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Geburtshilfe Frauenheilkd 2007; 67(1): 22-27
DOI: 10.1055/s-2006-924665
Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Stellenwert der Sentinel-Node-Biopsie im Rahmen neoadjuvanter Therapiekonzepte beim Mammakarzinom: Überblick und aktuelles Studienkonzept

The Value of Sentinel Node Biopsy after Neoadjuvant Chemotherapy of Primary Breast Cancer: Review and Introduction of a Prospective Study DesignI. Bauerfeind1 , T. Kühn2 , SENTINA-Studiengruppe
  • 1Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Ludwig-Maximilians-Universität München, Klinikum Großhadern
  • 2Krankenhaus Gifhorn, interdisziplinäres Brustzentrum
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Publication History

eingereicht 5.7.2006 revidiert 14.9.2006

akzeptiert 18.9.2006

Publication Date:
09 February 2007 (online)

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Zusammenfassung

Die Sentinel-Node-Biopsie (SNB) ist beim primär operierten Mammakarzinom als axilläre Stagingmaßnahme fest etabliert. Für Patientinnen, die eine primär systemische Therapie (PST) erhalten, wird die Datenlage für die Zuverlässigkeit der SNB als unsicher eingestuft. Daher wird bei diesen Patientinnen nach wie vor die klassische Axilladissektion (ALD) zur Sicherung der lokalen Kontrolle empfohlen. Etwa 40 % der Frauen, die eine PST erhalten, weisen einen negativen Nodalstatus auf und werden durch die Ausräumung der axillären Lymphknoten übertherapiert. Bei diesen Patientinnen wird der Vorteil der neoadjuvanten Therapie (Erhöhung der Rate an brusterhaltenden Operationen) durch den Nachteil einer erhöhten Schulter-Arm-Morbidität „erkauft“. Aus diesem Grunde erscheint es notwendig, die Wertigkeit der SNB im Rahmen neoadjuvanter Therapiekonzepte in einem prospektiven Studienansatz zu untersuchen. In dem vorliegenden Artikel sollen die aktuelle Datenlage zu der Thematik dargestellt und theoretische Fallstricke für die SNB im Rahmen eines neoadjuvanten Therapieplanes erörtert werden. Aus der Diskussion wird ein Studienkonzept (SENTINA-Studie) abgeleitet, nach dem die anstehenden Fragestellungen zielgerichtet untersucht werden können.

Abstract

Sentinel node biopsy (SNB) is a routinely established method for axillary staging in primary breast cancers. For patients undergoing primary systemic therapy (PST) the data on the reliability of SNB have been assessed as insufficient in international consensus recommendations (DGS, AGO). Thus, axillary dissection is still recommended in those patients to obtain local control. About 40 % of the patients receiving PST have a nodal negative axillary lymph node status and will be overtreated if they undergo classical axillary dissection. These patients accept the increased risk of shoulder arm morbidity in return for the benefits of PST (higher rate of breast conserving therapy). For that reason it is essential to analyze the role of SNB in neoadjuvant study concepts in a prospective setting. This report deals with the current data on this topic and elucidates theoretical pitfalls in the context of a neoadjuvant therapy plan. From this discussion a prospective trial (SENTINA = SENTInel node biopsy after NeoAdjuvant chemotherapy) emerges, which specifically addresses the questions at issue.

