Surgical Complications Associated With Sentinel Lymph Node Biopsy: Results From a Prospective International Cooperative Group Trial

Wilke, Lee G.; McCall, Linda; Posther, Katherine E.; Whitworth, Pat W.; Reintgen, Douglas S.; Leitch, A. Marilyn; Gabram, Sheryl G. A.; Lucci, Anthony; Cox, Charles E.; Hunt, Kelly K.; Herndon, James E.; Giuliano, Armando E.

doi:10.1245/aso.2006.05.013

Cited by 529 publications

(358 citation statements)

References 55 publications

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“…The incidence of chronic, potentially disabling complications such as lymphedema and paraesthesia is of greater concern to both patients and surgeons, and their incidence at 6 months post-operatively was also evaluated. Previous studies have reported that lymphoedema of the upper extremity occurs in approximately 5-8% of patients post-SNB [19][20][21] and 10-20% of patients post-ALND [22]. In the current analysis, the risk of upper limb lymphoedema and paraesthesia at 6 months was significantly diminished in those undergoing SNB (4.8 vs. 13.3%, SNB vs. ALND).…”

Section: Discussionmentioning

confidence: 41%

Outcome of axillary staging in early breast cancer: a meta-analysis

Kell

Burke

Barry

et al. 2010

Breast Cancer Res Treat

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Axillary lymph node dissection (ALND) is associated with significant morbidity, whilst sentinel node biopsy (SNB) has the potential to minimize complications in the management of breast cancer. The aim of this study was to systematically appraise the outcome of SNB when compared to ALND. A comprehensive search for published trials examining outcomes after SNB for breast cancer was performed using medline and cross-referencing available data. Each study was reviewed and data extracted. Primary outcomes were nodal positivity and surgery-related morbidity. A total of 9,608 patients were identified from trials comparing ALND and SNB. The overall rate of axillary lymph node positivity for those with no clinically palpable nodes was 28.8% for ALND and 27.6% for SNB (OR = 1.00, 95% CI = 0.86-1.17, P = 0.956), though there was a trend for superior detection of metastatic disease with SNB when this was compared with ALND alone (OR = 1.22, 95% CI = 0.95-1.57, P = 0.122). Patients who undergo SNB are significantly less likely to suffer post-operative morbidity relative to ALND: risk of infection (OR = 0.58, 95% CI = 0.42-0.80, P = 0.0011), seroma (OR = 0.40, 95% CI = 0.31-0.51, P = 0.0071), arm swelling (OR = 0.30, 95% CI = 0.14-0.66, P = 0.0028) and numbness (OR = 0.25, 95% CI = 0.1-0.59, P = 0.0018).SNB is at least equivalent to ALND in detecting metastatic disease in the axilla. SNB is the optimum approach in terms of morbidity for the assessment of axillary metastasis in clinically node negative breast cancer.

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Section: Discussionmentioning

confidence: 41%

Outcome of axillary staging in early breast cancer: a meta-analysis

Kell

Burke

Barry

et al. 2010

Breast Cancer Res Treat

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“…The ALMANAC trial 28 reported that the rates of lymphedema and sensory loss for patients who received SLNBs were 5% and 11%, respectively, at 12 months. In the trial by Wilke and colleagues, 29 8.6% of patients had axillary paresthesias, 3.8% had a decreased upper extremity range of motion and 6.9% demonstrated proximal upper extremity lymphedema at 6 months. Other complications related to SLNB at the time of prophylactic mastectomy, such as axillary seroma, 20 blue hives and axillary hematomas, 19 have been reported.…”

