Completion of Axillary Dissection for a Positive Sentinel Node: Necessary or Not?
Identifieur interne : 002790 ( Pmc/Curation ); précédent : 002789; suivant : 002791Completion of Axillary Dissection for a Positive Sentinel Node: Necessary or Not?
Auteurs : Kathleen M. Erb [États-Unis] ; Thomas B. Julian [États-Unis]Source :
- Current oncology reports [ 1523-3790 ] ; 2009.
Abstract
Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports of outcomes when axillary node dissection was not performed in the setting of positive sentinel nodes, models for predicting the status of nonsentinel nodes, and the morbidity associated with axillary operations. Despite an approximate 10% false-negative rate, early results indicate that there is a much lower local recurrence rate after sentinel node excision alone and that systemic therapy may sterilize the axilla. In selected patients, it may be appropriate to forgo an axillary node dissection, although there are no randomized clinical trial data to support or refute this suggestion.
Url:
PubMed: 19080737
PubMed Central: 2646630
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Erb</name><affiliation wicri:level="2"><nlm:aff id="A1">Allegheny General Hospital, Department of Human Oncology, Division of Breast Surgical Oncology, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Allegheny General Hospital, Department of Human Oncology, Division of Breast Surgical Oncology, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Julian, Thomas B" sort="Julian, Thomas B" uniqKey="Julian T" first="Thomas B." last="Julian">Thomas B. Julian</name><affiliation wicri:level="2"><nlm:aff id="A1">Allegheny General Hospital, Department of Human Oncology, Division of Breast Surgical Oncology, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Allegheny General Hospital, Department of Human Oncology, Division of Breast Surgical Oncology, Pittsburgh</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="A2">National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations Office, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations Office, Pittsburgh</wicri:cityArea></affiliation></author></analytic><series><title level="j">Current oncology reports</title><idno type="ISSN">1523-3790</idno><idno type="eISSN">1534-6269</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="P1">Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports of outcomes when axillary node dissection was not performed in the setting of positive sentinel nodes, models for predicting the status of nonsentinel nodes, and the morbidity associated with axillary operations. Despite an approximate 10% false-negative rate, early results indicate that there is a much lower local recurrence rate after sentinel node excision alone and that systemic therapy may sterilize the axilla. In selected patients, it may be appropriate to forgo an axillary node dissection, although there are no randomized clinical trial data to support or refute this suggestion.</p></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100888967</journal-id><journal-id journal-id-type="pubmed-jr-id">21927</journal-id><journal-id journal-id-type="nlm-ta">Curr Oncol Rep</journal-id><journal-title>Current oncology reports</journal-title><issn pub-type="ppub">1523-3790</issn><issn pub-type="epub">1534-6269</issn></journal-meta><article-meta><article-id pub-id-type="pmid">19080737</article-id><article-id pub-id-type="pmc">2646630</article-id><article-id pub-id-type="manuscript">NIHMS83773</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Completion of Axillary Dissection for a Positive Sentinel Node: Necessary or Not?</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Erb</surname><given-names>Kathleen M.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Julian</surname><given-names>Thomas B.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib></contrib-group><aff id="A1"><label>1</label>Allegheny General Hospital, Department of Human Oncology, Division of Breast Surgical Oncology, Pittsburgh, PA</aff><aff id="A2"><label>2</label>National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations Office, Pittsburgh, PA</aff><author-notes><corresp id="CR1">Corresponding author: Kathleen M. Erb, MD Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA. E-mail: <email>KERB@wpahs.org</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>19</day><month>12</month><year>2008</year></pub-date><pub-date pub-type="ppub"><month>1</month><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>1</month><year>2010</year></pub-date><volume>11</volume><issue>1</issue><fpage>15</fpage><lpage>20</lpage><abstract><p id="P1">Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports of outcomes when axillary node dissection was not performed in the setting of positive sentinel nodes, models for predicting the status of nonsentinel nodes, and the morbidity associated with axillary operations. Despite an approximate 10% false-negative rate, early results indicate that there is a much lower local recurrence rate after sentinel node excision alone and that systemic therapy may sterilize the axilla. In selected patients, it may be appropriate to forgo an axillary node dissection, although there are no randomized clinical trial data to support or refute this suggestion.</p></abstract><contract-num rid="CA1">U10 CA069974-13</contract-num><contract-num rid="CA1">U10 CA069651-15</contract-num><contract-num rid="CA1">U10 CA037377-23</contract-num><contract-num rid="CA1">U10 CA012027-38</contract-num><contract-sponsor id="CA1">National Cancer Institute : NCI</contract-sponsor></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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