Role of methylprednisolone in the prevention of seroma formation after mastectomy: A randomized controlled trial

Background: Seroma formation after mastectomy with axillary dissection is a major source of morbidity and results in a significant delay in starting the adjuvant treatment. Many different strategies, including the usage of steroids, have been tried to reduce the incidence of seroma with varying outcomes. This study aimed to assess the effect of a single dose of intracavitary methylprednisolone (MP) on seroma formation in patients undergoing total mastectomy with axillary lymph node dissection (ALND). Methods: A randomized controlled trial was conducted at our institute, from January 2018 till June 2019. In the intervention group of 36 patients, 80 mg of MP solution was injected into the wound on post operative day 1. The drain was clamped for 8 hours and then released. In the control group of 36 patients, saline was administered and the drain output was compared between the groups. Results: The mean drain volume in the intervention group was 409.08 mL and in the control group it was 566.97 mL (P < 0.005). The mean drain removal time was 7.86 days and 10.33 days in the intervention and control group, respectively (P < 0.0004). Conclusion: A single dose of intracavitary MP significantly reduced seroma formation and facilitated early removal of drain in patients undergoing total mastectomy with ALND.

Progress and strategy for axillary management of breast cancer / 国际外科学杂志

With the understanding of the biological characteristics of breast cancer and the improvement of systemic treatment, the treatment concept of breast cancer has changed, and the treatment strategy of axillary lymph nodes has also been constantly changing. With the change of these concepts, a large number of relevant clinical trials have been gradually carried out. The NSABP B04 study took the lead in exploring the transformation of axillary treatment strategies in the classic breast cancer treatment. Although this study did not change the clinical practice of axillary treatment at the time, it provided a preliminary data basis for a subsequent series of clinical studies on axillary preservation. In these changes, sentinel lymph node biopsy, as a milestone in the surgical treatment of breast cancer, has become the standard staging procedure for axillary negative patients. Since then, a series of related clinical studies have also been carried out, among which the results of studies on patients with low-load axillary metastasis have confirmed the feasibility of axillary preservation in some patients, which has influenced and changed clinical practice. In addition, the results of the study make it possible for some patients to preserve the axilla after neoadjuvant therapy reduce postoperative upper extremity edema effectively. Whether axillary surgery can be completely eliminated, and whether axillary dissection can be waived for patients with positive axilla after neoadjuvant therapy under the premise of equal survival benefit have also received extensive attention.

Disección axilar dirigida utilizando carbón vegetal como marcador en paciente con cáncer de mama tratada con quimioterapia neoadyuvante. Técnica quirúrgica / Targeted axillary dissection using charcoal as a marker in a patient with breast cancer treated with neoadjuvant chemotherapy. Surgical technique

Describir la técnica quirúrgica de la disección axilar dirigida (DAD) usando carbón vegetal como marcador del ganglio linfático axilar metastásico al momento del diagnóstico conjuntamente con la biopsia del ganglio centinela en paciente con cáncer de mama tratada con quimioterapia neoadyuvante con respuesta completa clínica y ecográficamente, demostrando su seguridad y eficacia. Material y Métodos: Estudio retrospectivo y descriptivo. Paciente con cáncer de mama y ganglio linfático metastásico en axila ipsilateral marcado con carbón vegetal al confirmarse ese diagnóstico y tratada con quimioterapia neoadyuvante con posterior negativización tanto clínica como ecográfica del ganglio linfático metastásico. Se planificó para disección axilar dirigida (extirpación del ganglio marcado con carbón vegetal y biopsia de ganglio centinela) con el fin de demostrar la eficacia del marcador utilizado y su relación o no con el ganglio centinela. Resultados: Se comprobó la identificación certera del ganglio afectado marcado con carbón vegetal el cual no presentó migración del colorante o reacción inflamatoria local coincidiendo además con dos ganglios centinelas todos con respuesta patológica completa. El carbón permaneció 153 días desde su administración hasta la cirugía axilar. Conclusión: Esta experiencia admite el marcaje con carbón vegetal del ganglio axilar metastásico al momento de su diagnóstico como un método seguro, sencillo, económico y accesible en relación a otros métodos de marcaje, además su asociación con la biopsia del ganglio centinela nos permite prescindir de la disección axilar en caso de respuesta patológica completa, sin embargo, es importante resaltar que se necesitan evaluar más casos para obtener conclusiones determinantes(AU)

