This thesis consisted a series of sentinel node biopsy (SNB) studies in Chinese
patients to evaluate its impact on the management of breast cancer.
Pilot studies
The first SNB pilot study was performed in 30 patients using the blue dye
technique. Accuracy was verified by axillary lymph node dissection (ALND). The
success rate was 83% and the false-negative rate was 25%. The second pilot study
was performed in 50 patients using combined mapping with isotope and dye. The
success rate was 94% with no false-negative. SNB is shown to be feasible and
accurate in Chinese.
The optimal mapping method
Combined mapping was superior to the blue dye technique. This could be due to
the mapping technique or improved experience. One hundred and twenty-three
women were randomly assigned to either the blue dye or combined mapping.
Combined mapping had a higher success rate than the blue dye technique (100%
versus 86%). False-negative rates were similar (0% versus 4.5%). Combined
mapping is the preferred method.
Accuracy of frozen section (FS)
FS was used intra-operatively to guide the need of ALND. In 260 SNB, FS was
compared to serial section and immuno-histochemical staining. FS detected 53 of
86 patients with SN metastases with a false-negative rate of 38.4%. The
false-negative rates for macro-, micro-metastases and isolated tumour cells (ITC)
were 2.4%, 57.7% and 94.4%. FS was accurate to diagnose macro-metastases but
not micro-metastases and ITC.
Can we skip ALND in SN metastases?
139 patients with SNB and ALND were studied to identify predictive factors for
non-SN metastases. 55 had metastatic SN but 38 (69%) had no residual
metastases in non-SN. Tumours <3 cm, a single metastatic SN, micro-metastases
and absence of extra-capsular spread were significant factors to predict no
residual nodal disease. Non-SN metastases were found in 42%, 19% and 0% when
SN contained macro-, micro-metastases and ITC. Based on risk of non-SN
involvement, ALND is indicated for macro- and micro-metastases but not for
ITC.
Extended indication for ductal carcinoma in situ (DCIS)
SNB may be useful for staging of patients with a pre-operative diagnosis of DCIS
because invasive cancer is not infrequently found on pathological examination of
resected specimens after surgical excision. One hundred and seven patients with
DCIS on core biopsy underwent SNB. Thirty-two patients (29.9%) were upstaged
to invasive cancer and 9 (28.1%) had SN metastases. Performing SNB reduced the
re-operation rate from 29.9% to 1.9%. Palpable mass and radiological mass lesion
were associated with upstage.
Extended indication: Sentinel Node Occult Lesion Localisation (SNOLL)
Radioisotope is used to localise non-palpable breast cancer and SN. Seventy-four
patients with non-palpable breast cancers underwent SNOLL. Radioisotope was
injected into cancer and gamma probe guided breast cancer and SN resection.
Primary cancer was removed in 73 patients (99%) after the first-round excision
and 82% had complete excision. Gamma probe identified SN in 82% and
supplementary blue dye increased SN detection to 97%.
SNB modified the practice of breast cancer surgery. It has a major impact on the
diagnosis, staging and treatment of breast cancer. / published_or_final_version / Surgery / Master / Master of Surgery
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/167187 |
| Date | January 2011 |
| Creators | Hung, Wai-ka., 熊維嘉. |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B48128648 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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