Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer.

Contains fulltext : 50651.pdf (publisher's version ) (Closed access)AIMS: To evaluate the feasibility and consequences of lymphatic mapping and a ("repeat") sentinel lymph node (SLN) procedure in patients with breast cancer relapse after previous breast and axillary surgery. METHODS: Review and presentation of a patient cohort. All SLN procedures included lymphoscintigraphy and blue dye injection technique. RESULTS: Twelve cases are described: two patients after a previous SLN procedure and ten after a previous complete axillary lymph node dissection (ALND). Ten patients (83%) had a successful repeat SLN biopsy. After previous ALND, lymphoscintigraphy revealed drainage towards the internal mammary chain in three patients, and contralateral axillary drainage in four. Based on the information from the "repeat" SLN biopsy further treatment strategy was altered in seven of the 12 patients. CONCLUSION: Lymphatic mapping and (repeat) SLN biopsy is possible and can be informative in patients who present with a relapse of breast cancer after previous surgery for primary breast cancer

Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection.

Item does not contain fulltextBACKGROUND: The sentinel node biopsy technique for breast cancer has been validated extensively in phase I and II studies. However, no data from phase III randomized clinical studies are available. It remains controversial whether a histologically negative sentinel node biopsy without further axillary dissection can be considered to be good clinical practice. METHODS: One hundred consecutive patients with breast cancer who had a negative sentinel node biopsy without additional axillary dissection were studied prospectively between 1997 and 2000 in order to identify tumour recurrence and to assess the morbidity of the sentinel node procedure. Special attention was paid to axillary or locoregional recurrence, distant metastases and overall survival. One year after the procedure patients were sent a questionnaire to assess any functional impairment of the arm or shoulder. RESULTS: Median follow-up was 24 (range 16-40) months. One patient had an axillary relapse 14 months after the initial diagnosis of breast cancer. She died after 2 years from metastatic disease. There were no other local axillary recurrences. There was a 94 per cent response rate to the questionnaire. Twelve patients developed mild disabilities, of whom two said that they had to change their hobbies, sports or daily activities owing to the sentinel node procedure. No patient developed lymphoedema or needed physiotherapy after the operation. CONCLUSION: When strict criteria for the sentinel node biopsy procedure are used, the sentinel node biopsy without further axillary dissection after a negative histological investigation is a safe procedure. It may therefore be considered to be the standard of care for the treatment of patients with breast cancer

Diagnosis, treatment and prognosis of internal mammary lymph node recurrence in breast cancer patients

Recurrences in the internal mammary lymph nodes (IMLN) are very rare, despite the fact that these nodes remain untreated in most patients. The aim of this study was to assess the chance for IMLN recurrence in a large patient series and to get insight into diagnostics, treatment and prognosis of this type of recurrence. Follow-up of nearly 6000 breast cancer patients resulted in the tracing of only six patients with IMLN recurrence. IMLN recurrence was defined as breast cancer recurrence in an internal mammary lymph node without a distant metastasis before the recurrence and confirmed by cytology and/or CT-scan. The time interval between diagnosis of the primary tumor and the recurrence varied between 5 months and 8 years and 6 months. One patient showed no symptoms, the other five all had a swelling and one of them also had pain. The size of the parasternal swelling varied from 30 to 90 mm; in one patient the size was unknown. Treatment resulted in a complete remission in four patients. In five of the six patients distant metastases occurred. The time interval between IMLN recurrence and the diagnosis of distant metastasis varied between 0 and 37 months. One patient was still free of distant metastasis in the time of this study. This large population-based study confirms the almost negligible risk of clinically apparent IMLN recurrence. Considering the high percentage of positive lymph nodes in studies evaluating sentinel node biopsy of the internal mammary chain, it becomes clear that just a fraction of these becomes clinically apparent as a recurrence. In almost all patients with IMLN it is a forerunner of metastatic disease

Long-term follow-up of axillary recurrences after negative sentinel lymph node biopsy: effect on prognosis and survival.

