Axillary Lymphadenectomy Research Articles

Endoscopic axillary lymphadenectomy in 10 steps

Endoscopic axillary lymphadenectomy in 10 steps

Methods of Controlling Postoperative Complications after Lymphadenectomy in Patients with Breast Cancer

Introduction. Reducing the aggressiveness of surgical tactics is currently considered a promising trend in medicine that is widely supported due to its better safety profile. However, a large percentage of patients need more intervention. In the treatment of breast cancer, the main difficulties in postoperative management are associated with lymphatic surgery. Aim. To perform a comparative analysis of techniques for intraoperative control of lymphorrhea in patients during lymph node dissection for breast cancer in Yaroslavl Regional Oncologic Hospital. Materials and methods. Case histories of 660 patients after axillary subclavian subscapular lymphadenectomy were analyzed. In the postoperative period, patients revealed prolonged lymphorrhea. Magnifying techniques (binocular lenses, microscope) were used during the interventions to detect and isolate lymphatic vessels in 108 patients. A double coagulation technique was used to ligate the lymphatic vessels. Sufficient coagulation surface was achieved by forming suture lines of an angle greater than 90°. When performing a mastectomy, the technique was supplemented by circular bandaging of the chest. Results and discussion. Analysis of case histories showed that lymphadenectomy proved to be the main significant factor influencing lymphorrhea. Sparing techniques reduced the risk of postmastectomy syndrome. Comparing the study group with the control group revealed a statistically significant reduction in the severity of lymphorrhea without an increase in the risk of other complications. Conclusion. The combination of these techniques demonstrated statistically significant advantages in controlling postoperative complications. The techniques are easy to perform, therefore, they can be introduced into practice with minimal costs. The economic benefits are associated with the absence of additional costs for surgery, as well as with a reduction in the duration of hospital stay for patients. All this significantly increases patient satisfaction with the treatment performed.

Breast and axillary marking in the neoadjuvant setting: survey results from experts of the Brazilian society of mastology.

The precise location of the tumor site is essential for the success of surgical treatment. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor and node localization. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached. This was an online survey conducted between June and December 2022. All 1,742 active mastologists affiliated to the SBM were invited anonymously. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program version 26.0. Post hoc analysis was performed when appropriate and the significance level was set at p < 0.05. Polychoric regression analyses were conducted using `VGAM` package. In total, 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%). Most professionals were board-certified (84,8%). The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree). However, there was consensus that the clinical and imaging evaluation was insufficient for staging the axilla as N1 (71.6%). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. When <3 lymph nodes were retrieved 41.0% of mastologists performed axillary lymphadenectomy. Among the 28 questions, consensus was reached on only 11 (39.3%). The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking.

Seroma incidence and risk factors in women undergoing mastectomies as surgical breast cancer treatment.

Seroma is the most common early complication following surgical breast cancer treatment. Its development is associated with pain, scar complications, adjuvant therapy delays, the need for outpatient visits, and increased care costs. Assess seroma incidence and risk factors in women undergoing mastectomies. This study comprises a prospective cohort encompassing women aged 18 or over undergoing mastectomies as a breast cancer treatment. Patients underwent physiotherapy on the 1st, 7th, and 30th postoperative days for kinetic-functional, skin, and wound healing assessments and were attended to by nurses for surgical wound care, draining liquid on the 7th, 14th, and 21st postoperative days. Seroma was defined as the presence of local fluctuations requiring puncture, regardless of the punctured volume. A total of 249 women were evaluated, with a mean age of 57.5 (SD = 11.8). A total of 77.1% were classified as overweight or obese, 60.2% were hypertensive, 21.3% were diabetic, 66.7% underwent neoadjuvant chemotherapy and 62.7% underwent axillary lymphadenectomies. Seroma incidence was 71.1%, requiring, on average, two aspiration punctures until condition resolution. Overweight or obese women and those who underwent axillary lymphadenectomies exhibited 1.92- and 2.06-fold higher risk for seroma development (OR = 1.92; 95% CI 1.02-3.61; p = 0.042; and OR = 2.06; 95% CI 1.17-3.63; p = 0.012), respectively. Seroma incidence was very high. Being overweight or obese and undergoing axillary lymphadenectomy comprise independent seroma development risk factors. This study is part of a randomized clinical trial evaluating the effectiveness of applying compressive taping to prevent post-mastectomy seroma, which was approved by the Brazilian National Cancer Institute, Research Ethics Committee (2,774,824), and it is registered in the ClinicalTrials.gov (NCT04471142, on July 15, 2020).

