ABSTRACT
Purpose To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection. Methods The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate. Results Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.110.17), the pooled SLNIR was 0.89 (95% CI 0.860.92), NPV was 0.83 (95% CI 0.790.87), and summary accuracy was 0.92 (95% CI 0.900.94). SLNB performed better when more than one node was removed and double mapping was used. Conclusions SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer (AU)
Subject(s)
Humans , Female , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Sentinel Lymph Node Biopsy , Breast Neoplasms/surgery , Lymph Node Excision , Lymph Nodes/pathology , Lymph Nodes/surgery , Neoadjuvant TherapyABSTRACT
PURPOSE: To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection. METHODS: The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate. RESULTS: Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.11-0.17), the pooled SLNIR was 0.89 (95% CI 0.86-0.92), NPV was 0.83 (95% CI 0.79-0.87), and summary accuracy was 0.92 (95% CI 0.90-0.94). SLNB performed better when more than one node was removed and double mapping was used. CONCLUSIONS: SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer.
Subject(s)
Breast Neoplasms , Female , Humans , Breast Neoplasms/surgery , Breast Neoplasms/diagnosis , Lymph Nodes/surgery , Lymph Nodes/pathology , Neoadjuvant Therapy , Axilla , Sentinel Lymph Node Biopsy , Lymph Node ExcisionABSTRACT
PurposeWe conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs.MethodsMEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews.ResultsSix systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 1314%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes.ConclusionsIt would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. (AU)
Subject(s)
Humans , Axilla , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Lymph Nodes/pathology , Lymph Nodes/surgery , Neoadjuvant Therapy/methods , Neoplasm Staging , PatientsABSTRACT
PURPOSE: We conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs. METHODS: MEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews. RESULTS: Six systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13-14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes. CONCLUSIONS: It would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. PROSPERO registration number: CRD42020114403.
Subject(s)
Breast Neoplasms , Neoadjuvant Therapy , Axilla , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Female , Humans , Lymph Node Excision/methods , Lymph Nodes/pathology , Lymph Nodes/surgery , Neoadjuvant Therapy/methods , Neoplasm Staging , Sentinel Lymph Node Biopsy/methodsABSTRACT
The amount of milk production in mothers of babies admitted to the neonatal intensive care unit (NICU) is mostly determined by some actions focused on the first hours and days after birth. Working for an improvement in our previous results in terms of maternal expressed breast milk (MEBM) production, we designed a pilot project and a small observational study. After increasing the number of breast milk pumps to allow full-time availability and implementing educational strategies and updated information for parents, the volume of MEBM production by day 14 after birth was doubled and increased to >500 mL per day. The rate of exclusive breastfeeding at discharge improved from 26.67% to 76.19%. The cost of the use of donor milk per patient decreased by 15.7%. This study is an example of a cost-beneficial quality improvement strategy. It demonstrates the importance of an optimal supply of breast milk pumps in NICU and educational interventions focused on enhancing MEBM production.
Subject(s)
Milk, Human , Mothers , Breast Feeding , Female , Humans , Infant , Infant, Newborn , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Pilot ProjectsABSTRACT
Breast cancer (BC) is the most common cancer in women in Spain. During the COVID-19 pandemic caused by the SARS-CoV-2 virus, patients with BC still require timely treatment and follow-up; however, hospitals are overwhelmed with infected patients and, if exposed, patients with BC are at higher risk for infection and serious complications if infected. Thus, health care providers need to evaluate each BC treatment and in-hospital visit to minimize pandemic-associated risks while maintaining adequate treatment efficacy. Here we present a set of guidelines regarding available options for BC patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the lack of evidence about COVID-19 infection, these recommendations are mainly based on expert opinion, medical organizations' and societies' recommendations, and some published evidence. We consider this a useful tool to facilitate medical decision making in this health crisis situation we are facing. IMPLICATIONS FOR PRACTICE: This work presents a set of guidelines regarding available options for breast cancer (BC) patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the suddenness of this health crisis, specialists have to make decisions with little evidence at hand. Thus, these expert guidelines may be a useful tool to facilitate medical decision making in the context of a worldwide pandemic with no resources to spare.
