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Can sentinel lymph node biopsy avoid axillary dissection in node negative breast cancer patients?
314 The Breast parameters examined (age, estrogen and/or progestorone receptor status, histologic grade, nuclear grade) showed a significant relationship to axillary failure, with a reasonable rate of local control in small tumors. Therefore, in these cases, wide excision without AD is a reasonable treatment, in order to avoid the arm morbidity of AD. On the basis of these results, a clinical trial including a breast-conserving surgical treatment arm without AD has been implemented in early breast cancer, cl.5 cm in size and with clinically negative nodes.
Can sentinel lymph node biopsy avoid axillary dissection in node negative breast cancer patients? S Zurrida, V Galimberti, P Veronesi, V Sacchini, G Mazzarol, B Bonanni, G Farante,G Andreoni, A Luini Istituto Europe0 di Oncologia, Via Ripamonti 435, Milano, Italy All patients at our Institute who undergo breast surgery and total axillary dissection for breast cancer of any size but with a clinically uninvolved axilla enter the study. The objectives are: (1) to identify the sentinel node which is first node to receive lymph from the tumor area by lymphoscintigraphy following injection of 99mTc-labeled human albumin subdermally overlying the tumor; (2) to mark the sentinel node thus identified by means of an indelible sign on the skin over the node; (3) to determine the feasibility of isolating this node surgically with the aid of a radioguided probe; and (4) to verify how often the node thus isolated is metastatic in comparison with involvement of the other removed nodes. In a consecutive series of 163 women with operable breast carcinoma, 9mTc was injected on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min and 3 h later. During breast surgery a hand-held gamma ray detector was used to locate the sentinel node, and facilitate its removal separately via a small axillary incision. Complete axillary lymphadenectomy was then performed. The sentinel node was tagged separately from all other nodes. Permanent sections of all removed nodes were prepared for pathological examination. The sentinel node accurately predicted axillary lymph node status in 156 (97.5%) of the 160 patients in whom a sentinel node was identified, and in all of the cases (45 patients) with tumor cl.5 cm in diameter. Of the 85 cases with metastatic axillary nodes, in 32 (37.6%) the only positive node was the sentinel node. In the great majority of patients lymphoscintigraphy and gamma probeguided surgery can locate the sentinel node in the axilla, obtaining important information on the status of axillary nodes. Breast cancer patients without clinical involvement of the axilla should undergo sentinel node biopsy routinely and may be spared complete axillary dissection when the sentinel node is free of disease.
Predictive value of the sentinel node biopsy in axillary staging of Tl-T2 breast cancer. A preliminary experience S Sandrucci,M Bell& S Danese,M Giai, R Giani, F Danese,G Bertuccio, B Greco, P Sorba,P Calderini, P Sismondi, G Giardina, A Bocci, G Bisi, A Mussa Turinese Sentinel Node Interdepartmental Study Group The low frequency of nodal metastases in the early stages of breast cancer (4% Tla, 28% Tic) makes the standard surgical axillary staging an overtreatment in such cases. Following the results already obtained in malignant melanoma, ‘sentinel node’ (SN), is being tried in breast cancer. From April 1996 to January 1997 37 patients affected by a Tl/T II (NO) breast cancer have been recruited for a multicentre study of the fast axil-
lary draining node (sentinel node) with a mammary lymphoscintigraphy performed with albumin microcolloid marked with 99mTc. 30 patients were evaluable. The protocol provided a perilesional injection of 99mTc labelled colloidal albumin (Nanocoll, 692 uCi on average in a 0.8 cc volume) followed by at least two gamma camera images. After a median delay of 18 f 4 hours patients were subjected to surgical intervention. The sentinel node (SN) was found with a handheld gamma probe (Gammed 2, Eurorad). Once found and excised, the surgical procedure went on according to standard protocols: quadrantectomy or simple mastectomy and axillary dissection of at least 10 nodes of the first level. In one case out of 30 lymphoscintigraphy was unsuccessful (3%); in 6 of 29 (20% 3 NO and 3 Nl) a SN was not localised. 23 SN out of 29 cases were found and excised (79.3%). The SN proved to be-predictive of axillary status in 19 of 23 (82.6%). In 2 cases the SN alone was metastatic (20% out of the Nl cases); in 4 cases the SN was reactive, but did not match with the axillary staging (4/23, 17% of false negatives). All cases with a false negative SN had only one metastatic node, out of an average of 19 removed nodes. The results obtained, although preliminary, appear promising; the totality of the experiences in Literature (a multicentric American study and an Italian study) is in fact characterised by a progressive improvement of results as the method refines. This study provides for a recruitment of at least 200 cases, the use of a more sensitive intraoperative probe and the optimisation of the colloid injecting method to obtain optimal tracer migration.
