Sentinel Lymph Node Surgery for Contralateral Prophylactic Mastectomy (CPM) – American Society of Breast Surgeons (ASBrS) Evidence-Based Recommendations

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The benefit of performing sentinel lymph node (SLN) surgery at the time of CPM is:
    • That the lymph nodes have been evaluated in the event that an occult malignancy is found
  • The downside is:
    • Increased surgical morbidity such as lymphedema
  • By meta-analysis:
    • The risk of lymphedema after SLN alone is:
      • 5.6 % (95 % CI 6.1–7.9 %) and increases with longer follow-up
    • The chance of finding occult invasive disease in a prophylactic mastectomy is:
      • 1.8 %
    • An additional small percent of CPM specimens harbor noninvasive disease:
      • That would not require nodal evaluation
    • The rate of nodal positivity in patients with occult malignancy in CPM is:
      • Only 1.3 %
    • Considering these data:
      • Routine SLN surgery at time of CPM:
        • Places more patients at risk of lymphedema:
          • Than would be expected from the 1% to 2 % of patients with occult disease undergoing axillary dissection
        • Therefore the consensus group:
          • Does not recommend routine SLN for CPM
  • Patients at higher risk of contralateral occult malignancy are:
    • Postmenopausal patients
    • Those with triple-negative
    • Locally advanced
    • Inflammatory breast cancer
    • Invasive lobular disease
  • MRI at the time of breast cancer diagnosis:
    • Identifies occult contralateral disease:
      • 2% to 4 % of the time
    • Suspicious lesions in the contralateral breast should be biopsied:
      • But if a biopsy is not done:
        • SLN surgery should be considered for highly suspicious lesions
  • Summary:
    • Sentinel lymph node surgery on the CPM side should not be routinely performed
  • References:
    • Contralateral Prophylactic Mastectomy Consensus Statement from the American Society of Breast Surgeons: Additional Considerations and a Framework for Shared Decision Making. Ann Surg Oncol (2016) 23:3106–3111

#Arrangoiz #BreastSurgeon #CancerSurgeon #Teacher #SurgicalOncology #CASO #Miami #CenterforAdvancedSurgicalOncology #BreastCancer #ProphylacticMastectomy #CPM #ContralateralProphylacticMastectomy

Unknown's avatar

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a comment