scholarly journals Locoregional Management of Early-Stage Breast Cancer

2020 ◽  
Vol 18 (7.5) ◽  
pp. 937-940
Author(s):  
Benjamin O. Anderson ◽  
Janice A. Lyons
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph ◽  
Recurrence Rates ◽  
Sentinel Nodes ◽  
Node Negative ◽  
Node Biopsy ◽  
Axillary Radiotherapy

Locoregional management of early-stage breast cancer has been trending toward less-extensive axillary resections, based on increasing evidence showing that patients with 1 or 2 positive sentinel nodes and/or micrometastases can safely be managed with sentinel node biopsy alone, thereby avoiding complete axillary lymph node dissection (cALND) in the significant majority of patients. Because of the 15% to 20% lymphedema risk associated with cALND, increasing efforts are being made to avoid the procedure when evidence suggests that more limited procedures are safe, as reflected by acceptable locoregional recurrence rates. Axillary radiotherapy (RT) has been shown to be an effective alternative to ALND for patients fitting criteria from the pivotal AMAROS trial: patients with T1/T2 disease and are clinically node-negative, who undergo either breast-conserving therapy or mastectomy. Considerations for RT begin with the question of nodal involvement, with treatment planned accordingly. With more neoadjuvant therapy being used, there are nuances in locoregional management that clinicians must now appreciate, both in terms of ALND and axillary RT.

Association between US features of primary tumor and axillary lymph node metastasis in patients with clinical T1–T2N0 breast cancer

2017 ◽  
Vol 59 (4) ◽  
pp. 402-408 ◽  
Author(s):  
Min Sun Bae ◽  
Sung Ui Shin ◽  
Sung Eun Song ◽  
Han Suk Ryu ◽  
Wonshik Han ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Early Stage ◽  
Univariate Analysis ◽  
Nodal Metastasis ◽  
Early Stage Breast Cancer ◽  
Architectural Distortion ◽  
Axillary Lymph ◽  
Node Negative ◽  
The Us

Background Most patients with early-stage breast cancer have clinically negative lymph nodes (LNs). However, 15–20% of patients have axillary nodal metastasis based on the sentinel LN biopsy. Purpose To assess whether ultrasound (US) features of a primary tumor are associated with axillary LN metastasis in patients with clinical T1–T2N0 breast cancer. Material and Methods This retrospective study included 138 consecutive patients (median age = 51 years; age range = 27–78 years) who underwent breast surgery with axillary LN evaluation for clinically node-negative T1–T2 breast cancer. Three radiologists blinded to the axillary surgery results independently reviewed the US images. Tumor distance from the skin and distance from the nipple were determined based on the US report. Association between US features of a breast tumor and axillary LN metastasis was assessed using a multivariate logistic regression model after controlling for clinicopathologic variables. Results Of the 138 patients, 28 (20.3%) had nodal metastasis. At univariate analysis, tumor distance from the skin ( P = 0.019), tumor size on US ( P = 0.023), calcifications ( P = 0.036), architectural distortion ( P = 0.001), and lymphovascular invasion ( P = 0.049) were associated with axillary LN metastasis. At multivariate analysis, shorter skin-to-tumor distance (odds ratio [OR] = 4.15; 95% confidence interval [CI] = 1.01–16.19; P = 0.040) and masses with associated architectural distortion (OR = 3.80; 95% CI = 1.57–9.19; P = 0.003) were independent predictors of axillary LN metastasis. Conclusion US features of breast cancer can be promising factors associated with axillary LN metastasis in patients with clinically node-negative early-stage breast cancer.

American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

2005 ◽  
Vol 23 (30) ◽  
pp. 7703-7720 ◽  
Author(s):  
Gary H. Lyman ◽  
Armando E. Giuliano ◽  
Mark R. Somerfield ◽  
Al B. Benson ◽  
Diane C. Bodurka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Clinical Oncology ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph ◽  
Term Survival ◽  
Node Biopsy ◽  
American Society

Purpose To develop a guideline for the use of sentinel node biopsy (SNB) in early stage breast cancer. Methods An American Society of Clinical Oncology (ASCO) Expert Panel conducted a systematic review of the literature available through February 2004 on the use of SNB in early-stage breast cancer. The panel developed a guideline for clinicians and patients regarding the appropriate use of a sentinel lymph node identification and sampling procedure from hereon referred to as SNB. The guideline was reviewed by selected experts in the field and the ASCO Health Services Committee and was approved by the ASCO Board of Directors. Results The literature review identified one published prospective randomized controlled trial in which SNB was compared with axillary lymph node dissection (ALND), four limited meta-analyses, and 69 published single-institution and multicenter trials in which the test performance of SNB was evaluated with respect to the results of ALND (completion axillary dissection). There are currently no data on the effect of SLN biopsy on long-term survival of patients with breast cancer. However, a review of the available evidence demonstrates that, when performed by experienced clinicians, SNB appears to be a safe and acceptably accurate method for identifying early-stage breast cancer without involvement of the axillary lymph nodes. Conclusion SNB is an appropriate initial alternative to routine staging ALND for patients with early-stage breast cancer with clinically negative axillary nodes. Completion ALND remains standard treatment for patients with axillary metastases identified on SNB. Appropriately identified patients with negative results of SNB, when done under the direction of an experienced surgeon, need not have completion ALND. Isolated cancer cells detected by pathologic examination of the SLN with use of specialized techniques are currently of unknown clinical significance. Although such specialized techniques are often used, they are not a required part of SLN evaluation for breast cancer at this time. Data suggest that SNB is associated with less morbidity than ALND, but the comparative effects of these two approaches on tumor recurrence or patient survival are unknown.

