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Indikationen zur Sentinellymphknotenentfernung beim Mammakarzinom

Indication of sentinel node biopsy in breast cancer

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Zusammenfassung

Nach den Empfehlungen der Konferenzen in Philadelphia 2002 und St. Gallen 2003 sowie den Empfehlungen der Deutschen Gesellschaft für Senologie 2004 und 2005 stellt die Sentinellymphknotenentfernung (engl. „sentinel node biopsy“, SNB) unter der Voraussetzung einer geeigneten Selektion sowie einer standardisierten und qualitätsgesicherten Durchführung eine geeignete operative Alternative für das axilläre Staging beim Mammakarzinom dar. Zielsetzung ist die Reduktion der operationsbedingten Morbidität im Schulter-Arm-Bereich ohne Verminderung der Staginggenauigkeit. Voraussetzung ist eine interdisziplinäre Zusammenarbeit sowie ausreichendes Training.

Abstract

The sentinel node biopsy has become an appropriate operative alternative for the axillary staging in breast cancer if done in a standardized quality controlled treatment protocol with precautious patient selection according to the Philadelphia consensus conference 2002, the St. Gallen conference and the Deutsche Gesellschaft für Senologie 2004 and 2005. Sentinel node biopsy aims to reduce the surgical morbidity of the shoulder arm region without reduction of the staging quality. Interdisciplinary team-work as well as an appropriate surgical training are necessary.

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Literatur

  1. 1.

    Silverstein MJ, Skinner KA, lomis TJ (2001) Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg 25: 767–772

  2. 2.

    Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT (1992) Assessment of morbidity from complete axillary dissection. Br J Cancer 66: 136–138

  3. 3.

    Hladiuk M, Huchcroft S, Temple W, Schnurr BE (1992) Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates. J Surg Oncol 50: 47–52

  4. 4.

    Keramopoulos A, Tsionou C, Minaretzis D, Michalas S, Aravantinos D (1993) Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariated approach. Oncology 50: 445–449

  5. 5.

    Schwartz GF, Giuliano AE, Veronesi U; Consensus Conference Committee (2002) Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, Pennsylvania. Cancer 94: 2542–2551

  6. 6.

    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: 2560–2566

  7. 7.

    Krag D, Weaver D, Ashikaga T et al. (1998) The sentinel node in breast cancer — a multicenter validation study. N Engl J Med 339: 941–946

  8. 8.

    Kühn T, Vogl FD, Santjohanser C et al. (2001) Sentinel-Node-Biopsie beim Mammakarzinom — Ergebnisse einer prospektiven Multizenterstudie. Geburtsh Frauenheilk 61: 1–8

  9. 9.

    Kim T, Agboola O, Lyman GH (2002) The predictive value of sentinel lymph node sampling in breast cancer staging: a meta-analysis. Breast Cancer Res Treat: abstract 502

  10. 10.

    Borgstein PJ, Meijer S, Pijpers R (1997) Intradermal blue dye to identify sentinel lymph-node in breast cancer. Lancet 49: 1668–1669

  11. 11.

    Motomura K, Komoike Y, Hasegawa Y, Kasugai T, Inaji H, Noguchi S, Koyama H (2003) Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patients. J Surg Oncol 82: 91–96

  12. 12.

    Haid A, Kuehn T, Konstantiniuk P, Koberle-Wuhrer R, Knauer M, Kreienberg R, Zimmermann G (2002) Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. Eur J Surg Oncol 28: 705–170

  13. 13.

    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: 546–553

  14. 14.

    Roumen RM, Kuijt GP, Liem IH, van Beek MW (2001) Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection. Br J Surg 88: 1639–1643

  15. 15.

    Chung MA, Steinhoff MM, Cady B (2002) Clinical axillary recurrence in breast cancer patients after a negative sentinel node biopsy. Am J Surg 184: 310–314

  16. 16.

    Takei H, Suemasu K, Kurosumi M et al. (2002) Sentinel lymph node biopsy without axillary dissection after an intraoperative negative histological investigation in 358 invasive breast cancer cases. Breast Cancer 9: 344–348

  17. 17.

