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1.
Monti S Galimberti V Trifiro G De Cicco C Peradze N Brenelli F Fernandez-Rodriguez J Rotmensz N Latronico A Berrettini A Mauri M Machado L Luini A Paganelli G 《Annals of surgical oncology》2007,14(10):2928-2931
Background Non-palpable breast lesions are diagnosed frequently posing the problem of localization and removal. When such lesions are
malignant, axillary node status must be determined. We report our experience using radio-guided occult lesion localization
(ROLL) for locating and removing non-palpable breast lesions together with sentinel node biopsy (SNB) to assess axillary status.
We call the technique SNOLL.
Methods From March 1997 to April 2004, 1046 consecutive patients presented suspicious non-palpable breast lesions and were programmed
for conservative surgery and SNB. In 87 patients intraoperative histological examination revealed a benign lesion and SNB
was not performed. The remaining 959 patients, with cytologically or histologically proven cancer, underwent SNOLL with immobile
radiotracer injected under mammographic or ultrasound (US) guidance into the lesion, and subsequent injection of mobile tracer
subdermally to localize the sentinel node (SN). Patients then underwent breast surgery and SNB.
Results Breast lesions were localized by ROLL in 99.6% of cases and were removed radically with negative margins in 91.9% of cases.
Sentinel nodes were detected in all but one case. Intraoperative or definitive histological examination revealed 776 invasive/microinvasive
carcinomas and 182 with in situ disease. Sentinel nodes were positive in 154 (19.8%) of 776 invasive/microinvasive cancers
and in two with ductal intraepithelial neoplasia (1.1%).
Conclusions In SNOLL the injection procedures are performed separately, but both lesion and SNs are removed together; axillary dissection
is performed if the SN is positive, thus definitive treatment of malignant non-palpable lesions occurs in a single surgical
session. 相似文献
2.
哨兵淋巴结活检对预测乳腺癌腋窝淋巴结转移的价值 总被引:30,自引:3,他引:30
目的 评估哨兵淋巴结(SN)活检对预测乳腺癌腋窝淋巴结(LN)转移的价值。方法 本组52例原发乳腺癌患者,临床及B超检测腋窝LN阴性。术中在原发肿瘤周围注射亚甲蓝进行腋窝淋巴结定位和哨兵淋巴结切除(SLND),随后行腋窝淋巴结清扫(ALND)。术中对部分SN、术后对全部LN(SN和非SN)行常规病理检查。结果 52例患者中46例检测到SN,成功率为88.5%;其中44例(95.7%)和SN可以准确 相似文献
3.
Background: Sentinel node biopsy (SNB) for breast cancer patients is a new technique with the potential to provide an accurate staging of the axillary nodal status while avoiding the morbidity of an axillary dissection. The objective of the present study is to validate the use of sentinel node biopsy in a New Zealand hospital and to compare the ability of patent blue dye (PB) alone with triple modality (TM) (preoperative lymphoscintigraphy, intraoperative gamma probe and intraoperative blue dye) to identify the sentinel node. Methods: A total of 104 patients who had a palpable breast lump that was confirmed to be malignant by radiology and cytology and a clinical diagnosis of stage I or stage II breast cancer, were enrolled for SNB and randomly assigned to triple modality or blue dye alone for the localization of the sentinel node. Axillary dissection was performed after the sentinel node(s) had been removed. Results: There were 63 patients in the PB group and 41 patients in the TM group. Both groups are comparable, with a similar mean age and primary tumour size. A sentinel node was identified in 57 (90%) of the PB group patients and 40 (98%) of the TM group patients. Of these 23 (37%) of the PB group and 23 (56%) in the TM group had axillary nodes positive for malignancy. There was one false negative SNB in the PB group and two false negative results in the TM group. Therefore, the PB group had an accuracy of 98% and a sensitivity of 96% compared to an accuracy of 95% and a sensitivity of 91% for the TM group. Conclusion: The results of the present study validate the use of SNB in suitable breast cancer patients. Identification and the accuracy of the sentinel node localization were similar between the two groups. Therefore, in hospital centres without adequate access to a nuclear medical facility, it would be feasible to conduct SNB using blue dye alone. 相似文献
4.
