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31.
Meijnen P Oldenburg HS Loo CE Nieweg OE Peterse JL Rutgers EJ 《The British journal of surgery》2007,94(8):952-956
BACKGROUND: The aim of the study was to assess the risk of invasion and axillary lymph node metastasis in patients with ductal carcinoma in situ (DCIS) diagnosed by preoperative core-needle biopsy. The data were used to select criteria for patients in whom sentinel node (SN) biopsy might be indicated. METHODS: One hundred and seventy-one women with 172 DCIS lesions diagnosed by core-needle biopsy were analysed. Axillary staging was performed by SN biopsy, axillary node sampling, or level 1-2 axillary lymph node dissection. RESULTS: Invasive breast cancer was found in the surgical specimens from 45 tumours (26.2 per cent). Risk factors for invasion were a palpable lesion (odds ratio (OR) 2.95 (95 per cent confidence interval 1.20 to 7.26); P = 0.019), presence of a mass on mammography (OR 3.06 (1.43 to 6.56); P = 0.004), and intermediate (OR 5.81 (1.18 to 28.57); P = 0.030) or poorly differentiated (OR 5.46 (1.17 to 25.64); P = 0.031) tumour grade. Lymph node metastases were found in ten women with DCIS and invasion on final pathology. Factors associated with metastases were age 55 years or less (P = 0.030), invasion of 1.0 cm or more (P < 0.001) and the presence of vascular invasion (P = 0.001). CONCLUSION: SN biopsy should be considered in women with an initial diagnosis of DCIS on core-needle biopsy who are at risk for invasion; this includes women with a palpable lump, a mass on mammography, and intermediate or poor tumour grade. 相似文献
32.
van Rijk MC Tanis PJ Nieweg OE Loo CE Olmos RA Oldenburg HS Rutgers EJ Hoefnagel CA Kroon BB 《Annals of surgical oncology》2007,14(2):627-632
Background Preliminary data have shown encouraging results of a single intratumoral radiopharmaceutical injection that enables both sentinel
node biopsy and probe-guided excision of the primary tumor in patients with nonpalpable breast cancer. The aim of the study
was to evaluate this approach in a large group of patients.
Methods Lymphoscintigraphy was performed in 368 patients with nonpalpable breast cancer after intratumoral injection of 99mTc-nanocolloid (.2 mL, 123 MBq, 3.3 mCi) guided by ultrasound or stereotaxis. The sentinel node was pursued with the aid of
vital blue dye (1.0 mL, intratumoral) and a gamma ray detection probe. In case of breast-conserving surgery, the probe was
used to guide the excision.
Results At least one sentinel node could be identified intraoperatively in 357 patients (97%), of whom 69 had involved nodes (19%).
Age over 60 years was associated with less frequent nonaxillary lymphatic drainage and absence of internal mammary chain dissemination.
Tumor-free margins were obtained in 262 (89%) of the 293 patients who underwent segmental excision. Re-excision of the primary
tumor bed was performed in six patients (2%). During a median follow-up of 22 months, one breast recurrence and one axillary
recurrence were observed.
Conclusions Lymphatic mapping and probe-guided tumor excision of nonpalpable breast cancer by intralesional administration of a single
dose of 99mTc-nanocolloid and blue dye resulted in 97% identification of the sentinel node and in tumor-free margins in 89% of the patients
who underwent breast-conserving surgery. Longer follow-up is needed to substantiate the accuracy and safety of this technique. 相似文献
33.
Nieweg OE 《Nederlands tijdschrift voor geneeskunde》2007,151(23):1272-1275
National and international guidelines for diagnosis and treatment are increasingly applied as standards for medical interventions. Evidence-based consensus guidelines are not consistently based on the outcome of scientific studies. Recent research yielding inherent low-grade evidence is liable to be overruled by personal impressions, sentiments and common sense. Guidelines are based on the average patient, with a certain range. With increasing specialisation, one increasingly sees that doctors justifiably digress from a guideline when a patient differs substantially from the average. 相似文献
34.
