Should internal mammary lymph node sentinel biopsy be performed in breast cancer: a systematic review and meta-analysis

Gong, Jing; Yu, Yongfu; Wu, Zeyu; Cai, Lin; Tu, Xin

doi:10.1186/s12957-019-1683-8

Cited by 10 publications

(8 citation statements)

References 37 publications

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“…All SNs identified with either methyl blue or radioactive compounds should be sent for frozen sectioning. Furthermore, metastasis in the internal mammary lymph nodes is possible in high-risk patients, and preoperative biopsy should be considered [ 24 , 25 ]. We did not perform sentinel biopsy for the internal mammary lymph nodes, and underestimating nodal staging should be considered.…”

Section: Discussionmentioning

confidence: 99%

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

et al. 2021

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Background Sentinel lymph node biopsy (SLNB) is the standard approach for the axillary region in early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes in intraoperative frozen sections (FNSN) using real-world data. Methods A case–control study with a 1:3 ratio was conducted. FNSN was determined when sentinel nodes (SNs) were negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections. Results A total of 20 FNSN cases and 60 matched controls from 333 SLNB patients were enrolled between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between the FNSN and control groups. The FNSN patients had larger tumor sizes on preoperative mammography (P = 0.033) and more lymphatic tumor emboli on core biopsy (P < 0.001). Four FNSN patients had metastasis in nonrelevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in nonrelevant SNs were recognized in two patients. All FNSN patients underwent a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed breast cancer recurrence. The disease-free survival, breast cancer-specific survival, and overall survival in FNSN were not inferior to those in controls. Conclusions Patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, the outcomes of FNSN patients after completing ALND were noninferior to those without SN metastasis. ALND provides a correct staging for patients with metastasis in nonsentinel axillary lymph nodes.

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Section: Discussionmentioning

confidence: 99%

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

et al. 2021

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“…While difficult relative to axillary sentinel LN biopsy, the success rate for IMLN biopsy currently averages 90% for experienced teams [52][53][54][55]. Thoracoscopic IMLN dissection in breast cancer has also been reported with the same positive IMLN rate and less morbidity than the conventional intercostal space incision [9,56].…”

Section: Histopathologically Confirmed Imln Metastasismentioning

confidence: 99%

“…Relative to lymphoscintigraphy alone, SPECT/CT provides advantages in terms of accurate anatomical localization, identification of false-positive results, fewer false-negative results, and better guidance regarding the surgical approach. Using lymphoscintigraphy and SPECT/CT after an intra-lesion injection of 99mTc-nanocolloid, the sentinel IMLN was found to contain metastasis in only 24% of patients from a pilot study [ 60 ] and in 34% of patients from a Dutch multicenter study [ 55 ]. The Breast Cancer Center of Shandong Cancer Hospital optimized the use of 99mTc-labeled sulfur colloid (99mTc-SC) in sentinel IMLN mapping and detection, evaluated the SPECT-CT image acquisition time, and modified the injection technique (peri-areolar intraparenchymal, high volume, and ultrasound guidance), which increased the IM-SLN visualization rate to 71.9% for breast cancer patients who were receiving initial surgery [ 52 , 57 , 58 , 62 , 63 ].…”

Section: Minimally Invasive Diagnosis Of Im-slnbmentioning

confidence: 99%

Internal mammary lymph node metastasis in breast cancer patients based on anatomical imaging and functional imaging

Wang

Qiu

2022

Breast Cancer

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Internal mammary lymph node (IMLN) metastasis forms part of the clinical node classification for primary breast cancer, which influences the treatment strategy. However, because of the IMLNs’ complicated anatomical structures and relationships with adjacent structures, IMLN biopsy or resection is associated with a limited improvement in prognosis and a high complication rate. The positivity rate also varies broadly according to imaging modality, and there is a low rate of agreement between the imaging and pathological diagnoses, which creates imprecision in the preoperative staging. The IMLN positivity rate also varies remarkably, and there are no clear, accurate, and non-invasive modalities for diagnosing the pre-mastectomy IMLN status. Nevertheless, medical imaging modalities continue to evolve, with functional imaging and image-guided thoracoscopic biopsy of sentinel IMLNs being well established. Thus, personalized decision-making and treatment selection should be based on the modality-specific differences in the diagnosis of IMLN metastasis/recurrence and the patient’s specific risk factors.

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“…Studies have shown that LN resection and radiotherapy are valuable for prognosis, but the NSABP B04 trial showed that late resection did not affect prognosis (11,16). Although de-escalation of axillary surgery is fairly common, for patients with negative LN status (N0), many studies have stated that ALND is not beneficial for sentinel LN-negative patients (17)(18)(19). Our mathematical modeling results suggest that nodal metastasis is not merely a straightforward process of BC, but has a complex effect on prognosis that can also be altered by treatment.…”

Section: An Additional Adjustment Was Made By Upgrading Stagementioning

confidence: 99%

Modeling effective tumor burden of primary lesion and metastatic lymph node in breast cancer patients from the SEER database

Hu¹,

Wu²,

Long³

et al. 2022

Gland Surg

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Background: Characterizing the role of the primary tumor and axillary lymph nodes (ALNs) in metastasis progression can provide a rational basis for effective local control and systemic treatments. Methods:We employed data from the Surveillance, Epidemiology, and End Results (SEER) database to perform survival analysis and modeling to estimate breast cancer (BC) progression in both untreated and treated patients. Effective tumor burden was defined as the number of cancer cells that can lead to distant metastasis. Quantified analysis was conducted for primary lesion and metastatic nodes, respectively. A tumor growth model was built based on mathematical modeling: ( ) ( ) ( ). In this model, the parameters "m" and "n" represent the contributions of the primary lesion and metastatic lymph nodes (LNs) to distant metastasis, respectively.Results: We found that both the primary lesion and the metastatic LNs contribute to the effective tumor burden. Through fitting the built tumor growth model, "m" in treated groups was determined to be 1, and "n" was determined to be 1.5; while in the untreated group, "m" was determined to be 1, and "n" was 0.15, which was 10 times smaller than in treated groups.Conclusions: Our study revealed that the prognostic value of the anatomic stage in BC progression varied in different historical periods, due to the development of oncological treatments. While tumor size was a significant prognostic factor in both untreated and treated patients, the prognostic value of nodal status was only significant in patients who received locoregional treatment and systemic treatment.

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Should internal mammary lymph node sentinel biopsy be performed in breast cancer: a systematic review and meta-analysis

Cited by 10 publications

References 37 publications

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients

Internal mammary lymph node metastasis in breast cancer patients based on anatomical imaging and functional imaging

Modeling effective tumor burden of primary lesion and metastatic lymph node in breast cancer patients from the SEER database

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