Ambulatory sentinel lymph node biopsy preceding neoadjuvant therapy in patients with operable breast cancer: a preliminary study

World Journal of Surgical Oncology

Kosei Hirakawa³  Seiichi Kitagawa¹  Masahiko Ohsawa²  Tsutomu Takashima³  Hidemi Kawajiri³  Satoru Noda³  Kento Kurata³  Yuka Asano³  Naoyoshi Onoda³  Shinichiro Kashiwagi³ 

[1] Department of Physiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan

关键词: False negative;    Sentinel lymph node biopsy;    Ambulatory surgical procedure;    Operation;    Breast cancer;   

Others  :  1131047
DOI  :  10.1186/s12957-015-0471-3

 received in 2014-09-01, accepted in 2015-01-17,  发布年份 2015

【 摘 要 】

Background

Sentinel lymph node biopsy (SNB)-oriented stepwise treatment under local anesthesia has been performed in the outpatient-ambulatory setting in patients receiving neoadjuvant therapy (NAT). We retrospectively reviewed our preliminary experience of ambulatory SNB in breast cancer patients scheduled to undergo NAT to evaluate the usefulness and feasibility of this method as a minimally invasive, stepwise treatment protocol.

Methods

We retrospectively identified 56 patients with breast cancer without obvious nodal involvement who were scheduled to receive NAT before breast surgery. SNB was performed under local anesthesia in an ambulatory outpatient setting before the initiation of NAT.

Results

The average number of removed sentinel lymph nodes was 1.9. Identification of the sentinel node was possible in all cases, and macrometastasis was observed in six cases (10.7%). Micrometastasis was observed in five cases, while isolated tumor cells were noted in six cases. There were no delays in the initiation of NAT as a result of complications of SNB.

Conclusions

This pilot study demonstrated the safety and feasibility of ambulatory SNB prior to NAT. Further studies are warranted to assess the strict indications, patient satisfaction, and medical economics of this procedure.

