Retrospective Cohort Study on the Longterm Oncologic Outcomes of Sentinel Lymph Node Mapping Methods (Dye-Only Versus Dye and Radioisotope Mapping) in Early Breast Cancer: A Propensity Score-Matched Analysis

임창진,강은혜,정지광,천종호,김홍규,이한별,문형곤,한원식 대한암학회 2023 Cancer Research and Treatment Vol.55 No.2

Purpose In sentinel lymph node (SLN) biopsy (SLNB) during breast cancer surgery, SLN mapping using dye and isotope (DUAL) may have lower false-negative rates than the dye-only (DYE) method. However, the long-term outcomes of either method are unclear. We aimed to compare long-term oncological outcomes of DYE and DUAL for SLNB in early breast cancer. Materials and Methods This retrospective single-institution cohort study included 5,795 patients (DYE, 2,323; DUAL, 3,472) with clinically node-negative breast cancer who underwent SLNB and no neoadjuvant therapy. Indigo carmine was used for the dye method and Tc99m-antimony trisulfate for the isotope. To compare long-term outcomes, pathologic N0 patients were selected from both groups, and propensity score matching (PSM), considering age, pT category, breast surgery, and adjuvant treatment, was performed (1,441 patients in each group). Results The median follow-up duration was 8.7 years. The median number of harvested sentinel nodes was 3.21 and 3.12 in the DYE and DUAL groups, respectively (p=0.112). The lymph node–positive rate was not significantly different between the two groups in subgroups of similar tumor sizes (p > 0.05). Multivariate logistic regression revealed that the mapping method was not significantly associated with the lymph node–positive rate (p=0.758). After PSM, the 5-year axillary recurrence rate (DYE 0.8% vs. DUAL 0.6%, p=0.096), and 5-year disease-free survival (DYE 93.9% vs. DUAL 93.7%, p=0.402) were similar between the two groups. Conclusion Dye alone for SLNB was not inferior to dual mapping regarding long-term oncological outcomes in early breast cancer.

Feasibility of Charcoal Tattooing of Cytology-Proven Metastatic Axillary Lymph Node at Diagnosis and Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients

Park, Seho,Koo, Ja Seung,Kim, Gun Min,Sohn, Joohyuk,Kim, Seung Il,Cho, Young Up,Park, Byeong-Woo,Park, Vivian Youngjean,Yoon, Jung Hyun,Moon, Hee Jung,Kim, Min Jung,Kim, Eun-Kyung Korean Cancer Association 2018 Cancer Research and Treatment Vol.50 No.3

<P><B>Purpose</B></P><P>Sentinel lymph node biopsy (SLNB) can be performed when node-positive disease is converted to node-negative status after neoadjuvant chemotherapy (NCT). Tattooing nodes might improve accuracy but supportive data are limited. This study aimed to investigate the feasibility of charcoal tattooing metastatic axillary lymph node (ALN) at presentation followed by SLNB after NCT in breast cancers.</P><P><B>Materials and Methods</B></P><P>Twenty patientswith cytology-proven node metastases prospectively underwent charcoal tattooing at diagnosis. SLNB using dual tracers and axillary surgery after NCT were then performed. The detection rate of tattooed node and diagnostic performance of SLNB were analyzed.</P><P><B>Results</B></P><P>All patients underwent charcoal tattooingwithout significant morbidity. Sentinel and tattooed nodes could be detected during surgery after NCT. Nodal pathologic complete response was achieved in 10 patients. Overall sensitivity, false-negative rate (FNR), negative predictive value, and accuracy of hot/blue SLNB were 80.0%, 20.0%, 83.3%, and 90.0%, respectively. Retrieving more nodes and favorable nodal response were associated with improved performance. The best accuracy was observed when excised tattooed node was calculated together (FNR, 0.0%). Cold/non-blue tattooed nodes of five patients were removed during non-sentinel axillary surgery but clinicopathological parameters did not differ compared to patients with hot/blue tattooed node detected during SLNB, suggesting the importance of the tattooing procedure itself to improve performance.</P><P><B>Conclusion</B></P><P>Charcoal tattooing of cytology-confirmed metastatic ALN at presentation is technically feasible and does not limit SLNB after NCT. The tattooing procedure without additional preoperative localization is advantageous for improving the diagnostic performance of SLNB in this setting.</P>

Value of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Previous Excisional Biopsy

Gokhan Coskun,Lutfi Dogan,Niyazi Karaman,Cihangir Ozaslan,Can Atalay 한국유방암학회 2012 Journal of breast cancer Vol.15 No.1

