Skip to main content

Evaluation of Axillary Nodes

  • Chapter
  • First Online:
  • 1642 Accesses

Abstract

The choice of treatment plan depends on the TNM staging and biology of the tumor. Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in clinically node-negative early-stage breast cancer patients. ALND has been considered mandatory in sentinel node-positive patients, but recent data have demonstrated that breast-conserving surgery (BCS) and radiotherapy are equivalent to ALND of micro-/macrometastatic sentinel lymph nodes (SLNs). This approach will reduce the morbidity of dissection without decreasing overall survival (OS).

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Morl F. Importance of the sternal lymph vessels for metastases of cancer of the breast. Chirurg. 1952;23(7):298–300.

    CAS  PubMed  Google Scholar 

  2. Haagensen CD, Feind KR, Herter FP, Slanetz CA, Weinberg JA. The lymphatics in cancer. Philadelphia: WB Saunders Company; 1972.

    Google Scholar 

  3. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39(2):456–66.

    Article  CAS  PubMed  Google Scholar 

  4. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.

    Article  CAS  PubMed  Google Scholar 

  5. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radio localization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2:335–9.

    Article  CAS  PubMed  Google Scholar 

  7. Albertini JJ, Lyman GH, Cox C, Yeatman T, Balducci L, Ku N, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996;276:1818–22.

    Article  CAS  PubMed  Google Scholar 

  8. Deurloo EE, Tanis PJ, Gilhuijs KG, Muller SH, Kröger R, Peterse JL, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer. 2003;39:1068–73.

    Article  CAS  PubMed  Google Scholar 

  9. Raut CP, Hunt KK, Akins JS, Daley MD, Ross MI, Singletary SE, et al. Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis: results of a surgical prospective clinical practice protocol. Cancer. 2005;104:692–99. ChengG, KuritaS, TorigianDA, AlaviA. Current status of sentinel lymph node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging. 2011 Mar;38(3):562–75. Vogt H, Schmidt M, Bares R, Brenner W, Grünwald F, Kopp J, et al. Procedure guideline for sentinel node diagnosis. Nuklear Med. 2010;49:167–72.

    Google Scholar 

  10. Gentilini O, Cremonesi M, Toesca A, Colombo N, Peccatori F, Sironi R, et al. Sentinel lymph node biopsy in pregnant patients with breast cancer. Eur J Nucl Med Mol Imaging. 2010;37:78–83.

    Article  PubMed  Google Scholar 

  11. Spanheimer PM, Graham MM, Sugg SL, Scott-Conner CE, Weigel RJ. Measurement of uterine radiation exposure from lymphoscintigraphy indicates safety of sentinel lymph node biopsy during pregnancy. Ann Surg Oncol. 2009;16:1143–7.

    Article  PubMed  Google Scholar 

  12. Sakr R, Bezu C, Raoust I, Antoine M, Ettore F, Darcourt J, et al. The sentinel lymph node procedure for patients with preoperative diagnosis of ductal carcinoma in situ: risk factors for unsuspected invasive disease and for metastatic sentinel lymph nodes. Int J Clin Pract. 2008;62:1730–5.

    Article  CAS  PubMed  Google Scholar 

  13. Sakr R, Antoine M, Barranger E, Dubernard G, Salem C, Darai E, et al. Value of sentinel lymph node biopsy in breast ductal carcinoma in situ upstaged to invasive carcinoma. Breast J. 2008;14:55–60.

    Article  PubMed  Google Scholar 

  14. Ansari B, Ogston SA, Purdie CA, Adamson DJ, Brown DC, Thompson AM. Meta- analysis of sentinel node biopsy in ductal carcinoma in situ of the breast. Br J Surg. 2008;95:547–54.

    Article  CAS  PubMed  Google Scholar 

  15. Lyman GH, Giuliano AE, Somerfield MR, Benson 3rd AB, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;30:7703–20.