To describe the surgical technique of targeted axillary dissection using charcoal marking of the metastatic lymph node at the time of diagnosis together with sentinel node biopsy in a breast cancer patient who received neoadjuvant chemotherapy with complete clinical and sonographical response, demonstrating its safety and efficacy. Material and Methods: Retrospective and descriptive study. Patient with breast cancer and metastatic lymph node in the ipsilateral axilla which was marked with charcoal upon confirmation of this diagnosis and treated with neoadjuvant chemotherapy with subsequent clinical and sonographical negativization of the metastatic lymph node. It was planned for targeted axillary dissection (removal of charcoal-marked lymph node and sentinel node biopsy) in order to demonstrate the efficacy of the marker used and its relationship or not with the sentinel node. Results: The correct identification of the affected lymph node marked with charcoal was verified, which did not present dye migration or local inflammatory reaction, also coinciding with two sentinel nodes, all of them with a complete pathological response. The charcoal remained 153 days from its administration until the axillary surgery. Conclusion: This experience supports charcoal marking of the metastatic lymph node at the time of diagnosis as a safe, simple, inexpensive and accessible method in relation to other marking methods, in addition its association with sentinel node biopsy allows us to dispense with axillary dissection in case of complete pathological response, however it is important to highlight that more cases need to be evaluated to obtain decisive conclusions(AU)

Computerized tomography based evaluation of level I and II axillary lymph nodes by high conventional tangential fields in carcinoma breast

Background: Axillary radiation and surgery have provided equivalent local control in early breast cancer patients. It is believed that tangential field (TF) radiation that was used to treat the breast coincidently delivered radiation treatment to the lower axilla and eradicated the disease. In the era of CT-based three dimensional- (3D) radiotherapy planning, however concerns have been raised about the adequacy of coverage of the axillary levels in the tangential fields. In this study, author evaluated the coverage of the axillary nodal levels I and II using high conventional tangential fields in patients with or without axillary dissection.Methods: A prospective study was conducted which included 18 cases for a period of one year, radiation therapy was planned to the chest wall or whole breast by using the high conventional tangential field using 2D radiation portals. Central lung distance (CLD) and the distance of superior border was measured form the head of the humerus and were recorded. CECT chest was done in the same position alike during conventional simulation. All the images were shifted to the treatment planning system. The Contouring of Axillary lymph nodes level I and II was done on Oncentra contouring software.Results: The coverage of the axillary nodes was not related to central lung distance (CLD). However, some with CLD of 1cm had more coverage of the level I nodes than with CLD of 2 cm and the maximum CLD in the field was 2.5 cm. Of the 18 patients in the study, 13 patients had <2 cm distance from the humeral head and all the axillary level II LN covered in the field. Whereas 5 patients having distance >2 cm did not have adequate coverage of level II axillary LN’s.Conclusions: The distance of the cranial border of the tangent portal from the head of the humerus shows a relationship with coverage of level II nodes cranially. As the distance decreases the coverage of level II nodes cranially keeps increasing. In majority of the patients a distance of 2 cm or less than 2 cm ensured good coverage of level II nodes cranially. Similarly, no correlation was found between volumetric coverage of the axillary nodes with central lung distance.

Ganglio Centinela en Cáncer de Mama: Experiencia de 11 años del Instituto Privado de Mastología, Ginecología y Obstetricia (imago) de la Provincia de Salta, Argentina / Sentinel node in breast cancer. 11 years experience at Instituto Privado de Mastología, Ginecología y Obstetricia (imago) of Provincia de Salta, Argentina

Introducción El desarrollo de la técnica de la Biopsia del Ganglio Centinela (bgc) descripta por Giuliano1,2 se convirtió en el procedimiento de elección para estadificar la axila en el cáncer de mama, ya que permite seleccionar un subgrupo de pacientes en las que la linfadenectomia axilar no aporta beneficio adicional alguno. Objetivos El objetivo de este trabajo fue comunicar nuestra experiencia de 11 años en la identificación del Ganglio Centinela. Material y método Desde enero de 2004 a enero de 2015, 223 pacientes con carcinoma mamario y ganglios axilares clínicamente negativos se sometieron a bgc. Resultados En 146 pacientes el gc fue negativo, 15 fueron a vaciamiento axilar por formar parte del periodo de curva de aprendizaje y en 131 pacientes no se llevó a cabo más tratamiento axilar. En 74 casos (33,18%), se hallaron uno o más gc positivos, y se realizó disección axilar total. Conclusiones Nuestra experiencia con 223 pacientes de cáncer de mama inicial a las que se les realizó bgc indica que en tumores pequeños (hasta 4 cm), con ganglios axilares clínicamente negativos, la bgc es el procedimiento de elección para determinar estadio ganglionar.