Predictors of regional recurrences in breast cancer patients with negative sentinel node.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 51-51
Author(s):  
Akiko Matsumoto ◽  
Maiko Takahashi ◽  
Tetsu Hayashida ◽  
Hiromitsu Jinno ◽  
Yuko Kitagawa
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Regional Recurrence ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Negative

51 Background: For patients with clinically node-negative, early-stage breast cancer, sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as a standard method for staging of regional lymph nodes. Regional recurrences after negative (SLNB) have generally been reported in the range of 0.5 to 2% and factors associated with regional recurrence in patients with negative SLNB are still to be elucidated. In this study, we evaluated regional recurrence rates and predictors of regional recurrences in patients with negative SLNB. Methods: Between January 2001 and December 2012, 1,322 patients with clinical node-negative invasive breast cancer less than 3cm underwent SLNB at Keio University Hospital. Of 1,322 patients with SLNB, 1,033 patients with negative SLNs were included in this study. Sentinel lymph nodes (SLNs) were detected using a combined method of blue dye and small-sized technetium-99m-labeled tin colloid. Intraoperative frozen examination was performed with hematoxylin and eosin (HE) staining. SLNs, fixed and embedded in paraffin, were additionally diagnosed with HE staining and immunohistochemical analysis. Results: Median age was 57.0 years (range, 25-89) and median tumor size was 1.9cm (range, 0.5-6.0cm). After a median follow-up of 54.8 months, there were 13 regional (1.3%) and 26 distant recurrences (2.5%). Median disease-free interval of regional and distant recurrences was 32.6 and 22.7 months, respectively (p=0.761). Higher nuclear grade (NG) was significantly correlated with regional and distant recurrences (p=0.001 and p=0.008). The rate of lymphovascular invasion (LVI) was significantly higher in patients with regional recurrences comparing with patients without recurrences (58.3% vs. 27.6%, p=0.026), however LVI was not a significant predictor of distant recurrences (p=0.072). Estrogen receptor negativity was significantly correlated with distant recurrences (p=0.013), whereas it was not associated with regional recurrences (p=0.626). Conclusions: Regional recurrences were rare in early-stage breast cancer patients with negative SLNB. LVI and NG can be used as predictive factors of regional recurrences after negative SLNB.

scholarly journals Axillary dissection compared to sentinel node biopsy for the treatment of pathologically node-negative breast cancer: a meta-analysis of four randomized trials with long-term follow up

2012 ◽  
pp. e20
Author(s):  
Fausto Petrelli ◽  
Veronica Lonati ◽  
Sandro Barni
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Axillary Dissection ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Early Stage Breast Cancer ◽  
Node Negative ◽  
Node Biopsy

Sentinel lymph node biopsy is now accepted as the initial approach for women with early stage breast cancer with clinically node-negative disease. We performed a pooled analysis of trials comparing axillary lymph node dissection to sentinel lymph node biopsy in patients with early stage breast cancer and pathologically negative sentinel lymph node analysis. A systematic MEDLINE review identified four randomized trials of axillary dissection versus sentinel lymph node biopsy in lymph node-negative early stage breast cancer patients. A meta-analysis was performed for survival and relapse. The combined analyses of these four trials found no significant difference in overall survival (relative risk [RR] 1.15; P=0.16; 95% CI: 0.95-1.39), breast cancer-specific (RR 1.03; P=0.85; 95% CI: 0.75- 1.43) and disease-free survival (RR 1.07; P=0.3; 95% CI: 0.94-1.21), distant metastases (RR 1; P=0.98; 95% CI: 0.76-1.32), and ipsilateral breast recurrence (RR 1.64; P=0.34; 95% CI: 0.60-4.47) associated with sentinel lymph node biopsy. In particular, a similar rate of nodal recurrences was seen after sentinel lymph node biopsy (RR 1.74; P=0.13; 95% CI: 0.86- 3.53). Axillary dissection does not confer a survival benefit nor prevent further nodal relapses in the setting of early stage, pathologically lymph node-negative breast cancer.

scholarly journals Axillary dissection compared to sentinel node biopsy for the treatment of pathologically node-negative breast cancer: a meta-analysis of four randomized trials with long-term follow up

2012 ◽  
Vol 6 (2) ◽  
pp. 20 ◽  
Author(s):  
Fausto Petrelli ◽  
Veronica Lonati ◽  
Sandro Barni
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Axillary Dissection ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Early Stage Breast Cancer ◽  
Node Negative ◽  
Node Biopsy

