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Which Patients Need an Axillary Clearance after Sentinel Node Biopsy?

By Anastasia Pazaiti and Ian S. Fentiman


Sentinel lymph node biopsy (SLNB) is a safe and accurate minimally invasive method for detecting axillary lymph node (ALN) involvement in the clinically negative axilla thereby reducing morbidity in patients who avoid unnecessary axillary lymph node dissection (ALND). Although current guidelines recommend completion ALND when macro- and micrometastatic diseases are identified by SLNB, the benefit of this surgical intervention is under debate. Additionally, the management of the axilla in the presence of isolated tumour cells (ITCs) in SLNB is questioned. Particularly controversial is the prognostic significance of minimal SLNB metastasis in relation to local recurrence and overall survival. Preliminary results of the recently published Z0011 trial suggest similar outcomes after SNB or ALND when the SN is positive, but this finding has to be interpreted with caution

Topics: Review Article
Publisher: SAGE-Hindawi Access to Research
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Provided by: PubMed Central

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  1. (2008). A .P a l ,E .P r o v e n z a n o
  2. (1972). A biological basis for the surgical treatment of clinically curable breast cancer,” Bulletin de la Societe internat i o n a l ed ec h i r u r g i e ,
  3. (2011). A novel automated assay for the rapid identificationofmetastaticbreastcarcinomainsentinellymph nodes,”
  4. (2003). A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer,”
  5. (2010). Alves,M.G.M.Tavares,andJ.C.S.G´ oes,“Clinicopathological predictor factors of axillary involvement in patients with metastatic breast cancer in the sentinel lymph node,”
  6. (2005). American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer,”
  7. (2003). Apostolikas et al., “Pathological work-up of sentinel lymph nodes in breast cancer. Review of cur-rent data to be considered for the formulation of guidelines,”
  8. (1992). Axillary dissection of level I and II lymph nodes is important in breast cancer classification.
  9. (2011). Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial,”
  10. (2009). Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients: long-term outcomes of a prospective study,”
  11. (2008). Breast cancer metastases are molecularly distinct from their primary tumors,”
  12. (2010). Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases,”
  13. (2010). Breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes,”
  14. (2008). Clinical evidence of breast cancer micrometastasis in the era of sentinel node biopsy,”
  15. (2009). Comparison of models to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a prospective multicenter study,”
  16. (2009). Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer,”
  17. (2010). Completion axillary lymph node dissection not required for regional control in patients with breast cancer who have micrometastases in a sentinel node,”
  18. (1999). Does local therapy affect survival rates in breast cancer?”
  19. (2010). e r e t o j a ,J .H .V i r o n e n ,P .S .H e i k k i l ¨
  20. (2001). Early distant relapsein’node-negative’ breastcancer patientsisnotpredicted by occult axillary lymph node metastases, but by the features of the primary tumour,”
  21. (2003). Gilhuijs et al., “Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer,”
  22. (2004). Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma: biologic metastasis or procedural artifact?”
  23. (2009). Impact of omission of completion axillarylymphnodedissection(cALND)oraxillaryradiotherapy (ax RT) in breast cancer patients with micrometastases (pN1mi) or isolated tumor cells (pN0[i+]) in the sentinel lymph node (SN): results from the MIRROR study,”
  24. (2010). Influence of isolated tumor cells in sentinel nodes on outcome in small, node-negative (pT1N0M0) breast cancer,”
  25. (2006). International Breast Cancer Study Group trial of sentinel node biopsy,”
  26. Intraoperative molecular assay for sentinel lymph node metastases in early stage breast cancer: a comparative analysis between one-step nucleic acid amplification whole node assay and routine frozen section histology,” Cancer.
  27. (2002). Keratin expression in human tissuesandneoplasms,”Histopathology, vol.40,no.5,pp.403– 439,
  28. (2001). l a u b e r - D e M o r e ,J .L .B .B e v i l a c q u a
  29. (2003). Learning curve for the detection of axillary sentinel lymph node in breast cancer,”
  30. (1999). Lessons learned from 500 cases of lymphatic mapping for breast cancer,”
  31. (2000). Long-term follow-up of the first breast conservation trial: guy’s wide excision study,”
  32. (2007). Low locoregional failure rates in selected breast cancer patients with tumor-positive sentinel lymph nodes who do not under-go completion axillary dissection,”
  33. (2008). Lymphovascular invasion and lobular histology are associated with increased incidence of isolated tumor cells in sentinel lymph nodes from early-stage breast cancer patients,”
  34. (2010). M.Yi,S.H.Giordano,F.Meric-Bernstametal.,“Trendsinand outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database,”
  35. (2008). Management of the axilla in women with breast cancer: current clinical practice and a new selective targeted approach,”