Introduction The sentinel node biopsy technique development (snb), described by Giuliano, became the procedure of choice for staging the axilla in breast cancer. This technique allows selection of a subset of patients in which axillary lymphadenectomy does not provide any additional benefit. Objectives The aim of this study is to report our 11 years experience in sentinel node identification. Materials and method From January 2004 to January 2015, we studied 223 breast carcinoma patients with clinically negative axillary nodes who underwent snb. Results We found that the centinel node was negative in 146 patients. 15 of those patients went to an axillary lymphadenectomy as part of the learning curve period. Finally, 131 patients did not carried out further axillary treatment. We found one or more positive sentinel nodes in 74 cases (33.18%) and, as a result of this, total axillary dissection was performed. Conclusions Our experience with 223 patients who had early breast cancer, in which we conducted snb, indicates that small tumors (up to 4 cm), with clinically negative axillary nodes, the sentinel node biopsy is the procedure of choice to determine nodal stage.

Ultrasonic scalpel versus electrocautery in axillary dissection in breast cancer patients / 临床外科杂志

Objective To evaluate the effects of ultrasonic scalpel and traditional electrocautery on postoperative complications in axillary dissection for breast cancer treatment.Methods The clinical data of 92 breast cancer patients with axillary dissection were analyzed retrospectively.The surgical proce-dures were randomly chosen by patients,including 37 cases with ultrasonic scalpel and 55 cases with elec-trocautery.Both groups were compared in operation time,number of harvested lymph nodes,postoperative drainage in 24 h,seroma formation rate,and drain removal time.Results There were no significant differ-ences in operation time[(148.2 ±30.4)min vs(143.5 ±40.8)min],number of harvested lymph nodes (17 nodes vs 16 nodes),and drain removal time[(16.0 ±5.3)d vs(16.7 ±4.4)d]between ultrasonic scalpel group and electrocautery group(P >0.05 ).There were significant differences in postoperative drainage [(118.8 ±65.8)ml vs(159.2 ±71.3)ml]and seroma formation rate(8.1% vs 20%)between ultrasonic scalpel group and electrocautery group(P <0.01).Conclusion For breast cancer,ultrasonic scalpel is similar to electrocautery in axillary dissection,but it can reduce postoperative complications.

Role of axillary sampling in the era of sentinel lymph node biopsy: A critical review.

Axillary lymph node dissection is the standard of care for treating and staging axilla in breast cancer. Sentinel lymph node biopsy and axillary sampling have been advocated as an alternative to axillary lymph node dissection with an added benefit of lesser morbidity. Herein, we are reviewing the role of axillary sampling in the present era of sentinel lymph node biopsy in the background of standard axillary dissection.

Sentinel node biopsy in breast cancer: results in a large series

Sentinel lymph node biopsy (SLNB) is an appropriate method for the evaluation of axillary status in cases of early breast cancer. We report our experience in treating cases evaluated using SLNB. We analyzed a total of 1192 cases assessed by means of SLNB from July 1999 to December 2007. SLNB processing was successfully completed in 1154 cases with the use of blue dye or radiolabeled 99mTc-Dextran-500, or both. Of these 1154 patients, 857 were N0(i-) (no regional lymph node metastasis, negative immunohistochemistry, IHC), 96 were N0(i+) (no regional lymph node metastasis histologically, positive IHC, no IHC cluster greater than 0.2 mm) and 201 were N1mi (greater than 0.2 mm, none greater than 2.0 mm). Most of the tumors (70 percent) were invasive ductal carcinomas and tumors were staged as T1 in 770 patients (65 percent). A total of 274 patients underwent SLNB and axillary dissections up to April 2003. The inclusion criteria were tumor size equal to or less than 3 cm in diameter, no clinically palpable axillary lymph nodes, no neoadjuvant therapy. In 19 cases, the SLN could not be identified intraoperatively. A false-negative rate of 11 percent and a negative predictive value of 88.2 percent were obtained for the 255 assessable patients. The overall concordance between SLNB and axillary lymph node status was 92 percent. SLNB sensitivity for nodes was 81 percent and specificity was 100 percent. The higher sensitivity, specificity, accuracy, and lower false-negative rates of SLNB suggest that this method may be an appropriate alternative to total axillary dissection in early breast cancer patients.