Long term results after breast conservative treatment. Analysis of 652 cases B Cutuli, M Velten, A Karst, D Jaeck,R Renaud, G Duperoux, JF Rodier Centre Paul Strauss, 3, Rue de la Porte de l’Hdpita1, 67085 Strasbourg Cedex, France and H6pitau.x Universitaires, 67091 Strasbourg Material: From January 1980 to December 1988, 652 women with TO-Tl-T2 I3 cm NO-N1 breast tumors were treated by breast conservative treatment (BCT). The median age was 51 years. 350 women were postmenopausal (54%). According to TNM classification, there were 93 TO (14.3%), 280 Tl (43%), 231 T2 (34.5%) and 48 TX (7.3%). The breast size was classified into three categories on the basis of a new dosimetric criterion. It was small in 12.2% of the cases, medium in 45.5% and large in 42.3%. TREATMENT: 161 and 491 patients respectively underwent quadrantectomy and lumpectomy, and 619 underwent axillary dissection (95%). All patients had whole breast irradiation by tangential fields with a median dose of 48 Gy by cobalt photons and a boost of 10 Gy with a direct electron field. Internal mammary chain and supraclavicular fossa were treated in central and inner turnours, or where there was axillary involvement. Adjuvant chemotherapy was given in 171 cases, generally 6 cycles of FAC/ FEC or CMF regimen. 420 women (64.4%) received hormonal treatments. HISTOLOGY: Ductal and lobular infiltrating carcinomas, DCIS and other types were found in 78.1%, 8.6%, 7.2% and 8.6% of the cases respectively. Excision was considered complete in 92.7%, doubtful in 1.6% and incomplete in 5.7%. An intraductal component (adjacent or distant) was found in 41% of the cases. Oestrogen and progesterone receptors were positive in 65% and 64% of cases respectively. Axillary involvement was found in 25% of the cases. RESULTS: With a median follow-up of 9 years, lo-year crude and specific survival rates are respectively 82% and 87%. According to T, loyear specific survival rates are respectively 93% and 85% for TO and Tl, T2 groups. According to pN, IO-year specific survival rates are 88% and 76% for pN0 and pN+groups.
Can sentinel lymph node biopsy avoid axillary dissection in node negative breast cancer patients? S Zurrida, V Galimberti, P Veronesi, V Sacchini, G Mazzarol, B Bonanni, G Farante,G Andreoni, A Luini Istituto Europe0 di Oncologia, Via Ripamonti 435, Milano, Italy All patients at our Institute who undergo breast surgery and total axillary dissection for breast cancer of any size but with a clinically uninvolved axilla enter the study. The objectives are: (1) to identify the sentinel node which is first node to receive lymph from the tumor area by lymphoscintigraphy following injection of 99mTc-labeled human albumin subdermally overlying the tumor; (2) to mark the sentinel node thus identified by means of an indelible sign on the skin over the node; (3) to determine the feasibility of isolating this node surgically with the aid of a radioguided probe; and (4) to verify how often the node thus isolated is metastatic in comparison with involvement of the other removed nodes. In a consecutive series of 163 women with operable breast carcinoma, 9mTc was injected on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min and 3 h later. During breast surgery a hand-held gamma ray detector was used to locate the sentinel node, and facilitate its removal separately via a small axillary incision. Complete axillary lymphadenectomy was then performed. The sentinel node was tagged separately from all other nodes. Permanent sections of all removed nodes were prepared for pathological examination. The sentinel node accurately predicted axillary lymph node status in 156 (97.5%) of the 160 patients in whom a sentinel node was identified, and in all of the cases (45 patients) with tumor cl.5 cm in diameter. Of the 85 cases with metastatic axillary nodes, in 32 (37.6%) the only positive node was the sentinel node. In the great majority of patients lymphoscintigraphy and gamma probeguided surgery can locate the sentinel node in the axilla, obtaining important information on the status of axillary nodes. Breast cancer patients without clinical involvement of the axilla should undergo sentinel node biopsy routinely and may be spared complete axillary dissection when the sentinel node is free of disease.
