Asian Pacific Journal of Cancer Prevention

  • 제17권3호
  • /
  • Pages.1149-1155
  • /
  • 2016
  • /
  • 1513-7368(pISSN)
  • /
  • 2476-762X(eISSN)
아시아태평양암예방학회 (Asian Pacific Journal of Cancer Prevention)
권호 표지
DOI QR코드

DOI QR Code

Sentinel Node Biopsy Examination for Breast Cancer in a Routine Laboratory Practice: Results of a Pilot Study

  • 발행 : 2016.04.11
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Examination of sentinel lymph node (SLN) biopsies provides accurate nodal staging for breast cancer and plays a key role in patient management. Procurement of SLNs and the methods used to process specimens are equally important. Increasing the level of detail in histopathological examination of SLNs increases detection of metastatic tumours but will also increase the burden of busy laboratories and thus may not be carried out routinely. Recommendation of a reasonable standard in SLN examination is required to ensure high sensitivity of results while maintaining a manageable practice workload. Materials and Methods: Twenty-four patients with clinically node-negative breast cancer were recruited. Combined radiotracer and blue dye methods were used for identification of SLNs. The nodes were thinly sliced and embedded. Serial sectioning and immunohistochemical (IHC) staining against AE1/AE3 were performed if initial H&E sections of the blocks were negative. Results: SLNs were successfully identified in all patients. Ten cases had nodal metastases with 7 detected in SLNs and 3 detected only in axillary nodes (false negative rate, FNR=30%). Some 5 out of 7 metastatic lesions in the SLNs (71.4%) were detected in initial sections of the thinly sliced tissue. Serial sectioning detected the remaining two cases with either micrometastases or isolated tumour cells (ITC). Conclusions: Thin slicing of tissue to 3-5mm thickness and serial sectioning improved the detection of micro and macro-metastases but the additional burden of serial sectioning gave low yield of micrometastases or ITC and may not be cost effective. IHC validation did not further increase sensitivity of detection. Therefore its use should only be limited to confirmation of suspicious lesions. False negative cases where SLNs were not involved could be due to skipped metastases to non-sentinel nodes or poor technique during procurement, resulting in missed detection of actual SLNs.

