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1.
Darryl Schuitevoerder Irvan Bubic Jeanine Fortino Kristen P. Massimino John T. Vetto 《American journal of surgery》2018,215(5):868-872
Introduction
Completion lymph node dissection (CLND) for melanoma after positive sentinel lymph node biopsy (SLNB) was recently shown to improve regional but not overall survival, likely due to the majority of patients harboring no further nodal disease. We sought to determine predictors of non-sentinel node (NSN) positivity.Methods
Retrospective review of prospectively collected data on melanoma patients undergoing SLNB.Results
116 patients underwent 119 CLNDs. The incidence of NSN positivity was 17.6%; the average number of positive NSNs in those cases was 1.5. Cervical and inguinofemoral location were most likely to yield positive NSN(s) (40% each). Conversely, the axilla was least likely at 18% (p?<?0.001). The average number of nodes harvested was 13 for NSN negative cases and 20 for NSN positive cases (p?=?0.005). Tumor thickness increased the probability of positive NSN(s) (OR 1.2, p?=?0.02).Conclusions
Tumor thickness and nodal basin were predictors of NSN metastasis, factors that could help determine which patients may benefit from CLND. Further, CLNDs with fewer nodes may inadequately clear residual nodal disease. 相似文献2.
Augusto Lombardi Giuseppe Nigri Stefano Maggi Gianluca Stanzani Valeria Vitale Andrea Vecchione Alessandro Nania Claudio Amanti 《The surgeon》2018,16(4):232-236
Background
Intraoperative frozen sections (FS) of sentinel lymph nodes (SLN) were evaluated to avoid the need for deferred axillary lymph node dissection (ALND) in patients with early breast cancer (EBC). However, FS has low sensitivity for detecting micro-metastases (<2 mm), resulting in patients who later undergo deferred ALND. The aim of the study was to determine the best clinical approach for selecting patients who would derive real benefit from ALND, as well as to minimize the functional and psychological damage caused by delayed surgery, and the risk of undertreating EBC patients.Methods
This study evaluated 1453 patients with early breast cancer (EBC) who underwent SLN biopsy, FS and definitive evaluation. Causes of discrepancies between SLN biopsy and FS results and the need for further surgery were evaluated.Results
A total of 1226 (86%) patients underwent FS; of these patients, 146 (11.9%) were false negatives. The global sensitivity of FS in detecting both macro and micrometastases was 53.7%. Although ACOSOG Z0011 criteria found that ALND could be avoided in 236 patients, 40 (17%) of these had >3 positive axillary lymph nodes. In contrast, application of the IBCSG 23-10 trial criteria, found that only three patients (3.1%) had >3 positive axillary lymph nodes.Conclusions
FS has a low sensitivity in detecting micrometastases (19%), but a reasonable sensitivity for macrometastases (75%). Most false negatives were smaller metastases (mean 2.1 mm) and more likely in patients with infiltrating lobular carcinoma. Retrospective modelling of the IBCSG 23-10 criteria reduced the percentage of patients requiring deferred surgery from 12% to 4%. Guidelines recommend irradiation of lymph node drainage stations in patients with ≥4 axillary metastatic lymph nodes. Omission of ALND from 40% of patients who met Z0011 criteria would have resulted in their undertreatment. This risk decreases to 3% by omitting axillary clearing only in patients with micrometastases. 相似文献3.
Background
Historical studies suggest no difference in disease outcome between neoadjuvant and adjuvant approaches in breast cancer. We hypothesize neoadjuvant chemotherapy (NCT) may offer several benefits, possibly improving quality of life outcomes.Methods
Retrospective review of Tumor Registry data of breast cancer patients from 2011 to 2015. Pathologists reviewed cases from 2012 to 2013 to provide additional RCB (residual cancer burden) scores.Results
From 2011 to 2015 there were 2707 breast cancer cases and 455 patients received NCT. RCB score was documented in 348 with excellent outcome in 41% (pCR in 115 patients, 28 RCB I). There were 137 RCB II and 68 RCB III. Clinically positive nodes were present in 202 of 455 and 77 (38%) had clearance of nodal disease. Of these 45 had axillary dissections.Discussion
Neoadjuvant therapy was associated with excellent response rates. Thirty eight percent of patients with positive nodes converted to node negative although over 50% underwent axillary dissection. Higher utilization of NCT could decrease need for axillary dissection thereby lowering incidence of lymphedema and improving quality of life for survivors. 相似文献4.