Subject(s)
Breast Neoplasms/therapy , COVID-19/epidemiology , Medical Oncology/standards , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , COVID-19/diagnosis , COVID-19/prevention & control , Clinical Decision-Making , Delivery of Health Care/standards , Female , Humans , Medical Oncology/organization & administration , Patient Admission/standards , SARS-CoV-2/isolation & purification , Spain/epidemiologyABSTRACT
BACKGROUND: In critically ill patients, changes in the velocity-time integral (VTI) of the left ventricular outflow tract, measured by transthoracic echocardiography (TTE), are often used to non-invasively assess the response to fluid administration or for performing tests assessing fluid responsiveness. However, the precision of TTE measurements has not yet been investigated in such patients. First, we aimed at assessing how many measurements should be averaged within one TTE examination to reach a sufficient precision for various variables. Second, we aimed at identifying the least significant change (LSC) of these variables between successive TTE examinations. METHODS: We prospectively included 100 haemodynamically stable patients in whom TTE examination was planned. Three TTE examinations were performed, the first and the third by one operator and the second by another one. We calculated the precision and LSC (1) within one examination depending on the number of averaged measurements and (2) between measurements performed in two successive examinations. RESULTS: In patients in sinus rhythm, averaging three measurements within an examination was enough for obtaining an acceptable precision (interquartile range highest value < 10%) for VTI. In patients with atrial fibrillation, averaging five measurements was necessary. The precision of some other common TTE variables depending on the number of measurements is provided. Between two successive examinations performed by the same operator, the LSC was 11 [5-18]% for VTI. If two operators performed the examinations, the LSC for VTI significantly increased to 14 [8-26]%. The LSC between two examinations for other TTE variables is also provided. CONCLUSIONS: Averaging three measurements within one TTE examination is enough for obtaining precise measurements for VTI in patients in sinus rhythm but not in patients with atrial fibrillation. Between two TTE examinations performed by the same operator, the LSC of VTI is compatible with the assessment of the effects of a 500-mL fluid infusion but is not precise enough for assessing the effects of some tests predicting preload responsiveness.
Subject(s)
Cardiac Output/physiology , Echocardiography/standards , Stroke Volume/drug effects , Weights and Measures/instrumentation , Aged , Aged, 80 and over , Critical Illness/therapy , Echocardiography/methods , Female , Fluid Therapy/instrumentation , Fluid Therapy/methods , France , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Stroke Volume/physiology , Weights and Measures/standardsABSTRACT
We present the long-term outcome (FU 127 months) of a prospective study with 248 breast cancer patients with close or positive surgical margin, treated with 50 Gy whole breast irradiation plus high-dose-rate boost, 3 × 4.4 Gy. Actuarial breast failure at 10/15 years was 6.5%/11.6%; with positive margin (120) 6.8%/14.8%, with margin ≤2 mm (76) 9.8%/9.8%, with margin >2 mm <5 mm (52) 2%/2%. In 90 patients aged ≤50 was 11.9%/17.8%, between 51 and 70, 3.8%/8.2%, >70, 0%. Fibrosis appeared in 26.7%. Cosmetic outcome was excellent/good in 85.8%. This approach avoids a second surgery in women >50 with positive surgical margin, or with close margins in all ages.
