Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study

PurposeThere is a debate on the role of adjuvant Radiotherapy (RT) in elderly breast cancer patients.The aim is to study Quality of Life (QL) throughout the treatment and follow-up periods in early stages breast cancer patients who have started radiotherapy, and to compare the QL of axillary surgery groups.Methods173 patients, ≥65 years completed the EORTC QLQ-C30 and QLQ-BR23, and the Interview for Deterioration in Daily Living Activities in Dementia(IDDD) questionnaires three times throughout treatment and follow-up periods. Linear mixed effect models were used to evaluate longitudinal changes in QL, and whether these changes differed among axillary surgery groups.ResultsQL scores were high (>70/100 points) in most QL areas, with moderate limitations (>30) in sexual functioning and enjoyment, future perspective and global QL.In six areas there was a decline at the RT sessions end, that after 6 weeks was recovered. For three areas, there was an improvement in the follow-up measurement compared to the previous assessments. Changes in seven areas were <5 points.Axillary node dissection patients had a body image decrease (6 points) in the follow up period. The lymphadenectomy group had more fatigue (10 points, p = 0.078) than the other two axillary surgery groups.ConclusionsResults orientate towards good patients' adaptation to their disease and treatments, and to administering RT in early stages breast cancer patients. QL differences between the axillary surgery groups and in their evolutions were few but have appeared in key QL areas.     

Methylene Blue Absorption in Sentinel Lymph Node Biopsy for Early Breast Cancer after Neoadjuvant Chemotherapy

Introduction: Chemotherapy is claimed to cause lymphatic drainage damage because of the tumor cell’s apoptosis process. This event might cause decreased marker (radioactive solution and/or blue dye) absorption on sentinel lymph nodes (SLN). In this study, the researchers used methylene blue only and wished to evaluate the methylene blue absorption of the SLNB procedure on early-stage breast-cancer patients after neoadjuvant chemotherapy (NAC). Materials and methods: The method used was the historical cohort study conducted from 2016-2019 in Indonesia. Samples were collected from 117 patients of stage I and II breast cancer with clinically negative axillary lymph nodes, who were then grouped into post-NAC and no-NAC (control group), in which SLNB procedures were conducted on the two groups by using single-method methylene blue. The results of methylene blue absorption were then analyzed by the Chi-square hypothesis test. Results: From the total of 564 early-stage patients who were referred to surgical oncologists, 117 patients were found to meet criteria of inclusion, consisting of the control group (52 patients) and the post-NAC group (65 patents). Of 65 patients who had undergone NAC treatment and SLNB procedure, it was found that 40 patients (61.5%) showed positive blue SLN. Of 52 pre-NAC breast-cancer patients, it was found that 47 patients (90.4%) showed methylene blue absorption on SLN with the p-value of 0.000 (P<0.05, significant). The relative risk value amounted to 0.522. Post-NAC patients had a tendency of decreased absorption of methylene blue. Conclusion: Neoadjuvant chemotherapy can cause the decrease of methylene blue absorption on SLNB procedure.     

Can Low-cost Indo Cyanine Green Florescence Technique for Sentinel Lymph Node Biopsy Replace Dual Dye (Radio-colloid and Blue Dye) Technique in Early Breast Cancer: A Prospective Two-arm Comparative Study

BackgroundThe objective of this study was to assess the detection and accuracy of sentinel lymph node (SLN) biopsy (SLNB) using the low-cost indocyanine green (ICG) fluorescence method and to compare this method with the gold standard dual-dye method (radio-colloid + methylene blue dye [MB]).Materials and MethodsOne hundred patients with node-negative early breast cancer assessed clinically and by ultrasound axilla underwent an SLNB procedure using technetium-99m radio-colloid, MB, and ICG. The detection rate of SLNs and positive SLNs and the number of SLNs were compared. The injection safety of ICG and MB was evaluated.ResultsOne hundred female patients with a median age of 52.3 years participated in the study. Sixty-eight percent had a body mass index < 25, 85% presented with a palpable lump, of which 59% were in the outer quadrant. SLNs were identified in all 100 cases. A total of 290 SLNs were removed (mean, 2.9; range, 1-6). The identification rate with dual dye was 94%, whereas with ICG alone, it was 96%. The SLNB sensitivity rate and false negative rate were 97.6% versus 93.2% and 3.1% versus 6.2% in the ICG and dual-dye combination, respectively. None of the patients had any local or systemic reaction with ICG; 3 patients with blue dye had tattooing and staining of skin.ConclusionICG fluorescence imaging permits real time visualization of lymphatics and provides an additional dimension to SLN biopsy that is safe and effective. These results confirm high sensitivity for fluorescence localization with comparable performance to the gold standard. ICG can reliably replace dual dye and be employed as a sole tracer for SLNB in early breast cancer.     

Sentinel lymph node biopsy in melanoma: Which hot nodes should be harvested and is blue dye really necessary?

