, Theo; Tjan‐Heijnen, Vivianne C. G.

doi:10.1245/s10434-006-9084-y

Cited by 23 publications

(15 citation statements)

References 18 publications

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“…The extensive pathology workup of SLNs has resulted in a frequent observation of micrometastases [2,6]. The clinical relevance of small lymph node metastasis (TNMstage N1mi) is still under debate.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, various other protocols are in use by different laboratories [7]. The pathology protocol may well have an effect on the probability to detect micrometastases and consequently influence treatment [2,13]. Using a mathematical model, the probability of finding micrometastases within a SLN, examined according to the national guidelines, was calculated.…”

Section: Introductionmentioning

confidence: 99%

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Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

et al. 2008

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Due to the extensive pathologic evaluation of the sentinel lymph node (SLN), micrometastases are frequently observed. If micrometastases are clinically relevant, the histopathologic examination of SLNs should be sensitive enough to detect them. The probability of detecting micrometastases was calculated when examining the SLN according to the current Dutch pathology protocol and strategies evaluated to optimize the chance of detection. The dimensions of 20 consecutive axillary SLNs in patients with cT1-2N0 breast cancer were measured. In a mathematical model, the probability of detecting micrometastases in a SLN was calculated. Similarly, strategies to optimize the probability of detecting micrometastases were explored. When applying the pathology guidelines, the calculated probability to detect a micrometastasis was 18% for a 200-microm micrometastasis and 69% for a 2.0-mm metastasis in a median sized SLN. To detect the smallest micrometastasis in a median-sized SLN with a 95% probability, the interval between the sections must be decreased to 200 microm, and 20 levels from both halves must be examined. Given a prognostic significance of micrometastases, our current pathology guidelines are not sensitive enough. The number of sections should be increased, while the interval between cuts should be no more than 200 microm.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

et al. 2008

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“…[8][9][10][11] Indeed, the more detailed protocols have been shown to up-stage some patients from lymph node negative to lymph node positive, an up-staging that will affect the treatment of patients, as has been shown for breast cancer. 13 In breast cancer, staging includes metastasis size estimates 14 and thus this parameter influences the choice of treatment. Similarly, in melanoma, increasing evidence is emerging to support the view that SLN metastasis size is of prognostic significance.…”

mentioning

confidence: 99%

Stage migration after minor changes in histologic estimation of tumor burden in sentinel lymph nodes

Riber-Hansen¹,

Nyengaard²,

Hamilton-Dutoit³

et al. 2009

Cancer

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Extraneural metastases of ependymoma are rare, and have been reported in the lungs, lymph nodes, pleura, mediastinum, liver, diaphragmatic muscle, and bone. We report a case of anaplastic ependymoma with distant metastases to the vertebral bones, lungs, liver, and lymph nodes following treatment with bevacizumab. Recent research has hypothesized that angiogenic tumors may develop means of resistance to antiangiogenic therapies, and some evidence suggests potential for antiangiogenic therapies to promote additional means for cancer spread. Nevertheless, antiangiogenic therapies continue to demonstrate potential as potent therapies for the treatment of many cancers, and should continue to be researched for future uses. Pediatr Blood Cancer 2013; 60: 143–145. © 2012 Wiley Periodicals, Inc.

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“…Bols ter et al and Co u fal et al sta ted that the in ciden ce of n-SLN me tas ta ses was re la ted to the si ze of the SLN me tas ta ses. 18,19 The re sults of a number of stu di es in the li te ra tu re indicate a di rect relationship bet we en SLN me tas ta sis and age, pri mary tumor di a me ter, lympha tic in va si on and ve no us/vascu lar in va si on. 20,21 Tur ner et al sta ted that pri mary tu mor di a me ter indicated a high risk for SLN me tasta sis.…”

Section: Discussionmentioning

confidence: 99%

“…The cli ni cal sig ni fi can ce and ma na gement of pa ti ents af ter di ag no sis of mic ro me tas ta ses or ITCs in the SLNs ha ve re ma i ned a po int of contro versy. 18 Wa da et al re por ted that pa ti ents with mic ro me tas ta ses sho uld be given ad ju vant systemic the rapy. 22 ITCs are now ge ne rally be li e ved to be of li mi ted prog nos tic sig ni fi can ce and are ca tego ri zed as no de-ne ga ti ve di se a se and re qu i re no furt her tre at ment.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Characteristics of Sentinel Lymph Node Biopsy in Breast Carcinoma: Uludağ University Faculty of Medicine Experience

