Interview
with Neil Love, MD from Breast Cancer Update for Surgeons,
Program 1 2000
Play
Audio Below:
There’s three reasons that we do axillary dissections. The
first is for regional control, the second is for staging and prognosis,
and the third is possibly to improve survival. Let’s look at
each one of these. Ok? The staging, which is what most people kind
of think of as the first thing, historically was not our first priority
for doing axillary dissection, it was therapeutic. For staging,
we’ve got enough literature from a variety of techniques and
sources around the world to tell us the accuracy of sentinel node
for staging the axilla. We know what the range of false negative
rates are and so forth. If that’s all we’re after, we’re
done. We can go ahead and use this. The other two issues, which
are extremely important, are regional control. Surgery has close
to 100% regional control in the axillary area. Irradiation also
has similar control. So before we abandon something that works very
well therapeutically we have to be very careful. We don’t have
any long-term data on this for sentinel nodes. We don’t know
what the long term regional control rate will be. And if somebody
does have a regional recurrence, these are bad. The mortality associated
with the regional recurrence is about 50%, and the ability to control
that axilla, just from a local perspective, there’s a lot of
horror studies for those few patients who do get those. So it’s
not a small issue. The third is survival, and I know this is a little
heretical to say this, but there may be a survival difference by
controlling that axilla. I say that because one we don’t have
many studies not doing axillary dissections to really look at this.
The studies that have been done, the NASBP studies were in an era
when we would randomize hundreds of patients, not thousands of patients.
So in those studies it is quite correct that there was no survival
difference, but the ability to measure a survival difference of
let’s say 5, 6, 7% was not in that study. The power was not
there to establish that.
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.
