Year: 2004
Type: dissertation
Study design: Observational Study
Abstract: Aim:The purpose of the present study was to evaluate the feasibility of sentinel node biopsy (SNB) in lymph node staging in breast cancer with a special emphasis on radioguided occult lesion localization (ROLL), hospital costs, and postoperative morbidity. Patients and methods:The study population comprised of clinically stage T1-2 and node-negative breast cancer patients, who underwent breast surgery and SNB between 31 May 2000 and 28 February 2002 at the Breast Surgery Unit, Helsinki University Hospital.Preoperative lymphoscintigraphy (LS), intraoperative gamma probe, and blue dye were used for identification of sentinel nodes (SNs).Axillary clearance (AC) was performed when the SNs in the axilla were involved or were not identified.Any SN outside level I-II of axilla, when clearly visible in LS, was also excised.Single intratumoral injection of the radioactive tracer in ultrasound (US) guidance for nonpalpable tumors visible in US, was the only tumor localization method (ROLL).The sequence of the treatment procedures of 237 consecutive patients was recorded and evaluated by use of three hypothetical scenarios: Diagnostic axillary lymph node dissection (ALND), SNB without frozen section diagnosis, and SNB as day-case surgery prior to the breast operation.The total hospital costs were calculated in all protocols.One-year breast morbidity was evaluated by clinical examination and breast ultrasound (US) in 102 patients.To evaluate postoperative arm morbidity, a physiotherapist examined 83 patients preoperatively and 3,6, and 12 months postoperatively; the range of shoulder motion on both sides and the sense of touch in the axillary and breast areas was measured.Self-experienced morbidity was estimated by a questionnaire concerning postoperative pain, range of shoulder motion, numbness, muscle weakness, lymphedema, and sensory disorders.Results: LS showed SN in the axilla in 88% of the 170 patients, 17% with SN outside level I-II of the axilla.Axillary metastases were found in 40% of the patients with SNs outside the axilla; SN outside the axilla were involved in 3% of all cases.Two patients with extra-axillary node metastases had no axillary metastases.Excision of the tumors was complete in 93% of all the 215 cases after the primary operation and in 89% with radioguided occult lesion localization (ROLL).In addition, at least 10-mm free margins were achieved with ROLL in a primary operation in 69% of the patients.The hospital costs per patient were 3750 € by frozen-section diagnosis of SNs.Hospital costs per patient would have been 3020 € with the ALND for ABSTRACT axillary staging, 4087 € without the frozen section, and 4573 € with the "SNB as day-case surgery" model.Costs with or without intraoperative frozen-section diagnosis would have been equal with a false-negative rate of 35%.One year after surgery, the clinical examination revealed breast edema in 23% of 57 patients after SNB.US revealed subcutaneous edema and interstitial fluid in the breast significantly more often after AC.Approximately a quarter of the 43 patients experienced at least mild arm morbidity one year after SNB alone, whereas half the patients had similar symptoms after AC.None of the patients after SNB alone received lymph therapy.Conclusion: SNB is a feasible method in lymph node staging of breast cancer.Intratumoral tracer injection makes excision of nonpalpalpable tumors possible without other localization methods.SNB seems to be associated with higher hospital costs than is diagnostic ALND, but frozen section diagnosis in SNB is worthwhile as long as the false-negative rate is less than 35%.The risk for severe morbidity after SNB seems to be low.
Source: Työväentutkimus Vuosikirja
Author: R. Rönkä
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W625516268