Cancer Research and Treatment

Original Articles

Breast cancer

Retrospective Cohort Study on the Long-term Oncologic Outcomes of Sentinel Lymph Node Mapping Methods (Dye-Only versus Dye and Radioisotope Mapping) in Early Breast Cancer: A Propensity Score-Matched Analysis: Changjin Lim, Eunhye Kang, Ji Gwang Jung, Jong-Ho Cheun, Hong-Kyu Kim, Han-Byoel Lee, Hyeong-Gon Moon, Wonshik Han; Cancer Res Treat. 2023;55(2):562-569. Published online September 26, 2022; DOI: https://doi.org/10.4143/crt.2022.871

Abstract PDF PubReader ePub: Purpose
In sentinel lymph node (SLN) biopsy (SLNB) during breast cancer surgery, SLN mapping using dye and isotope (DUAL) may have lower false-negative rates than the dye-only (DYE) method. However, the long-term outcomes of either method are unclear. We aimed to compare long-term oncological outcomes of DYE and DUAL for SLNB in early breast cancer.
Materials and Methods
This retrospective single-institution cohort study included 5,795 patients (DYE, 2,323; DUAL, 3,472) with clinically node-negative breast cancer who underwent SLNB and no neoadjuvant therapy. Indigo carmine was used for the dye method and Tc99m-antimony trisulfate for the isotope. To compare long-term outcomes, pathologic N0 patients were selected from both groups, and propensity score matching (PSM), considering age, pT category, breast surgery, and adjuvant treatment, was performed (1,441 patients in each group).
Results
The median follow-up duration was 8.7 years. The median number of harvested sentinel nodes was 3.21 and 3.12 in the DYE and DUAL groups, respectively (p=0.112). The lymph node–positive rate was not significantly different between the two groups in subgroups of similar tumor sizes (p > 0.05). Multivariate logistic regression revealed that the mapping method was not significantly associated with the lymph node–positive rate (p=0.758). After PSM, the 5-year axillary recurrence rate (DYE 0.8% vs. DUAL 0.6%, p=0.096), and 5-year disease-free survival (DYE 93.9% vs. DUAL 93.7%, p=0.402) were similar between the two groups.
Conclusion
Dye alone for SLNB was not inferior to dual mapping regarding long-term oncological outcomes in early breast cancer.

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Axillary Lymph Node Dissection Does Not Improve Post-mastectomy Overall or Disease-Free Survival among Breast Cancer Patients with 1-3 Positive Nodes: Ji Hyeon Joo, Su Ssan Kim, Byung Ho Son, Seung Do Ahn, Jin Hong Jung, Eun Kyung Choi, Sei Hyun Ahn, Jong Won Lee, Hee Jeong Kim, Beom Seok Ko; Cancer Res Treat. 2019;51(3):1011-1021. Published online October 16, 2018; DOI: https://doi.org/10.4143/crt.2018.438

Abstract PDF Supplementary Material PubReader ePub

Purpose
Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs.
Materials and Methods
A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method.
Results
Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months.
Conclusion
ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.