A nonrandomized follow-up comparison between standard axillary node dissection and sentinel node biopsy in breast cancer 总被引:1,自引:0,他引:1
Konstantiniuk P Schrenk P Reitsamer R Koeberle-Wuehrer R Tausch C Roka S Riedl O Poestlberger S Hecke D Janauer M Haid A 《Breast (Edinburgh, Scotland)》2007,16(5):520-526
INTRODUCTION: In many countries sentinel node biopsy (SNB) has become the standard of care in breast cancer based on a large number of observational studies but without results from prospective randomized trials. The goal of our study was to evaluate the oncological safety of the SNB in breast cancer in a multicenter, nonrandomized setting with comparable groups. PATIENTS AND METHODS: Between 1996/05 and 2004/11, 2942 patients from 14 departments in Austria with unicentric, unilateral, invasive disease without neoadjuvant therapy were collected in a database. The recommendations of the Austrian Sentinel Node Study Group were to complete a training period (phase I) with 50 cases of SNB followed by axillary lymph node dissection (ALND) to prove a detection rate of > or = 90% and a false-negative rate of < or = 5%. In the executing period (phase II), SNB was followed by ALND only if the sentinel node (SN) contained metastases. We compared the results on disease-free survival, local recurrence rates, distant recurrence rates and overall survival of both groups. Cases from phases I and II generated groups I (n=671) and 2 (n=2271 cases), respectively. RESULTS: Overall mean follow-up time: 34.41 months. CONCLUSION: SNB followed by ALND only in cases with metastases in the SN is a safe procedure and at least equal to ALND in all cases. 相似文献
5.
Tausch C Steger GG Haid A Jakesz R Fridrik MA Reitsamer R Pöstlberger S Lang A Gnant M Greil R 《The breast journal》2011,17(3):230-238
Over the past years, experience has been increasing with lymphatic mapping and sentinel node biopsy (SNB) after preoperative chemotherapy for breast cancer, with a wide range of results reported in the literature and final conclusions on the diagnostic value and clinical consequences of this sequential approach still missing. Between 1999 and 2002, the Austrian Breast and Colorectal Cancer Study Group (ABCSG) conducted a prospective randomized multicenter trial comparing three versus six preoperative cycles of epirubicin/docetaxel + granulocyte colony-stimulating factor for operable breast cancer. Of the 292 patients recruited to the trial overall, 111 were enrolled in a prospective subprotocol for performing LM and SNB in addition to obligatory axillary lymph node dissection (ALND) after PC. SNB after PC identified at least one sentinel node in 100 of 111 patients (identification rate 90%). In six cases, a false-negative SN was identified, resulting in a false-negative rate of 13% (6 of 47). We only found little correlation between patients and tumor characteristics and the identification rate or false-negative rate. Lymphatic mapping and SNB after primary chemotherapy failed to predict histologic infiltration of the sentinel node with sufficient sensitivity. The routine use of SNB after primary chemotherapy should therefore be discouraged. 相似文献
6.
Sentinel lymph node biopsy performed with local anesthesia in patients with early-stage breast carcinoma 总被引:2,自引:0,他引:2
Luini A Gatti G Frasson A Naninato P Magalotti C Arnone P Viale G Pruneri G Galimberti V De Cicco C Veronesi U 《Archives of surgery (Chicago, Ill. : 1960)》2002,137(10):1157-1160
HYPOTHESIS: Sentinel lymph node (SN) biopsy performed with local anesthesia has a positive effect on patients' quality of life and on treatment management for early-stage breast carcinoma. This method represents an interesting development in breast-conserving surgery. DESIGN: We performed SN biopsy with local anesthesia in selected patients to test the feasibility of the technique and its impact on our organization and on patients' quality of life. PATIENTS AND METHODS: From September 2000 to December 2001, we studied 115 patients with a palpable breast tumor (maximum diameter, 2.5 cm). The axilla was clinically negative for metastasis in all cases. RESULTS: Forty-eight patients (41.7%) had SNs that were positive for metastasis. In 20 cases (17.4%), the SN was macrometastatic and in 28 cases (24.3%), it was micrometastatic (diameter <2 mm). The SN was negative for metastasis in 66 cases (57.4%). In 1 case, the histologic examination revealed the presence of a non-Hodgkin B-cell lymphoma. The complete axillary dissection performed in the subgroup of patients with macrometastatic SNs showed that in 9 cases (45%), the SN was the only positive node. In another 9 cases (45%), patients had fewer than 4 positive axillary lymph nodes; more than 4 axillary nodes were metastatic in 2 cases (10%). Among the 28 patients with SN micrometastasis, 21 received complete axillary dissection: 15 patients (53.6%) had no other metastasis to the axillary nodes and 6 patients (21.4%) had cancer cells in other axillary nodes. In case of micrometastasis, we suggested that patients enter the International Breast Cancer Study Group 2301 trial (15 of them accepted and signed the informed consent), which compared completion of axillary dissection with no further surgical treatment of the axilla. Based on randomization, 7 patients (25%) in the group with micrometastasis to the SN received no axillary dissection. Patients' tolerance to this kind of treatment was excellent. CONCLUSION: Our experience indicates that SN biopsy performed with local anesthesia can be a suitable alternative to standard intraoperative evaluation with general anesthesia in patients with unifocal, early-stage breast carcinoma. 相似文献
7.
