Sentinel lymph node biopsy in breast cancer

ةيوافمللا ةدغلا هلازإ لاجم يف انتربخ نايب ضرعتسن :فادهلأا .ركبلما يدثلا ناطرس تاضيرم ىدل ةسرالحا دلاخ كللما ىفشتسم يف ةيعجرلما ةساردلا هذه تيرجأُ :ةقيرطلا رياني ينب ام ةرتفلا للاخ ةيدوعسلا ةيبرعلا ةكلملما ،ضايرلا ،يعمالجا ناطرسب ةضيرم 120 ةساردلا تلمش .م2014 ربمسيد و م2005 عم ةسرالحا ةيوافمللا ةدغلا ةلازإ ةيلمعل نعضخ يتلالا و يدثلا ةصالخا تامولعلما عمج تم .ةدغلا هذهل ينلاا يحيرشتلا صحفلا و ةسرالحا ةدغلا و ساسلأا مرولا صئاصخ و تاضيرلما صئاصخب .ةيلمعلا هذه رارضأ و طبلإا يف مرولا هساكتنا نع تامولعلما كلذك 120 ىدل يدثلا يف يناطرس مرو 123 كلانه ناك :جئاتنلا ةضيرم 117 ىدل ةسرالحا ةيوافمللا ةدغلا ىـلع روثعلا تم .ةضيرم متي مل .97.6% حانج هبسنب يدثلا يف يناطرس مرو 120 نهيدل 3 يف ةيحارلجا ةيلمعلا للاخ ةسرالحا ةيوافمللا ةدغلا ىلع روثعلا ةسرالحا ةيوافمللا ةدغلل ينلاا يحيرشتلا صحفلا جئاتن .تاضيرم لمع متي مل اذل ةضيرم 95 ىدل مرولا نم ةيلاخ ةدغلا هذه نأ ّن ينب اندجو امنيب ،نهيدل ةيلمعلا تقو طبلإا يف ةيوافمللا ددغلل فيرتج ىدل ةيناطرس ايلاخ ىلع يوتتح تناك ةسرالحا ةيوافمللا ةدغلا نأ ءارجإ تقو طبلإا يف ةيوافمللا ددغلل فيرتج لمع تم اذل ةضيرم 25 ينلسكوتاميه( ةمدقتم ةيربخم تاصوحف تيرجأُ .ةيحارلجا ةيلمعلا اهيف كوكشلما تلاالحا ىلع )ةيئاميك ةيعانم تاغبص( و )ينسوي و ةسرالحا ةيوافمللا ةدغلا تناك يتلالاو ةلاح ينعستو ةسملخا نم تنّن يب و اهل ينلاا يحيرشتلا صحفلل اًقبط مرولا نم ةيلاخ نهيدل ةليلق ةيناطرس ايلاخ نهيدل تاضيرم 10 نأ ةمدقتلما صوحفلا هذه ددغلل فيرتج لمع تم اًقحلا( هسرالحا ةيوافمللا نهددغ يف ددعلا عبرلأا يف كلذ لمعي مل و نهنم تاضيرم 6 يف طبلإا يف ةيوافمللا امنيب ًارهش 35.5 وه تاضيرلما ةعباتلم طسوتلما ددعلا .)تايرخلاا ةدحاو ةلاح قيثوت تم .ًارهش 38.8 ناك نهتعباتلم ينمزلا طسوتلما تناك يتلالا تاضيرلما ةعومجم نم ةضيرم ىدل مرولا ةساكتنلا تناك.ةيناطرس ايلاخ يأ ىلع يوتتح لا ةسرالحا ةيوافمللا نهددغ .ةليلق ةسرالحا ةيوافمللا ةدغلا ةلازإ ةيلمع نم تافعاضلما لاجم يف ةيللمحا انتبرتج نم اهيلع لوصلحا تم يتلا جئاتنلا :ةتمالخا عم قفاوتت يدثلا ناطرس تلااح يف ةسرالحا ةيوافمللا ةدغلا هلازإ يف مرولا ةساكتنا ةبسن تاذلاب و ةهباشلما تاساردلا يف هرشن تم ام ةدغلا ةلازإ ةيلمع نع تجتن ةليلق تافعاضم كلانه تناك .طبلإا .ةسرالحا ةيوافمللا Objectives: To report our experience in sentinel lymph node biopsy )SLNB( in early breast cancer. Methods: This is a retrospective study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2005 and December 2014. There were 120 patients who underwent SLNB with frozen section examination. Data collected included the characteristics of patients, index tumor, and sentinel node )SN(, SLNB results, axillary recurrence rate and SLNB morbidity. Results: There were 120 patients who had 123 cancers. Sentinel node was identified in 117 patients having 120 tumors )97.6% success rate(. No SN was found intraoperatively in 3 patients. Frozen section results showed that 95 patients were SN negative, those patients had no immediate axillary lymph node dissection )ALND(, whereas 25 patients were SN positive and subsequently had immediate ALND. Upon further examination of the 95 negative SN’s by hematoxylin & eosin )H&E( and immunohistochemical staining for doubtful H&E cases, 10 turned out to have micrometastases )6 had delayed ALND and 4 had no further axillary surgery(. Median follow up of patients was 35.5 months and the mean was 38.8 months. There was one axillary recurrence observed in the SN negative group. The morbidity of SLNB was minimal. Conclusion: The obtainable results from our local experience in SLNB in breast cancer, concur with that seen in published similar literature in particular the axillary failure rate. Sentinel lymph node biopsy resulted in minimal morbidity. Saudi Med J 2015; Vol. 36 (9): 1053-1060 doi: 10.15537/smj.2015.9.12228 From the Department of Surgery, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Received 10th May 2015. Accepted 3rd August 2015. Address correspondence and reprint request to: Dr. Abdulaziz A. Alsaif, Department of Surgery, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: [email protected] / [email protected] OPEN ACCESS 1053 www.smj.org.sa Saudi Med J 2015; Vol. 36 )9( 1054 Sentinel lymph node biopsy in breast cancer ... Alsaif Saudi Med J 2015; Vol. 36 )9( www.smj.org.sa B cancer )BC( is the top cancer in women both in the developed and developing world.1 In the USA, nearly 230,000 BCs are diagnosed annually.2 The population of