Sentinel Lymph Node Biopsy in Primary Breast Cancer: Window to Management of the Axilla

Abstract

In patients with primary breast cancer, several large, randomized prospective trials have shown that sentinel node biopsy (SNB) substantially reduces the morbidity associated with axillary surgery compared with formal axillary lymph node dissection (ALND). Moreover, the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial has demonstrated that when the sentinel node reveals no evidence of metastatic disease, then no further ALND is required. Recently, the results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial have challenged the notion that all patients with metastases to the sentinel node require ALND. The results of this trial suggest that in selected sentinel node-positive patients, ALND can be potentially avoided. Yet, some concerns about the ACOSOG Z0011 trial have been raised, and these concerns may have implications in the widespread implementation of the results of this trial. Since the advent of the SNB technology, occult metastases within the sentinel node are frequently observed, and the significance of these findings remains controversial. Finally, this review considers special situations, such as pregnancy and the neoadjuvant setting, where the use of SNB should be applied judiciously. The SNB technology has dramatically improved the quality of life for women with breast cancer, and further modifications of its role in breast cancer treatment should be based on evidence obtained from randomized, controlled trials.

Pratigimizde Son Bir Yilda Erken Evre Meme Kanserinde Uygulanan Sentinel Lenf Nodu Biyopsi Sonuclarimiz

“…Bu nedenle hastalığın evrelenmesi ve prognozun belirlenmesinde aksiller lenf nodu durumunun doğru değerlendirilmesi gerekmektedir. Bu amaçla erken evre dahil tüm meme kanserlerinde rutin aksiller lenf nodu disseksiyonu uygulanmakta fakat disseksiyona bağlı olarak lenf ödem, ağrı, duyu kaybı, omuz hareketlerinde kısıtlılık, seroma, damar ve sinir hasarı gelişebilmektedir (6). Günümüzde ise bu gibi komplikasyonlardan ve gereksiz aksiller disseksiyonlardan kaçınmak için özellikle erken evre hastalıkta sentinel lenf nodu biyopsisi uygulanmaktadır.…”

Local Treatment of Breast Cancer

“…For low-and medium-grade DCIS, SLNB is often not performed. 17 The controversy surrounding treatment of DCIS requires additional explanation by the nurse practitioner to determine patient understanding and comfort with the treatment regimen. Reinforcement that DCIS is stage 0 with no potential to metastasize 18 or cause their premature death (as with stage I-IV breast cancers) is often necessary.…”

“…17,38,39 SLNB can be performed the day of breast surgery with peritumoral injection of 99m Tc sulphur colloid at least 1 hour before surgery, followed by a subareolar lymphatic plexus injection of vital blue dye in the operating room and five minutes of gentle whole breast massage. 17,38,39 The axilla is surveyed with a gamma probe to find the most intense area of radioisotope uptake. 17,38,39 Once identified, a small incision is made in the axilla to allow the surgeon to identify the visible network of blue dye that corresponds with an increased auditory sound from the gamma machine.…”

“…5,25 Therefore, with the exceptions of contralateral or bilateral prophylactic mastectomy, all women should undergo SLNB 38,39 or axillary dissection on the affected side to examine axillary contents and identify pathological stage of disease. 2,17 SENTINEL LYMPH NODE BIOPSY SLNB requires an experienced sentinel lymph node team because proficiency is measured by the frequency of successful procedures compared with postoperative pathology results. 17,38,39 SLNB can be performed the day of breast surgery with peritumoral injection of 99m Tc sulphur colloid at least 1 hour before surgery, followed by a subareolar lymphatic plexus injection of vital blue dye in the operating room and five minutes of gentle whole breast massage.…”

“…2,17 SENTINEL LYMPH NODE BIOPSY SLNB requires an experienced sentinel lymph node team because proficiency is measured by the frequency of successful procedures compared with postoperative pathology results. 17,38,39 SLNB can be performed the day of breast surgery with peritumoral injection of 99m Tc sulphur colloid at least 1 hour before surgery, followed by a subareolar lymphatic plexus injection of vital blue dye in the operating room and five minutes of gentle whole breast massage. 17,38,39 The axilla is surveyed with a gamma probe to find the most intense area of radioisotope uptake.…”