Genta F Zanon E Camanni M Deltetto F Drogo M Gallo R Gilardi C 《World journal of surgery》2007,31(6):1157-1165
We evaluated the effectiveness and the cost of axillary staging in breast cancer patients by ultrasound-guided fine-needle
aspiration cytology (US-FNAC), sentinel node biopsy (SNB), and frozen sections of the sentinel node to achieve the target
of the highest number of immediate axillary dissections. From January 2003 through October 2005, a total of 404 consecutive
eligible breast cancer patients underwent US-FNAC of suspicious axillary lymph nodes. If tumor cells were found, immediate
axillary dissection was proposed (33% of node-positive cases). If US or cytology was negative, SNB was performed. Frozen sections
of the sentinel node allowed immediate axillary dissection in 31% of node-positive cases. The remaining 36% underwent delayed
axillary dissection. We compared our policy with clinical evaluation of the axilla, showing better specificity of US-FNAC,
the cost balanced by a 12% reduction of SNBs, and a marked reduction of unnecessary axillary dissections resulting from false-positive
clinical staging. Moreover, the comparison between our policy and permanent histology of the sentinel node showed an 8% cost
saving, mainly associated with the immediate axillary dissections. US-FNAC of axillary lymph nodes in breast cancer patients
reliably predicts the presence of metastases and therefore refers a significant number of patients to the appropriate surgical
treatment, avoiding an SNB. As cost saving to the health care system in our study is mainly related to one-step axillary surgery,
US-FNAC of axillary lymph nodes and frozen section of the sentinel node generate significant cost saving for patients who
have metastatic nodes. 相似文献
8.
BACKGROUND: Sentinel lymph node biopsy (SNB) is rapidly gaining acceptance as an alternative to axillary dissection (AD) in patients with early breast cancer. Debate continues regarding the optimum technique for sentinel node (SN) mapping. We have used our series of 364 SNBs to compare two different techniques. METHODS: A retrospective review of patients undergoing SNB by surgeons in our breast service. Overall results were analysed, with particular attention to those having blue dye alone and those having blue dye in combination with radio-labelled colloid. SNs were analysed using haematoxylin-eosin and immunohistochemical staining. RESULTS: SN identification rates were similar: 96% for dye alone and 89% for dye and colloid in combination. Twenty-one per cent of SN mapped with dye alone contained metastases, compared to 30% with dye and colloid in combination. The false-negative rate was correspondingly higher in the dye alone group (21 vs 2.8%). CONCLUSION: SNB using dye and colloid in combination was significantly superior to dye alone in this series. We advocate using both dye and colloid for intraoperative SN mapping. 相似文献
9.
Vieni S Cipolla C Fricano S Amato C Graceffa G Sandonato L Prinzi G Latteri S Latteri MA 《Chirurgia italiana》2004,56(2):215-222
Since it was introduced in the 1990s, axillary sentinel lymph-node biopsy has been rapidly and widely adopted to avoid complete axillary dissection (though this is still the standard procedure). The aims of the study were two-fold: (i) to determine the value of different techniques of sentinel lymph-node identification and (ii) to verify the predictive value of such procedures through histological examination of the sentinel lymph node and axillary dissection in the same patients. Both sentinel lymph-node biopsy and axillary dissection were performed in 230 patients with T1 and T2 (< 3 cm) carcinoma of the breast. Preoperative lymphoscintigraphy was able to identify the sentinel lymph node in 97.4% of cases, but, with an intraoperative hand-held probe, it was possible to find the sentinel lymph node in 98.2% of cases (226/230 patients). The sentinel lymph node was metastatic in 49.1% of cases (111/226 patients) and negative in 50.9% (115/226). The incidence of false-negative cases was 2.6% (2/115 patients). The predictive value of the sentinel lymph node was 98.7%. Finally, lymph-mode mapping is possible is a very high percentage of patients and therefore it is always advisable to use all three methods of identification together. The diagnostic reliability of sentinel lymph-node status is equally high. At present there no studies are available with a long-term follow-up to confirm these findings, and therefore axillary dissection is still the standard surgical treatment for breast cancer. 相似文献
10.