  36. (2004). Meta-analysis of nonsentinel node metastases associated with micrometastatic sen-8
  37. (2009). Micrometastases or isolated tumor cells and the outcome of breast cancer,”
  38. (2006). Micrometastasesinsentinellymphnodeinamulticentricstudy:predictive factors of nonsentinel lymph node involvement -
  39. (2004). Micrometastasis in the sentinel lymph node of breast cancer does not mandate
  40. (2010). Micrometastatic sentinel lymph node disease: do patients benefit or suffer harm from axillary lymph node dissection?”
  41. (2009). Minimal lymph node involvement and outcome of breast cancer.
  42. (2009). Molecular detection of lymph node metastases in breast cancer patients: results of a multicenter trial using the one-step nucleic acid amplification assay,”
  43. (2011). Multicentre evaluation of intraoperative molecular analysis of sentinel lymph nodes in breast carcinoma,”
  44. (2008). New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients,”
  45. (2005). Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram,”
  46. (2009). One-step nucleic acid amplification-a molecular method for the detection of lymph node metastases in breast cancer patients;
  47. (2010). P .B urk e,M.Barry ,andM.M o rr o w ,“ Ou t c o meo f axillary staging in early breast cancer: a meta-analysis,”
  48. (1948). P a t e ya n dW .H .D y s o n ,“ T h ep r o g n o s i so fc a r c i n o m a of the breast in relation to the type of operation performed,”
  49. (2001). P e t r e k ,R .T .S e n i e ,M .P e t e r s ,a n dP .P e t e r r o s e n ,“ L y m -phedema in a cohort of breast carcinoma survivors 20 years after diagnosis,”
  50. (2000). Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma: a multicenter study,”
  51. (1985). Patients with early breast cancer benefit from effectiveaxillarytreatment,”BreastCancerResearch and Treatment,
  52. (2005). Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy,”
  53. (2007). Predictive value of tumor load in breast cancer sentinel lymph nodes for second echelon lymph node metastases,”
  54. (2007). Predictors of axillary lymph node metastasis in breast cancer: a systematic review,”
  55. (2008). Predictors to assess nonsentinel lymph node status in breast cancer patients with sentinel lymph node metastasis,”
  56. (1992). Prognostic significance of breast cancer axillary lymph node micrometastases assessed by two special techniques: reevaluation with longer follow-up,”
  57. (2003). Prospective identification of tumorigenic breast cancer cells,”
  58. (2000). Prospective observational study of sentinel lymphadenectomy without furtheraxillarydissectioninpatientswithsentinelnode-negative breast cancer,”
  59. (1999). R.K.Orr,“Theimpactofprophylacticaxillarynodedissection on breast cancer survival - A Bayesian meta-analysis,”
  60. (2006). Randomized multicenter trial of sentinel node biopsy versus standard axillarytreatmentinoperablebreastcancer:theALMANACtrial,”
  61. (2007). Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer,”
  62. (1989). Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases,”
  63. (2003). Revision of breast cancer staging: the 6th edition of
  64. (2005). S p e c h t ,J .V .F e y ,P .I .B o r g e n ,a n dH .S .C o d y ,“ I st h e clinically positive axilla in breast cancer really a contraindicationtosentinellymphnodebiopsy?”JournaloftheAmerican College of Surgeons,
  65. (2010). S.P ernas,M.Gil,A.Ben´ ıtezetal.,“Avoidingaxillarytreatment in sentinel lymph node micrometastases of breast cancer: a prospective analysis of axillary or distant recurrence,”
  66. (2004). Sentinel lymph node biopsy,”
  67. (1999). Sentinel lymph nodebiopsywithmetastasis:canaxillarydissectionbeavoided in some patients with breast cancer?”
  68. (2010). Sentinel node identification rate and nodal involvement in
  69. (2011). Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study,”
  70. (2006). Sentinel node micrometastasis and distant failure in breast cancer patients,”
  71. (2010). Sentinel-lymphnode resection compared with conventional axillary-lymphnodedissectioninclinicallynode-negativepatientswithbreast cancer:
  72. (1980). T.Nemoto,J.Vana,andR.N.Bedwani,“Managementandsurvival of female breast cancer: results of a national survey by the American college of surgeons,”
  73. (1999). The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-Year results of a randomised trial,”
  74. (2005). The effect of sentinel node tumor burden on non-sentinel node status and recurrence rates in breast cancer,”
  75. The impact of nodal isolated tumor cells on survival of breast cancer pa-tients,” AmericanJournalofSurgery,vol.193,no.5,pp.571–574,2007.
  76. (1996). The new era in breast cancer: invasion, size, and nodal involvement dramatically decreasing as a result of mammographic screening,”
  77. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospitals
  78. (2002). Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation,” The New England
  79. (2002). V a n ’ tV e e r ,H .D a i ,M .J .V a nd eV i j v e re ta l . ,“ G e n ee x -pression profiling predicts clinical outcome of breast cancer,”
  80. (2003). V a nZ e e ,D .M .E .M a n a s s e h
  81. (2007). Yoshidome et al., “Onestep nucleic acid amplification for intraoperative detection of lymphnodemetastasisinbreastcancerpatients,”ClinicalCancer

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