Implications of Isolated Tumor Cells in Sentinel Lymph Nodes of Breast Cancer Patients

PURPOSE: Sentinel lymph node (SLN) biopsy has replaced unnecessary axillary dissection in breast cancer surgery except when the nodes are positive for macrometastasis. But guidelines for isolated tumor cells (ITCs) found in SLNs has not yet been established and further study is ongoing. The goal of this study was to consider the implication of the isolated tumor cells found in the SLNs of Korean breast cancer patients. METHODS: Between September 2003 and March 2008, 985 primary breast cancer patients underwent SLN biopsy. On reviewing the medical records, 81 patients were found to have ITCs in SLNs without macrometastasis or micrometastasis. ITCs were detected by serial sectioning and immunohistochemistry. RESULTS: The mean number of detected SLNs was 3.5+/-1.7. Thirty three patients had multifocally distributed ITCs and 9 had ITCs in multiple SLNs whose N stage was N0 (i+). Completion axillary dissection has been performed in 9 patients and 3 of them (33.3%) finally were found to be N1 or N1mi. CONCLUSION: The characteristics of ITCs are not clear yet and their prognostic value is still under investigation. Until the significance of ITCs found in SLNs become definite, axillary dissection should be more aggressively considered.

Morbidade entre a pós-biópsia de linfonodo sentinela e a dissecção axilar no câncer de mama / Morbidity after sentinel node biopsy and axillary dissection in breast cancer

OBJETIVO: O objetivo deste estudo foi avaliar a morbidade cirúrgica pós-biópsia de linfonodo sentinela (BLS) ou dissecção axilar com (DA-NP) e sem preservação do nervo intercostobraquial (DA-NS). MÉTODOS: Fez-se estudo coorte prospectivo com 108 pacientes divididas em três grupos: BLS (n=35), DA-NP (n=36) e DA-NS (n=37). Foram avaliadas ocorrência de déficit sensorial, dor, linfedema, seroma e infecção no membro superior homolateral à cirurgia. Monofilamentos de Semmes-Weinstein foram usados para avaliar o déficit sensorial, perimetria braquial foi feita para avaliação da presença de linfedema e aplicado questionário de dor. Para análise estatística foram utilizados os testes ANOVA e Kruskal-Wallis. Foi feita análise bivariada e multivariada. RESULTADOS: Pelo menos uma complicação pós-cirúrgica, imediata ou tardia, ocorreu em 45/108 (41,7 por cento) pacientes avaliadas. A complicação mais comum foi dor. Houve diferença estatisticamente significante entre os três grupos somente quanto ao déficit sensorial (p=0,04). Dor, linfedema e déficit sensorial ocorreram com maior freqüência no grupo DA-NS. As pacientes dos grupos BLS e DA-NP não apresentaram diferenças estatisticamente significantes para nenhuma das variáveis analisadas. A pesquisa com os monofilamentos mostrou sensibilidade cutânea preservada em 28/35 pacientes do grupo BLS, em 25/36 pacientes do grupo DA-NP e em 10/37 pacientes do grupo DA-NS (p<0,001). CONCLUSÃO: A secção do nervo está relacionada a maior déficit sensorial havendo diferença estatisticamente significante entre os três grupos, o que não demonstrou ser significante com os demais critérios avaliados dentre os grupos analisados.

