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Breast cancer. Sentinel nodes. Neos

T Reimer, A Stachs, V Nekljudova, S Loibl, S Hartmann, K Wolter, G Hildebrandt, B Gerber
Axillary lymph node status remains an important prognostic factor in early breast cancer. It is regarded as an indicator for (neo)adjuvant systemic treatment and postoperative radiotherapy of the regional lymphatics. Commenced in September 2015, the INSEMA trial is investigating whether operative determination of nodal status as part of breast conserving therapy (BCT) for early stage breast cancer (c/iT1-2 c/iN0) can be avoided without reducing oncological safety. After inclusion of 1001 patients there was general acceptance of the complex study design by patients and study doctors so that recruitment for the first randomisation (axillary sentinel lymph node biopsy [SLNB]: yes or no) achieved predicted case numbers...
February 2017: Geburtshilfe und Frauenheilkunde
C Nos, K B Clough, P Bonnier, S Lasry, G Le Bouedec, B Flipo, J-M Classe, M-C Missana, V Doridot, S Giard, H Charitansky, A Charles-Nelson, A-S Bats, C Ngo
BACKGROUND: Two thirds of node-positive breast cancer patients have limited pN1 disease and could benefit from a less extensive axillary lymph node dissection (ALND). METHODS: 172 breast cancers patients requiring an ALND were prospectively enrolled in the Sentibras Protocol of Axillary Reverse Mapping (ARM). Radioisotope was injected in the ipsilateral hand the day before surgery. ALND was standard. Removed lymph nodes were classified into non radioactive nodes and radioactive nodes (ARM nodes)...
December 2016: European Journal of Surgical Oncology
C Hennequin, I Barillot, D Azria, Y Belkacémi, M Bollet, B Chauvet, D Cowen, B Cutuli, A Fourquet, J M Hannoun-Lévi, M Leblanc, M A Mahé
In breast cancer, radiotherapy is an essential component of the treatment. After conservative surgery for an infiltrating carcinoma, radiotherapy must be systematically performed, regardless of the characteristics of the disease, because it decreases the rate of local recurrence and by this way, specific mortality. Partial breast irradiation could not be proposed routinely but only in very selected and informed patients. For ductal carcinoma in situ, adjuvant radiotherapy must be also systematically performed after lumpectomy...
September 2016: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
Anita Mamtani, Julie J Gonzalez, Dayna Neo, Priscilla J Slanetz, Mary Jane Houlihan, Christina I Herold, Abram Recht, Michele R Hacker, Ranjna Sharma
BACKGROUND: Nodal staging with sentinel node biopsy (SLNB), post-lumpectomy radiotherapy (RT), and endocrine therapy (ET) for estrogen receptor-positive (ER+) tumors is valuable in the treatment of early-stage (stages 1 or 2) breast cancer but used less often for elderly women. METHODS: This retrospective study investigated women referred for surgical evaluation of biopsy-proven primary early-stage invasive breast cancer from January 2001 to December 2010. Clinicopathologic features, treatment course, and outcomes for women ages 80-89 years and 50-59 years were compared...
October 2016: Annals of Surgical Oncology
Long Trinh, Kanae K Miyake, Frederick M Dirbas, Nishita Kothary, Kathleen C Horst, Jafi A Lipson, Catherine Carpenter, Atalie C Thompson, Debra M Ikeda
Resection of biopsy-proven involved axillary lymph nodes (iALNs) is important to reduce the false-negative rates of sentinel lymph node (SLN) biopsy after neo-adjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer. Preoperative wire localization for iALNs marked with clips placed during biopsy is a technique that may help the removal of iALNs after NAC. However, ultrasound (US)-guided localization is often difficult because the clips cannot always be reliably visible on US. Computed tomography (CT)-guided wire localization can be used; however, to date there have been no reports on CT-guided wire localization for iALNs...
July 2016: Breast Journal
Guusje Vugts, Adriana J G Maaskant-Braat, Grard A P Nieuwenhuijzen, Rudi M H Roumen, Ernest J T Luiten, Adri C Voogd
Neo-adjuvant chemotherapy (NAC) is used to facilitate radical surgery for initially irresectable or locally advanced breast cancer. The indication for NAC has been extended to clinically node negative (cN0) patients in whom adjuvant systemic therapy is foreseen. A population-based study was conducted to evaluate the increasing use of NAC, breast conserving surgery (BCS) after NAC and timing of the sentinel node biopsy (SNB). All female breast cancer patients, treated in 10 hospitals in the Eindhoven Cancer Registry area in the Netherlands between January 2003 and June 2012 were included (N = 18,427)...