Maria E. Linnaus Amylou C. Dueck Heidi E. Kosiorek Richard J. Gray Nabil Wasif Donald W. Northfelt Karen S. Anderson Ann E. McCullough William W. Wong Michele Y. Halyard Samir H. Patel Barbara A. Pockaj 《American journal of surgery》2015,210(6):1155-1161
Background
The incidence of all-location regional recurrence after sentinel lymph node biopsy is not well documented. This study attempts to identify risk factors.Methods
A prospectively maintained database was queried to identify patients with a regional recurrence of breast cancer after a first operation for invasive unilateral breast cancer. Patients with regional recurrence were compared with those alive and disease free at 5 years.Results
Twenty-one of 1,060 patients (2%) experienced a regional recurrence. Most patients (95%) underwent sentinel lymph node biopsy as their axillary staging. Those with regional recurrences had larger tumors (P < .001), higher stage disease (P < .001), more estrogen receptor– and triple-negative breast cancers (P < .001), and more positive lymph nodes (P = .007). Mastectomy (P = .001) and receipt of neoadjuvant and/or chemotherapy (P < .001) were more common among those with regional recurrences.Conclusions
Regional recurrence of breast cancer occurs infrequently. Risk factors include high-risk cancers, higher stage at presentation, nodal involvement, and need for therapies reflecting higher risk biology. 相似文献5.
Karen Tsung Stephen R. Grobmyer Chao Tu Jame Abraham G. Thomas Budd Stephanie A. Valente 《American journal of surgery》2018,215(3):509-512
Background
This study investigated patients with invasive lobular breast carcinoma (ILC) to determine the benefit of neoadjuvant systemic therapy (NAST).Methods
Patients with ILC treated from 2006 to 2015 were identified. Tumor characteristics and treatment data were analyzed.Results
Of the 560 patients with ILC, 77 patients received NAST. Patients who received NAST presented with larger clinical T stages compared to patients who received surgery first (p < 0.001). Pathological complete response (pCR) to NAST was seen in 17% of patients. Only 14% of patients with clinically positive lymph nodes downstaged to N0. These patients were more likely to have HER2 positive tumors (p < 0.029) and larger tumor size at diagnosis (p < 0.015). Mastectomy was performed in 84% of patients and lumpectomy in 16%.Conclusions
Only a minority of patients with ILC achieve pCR. The majority of patients still undergo mastectomy; therefore the benefit of NAST in ILC appears limited. 相似文献6.
Rosalind P. Candelaria Palita Hansakul Alastair M. Thompson Huong Le-Petross Vicente Valero Roland Bassett Monica L. Huang Lumarie Santiago Beatriz E. Adrada 《American journal of surgery》2018,215(4):693-698
Background
To determine the cancer yield of stereotactic biopsy of suspicious calcifications identified within 24 months after breast conservation therapy (BCT).Methods
Retrospective review of stereotactic biopsies performed during 2009–2013 for suspicious calcifications in the ipsilateral breast of patients who completed BCT.Results
94/2773 (3.4%) had stereotactic biopsies for suspicious calcifications in the ipsilateral breast; 7/94 (7.4%) had DCIS (6) or invasive (1) cancer; 5/7 occurred in the same breast quadrant as the primary. All 7 originally had negative surgical margins (≥2 mm); 6 received whole breast irradiation, and 2 received adjuvant chemotherapy + endocrine therapy. Median time to detection was 11 months (range, 6–20 months). There was a strong association between calcification morphology (particularly pleomorphic) and likelihood of malignancy (p = 0.008).Conclusions
Stereotactic biopsy of calcifications identified within 24 months post-BCT has a 7% cancer yield. Tissue biopsy should be performed rather than imaging followup alone when breast calcifications have suspicious morphology. 相似文献7.
