Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial

Krag, David N.; Anderson, Stewart J.; Julian, Thomas B.; Brown, A; Harlow, Seth P.; Ashikaga, Takamaru; Weaver, Donald L.; Miller, Barbara J.; Jalovec, Lynne M.; Frazier, Thomas G.; Noyes, R. Dirk; Robidoux, André; Scarth, Hugh M.C.; Mammolito, Denise M.; McCready, David R.; Mamounas, Eleftherios P.; Costantino, Joseph P.; Wolmark, Norman

doi:10.1016/s1470-2045(07)70278-4

Cited by 959 publications

(621 citation statements)

References 27 publications

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“…Seven trials were thus eligible, as shown in Table 1 [3,4,[7][8][9][10][11]. A total of 9,608 patients were randomly assigned to treatment (658 in the SNB only arm, 5,084 in the ALND only arm and 4,406 who had SNB and then went onto have ALND), and data was available for analysis from 8,853 of them (636, 4,389 and 3,828 in the three arms, respectively).…”

Section: Eligible Studiesmentioning

confidence: 99%

“…There was little variability among studies in the menopausal status, eligible stages of breast cancer and tumour size of participants. All seven trials enroled patients between 1998 and 2005, and six of the seven studies were multicentre trials [4,[7][8][9][10][11].…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Five trials [3,4,7,9,11] described the method of power calculation, six trials [4,[7][8][9][10][11] described in detail the mode of randomization and five trials [4,[7][8][9]11] described the mode of allocation concealment in detail. Withdrawals were described in detail in six trials [3,4,[8][9][10][11].…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Withdrawals were described in detail in six trials [3,4,[8][9][10][11]. None of the seven studies were blinded.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…In four trials the control group underwent SNB followed by routine ALND and the test group underwent SNB with ALND only if the SNB was positive [3,[8][9][10]. In two trials the control group underwent ALND only and the test group underwent SNB with ALND only if the SNB was positive [4,11].…”

Section: Nodal Positivitymentioning

confidence: 99%

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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: Eligible Studiesmentioning

confidence: 99%

Section: Eligible Studiesmentioning

confidence: 99%

Section: Eligible Studiesmentioning

confidence: 99%

“…Withdrawals were described in detail in six trials [3,4,[8][9][10][11]. None of the seven studies were blinded.…”

Section: Eligible Studiesmentioning

confidence: 99%

Section: Nodal Positivitymentioning

confidence: 99%

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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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Quality Measures for Breast Cancer Surgery

McCahill

Privette²,

James³

et al. 2009

Arch Surg

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Risk Factors for Lymphedema in a Prospective Breast Cancer Survivorship Study

Kwan

Darbinian

Schmitz³

et al. 2010

Arch Surg

139

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Objective To determine the incidence of breast cancer-related lymphedema (BCRL) during the early survivorship period, and demographic, lifestyle, and clinical factors associated with BCRL development. Design The Pathways Study, a prospective cohort study of breast cancer survivors with a mean follow-up of 20.9 months. Setting Kaiser Permanente Northern California (KPNC) Medical Care Program. Participants 997 women diagnosed from January 2006 to October 2007 with primary invasive breast cancer and at least 21 years of age at diagnosis, had no prior history of any cancer, and spoke English, Spanish, or Chinese. Main Outcome Measures Clinical indication of BCRL as determined from outpatient or hospitalization diagnostic codes, outpatient procedural codes, and durable medical equipment orders. Results 133 women (13.3%) had a clinical indication of BCRL, with a mean time to diagnosis of 8.3 months (range: 0.7–27.3). Being African American (HR = 1.93; 95% CI: 1.00–3.72) or more educated (p trend = 0.03) was associated with an increased risk of BCRL. Removal of at least one lymph node (HR = 1.04; 95% CI: 1.02–1.07) was associated with increased risk, yet no significant association was observed for type of lymph node surgery. Being obese at breast cancer diagnosis was suggestive of an elevated risk (HR = 1.43; 95% CI: 0.88–2.31). Conclusions In a large cohort study, BCRL occurs among a substantial proportion of early breast cancer survivors. Our findings agree with previous studies on the increased risk of BCRL with removal of lymph nodes and being obese, yet point to differential risk by race/ethnicity.

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Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial

Cited by 959 publications

References 27 publications

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

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

Quality Measures for Breast Cancer Surgery

Risk Factors for Lymphedema in a Prospective Breast Cancer Survivorship Study

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