Section: Discussionmentioning

confidence: 97%

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

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Background: Prophylactic mastectomy is performed to decrease the risk of breast cancer in women at high risk for the disease. The benefit of sentinel lymph node biopsy (SLNB) at the time of prophylactic mastectomy is controversial, and we performed a meta-analysis of the reported data to assess that benefit. Methods:We searched MEDLINE, EMBASE and the Cochrane Library databases from January 1993 to December 2009 for studies on patients who underwent SLNB at the time of prophylactic mastectomy. Two reviewers independently evaluated all the identified papers, and only retrospective studies were included. We used a mixedeffect model to combine data. Results:We included 6 studies in this review, comprising a total study population of 1251 patients who underwent 1343 prophylactic mastectomies. Of these 1343 pooled prophylactic mastectomies, the rate of occult invasive cancer (21 cases) was 1.7% (95% confidence interval [CI] 1.1%-2.5%), and the rate of positive SLNs (23 cases) was 1.9% (95% CI 1.2%-2.6%). In all, 36 cases (2.8%, 95% CI 2.0%-3.8%) led to a significant change in surgical management as a result of SLNB at the time of prophylactic mastectomy. In 17 cases, patients with negative SLNs were found to have invasive cancer at the time of prophylactic mastectomy and avoided axillary lymph node dissection (ALND). In 19 cases, patients with positive SLNBs were found not to have invasive cancer at the time of prophylactic mastectomy and needed a subsequent ALND. Of the 23 cases with positive SLNs, about half the patients had locally advanced disease in the contralateral breast. Conclusion:Sentinel lymph node biopsy is not suitable for all patients undergoing prophylactic mastectomy, but it may be suitable for patients with contralateral, locally advanced breast cancer.Contexte : La mastectomie prophylactique vise à réduire le risque de cancer du sein chez les femmes à risque élevé. L'avantage de la biopsie du ganglion lymphatique sentinelle (BGLS) au moment de la mastectomie prophylactique suscite la controverse et nous avons procédé à une méta-analyse des données qui ont fait l'objet de rapports afin d'évaluer l'avantage en question. Méthodes :Nous avons cherché dans les bases de données MEDLINE, EMBASE et la Bibliothèque Cochrane, de janvier 1993 à décembre 2009, des études portant sur des patientes qui ont subi une BGLS au moment de la mastectomie prophylactique. Deux examinateurs ont évalué indépendamment toutes les études repérées et nous avons inclus seulement les études rétrospectives. Nous avons utilisé un modèle à effets mixtes pour combiner les données.Résultats : Nous avons inclus dans cette analyse 6 études regroupant une population totale de 1251 patientes qui ont subi 1343 mastectomies prophylactiques. Parmi ces 1343 mastectomies prophylactiques regroupées, le taux de cancer envahissant occulte (21 cas) s'est établi à 1,7 % (intervalle de confiance [IC] à 95 %, 1,1 %-2,5 %) et le taux de GLS positifs (23 cas) a atteint 1,9 % (IC à 95 %, 1,2 %-2,6 %). Au total, les constatations dans 36 cas (2,8 %, IC ...

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“…The SN biopsy has therefore reduced the morbidity associated with axillary lymph node dissection (ALND) and has readily evolved into the standardized staging procedure in clinically node negative breast cancer patients (Veronesi et al 1999;Golshan et al 2003;Lyman et al 2005;Ferrari et al 2006). For instance, previous studies demonstrated that morbidity of ALND including lymphedema, arm paresthesia, chronic pain and immobility occurs in 5% to 50% of the patients (Kuehn et al 2000;Petrek et al 2001;Silberman et al 2004;Wilke et al 2006). In addition, SN biopsy is an acceptable procedure alterative to ALND for staging the axillary lymph node status in patients with early stage breast cancer (Lyman et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Evaluation of Axillary Lymph Node Status in Breast Cancer Patients Using Shear Wave Elastography

Tamaki¹,

Tamaki²,

Kamada³

et al. 2013

Tohoku J. Exp. Med.

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Less invasive procedures are currently required to examine the axillary lymph node status. Shear wave elastography with acoustic radiation force impulse provides objective and reproducible quantification of the intrinsic property of the soft tissue. In this study, we measured shear wave velocity of the axillary lymph nodes of patients with breast cancer using Virtual Touch Tissue Quantification (VTTQ). The degree of lymph node metastasis was evaluated by measuring the expression level of cytokeratin 19 (CK19) mRNA, a specific marker for breast cancer cells. The one-step nucleic acid amplification (OSNA) was used to determine the copy number of CK19 mRNA in 149 lymph node specimens of 149 primary breast cancer patients. Axillary lymph node status according to OSNA (copy number/μl) were categorized as 0-249 copies (−), 250-5,000 copies (+), and copy number > 5,000 (++). A category (−) represents no metastasis in the axillary lymph node. There were 121 patients with OSNA−, 9 with OSNA+ and 19 with OSNA++. The average velocities according to OSNA categories were 1.64 ± 0.42 m/second for OSNA−, 2.25 ± 0.78 m/second for OSNA+, and 2.79 ± 0.98 m/second for OSNA++. There were significant differences in the shear wave velocity between OSNA− and OSNA+ (P = 0.040) or OSNA++ (P < 0.001). The most optimal cutoff velocity to distinguish benign from metastasis is 1.44 m/second, as determined using the receiver operating characteristic method. The shear wave velocity measured with VTTQ could provide clinically useful information about axillary lymph node metastasis in patients with primary breast cancer.

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Surgical Complications Associated With Sentinel Lymph Node Biopsy: Results From a Prospective International Cooperative Group Trial

Abstract: This study provides a prospective assessment of the sentinel lymph node biopsy procedure, as performed by a wide range of surgeons, demonstrating a low complication rate.

Cited by 529 publications

References 55 publications

Outcome of axillary staging in early breast cancer: a meta-analysis

Outcome of axillary staging in early breast cancer: a meta-analysis

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Non-Invasive Evaluation of Axillary Lymph Node Status in Breast Cancer Patients Using Shear Wave Elastography

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