Purpose: Sentinel lymph node biopsy (SLNB) in breast cancer patients with clinically negative axilla will ensure axillary dissection only for cases with lymph node metastasis and provide information about pathologic staging as accurate as the axillary dissection. It was shown that SLNB could be successfully performed regardless of the type of biopsy. The aim of this study was to investigate the feasibility of SLNB after excisional biopsy. Methods:One hundred patients diagnosed with excisional biopsy or guide wire-localization and operated on with SLNB between February 2007 and March 2009 were retrospectively analyzed. SLNB was performed with 10 cc of 1% methylene blue alone or both methylene blue and 1 mCi of Tc-99m nanocolloid combination. Age, tumor localization and size, length of the biopsy incision, size of the biopsy specimen, multifocality, lymphovascular invasion, tumor grade, staining with methylene blue, localization, number and metastatic status of the lymph nodes stained, and success rate with a gamma probe were evaluated. Results: Sentinel lymph node (SLN) could not be identified in 9 (16.9%) of patients in the methylene blue group (n=53). In the combination group (n=47), SLN could not be identified in one patient. Of 32 patients with negative SLNB, metastatic involvement was found to be present in 5 patients after axillary lymph node dissection (false negatives). The average numbers of SLNs found in the methylene blue group and combination group were 1.4 and 1.6, respectively. SLN detection and false negative rates in the methylene blue group were 83% and 15.7%, respectively. The rates for the combination group were 98% and 6.4%, respectively. None of the parameters related to patient, tumor or process were found to affect detection rates of SLN. Conclusion: Only SLNB using a combination method is a safe and reliable technique for breast cancer patients diagnosed with excisional biopsy.

FCP 6 : Sentinel lymph node biopsy of the 104 malignant melanoma of KNUH over 9 years (2006~2014)

( Hyun Bo Sim ),( Soo Yuhl Chae ),( Yong Hyun Jang ),( Weon Ju Lee ),( Do Won Kim ),( Seok Jong Lee ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: In these days, Sentinel lymph node biopsy (SLNB) is used as the most sensitive and specific staging tool available for determination of disease status of regional lymph node and it also developed as a technique to surgically assess the regional lymph nodes i.e. sentinel lymph node(SLN) and allowed to spare node-negative patients unnecessary and potentially morbid complete lymphadenectomies. Objectives: To examine the clinical analysis of SLNB cases in Kyungpook national university hospital (KNUH) over 9 years. Methods: In the period from January 2006 to January 2014, a SLNB was performed in 104 patients under cooperation of the department of dermatology, general surgery or orthopedic surgery in KNUH. Data were collected from medical records and the melanoma registry of KNUH. Results: Of the 104 melanoma patients who underwent SLNB, 49 were males (47.1%), 55 were females (52.9%) and their ages ranged from 34~93 years (average: 60.9). Detection rate of SLN was 98.1% (102/104). Twenty nine patients had a tumor-positive SLNB (27.8%) and underwent completion regional lymph node dissection. The mean Breslow thickness of the primary tumors was 3.76 mm, and the proportion of ulcerated melanomas was 51.4%. Two side effects had been observed such as seroma (1case) and lymphocele (1case). Conclusion: Herein, we reviewed the importance of SLNB as prognostic and staging tools with minimal morbidity through our experience of 104 malignant melanoma cases during past 9 years.

Sentinel Lymph Node Biopsy in Breast Cancer Patients With Pathological Complete Response in the Axillary Lymph Node After Neoadjuvant Chemotherapy

김현희,한재홍,김선영,이은숙,강한성,이시윤,정소연,이은경 한국유방암학회 2021 Journal of breast cancer Vol.24 No.6

Purpose: Sentinel lymph node biopsy (SLNB) alone following neoadjuvant chemotherapy (NAC) remains controversial in patients with breast cancer who are initially lymph node-positive. The present study aimed to evaluate the impact of SLNB and axillary lymph node dissection (ALND) on breast cancer recurrence and survival in patients who converted from lymph node-positive to pathological node-negative (ypN0) after NAC. Methods: This single-center retrospective study included 223 patients who converted to axillary lymph node-negative status after NAC and underwent breast and axillary surgery between January 2006 and December 2015. This study compared the overall survival (OS), disease-free survival (DFS), ipsilateral axillary lymph node recurrence rates and incidence of postoperative complications, especially, arm lymphedema and shoulder stiffness between SLNB and ALND. Results: This study included 223 patients with axillary pathological complete response (pCR) after NAC and surgery. The SLNB and ALND groups included 94 and 129 patients, respectively. The median follow-up time was 57 (range, 6–155) in the SLNB group and 99 (range 2–159) months in the ALND group. The corresponding 5-year OS and DFS rates were 96.3% and 94.2% (p = 0.392), and 89.2% and 86.4% (p = 0.671), respectively. Four patients (4.3%) in the SLNB group and nine (7.0%) in the ALND group developed locoregional recurrences. Ipsilateral axillary lymph node recurrence and distant metastasis were observed in one (1.1%) and three (2.3%) patients, and in 10 (10.6%) and 11 (8.5%) patients, respectively. Patients in the ALND group were more likely than their SLNB counterparts to experience complications, such as shoulder stiffness (9 [7.0%] vs. 4 [4.3%] patients, p = 0.57). The rate of lymphedema in the ALND group was three times that in the SLNB group (35 [27.1%] vs. 8 [8.5%] patients, p < 0.001). Conclusion: As an alternative to ALND, SLNB has oncological safety in patients with axillary pathological complete response after NAC.

