Partial axillary lymph node dissection inferior to the intercostobrachial nerves complements sentinel node biopsy in patients with clinically node-negative breast cancer
نویسندگان
چکیده
BACKGROUND The practice of breast cancer diagnosis and treatment in China varies to that in western developed countries. With the unavailability of radioactive tracer technique for sentinel lymph nodes biopsy (SLNB), using blue dye alone has been the only option in China. Also, the diagnosis of breast malignant tumor in most Chinese centres heavily relies on intraoperative instant frozen histology which is normally followed by sentinel lymph nodes mapping, SLNB and the potential breast and axillary operations in one consecutive session. This practice appears to cause a high false negative rate (FNR) for SLNB. The present study aimed to investigate the impact of the current practice in China on the accuracy of SLNB, and whether partial axillary lymph node dissection (PALND), dissection of lymph nodes inferior to the intercostobrachial nerve (ICBN), was a good complementary procedure following SLNB using blue dye. METHODS 289 patients with clinically node-negative breast cancer were identified and recruited. Tumorectomy, intraoperative instant frozen histological diagnosis, SLNB using methylene blue dye, and PALND or complete axillary node dissection (ALND) were performed in one consecutive operative session. The choice of SLNB only, SLNB followed by PALND or by ALND was based on the pre-determined protocol and preoperative choice by the patient. Clinical parameters were analyzed and survival analysis was performed. RESULTS 37% patients with clinically negative nodes were found nodes positive. 59 patients with positive SLN underwent ALND, including 47 patients with up to two positive nodes which were all located inferior to the ICBN. 9 patients had failed SLNB and underwent PALND. Among them, 3 (33.3%) patients were found to have one metastatic node. 149 patients showed negative SLNB but chose PALND. Among them, 30 (20.1%), 14 (9.4) and 1 (0.7%) patients were found to have one, two and three metastatic node(s), respectively. PALND detected 48 (30.4%) patients who had either failed SLNB or negative SLNB to have additional positive nodes. All the patients with up to two positive nodes had their nodes located inferior to the ICBN. The FNR of SLNB was 43%. The accuracy rate was 58%. The follow-up ranged 12-33 months. The incidence of lymphedema for SLNB, PALND, and ALND was 0%, 0%, and 25.4%, respectively (P < 0.005). The disease-free survivals for SLNB, PALND, and ALND groups were 95.8%, 96.8%, and 94.9%, respectively (p > 0.05). CONCLUSIONS Under the circumstances of current practice in China, PALND is a good complementary procedure following SLNB in clinically node-negative breast cancer.
منابع مشابه
Standardization of whole breast radiotherapy is required for safe omission of axillary lymph node dissection in breast cancer patients
Background: The purpose of this study was to assess the dose distribution and coverage of level Ⅰ-Ⅱ axillary lymph nodes during whole breast tangential field radiotherapy (RT) after breast-conserving surgery in patients with breast cancer. Materials and Methods: The level Ⅰ-Ⅱ axillary lymph node volumes were retrospectively contoured by a single radiation oncologist based on computed tomography...
متن کاملThe need for skin pen marking for sentinel lymph node biopsy: A comparative study
Introduction: There is a consensus in the literature that sentinel lymph node biopsy is the standard procedure for axillary staging in early stage (I and II) breast cancer patients. Usually during lymphoscintigraphy, the location of the sentinel lymph node is marked on the skin by an indelible ink. In this study we evaluated this issue in our patients. Methods: 40 ...
متن کاملSentinel lymph node biopsy correctly predicts regional lymph node recurrence in trunk malignant melanoma with multiple drainage basins
We report a young male with an initial excisional biopsy report of melanoma of the lower back, referred to our hospital for complete excision and sentinel lymph node (SLN) biopsy. Four peritumoral intradermal Tc-99m phytate injection was performed and SLNs were detected in both axillary and right inguinal regions. On the biopsy only the right axillary SLN was metastatic leading to right axilla...
متن کاملIntercostobrachial Nerves as a Novel Anatomic Landmark for Dividing the Axillary Space in Lymph Node Dissection
Purpose. Our aim was to assess the feasibility of using the intercostobrachial nerves (ICBNs) as a possible new anatomic landmark for axillaries lymph node dissection in breast cancer patients. Background Data Summary. The preservation of ICBN is now an accepted procedure in this type of dissection; however, it could be improved further to reduce the number of postoperative complications. The a...
متن کاملPrediction Axillary Lymph Node Involvement Status on Breast Cancer Data
Introduction: one of the foremost usual methods for evaluating breast cancer is the removal of axillary lymph nodes (ALN) which include complications such as edema, limited hand movements, and lymph accumulation. Although studies have shown that the sentinel gland condition represents the axillary nodules context in the mammary gland, the efficacy, and safety of the guard node biopsy need to be...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره 15 شماره
صفحات -
تاریخ انتشار 2015