Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center

Garcia–Etienne, Carlos A.; Ferrari, Alberta; Valle, Angelica Della; Lucioni, Marco; Ferraris, Elisa; Giulio, Giuseppe Di; Squillace, Luigi; Bonzano, Elisabetta; Lasagna, Angioletta; Rizzo, Gianpiero; Tancredi, Richard; Foglieni, Andrea Scotti; Dionigi, Francesca; Grasso, Maurizia; Arbustini, Eloisa; Cavenaghi, Giorgio; Pedrazzoli, Paolo; Filippi, Andrea Riccardo; Dionigi, Paolo; Sgarella, Adele

doi:10.1016/j.ejso.2019.08.013

Cited by 29 publications

(18 citation statements)

References 48 publications

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“…3 The sentinel lymph node (SLN) is the first lymph node that receives lymphatic drainage from an organ or tissue, through which the tumor metastasizes to other lymph nodes. 4,5 Lymph node skipping metastasis rarely occurs in the tumor. Therefore, the pathological status of axillary SLNs in breast cancer can represent the whole lymph node status in the axillary region.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic efficacy of sentinel lymph node in breast cancer under percutaneous contrast‐enhanced ultrasound: An updated meta‐analysis

et al. 2021

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Background: To investigate the diagnostic efficacy of sentinel lymph nodes (SLN) in breast cancer by percutaneous contrast-enhanced ultrasound (CEUS) through pooled analysis of relevant studies published before June 2021. Methods: We conducted a systematic review and meta-analysis of relevant studies by searching the electronic databases of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and VIP and the studies were screened according to their inclusion and exclusion criteria. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (ÀLR) and diagnostic odds ratio (DOR) were calculated by Meta-disc 1.4 software and the summary receiver operating characteristic (SROC) curve and area under the curve of ROC (AUC) were constructed.Results: Twenty-two publications evaluating the diagnostic efficacy of SLN in breast cancer under percutaneous CEUS were included in the meta-analysis. The diagnostic sensitivity, specificity were 0.86 (95% CI: 0.83-0.88) and 0.89 (95% CI: 0.87-0.91) for SLN in breast cancer detected by percutaneous CEUS respectively using a random effect model. The +LR and -LR were combined in a random effect model due to significant statistical heterogeneity (p < 0.05). The pooled +LR, ÀLR were 7.06 (95% CI: 4.34-11.50), and 0.17 (95% CI: 0.12-0.24), respectively. The combined DOR was 53.32 (95% CI: 29.74-95.61) for SLN diagnosis in breast cancer by percutaneous CEUS under a random effect model. The AUC was 0.94 which indicated that CEUS had high diagnostic efficacy of SLN in patients with breast cancer. Conclusions: CEUS is a noninvasive method for the detection SLN in patients of breast cancer with relative high prediction efficacy.

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Section: Introductionmentioning

confidence: 99%

Diagnostic efficacy of sentinel lymph node in breast cancer under percutaneous contrast‐enhanced ultrasound: An updated meta‐analysis

et al. 2021

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“…The predominant lymphatic drainage pathway drains from the breast toward the axilla (1). However, nodal metastases outside the axilla may be present in up to 56% of breast cancer patients (2).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Intercostal Lymph Node Metastasis: A Case Report and Review of the Literature

et al. 2021

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The axillary lymph nodes are the primary group responsible for lymphatic drainage in the breast and, consequently, are the most common location for breast cancer metastasis. However, lymphatic pathways running from the breast, via intercostal spaces, to parasternal lymph vessels have also been identified. According to the American Joint Committee on Cancer eighth edition manual, regional lymph node metastasis normally travels to the ipsilateral axillary, supraclavicular, subclavicular, and internal mammary lymph nodes. The presence of intercostal metastasis is out the range of these regional lymph nodes. It is very rare for intercostal lymph nodes to be the extra-axillary site of metastasis in breast cancer, and it has been little reported on in the literature. Despite its rarity, it has the capacity to adversely affect the prognosis of breast cancer and drastically influence treatment choice. Here, we analyze such a case, with a patient receiving a radical mastectomy and metastatic intercostal lymph node dissection due to the presence of intercostal lymph node metastasis indicated via MRI. Furthermore, the potential application of preoperative 3-dimensional (3D) visualization and surgical planning is also discussed.

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“…However, SLNB remains an unstandardized procedure surrounded by many unresolved controversies regarding the technique itself [3-5]. For example, there are 3 methods to detect sentinel lymph node (SLN) metastases.…”

Section: Introductionmentioning

confidence: 99%

“…Recent evidence [9] and some published SLNB guidelines [3-5] suggest that axillary lymphadenectomy is not required for micrometastases of breast sentinel nodes, and that in the clinical management of sentinel nodes, only macrometastases (>2 mm) should be detected intraoperatively. The purpose of this study was to demonstrate whether TIC is more useful than FS in the identification of macrometastases from SLNs during surgery for early breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Prospective Comparison of Intraoperative Touch Imprint Cytology and Frozen Section Histology on Axillary Sentinel Lymph Nodes in Early Breast Cancer Patients

2020

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Introduction: Since the late 1970s, sentinel lymph node biopsy (SLNB) has been used for several solid malignancies to identify lymph node metastases. This procedure is associated with less surgical morbidity than complete lymphadenectomy. Recent evidence suggests that axillary lymphadenectomy is not required for breast sentinel nodes with micrometastases (≤2 mm). Current clinical management of sentinel nodes indicates that only macrometastases (>2 mm) should be detected intraoperatively. In Japan, an intraoperative histopathological frozen section (FS) method is used to identify lymph node metastases, but this method takes more than 30 min and requires complex techniques and expensive equipment. Touch imprint cytology (TIC) is an easier, less expensive, and faster method, but its sensitivity has been shown to be low. Objective: The purpose of this study was to determine if TIC is more useful than FS in identifying macrometastases in sentinel lymph nodes in preoperative node-negative breast cancer operations. Methods: A prospective review of 49 consecutive patients with node-negative breast cancer treated with SLNB and intraoperative TIC and FS between November 2017 and June 2019 was performed. TIC samples were stained using Papanicolaou and Diff-Quick stains. Results were compared with routine postoperative paraffin sections. Results: With TIC, the Papanicolaou stain took a mean of 12 min, and the Diff-Quick stain took a mean of 10 min. Results of both TIC stain methods were the same. In contrast, the FS method took a mean of 80 min (including the transfer of specimens to a different hospital with the necessary equipment). TIC confirmed macrometastases in 5 cases. All macrometastases were diagnosed equally by the 2 techniques. Both the sensitivity and specificity of TIC were 100% for detection of macrometastases. Conclusion: TIC of SLNB for breast cancer is an easy and useful method for the detection of macrometastases of breast sentinel nodes.

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Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center

Cited by 29 publications

References 48 publications

Diagnostic efficacy of sentinel lymph node in breast cancer under percutaneous contrast‐enhanced ultrasound: An updated meta‐analysis

Diagnostic efficacy of sentinel lymph node in breast cancer under percutaneous contrast‐enhanced ultrasound: An updated meta‐analysis

Case Report: Intercostal Lymph Node Metastasis: A Case Report and Review of the Literature

Prospective Comparison of Intraoperative Touch Imprint Cytology and Frozen Section Histology on Axillary Sentinel Lymph Nodes in Early Breast Cancer Patients

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