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Annals of Surgery Mar 2022A simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated. (Observational Study)
Observational Study
OBJECTIVE
A simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated.
SUMMARY AND BACKGROUND DATA
The reduction in the number of ALNDs conducted has led to decreased resident exposure and confidence.
METHODS
A cross-sectional multicenter observational study was carried out between July 2017 and August 2018. Following model development, 30 surgeons of varying experience (n = "experts," n = 11 "senior residents," and n = 10 "junior residents") were asked to perform a simulated ALND. Face and content validity questionnaires were administered immediately after ALND. All ALND procedures were retrospectively assessed by 2 attending breast surgeons, blinded to operator identity, using a video-based assessment tool, and an end product assessment tool.
RESULTS
Statistically significant differences between groups were observed across all operative subphases on the axillary clearance assessment tool (P < 0.001). Significant differences between groups were observed for overall procedure quality (P < 0.05) and total number of lymph nodes harvested (P < 0.001). However, operator grade could not be distinguished across other end product variables such as axillary vein damage (P = 0.864) and long thoracic nerve injury (P = 0.094). Overall, participants indicated that the simulator has good anatomical (median score >7) and procedural realism (median score >7).
CONCLUSIONS
Video-based analysis demonstrates construct validity for ALND assessment. Given reduced ALND exposure, this simulation is a useful adjunct for both technical skills training and formative Deanery or Faculty administered assessments.
Topics: Axilla; Clinical Competence; Cross-Sectional Studies; Humans; Lymph Node Excision; Retrospective Studies
PubMed: 32590540
DOI: 10.1097/SLA.0000000000003946 -
Journal of Surgical Oncology Jan 2020Over the last 25 years, modifications in systemic and radiation therapy for breast cancer have led to significant reductions in the risk of regional recurrence. During... (Review)
Review
Over the last 25 years, modifications in systemic and radiation therapy for breast cancer have led to significant reductions in the risk of regional recurrence. During the same time, surgeons have demonstrated that it is safe to forego axillary dissections for patients with low burdens of axillary lymph node disease. When these advances are added to those by reconstructive microsurgeons, the promise of reducing morbidity rates from posttreatment lymphedema seems within our grasp.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Recurrence, Local; Randomized Controlled Trials as Topic
PubMed: 31240726
DOI: 10.1002/jso.25591 -
Journal of Visceral Surgery Feb 2023
Topics: Humans; Female; Lymph Node Excision; Lymph Nodes; Breast Neoplasms; Sentinel Lymph Node Biopsy; Neoplasm Staging; Axilla
PubMed: 36192307
DOI: 10.1016/j.jviscsurg.2022.08.006 -
Journal of Clinical Oncology : Official... Jan 2024
Topics: Humans; Female; Breast Neoplasms; Sentinel Lymph Node Biopsy; Lymph Node Excision; Lymph Nodes; Axilla
PubMed: 38048518
DOI: 10.1200/JCO.23.02121 -
Surgical Oncology Sep 2022The purpose of this study was to assess the feasibility of using the single-incision round block technique in breast-conserving surgery with sentinel lymph node (SLN)... (Observational Study)
Observational Study
AIMS AND OBJECTIVES
The purpose of this study was to assess the feasibility of using the single-incision round block technique in breast-conserving surgery with sentinel lymph node (SLN) retrieval for breast cancer without compromising oncological safety.
MATERIALS AND METHODS
A retrospective observational case-control study was conducted from January 2017 to October 2021. The study population consisted of two groups. In both groups, breast-conserving surgery was carried out through the round-block technique. In group A, SLN retrieval was performed using the round-block incision (study group), while in group B, SLN retrieval was conducted through a second skin incision in the axilla (control group). The study was approved by the local ethics committee Zurich (BASEC-Nr. 2020-02857), and written informed consent was obtained from all participants.
RESULTS
Overall, 134 patients met the inclusion criteria, of whom 86 women underwent breast-conserving surgery and SLN retrieval using the single-incision approach (group A), and 48 women underwent conventional surgery, using two independent incisions for tumour resection and SLN retrieval (group B). The overall success rate in group A regarding SLN retrieval was 97.7%, whereas most tumours were located in the upper outer (47.7%) and upper inner quadrant (27.9%). Although the technique was equally successful in the other quadrants, the share of tumours in the lower outer, and the lower inner quadrant, and the retroareolar region was smaller, representing 17.4%, 3.5% and 3.5%, respectively. The median number of dissected lymph nodes was two, with a positivity rate of 24.4%. The occurrence of axillary neuralgia and axillary skin retraction was significantly higher in group B along with tendentially more axillary seroma formation. There were no significant differences regarding reintervention rates, in terms of complications, resection margins, locoregional recurrences, or deaths with a mean follow-up of 11 months.
