The effect of internal mammary lymph node biopsy on the therapeutic decision and survival of patients with breast cancer

Özmen, Vahit; Özçınar, Beyza; Bozdogan, Atilla; Eralp, Y.; Yavuz, Ekrem; Dincer, Maktav

doi:10.1016/j.ejso.2015.07.005

Cited by 15 publications

(6 citation statements)

References 35 publications

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“…The incidences of IMLNs metastasis for these patients were more than 20% [19]. The IMLN metastasis rate was higher in patients with ALN-positive than those with ALN-negative [16–18, 20]. Most patients received NAC were in the advanced stage with high risk of IMLN metastasis, so it was necessary to make clear the pathology status of IMLN in these patients.…”

Section: Discussionmentioning

confidence: 99%

Axillary and internal mammary sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy

Cao

Cong

et al. 2016

Oncotarget

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With the improvement of neoadjuvant chemotherapy (NAC), the proportion of pathological complete response (pCR) in the breast and axillary lymph node (ALN) is increasing. The evaluation of pCR does not include the status of internal mammary lymph node (IMLN). This study is to evaluate the roles of both axillary sentinel lymph node biopsy (ASLNB) and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC. There were 74 patients enrolled into this study. IM-SLNB was performed on patients with radioactive internal mammary sentinel lymph node (IM-SLN). Patients (n = 8) with cN0 and ycN0 received ASLNB, and axillary lymph node dissection (ALND) in cases of positive axillary sentinel lymph node (ASLN). Patients (n = 48) with cN+ but ycN0 received ASLNB and ALND. Patients (n = 18) with ycN+ received ALND without ASLNB. The visualization rate of IM-SLN was 56.8% (42/74). The success rate of IM-SLNB was 97.6% (41/42) and the metastasis rate of IM-SLN was 7.3% (3/41). The success rate of ASLNB was 100% (56/56). The false negative rate (FNR) of ASLNB was 17.2% (5/29). The FNR in patients with 1, 2 and ≥ 3ASLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/8) respectively. ASLNB could be performed on ycN0 after NAC, and ALND should be performed on initially ALN-positive patients. IM-SLNB should be considered after NAC, especially for patients with clinically positive axillary nodes before NAC, which might help make clear of the pathological nodal staging of both ALN and IMLN, improve the definition of nodal pCR, and guide the individual adjuvant regional and systemic therapy.

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Section: Discussionmentioning

confidence: 99%

Axillary and internal mammary sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy

Cao

Cong

et al. 2016

Oncotarget

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“…2 ). Clinically, the detection of sentinel lymph node (LN) metastases at diagnosis is clearly associated with a reduced survival in breast cancer ( Penault-Llorca and Radosevic-Robin, 2016 , Jatoi et al, 1999 , Weigelt et al, 2005a , Ozmen et al, 2015 , Gipponi et al, 2004 , Rakha et al, 2012 ). Cancer-related deaths occurred only in patients whose tumors had spread to the sentinel lymph nodes (LN) and beyond.…”

Section: Resultsmentioning

confidence: 99%

SIAH and EGFR, Two RAS Pathway Biomarkers, are Highly Prognostic in Locally Advanced and Metastatic Breast Cancer

et al. 2016

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BackgroundMetastatic breast cancer exhibits diverse and rapidly evolving intra- and inter-tumor heterogeneity. Patients with similar clinical presentations often display distinct tumor responses to standard of care (SOC) therapies. Genome landscape studies indicate that EGFR/HER2/RAS “pathway” activation is highly prevalent in malignant breast cancers. The identification of therapy-responsive and prognostic biomarkers is paramount important to stratify patients and guide therapies in clinical oncology and personalized medicine.MethodsIn this study, we analyzed matched pairs of tumor specimens collected from 182 patients who received neoadjuvant systemic therapies (NST). Statistical analyses were conducted to determine whether EGFR/HER2/RAS pathway biomarkers and clinicopathological predictors, alone and in combination, are prognostic in breast cancer.FindingsSIAH and EGFR outperform ER, PR, HER2 and Ki67 as two logical, sensitive and prognostic biomarkers in metastatic breast cancer. We found that increased SIAH and EGFR expression correlated with advanced pathological stage and aggressive molecular subtypes. Both SIAH expression post-NST and NST-induced changes in EGFR expression in invasive mammary tumors are associated with tumor regression and increased survival, whereas ER, PR, and HER2 were not. These results suggest that SIAH and EGFR are two prognostic biomarkers in breast cancer with lymph node metastases.InterpretationThe discovery of incorporating tumor heterogeneity-independent and growth-sensitive RAS pathway biomarkers, SIAH and EGFR, whose altered expression can be used to estimate therapeutic efficacy, detect emergence of resistant clones, forecast tumor regression, differentiate among partial responders, and predict patient survival in the neoadjuvant setting, has a clear clinical implication in personalizing breast cancer therapy.FundingThis work was supported by the (A.H. Tang); (MF14S-009-LS to A.H. Tang), and (CA140550 to A.H. Tang).

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“…Even so, the introduction of the procedure of SLN biopsy in the ITC has renewed interest in the status of ITLNs, because it can modify adjuvant therapy for BC patients without causing significant rise in morbidity [ 26 ]. For example, according to Caudle et al and Ozmen et al, SLN-ITC involvement altered adjuvancy, respectively, in 7 and 15.2 % of the patients in whom SLN biopsy was performed after preoperative lymphoscintigraphic showed drainage into the ITC [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical anatomy of the internal thoracic lymph nodes in fresh human cadavers: basis for sentinel node biopsy

et al. 2016

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BackgroundWhile the optimal management of early breast cancer patients with sentinel lymph node (SLN) involvement mapped in the internal thoracic chain is still debated, biopsy may be performed when surgeons select patients who are most likely to benefit.The aim of this study is to examine anatomical aspects of internal thoracic nodes (ITNs) to orientate SLN biopsy in the parasternal area.MethodsThis study was based on dissections of 29 female cadavers. The parameters analyzed were the number of intercostal spaces (ICSs) containing at least one ITN, mean number of nodes in each ICS, position of the ITNs in relation to the internal thoracic artery (ITA), number of retrocostal spaces (RCSs) containing at least one ITN, and mean number of nodes in each RCS.ResultsThe ICS that was most likely to have at least one ITN was the third, with 86.2 % in the right side and 75.8 % in the left side. In the second ICS, the rates were 69.2 and 73.6 %, and in the fourth, the rates were 48.1 and 33.3 %. In the third ICS, on both sides, the mean number of ITNs was the highest (1.2). A tendency of the nodes to be laterally located in the second ICS and medially located in the downward dissection was observed. Most of the RCSs did not present any nodes.ConclusionsThis study indicates that most of the second and third ICSs presented at least one ITN, and the mean number of nodes in the third space was greater. There is a tendency to find nodes medial to the artery downwards from the second to the fourth ICS. ITNs are generally located in ICSs, and the majority of RCSs did not contain any nodes.

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The effect of internal mammary lymph node biopsy on the therapeutic decision and survival of patients with breast cancer

Cited by 15 publications

References 35 publications

Axillary and internal mammary sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy

Axillary and internal mammary sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy

SIAH and EGFR, Two RAS Pathway Biomarkers, are Highly Prognostic in Locally Advanced and Metastatic Breast Cancer

Surgical anatomy of the internal thoracic lymph nodes in fresh human cadavers: basis for sentinel node biopsy

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