Impact of the axillary nodal status on sentinel node mapping in breast cancer and its relevance for technical proceeding

Heuser, Thomas; Rink, Thomas; Weller, Esra; Fitz, H.; Zippel, Hans-Herbert; Kreienberg, R.; Kühn, Thorsten

doi:10.1023/a:1010619223296

Cited by 26 publications

(12 citation statements)

References 19 publications

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“…However, indirect effects of tumor infiltration can manifest as SLS findings. A few previous studies reported a correlation between decreased SLN uptake and increased risk of axillary involvement (13)(14)(15). A reasonable explanation for this phenomenon would be that the lymphatics become progressively infiltrated with tumor cells, blocking the passage of radiotracers (13).…”

Section: Discussionmentioning

confidence: 97%

Predicting Nonsentinel Lymph Node Metastasis Using Lymphoscintigraphy in Patients with Breast Cancer

et al. 2012

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Several models for predicting the likelihood of nonsentinel lymph node (NSLN) metastasis using histopathologic parameters in sentinel-positive breast cancer patients have been proposed. In this study, we established a new model that uses sentinel lymphoscintigraphic findings and histopathologic parameters as covariates and assessed its predictive performance. Methods: The analysis included breast cancer patients (n 5 301 women) who underwent sentinel lymphoscintigraphy (SLS) using 99m Tc-labeled human serum albumin, had sentinel lymph node biopsy results positive for metastasis, and subsequently underwent complete axillary lymph node dissection. First, we devised a grading system relating SLS patterns to the risk of NSLN metastasis positivity. Second, we developed a multivariate logistic regression model for the prediction of NSLN metastasis using the SLS pattern and histopathologic parameters as covariates and compared its performance with that of the extensively validated Memorial Sloan-Kettering Cancer Center model using receiver-operating-characteristic curve analysis. Results: The SLS visual grade was strongly correlated with the presence of NSLN metastases. A well-calibrated prediction model for NSLN metastasis was constructed using SLS grade and histopathologic findings. The mean area under the curve of our model was 0.812, which is significantly greater than that of the Memorial Sloan-Kettering Cancer Center model (P , 0.001). A nomogram was drawn to facilitate the application of our model. Conclusion: SLS can aid in predicting NSLN metastasis in patients with breast cancer. Our model performed better than did established prediction models. Thereduct ion of the extent of surgery has been a recent continuous trend in breast cancer treatment. Breast-conserving surgery and sentinel lymph node biopsy (SLNB) techniques have largely replaced modified radical mastectomy and systematic axillary dissection for early-stage breast cancer patients. SLNB facilitates the assessment of axillary lymph node (LN) status with high negative predictive value in patients with clinically node-negative early-stage breast cancer. When positive LN metastasis is detected by SLNB, the patient then undergoes complete axillary LN dissection (ALND). However, previous reports suggest that no additional LN metastasis is found on axillary dissection in approximately 50%-65% of such patients (1,2). Therefore, more than half of patients positive for sentinel lymph node (SLN) metastasis will have unnecessary ALND under the current guidelines.Many studies concerning the predictive factors for additional LN metastasis in SLN-positive patients have been published. Several centers have developed models for predicting additional LN metastasis based on histopathologic findings (3-7), but these usually perform suboptimally. For example, the receiver-operating-characteristic (ROC) curve analysis of the Memorial Sloan-Kettering Cancer Center (MSKCC) model (3), one of the most extensively validated models, shows an area under the curve (AUC) of 0. 72...