Feasibility of axillary ultrasound in the quality assessment of sentinel node biopsy in breast cancer surgery. 总被引:1,自引:0,他引:1
H Paajanen V M Kilponen J Heikkinen H Sammalkorpi M Helle 《Scandinavian journal of surgery》2006,95(3):195-198
BACKGROUND AND AIMS: The purpose of this study was to evaluate the efficacy of high-resolution axillary ultrasound (AU) in detecting the rate of recurrence after a negative sentinel node (SN) biopsy in patients with breast cancer and without additional axillary dissection. MATERIALS AND METHODS: The operating oncologic surgeon performed 196 consequent sentinel node biopsies during surgery of breast cancer. The sentinel nodes were identified by using preoperative lymphoscintigraphy, intraoperative gamma probe and Patent Blue dye. A routine postoperative follow-up of the patients were performed every 3rd month including clinical examinations, blood chemistry and mammography. After 31 months (range 14-49 months), a high-resolution AU was performed for 107 patients with a negative sentinel node during surgery and without axillary dissection, to visualize any abnormal lymph nodes in the axilla. If necessary, large core biopsies were undertaken to obtain histology of abnormal axillary nodes. RESULTS: The SNs were visualized during preoperative lymphoscintigraphy in 167/196 (85%) and found during the surgery in 163/167 (98%) of patients. The mean number of removed SN were 1.7+/-0.8. The SN metastasis were found in 29% (56/196) of patients. During the follow-up, abnormal nodes were identified during AU in only 4/107 patients. Core biopsies confirmed benign histology in three patients and one case of lymphoma was detected. CONCLUSIONS: There were no axillary recurrences of breast cancer after a negative SN biopsy during the 2.6 year follow-up. Axillary ultrasound is a useful tool in the quality control of patients with negative SN biopsy and without diagnostic axillary dissection. 相似文献
11.
Utility of axillary ultrasound examination to select breast cancer patients suited for optimal sentinel node biopsy 总被引:2,自引:0,他引:2
Sato K Tamaki K Tsuda H Kosuda S Kusano S Hiraide H Mochizuki H 《American journal of surgery》2004,187(6):679-683
BACKGROUND: Because sentinel node (SN) biopsy (SNB) is known to produce false-negative results, we examined the usefulness of axillary ultrasound (AUS) in selecting patients suitable for optimal SNB. METHODS: A positive AUS finding (positive AUS) was defined as an echo pattern of a homogeneously hypoechoic SN without an echo-rich center, indicating massive to extensive nodal involvement. The identification of SNs was performed, and complete axillary dissection was carried out. RESULTS: A total of 262 women were enrolled into the study (T1 disease = 94; T2 disease = 145; and T3 disease = 23). The incidence of positive AUS increased with increasing size of breast tumor (P <0.0001). The overall identification and false-negative rates were 88.2% and 10.8%, respectively. However, when limited to AUS-negative patients, SNs were identified in 205 of 208 patients (98.6%), and the false-negative rate was 1.7%. CONCLUSIONS: AUS should be included in the preoperative procedure for the selection of breast cancer patients suitable for SNB. 相似文献
12.