Kingdom of Saudi Arabia )KSA( is approximately 30 million, 65% of them are below the age of 30.3 In KSA, the total number of patients diagnosed to have BC in the year 2010 was 1,473 patients, which constituted 27.4% of all newly diagnosed female cancers in the year 2010. The Age Standardized Rate was 24.9/100,000 for female population. The median age at diagnosis was 49 years. More than half of BC patients in KSA presented with locoregional or distant disease.4 In KSA, there is no national screening program for BC and the Saudi Cancer Registry does not include ductal carcinoma in situ )DCIS( cases in their capture form, which may explain the low number of DCIS cases reported from local centers. It is clear that, KSA is among countries with low disease burden, but it is expected that this burden will increase in the years to come.5 Axillary lymph node status is considered the most important prognostic factor for patients with BC, and it participates largely in the decision regarding subsequent adjuvant systemic treatment.6,7 Axillary lymph node dissection )ALND( for patients with BC was introduced more than 200 years ago for staging and local control.8,9 It is associated with an increase risk of adverse outcomes, including lymphedema in 14% of cases, limited shoulder motion in 28% of the cases and neuropathic pain in 31% of the cases.10 The therapeutic advantage of removing negative nodes with respect to axillary control and survival remains questionable.11-14 At the present time, most BC patients receive some sort of adjuvant systemic therapy irrespective of their lymph node status.15 Based on that, minimally invasive procedures for staging the axilla have been introduced. Sentinel lymph node biopsy )SLNB( in BC, a minimally invasive procedure, was first described in 1994.16 Since then, it has been widely practiced with a wide literature to support its reliability for ascertaining the status of the axillary lymph nodes. Currently, SLNB is accepted as the standard of care for axillary staging in early BC.17-19 In this paper, we are documenting the beginning, development, results and follow up of patients who underwent SLNB for BC at King Khalid University Hospital )KKUH(, Riyadh, Saudi Arabia. Methods. Over a 10-year period )January 2005 to December 2014(, a total of 916 BC patients were diagnosed and treated at KKUH )6 patients with pure DCIS and 910 patients with invasive disease(. Of those 916 patients, there were 120 patients who fulfilled the criteria to undergo SLNB procedure, 3 of them had bilateral disease. The inclusion criteria were set at the beginning of the experience and changed as time passed by, the changes in the inclusion criteria were based on cumulative scientific evidence favoring the change )Figure 1(. The Institutional Review Board, College of Medicine, King Saud University )Ethical Review Committee( approved this study. We conducted the study by reviewing the data of 117 patients who had 120 SLNB procedures, of them, 85 sentinel node )SN( negative patients who had only SLNB with no further ALND and 10 patients who had negative SN on frozen section )FS(, doubtful hematoxylin & eosin )H&E( result, but turned out to have micrometastasis on immunohistochemistry )IHC( testing, ALND was performed to 6 of the 10 patients, but no ALND was performed on the remaining 4 patients. Twenty-five patients in this series had positive SN on FS, so immediate ALND was performed to them. At KKUH, the first case of SLNB in BC was carried out in 2005 by one of the surgeons who had formal overseas training on the procedure where he attained the initial learning phase and validation of the procedure. Patient’s characteristics were age, gender, bilaterality, and hormonal status. Tumor characteristics were histological type, tumor size, lymphovascular invasion, tumor grade, perineural invasion, hormonal receptors. Sentinel node characteristics were number of SN Figure 1 Beginning and development of sentinel lymph node biopsy )SLNB( program at King Khalid University Hospital, Riyadh, Saudi Arabia. ALND axillary lymph node biopsy, DCIS ductal carcinoma in situ, NAC neoadjuvant chemotherapy Disclosure. Authors have no conflict of interests, and the work was not supported or funded by any drug company.