Interview
with Neil Love, MD from Breast Cancer Update for Surgeons,
Program 2 2000
Play
Audio Below:
Dr. Borgen: The American College of Surgeons
trial is more problematic, and let me preface this by saying that
I was actually the first Chairman of the ACOS Oncology Trials Group,
so my heart is clearly, strongly with that organization. Unfortunately,
my group has two major problems with the trial. The first one is
that part of the pathology – the immunohistochemistry –
is blinded. In our experience now of over 2,000 cases, a non-trivial
percentage of the time, it is the immunohistochemistry that leads
us to find H&E metastatic disease in a lymph node, so to be
blinded to the IHC’s at this point in time would be difficult.
Dr.
Love: You are saying, it’s the immunohistochemistry of the
sentinel node that leads you to get a positive H&E in the axilla?
Dr.
Borgen: Yes, very, very commonly the IHC will reveal the tip of
an iceberg of an H&E positive met. The rationale behind blinding
to IHC is a legitimate rationale. Are these cells biologically relevant?
Are they dangerous? Should these people get chemotherapy? The problem
is that in doing this, we run the risk of understaging patients
who have believable mets. There is a solution to this, and that
is scan the node with IHC first, identified all of the H&E disease
you can, and then simply blind yourself to the balance of these,
and we’ve proposed that to the trial organization. The second
part of the trial randomizes the sentinel node positive patients
to conventional axillary dissection or no further axillary treatment.
Depending on tumor size, between 15%-40% of these patients will
have cancer left behind in lymph nodes. I absolutely do not believe
that there is data available that suggests that chemotherapy will
sterilize this disease and that this is a safe thing to do. So,
really the first part of the trial is problematic, but the second
part is impossible. The second part is not a trial I would put a
family member on, and therefore I can’t offer it to my patients.
Is
routine intraoperative frozen-section examination of sentinel lymph
nodes in breast cancer worthwhile Weiser, M. R.; Montgomery,
L. L.; Susnik, B.; Tan, L. K.; Borgen, P. I., and Cody, H. S.? Annals
of Surgical Oncology. 7(9):651-655, 2000 Oct. In progress
Micrometastatic
nodal disease in breast cancer - The dilemma continues. Rose, M. D. and Giuliano, A. E. (Reprint available from:
Giuliano AE St Johns Hlth Ctr, John Wayne Canc Inst 2200 Santa Monica
Blvd Santa Monica, CA 90404 USA). Journal of Surgical Oncology.
74(2):87-89, 2000 Jun. No abstract
Variation
in axillary node dissection influences the degree of nodal involvement
in breast cancer patients.
Saha, S.; Farrar, W. B.; Young, D. C.; Ferrara, J. J., and Burak,
W. E.. Journal of Surgical Oncology. 73(3):134-137, 2000 Mar.
A
multicenter validation study of sentinel lymph node biopsy by the
Japanese Breast Cancer Society.
Noguchi, M.; Motomura, K.; Imoto, S.; Miyauchi, M.; Sato, K.; Iwata,
H.; Ohta, M.; Kurosumi, M., and Tsugawa, K. (Reprint available from:
Noguchi M Kanazawa Univ Hosp, Operat Ctr Takara Machi 13-1 Kanazawa
Ishikawa 9208641 Japan).. Breast Cancer Research & Treatment.
63(1):31-40, 2000 Sep. In process
Sentinel-node
biopsy sampling in breast cancer. Nieweg, O. E.; Tanis, P. J.; Olmos, R. A. V.; Rutgers, E. J.
T., and Kroon, B. B. R. (Reprint available from: Nieweg OE Netherlands
Canc Inst, Antoni Van Leeuwenhoek Hosp, Dept Surg Plesmanlaan 121
NL-1066 CX Amsterdam Netherlands).. Lancet. 356(9243): 1770, 2000
Nov 18. In process
Increased
false negative sentinel node biopsy rates after preoperative chemotherapy
for invasive breast carcinoma Nason, K. S.; Anderson, B. O.; Byrd, D. R.; Dunnwald, L. K.;
Eary, J. F.; Mankoff, D. A.; Livingston, R.; Schmidt, R. A.; Jewell,
K. D.; Yeung, R. S., and Moe, R. E.. Cancer. 89(11):2187-2194, 2000
Dec 1. In process
Pathologic
analysis of sentinel lymph nodes in breast carcinoma. Liberman, L. (Reprint available from: Liberman L Mem Sloan Kettering
Canc Ctr, Dept Radiol, Breast Imaging Sect 1275 York Ave New York,
NY 10021 USA). Cancer. 88(5):971-977, 2000 Mar 1. No abstract
Long-term
morbidity following axillary dissection in breast cancer patients
- clinical assessment, significance for life quality and the impact
of demographic, oncologic and therapeutic factors. Kuehn, T.; Klauss, W.; Darsow, M.; Regele, S.; Flock, F.; Maiterth,
C.; Dahlbender, R.; Wendt, I., and Kreienberg, R. Breast Cancer
Research & Treatment. 64(3):275-286, 2000 Dec.
Sentinel
lymph node biopsy: Is it indicated in patients with high-risk ductal
carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Klauber-DeMore, N.; Tan, L. K.; Liberman, L.; Kaptain, S.; Fey,
J.; Borgen, P.; Heerdt, A.; Montgomery, L.; Paglia, M.; Petrek,
J. A.; Cody, H. S., and Van Zee, K. J. Annals of Surgical Oncology.
7(9):636-642, 2000 Oct. In process
Pilot
study on sentinel node biopsy in breast cancer - Commentary Greene, F. L. (Reprint available from: Greene FL Carolinas Med
Ctr, Dept Gen Surg Charlotte, NC 28203 USA).. Journal of Surgical
Oncology. 73(3):133, 2000 Mar.
Impact
of sentinel lymph node mapping on relative charge in patients with
early-stage breast cancer. Gemignani, M. L.; Cody, H. S.; Fey, J. V.; Tran, K. N.; Venkatraman,
E., and Borgen, P. I. Annals of Surgical Oncology. 7(8):575-580,
2000 Sep. In process
Does
sentinel lymphadenectomy improve staging and alter therapy in elderly
women with breast cancer? DiFronzo, L. A.; Hansen, N. M.; Stern, S. L.; Brennan, M. B.,
and Giuliano, A. E. Annals of Surgical Oncology. 7(6):406-410, 2000
Jul. In process
A
high number of tumor free axillary lymph nodes from patients with
lymph node negative breast is associated with poor outcome. Cody, H. S. and Van Zee, K. J. (Reprint available from: Cody
HS Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol 1275 York Ave
New York, NY 10021 USA).. Cancer. 89(1):218, 2000 Jul 1. No abstract
Challenging
the myth of exercise-induced lymphedema following breast cancer:
A series of case reports — Commentary.
(Reprint available from: Cady B Brown Univ, Women & Infants
Hosp, Breast Hlth Ctr Providence, RI 02908 USA).. Journal of Surgical
Oncology. 74(2):98-99, 2000 Jun. No abstract
Should
irradiation replace dissection for patients with breast cancer with
clinically negative axillary lymph nodes? Recht, A. (Reprint available from: Recht A Beth Israel Deaconess
Med Ctr, Dept Radiat Oncol East Campus,Finard Bldg B25,330 Brookline
Ave Boston, MA 02215 USA). Journal of Surgical Oncology. 72(4):184-192,
1999 Dec. No abstract
Lymphedema:
Current issues in research and management. Petrek, J. A.; Pressman, P. I., and Smith, R. A. Ca: a Cancer
Journal for Clinicians. 50(5):292-307, 2000 Sep-Oct.
