Prediction capability of axillary nodal status by five node sampling in early invasive breast cancer
DOI:
https://doi.org/10.18203/2349-2902.isj20160212Keywords:
Breast cancer, Five node sampling, Sentinel node biopsy, Axillary samplingAbstract
Background: Management of axilla in early breast cancer is controversial with options being sentinel lymph node biopsy (SLNB), axillary sampling and axillary dissection. In our study we explored the possibilities of 5-node sampling as an alternative or adjunct to SLNB in early invasive breast cancer.
Methods: We did an observational study of the 45 patients, who underwent modified radical mastectomy and compared the initial 5-nodes pathology with standard axillary dissection in the excised breast tissue specimen.
Results: Out of 45 patients, first 5-nodes were found positive in 25 cases. In 8 cases only initial 5-nodes were involved. Sensitivity improved with increasing number of nodes examined in 5-node biopsy, approaching 100% with 5 nodes examined. In all pathological negative axilla, 5-node pathology was also negative.
Conclusions: Five node sampling of axilla has a comparable sensitivity and false negative rate as SLNB. It fairly represents axillary nodal status and could be a good adjunct to SLNB for further increasing accuracy of later. It can also be an alternative to SLNB in situation where lack of feasibility to perform it as in many developing countries. We also recommend further study directly comparing five-node sampling and SLNB in future.
References
Ferlay JSH, Bray F, Forman D, Mathers C, Parkin DM. Globocan. Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10. 2008;2. Available from: http://globocan.iarc.fr.
Clark GM. Prognostic and predictive factors. In Harris J, Lippman M, Morrow M, Hellman S, eds. Diseases of the breast. Philadephia, Lippincott-Raven Publishers. 1996:461-85.
Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT. Assessment of morbidity from complete axillary dissection. Br J Cancer. 1992;66:136-8.
Giuliano AE, Kirgan DM, Guenther JM, Mort on DL. Lymphatic mapping and sentinel lymph adenectomy for breast cancer. Ann Surg. 1994;220:391-401.
Veronesi U, Paganelli G, Galimbert IV, Viale G, Bedoni M. Sentinel lymph node biopsy to avoid axillary dissection in breast cancer with clinically negative nodes. Lancet. 1997;349:1864-7.
Forrest AP, Stewart HJ, Robert MM. Simple mastectomy and axillary node sampling in management of primary breast cancer. Ann Surg. 1982;196:371-7.
Veronesi, U, Paganelli G, Viale G, Galimberti V, Luini A, Zurrida S et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst.1999;91:368-73.
Frisell J, Bergqvist L, Liljegren G, Thorn M, Damm S, Rydman H et al. Sentinel node in breast cancer- a Swedish pilot study of 75 patients. Eur J Surg. 2001;167:179-83.
Bassi KK, Seenu V, Srivastava A, Al Sharara N. Role of axillary sampling in the era of sentinel lymph node biopsy: A critical review. Indian J Cancer. 2012;49:66-73.
Steele R, Forrest A, Gibson T, Stewart H, Chetty U. The Efficacy of Lower Axillary Sampling in Obtaining Lymph Node Status in Breast cancer: A Controlled Randomized Trial. Br J Surg. 1985;72:368-9.
Frisell J, Bergqvist L, Liljegren G, Thorn M, Damm S, Rydman H et al. Sentinel node in breast cancer--a Swedish pilot study of 75 patients. Eur J Surg. 2001;167:179-83.
Macmillan RD, Barbera D, Hadjiminas DJ, Rampaul RS, Lee AH, Pinder SE. Sentinel Node biopsy for breast cancer may have little to offer four-node-samplers. results of a prospective comparison study. Eur J Cancer. 2001;37:1076-80.
Sato K, Tamaki K, Takeuchi H, Tsuda H, Kosuda S, Kusano S. Management of the axilla in breast cancer: A comparative study between sentinel lymph node biopsy and four-node sampling procedure. Jpn J Clin Oncol. 2001;31:318-21.
Frisell, J, Bergqvist L, Liljegren G, Thorn M, Damm S, Rydman H. Sentinel node in breast cancer--a Swedish pilot study of 75 patients. Eur J Surg. 2001;167:179-83.
Dowlatshahi, K, Fan M, Snider HC, Habib FA. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer. 1997;80:1188-97.
Fisher B, Redmond C, Fisher ER, Bauer M, Wolmark N, Wickerham D et al. Ten Year Results of a Randomized Clinical Trial Comparing Radical Mastectomy and Total Mastectomy With or Without Radiation. N Engl J Med. 1985;312:674-81.
Goldhirsch, A, Glick JH, Gelber RD, Coates AS, Senn HJ. Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer. J Clin Oncol. 2001;19:3817-27.
Chetty U, Jack W, Prescott RJ, Tyler C, Rodger A. Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial. Edinburgh Breast Unit. Br J Surg. 2000;87:163-9.
Larson, D, Weinstein M, Goldberg I. Edema of the Arm as a Function of the Extent of Axillary Surgery in patients With Stage I-II Carcinoma of the Breast treated With Primary Radiotherapy. Int J Radiat Oncol Biol Phys. 1986;12:1575-82.
Christensen BS, Lundgren E. Sequelae of Axillary Dissection vs Axillary Sampling With or Without Irradiation for Breast Cancer. Acta Chir Scand. 1989;155:515-20.
Fisher B, Redmon dC, Fisher ER, Bauer M, Wol mark N, Wickerham DL. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med. 1985;312:674-81.
Benson JR, Della Rovere GQ. Axilla Management Consensus Group. Management of the axilla in women with breast cancer. Lancet Oncol. 2007;8:331-48.
