Effectiveness Of Sentinel Lymph Node Biopsy Research Articles

Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update.

Pregnant patients diagnosed with breast cancer (PrBC) may receive substantially different treatments compared to general population, considering that certain treatment options cannot be applied during pregnancy due to their potential harmful effects to the foetus. Regarding the use of sentinel lymph node biopsy (SLNB) in pregnant patients, potential concerns include foetal harm from radiation exposure, possible teratogenic effects of blue dyes and maternal anaphylaxis to isosulfan. The main objective of the present systematic review is to summarize and present current knowledge and up-to-date evidence about the safety and efficacy of SLNB in PABC. MEDLINE, Google Scholar and UpToDate databases were searched up to 22 January 2023. Articles studying the safety and effectiveness of SLNB in patients for PrBC were eligible for inclusion in the present review. In total, 63 articles that met the inclusion criteria were included in this study. Forty-seven articles were strongly in favour of performing SLNB in PABC, 4 articles were partially in favour, 10 articles were strongly against and 2 articles were partially against performing SLNB in PABC. Sub-categorization based on type of study showed that the majority of studies in favour were of higher level of evidence than those against. Furthermore, there were overall 12 studies reporting on outcomes. There were overall 382 women with PrBC that underwent SLNB. Full data were reported for 237 cases. Overall live birth rate was 95.8%, while overall neonatal complication rate was 3.4%. No case of maternal side effects or anaphylactic reaction, maternal death, stillbirth and neonatal death was reported (0%). Sentinel lymph node biopsy seems to be safe and effective technique for breast cancer during pregnancy.

Abstract PS1-10: Outcomes after sentinel lymph node biopsy and radiation therapy in women over 70 years old with ER+, HER2-, clinically node negative breast cancer

Abstract Overtreatment of early-stage breast cancer with favorable tumor biology in elderly patients can result in higher rates of complications and morbidities without impacting survival. Guidelines directed towards deimplementation of sentinel lymph node biopsy (SLNB) (Choosing Wisely) and radiation therapy (RT) (National Comprehensive Cancer Network) have been recommended. We sought to describe rates and impact on disease recurrence and survival of SLNB and RT in elderly patients with early breast cancer. Patient data were obtained from the cancer registry and electronic health record from University of Pittsburgh Medical Center, multicenter, single health care system. Consecutive female patients aged ≥ 70 with ER+, HER2- clinically node-negative breast cancer within a health care system from 2010 to 2018 were identified. Rates and patient characteristics associated with receipt of SLNB and RT, as well as local recurrence free survival (LRFS) and disease-free survival (DFS) were compared for patients that were diagnosed between 2010 and 2014 to allow for adequate follow up time. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of mortality. Among 3,361 identified women, 2,195 (65.3%) received SLNB and 1,828 (54.4%) received RT. Rates of SLNB steadily increased (1.0% per year); this trend persisted in 2017 and 2018, even after the Society of Surgical Oncology adopted the Choosing Wisely Guidelines in 2016. During the same time period, rates of RT declined (3.4% per year). To examine outcomes, we limited the analysis to 2109 cases from 2010-2014; median (IQR) follow up time was 4.1 (2.5-5.7) years. Median (IQR) age was 77 (73-82) years. 1373 (65.1%) received SLNB and 1,219 (57.8%) received RT. Patients receiving SLNB were younger (P < 0.001) with smaller (P < 0.0001) and lower stage (P < 0.0001) tumors. They had fewer comorbidities (P < 0.001), longer follow-up times (P < 0.001), were less likely on Medicaid/Medicare (P = 0.0091), and were more often seen at an academic center (P < 0.0001). There was no difference in grade between those that did and did not receive SLNB (P = 0.31) and those that did and did not receive RT (P = 0.13). Multivariate cox proportional hazard analysis showed no effect of SLNB on LRFS (HR = 1.17, 95% CI 0.29-4.75, P = 0.83) or DFS (HR = 0.90, 95% CI 0.44-1.83, P = 0.77). Log rank test showed no difference in 5-year LRFS (P = 0.78) between patients who received (98.5%, 95% CI 97.7%-99.7%) and did not receive (98.1%, 95% CI 96.7%-99.5%) SLNB, but an increase was seen with 5-year DFS (P = 0.023), with 96.2% (95% CI 95.0%-97.4%) of patients disease-free among those who did receive SLNB vs. 93.0% (95% CI 90.6%-95.4%) with no SLNB. Multivariate cox proportional hazard analysis showed that RT was associated with improved LRFS (HR = 0.13, 95% CI 0.03-0.51, P < 0.01) and DFS (HR = 0.32, 95% CI 0.15-0.68, P < 0.01). Log rank test showed a difference in 5-year LRFS (P < 0.0001) for those who received RT (99.4%, 95% CI 98.8%-100%) against those who did not (96.5%, 95% CI 95.0%-98.1%), and a similar difference in 5-year DFS (P < 0.0001) in patients who did (97.0%, 95% CI 95.8%-98.1%) and did not (92.4%, 95% CI 90.2%-94.7%) receive RT. Lower age (OR = 0.89, 95% CI 0.87-0.92) and comorbidities (OR = 0.79, 95% CI 0.66-0.94) were associated with receipt of SLNB, while only age (OR = 0.91, 95% CI 0.88-0.94) was associated with receipt of RT. We conclude that receipt of SLNB has no impact upon DFS or LRFS. This data supports deimplementation of SLNB for this patient population. Receipt of RT is important for controlling locoregional recurrence, supporting use of RT in this patient cohort. Citation Format: Priscilla F McAuliffe, Neil M Carleton, Jian Zou, Yusi Fang, Stephen E Koscumb, Osama Shah, Fangyuan Chen, Sushil Beriwal, Emilia J Diego, Adam M Brufsky, Steffi Oesterreich, Steve D Shapiro, Robert Ferris, Leisha A Emens, George Tseng, Oscar C Marroquin, Adrian V Lee. Outcomes after sentinel lymph node biopsy and radiation therapy in women over 70 years old with ER+, HER2-, clinically node negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-10.

