The changing landscape of axillary surgery: Which breast cancer patients may still benefit from complete axillary lymph node dissection?
Background and Objectives Many breast cancer patients undergoing completion axillary lymph node dissection (CALND) for sentinel lymph node (SLN) metastases have no further disease. Predicting patients at high risk of non‐sentinel lymph node (NSLN) metastasis may help guide effective utilization of C...
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| Veröffentlicht in: | Journal of surgical oncology 2012-09, Vol.106 (3), p.254-259 |
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| container_title | Journal of surgical oncology |
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| creator | McGhan, L.J. Dueck, A.C. Gray, R.J. Wasif, N. McCullough, A.E. Pockaj, B.A. |
| description | Background and Objectives
Many breast cancer patients undergoing completion axillary lymph node dissection (CALND) for sentinel lymph node (SLN) metastases have no further disease. Predicting patients at high risk of non‐sentinel lymph node (NSLN) metastasis may help guide effective utilization of CALND.
Methods
SLN+ breast cancer patients undergoing frozen section (FS) analysis at a single institution (2004–2010) were studied retrospectively. Factors associated with NSLN metastases were identified.
Results
Two‐hundred forty SLN+ patients were identified. The incidence of NSLN metastases was 45% in FS(+) patients undergoing CALND, compared to 10% of FS(−) patients following CALND (P |
| doi_str_mv | 10.1002/jso.22131 |
| format | Article |
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Many breast cancer patients undergoing completion axillary lymph node dissection (CALND) for sentinel lymph node (SLN) metastases have no further disease. Predicting patients at high risk of non‐sentinel lymph node (NSLN) metastasis may help guide effective utilization of CALND.
Methods
SLN+ breast cancer patients undergoing frozen section (FS) analysis at a single institution (2004–2010) were studied retrospectively. Factors associated with NSLN metastases were identified.
Results
Two‐hundred forty SLN+ patients were identified. The incidence of NSLN metastases was 45% in FS(+) patients undergoing CALND, compared to 10% of FS(−) patients following CALND (P < 0.001). Multivariate analysis revealed that FS positivity, tumor size, and the presence of angiolymphatic invasion were significant factors associated with NSLN metastases (all P < 0.05). Further analysis of FS(+) patients revealed that tumor size, ER(−) status, and lymph node metastasis size were also associated with risk of NSLN metastases. An algorithm for the management of the axilla in SLN+ breast cancer patients was devised, based on clinic‐pathologic predictors of NSLN metastases.
Conclusion
A SLN+ biopsy by FS predicts the presence of NSLN metastases and, in combination with other factors, may justify immediate CALND. CALND may, however, be avoided in selected low‐risk SLN+ patients. J. Surg. Oncol. 2012; 106:254–259. © 2011 Wiley Periodicals, Inc.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.22131</identifier><identifier>PMID: 22034211</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Algorithms ; Axilla ; Breast Neoplasms - metabolism ; Breast Neoplasms - mortality ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Carcinoma, Ductal, Breast - metabolism ; Carcinoma, Ductal, Breast - mortality ; Carcinoma, Ductal, Breast - pathology ; Carcinoma, Ductal, Breast - surgery ; Carcinoma, Lobular - metabolism ; Carcinoma, Lobular - mortality ; Carcinoma, Lobular - pathology ; Carcinoma, Lobular - surgery ; completion axillary lymph node dissection ; Female ; frozen section ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; non-sentinel lymph node metastases ; predictive model ; Receptor, ErbB-2 - metabolism ; Retrospective Studies ; Risk Assessment ; sentinel lymph node biopsy</subject><ispartof>Journal of surgical oncology, 2012-09, Vol.106 (3), p.254-259</ispartof><rights>Copyright © 2011 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3631-3d84f881e7c71d509134df5e086ce344ecea90907e76799b01d52ca3846be3ec3</citedby><cites>FETCH-LOGICAL-c3631-3d84f881e7c71d509134df5e086ce344ecea90907e76799b01d52ca3846be3ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjso.22131$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjso.22131$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22034211$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McGhan, L.J.</creatorcontrib><creatorcontrib>Dueck, A.C.</creatorcontrib><creatorcontrib>Gray, R.J.</creatorcontrib><creatorcontrib>Wasif, N.</creatorcontrib><creatorcontrib>McCullough, A.E.</creatorcontrib><creatorcontrib>Pockaj, B.A.</creatorcontrib><title>The changing landscape of axillary surgery: Which breast cancer patients may still benefit from complete axillary lymph node dissection?</title><title>Journal of surgical oncology</title><addtitle>J. Surg. Oncol</addtitle><description>Background and Objectives
Many breast cancer patients undergoing completion axillary lymph node dissection (CALND) for sentinel lymph node (SLN) metastases have no further disease. Predicting patients at high risk of non‐sentinel lymph node (NSLN) metastasis may help guide effective utilization of CALND.
