Bleznak, Aaron D, MD, FACS

Bleznak, Jennifer

Galley, Aileen, MSW

Gutch, Barbara, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineComparative Prognostic Significance of SentinelLymph Node Biopsy and AxillaryLymphadenectomy in Carcinoma of the BreastAaron D. Bleznak MD, FACSLehigh Valley Health NetworkJennifer BleznakMuhlenberg CollegeBarbara Gutch RNMt. Nittany Medical CenterAileen Galley MSWMt. Nittany Medical CenterFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtBleznak, A. D., Bleznak, J., Gutch, B., & Galley, A. (2011). Comparative Prognostic Significance of Sentinel Lymph Node Biopsy andAxillary Lymphadenectomy in Carcinoma of the Breast. LVHN Scholarly Works. Retrieved from https://scholarlyworks.lvhn.org/medicine/13COMPARATIVE PROGNOSTIC SIGNIFICANCE OF SENTINEL LYMPH NODE BIOPSY AND AXILLARY LYMPHADENECTOMY IN CARCINOMA OF THE BREASTAaron D. Bleznak, MD, FACS1, Jennifer Bleznak2, Barbara Gutch, RN3, Aileen Galley, MSW31Section of Surgical Oncology, Lehigh Valley Hospital, Allentown, PA; 2Muhlenberg College, Allentown, PA; 3Mt. Nittany Medical CenterPurpose:It has been hypothesized that the enhanced pathologic assessment and immunohistochemical staging performed for nodes identified by lymphatic mapping/sentinel lymph node biopsy will identify patients with small metastases, resulting in stage migration and improved outcomes for pN0(i-) patients as compared to those who are pN0 by axillary lymphadenectomy.  This study compares the prognostic accuracies of axillary lymphadenectomy (ALND) and SLNB in patients with carcinoma of the breast, operated on by a single breast surgeon during the period 1991-2004.Conclusions:This data set demonstrates equivalent prognostic ability for sentinel node biopsy and axillary lymphadenectomy as assessed by disease-free survival at a median follow-up of almost six years.  These two cohorts were statistically similar in age, stage of disease, grade of disease, and use of adjuvant systemic therapy.  Significant differences exist in the frequency of breast conserving surgery and radiation therapy, perhaps reflecting more frequent and sensitive screening mammography in the cohort operating upon from 1997-2004.    Methods:An Institutional Review Board-approved retrospective analysis of a prospectively maintained database of breast cancer patients identified all node negative women operated upon from 1991-2004.  This population included 135 women who underwent ALND from 1991-1996 and 238 patients assessed by SLNB from 1997-2004.  The demographics of these cohorts were compared using Chi-Square analyses (MS Excel). Disease free status was calculated for both groups and compared.Results:The ALND and SLNB cohorts were statistically similar (Table 1). Although there were no statistically significant differences in the demographics, women from the ALND cohort had a slight preponderance of T2 cancers.  The SLNB patients were more likely to have breast preservation (87% versus 64%, p < 0.01) and consequently were also more often treated with adjuvant radiation therapy (85% versus 61%, p = 0.03). Adjuvant chemotherapy (21% v. 16%) and endocrine therapy (49% v. 48%) were employed equally in these two cohorts.  In our study, 89.6% of the ALND cohort was disease free at a median follow-up of 130 months while 95.8% of the SLNB cohort was disease free at a median follow-up of 71 month.  At a comparable median follow-up of 71 months, 92.2% of the ALND cohort was free of disease (p=0.73).Table 1. Patient Demographics Axillary Lymph NodeDissectionSentinel Lymph NodeBiopsy p valueN 135 239  Age 61.3 60.5 NS% ER Positive 108/130 (83%) 187/225 (83%) 0.16Stage     0 2 (1%) 13 (5%) 0.07     1 108 (80%) 204 (85%) 0.57     2 25 (19%) 22 (9%) 0.03Grade      Well 37 (27%) 102 (43%) 0.05     Moderate 53 (39%) 71 (30%) 0.02     Poor 31 (23%) 54 (23%) 0.41     N/D 14 (10%) 12 (5%)Tx     BCS 86 (64%) 208 (87%) <0.01     MAST 49 (36%) 31 (13%) <0.01     CT 28/135 (21%) 39/239 (16%) 0.33     HT 66/134 (49%) 114/239 (48%) 0.64     RT 82/135 (61%) 202/239 (85%) 0.03    Figure 1. Disease Free Survival by Nodal Procedure1ALNDSLNB0.50.550.60.650.70.750.80.850.90.9512 3 4 5 6 7 8 9 10 11 12 13YearsDiseaseFree

Comparative Prognostic Significance of Sentinel Lymph Node Biopsy and Axillary Lymphadenectomy in Carcinoma of the Breast

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1012&context=medicine

Comparative Prognostic Significance of Sentinel Lymph Node Biopsy and Axillary Lymphadenectomy in Carcinoma of the Breast

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