Aims
In patients presenting with a breast lesion, when initial core biopsy histology falls into the category of “uncertain malignant potential” (i.e. a B3 lesion), the next line of investigation has traditionally been a surgical biopsy (SBx). Vacuum-assisted biopsy (VAB) may be a viable minimally invasive alternative to SBx for B3 lesions. The primary aims of this study were to establish whether VAB reduces the need for surgical biopsy and determine VAB sensitivity for carcinoma following initial B3 histology.Materials and methods
B3 lesion data was collected from 2004 to 2013 retrospectively, from a single institution that utilises both VAB and SBx.Results
A total of 413 lesions were categorised B3 on initial biopsy. Mean age was 61 years (range: 24–91 years). Mean follow up was 52 months (range: 19–60 months). 156 patients (38%) underwent VAB. Only 20% of patients underwent VAB in 2004, with an increase to 95% by 2013. VAB histology revealed twelve carcinomas, all of which progressed to surgical excision. In six cases, a SBx was required following VAB in order to provide further diagnostic information. In one case, carcinoma was missed on VAB.Conclusion
The increase in VAB use over time suggests that the procedure is well tolerated. The results demonstrate a VAB sensitivity of 92% for carcinoma diagnosis. In 96% of cases (150 of 156), VAB results were conclusive enough to avoid a subsequent SBx. This data suggests that VAB may be a preferable alternative to surgical biopsy for many B3 lesions. 相似文献8.
D.P. Joyce D. Murphy A.J. Lowery C. Curran K. Barry C. Malone R. McLaughlin M.J. Kerin 《The surgeon》2017,15(5):272-277
Introduction
Triple-negative breast cancers (TNBC) are associated with a poor prognosis owing to an aggressive phenotype. We aimed to carry out a prospective study comparing management strategies and response to therapy in TNBC and non-TNBC patients.Methods
Data were obtained from a prospectively maintained database of patients treated for breast cancer.Results
A total of 142 TNBC and 142 age-, stage- and NPI-matched non-TNBC patients were treated. The difference in overall survival between the 2 groups was statistically significant (77% of TNBC patients alive at a mean follow-up of 32 months, versus 92% of non-TNBC patients at a mean follow-up of 38 months, P = 0.0 Log rank test). This survival difference was found to be independent of NPI (P = 0.0 Log rank test). Locoregional recurrence rates were similar between TNBC patients who were treated with wide local excision versus mastectomy (P = 0.449 Log rank test). A significant difference in survival was noted between TNBC patients who responded differentially to neoadjuvant chemotherapy (P = 0.035 Log rank test).Conclusion
Patients with TNBC have adverse outcomes despite aggressive treatment. The development of effective targeted therapies is essential for this breast cancer subtype. 相似文献9.
Joseph C. Fusco Brittani K.N. Seynnaeve Alexander J. Davit Michael R. Czachowski Judith M. Joyce Barbara A. Gaines Marcus M. Malek 《Journal of pediatric surgery》2018,53(1):77-80
Background
Lymphatic mapping to guide sentinel lymph node biopsy (SLNB) typically requires lymphoscintigraphy prior to surgery. In young pediatric patients, this process often requires intubation in the nuclear medicine suite followed by transport to the operating room (OR).Methods
We reviewed 14 pediatric cases in which a portable nuclear imaging camera was utilized to perform the entirety of the SLNB in the OR.Results and Conclusion
This method, utilizing intraoperative nuclear imaging, helped to confirm removal of the sentinel lymph node in real time, decreased anesthesia time, and avoided transport of a sedated or intubated child.Level of Evidence
III. 相似文献10.
Carla Pajak JinSi Pao Amandeep Ghuman Elaine C. McKevitt Urve Kuusk Carol K. Dingee Rebecca Warburton 《American journal of surgery》2018,215(5):922-925
Introduction
Breast Conserving Surgery (BCS) is considered standard of care for women with early stage breast cancer. Between 20 and 50% of women treated with BCS will require re-operation for positive or close margins and it has been suggested that routine cavity shave margins may reduce the frequency of positive margins.Methods
Retrospective chart review of a prospectively maintained surgical database of patients undergoing BCS for early stage breast cancer, at a single institution, between January 2012 and December 2015. Cohort was followed until June 2016 to capture re-operations.Results
Among 2096 patients with stage 0-III breast cancers, 872 (42%) underwent primary mastectomies and 1224 (58%) underwent primary BCS. Margins were positive in 128 (11%) and close in 442 (36%). Re-operation rate for patients after BCS was 19%.Conclusion
A lower than predicted positive margin rate suggests that routine shave margins are not warranted at our institution. 相似文献11.
