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No Axillary Disease Recurrences After Sentinel Lymph Node Biopsy.

SAN ANTONIO -- Intermediate-term follow-up of breast cancer patients managed via sentinel lymph node biopsy showed an encouraging absence of axillary disease recurrences in a large patient series.

This finding strongly suggests that breast cancer lymphatic mapping via the sentinel lymph node biopsy (SLNB) technique is a sensitive method for detecting nodal metastases. The 971 patients in the study, who were followed for a mean of 25 months, were spared complete axillary node dissection because of a negative sentinel node, Dr. Sophie Dessureault reported at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

The advantage of this minimally invasive technique is that it identifies women who don't need complete axillary lymph node dissection for local control of their cancer. They can thus be spared a costly procedure involving substantial long-term morbidity, said Dr. Dessureault of the H. Lee Moffitt Cancer Center at the University of South Florida, Tampa.

In a separate presentation, Dr. Jose-Luis B. Bevilacqua reported that the SLNB experience at Memorial Sloan-Kettering Cancer Center, New York, suggests the technique offers an additional advantage: It finds an absolute 7% more metastases than with conventional axillary dissection. Dr. Bevilacqua reported on 596 patients who underwent SLNB and definitive surgical therapy at Sloan-Kettering for breast cancers 1 cm or smaller.

The incidence of axillary metastasis was 20.4% when the enhanced pathologic analysis with immunohistochemistry and serial sectioning that is routine with SLNB was used. In contrast, the incidence was only 13.2% in 258 women who underwent standard axillary dissection with a single hematoxylin-eosin--stained section per lymph node in the pre-SLNB era at Sloan-Kettering.

Lymphatic mapping involves injecting a breast tumor with blue dye and/or a radioactive tracer. The sentinel lymph node, which drains the tumor bed through a direct lymphatic channel, is not always the closest node to the tumor. It is the one most likely to contain metastatic deposits should the tumor metastasize. It is readily identifiable because it turns blue with the dye and hot with radioactivity.

Knowledge of axillary lymph node status is widely accepted as the single most important prognostic factor in breast cancer patients. Finding one or more positive nodes steers treatment in the direction of adjuvant radiation and/or systemic chemotherapy; node-negative patients don't routinely receive these treatments.

Dr. Dessureault reported on 1,706 consecutive women who underwent SLNB at the Moffitt Cancer Center. Of these women, 33.6% had a positive sentinel node and therefore underwent complete axillary dissection. Findings of this procedure indicated that 58.6% of the women had only the sentinel lymph node affected by cancer; the rest had additional nodes positive for metastatic disease.

Among the subset of 760 women with invasive breast cancer--either infiltrating ductal carcinoma or lobular carcinoma--and negative SLNB results, there have been no axillary recurrences after a median follow-up of 23 months. Forty of these women have now been followed for more than 4 years.

Complications of the procedure were minor and infrequent, consisting chiefly of a 5% incidence of seromas requiring drainage. There have been no nerve injuries and no evidence of lymphedema, a common and vexing long-term complication of conventional axillary lymph node dissection.

The only way to determine the false-negative rate of SLNB in women who don't undergo complete axillary node dissection is through long-term follow-up. A recent study concluded that the median time to axillary recurrence in patients treated without SLNB, axillary dissection, or radiotherapy was 17.2 months, with 70% of recurrences occurring within 3 years. By this yardstick the Moffitt data are highly encouraging, she said.

But audience member Dr. John F.R. Robertson, professor of medicine at the University of Nottingham (England), told her he views the mean 25-month follow-up period as "a little short" to provide reassurance regarding the absence of recurrences due to micrometastases.
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Publication:OB GYN News
Date:Mar 15, 2001
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