Sentinel node staging for breast cancer: Intraoperative molecular pathology overcomes conventional histologic sampling errors

BACKGROUND: When sentinel node dissection reveals breast cancer metastasis, completion axillary lymph node dissection is ideally performed during the same operation. Intraoperative histologic techniques have low and variable sensitivity. A new intraoperative molecular assay (GeneSearch BLN Assay; Veridex, LLC, Warren, NJ) was evaluated to determine its efficiency in identifying significant sentinel lymph node metastases (\u3e.2 mm). METHODS: Positive or negative BLN Assay results generated from fresh 2-mm node slabs were compared with results from conventional histologic evaluation of adjacent fixed tissue slabs. RESULTS: In a prospective study of 416 patients at 11 clinical sites, the assay detected 98% of metastases \u3e2 mm and 88% of metastasis greater \u3e.2 mm, results superior to frozen section. Micrometastases were less frequently detected (57%) and assay positive results in nodes found negative by histology were rare (4%). CONCLUSIONS: The BLN Assay is properly calibrated for use as a stand alone intraoperative molecular test

Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial

The results of the American College of Surgeons Oncology Group Z0011 (ACOSOG Z0011) trial were first reported in 2005 with a median follow-up of 6.3 years. Longer follow-up was necessary because the majority of the patients had estrogen receptor–positive tumors that may recur later in the disease course (the ACOSOG is now part of the Alliance for Clinical Trials in Oncology)

Preventing Breast Cancer-Related Lymphedema in High-Risk Patients: The Impact of a Structured Surveillance Protocol Using Bioimpedance Spectroscopy

PurposeWe evaluated the impact of structured surveillance using bioimpedance spectroscopy (BIS) to reduce the rate of chronic breast cancer-related lymphedema (BCRL) in high-risk patients undergoing axillary lymph node dissection (ALND).MethodsFrom April 2010 through November 2016, 93 patients who underwent ALND were prospectively monitored with BIS using L-Dex. Intervention for an L-Dex increase of >10 consisted of applying an over the counter (OTC) sleeve followed by re-evaluation after 4 weeks. The utilization of complex decongestive physiotherapy (CDP) represented a surrogate for chronic BCRL.ResultsMedian follow-up was 24 months. 55% of patients received taxane-based chemotherapy, 24% received some form of axillary irradiation (includes additional fields or high tangents) and 66% had an elevated body mass index (BMI) with the median number of nodes removed being 19. Overall, 75% of these patients had at least one additional high-risk feature (taxane chemotherapy, axillary radiation, elevated BMI), 48% had at least two, and 6% had all. Thirty-three patients (35.4%) developed an elevated L-Dex score with only 10 (10.8%) requiring CDP (30.3% of those undergoing treatment with sleeve). At last follow-up, only three patients (3%) had unresolved BCRL.ConclusionThe results of this analysis support previous data regarding prospective BCRL surveillance and early intervention using BIS. With this approach, only 3% of patients have chronic BCRL