Sentinel Lymph Node Dissection versus Complete Axillary Dissection in Invasive Breast Cancer

2017 ◽  
Author(s):  
Rachel J. Kwon
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Dissection ◽  
Invasive Breast Cancer ◽  
Axillary Dissection ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Sentinel Node Dissection

This chapter provides a summary of a landmark study in breast surgical oncology: the Z0011 trial. In patients with invasive breast cancer and positive sentinel lymph nodes, does complete axillary lymph node dissection improve survival relative to sentinel node dissection alone? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving axillary dissection versus sentinel lymph node biopsy only.

scholarly journals Role of sentinel lymph node biopsy in assessing the cancer spread to axilla in early breast cancer

2016 ◽  
Vol 4 (1) ◽  
pp. 53
Author(s):  
Ashutosh Gumber ◽  
Manish Mudgal
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Biopsy

Background:Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to axillary lymph node dissection as a way to stage breast cancer in clinically node-negative patients. Objective of the study was to determine the safety and reliability of sentinel lymph node biopsy without axillary lymph node dissection (ALND) in early breast cancer patients.Methods: This prospective study was conducted in patients with operable breast cancer in a single surgical unit of our hospital. Patients with T1-T3 breast cancer with clinically negative axilla and patients with previous lumpectomy were included. All the patients had undergone complete axillary lymph node dissection after sentinel lymph node biopsy. All the specimens were sent separately for paraffin section histopathology.Results:Mean age of 35 female patients included was 54 years. SLN was identified in 94.29% cases and it could not be identified in 2 cases. SLN (96.97%) was most commonly identified at level I. Mean numbers of sentinel node and axillary node were 1.52 and 16.11 respectively. Study of SLN biopsy with methylene blue dye for staging the axilla was done with 81.25% sensitivity and 100% specificity. Positive predictive value was 100% and was able to negatively predict the axilla in 86.36% with an overall accuracy of staging of 96.97% and false negative rate of 18.75%.Conclusions:Sentinel lymph node biopsy without axillary lymph node dissection in sentinel lymph node negative breast cancers appears to be a safe and reliable procedure for determining the nodal status and ensuring the loco-regional control.

Cost comparison of two surgical strategies in the treatment of breast cancer: Sentinel lymph node biopsy versus axillary lymph node dissection

2004 ◽  
Vol 20 (4) ◽  
pp. 449-454 ◽  
Author(s):  
Lionel Perrier ◽  
Karima Nessah ◽  
Magali Morelle ◽  
Hervé Mignotte ◽  
Marie-Odile Carrère ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Medical Costs ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Direct Medical Costs ◽  
Node Biopsy

Objectives: The feasibility and accuracy of sentinel lymph node biopsy (SLNB) in the treatment of breast cancer is widely acknowledged today. The aim of our study was to compare the hospital-related costs of this strategy with those of conventional axillary lymph node dissection (ALND).Methods: A retrospective study was carried out to determine the total direct medical costs for each of the two medical strategies. Two patient samples (n=43 for ALND; n=48 for SLNB) were selected at random among breast cancer patients at the Centre Léon Bérard, a comprehensive cancer treatment center in Lyon, France. Costs related to ALND carried out after SLNB (either immediately or at a later date) were included in SLNB costs (n=18 of 48 patients).Results: Total direct medical costs were significantly different in the two groups (median 1,965.86€ versus 1,429.93€, p=0.0076, Mann-Whitney U-test). The total cost for SLNB decreased even further for patients who underwent SLNB alone (median, 1,301€). Despite the high cost of anatomic pathology examinations and nuclear medicine (both favorable to ALND), the difference in direct medical costs for the two strategies was primarily due to the length of hospitalization, which differs significantly depending on the technique used (9-day median for ALND versus 3 days for SLNB, p<0.0001).Conclusions: A lower morbidity rate is favorable to the generalization of SLNB, when the patient's clinical state allows for it. From an economic point of view, SLNB also seems to be preferred, particularly because our results confirm those found in two published studies concerning the cost of SLNB.

scholarly journals Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy

2019 ◽  
Vol 18 ◽  
pp. 153303381882110 ◽  
Author(s):  
Willard Wong ◽  
Illana Rubenchik ◽  
Sharon Nofech-Mozes ◽  
Elzbieta Slodkowska ◽  
Carlos Parra-Herran ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Neoadjuvant Therapy ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Frozen Section ◽  
Axillary Lymph ◽  
Node Dissection

Background: Shift toward minimizing axillary lymph node dissection in patients with breast cancer post neoadjuvant therapy has led to the assessment of sentinel lymph nodes by frozen section intraoperatively to determine the need for axillary lymph node dissection. However, few studies have examined the accuracy of sentinel lymph node frozen section after neoadjuvant therapy. Our objective is to compare the accuracy of sentinel lymph node frozen section in patients with breast cancer with and without neoadjuvant therapy and to identify features that may influence accuracy. Design: We identified 161 sentinel lymph node frozen section from 77 neoadjuvant therapy patients and 255 sentinel lymph node frozen section from 88 non-neoadjuvant therapy patients diagnosed between 2010 and 2016 in 2 institutions. The frozen section diagnoses were compared to the final diagnoses, and clinicopathologic data were analyzed. Results: The sensitivity, specificity, and accuracy of frozen section analysis were comparable between neoadjuvant therapy patients and non-neoadjuvant therapy patients (71.9% vs 50%, 100% vs 100%, and 88.3% vs 81.8%). Nine (11.7%) of 77 neoadjuvant therapy patients had discordant results, most often due to undersampling (tumor absent on frozen section slide). Four of these patients subsequently underwent axillary lymph node dissection. Discordant results (all false negatives) were significantly more likely in neoadjuvant therapy patients with Estrogen Receptor-positive/HER2-negative status, and in sentinel lymph node with pN1mic and pN0i+ deposits; age, preneoadjuvant therapy lymph node status, histotype, nuclear grade, tumor size, and response to neoadjuvant therapy showed no significant differences. For non-neoadjuvant therapy cases, large tumor size, lobular histotype, and sentinel lymph node with pN1mic and pN0i+ were associated with false-negative frozen section assessment. Conclusion: Sentinel lymph node frozen section diagnosis post-neoadjuvant therapy has comparable sensitivity, specificity, and accuracy to the sentinel lymph node frozen section diagnosis in the non-neoadjuvant therapy setting.

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