Micrometastasis in the Sentinel Lymph Node of Breast Cancer Does Not Mandate Completion Axillary Dissection
Identifieur interne : 003E27 ( Pmc/Checkpoint ); précédent : 003E26; suivant : 003E28Micrometastasis in the Sentinel Lymph Node of Breast Cancer Does Not Mandate Completion Axillary Dissection
Auteurs : Keith Fournier ; Anne Schiller ; Roger R. Perry ; Christine LarongaSource :
- Annals of Surgery [ 0003-4932 ] ; 2004.
Abstract
To determine if micrometastatic disease in the sentinel lymph node is a predictor of non-sentinel lymph node (non-SLN) involvement in breast cancer.
Sentinel lymph node biopsy (SLN) is an accepted alternative to axillary dissection in staging breast cancer. If the SLN contains metastatic foci, the standard recommendation is completion axillary node dissection (CAD). However, a large subset of patients with metastasis limited to the SLN is unnecessarily subjected to the morbidity of CAD.
A retrospective review of prospectively gathered breast cancer patients having SLN was conducted. Patients with metastasis to the SLN were selected for analysis. Various clinicopathologic features were analyzed for association with metastasis to the non-SLN.
A total of 194 women underwent successful SLN dissection. Metastasis to the SLN was found in 48 patients (21 had micrometastases, 27 had macrometastases). Of those with micrometastases, 16 underwent CAD with 1 patient having metastasis to the non-SLN. In patients with macrometastases, 26 had CAD with 14 patients having non-SLN metastasis. Multivariable logistic regression identified only macrometastatic disease in the SLN as significantly associated with involvement of the non-SLN (
This study demonstrates that the incidence of non-SLN involvement is low in SLN that contains only micrometastatic foci and is within the accepted range of the false-negative rate of SLN. This suggests that a CAD may be omitted in patients with micrometastatic disease.
Url:
DOI: 10.1097/01.sla.0000128302.05898.a7
PubMed: 15166965
PubMed Central: 1356294
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Perry</name><affiliation><nlm:aff id="N0x8c4e010.0x9282a98"></nlm:aff></affiliation></author><author><name sortKey="Laronga, Christine" sort="Laronga, Christine" uniqKey="Laronga C" first="Christine" last="Laronga">Christine Laronga</name><affiliation><nlm:aff id="N0x8c4e010.0x9282a98"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">15166965</idno><idno type="pmc">1356294</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356294</idno><idno type="RBID">PMC:1356294</idno><idno type="doi">10.1097/01.sla.0000128302.05898.a7</idno><date when="2004">2004</date><idno type="wicri:Area/Pmc/Corpus">001347</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001347</idno><idno type="wicri:Area/Pmc/Curation">001346</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001346</idno><idno type="wicri:Area/Pmc/Checkpoint">003E27</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003E27</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Micrometastasis in the Sentinel Lymph Node of Breast Cancer Does Not Mandate Completion Axillary Dissection</title><author><name sortKey="Fournier, Keith" sort="Fournier, Keith" uniqKey="Fournier K" first="Keith" last="Fournier">Keith Fournier</name><affiliation><nlm:aff id="N0x8c4e010.0x9282a98"></nlm:aff></affiliation></author><author><name sortKey="Schiller, Anne" sort="Schiller, Anne" uniqKey="Schiller A" first="Anne" last="Schiller">Anne Schiller</name><affiliation><nlm:aff id="N0x8c4e010.0x9282a98"></nlm:aff></affiliation></author><author><name sortKey="Perry, Roger R" sort="Perry, Roger R" uniqKey="Perry R" first="Roger R." last="Perry">Roger R. Perry</name><affiliation><nlm:aff id="N0x8c4e010.0x9282a98"></nlm:aff></affiliation></author><author><name sortKey="Laronga, Christine" sort="Laronga, Christine" uniqKey="Laronga C" first="Christine" last="Laronga">Christine Laronga</name><affiliation><nlm:aff id="N0x8c4e010.0x9282a98"></nlm:aff></affiliation></author></analytic><series><title level="j">Annals of Surgery</title><idno type="ISSN">0003-4932</idno><idno type="eISSN">1528-1140</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective:</title><p>To determine if micrometastatic disease in the sentinel lymph node is a predictor of non-sentinel lymph node (non-SLN) involvement in breast cancer.</p></sec><sec><title>Summary Background Data:</title><p>Sentinel lymph node biopsy (SLN) is an accepted alternative to axillary dissection in staging breast cancer. If the SLN contains metastatic foci, the standard recommendation is completion axillary node dissection (CAD). However, a large subset of patients with metastasis limited to the SLN is unnecessarily subjected to the morbidity of CAD.</p></sec><sec><title>Methods:</title><p>A retrospective review of prospectively gathered breast cancer patients having SLN was conducted. Patients with metastasis to the SLN were selected for analysis. Various clinicopathologic features were analyzed for association with metastasis to the non-SLN.