Contains fulltext : 118739pub.pdf (publisher's version ) (Closed access) Contains fulltext : 118739pos.pdf (postprint version ) (Open Access)As axillary recurrence (AR) after a negative sentinel lymph node biopsy (SLNB) is rare, the prognosis of these patients is unknown. Since treatment paradigms for patients with breast cancer are shifting toward less axillary surgery, the number of ARs might increase. In this study, we evaluated primary and salvage treatment as well as long-term survival of patients diagnosed with an AR. A retrospective analysis of the cancer registry of 16 breast cancer units in the Netherlands was used to identify patients who developed an AR after a negative SLNB performed between 2002 and 2004. Using local hospital records we recorded primary patient-, tumor-, and treatment-characteristics, as well as salvage treatment. We identified 54 patients with an AR, median 30 months (range 3-79) after SLNB. Eighteen patients (33 %) were initially treated with breast conserving therapy, 15 of whom received external beam radiation therapy (EBRT). Thirty-three patients (61 %) did not receive adjuvant systemic treatment. In 45 of the 54 (83 %) patients, a salvage axillary lymph node dissection was performed showing a median of three positive nodes (range 1-24). Nine patients (17 %) were not treated surgically: three were treated with salvage EBRT and six with salvage systemic therapy only. At time of detection of the AR, a total of 7 patients (13 %) had proven distant metastases. After a median follow-up of 47 months (range 3-118), the 5-year "post-recurrence" distant metastasis free survival was 50 % and overall survival was 58 %. Significant negative predictors of survival were negative estrogen receptor (ER) status and receiving adjuvant chemotherapy at initial treatment. AR following a negative SLNB is associated with a 58 % 5-year OS. Prognostic factors are ER- primary tumor and receiving adjuvant chemotherapy as a part of initial treatment, reflecting an aggressive phenotype. Adequate regional and systemic salvage therapy constitute a chance for long-term survival after AR.01 juli 201

Survival after negative sentinel lymph node biopsy in breast cancer at least equivalent to after negative extensive axillary dissection

Aim: Sentinel lymph node biopsy (SLNB) without completion axillary lymph node dissection (ALND) is replacing ALND as the axillary staging procedure of choice in breast cancer patients with a clinically negative axilla even though it is unclear whether this influences patient survival. Our aim was to compare the survival of breast cancer patients with a negative SLNB without completion ALND to that of extensive ALND-negative patients. Methods: Eindhoven Cancer Registry data on breast cancer patients diagnosed between 1989 and 2002 with follow-up to I January 2005 was used. Survival was compared between 880 SLNB-negative women (median follow-up 3.6 years) without completion ALND and 1681 ALND-negative women (median follow-up 7.7 years) with at least 10 axillary nodes removed. Conclusions were made after correcting for age. turnout size. tumour location, tumour histology, tumour grade, mitotic activity index (MAI), hormone receptor status, and local and systemic treatment in uni- and multivariate analyses. Results: Crude 5-year survival rates were 85% for ALND-negative and 89% for SLNB-negative breast cancer patients (p = 0.026). After correction for potential confounders in a multivariate Cox regression analyses, the hazard ratio for overall mortality of ALND-negative compared to SLNB-negative patients without completion ALND was 1.23 (95% confidence interval: 0.93-1.64). Conclusion: Survival after a SLNB without completion ALND is at least equivalent to after an extensive ALND in node-negative breast cancer patients. This means that the SLNB only can safely replace ALND as the procedure of choice for axillary staging in breast cancer patients with a clinically negative axilla

The significance of one positive axillary node.

Item does not contain fulltextAIMS: The aim of this study was to identify a subgroup of patients with breast cancer that can safely avoid axillary dissection. METHODS: Using data collected by the Eindhoven Cancer Registry, we compared the clinico-pathological features of 489 patients with only one positive lymph node to those of 817 patients with more than one positive lymph node in the axilla. All patients underwent complete axillary dissection, not preceded by a sentinel node biopsy. RESULTS: Tumour size greater than 1cm, harvesting more than 15 axillary lymph nodes at histopathological examination, metastasis size larger than 2mm, extranodal extension, and nodal involvement of the axillary apex are independently associated with the occurrence of more than one metastatic axillary lymph node. CONCLUSION: No subgroup could be identified in which axillary dissection can always be omitted. However, tumour size<1cm, finding a micrometastasis rather than a macrometastasis, and especially not finding extranodal extension were independently associated with finding only one positive axillary lymph node

The prognostic significance of axillary lymph-node micrometastases in breast cancer patients.