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.

早期乳腺癌腋窝亚LevelⅡ淋巴结清扫的初步研究

目的:探索基层医院早期乳腺癌腋窝淋巴结外科处理的适宜方法。方法:对9例符合研究条件的病例先美兰染色(meythylene blue staining)实施前哨淋巴结活检(sentinel lymph node biopsy,SLNB),再补充实施腋窝淋巴结清扫术(axillary lymph node dissection,ALND);ALND术中显露腋静脉,以腋静脉下2cm为界缝线标记,术后将标本从缝线处分离,对淋巴结进行分组取材,将前哨淋巴结、腋静脉下2cm内淋巴结(亚levelⅡ淋巴结)、腋窝其余淋巴结(其余淋巴结)分组送病理检查,观察各组淋巴结数量及肿瘤细胞腋淋巴结转移规律。结果:找到前哨淋巴结6例;5例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阴性;1例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阳性;另有1例患者前哨淋巴结未找到,而亚levelⅡ淋巴结检出阳性。结论:基层医院对于早期乳腺癌腋窝淋巴结清扫,可以用美兰染色行前哨淋巴结活检,若前哨淋巴结阳性或未找到前哨淋巴结,行ALND;若前哨淋巴结阴性,行亚levelⅡ淋巴结清扫。     

研究胃癌前哨淋巴结面临的问题

黑色素瘤和乳腺癌等恶性肿瘤的前哨淋巴结活检(sentinel lymph node biopsy，SLNB)已广泛开展和应用。近年来胃癌SLNB的初步研究结果也显示：SLNB可能在指导胃癌外科淋巴结清扫、提高胃癌分期的准确性、正确评估胃癌患者的预后和制定术后辅助治疗方案等方面发挥重要作用，因此受到胃肠外科医师的广泛关注。但将前哨淋巴结(sentinel lymph node，SLN)概念引入胃癌的研究才刚刚开始，相关的理论和技术还不成熟，其可行性和实用性还不明确。     

Axillary Reverse Mapping (ARM): A New Concept to Identify and Enhance Lymphatic Preservation

Background Variations in arm lymphatic drainage put the arm lymphatics at risk for disruption during axillary lymph node surgery. Mapping the drainage of the arm with blue dye (axillary reverse mapping, ARM) decreases the likelihood of disruption of lymphatics and subsequent lymphedema. Methods This institutional review board (IRB)-approved study from May to October 2006 involved patients undergoing SLNB and/or ALND. Technetium sulfur colloid (4 mL) was injected in the subareolar plexus and 2–5 mL of blue dye intradermally was injected in the ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage that impacted SLNB or ALND, successful identification and protection of the arm lymphatics, any crossover between a hot breast node and a blue arm node, and occurrence of lymphedema. Results Of the 40 patients undergoing surgery for breast cancer, 18 required an ALND, with a median age of 49.7 years old. Fourteen patients had a SLNB + ALND, and four patients had ALND alone. In 100% of patients, all breast SLNs were hot but not blue, and the false negative rate was 0. In 11 of 18 ALNDs (61%) blue lymphatics or blue nodes were identified in the axilla. In the initial seven cases with positive lymph nodes in the axilla, the blue node draining from the arm was biopsied and all were negative. Conclusions ARM identified significant lymphatic variations draining the upper extremities and facilitated preservation in all but one case. ARM added to present-day ALND and SLNB further defines the axilla and may be useful to prevent lymphedema. Supported by the Susan G. Komen Breast Cancer Clinical Fellowship and the Arkansas Breast Cancer Act     

前哨淋巴结活检在结直肠癌中的临床应用研究

目的探讨前哨淋巴结活检(SLNB)在结直肠癌根治术中的可行性及其应用价值。方法应用美蓝对43例结直肠癌患者行前哨淋巴结(SLN)定位活检,采用HE染色病理检查法、CK-20免疫组化染色检查法。结果共检出淋巴结705枚,其中SLN 73枚,43例患者中40例检出SLN,平均1.83枚/例。入组患者SLN的转移率明显高于区域淋巴结的转移率(P0.01);免疫组化检测SLN癌转移的敏感性明显高于HE染色,而假阴性明显低于后者。结论结直肠癌根治术中SLN定位具有切实的可行性,能够预测区域淋巴结的转移状况,对指导结直肠癌术中切除范围及术后病理分期和制定综合治疗方案有一定意义。     

前哨淋巴结活检技术在乳腺癌保乳手术中的应用研究

目的探讨前哨淋巴结活检术在保乳手术中的应用价值。方法 2004年7月-2009年4月对经前哨淋巴结活检术指导保乳手术46例综合治疗临床分析。结果前哨淋巴结活检术在指导保乳手术等综合治疗过程中具有重要地位。结论采用前哨淋巴结活检术行保乳手术,综合治疗,效果满意,值得在基层医疗单位推广应用。