Biopsia del ganglio centinela y quimioterapia neoadyuvante en pacientes con cáncer de mama: nuestra experiencia / Sentinel lymph node biopsy and neoadjuvant chemotherapy in breast cancer patients: our experience

Objetivo. Revisar nuestra experiencia en la biopsia selectiva del ganglio centinela (BGC) en pacientes con cáncer de mama operable tratadas con quimioterapia neoadyuvante (QTN). Material y métodos. Estudio prospectivo, enero de 2008/diciembre de 2014, 235 BGC en pacientes con cáncer de mama infiltrante T1-3/N0-1, tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en Her2/neu positivas. El estatus axilar se estableció por exploración física, ecografía axilar y punción de ganglios sospechosos. El día antes de la cirugía se inyectaron periareolarmente 74-111 MBq de 99mTc-nanocoloide de albúmina. Al finalizar el tratamiento se realizó BGC y linfadenectomía axilar. El GC se analizó por cortes de congelación, hematoxilina-eosina, inmunohistoquímica o one-step nucleic acid amplification. Se determinaron tasa de identificación (Id.GC) y falsos negativos (FN). Resultados. Grupo I BGC pre-QTN pacientes cN0 de inicio: n = 73, Id.GC 97,2% (IC 95% 90,5-99,2). Grupo II 2.a BGC pos-QTN pacientes pN1(gc) de inicio: n = 31, Id.GC 61,3% (IC 95% 43,8-76,3), FN 18,2% (IC 95% 5,1-47,7). Grupo III BGC pos-QTN pacientes cN0 de inicio: n = 54, Id.GC 96,3% (IC 95% 87,5-99,0), FN 9,5% (IC 95% 2,7-28,9). Grupo IV BGC pos-QTN pacientes cN1 de inicio, ycN0 posneoadyuvancia: n = 77, Id.GC 83,1% (IC 95% 73,2-89,8), FN 8,3% (IC 95% 2,9-21,8). Conclusiones. La identificación de la BGC pre-QTN es excelente. En pacientes pN1(gc) al diagnóstico, una 2.a BGC pos-QTN no es válida para su aplicación clínica. La BGC pos-QTN puede realizarse con fiabilidad en pacientes cN0 y cN1 de inicio, con axila clínicamente negativa al finalizar la neoadyuvancia (ycN0), y linfadenectomía axilar si el resultado del GC es positivo o no se identifica en la cirugía, en el ámbito de un equipo multidisciplinar con experiencia (AU)

Aim. To analyze our experience of sentinel lymph node biopsy (SLNB) in patients with operable breast cancer treated with neoadjuvant chemotherapy (NAC). Material and methods. A prospective study was conducted between January 2008 and December 2014 in 235 SLNB in patients with infiltrating breast carcinoma T1-3/N0-1 treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination and ultrasound, with guided core needle biopsy of any suspicious lymph nodes. The day before surgery, 74-111 MBq of 99mTc-albumin nanocolloid was injected periareolar. Following NAC, patients underwent SLNB and axillary lymph node dissection. SLN were examined with hematoxylin-eosin staining and immunohistochemical analysis or one-step nucleic acid amplification. The identification rate (IR) and false-negative rate (FNR) were determined. Results. Group I SLNB pre-NAC in patients cN0 at diagnosis: n = 73, IR 97.2% (95%CI: 90.5-99.2). Group II 2nd SLNB pos-NAC in patients pN1(sn) at diagnosis: n = 31, IR 61.3% (95%CI: 43.8-76.3), FNR 18.2% (95%CI: 5.1-47.7). Group III SLNB pos-NAC in patients cN0 at diagnosis: n = 54, IR 96.3% (95%CI: 87.5-99.0), FNR 9.5% (95%CI: 2.7-28.9). Group IV SLNB pos-NAC in patients cN1 at diagnosis and ycN0 post-treatment: n = 77, IR 83.1% (95%CI: 73.2-89.8), FNR 8.3% (95%CI: 2.9-21.8). Conclusions. The detection rate for SLNB prior to NAC is excellent. A second SLNB after NAC in women with a positive SLN at diagnosis is not useful. SLNB after NAC is feasible in cN0 and cN1 patients at diagnosis, clinically axillary node-negative after therapy (ycN0), with subsequent axillary lymph node dissection if the SLNB is positive or not identified during surgery, when performed by an experienced multidisciplinary team (AU)

Local treatment of breast cancer.

