Abstract
The aim of this study was to use the Association of Breast Surgery at the British Association of Surgical Oncology audit data to model the possible consequences of the rollout of sentinel lymph node biopsy (SLNB) across the NHS Breast Screening Programme. The lymph node status, invasive size, grade and number of operations were examined for 26,431 screen-detected invasive cancers diagnosed in women who were invited for screening between 1 April 2001 and 31 March 2004. Seventy-five per cent of screen-detected invasive breast cancer had a negative nodal status. The average number of nodes removed in these cases was 10. If these cases had had their axilla assessed using SLNB, then the majority of women diagnosed with screen-detected breast cancer would have had a minimally invasive axillary procedure. Assuming that the protocol utilised during the ALMANAC study was continued, the 25% of cases with positive lymph nodes would require a second operation to clear the axilla. This would represent a 20% increase in the number of cases requiring a second therapeutic operation. In addition, as over 80% of these cases had less than five positive nodes found, a full axillary clearance may be overtreatment. Analysis of the variation of lymph node positivity with size and grade demonstrates that these factors could be used to determine which women with a positive sentinel lymph node require a full axillary clearance and which women could be appropriately managed with a level 1 clearance, thus reducing the possible complications of lympho-edema.
Highlights
Axillary lymph node dissection has been standard practice for staging invasive breast cancer
Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography
Full field digital mammography (FFDM) had a higher detection rate for ductal carcinoma in situ (DCIS) but no difference was observed for invasive tumours
Summary
Axillary lymph node dissection has been standard practice for staging invasive breast cancer. Aim To assess the feasibility of surgeons performing breast US in symptomatic breast clinics either as an adjunct to triple assessment or on their own for diagnostic and therapeutic purposes. The performance of individual units is monitored to ensure all women have access to an excellent service Aim This project aims to demonstrate how the Liverpool Breast Unit addressed failure to meet the national quality standard for the benign. Method A retrospective review of the records of patients who had undergone benign biopsy (2001–2002) was conducted to establish reasons for surgical referral and suggest corrective measures to enable the unit to meet the standard in the future. Columnar cell change (CCC) is diagnosed on core biopsies performed for indeterminate microcalcification. Method Mammograms of 33 cases with established CCC on core biopsy were reviewed and the radiological features, follow-up imaging and surgical excision histology (if performed) were collated. The results were completed when all units were undergoing assimilation onto the new banding procedures
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