ABSTRACT
INTRODUCCIÓN: La utilidad de la biopsia selectiva del ganglio centinela (BSGC) en pacientes con cáncer de mama que precisan quimioterapia neoadyuvante (QTN) es controvertida. Nuestro objetivo es analizar la tasa de detección (TD) y de falsos negativos (FN) de la BSGC tras QTN así como la influencia de la afectación ganglionar inicial y de los protocolos aplicados. MÉTODOS: Estudio prospectivo observacional multicéntrico con mujeres con cáncer de mama tratadas con QTN y a las que se les realizó BSGC tras recibir la QTN y linfadenectomía posterior. Se calcularon las TD y las tasas de FN, tanto globales como dependientes de la afectación ganglionar inicial o del uso de protocolos de diagnóstico pre-BSGC. RESULTADOS: No se demostraron diferencias en la TD entre los casos sin afectación ganglionar inicial y los que sí la tuvieron (89,8 vs. 84,4%; p = 0,437). Sí se encontraron diferencias significativas (94,1 vs. 56,5%; p = 0,002) en el valor predictivo negativo, menor cuando existía afectación ganglionar inicial, y mayor tasa de FN, aunque no de forma significativa (18,2 vs. 43,5%; p = 0,252) en ese mismo supuesto. Un estudio de la axila antes de indicar la BSGC y tras la QTN disminuyó significativamente la tasa de FN en los casos en los que existía afectación inicial (55,6 vs. 12,5; p = 0,009). CONCLUSIONES: La QTN da lugar a una menor TD y a una mayor tasa de FN en la BSGC posterior, sobre todo si hay afectación ganglionar inicial. Los protocolos para la evaluación axilar después de administrar la QTN y antes de la BSGC disminuyen la tasa de FN en estas pacientes
INTRODUCTION: A controversial aspect of breast cancer management is the use of sentinellymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS: Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS: No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P= 0,002) inthe negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS: NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients
Subject(s)
Humans , Female , Sentinel Lymph Node Biopsy , Breast Neoplasms/drug therapy , Neoadjuvant Therapy , Risk Factors , False Negative Reactions , Sensitivity and Specificity , Prospective StudiesABSTRACT
INTRODUCTION: A controversial aspect of breast cancer management is the use of sentinel lymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS: Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS: No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P=0,002) in the negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS: NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients.
Subject(s)
Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Neoadjuvant Therapy , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Female , Humans , Middle Aged , Prospective StudiesABSTRACT
Objetivo: Valorar la eficacia de la técnica de localización de lesiones mamarias no palpables, mediante la utilización de tecnecio radiactivo (99mTc). Material y métodos: Se realizaron 50 biopsias tumorectomías de mama con esta técnica, desde agosto de 2003 hasta marzo de 2005 en el Departamento de Obstetricia y Ginecología del Hospital Universitario de Canarias (La Laguna, Tenerife). La inyección del 99mTc se realiza bajo control estereotáxico o ecográfico. Resultados: Conseguimos un 98% de éxitos en la extirpación de la imagen sospechosa tras la localización; el 76% de las biopsias-tumorectomías fueron lesiones neoplásicas. En el 92,1% de las tumorectomías los márgenes estaban libres de afectación tumoral. Conclusiones: La técnica ROLL (localización de lesión oculta radioguiada) es una forma rápida, segura y cómoda para la paciente, el radiólogo y el cirujano en la extirpación de lesiones mamarias no palpables
Objective: To evaluate the efficacy of the radioguided (99Tc) occult lesion localization (ROLL) technique. Material and methods: We performed 50 breast biopsies-tumorectomies using this technique between August 2003 and March 2005 in the Department of Obstetrics and Gynecology of the Hospital Universitario de Canarias (La Laguna, Tenerife). Injection of 99Tc was performed under stereotactic or ultrasonographic guidance. Results: A success rate of 98% was achieved in extirpation of suspected lesions after localization. Seventy-six percent of the lesions were neoplastic, and 92.1% of the surgical specimens had disease-free margins. Conclusions: The ROLL technique is rapid, safe, and well tolerated by patients. The technique is easily performed by radiologists and surgeons when resecting occult breast lesions