Sentinel lymph node biopsy is now accepted as the initial approach for women with early stage breast cancer with clinically node-negative disease. We performed a pooled analysis of trials comparing axillary lymph node dissection to sentinel lymph node biopsy in patients with early stage breast cancer and pathologically negative sentinel lymph node analysis. A systematic MEDLINE review identified four randomized trials of axillary dissection versus sentinel lymph node biopsy in lymph node-negative early stage breast cancer patients. A meta-analysis was performed for survival and relapse. The combined analyses of these four trials found no significant difference in overall survival (relative risk [RR] 1.15; P=0.16; 95% CI: 0.95-1.39), breast cancer-specific (RR 1.03; P=0.85; 95% CI: 0.75- 1.43) and disease-free survival (RR 1.07; P=0.3; 95% CI: 0.94-1.21), distant metastases (RR 1; P=0.98; 95% CI: 0.76-1.32), and ipsilateral breast recurrence (RR 1.64; P=0.34; 95% CI: 0.60-4.47) associated with sentinel lymph node biopsy. In particular, a similar rate of nodal recurrences was seen after sentinel lymph node biopsy (RR 1.74; P=0.13; 95% CI: 0.86- 3.53). Axillary dissection does not confer a survival benefit nor prevent further nodal relapses in the setting of early stage, pathologically lymph node-negative breast cancer.

BAG-1: A Novel Biomarker Predicting Long-Term Survival in Early-Stage Breast Cancer

2001 ◽  
Vol 19 (4) ◽  
pp. 992-1000 ◽  
Author(s):  
Bruce C. Turner ◽  
Stanislaw Krajewski ◽  
Maryla Krajewska ◽  
Shinichi Takayama ◽  
Andrew A. Gumbs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Node Negative

PURPOSE: Among women with early-stage breast cancer treated with lumpectomy and radiation therapy, 30% to 40% will develop metastatic disease, which is often fatal. A need exists therefore for biomarkers that distinguish patients at high risk of relapse. We performed a retrospective correlative analysis of BAG-1 protein expression in breast tumors derived from a cohort of early-stage breast cancer patients. PATIENTS AND METHODS: Archival paraffin blocks from 122 women with stages I to II breast cancer treated with lumpectomy and radiation therapy (median follow-up, 12.1 years) were analyzed by immunohistochemical methods using monoclonal antibodies recognizing BAG-1 and other biomarkers, including Bcl-2, estrogen receptor, progesterone receptor, p53, and HER2/Neu. Immunostaining data were correlated with distant metastasis-free survival (DMFS) and overall survival (OS). RESULTS: Cytosolic immunostaining for BAG-1 was upregulated in 79 (65%) of 122 invasive breast cancers (P < .001) compared with normal breast. Elevated BAG-1 was significantly associated with longer DMFS and OS, overall (stages 1 and II) and in node-negative (stage I only) patients, on the basis of univariate and multivariate analyses (DMFS, P = .005; OS, P = .01, in multivariate analysis of all patients; DMFS, P = .005; OS, P = .001, in multivariate analysis of node-negative patients). All other biomarkers failed to reach statistical significance in multivariate analysis. Clinical stage was an independent predictor of OS (P = .04) and DMFS (P = .02). CONCLUSION: These findings provide preliminary evidence that BAG-1 represents a potential marker of improved survival in early-stage breast cancer patients, independent of the status of axillary lymph nodes.

scholarly journals Omitting ALND Is Not Safe for a Cohort of Early-Stage Breast Cancer Patients with 1-2 SLNs Macro-Metastases and BreastConserving Therapy: A Single-Center Retrospective Study

2020 ◽  
Author(s):  
Xiangyu WANG ◽  
Yinqi GAO ◽  
Xue YANG ◽  
Xiangyi KONG ◽  
Zixing WANG ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Predictive Model ◽  
Cancer Patients ◽  
Early Stage ◽  
Area Under The Curve ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph ◽  
Breast Cancer Patients

Background: Omitting axillary lymph node dissection (ALND) is recommended for early-stage breast cancer patients with 1-2 sentinel lymph nodes (SLNs) macro-metastases and breast-conserving therapy. However, it is not safe for part of patients, so it is significant to find risk factors and develop a predictive model of non-SLNs metastases in breast cancer patients with 1-2 SLNs macro-metastases and breast-conserving therapy. Methods: This retrospective study enrolled 228 breast cancer patients with 1-2 SLNs macro-metastases who underwent ALND and breast-conserving surgery between Jan 2012 and Dec 2017 at Cancer Hospital Chinese Academy of Medical Sciences. Chi-square test and backward stepwise binary logistic regression were used to find factors that influenced non-SLN metastases, then a predictive model was formulated and obtained its area under the curve. Results: Tumor pathologic invasion size, number of positive SLNs and ALN status on imaging was associated with non-SLNs metastases. The predictive model was also formulated based on these three factors to assess and the area under the curve of model was 0.708. Conclusion: We developed a predictive model to assess the high-risk cohort of patients of non-SLNs metastases which can be an auxiliary tool for doctors.

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