Krivorotko, P. V., Tabagua, T. T., Novikov, S. N., Amirov, N., Levchenko, V. E., Pesotsky , R. S., Emelyanov, A. S., Mortada, V. V., Zhiltsova, E. K., Semiglazov, V. V., Krzhivitsky, P. I., Artemyeva, A. S., Donskih, R. V., & Semiglazov, V. F. (2024). The Sentiel Lymph Node Biopsy in breast cancer . Voprosy Onkologii, 70(3), 516–525. https://doi.org/10.37469/0507-3758-2024-70-3-516-525

Abstract

Introduction. This paper presents a retrospective analysis of the use of sentinel lymph node biopsy (SLNB) in patient groups under-represented in existing clinical trials. Disease-free survival was analysed in the groups of patients with stage cT3, multicentric forms of cancer and patients treated by mastectomy and one-stage reconstruction with endoprosthesis.

Aim. To evaluate the safety of the SLNB procedure in patients with multicentric tumors, cohort of patients with clinical stage cT3N0M0, group of patients with mastectomy and single-stage reconstruction with endoprosthesis; to analyse the survival rate of patients with clinical stage cT1-3N0M0 depending on the biological subtype of the tumour in whom the SLNB results revealed 1-2 macromestases; and to evaluate the necessity of intraoperative histological examination of SLN in patients with cN0 status.

Materials and Methods. We performed a retrospective analysis of 2 854 patients who underwent surgery at the Department of Breast Tumours, N.N. Petrov National Medical Research Centre of Oncology. The SLB procedure was most commonly performed using Tc-99m sulphur colloid. Urgent histological examination was performed at the discretion of the operating surgeon. In case of urgent histological examination, LN status was assessed using the frozen section technique. In 607 patients with 1-2 macrometastases in the SLN, 5-year DFS was evaluated according to the biological subtype of the tumor. Patients with multicentric forms of BC, those who had undergone mastectomy and women with clinical stage T3 BC were allocated to separate groups. In these groups, the 5-year regional recurrence rate and 5-year DFS were evaluated according to the volume of axillary surgery performed.

Results. In patients with multicentric tumors, DFS was 88.7 % in the axillary lymph node dissection (ALD) group and 89.5 % without LND [HR 0.997 (95 % CI 0.207-4.802)]. The number of axillary recurrences was 1 (1.2 %) in the ALD group and 2 (2.5 %) in the non-ALD group. In patients with clinical stage cT3N0M0, the DFS was 80.8 % in the group with ALD and 82.7 % in the group without ALD [HR 1.018 (95 % CI 0.333 to 3.111)]. Axillary recurrences were observed in 3 patients (3.9 %) in the ALD group and 3 patients (3.9 %) in the non-ALD group. After mastectomy and single-stage reconstruction with endoprosthesis, DFS was 85.8 % in the ALD group and 90.5 % without ALD [HR 1.847 (95 % CI 0.808 to 4.219)]. The number of axillary recurrences was 3 (3.5 %) in the group with ALD and 4 (3.4 %) in the group without ALD. Among patients with 1-2 macrometastases in lymph nodes, DFS by biological subtype was as follows 84 % for luminal A, 81.7 % — for luminal B, 76.2 % — for HER2-positive and 77.8 % — for triple-negative BC (p = 0.075). We analyzed 915 patients who underwent SLNB without urgent histological examinations. Of these, 1 or 2 affected lymph nodes were identified in 106 (11.6 %) and 65 (7.1 %) patients, respectively. 3 or more affected lymph nodes were identified in 17 (1.9 %) patients. In the remaining 727 patients (79.4 %), no tumor cells were found in the lymph nodes according to postoperative histological data.

https://doi.org/10.37469/0507-3758-2024-70-3-516-525

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References

Криворотько П.В., Новиков С.Н., Табагуа Т.Т., et al. Метод определения сигнальных лимфатических узлов при раке молочной железы с помощью радиоизотопного и/или флуоресцентного методов. Учебно-методическое пособие, СПб.: НМИЦ онкологии им. Н.Н. Петрова. 2024: 8-9. [Krivorotko P.V., Novikov S.N., Tabagua T.T., et al. Method for the determination of signalling lymph nodes in breast cancer using radioisotope and/or fluorescent methods. Training manual, St. Petersburg: N.N. Petrov NMRC of Oncology. 2024: 8-9. (In Rus)].

Семиглазов В.Ф., Канаев С.В., Криворотько П.В., et al. Методические вопросы биопсии сигнальных лимфоузлов у больных раком молочной железы. Вопросы онкологии. 2013; 59(20): 90-94. [Semiglazov V.F., Kanaev S.V., Krivorotko P.V., et al. Methodological issues of biopsy of signalling lymph nodes in patients with breast cancer. Voprosy Onkologii = Problems in Oncology. 2013; 59(20): 90-94. (In Rus)].