BACKGROUND: The aim of this study was to evaluate the morbidity after sentinel node biopsy (SNB) and axillary dissection with (AD-NS) or without sparing the intercostobrachial nerve (AD-NOS). Methods: A prospective cohort study was performed on 108 patients divided into three groups: SNB (n=35), AD-NS (n=36) and AD-NOS (n=37). We evaluated the incidence of sensory loss, pain, lymphedema, seroma formation and infection in the arm homolateral to the breast surgery. Semmes-Weinstein monofilaments were used to assess the sensory loss; brachial perimetry was used to evaluate presence of lymphedema and a pain questionnaire was administered. ANOVA and Kruskal-Wallis statistical tests were used. Bivariate and Multivariate analyses were performed. RESULTS: After surgery at least one complication was reported by 45/108 (41.7 percent) patients. Pain was the outcome more often reported by patients. In the three groups a significant difference was observed only regarding sensory loss (p=0.04). Pain, lymphedema, and sensory loss were more frequently found in the AD-NOS group. No significant difference was observed between SNB and AD-NS groups. Semmes-Weinstein monofilaments showed preservation of cutaneous sensitivity in 28/35 patients from the SNB group, in 25/36 patients from AD-NS group but in only 10/37 patients from AD-NOS group (p<0.001). CONCLUSION: The ICB section is associated with higher sensory loss, with statistically significant difference between the groups that were not shown to be significant with the others complications.

Avaliação das compensações linfáticas no pós-operatório de câncer de mama com dissecção axilar através da linfocintilografia: [revisão] / Evaluation of lymphatic compensation by lymphoscintigraphy in the postoperative period of breast cancer surgery with axillary dissection: [review]

O sistema linfático é um componente do corpo humano intimamente relacionado ao sistema venoso. Entretanto, o conhecimento científico a seu respeito é limitado. A etiologia e os fatores de risco para o desenvolvimento do linfedema no pós-operatório de câncer de mama são multifatoriais e ainda não foram completamente esclarecidos. O objetivo desta revisão da literatura foi descrever o padrão linfocintilográfico e avaliar as compensações linfáticas do membro superior no pós-operatório de câncer de mama com dissecção axilar.

The lymphatic system is a component of the human body that is closely related to the venous system. However, scientific knowledge of this system is limited. The etiology and risk factors for the development of postoperative lymphedema in patients with breast cancer seem to be multifactorial and have not been fully understood yet. The objective of this review of the literature was to describe lymphoscintigraphic pattern and to evaluate upper limb lymphatic compensation following breast cancer surgery with axillary dissection.

Perfil das pacientes pós-cirurgia de câncer de mama com síndrome do cordão axilar / Profile of the patients after breast cancer surgery with axillary web syndrome

O câncer de mama representa o segundo tipo mais freqüente no mundo e o que mais causa mortesentre as mulheres. O objetivo deste estudo foi analisar, por meio de prontuários fisioterapêuticos emédicos, o perfil das pacientes pós-cirurgia de câncer de mama com axillary web syndrome (AWS)do Hospital de Câncer de Pernambuco e da Faculdade Integrada do Recife (FIR). Das 112 pacientesavaliadas de abril a outubro de 2006, 7,1% apresentaram AWS. A maioria apresentou dore restrição de movimento, e 50% apresentaram linfedema. Metade realizou quadrantectomia e asdemais mastectomia, todas associadas ao esvaziamento axilar. Em 37,5%, a AWS se estendeu atéo antebraço. O tumor mais freqüente foi o carcinoma ductal invasivo e os estadiamentos I e IIapresentaram freqüência de 40%. Todas as pacientes realizaram quimioterapia e 80% realizaramradioterapia associada. Concluí-se, assim, que a AWS é significativa complicação pós-operatória eseus sintomas podem acarretar alterações na qualidade de vida.

Breast cancer represents the second most frequent type of cancer in the world and the one that most causesdeath among women. This study aimed at analyzing the profile of patients from the Cancer Hospital ofPernambuco and from FIR, after a breast cancer surgery with Axillary Web Syndrome (AWS), by meansof medical and physical therapeutic records. Within the 112 evaluated patients from April to Octoberof 2006, 7.1% presented AWS. The majority presented pain and restriction of movement, and 50%presented lymphedema. Half of the patients had a quadrantectomy done, while the remaining ones hada mastectomy, all of them associated with axillary dissection. In 37.5%, AWS reached the forearm. Themost frequent tumor was invasive ductal carcinoma and staging I and II presented frequency of 40%. Allpatients had chemotherapy done, and 80% of these had associated radiotherapy. Thus, it was concludedthat AWS is a significant post surgical complication, and its symptoms may lead to changes in the patient’slife quality.

