BJMO - , issue ,
K. Van Baelen , N. Van den Rul , S. Marquette , L. Vansteelant , J. Mebis MD, PhD, C. Thywissen , A.-S. Vliegen , L. Noé , M. Drijkoningen , G. Orye
In clinical practice, the diversity in the surgical management of the axilla after neo-adjuvant chemotherapy (NACT) for node positive patients is huge. Given the morbidity of axillary lymph node dissection (ALND), a trend to perform a less invasive technique is seen in both literature and clinical practice. There are three major techniques: 1) sentinel lymph node biopsy (SLNB), 2) guided removal of lymph nodes that were positive prior to NACT, and 3) Targeted Axillary Dissection (TAD) which is a combination of the previous two techniques. Criteria for patients eligible for these techniques vary widely and oncological safety cannot always be guaranteed. With this report, we aim to introduce TAD in a safe way into the clinical practice.
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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