May 2016: Breast Journal
B Pouw, D Hellingman, M Kieft, W V Vogel, K J van Os, E J T Rutgers, R A Valdés Olmos, M P M Stokkel
INTRODUCTION: Lymphoscintigraphy with planar imaging is considered a helpful tool to depict lymph node drainage in patients with invasive breast cancer. Single Photon Emission Computed Tomography with integrated CT (SPECT/CT) is usually performed to detect sentinel nodes (SN)s in breast cancer patients showing non-visualisation on lymphoscintigraphy. Incorporation of new SN indications (recurrent surgery, previous radiotherapy, or neo-adjuvant chemotherapy) has led to an increase of non-visualisation rates...
April 2016: European Journal of Surgical Oncology
Gaurav Agarwal, Sendhil Rajan, Sanjay Gambhir, Punita Lal, Narendra Krishnani, Subhash Kheruka
INTRODUCTION: Sentinel lymph node biopsy (SLNB) is the standard of care for staging N0 primary early breast cancers (EBC). Patients in developing countries mostly present with large (LOBC) or locally advanced cancers (LABC) and are treated with neo-adjuvant chemotherapy (NACT). Accuracy of SLNB in staging stage III N0 and post-NACT N0 patients is uncertain. This prospective validation study on LOBC/LABC patients compared the accuracy of SLNB between primary versus post-NACT surgery. MATERIALS AND METHODS: Fifty T3/T4, N0 patients undergoing primary surgery (Group I) and 70 LOBC/LABC (index stage) treated with NACT and N0 at the time of surgery (Group II) were inducted...
July 2016: World Journal of Surgery
Mangesh A Thorat
No abstract text is available yet for this article.
January 15, 2016: International Journal of Cancer. Journal International du Cancer
D K Patten, K E Zacharioudakis, H Chauhan, S J Cleator, D J Hadjiminas
The advent of sentinel lymph node biopsy has revolutionised surgical management of axillary nodal disease in patients with breast cancer. Patients undergoing neo-adjuvant chemotherapy for large breast primary tumours may experience complete pathological response on a previously positive sentinel node whilst not eliminating the tumour from the other lymph nodes. Results from 2 large prospective cohort studies investigating sentinel lymph node biopsy after neo-adjuvant chemotherapy demonstrate a combined false negative rate of 12...
August 2015: Breast: Official Journal of the European Society of Mastology
Melvin J Kilsdonk, Boukje Ac van Dijk, Renee Otter, Wim H van Harten, Sabine Siesling
BACKGROUND: Treatment variation is an important issue in health care provision. An external peer review programme for multidisciplinary cancer care was introduced in 1994 in the Netherlands to improve the multidisciplinary organisation of cancer care in hospitals.So far the clinical impact of external quality assessment programmes such as external peer review and accreditation remains unclear. Our objective was to examine the degree of variation in treatment patterns and the possible effect of external peer review for multidisciplinary cancer care for breast cancer patients...
2014: BMC Cancer
Rohan Khandelwal, C U Poovamma, Chauhan Shilpy, M Prema, Pais Anthony
INTRODUCTION: Axillary dissection is associated with a high incidence of lymphedema, which has been brought down with the introduction of sentinel lymph node biopsy (SLNB) in patients with early breast cancer. However, sentinel lymph node biopsy is not widely accepted in patients of locally advanced breast cancer (LABC) [T3N1, Any T4, Any N2-3 with no distant metastasis] after neo-adjuvant chemotherapy (NACT) and these patients routinely undergo axillary lymph node clearance. Axillary reverse mapping (ARM) with blue dye has the potential to differentiate the arm lymphatics from the breast lymphatics and it can be used to decrease lymphedema in patients undergoing ALND by preserving these lymphatics...
January 1, 2014: Breast Disease
Wolfgang Janni, Thorsten Kühn, Lukas Schwentner, Rolf Kreienberg, Tanja Fehm, Achim Wöckel
BACKGROUND: Increasing evidence suggests that surgical removal of the axillary lymph nodes (axillary dissection, ALD) in early breast cancer yields no advantage in terms of either overall or disease-free survival, even in women with involvement of sentinel nodes. The optimal role of sentinel node biopsy (SNB) in neo-adjuvant therapy is currently under discussion. METHOD: This review is based on a selective search in the Medline, EMBASE, Cochrane Library, and G.I...