OBJECTIVES: To describe the local control of breast cancer, including initial biopsy, lumpectomy or mastectomy, and sentinel node biopsy or axillary node dissection, and to discuss the role of radiation therapy following lumpectomy or mastectomy in advanced cancer. DATA SOURCES: PubMed, Scopus, Cochran. CONCLUSION: The local treatment of breast cancer is an essential component of primary breast cancer treatment. Residual cancer cells may increase the risk of recurrent ipsilateral disease. IMPLICATIONS FOR NURSING PRACTICE: Nurses and advanced practice nurses who provide care for cancer survivors should possess the skills to patiently teach information, empathetically understand the flagrant or suppressed emotional turmoil, explain the full complement of treatment options, appreciate the rationale behind choices made, and help patients navigate the educational and decisional byways.

Caring for a patient after mastectomy.

Breast cancer is the most common cancer in women in the United States, and the second leading cause of cancer death in women after lung cancer. In 2008, about 182,460 women were expected to be diagnosed with either invasive or noninvasive breast cancer. Because most breast cancers are diagnosed at an early stage, thanks to the success of mammography screening, many women have several treatment options. Breast conserving surgery (a lumpectomy or partial mastectomy followed by radiation therapy or chemotherapy) is the most common local treatment for breast cancer. However, mastectomy, which involves removal of all the breast tissue, is still performed in some situations; for example, if the tumor is 5 cm or larger, if the tumor is large compared with breast size and a lumpectomy would result in a poor cosmetic outcome, if clear margins couldn't be obtained with a reexcision of a lumpectomy site, or if the procedure is being done for breast cancer risk reduction. A woman undergoing mastectomy will need more nursing care than one undergoing lumpectomy, as well as extra emotional support and extensive patient education about postoperative care. Let's look at what you'll need to know.

[Burden and coping strategies of women suffering from breast cancer during their surgical primary therapy--the view of nurses]. / Belastungen und Bewältigungsstrategien von Frauen mit Brustkrebs in der Phase der chirurgischen Primärtherapie--die Sicht der Pflegenden.

The findings illustrated in this article, are part of a larger research project funded/financed by the Deutsche Krebshilfe e.V., with the aim of gaining understanding of the stresses and strains, coping strategies and needs of women suffering from breast cancer during their surgical primary treatment. Breast cancer leads to a variety of burden for women and their families. To cope with the disease women use different strategies. External assessment and self-assessment of burden and coping sometimes result in different outcomes, such as experts overestimating their patients' fear or depression or uncovering coping strategies oblivious to the interviewees. Qualitative interviews with twelve nurses in three Northern German hospitals were conducted. The content analysis of the interviews followed Mayring's approach. Uncertainty and anxiety are common characteristics for the affected women. The observed strategies can be classified into five categories: to deny the disease, to withdraw from others, to communicate, to comprehend the disease, to accept the disease. Coping strategies such as withdrawal and denial present a challenge to the nurses' communication behaviour. The findings of the survey at hand indicate a demand for suitable care interventions, further education, and training for professionals nursing women with breast cancer. Scientifically supported nursing concepts and specialised nurses are expected to comply with the affected women's special requirements.

Innovative computer-based learning for breast cancer surgery.

Discussions with student nurses when they have been on placement on the breast cancer surgery ward highlighted their lack of knowledge about breast cancer surgery. This lack of knowledge by student nurses necessitated the development of a computer-based learning tool. A distance-learning tool was found to be an effective way of providing education, due to lack of facilities and workload on the ward. The student nurses using this tool will have better understanding of the treatments their patients are undergoing, leading to improved patient care.

Surgical management of testicular cancer.