</p></sec><sec><title>Results:</title><p>A total of 194 women underwent successful SLN dissection. Metastasis to the SLN was found in 48 patients (21 had micrometastases, 27 had macrometastases). Of those with micrometastases, 16 underwent CAD with 1 patient having metastasis to the non-SLN. In patients with macrometastases, 26 had CAD with 14 patients having non-SLN metastasis. Multivariable logistic regression identified only macrometastatic disease in the SLN as significantly associated with involvement of the non-SLN (<italic>P</italic> = 0.03). None of the patients with micrometastases, including those without CAD, has evidence of local recurrence to date (3–30 months).</p></sec><sec><title>Conclusion:</title><p>This study demonstrates that the incidence of non-SLN involvement is low in SLN that contains only micrometastatic foci and is within the accepted range of the false-negative rate of SLN. This suggests that a CAD may be omitted in patients with micrometastatic disease.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Surg</journal-id><journal-id journal-id-type="publisher-id">Annals of Surgery</journal-id><journal-title>Annals of Surgery</journal-title><issn pub-type="ppub">0003-4932</issn><issn pub-type="epub">1528-1140</issn></journal-meta><article-meta><article-id pub-id-type="pmid">15166965</article-id><article-id pub-id-type="pmc">1356294</article-id><article-id pub-id-type="publisher-id">0000658-200406000-00013</article-id><article-id pub-id-type="doi">10.1097/01.sla.0000128302.05898.a7</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles and Discussions</subject></subj-group></article-categories><title-group><article-title>Micrometastasis in the Sentinel Lymph Node of Breast Cancer Does Not Mandate Completion Axillary Dissection</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Fournier</surname><given-names>Keith</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="N0x8c4e010.0x9282a98">*</xref></contrib><contrib contrib-type="author"><name><surname>Schiller</surname><given-names>Anne</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="N0x8c4e010.0x9282a98">†</xref></contrib><contrib contrib-type="author"><name><surname>Perry</surname><given-names>Roger R.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="N0x8c4e010.0x9282a98">*</xref></contrib><contrib contrib-type="author"><name><surname>Laronga</surname><given-names>Christine</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="N0x8c4e010.0x9282a98">*</xref></contrib></contrib-group><aff id="N0x8c4e010.0x9282a98">From the *Departments of *Surgery and †Pathology, Eastern Virginia Medical School, Norfolk, VA.<break></break></aff><pub-date pub-type="ppub"><month>6</month><year>2004</year></pub-date><volume>239</volume><issue>6</issue><fpage>859</fpage><lpage>865</lpage><copyright-statement>© 2004 Lippincott Williams & Wilkins, Inc.</copyright-statement><abstract><sec><title>Objective:</title><p>To determine if micrometastatic disease in the sentinel lymph node is a predictor of non-sentinel lymph node (non-SLN) involvement in breast cancer.</p></sec><sec><title>Summary Background Data:</title><p>Sentinel lymph node biopsy (SLN) is an accepted alternative to axillary dissection in staging breast cancer. If the SLN contains metastatic foci, the standard recommendation is completion axillary node dissection (CAD). However, a large subset of patients with metastasis limited to the SLN is unnecessarily subjected to the morbidity of CAD.</p></sec><sec><title>Methods:</title><p>A retrospective review of prospectively gathered breast cancer patients having SLN was conducted. Patients with metastasis to the SLN were selected for analysis. Various clinicopathologic features were analyzed for association with metastasis to the non-SLN.</p></sec><sec><title>Results:</title><p>A total of 194 women underwent successful SLN dissection. Metastasis to the SLN was found in 48 patients (21 had micrometastases, 27 had macrometastases). Of those with micrometastases, 16 underwent CAD with 1 patient having metastasis to the non-SLN. In patients with macrometastases, 26 had CAD with 14 patients having non-SLN metastasis. Multivariable logistic regression identified only macrometastatic disease in the SLN as significantly associated with involvement of the non-SLN (<italic>P</italic> = 0.03). None of the patients with micrometastases, including those without CAD, has evidence of local recurrence to date (3–30 months).</p></sec><sec><title>Conclusion:</title><p>This study demonstrates that the incidence of non-SLN involvement is low in SLN that contains only micrometastatic foci and is within the accepted range of the false-negative rate of SLN. This suggests that a CAD may be omitted in patients with micrometastatic disease.</p></sec></abstract><abstract abstract-type="toc"><p>A retrospective review of breast cancer patients demonstrated that when the sentinel lymph node contains only micrometastasis to the non-sentinel lymph node is an uncommon event, occurring in only 6% of patients in our series.</p></abstract></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Fournier, Keith" sort="Fournier, Keith" uniqKey="Fournier K" first="Keith" last="Fournier">Keith Fournier</name><name sortKey="Laronga, Christine" sort="Laronga, Christine" uniqKey="Laronga C" first="Christine" last="Laronga">Christine Laronga</name><name sortKey="Perry, Roger R" sort="Perry, Roger R" uniqKey="Perry R" first="Roger R." last="Perry">Roger R. Perry</name><name sortKey="Schiller, Anne" sort="Schiller, Anne" uniqKey="Schiller A" first="Anne" last="Schiller">Anne Schiller</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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