Schlüsselwörter

Sentinel‐Node‐Biopsie - primär systemische Chemotherapie - Mammakarzinom

Key words

Sentinel node biopsy - primary systemic chemotherapy - breast cancer

Literatur

  • 1 Kuehn T, Bembenek A, Decker T, Munz D L, Sautter-Bihl M L, Untch M, Wallwiener D. Consensus Committee of the German Society of Senology. A concept for the clinical implementation of sentinel lymph node biopsy in patients with breast carcinoma with special regard to quality assurance.  Cancer. 2005;  103 451-461
    CrossrefPubMedSearch in Google Scholar
  • 2 Lyman G L, Giuliano A E, Somerfield M R, Benson I IIAIB, Bodurka D C, Burstein H J, Cochran A J, Cody I IIHS, Edge S B, Galper S, Hayman J A, Kim T Y, Perkins C L, Podoloff D A, Sivasubramaniam V H, Turner R R, Wahl R, Weaver D L, Wolff A C, Winer E P. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.  J Clin Oncol. 2005;  23 7703-7720
    CrossrefPubMedSearch in Google Scholar
  • 3 Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from national surgical adjuvant breast and bowel project B‐18.  J Natl Cancer Inst Monographs. 2001;  30 96-102
    PubMedSearch in Google Scholar
  • 4 Gianni L, Baselga J, Eiermann W. et al . First report of the European Cooperative Trial in operable breast cancer (ECTO): Effects of primary systemic therapy (PST) on local-regional disease.  Proc ASCO. 2002;  21 abstr 132
    PubMedSearch in Google Scholar
  • 5 Kim T, Giuliano A E, Lyman G H. Lymphatic mapping and sentinel lymph node biopsy in early stage breast carcinoma: a metaanalysis.  Cancer. 2006;  106 4-6
    CrossrefPubMedSearch in Google Scholar
  • 6 Xing Y, Foy M, Cox D D, Kuerer H M, Hunt K K, Cormier J N. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer.  Br J Surg. 2006;  93 539-546
    CrossrefPubMedSearch in Google Scholar
  • 7 Mamounas E P. Sentinel lymph node biopsy after neoadjuvant systemic therapy.  Surg Clin North Am. 2003;  83 931-942
    CrossrefPubMedSearch in Google Scholar
  • 8 Nason K S, Anderson B O, Byrd D R, Dunnwald L K, Eary J F, Mankoff D A. et al . Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma.  Cancer. 2000;  89 2187-2194
    CrossrefPubMedSearch in Google Scholar
  • 9 Fernandez A, Cortes M, Benito E, Azpeitia D, Prieto L, Moreno A. et al . Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme.  Nucl Med Commun. 2001;  22 361-366
    PubMedSearch in Google Scholar
  • 10 Tafra L, Verbanac K M, Lannin D R. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer.  Am J Surg. 2001;  182 312-315
    CrossrefPubMedSearch in Google Scholar
  • 11 Brady E W. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer.  Breast J. 2002;  8 97-100
    CrossrefPubMedSearch in Google Scholar
  • 12 Stearns V, Ewing C A, Slack R, Penannen M F, Hayes D F, Tsangaris T N. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer.  Ann Surg Oncol. 2002;  9 235-242
    CrossrefPubMedSearch in Google Scholar
  • 13 Piato J R, Barros A C, Pincerato K M, Sampaio A P, Pinotti J A. Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study.  Eur J Surg Oncol. 2003;  29 118-120
    CrossrefPubMedSearch in Google Scholar
  • 14 Balch G C, Mithani S K, Richards K R, Beauchamp R D, Kelley M C. Lymphatic mapping and sentinel lymphadenectomy after preoperative therapy for stage II and III breast cancer.  Ann Surg Oncol. 2003;  10 616-621
    CrossrefPubMedSearch in Google Scholar
  • 15 Haid A, Koeberle-Wuehrer R, Offner F, Jasarevic Z, Fritzsche H, Zimmermann G. Clinical usefulness and perspectives of sentinel node biopsy in the management of breast cancer.  Chirurg. 2003;  74 657-664
    CrossrefPubMedSearch in Google Scholar
