Node staging today

Authors

  • José Luís Fougo Centro Hospitalar de São João e Faculdade de Medicina da Universidade do Porto, Portugal
  • Fernando Osório Centro Hospitalar de São João e Faculdade de Medicina da Universidade do Porto, Portugal
  • Susy Costa Centro Hospitalar de São João e Faculdade de Medicina da Universidade do Porto, Portugal
  • André Magalhães Centro Hospitalar de São João e Faculdade de Medicina da Universidade do Porto, Portugal

Abstract

The need to perform an Axillary Dissection when the Sentinel Node is metastasized, in Breast Cancer patients, is being questioned. Most part of the patients do not have any additional metastasis in the Non Sentinel Nodes and, in many cases, the decision to perform adjuvant treatments is not dependent on the axillary nodes analysis. The recent publication of the randomized trial ACOSOG Z0011 launched the discussion on the need and usefulness of the axillary lymph node dissection.

Keywords: Breast Cancer; Node Staging, Sentinel Node, Non-Sentinel Node, Axillary Radiotherapy, Lymphedema. 

Downloads

Download data is not yet available.

References

Giuliano A, Kirgan D, Guenther J, Morton D. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220:391-401

Krag D, Weaver D, Alex J, Fairbank J. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma- -probe. Surg Oncol 1993; 2: 335-9

Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003; 349: 546–53.

Krag D, Anderson S, Julian T, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11: 927-33

Fougo J, Dinis-Ribeiro M, Araújo C et al. El concepto del Ganglio Centinela en Cáncer de Mama: estúdio prospectivo e aleatorizado (linfadenectomia axilar versus observación) centrado en la recurrencia axilar y morbilidade del membro superior. Cir Esp 2011; 89: 307-16

Houvenaeghel G, Nos C, Mignotte H et al. Micrometastasis in sentinel lymph node in a multicentric study: predictive factors of nonsentinel lymph node involvement – Groupe des chirurgiens de la federation des centres contre le cancer. J Clin Oncol 2006; 24: 1814-22.

Nos C, Harding MacKean C, Frénaux P et al. Prediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastasis. Br J Surg 2003; 90: 1354-60.

Fougo J, Afonso M, Senhorães-Senra F et al. Predictive factors for non-sentinel lymph node involvement in breast cancer patients with a positive sentinel node: should we consider sentinel node related factors? Clin Trans Oncol 2009; 11: 165-75.

Kamath V, Giuliano R, Dauwey E et al. Characteristics of the sentinel lymph node in breast cancer predict further involvement in higher echelon nodes in the axilla (a study to evaluate the need for complete axillary lymph node dissection). Arch Surg 2001; 136: 688-92.

Sachdev U, Murphy K, Derzie A et al. Predictors of nonsentinel lymph node metastasis in breast cancer patients. Am J Surg 2002; 183: 213-7.

Peg V, Espinosa-Bravo M, Vieites B et al. Intraoperative molecular analysis of total tumor load in sentinel lymph node: a new predictor of axillary status in early breast cancer patients. Breast Cancer Res Treat 2013; 139: 87-93

Espinosa-Bravo M, Sansano I, Pérez-Hoyos S et al. Prediction of non-sentinel lymph node metastasis in early breast cancer by assessing total tumoral load in the sentinel lymph node by molecular assay. Eur J Surg Oncol 2013; 39: 766-773

Van Zee K, Manasseh D, Bevilacqua J et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 2003; 10: 1140-51

Kohrt H, Olshen R, Bermas H et al. New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer 2008; 8: 66

Pal A, Provenzano E, Duffy S, Pinder S, Purushotham A. A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positive. Br J Surg 2008; 95: 302

Barranger E, Coutant C, Flahault A et al. An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treat 2005; 91: 113-9

Meretoja T, Audisio R, Heikkila P et al. International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases. Breast Cancer Res Treat 2013; 138: 817-27

Fougo J, Senra F, Araújo C et al. Validating the MSKCC nomogram and a clinical decision rule in the prediction of non-sentinel node metastases in a Portuguese population of breast cancer patients. Breast 2011; 20: 134-40

Fisher B, Redmond C, Fisher E et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. New Eng J Med 1985; 312: 674-81

Orr R. The impact of prophylactic axillary node dissection on breast cancer survival-a Bayesian meta-analysis. Ann Surg Oncol 1999; 6: 109-116

Bilimoria K, Bentrem D, Hansen N et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol 2009; 27: 2946-53

Giuliano A, Hunt K, Ballman K et al. Axillary dissection versus no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. JAMA 2011; 305: 569-75

Goldhirsch A, Winer E, Coates A, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen Interna- tional Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 2013; 24: 2206-23

http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (accessed november 17th, 2013)

https://www.breastsurgeons.org/statements/PDF_Statements/Axillary_Management.pdf (accessed November 17th, 2013)

Galimberti V, Cole B, Zurrida S et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG

-01): a phase 3 randomised controlled trial. Lancet Oncol 2013; 14: 297-305

Straver M, Meijnen P, van Tienhoven G et al. Role of axillary clearance after a tumor-positive sentinel node in the administration of adjuvant

therapy in early breast cancer. J Clin Oncol 2010; 28: 731-7

Montemurro F, Maggiorotto F, Valabrega G et al. Omission of axillary dissection after a positive sentinel node dissection may influence

adjuvant chemotherapy indications in operable breast cancer patients. Ann Surg Oncol 2012; 19: 3755-61

Published

2014-01-31

Issue

Section

Special Notebook

Most read articles by the same author(s)