Contains fulltext : 48528.pdf (publisher's version ) (Closed access)AIMS: We analysed the results of regional community practice to determine the prognosis of axillary lymph-node micrometastases in women with breast cancer. METHODS: Patient data were retrieved from the population-based Eindhoven Cancer Registry in The Netherlands. Between 1975 and 1997, 10,111 patients were diagnosed as having invasive breast cancer. We compared three subgroups: patients without axillary involvement (the pN0 group), patients with axillary micrometastasis ( 2 mm, the pN1 group). Follow-up was completed until April 2002. RESULTS: The relative risk (RR) of dying comparing the pN1a group and the pN1 group to the pN0 group was 1.32 and 1.34, respectively. Excluding the adjuvantly treated patients, the RR of dying was 1.51 and 1.91, respectively for the pN1a group and the pN1 group vs. the pN0 group. CONCLUSION: This outcome data of nearly 25 years of community practice show that breast cancer patients with axillary lymph node micrometastasis have a significantly worse survival rate than those without independent of age or tumour size. Adjuvant systemic therapy should be contemplated when treating these patients

Impact of early, late, and no ST-segment resolution measured by continuous ST Holter monitoring on left ventricular ejection fraction and infarct size as determined by cardiovascular magnetic resonance imaging

Background: The goal of this study is to determine the predictive value of ST-segment resolution (STR) early after percutaneous coronary intervention (PCI), late STR, and no STR for left ventricular ejection fraction (LVEF) and infarct size (IS) by cardiovascular magnetic resonance (CMR) at follow-up in patients with ST-segment elevation myocardial infarction. Methods: The analysis included 199 patients who were enrolled in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation trial and in whom both continuous ST Holter and CMR at follow-up were available. Patients were stratified into 3 groups: (1) early complete (≥70%) STR measured immediately after last contrast injection (n = 113); (2) late complete STR (n = 52), defined as complete STR from 30 to 240 minutes after PCI; and (3) no complete STR after 240 minutes (n = 34). Results: Patients with early STR had more preserved LVEF and smaller IS compared to patients with late STR or no STR (LVEF: early STR, 54% ± 8%; late STR, 46% ± 13%; no STR, 43% ± 11%; and IS: 3.9 ± 3.3 g/m2; 8.0 ± 6.9 g/m2; 12.0 ± 6.0 g/m2; respectively; all P < .0001). Early STR was independently predictive for LVEF (β = 8.5; P = .0005) and IS (β = -7.0; P < .0001). Late STR was not predictive for LVEF (β = 1.6; P = .51) but predictive for IS (β = -3.5; P = .003). Conclusions: Patients with early complete STR after primary PCI have better preserved LVEF and smaller IS. Patients with late complete STR do not have better preserved LVEF but do have smaller IS. ST-segment resolution is a strong, independent predictor of LVEF and IS as assessed by CMR

Pressure-controlled intermittent coronary sinus occlusion (PICSO) in acute ST-segment elevation myocardial infarction: Results of the Prepare RAMSES safety and feasibility study

Aims: Pressure-controlled intermittent coronary sinus occlusion (PICSO) may improve myocardial perfusion after pPCI. We evaluated the safety and feasibility of PICSO after pPCI for STEMI, and explored its effects on infarct size and myocardial function. Methods and results: Thirty patients were enrolled following successful pPCI of a left anterior descending coronary artery culprit lesion for anterior STEMI, in whom PICSO for 90 minutes was attempted. Infarct size and myocardial function were assessed by cardiovascular magnetic resonance (CMR) at two to five days and four months post pPCI. An independent core laboratory selected matched historical control patients with CMR data for comparison. PICSO was initiated in 19 patients (63%), and could be maintained for 90 (±2) minutes in 12 patients (40%). Major adverse safety events occurred in one patient (3%). Comparing all PICSO-treated patients to matched controls demonstrated no significant differences in infarct size or myocardial recovery. However, infarct size reduction from two to five days to four months was greater for patients successfully treated with PICSO compared with matched controls (41.6±8.2% vs. 27.7±9.9%, respectively; p=0.04). Conclusions: PICSO is safe in the setting of STEMI, although feasibility was limited. Administration of sufficient PICSO therapy may be associated with enhanced myocardial recovery during follow-up, warranting further evaluation of this novel therapy