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Factors affecting identification rate and positivity of the sentinel node in breast cancer in 1567 patients, using blue dye and99mTc-labelled colloid, based on a multicentre database project in Austria

Welche Faktoren beeinflussen die Identifikationsrate und die Metastasierung im Sentinel Lymphknoten beim Mammakarzinom — eine Analyse von 1 567 Patientinnen im Rahmen eines Multicentre Database Projects in Österreich

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Summary

Background: In several studies sentinel node biopsy has been determined to be a predictive indicator of the axillary nodal status in patients with breast cancer. Although the acceptance of this procedure is growing worldwide, no consensus has yet been reached on the methodology. The aim of this analysis was to evaluate a nationwide standardized central database as an instrument of quality control for sentinel node biopsy in patients with breast cancer and to elucidate factors associated with identification rate, positivity of the sentinel node and the axillary specimen in a prospective nationwide multicentre program.

Methods: Since 1996, patient data from nine departments in Austria have been collected. Both blue dye and99 mTc-labelled colloid were used, either alone or in combination. Identification methods varied but had to be consistent within one department. Inclusion criteria and pathological examination of the sentinel node corresponded with national guidelines. Collected data also included the learning period of every centre. Data were coded and transferred to a central database per e-mail

Results: Data on 1567 patients were eligible. Identification rate was 87.3%. Multivariate analysis showed age, tumour size, learning period and the department to be significant factors in identification, whereas large tumour size, histological type and palpability of the tumour were significant for a histologically positive sentinel node.

Conclusions: Sentinel node biopsy is an accurate and feasible staging method for axillary nodal status if it is performed in a standardized setting. A central database is helpful in gaining nationwide optimal quality control.

Zusammenfassung

Grundlagen: In diversesten Studien wurde die Sentinel Lymphknoten Biopsie beim Mammakarzinom bereits als geeignetes Instrument zum axillären Staging beschrieben. Obwohl die Methode weltweit bereits große Akzeptanz besitzt, gibt es noch keinen Konsensus über die Art der Durchführung und Anwendung. Ziel dieser Untersuchung war die Evaluierung einer standardisierten Datenbank als Instrument zur Qualitätskontrolle anhand einer prospektiven österreichweiten Multicenterstudie und die Analyse von Faktoren, die die Identifikationsrate und die Positivität des Wächterlymphknotens beeinflussen.

Methodik: Seit 1996 wurden Daten von 9 österreichischen Abteilungen zusammengeführt. Als Identifikationsmethoden wurden Blaufarbstoff und die Lymphoszintigraphie, sowohl alleine als auch in Kombination, angewendet. Die Identifikationsmethoden variierten von Abteilung zu Abteilung, Einschlusskriterien und histologische Untersuchung erfolgten nach festgelegten Empfehlungen für Österreich. Die Daten wurden anonymisiert und via e-mail an die zentrale Datenbank transferiert. Die Erfassungszeit schließt die Lernphase der einzelnen Abteilungen ein.

Ergebnisse: Daten von 1 567 Patienten wurden analysiert. Die Identifikationsrate betrug 87.3%. Die multivariate Analyse zeigte, dass Patientenalter, Tumorgröße, Lernphase und die operierende Abteilung signifikant die Identifikationsrate beeinflussen, wohingegen die Tumorgröße, die Histologie und die Tastbarkeit des Tumors die Positivität des Sentinel Lymphknotens beeinflussen.

Schlußfolgerungen: Die Wächterlymphknoten Biopsie ist eine genaue und gut praktikable Methode zum axillären Staging, wenn sie in einem standardisierten und kontrollierten Setting durchgeführt wird. Eine zentrale Datenbank im Rahmen eines landesweiten Programms ist hilfreich zur optimalen Qualitätskontrolle.

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References

  1. Balslev I, Axilsson CK, Zedeler K, Rasmussen BB, Carstensen B, Mouridsen HT: The Nottingham Prognostic Index applied to 9,149 patients from the studies of the Danish Breast Cancer Cooperative Group (DBCG). Breast Cancer Res Treat 1994;32:281–290.

    Article  CAS  PubMed  Google Scholar 

  2. Barth A, Craig PH, Silverstein MJ: Predictors of axillary lymph node metastases in patients with T1 breast carcinoma. Cancer 1997;79:1918–1922.

    Article  CAS  PubMed  Google Scholar 

  3. Cody HS, Hill ADK, Tran KN, Brennan MF, Borgen PI: Credentialing for the lymphatic mapping: how many cases are enough? Ann Surg 1999;229:723–728.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cote RJ, Peterson JF, Chaiwun B, Gelber RD, Goldhirsch A, Castiglione-Gertsch M, Gusterson B, Neville AM: Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast Cancer Study Group. Lancet 1999;354:896–900.