Lymphatic mapping and sentinel lymphadenectomy for breast cancer. 总被引:29,自引:4,他引:29
OBJECTIVE: The authors report the feasibility and accuracy of intraoperative lymphatic mapping with sentinel lymphadenectomy in patients with breast cancer. SUMMARY BACKGROUND DATA: Axillary lymph node dissection (ALND) for breast cancer generally is accepted for its staging and prognostic value, but the extent of dissection remains controversial. Blind lymph node sampling or level I dissection may miss some nodal metastases, but ALND may result in lymphedema. In melanoma, intraoperative lymph node mapping with sentinel lymphadenectomy is an effective and minimally invasive alternative to ALND for identifying nodes containing metastases. METHODS: One hundred seventy-four mapping procedures were performed using a vital dye injected at the primary breast cancer site. Axillary lymphatics were identified and followed to the first ("sentinel") node, which was selectively excised before ALND. RESULTS: Sentinel nodes were identified in 114 of 174 (65.5%) procedures and accurately predicted axillary nodal status in 109 of 114 (95.6%) cases. There was a definite learning curve, and all false-negative sentinel nodes occurred in the first part of the study; sentinel nodes identified in the last 87 procedures were 100% predictive. In 16 of 42 (38.0%) clinically negative/pathologically positive axillae, the sentinel node was the only tumor-involved lymph node identified. The anatomic location of the sentinel node was examined in the 54 most recent procedures; ten cases had only level II nodal metastases that could have been missed by sampling or low (level I) axillary dissection. CONCLUSIONS: This experience indicates that intraoperative lymphatic mapping can accurately identify the sentinel node--i.e., the axillary lymph node most likely to contain breast cancer metastases--in some patients. The technique could enhance staging accuracy and, with further refinements and experience, might alter the role of ALND. 相似文献
13.
Dr. A. Haid R. Koeberle-Wuehrer F. Offner Z. Jasarevic H. Fritzsche G. Zimmermann 《Der Chirurg》2003,74(7):657-664
INTRODUCTION: In view of its predictive potential, axillary nodal status plays a particularly important role in breast cancer. The concept of sentinel node biopsy (SNB) revealed an accurate method with low postoperative morbidity for staging the axilla in patients with lymph node-negative breast cancer. The aim of this study was to show that SNB alone must have a place in routine clinical work and is reliable after preoperative chemotherapy (PC) and also in patients with multicentric tumors (MC). PATIENTS AND METHOD: Between April 1997 and March 2002, a total of 300 SNBs were performed in patients with uni- or bilateral breast cancer. Of them, 45 who had completed PC and 13 with multicentric lesions underwent SNB followed by axillary dissection. The sentinel nodes (SN) were labelled with a blue dye and radioactive colloids. Median follow-up was 33.6 months (range 8.2-67.0) (StAw 1.4). RESULTS: The detection rate in the learning phase was 81.8% and later 93.5%, independently of the size of the primary tumor. Overall accuracy and negative predictive value of the first 55 patients, after PC and in those with MC came to 97.8% and 96.7%, 97.6%, 95.8% and 100%, respectively. Through focused pathologic examination, staging was improved in 11.3% of patients. A year after the procedure, one patient developed recurrence. Morbidity after SNB alone was significantly lower than after axillary dissection. CONCLUSION: Our experience shows SNB to be reliable and accurate for axillary staging in breast cancer patients. Morbidity after SNB alone was low. Conclusive data on the local recurrence rate are not yet available. Under certain conditions, SNB appears to have future clinical potential, even in patients with PC and MC, which must be confirmed in further multicentric studies.In the meantime, this method has attained definite value in the surgical therapy of breast cancer patients. 相似文献
14.
Jeryong Kim Jinsun Lee Eilsung Chang Seongmin Kim Kwangsun Suh Jiyoung Sul Insang Song Yonghoon Kim Chuljoo Lee 《World journal of surgery》2009,33(5):943-949
Background This study was designed to determine whether a preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated
with computed tomography (CT) (FDG-PET/CT) could be used as a guide for axillary node dissection (AND) or sentinel lymph node
biopsy (SNB) in breast cancer patients.
Methods Between February 2007 and April 2008, we performed FDG-PET/CT scans in 137 biopsy-proven breast cancer patients planning to
have an SNB to select patients for either AND (PET/CT N+) or SNB (PET/CT N0). In performing SNB, we also performed additional
non-SNB (ADD), which was enlarged at the lower axilla.
Results Twenty-seven patients with positive scans underwent complete AND as a primary procedure, and 110 patients with negative scans
underwent SNB + ADD. There were 8 cases of false negative scans, and no case of false positive scan. The overall sensitivity,
specificity, positive predictive value, and overall accuracy of FDG-PET/CT in predicting axillary metastasis were 77.1%, 100%,
100%, and 94.2%, respectively. In a subset of 110 patients with SNB + ADD, 104 patients had histologically negative SN, and
6 patients had positive SN in frozen section. Among 110 SNB + ADD cases, there were only 8 cases (7.3%) of positive axillary
basins in permanent biopsy, including two cases of late positives that had micrometastases in the SN only. Through selective
SNB + ADD based on an FDG-PET/CT, we have spared 27 unnecessary SNBs (true positive scans).