A Case Report on Concurrent Respiratory Symptoms and Axillary Lymphadenectomy Possibly caused by Mycobacterium Triviale

A Case Report on Concurrent Respiratory Symptoms and Axillary Lymphadenectomy Possibly caused by Mycobacterium Triviale

Disección axilar dirigida tras tratamiento sistémico primario en cáncer de mama N1. Validación de la técnica y experiencia a los 4 años

ObjectivesTo assess the omission of systematic axillary lymphadenectomy (ALND) in patients with N1 breast cancer with axillary pathological response (APR) after primary systemic treatment (PST). Description and experience of the Technique: Target Axillary Dissection TAD. Identify which subtypes are associated with higher APR. Patients and methodsA descriptive, retrospective study of 90 patients with cT1-T3/N1/M0 stage breast carcinoma who received TSP at the Valencian Institute of Oncology (IVO), between January 2020 and December 2023; 63 received chemotherapy and/or anti-HER2 therapy and 27 received hormonal therapy. Biopsy and labeling of the suspicious lymph node (maximum 3) were performed. In the surgery, a harpoon was placed in the axillary lymph node and the sentinel lymph node (BSGC) technique was also performed with technetium-99m and methylene blue. ResultsAPR was achieved in 46/90 cases (51.2%), in 30/46 (65.2%) pCR, and in 16/46 ITC (isolated tumor cells) or micrometastases remained. Macrometastases were observed in 44/90 (48.8%) and therefore ALND or axillary Rt was performed. There have been no axillary or distant relapses. Detection of the marked node: 100%. RPA occurred in: Luminal A, 26%; Luminal B, 42%; HER2-positive, 86% and Triple Negative, 66%. ConclusionsIn the IVO, ADT is a feasible technique. More than 50% of the cohort had an APR avoiding ALND. The HER2-positive and triple negative subtypes have the highest response rate. It is an oncologically safe procedure; NOT less than ALND.

New Strategy for Breast Cancer Related Lymphedema Treatment by Endermology: ELOCS Phase II Randomized Controlled Trial

Background: This phase II trial sought to be the first of its kind to estimate the success rate of endermology in reducing breast cancer-related lymphedema. Patients and MethodsELOCS is a French, monocentric, randomized, open-label phase II trial. Patients were randomized to receive the following over a 5-day treatment period: standard intensive decongestant treatment (IDT) (bandages and manual lymphatic drainage MLD) (group 1); IDT including bandages, MLD, and Cellu M6 (group 2); and IDT including bandages and Cellu M6 (Group 3). The main endpoint was the success rate in each group, (reduction of at least 30% in the excess volume). We estimated that endermology treatment (groups 2 and 3) would be of interest successes occurred in at least 21 out of 31 patients. ResultsA total of 93 patients were included (31 patients in each of the 3 groups). The median age was 64.5 years (IQR: [56.4-71.3]). Patients were treated with mastectomy (n = 35), axillary lymphadenectomy (n = 80), radiotherapy (n = 91), and chemotherapy (n = 68). The mean relative reduction in excess volume was 38% in group 1, 33% in group 2, and 34% in group 3. Success rate was 58.1% in group 1 (18/31, P = ,0237), 51.6% (16/31, P = ,5) in group 2, and 64.5% (20/31, P = ,075) in group 3. In the LPG groups (2 and 3), 10/62 (16%) patients found LPG painful and 9/62 (15%) patients considered it to be unpleasant. ConclusionEven though the critical threshold of 21 successes was not met, this study was the first to validate a standardized and reproducible endermology protocol.

A Prospective Study of the Efficacy of Endofascial Axillary Dissection to Reduce Axillary Seroma Formation.