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Section: Discussionmentioning

confidence: 97%

Predicting Nonsentinel Lymph Node Metastasis Using Lymphoscintigraphy in Patients with Breast Cancer

et al. 2012

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“…Our data collection started in the soon after the establishment of SLNB [21]. Since that time, numerous randomized controlled multicenter trials confirmed the performance and precision of SLNB as a surgical axillary staging procedure.…”

Section: Discussionmentioning

confidence: 99%

“…In this multicentered research approach, we retrospectively analyzed data from 1,214 patients diagnosed with T1-T2 invasive breast cancer undergoing primary surgery at Hanau City Hospital Breast Cancer Center and 2 other cooperating German clinics of obstetrics and gynecology (Hanau City Hospital (n = 880); MainKinzig-Hospital, Gelnhausen (n = 226); St. Vinzenz Hospital, Hanau (n = 168) between 1998 and 2011. The SLNB was evaluated and established at Hanau City Hospital [21] and has rapidly become part of daily routine. Rink et al [22,23] established standardized protocols for SLN detection and found that scintigraphical visualization of SLNs is influenced by metastatic involvement.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of Sentinel Lymph Node Biopsy and Axillary Lymph Node Dissection for Breast Cancer Treatment Concepts - a Retrospective Study of 1,214 Breast Cancer Patients

et al. 2017

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Background: Most breast cancer patients require lumpectomy with axillary sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). The ACOSOG Z0011-trial failed to detect significant effects of ALND on disease-free and overall survival among patients with limited sentinel lymph node (SLN) metastases. Intense dose-dense chemotherapy and supraclavicular fossa radiation (SFR) are indicated for patients with extensive axillary metastases. In this multicentered study, we investigated the relevance of ALND after positive SLNB to determine adequate adjuvant therapy. Methods: We retrospectively analyzed data from 1,214 patients with clinically nodal negative T1-T2 invasive breast cancer undergoing surgery at Hanau City Hospital Breast cancer center. Results: 681 patients underwent ALND after SLNB. 20 patients (8.5%) from the group with 1 or 2 SLN metastases (n = 236) showed more than 3 lymph node metastases after ALND. 13 patients (31.7%) from the group with more than 2 SLN metastases (n = 41) were diagnosed with a minimum of 4 axillary lymph node metastases after ALND. Conclusions: In 8.5% of the patients with 1 or 2 SLN metastases, ALND detected more than 3 macrometastases, setting the indication for intense dose-dense chemotherapy and SFR. More than 2 SLN metastases, T stage and grading predict lymph node metastases.

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“…In breast cancer, where axillary nodal drainage is almost always evident,lymphoscintigraphyincreasesthetimeandcostofSLN mapping but does not improve the SLN identification rate [11].Anotheruseoflymphoscintigraphyistoensuresafetyby meansofreducingfalse-negatives [12].Whiledrainagetothe internalmammarynodesissometimesevident,itisnearlyalways accompanied by concomitant axillary nodal drainage [13].Therefore,preoperativelymphoscintigraphymighthave limitedutilityforsurgeonswhodecidenottoremoveinternal mammarySLN [14].…”

Section: Technical Issues In Sln Biopsymentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Breast Cancer: A Systematic Review

2010

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Lymphatic mapping and sentinel lymphadenectomy have become an important tool for axillary lymph node staging in women with early-stage breast cancer. Many issues such as indications, usefulness, or best method of performing a sentinel node biopsy need to be addressed. Multiple studies now confirm that sentinel lymphadenectomy accurately stages the axilla and is associated with less morbidity than axillary dissection. Blue dye, radiocolloid, or both can be used to identify the sentinel node, and several injection techniques may be used successfully. Many patient factors previously thought to affect accuracy of the procedure have now been shown to be of limited significance. This paper’s main purpose is to present the pros and cons of the sentinel lymph node biopsy, and to elucidate all questions regarding to the matter by reviewing the current medical literature.

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Impact of the axillary nodal status on sentinel node mapping in breast cancer and its relevance for technical proceeding

Cited by 26 publications

References 19 publications

Predicting Nonsentinel Lymph Node Metastasis Using Lymphoscintigraphy in Patients with Breast Cancer

Predicting Nonsentinel Lymph Node Metastasis Using Lymphoscintigraphy in Patients with Breast Cancer

Evaluation of Sentinel Lymph Node Biopsy and Axillary Lymph Node Dissection for Breast Cancer Treatment Concepts - a Retrospective Study of 1,214 Breast Cancer Patients

Sentinel Lymph Node Biopsy in Breast Cancer: A Systematic Review

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