Sentinel Lymph Node Biopsy and Axillary Dissection in Breast Cancer: Results in a LargeSeries
Identifieur interne : 00AC88 ( Main/Exploration ); précédent : 00AC87; suivant : 00AC89Sentinel Lymph Node Biopsy and Axillary Dissection in Breast Cancer: Results in a LargeSeries
Auteurs : Umberto Veronesi ; Giovanni Paganelli ; Giuseppe Viale ; Viviana Galimberti ; Alberto Luini ; Stefano Zurrida ; Chris Robertson ; Virgilio Sacchini ; Paolo Veronesi ; Enrico Orvieto ; Concetta De Cicco ; Mattia Intra ; Giampiero Tosi ; Daniela Scarpa [Italie]Source :
- Journal of the National Cancer Institute [ 0027-8874 ] ; 1999-02-17.
Abstract
BACKGROUND: Axillary lymph node dissection is an established component of the surgical treatment of breast cancer, and is an important procedure in cancer staging; however, it is associated with unpleasant side effects. We have investigated a radioactive tracer-guided procedure that facilitates identification, removal, and pathologic examination of the sentinel lymph node (i.e., the lymph node first receiving lymphatic fluid from the area of the breast containing the tumor) to predict the status of the axilla and to assess the safety of foregoing axillary dissection if the sentinel lymph node shows no involvement. METHODS: We injected 5-10 MBq of 99mTc-labeled colloidal particles of human albumin peritumorally in 376 consecutive patients with breast cancer who were enrolled at the European Institute of Oncology during the period from March 1996 through March 1998. The sentinel lymph node in each case was visualized by lymphoscintigraphy, and its general location was marked on the overlying skin. During breast surgery, the sentinel lymph node was identified for removal by monitoring the acoustic signal from a hand-held gamma ray-detecting probe. Total axillary dissection was then carried out. The pathologic status of the sentinel lymph node was compared with that of the whole axilla. RESULTS: The sentinel lymph node was identified in 371 (98.7%) of the 376 patients and accurately predicted the state of the axilla in 359 (95.5%) of the patients, with 12 false-negative findings (6.7%; 95% confidence interval = 3.5%-11.4%) among a total of 180 patients with positive axillary lymph nodes. CONCLUSIONS: Sentinel lymph node biopsy using a gamma ray-detecting probe allows staging of the axilla with high accuracy in patients with primary breast cancer. A randomized trial is necessary to determine whether axillary dissection may be avoided in those patients with an uninvolved sentinel lymph node.
Url:
DOI: 10.1093/jnci/91.4.368
Affiliations:
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Galimberti</name></author><author><name sortKey="Luini, Alberto" sort="Luini, Alberto" uniqKey="Luini A" first="Alberto" last="Luini">Alberto Luini</name></author><author><name sortKey="Zurrida, Stefano" sort="Zurrida, Stefano" uniqKey="Zurrida S" first="Stefano" last="Zurrida">Stefano Zurrida</name></author><author><name sortKey="Robertson, Chris" sort="Robertson, Chris" uniqKey="Robertson C" first="Chris" last="Robertson">Chris Robertson</name></author><author><name sortKey="Sacchini, Virgilio" sort="Sacchini, Virgilio" uniqKey="Sacchini V" first="Virgilio" last="Sacchini">Virgilio Sacchini</name></author><author><name sortKey="Veronesi, Paolo" sort="Veronesi, Paolo" uniqKey="Veronesi P" first="Paolo" last="Veronesi">Paolo Veronesi</name></author><author><name sortKey="Orvieto, Enrico" sort="Orvieto, Enrico" uniqKey="Orvieto E" first="Enrico" last="Orvieto">Enrico Orvieto</name></author><author><name sortKey="De Cicco, Concetta" sort="De Cicco, Concetta" uniqKey="De Cicco C" first="Concetta" last="De Cicco">Concetta De Cicco</name></author><author><name sortKey="Intra, Mattia" sort="Intra, Mattia" uniqKey="Intra M" first="Mattia" last="Intra">Mattia Intra</name></author><author><name sortKey="Tosi, Giampiero" sort="Tosi, Giampiero" uniqKey="Tosi G" first="Giampiero" last="Tosi">Giampiero Tosi</name></author><author><name sortKey="Scarpa, Daniela" sort="Scarpa, Daniela" uniqKey="Scarpa D" first="Daniela" last="Scarpa">Daniela Scarpa</name><affiliation wicri:level="3"><country xml:lang="fr">Italie</country><wicri:regionArea>Affiliations of authors: U. Veronesi, V. Galimberti, A. Luini, S.Zurrida, V. Sacchini, P. Veronesi, M. Intra (Senology Division), G. Pagnelli, C. De Cicco(Nuclear Medicine Division), G. Viale, E. Orvieto (Pathology Division), C. Robertson(Epidemiology and Biostatistics Division), G. Tosi (Medical Physics Division), D. Scarpa(Anesthesiology Division), Istituto Europeo di Oncologia, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the