Introduction Seroma formation is a common complication following axillary dissection. The pathogenesis of seroma is poorly understood. Various chemical and mechanical methods have been tried to reduce seroma with varying results. In this study, we look at a novel method of axillary dissection to reduce seroma and its attendant morbidity. The objective of the study is to compare endofascial axillary lymphadenectomy with routine axillary lymphadenectomy regarding axillary drain output following breast conservation surgery. Methods We did a prospective interventional study of endofascial axillary dissection in patients undergoing breast conservation surgery. Comparison was done with historical controls who underwent breast conservation surgery with routine axillary lymphadenectomy before the study period. All patients were operated by the same surgeon. Results Breast conservation surgery with endofascial axillary dissection was performed in 36 patients and compared with 36 patients who underwent routine axillary dissection before the study period. The mean total axillary drain output in the endofascial and routine groups were 796.8 and 1,259.3 mL, respectively ( p = 0.001). The average day of drain removal in the endofascial and routine groups were 10.8 and 14.9 days, respectively ( p = 0.001). The nodal yield of the endofascial and routine groups were 15.3 and 16.4 nodes, respectively ( p = 0.449). The duration of surgery of the endofascial and routine groups were 89.3 and 85.1 minutes, respectively ( p = 0.366). Conclusion Endofascial axillary dissection significantly reduced the mean total axillary drain output and resulted in early drain removal compared with routine axillary dissection. There were no significant differences in the nodal yield, operative time, seroma aspirations, and wound complications between the endofascial and routine axillary dissection groups.

Is Axillary Lymphadenectomy Necessary in Triple Negative Breast Cancer Patients Treated with Subcutaneous Mastectomy with The Immediate Reconstruction?

Is Axillary Lymphadenectomy Necessary in Triple Negative Breast Cancer Patients Treated with Subcutaneous Mastectomy with The Immediate Reconstruction?

Reducing the incidence of problematic seroma formation and skin necrosis post-lymphadenectomy: Triple action of topical tranexamic acid, negative pressure wound therapy, and prolonged drainage

BackgroundAxillary and inguinal lymph node dissections are commonly associated with complications that often require additional interventions. MethodsPatients who underwent axillary or inguinal lymphadenectomy via standard procedures were compared to an intervention cohort of patients who underwent axillary or inguinal lymphadenectomy with the use of topical tranexamic acid (TXA) to the wound cavity, a PICO (Smith&Nephew UK) closed-incision negative pressure dressing, and discharged early with a drain in-situ. ResultsSeventy-six patients in the control group (mean age 65.8 years, mean BMI 28.4 kg/m2) underwent open lymphadenectomy without topical TXA and a simple dressing. Seventy-eight patients were included in the intervention group (mean age 67.1 years, mean BMI 28.5 kg/m2). Patients in the intervention group had an inpatient stay of mean 5.6 days fewer than those in the control group (CI 3.09–5.31; p < .0001), an estimated saving to the healthcare trust of £ 3046.40 (US$3723.61) per patient in “bed days.” They had longer drain duration (mean 15 days vs. 8.3 days); however, they had a statistically significant lower risk of seroma formation requiring drainage (6.4% vs. 21%; p = .009), and skin necrosis (0% vs. 6.6%; p = .027). They also had a lower risk of infection (17% vs. 29%), wound dehiscence (15% vs. 25%), and readmission (7.7% vs. 14%), although they were not statistically significant.Patients in the control group were more likely to receive antibiotics as inpatients (51% vs. 7.7%; p < .00001) and on discharge (24% vs. 5%; p < .0011) than those in the intervention group. ConclusionsTopical TXA, PICO dressing, and early discharge with a drain following lymphadenectomy results in a reduced rate of complications.

Abstract PO5-17-05: Recommendations of a panel of experts from the Brazilian Society of Mastology on breast and axilla clipping: when, how and for whom?

