Sentinel lymph node biopsy followed by delayed mastectomy and reconstruction
The role of sentinel lymph node (SLN) biopsy with total mastectomy is evolving. In patients who desire mastectomy with immediate reconstruction, the final pathologic results of the SLN may create unique problems. Specifically, if the SLN is found to be positive on final pathology, the reconstructed...
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| Veröffentlicht in: | The American journal of surgery 2003-02, Vol.185 (2), p.114-117 |
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| creator | Brady, Bridget Fant, Jerri Jones, Ronald Grant, Michael Andrews, Valerie Livingston, Sheryl Kuhn, Joseph |
| description | The role of sentinel lymph node (SLN) biopsy with total mastectomy is evolving. In patients who desire mastectomy with immediate reconstruction, the final pathologic results of the SLN may create unique problems. Specifically, if the SLN is found to be positive on final pathology, the reconstructed patient would generally require a potentially difficult re-operation on the remaining axillary nodes. The purpose of this study was to review the results of patients who underwent an initial SNL biopsy followed by a planned mastectomy and reconstruction.
A chart review of patients who underwent staged SLN biopsy with subsequent definitive procedure between 1997 and 2001 was conducted. These were evaluated with regard to type of tumor, status of sentinel node, and design of subsequent operation.
There were 40 patients who underwent an initial SLN biopsy followed by a staged mastectomy with reconstruction. Tumors included high-grade carcinoma in situ (n = 4), infiltrating ductal carcinoma (n = 28), invasive lobular carcinoma (n = 4), mucinous carcinoma (n = 1), adenoid cystic carcinoma (n = 1), and mixed ductal and lobular carcinoma (n = 2). Tissue biopsy was obtained by either open (n = 9) or needle (n = 31) technique. Twenty-five patients had a negative SLN biopsy and a delayed total mastectomy with immediate reconstruction. Positive SLNs were identified in 15 patients (37%). Eight patients had macroscopic nodal metastases and underwent a delayed modified radical mastectomy and immediate reconstruction. Seven patients had microscopic nodal metastases and 3 declined further axillary dissection. They proceeded with total mastectomy and immediate reconstruction.
These data suggest that a substantial proportion of patients treated with SLN biopsy, simple mastectomy, and reconstruction will have positive sentinel lymph nodes. Thus, the ideal approach for patients who wish to have reconstruction should involve an initial SLN biopsy as a separate procedure. If the SLN is benign, the patient may undergo a total mastectomy with immediate reconstruction. However, a patient with a positive SLN may proceed to a modified radical mastectomy with immediate reconstruction. This treatment algorithm eliminates a potentially difficult reoperation on the axilla following reconstruction. |
| doi_str_mv | 10.1016/S0002-9610(02)01205-9 |
| format | Article |
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A chart review of patients who underwent staged SLN biopsy with subsequent definitive procedure between 1997 and 2001 was conducted. These were evaluated with regard to type of tumor, status of sentinel node, and design of subsequent operation.
There were 40 patients who underwent an initial SLN biopsy followed by a staged mastectomy with reconstruction. Tumors included high-grade carcinoma in situ (n = 4), infiltrating ductal carcinoma (n = 28), invasive lobular carcinoma (n = 4), mucinous carcinoma (n = 1), adenoid cystic carcinoma (n = 1), and mixed ductal and lobular carcinoma (n = 2). Tissue biopsy was obtained by either open (n = 9) or needle (n = 31) technique. Twenty-five patients had a negative SLN biopsy and a delayed total mastectomy with immediate reconstruction. Positive SLNs were identified in 15 patients (37%). Eight patients had macroscopic nodal metastases and underwent a delayed modified radical mastectomy and immediate reconstruction. Seven patients had microscopic nodal metastases and 3 declined further axillary dissection. They proceeded with total mastectomy and immediate reconstruction.