Citations

Citations to this article as recorded by

The Impact of Sentinel Lymph Node Biopsy on Female Patients With T3-4c Breast Cancer and 1-2 Positive Lymph Nodes: A Population-Based Cohort Study
Hanzhao Yang, Yadong Sun, Peili Wang, Jianghua Qiao, Chengzheng Wang, Zhenzhen Liu
Clinical Breast Cancer.2024; 24(3): e126. CrossRef
Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis
Changzai Li, Pan Zhang, Jie Lv, Wei Dong, Baoshan Hu, Jinji Zhang, Hongcheng Zhu
Frontiers in Oncology.2024;[Epub] CrossRef
Reevaluating Axillary Lymph Node Dissection in Total Mastectomy for Low Axillary Burden Breast Cancer: Insights from a Meta-Analysis including the SINODAR-ONE Trial
Munaser Alamoodi, Neill Patani, Kinan Mokbel, Umar Wazir, Kefah Mokbel
Cancers.2024; 16(4): 742. CrossRef
RecurIndex-Guided postoperative radiotherapy with or without Avoidance of Irradiation of regional Nodes in 1–3 node-positive breast cancer (RIGAIN): a study protocol for a multicentre, open-label, randomised controlled prospective, phase III trial
Jing Liu, Yuting Tan, Zhuofei Bi, Suning Huang, Na Zhang, An-du Zhang, Lina Zhao, Yu Wang, Zibin Liang, Yu Hou, Xiangying Xu, Jianying Chen, Fei Wang, Xiaowen Lan, Xiao Lin, Xiaoxue Zhang, Wenyi Zhou, Xuting Ye, Jian-gui Guo, Xiaohong Wang, Ran Ding, Jiay
BMJ Open.2024; 14(7): e078049. CrossRef
The prognostic analysis of further axillary dissection in breast cancer with 1-2 positive sentinel lymph nodes undergoing mastectomy
Xueyi Zhao, Liu Yang, Congbo Cao, Zhenchuan Song
Frontiers in Oncology.2024;[Epub] CrossRef
Sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients undergoing mastectomy
Damiano GENTILE, Corrado TINTERRI
Minerva Surgery.2024;[Epub] CrossRef
Can Axillary Lymph Node Dissection be Omitted in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes Undergoing Mastectomy? A Systematic Review and Meta‐Analysis of Real‐World Evidence
Fulong Chen, Xiaowen Li, Xianjun Lin, Lijia Chen, Zhaoling Lin, Hao Wu, Jishang Chen
World Journal of Surgery.2023; 47(10): 2446. CrossRef
De-implementation of Axillary Dissection in Women Undergoing Mastectomy for Breast Cancer
Laura D. Leonard, Thiago B. de Araujo, Christopher Quinn, Madeline B. Thomas, Laurel Beaty, Nicole M. Mott, Kathryn Colborn, Alicia A. Heelan, Sarah E. A. Tevis, Nicole Christian, Gretchen Arhendt, Ana L. Gleisner
Annals of Surgical Oncology.2023; 30(9): 5692. CrossRef
A multi-dimensional nomogram to predict non-sentinel lymph node metastases in T1–2HR+ breast cancer
Ke Xiang, Jialin Chen, Yu Min, Hang Chen, Jiaxin Yang, Daixing Hu, Yuling Han, Guobing Yin, Yang Feng
Frontiers in Endocrinology.2023;[Epub] CrossRef
Sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients undergoing mastectomy with one to two metastatic sentinel lymph nodes: sub-analysis of the SINODAR-ONE multicentre randomized clinical trial and reopening of enrolm
Corrado Tinterri, Giuseppe Canavese, Wolfgang Gatzemeier, Erika Barbieri, Alberto Bottini, Andrea Sagona, Giulia Caraceni, Alberto Testori, Simone Di Maria Grimaldi, Carla Dani, Luca Boni, Paolo Bruzzi, Bethania Fernandes, Marta Scorsetti, Alberto Zambell
British Journal of Surgery.2023; 110(9): 1143. CrossRef
Efficacy and safety comparison between axillary lymph node dissection with no axillary surgery in patients with sentinel node-positive breast cancer: a systematic review and meta-analysis
Yu-Jia Fan, Jin-Cheng Li, De-Miao Zhu, Hai-Long Zhu, Yi Zhao, Xin-Bing Zhu, Gang Wu, Ting-ting Bai
BMC Surgery.2023;[Epub] CrossRef
Factores predictivos de metástasis en ganglios no centinela en el cáncer de mama con ganglio centinela positivo
Mariana Peyroteo, Rita Canotilho, Ana Margarida Correia, Catarina Baía, Cátia Ribeiro, Paulo Reis, Abreu de Sousa
Cirugía Española.2022; 100(2): 81. CrossRef
Optimizing Axillary Management in Clinical T1-2N0 Mastectomy Patients with Positive Sentinel Lymph Nodes
Olga Kantor, Jessica Means, Samantha Grossmith, Tanujit Dey, Jennifer R. Bellon, Elizabeth A. Mittendorf, Tari A. King
Annals of Surgical Oncology.2022; 29(2): 972. CrossRef
Predictive factors of non-sentinel lymph node disease in breast cancer patients with positive sentinel lymph node
Mariana Peyroteo, Rita Canotilho, Ana Margarida Correia, Catarina Baía, Cátia Ribeiro, Paulo Reis, Abreu de Sousa
Cirugía Española (English Edition).2022; 100(2): 81. CrossRef
Axilla lymph node dissection can be safely omitted in patients with 1–2 positive sentinel nodes receiving mastectomy: a large multi-institutional study and a systemic meta-analysis
Weiqi Gao, Shuangshuang Lu, Yufei Zeng, Xiaosong Chen, Kunwei Shen
Breast Cancer Research and Treatment.2022; 196(1): 129. CrossRef
Comparison of survival outcomes between axillary conservation and axillary lymph node dissections in N1 early breast cancer: a propensity-matched SEER analysis
Nisha Wu, Xiaohan Su, Qiao Tan, Jing Luo, Yewei Yuan, Lingmi Hou, Junyan Li
Clinical and Translational Oncology.2022; 25(4): 1091. CrossRef
Surgeon Bias in the Management of Positive Sentinel Lymph Nodes
Brittany J. Mathias, James Sun, Weihong Sun, Jun-Min Zhou, William J. Fulp, Christine Laronga, M. Catherine Lee, John V. Kiluk
Clinical Breast Cancer.2021; 21(1): 74. CrossRef
Impact of Axillary Dissection Among Patients With Sentinel Node–Positive Breast Cancer Undergoing Mastectomy
James Sun, Brittany J. Mathias, Christine Laronga, Weihong Sun, Jun-Min Zhou, William J. Fulp, John V. Kiluk, M. Catherine Lee
Journal of the National Comprehensive Cancer Network.2021; 19(1): 40. CrossRef
Evolution of the Use of Completion Axillary Lymph Node Dissection in Patients with T1/2N0M0 Breast Cancer and Tumour-Involved Sentinel Lymph Nodes Undergoing Mastectomy: A Cohort Study
André Hennigs, Fabian Riedel, Manuel Feißt, Melitta Köpke, Mahdi Rezai, Ulrike Nitz, Mareike Moderow, Michael Golatta, Christof Sohn, Jörg Heil
Annals of Surgical Oncology.2019; 26(8): 2435. CrossRef

