Role of Sentinel Lymph Node Biopsy in Microinvasive Breast Cancer

Fan, Betty; Pardo, Jaime; Serres, Stephanie K.; Alapati, Amulya; Szewczyk, Joanne; Mele, Alessandra; James, Ted A.

doi:10.1245/s10434-020-08606-3

Cited by 17 publications

(9 citation statements)

References 28 publications

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“…In this regard, also Phantana-angkool et al recently reported a low SLN metastasis rate in patients with MIC preoperatively diagnosed on core biopsy and then confirmed at final pathology (2%) [54] . Furthermore, a small rate of SLN metastases in microinvasive BC (2.9%) was also described by Fan et al, who studied a wide cohort from a National Cancer Database [55] . Indeed, these observations are supported by Level 1 evidence underlining that axillary dissection may be avoided in SLN-positive breast cancer patients undergoing BCS with radiotherapy when there is a low axillary metastatic burden (Z0011) [52] .…”

Section: Looking Toward the Futurementioning

confidence: 56%

Axillary surgery in breast cancer: An updated historical perspective

Magnoni

Galimberti

Corso

et al. 2020

Seminars in Oncology

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This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing effort s of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been replaced by sentinel lymphnode biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. However, this is only the beginning. Strategies in defining systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly refined and targeted breast cancer treatment tools. In recent years, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to revolutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more finite "targeted" procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scientific evaluation. The changes over time in the surgical approach to breast cancer have been numerous and significant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer.

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Section: Looking Toward the Futurementioning

confidence: 56%

Axillary surgery in breast cancer: An updated historical perspective

Magnoni

Galimberti

Corso

et al. 2020

Seminars in Oncology

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“…A Danish nationwide study analyzed 233 patients, of whom 27 (11.6%) had LN metastasis including micrometastasis [ 9 ]. A study using the Surveillance, Epidemiology, and End Results database showed that 7.6% of patients had LN metastasis (n = 8,863) [ 15 ], whereas data from the National Cancer Database reported a rate of LN metastasis of 2.9% (n = 2,609) [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Low incidence of lymph node metastasis in patients with microinvasive breast cancer: a Korean nationwide study

Paik

Lee

et al. 2022

Ann Surg Treat Res

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Purpose Microinvasive breast cancer (MIBC) is an invasive carcinoma with a tumor dimension not exceeding 1 mm. Owing to its low incidence, the rate of axillary node metastasis and its management are not well established. The aim of this study was to assess the incidence of lymph node metastasis (LNM) and identify variables associated with LNM, as well as to evaluate the need for axillary staging in MIBC patients by analyzing nationwide data. Methods The Korean Breast Cancer Society registry was searched to identify MIBC patients diagnosed between January 1996 and April 2020. Patients without neoadjuvant chemotherapy experiences, systemic metastasis, and missing or discordant data were eligible for the analysis. The incidence rate of LNM was determined, and variables associated with LNM were identified by multivariable regression analysis. Results Of 2,427 MIBC patients identified, 98 (4.0%) had LNM and 12 (0.5%) had N2/3 disease. Type of breast operation (odds ratio [OR], 2.093; 95% confidence interval [CI], 1.332–3.290; P = 0.001), age (OR, 2.091; 95% CI, 1.326–3.298; P = 0.002), hormone receptor status (OR, 2.220; 95% CI, 1.372–3.594; P = 0.001), and lymphovascular invasion (OR, 11.143; 95% CI, 6.354–19.540; P < 0.001) were significantly related to LNM. Conclusion The incidence of LNM in MIBC patients was only 4.0% in our study, suggesting that de-escalation of axillary surgical interventions could be carefully considered. The indications for axillary staging should be individualized considering tumor volume, age, hormone receptor status, and lymphovascular invasion to improve the quality of life of MIBC survivors.

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“…The rate of regional recurrence did not differ according to the receipt of ALND. Fan et al 37 confirmed that SLNB metastases are rare in patients with DCIS-MI. These findings suggest that SLNB may not be helpful in DCIS-MI owing to the low risk of lymph node metastasis and good prognosis, and fewer surgeries can achieve the same OS with better quality of life for patients.…”

Section: Management Of Axillary Lymph Nodes Dcis-mimentioning

confidence: 93%

Clinical characteristics of breast ductal carcinoma in situ with microinvasion: a narrative review

Zheng

Zhou

2020

J Int Med Res

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Ductal carcinoma in situ (DCIS) with microinvasion (DCIS-MI) is defined as the extension of cancer cells beyond the basement membrane into adjacent tissue with no focus larger than 1 mm or a maximum diameter of less than 1 mm for multiple invasive foci. DCIS-MI constitutes approximately 1% of all breast cancer cases and 5% to 10% of cases of DCIS. The current literature is controversial concerning the clinical prognostic features and management of DCIS-MI. This narrative review described recently reported literature regarding the characteristics, diagnosis, treatment, and prognosis of DCIS-MI.

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Role of Sentinel Lymph Node Biopsy in Microinvasive Breast Cancer

Cited by 17 publications

References 28 publications

Axillary surgery in breast cancer: An updated historical perspective

Axillary surgery in breast cancer: An updated historical perspective

Low incidence of lymph node metastasis in patients with microinvasive breast cancer: a Korean nationwide study

Clinical characteristics of breast ductal carcinoma in situ with microinvasion: a narrative review

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