Simple mastectomy and pectoral node biopsy

Forrest, A. P. M.; Roberts, M M; Cant, E. L. M.; Shivas, A. A.

doi:10.1002/bjs.1800630802

Cited by 51 publications

(14 citation statements)

References 7 publications

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“…In 22 patients, fresh tissue was obtained from both the primary tumour and from 1 to 3 nodal metastases at the time of mastectomy and node sampling (10). In a further two cases, the primary tissue was obtained by biopsy and nodal tissue was obtained within a further 10 days.…”

Section: Methodsmentioning

confidence: 99%

Oestrogen receptor concentration in primary breast cancer and axillary node metastases

Hawkins

Black

Steele

et al. 1981

Breast Cancer Res Tr

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The primary tumour and 1-3 invaded, axillary nodes from each of 24 patients were examined both histologically for the proportion of the specimen constituted by malignant epithelial cells ('cellularity index') and biochemically for oestrogen receptor concentration. Both malignant epithelial cell content and oestrogen receptor concentration were significantly higher in the nodal metastases than in the primary tumours, malignant cells constituting approximately half of the former tissue and three quarters of the latter. On average, receptor concentrations were 1.6 x (protein basis) to 2.3 x (wet weight basis) higher in nodes than in the primary tumours, probably due at least in part to the difference in cellularity. When, to eliminate the effect of the latter, receptor concentration in each tumour deposit was 'corrected' using the appropriate 'cellularity index', the difference in receptor concentration between primary and node was significantly diminished, but not quite eliminated. In one patient, progestogen receptor concentrations were also studied and found to be higher in the nodes than in the primary tumour. If the actual quantity of receptor is to be used for predictive/prognostic purposes, then either a different 'cut-off point' should be used for invaded nodes from that used for assessment on the primary tumour, or receptor concentrations should be corrected for differences in cellularity.

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Section: Methodsmentioning

confidence: 99%

Oestrogen receptor concentration in primary breast cancer and axillary node metastases

Hawkins

Black

Steele

et al. 1981

Breast Cancer Res Tr

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“…Complete axillary dissection and the routine histopathological work up of a minimum of 10 to 11 nodes was once the standard staging and therapeutic procedure, but several alternative ways have been studied to reduce possible complications of the dissection and to spare the increasing proportion of patients without axillary metastases. Axillary sampling [6][7][8][9][10] and sentinel lymph node biopsy [11][12][13][14] are suitable alternatives, with the aim of staging the disease and identifying the need for further treatment of the axilla. Accumulating data suggest that sentinel node assessment will play the major role in the future of axillary surgery for a considerable number of patients, but this does not fall in the scope of the present paper.…”

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confidence: 99%

The reliability of sampling three to six nodes for staging breast cancer.

Cserni

1999

J Clin Pathol

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Aims-To test the hypothesis that a correct qualitative assessment of axillary nodal status can be established by examining only a limited number of lymph nodes. Methods-Slides from 499 pN1 or pN0 axillary dissection specimens relating to symptomatic breast cancer cases operated on at our institution between 1991 and 1996 were reviewed. Nodes were ranked in descending order on the basis of their estimated size and lymphoid or metastatic tissue content. After ranking, all nodes were studied microscopically; 265 axillary clearance specimens were positive. Results-Assessment of the 3-6 largest/ firmest nodes can lead to the detection of 93-98% of node positive patients and can give a correct qualitative assessment of axillary node status in 96-99%. Conclusions-Sampling the 4-6 largest/ firmest nodes seems to be a reliable alternative for the staging of symptomatic breast cancer. These results suggest a reconsideration of the generally held view that a minimum of 10 nodes is required for adequate identification of the pN0 category. (J Clin Pathol 1999;52:681-683) Keywords: axillary clearance; axillary sampling; breast cancerThe axillary lymph node status is still the most important single prognostic factor in breast cancer. Clinical examination 1 2 and the use of imaging techniques [3][4][5] to assess the node status are not reliable enough procedures because of the high rates of false positive and false negative results. Histopathological assessment has rather been considered the gold standard for the evaluation of lymph nodes. However, there are numerous ways to assess the axillary lymph nodes, depending on the surgical procedure performed and the histopathological tools used. Complete axillary dissection and the routine histopathological work up of a minimum of 10 to 11 nodes was once the standard staging and therapeutic procedure, but several alternative ways have been studied to reduce possible complications of the dissection and to spare the increasing proportion of patients without axillary metastases. Axillary sampling 6-10 and sentinel lymph node biopsy [11][12][13][14] are suitable alternatives, with the aim of staging the disease and identifying the need for further treatment of the axilla. Accumulating data suggest that sentinel node assessment will play the major role in the future of axillary surgery for a considerable number of patients, but this does not fall in the scope of the present paper. On the other hand, there is controversy over axillary sampling as a means of evaluating the axilla; it is not a uniform procedure and has many opponents. [15][16][17][18][19][20] I have used our archive of histopathology reports and slides to assess the value of examining a limited number of lymph nodes, modelling axillary sampling versus axillary dissection and examination of the full lymph node content. MethodsHistopathology reports from the archives of department of pathology, Bács-Kiskun County Teaching Hospital, were reviewed and records relating to breast cancer cases treated by mastectomy or br...

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“…Following histological confirmation of the diagnosis all patients had a simple mastectomy with axillary node sampling (Forrest et al, 1976 (Elston et al, 1982) was a modification of the system developed by Bloom and Richardson (1957). Oestrogen and progesterone receptors were assayed using the dextran coated charcoal method and Scatchard analysis (McGuire & De La Garza, 1973 (Peto et al, 1977).…”

Section: Treatmentmentioning

confidence: 99%

West Midlands Oncology Association trials of adjuvant chemotherapy in operable breast cancer: results after a median follow-up of 7 years. I. Patients with involved axillary lymph nodes

Morrison

Howell²,

Kelly³

et al. 1989

Br J Cancer

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Simple mastectomy and pectoral node biopsy

Abstract: Evidence is presented to support the view that biopsy of the pectoral and axillary tail nodes obtained at simple (total) mastectomy gives a reliable estimate of axillary node status. The technique is described.

Cited by 51 publications

References 7 publications

Oestrogen receptor concentration in primary breast cancer and axillary node metastases

Oestrogen receptor concentration in primary breast cancer and axillary node metastases

The reliability of sampling three to six nodes for staging breast cancer.

West Midlands Oncology Association trials of adjuvant chemotherapy in operable breast cancer: results after a median follow-up of 7 years. I. Patients with involved axillary lymph nodes

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