Our Summary

The study involves ten patients who are in the early stages of breast cancer. These patients had either one or two lymph nodes that appeared suspicious under ultrasound. The researchers marked these lymph nodes using a product called Twirl® breast markers. This allowed the doctors to identify these lymph nodes as the sentinel lymph nodes, which are the first lymph nodes that the cancer is likely to spread to.

In three of the patients, less than three sentinel lymph nodes showed signs of cancer spread. These patients were suitable for a less invasive surgery that leaves some lymph nodes intact. One of these patients had her breast removed without any lymph nodes, while the other two had all of their lymph nodes removed along with their breasts.

The findings of this study suggest that if a patient meets certain criteria (known as the ACOSOG Z-0011 criteria), they might be able to have less invasive surgery even if the initial tests show that their lymph nodes might be cancerous. This is because all the suspicious nodes they tested turned out to be sentinel nodes.

FAQs

  1. What is a sentinel lymph node biopsy and how does it work in breast cancer patients?
  2. What is the role of Twirl® breast markers in sentinel lymph node biopsies?
  3. What are the ACOSOG Z-0011 criteria and how do they relate to sentinel lymph node biopsies?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sentinel lymph node biopsy is that it can help determine if cancer has spread to nearby lymph nodes, which can help guide treatment decisions. It is also important to follow up with your doctor for any follow-up tests or treatments recommended based on the results of the biopsy.

Suitable For

Patients with stage I or II breast cancer who have one or two suspicious lymph nodes detected on ultrasonography are typically recommended for sentinel lymph node biopsy (SLNB). This procedure helps determine if the cancer has spread to the lymph nodes and guides further treatment decisions. Patients who have less than three sentinel lymph node metastases may be candidates for sparing completion axillary lymph node dissection (cALND), allowing for a less invasive surgical approach. Ultimately, the decision to recommend SLNB depends on individual patient characteristics and the specific guidelines set forth by organizations such as the American College of Surgeons Oncology Group (ACOSOG).

Timeline

Before Sentinel Lymph Node Biopsy:

  1. Patient undergoes ultrasound imaging which detects suspicious lymph nodes.
  2. Fine-needle aspiration cytology may be performed on the suspicious lymph nodes.
  3. Twirl® breast markers are inserted into the suspicious lymph nodes to aid in identifying them during surgery.

After Sentinel Lymph Node Biopsy:

  1. During surgery, the Twirl®-marked lymph nodes are identified as sentinel lymph nodes.
  2. If the sentinel lymph nodes show metastases, the patient may undergo completion axillary lymph node dissection.
  3. Patients who meet the ACOSOG Z-0011 criteria may be candidates for sparing completion axillary lymph node dissection.
  4. Some patients may be able to avoid axillary lymph node dissection altogether and undergo breast-conserving surgery.
  5. Patients with positive sentinel lymph nodes may undergo further treatment based on the extent of disease found in the lymph nodes.

What to Ask Your Doctor

  1. What is a sentinel lymph node biopsy and why is it recommended for stage I/II breast cancer patients with suspicious lymph nodes?
  2. How is the Twirl® breast marker used in the procedure and what are the benefits of using it?
  3. What are the criteria for determining if a patient is a candidate for sparing completion axillary lymph node dissection (cALND) after SLNB?
  4. What are the potential risks and complications associated with SLNB?
  5. How accurate is SLNB in detecting lymph node metastases compared to other methods such as fine-needle aspiration cytology?
  6. What are the implications of having positive results on preoperative fine-needle aspiration cytology for suspicious lymph nodes?
  7. How does the use of SLNB alone impact the overall treatment plan for patients who meet the ACOSOG Z-0011 criteria?
  8. What are the long-term outcomes and prognosis for patients who undergo SLNB with suspicious lymph nodes detected on ultrasound?
  9. Are there any alternative or additional tests or treatments that should be considered in conjunction with SLNB for patients with suspicious lymph nodes?
  10. How often should patients undergo follow-up evaluations and monitoring after SLNB with suspicious lymph nodes?

Reference

Authors: Miyake T, Shimoda M, Tanei T, Kagara N, Naoi Y, Kim SJ, Shimazu K, Noguchi S. Journal: Breast Cancer. 2021 May;28(3):772-775. doi: 10.1007/s12282-020-01195-9. Epub 2021 Jan 3. PMID: 33389555