Management of the Axilla after Neoadjuvant Systemic Therapy

Stankowski-Drengler, Trista J.; Neuman, Heather B.

doi:10.1007/s11864-020-00755-7

Cited by 5 publications

(3 citation statements)

References 39 publications

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“…In most cases, the standard surgical treatment for patients with an initially positive axilla and indicated for NAST is ALND, because NAST can increase the false negative rate (FNR) of SLNB [8][9][10]. Further research into the feasibility of Post-NAST SLNB in pathologically proven node-positive cases before NAST is required to avoid unnecessary ALND in patients that show a pathologic complete axillary response [11].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Axillary Lymph Node Marking with Magseed® before and after Neoadjuvant Systemic Therapy in Breast Cancer Patients: MAGNET Study

et al. 2022

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Background. Due to the high false negative rate (FNR) associated with sentinel lymph node biopsy (SLNB) after neoadjuvant systemic therapy (NAST), the standard surgical treatment for patients with an initially positive axilla and indicated for NAST is axillary lymph node dissection (ALND). To avoid unnecessary ALND, this multicenter, prospective, observational study aimed to determine the effectiveness and ease of using magnetic seeds (Magseed®) for targeted axillary dissection (TAD) when the seeds are placed before or after NAST. Materials and Methods. We recruited 81 patients diagnosed with T1-T3 breast cancer, with clinically/radiologically positive nodal involvement (cN1, 75 patients with 1–3 nodes suspected nodes and 6 patients with up to 4 suspected nodes) prior to NAST. Positive nodes detected by fine-needle aspiration biopsy or core needle biopsy were marked with a stainless steel marker coil and after NAST with Magseed® prior to surgery (Post-NAST group), or directly with Magseed® before NAST (Pre-NAST group). The correlation between lymph nodes marked with Magseed® (MLNs) and sentinel lymph nodes (SLNs) was calculated based on pathologic assessment with the OSNA assay (Sysmex Corporation, Kobe) or conventional sectioning and staining techniques according to the standard protocols of each center. Results. All magnetic seeds were successfully identified and retrieved in just over 10 minutes of surgery, guided by the Sentimag® magnetometer system. The overall concordance rate between MLNs and SLNs was 81.5%, and the concordance between MLNs and SLNs with metastasis was 93.8%. Metastasis was detected in 54.3% of the MLNs compared with 48.1% of SLNs. In cases that presented negative MLN and negative SLN (negative TAD), the FNR was 0%. No significant differences were found between the Post-NAST and Pre-NAST groups. Conclusions. Our results validate the use of Magseed® for long-term marking of axillary lymph nodes and show that when used in combination with SLNB for TAD, a FNR of 0% can be achieved, avoiding unnecessary ALND.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Axillary Lymph Node Marking with Magseed® before and after Neoadjuvant Systemic Therapy in Breast Cancer Patients: MAGNET Study

et al. 2022

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“…Current guidelines recommend the use of dual-mapping technique for SLNB in post-PST patients, as a means of reducing the FNR [ 25 ]. Furthermore, any isolated tumor cell counts in the decision to perform ALND [ 26 , 27 ]. Thus, a combined-mapping technique (such as fhSPECT combined with the γ-probe) seems appropriate for staging these patients.…”

Section: Discussionmentioning

confidence: 99%

Study on intraoperative localization of sentinel lymph nodes using freehand SPECT in breast cancer patients.

Αργέντου¹,

Iliopoulos²,

Verras³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction The diagnostic and therapeutic approach to axillary lymph nodes is considered indispensable in the treatment of breast cancer patients. Aim To investigate the effectiveness of 3D freehand SPECT (fhSPECT) in sentinel lymph node (SLN) mapping in breast cancer, compared with the use of a conventional gamma probe. Material and methods We retrospectively compared the fhSPECT lymph node mapping modality, with gamma probe detection in early-stage, clinically node-negative breast cancer patients, with biopsy-confirmed malignancy. The two techniques were compared based on the average number of LNs excised per axilla. The duration of SLN mapping was also compared between the two groups. The performance of the two methods on obese and post-systemic therapy patients was evaluated. FhSPECT was used in 150 cases, while the gamma probe was employed in 50 cases. Results FhSPECT detected at least 3 nodes in 83.3% of the patients vs. 72.0% with the γ -probe (p = 0.107). The mean number of SLNs excised per axilla was 3.66 using the γ -probe and 4.18 with fhSPECT (p = 0.03). The average surgical time was 39 ±7 min with the γ -probe and 37.54 ±17 min with fhSPECT (p = 0.228). Sentinel lymph node biopsy (SLNB) mean surgical time evolved from 40.2 ±20.77 min to 32.35 ±10.46 min (p = 0.033). In obese patients, a reduction in surgical times was noted from 45.5 ±3.09 min to 44.04 ±20.9 (p = 0.27), in addition to a significant increase in average LN detection in the fhSPECT group (4.26 ±1.44) compared to the γ -probe group (3.2 ±1.65) (p = 0.043). Conclusions The use of the fhSPECT modality is effective and safe, and, when compared to the γ -probe, has significant advantages in SLN mapping.

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“…Las pacientes con tumores de mama grandes (mayores de 5 cm) con compromiso clínico a nivel axilar, son candidatas para recibir quimioterapia antes del tratamiento quirúrgico. Esto con la finalidad de reducir el volumen tumoral y poder realizar procedimientos quirúrgicos con más facilidad y en muchas oportunidades cada vez menos radicales (6,7).…”

Section: Introductionunclassified

Cáncer de mama en la provincia. La axila postneoadyuvancia

R¹

2023

Gac Méd Caracas

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El tratamiento quirúrgico del cáncer de mama post-neoadyuvancia como primera línea de tratamiento ha experimentado numerosos cambios en los últimos años. El objetivo de esta investigación radicó en determinar la respuesta (presencia y/o ausencia) de ganglios axilares en un grupo consecutivo de pacientes que recibieron diversos esquemas de quimioterapia neoadyuvante. Como objetivo secundario, la existencia de dependencia o independencia entre las diversas variables con respecto al estatus ganglionar axilar. Se realiza una investigación observacional, retrospectiva y de corte transversal en un grupo consecutivo de pacientes entre junio 2021 y agosto 2022 que asistieron al servicio de oncología del Hospital Universitario Dr. Luis Razetti de Barinas. Luego de recibir quimioterapia, a todas se les practicó una mastectomía radical modificada. Los datos fueron incluidos y analizados mediante el paquete estadístico para ciencias sociales SPSS v.22.

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Management of the Axilla after Neoadjuvant Systemic Therapy

Cited by 5 publications

References 39 publications

Evaluation of Axillary Lymph Node Marking with Magseed® before and after Neoadjuvant Systemic Therapy in Breast Cancer Patients: MAGNET Study

Evaluation of Axillary Lymph Node Marking with Magseed® before and after Neoadjuvant Systemic Therapy in Breast Cancer Patients: MAGNET Study

Study on intraoperative localization of sentinel lymph nodes using freehand SPECT in breast cancer patients.

Cáncer de mama en la provincia. La axila postneoadyuvancia

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