Linfocintigrafia pré-operatória em gama-câmara associada ao azul patente para biópsia do linfonodo sentinela no câncer de mama / Gamma-camera lymphoscintigrahy and blue dye for sentinel node biopsy in breast cancer

Apesar do gama-probe ser a técnica que possui os melhores resultados na identificação do linfonodo sentinela (LS), a sua maior difusão nos países em desenvolvimento ainda é limitada em razão de seu custo elevado. Assim, o propósito deste estudo, realizado entre outubro de 1999 e agosto de 2004, foi determinar a eficácia da associação da linfocintigrafia pré-operatória na gama-câmara com o azul patente para biópsia do LS, sem o uso do gama-probe. Caso o linfonodo não estivesse corado com o azul patente, então era realizada amostragem do lifonodo com a projeção marcada na pele pela gama-câmara. Foram incluídas 146 pacientes com carcinomas invasivos T1-2 N0M0. As primeiras 50 pacientes foram submetidas ao esvaziamento axilar, para verificar o índice de falso-negativo da técnica, que resultou em 5,9%. A média de idade foi de 58,1 anos e a média do tamanho tumoral foi de 20,7 mm. O LS foi identificado em 98,6% das pacientes. Em 6 (4,1%), o LS foi identificado apenas pela gama-câmara e, em 2 pacientes, apenas o azul patente identificou o LS. Esses resultados demonstraram que essa técnica é uma alternativa viável para biópsia do LS no nosso meio.

Gamma-probe is the most reliable technique for sentinel node (SN) biopsy, but is remains cost-limiting for its widespread use in development countries. Then, the purpose of this study, performed from October 1999 to August 2004, was to determine the efficacy of the association of preoperative gamma camera lymphoscintigraphy and blue dye for SN biopsy, without the use of the gamma- probe. If the blue node were not find at surgery, then axillary sampling should be done in SN projection designated by gamma-camera.146 T1-2, N0, M0, invasive breast cancer patients were enrolled in this trial. The first 50 patients were submitted to axillary dissection, in order to find the false-negative rate. It was 5.9%. The mean age was 58.1 years and the mean tumor size was 20.7 mm. SN was identified in 98.6% of patients. In 6 (4.1%)patients. SN was identification was supported only by the gamma-camera, and the blue dye identified the SN IN 2 (1,4%) gamma-camera failure. These data support it as a reliable and low cost technique for SN biopsy.

Comparison of Early Postoperative Axillary Morbidity Following the Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection / 한국유방암학회지

PURPOSE: Sentinel lymph node biopsy (SLNB) is a relatively accurate diagnostic method for determining the presence of axillary lymph node metastasis (ALND). SLNB reduces the need for axillary lymph node dissection, thereby decreasing the postoperative axillary morbidity. The present study compared the postoperative axillary morbidity rates during early postoperative days for patients undergoing either SLNB or conventional ALND. METHODS: We conducted a prospective case-control study of breast cancer patients. The degree of axillary morbidity was compared between 28 SLNB patients (Group I) and 38 ALND patients (Group II). RESULTS: The SLNB group showed decreased arm swelling and restriction of their shoulder motion in comparison with the conventional axillary dissection group (p<0.05). SLNB and additional lymph node sampling did not result in any additional morbidity. CONCLUSION: SLNB or lymph node sampling was associated with less axillary morbidity like arm edema, limitation of motion than was conventional ALND. The rate of postoperative axillary morbidity did not differ following lymph node sampling and SLNB. SLNB may be an effective method for diagnosing of axillary lymph node metastasis with decreasing the postoperative axillary morbidity

The Risk Factors Associated with Lymphedema after Axillary Dissection for Breast Cancer

PURPOSE: We wanted to evaluate the risk factors for developing lymphedema following axillary lymph node dissection in breast cancer patients. METHODS: Ninety-six patients who underwent axillary dissection for breast cancer were followed-up for up to 1 year. Lymphedema was assessed using a serial circumferential measurement method. More than a 2 cm difference in circumference was considered as clinically significant lymphedema. The effects of age, the body mass index (BMI), the cancer stage, chemotherapy, radiotherapy, the location of cancer and creating a latissimus dorsi (LD) flap on the development of lymphedema were analyzed. RESULTS: The incidence of lymphedema was increased with the advancing cancer stage. Radiotherapy was found to increase the incidence of lymphedema. Patients who had received an LD flap showed a lower incidence of lymphedema. CONCLUSION: These results could be useful as a clinical guideline for creating a management plan for postoperative lymphedema. Because there are some differences in the results between all the relevant reports, including ours, further research is needed in the form of a large, multi-center, long-term study.

