Morbidity After Sentinel Lymph Node Biopsy in Primary Breast Cancer: Results From a Randomized Controlled Trial

Purushotham, Arnie; Upponi, Sara; Klevesath, Manfred; Bobrow, Lynda G.; Millar, Keith; Myles, Jonathan P.; Duffy, Stephen W.

doi:10.1200/jco.2005.03.228

Cited by 467 publications

(289 citation statements)

References 35 publications

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“…Recent interest has focused on SNB as a method to stage the axilla. This technique has resulted in a significant reduction in morbidity compared with axillary lymph node dissection (ALND) and clearance [4]. It is unsuccessful in 3-6% of patients and has a false negative rate of 2.1-2.7% when compared to axillary node dissection and clearance [5,6].…”

Section: Introductionmentioning

confidence: 99%

The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature

Peare

Staff

Heys

2010

Breast Cancer Res Treat

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International audienceAxillary lymph node status is the most powerful prognostic indicator in patients with breast cancer. FDG-PET has been suggested as a non-invasive method of staging the axilla. The aim of this study was to review and aggregate all studies that measured the performance of FDG-PET in patients with breast cancer, using surgically obtained axillary histology as a reference, in a meta-analysis. A systematic review of the literature was performed and data extracted from all eligible studies. These were then analysed using meta-analysis software and summary receiver operating characteristic (SROC) curves were plotted for the aggregate data. The data was then tested to determine which parameters impacted on the sensitivity and specificity of the studies. Sensitivities ranging from 20 to 100% and specificities ranging from 65 to 100% have been reported. An aggregated ROC analysis found an area under the curve of 0.95 (95% CI 0.91–0.97) and a * value of 0.89 (95% CI 0.85–0.92) in a total of 25 studies involving 2,460 patients. The AUC and * values indicated little difference between the compared study characteristics. The performance of the technique currently remains below, which is required to replace assessment of axillary node status by surgical biopsy and histological assessment. However, sensitivity and specificity are high and FDG-PET may have a role to play under particular circumstances. Moreover, the additional benefit of an assessment of distal metastatic spread provided by FDG-PET requires further investigation

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Section: Introductionmentioning

confidence: 99%

The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature

Peare

Staff

Heys

2010

Breast Cancer Res Treat

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“…18 On the basis of the results of large randomized trials confirming its efficacy and reduced morbidity, sentinel lymph node biopsy has become a standard of care for axillary evaluation in breast cancer patients with early stage disease in many institutions. [19][20][21][22] As such, a number of methodologies have been investigated to improve diagnostic yield in detecting lymph node metastases. In one such study, occult metastases were detected in 4% of breast sentinel lymph nodes previously reported to be benign, using a combination of deeper sectioning of the tissue blocks and cytokeratin immunohistochemistry.…”

Section: Discussionmentioning

confidence: 99%

The role of OCT4 immunohistochemistry in evaluation of retroperitoneal lymph node dissections: a pilot study

et al. 2013

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We investigated the role of OCT4 immunohistochemical staining in detecting germ cell tumor lymph node metastases. Retroperitoneal lymph node dissection is important for staging and treatment of testicular germ cell tumors, and OCT4 is sensitive and specific for pluripotent testicular germ cell tumors; however, micrometastases, particularly from seminoma, can be difficult to detect. We examined 262 lymph nodes in 45 retroperitoneal lymph node dissection specimens from germ cell tumor patients. Specimens were categorized as postchemotherapy and untreated retroperitoneal lymph node dissection with or without clinical suspicion, based on lymphadenopathy or elevated serum germ cell tumor markers. Sections were stained with anti-OCT4 antibody. Twenty-one additional positive lymph nodes in 12 cases were detected to harbor scattered seminoma cells, singly and in small clusters, from 256 previously considered benign in: untreated retroperitoneal lymph node dissection with clinical suspicion (13% increase), postchemotherapy retroperitoneal lymph node dissection (7%), and untreated retroperitoneal lymph node dissection without suspicion (4%). However, no patient with an entirely negative dissection specimen was reclassified as positive. OCT4 immunohistochemistry detected scattered seminoma cells and small clusters of seminoma cells in lymph nodes previously considered to be benign for an overall increase of 8%, greatest in the setting of untreated retroperitoneal lymph node dissection with clinical suspicion. However, immunohistochemistry did not convert any entirely negative specimen to positive. Future studies will be useful to determine whether the small volume of disease detected by immunohistochemistry has the same impact as routinely detected lymph node metastases.

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“…Since the initial reports of SLN mapping by Krag in 1993 (using radioisotope), 1 by Giuliano in 1994 (using blue dye), 2 and by Albertini in 1995 (using a combination of isotope and dye), 3 6 randomized trials [4][5][6][7][8][9] and numerous observational studies of SLN biopsy validated by a completion axillary lymph node dissection have established that SLN biopsy is feasible, accurate and safe.…”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node biopsy in breast cancer: the node to recovery

Goyal

2010

Indian J Surg Oncol

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The widespread adoption of sentinel lymph node biopsy to stage the axilla has led to decrease in arm and shoulder morbidity. Sentinel lymph node biopsy is suitable for patients with clinically/radiologically node negative invasive breast cancer and selected patients with DCIS (those with clinical/radiological mass or extensive lesions requiring mastectomy). The combined isotope-blue dye injection technique gives the best results. We inject the isotope intra-dermally preoperatively and blue dye dye subdermally after anesthetic induction into the tumour quadrant peri-areolar tissue. Lymphoscintiscan is not necessary but is useful during the learning phase. Sentinel node biopsy can be performed through a small transverse or vertical axillary incision (~3 cm) appropriately placed to allow axillary lymph node clearance if needed.

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Morbidity After Sentinel Lymph Node Biopsy in Primary Breast Cancer: Results From a Randomized Controlled Trial

Abstract: SLNB in patients undergoing surgery for breast cancer results in a significant reduction in physical and psychological morbidity.

Cited by 467 publications

References 35 publications

The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature

The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature

The role of OCT4 immunohistochemistry in evaluation of retroperitoneal lymph node dissections: a pilot study

Sentinel lymph node biopsy in breast cancer: the node to recovery

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