키워드

참고문헌

  1. Abdollahi A, Jangjoo A, Dabbagh Kakhki VR, et al (2010). Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer. Rev Esp Med Nucl, 29, 73-7. https://doi.org/10.1016/j.remn.2009.10.001
  2. Albertini JJ, Lyman GH, Cox C, et al (1996). Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA, 276, 1818-22. https://doi.org/10.1001/jama.1996.03540220042028
  3. Amir AS, Azar FP, Sahram N, et al (2012). Prevalence of occult metastases in axillary sentinel lymph nodes of breast carcinoma. Pol J Pathol, 63, 40-4.
  4. Amoui M, Akbari ME, Tajeddini A, et al (2012). Value of sentinel lymph node biopsy in breast cancer surgery with simple pathology facilities--an Iranian local experience with a review of potential causes of false negative results. Asian Pac J Cancer Prev, 13, 5385-9. https://doi.org/10.7314/APJCP.2012.13.11.5385
  5. Andersson Y, Frisell J, Sylvan M, et al (2013). Causes of falsenegative sentinel node biopsy in patients with breast cancer. Br J Surg, 100, 775-83. https://doi.org/10.1002/bjs.9085
  6. Andersson Y, Frisell J, Sylvan M, et al ( 2010). Breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. J Clin Oncol, 28, 2868-73. https://doi.org/10.1200/JCO.2009.24.5001
  7. Barnwell JM, Arredondo MA, Kollmorgen D, et al (1998). Sentinel node biopsy in breast cancer. Ann Surg Oncol, 5, 126-30. https://doi.org/10.1007/BF02303845
  8. Borgstein PJ, Pijpers R, Comans EF, et al (1998). Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg, 186, 275-83. https://doi.org/10.1016/S1072-7515(98)00011-8
  9. Chagpar A, Pilavas J, Chao C, et al (2003). Sentinel lymph node biopsy for breast cancer:addressing the controversies. Cancer Therapy, 1, 223-32.
  10. Chu KU, Turner RR, Hansen NM, et al (1999). Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg, 229, 536-41. https://doi.org/10.1097/00000658-199904000-00013
  11. Cody HSr, Hill AD, Tran KN, et al (1999). Credentialing for breast lymphatic mapping: how many cases are enough? Ann Surg, 229, 723-6. https://doi.org/10.1097/00000658-199905000-00015
  12. Cox CE, Bass SS, McCann CR, et al (2000). Lymphatic mapping and sentinel lymph node biopsy in patients with breast cancer. Annu Rev Med, 51, 525-42. https://doi.org/10.1146/annurev.med.51.1.525
  13. Cserni G (1999). Metastases in axillary sentinel lymph nodes in breast cancer as detected by intensive histopathological work up. J Clin Pathol, 52, 922-4. https://doi.org/10.1136/jcp.52.12.922
  14. Cserni G, Gregori D, Merletti F, et al (2004). Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg, 91, 1245-52. https://doi.org/10.1002/bjs.4725
  15. Dauway EL, Giuliano R, Haddad F, et al (1999). Lymphatic mapping in breast cancer. Hematol Oncol Clin North Am, 13, 349-71. https://doi.org/10.1016/S0889-8588(05)70060-5
  16. de Boer M, van Dijck JA, Bult P, et al (2010). Breast cancer prognosis and occult lymph node metastases, isolated tumour cells and micrometastases. J Natl Cancer Inst, 102, 410-25. https://doi.org/10.1093/jnci/djq008
  17. Dowlatshahi K, Fan M, Snider HC, et al (1997). Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer, 80, 1188-97. https://doi.org/10.1002/(SICI)1097-0142(19971001)80:7<1188::AID-CNCR2>3.0.CO;2-H
  18. Ellis IO (2005). Pathology reporting of breast disease. In 'NHS Breast Screening Programme (NHSBSP) publication. NHS Cancer Screening Programmes and The Royal College of Pathologists.', Eds Publication No.58. London,
  19. Ensani F, Enayati L, Rajabiani A, et al (2013). Improved detection of metastases by step sectioning and immuno-histochemical staining of axillary sentinel nodes in patients with breast carcinoma. Asian Pac J Cancer Prev, 14, 5731-4. https://doi.org/10.7314/APJCP.2013.14.10.5731
  20. Fancellu A, Cottu P, Feo CF, et al (2012). Sentinel node biopsy in early breast cancer: lessons learned from more than 1000 cases at a single institution. Tumori, 98, 413-20. https://doi.org/10.1177/030089161209800403
  21. Fitzgibbons PL, Page DL, Weaver D, et al (2000). Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med, 124, 966-78.
  22. Freneaux P, Nos C, Vincent-Salomon A, et al (2002). Histological detection of minimal metastatic involvement in axillary sentinel nodes: a rational basis for a sensitive methodology usable in daily practice. Mod Pathol, 15, 641-6. https://doi.org/10.1038/modpathol.3880580
  23. Gill J, Lovegrove R, Naessens K, et al (2011). Sentinel lymph node biopsy in breast cancer: an analysis of the maximum number of nodes requiring excision. Breast J, 17, 3-8. https://doi.org/10.1111/j.1524-4741.2010.01019.x
  24. Giuliano AE, Dale PS, Turner RR, et al (1995). Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg, 222, 394-401. https://doi.org/10.1097/00000658-199509000-00016