    Reitsamer R, Peintinger F, Prokop E, Rettenbacher L, Wenzel C (2003) Follow up of sentinel lymph node negative breast cancer patients who had no axillary lymph node dissection. Int J Gyn Cancer 13 [Suppl 1]: 1–122

  18. 18.

    Giuliano AE, Haigh PI, Brennan MB et al. (2000) Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 18: 2553–2559

  19. 19.

    Boolbol SK, Fey JV, Borgen PI et al. (2001) Intradermal isotope injection: a highly accurate method of lymphatic mapping in breast carcinoma. Ann Surg Oncol 8: 20–24

  20. 20.

    Wong SL, Chao C, Edwards MJ et al.; University of Louisville Breast Cancer Study Group (2002) Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg 184: 492–498

  21. 21.

    Brady EW (2002) Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer. Breast J 8: 97–100

  22. 22.

    Nason KS, Anderson BO, Byrd DR et al. (2000) Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 89: 2187–2194

  23. 23.

    Stearns V, Ewing CA, Slack R, Penannen MF, Hayes DF, Tsangaris TN (2002) Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol 9: 235–242

  24. 24.

    Tafra L, Verbanac KM, Lannin DR (2001) Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer. Am J Surg 182: 312–315

  25. 25.

    Julian TB, Dusi D, Wolmark N (2002) Sentinel node biopsy after neoadjuvant chemotherapy for breast cancer. Am J Surg 184: 315–317

  26. 26.

    Cohen LF, Breslin TM, Kuerer HM, Ross MI, Hunt KK, Sahin AA (2000) Identification and evaluation of axillary sentinel lymph nodes in patients with breast carcinoma treated with neoadjuvant chemotherapy. Am J Surg Pathol 24: 1266–1272

  27. 27.

    Fernandez A, Cortes M, Benito E et al. (2001) Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme. Nucl Med Commun 22: 361–366

  28. 28.

    Breslin TM, Cohen L, Sahin A et al. (2000) Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol 18: 3480–3486

  29. 29.

    Mamounas EP (2003) Sentinel lymph node biopsy after neoadjuvant systemic therapy. Surg Clin North Am 83: 931–942

  30. 30.

    Piato JR, Barros AC, Pincerato KM, Sampaio AP, Pinotti JA (2003) Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study. Eur J Surg Oncol 29: 118–120

  31. 31.

    Sabel MS, Schott AF, Kleer CG et al. (2003) Sentinel node biopsy prior to neoadjuvant chemotherapy. Am J Surg 186: 102–105

  32. 32.

    Schrenk P, Hochreiner G, Fridrik M, Wayand W (2003) Sentinel node biopsy performed before preoperative chemotherapy for axillary lymph node staging in breast cancer. Breast J 9: 282–287

  33. 33.

    Engel J, Hölzel D, Kerr J, Schubert-Fritschle G (2003) Epidemiologie. In: Tumorzentrum München (Hrsg) Manual Mammakarzinome, 9. Aufl., Zuckschwerdt, München, S 1–11

  34. 34.

    Rebner M, Raju U (1994) Noninvasive breast cancer. Radiology 190: 623–631

  35. 35.

    Lagios MD (1990) Duct carcinoma in situ: pathology and treatment. Surg Clin North Am 70: 853–871

  36. 36.

    Schnitt SJ, Silen W, Sadowsky NL, Connolly JL, Harris JR (1988) Ductal carcinoma in situ. N Engl J Med 318: 898–902

  37. 37.

    WHO (1981) Histological typing of breast tumours, 2nd ed. WHO, Geneva

  38. 38.

    Lagios MD, Silverstein MJ (2001) Sentinel node biopsy for patients with DCIS: a dangerous and unwarranted direction. Ann Surg Oncol 8: 275–277

  39. 39.

    Cox CE, Nguyen K, Gray RJ et al. (2001) Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg 67: 513–519

  40. 40.