Fisher B., Fisher E.R. The biology of metastasis. In Davis JH, ed. Current Concepts in Surgery. New York:McGraw Hill. 1965: 321-351.

Fisher B., Redmond C., Fisher E.R., 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(11): 674-81.

Veronesi U., Saccozzi R., Del Vecchio M., et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981; 305(1): 6-11.

Veronesi U., Valagussa P. Inefficacy of internal mammary nodes dissection in breast cancer surgery. Cancer. 1981; 47(1): 170-5.

Halsted W.S. The result of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889 to January, 1894. Johns Hopkins Hosp. Ann Surg. 1894; 20(5): 497-555.

Giuliano A.E., Kirgan D.M., Guenther J.M., Morton D.L. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994; 220(3): 391-8; discussion 398-401.

Krag D.N., Weaver D.L., Alex J.C., Fairbank J.T. Surgical resection and radio-localization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993; 2(6): 335-9; discussion 340.

Purushotham A.D., Upponi S., Klevesath M.B., et al. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol. 2005; 23(19): 4312-21.-DOI: https://doi.org/10.1200/JCO.2005.03.228.

Langer I., Guller U., Berclaz G., et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 2007; 245(3): 452-61.-DOI: https://doi.org/10.1097/01.sla.0000245472.47748.ec.

Fisher B., Jeong J.H., Anderson S., et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002; 347(8): 567-75.-DOI: https://doi.org/10.1056/NEJMoa020128.

Greco M., Agresti R., Cascinelli N., et al. Breast cancer patients treated without axillary surgery: clinical implications and biologic analysis. Ann Surg. 2000.-DOI: https://doi.org/10.1097/00000658-200007000-00001.

Hwang R.F., Gonzalez-Angulo A.M., Yi M., et al. Low locoregional failure rates in selected breast cancer patients with tumor-positive sentinel lymph nodes who do not undergo completion axillary dissection. Cancer. 2007; 110(4): 723-30.-DOI: https://doi.org/10.1002/cncr.22847.

Sekine C., Nakano S., Mibu A., et al. Breast cancer hormone receptor negativity, triple-negative type, mastectomy and not receiving adjuvant radiotherapy were associated with axillary recurrence after sentinel lymph node biopsy. Asian J Surg. 2020; 43(1): 148-153.-DOI: https://doi.org/10.1016/j.asjsur.2019.05.001.

Giuliano A.E., Ballman K.V., McCall L., et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA. 2017; 318(10): 918-926.-DOI: https://doi.org/10.1001/jama.2017.11470.

Güth U., Myrick M.E., Viehl C.T., et al. The post ACOSOG Z0011 era: does our new understanding of breast cancer really change clinical practice? Eur J Surg Oncol. 2012; 38(8): 645-50.-DOI: https://doi.org/10.1016/j.ejso.2012.04.018.

Voutsadakis I.A., Spadafora S. Recommendation for omitting axillary lymph node dissection should be individualized in patients with breast cancer with one or two positive sentinel lymph nodes. J Clin Oncol. 2014; 32(34): 3901-2.-DOI: https://doi.org/10.1200/JCO.2014.57.1190.

Goyal A., Dodwell D., Reed M.W., Coleman RE. Axillary treatment in women with one or two sentinel nodes with macrometastases: more evidence is needed to inform practice. J Clin Oncol. 2014; 32(34): 3902-3902.-DOI: https://doi.org/10.1200/JCO.2014.57.3717.

Dengel L.T., Van Zee K.J., King T.A., et al. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy. Ann Surg Oncol. 2013; 21(1): 22-7.-DOI: https://doi.org/10.1245/s10434-013-3200-6.

Caudle A.S., Hunt K.K., Kuerer H.M., et al. Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol. 2011; 18(9): 2407-12.-DOI: https://doi.org/10.1245/s10434-011-1593-7.

Tsao M.W., Cornacchi S.D., Hodgson N., et al. A population-based study of the effects of a regional guideline for completion axillary lymph node dissection on axillary surgery in patients with breast cancer. Ann Surg Oncol. 2016; 23(10): 3354-64.-DOI: https://doi.org/10.1245/s10434-016-5310-4.

Morrow M., Jagsi R., Chandler M., et al. Surgeon attitudes toward the omission of axillary dissection in early breast cancer. JAMA Oncol. 2018; 4(11): 1511.-DOI: https://doi.org/10.1001/jamaoncol.2018.1908.

de Boniface J., Frisell J., Andersson Y., et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer. 2017; 17(1).-DOI: https://doi.org/10.1186/s12885-017-3361-y.

