Collective ReviewsSentinel node biopsy in breast cancer1☆,
Section snippets
Sentinel node concept
Sentinel node biopsy technique is based on the sentinel node concept: the tumor-bearing status of the first node in the regional nodal basin draining a primary tumor reflects the tumor status of the entire nodal basin. This concept was first proposed by Cabanas in 1977 for penile carcinoma.23 He noted that radioopaque material injected through the dorsal penile lymphatics in patients with penile carcinoma consistently flowed to a specific draining lymph basin. Subsequently he performed 46 blind
Feasibility trials of breast sentinel node biopsy
The success of SNB in accurately identifying nodal involvement in melanoma stirred interest in applying this technique in breast cancer where identification of nodal metastases also has prognostic significance. But the technique of SNB may not be the same in breast cancer (a parenchymal tumor) because the kinetics of lymphatic flow and the distribution of lymphatic pathways may be different from melanoma (a cutaneous tumor). With any introduction of a new technique into the clinical setting,
Validation studies of sentinel node biopsy in breast cancer
The results of our feasibility trial enabled us to define the optimal technique and patient population for SNB. Three of the 5 false-negative SNBs were related to misidentification of blue-stained fat as a sentinel lymph node. Introduction of frozen section analysis on the sentinel node prevented this problem in subsequent patients. In our feasibility study, sentinel nodes were only examined by hematoxylin and eosin (H&E) staining. One of the sentinel nodes that was negative for metastases on
Patient selection
Selection of appropriate patients is the first step to successful and rational application of SNB in breast cancer management. Ideal SNB patients are those with low probability of harboring axillary metastases, but in whom the presence of axillary nodal involvement would change adjuvant systemic therapy, ie, patients with small primary tumors. There are no absolute contraindications for SNB except patients with a history of hypersensitivity reaction to the lymphatic mapping materials. Patients
Discussion
The introduction of intraoperative lymphatic mapping and sentinel node biopsy may alter the current surgical management of patients with invasive breast cancer. For patients with small primary tumors, an accurate and minimally morbid axillary staging tool like SNB is especially invaluable. Although the likelihood of axillary metastasis in a patient with a small lesion is low,58, 59, 60, 61 the tumor status of the axilla is frequently the deciding factor for the need and type of adjuvant
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Cited by (58)
Assessment and designation of breast cancer stage
2018, The Breast: Comprehensive Management of Benign and Malignant DiseasesThe inextricable axis of targeted diagnostic imaging and therapy: An immunological natural history approach
2016, Nuclear Medicine and BiologyCitation Excerpt :In the preceding 25 years there has evolved a confluence of tumor biology ideology, nuclear medicine and surgical oncology that has led to the development of the theory of the “sentinel node” [1–5]. Data accrued over the intervening years have provided a confirmation of the sentinel node theory as it relates to the incorporation of sentinel lymph node detection/biopsy in breast cancer and melanoma patient outcome in surgical practice [6–14]. Sentinel node theory holds that there is a predictable anatomical relationship between the immediate tumor environment and the proximate lymphatic system such that assessment of this nexus can provide a reliable appraisal of the nodal disease stage and reduce or eliminate the need for expanded surgery as this relates to lymphadenectomy, and be equally predictive of nodal status with similar outcomes with regard to any such expatiated surgery [15–24].
The effect of internal mammary lymph node biopsy on the therapeutic decision and survival of patients with breast cancer
2015, European Journal of Surgical OncologyCitation Excerpt :In contrast to the high success rate of IMLNB, the lymphatic flow by lymphoscintigraphy to the extra-axillary lymph nodes were low in different series, ranging from 0% to 37%.4–9 Over the last two decades, visualization of internal mammary lymph nodes by preoperative lymphoscintigraphy has attracted attention again, most recently to the internal mammary chain.1–3 The increase in evaluation of IMLNs required change in the American Joint Committee on Cancer (AJCC) staging system.10
Extent and Multicentricity of in Situ and Invasive Carcinoma
2009, The Breast: Comprehensive Management of Benign and Malignant DiseasesAlternative Breast-Imaging Approaches
2007, Radiologic Clinics of North AmericaCitation Excerpt :Various techniques have been investigated with this nuclear medicine approach, all using technetium-99m tracers that can be imaged in terms of their pattern of spread or simply detected manually by gamma-probes in the axilla. Injection into the peritumoral site, the subdermis, or the subareolar complex produces satisfactory results, consequent to the development of the lymphatic system [55]. In addition, different tracers have been studied with variable success, including sulfur colloid (filtered and ultrafiltered), human serum albumin colloid, dextran 40, microlite, and cardiolite, as well as combinations of isosulfan blue and technetium radiotracers.
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Supported in part by funding from the Ben B. and Joyce E. Eisenberg Foundation, Los Angeles, CA, and the Fashion Footwear Association of New York.
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No competing interests declared.