The omission of axillary lymph node dissection by Sentinel Node biopsy

Abstract

Sentinel Node Biopsy, SNB has become very popular not only among medical experts but also among breast cancer patients and is now the hottest maneuver in minimizing breast cancer surgery in Japan. In this sense, this presidential symposium Possibility of omitting ALND by SNBwas presented as the first event at the 14th Annual Meeting of the Japanese Breast Cancer Society. The symposium was consisted of 6 speakers, including one speaker from abroad, Korea. The first presentation was a preliminary report on the possibility of SNB in cases of Primary Systemic Treatment, PST by Dr. Kinoshita of the Central Hospital of the National Cancer Center. He spoke about the results of 104 PST cases who received SNB and radical surgery. The results approached those obtained with usual SNB with backup dissection. The identification rate was 93.3% and the false negative rate was 10%. Based on this result, they started omitting ALND in cases of SNB ca(-) after PST from October, 2005. The second presentation was also a success report of SNB after PST by Dr. S. Y. Lee of the National Cancer Center, Goyand, Korea. Although the identification rate was low at 77.6%, the false negative rate was only 5.0% compared to 7.0% in cases without PST. The third speaker was Dr. the Takei, Saitama Prefecture Cancer Center who spoke about the outcome of 1,704 cases of SNB in mean observation period 36 m (8-82 m). General metastasis of SNB N(-) and ALND(-) cases was 5.0%, whereas SNB N(-) and ALND(+) cases was 6.9%.They considered SNB to be safe and useful. The fourth presentation was by Dr. Motomura, the Osaka Medical Center for Cancer and Cardiovascular Disease. He spoke about their feasibility study of combined dye (ICG) and RI (Tc Tin colloid)method. The detection rate was 93%, and the FNR was 3.5%. After that, observational study started in 2000, ALND was omitted in 432 cases. The results were satisfactory and the physicians concluded that SNB was safe and useful. The fifth presentation was by Dr. Imoto of the East Hospital National Cancer Center. He talked about SNB guidelines from the study group of Sentinel Node Navigation Surgery, SNNS in Japan. They are making a revised version now. It would be available free of charge. The last presentation was by Dr. Sato of the National Defense Medical College, who introduced the largest projects in the world presently under analysis. These have already been performed and we are waiting for their final results now. These projects are NSABP B-32, AOSOGZ0010, Z0011, and EORTC-10981 ARAMOS SNB. Although its true efficacy is still uncertain, has spread all over the world and now the main topic is not an omission of ALND after SNB ca(-) but an omission of ALND after even SNB ca(+). SNB may not only predict axillary status but also predict the need for chemotherapy and endocrine therapy.