Sentinel Lymph Node Resection in Breast Cancer

  • Sentinel node vs. axillary clearance (SNAC):
    • One-year outcomes from the SNAC trial:
      • Demonstrated that sentinel lymph node resection (SLNR) alone in the setting of a sentinel node (SN)-negative axilla:
        • Reduced arm morbidity:
          • While preserving oncologic safety
    • In this study (SNAC):
      • 1088 women
      • With clinically node-negative early-stage breast cancer:
        • Were assigned to receive either:
          • SLNR followed by ALND:
            • If the SN was positive or not detected, or
          • Routine ALND:
            • Defined as SLNR followed immediately by ALND
    • The primary endpoint was:
      • Increase in arm volume from baseline
    • Secondary endpoints included:
      • An increase in arm volume by 15%
      • Early axillary morbidity:
        • Defined as arm dysfunction, or disability
    • Arm volume increased:
      • In the SLNR group by 2.8%, and
      • By 4.2% in the ALND group
        • P=0.002
    • Lower rates of:
      • Arm swelling (P<0.001), symptoms (P<0.001), and dysfunction (P=0.02):
        • Were reported in the SLNR group:
          • While disability (P=0.5) was not
    • The study showed that SLNR:
      • Had a sensitivity of 94.5%
      • A false-negative rate of 5.5%, and
      • A negative predictive value of 98%
    • The study concluded:
      • That SLNR followed oncologic principles and
      • Resulted in significantly less morbidity than ALND
  • The ALMANAC trial:
    • A randomized multicenter trial:
      • Of sentinel node (SN) biopsy versus standard axillary treatment:
        • In operable breast cancer:
      • It took the benefits of SLNR in the clinically node-negative axilla one step further:
        • By demonstrating improved quality of life:
          • In patients receiving SLNR versus ALND
  • In this study (ALMANAC):
    • 1031 patients
    • Were assigned to undergo SLNR or ALND
    • Patients with a SN-positive axilla:
      • Were subsequently treated:
        • With delayed ALND or
        • Axillary radiation
    • Such measures as:
      • Usage of drains
      • Hospital length of stay, and
      • Time to resumption of daily activities postoperatively were monitored
    • All were statistically significant and lower:
      • In the SLNR group:
        • P<0.001
    • Quality of life and arm functioning scores as reported by patients were statistically significantly better:
      • In the SLNR group:
        • P≤0.003
    • From these results:
      • It was concluded that:
        • SLNR should be the treatment of choice for patients with early-stage breast cancer and clinically negative nodes:
          • Because it is associated with reduced arm morbidity and better quality of life when compared with ALND
  • The ACOSOG Z0011 trial:
    • Took the results of previous trials on the safety and validity of SLNR and went one step further:
      • To suggest avoiding ALND for small cancers with clinically node-negative, SN-positive disease:
        • Provided that systemic therapy and whole-breast irradiation (WBI):
          • Is incorporated into the treatment strategy for early-stage breast cancer following breast-conserving surgery
    • Adverse surgical effects were reported:
      • In 70% of patients:
        • After SLND plus ALND, and
        • 25% after SLND alone:
          • P≤.001
    • Patients in the SLND plus ALND group had more:
      • Wound infections (P ≤ .0016)
      • Seromas (P≤ .0001), and
      • Paresthesias (P≤.0001):
        • Than those in the SLND alone group
  • The NSABP B-32:
    • Demonstrated the superiority of SLNR over ALND:
      • In terms of morbidity
    • Three-year postsurgical morbidity levels were compared:
      • Between patients with negative SLNR alone and those with negative SLNR and negative ALND
    • Shoulder range-of-motion and arm volumes were assessed on:
      • 1975 ALND and
      • 2008 SLND:
        • Node-negative breast cancer patients
    • Shoulder abduction deficits and arm volume differences:
      • Between the affected arm and the contralateral arms were calculated
    • Shoulder abduction deficits greater than or equal to 10%:
      • Peaked at one week for the:
        • ALND (75%) and
        • SLND (41%) groups
    • Arm volume differences greater than or equal to 10% at 36 months:
      • Were 14% for the ALND group and
      • 8% for the SLND groups
    • Numbness and tingling peaked at 6 months:
      • For the ALND:
        • Numbness: 49%
        • Tingling: 23% and
      • SLNR:
        • Numbness: 15%
        • Tingling: 10%
    • These results indicate:
      • The superiority of SLNR compared to ALND:
        • In terms of postsurgical morbidity outcomes over a 3-year follow-up period

#Arrangoiz #BreastSurgeon #BreastCancer #BreastExpert #CancerSurgeon #SurgicalOncologist #Surgeon #Teacher

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