Methods
SLN+ breast cancer patients undergoing frozen section (FS) analysis at a single institution (2004–2010) were studied retrospectively. Factors associated with NSLN metastases were identified.
Results
Two‐hundred forty SLN+ patients were identified. The incidence of NSLN metastases was 45% in FS(+) patients undergoing CALND, compared to 10% of FS(−) patients following CALND (P < 0.001). Multivariate analysis revealed that FS positivity, tumor size, and the presence of angiolymphatic invasion were significant factors associated with NSLN metastases (all P < 0.05). Further analysis of FS(+) patients revealed that tumor size, ER(−) status, and lymph node metastasis size were also associated with risk of NSLN metastases. An algorithm for the management of the axilla in SLN+ breast cancer patients was devised, based on clinic‐pathologic predictors of NSLN metastases.
Conclusion
A SLN+ biopsy by FS predicts the presence of NSLN metastases and, in combination with other factors, may justify immediate CALND. CALND may, however, be avoided in selected low‐risk SLN+ patients. J. Surg. Oncol. 2012; 106:254–259. © 2011 Wiley Periodicals, Inc.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Algorithms</subject><subject>Axilla</subject><subject>Breast Neoplasms - metabolism</subject><subject>Breast Neoplasms - mortality</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Carcinoma, Ductal, Breast - metabolism</subject><subject>Carcinoma, Ductal, Breast - mortality</subject><subject>Carcinoma, Ductal, Breast - pathology</subject><subject>Carcinoma, Ductal, Breast - surgery</subject><subject>Carcinoma, Lobular - metabolism</subject><subject>Carcinoma, Lobular - mortality</subject><subject>Carcinoma, Lobular - pathology</subject><subject>Carcinoma, Lobular - surgery</subject><subject>completion axillary lymph node dissection</subject><subject>Female</subject><subject>frozen section</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymph Node Excision</subject><subject>Lymphatic Metastasis</subject><subject>Middle Aged</subject><subject>non-sentinel lymph node metastases</subject><subject>predictive model</subject><subject>Receptor, ErbB-2 - metabolism</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>sentinel lymph node biopsy</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMtO3DAUhq2qFQyXRV8AedkuAnbsXNxNVY0KtCBYMGiWluOcTAyJHWyPyrwBj43b4bLqxmfh7_90zo_QZ0qOKSH5yV1wx3lOGf2AZpSIMhNE1B_RLP3lGa8E2UV7IdwRQoQo-Q7azXPCeE7pDD0tesC6V3Zl7AoPyrZBqwmw67B6NMOg_AaHtV-B33zDy97oHjceVIhYK6vB40lFAzYGPKpExhTBDVjoTMSddyPWbpwGiPCuGzbj1GPrWsCtCQF0NM5-P0CfOjUEOHyZ--j29Odifp5dXp_9mv-4zDQrGc1YW_OurilUuqJtQQRlvO0KIHWpgXEOGlS6nlRQlZUQDUlQrhWredkAA8320Zetd_LuYQ0hytEEDWk1C24dJCWM8YKnN6Fft6j2LgQPnZy8GdMJCZJ_i5epePmv-MQevWjXzQjtG_nadAJOtsAfM8Dm_yb5--b6VZltEyZEeHxLKH8vy4pVhVxenUl-cV7QZb2QNXsG-CSd5Q</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>McGhan, L.J.</creator><creator>Dueck, A.C.</creator><creator>Gray, R.J.</creator><creator>Wasif, N.</creator><creator>McCullough, A.E.</creator><creator>Pockaj, B.A.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>The changing landscape of axillary surgery: Which breast cancer patients may still benefit from complete axillary lymph node dissection?</title><author>McGhan, L.J. ; Dueck, A.C. ; Gray, R.J. ; Wasif, N. ; McCullough, A.E. ; Pockaj, B.A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3631-3d84f881e7c71d509134df5e086ce344ecea90907e76799b01d52ca3846be3ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Algorithms</topic><topic>Axilla</topic><topic>Breast Neoplasms - metabolism</topic><topic>Breast Neoplasms - mortality</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Carcinoma, Ductal, Breast - metabolism</topic><topic>Carcinoma, Ductal, Breast - mortality</topic><topic>Carcinoma, Ductal, Breast - pathology</topic><topic>Carcinoma, Ductal, Breast - surgery</topic><topic>Carcinoma, Lobular - metabolism</topic><topic>Carcinoma, Lobular - mortality</topic><topic>Carcinoma, Lobular - pathology</topic><topic>Carcinoma, Lobular - surgery</topic><topic>completion axillary lymph node dissection</topic><topic>Female</topic><topic>frozen section</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymph Node Excision</topic><topic>Lymphatic Metastasis</topic><topic>Middle Aged</topic><topic>non-sentinel lymph node metastases</topic><topic>predictive model</topic><topic>Receptor, ErbB-2 - metabolism</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>sentinel lymph node biopsy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McGhan, L.J.</creatorcontrib><creatorcontrib>Dueck, A.C.</creatorcontrib><creatorcontrib>Gray, R.J.</creatorcontrib><creatorcontrib>Wasif, N.</creatorcontrib><creatorcontrib>McCullough, A.E.</creatorcontrib><creatorcontrib>Pockaj, B.A.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McGhan, L.J.</au><au>Dueck, A.C.</au><au>Gray, R.J.</au><au>Wasif, N.</au><au>McCullough, A.E.</au><au>Pockaj, B.A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The changing landscape of axillary surgery: Which breast cancer patients may still benefit from complete axillary lymph node dissection?</atitle><jtitle>Journal of surgical oncology</jtitle><addtitle>J. Surg. Oncol</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>106</volume><issue>3</issue><spage>254</spage><epage>259</epage><pages>254-259</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract>Background and Objectives
Many breast cancer patients undergoing completion axillary lymph node dissection (CALND) for sentinel lymph node (SLN) metastases have no further disease. Predicting patients at high risk of non‐sentinel lymph node (NSLN) metastasis may help guide effective utilization of CALND.
Methods
SLN+ breast cancer patients undergoing frozen section (FS) analysis at a single institution (2004–2010) were studied retrospectively. Factors associated with NSLN metastases were identified.
Results
Two‐hundred forty SLN+ patients were identified. The incidence of NSLN metastases was 45% in FS(+) patients undergoing CALND, compared to 10% of FS(−) patients following CALND (P < 0.001). Multivariate analysis revealed that FS positivity, tumor size, and the presence of angiolymphatic invasion were significant factors associated with NSLN metastases (all P < 0.05). Further analysis of FS(+) patients revealed that tumor size, ER(−) status, and lymph node metastasis size were also associated with risk of NSLN metastases. An algorithm for the management of the axilla in SLN+ breast cancer patients was devised, based on clinic‐pathologic predictors of NSLN metastases.
Conclusion
A SLN+ biopsy by FS predicts the presence of NSLN metastases and, in combination with other factors, may justify immediate CALND. CALND may, however, be avoided in selected low‐risk SLN+ patients. J. Surg. Oncol. 2012; 106:254–259. © 2011 Wiley Periodicals, Inc.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>22034211</pmid><doi>10.1002/jso.22131</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Algorithms Axilla Breast Neoplasms - metabolism Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms - surgery Carcinoma, Ductal, Breast - metabolism Carcinoma, Ductal, Breast - mortality Carcinoma, Ductal, Breast - pathology Carcinoma, Ductal, Breast - surgery Carcinoma, Lobular - metabolism Carcinoma, Lobular - mortality Carcinoma, Lobular - pathology Carcinoma, Lobular - surgery completion axillary lymph node dissection Female frozen section Humans Kaplan-Meier Estimate Lymph Node Excision Lymphatic Metastasis Middle Aged non-sentinel lymph node metastases predictive model Receptor, ErbB-2 - metabolism Retrospective Studies Risk Assessment sentinel lymph node biopsy |
| title | The changing landscape of axillary surgery: Which breast cancer patients may still benefit from complete axillary lymph node dissection? |
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