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Feasibility of Charcoal Tattooing of Cytology-Proven Metastatic Axillary Lymph Node at Diagnosis and Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients: Seho Park, Ja Seung Koo, Gun Min Kim, Joohyuk Sohn, Seung Il Kim, Young Up Cho, Byeong-Woo Park, Vivian Youngjean Park, Jung Hyun Yoon, Hee Jung Moon, Min Jung Kim, Eun-Kyung Kim; Cancer Res Treat. 2018;50(3):801-812. Published online August 17, 2017; DOI: https://doi.org/10.4143/crt.2017.210

Abstract PDF PubReader ePub

Purpose
Sentinel lymph node biopsy (SLNB) can be performed when node-positive disease is converted to node-negative status after neoadjuvant chemotherapy (NCT). Tattooing nodes might improve accuracy but supportive data are limited. This study aimed to investigate the feasibility of charcoal tattooing metastatic axillary lymph node (ALN) at presentation followed by SLNB after NCT in breast cancers.
Materials and Methods
Twenty patientswith cytology-proven node metastases prospectively underwent charcoal tattooing at diagnosis. SLNB using dual tracers and axillary surgery after NCT were then performed. The detection rate of tattooed node and diagnostic performance of SLNB were analyzed.
Results
All patients underwent charcoal tattooingwithout significant morbidity. Sentinel and tattooed nodes could be detected during surgery after NCT. Nodal pathologic complete response was achieved in 10 patients. Overall sensitivity, false-negative rate (FNR), negative predictive value, and accuracy of hot/blue SLNB were 80.0%, 20.0%, 83.3%, and 90.0%, respectively. Retrieving more nodes and favorable nodal response were associated with improved performance. The best accuracy was observed when excised tattooed node was calculated together (FNR, 0.0%). Cold/non-blue tattooed nodes of five patients were removed during non-sentinel axillary surgery but clinicopathological parameters did not differ compared to patients with hot/blue tattooed node detected during SLNB, suggesting the importance of the tattooing procedure itself to improve performance.
Conclusion
Charcoal tattooing of cytology-confirmed metastatic ALN at presentation is technically feasible and does not limit SLNB after NCT. The tattooing procedure without additional preoperative localization is advantageous for improving the diagnostic performance of SLNB in this setting.

Citations

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Prospective Evaluation of the Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Negative Axillary Conversion after Neoadjuvant Chemotherapy: Hy-De Lee, Sung Gwe Ahn, Seung Ah Lee, Hak Min Lee, Joon Jeong; Cancer Res Treat. 2015;47(1):26-33. Published online August 29, 2014; DOI: https://doi.org/10.4143/crt.2013.208

Abstract PDF PubReader ePub

Purpose
Tumor response to neoadjuvant chemotherapy (NAC) may adversely affect the identification and accuracy rate of sentinel lymph node biopsy (SLNB). This study was conducted to evaluate the feasibility of SLNB in node-positive breast cancer patients with negative axillary conversion after NAC. Materials and Methods Ninety-six patients with positive nodes at presentation were prospectively enrolled. 18Fluorodeoxyglucose-positron emission tomography (18F-FDG PET) and ultrasonography were performed before and after NAC. A metastatic axillary lymph node was defined as positive if it was positive upon both 18F-FDG PET and ultrasonography, while it was considered negative if it was negative upon both 18F-FDG PET and ultrasonography. Results After NAC, 55 cases (57.3%) became clinically node-negative, while 41 cases (42.7%) remained node-positive. In the entire cohort, the sentinel lymph node (SLN) identification and false-negative rates were 84.3% (81/96) and 18.4% (9/49), respectively. In the negative axillary conversion group, the results of SLNB showed an 85.7% (48/55) identification rate and 16.7% (4/24) false-negative rate. Conclusion For breast cancer patients with clinically positive nodes at presentation, it is difficult to conclude whether the SLN accurately represents the metastatic status of all axillary lymph nodes, even after clinically negative node conversion following NAC.

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