Critical review of axillary recurrence in early breast cancer.

Around 2% of early breast cancer cases treated with axillary lymph node dissection (ALND) underwent axillary recurrence (AR) and it has a deleterious effect in prognosis. Different scenarios have incorporated Sentinel Lymph Node (SLN) Biopsy (SLNB) instead of ALND as part of the standard treatment and more effective systemic treatment has also been incorporated in routine management after first curative surgery and after regional recurrence. However, there is concern about the effect of SLNB alone over AR risk and how to predict and treat AR. SLN biopsy (SLNB) has been largely accepted as a valid option for SLN-negative cases, and recent prospective studies have demonstrated that it is also safe for some SLN-positive cases and both scenarios carry low AR rates. Different studies have identified clinicopathological factors related to aggressiveness as well as high-risk molecular signatures can predict the development of locoregional recurrence. Other publications have evaluated factors affecting prognosis after AR and find that time between initial treatment and AR as well as tumor aggressive behavior influence patient survival. Retrospective and prospective studies indicate that treatment of AR should include local and systemic treatment for a limited time.

Upper limb lymphedema in breast cancer patients in the era of Z0011, sentinel lymph node biopsy and breast conservation.

Surgical techniques in breast cancer (BCa) have seen a dramatic change recently with breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). The ACOSOG-Z0011 trial reported equivalence in outcomes for certain patients with SLN metastases treated with axillary lymph node dissection (ALND) or SLNB alone. Our aim was to investigate changes in lymphedema referral patterns in BCa patients over the last 3years in a specialist unit and to elucidate effects of SLNB, BCS, and Z0011 trial publication on such patterns. A retrospective study was performed over a 3-year period (May 2012-May 2015). Patients were identified using a prospectively maintained lymphedema database and newly referred BCa patients with data availability were included. Overall lymphedema incidence was 11% (19.2% in ALND and 5.1% in SLNB cohort). There was a statistically significant difference in lymphedema referral patterns after Z0011, new referrals reduced by 20% (chi-sq; p=0.001). Volume of referrals post ALND was reduced by 40% with concomitant 31% rise in those post SLNB alone, reflecting changing surgical patterns. There was a significant change in extent of lymphnode dissection during ALND (p=0.003). The Z0011 trial in association with wider implementation of SLNB has led to significant changes in the lymphedema referral patterns and extent of ALND.