  25. Giuliano AE, Jones RC, Brennan M, et al (1997). Sentinel lymphadenectomy in breast cancer. J Clin Oncol, 15, 2345-50. https://doi.org/10.1200/JCO.1997.15.6.2345
  26. Giuliano AE, Kirgan DM, Guenther JM, et al (1994). Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg, 220, 391-401. https://doi.org/10.1097/00000658-199409000-00015
  27. Gobardhan PD, Elias SG, Madsen EV, et al (2009 ). Prognostic value of micrometastases in sentinel lymph nodes of patients with breast carcinoma: a cohort study. Ann Oncol, 20, 41-8.
  28. Goyal A, Newcombe RG, Chhabra A, et al (2006). Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer--results of the ALMANAC validation phase. Breast Cancer Res Treat, 99, 203-8. https://doi.org/10.1007/s10549-006-9192-1
  29. Grabau D, Ryden L, Ferno M, et al (2011). Analysis of sentinel node biopsy - a single-institution experience supporting the use of serial sectioning and immunohistochemistry for detection of micrometastases by comparing four different histopathological laboratory protocols. Histopathol, 59, 129-38. https://doi.org/10.1111/j.1365-2559.2011.03881.x
  30. Groen RS, Oosterhuis AW, Boers JE (2007). Pathologic examination of sentinel lymph nodes in breast cancer by a single haematoxylin-eosin slide versus serial sectioning and immunocytokeratin staining: clinical implications. Breast Cancer Res Treat, 105, 1-5.
  31. Huvos A, Hutter R, Berg J (1971). Significance of axillary macrometastases and micrometastases in mammary cancer. Ann Surg, 173, 44-6. https://doi.org/10.1097/00000658-197101000-00006
  32. Jakub JW, Pendas S, Reintgen DS (2003). Current status of sentinel lymph node mapping and biopsy: facts and controversies. Oncologist, 8, 59-68. https://doi.org/10.1634/theoncologist.8-1-59
  33. Jannink I, Fan M, Nagy S, et al (1998). Serial sectioning of sentinel nodes in patients with breast cancer: a pilot study. Ann Surg Oncol, 5, 310-4. https://doi.org/10.1007/BF02303493
  34. Kamath VJ, Giuliano R, Dauway EL, et al (2001). Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the Axilla. Arch Surg, 136, 688-92. https://doi.org/10.1001/archsurg.136.6.688
  35. Keskek M, Balas S, Gokoz A, et al (2006). Re-evaluation of axillary skip metastases in the era of sentinel lymph node biopsy in breast cancer. Surg Today, 36, 1047-52. https://doi.org/10.1007/s00595-006-3322-6
  36. Kim T, Giuliano AE, Lyman GH (2006). Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer, 106, 4-16. https://doi.org/10.1002/cncr.21568
  37. Koslow SB, Eisenberg RE, Qiu Q, et al (2014 ). Sentinel lymph node biopsy is a reliable method for lymph node evaluation in neoadjuvant chemotherapy-treated patients with breast cancer. Am Surg, 80, 171-7.
  38. Krag D, Weaver D, Ashikaga T, et al (1998). The sentinel node in breast cancer--a multicenter validation study. N Engl J Med, 339, 941-6. https://doi.org/10.1056/NEJM199810013391401
  39. Krag DN, Anderson SJ, Julian TB, et al (2007). Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol, 8, 881-8. https://doi.org/10.1016/S1470-2045(07)70278-4
  40. Lee AHS, Ellis IO, Pinder SE, et al (2000). Pathological assessment of sentinel lymph-node biopsies in patients with breast cancer. Virchows Arch, 436, 97-101. https://doi.org/10.1007/PL00008220
  41. Liberman L (2000). Pathologic analysis of sentinel lymph nodes in breast carcinoma. Cancer, 88, 971-7. https://doi.org/10.1002/(SICI)1097-0142(20000301)88:5<971::AID-CNCR3>3.0.CO;2-F
  42. Lin PP, Allison DC, Wainstock J, et al (1993). Impact of axillary lymph node dissection on the therapy of breast cancer patients. J Clin Oncol, 11, 1536-44. https://doi.org/10.1200/JCO.1993.11.8.1536
  43. Lyman GH, Giuliano AE, Somerfield MR, et al (2005). American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol, 23, 7703-20. https://doi.org/10.1200/JCO.2005.08.001
  44. Madsen EV, Elias SG, van Dalen T, et al (2013). Predictive factors of isolated tumor cells and micrometastases in axillary lymph nodes in breast cancer. Breast, 22, 748-52. https://doi.org/10.1016/j.breast.2012.12.013
  45. Martin RC, Chagpar A, Scoggins CR, et al (2005). Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg, 241, 1005-12. https://doi.org/10.1097/01.sla.0000165200.32722.02
  46. McMasters KM, Tuttle TM, Carlson DJ, et al (2000). Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol, 18, 2560-6. https://doi.org/10.1200/JCO.2000.18.13.2560
  47. National.Coordinating.Group.for.Breast.Screening.Pathology 1997. Pathology reporting in breast cancer screening, Sheffield:NHSBSP Publications.
  48. Patani N, Mokbel K (2011). Clinical significance of sentinel lymph node isolated tumour cells in breast cancer. Breast Cancer Res Treat, 127, 325-34. https://doi.org/10.1007/s10549-011-1476-4