Conclusions FDG-PET/CT is a specific imaging modality for predicting axillary node metastasis, and allows for a selective approach to
either AND or SNB. A selective SNB + ADD based on an FDG-PET/CT reduced both unnecessary SNBs and positive axillary basins,
enhancing the identification rates of SN and the accuracy of SNB. 相似文献
15.
Background: Sentinel node biopsy (SNB) is being increasingly used but its place outside randomized trials has not yet been established. Methods: The first 114 sentinel node (SN) biopsies performed for breast cancer at the Princess Alexandra Hospital from March 1999 to June 2001 are presented. In 111 cases axillary dissection was also performed, allowing the accuracy of the technique to be assessed. A standard combination of preoperative lymphoscintigraphy, intraoperative gamma probe and injection of blue dye was used in most cases. Results are discussed in relation to the risk and potential consequences of understaging. Results: Where both probe and dye were used, the SN was identified in 90% of patients. A significant number of patients were treated in two stages and the technique was no less effective in patients who had SNB performed at a second operation after the primary tumour had already been removed. The interval from radioisotope injection to operation was very wide (between 2 and 22 h) and did not affect the outcome. Nodal metastases were present in 42 patients in whom an SN was found, and in 40 of these the SN was positive, giving a false negative rate of 4.8% (2/42), with the overall percentage of patients understaged being 2%. For this particular group as a whole, the increased risk of death due to systemic therapy being withheld as a consequence of understaging (if SNB alone had been employed) is estimated at less than 1/500. The risk for individuals will vary depending on other features of the particular primary tumour. Conclusion: For patients who elect to have the axilla staged using SNB alone, the risk and consequences of understaging need to be discussed. These risks can be estimated by allowing for the specific surgeon's false negative rate for the technique, and considering the likelihood of nodal metastases for a given tumour. There appears to be no disadvantage with performing SNB at a second operation after the primary tumour has already been removed. Clearly, for a large number of patients, SNB alone will be safe, but ideally participation in randomized trials should continue to be encouraged. 相似文献
16.
D'Ereditá G Ferrarese F Massa TS Cecere V Serio G Giardina C 《Il Giornale di chirurgia》2002,23(11-12):435-439
Axillary lymph nodal status in breast cancer remains one of the more important prognostic factors. In early breast cancer axillary lymph node metastasis are found only in 10-18%. It can be deduced that in all these patients a complete axillary dissection is an overtreatment. The concept of sentinel lymph node (SN) was applied to breast cancer. Of course if SN examination gives negative findings, the patient will avoid axillary lymphadenectomy. 134 patients with localized breast cancer were evaluated for enrollment into the study. In 40 (29.8%) patients lymphoscintigraphy was performed together with an injection of vital dye to identify the SN, in 94 (70.1%) only vital dye was utilized. The mapping procedure was successful in 129 cases (96.2%). In our study there was concordance between SNs and axillary nodes in 120 out off 124 cases (96.7%). The false-negative rate was 4.8% (4/83). The overall sensitivity of the SN biopsy was 91.1% (41/45), with a negative predictive value of 95.1% (79/83). Five patients had SN negative and they decided do not undergo axillary lymphadenectomy. This study demonstrates that accurate SN identification was obtained combining lymphoscintigraphy and blue dye. Moreover, each method requires a suitable learning curve. After an accurate training, complete axillary lymphadenectomy can be avoided in selected patients. 相似文献
17.
Surgical treatment of breast cancer has changed dramatically during the last few decades with the aim of reducing surgical radicality in the breast and also in the axilla. In this context sentinel node biopsy is a reliable technique to determine axillary node status of breast cancer patients and reduce morbidity associated with standard axillary lymph node dissection. Although SNB is performed with increasing frequency, an incorrect indication and lack of experience with the surgical procedure can minimize the sensitivity and specificity of this method. In consequence, this could lead to wrong tumor staging and inappropriate adjuvant therapy. Therefore, we describe the basic requirements, indications, and pitfalls of this technique. Since many issues are controversial such as the prognostic value of micrometastases and extramammary nodes as well as the use of SNB after primary chemotherapy and in ductal carcinoma in situ, further clinical studies are necessary. 相似文献
18.