Subject(s)
Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Margins of Excision , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/radiotherapy , Carcinoma, Intraductal, Noninfiltrating/surgery , Female , Humans , Mastectomy, Segmental/methods , Middle Aged , Neoplasm Recurrence, Local/pathology , Prospective Studies , Sentinel Lymph Node BiopsyABSTRACT
La biopsia selectiva del ganglio centinela es una técnica diagnóstica aceptada como el procedimiento de elección para la estadificación axilar del cáncer de mama. En este documento, correspondiente a la última Reunión de Consenso celebrada en Valencia y organizada por la Sociedad Española de Senología y Patología Mamaria, se actualizan los consensos previos y se reflejan las conclusiones acerca de las últimas propuestas en el manejo del ganglio centinela en el cáncer de mama (AU)
Sentinel lymph node biopsy is currently a widely accepted diagnostic technique and is the procedure of choice for axillary staging of breast cancer. In this article, following the latest Consensus Meeting held in Valencia organized by the Spanish Society of Senology and Breast Pathology, previous consensus are updated. Also discussed are conclusions related to the latest trends in the management of the sentinel node in breast cancer (AU)
Subject(s)
Humans , Female , Sentinel Lymph Node Biopsy/methods , Breast Neoplasms/pathology , Pathology, Molecular/methods , Tumor Burden , Lymph Node Excision/methods , Patient Selection , Neoplasm StagingABSTRACT
La biopsia selectiva del ganglio centinela es una técnica diagnóstica aceptada como el procedimiento de elección para la estadificación axilar del cáncer de mama. En este documento, correspondiente a la última Reunión de Consenso celebrada en Valencia y organizada por la Sociedad Española de Senología y Patología Mamaria, se actualizan los consensos previos y se reflejan las conclusiones acerca de las últimas propuestas en el manejo del ganglio centinela en el cáncer de mama
Sentinel lymph node biopsy is currently a widely accepted diagnostic technique and is the procedure of choice for axillary staging of breast cancer. In this article, following the latest Consensus Meeting held in Valencia organized by the Spanish Society of Senology and Breast Pathology, previous consensus are updated. Also discussed are conclusions related to the latest trends in the management of the sentinel node in breast cancer
Subject(s)
Humans , Female , Sentinel Lymph Node Biopsy/instrumentation , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy , Breast Neoplasms/diagnosis , Molecular Biology/methods , Lymph Node Excision/instrumentation , Lymph Node Excision/methods , Lymph Node Excision , Sentinel Lymph Node Biopsy/standards , Sentinel Lymph Node Biopsy/trends , Societies, Medical/standards , Societies, Medical , Brachytherapy/instrumentation , Brachytherapy/methods , Radiotherapy/instrumentation , Radiotherapy/methodsABSTRACT
INTRODUCTION: Nomograms are used to predict the involvement of non-sentinel nodes (nSN) in breast cancer. This study attempts to externally validate two of the more commonly used nomograms (MSKCC and Stanford University). MATERIALS AND METHODS: Five hundred and one cases of positive SNB with posterior axillary lymphadenectomy from 11 Spanish hospitals with widespread experience of the technique were studied. In all cases, an estimate of the probability of nSN involvement was made using the MSKCC and the Stanford University nomograms. Discrimination was assessed by calculating the area under the receiver operating characteristic curve. To assess the calibration of the nomogram, observed probability was plotted against the nomogram-calculated predicted probability. RESULTS: The overall predictive accuracy of the MSKCC nomogram was 0.684 (95 % confidence interval, 0.635-0.732), while in the case of that from Stanford the predictive accuracy was 0.658 (95 % confidence interval 0.607-0.709). The mean predicted probability of nSN metastases in each group of patients was correlated with the observed probability with an acceptable concordance (r = 0.820; p < 0.004 in MSKCC nomogram and r = 0.888; p < 0.001 in Stanford nomogram). CONCLUSION: These nomograms can be useful tools in the evaluation of patients with breast cancer and positive sentinel nodes but other factors, including a comprehensive clinical assessment, must be used to decide the most appropriate surgical approach for an individual patient, especially with regard to avoiding unnecessary lymphadenectomy.