    Klauber-DeMore N, Tan LK, Liberman A et al. (2000) Sentinel lymph node biopsy: is it indicted in patients with high risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann Surg Oncol 7: 636–642

  41. 41.

    Pendas S, Dauway E, Giuliano R, Ku NN, Cox CE, Reintgen DS (2000) Sentinel node biopsy in DCIS patients. Ann Surg Oncol 7: 15–20

  42. 42.

    Intra M, Veronesi P, Mazzarol G et al. (2003) Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg 138: 309–313

  43. 43.

    Klauber-DeMore N, Tan LK, Liberman A et al. (2000) Sentinel lymph node biopsy: is it indicted in patients with high risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann Surg Oncol 7: 636–642

  44. 44.

    Cserni G (2002) Sentinel lymph node biopspy as a tool for the staging of ductal carcinoma of situ in patients with breast carcinoma. Surg Today 32: 99–103

  45. 45.

    Zelis JJ, Sickle-Santanello BJ, Liang WC, Nims TA (2002) Do not contemplate invasive surgery for ductal carcinoma in situ. Am J Surg 184: 348–349

  46. 46.

    Lagios MD, Westdahl PR, Margolin FR et al. (1982) Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failure. Cancer 50: 1309–1314

  47. 47.

    Carter BA, Jensen RA, Simpson JF, Page DL (2000) Benign transport of breast epithelium into axillary lymph nodes after biopsy. Am J Pathol 113: 259–265

  48. 48.

    Solin LJ, Kurtz J, Fourquet A et al. (1996) 15 year results of breast conserving surgery and definite breast irridiation for treatment of ductal carcinoma in situ of the breast. J Clin Oncol 14: 754–763

  49. 49.

    Silverstein MJ, Lagios MD, Martino S et al. (1998) Outcome after invasive local recurrence in patients with ductal carcinoma in situ of the breast. J Clin Oncol 16: 1367–1373

  50. 50.

    Silverstein MJ, Lagios MD, Groshen S et al. (1999) The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 340: 1455–1461

  51. 51.

    Julien JP, Bijker N, Fentiman I et al. (2000) Radiotherapy in breast conserving treatment for ductal carcinoma in situ: first results of EORTC randomised phase III trial 10853. Lancet 355: 528–533

  52. 52.

    Bleicher RJ, Giuliano AE (2003) The selective use of sentinel node biopsy in ductal carcinoma in situ. Arch Surg 138: 489

  53. 53.

    Union International Contre Cancer (2002) TNM classification of malignant tumours, 6th ed. Wiley, New York

  54. 54.

    Wong JH, Kopald KH, Morton DL (1990) The impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer. Arch Surg 125: 1298–1301

  55. 55.

    Silverstein MJ, Gierson ED, Colburn WJ, Rosser RJ, Waisman JR, Gamagani P (1991) Axillary lymphadenectomy for intraductal carcinoma of the breast. Surg Gynecol Obstet 172: 211–214

  56. 56.

    Solin LJ, Fowble BL, Yeh IT et al. (1992) Microinvasive ductal carcinoma of the beast treated with breast conserving surgery and definite irridiation. Int J Radiat Oncol Biol Phys 23: 961–918

  57. 57.

    Silver SA, Tavassoli FA (1998) Mammari ductal carcinoma in situ with microinvasion. Cancer 82: 2382–2390

  58. 58.

    Riveradeneira DE, Simmons RM, Christos P et al. (2000) Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients. J Am Coll Surg 191: 1–8

  59. 59.

    Zavotsky J, Hansen N, Brennan MB, Turner RR, Giuliano AE (1999) Lymph node metastasis from ductal carcinoma in situ with microinvasion. Cancer 85: 2439–2443

  60. 60.

    Shen P, Glass EC, DiFronzo LA, Giuliano AE (2001) Dermal versus intraparenchymal lymphoscintigraphy of the breast. Ann Surg Oncol 8: 241–248

  61. 61.

