Outcomes and bioethical implications of lymphadenectomy in mastectomized patients: Importance and indication of ultrasound-guided fine-needle aspiration biopsy

Autores/as

DOI:

https://doi.org/10.22267/rus.232501.296

Palabras clave:

Bioética, Cáncer de mama, Ganglio linfático centinela, Salud pública, Linfedema

Resumen

Introduction: Lymph node involvement is the main prognostic factor in breast cancer. Mastectomized patients usually undergo lymphadenectomy (LA) of micrometastatic sentinel lymph nodes (SLNs) despite the evidence of AMAROS trial to replace this therapy with radiotherapy in select cases. Objective: Demonstrate the ability of ultrasonography to detect non-metastatic or micrometastatic SLNs. Materials and methods: 132 patients who underwent mastectomy were evaluated. Ultrasound-guided fine-needle aspiration biopsy (FNAB) was indicated for suspicious lymph nodes. LA and SNL biopsy (SLNB) were performed in patients with positive and negative FNAB, respectively. LA was performed in FNAB positive or SLNB positive cases, except in the presence of isolated tumor cells and micrometastatic SLNs. The tumor burden after LA in patients with negative FNAB and positive SLNB was measured; the presence of two or fewer positive SLNs was considered a low burden. Results: Sensitivity of FNAB for detecting positive lymph nodes in patients with a high tumor burden was 93% and specificity was 84%. Positive (PPV) and negative predictive value (NPV) were 60% and 79%, respectively. Conclusions: LA could have been avoided in 90% of mastectomized patients with negative FNAB and a low tumor burden who met the AMAROS criteria with a high NPV (79%).

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Sabadell-Mercadal MD, Izquierdo-Sanz M, Prats de Puig M, Modolell Roig A. Factores pronósticos y predictivos en cáncer de mama [Online]. Sociedad Española de Senología y Patología Mamaria. Madrid: Fundación Española de Senología y Patología Mamaria; 2017. Available from: https://www.sespm.es/wp-content/uploads/2018/06/MONOGRAFIA-SESPM-2017-Ebook.pdf

Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Auxillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial. JAMA [Online]. 2001; 305(6):569-75. DOI: 10.1001/jama.2011.90.

Giuliano AE, Ballman KV, McCall LM, Beitsch PD, Whitworth PW, Blumencranz PW. Locorregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients with Sentinel Lymph Node Metastases: Long-Term Follow-Up from the American College or Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomiced Trial. Ann Surg [Online]. 2016; 264(3):413-20. DOI: 10.1097/SLA.0000000000001863.

Straver ME, Meijnen P, van Tienhoven G, van de Velde CJH, Mansel RE, Bogaerts J. Sentinel Node Identification Rate and Nodal Involvement in the EORTC 10981-22023 AMAROS Trial. Ann Surg Oncol [Online]. 2010; 17(7):1854-61. DOI: 10.1245/s10434-010-0945-z.

Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJH, Mansel RE. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cáncer (EORC 201981-22023AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet [Online]. 2014; 15 (12):1303-10. DOI: 10.1016/S1470-2045(14)70460-7.

Amonkar SJ, Oates E, McLean L, Nicholson S. Pre-operative staging of the axilla in primary breast cancer. By redefining the abnormal appearing node can we reduce investigations without affecting overall treatment? Breast [Online]. 2013; 22(6): 1114-8. DOI: 10.1016/j.breast.2013.06.004.

Houssami N, Turner RM. Staging the axilla in women with breast cancer: the utility of preoperative ultrasound‐guided needle biopsy. Cancer Bio Med [Online]. 2014; 11(2):69-77. Available from: https://www.cancerbiomed.org/content/11/2/69/tab-article-info

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report [Online]. EEUU: Office for Human Resesarch Protections; 1979. Available from: https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html

Goldhirsch A, Ingle JN, Gelber RD, Coates AS, Thürlimann B, Senn H-J. Thresholds for therapies: highlights on the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009. Ann Oncol [Online]. 2009; 20(8):1319-29. DOI: 10.1093/annonc/mdp322.

Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surgery [Online]. 2018; 7(4):379-403. DOI: 10.21037/gs.2017.11.04.

DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphedema after breast cancer: A systematic review and meta-analysis. Lancet Oncol [Online]. 2013; 14(6):500-15. DOI: 10.1016/S1470-2045(13)70076-7.

Verheuvel NC, van den Hoven I, Ooms HWA, Voogd AC, Roumen RHM. The Role of Ultrasound‐Guided Lymph Node Biopsy in Axillary Staging of Invasive Breast Cancer in the Post‐ACOSOG Z0011 Trial Era. Ann Surg Oncol [Online]. 2015; 22(2):409-15. DOI: 10.1245/s10434-014-4071-1.

