Problems concerning patients’ qualification for surgical procedures allowing for evaluation of the condition of axillary fossa lymph nodes in the radical treatment of breast cancer
Languages of publication
The presence of metastases in the lymph nodes of the axillary fossa is the most important prognostic factor in patients with breast cancer. The surgical treatment option required for evaluation of the condition of the axillary lymph nodes depends on the results of a preoperative physical examination of the patients. The aim of the study was to evaluate the correctness of breast cancer patients’ qualification to surgical procedures allowing for evaluation of the condition of the axillary lymph nodes. Material and methods. A retrospective analysis of a group of 963 patients with a diagnosed malignancy of the breast, treated surgically in the period from 01 Jan 2011 to 29 Feb 2012. Depending on the result of evaluation of the axillary lymph node clinical condition, the patients underwent sentinel lymph node biopsy or elective axillary lymphadenectomy. Results. In 27.4% of patients subjected to excision of the sentinel lymph node, metastatic lesions were found in the lymph nodes removed during the procedure. In most cases (98.1%) that concerned the lymph nodes of the lower part of the axilla. In 17.4% of patients, metastases were located also in the middle or upper part (9%). In the group of patients primarily qualified to lymphadenectomy, the metastatic lesions in the axillary lymph nodes were diagnosed in 67.2% of patients. They were most commonly located in the lower part of the axillary fossa (in 96.7% of cases), and in 68.8% of patients in the middle or upper part (35.8%). Conclusions. Biopsy of the sentinel lymph node in patients with clinically advanced breast cancer is an effective and safe method of evaluation of the condition of the axillary fossa lymph nodes. A high rate of false positive results concerning the clinical stage of the disease requires changing the rules of patients’ qualification to elective axillary lymphadenectomy.
1 - 6 - 2015
11 - 2 - 2015
4 - 8 - 2015
- 1. Donegan WL: Tumor-related prognostic factors for breast cancer. CA Cancer Clin J 1997; 47: 28‑51.
- 2. Giuliano AE, Hunt KK, Ballman KV et al.: Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. JAMA 2011; 305: 569‑75.
- 3. Goldhirsch A, Wood WC, Coates AS and panel members: Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 2011; 22: 1736‑47.
- 4. Jassem J, Krzakowski M (red.): Rak piersi. W: Zalecenia postępowania diagnostyczno-terapeutycznego w nowotworach złośliwych 2013 rok. Krzakowski M, Warzocha K (red.). Onkologia w Praktyce Klinicznej. Gdańsk 2013; tom I: 211‑63.
- 5. Berg JW: The significance of axillary node levels in the study of breast carcinoma. Cancer 1955; 8: 776‑78.
- 6. Krag DN, Anderson SJ, Julian TB et al.: Sentinel- lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11(10): 927‑33.
- 7. Mansel RE , Fallowfield L, Kissin M et al.: Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 2006; 98(9): 599‑609.
- 8. Kim T, Giuliano AE, Lyman GH: Lymphatic mapping and sentinel lymph node biopsy in earlystage breast carcinoma: a metaanalysis. Cancer 2006; 106(1): 4‑16.
- 9. Greene FL: American Joint Committee on Cancer, American Cancer Society, AJCC. Cancer Staging Manual, 6th ed. New York: Springer-Verlag; 2002.
- 10. Specht MC, Fey JV, Borgen PI, Cody HS 3rd: Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy? J Am Coll Surg 2005; 200(1): 10‑14.
- 11. Herman K, Marczyk E: Rak piersi - rekomendacje Konsultanta Krajowego w dziedzinie chirurgii onkologicznej. W: Zegarski W, Jastrzębski T, Nowikiewicz T (red.): Rak piersi - postępy diagnostyki i leczenia. Medipage, Warszawa 2013, 1‑6.
Publication order reference