    Article  Google Scholar 

  16. Kumar R, Jana S, Heiba SI, Dakhel M, Axelrod D, Siegel B, et al. Retrospective analysis of sentinel node localization in multifocal, multicentric, palpable or nonpalpable breast cancer. J Nucl Med. 2003;44:7–10.

    PubMed  Google Scholar 

  17. Knauer M, Konstantiniuk P, Haid A, Wenzl E, Riegler-Keilb M, Postlberger S, et al. Multicentric breast cancer: a new indication for sentinel node biopsy a multi-institutional validation study. J Clin Oncol. 2006;24:3374–80.

    Article  PubMed  Google Scholar 

  18. Goyal A, Newcombe RG, Mansel RE, Chetty U, Ell P, Fallowfield L, ALMANAC Trialists Group, et al. Sentinel lymph node biopsy in patients with multifocal breast cancer. Eur J Surg Oncol. 2004;30:475–9.

    Article  CAS  PubMed  Google Scholar 

  19. D’Eredita G, Giardina C, Ingravallo G, Rubini G, Lattanzio V, Berardi T. Sentinel lymph node biopsy in multiple breast cancer using subareolar injection of the tracer. Breast. 2007;16:316–22.

    Article  PubMed  Google Scholar 

  20. Port ER, Garcia-Etienne CA, Park J, Fey J, Borgen PI, Cody 3rd HS. Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence. Ann Surg Oncol. 2007;14:2209–14.

    Article  PubMed  Google Scholar 

  21. Luini A, Galimberti V, Gatti G, Arnone P, Vento AR, Trifiro G, et al. The sentinel node biopsy after previous breast surgery: preliminary results on 543 patients treated at the European Institute of Oncology. Breast Cancer Res Treat. 2005;89:159–63.

    Article  PubMed  Google Scholar 

  22. Intra M, Trifiro G, Galimberti V, Gentilini O, Rotmensz N, Veronesi P. Second axillary sentinel node biopsy for ipsilateral breast tumor recurrence. Br J Surg. 2007;94:1216–9.

    Article  CAS  PubMed  Google Scholar 

  23. Koizumi M, Koyama M, Tada K, Nishimura S, Miyagi Y, Makita M, et al. The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol. 2008;34:365–8.

    Article  CAS  PubMed  Google Scholar 

  24. Rodriguez Fernandez J, Martella S, Trifiro G, Caliskan M, Chifu C, Brenelli F, et al. Sentinel node biopsy in patients with previous breast aesthetic surgery. Ann Surg Oncol. 2009;16:989–92.

    Article  PubMed  Google Scholar 

  25. Karam A, Stempel M, Cody 3rd HS, Port ER. Reoperative sentinel lymph node biopsy after previous mastectomy. J Am Coll Surg. 2008;207:543–8.

    Article  PubMed  Google Scholar 

  26. Filippakis GM, Zografos G. Contraindications of sentinel lymph node biopsy: are there any really? World J Surg Oncol. 2007;5:10.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Soran A. Uras C, Aydoğan F. In: Uras C, Aydogan F editors. Sentinel Lenf Nodu Biopsisi, 1. Baskı, İstanbul Medical Yayıncılık, Neoadjuvan kemoterapi alanlarda sentinel lenf nodu biyopsisi. 2007. p. 93–99.

    Google Scholar 

  28. Sabel MS, Schott AF, Kleer CG, Merajver S, Cimmino VM, Diehl KM, et al. Sentinel node biopsy prior to neoadjuvant chemotherapy. Am J Surg. 2003;186:102–5.

    Article  PubMed  Google Scholar 

  29. Mamounas EP, Brown A, Anderson S, Smith R, Julian T, Miller B, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2005;23:2694–702.

    Article  PubMed  Google Scholar 

  30. Xing Y, Foy M, Cox DD, Kuerer HM, Hunt KK, Cormier JN. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg. 2006;93:539–46.

