Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer
Identifieur interne : 005492 ( Istex/Corpus ); précédent : 005491; suivant : 005493Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer
Auteurs : Seung-Hye Choi ; Sanford H. Barsky ; Helena R. ChangSource :
- The Breast Journal [ 1075-122X ] ; 2003-05.
Abstract
Abstract: Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both 99Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty‐three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty‐three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (p = 0.036) and the presence of lymphatic/vascular invasion (LVI) (p = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (p = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER‐2/neu and p53 status, S‐phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.
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DOI: 10.1046/j.1524-4741.2003.09304.x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title><author><name sortKey="Choi, Seung Ye" sort="Choi, Seung Ye" uniqKey="Choi S" first="Seung-Hye" last="Choi">Seung-Hye Choi</name><affiliation><mods:affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</mods:affiliation></affiliation></author><author><name sortKey="Barsky, Sanford H" sort="Barsky, Sanford H" uniqKey="Barsky S" first="Sanford H." last="Barsky">Sanford H. Barsky</name><affiliation><mods:affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</mods:affiliation></affiliation></author><author><name sortKey="Chang, Helena R" sort="Chang, Helena R" uniqKey="Chang H" first="Helena R." last="Chang">Helena R. Chang</name><affiliation><mods:affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: hchang@mednet.ucla.edu.</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:B4B92B8B271BE675D6F15B6448ED15F2DF612D4D</idno><date when="2003" year="2003">2003</date><idno type="doi">10.1046/j.1524-4741.2003.09304.x</idno><idno type="url">https://api.istex.fr/document/B4B92B8B271BE675D6F15B6448ED15F2DF612D4D/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">005492</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">005492</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main">Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title><author><name sortKey="Choi, Seung Ye" sort="Choi, Seung Ye" uniqKey="Choi S" first="Seung-Hye" last="Choi">Seung-Hye Choi</name><affiliation><mods:affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</mods:affiliation></affiliation></author><author><name sortKey="Barsky, Sanford H" sort="Barsky, Sanford H" uniqKey="Barsky S" first="Sanford H." last="Barsky">Sanford H. Barsky</name><affiliation><mods:affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</mods:affiliation></affiliation></author><author><name sortKey="Chang, Helena R" sort="Chang, Helena R" uniqKey="Chang H" first="Helena R." last="Chang">Helena R. Chang</name><affiliation><mods:affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: hchang@mednet.ucla.edu.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="ISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><imprint><biblScope unit="vol">9</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="153">153</biblScope><biblScope unit="page" to="162">162</biblScope><biblScope unit="page-count">10</biblScope><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2003-05">2003-05</date></imprint><idno type="ISSN">1075-122X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1075-122X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Abstract: Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both 99Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty‐three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty‐three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (p = 0.036) and the presence of lymphatic/vascular invasion (LVI) (p = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (p = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER‐2/neu and p53 status, S‐phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>slns</json:string><json:string>node</json:string><json:string>axillary</json:string><json:string>alnd</json:string><json:string>positive slns</json:string><json:string>breast cancer</json:string><json:string>metastasis</json:string><json:string>slnb</json:string><json:string>surg</json:string><json:string>lymph</json:string><json:string>colloid</json:string><json:string>lymphoscintigraphy</json:string><json:string>carcinoma</json:string><json:string>lymphatic</json:string><json:string>sulfur colloid</json:string><json:string>lymph nodes</json:string><json:string>nodal</json:string><json:string>micrometastases</json:string><json:string>micrometastasis</json:string><json:string>metastatic</json:string><json:string>negative slns</json:string><json:string>quadrant</json:string><json:string>cytokeratin</json:string><json:string>ductal</json:string><json:string>sentinel lymph node biopsy</json:string><json:string>axilla</json:string><json:string>giuliano</json:string><json:string>handheld</json:string><json:string>preoperative</json:string><json:string>sentinel</json:string><json:string>choi</json:string><json:string>lymphedema</json:string><json:string>tumor size</json:string><json:string>morbidity</json:string><json:string>nonpalpable</json:string><json:string>handheld gamma probe</json:string><json:string>sulfur</json:string><json:string>preoperative lymphoscintigraphy</json:string><json:string>small breast cancers</json:string><json:string>identification rate</json:string><json:string>early breast cancer</json:string><json:string>axillary lymph nodes</json:string><json:string>lymphatic mapping</json:string><json:string>breast cancers</json:string><json:string>exact test</json:string><json:string>nuclear grade</json:string><json:string>sentinel lymphadenectomy</json:string><json:string>axillary dissection</json:string><json:string>clinicopathologic analysis</json:string><json:string>breast</json:string><json:string>bilateral breast cancer</json:string><json:string>arch surg</json:string><json:string>detection rate</json:string><json:string>ductal carcinoma</json:string><json:string>nodal metastasis</json:string><json:string>breast center</json:string><json:string>lobular carcinoma</json:string><json:string>breast cancer patients</json:string><json:string>univariate analysis</json:string><json:string>primary tumor</json:string><json:string>multivariate analysis</json:string><json:string>sentinel node biopsy</json:string><json:string>negative