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

Experience of Ovarian Function Suppression Therapy: Endocrine Response Preand Perimenopausal Korean Breast Cancer Patients in the Adjuvant Setting / 한국유방암학회지

PURPOSE: Published Early Breast Cancer Trialists' Collaborative Group overview results have been the beneficial effects of tamoxifen and ovarian ablation for pre and perimenopausal women with node negative breast cancer. Chemotherapy and Luteinizing Hormone Releasing Hormone (LHRH) agonists (medical ovarian ablation) have been shown to be effective adjuvant therapies for early stage breast cancer in several clinical trials however, the efficacy and tolerance of LHRH agonists in Korean breast cancer patients has not been evaluated. METHODS: Three thousand one hundred fifty breast cancer patients were treated at Asan Medical Center between January 2003 and December 2005. We selected 185 patients with node negative early breast cancer who were endocrine responsive (more than intermediate intensity), with a tumor size more than 1 cm, and who were reluctant to undergo chemotherapy due to the side effects. They received LHRH agonists (Zoladex(R) 3.6 mg) every 28 days with tamoxifen for two years. We prospectively evaluated mammography, chest PA, and physical examination every six months and evaluated the side effects and quality of life. RESULTS: The mean age was 43.5 yr, and the mean tumor size was 1.62 cm. One hundred sixty-two patients had Stage I, and 23 Stage II disease. The incidence of severe menopausal symptoms was 24.1%, but these symptoms were reported to be "tolerable" during the two year follow-up. Quality of life and physical activity were essentially unchanged. The median follow-up duration was 18 months, and there was no local recurrence or distant metastases during the study. CONCLUSION: Adjuvant therapy with LHRH agonists is safe and tolerable, and may be an alternative to chemotherapy for pre-and perimenopausal women with hormone responsive early breast cancer who are reluctant to undergo chemotherpy.

Result of Sentinel Lymph Node Biopsy Using Radioisotope in Clinically Lymph Node Negative Breast Cancer / 한국유방암학회지

PURPOSE: Sentinel lymph node biopsy (SLNB) has been developed to accurately assess the axillary lymph node status accurately without having to remove most of the axillary contents in node negative early breast cancer patients. The aims of this study were to evaluate the accuracy, the false negative rate and the advantage of additional axillary sampling for SLNB with using radioisotope. METHODS: Between December 2003 and June 2005, we carried out SLNB for 574 breast cancer patients who were diagnosed and had operation at Asan Medical Center. For detection of the sentinel lymph node (SLN), radioisotope was injected into the periareolar area on the operating day, breast scintigraphy was performed and finally the biopsy was done using a gamma-detection probe in the operating room. If the SLN turned out to be positive for metastatic malignancy according to the frozen section histology, then additional axillary lymph nodes (LN) dissection was performed. But, if it was free of metastasis, then only axillary node sampling (n< or =5) or no further treatment was done. RESULTS: The mean number of resected SLNs was 2.67+/-0.98 (1-7) and the mean number of total LN was 8.5+/-5.0 (1-38). The SLN was detected 82.8% of the time on lymphoscintigraphy and 98.4% of the time with the gamma probe. Axillary metastasis was founded in 118 cases (20.9%). The accuracy was 98.2%, and the false negative rate was 7.89%. For the SLN positive cases, there were 73/78 cases (93.6%) of 1st SLN metastasis, there were 75/78 cases (93.6%) of 1st and 2nd SLN metastasis, and 75/78 (93.6%) of 1st to 3rd SLN metastasis. The false negative rate of the alternative frozen section was 40% and that of the full frozen section was 24.1%. The difference was statistically significant. CONCLUSION: SLNB using (99m)Tc-antimony trisulfide colloid (0.5 mCi) showed a high detection rate and a low false negative rate. The false negative rate was decreased by using full section H&E staining and at least 3 SLNs showed the exact LN status. Even if the SLN was free of metastasis, additional sampling may decrease the false negative rate.