Optimized Criteria for Sentinel Lymph Node Biopsy in Patients with Clinically Node Negative Breast Cancer

Jeong Suk Kim,Moo Hyun Lee,Sun Hee Kang,Jihyoung Cho 한국유방암학회 2021 Journal of Breast Disease Vol.9 No.1

Purpose: Sentinel lymph node biopsy (SLNB) is a well-established staging procedure for patients with early breast cancer who have clinically negative axillary lymph node. However, no consensus exists about the number of sentinel lymph nodes (SLN) that should be removed based on radioactivity counts in breast cancer. We reviewed and analyzed cases in which more than one SLN was detected and there was at least one pathologically positive node. Methods: We retrospectively studied breast cancer patients who underwent lymphoscintigraphy with injection of a radioactive colloid and SLNB along with intraoperative determination of radioactive counts of lymph nodes using a gamma probe between 2006 and 2018. In total 326 patients with more than one radioactive SLN were enrolled in this study. Results: Fifty-four patients had nodal metastases, of whom 46 (85.2%) had metastases in the hottest lymph node. All metastatic SLNs were identified as one of the first three lymph nodes dissected. The lowest radioactive count of a positive SLN corresponded to 10% of that of the hottest node. Conclusion: We suggest that removal of the first three lymph nodes or nodes covered by the “10% rule” is sufficient in SLNB for patients with breast cancer.

One-step Nucleic Acid Amplification(OSNA): Intraoperative Rapid Molecular Diagnostic Method for the Detection of Sentinel Lymph Node Metastases in Breast Cancer Patients in Korean Cohort

양정현,최윤라,안수경,배영경,박인애,민준원,이규원,배진혜,한원식,최정은,조은윤,김상민,이혜숙,남석진,이정은,이수정,노동영 한국유방암학회 2010 Journal of breast cancer Vol.13 No.4

Purpose: Sentinel lymph node (SLN) biopsy has become a standard procedure in breast cancer patient management. Accurate intraoperative assessment of metastasis of SLNs is essential for appropriate selection to avoid unnecessary axillary dissection. The aim of this study was to evaluate the performance of one-step nucleic acid amplification (OSNA) assay for detection of sentinel lymph node metastasis examination in breast cancer patients. Methods: In this study, we compared intraoperative OSNA to histological investigation with multi-level observation in 284 sentinel lymph nodes of 199 patients. Surgically obtained sentinel lymph nodes were sectioned into 2 mm intervals of up to four pieces, half of which were examined with the OSNA assay. The other half of adjacent pieces were histopathologically examined both intraoperatively and postoperatively. The presence/absence of metastases was judged by observing hematoxylin and eosin staining and cytokeratin (AE1/AE3) immunohistochemically stained multiple slides from one lymph node. Results: Among 199 patients included,36 cases were positive on histological examination and 34 cases were positive on OSNA assay. There were 14 discordant cases. The overall concordance with histology was 93.0% (95% confidence interval [CI], 0.86-0.96), with a sensitivity of 77.8% (95% CI, 0.61-0.90), specificity of 96.3%(95% CI, 0.92-0.99), positive predictive value of 82.4% (95% CI, 0.65-0.93) and negative predictive value of 95.2% (95% CI, 0.91-0.98). The kappa statistic analysis indicated substantial agreement of both methods, with a value of 0.76 (95% CI, 0.64-0.88). The average turnaround time was 39.0minutes. Conclusion: The results of this study indicate that the OSNA assay has equivalent accuracy to histopathology in detecting breast cancer metastasis to lymph nodes when each method is assigned two alternate blocks of four blocks sectioned at 2 mm intervals.