Effect of sentinel lymph-node biopsy alone on the morbidity of the surgical treatment of early cervical cancer: Results from the prospective randomized study Senticol2.

5521 Background: Sentinel lymph node (SLN) biopsy is now part of the management of early cervical cancer. Feasibility and low false negative rate in case of bilateral detection have been demonstrat...

The Initial Implementation of the Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer Management in Malta

Over the past two decades, the sentinel lymph node biopsy (SLNB) based on sentinel node (SN) being the first lymph node that harbors metastases, revolutionized breast cancer management. SLNB presents much less morbidity when compared to radical axillary lymph node dissection (ALND) where all nodes are dissected irrespective of their metastatic involvement. The purpose of this study was to evaluate the effectiveness of SLNB by investigating whether the histological characteristics of the SNs identified using scintigraphy are predictive of the histological characteristics of the ALN basin. Methods: Fifty-five female breast cancer patients underwent lymphoscintigraphy and SLNB followed by ALND. The histological status of the SN/s was correlated to the histological status of the ALNs to determine whether the SN accurately stages the ALNs in breast cancer. Results: During surgery, SNs were successfully isolated in 52 out of 55 cases (94.5%) (range, 0 to 9). No SNs were identified in 3 cases (5.5%). Results demonstrate a significant association (p = 0.05) between the metastatic status of SNs and the corresponding ALNs in 42 out of 52 patients (80.8%), but with a high false-negative rate (FNR) of 37.5%. Conclusion: The findings of this study show that the sentinel node concept provides the benefits of SLNB in the majority of instances. However, further work is required in reducing the FNR. Once the effectiveness of SLNB as a staging technique is locally established, the need of ALND in SN-negative patients would be limited, thus improving the quality of life of Maltese breast cancer patients.

Thirty One Cases of Radioguided Biopsies of Sentinel Lymph Nodes Located in the Internal Mammary Chain

INTRODUCTION: The methodology of sentinel lymph node (SLN) biopsy in breast cancer has renewed the interest in harvesting lymph nodes in internal mammary chain (IMC). The presence of the disease in IMC nodes implicates in increase of the risk for distant metastases caused by secondary seeding from persistent disease. SLN biopsy in IMC is not a troublesome procedure and could modify the indication of adjuvant chemotherapy or regional radiotherapy. However, the effect of SLN biopsy in IMC on survival still is unknown. This study examines the histopathologic involvement of sentinel nodes identified by lymphatic mapping within this drainage pathway. METHOD: We performed SLN mapping in 831 patients with early infiltrating BC staged as T1-2 N0. On the day before surgery, a solution containing dextran labeled with technetium was injected around the lesion under ultrasound or stereotaxic mammography guidance. Planar scintigraphy images were obtained with a gama camara. Among the cases in whom the SLN was mapped (hot spot) in IMC (3 SLN exclusively in IMC and 28 with simultaneous SLN in axilla), in 31 the SLN was retrieved. The IMC nodes were explored through the same incision made for removal of the primary tumor. After splitting the pectoral muscle fibers, the intercostals muscles were separated from the lower rib to expose the internal mammary vessels in contact with the SLN over the parietal pleura. Never was a rib resected. RESULTS: in 4 patients (4/31 = 12. 9%) metastatic SLNs in IMC were discovered. of them, in one occasion the nodal involvement was seen only in IMC, while in the other 3, the axillary SLNs also contained metastatic disease. Upstaging of the BC was observed in 12. 9% of the patients who were submitted to SLN biopsy in IMC, causing better selection of cases who might benefit from postoperative irradiation of IMC and systemic chemotherapy. In one patient, the internal mammary artery was damaged during the pursuit of the node, but secure hemostasis was obtained without difficulty easily. There was not any case of accidental opening of the pleural cavity. CONCLUSION: SLN biopsy in IMC provide a more accurate staging of BC patients. Prospective randomized trials are needed to determine whether the adjustments in adjuvant therapy, caused by the biopsy, are associated with improvements in disease-free and overall survival.