【 授权许可】

   
2015 Kashiwagi et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al.: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002, 347:1227-32.
• [2]Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al.: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002, 347:1233-41.
• [3]Schwartz GF, Giuliano AE, Veronesi U: Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast April 19 to 22, 2001, Philadelphia, Pennsylvania. Hum Pathol 2001, 2002(33):579-89.
• [4]Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al.: A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003, 349:546-53.
• [5]Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al.: Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 2006, 7:983-90.
• [6]Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B: Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 2001, 30:96-102.
• [7]Semiglazov VF, Semiglazov VV, Dashyan GA, Ziltsova EK, Ivanov VG, Bozhok AA, et al.: Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer. Cancer 2007, 110:244-54.
• [8]Nason KS, Anderson BO, Byrd DR, Dunnwald LK, Eary JF, Mankoff DA, et al.: Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 2000, 89:2187-94.
• [9]Cohen LF, Breslin TM, Kuerer HM, Ross MI, Hunt KK, Sahin AA: Identification and evaluation of axillary sentinel lymph nodes in patients with breast carcinoma treated with neoadjuvant chemotherapy. Am J Surg Pathol 2000, 24:1266-72.
• [10]Breslin TM, Cohen L, Sahin A, Fleming JB, Kuerer HM, Newman LA, et al.: Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol 2000, 18:3480-6.
• [11]Mamounas EP, Brown A, Anderson S, Smith R, Julian T, Miller B, et al.: Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2005, 23:2694-702.
• [12]Newman EA, Sabel MS, Nees AV, Schott A, Diehl KM, Cimmino VM, et al.: Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation. Ann Surg Oncol 2007, 14:2496-952.
• [13]Tausch C, Konstantiniuk P, Kugler F, Reitsamer R, Roka S, Pöstlberger S, et al.: Sentinel lymph node biopsy after preoperative chemotherapy for breast cancer: findings from the Austrian Sentinel Node Study Group. Ann Surg Oncol 2008, 15:3378-83.
• [14]Kashiwagi S, Onoda N, Takashima T, Asano Y, Aomatsu N, Nakamura M, et al.: Breast conserving surgery and sentinel lymph node biopsy under local anesthesia for breast cancer. J Cancer Ther 2012, 3:810-3.
• [15]Fenaroli P, Tondini C, Motta T, Virotta G, Personeni A: Axillary sentinel node biopsy under local anaesthesia in early breast cancer. Ann Oncol 2000, 11:1617-8.
• [16]Luini A, Gatti G, Frasson A, Naninato P, Magalotti C, Arnone P, et al.: Sentinel lymph node biopsy performed with local anesthesia in patients with early-stage breast carcinoma. Arch Surg 2002, 137:1157-60.
• [17]Smidt ML, Janssen CM, Barendregt WB, Wobbes T, Strobbe LJ: Sentinel lymph node biopsy performed under local anesthesia is feasible. Am J Surg 2004, 187:684-7.
• [18]Luini A, Caldarella P, Gatti G, Veronesi P, Vento AR, Naninato P, et al.: The sentinel node biopsy under local anesthesia in breast cancer: advantages and problems, how the technique influenced the activity of a breast surgery department; update from the European Institute of Oncology with more than 1000 cases. Breast 2007, 16:527-32.
• [19]van Berlo CL, Hess DA, Nijhuis PA, Leys E, Gerritsen HA, Schapers RF: Ambulatory sentinel node biopsy under local anaesthesia for patients with early breast cancer. Eur J Surg Oncol 2003, 29:383-5.
• [20]Athey N, Gilliam AD, Sinha P, Kurup VJ, Hennessey C, Leaper DJ: Day-case breast cancer axillary surgery. Ann R Coll Surg Engl 2005, 87:96-8.
• [21]Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al.: Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005, 366:2087-106.
• [22]Kim T, Giuliano AE, Lyman GH: Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006, 106:4-16.
• [23]Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al.: Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007, 8:881-8.
• [24]Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, et al.: American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005, 23:7703-20.
• [25]Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, 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.
• [26]McMasters KM, Tuttle TM, Carlson DJ, Brown CM, Noyes RD, Glaser RL, et al.: Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol 2000, 18:2560-6.
• [27]Lee A, Krishnamurthy S, Sahin A, Symmans WF, Hunt K, Sneige N: Intraoperative touch imprint of sentinel lymph nodes in breast carcinoma patients. Cancer 2002, 96:225-31.
• [28]Khanna R, Bhadani S, Khanna S, Pandey M, Kumar M: Touch imprint cytology evaluation of sentinel lymph node in breast cancer. World J Surg 2011, 35:1254-9.
• [29]Houvenaeghel G, Nos C, Mignotte H, Classe JM, Giard S, Rouanet P, et al.: Micrometastases in sentinel lymph node in a multicentric study: predictive factors of nonsentinel lymph node involvement–Groupe des Chirurgiens de la Federation des Centres de Lutte Contre le Cance. J Clin Oncol 2006, 24:1814-22.
• [30]Recht A, Pierce SM, Abner A, Vicini F, Osteen RT, Love SM, et al.: Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1991, 9:988-96.
• [31]Vicini FA, Horwitz EM, Lacerna MD, Brown DM, White J, Dmuchowski CF, et al.: The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 1997, 39:1069-76.
• [32]Motomura K, Inaji H, Komoike Y, Kasugai T, Nagumo S, Noguchi S, et al.: Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery. Br J Surg 2000, 87:597-601.
• [33]Llatjós M, Castellà E, Fraile M, Rull M, Julián FJ, Fusté F, et al.: Intraoperative assessment of sentinel lymph nodes in patients with breast carcinoma: accuracy of rapid imprint cytology compared with definitive histologic workup. Cancer 2002, 96:150-6.
• [34]Henry-Tillman RS, Korourian S, Rubio IT, Johnson AT, Mancino AT, Massol N, et al.: Intraoperative touch preparation for sentinel lymph node biopsy: a 4-year experience. Ann Surg Oncol 2002, 9:333-9.
• [35]Aihara T, Munakata S, Morino H, Takatsuka Y: Comparison of frozen section and touch imprint cytology for evaluation of sentinel lymph node metastasis in breast cancer. Ann Surg Oncol 2004, 11:747-50.
• [36]Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al.: Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 2013, 14:609-18.
• [37]Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al.: Alliance for Clinical Trials in Oncology: sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013, 310:1455-61.
• [38]Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, 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.