Lymphatic mapping and sentinel lymphadenectomy for breast cancer.
Identifieur interne : 00B404 ( Ncbi/Curation ); précédent : 00B403; suivant : 00B405Lymphatic mapping and sentinel lymphadenectomy for breast cancer.
Auteurs : A E Giuliano ; D M Kirgan ; J M Guenther ; D L MortonSource :
- Annals of Surgery [ 0003-4932 ] ; 1994.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Aisselle, Faux négatifs, Femelle, Humains, Lymphadénectomie (), Magenta I, Métastase lymphatique, Noeuds lymphatiques (anatomopathologie), Période peropératoire, Reproductibilité des résultats, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein (), Tumeurs du sein (anatomopathologie), Études de faisabilité.
- MESH :
- anatomopathologie : Noeuds lymphatiques, Tumeurs du sein.
- Adulte, Adulte d'âge moyen, Aisselle, Faux négatifs, Femelle, Humains, Lymphadénectomie, Magenta I, Métastase lymphatique, Période peropératoire, Reproductibilité des résultats, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein, Études de faisabilité.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Axilla, Breast Neoplasms (pathology), Breast Neoplasms (surgery), False Negative Reactions, Feasibility Studies, Female, Humans, Intraoperative Period, Lymph Node Excision (methods), Lymph Nodes (pathology), Lymphatic Metastasis, Middle Aged, Reproducibility of Results, Rosaniline Dyes.
- MESH :
- chemical : Rosaniline Dyes.
- methods : Lymph Node Excision.
- pathology : Breast Neoplasms, Lymph Nodes.
- surgery : Breast Neoplasms.
- Adult, Aged, Aged, 80 and over, Axilla, False Negative Reactions, Feasibility Studies, Female, Humans, Intraoperative Period, Lymphatic Metastasis, Middle Aged, Reproducibility of Results.
Abstract
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.
Url:
PubMed: 8092905
PubMed Central: 1234400
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PMC:1234400Le document en format XML
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<term>Breast Neoplasms (surgery)</term>
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<term>Intraoperative Period</term>
<term>Lymph Node Excision (methods)</term>
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<term>Aisselle</term>
<term>Faux négatifs</term>
<term>Femelle</term>
<term>Humains</term>
<term>Lymphadénectomie ()</term>
<term>Magenta I</term>
<term>Métastase lymphatique</term>
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<term>Reproductibilité des résultats</term>
<term>Sujet âgé</term>
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<term>Études de faisabilité</term>
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<term>False Negative Reactions</term>
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<term>Humans</term>
<term>Intraoperative Period</term>
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<term>Reproducibility of Results</term>
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<term>Aisselle</term>
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<term>Femelle</term>
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<front><div type="abstract" xml:lang="en"><p>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.</p>
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