Abstract Background: The precise location of the tumor site is essential for obtaining free margins and success of surgical treatment, reducing the rates of reoperation and local recurrences. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor localization, due to the different patterns of locoregional response, limitations related to imaging methods, and the possibility of a pathological complete response (pCR). In addition, there are several divergent approaches regarding preoperative axillary evaluation, lymph node marking methods and approaches when facing cN1. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached. Methods: This is an online survey conducted between June and December 2022. All 1.742 active mastologists affiliated to SBM were anonymously invited to participate in the study. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed several relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program. Post hoc analysis was performed when appropriate and, in all analyses, the significance level of p &amp;lt; 0.05 was adopted. Results: A total of 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%), male (50.4%), and residents of state capitals (63.9%). Most professionals were board-certified (84,8%), 87.7% for more than five years. The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). If available, the US-visible clip is preferred (86.5%). With respect to the marking of the breast and axilla prior to NAC, 93.3% of the mastologists considered relevant issues related to the techniques and materials. There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree), however there was consensus that the clinical and imaging evaluation is insufficient for staging the axilla as N1 (71.6 %). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. There was also consensus on the indication of axillary lymphadenectomy (89%) after NAC when double marking with technetium and patent blue for SLNB is not available. In addition, 41.0% of mastologists perform axillary lymphadenectomy when less than three lymph nodes are found in the SLNB. Among the 28 questions, consensus was reached on only 11 (39.3%); with some consensus variations according to age group, sex, geographic location of residence, place of professional activity (public or private), and professional experience. Conclusion: The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking, indicating the need to establish continuing education programs on the subject. Citation Format: Henrique Couto, Augusto Hassan, Dalton Steinmacher, Eduardo Pessoa, Eduardo Millen, Felipe Zerwes, Francisco Pimentel Cavalcante, Giuliano Tosello, Gustavo Badan, José Francisco, Leonardo Soares, Lucas Budel, Luciano Chala, Raquel Fernandes, Ruffo Freitas-Junior, Vilmar Oliveira, Vinicius Budel, Andre Mattar. Recommendations of a panel of experts from the Brazilian Society of Mastology on breast and axilla clipping: when, how and for whom? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-17-05.

Abstract PO3-12-02: SAFETY AND TOLERANCE OF THE USE OF SHOCK WAVE THERAPY IN LYMPHEDEMA SECONDARY TO THE TREATMENT OF BREAST CANCER

Abstract Introduction: Lymphedema is a very common complication of breast cancer treatment. The first-line therapeutic method for lymphedema is Complex Physical Therapy. An option currently mentioned as an adjuvant and non-invasive treatment for lymphedema secondary to breast cancer is Shockwave Therapy. Objectives: To evaluate the safety and tolerance of shockwave therapy for the treatment of upper limb lymphedema secondary to breast cancer treatment. Methods: This is a quasi-experimental study carried out with 17 women who underwent breast surgery associated with axillary lymphadenectomy or Sentinel Lymph Node Biopsy and who had upper limb lymphedema secondary to the treatment of breast cancer. All were treated with complex physical therapy prior to the study. Four sessions of Shockwave Therapy were applied, 4000 shocks at 0.06 mJ/mm2, 1 time per week for 4 consecutive weeks. For that, the participants were evaluated through the application of questionnaires and physical examination and underwent shock wave therapy for the upper limb ipsilateral to the surgery. Results: After the intervention, none of the participants had skin lesions, blisters, desquamation or hyperthermia of the limbs, and 17.65% had skin redness. Most patients reported no change in their social life and that they felt safer in daily activities and very satisfied with the treatment. The patients showed improvement in upper limb functionality after the intervention versus baseline (p=0.02). No difference in limb volume and shoulder range of motion over time for all movements performed was found after the intervention and at the evaluated intervals. In addition, improvements were observed in some domains of the quality-of-life questionnaires. Conclusion: Shockwave Therapy proved to be safe and tolerable in patients with lymphedema, with improved functionality and no significant change in the volume of the affected limb. Keywords: Extracorporeal shock wave therapy; Lymphedema; Breast cancer. Citation Format: Patricia Lima Ventura, Cinira Haddad, Vanessa Sanvido, Afonso Nazário, Gil Facina, Amanda Estevao, Samantha Lopes de Almeida Rizzi. SAFETY AND TOLERANCE OF THE USE OF SHOCK WAVE THERAPY IN LYMPHEDEMA SECONDARY TO THE TREATMENT OF BREAST CANCER [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-02.

Surgical Treatment of Breast Lymphedema: A Distinct Pathology With Unique Challenges.

