BJMO - volume 8, issue 4, september 2014
A. Smeets MD, PhD
The aim of this PhD-project was to identify predictors of lymph node metastasis in patients with breast cancer and to integrate these findings in the surgical management of the axilla.
In first phase, we aimed to provide more insight in the biology of lymph node metastasis. We performed gene and miRNA expression profiles of primary tumour tissue and showed that lymph node involvement is not a genetically random process. In a next step, we built a model to predict lymph node involvement based on clinicopathological variables. Tumour size, presence of lymphovascular invasion, multifocality and the location of the tumour in the breast emerged as independent predictors of the lymph node status. Additionally, our data provided evidence that the axillary lymph node status is not only a reflection of the chronological age of a tumour, but also of tumour biology. We then demonstrated that the macrophage density in primary tumour tissue is related to mitotic grade, but not to lymph node status.
In second phase, we aimed to optimise axillary surgery policy in patients with breast cancer. We showed that sentinel lymph node biopsy is at least as accurate as axillary lymph node dissection to detect positive lymph nodes. Additionally, we developed an algorithm for a tailored surgical approach of the axilla. We suggested omitting completion axillary lymph node dissection in a subgroup of patients with a positive lymph node and a low risk of positive non-sentinel lymph nodes. Finally, our findings indicated that implementation of a tailored surgical approach to the axilla results in significant inter-institutional differences.
(BELG J MED ONCOL 2014;8(4):129–31)
Read moreBJMO - volume 6, issue 3, june 2012
A. Smeets MD, PhD, B. Carly MD, V. Cocquyt , M. Vanhoeij , C. Bourgain MD, PhD, E. Lifrange , G Villeirs MD, PhD, M. De Ridder MD, PhD, M. Drijkoningen , J. Lamote , R. Van Den Broecke , M. Voordeckers , J. De Grève MD, PhD, P. Neven MD, PhD, M.R. Christiaens
The aim of this article is to highlight the recent changes in the surgical approach of the axilla in breast cancer patients. Axillary staging is dominated by the sentinel lymph node (SLN) biopsy, which is now widely practiced in clinically node negative patients. Most authors believe a SLN biopsy may even be performed in patients with a large or multifocal tumour, before neo-adjuvant systemic therapy, during pregnancy, after prior excisional biopsy and after prior mantle field radiotherapy of the breast. Intra-operative assessment of the SLN is recommended as it can identify half of all positive lymph nodes. It is generally accepted that it is safe to omit an axillary lymph node dissection (ALND) in patients with a negative SLN or with only isolated tumour cells (<0.2 mm) in the SLN. Moreover, in a subset of patients with a micro-/macrometastasis in the SLN it might not be necessary to perform a completion of ALND. We suggest to accept the option of omitting completion of ALND in frail patients with a positive sentinel lymph node on final pathology OR in these patients with, on final pathology, one or two positive SLNs AND a grade I or II tumour smaller than 4 cm AND adjuvant radiotherapy on the whole breast or chest wall. In conclusion, an increasingly tailored surgical approach is guiding the management of the axilla for women with early breast cancer. (BELG J MED ONCOL 2012;6:87–95)
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