    Paganelli G, Galimberti V, Trifiro G et al. (2002) Internal mammary node lymphoscintigraphy and biopsy in breast cancer. Q J Nucl Med 46: 138–144

  62. 62.

    van der Ent FW, Kengen RA, van der Pol HA, Povel JA, Stroeken HJ, Hoofwijk AG (2001) Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 234: 79–84

  63. 63.

    van der Ent F (2002) Surgical approach to internal mammary lymph node biopsy. J Am Coll Surg 194: 685

  64. 64.

    Dupont E, Cox CE, Nguyen K et al. (2001) Utility of internal mammary lymph node removal when noted by intraoperative gamma probe detection. Ann Surg Oncol 8: 833–836

  65. 65.

    Galimberti V, Veronesi P, Arnone P et al. (2002) Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients. Ann Surg Oncol 9: 924–928

  66. 66.

    Paganelli G, Galimberti V, Trifiro G et al. (2002) Internal mammary node lymphoscintigraphy and biopsy in breast cancer. Q J Nucl Med 46: 138–144

  67. 67.

    Ogawa Y, Ishikawa T, Sawada T et al. (2003) Thoracoscopic internal mammary sentinel node biopsy for breast cancer. Surg Endosc 17: 315–319

  68. 68.

    Tanis PJ, Nieweg OE, Valdes Olmos RA, Peterse JL, Rutgers EJ, Hoefnagel CA, Kroon BB (2002) Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients. Br J Cancer 87: 705–710

  69. 69.

    Carcoforo P, Basaglia E, Soliani G, Bergossi L, Corcione S, Pozza E, Feggi L (2002) Sentinel node biopsy in the evaluation of the internal mammary node chain in patients with breast cancer. Tumori 88: S5–7

  70. 70.

    Kern KA (2002) Concordance and validation study of sentinel lymph node biopsy for breast cancer using subareolar injection of blue dye and technetium 99m sulfur colloid. J Am Coll Surg195: 467–475

  71. 71.

    Klimberg VS, Rubio IT, Henry R, Cowan C, Colvert M, Korourian S (1999) Subareolar versus peritumoral injection for location of the sentinel lymph node. Ann Surg 229: 860–864

  72. 72.

    Jin Kim H, Heerdt AS, Cody HS, Van Zee KJ (2002) Sentinel lymph node drainage in multicentric breast cancers. Breast J 8: 356–361

  73. 73.

    Kumar R, Jana S, Heiba SI et al. (2003) Retrospective analysis of sentinel node localization in multifocal, multicentric, palpable, or nonpalpable breast cancer. J Nucl Med 44: 7–10

  74. 74.

    Schrenk P, Wayand W (2001) Sentinel-node biopsy in axillary lymph-node staging for patients with multicentric breast cancer. Lancet 357: 122

  75. 75.

    Ozmen V, Muslumanoglu M, Cabioglu N et al. (2002) Increased false negative rates in sentinel lymph node biopsies in patients with multi-focal breast cancer. Breast Cancer Res Treat 76: 237–244

  76. 76.

    Bauerfeind I, Untch M (2003) Schwangerschaft und Mammakarzinom — ein Überblick. Geburtsh Frauenheilk 63: 417–425

  77. 77.

    Strahlenschutzkommission (2005) Nuklearmedizinischer Nachweis des Wächter-Lymphknotens. http://www.ssk.de

  78. 78.

    Bundesamt für Strahlenschutz http://www.bfs.de

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Himsl, I., Bauerfeind, I., Kahlert, S. et al. Indikationen zur Sentinellymphknotenentfernung beim Mammakarzinom. Gynäkologe 38, 869–876 (2005). https://doi.org/10.1007/s00129-005-1746-5

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Schlüsselwörter

  • Sentinellymphknoten
  • Mammakarzinom
  • Neoadjuvante Chemotherapie
  • Axilläres Staging
  • Duktales Carcinoma in situ

Keywords

  • Sentinel node
  • Breast cancer
  • Axillary staging
  • Neoadjuvant chemotherapy
  • Ductal carcinoma in situ