scholarly journals New approaches to surgery for breast cancer.

2001 ◽  
pp. 265-286 ◽  
Author(s):  
S E Singletary
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Breast Conservation ◽  
Axillary Lymph ◽  
Invasive Procedures ◽  
Less Invasive ◽  
High Risk Women ◽  
Treatment Standard ◽  
Risk Of Cancer

The surgical management of breast cancer is rapidly evolving towards less invasive procedures. Alternative biopsy techniques, including fine-needle aspiration and core needle biopsy, are replacing excisional biopsy as the treatment standard. Breast conservation therapy is now widely used in place of mastectomy, both for small tumors and for larger tumors that have been downstaged through induction chemotherapy. Less invasive procedures for axillary treatment such as lymphatic mapping and sentinel lymph-node biopsy are being explored in an effort to avoid the morbidity associated with axillary lymph-node dissection. For women who still prefer or need to receive a mastectomy, immediate breast reconstruction with autologous tissue provides an excellent cosmetic outcome that is oncologically sound. This is especially appealing to high-risk women who opt to have a prophylactic mastectomy. High-risk women are also being offered the option of receiving chemopreventive treatment that may reduce their lifetime risk of cancer by almost 50%. These new, less invasive approaches require the close cooperation of a team of physicians,including surgeons, pathologists, radiologists, and medical and radiation oncologists.

Locoregional Therapy in Breast Cancer

2009 ◽  
Vol 05 (01) ◽  
pp. 45
Author(s):  
Lorenzo Livi ◽  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Local Control ◽  
Breast Conservation ◽  
Standard Of Care ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
Axillary Lymph ◽  
Breast Irradiation ◽  
Axillary Lymph Node Metastases

Breast cancer is the most common cancer in women. In 2004, estimates were that about 215,990 women and approximately 1,500 men in the US would be diagnosed with invasive breast cancer. Surgery and radiotherapy, either alone or combined, remain the most effective techniques to treat cancer. Surgical procedures have been clearly defined by several randomised clinical trials that demonstrated equivalent survival with breast-conservation surgery combined with radiotherapy versus mastectomy. In the last few years, in order to avoid the risk of lymphoedema caused by axillary dissection, in patients free from axillary lymph node metastases sentinel lymph node biopsy has been widely accepted as a standard of care. The use of whole-breast irradiation with or without a boost is the standard of care at present. The value of adding nodal irradiation to the breast irradiation is unproven. Local control is influenced not only by treatment modalities but also by screening programmes, allowing the possibility of identifying smaller and smaller lesions. Nowadays, local control for breast cancer is a fundamental part of treatment. The surgical approach is tailored towards conservation of the breast and good-looking cosmesis, while radiotherapy is tailored towards reduction of treated volume to reduce damage and to spare time and cost.

scholarly journals Surgical Treatment for Breast Cancer and Axillary Metastases

2021 ◽  
Vol 19 (1) ◽  
pp. 125-136
Author(s):  
Damir Grebić ◽  
Aleksandra Pirjavec ◽  
Domagoj Kustić ◽  
Tihana Klarica Gembić
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Pectoralis Major ◽  
Axillary Staging ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Early Stage Disease

Breast cancer (BC) is the most common malignancy to affect females. The first suggestions of BC and its treatment date back to Ancient Egypt, 1500-1600 B.C. Throughout history, the management of BC has evolved from extensive radical mastectomy towards less invasive treatments. Radical mastectomy was introduced by W.S. Halsted in 1894, involving the resection of the breast, regional lymph nodes, pectoralis major and minor. Despite its mutiloperative lymphatic mapping and the concept of sentinel lymph node (SLN) biopsy (SLNB) have been developed. SLNB has replaced axillary lymph node dissection (ALND) to be the standard procedure for axillary staging in patients with clinically node-negative BC. Many women have since been spared ALND, including those with negative SLNB or with SLNs involved with micrometastases (0.2-2 mm in size). In the last decade, evidence gathered from new clinical trials suggests that ALND may be safely omitted even in BC patients with 1 or 2 positive SLNs if adjuvant radiotherapy is delivered.ating effect, it had been the main surgical approach to BC patients until 1948, when Patey and Dyson proposed its modified form that conserved pectoralis major and minor and the level III of axillary lymph nodes. The latter was associated with less postoperative morbidity and improved quality of life. The idea of limited breast tissue resection was introduced in the 1970s by Umberto Veronesi and led to further minimizations of surgery in BC patients until breast conservation became the standard of care for early-stage disease. In the 1990s, intra