Eficacia de la biopsia intraoperatoria del ganglio centinela mediante el método one step nucleic acid amplification para evitar la linfadenectomía axilar en mujeres con cáncer de mama tratadas previamente con quimioterapia neoadyuvante

ObjectivesTo evaluate in patients with clinically negative axillary nodes at initial presentation, the effectiveness of sentinel lymph node biopsy (SLNB) using intraoperative the one step nucleic acid amplification (OSNA) method to detect microscopic metastases or isolated tumor cells after neoadjuvant chemotherapy. Thus, axillary dissection and duplication of surgical procedures will be avoided. Patients and methodsWe evaluated in patients with breast cancer and clinically negative axilla, the effectiveness of SLNB by OSNA after neoadjuvant chemotherapy (44 patients) or prior to neoadjuvant chemotherapy (33 patients). ResultsThe rate of SLN identification was 100% in both groups. In patients with SLNB prior to systemic treatment, 13 women showed positive nodes (11 macrometastases and 2 micrometastases), and those with SLNB after neoadjuvant chemotherapy, positive SLNB were detected in 10 women, which were all of them macrometastases. The negative predictive value of ultrasonography was 60.6% in patients with SLNB prior to neoadjuvant therapy and 77.3% in patients with chemotherapy followed by SLNB. ConclusionsIntraoperative SLNB using OSNA in women with clinically negative axillary lymph nodes at initial presentation who received neoadjuvant chemotherapy, predicts axillary status with high accuracy. Also it allows immediately make decisions about the indication or not to perform an axillary dissection, thus avoiding delay in the administration of chemotherapy and benefit the patients for a single surgical procedure.

Intérêt de l’injection péritumorale de nanocolloïdes technétiés pour la détection du ganglion sentinelle mammaire interne

Objectives Until now, the effectiveness of sentinel lymph-node biopsy (SLNB) has only been demonstrated for the detection of axillary lymphatic involvement in early breast cancer (cT1N0). The purpose of this study was to evaluate whether the detection of an extra-axillary internal mammary sentinel lymph node (SLN), using peritumoral injection of radiolabelled nanocolloids (NC), can lead to a modification in management for these patients. Materials and methods A total of 538 consecutives SLNB was analysed from a cohort of 529 patients. Peri- and infratumoral injections of radiolabelled NC were made under ultrasound control. Results A SLN was identified on 524 occasions, 147 (28.1%) of which were located in the internal mammary chain (IMC). In 10 cases, the SLN in the IMC was not associated with an axillary SLN. One hundred and thirty-five surgical biopsies of the IMC SLN were performed without significant morbidity. Sixteen patients demonstrated local involvement of an IMC SLN, which on seven occasions was isolated to this region. For six of these patients, the finding of SLN involvement led to a recommendation for adjuvant chemotherapy. For 308 patients, for lack of IMC involvement, the adjuvant IMC radiotherapy could have been avoided (i.e.: 95% of the theoretical indications for adjuvant radiotherapy). Conclusions Peritumoral injection of radiolabelled NC, associated with a systematic IMC SLN biopsy, enabled the rationalisation of management in patients with stage cT1 breast cancer and did not affect the usual performance of the technique nor led to a significant increase in morbidity. The long-term survival and morbidity outcomes of these therapeutic modifications, particularly with regards to radiotherapy, will need to be demonstrated.