Bobin JY Spirito C Isaac S Zinzindohoue C Joualee A Khaled M Perrin-Fayolle O 《Annales de chirurgie》2000,125(9):861-870
STUDY AIM: To evaluate the effect of intraoperative lymph node mapping and sentinel lymph node dissection (SLND) on the axillary staging of patients with N0 breast carcinoma. Two techniques were used: blue dye alone (Evans Blue and Patent Blue) and combined technique (blue dye and isotope). METHODS: The incidence of axillary node metastasis in axillary lymph node dissection (ALND) and SLND was compared prospectively. Multiple sections of each SLN were examined by HPS staining and immunohistochemical techniques. Two sections of each non sentinel node in ALND specimens were examined by routine HPS staining. RESULTS: 243 patients underwent ALND after SLN biopsy. The SLN detection rate was 225/243 cases (92.59%): 89.94% with blue dye alone and 100% with the combined technique. The false-negative rate was less than 2%. CONCLUSION: SN biopsy is an accurate staging technique for N0 breast cancer. SLN biopsy with multiple sections and immunohistochemical staining of the SLN can identify significantly more patients with lymph node metastases than ALND with routine HPS staining. 相似文献
19.
Background Sentinel node (SN) biopsy for patients with locally advanced breast cancer after neoadjuvant chemotherapy results in a lower
detection rate and higher false-negative rate. The aims of the study were to explore the role of SN biopsy in these patients
in Taiwan and to assess the role of intraoperative ultrasound examination of the non-SN level.
Methods We used a blue dye to identify the SNs in 127 patients with T3 locally advanced breast cancer initially treated with neoadjuvant
chemotherapy. After SN biopsy, we used intraoperative ultrasound to explore the non-SN region for additional lymph nodes,
followed by at least level II axillary dissection. All the SNs were evaluated histologically and immunohistochemically with
anticytokeratin antibodies. All the non-SNs were examined by routine histology.
Results SNs were identified in 116 (91.3%) of 127 procedures. SN metastases were found in 64 cases (55.2%). Subsequent axillary dissection
revealed tumor involvement of non-SNs in 40 (62.5%) of 64 cases. SN biopsy results had a sensitivity of 92.8%, a specificity
of 100%, and a false-negative rate of 9.6%. Furthermore, intraoperative ultrasound detected suspicious malignant nodes in
the non-SN level in 39 out of 40 cases, and detected 5 cases with non-SN metastases that had false-negative SN mapping. This
technique decreased the false-negative rate of SN mapping from 9.6% to only 1.39% for these cases.
Conclusions SN biopsy results combined with intraoperative ultrasonography can accurately assess the non-SN status and help breast surgeons
to decide whether subsequent axillary dissection is warranted after SN biopsy has been performed. 相似文献
20.
The learning curve for sentinel node biopsy in breast cancer: practical considerations. 总被引:3,自引:0,他引:3
HYPOTHESIS: Performance of sentinel node biopsy (SNB) instead of full axillary lymph node dissection (ALND) by inexperienced surgeons will lead to understaging of some women with breast cancer and increased costs. DESIGN: A decision analysis model was used to investigate the implications of SNB vs. full ALND during the learning phase (60-80 procedures). This model simulates a randomized trial of 10000 women in each arm. Data regarding the learning curve were obtained from published series. MAIN OUTCOME MEASURES: Percentage of women with inaccurate staging of their breast cancer, overall survival, quality-adjusted survival, and potential costs of SNB vs ALND. RESULTS: Performance of SNB instead of ALND results in inability to locate a sentinel node in 38% of attempts during the learning phase (compared with 10% in later cases) and understaging in 12% of patients during the learning phase (compared with 0% in later cases). This understaging is associated with a small decrement in survival (1%-2%) and an increased risk of axillary recurrence. Sentinel node biopsy is cost-effective only when the ability to detect sentinel nodes exceeds 80%; and the cost of SNB is less than 50% of the cost of ALND. CONCLUSIONS: To ensure accurate staging of patients with breast cancer, all surgeons should perform full ALND while learning SNB techniques. Only after documentation of accuracy of SNB (sensitivity >90%) should full ALND be omitted for women with negative sentinel nodes. 相似文献