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  • 1
    Digitale Medien
    Digitale Medien
    Is Routine Intraoperative Frozen-Section Examination of Sentinel Lymph Nodes in Breast Cancer Worthwhile? (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 651-655 
    Details
    ISSN: 1534-4681
    Schlagwort(e): Sentinel lymph nodes ; Frozen section ; Macrometastases ; Micrometastases
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background: Routine intraoperative frozen section (FS) of sentinel lymph nodes (SLN) can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation. Routine FS is also costly, increases operative time, and is subject to false-negative results. We examined the benefit of routine intraoperative FS among the first 1000 patients at Memorial Sloan Kettering Cancer Center who had SLN biopsy for breast cancer. Methods: We performed SLN biopsy with intraoperative FS in 890 consecutive breast cancer patients, none of whom had a back-up axillary dissection planned in advance. Serial sections and immunohistochemical staining for cytokeratins were performed on all SLN that proved negative on FS. The sensitivity of FS was determined as a function of (1) tumor size and (2) volume of metastatic disease in the SLN, and the benefit of FS was defined as the avoidance of a reoperative axillary dissection. Results: The sensitivity of FS ranged from 40% for patients with T1a to 76% for patients with T2 cancers. The volume of SLN metastasis was highly correlated with tumor size, and FS was far more effective in detecting macrometastatic disease (sensitivity 92%) than micrometastases (sensitivity 17%). The benefit of FS in avoiding reoperative axillary dissection ranged from 4% for T1a (6 of 143) to 38% for T2 (45 of 119) cancers. Conclusions: In breast cancer patients having SLN biopsy, the failure of routine intraoperative FS is largely the failure to detect micrometastatic disease. The benefit of routine intraoperative FS increases with tumor size. Routine FS may not be indicated in patients with the smallest invasive cancers.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s10434-000-0651-3
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  • 2
    Digitale Medien
    Digitale Medien
    Internal mammary node status: A major prognosticator in axillary node-negative breast cancer (1995)
    Springer
    Annals of surgical oncology 2 (1995), S. 32-37 
    Details
    ISSN: 1534-4681
    Schlagwort(e): Breast cancer ; Metastasis, internal mammary and axillary ; Prognosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background: The internal mammary lymph nodes (IMN) have received little attention in recent years, yet are a well-documented site of metastasis and a major prognostic factor in early-stage breast cancer. Methods/Results: Ten-year follow-up of the final 195 patients treated by extended radical mastectomy (ERM) in this practice (selected largely on the basis of medial tumor location, and comprising 15% of all patients treated from 1965 to 1978) found IMN + in 24% of all cases: 36% of AX + versus 18% of AX -patients (p=0.0023). In a multivariate analysis, the disease-free survival impact of IMN + (p=0.004) was second only to axillary node involvement (p〈0.0005), and surpassed tumor size (p=0.077). IMN + was equally frequent for tumors less than, or greater than, 2 cm (24%), and was not significantly related to patient age. Among AX - patients, there was a twofold greater risk of recurrence or death at 10 years for IMN + than for IMN -. Among T1N0 patients, 19.6% were IMN +. Conclusions: Failure to consider IMN status in the steadily enlarging cohort of T1N0 breast cancers may result in the undertreatment of a significant proportion of stage I patients. Systemic adjuvant therapy should be considered for T1N0 patients with central or medial tumors.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02303699
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  • 3
    Digitale Medien
    Digitale Medien
    Sentinel Lymph Node Biopsy: Is It Indicated in Patients With High-Risk Ductal Carcinoma-In-Situ and Ductal Carcinoma-In-Situ With Microinvasion? (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 636-642 
    Details
    ISSN: 1534-4681
    Schlagwort(e): Breast carcinoma ; Ductal carcinoma-in-situ ; Microinvasion ; Sentinel lymph node biopsy ; Intraductal carcinoma ; Micrometastases
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background: Axillary lymph node status is the strongest prognostic indicator of survival for women with breast cancer. The purpose of this study was to determine the incidence of sentinel node metastases in patients with high-risk ductal carcinoma-in-situ (DCIS) and DCIS with microinvasion (DCISM). Methods: From November 1997 to November 1999, all patients who underwent sentinel node biopsy for high-risk DCIS (n = 76) or DCISM (n = 31) were enrolled prospectively in our database. Patients with DCIS were considered high risk and were selected for sentinel lymph node biopsy if there was concern that an invasive component would be identified in the specimen obtained during the definitive surgery. Patients underwent intraoperative mapping that used both blue dye and radionuclide. Excised sentinel nodes were serially sectioned and were examined by hematoxylin and eosin and by immunohistochemistry. Results: Of 76 patients with high-risk DCIS, 9 (12%) had positive sentinel nodes; 7 of 9 patients were positive for micrometastases only. Of 31 patients with DCISM, 3 (10%) had positive sentinel nodes; 2 of 3 were positive for micrometastases only. Six of nine patients with DCIS and three of three with DCISM and positive sentinel nodes had completion axillary dissection; one patient with DCIS had an additional positive node detected by conventional histological analysis. Conclusions: This study documents a high incidence of lymph node micrometastases as detected by sentinel node biopsy in patients with high-risk DCIS and DCISM. Although the biological significance of breast cancer micrometastases remains unclear at this time, these findings suggest that sentinel node biopsy should be considered in patients with high-risk DCIS and DCISM.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s10434-000-0636-2
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