Sanders MM Waheed S Joshi S Pogson C Ebbs SR 《Annals of the Royal College of Surgeons of England》2011,93(2):103-105
INTRODUCTION
To ensure appropriate axillary surgery is performed at a single operation, we have sought to identify patients with involved nodes who might progress directly to axillary dissection.PATIENTS AND METHODS
We evaluated pre-operative ultrasound of the axilla and intra-operative frozen section of sentinel lymph nodes over a 3-year period. Patients with clinical early breast cancer underwent axillary ultrasound. Abnormal nodes were defined as a cortex > 2.5 mm, loss of high echogenic medulla, and morphological changes. Any axilla containing a lymph node considered abnormal had ultrasound-directed fine needle aspiration (FNA) performed. Patients with positive cytology proceeded directly to axillary dissection. Patients with negative cytology and those with normal ultrasound proceeded to sentinel four-node biopsy using Patent Blue dye alone. A single sentinel node was evaluated by intra-operative frozen section.RESULTS
A total of 311 patients underwent pre-operative ultrasound successfully, identifying 115 (77%) patients of the total 150 who were found to have positive lymph nodes. Overall, 196 patients underwent sentinel lymph node biopsy analysis intra-operatively. Of the 11 false negative cases in which the lymph node was found to be positive postoperatively, eight cases showed the single tested sentinel node contained cancer that was recognised on postoperative staining but not frozen section. In six, the deposit in the sentinel node was a micrometastasis. Three cases were found to contain cancer in the ‘non-sentinel'' node; in all, this was micrometastatic disease.CONCLUSIONS
This study confirms the value of pre-operative ultrasound and intra-operative frozen section examination of axillary nodes. Only 3.5% of patients required two operations. 相似文献12.
Reoperative Sentinel Lymph Node Biopsy: A New Frontier in the Management of Ipsilateral Breast Tumor Recurrence 总被引：4，自引：1，他引：3
Port ER Garcia-Etienne CA Park J Fey J Borgen PI Cody HS 《Annals of surgical oncology》2007,14(8):2209-2214
Background
Breast conservation therapy (BCT) with sentinel lymph node (SLN) biopsy is a well-established standard of care for primary operable breast cancer; 5–10% of BCT patients will develop local recurrence (LR). The question then arises: How best to manage the axilla in the setting of LR after previous BCT and SLN biopsy or axillary dissection (ALND)?Methods
Between 9/96 and 12/04, 117 reoperative SLN were performed for LR after BCT and either SLN biopsy or ALND more than 6 months previously. Because of wide variation in the number of nodes removed at the initial procedure, validation by backup ALND was not feasible in all cases.Results
Reoperative SLN was successful in 64/117 (55%) patients. SLNs were identified by isotope and dye in 28/64 (44%); isotope only in 29/64 (45%); dye only in 4/64 (6%); 3/64 (5%) unknown. Positive reoperative SLN were found in 10/64 (16%) successful cases. Among 54/64 (84%) patients with negative reoperative SLNs, 23 (43%) had additional non-SLN removed concurrently: these were negative in 21/23 cases (91%). In 2/23 (9%), reoperative SLN were falsely negative: one with a positive intramammary node, and the other with a positive non-SLN palpated at surgery. Success of reoperative SLN was inversely related to number of nodes removed previously, and was more likely to be successful after a previous SLN biopsy than a previous ALND (74% vs. 38%, P = 0.0002). Non-axillary drainage was identified by lymphoscintigraphy significantly more often in reoperative SLN than in primary SLN biopsy (30% vs. 6%, P < 0.0001). There were no local or axillary recurrences at a mean follow up of 2.2 years; 6 patients developed systemic recurrence.Conclusions
Reoperative SLN biopsy is feasible in the setting of LR after previous BCT/axillary surgery and deserves further study in this increasingly common clinical scenario. The added benefit of lymphoscintigraphy in identifying sites of non-axillary drainage may be greater in the setting of reoperative SLN than for the initial SLN procedure.13.