Boone BA, Huynh C, Spangler ML, Sumkin J, Johnson R, McGuire KP, et al. Axillary Lymph Node Burden in Invasive Breast Cancer: A Comparison of the Predictive Value of Ultrasound‐Guided Needle Biopsy and Sentinel Lymph Node Biopsy. Clin Breast Cancer [Online]. 2015; 15(5):243-8. DOI: 10.1016/j.clbc.2015.03.011.

Ying Z, Wei Z, Jian‐qiao Z, Xiao‐chun F, Ting‐Jun Y, Ou H, et al. Axillary Staging of Early‐Stage Invasive Breast Cancer by Ultrasound‐Guided Fine‐Needle Aspiration Cytology: Which Ultrasound Criteria for Classifying Abnormal Lymph Nodes Should Be Adopted in the Post‐ACOSOG Z0011 Trial Era? J Ultrasound Med [Online]. 2016; 35(5):885-93. DOI: 10.7863/ultra.15.06019.

Moossdorff M, Nakhlis F, Hu J, Barry WT, Losk K, Haskertt C, et al. The Potential Impact of AMAROS on the Management of the Axilla in Patients with Clinical T1-2N0 Breast Cancer Undergoing Primary Total Mastectomy. Ann Surg Oncol [Online]. 2018; 9(25):2612-9. DOI: 10.1245/s10434-018-6519-1.

Grossmith S, Nguyen A, Hu J, Plitchta JK, Nakhlis F, Cutone L, et al. Multidisciplinary Management of the Axilla in Patients with cT1-T2 N0 Breast Cancer Undergoing Primary Mastectomy: Results from a Prospective Single-Institution Series. Ann Surg Oncol [Online]. 2018; 25(12):3527-34. DOI: 10.1245/s10434-018-6525-3.

Gregorowitsch ML, Verkooijen HM, Houweiling A, Fuhler N, Koelemij R, Schoenmaeckers EJP. Impact of modern day axillary treatment on patient reported arm morbidity and physical functioning in breast cancer patients. Radiother Oncol [Online]. 2019; 131:221-8. DOI: 10.1016/j.radonc.2018.07.006.

Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmactectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. Ann Surg Oncol [Online]. 2017; 24(1):38-51. DOI: 10.1245/s10434-016-5558-8.

Donker M, Straver ME, van Tienhoven G, van der Velde CJH, Mansel RE, Litiere S, et al. Comparison of the sentinel node prodecedure between patients with multifocal and unifocal breast cancer in the EORTC 10981-22023 AMAROS Trial: Identification rate and nodal outcome. Eur J Cancer [Online]. 2013; 49(9):2093-100. DOI: 10.1016/j.ejca.2013.02.017.

Van Roozendaal LM, Smit LH, Duijsens GH, de Vries B, Siesling S, Lobbes MB, et al. Risk of regional recurrence in triple-negative breast cancer patients: a Dutch cohort study. Breast Cancer Res Treat [Online]. 2016; 156(3):465-72. DOI: 10.1007/s10549-016-3757-4.

Farace P, Deidda MA, Amichetti M. Axillary irradiation omitting axillary dissection in breast cancer: is there a role for shoulder-sparing proton therapy? BJR [Online]. 2015; 88(1054):20150274. DOI: 10.1259/bjr.20150274.

Boughey JC. How do the AMAROS trial results change practice? Lancet [Online]. 2014; 15(12):1280-1. DOI: 10.1016/S1470-2045(14)71018-6.

Morrow M, Jagsi R, McLeoud MC, Shumway D, Katz SJ. Surgeon Attitudes Toward the Omission of Axillary Dissection in Early Breast Cancer. JAMA [Online]. 2018; 4(11):1511-6. DOI: 10.1001/jamaoncol.2018.1908.

Magnoni F, Galimberti V, Corso G, Intra M, Sacchini V, Veronesi P. Axillary surgery in breast cancer: An updated historical perspective. Semin Oncol [Online]. 2020;47(6):341-352. DOI: 10.1053/j.seminoncol.2020.09.001.

Chang DW, Bressel M, Hansen C, Blinman P, Schofield P, Chua BH. Axillary dissection in sentinel lymph node positive breast cancer: Is the staging information worthwhile for patients? Asia Pac J Clin Oncol [Online]. 2021; 17(2):e27-34. DOI: 10.1111/ajco.13238.

Publicado

2023-01-31

Cómo citar

1.
Huertas-Moreno M, Gonzalvo-Cirac M. Outcomes and bioethical implications of lymphadenectomy in mastectomized patients: Importance and indication of ultrasound-guided fine-needle aspiration biopsy. Univ. Salud [Internet]. 31 de enero de 2023 [citado 1 de abril de 2023];25(1):D6-D14. Disponible en: https://revistas.udenar.edu.co/index.php/usalud/article/view/7252

Número

Sección

Calidad de servicios en salud