Should a Sentinel Lymph Node Biopsy be Performed During a Prophylactic Mastectomy?

👉The rationale for performing sentinel lymph node biopsy (SLNB) is to have nodal staging in the event invasive carcinoma is identified pathologically in the breast that was removed prophylactically.

👉Multiple studies have reported that the chance of finding invasive disease in the surgical specimen with prophylactic mastectomy is less than 3%.

👉In a large series from the MD Anderson Cancer Center that included 436 prophylactic mastectomies, cancer was identified in 22 (5%) cases.

👉Of these, the majority of patients (14) had ductal carcinoma in situ.

👉Only eight patients (1.8%) had invasive cancer, with a mean tumor size of 5 mm.

👉The study included 23 patients with BRCA mutations, and no invasive cancers were identified in these cases.

👉Significantly increased risk of invasive cancer in the prophylactic mastectomy was seen in postmenopausal patients (3.7%; p=0.007), patients age greater than 60 years (7.5%; p=0.008), and patients with invasive lobular carcinoma (9.7%; p0.0002) or lobular carcinoma in situ (7.7%; p=0.008).

👉A decision-analytic model was created by the same group to compare the risk/benefit ratio of routine SNB for all prophylactic mastectomies compared to omitting SLNB and performing ALND only when invasive cancer is found in the breast.

👉The pertinent literature was reviewed to determine the chance of finding invasive cancer in a prophylactic mastectomy specimen and to estimate the chance of complications (lymphedema, paresthesias, decreased range of shoulder motion) with SNB and ALND.

👉At a rate of finding invasive cancer of 1.9%, 73 SLNBs were required to avoid 1 ALND.

👉After reviewing the literature, the complication rate was estimated at 7% for SLNBs and 31% for ALND.

👉In one model scenario, the probability of complications per breast cancer detected was 9-fold greater with the SLNBs strategy than with the directed ALND strategy.

👉This model supported the decision to forego SLNB in most patients undergoing prophylactic mastectomy, given the large number of procedures required to benefit one patient.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad QuirĂşrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

  • Es experto en el manejo del cáncer de mama.

 

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

 

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

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