Multicenter prospective evaluation of the reliability of the combined use of two models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: the MSKCC nomogram and the Tenon score. Results of the NOTEGS study.

BACKGROUND: The purpose of this study was to prospectively evaluate the combined use of The Memorial Sloan Kettering Cancer Center nomogram and Tenon score to select, in patients with metastatic sentinel lymph node (SN), those at low risk of metastatic non-SN for whom additional axillary lymph node dissection (ALND) could be avoided. METHODS: From January 2011 to July 2012, a prospective non-interventional nationwide study was conducted (NCT01509963). We sought to identify the false reassurance rate (FRR, a negative test result is false) in patients with both a ⩽10% probability of metastatic non-SN with the MSKCC nomogram and a Tenon score ⩽3.5 (low risk): the proportion of patients with metastatic non-SN at additional ALND. Our hypothesis was that these patients would have a FRR⩽5%. RESULTS: Data on 2822 patients with breast cancer from 53 institutions were prospectively recorded. At least one SN was metastatic (isolated tumour cells, micro- or macrometastases) in 696 patients (24.7%). Among patients with ALND and complete data to calculate combined risk (n=504), 67 and 437 patients had low and high combined risk, respectively. Patients at low risk had less ALND (47%) compared to patients at high risk (P<0.001). This study did not meet its primary objective because the FRR in patients with low risk was 16.4% (11 out of 67) (95% confidence interval (CI): 9.7-23.1%). In the high-risk group, 33.9% (148 out of 437) (95% CI: 29.6-38.4%) had non-SN metastases (P=0.004). CONCLUSIONS: In this controlled prospective study, metastatic SN patients with both a ⩽10% probability of metastatic non-SN with the MSKCC nomogram and a Tenon score ⩽3.5 failed to identify patients at low risk of metastatic non-SN when completion ALND was not systematic.

Stereotactic radioguided surgery by siteSelect for subclinical mammographic lesions.

BACKGROUND: We defined the indications for and evaluated the results of a new technique for radioguided surgery, the SiteSelect system. The procedure allows en-bloc resection of the breast parenchyma under local anesthesia. METHODS: This prospective study was based on 167 patients operated on between December 2000 and October 2003 with 2 phases. The first step was an evaluation of the feasibility of the procedure with the 15-mm cannula, and the second was therapeutic with the 22-mm cannula. RESULTS: The mean duration of the procedure was 42 minutes. In 96.9% of procedures, the lesion was excised successfully. Only one complication (hematoma) and two failures and were observed. Histological examination revealed benign disease in 65.8% of cases and cancer in 34.2% of cases. In the latter cases, the specimen margins were histologically involved in 86.2% of cases with the 15-mm procedure and in 41% with the 22-mm procedure. During the first evaluation, all patients with a cancer underwent systematic surgical re-excision: residual tumor was present in 18 cases (64.2%). The biopsy was painless for 88 patients, and the cosmetic result was good in all cases. CONCLUSIONS: This study shows that the SiteSelect procedure allows resection of the lesion in 96.9% of cases. Combined with complementary surgical lumpectomy during the same operation, this procedure achieved a success rate of 98.7%. In the case of cancer, the 15-mm cannula is not wide enough to allow free margins. The use of a new 22-mm cannula, currently under evaluation, might solve this problem.

[Axillary lymphocele after axillary dissection or sampling of sentinel lymph node in breast cancer]. / Lymphocèles axillaires après curage ou prélèvement du ganglion sentinelle en cas de cancer du sein.

The goal of this study was to evaluate the rate of seromas after axillary dissection or sentinel lymph node biopsy. This is a prospective study based upon a series of 229 patients. Among those 229 patients, 179 had an axillary dissection and 50 had a sentinel lymph node biopsy. In the axillary dissection group, 40% of patients developed a seroma. The maximum number of aspirations needed was 8. In the sentinel lymph node group, 18% of patients developed a seroma that never recurred after a single aspiration. Seromas are still a very frequent complication after axillary dissection. The sentinel lymph node biopsy has helped to reduce the rate of axillary seroma, and the number of aspirations needed to evacuate them.

[Routine sentinel node detection in breast cancer. Experience of the Curie Institute]. / Le ganglion sentinelle en routine dans le cancer du sein: expérience de l'Institut Curie.

Since January 2000, sentinel lymph node detection is routinely performed at the Institut Curie, involving a multidisciplinary team of trained surgeons, nuclear medicine physicians, radiologists and pathologists. During a three-year period, 738 patients undergoing tumorectomy with conservative surgical treatment of the breast were included in the sentinel node procedure consisting of systematic pre-operative tumor biopsies, peritumoral lymph tracer injections at tumor contact (radionuclide/blue dye), primary surgical removal of the first sentinel lymph node, frozen section diagnosis, followed by a standardized pathological analysis, and finally the application of precise criteria to determine whether further surgery is necessary. This article is an evaluation of the sentinel lymph node technique in a specialized Center providing a breakdown of the strong points and weak points of the procedure.

[Breast-conserving therapy in breast cancer]. / Nouvelles approches du traitement conservateur du cancer du sein.

The combination of lumpectomy, axillary node treatment and radiotherapy of the breast is the base of breast-conserving therapy. This combination of surgery and radiotherapy is now accepted as a standard treatment option for unifocal, non inflammatory lesion less than 3 cm. The widespread use of mammography to detect infraclinic breast carcinoma leads to a significant increase in the proportion of breast conserving treatment. Neoadjuvant therapeutics (chemotherapy, radiotherapy and hormonotherapy) can extend the standard indication to breast carcinoma larger than 3 cm. The standard definition is also modified by sentinel node biopsy, oncoplastic techniques and stereotactic surgery with satisfactory cosmetic results. The risk of local recurrence, particularly the margins, must be evaluated whatever the surgical treatment optimizing oncologic management.

Obstetric outcome after endoscopic transection of the uterine septum.

STUDY OBJECTIVE: To analyze results of endoscopic transection of uterine septum in women with primary infertility and history of recurrent abortion or late abortion. DESIGN: Observational study over 6 years (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Seventy women, 21 with primary infertility, 33 with recurrent abortions, and 16 with late abortion or preterm delivery. INTERVENTION: Hysteroscopic metroplasty with transection of uterine septum. MEASUREMENTS AND MAIN RESULTS: Hysteroscopic metroplasty was possibly effective for women with primary infertility, none of whom had had abortions. It was also effective in reducing the early abortion rate and in increasing term deliveries in the group with late abortion. CONCLUSION: Endoscopic transection of uterine septum may improve obstetric outcomes in women with late abortion, decrease abortion rates in those with recurrent abortions, and avoid pregnancy loss for patients with primary infertility.

[Sentinel node identification in breast cancer: logistic aspects]. / Identification du ganglion sentinelle dans le cancer du sein : aspects logistiques.

Sentinel node identification has gained its place in early breast cancer surgical management before the results of prospective randomized trials. Published results can be explained by teams configurations and technical aspects can create some confusion in results analysis. Logistic aspects confers a specificity for each team. Sentinel node technique should be reserved to experienced treatment center where it can be utilized routinely.