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Sentinel node biopsy for breast cancer larger than 3 cm in diameter
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
2007 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 94, no 8, 948-951 p.Article in journal (Refereed) Published
Abstract [en]

Background:Sentinel node biopsy (SNB) is a standard staging procedure in early breast cancer. Its suitability for larger tumours has been questioned. This study evaluated the reliability of SNB in women with invasive breast cancer larger than 3 cm in diameter who were clinically axillary node negative.Methods:Some 109 women with a tumour larger than 3 cm on pathological analysis were identified from the Swedish prospective SNB database. They were included if a completion axillary clearance was planned, regardless of SNB results.Results:The sentinel node detection rate was 103 (94·5 per cent) of 109. The overall false-negative rate was eight (13 per cent) of 64. Although a preoperative diagnosis of multifocal tumour was an exclusion criterion, 16 such cases were revealed on postoperative pathological examination. The false-negative rate in this subgroup was higher than that in women with a unifocal tumour (four (31 per cent) of 13 versus four (8 per cent) of 51; P = 0·012). No other significant predictors of a false-negative sentinel node biopsy were identified.Conclusion:SNB is feasible in patients with unifocal breast tumours larger than 3 cm. When large tumour size coincides with multifocality, however, the false-negative rate seems to be increased and a completion axillary clearance should be considered even if the SNB is negative.

Place, publisher, year, edition, pages
2007. Vol. 94, no 8, 948-951 p.
Keyword [en]
Mammary gland diseases, Breast cancer, Treatment, Surgery, Medicine, Diameter, Mammary gland, Anatomic pathology, Biopsy, Sentinel lymph node, Malignant tumor
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95904DOI: 10.1002/bjs.5713ISI: 000248921700006PubMedID: 17436338OAI: oai:DiVA.org:uu-95904DiVA: diva2:170279
Available from: 2007-05-11 Created: 2007-05-11 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Sentinel Node Biopsy in Breast Cancer: Clinical and Immunological Aspects
Open this publication in new window or tab >>Sentinel Node Biopsy in Breast Cancer: Clinical and Immunological Aspects
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The most important prognostic factor in breast cancer is the axillary lymph node status. The sentinel node biopsy (SNB) is reported to stage the axilla with an accuracy > 95 % in early breast cancer. Tumour-related perturbation of T-cell function has been observed in patients with malignancies, including breast cancer. The down-regulation of the important T-cell activation molecules CD3-ζ and CD28 may cause T-cell dysfunction, anergy, tolerance and deletion.

The expression of CD3-ζ and CD28 was evaluated in 25 sentinel node biopsies. The most pronounced down-regulation was seen in the paracortical area, where the best agreement between both parameters was observed. CD28 expression was significantly more suppressed in CD4+ than in CD8+ T-cells.

From the Swedish sentinel node database, 109 patients with breast cancer > 3 cm planned for both SNB and a subsequent axillary dissection were identified. The false negative rate (FNR) was 12.5%. Thirteen cases of tumour multifocality were detected on postoperative pathology. The FNR in this subgroup was higher (30.8%) than in patients with unifocal disease (7.8%; P = 0.012).

From the Swedish SNB multicentre cohort trial, 2246 sentinel node-negative patients who had not undergone further axillary surgery were selected for analysis. After a median follow-up time of 37 months (range 0-75), 13 isolated axillary recurrences (13/2246; 0.6%) were found. In another 14 cases, local or distant failure preceded or coincided with axillary relapse (27/2246; 1.2%).

In conclusion, the immunological analysis of the sentinel node might provide valuable prognostic information and aid selection of patients for immunotherapy. SNB is encouraged in breast cancer larger than 3 cm, if no multifocal growth pattern is present. The axillary recurrence rate after a negative SNB in Sweden is in accordance with international figures. However, a longer follow-up is mandatory before the true failure rate of the SNB can be determined.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 259
Keyword
Surgery, breast cancer, tumour immunology, sentinel node biopsy, CD3-zeta, CD28, Kirurgi
Identifiers
urn:nbn:se:uu:diva-7890 (URN)978-91-554-6897-2 (ISBN)
Public defence
2007-06-01, Aulan, Ingång 21, Centrallasarettet, 72189 Västerås, 13:15
Opponent
Supervisors
Available from: 2007-05-11 Created: 2007-05-11Bibliographically approved

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Schüle, JanaBergkvist, Leif

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