Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and safety of surgical interventions for the management of groin pain as a consequence of previous inguinal hernia repair in adults

Risk of Regional Recurrence After Negative Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence

Repeat sentinel lymph node biopsy (rSLNB) has increasingly been used in patients with ipsilateral breast tumor recurrence (IBTR). The safety in terms of regional disease control after this procedure remains unclear. This study evaluates occurrence of regional recurrence as first event in patients with IBTR and negative rSLNB, treated without additional lymph node dissection. Data were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 201 patients, tumor-negative rSLNB was obtained without performing additional lymph node dissections. 99mtechnetium) used during rSLNB were associated with developing regional recurrence as first event after negative rSLNB (P < 0.05). The risk of developing regional recurrence after negative rSLNB is low. The low relapse rate supports the safety of rSLNB as primary nodal staging tool in IBTR. The time has come for clinical guidelines to adopt rSLNB as axillary staging tool in patients with IBT

Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study

International audienceSentinel node biopsy (SNB) for axillary staging in breast cancer allows the application of more extensive pathologic examination techniques. Micrometastases are being detected more often, however, coinciding with stage migration. Besides assessing the prognostic relevance of micrometastases and the need for administering adjuvant systemic and regional therapies, there still seems to be room for improvement. In a population-based analysis, we compared survival of patients with sentinel node micrometastases with those with node-negative and node-positive disease in the era after introduction of SNB. Data from the population-based Eindhoven Cancer Registry were used on all ( = 6803) women who underwent SNB for invasive breast cancer in the Southeast Region of The Netherlands in the period 1996-2006. In 451 patients (6.6%) a sentinel node micrometastasis (pN1mi) was detected and in 126 patients (1.9%) isolated tumor cells (pN0(i+)). Micrometastases or isolated tumor cells in the SNB did not convey any significant survival difference compared with node-negative disease. After adjustment for age, pT, and grade, still no survival difference emerged pN1mi: [HR 0.9 (95% CI, 0.6-1.3)] and pN0(i+): [HR 0.4 (95% CI, 0.14-1.3)] and neither was the case after additional adjustment for adjuvant systemic therapy. Our practice-based study showed that the presence of sentinel node micrometastases in breast cancer patients has hardly any impact on breast cancer overall survival during the first years after diagnosis

Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients

The purpose of this study was to evaluate the occurrence of lymphatic drainage to non-axillary sentinel nodes and to determine the implications of this phenomenon. A total of 549 breast cancer patients underwent lymphoscintigraphy after intratumoural injection of 99mTc-nanocolloid. The sentinel node was intraoperatively identified with the aid of intratumoural administered patent blue dye and a gamma-ray detection probe. Histopathological examination of sentinel nodes included step-sectioning at six levels and immunohistochemical staining. A sentinel node outside level I or II of the axilla was found in 149 patients (27%): internal mammary sentinel nodes in 86 patients, other non-axillary sentinel nodes in 44 and both internal mammary and other non-axillary sentinel nodes in nineteen patients. The intra-operative identification rate was 80%. Internal mammary metastases were found in seventeen patients and metastases in other non-axillary sentinel nodes in ten patients. Staging improved in 13% of patients with non-axillary sentinel lymph nodes and their treatment strategy was changed in 17%. A small proportion of clinically node negative breast cancer patients can be staged more precisely by biopsy of sentinel nodes outside level I and II of the axilla, resulting in additional decision criteria for postoperative regional or systemic therapy

Clinical aspects of sentinel node biopsy

Sentinel lymph node (SLN) biopsy requires validation by a backup axillary dissection in a defined series of cases before becoming standard practice, to establish individual and institutional success rates and the frequency of false negative results. At least 90% success in finding the SLN with no more than 5-10% false negative results is a reasonable goal for surgeons and institutions learning the technique. A combination of isotope and dye to map the SLN is probably superior to either method used alone, yet a wide variety of technical variations in the procedure have produced a striking similarity of results. Most breast cancer patients are suitable for SLN biopsy, and the large majority reported to date has had clinical stage T1-2N0 invasive breast cancers. SLN biopsy will play a growing role in patients having prophylactic mastectomy, and in those with 'high-risk' duct carcinoma in situ, microinvasive cancers, T3 disease, and neoadjuvant chemotherapy. SLN biopsy for the first time makes enhanced pathologic analysis of lymph nodes logistically feasible, at once allowing greater staging accuracy and less morbidity than standard methods. Retrospective data suggest that micrometastases identified in this way are prognostically significant, and prospective clinical trials now accruing promise a definitive answer to this issue

Abstract P2-01-03: What to do with non-visualized sentinel nodes; to dissect or not to dissect the axilla?

Abstract Background Both in the literature and in international guidelines evidence is scarce on clinicopathological characteristics and axillary treatment recommendations in patients with a non-visualized sentinel node (nvSN) during the sentinel lymph node (SLN) procedure. Therefore, this study aims to evaluate the prevalence of nvSN in a Dutch population of breast cancer patients and to compare their characteristics and prognosis with patients in whom the SLN could be visualized. Moreover, we have distributed a questionnaire among certified oncological surgeons in the Netherlands in order to determine their routine regarding the axillary treatment after a nvSN. Methods A retrospective population based study was performed including patients diagnosed with invasive breast cancer in the Netherlands between January 2000 and December 2013. Patients were included if they had no clinically palpable lymphadenopathy (cN0) or clinically apparent metastases (cM0). Patients receiving neo-adjuvant systemic treatment, patients with palpable axillary nodes and patients who did not undergo a SLN procedure were excluded. Also, a questionnaire containing 10 questions regarding clinical routine during the sentinel node procedure and axillary treatment of nvSN patients was distributed among 150 oncological (breast) surgeons. Results Of the 101,289 patients who fulfilled the inclusion criteria, 2545 (2.5%) had a nvSN. Univariate and multivariate analyses show that patients with a nvSN were older (p&amp;lt;0.001), were more often diagnosed in the years 2000-2005 (p&amp;lt;0.001), had a larger tumor (p=0.003) with more often a mastectomy (p=0.02) and were more likely to have ≥3 positive lymph nodes (p&amp;lt;0.001) compared to patients in whom the SLN could be visualized. However, adjusted survival analyses showed a borderline not-significant survival difference between these groups (HR=1.23, 95%CI=0.99-1.28). Of the 2545 patients with a nvSN, 2127 (84%) patients underwent an axillary lymph node dissection (ALND). Multivariate analyses show that patients receiving an ALND were more often diagnosed in the years 2000-2005, had a larger tumor and more often received adjuvant systemic therapy with both hormonal and chemotherapy. Adjusted survival analyses showed no statistically significant association between ALND and survival (HR=0.89, 95%CI=0.92-1.27). The questionnaire was completed by 122 (24%) oncological (breast) surgeons. It showed that 39% of the respondents estimated the prevalence of a nvSN to be 1-2%. Most surgeons are currently more reserved to perform an ALND than before the Z0011 trial, depending on various clinicopathological characteristics; 23 respondents answered to opt for an alternative axillary treatment option. Conclusion NvSN patients had worse disease characteristics compared to patients in whom the sentinel node could be visualized, though an ALND was not associated with a better survival. The results of the questionnaire show that surgeons are more reluctant to perform an ALND in case of a nvSN, especially after publication of the Z0011 trial, and that they would like the guideline to be revised and clarified regarding the axillary treatment in case of a nvSN. Citation Format: Verheuvel NC, Voogd AC, Tjan-Heijnen VCG, Roumen RMH. What to do with non-visualized sentinel nodes; to dissect or not to dissect the axilla? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-03.</jats:p