National Cancer Institute</title><title level="j" type="abbrev">JNCI J Natl Cancer Inst</title><idno type="ISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="1999-02-17">1999-02-17</date><biblScope unit="volume">91</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="368">368</biblScope><biblScope unit="page" to="373">373</biblScope></imprint><idno type="ISSN">0027-8874</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0027-8874</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">BACKGROUND: Axillary lymph node dissection is an established component of the surgical treatment of breast cancer, and is an important procedure in cancer staging; however, it is associated with unpleasant side effects. We have investigated a radioactive tracer-guided procedure that facilitates identification, removal, and pathologic examination of the sentinel lymph node (i.e., the lymph node first receiving lymphatic fluid from the area of the breast containing the tumor) to predict the status of the axilla and to assess the safety of foregoing axillary dissection if the sentinel lymph node shows no involvement. METHODS: We injected 5-10 MBq of 99mTc-labeled colloidal particles of human albumin peritumorally in 376 consecutive patients with breast cancer who were enrolled at the European Institute of Oncology during the period from March 1996 through March 1998. The sentinel lymph node in each case was visualized by lymphoscintigraphy, and its general location was marked on the overlying skin. During breast surgery, the sentinel lymph node was identified for removal by monitoring the acoustic signal from a hand-held gamma ray-detecting probe. Total axillary dissection was then carried out. The pathologic status of the sentinel lymph node was compared with that of the whole axilla. RESULTS: The sentinel lymph node was identified in 371 (98.7%) of the 376 patients and accurately predicted the state of the axilla in 359 (95.5%) of the patients, with 12 false-negative findings (6.7%; 95% confidence interval = 3.5%-11.4%) among a total of 180 patients with positive axillary lymph nodes. CONCLUSIONS: Sentinel lymph node biopsy using a gamma ray-detecting probe allows staging of the axilla with high accuracy in patients with primary breast cancer. A randomized trial is necessary to determine whether axillary dissection may be avoided in those patients with an uninvolved sentinel lymph node.</div></front></TEI><affiliations><list><country><li>Italie</li></country><region><li>Lombardie</li></region><settlement><li>Milan</li></settlement></list><tree><noCountry><name sortKey="De Cicco, Concetta" sort="De Cicco, Concetta" uniqKey="De Cicco C" first="Concetta" last="De Cicco">Concetta De Cicco</name><name sortKey="Galimberti, Viviana" sort="Galimberti, Viviana" uniqKey="Galimberti V" first="Viviana" last="Galimberti">Viviana Galimberti</name><name sortKey="Intra, Mattia" sort="Intra, Mattia" uniqKey="Intra M" first="Mattia" last="Intra">Mattia Intra</name><name sortKey="Luini, Alberto" sort="Luini, Alberto" uniqKey="Luini A" first="Alberto" last="Luini">Alberto Luini</name><name sortKey="Orvieto, Enrico" sort="Orvieto, Enrico" uniqKey="Orvieto E" first="Enrico" last="Orvieto">Enrico Orvieto</name><name sortKey="Paganelli, Giovanni" sort="Paganelli, Giovanni" uniqKey="Paganelli G" first="Giovanni" last="Paganelli">Giovanni Paganelli</name><name sortKey="Robertson, Chris" sort="Robertson, Chris" uniqKey="Robertson C" first="Chris" last="Robertson">Chris Robertson</name><name sortKey="Sacchini, Virgilio" sort="Sacchini, Virgilio" uniqKey="Sacchini V" first="Virgilio" last="Sacchini">Virgilio Sacchini</name><name sortKey="Tosi, Giampiero" sort="Tosi, Giampiero" uniqKey="Tosi G" first="Giampiero" last="Tosi">Giampiero Tosi</name><name sortKey="Veronesi, Paolo" sort="Veronesi, Paolo" uniqKey="Veronesi P" first="Paolo" last="Veronesi">Paolo Veronesi</name><name sortKey="Veronesi, Umberto" sort="Veronesi, Umberto" uniqKey="Veronesi U" first="Umberto" last="Veronesi">Umberto Veronesi</name><name sortKey="Viale, Giuseppe" sort="Viale, Giuseppe" uniqKey="Viale G" first="Giuseppe" last="Viale">Giuseppe Viale</name><name sortKey="Zurrida, Stefano" sort="Zurrida, Stefano" uniqKey="Zurrida S" first="Stefano" last="Zurrida">Stefano Zurrida</name></noCountry><country name="Italie"><region name="Lombardie"><name sortKey="Scarpa, Daniela" sort="Scarpa, Daniela" uniqKey="Scarpa D" first="Daniela" last="Scarpa">Daniela Scarpa</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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