April 4, 2014: Deutsches Ärzteblatt International
Paul D Gobardhan, Elisabeth G Klompenhouwer, Martinus A Beek, Adri C Voogd, Ernest J T Luiten
A considerable percentage of breast cancer patients who have undergone an axillary lymph node dissection (ALND) experience postoperative complications, with lymphoedema occurring most frequently. Axillary Reverse Mapping (ARM) is a new technique in which the lymphatic drainage system of the upper extremity can be visualized during an ALND. If lymphoedema is caused by severing of the lymphatic drainage system or removal of its associated lymph nodes, the preservation of these structures should reduce the incidence of lymphoedema...
2013: Nederlands Tijdschrift Voor Geneeskunde
Jennifer E Joh, Nicole N Esposito, John V Kiluk, Christine Laronga, Nazanin Khakpour, Hatem Soliman, M Catherine Lee
Neo-adjuvant chemotherapy is used for locally advanced breast cancer patients with significant variation in tumor response. Our objective is to determine the clinicopathologic effect of neo-adjuvant chemotherapy on invasive lobular carcinoma. A review of a single-institution data base of women diagnosed with breast cancer identified 30 patients from 1999 to 2009 with operable invasive lobular carcinoma who received neo-adjuvant chemotherapy. Patient demographics and clinicopathologic data were reviewed. Cases were reviewed by a single pathologist (NNE)...
November 2012: Breast Journal
Christina Van Onselen, Steven M Paul, Kathryn Lee, Laura Dunn, Bradley E Aouizerat, Claudia West, Marylin Dodd, Bruce Cooper, Christine Miaskowski
CONTEXT: Sleep disturbance is a problem for oncology patients. OBJECTIVES: To evaluate how sleep disturbance and daytime sleepiness (DS) changed from before to six months following surgery and whether certain characteristics predicted initial levels and/or the trajectories of these parameters. METHODS: Patients (n=396) were enrolled prior to surgery and completed monthly assessments for six months following surgery. The General Sleep Disturbance Scale was used to assess sleep disturbance and DS...
February 2013: Journal of Pain and Symptom Management
G Canavese, B Dozin, C Vecchio, D Tomei, G Villa, F Carli, L Del Mastro, A Levaggi, C Rossello, S Spinaci, P Bruzzi, A Catturich
BACKGROUND: Feasibility and accuracy of sentinel node biopsy (SLNB) after the delivery of neo-adjuvant chemotherapy (NAC) is controversial. We here report our experience in NAC-treated patients with locally advanced breast cancer and clinically positive axillary nodes, and compare it with the results from our previous randomized trial assessing SLNB in early-stage breast cancer patients. PATIENTS AND METHODS: Sixty-four consecutive patients with large infiltrating tumor and clinically positive axillary nodes received NAC and subsequent lymphatic mapping, SLNB and complete axillary lymph node dissection (ALND)...
August 2011: European Journal of Surgical Oncology
Srinivasamurthy Devaraj, Mohd Iqbal, Jill Donnelly, Allan P Corder
Preoperative axillary ultrasound (USS) and fine needle aspiration cytology (FNAC) may allow diagnosis of axillary metastases and reduce repeat axillary procedures. This procedure is usually performed by radiologists. The aim of this prospective study was to evaluate the diagnostic accuracy of surgeon performed axillary USS and/or FNAC in determining axillary nodal status preoperatively. Patients with invasive breast cancer from August 2007 to July 2008 were studied prospectively. Patients who had primary hormonal therapy, neo-adjuvant therapy or distant metastases were excluded...
March 2011: Breast Journal
Chintamani, Megha Tandon, Ashwani Mishra, Usha Agarwal, Sunita Saxena
BACKGROUND: Sentinel lymph node biopsy (SLNB) is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC) after neo-adjuvant chemotherapy (NACT) is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB) using "dye alone" (methylene blue) method in patients with LABC following NACT. MATERIALS AND METHODS: Thirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil) were subjected to SLNB (using methylene blue dye) followed by complete axillary lymph node dissection (levels I-III)...
2011: World Journal of Surgical Oncology
Virginia H Stell, Teresa S Flippo-Morton, H James Norton, Richard L White
The timing of sentinel node biopsy in the setting of neo-adjuvant chemotherapy for breast cancer is controversial. Sentinel node biopsy performed after neo-adjuvant chemotherapy may save patients with a nodal response the morbidity of an axillary lymph node dissection. A retrospective review of prospectively collected data compared sentinel node biopsies performed after patients had received neo-adjuvant chemotherapy with patients who had not received neo-adjuvant chemotherapy. Demographic factors, tumor characteristics, and the results of the sentinel node biopsies and completion lymph node dissections (when applicable) were compared...
January 2011: Breast Journal
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