Comparative Study between Sentinel Lymph Node Biopsy and Axillary Dissection in Patients with One or Two Lymph Node Metastases

이진아,최정은,김세중,이새별,성민기,정준,윤찬석,김봉균,선우영,Korean Breast Cancer Society 한국유방암학회 2018 Journal of breast cancer Vol.21 No.3

Purpose: Sentinel lymph node biopsy (SLNB) is a standard axillary surgery in early breast cancer. If the SLNB result is positive, subsequent axillary lymph node dissection (ALND) is a routine procedure. In 2011, the American College of Surgeons Oncology Group Z0011 trial revealed that ALND may not be necessary in early breast cancer with one or two positive sentinel lymph nodes. The purpose of this study was to compare outcomes among Korean patients with one or two positive axillary lymph nodes in the final pathology who did and did not undergo ALND. Methods: A total of 131,717 patients from the Korea Breast Cancer Society registry database received breast cancer surgery from January 1995 to December 2014. Inclusion criteria were T stage 1 or 2, one or two positive lymph nodes, and having received breast-conserving surgery (BCS), whole breast radiation therapy, and no neoadjuvant therapy. We analyzed the differences in disease-specific survival (DSS) and overall survival (OS) between patients who received SLNB only and those who underwent SLNB+ALND. Results: A total 4,442 patients met the inclusion criteria, with 1,268 (28.6%) in the SLNB group and 3,174 (71.4%) in the SLNB+ALND group. There were no differences in DSS and OS between the two groups (p=0.378 and p=0.925, respectively). The number of patients who underwent SLNB alone for one or two positive lymph nodes increased continuously from 2004 to 2014. Conclusion: Korean patients with early breast cancer and 1 or 2 positive axillary lymph nodes who received BCS plus SLNB showed no significant difference in DSS and OS regardless of whether they received ALND. The findings of this retrospective study demonstrate that omitting ALND can be considered when treating selected patients with early breast cancer who have one or two positive lymph nodes.

A Comparison of Outcomes for the Patients with Pathologically Node-negative Breast Cancer and Who Were Treated Either with Sentinel Lymph Node Biopsy Only or with Conventional Axillary Lymph Node Dissection

Hyun-Ah Kim,Eun-Jeong Jo,Min-Suk Kim,김양희,백남선,Nan-Mo Moon,이종인,양광모,노우철 한국유방암학회 2009 Journal of breast cancer Vol.12 No.4

Purpose: False negative results obtained with the use of a sentinel lymph node biopsy (SLNB) can result in down staging of tumors, whereas the use of a more elaborated pathological examination of sentinel lymph nodes might lead to upstaging of tumors. The purpose of this study was to compare results after performing only an SLNB as compared with performing conventional axillary lymph node dissection (ALND) without an SLNB in pathologically node negative (pN0) breast cancer patients. Methods: From April 2004 to June 2007, SLNBs were performed for patients with primary breast cancer who had no clinical evidence of a lymph node metastasis. A total of 272 patients were treated with only an SLNB. During the same period, 278 patients were confirmed as pN0 after conventional ALND without an SLNB. A prospectively collected database and medical records of these patients were reviewed. Results: For patients that had undergone only an SLNB, there was no local or regional recurrence. A distant metastasis developed in four patients (1.5%). In patients that had undergone ALND without an SLNB, a recurrence was found in 13 patients (4.7%). Patients that had undergone only an SLNB showed significantly better diseasefree survival as compared to patients that had undergone ALND without an SLNB (p=0.032). Conclusion: pN0 patients treated with only an SLNB showed a significantly better outcome as compared to patients treated with conventional ALND without an SLNB. These results suggest that performing an SLNB might result in the upstaging of a subset of patients who would have been understaged by the use of conventional ALND.

수술 전 관상피내암으로 진단된 환자에서의 감시림프절 생검을 고려해야 하는 위험인자들에 대한 고찰

김진주,엄용화,채병주,송병주,정상설 한국유방암학회 2015 Journal of Breast Disease Vol.3 No.2

Purpose: Sentinel lymph node (SLN) biopsy has become the gold standard for axillary staging of invasive breast cancer. However, some controversy has existed concerning the usefulness of SLN biopsy in ductal carcinoma in situ (DCIS). In this study, we tried to identify the usefulness of SLN biopsy in patients with an initial preoperative diagnosis of DCIS. Methods: A retrospective analysis was performed using single-center data of 415 patients with an initial diagnosis of DCIS between January 2003 and December 2013. Many features were correlated with upstaging and positive SLN biopsy using univariate analysis and multivariate analysis. Results: A total of 415 patients with a preoperative diagnosis of DCIS were enrolled in this study. Total 320 of 415 patients (77.1%) underwent axillary evaluation via SLN biopsy, axillary lymph node dissection, or additional axillary lymph node dissection, and 24 of 320 patients (7.5%) were diagnosed with axillary lymph node metastasis or micrometastases in the lymph nodes. Of 415, 296 patients (71.3%) underwent SLN biopsy and 16 patients (5.4%) had positive SLN biopsy. The rate of upstaging to invasive cancer was 4.1% (17 of 415 patients) on final pathology. Of the 17 patients who were upstaged to invasive carcinoma at final pathology, seven patients (41.2%) had a positive SLN biopsy. The statistically significant factors of upstaging were large tumor size (≥2 cm), histologic features of intermediate or high-grade tumor, and positive SLN biopsy. Conclusion: SLN biopsy should be considered in patients with high risk DCIS as a part of the primary surgical procedure.