The
American College of Surgeons sentinel node trial: Part one: Node-negative
patients
Interview
with Neil Love, MD from Breast Cancer Update for Surgeons,
Program 2 2000
Play
Audio Below:
The
American College of Surgeons trial takes surgeons, as I said, who
are proficient with the procedure, and patients who are T1 or T2,
N0, M0 are treated with sentinel node alone and they’re followed
to determine axillary recurrence, overall survival. At the time
of operation they have a bilateral illeac crest bone marrow aspiration
and the sentinel node, a portion of which is removed and sent for
immunohistochemistry. I think that’s a very important trial
because the value of immunohistochemistry and the detection of micrometastases
in the sentinel node or the bone marrow is not known. There are
good studies now with bone marrow, showing that bone marrow micrometastases
adversely effects survival, and these micrometastases seem to be
independent of axillary nodal metastases, and they’re probably
an independent path of spread of independent prognostic significance.
These studies have all been done in Germany – relatively small
– and I think its important for us to look at the same type
of information here in America where we tend to use chemotherapy
differently and may have different outcomes because of our more
aggressive adjuvant treatment. In addition, the data on the micrometastases
in the sentinel node is not clear. There are studies that show occult
metastases or micrometastases in sentinel node does not adversely
affect survival. Yet there are other studies that show they do.
All studies are retrospective, they’re all small, they have
different definitions of micrometastasis in different techniques
of detection. Our trial will standardize these techniques and definitions
and hopefully, answer the question of, "Should we look for micrometastases
in sentinel nodes, do special studies on these sentinel nodes to
identify high risk or low risk women on the basis of occult metastases."
So the blinding has been a problem, because some physicians, surgeons
and medical oncologists feel that micrometastases are important
things to know about and can base therapy on micrometastases, and
they’re reluctant to have patients in a blinded study.
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.