Supermicrosurgical advances such as lymphovenous bypass (LVB) have enabled effective physiologic treatment of lymphedema affecting the extremities. Reports of surgical treatment for breast lymphedema (BL) are sparse, consisting of case reports and almost exclusively LVB. We report our experience with BL, including a case of mastectomy and breast reconstruction with abdominal free flap and inguinal vascularized lymph node transfer (VLNT) for BL. We compare our series with the surgical literature to discern unique characteristics and treatment limitations inherent to this disease. A database was prospectively maintained from September 2020 to May 2023 including all patients diagnosed with BL who were referred to our institution. Breast lymphedema was diagnosed using clinical criteria, and relevant patient data were recorded. Patients interested in surgical management underwent indocyanine green lymphography to determine candidacy for LVB or other interventions. All patients, including those surgically managed, were treated with complex decongestive therapy. Nine patients with BL were included. Eight had undergone breast-conserving therapy for breast cancer with whole breast irradiation. One patient was treated for Hodgkin lymphoma with axillary lymphadenectomy and axillary radiation. Indocyanine green lymphography was performed in 6 patients, of which 4 patients had diffuse dermal backflow. Two patients had lymphatic targets suitable for LVB, including the patient without breast irradiation. Three patients were managed surgically. One patient without bypass targets underwent breast reduction with partial symptomatic relief, later followed by a mastectomy with abdominal free flap reconstruction and VLNT. Two patients with suitable bypass targets underwent LVB, with resolution of breast swelling and subjective symptoms. The diffuse lymphatic obliteration due to radiation field effect in BL results in a distinct pathophysiology compared with extremity lymphedema. Although published reports of surgical BL treatment almost exclusively describe LVB, other surgical options may be more frequently required. Ablative strategies such as mastectomy and regenerative techniques such as VLNT should be considered potential first-line treatment options for these patients.

Evaluation of the Possible Benefits of Breast Cancer Screening in Women Aged 40 to 49 Years in the Steel Valley Region, Brazil

Background: This study investigates the effectiveness of mammographic screening for women aged 40 to 49 in Brazil's Steel Valley Region. Despite a Ministry of Health recommendation to start screenings at 50, 25% of breast cancer cases occur in the 40-49 age group. Methods: The retrospective analysis, spanning 2008-2019 at Marcio Cunha Hospital, compared two groups: cancer diagnosed via screening mammography (277) and diagnostic mammography (229). Results: Results showed delayed diagnoses for non-screened women, with 4.16 times higher mortality rate. Screening facilitated earlier detection of less malignant cancers (85.9% vs. 43.7%). Women diagnosed through screening were more likely to preserve their breasts (28.9% vs. 55.5% for Radical Breast Surgery and 71.1% vs. 28.9% for Breast-Sparing Surgery), and fewer axillary lymphadenectomies were performed. All statistical tests performed returned a p-value lower than 0.05 showing high statistical significance. Conclusion: The findings support extending screening mammography access to all women over 40 in the Steel Valley region and underscore the need for broader-scale research in other areas. Recommendations include enhancing public awareness and establishing a breast cancer surveillance service.

The Impact of Neoadjuvant Chemotherapy on Axillary Surgical Management of Patients With Breast Cancer and Positive Axillary Lymph Nodes.

Sentinel lymph node biopsy (SLNB) is effective in patients with breast cancer (BC) and positive axillary lymph nodes undergoing neoadjuvant chemotherapy (NAC). However, the frequency with which axillary lymphadenectomy (ALND) can be avoided remains debated. This study aimed to identify patient populations that can benefit from this approach. The data of 195 consecutive patients with BC and positive axillary lymph nodes at diagnosis who underwent NAC were retrospectively analyzed. In all cases, the positivity of the lymph nodes was confirmed by cytological examination. Patients converted to ycN0 after NAC were considered eligible for SLNB. Indications for ALND were failed mapping, fewer than three SLNs recovered, and positive SLNs. Of 195 cN1 patients potentially eligible for SLNB, 71 (36.4%) remained clinically ycN+ after NAC and underwent elective ALND, while 124 (83.7%) converted to ycN0 after NAC and SLNB. The lymph node identification rate was 95.9% (119/124 patients) with three or more SLNs recovered in 83 cases (89.8%). One or two lymph nodes were recovered in 36 cases (30.2%). Nodal pathologic complete response (pCR) was found in 34/83 (40.9%) patients with three or more SLNs recovered. Considering all 195 patients initially included in the study, 55 patients (28.2%) achieved lymph node pCR after NAC. Nodal pCR varied based on hormone receptor and HER2 status, with rates ranging from 20.7% for ER+/HER2- patients to 95.3% for ER-/HER2+ patients (p<0.001). More than 80% of cN1 patients in our study were eligible for SLNB after NAC. ALND could be avoided in approximately 30% of cases, supporting the role of NAC in reducing the need for ALND among patients with lymph node metastases.