These data suggest that a substantial proportion of patients treated with SLN biopsy, simple mastectomy, and reconstruction will have positive sentinel lymph nodes. Thus, the ideal approach for patients who wish to have reconstruction should involve an initial SLN biopsy as a separate procedure. If the SLN is benign, the patient may undergo a total mastectomy with immediate reconstruction. However, a patient with a positive SLN may proceed to a modified radical mastectomy with immediate reconstruction. This treatment algorithm eliminates a potentially difficult reoperation on the axilla following reconstruction.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/S0002-9610(02)01205-9</identifier><identifier>PMID: 12559439</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Biopsy ; Breast cancer ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Carcinoma, Ductal, Breast - pathology ; Carcinoma, Ductal, Breast - surgery ; Carcinoma, Intraductal, Noninfiltrating - pathology ; Carcinoma, Intraductal, Noninfiltrating - surgery ; Carcinoma, Lobular - pathology ; Carcinoma, Lobular - surgery ; Female ; Humans ; Immediate breast reconstruction ; Lymphatic system ; Mammaplasty ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Medical sciences ; Patients ; Sentinel Lymph Node Biopsy ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the genital tract and mammary gland</subject><ispartof>The American journal of surgery, 2003-02, Vol.185 (2), p.114-117</ispartof><rights>2003 Excerpta Medica Inc.</rights><rights>2003 INIST-CNRS</rights><rights>Copyright Elsevier Limited Feb 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-a8f429778251b9b2eccc9e142582b723cc3d260ab9d5308e1ed59a868c9091013</citedby><cites>FETCH-LOGICAL-c447t-a8f429778251b9b2eccc9e142582b723cc3d260ab9d5308e1ed59a868c9091013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1444585823?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14517443$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12559439$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brady, Bridget</creatorcontrib><creatorcontrib>Fant, Jerri</creatorcontrib><creatorcontrib>Jones, Ronald</creatorcontrib><creatorcontrib>Grant, Michael</creatorcontrib><creatorcontrib>Andrews, Valerie</creatorcontrib><creatorcontrib>Livingston, Sheryl</creatorcontrib><creatorcontrib>Kuhn, Joseph</creatorcontrib><title>Sentinel lymph node biopsy followed by delayed mastectomy and reconstruction</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>The role of sentinel lymph node (SLN) biopsy with total mastectomy is evolving. In patients who desire mastectomy with immediate reconstruction, the final pathologic results of the SLN may create unique problems. Specifically, if the SLN is found to be positive on final pathology, the reconstructed patient would generally require a potentially difficult re-operation on the remaining axillary nodes. The purpose of this study was to review the results of patients who underwent an initial SNL biopsy followed by a planned mastectomy and reconstruction.
A chart review of patients who underwent staged SLN biopsy with subsequent definitive procedure between 1997 and 2001 was conducted. These were evaluated with regard to type of tumor, status of sentinel node, and design of subsequent operation.
There were 40 patients who underwent an initial SLN biopsy followed by a staged mastectomy with reconstruction. Tumors included high-grade carcinoma in situ (n = 4), infiltrating ductal carcinoma (n = 28), invasive lobular carcinoma (n = 4), mucinous carcinoma (n = 1), adenoid cystic carcinoma (n = 1), and mixed ductal and lobular carcinoma (n = 2). Tissue biopsy was obtained by either open (n = 9) or needle (n = 31) technique. Twenty-five patients had a negative SLN biopsy and a delayed total mastectomy with immediate reconstruction. Positive SLNs were identified in 15 patients (37%). Eight patients had macroscopic nodal metastases and underwent a delayed modified radical mastectomy and immediate reconstruction. Seven patients had microscopic nodal metastases and 3 declined further axillary dissection. They proceeded with total mastectomy and immediate reconstruction.