  • 16 Schwartz G F, Meltzer A J. Accuracy of axillary sentinel lymph node biopsy following neoadjuvant (induction) chemotherapy for carcinoma of the breast.  Breast J. 2003;  9 374-379
    CrossrefPubMedSearch in Google Scholar
  • 17 Reitsamer R, Peintinger F, Rettenbacher L, Prokop E. Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy.  J Surg Oncol. 2003;  84 63-67
    CrossrefPubMedSearch in Google Scholar
  • 18 Aihara T, Munakata S, Morino H, Takatsuka Y. Feasibility of sentinel node biopsy for breast cancer after neoadjuvant endocrine therapy: a pilot study.  J Surg Oncol. 2004;  85 77-81
    CrossrefPubMedSearch in Google Scholar
  • 19 Shimazu K, Tamaki Y, Taguchi T, Akazawa K, Inoue T, Noguchi S. Sentinel lymph node biopsy using periareolar injection of radiocolloid for patients with neoadjuvant chemotherapy-treated breast carcinoma.  Cancer. 2004;  100 2555-2561
    CrossrefPubMedSearch in Google Scholar
  • 20 Hauschild M, Thomas A, Maza S, Kuemmel S, Fischer T, Mallman P. et al . Sentinel node biopsy in breast cancer after neoadjuvant therapy.  J Clin Oncol. 2004;  22 691 (Abstract)
    PubMedSearch in Google Scholar
  • 21 Patel N A, Piper G, Patel J A, Malay M B, Julian T B. Accurate axillary nodal staging can be achieved after neoadjuvant therapy for locally advanced breast cancer.  Am Surg. 2004;  70 696-699
    PubMedSearch in Google Scholar
  • 22 Kang S H, Kim S K, Kwon Y, Kang H S, Kang J H, Ro J. et al . Decreased identification rate of sentinel lymph node after neoadjuvant chemotherapy.  World J Surg. 2004;  28 1019-1024
    CrossrefPubMedSearch in Google Scholar
  • 23 Tio J, Buehner M, Wulfing P, Parchent H, Volkholz H, Schulze W. et al .Sentinel lymph node biopsy after primary systemic therapy of locally advanced breast cancer. Proceedings of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
    Search in Google Scholar
  • 24 Lang J E, Esserman L J, Ewing C A, Rugo H S, Lane K T, Leong S P. et al . Accuracy of selective sentinel lymphadenectomy after neoadjuvant chemotherapy: effect of clinical node status at presentation.  J Am Coll Surg. 2004;  199 856-862
    CrossrefPubMedSearch in Google Scholar
  • 25 Shen J, Mirza N Q, Gilcrease M, Babiera G V, Ross M I, Ames F C. et al .Feasibility and accuracy of sentinel lymph node biopsy following neoadjuvant chemotherapy in breast cancer patients with cytologically proven axillary metastases. Proceedings of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
    Search in Google Scholar
  • 26 Kinoshita T, Fukutomi T, Akashi S, Shimizu C, Ando M, Katsumata N. et al .Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer. Proceeding of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
    Search in Google Scholar
  • 27 Bonardi S, Bottini A, Brizzi M P, Allevi G, Aguggini S, Generali D. et al .Role of sentinel lymph node mapping in human breast cancer after primary chemotherapy. Proceedings of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
    Search in Google Scholar
  • 28 Jinno H, Ikeda T, Kitajima M, Fujii H, Mukai M. Keio Analysis of sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy. http://www.abstracts2view.com/sabcs05/Abstract 1007
  • 29 Kinoshita T, Fukutomi T, Akashi-Tanaka S, Terada K, Takasugi M, Shimizu C, Ando M, Katsumata N, Fujiwara Y. Sentinel lymph node biopsy for breast cancer patients with clinically negative axillary lymph nodes after neoadjuvant chemotherapy. http://www.abstracts2view.com/sabcs05/Abstract 1008
  • 30 Kuehn T, Vogl F D, Helms G, Pueckler S V, Schirrmeister H, Strueber R. et al . Sentinel-node-biopsy for axillary staging in breast cancer: results from a large prospective German multi-institutional trial.  Eur J Surg Oncol. 2004;  30 252-259
