Is it possible to avoid axillary dissection?
Authors:
J. Gatěk 1; D. Vrána 2; B. Dudešek 1; J. Duben 1
Authors‘ workplace:
Chirurgické oddělení nemocnice Atlas Zlín, Univerzita Tomáše Bati ve Zlíně
přednosta: doc. MUDr. J. Gatěk Ph. D.
1; Onkologická klinika LF Univerzity Palackého v Olomouci
přednosta: prof. MUDr. B. Melichar Ph. D.
2
Published in:
Rozhl. Chir., 2017, roč. 96, č. 8, s. 318-323.
Category:
Review
Overview
The essential aim of oncology surgery including breast cancer is to remove the malignant tumour and lymph nodes. For many decades, dissection of axillary lymph nodes has been a common part of mastectomy, virtually the only surgical procedure in breast cancer treatment until the 90ies of the previous century. Although mastectomy has been replaced with breast preserving procedures, axillary dissection remained an integral part of the surgery. Sentinel lymph node biopsy (SLNB) has introduced a revolutionary change in breast cancer treatment in the axilla, replacing dissection in clinically negative axillary nodes. As a result, the number of radical procedures in the axilla was significantly limited, as well as the incidence of serious complications that may have a negative impact on the quality of life of the patients. As shown by other studies, the number of dissections can be reduced even further. Subsequent axillary dissection is unnecessary where the sentinel nodes contain only malignant cells, micrometastases and even a limited number of macrometastases. SLNB can also be used in a selected group of patients after neoadjuvant chemotherapy.
Key words:
breast carcinoma – axillary dissection – sentinel lymph node – micrometastases – macrometastases
Sources
1. http://www.nsabp.pitt.edu/B-04.asp
2. Fisher B, Montague E, Redmond C, et al. Comparison of radical mastectomy with alternative treatments for primary breast cancer. A first report of results from a prospective randomized clinical trial. Cancer 1977;3(6 Suppl):2827–39.
3. Fisher B, Montaguae E, Redmond C, et al. Findings from NSAB Protocol No. B-04-comparison of radical mastectomy with alternative treatments for primary breast cancer. I. Radiation compliance and its relation to treatment outcome. Cancer 1980;48:1–13.
4. Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989;320:822–8.
5. Krag DN, Anderson SJ, Julian TB, 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 randomized phase 3 trial. Lancet Oncol 2010;11:927–33.
6. Kim T, Giuliano A, Lyman, G, et al. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: metaanalysis. Cancer 2006;106:266–75.
7. Benson JR, Wishart GC. Role of axillary clearance for patients with sentinel node-positive early breast cancer. British Journal of Surgery 2011;98:1499–500.
8. Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Onco 2014;32:1365–83.
9. Gatěk J, Duben J, Dudešek B, et al. Sentinelová uzlina u karcinomu prsu. Rozhledy v chirurgii 2000;79:77–80.
10. Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 2014;15:351–62.
11. Benson J. Indocyanine green fluorescence for sentinel lymph node detection in early breast cancer. Ann Surg Oncol 2016;23:6–8.
12. Coufal O, Fait V. Use of indocyanine green and the HyperEye system for detecting sentinel lymph nodes in breast cancer within a population of European patients: a pilot study. World J Surg Oncol 2016;299.
13. Coufal O, Fait V, Lžičařová E, et al. SentiMag – the magnetic detection system of sentinel lymph nodes in breast cancer. Rozhl Chir 2015;94:283–8.
14. Goldhirsch A, Ingle JN, Gelber RD, et al. Thresholds for therapies: highlights of the St. Gallen International Expert Consensus on the primary therapy of early breast cancer. Annals of Oncology 2009;20:1319–29.
15. Gnant M, Harbeck N, CH. St. Gallen 2011: Summary of the consensus discussion breast care (Basel). 2011;2:136–141.
16. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 2011;305:569–75.
17. Kaufman M, von Minckwitz G, Mamounas E. Recommendation from an international consesus conference on current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol 2012;19:1508–16.
18. Coufal O. Možnost eliminace axilárních disekcí u pacientek s karcinomem prsu pomocí neoadjuvantní léčby. Rozhl Chir 2016;95:381–5.
19. Boughey J, MD, Suman V, Mittendorf E, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: The American College of Surgeons Oncology Group (ACOSOG) Z1071 Clinical Trial. JAMA 2013;310:1455–61.
20. Diego EJ, McAuliffe PF, Soran A, et al. Axillary staging after neoadjuvant chemotherapy for breast cancer: A pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes. Ann Surg Oncol 2016;23:1549–53.
21. Caudle AS, Yang WT, Mittendorf EA, et al. Selective surgical localization of axillary lymph nodes containing metastases in patients with breast cancer: a prospective feasibility trial. JAMA Surg 2015;150:137–43.
22. Choy N, Lipson J, Porter P, et al. Initial results with preoperative tattooing of biopsied axillary lymph nodes and correlation to sentinel lymph nodes in breast cancer patients. Annals of Surgical Oncology 2015;22:377–82.
23. Francis AM, Haugen CE, Grimes LM, et al. Is sentinel lymph node dissection warranted for patients with a diagnosis of ductal carcinoma in situ? Ann Surg Oncol 2015;13:4270–9.
24. Francis A, Thomas J, Fallowfield L, et al. Addressing overtreatment of screen detected DCIS; the LORIS trial. Eur J Cancer 2015;102:2296–303.
25. Gogineni K. Ductal carcinoma in situ: How much is too much? Cancer 2016;122:2780–2.
26. Morrow M, Katz SJ. Addressing overtreatment in DCIS: What should physicians do now? J Natl Cancer Inst 2015;107:djv290.
27. Gatěk J, Duben J, Hnátek L. Chirurgická terapie duktálního karcinomu in situ. Rozhl Chir 2004;83:597–603.
28. Keleher A, Wendt R, Delpassand R, et al. The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid. Breast 2004;10:492–5.
29. Lee M, Laronga Ch. The pregnant breast cancer patient: Are we failing our most vulnerable population? Ann Surg Oncol 2014;21:2474–5.
30. Gropper AB, Calvillo KZ, Dominici L, et al. Sentinel lymph node biopsy in pregnant women with breast cancer. Ann Surg Oncol 2014;21:2506–11.
31. Amant F, Deckers S, Van Calsteren K, et al. Breast cancer in pregnancy: recommendation of an international consensus meeting. Eur J Cancer 2010;18:3158–68.
32. Loibl S, von Minckwitz G, Gwyn K, et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer 2006;106:237–46.
33. Motomura K, Izumi T, Tateishi S, et al. Supermagnetic iron oxide-enhanced MRI at 3T for accurate axillary staging in breast cancer. Br J Surg 2016;103:60–9.
34. Beek MA, Verheuvel NC, Luiten EJ, et al. Two decades of axillary management in breast cancer. Br J Surg 2015;102:1658–64.
35. Gatěk J. Vývoj chirurgických výkonů v axile. Onkologická revue 2016;10:0–4.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2017 Issue 8
Most read in this issue
- A new perspective on axillary dissection in situations of metastatic sentinel node
- Satisfaction and overall quality of life in BRCA positive women after prophylactic surgeries
- Is it possible to avoid axillary dissection?
- Magnetic resonance imaging in preoperative diagnosis of invasive lobular carcinomas of the breast – analysis of 230 cases