Sentinel lymph node biopsy before and after neoadjuvant chemotherapy in cN0 breast cancer patients: impact on axillary morbidity and survival—a propensity score cohort study

PurposeIn patients with clinically lymph node-negative (cN0) breast cancer, performing sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) has been preferentially embraced in comparison to before NACT. However, survival outcomes associated with both strategies remain understudied. We aimed to compare the axillary lymphadenectomy (ALND) rate, disease-free survival (DFS), and overall survival (OS), between two strategies.MethodsWe included 310 patients in a retrospective observational study. SNLB was performed before NACT from December 2006 to April 2014 (107 cases) and after NACT from May 2014 to May 2020 (203 patients). An inverse probability of treatment weighting (IPTW) method was applied to homogenize both groups. Hazard ratios (HR) and odd ratios (OR) are reported with 95% confidence intervals (95%CI).ResultsThe lymphadenectomy rate was 29.9% before NACT and 7.4% after NACT (p < 0.001), with an OR of 5.35 95%CI (2.7–10.4); p = .002. After 4 years of follow-up, SLNB after NACT was associated with lower risk for DFS, HR 0.42 95%CI (0.17–1.06); p = 0.066 and better OS, HR 0.21 CI 95% (0.07–0.67); p = 0.009 than SLNB before NACT. After multivariate analysis, independent adverse prognostic factors for OS included SLNB before NACT, HR 3.095 95%CI (2.323–4.123), clinical nonresponse to NACT, HR 1.702 95% CI (1.012–2.861), and small tumors (cT1) with high proliferation index, HR 1.889 95% (1.195–2.985).ConclusionPerforming SLNB before NACT results in more ALND and has no benefit for patient survival. These findings support discontinuing the practice of SLNB before NACT in patients with cN0 breast cancer.

Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in cN0 Breast Cancer: Impact of HER2-Positive Status on Survival.

High rates of negative sentinel lymph node biopsy (SLNB) in clinically node-negative (cN0) breast cancer (BC) after neoadjuvant chemotherapy (NAC) have been described. These results are associated with triple-negative (TNBC) and human epidermal growth factor receptor 2 (HER2+) subtypes achieving pathologic complete response (pCR). This study evaluates predictive variables and survival in order to assess the possible omission of SLNB after NAC. Prospective study of women with cN0 BC treated with NAC and subsequent surgery, between April 2010 and May 2021. SLNB technique included, performing axillary lymphadenectomy in the absence of detection or SLNB-positivity. Multivariable logistic regression was used for analysis of NAC-response and SLNB-results in molecular subtypes: HR-/HER2+, TNBC, HR+/HER2- and HR+/HER2+. Kaplan-Meyer and log-rank were used for survival analysis. A total of 179 patients (50.5±10.1 years) were included. Of these, 39.7% achieved pCR (ypT0/Tis). HR-negative subtypes had higher pCR rates (HR-/HER2+: 59.4%; TNBC: 53.4%), with no cases of SLNB-positive. With residual disease, HR-/HER2+ and TNBC showed low rates of SLNB-positivity (6.7% and 10.3%) versus HR+ (HR+/HER2+: 20%; HR+/HER2-: 44%; p<0.001). Multivariable analysis identified independent predictors of SLNB-negativity (p<0.0001) to be: HR- [odds ratio (OR)=0.15; 95% confidence interval (CI): 0.06-0.37; p = 0.0001], HER2+ (OR=0.34; 95% CI: 0.14-0.81; p = 0.015) and high-grade Nottingham (OR=0.42; 95% CI: 0.18-0.99; p = 0.048). Disease-free survival showed worse outcomes with SLNB-positivity (p<0.0001), HR+/HER2- (p = 0.0277), larger tumor size (p = 0.002) and residual disease after NAC (p<0.0001). Patient selection based on NAC response, molecular subtype, and survival outcomes is a priority for establishing individualized therapeutic strategies after NAC. Molecular subtypes with higher pCR rates and lower rates of SLNB-positivity could benefit from non-invasive strategies that include omission of SLNB.