status</json:string><json:string>biopsy</json:string><json:string>radiolabeled tracer</json:string><json:string>tumor differentiation</json:string><json:string>axillary lymph node dissection</json:string><json:string>axillary nodal status</json:string><json:string>metastatic lymph nodes</json:string><json:string>metastatic slns</json:string><json:string>sentinel lymph node mapping</json:string><json:string>tumor characteristics</json:string><json:string>coll surg</json:string><json:string>entire group</json:string><json:string>conventional alnd</json:string><json:string>breast carcinoma</json:string><json:string>pathologic characteristics</json:string><json:string>sentinel lymph node</json:string><json:string>dissection</json:string></teeft></keywords><author><json:item><name>Seung‐Hye Choi MD, PhD</name><affiliations><json:string>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</json:string></affiliations></json:item><json:item><name>Sanford H. Barsky MD</name><affiliations><json:string>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</json:string></affiliations></json:item><json:item><name>Helena R. Chang MD, PhD</name><affiliations><json:string>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</json:string><json:string>E-mail: hchang@mednet.ucla.edu.</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>sentinel lymph node mapping</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>small breast cancer</value></json:item></subject><articleId><json:string>TBJ09304</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Abstract: Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both 99Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty‐three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty‐three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (p = 0.036) and the presence of lymphatic/vascular invasion (LVI) (p = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (p = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER‐2/neu and p53 status, S‐phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.</abstract><qualityIndicators><score>8.5</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595 x 782 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>3118</abstractCharCount><pdfWordCount>5675</pdfWordCount><pdfCharCount>36142</pdfCharCount><pdfPageCount>10</pdfPageCount><abstractWordCount>471</abstractWordCount></qualityIndicators><title>Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title><genre><json:string>article</json:string></genre><host><title>The Breast Journal</title><language><json:string>unknown</json:string></language><doi><json:string>10.1111/(ISSN)1524-4741</json:string></doi><issn><json:string>1075-122X</json:string></issn><eissn><json:string>1524-4741</json:string></eissn><publisherId><json:string>TBJ</json:string></publisherId><volume>9</volume><issue>3</issue><pages><first>153</first><last>162</last><total>10</total></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>oncology</json:string><json:string>obstetrics & gynecology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>oncology & carcinogenesis</json:string></scienceMetrix></categories><publicationDate>2003</publicationDate><copyrightDate>2003</copyrightDate><doi><json:string>10.1046/j.1524-4741.2003.09304.x</json:string></doi><id>B4B92B8B271BE675D6F15B6448ED15F2DF612D4D</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/B4B92B8B271BE675D6F15B6448ED15F2DF612D4D/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/B4B92B8B271BE675D6F15B6448ED15F2DF612D4D/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/B4B92B8B271BE675D6F15B6448ED15F2DF612D4D/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title></titleStmt><publicationStmt><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2003-05"></date></publicationStmt><notesStmt><note type="content-type" subtype="article" source="article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</note><note type="publication-type" subtype="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title><title level="a" type="short">Clinicopathologic Analysis of SLN Mapping</title><author xml:id="author-0000"><persName><forename type="first">Seung‐Hye</forename><surname>Choi</surname><roleName type="degree">MD, PhD</roleName></persName><affiliation>
*
<address><country key="US"></country></address></affiliation></author><author xml:id="author-0001"><persName><forename type="first">Sanford H.</forename><surname>Barsky</surname><roleName type="degree">MD</roleName></persName><affiliation>
*
<address><country key="US"></country></address></affiliation></author><author xml:id="author-0002" role="corresp"><persName><forename type="first">Helena R.</forename><surname>Chang</surname><roleName type="degree">MD, PhD</roleName></persName><affiliation>
*
<address><country key="US"></country></address></affiliation><affiliation>Address correspondence and reprint requests to: Helena R. Chang, MD, PhD, Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine, 200 UCLA Medical Plaza, Los Angeles, CA 90095, USA, or email: hchang@mednet.ucla.edu.</affiliation></author><idno type="istex">B4B92B8B271BE675D6F15B6448ED15F2DF612D4D</idno><idno type="DOI">10.1046/j.1524-4741.2003.09304.x</idno><idno type="unit">TBJ09304</idno><idno type="toTypesetVersion">file:TBJ.TBJ09304.pdf</idno></analytic><monogr><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="pISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><idno type="book-DOI">10.1111/(ISSN)1524-4741</idno><idno type="book-part-DOI">10.1111/tbj.2003.9.issue-3</idno><idno type="product">TBJ</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">9</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="153">153</biblScope><biblScope unit="page" to="162">162</biblScope><biblScope unit="page-count">10</biblScope><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2003-05"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p><hi rend="bold">Abstract:</hi> Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both <hi rend="superscript">99</hi>Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty‐three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty‐three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (<hi rend="italic">p</hi> = 0.036) and the presence of lymphatic/vascular invasion (LVI) (<hi rend="italic">p</hi> = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (<hi rend="italic">p</hi> = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER‐2/<hi rend="italic">neu</hi> and