Goyal A., Dodwell D. POSNOC: A randomised trial looking at axillary treatment in women with one or two sentinel nodes with macrometastases. Clin Oncol (R Coll Radiol). 2015; 27(12): 692-5.-DOI: https://doi.org/10.1016/j.clon.2015.07.005.

Reimer T., Stachs A., Nekljudova V., et al. Restricted axillary staging in clinically and sonographically node-negative early invasive breast cancer (c/iT1-2) in the context of breast conserving therapy: first results following commencement of the intergroup-sentinel-mamma (INSEMA) trial. Geburtshilfe Frauenheilkd. 2017; 77(2): 149-157.-DOI: https://doi.org/10.1055/s-0042-122853.

Tinterri C., Gentile D., Gatzemeier W., et al. Preservation of axillary lymph nodes compared with complete dissection in t1-2 breast cancer patients presenting one or two metastatic sentinel lymph nodes: The SINODAR-ONE MULTICENTER RANDOMIZED CLINICAL TRIAL. Ann Surg Oncol. 2022; 29(9): 5732-5744.-DOI: https://doi.org/10.1245/s10434-022-11866-w.

Chao C., Wong S.L., Ackermann D., et al. Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer. Am J Surg. 2001; 182(6): 609-15.-DOI: https://doi.org/10.1016/s0002-9610(01)00794-2.

Canavese G., Bruzzi P., Catturich A., et al. Sentinel lymph node biopsy versus axillary dissection in node-negative early-stage breast cancer: 15-year follow-up update of a randomized clinical trial. Ann Surg Oncol. 2016; 23(8): 2494-500.-DOI: https://doi.org/10.1245/s10434-016-5177-4.

Miltenburg D.M., Miller C., Karamlou T.B., Brunicardi F.C. Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res. 1999; 84(2): 138-42.-DOI: https://doi.org/10.1006/jsre.1999.5629.

Godazande G., Moradi S., Naghshvar F., Shojaee L. Is necessary intraoprative frozen section in sentinel lymph node biopsy for breast cancer patients? Asian Pac J Cancer Prev. 2020; 21(3): 647-51.-DOI: https://doi.org/10.31557/APJCP.2020.21.3.647.

Bishop J.A., Sun J., Ajkay N., Sanders M.A. Decline in frozen section diagnosis for axillary sentinel lymph nodes as a result of the american college of surgeons oncology group Z0011 Trial. Arch Pathol Lab Med. 2016; 140(8): 830-5.-DOI: https://doi.org/10.5858/arpa.2015-0296-OA.

Holck S., Galatius H., Engel U., et al. False-negative frozen section of sentinel lymph node biopsy for breast cancer. Breast. 2004; 13(1): 42-8.-DOI: https://doi.org/10.1016/S0960-9776(03)00124-3.

Geertsema D., Gobardhan P.D., Madsen E.V., et al. Discordance of intraoperative frozen section analysis with definitive histology of sentinel lymph nodes in breast cancer surgery: complementary axillary lymph node dissection is irrelevant for subsequent systemic therapy. Ann Surg Oncol. 2010; 17(10): 2690-5.-DOI: https://doi.org/10.1245/s10434-010-1052-x.

Wong J., Yong W.S., Thike A.A., et al. False negative rate for intraoperative sentinel lymph node frozen section in patients with breast cancer: a retrospective analysis of patients in a single Asian institution. J Clin Pathol. 2015; 68(7): 536-40.-DOI: https://doi.org/10.1136/jclinpath-2014-202799.

Jensen A.J., Naik A.M., Pommier R.F., et al. Factors influencing accuracy of axillary sentinel lymph node frozen section for breast cancer. Am J Surg. 2010; 199(5): 629-35.-DOI: https://doi.org/10.1016/j.amjsurg.2010.01.017.

Layfield D.M., Agrawal A., Roche H., Cutress R.I. Intraoperative assessment of sentinel lymph nodes in breast cancer. Br J Surg. 2011; 98(1): 4-17.-DOI: https://doi.org/10.1002/bjs.7229.

Gentilini O.D., Botteri E., Sangalli C., et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: The SOUND randomized clinical trial. JAMA Oncol. 2023; 9(11): 1557-1564.-DOI: https://doi.org/10.1001/jamaoncol.2023.3759.

Reimer T., Stachs A., Veselinovic K., et al. Patient-reported outcomes for the Intergroup Sentinel Mamma study (INSEMA): A randomised trial with persistent impact of axillary surgery on arm and breast symptoms in patients with early breast cancer. EClinicalMedicine. 2022; 55: 101756.-DOI: https://doi.org/10.1016/j.eclinm.2022.101756.

van Roozendaal L.M., Vane M.L.G., van Dalen T., et al. Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up: a Dutch randomized controlled multicentre trial (BOOG 2013-08). BMC Cancer. 2017; 17(1): 459.-DOI: https://doi.org/10.1186/s12885-017-3443-x.

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