Avaliação da morbidade do membro superior homolateral à cirurgia após biópsia do linfonodo sentinela versus dissecção axilar em pacientes com câncer de mama / Evaluation of morbity in the ipsilateral superior limb with surgery after sentinel lymph node biopsy versus axilar dissection on patients with breast cancer

O câncer de mama é uma das neoplasias mais estudadas em todo mundo pelo fato dessa patologia ser responsável por altas taxas de morbidade e mortalidade. O presente estudo teve como objetivo avaliar a morbidade (sensibilidade, dor, mobilidade articular e edema) relacionadas ao membro superior de pacientes com câncer de mama, após biópsia do linfonodo sentinela ou dissecção axilar. Foi realizado um estudo com 25 mulheres, desenvolvido no período de abril a novembro de 2003, junto ao Centro da Mama do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul. As características do exame físico das mulheres foram comparadas entre o pré e o pós-operatório e entre as técnicas cirúrgicas. A análise dos dados, do presente trabalho, caracteriza a biópsia do linfonodo sentinela como a técnica com menor morbidade quando comparada com a dissecção axilar.

Breast cancer is one of the most studied neoplasias in the world. It is due to the fact that this pathology is responsible for high rates of morbidity and mortality in women since the second half of the last century. The objective of the present study is to evaluate morbidity (sensibility, pain, joint mobility and edema) related to the superior limb of patients with breast cancer after biopsy of sentinel lymph node or axillary dissection. A study was performed in 25 women, from April to November of 2003 at the Breast Center of Sao Lucas Hospital at PUCRS. The characteristics of the physical exam were compared between the pre and post surgical and between the surgical techniques. Analysis of the data in the present paper characterizes the biopsy of the sentinel lymph node as a technique with less morbidity when compared to axillary dissection.

Arm Morbidity after Breast Cancer Treatments and Analysis of Related Factors / 대한방사선종양학회지

PURPOSE: To evaluate the incidence of arm morbidity following breast cancer surgery including axillary dissection and to identify related factors. MATERIASL AND METHODS: One hundred and fifty nine patients were studied using a self-report questionnaire and a clinical examination. Lymphedema, reduction of range of motion in shoulder joint and subjective symptoms (pain, impaired arm movement, numbness, stiffness) were evaluated. As related factors, demographic, oncologic characteristics and types of treatment were analysed. RESULTS: The incidence of lymphedema (> or =2 cm difference comparing to unaffected arm) was 6.3%, 10.7%, 22.6% and 23.3% at each 10 cm, 20 cm, 30 cm, and 40 cm from wrist. Reduction of range of motion in shoulder joint (> or =20 degree difference comparing to unaffected arm) was noted in more than 1/3 patients for flexion, abduction and internal rotation. Especially the reduction of range of motion in internal rotation was severe (> 50% reduction) in 1/3 patients. Approximately 50 to 60% of patients complained impaired arm movement, numbness, stiffness and pain. Body mass index (BMI) was the significant risk factor for lymphedema. CONCLUSION: Lymphedema was present in 1/3 of patients and the common sites of edema were 30 cm 40 cm proximal from the wrist. Also most severe reduction of range of motion in shoulder joint was with internal rotation. There needs weight control for lymphedema because BMI was the significant risk factor for lymphedema. Also rehabilitation program for range of motion especially internal rotation in shoulder joint should be developed.

Surgical Treatment of Breast Cancer

Breast cancer is the most common malignancy among women in Korea. Over the past decades, the surgical treament of the breast cancer evolved significantly, and the trend has been towards less conservative approaches. The introduction of percutaneous image-guided biopsy has allowed less invasive diagnosis of nonpalpable breast lesions. Breast conservative therapy has become accepted as an alternative to mastectomy for more patients with ductal carcinoma in situ and early stage invasive brest cancer. Another major advance in the surgical treatment of breast cancer has been the development of the sentinel node biopsy procedure. This is a way to determine if the axilla is negative for metastases without a complete axillary dissection and its physical and functional complications. Since many patients today are diagnosed with early stage breast cancer and negative axillary nodes, this technique offers substantial benefit to numerous women.