Predictive value of the sentinel node biopsy in axillary staging of Tl-T2 breast cancer. A preliminary experience S Sandrucci,M Bell& S Danese,M Giai, R Giani, F Danese,G Bertuccio, B Greco, P Sorba,P Calderini, P Sismondi, G Giardina, A Bocci, G Bisi, A Mussa Turinese Sentinel Node Interdepartmental Study Group The low frequency of nodal metastases in the early stages of breast cancer (4% Tla, 28% Tic) makes the standard surgical axillary staging an overtreatment in such cases. Following the results already obtained in malignant melanoma, ‘sentinel node’ (SN), is being tried in breast cancer. From April 1996 to January 1997 37 patients affected by a Tl/T II (NO) breast cancer have been recruited for a multicentre study of the fast axil-
lary draining node (sentinel node) with a mammary lymphoscintigraphy performed with albumin microcolloid marked with 99mTc. 30 patients were evaluable. The protocol provided a perilesional injection of 99mTc labelled colloidal albumin (Nanocoll, 692 uCi on average in a 0.8 cc volume) followed by at least two gamma camera images. After a median delay of 18 f 4 hours patients were subjected to surgical intervention. The sentinel node (SN) was found with a handheld gamma probe (Gammed 2, Eurorad). Once found and excised, the surgical procedure went on according to standard protocols: quadrantectomy or simple mastectomy and axillary dissection of at least 10 nodes of the first level. In one case out of 30 lymphoscintigraphy was unsuccessful (3%); in 6 of 29 (20% 3 NO and 3 Nl) a SN was not localised. 23 SN out of 29 cases were found and excised (79.3%). The SN proved to be-predictive of axillary status in 19 of 23 (82.6%). In 2 cases the SN alone was metastatic (20% out of the Nl cases); in 4 cases the SN was reactive, but did not match with the axillary staging (4/23, 17% of false negatives). All cases with a false negative SN had only one metastatic node, out of an average of 19 removed nodes. The results obtained, although preliminary, appear promising; the totality of the experiences in Literature (a multicentric American study and an Italian study) is in fact characterised by a progressive improvement of results as the method refines. This study provides for a recruitment of at least 200 cases, the use of a more sensitive intraoperative probe and the optimisation of the colloid injecting method to obtain optimal tracer migration.
Long term results after breast conservative treatment. Analysis of 652 cases B Cutuli, M Velten, A Karst, D Jaeck,R Renaud, G Duperoux, JF Rodier Centre Paul Strauss, 3, Rue de la Porte de l’Hdpita1, 67085 Strasbourg Cedex, France and H6pitau.x Universitaires, 67091 Strasbourg Material: From January 1980 to December 1988, 652 women with TO-Tl-T2 I3 cm NO-N1 breast tumors were treated by breast conservative treatment (BCT). The median age was 51 years. 350 women were postmenopausal (54%). According to TNM classification, there were 93 TO (14.3%), 280 Tl (43%), 231 T2 (34.5%) and 48 TX (7.3%). The breast size was classified into three categories on the basis of a new dosimetric criterion. It was small in 12.2% of the cases, medium in 45.5% and large in 42.3%. TREATMENT: 161 and 491 patients respectively underwent quadrantectomy and lumpectomy, and 619 underwent axillary dissection (95%). All patients had whole breast irradiation by tangential fields with a median dose of 48 Gy by cobalt photons and a boost of 10 Gy with a direct electron field. Internal mammary chain and supraclavicular fossa were treated in central and inner turnours, or where there was axillary involvement. Adjuvant chemotherapy was given in 171 cases, generally 6 cycles of FAC/ FEC or CMF regimen. 420 women (64.4%) received hormonal treatments. HISTOLOGY: Ductal and lobular infiltrating carcinomas, DCIS and other types were found in 78.1%, 8.6%, 7.2% and 8.6% of the cases respectively. Excision was considered complete in 92.7%, doubtful in 1.6% and incomplete in 5.7%. An intraductal component (adjacent or distant) was found in 41% of the cases. Oestrogen and progesterone receptors were positive in 65% and 64% of cases respectively. Axillary involvement was found in 25% of the cases. RESULTS: With a median follow-up of 9 years, lo-year crude and specific survival rates are respectively 82% and 87%. According to T, loyear specific survival rates are respectively 93% and 85% for TO and Tl, T2 groups. According to pN, IO-year specific survival rates are 88% and 76% for pN0 and pN+groups.