Surgery is an integral component in the management of testicular cancer. Prior to the advent of cisplatin chemotherapy, a retroperitoneal lymph node dissection (RPLND) was the only chance for cure of testicular cancer. Over the years, the surgical techniques have been improved greatly to decrease the occurrence of complications (e.g., incidence of retrograde ejaculation). Currently, RPLND can be done as the initial therapy or after chemotherapy. In either situation, the postoperative management of patients with testicular cancer can be complicated and requires thorough, ongoing assessment. This article presents the surgical indications for RPLND and the nursing management.

Eighteen sensations after breast cancer surgery: a comparison of sentinel lymph node biopsy and axillary lymph node dissection.

PURPOSE/OBJECTIVES: To evaluate prevalence, severity, and level of distress of 18 sensations at 3-15 days (baseline), 3 months, and 6 months after breast cancer surgery; to compare sentinel lymph node biopsy (SLNB) to SLNB with immediate or delayed axillary lymph node dissection; to evaluate the Breast Sensation Assessment Scale(c) (BSAS(c)) for reliability and validity. DESIGN: Prospective, descriptive. SETTING: Evelyn H. Lauder Ambulatory Breast Center at Memorial Sloan-Kettering Cancer Center in New York City. SAMPLE: 283 women with breast cancer; 187 had SLNB, and 96 had SLNB and axillary lymph node dissection. METHODS: Patients completed the BSAS(c) at baseline, three months, and six months after surgery. MAIN RESEARCH VARIABLES: Prevalence, severity, and level of distress of sensations in patients who had breast cancer surgery. FINDINGS: Sensations were less prevalent, severe, and distressing following SLNB compared with axillary lymph node dissection at all three time points. Tenderness and soreness remained highly prevalent following SLNB at the three time points. Tenderness, soreness, tightness, and numbness were among the most severe and distressing symptoms in both groups. The BSAS(c) demonstrated good reliability and validity. CONCLUSIONS: Overall prevalence, severity, and level of distress were lower following SLNB compared with axillary lymph node dissection at baseline, three months, and six months after surgery. Certain sensations remained prevalent, severe, and distressing in both groups. The BSAS(c) is a reliable and valid instrument. IMPLICATIONS FOR NURSING: Nurses should be familiar with prevalent sensations patients experience after SLNB and axillary lymph node dissection so they can provide education and support.

Sentinel lymph node biopsy in breast cancer and the role of the oncology nurse.

The pathological status of axillary lymph nodes remains the most important prognostic indicator in the management of invasive breast cancer. Axillary lymph node dissection removes histologically negative nodes in more than 70% of stage I breast cancers with no obvious benefit to the patient. Moreover, the procedure is associated with well-described morbidity. Sentinel lymph node biopsy is a new procedure that shows promise in reducing the number of unnecessary lymph node dissections. This article describes the procedure, pertinent issues surrounding it, and nursing implications.

Current issues in the surgical treatment of early stage breast cancer.

Surgery remains the primary treatment for early stage breast cancer. Modified radical mastectomy and lumpectomy with axillary dissection continue to be the two procedures most commonly performed. Changes in the healthcare system and advances in medical research in cancer treatment affect the nursing care of these patients. The introduction of the sentinel node biopsy may change certain aspects of surgical treatment, as some patients may not require an axillary dissection. The challenge for nurses is to provide quality care and maintain established standards for patients with breast cancer as their hospitalizations are shortened to same day or overnight stays. The purpose of this article is to review the standard surgical treatments and related nursing care and discuss the impact of the sentinel node biopsy and the impact of changes in the length of hospital stay on the care of women with breast cancer.

Lymphatic mapping and sentinel node biopsy. New technology for women's health.

The current surgical standard of care for the management of invasive breast cancer is the complete removal of the cancer with documented negative margins by either mastectomy or lumpectomy followed by complete axillary lymph node dissection. These procedures can be associated with significant morbidity which leads to increased hospitalizations, increased overall costs and considerable discomfort and life-style changes for the patients. With sentinel node identification and biopsy, patients with probable negative lymph nodes may avoid axillary dissection, and easily be treated as outpatients.