Sentinel lymph node biopsy in breast cancer using radiolabeled sulphur colloid / 中国癌症杂志

Purpose:To evaluate the performance and feasibility of sentinel node biopsy (SNB) in breast cancer patients using 99mTc Sulphur colloid and gamma probe.Methods:At Cancer Hospital,from May 2000 30 patients with tumor less than 5 cm with clinically negative axilla underwent SNB, which is followed by standard axillary dissection. 99mTc sulphur colloid was injected around the breast tumor and gamma probe was used to detect the SLN during surgery. SNB is compared with standard axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes.Results:The sentinel node is successfully identified in 90% (27/30) of the patients. Number of sentinel nodes ranged from 1—3,average 1.5, nonsentinael nodes 5—20,average 13.3 per patient. Of the 27 patients 52%(14/27) were histologically positive. The sentinel node was falsely negative in 2 patients, yielding an accuracy of 92.6%. In T 1 tumors, SNB was more accurate than for T 2 tumors.Conclusions:Gamma probe guided method is technically feasible in detecting sentinel nodes in most cases and predicts the axillary status quite accurately, and appears to be more accurate for T 1 lesions than for larger lesions. This minimally invasive axillary staging procedure represents a major advance in the surgical treatment of breast cancer.

Significance of an Intraoperative Frozen Section of the Axillary Sentinel Lymph Node and the Preoperative PET Evaluation of Breast Cancer Patients

The axillary lymph node status is the most important prognostic factor when deciding whether or not to treat breast cancer patients with adjuvant therapy and its status is determined by radical axillary lymph node dissection. Although radical axillary dissection is regarded as the gold standard for staging breast cancer, postoperative problems, such as lymphedema are considerable. However the same procedure is performed on all patients even in patients with no sign of axillary lymph node involvement. Recently, many trials that intend to determine the axillary status through more conservative procedures have been reported. This study was undertaken to evaluate the diagnostic accuracy of preoperative positron emission tomography (PET) and sentinel lymphadenectomy (SLND) for the detection of axillary lymph node metastases in patients with breast cancer. The sentinel node was studied with vital dye, isosulphan blue, to see if the sentinel node could predict axillary nodal status with accuracy. Eighteen patients (14 cases of radical mastectomy, 4 cases of conserving surgery) with breast cancer underwent axillary dissection, who had a preoperative PET and a successful intraoperative SLND for staging in the Department of Surgery at Samsung Medical Center from September 1995 to August 1996. PET imaging with the radiolabeled glucose analogue (F-18 FDG) was used to visualize the primary breast tumors. Sentinel lymphadenectomy was done under general anesthesia, and isosulphan blue was injected into the center of the mass and its margin. Axillary dissection was performed to identify any stained lymphatics. If stained lymphatics were identified, the dissection was extended along the lymphatics bidirectionally to detectthe stained lymph node nearest to the primary tumor (sentinel node). After frozen biopsy of the sentinel node, a routine axillary lymph node dissection was performed. Following this, the pathologic results of both specimens were compared. Out of all 18 cases, 6 cases had the sentinel node as the only positive node in the permanent pathologic results. Although the preliminary lymph node results were not positive in 3 patients who had undergone PET and in one patient who had undergone a frozen biopsy of the sentinel node, their actual permanent axillary nodes were later found to be positive. The sensitivity and the specificity of the sentinel node method and the PET method for detection of axillary lymph node metastases were 83% and 100% and 50% and 100%, respectively. A sentinel lymphadenectomy with multiple sectioning and immunohistochemical staining of the sentinel nodes increases the accuracy of axillary staging in breast cancer and can identify significantly more patients with 1ymph node metastases, especially micrometastases. The sentinel node method (SLND) can accurately predict the axillary nodal status in breast cancer patients. Therefore, a more conservative procedure can be performed on patients with negative sentinel node status, and routine axillary dissection can be omittend when possible in the future.