These data suggest that a substantial proportion of patients treated with SLN biopsy, simple mastectomy, and reconstruction will have positive sentinel lymph nodes. Thus, the ideal approach for patients who wish to have reconstruction should involve an initial SLN biopsy as a separate procedure. If the SLN is benign, the patient may undergo a total mastectomy with immediate reconstruction. However, a patient with a positive SLN may proceed to a modified radical mastectomy with immediate reconstruction. This treatment algorithm eliminates a potentially difficult reoperation on the axilla following reconstruction.</description><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Carcinoma, Ductal, Breast - pathology</subject><subject>Carcinoma, Ductal, Breast - surgery</subject><subject>Carcinoma, Intraductal, Noninfiltrating - pathology</subject><subject>Carcinoma, Intraductal, Noninfiltrating - surgery</subject><subject>Carcinoma, Lobular - pathology</subject><subject>Carcinoma, Lobular - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Immediate breast reconstruction</subject><subject>Lymphatic system</subject><subject>Mammaplasty</subject><subject>Mastectomy</subject><subject>Mastectomy, Modified Radical</subject><subject>Mastectomy, Radical</subject><subject>Mastectomy, Segmental</subject><subject>Medical sciences</subject><subject>Patients</subject><subject>Sentinel Lymph Node Biopsy</subject><subject>Surgery (general aspects). 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In patients who desire mastectomy with immediate reconstruction, the final pathologic results of the SLN may create unique problems. Specifically, if the SLN is found to be positive on final pathology, the reconstructed patient would generally require a potentially difficult re-operation on the remaining axillary nodes. The purpose of this study was to review the results of patients who underwent an initial SNL biopsy followed by a planned mastectomy and reconstruction.
A chart review of patients who underwent staged SLN biopsy with subsequent definitive procedure between 1997 and 2001 was conducted. These were evaluated with regard to type of tumor, status of sentinel node, and design of subsequent operation.
There were 40 patients who underwent an initial SLN biopsy followed by a staged mastectomy with reconstruction. Tumors included high-grade carcinoma in situ (n = 4), infiltrating ductal carcinoma (n = 28), invasive lobular carcinoma (n = 4), mucinous carcinoma (n = 1), adenoid cystic carcinoma (n = 1), and mixed ductal and lobular carcinoma (n = 2). Tissue biopsy was obtained by either open (n = 9) or needle (n = 31) technique. Twenty-five patients had a negative SLN biopsy and a delayed total mastectomy with immediate reconstruction. Positive SLNs were identified in 15 patients (37%). Eight patients had macroscopic nodal metastases and underwent a delayed modified radical mastectomy and immediate reconstruction. Seven patients had microscopic nodal metastases and 3 declined further axillary dissection. They proceeded with total mastectomy and immediate reconstruction.
These data suggest that a substantial proportion of patients treated with SLN biopsy, simple mastectomy, and reconstruction will have positive sentinel lymph nodes. Thus, the ideal approach for patients who wish to have reconstruction should involve an initial SLN biopsy as a separate procedure. If the SLN is benign, the patient may undergo a total mastectomy with immediate reconstruction. However, a patient with a positive SLN may proceed to a modified radical mastectomy with immediate reconstruction. This treatment algorithm eliminates a potentially difficult reoperation on the axilla following reconstruction.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>12559439</pmid><doi>10.1016/S0002-9610(02)01205-9</doi><tpages>4</tpages></addata></record> |
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| subjects | Biological and medical sciences Biopsy Breast cancer Breast Neoplasms - pathology Breast Neoplasms - surgery Carcinoma, Ductal, Breast - pathology Carcinoma, Ductal, Breast - surgery Carcinoma, Intraductal, Noninfiltrating - pathology Carcinoma, Intraductal, Noninfiltrating - surgery Carcinoma, Lobular - pathology Carcinoma, Lobular - surgery Female Humans Immediate breast reconstruction Lymphatic system Mammaplasty Mastectomy Mastectomy, Modified Radical Mastectomy, Radical Mastectomy, Segmental Medical sciences Patients Sentinel Lymph Node Biopsy Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the genital tract and mammary gland |
| title | Sentinel lymph node biopsy followed by delayed mastectomy and reconstruction |
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