    Article  CAS  PubMed  Google Scholar 

  5. Crowe JP Jr, Gordon NH, Shenk RR, Zollinger RM Jr, Brumberg DJ, Shuck JM: Age does not predict breast cancer outcome. Arch Surg 1994;129:483–487.

    Article  PubMed  Google Scholar 

  6. Gallowitsch HJ et al.: Eur Surg 2002;34:267–271.

    Article  Google Scholar 

  7. Gann PH, Colilla SA, Gapstur SM, Winchester DJ, Winchester DP: Factors associated with axillary lymph node metastasis from breast carcinoma: descriptive and predictive analyses. Cancer 1999;86:1511–1519.

    Article  CAS  PubMed  Google Scholar 

  8. Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL: Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995;222:394–401.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Giuliano AE, Kirgan DM, Güenther JM, Morton DL: Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220:391–398.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Haid A, Koehn Th, Konstantiniuk P, Koeberle-Wuehrer R, Burtscher J, Knauer M, Kreienberg R, Zimmermann G: Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. EJCO 2002; accepted for publication.

  11. Jakesz R, Samonigg H, Gnant M, Kubista E, Steindorfer P, Hausmaninger H, Sevelda P, Tschurtschenthaler B, Fridrik M, Stierer M, Kolb R, Steger G: Very low-dose adjuvant chemotherapy in steroid receptor negative stage I breast cancer patients. Austrian Breast Cancer Study Group. Eur J Cancer 1998;34:66–70.

    Article  CAS  PubMed  Google Scholar 

  12. Jakesz R, Hausmaninger H, Samonigg H, Kubista E, Haider K, Mlineritsch B, Schmid M, Tausch C, Reiner G, Renner K, Stierer M, Jatzko G, Hofbauer F, Fridrik M, Schennach W, Sevelda P, Dadak C, Haid A, Schol R, Lenzhofer P, Steindorfer P, Berger A, Mischinger HJ: Therapy studies of the Austrian Breast Cancer Group (ABC). Zentralbl Chir 1998;123(Suppl 5):28–32.

    PubMed  Google Scholar 

  13. Jakesz R, Hausmaninger H, Haider K, Kubista E, Samonigg H, Gnant M, Manfreda D, Tschurtschenthaler G, Kolb R, Stierer M, Fridrik M, Mlineritsch B, Steindorfer P, Mittlbock M, Steger G: Randomized trial of low-dose chemotherapy added to tamoxifen in patients with receptor-positive and lymph node-positive breast cancer. J Clin Oncol 1999;17:1701–1709.

    CAS  PubMed  Google Scholar 

  14. Jakesz R, Hausmaninger H, Samonigg H: Chemotherapy versus hormonal adjuvant treatment in premenopausal patients with breast cancer. Eur J Cancer 2002;38:327–332.

    Article  CAS  PubMed  Google Scholar 

  15. Jansen L, Doting MH, Rutgers EJ, de Vries J, Olmos RA, Nieweg OE: Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer. Br J Surg 2000;87:920–925.

    Article  CAS  PubMed  Google Scholar 

  16. Konstantiniuk P, Kowatsch E, Haid A, Bauer C, Steindorfer P: Das Multi Center Database Project (MCDBP). Acta Chir Austriaca 2001;33:201.

    Article  Google Scholar 

  17. Krag DN, Weaver DL, Alex JC, Fairbanks JT: Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993;2:335–340.

    Article  CAS  PubMed  Google Scholar 

  18. Kucera E, Speiser P, Gnant M, Szabo L, Samonigg H, Hausmaninger H, Mittlbock M, Fridrik M, Seifert M, Kubista E, Reiner A, Zeillinger R, Jakesz R: Prognostic significance of mutations in the p53 gene, particularly in the zinc-binding domains, in lymph node- and steroid receptor positive breast cancer patients. Austrian Breast Cancer Study Group. Eur J Cancer 1999;35:398–405.

    Article  CAS  PubMed  Google Scholar 

  19. McMasters KM, Wong SL, Martin RCG, Chao C, Tuttle TM, Noyes RD, Carlson DJ, Laidley AL, McGlothin TQ, Ley PB, Brown CM, Glaser RL, Pennington RE, Turk PS, Simpson D, Cerrito BP, Edwards MJ: Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy: Results of a multiinstitutional Study. Ann Surg 2001;233:676–687.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Morrow M, Rademaker AW, Bethke KP, Talamonti MS, Dawes LG, Clauson J, Hansen N: Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 1999;126:714–722.