The hidden sentinel node and SPECT/CT in breast cancer patients 总被引:1,自引:1,他引:0
van der Ploeg IM Olmos RA Kroon BB Rutgers EJ Nieweg OE 《European journal of nuclear medicine and molecular imaging》2009,36(1):6-11
Purpose In a minority of breast cancer patients, lymphoscintigraphy shows no lymphatic drainage and ‘hidden’ sentinel nodes may remain
undiscovered. The purpose of this study was to explore the additional value of the recently introduced hybrid SPECT/CT in
breast cancer patients with axillary non-visualisation on planar images. The role of blue dye and careful palpation of the
axilla was evaluated in patients in whom axillary sentinel nodes remained hidden after SPECT/CT.
Methods Fifteen breast cancer patients with non-visualisation on planar lymphoscintigraphy and 13 women with only extra-axillary sentinel
nodes underwent SPECT/CT following late planar imaging without re-injection of the radiopharmaceutical.
Results SPECT/CT visualised lymphatic drainage in eight of the 15 patients (53%) with non-visualisation on planar imaging, depicted
nine of the 14 harvested sentinel nodes (64%) and three of five tumour-positive sentinel nodes. In two of the 13 patients
(15%) with only extra-axillary sentinel nodes on their planar lymphoscintigram, SPECT/CT showed an axillary sentinel node
that appeared to be uninvolved. Careful exploration of the axilla with the combined use of blue dye, a gamma probe and intra-operative
palpation revealed an axillary sentinel node in the remaining 18 patients. SPECT/CT showed the exact anatomical location of
all visualised sentinel nodes.
Conclusion SPECT/CT discovered ‘hidden’ sentinel nodes in the majority of patients with non-visualisation, but was less valuable in patients
with only extra-axillary lymphatic drainage on the planar images. Exploration of the axilla in patients with persistent non-visualisation
improved the identification of axillary (involved) sentinel nodes. 相似文献
35.
Nieweg OE 《Annals of surgical oncology》2008,15(8):2347-2347; author reply 2349
36.
Breast Cancer Patients with Extra-Axillary Sentinel Nodes Only may be Spared Axillary Lymph Node Dissection 总被引:1,自引:0,他引:1
van der Ploeg IM Tanis PJ Valdés Olmos RA Kroon BB Rutgers EJ Nieweg OE 《Annals of surgical oncology》2008,15(11):3239-3243
Background In breast cancer patients with only extra-axillary sentinel nodes, surgeons typically perform axillary node dissection. The
purpose of this study was to evaluate our approach to spare such patients further dissection based on the hypothesis that
a sentinel node is not necessarily located in the axilla.
Methods Between March 11, 1999 and March 5, 2008, 1,949 breast cancer patients underwent lymphatic mapping with preoperative lymphoscintigraphy
and intraoperative use of a gamma-ray detection probe and patent blue dye. The tracers were injected into the tumors.
Results Eighty-two of the 1,949 patients had only extra-axillary drainage on their lymphoscintigrams. A sentinel node was harvested
from the axilla in 62 patients but not in the remaining 20 patients. No axillary lymph nodes were removed in 4 of these 20
patients, suspicious palpable nodes were excised in another 4 patients, and node sampling was done in the remaining 12. These
nodes were all free of disease. All sentinel nodes outside the axilla were removed. Two patients had a metastasis in an internal
mammary chain node. No lymph node recurrences were detected in or outside the axilla in any of the 20 patients with a median
follow-up time of 49 months.
Conclusion 4% of the patients have only extra-axillary drainage on preoperative lymphoscintigrams. It is worthwhile to explore the axilla
since a sentinel node can be found in three-quarters. In the remaining 1% without axillary sentinel nodes, axillary sampling
seems unnecessary and the approach to refrain from axillary dissection appears valid. 相似文献
37.