Hiba El Hage ChehadeHannah Headon M.B.B.S. B.Sc. Omar El TokhyJennifer Heeney B.C.N. Abdul KasemKefah Mokbel M.S. F.R.C.S. 《American journal of surgery》2016,212(5):969-981
BACKGROUND
The use of sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC) in patients presenting with clinically positive lymph nodes remains controversial.Methods
A computer-aided search of the literature regarding SLNB in clinically node-positive breast cancer treated with NAC was carried out to identify the false negative rate (FNR), sentinel lymph node identification rate (IR), and axillary pathological complete response (pCR).Results
Nineteen articles were used in the analysis yielding 3,398 patients. The pooled estimate of the FNR was 13% and that of the IR was 91%. The adjusted pCR rate was 47%. A trend toward significance was observed with only clinical stage N1 (cN1) disease whereby clinical stage N1 was associated with an increased pCR rate when compared to N2 or N3 disease (P = .06).Conclusions
SLNB after NAC in biopsy-proven node-positive patients results in reasonably acceptable FNR and IR, making it a valid alternative management strategy to axillary dissection. More refined patient selection and optimal techniques can improve the FNR and IR in this patient population. 相似文献14.
JM Ranson NM Pantelides D Gharpuray Pandit JKG Laitung 《Journal of plastic, reconstructive & aesthetic surgery》2018,71(9):1269-1273
Objectives
The ‘10% rule’ has become widely accepted by surgeons performing sentinel lymph node biopsy (SLNB) for melanoma. The purpose of this study was to compare the ‘10% rule’ with alternative node harvesting criteria. In particular, we were interested to see whether the use of blue dye had any impact on the sensitivity of the test and whether it is necessary to remove all hot nodes.Methods
We reviewed 537 SLNBs performed for primary melanoma from 2009–2015. SLNB was offered to all patients with 1–4?mm Breslow thickness melanoma and sentinel nodes were harvested according to the ‘10% rule’.Results
One hundred sixteen patients (22%) had at least one positive sentinel node and there were 45 positive nodal basins from which more than one sentinel node had been harvested. Excluding blue dye and sampling only hot nodes would have enabled a 5% reduction in nodes harvested, without any compromise in the sensitivity of the test. However, applying harvesting criteria whereby not all hot nodes are taken was associated with a loss of sensitivity, with positive sentinel nodes being missed and patients understaged.Conclusions
Our data do not support the continued use of blue dye in SLNB for melanoma, as it does not improve the sensitivity of the test. This series adds to growing evidence, suggesting that the ‘10% rule’ with the inclusion of blue nodes should be reconsidered and that radiocolloid tracer alone is sufficient for sentinel node localisation. 相似文献15.
Elaine McKevitt Carol Dingee Rebecca Warburton Jin-Si Pao Carl J. Brown Christine Wilson Urve Kuusk 《American journal of surgery》2018,215(5):805-811
Introduction
Concern has been raised about delays for patients presenting with breast symptoms in Canada. Our objective was to determine if our Rapid Access Breast Clinic (RABC) improved care for patients presenting with breast symptoms compared to the traditional system (TS).Methods
A retrospective chart review tabulated demographic, surgical, pathology and radiologic information. Wait times to care were determined for patients presenting with symptomatic and screen detected breast problems.Results
Time from presentation to surgeon evaluation was shorter in the RABC group for patients with breast symptoms (81 vs 35 days, p?<?.0001) and abnormal screens (72 vs 40 days, p?=?.092). Cancer patients with abnormal screens had shorter wait times than patients with breast symptoms in the TS (47 vs 70 days, p?=?.036).Conclusion
Coordination of imaging and clinical care reduces wait times in patients with both abnormal screening mammograms and symptomatic breast presentations and should be expanded in our province. 相似文献16.
Paris D. Butler Olatomide Familusi Joseph M. Serletti Justin P. Fox 《American journal of surgery》2018,215(6):987-994
Background
This study evaluates the rates of immediate breast reconstruction (IBR) among racial and insurance status subgroups, in the setting of a changing plastic surgeon workforce.Methods
Using state level inpatient and ambulatory surgery data, we identified discharges for adult women who underwent mastectomy for breast cancer. This information was supplemented with plastic surgeon workforce data and aggregated to the health service area-level (HSA). Hierarchical linear models were used to risk standardized IBR rates for 8 race-payer subgroups.Results
The final cohort included 65,246 women treated across 67 HSAs. The plastic surgeon density per 100,000 population directly related to the IBR rate. While all subgroups saw a modest increase in IBR rates, Caucasian women with private insurance realized the largest absolute increase (46%) while African-American and Asian women with public insurance saw the smallest increase (6%).Conclusion
Significant disparities persist in the provision of IBR according to the form of insurance a patient possesses. Of heightened concern is the novel finding that even within privately insured patients, women of color have significantly lower IBR rates compared to Caucasian women. 相似文献17.