    Article  CAS  PubMed  Google Scholar 

  31. Kelly AM, Dwamena B, Cronin P, Carlos RC. Breast cancer sentinel node identification and classification after neoadjuvant chemotherapy-systematic review and meta-analysis. Acad Radiol. 2009;16:551–63.

    Article  PubMed  Google Scholar 

  32. Boughey JC, Bedrosian I, Meric-Bernstam F, Ross MI, Kuerer HM, Akins JS, et al. Comparative analysis of sentinel lymph node operation in male and female breast cancer patients. J Am Coll Surg. 2006;203:475–80.

    Article  PubMed  Google Scholar 

  33. Gentilini O, Chagas E, Zurrida S, Intra M, De Cicco C, Gatti G, et al. Sentinel lymph node biopsy in male patients with early breast cancer. Oncologist. 2007;12:512–5.

    Article  PubMed  Google Scholar 

  34. Synn LW, Park J, Patil SM, Cody 3rd HS, Port ER. Sentinel lymph node biopsy is successful and accurate in male breast carcinoma. J Am Coll Surg. 2008;206:616–21.

    Article  Google Scholar 

  35. Sayman HB. In: Uras C, Aydogan F editors, Sentinel Lenf Nodu Biopsisi, 1.Baskı, İstanbul Medical Yayıncılık, Sentinel lenf nodu biyopsisinde nükleer tıp teknikleri. Istanbul; 2007. p. 45–53.

    Google Scholar 

  36. Sherman AI, Ter-Pogossian M. Lymph-node concentration of radioactive colloidal gold following interstitial injection. Cancer. 1953;6:1238–40.

    Article  CAS  PubMed  Google Scholar 

  37. Wilhelm AJ, Mijnhout GS, Franssen EJ. Radiopharmaceuticals in sentinel lymph-node detection – an overview. Eur J Nucl Med. 1999;26:36–42.

    Article  Google Scholar 

  38. Wilke LG, McCall LM, Posther KE, Whitwoth PW, Reintgen DS, Leitch AM, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13:491–500.

    Article  PubMed  Google Scholar 

  39. Albo D, Wayne JD, Hunt KK, Rahlfs TF, Singletary SE, Ames FC, et al. Anaphylactic reactions to isosulphane blue during sentinel lymph node biopsy for breast cancer. Am J Surg. 2001;182:393–8.

    Article  CAS  PubMed  Google Scholar 

  40. Stradling B, Aranha G, Gabram S. Adverse skin reactions after methylene blue injections for sentinel lymph node localization. Am J Surg. 2002;184:350–2.

    Article  PubMed  Google Scholar 

  41. Kargozaran H, Shah M, Li Y, Beckett L, Gandour-Edwards R, Schneider PD, et al. Concordance of peritumoral technetium 99m colloid and subareolar blue dye injection in Breast cancer sentinel lymph node biopsy. J Surg Res. 2007;143:126–9.

    Article  PubMed  Google Scholar 

  42. Rodier JF, Velten M, Wilt M, Martel P, Ferron G, Vaini-Elies V, et al. Prospective multicentric randomized study comparing periareolar and peritumoral injection of radiotracer and blue dye for the detection of sentinel lymph node in breast sparing procedures: Fransenode trial. J Clin Oncol. 2007;25:3664–9.

    Article  PubMed  Google Scholar 

  43. Derossis AM, Fey J, Yeung H, Yeh SD, Heerdt AS, Petrek J, et al. A trend analysis of the relative value of blue dye and isotope localization in 2,000 consecutive cases of sentinel node biopsy for breast cancer. J Am Coll Surg. 2001;193:473–8.

    Article  CAS  PubMed  Google Scholar 

  44. Bauer TW, Spitz FR, Callans LS, Alavi A, Mick R, Weinstein SP, et al. Subareolar and peritumoral injection identify similar sentinel nodes for breast cancer. Ann Surg Oncol. 2002;9:169–76.

