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Addressing Node-Negative Axilla (N0) in Resource-Constrained Scenarios

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Sentinel Node Biopsy in Breast Cancer
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Abstract

Axillary lymph node dissection (ALND) for a node-negative axilla in early breast cancer is now considered an overtreatment due to the resultant morbidity and lifelong limitations to the affected limb. For operable early-stage breast cancer, dual technique (blue dye with radiocolloid guided) sentinel lymph node biopsy (SLNB) is now the standard of care and a pre-requisite to addressing the axilla completely only in node positive axilla. Resource-constrained countries have limited access to radio-guided sentinel node biopsy and, therefore, other low cost strategies may need to be considered for optimal management of patients with early breast cancer.

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References

  1. Celliers L, Mann GB. Alternative sites of injection for sentinel lymph node biopsy in breast cancer. ANZ J Surg. 2003;73(8):600–4.

    Article  PubMed  Google Scholar 

  2. https://www.aerb.gov.in/images/PDF/NuclearMedicine/RSD1.pdf.

  3. Glass EC, Essner R, Morton DL. Kinetics of three lymphoscintigraphic agents in patients with cutaneous melanoma. J Nucl Med. 1998;39:1185–90.

    CAS  PubMed  Google Scholar 

  4. Morton D, Cagle L, Wong J, et al. Intraoperative lymphatic mapping and selective lymphadenectomy: technical details of a new procedure for clinical stage I melanoma. In: Presented at the annual meeting of the Society of Surgical Oncology, Washington, DC; 1990.

    Google Scholar 

  5. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;392-99:392.

    Article  Google Scholar 

  6. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Chagpar AB, Scoggins CR, Martin RCG II, Carlson DJ, Laidley AL, El-Eid SE, McGlothin TQ, McMasters KM, for the University of Louisville Breast Sentinel Lymph Node Study Investigators. Are 3 sentinel nodes sufficient? Arch Surg. 2007;142:456–60.

    Article  PubMed  Google Scholar 

  8. Krag DN, Anderson SJ, Julian TB, et al; National Surgical Adjuvant Breast and Bowel Project. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007;8(10):881–8.

    Google Scholar 

  9. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Ahmed M, Rubio IT, Kovacs T, Klimberg VS, Douek M. Systematic review of axillary reverse mapping in breast cancer. Br J Surg. 2016;103(3):170–8.

    Article  CAS  PubMed  Google Scholar 

  11. Parmar V, Hawaldar R, Nair NS, et al. Sentinel node biopsy versus low axillary sampling in women with clinically node negative operable breast cancer. Breast. 2013;22(6):1081–6. https://doi.org/10.1016/j.breast.2013.06.006. pii: S0960-9776(13)00171-9. PubMed PMID: 23948301.

    Article  CAS  PubMed  Google Scholar 

  12. Reddy A, Nair NS, Mokal S, et al. Can we avoid axillary lymph node dissection (ALND) in patients with 1–2 positive sentinel/low axillary lymph nodes (SLN/LAS+) in the Indian setting? Indian J SurgOncol. 2021;12:272. https://doi.org/10.1007/s13193-021-01297-6.

    Article  CAS  Google Scholar 

  13. Parmar V, Nair NS, Vanmali V, et al. Sentinel node biopsy versus low axillary sampling in predicting nodal status of postchemotherapy axilla in women with breast cancer. JCO Glob Oncol. 2020;6:1546–53.

    Article  PubMed  Google Scholar 

  14. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455–61.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. 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(6):569–75.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Galimberti V, Cole BF, Zurrida S, et al. International Breast Cancer Study Group. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.

    Google Scholar 

  17. Sola MS, Alberro JA, Fraile M, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013;20:120–7.

    Article  PubMed  Google Scholar 

  18. Savolt A, Musonda P, Matrai Z, et al. Optimal treatment of the axilla after positive sentinel lymph node biopsy in early invasive breast cancer. Early results of the OTOASOR trial. Orv Hetil. 2013;154:1934–42.

    Article  PubMed  Google Scholar 

  19. Straver ME, Meijnen P, van Tienhoven G, et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol. 2010;17:1854–61.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Schmidt-Hansen M, et al. Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses. Springerplus. 2016;5(1):85.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Agarwal G, Gambhir S, Lal P, Krishnani N, Rajan S. Avoidance of axillary dissection in cN0 breast cancer patients with metastatic sentinel lymph node(s) using ACOSOG Z-0011 criteria: is it appropriate for Indian patients? J Clin Oncol. 2015;33(28 Suppl):62.

    Article  Google Scholar 

  22. Van la Parra RF, Peer PG, Ernst MF, et al. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol. 2011;37:290–9.

    Article  Google Scholar 

  23. Toshikawa C, Koyama Y, Nagahashi M, et al. Predictive factors for non-sentinel lymph node metastasis in the case of positive sentinel lymph node metastasis in two or fewer nodes in breast cancer. J Clin Med Res. 2015;7:620–6.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Gooch J, King TA, Eaton A. The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1-T2 breast cancer. Ann Surg Oncol. 2014;21:2897–903.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Reddy A, Nair NS, Mokal S, et al. Validation of nomograms to predict non-sentinel lymph node metastasis after positive sentinel lymph node in breast cancer: Indian cohort background. J Clin Oncol. 2020;38(15_Suppl):568.

    Article  Google Scholar 

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Parmar, V., Nair, N.S. (2023). Addressing Node-Negative Axilla (N0) in Resource-Constrained Scenarios. In: Chintamani (eds) Sentinel Node Biopsy in Breast Cancer. Springer, New Delhi. https://doi.org/10.1007/978-81-322-3994-9_11

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  • DOI: https://doi.org/10.1007/978-81-322-3994-9_11

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  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-3992-5

  • Online ISBN: 978-81-322-3994-9

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