Lymphatic Mapping in Patients with Breast Cancer and Previous Augmentation Mammoplasty

2007 ◽  
Vol 73 (10) ◽  
pp. 981-983
Author(s):  
Anna Kaminski ◽  
Dena Amr ◽  
Melinda Lacerna Kimbrell ◽  
L. Andrew Difronzo
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymphatic Mapping ◽  
Metastatic Cancer ◽  
Breast Conservation ◽  
Develop Breast Cancer ◽  
Axillary Lymph ◽  
Augmentation Mammoplasty ◽  
Sentinel Nodes

Sentinel lymph node biopsy (SLNB) is now an established method of axillary staging in patients with breast cancer. However, the augmented breast poses an interesting challenge to this procedure. We hypothesized that SLNB is feasible in patients with augmented breasts who subsequently develop breast cancer. A retrospective study was performed from 1995 to 2006. Ten patients with augmented breasts underwent breast conservation therapy with SLNB. Sentinel lymph nodes were identified in all 10 patients. Three patients had positive sentinel nodes. Two patients proceeded to axillary lymph node dissection (ALND), and one declined. The subsequent ALND were negative for metastatic cancer. Seven patients had negative sentinel nodes. One patient with a negative sentinel node underwent ALND with all nodes negative for metastasis. Two patients were lost to follow-up. Of the remaining eight patients, the mean duration of follow-up was 71 months. None of these patients had evidence of axillary recurrence or distant metastasis at time of last follow-up. SLNB is a feasible method of axillary node staging in patients who have undergone augmentation mammoplasty who subsequently develop breast cancer. Further studies are needed to better determine the accuracy of lymphatic mapping in this patient population.

scholarly journals The accuracy of USG and USG guided FNAC axilla in predicting nodal metastasis in a clinically lymph node negative cancer breast patient

2016 ◽  
Vol 5 (1) ◽  
pp. 196 ◽  
Author(s):  
Vaibhav Shrivastava ◽  
Sanjay Singh ◽  
Sanjay Singh ◽  
Aklesh Kumar Maurya ◽  
Aklesh Kumar Maurya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Predictive Value ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Negative

Background: Breast malignancies are the second most common cause of cancer-related mortality among women. As the size of the primary breast cancer increases, some cancer cells are shed into cellular spaces and transported via the lymphatic network of the breast to the regional lymph nodes, especially the axillary lymph nodes. Objective of the study was to determine the accuracy of USG and US-FNAC in detecting lymph node metastasis in a clinically lymph node negative CA Breast patient.Methods: This prospective study was conducted on 40 consecutive patients with biopsy proven breast cancer with clinically negative axilla, who had attending the OPD or IPD in our department of surgery, Swaroop Rani Nehru Hospital, Allahabad, during the period of 2014 to 2015. All of these patients were planned to undergo surgery (breast conservation or modified radical mastectomy with axillary clearance).Results: Sensitivity of the study = 97.77%, specificity = 25%, positive predictive value =92.01%, negative predictive value =50%, diagnostic accuracy =90%.Conclusions: Using axillary ultrasound and selective US-FNAC is a rapid, non-morbid method of staging the axilla in newly diagnosed breast cancer patients and should become a routine part of patient care because it can spare many patients particularly those who are undergoing axillary dissection.