    CrossrefPubMedSearch in Google Scholar
  • 31 Khan A, Sabel M S, Nees A, Diehl K M, Cimmino V M, Kleer C G, Schott A F, Hayes D F, Chang A E, Newman L A. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel.  Ann Surg Oncol. 2005;  12 697-704
    CrossrefPubMedSearch in Google Scholar
  • 32 Intra M, Triro G, Viale G, Rotmensz N, Gentilizi O D, Soteldo J, Galimberti V, Veronesi P, Luini A, Paganelli G, Veronesi U. Second biopsy of axillary sentinel lymph node for reappearing breast cancer after previous sentinel lymph node biopsy.  Ann Surg Oncol. 2005;  12 895-899
    CrossrefPubMedSearch in Google Scholar
  • 33 Salmon R J, Bouillet T H, Lewis J S, Clough K B. Recurrence in the axilla after sentinel lymph node biopsy for breast cancer.  Eur J Surg Oncol. 2002;  28 199
    CrossrefPubMedSearch in Google Scholar
  • 34 Blanchard D K, Donohue J H, Reynolds C, Grant C S. Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer.  Arch Surg. 2003;  138 482-487
    CrossrefPubMedSearch in Google Scholar
  • 35 Loza J, Colo F, Nadal J, Viniegra M, Chacon R. Axillary recurrence after sentinel node biopsy for operable breast cancer.  Eur J Surg Oncol. 2002;  28 897-898
    PubMedSearch in Google Scholar
  • 36 Chung M A, Steinhoff M M, Cady B. Clinical axillary recurrence in breast cancer patients after a negative sentinel node biopsy.  Am J Surg. 2002;  184 310-314
    CrossrefPubMedSearch in Google Scholar
  • 37 Roumen R M, Kuijt G P, Liem I H, van Beek M W. Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection.  Br J Surg. 2001;  88 1639-1643
    PubMedSearch in Google Scholar
  • 38 Estourgie S H, Nieweg O E, Valdes-Olmos R A. et al . Eight false negative sentinel node procedures in breast cancer: what went wrong?.  Eur J Surg Oncol. 2003;  29 336-340
    CrossrefPubMedSearch in Google Scholar
  • 39 Yen T W, Mann G N, Lawton T J, Livingston R B, Anderson B O. An axillary recurrence of breast cancer following a negative sentinel lymph node biopsy.  Breast J. 2003;  9 234-236
    CrossrefPubMedSearch in Google Scholar
  • 40 Reitsamer R, Peintinger F, Prokop E. et al . Sentinel lymph node biopsy alone without axillary lymph node dissection - follow up of sentinel lymph node negative breast cancer patients.  Eur J Surg Oncol. 2003;  29 221-223
    CrossrefPubMedSearch in Google Scholar
  • 41 Badgwell B D, Povoski S P, Abdessalam S F. et al . Patterns of recurrence after sentinel lymph node biopsy for breast cancer.  Ann Surg Oncol. 2003;  10 376-380
    CrossrefPubMedSearch in Google Scholar
  • 42 Giuliano A E, Haigh P I, Brennan M B. et al . Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer.  J Clin Oncol. 2000;  18 2553-2559
    PubMedSearch in Google Scholar
  • 43 Dessureault S, Dupont E, Shons A. et al . Early results of breast cancer lymphatic mapping from the H. Lee Moffit Cancer Center: no axillary recurrences in breast cancer patients after a negative sentinel lymph node biopsy.  Breast Cancer Res Treat. 2000;  64 26
    PubMedSearch in Google Scholar
  • 44 Kühn T. Konsensuspanel der Dt. Gesellschaft für Senologie . Sentinel-Node-Biopsie beim Mammakarzinom: Interdisziplinär abgestimmter Konsensus der Deutschen Gesellschaft für Senologie für eine qualitätsgesicherte Anwendung in der klinischen Routine.  Geburtsh Frauenheilk. 2003;  63 835-840
    Thieme ConnectPubMedSearch in Google Scholar

Dr. Ingo Bauerfeind

Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Ludwig-Maximilians-Universität München, Klinikum Großhadern

Marchioninistraße 15

81377 München

Email: ingo.bauerfeind@med.uni-muenchen.de