Subject(s)
Breast Neoplasms/pathology , Lymphatic Metastasis/diagnosis , Nomograms , Adult , Aged , Aged, 80 and over , Area Under Curve , Female , Humans , Middle Aged , ROC Curve , Sentinel Lymph Node BiopsyABSTRACT
AIMS AND BACKGROUND: Sentinel lymph node biopsy has become an ordinary method for breast cancer staging. Neoadjuvant chemotherapy has been considered one of the contraindications for sentinel lymph node biopsy due to potential secondary fibrosis and lymphatic distortion. Timing and influence on sentinel lymph node biopsy result by primary systemic therapy are current and controversial topics. METHODS AND STUDY DESIGN: The experience in the medical literature is reviewed. A search was performed in the following databases: Medline (through Pubmed), EMBASE, Tripdatabase and Cochrane Library, between January 1998 and December 2008. RESULTS AND CONCLUSIONS: After analyzing the conclusions from 42 series and waiting for the end of related prospective trials, it could be concluded that sentinel lymph node biopsy is a useful diagnostic tool that should be integrated in the algorithm for the management of breast cancer patients when primary systemic therapy is needed.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Sentinel Lymph Node Biopsy , Algorithms , Axilla , Breast Neoplasms/surgery , Female , Humans , Lymphatic Metastasis/diagnosis , Sentinel Lymph Node Biopsy/methodsABSTRACT
Sentinel lymph node biopsy is a useful diagnostic technique in the management of breast cancer and is widely used and accepted in clinical practice. The results of this technique allow adequate staging with lower associated morbidity. However, at present, there are numerous methodological issues that remain to be resolved in on-going trials and investigations and Consensus Meetings are required to standardize the methodological variations and indications of this procedure. The conclusions of the Consensus Meeting held in Murcia, Spain, organized by The Spanish Society of Mastology and Breast Disease, are reported in this document.
Subject(s)
Breast Neoplasms/pathology , Carcinoma/pathology , Sentinel Lymph Node Biopsy/methods , Societies, Medical , Surgical Procedures, Operative/methods , Breast Neoplasms/surgery , Carcinoma/surgery , Female , Humans , Prospective Studies , SpainABSTRACT
La biopsia selectiva del ganglio centinela es una técnica diagnóstica útil en el manejo del carcinoma de mama que se ha introducido en la práctica clínica con una gran difusión y aceptación. Sus resultados permiten realizar una adecuada estadificación con una menor morbilidad asociada. No obstante, en la actualidad, existen numerosas variaciones metodológicas en su ejecución pendientes de ser contestadas en ensayos e investigaciones en curso. Esto implica realizar reuniones de consenso para tratar de homogeneizar los aspectos relacionados con el método y la indicación de la técnica. En este documento se reflejan las conclusiones de la Reunión de Consenso celebrada en Murcia y organizada por la Sociedad Española de Senología y Patología Mamaria (AU)
Sentinel lymph node biopsy is a useful diagnostic technique in the management of breast cancer and is widely used and accepted in clinical practice. The results of this technique allow adequate staging with lower associated morbidity. However, at present, there are numerous methodological issues that remain to be resolved in on-going trials and investigations and Consensus Meetings are required to standardize the methodological variations and indications of this procedure. The conclusions of the Consensus Meeting held in Murcia, Spain, organized by The Spanish Society of Mastology and Breast Disease, are reported in this document (AU)
Subject(s)
Female , Humans , Sentinel Lymph Node Biopsy , Breast Neoplasms/pathology , Lymph Node Excision , Societies, MedicalABSTRACT
La biopsia selectiva del ganglio centinela es una técnica diagnóstica útil en el manejo del carcinoma de mama que se ha introducido en la práctica clínica con una gran difusión y aceptación. Sus resultados permiten realizar una adecuada estadificación con una menor morbilidad asociada. No obstante, en la actualidad, existen numerosas variaciones metodológicas en su ejecución pendientes de ser contestadas en ensayos e investigaciones en curso. Esto implica realizar Reuniones de Consenso para tratar de homogeneizar los aspectos relacionados con el método y la indicación de la técnica. En este documento se reflejan las conclusiones de la Reunión de Consenso celebrada en Murcia y organizada por la Sociedad Española de Senología y Patología Mamaria