Elezoğlu¹,

Tolunay²,

Taşdelen³

et al. 2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : No wa days, sen ti nel lymph no de (SLN) bi opsy is a stan dard ap pro ach giving information abo ut sta tus of the axil lary lymph no des. Se ve ral fac tors af fect me tas ta sis to SLN. In our ca se, we aimed to in dica te his to pat ho lo gi cal pa ra me ters that af fect SLN and non-sen ti nel lymph no de (n-SLN) me tas ta sis, the im portan ce of fro zen sec ti on to de ter mi ne me tas ta sis and im mu no his toc he mistry met hod for his to pat ho lo gi cal exa mi na ti ons. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : In Ulu dag Uni ver sity Fa culty of Me di ci ne, 265 ca ses who had SLN bi op sies we re ret ros pec ti vely exa mi ned. Fro zen sec ti ons, per ma nent sec ti ons and sec ti ons with im mu no his toc he mistry we re fo und out from the arc hi e ve. Then, pre pa ra ti ons we re re-exa mi ned by ex pert pat ho lo gists on bre ast pat hology. R Re e s su ul lt ts s: : The me an age of the ca ses was 53 ye ars. The most frequently ob ser ved tu mor type was in va si ve ductal car ci no ma. Most of the ca ses ha d nuc le ar gra de 2. One hundred ca ses are di ag no sed as ma lig nant. As a re sult of imp le men ta ti on of se ri al sec ti ons and im mu no his toc he mistry to 12 ca ses wit ho ut me tas ta sis, mac ro-me tas tasis in four ca ses, mic ro-me tas ta sis in six ca ses and fi nally iso la ted tu mo ur cells in two ca ses we re de ter mi ned. In pri mary bre ast tu mor, the pre sen ce of ve no us/vas cu lar in va si on (p= 0.021), lympha tic in va si on (p< 0.001), in crea sed pri mary tu mor di a me ter (p= 0.001) and in cre a sed age (p= 0.026) increased SLN me tas ta sis. In pri mary breast tu mor, the pre sen ce of pe ri ne u ral in va si on (p= 0.033) and lympha tic in va si on (p= 0.045), in cre a sed tu mor di a me ter (p= 0.001), and in cre a sed num ber of po si ti ve SLNs (p= 0.015) ca u sed an in cre a se in n-SLN me tas ta sis. C Co on nc c l lu u s si i o on n: : SLN bi opsy is a simp le and re li ab le met hod. In our study, we fo und sta tis ti cally significant re sults bet we en SLN me tas ta sis and age, pri mary tu mor di a me ter, lympha tic in va si on and ve no us/vas cu lar in va si on. Be sides, sta tis ti cally sig ni fi cant re la ti ons hips were fo und bet we en n-SLN me tas ta sis and pri mary tu mor di a me ter, pe ri ne u ral in va si on and lympha tic in va si on as well. In tra o pe ra ti ve analy sis of SLN is very important for sta ging of bre ast car ci no ma and prog no sis. Mo re o ver, ac cu racy of di ag no sis in cre a ses with the app li ca ti ons of se ri al secti on and im mu no his toc he mi cal met hod. K Ke ey y W Wo or rd ds s: : Sen ti nel lymph no de bi opsy; bre ast ne op lasms; pat ho logy Ö ÖZ ZE ET T A Am ma aç ç: : Gü nü müz de sen ti nel lenf no du (SLN) bi yop si si ak sil ler lenf nod la rı nın du ru mu hak kın da bil gi ve ren stan dart bir yak la şım dır. SLN me tas ta zı nı çe şit li fak tör ler et ki ler. Ya zı mız da, SLN ve non sentinel lenf n...

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Differences in Sentinel Lymph Node Pathology Protocols Lead to Differences in Surgical Strategy in Breast Cancer Patients

Abstract: Differences in SN pathology protocols between hospitals do have a substantial effect on SN findings and subsequent surgical treatment strategies. Whether ultrastaging and, thus, additional surgery can offer better survival remains to be determined.

Cited by 23 publications

References 18 publications

Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

Stage migration after minor changes in histologic estimation of tumor burden in sentinel lymph nodes

Histopathologic Characteristics of Sentinel Lymph Node Biopsy in Breast Carcinoma: Uludağ University Faculty of Medicine Experience

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