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Home:
Meeting
Highlights: 2001
Interactive Report
Section
3: Sentinel Node Biopsy/Axillary Dissection
17.
A 65-year-old woman with a history of adult onset diabetes and
obesity (5’8", 190 pounds), has a lumpectomy for a
1.2 cm, ER+ infiltrating ductal carcinoma. Axillary nodes are
negative, and she will be treated with radiation therapy to
the breast and tamoxifen. At the end of the five years the risk
of lymphadema is:
Negligible
About 10%
About 15%
About 25%
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7%
40%
34%
19%
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Monica Morrow, MD
We know that older age and high body mass index, or obesity,
appear to correlate with the risk of lymphedema. I would put
this patient’s risk at the end of five years in the 15
to 25 percent range — if you actually look for lymphedema.
This highlights a very important issue — physicians greatly
underestimate the incidence of lymphedema, because, by and large,
it’s not a life-threatening problem. Even when you look
at modern series done by expert breast surgeons, patients still
develop lymphedema. It’s an unavoidable problem if you
dissect the axilla. |
18.
A patient presents with a 1 centimeter infiltrating ductal
breast cancer. Which of the following procedures would you
usually recommend?
Sentinel
node biopsy
Axillary sampling
Axillary dissection to Level I
Axissection to Level II
Other |
61%
4%
7%
24%
4%
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19.
(For surgeons only): When you do a sentinel node biopsy in a
patient with clinically negative nodes along with an excision
of the primary lesion, which procedure do you do first?
Sentinel
node biopsy
Excision of the primary tumor |
78%
22%
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Monica Morrow, MD
This is very dependent on the technique used for mapping. With
blue dye, you have a big open biopsy cavity, and a lot of the
dye will leak back into the cavity. If you’re going to
map with blue dye it makes sense to do the sentinel node first.
With radioactivity, that may not be so critical, because you’ve
let the patient sit for an hour or two anyway, so a substantial
amount of the radioactivity has already left the primary tumor
site and is in the axilla.
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