  49. Pendas S, Dauway EL, Giuliani R, et al (2000). Sentinel node biopsy in ductal carcinoma in situ patients. Ann Surg Oncol, 7, 15-20. https://doi.org/10.1007/s10434-000-0015-z
  50. Reintgen DS, Haddad F, Pendas S, et al (1998). Lymphatic mapping and sentinel lymph node biopsy. Sci Am, 17, 1-17.
  51. Snider H, Dowlatshahi K, Fan M, et al (1999). Sentinel node biopsy in staging of breast cancer. Am J Surg, 176, 305-10.
  52. Straver ME, Meijnen P, van Tienhoven G, et al (2010). Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol, 17, 1854-61. https://doi.org/10.1245/s10434-010-0945-z
  53. Sun J, Yin J, Ning L, et al (2012). Clinicopathological characteristics of breast cancers with axillary skip metastases. J Invest Surg, 25, 33-6. https://doi.org/10.3109/08941939.2011.598605
  54. Tafra L, Lannin DR, Swanson MS, et al (2001). Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg, 233, 51-9. https://doi.org/10.1097/00000658-200101000-00009
  55. Tai P, Joseph KJ, Yu E (2011). Issues related to sentinel lymph node assessment in the management of breast cancer-what are relevant in pathology reports? Patholog Res Int, 2011.
  56. Torrenga H, Rahusen FD, Meijer S, et al (2001). Sentinel node investigation in breast cancer; detailed analysis of the yield from step sectioning and immunohistochemistry. J Clin Pathol, 54, 550-2. https://doi.org/10.1136/jcp.54.7.550
  57. Turner RR, Ollila DW, Krasne DL, et al (1997). Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg, 226, 271-8. https://doi.org/10.1097/00000658-199709000-00006
  58. Turner RR, Ollila DW, Stern S, et al (1999). Optimal histopathologic examination of the sentinel lymph node for breast carcinoma staging. Am J Surg Pathol, 23, 263-7. https://doi.org/10.1097/00000478-199903000-00003
  59. van Diest PJ (1999). Histopathological workup of sentinel lymph nodes: how much is enough? J Clin Pathol, 52, 871-3. https://doi.org/10.1136/jcp.52.12.871
  60. van Diest PJ, Peterse HL, Borgstein PJ, et al (1999). Pathological investigation of sentinel lymph nodes. Eur J Nucl Med, 26, 43-9. https://doi.org/10.1007/s002590050577
  61. Verma R, Rajan SS, Verghese ET, et al (2014). Pathological evaluation of the staging axillary lymph nodes for breast cancer: a national survey in the United Kingdom. Histopathol, 65, 707-11. https://doi.org/10.1111/his.12440
  62. Veronesi U, Paganelli G, Galimberti V, et al (1997). Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet, 349, 1864-7. https://doi.org/10.1016/S0140-6736(97)01004-0
  63. Veronesi U, Paganelli G, Viale G, et al (1999). Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst, 91, 368-73. https://doi.org/10.1093/jnci/91.4.368
  64. Veronesi U, Paganelli G, Viale G, et al (2003). A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med, 349, 546-53. https://doi.org/10.1056/NEJMoa012782
  65. Vijayakumar V, Boerner PS, Jani AB, et al (2005). A critical review of variables affecting the accuracy and false-negative rate of sentinel node biopsy procedures in early breast cancer. Nucl Med Commun, 26, 395-405. https://doi.org/10.1097/00006231-200505000-00002
  66. Weaver D, Krag DN, Manna EA, et al (2002). Comparison of occult micrometastasis detection in breast caner sentinel lymph nodes using manual cytokeratin immunohistochemistry and image analysis. Mod Pathol, 15, 55A-6A.
  67. Weaver DL (2010). Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale. Mod Pathol, 23, 26-32. https://doi.org/10.1038/modpathol.2010.36
  68. Weaver DL, Krag DN, Ashikaga T, et al (2000). Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma: a multicenter study. Cancer, 88, 1099-107. https://doi.org/10.1002/(SICI)1097-0142(20000301)88:5<1099::AID-CNCR22>3.0.CO;2-7
  69. Wilking N, Rutqvist LE, Carstensen J, et al (1992). Prognostic significance of axillary nodal status in primary breast cancer in relation to the number of resected nodes. Stockholm Breast Cancer Study Group. Acta Oncol, 31, 29-35. https://doi.org/10.3109/02841869209088261
  70. Wong SL, Edwards MJ, Chao C, et al (2001a). The effect of lymphatic tumor burden on sentinel lymph node biopsy results. Breast J, 8, 192-8.
  71. Wong SL, Edwards MJ, Chao C, et al (2001b). Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate. J Am Coll Surg, 192, 684-9. https://doi.org/10.1016/S1072-7515(01)00858-4
  72. Zakaria S, Degnim AC, Kleer CG, et al (2007). Sentinel lymph node biopsy for breast cancer: how many nodes are enough? J Surg Oncol, 96, 554-9. https://doi.org/10.1002/jso.20878

피인용 문헌

  1. Application of automated image analysis reduces the workload of manual screening of sentinel lymph node biopsies in breast cancer vol.71, pp.6, 2017, https://doi.org/10.1111/his.13305