Seroma control in axillary lymphadenectomy with Glubran 2® without drain. Multicenter, prospective, randomized, clinical trial. GALA-ND study (Glubran, Axillary Lymphadenectomy, Ambulatory, No Drain)

BackgroundSeroma after breast cancer surgery is a frequent entity; therefore, different products have been described in literature with the aim to reduce it. The most studied ones have been the sealants products, being tested with aspirative drains. Symptomatic seroma represents the 19% after axillary lymphadenectomy without drains. The aim of this study is to analyze the effect of a sealant in the seroma control after axillary lymphadenectomy without drains and identify the risk factors related to symptomatic seroma.MethodsThis is a prospective, multicenter, international, and randomized clinical trial. Patients undergoing conservative surgery and axillary lymphadenectomy for breast cancer will be randomized to control group (lymphadenectomy without sealant) or interventional group (lymphadenectomy with sealant Glubran 2®). In any of the study groups, drains are placed. Patients who received neoadjuvant treatment are included. Measurements of the study outcomes will take place at baseline; at 7, 14, and 30 days post-surgery; and at 6–12 months. The primary outcome is symptomatic seroma. Secondary outcomes are seroma volume, morbidity, quality of life, and lymphedema.DiscussionSeveral studies compare the use of sealant products in axillary lymphadenectomy but generally with drains. We would like to demonstrate that patients who underwent axillary lymphadenectomy could benefit from an axillary sealant without drains and reduce axillary discomfort while maintaining a good quality of life. Assessing the relationship between axillary volume, symptoms, and related risk factors can be of great help in the control of seroma in patients who received breast cancer surgery.Trial registrationClinicalTrials.gov, NCT05280353. Registration date 02 August 2022.

Diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer. Summary experience of several specialized centers

To study the diagnostic value of fluorescent lymphography for sentinel lymph node biopsy in breast cancer. The cohort study, conducted at 4 specilized centers between June 2019 and March 2024, included 333 patients with cT1-4 N0-1M0 breast cancer. 50 patients received neoadjuvant systemic therapy, 14 of them had single metastases, confirmed by cytological or histological methods, which clinically completely regressed after systemic treatment. Immediately before the operation, 1 ml (5mg) of indocyanine green was injected subareolarly or subcutaneously into the tumor projection. Fluorescence imaging was performed using various devices for ICG navigation in the open surgical field - MARS, IC-Flow, Stryker SPY-PHI, IC-GOR. In 78 patients after sentinel lymph node biopsy standard axillary lymphadenectomy was performed. Detection level was 99.1%. The average number of sentinel lymph nodes was 3.4. Metastatic lesions of sentinel lymph nodes were detected in 54 of 330 patients (16.4%). The average number of metastatic lymph nodes was 1.6; in 90.7% of cases metastases to 1-2 lymph nodes were registered. Intraoperative morphological examination revealed metastases only in 59% of cases. No systemic adverse events were recorded. The false-negative error rate in the group of patients who underwent axillary lymphadenectomy was 6.6%. The overall accuracy of fluorescent lymphography for sentinel lymph node biopsy in breast cancer was 94%. The SLNB technique using fluorescence lymphography is safe and highly accurate as a stand-alone method.

Fluorescence lymphography for sentinal lymph node biopsy in breast cancer

To study diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer. The study enrolled 25 patients with breast cancer T1-2N0-1M0 between March 2023 and July 2023. Eight ones underwent neoadjuvant chemotherapy. In 3 patients, morphologically verified metastases cN1 in axillary lymph nodes regressed after treatment. After sentinel lymph node biopsy, all patients underwent standard axillary lymphadenectomy. Subareolar injection of indocyanine green 1 ml (5 mg/ml) was performed immediately before surgery. Fluorescence imaging was performed using the MARS system. Detection rate was 100%. Mean number of sentinel lymph nodes was 2. Metastatic lesions of sentinel lymph nodes were observed in 6 patients (24%) with micro-metastases in 2 cases. In 50% of cases, metastatic lesion did not extend beyond sentinel lymph nodes. False negative result was obtained in 1 (4%) patient. Mean number of metastases was 1.8 (max 3 in one patient). Sentinel lymph node biopsy with fluorescence lymphography is a sensitive method. The advantages of this technique are visualization of subcutaneous lymphatic vessels and skin incision for access to sentinel lymph nodes, as well as visualization of sentinel lymph nodes after skin incision.