p53 status, S‐phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">sentinel lymph node mapping</term><term xml:id="k2">small breast cancer </term></keywords><classCode scheme="tocHeading1">Original Articles</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/B4B92B8B271BE675D6F15B6448ED15F2DF612D4D/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Science Inc</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1524-4741</doi><issn type="print">1075-122X</issn><issn type="electronic">1524-4741</issn><idGroup><id type="product" value="TBJ"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="BREAST JOURNAL">The Breast Journal</title></titleGroup></publicationMeta><publicationMeta level="part" position="05003"><doi origin="wiley">10.1111/tbj.2003.9.issue-3</doi><numberingGroup><numbering type="journalVolume" number="9">9</numbering><numbering type="journalIssue" number="3">3</numbering></numberingGroup><coverDate startDate="2003-05">May 2003</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="0015300" status="forIssue"><doi origin="wiley">10.1046/j.1524-4741.2003.09304.x</doi><idGroup><id type="unit" value="TBJ09304"></id></idGroup><countGroup><count type="pageTotal" number="10"></count></countGroup><titleGroup><title type="tocHeading1">Original Articles</title></titleGroup><eventGroup><event type="firstOnline" date="2003-05-08"></event><event type="publishedOnlineFinalForm" date="2003-05-08"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-04"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-10"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-04"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="153">153</numbering><numbering type="pageLast" number="162">162</numbering></numberingGroup><correspondenceTo>Address correspondence and reprint requests to: Helena R. Chang, MD, PhD, Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine, 200 UCLA Medical Plaza, Los Angeles, CA 90095, USA, or email: <email>hchang@mednet.ucla.edu.</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:TBJ.TBJ09304.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="7"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="40"></count><count type="wordTotal" number="5228"></count></countGroup><titleGroup><title type="main">Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title><title type="shortAuthors"><sc>choi et al.</sc></title><title type="short"><i>Clinicopathologic Analysis of SLN Mapping</i></title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#aff-1-1"><personName><givenNames>Seung‐Hye</givenNames><familyName>Choi</familyName><degrees>MD, PhD</degrees></personName></creator>*
<creator creatorRole="author" xml:id="cr2" affiliationRef="#aff-1-1"><personName><givenNames>Sanford H.</givenNames><familyName>Barsky</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#aff-1-1" corresponding="yes"><personName><givenNames>Helena R.</givenNames><familyName>Chang</familyName><degrees>MD, PhD</degrees></personName></creator>*
</creators><affiliationGroup><affiliation xml:id="aff-1-1" countryCode="US"><unparsedAffiliation><i> Departments of </i>
*
<i>Surgery and </i><sup>†</sup><i>Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</i></unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">sentinel lymph node mapping</keyword><keyword xml:id="k2">small breast cancer </keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Abstract:</b> Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both <sup>99</sup>Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty‐three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty‐three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (<i>p</i> = 0.036) and the presence of lymphatic/vascular invasion (LVI) (<i>p</i> = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (<i>p</i> = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER‐2/<i>neu</i> and p53 status, S‐phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Clinicopathologic Analysis of SLN Mapping</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Clinicopathologic Analysis of Sentinel Lymph Node Mapping in Early Breast Cancer</title></titleInfo><name type="personal"><namePart type="given">Seung‐Hye</namePart><namePart type="family">Choi</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sanford H.</namePart><namePart type="family">Barsky</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Helena R.</namePart><namePart type="family">Chang</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Departments of * Surgery and † Pathology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, California</affiliation><affiliation>E-mail: hchang@mednet.ucla.edu.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Science Inc</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2003-05</dateIssued><copyrightDate encoding="w3cdtf">2003</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">7</extent><extent unit="references">40</extent><extent unit="words">5228</extent></physicalDescription><abstract>Abstract: Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both 99Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty‐three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty‐three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (p = 0.036) and the presence of lymphatic/vascular invasion (LVI) (p = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (p = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER‐2/neu and p53 status, S‐phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.</abstract><subject lang="en"><genre>keywords</genre><topic>sentinel lymph node mapping</topic><topic>small breast cancer</topic></subject><relatedItem type="host"><titleInfo><title>The Breast Journal</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1075-122X</identifier><identifier type="eISSN">1524-4741</identifier><identifier type="DOI">10.1111/(ISSN)1524-4741</identifier><identifier type="PublisherID">TBJ</identifier><part><date>2003</date><detail type="volume"><caption>vol.</caption><number>9</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>153</start><end>162</end><total>10</total></extent></part></relatedItem><identifier type="istex">B4B92B8B271BE675D6F15B6448ED15F2DF612D4D</identifier><identifier type="DOI">10.1046/j.1524-4741.2003.09304.x</identifier><identifier type="ArticleID">TBJ09304</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Science Inc</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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