Axillary lymph node ratio (LNR) versus pathologic nodal stage (pN) as a prognostic factor in breast cancer: Validation of Vinh-Hung's model in an Indian population.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1099-1099
Author(s):  
Swati Batra ◽  
Manomoy Ganguly ◽  
Narayanan Kannan ◽  
Rajnish Talwar ◽  
Puneet Takkar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Axillary Lymph Node ◽  
Lymph Node Ratio ◽  
Tertiary Care ◽  
Risk Groups ◽  
Axillary Lymph ◽  
Care Hospital ◽  
Node Ratio

1099 Background: The axillary lymph node ratio (LNR), i.e., the ratio of positive over excised lymph nodes offers potentially improved prognostication, selection for adjuvant therapy and inter-institutional comparability compared to conventional pathological nodal staging (pN). A consensus on appropriate cut-offs however, remains to be achieved. Values of 0.20 and 0.65 to classify patients into low, intermediate and high-risk groups were proposed by Vinh-Hung et al, in the largest study on the subject till date. We perform a validation of the LNR concept for the first time in an independent patient population from the Indian subcontinent. Methods: 225 patients with a median follow-up of 42 months (range: 2 – 246 months) who underwent upfront surgery for breast cancer at a tertiary care hospital in Delhi, India, were retrospectively analysed, using Cox multivariate regression. Results: Using the above cut-off points, 10-year disease-free survival (DFS) rates of 83%, 74% and 28% and adjusted hazard ratios (HR) of 1.19 (95% CI 0.33 to 4.37), 2.21 (95% CI 0.75 to 6.51) and 6.88 (95% CI 1.58 – 29.92; P = 0.01) were obtained for the low-, intermediate- and high-risk groups respectively. The corresponding risks for the pN1, pN2 and pN3 categories were 1.74, 1.74, and 1.35, representing inadequate, even reversed prognostic separation. When both the LNR and pN were included as continuous variables, the nodal ratio remained prognostically significant with an adjusted HR of 12.33 (95% CI 1.1 – 142.5, P = 0.04) in contrast to the number of positive nodes which were not found to be significantly associated with DFS (HR = 0.97, 95% CI 0.9 – 1.1, P = 0.41). Conclusions: The LNR outperformed the pN staging in predicting DFS in our cohort of patients, irrespective of whether it was modeled as a categorical or a continuous variable. Simultaneous analysis with pN only increased its prognostic weight and resulted in exclusion of pN from the multivariate model. Our study thus provides independent external validation of Vinh-Hung’s proposed cut-offs and contributes to the growing body of literature supporting the incorporation of a ratio-based system into breast cancer staging.

scholarly journals IMPACT OF THE NUMBER OF DISSECTED AXILLARY LYMPH NODES ON SURVIVAL IN BREAST CANCER PATIENTS

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. CM Goapl Kesari ◽  
Dr. Sudhakar Kotlapati
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Breast Cancer Mortality ◽  
Breast Conservation ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Breast Irradiation ◽  
Node Dissection

INTRODUCTION: Locoregional control as well as breast cancer mortality benefit have been shown from adjuvant radiation therapy following breast conservation surgery or following mastectomy with node-positive disease. Partial breast irradiation via external brachytherapy, beam, or intraoperative techniques has been shown to limit the volume of irradiated tissue in select groups of women while preserving efficacy although data on long-term outcomes is limited. MATERIAL AND METHODS: Early stage breast cancer (BC) patients with histologically confirmed invasive breast carcinoma clinically 5 cm or less in size, no palpable adenopathy, and with sentinel nodes were included in the study that received lumpectomy with whole-breast irradiation, and underwent either axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. Patients were followed up to three years and assessed for disease recurrence with a history and physical examination every 6 months. RESULTS: A total of 86 patients were included in the study. Of the 86 patients 43 were in SLND group and 43 were in the ALND group. In SLND group 40 (93%) received radiation therapy and in ALND group 41 (95%). No difference was noted in the groups in the use of high tangents, nodal irradiation, or no irradiation. Adjuvant systemic therapy was given to 42 (98%) in SLND group and 42 to (98%) ALND group. CONCLUSION: Radiation therapy has an integral role in the management of breast cancer. In SLND group three years disease free survival was 41 (95%) and for ALND group 40(93%). KEYWORDS: AJND, SLND, Breast Cancer and Radiotherapy.

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