    Article  CAS  PubMed  Google Scholar 

  21. Motomura K, Inaji H, Komoike Y, Kasugai T, Nagumo S, Hasegawa Y, Noguchi S, Koyama H: Combination technique is superior to dye alone in identification of the sentinel node in breast cancer patients. J Surg Oncol 2001;76:95–99.

    Article  CAS  PubMed  Google Scholar 

  22. Orr RK, Hoehn JL, Col NF: The learning curve for sentinel node biopsy in breast cancer: practical sonsiderations. Arch Surg 1999;134:764–767.

    Article  CAS  PubMed  Google Scholar 

  23. Rahusen FD, Torrenga H, van Diest PJ, Pijpers R, van der Wall E, Licht J, Meijer S: Predictive Factors for Metastatic Involvement of Nonsentinel Nodes in Patients With Breast Cancer. Arch Surg 2001;136:1059–1063.

    Article  CAS  PubMed  Google Scholar 

  24. Roka S, Konstantiniuk P, Heck D, Schrenk P, Jagoutz-Herzlinger M, Koeberle-Wuehrer R, Urbania A, Jakesz R: Axillary Recurrence after Sentinel Node Biopsy. Eur Surg 2002;34:280–282.

    Article  Google Scholar 

  25. Rudas M, Konstantiniuk P, Horvat R, Niedermoser, Bogner S, Pichler-Gebhard B, Hoffmann B, Offner F: Sentinel Lymph Node Examination: Balancing between high Workload and low Metastases Detection Rate. Eur Surg 2002;34:277–279.

    Article  Google Scholar 

  26. Schrenk P, Haid A, Tausch C, Gebhard B, Reitsamer R: Die Biopsie des leitenden Lymphknotens beim Mammakarzinom. Acta Chir Austriaca 2000;32:105–109.

    Article  Google Scholar 

  27. Schrenk P, Wölfl S, Tausch C, Mauritz C, Konstantiniuk P, Haid A, Riegler-Keil M, Roka S: Sentinel node biopsy in patients with multicentric breast cancer using a subareolar injection technique. Eur Surg 2002;34:288–291.

    Article  Google Scholar 

  28. Silverstein MJ, Skinner KA, Lomis TJ: Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg 2001;25:767–772.

    Article  CAS  PubMed  Google Scholar 

  29. Tafra L, Lannin DR, Swanson MS, Van Eyk JJ, Verbanac KM, Chua AN, Ng PC, Edwards MS, Halliday BE, Henry CA, Sommers LM, Carman CM, Molin MR, Yurko JE, Perry RR, Williams R: Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid an isosulfan blue dye. Ann Surg 2001;1:51–59.

    Article  Google Scholar 

  30. Tausch C, Konstantiniuk P, Jörg L, Dubsky P, Denison U, Haid A, Pichler-Gebhard B, Rudas M: Sentinel Lymph Node Biopsy after Preoperative Chemotherapy in Breast Carcinoma — Is it safe? Eur Surg 2002;34:283–287.

    Article  Google Scholar 

  31. van der Ent FW, Kengen RA, van der Pol HA, Povel JA, Stroeken HJ, Hoofwijk AG: Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 2001;234:79–84.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M: Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes. Lancet 1997;349:1864–1867.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Landeskrankenhaus Voecklabruck, Hatschekstraße 24, A-4840, Voecklabruck, Austria

    Barbara Pichler-Gebhard

  2. Second Department of Surgery, Landeskrankenhaus Graz, Austria

    P. Konstantiniuk

  3. Department of Surgery, Barmherzige Schwestern Hospital, Linz

    C. Tausch

  4. Department of Nuclear Medicine, Barmherzige Schwestern Hospital, Linz

    L. Joerg

  5. Department of Surgery, Landeskrankenhaus Feldkirch, Austria

    A. Haid

  6. Second Department of Surgery — Ludwig Boltzmann Institute for Surgical Laparoscopy, Allgemein Öffentliches Krankenhaus, Linz

    P. Schrenk

  7. Department of Gynaecology, Krankenhaus Lainz, Austria

    C. Peters-Engl

  8. Vienna and the Division of General Surgery, Department of Surgery, University of Vienna, Austria

    S. Roka

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  1. Barbara Pichler-Gebhard
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  2. P. Konstantiniuk
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  3. C. Tausch
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  4. L. Joerg
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  5. A. Haid
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  6. P. Schrenk
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  8. S. Roka
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Correspondence to Barbara Pichler-Gebhard.

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Pichler-Gebhard, B., Konstantiniuk, P., Tausch, C. et al. Factors affecting identification rate and positivity of the sentinel node in breast cancer in 1567 patients, using blue dye and99mTc-labelled colloid, based on a multicentre database project in Austria. Eur. Surg. 34, 272–276 (2002). https://doi.org/10.1046/j.1563-2563.2002.02066.x

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