Won Hwa Kim Hye Jung Kim Jin Hyang Jung Ho Yong Park Jeeyeon Lee Wan Wook Kim Ji Young Park Yee Soo Chae Soo Jung Lee 《Annals of surgical oncology》2018,25(2):494-500
Objective
The aim of this study was to review our experience with ultrasound (US)-guided localization of axillary lymph nodes using activated charcoal for the guidance of axillary surgery after neoadjuvant chemotherapy (NAC) in clinically node-positive breast cancer patients.Methods
Between April 2016 and April 2017, US-guided localization of the most suspicious axillary lymph nodes at restaging US using activated charcoal (Charcotrace?) was performed in 45 consecutive, clinically node-positive breast cancer patients who had less than two suspicious nodes after NAC and axillary surgery with sentinel node biopsy. Sentinel nodes were defined as radioactive nodes or nodes containing blue dye. The concordance between final pathological results for both the tattooed and sentinel nodes was analyzed.Results
Sentinel node biopsy failed in five patients (11%) in whom axillary surgery was performed under the guidance of the tattooed node. The tattooed nodes were identified in the surgical field in 44 patients (98%). Of the 44 tattooed nodes, 25 (57%) were concordant with the sentinel nodes and 19 (43%) were non-sentinel nodes, including the five nodes with failed sentinel node biopsy. In the final pathological results, 18 patients (40%) had metastatic nodes. The sensitivities for detecting axillary metastasis of the sentinel node biopsy, tattooed node biopsy, and the sentinel and/or tattooed node biopsy were 61% (11/18), 67% (12/18), and 78% (14/18), respectively.Conclusion
US-guided localization of axillary lymph nodes using activated charcoal at restaging after NAC in clinically node-positive breast cancer patients is a useful technique to guide axillary surgery, with a high identification rate.18.
Rakhshanda Layeequr Rahman Eric Siegel Cristiano Boneti Malene Ingram Julie Kepple Ronda S. Henry-Tillman V. Suzanne Klimberg 《American journal of surgery》2009,197(4):491-496
Background
Axillary staging provides the single most important piece of prognostic information in breast cancer patients. This retrospective study was performed to document the phenomenon of stage migration.Methods
Of 392 patients, 5 (1%) failed identification of sentinel lymph nodes (SLNs) and therefore underwent axillary lymph node dissection (ALND). Four patients (80%) had metastatic lymph nodes, 302 (77%) patients had negative SLNs, 47 (15%) underwent ALND, 85 (22%) had positive SLNs, 11 (13%) received adjuvant radiation treatment to the axilla, and 74 (87%) underwent completion ALND.Results
The median (quartiles) follow-up period was 29 months (19-46 mo). Twenty of 392 (5%) patients had disease relapse; 2 of which were local (.5%) and the rest were systemic. Earlier relapse was related significantly to lymph node status, tumor grade, and tumor size. SLN-negative patients who did not receive ALND had a relapse rate of 2.3% (6 of 256) compared with 0% in those who were truly negative based on confirmatory ALND. SLN-positive patients who did not receive ALND had a 9% (1 of 11) relapse rate.Discussion
The stage-matched pattern of relapse between SLN biopsy and ALND patients revealed lower relapse rates in SLN biopsy-staged patients, documenting the stage migration phenomenon. 相似文献19.
Alireza Hamidian Jahromi Sankaran Narayanan Fiona MacNeill Peter Osin Ashutash Nerurkar Gerald Gui 《Annals of the Royal College of Surgeons of England》2009,91(4):336-339
INTRODUCTION
Sentinel lymph node biopsy is emerging as the new standard for axillary staging in breast cancer. Intra-operative assessment of the sentinel lymph nodes allows immediate completion of axillary dissection during the same anaesthetic. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intra-operative assessment of sentinel lymph nodes using touch imprint cytology in our centre.PATIENTS AND METHODS
This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results.RESULTS
Mean time to report touch imprint cytology was 25.7 ± 6.4 min (range, 15–40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients.CONCLUSIONS
Intra-operative sentinel lymph node assessment using touch imprint cytology is feasible within a busy NHS practice. We now offer touch imprint cytology to patients following appropriate counselling. 相似文献20.
Angelena Crown Nicketti Handy Flavio G. Rocha Janie W. Grumley 《American journal of surgery》2018,215(5):910-915