38.
Radio-guided surgery improves outcome of therapeutic excision in non-palpable invasive breast cancer 总被引:2,自引:0,他引:2
Gallegos Hernandez JF Tanis PJ Deurloo EE Nieweg OE Th Rutgers EJ Kroon BB Valdés Olmos RA 《Nuclear medicine communications》2004,25(3):227-232
Intratumoral injection of a radiocolloid for lymphatic mapping enables the therapeutic excision of clinically occult breast cancer with the aid of a gamma-ray detection probe. The aim of this study was to determine the success rate of radio-guided tumour excision in addition to a guide wire and to identify factors predicting clear margins. Sixty-five consecutive patients underwent radio-guided tumour excision after intratumoral injection of 99mTc-nanocolloid guided by ultrasound or stereotaxis. A localization wire was inserted after scintigraphy had been performed (group 1). The results were compared with retrospective data from 67 consecutive patients who underwent therapeutic wire-directed excision alone (group 2). Factors predicting clear margins (> or = 1 mm) were determined in a logistic regression model. Adequate margins were obtained in 83% of group 1 and in 64% of group 2 (P = 0.014). The invasive component was incompletely excised in two patients in group 1 and in 14 patients in group 2. Further surgery was performed in four patients in group 1 and in 14 patients in group 2. Factors predictive of clear margins were decreasing pathological tumour diameter (P = 0.035), increasing weight of the specimen (P = 0.046), absence of microcalcifications (P = 0.004) and absence of carcinoma in situ component (P = 0.024). Radio-guided excision was an independent predictor of complete excision of the invasive component (P = 0.012). The application of radio-guided surgery combined with wire localization seems to improve the outcome of therapeutic excision of non-palpable invasive breast cancer compared with wire-directed excision alone. 相似文献
39.
OBJECTIVES: The aim of this study was to describe the lymphatic drainage patterns from the 5 "quadrants" of the breast. SUMMARY BACKGROUND DATA: Lymphatic mapping has provided techniques to visualize and harvest sentinel nodes in various locations and has generated renewed interest in nodes outside the axilla. METHODS: Between January 1997 and June 2002, 700 sentinel node procedures were performed in patients with cN0 breast cancer. Preoperative lymphoscintigraphy was performed after injection of 99mTc-nanocolloid into the tumor in a volume of 0.2 mL and a mean dose of 107.7 MBq (2.8 mCi). Intraoperatively, the sentinel node was pursued with the aid of a gamma-ray detection probe and patent blue dye (1.0 mL, into the lesion). The patients were divided into 5 groups according to the location of the primary breast cancer. In each group, a distinction was made between palpable and nonpalpable lesions of the breast. RESULTS: Drainage to either an axillary or an extra-axillary basin was observed in 678 patients. Both palpable and nonpalpable lesions may drain toward the internal mammary chain, although the latter more frequently, regardless of the quadrant. Drainage was also observed to supraclavicular, infraclavicular, interpectoral, and intramammary sentinel nodes. CONCLUSION: In each quadrant, a breast cancer may drain to sentinel nodes in various locations. There is a distinct difference in drainage patterns between palpable and nonpalpable lesions. These findings may improve the assessment of lymphatic dissemination in invasive breast cancer. 相似文献
40.
Rationale for superficial injection techniques in lymphatic mapping in breast cancer patients 总被引:3,自引:0,他引:3
One of the most avidly debated issues in lymphatic mapping is where the tracers are best deposited in patients with breast cancer. The four superficial approaches are easy to perform and have several other distinct advantages. They are based on the hypothesis that the entire breast parenchyma and the overlying skin drain to a common node in the axilla because of their common embryological origin. Evidence is presented that casts doubt upon the correctness of this assumption. Tracer administration close to the tumor site appears to be the safest approach for the time being. Excellent results can be obtained with this latter approach, despite the fact that it is technically more demanding. 相似文献