CONCLUSIONS
The single-incision method through the round block technique is as safe and effective as the standard two-incision approach regarding nodal staging and resection margins, and seems to be applicable for tumours in all breast quadrants.
Topics: Axilla; Breast Neoplasms; Case-Control Studies; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Margins of Excision; Mastectomy, Segmental; Retrospective Studies; Sentinel Lymph Node Biopsy
PubMed: 36126348
DOI: 10.1016/j.suronc.2022.101847 -
Current Treatment Options in Oncology May 2020As the use of neoadjuvant systemic therapy (NAST) increases, the optimal management of the axilla has become increasingly complex. Consensus among professional... (Review)
Review
As the use of neoadjuvant systemic therapy (NAST) increases, the optimal management of the axilla has become increasingly complex. Consensus among professional organizations is that those patients with clinically negative axillary nodes who are being considered for NAST should undergo a sentinel lymph node (SLN) biopsy following NAST. If a positive SLN is subsequently identified, an axillary lymph node dissection (ALND) is the current standard of care. For patients with clinically node-positive disease, SLN biopsy is a reasonable option for those with a good response to NAST. Patients should undergo SLN mapping with a dual dye technique. Additionally, at least 2 lymph nodes should be removed, including the previously biopsied and marked lymph node with cancer. In this setting, the identification and false negative rates are acceptable. Patients found to have a negative SLN at this time may be spared the morbidity associated with ALND. Patients found to have persistently positive lymph nodes following NAST, either clinically or pathologically, should undergo a complete ALND.
Topics: Axilla; Breast Neoplasms; Clinical Decision-Making; Clinical Trials as Topic; Disease Management; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoadjuvant Therapy; Sentinel Lymph Node Biopsy; Treatment Outcome
PubMed: 32462230
DOI: 10.1007/s11864-020-00755-7 -
World Journal of Surgical Oncology Mar 2021In the last decade, two research groups, the French group by Clough et al. (Br J Surg. 97:1659-65, 2010) and the Chinese one by Li et al. (ISRN Oncol 2013:279013, 2013),... (Review)
Review
BACKGROUND
In the last decade, two research groups, the French group by Clough et al. (Br J Surg. 97:1659-65, 2010) and the Chinese one by Li et al. (ISRN Oncol 2013:279013, 2013), proposed two types of classification of axillary lymph nodes in breast cancer, identifying novel anatomic landmarks for dividing the axillary space in lymph node dissection.
MAIN BODY
Knowledge of the exact location of the sentinel node helps to focus the surgical dissection and to reduce the morbidity of sentinel lymph node biopsy procedures, in particular the risk of arm lymphedema, without compromising sensitivity.
CONCLUSION
In this article, we aimed at focusing on the clinical impact that the most recent classifications of axillary lymph nodes have obtained in literature, highlighting the importance of defining new demarcations to preserve the axillary lymph nodes as much as possible in breast surgery.
Topics: Axilla; Breast Neoplasms; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Prognosis; Sentinel Lymph Node Biopsy
PubMed: 33781279
DOI: 10.1186/s12957-021-02209-2 -
Annals of Surgical Oncology Dec 2022Chyle leak after axillary surgery is a rare complication that lacks consensus and management guidelines. This study aimed to present the experiences of two centers in... (Review)
Review
BACKGROUND
Chyle leak after axillary surgery is a rare complication that lacks consensus and management guidelines. This study aimed to present the experiences of two centers in chyle leak management after axillary node clearance for breast cancer. Furthermore the authors provide a review of its pathophysiology and clinical diagnostic methods. They compare approaches for management of the axilla with those for other locations.
METHODS
A multicentre case series descriptive analysis of chyle leak after breast cancer axillary node clearance between 1 January 2013 and 31 May 2020 was performed.
