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The Role of Surgical Axillary Staging Prior to Immediate Breast Reconstruction in the Era of De-Escalation of Axillary Management in Early Breast Cancer

Svensson, Miriam and Dihge, Looket LU (2022) In Journal of Personalized Medicine 12(8).
Abstract

Postmastectomy radiotherapy (PMRT) following immediate breast reconstruction (IBR) is associated with postoperative complications. Although the incidence of node-positive breast cancer is declining, a separate sentinel lymph node biopsy (SLNB) is still performed before mastectomy when IBR is planned, in order to evaluate nodal status and the need for PMRT. This study assessed the impact of staged SLNB on the breast reconstructive planning, and presents common clinicopathological characteristics of breast cancer with macrometastatic nodal spread where staged SLNB would be beneficial to indicate PMRT. Medical records of breast cancer patients scheduled for mastectomy and IBR at Skåne University Hospital, Sweden, from November 2014 to... (More)

Postmastectomy radiotherapy (PMRT) following immediate breast reconstruction (IBR) is associated with postoperative complications. Although the incidence of node-positive breast cancer is declining, a separate sentinel lymph node biopsy (SLNB) is still performed before mastectomy when IBR is planned, in order to evaluate nodal status and the need for PMRT. This study assessed the impact of staged SLNB on the breast reconstructive planning, and presents common clinicopathological characteristics of breast cancer with macrometastatic nodal spread where staged SLNB would be beneficial to indicate PMRT. Medical records of breast cancer patients scheduled for mastectomy and IBR at Skåne University Hospital, Sweden, from November 2014 to February 2020, were reviewed. Of 92 patients, node-positive disease was present in 15 (16%). Fifty-three patients underwent staged SLNB before mastectomy and IBR, and 10 (19%) presented with nodal metastasis. All patients with macrometastatic sentinel nodes were presented with palpable, multifocal, ER+ breast carcinoma of no special type with tumor size > 17.0 mm. Overall, four women received PMRT after verified metastasis by staged SLNB, and IBR was cancelled for three patients. These findings question the benefit of routine staged SLNB before mastectomy and IBR in breast cancer populations within established mammography screening programs with low risk of nodal metastasis.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
axillary lymph node status, breast cancer, de-escalating, immediate breast reconstruction, mastectomy, radiotherapy, sentinel lymph node biopsy
in
Journal of Personalized Medicine
volume
12
issue
8
article number
1283
publisher
MDPI AG
external identifiers
  • scopus:85137393368
  • pmid:36013232
ISSN
2075-4426
DOI
10.3390/jpm12081283
language
English
LU publication?
yes
id
1dab5c3a-b029-4f09-a9a8-8dd224235403
date added to LUP
2022-11-23 10:31:52
date last changed
2024-05-29 22:27:35
@article{1dab5c3a-b029-4f09-a9a8-8dd224235403,
  abstract     = {{<p>Postmastectomy radiotherapy (PMRT) following immediate breast reconstruction (IBR) is associated with postoperative complications. Although the incidence of node-positive breast cancer is declining, a separate sentinel lymph node biopsy (SLNB) is still performed before mastectomy when IBR is planned, in order to evaluate nodal status and the need for PMRT. This study assessed the impact of staged SLNB on the breast reconstructive planning, and presents common clinicopathological characteristics of breast cancer with macrometastatic nodal spread where staged SLNB would be beneficial to indicate PMRT. Medical records of breast cancer patients scheduled for mastectomy and IBR at Skåne University Hospital, Sweden, from November 2014 to February 2020, were reviewed. Of 92 patients, node-positive disease was present in 15 (16%). Fifty-three patients underwent staged SLNB before mastectomy and IBR, and 10 (19%) presented with nodal metastasis. All patients with macrometastatic sentinel nodes were presented with palpable, multifocal, ER+ breast carcinoma of no special type with tumor size &gt; 17.0 mm. Overall, four women received PMRT after verified metastasis by staged SLNB, and IBR was cancelled for three patients. These findings question the benefit of routine staged SLNB before mastectomy and IBR in breast cancer populations within established mammography screening programs with low risk of nodal metastasis.</p>}},
  author       = {{Svensson, Miriam and Dihge, Looket}},
  issn         = {{2075-4426}},
  keywords     = {{axillary lymph node status; breast cancer; de-escalating; immediate breast reconstruction; mastectomy; radiotherapy; sentinel lymph node biopsy}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{8}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Personalized Medicine}},
  title        = {{The Role of Surgical Axillary Staging Prior to Immediate Breast Reconstruction in the Era of De-Escalation of Axillary Management in Early Breast Cancer}},
  url          = {{http://dx.doi.org/10.3390/jpm12081283}},
  doi          = {{10.3390/jpm12081283}},
  volume       = {{12}},
  year         = {{2022}},
}