Minimally invasive surgeryAxillary ultrasound examination is useful for selecting patients optimally suited for sentinel lymph node biopsy after primary systemic chemotherapy
Section snippets
Patients
This study was performed in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Saitama Medical University International Center Review Board. Informed consent was obtained from all patients for primary systemic chemotherapy, sentinel lymph node biopsy, and surgical procedures. The study included 87 patients whose symptoms corresponded to the American Joint Committee on Cancer stage II or III breast cancer and who were treated between June 2007 and June
Response to primary systemic chemotherapy
Responses to primary systemic chemotherapy were evaluated clinically and pathologically only in breast tumors. According to the Response Evaluation Criteria in Solid Tumors guidelines, 7 patients (8%) experienced a complete clinical response, and 58 (66.7%) experienced a partial clinical response. Therefore, the clinical response rate to primary systemic chemotherapy was 74.7% (Table 2). A pathologically complete response, which was defined as no residual cancer cells including either invasive
Comments
Because of its accuracy, easy availability, and safety (no radiation exposure), axillary ultrasound should be included in the patient assessment during primary systemic chemotherapy and before surgery for selecting patients optimally suited for sentinel lymph node biopsy after primary systemic chemotherapy. Sentinel lymph node biopsy has been widely performed as an accurate alternative to axillary lymph node dissection in patients with clinically node-negative early-stage breast cancer.1, 2
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2022, International Journal of Biological MacromoleculesThe Loss of Lymph Node Metastases After Neoadjuvant Chemotherapy in Patients With Cytology-proven Axillary Node-positive Primary Breast Cancer
2019, Clinical Breast CancerCitation Excerpt :Over 30% of patients with breast cancer and axillary lymph node (LN) metastases reportedly achieve axillary pathologic complete response (pCR) after NAC,3-9 whereas the rate of response to NAC depends on breast cancer subtype.10,11 However, assessment of LN status after NAC by physical examination or ultrasonography (US) is problematic because of the high false-negative rate (FNR) of over 40%.12-14 The FNR by sentinel lymph node biopsy (SNB) after NAC is also over 10%.13-16
Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients
2016, American Journal of SurgeryCitation Excerpt :Axillary ultrasound scanning (AUS) is commonly used at initial diagnosis of breast cancer to clinically stage the axillary nodes. Its role in post-NAC patients has been investigated in several studies, where it has been found to be better at detecting positive nodes rather than predicting pCR, with a sensitivity, specificity and positive predictive value (PPV) of 32% to 69.8%, 56% to 94%, and 59% to 89%, respectively.10,55–58 Boughey et al55 have suggested that using a strategy where patients with a normal AUS undergo SLNB may reduce the FNR from 12.6% to 9.8% when 2 or more nodes are removed while sparing many patients from ALND.
The diagnostic performance of sentinel lymph node biopsy in pathologically confirmed node positive breast cancer patients after neoadjuvant systemic therapy: A systematic review and meta-analysis
2015, European Journal of Surgical OncologyCitation Excerpt :In their study, the PPV for axillary ultrasound in breast cancer patients improved from 79.6 towards 100%, when fine-needle cytology was added to the general axillary ultrasound. As a consequence, several studies were excluded for this meta-analysis due to differences in defining clinically node positive patients, like the SENTINA trial.38–40 In the SENTINA trial, pathologically confirmed nodal disease was not required for inclusion, resulting in the definition of node positive disease based on ultrasound.
Delivery of Molecules to the Lymph Node via Lymphatic Vessels Using Ultrasound and Nano/Microbubbles
2015, Ultrasound in Medicine and BiologyCitation Excerpt :The sentinel lymph node (LN) is defined as the first LN or group of LNs to which tumor cells are likely to spread from the primary lesion, and its status is regarded as an independent prognostic factor (Hirakawa et al. 2009; Tobler and Detmar 2006). Metastasis to the sentinel LN is typically diagnosed with imaging modalities such as ultrasound (US), computed tomography (CT), magnetic resonance imaging and positron emission tomography, and the metastasis is histologically confirmed by biopsy (Black et al. 2007; Shigekawa et al. 2012; Yamamoto et al. 2010). In cases of head and neck cancer, when the sentinel LN is positive, neck dissection is performed to improve the survival rate (Liauw et al. 2006).