RESULTS
The center in the United Kingdom and the center in Italy performed 655 and 4969 axillary node clearances, respectively. Four patients experienced chyle leaks. All the leaks had left-sided surgery (3 patients had level 3 clearances with mastectomy and implant-based breast reconstructions; 1 patient had level 2 clearance with therapeutic mammoplasty). All the leaks appeared within 3 days after surgery. Leak duration was between 11 and 29 days. The maximum daily output was 600 mL. All the leaks were treated conservatively with nutritional team support together with close drainage monitoring. The management strategy included a low-fat diet, a high-protein diet, total parenteral nutrition, and medium chain triglyceride supplements, as well as other elements. No negative effects on oncoplastic and reconstructive breast surgery wound-healing and no delays in adjuvant treatment were observed.
CONCLUSION
The incidence of chyle leak after breast cancer axillary node clearance was 0.07%. Early diagnosis and close monitoring together with conservative management involving nutritional team support can result in successful treatment of chyle leak without negative sequalae of breast cancer oncologic treatment.
Topics: Humans; Female; Chyle; Mastectomy; Breast Neoplasms; Lymph Node Excision; Axilla
PubMed: 35849297
DOI: 10.1245/s10434-022-12094-y -
Breast Cancer Research and Treatment Aug 2024Prior data from this Center demonstrated that for patients who had biopsy-proven axillary metastases, were ycN0 after neoadjuvant chemotherapy (NAC), and had a...
PURPOSE
Prior data from this Center demonstrated that for patients who had biopsy-proven axillary metastases, were ycN0 after neoadjuvant chemotherapy (NAC), and had a wire-directed (targeted) sentinel lymphadenectomy (WD-SLND), 60% were node negative. The hypothesis of this study was that results of axillary imaging either before or after NAC would be predictive of final pathologic status after WD-SLND.
METHODS
For patients treated with NAC between 2015 and 2023, ultrasound and MRI images of the axilla were retrospectively reviewed by radiologists specializing in breast imaging, who were blinded to the surgical and pathology results.
RESULTS
Of 113 patients who fit the clinical criteria, 66 (58%) were ypN0 at WD-SLND and 34 (30%) had a pathologic complete response to NAC. There was no correlation between the number of abnormal lymph nodes on pre-NAC ultrasound or MRI imaging and the final pathologic status of the lymph nodes. The positive predictive value (PPV) of abnormal post-NAC axillary imaging was 48% for ultrasound and 53% for MRI. The negative predictive value (NPV) for normal post-NAC axillary imaging was 67% for ultrasound and 68% for MRI.
CONCLUSION
The results of axillary imaging were not adequate to identify lymph nodes after NAC that were persistently pathologically node positive or those which had become pathologically node negative.
Topics: Humans; Female; Breast Neoplasms; Axilla; Neoadjuvant Therapy; Magnetic Resonance Imaging; Middle Aged; Adult; Aged; Sentinel Lymph Node Biopsy; Neoplasm Staging; Retrospective Studies; Lymphatic Metastasis; Lymph Nodes; Ultrasonography; Lymph Node Excision
PubMed: 38700572
DOI: 10.1007/s10549-024-07332-8 -
Breast Cancer Research and Treatment Jun 2021Axillary nodal status is one of the most important prognostic factors in breast cancer. While sentinel lymph node biopsy (SLNB) is a safe and validated procedure for... (Review)
Review
Axillary nodal status is one of the most important prognostic factors in breast cancer. While sentinel lymph node biopsy (SLNB) is a safe and validated procedure for clinically node-negative patients, axillary management of clinically node-positive patients has been more controversial. Patients with clinically detected axillary metastases often benefit from neoadjuvant chemotherapy (NAC). Those who convert to node-negative disease following NAC are important to identify, since they can often be spared significant morbidity from axillary dissection. SLNB has shown widely varying false-negative rates (FNR) but with the use of dual mapping and surgical biopsy of 3 or more nodes, it is considered an acceptable method to stage the axilla in clinically node-positive patients who receive NAC. Various methods including targeted axillary dissection (TAD) have been shown to decrease the FNR of SLNB. We will review appropriate methods to identify a metastatic node and subsequent ultrasound-guided biopsy with tissue marking techniques. We underscore key points in monitoring axillary response, techniques to accurately localize the biopsied and clipped known metastatic node for surgical excision and the effect of various methods in reducing the FNR of SLNB, including the emerging concept of TAD on patient care.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoadjuvant Therapy; Neoplasm Staging; Sentinel Lymph Node Biopsy
PubMed: 33982209
DOI: 10.1007/s10549-021-06248-x