Sentinel lymph node selective biopsy is a diagnostic useful technique in the breast cancer management that has had a good acceptation and diffusion in clinical practice. Its results allow an adequate staging with a lesser associated morbidity. Nevertheless, at present, a lot of methodological variations have been described to do it and they are being studied in several in course assays and research studies. This imply Consensus Meetings are needed to harmonize the methodological aspects and the indications of the technique. In this paper, conclusions of the Spanish Society of Senology and Breast Pathology Consensus Meeting, that was celebrated in Murcia, are described
Subject(s)
Female , Humans , Sentinel Lymph Node Biopsy/methods , Breast Neoplasms/pathology , Nuclear Medicine/methods , Patient SelectionABSTRACT
La biopsia selectiva del ganglio centinela es una técnica diagnóstica útil en el manejo del carcinoma de mama que se ha introducido en la práctica clínica con una gran difusión y aceptación. Sus resultados permiten realizar una adecuada estadificación con una menor morbilidad asociada. No obstante, en la actualidad, existen numerosas variaciones metodológicas en su ejecución pendientes de ser contestadas en ensayos e investigaciones en curso. Esto implica realizar Reuniones de Consenso para tratar de homogeneizar los aspectos relacionados con el método y la indicación de la técnica. En este documento se reflejan las conclusiones de la Reunión de Consenso celebrada en Murcia y organizada por la Sociedad Española de Senología y Patología Mamaria
Sentinel lymph node selective biopsy is a diagnostic useful technique in the breast cancer management that has had a good acceptation and diffusion in clinical practice. Its results allow an adequate staging with a lesser associated morbidity. Nevertheless, at present, a lot of methodological variations have been described to do it and they are being studied in several in course assays and research studies. This imply Consensus Meetings are needed to harmonize the methodological aspects and the indications of the technique. In this paper, conclusions of the Spanish Society of Senology and Breast Pathology Consensus Meeting, that was celebrated in Murcia, are described
Subject(s)
Female , Humans , Sentinel Lymph Node Biopsy/methods , Breast Neoplasms/pathology , Nuclear Medicine/methods , Patient SelectionABSTRACT
The sentinel lymph node (SLN) is the first draining node from the area in which a tumour is located. The presence or absence of SLN micrometastasis is an important prognostic factor for melanoma. As the first dissemination route for melanoma is lymphatic and we know that the immune system plays an important role in melanoma response, we hypothesize that melanoma and its corresponding SLN should constitute an immunological unit. Small portions of 54 SLNs from 37 patients undergoing selective lymphadenectomy were subjected to quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) to quantify messenger RNA (mRNA) transcripts of the following genes: tyrosinase, telomerase, cyclooxygenase-1 (COX-1), COX-2, granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-2 (IL-2), interferon-gamma (IFN-gamma), IL-4, IL-10 and IL-12. In addition, 11 non-sentinel lymph nodes (NSLNs) were excised from 11 of the 37 patients and the same study was performed. Immunohistochemistry with different antibodies against dendritic cells (DCs) was performed in 10 pairs of SLNs and NSLNs. Significantly higher mRNA expression of COX-2, GM-CSF, IFN-gamma and IL-10 was found in SLNs compared with NSLNs in the overall group. DCs, as labelled by S-100 and CD1a, were significantly decreased in NSLNs compared with SLNs. These data suggest that the initial increase in GM-CSF observed in SLNs could lead to the attraction of a high number of DCs to SLNs. However, the presence of certain immunosuppressive molecules, such as IL-10 and COX-2, could block their maturation and their ability to become efficient antigen presenters.