    Article  PubMed  Google Scholar 

  45. Pelosi E, Baiocco C, Ala A, Gay E, Bello M, Varetto T, et al. Lymphatic mapping in early stage breast cancer: comparison between periareolar and subdermal injection. Nucl Med Commun. 2003;24:519–23.

    Article  CAS  PubMed  Google Scholar 

  46. Noguchi M, Inokuchi M, Zen Y. Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy. J Surg Oncol. 2009;100:100–5.

    Article  PubMed  Google Scholar 

  47. Argon AM, Duygun U, Acar E, Daglioz G, Yenjay L, Zekioglu O, et al. The use of periareolar intradermal Tc-99m tin colloid and peritumoral intraparenchymal isosulfan blue dye injections for determination of the sentinel lymph node. Clin Nucl Med. 2006;31:795–800.

    Article  PubMed  Google Scholar 

  48. Goyal A, Newcombe RG, Mansel RE, Axillary Lymphatic Mapping Against Nodal axillary Clearance (ALMANAC) Trialists Group. Clinical relevance of multiple sentinel nodes in patients with breast cancer. Br J Surg. 2005;92:438–42.

    Article  CAS  PubMed  Google Scholar 

  49. Goyal A, Newcombe RG, Chhabra A, Mansel RE, ALMANAC Trialists Group. Factors affecting failed localization and false-negative rates of sentinel node biopsy in breast cancer: results of the ALMANAC validation phase. Breast Cancer Res Treat. 2006;99:203–8.

    Article  PubMed  Google Scholar 

  50. Schrenk P, Rehberger W, Shamiyeh A, Wayand W. Sentinel node biopsy for breast cancer: does the number of sentinel nodes removed have an impact on the accuracy of finding a positive node? J Surg Oncol. 2002;803:130–6.

    Article  Google Scholar 

  51. Ilvan Ş. In: Uras C, Aydogan F editors, Sentinel Lenf Nodu Biopsisi, 1. Baskı, İstanbul Medikal Yayıncılık. Sentinel lenf nodlarının patolojik değerlendirmesi. 2007. p. 93–99.

    Google Scholar 

  52. Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Bussolati G, et al. Pathological work-up of sentinel lymph node breast in cancer. Review of current data to be considered fort the formulation of guide lines. Eur J Cancer. 2003;39:1654–67.

    Article  CAS  PubMed  Google Scholar 

  53. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.

    Article  CAS  PubMed  Google Scholar 

  54. Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet. 2013;14:609–18.

    Article  PubMed  Google Scholar 

  56. Sauer T, Engh V, Holck AM, Sørpebøl G, Heim M, Furu I, et al. Imprint cytology of sentinel lymph nodes in breast cancer. Experience with rapid, intraoperative diagnosis and primary screening by cytotechnologists. Acta Cytol. 2003;47:768–73.

    Article  PubMed  Google Scholar 

  57. Couceiro TC, Menezes TC, Valênça MM. Post mastectomy pain syndrome: the magnitude of the problem. Rev Bras Anestesiol. 2009;59:358–65.

    Article  PubMed  Google Scholar 

  58. Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A. The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema. Support Care Cancer. 2011;19:685–90. Noguchi M. Axillary reverse mapping for breast cancer. Breast Cancer Res Treat. 2010;119:529–35.

    Google Scholar 

  59. Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A. The short-term effect laser therapy in the management of breast cancer related lymph edema. Support Care Cancer. 2011;19:685–90.

    Article  PubMed  Google Scholar 

  60. Noguchi M. Axillary reverse mapping for breast cancer. Breast Cancer Res Treat. 2010;119:529–35.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mahmut Müslümanoğlu MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Müslümanoğlu, M. (2016). Evaluation of Axillary Nodes. In: Aydiner, A., İgci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-26012-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26012-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26010-5

  • Online ISBN: 978-3-319-26012-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics