Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes

Veronesi, Umberto; Paganelli, Giovanni; Galimberti, Viviana; Viale, Giuseppe; Zurrida, Stefano; Bedoni, Marilia; Costa, Ana Cláudia; Cicco, Concetta De; Geraghty, James; Luini, Alberto; Sacchini, Virgilio; Veronesi, Paolo

doi:10.1016/s0140-6736(97)01004-0

Cited by 1,821 publications

(718 citation statements)

References 15 publications

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“…Therefore, a tumour-free sentinel lymph node implies the absence of lymph node metastases in the entire lymphatic basin. This sentinel node concept had been previously confirmed by H&E examinations, immunohistochemical study and nonquantitative RT -PCR assays (Giuliano et al, 1994;Albertini et al, 1996;Veronesi et al, 1997;Krag et al, 1998;Kataoka et al, 2000;Manzotti et al, 2001;Branagan et al, 2002;Ishida et al, 2002).…”

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confidence: 62%

“…In addition, no post-PCR manipulations are required with this method, and quantification and calculation of the results are all automated. Currently, many investigators reported sentinel lymph node biopsy for the diagnosis of axillary lymph node metastases from breast cancer (Giuliano et al, 1994;Albertini et al, 1996;Veronesi et al, 1997;Krag et al, 1998). The sentinel lymph node is the first lymph node to receive drainage from the primary tumours in early stage cancers (Morton et al, 1992).…”

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confidence: 99%

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Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

et al. 2003

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We have established a highly sensitive and quantitative reverse transcriptase -polymerase chain reaction (RT -PCR) method to detect axillary lymph node metastases of breast cancer. Amplifying cytokeratin 19 (CK19) mRNA transcripts using real-time TaqMan PCR made it possible to quantify axillary metastatic burden. Metastases in 358 axillary lymph nodes obtained from 23 breast cancers of 22 patients were investigated by conventional haematoxylin and eosin (H&E) staining, immunohistochemical staining and quantitative RT -PCR assay. The detection rates of axillary lymph node metastasis using H&E staining, immunohistochemistry and RT -PCR assay were 4.5, 5.9 and 13.1%, respectively. RT -PCR assay was the most sensitive of these three methods for detecting lymph node metastases. Cytokeratin 19 mRNA expression values of both histologically and immunohistochemically positive lymph nodes were significantly higher than the values for lymph nodes judged to be negative by both histological and immunohistochemical methods (Po0.0001), and those of histologically negative, but immunohistochemically positive lymph nodes were significantly higher than the values for lymph nodes judged to be negative by both histological and immunohistochemical methods (Po0.0001). Furthermore, metastatic rates of sentinel nodes were higher than the rates of nonsentinel lymph nodes as measured by all three methods. These results indicate that quantitative RT -PCR assay is a sensitive and reliable method for detecting lymph node metastasis. Furthermore, quantification of metastases in sentinel lymph nodes by quantitative RT -PCR assay may be useful to assess the entire axillary burden of breast cancer patients.

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confidence: 62%

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confidence: 99%

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

et al. 2003

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“…More recently, sentinel lymph node biopsy (SLNB) has been proposed as an alternative method for staging the axilla in women who have early breast cancer with clinically node negative axillae (Giuliano et al, 1994;Veronesi et al, 1997;McIntosh and Purushotham, 1998;Veronesi et al, 1999;Veronesi et al, 2003). The SLN is the first lymph node to receive lymphatic drainage from a tumour.…”

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The value of immunohistochemistry in sentinel lymph node histopathology in breast cancer

et al. 2005

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The optimal protocol for the histopathological examination of sentinel lymph nodes (SLNs) in breast cancer has not been determined. The value of more detailed examination using immunohistochemistry (IHC) is controversial. A total of 476 SLNs from 216 patients were reviewed. Sentinel lymph nodes were sectioned at three levels at 100 mm intervals and stained with haematoxylin and eosin (H&E). If the H&E sections showed no evidence of metastasis, then the three serial sections were stained with a murine monoclonal anti-cytokeratin antibody (CAM 5.2). Metastatic deposits were classified as macrometastasis (42.0 mm), micrometastasis (0.2 -2.0 mm) or isolated tumour cells (ITC, o0.2 mm). Of the 216 patients, 56 (26%) had metastasis as identified by H&E. Immunohistochemistry detected metastatic deposits in a further nine patients (4%), of whom four (2%) had micrometastasis and five (2%) had ITC only. Those cases with micrometastases were all, on review, visible on the H&E sections. Immunohistochemistry detects only a small proportion of metastasis in SLNs. All metastatic deposits identified by IHC were either micrometastasis or ITC. Until the prognostic significance of these deposits has been determined, IHC may be of limited value in the histopathological examination of SLNs.

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“…[1][2][3] The technique identifies a sentinel lymph node or nodes in the axilla of a patient with breast carcinoma using a vital dye or radionuclide. If the sentinel lymph node is negative for malignancy, the patient can forego regular axillary lymph node dissection, since the probability that the additional dissected lymph nodes will contain metastatic tumor when the sentinel node is negative is about 5%.…”

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confidence: 99%

Frozen section diagnosis for axillary sentinel lymph nodes: the first six years

Mitchell

2005

Modern Pathology

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Intraoperative frozen section of axillary lymph nodes for the detection of metastatic breast cancer has been controversial because of the labor-intensive techniques necessary to obtain a highly sensitive test, and because of the uncertain significance of frequently detected submicrometastatic carcinoma. In total, 874 consecutive axillary sentinel lymph node cases examined by intraoperative frozen section over a 6-year period were reviewed retrospectively. Frozen section had a sensitivity of 60% and was 100% specific, but when cases with submicrometastatic tumor cells were considered negative, the sensitivity rose to 83%. Rare cases were called 'atypical' on frozen section; almost all of these cases were negative for carcinoma on permanent sections.

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Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes

Cited by 1,821 publications

References 15 publications

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

Quantitative evaluation of metastases in axillary lymph nodes of breast cancer

The value of immunohistochemistry in sentinel lymph node histopathology in breast cancer

Frozen section diagnosis for axillary sentinel lymph nodes: the first six years

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