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The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients

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Abstract
Several independent randomized controlled trials are initiated to investigate whether sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients with negative axillary ultrasound findings, who are treated with breast conserving therapy. A consequence of omitting sentinel lymph node biopsy is absence of pathological lymph node status information. We aimed to investigate the impact of omitting sentinel lymph node biopsy on adjuvant systemic treatment recommendations. Data from all consecutive patients with invasive breast cancer and negative axillary ultrasound findings treated with breast conserving therapy and sentinel lymph node biopsy between 2008 and 2012 were collected from a prospective database. Two methods, Adjuvant! Online and the Dutch breast cancer guideline 2012, were used to determine the adjuvant systemic treatment recommendations of every patient. At first, each patient was considered to be lymph node negative, and secondly the patients' true pathological lymph node status was used. A total of 303 patients were consecutively included. Pathological lymph node status was pN0 in 72.3 %, pN0(i+) in 12.9 %, pN1mi+ in 5.6 %, pN1 in 7.3 %, and pN2 in 2.0 % of the patients. The decision to recommend adjuvant systemic treatment changed due to the pathological lymph node status in 1.0 % of the patients (3/303) when using Adjuvant! Online and in 3.6 % (11/303) when using the 2012 Dutch breast cancer guideline. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients with negative axillary ultrasound findings treated with breast conserving therapy is limited. The safety of omitting the sentinel lymph node biopsy should be confirmed by the initiated randomized controlled trials.
Keywords
Breast neoplasms, Nodal staging, Axillary ultrasound, Sentinel lymph node biopsy, Pathological lymph node status, Adjuvant systemic treatment, SENTINEL-NODE, AXILLARY DISSECTION, TRIAL, MICROMETASTASES, METASTASES, SURVIVAL, BIOPSY, WOMEN, ULTRASOUND, RATIO

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Citation

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Chicago
van Roozendaal, LM, RJ Schipper, Koen Van de Vijver, CM Haekens, MBI Lobbes, VCG Tjan-Heijnen, M de Boer, and ML Smidt. 2014. “The Impact of the Pathological Lymph Node Status on Adjuvant Systemic Treatment Recommendations in Clinically Node Negative Breast Cancer Patients.” Breast Cancer Research and Treatment 143 (3): 469–476.
APA
van Roozendaal, L., Schipper, R., Van de Vijver, K., Haekens, C., Lobbes, M., Tjan-Heijnen, V., de Boer, M., et al. (2014). The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients. BREAST CANCER RESEARCH AND TREATMENT, 143(3), 469–476.
Vancouver
1.
van Roozendaal L, Schipper R, Van de Vijver K, Haekens C, Lobbes M, Tjan-Heijnen V, et al. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients. BREAST CANCER RESEARCH AND TREATMENT. 2014;143(3):469–76.
MLA
van Roozendaal, LM et al. “The Impact of the Pathological Lymph Node Status on Adjuvant Systemic Treatment Recommendations in Clinically Node Negative Breast Cancer Patients.” BREAST CANCER RESEARCH AND TREATMENT 143.3 (2014): 469–476. Print.
@article{8588702,
  abstract     = {Several independent randomized controlled trials are initiated to investigate whether sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients with negative axillary ultrasound findings, who are treated with breast conserving therapy. A consequence of omitting sentinel lymph node biopsy is absence of pathological lymph node status information. We aimed to investigate the impact of omitting sentinel lymph node biopsy on adjuvant systemic treatment recommendations. Data from all consecutive patients with invasive breast cancer and negative axillary ultrasound findings treated with breast conserving therapy and sentinel lymph node biopsy between 2008 and 2012 were collected from a prospective database. Two methods, Adjuvant! Online and the Dutch breast cancer guideline 2012, were used to determine the adjuvant systemic treatment recommendations of every patient. At first, each patient was considered to be lymph node negative, and secondly the patients' true pathological lymph node status was used. A total of 303 patients were consecutively included. Pathological lymph node status was pN0 in 72.3 %, pN0(i+) in 12.9 %, pN1mi+ in 5.6 %, pN1 in 7.3 %, and pN2 in 2.0 % of the patients. The decision to recommend adjuvant systemic treatment changed due to the pathological lymph node status in 1.0 % of the patients (3/303) when using Adjuvant! Online and in 3.6 % (11/303) when using the 2012 Dutch breast cancer guideline. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients with negative axillary ultrasound findings treated with breast conserving therapy is limited. The safety of omitting the sentinel lymph node biopsy should be confirmed by the initiated randomized controlled trials.},
  author       = {van Roozendaal, LM and Schipper, RJ and Van de Vijver, Koen and Haekens, CM and Lobbes, MBI and Tjan-Heijnen, VCG and de Boer, M and Smidt, ML},
  issn         = {0167-6806},
  journal      = {BREAST CANCER RESEARCH AND TREATMENT},
  keywords     = {Breast neoplasms,Nodal staging,Axillary ultrasound,Sentinel lymph node biopsy,Pathological lymph node status,Adjuvant systemic treatment,SENTINEL-NODE,AXILLARY DISSECTION,TRIAL,MICROMETASTASES,METASTASES,SURVIVAL,BIOPSY,WOMEN,ULTRASOUND,RATIO},
  language     = {eng},
  number       = {3},
  pages        = {469--476},
  title        = {The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients},
  url          = {http://dx.doi.org/10.1007/s10549-013-2822-5},
  volume       = {143},
  year         = {2014},
}

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