Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy?

Sarah A. McLaughlin, Michelle Stempel, Elizabeth A. Morris, Laura Liberman, Tari A. King

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND. Sentinel lymph node biopsy (SLNB) in the setting of prophylactic mastectomy (PM) remains controversial. In the current study, recent experience with PM was described and the value of preoperative magnetic resonance imaging (MRI) was analyzed in selecting patients for PM with or without SLNB. METHOOS. Between January 1999 and January 2006, 529 patients underwent 613 PMs. Both preoperative magnetic resonance imaging (MRI) and SLNB were performed selectively at the discretion of the surgeon. RESULTS. Occult cancer was identified in 33 of 613 PMs (5%) (10 invasive and 23 ductal carcinoma in situ cases). PM with SLNB was performed in 393 of 529 patients (74%), 178 of whom underwent MRI. Of these, occult cancer was found in 6 of 178 patients (3%), all of whom had negative SLNB. Preoperative MRI was concordant with PM in 4 of 6 cases with occult carcinoma. The remaining 215 of 393 patients (55%) underwent PM with SLNB without MRI. Occult cancer was found in 18 of 215 patients (8%); 3 had positive SLNB. Overall, PM with SLNB spared 4 of 393 patients (1%) from axillary lymph node dissection (ALND). Among 136 patients undergoing PM alone, 57 had preoperative MRI. MRI detected 5 cancers and PM revealed an additional 4 occult carcinomas not detected by MRI. Overall, 9 of 136 patients (7%) undergoing PM alone were found to have occult cancer, 3 of which were invasive, raising the decision of reoperation with ALND. CONCLUSIONS. Occult cancer was identified in 5% of PMs. PM with or without SLNB spared only 4 of 393 patients (1%) from undergoing ALND, whereas PM alone identified unsuspected invasive disease in 3 of 136 patients (2%). When performed, MRI accurately ruled out the presence of an invasive cancer in the prophylactic breast, suggesting that MRI can be used to select patients for PM without SLNB.

Original languageEnglish (US)
Pages (from-to)1214-1221
Number of pages8
JournalCancer
Volume112
Issue number6
DOIs
StatePublished - Mar 15 2008
Externally publishedYes

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Sentinel Lymph Node Biopsy
Magnetic Resonance Imaging
Lymph Node Excision
Neoplasms
Prophylactic Mastectomy
Carcinoma
Carcinoma, Intraductal, Noninfiltrating
Reoperation

Keywords

  • Breast cancer
  • Breast magnetic resonance imaging
  • Prophylactic mastectomy
  • Sentinel lymph node biopsy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

McLaughlin, S. A., Stempel, M., Morris, E. A., Liberman, L., & King, T. A. (2008). Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy? Cancer, 112(6), 1214-1221. https://doi.org/10.1002/cncr.23298

Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy? / McLaughlin, Sarah A.; Stempel, Michelle; Morris, Elizabeth A.; Liberman, Laura; King, Tari A.

In: Cancer, Vol. 112, No. 6, 15.03.2008, p. 1214-1221.

Research output: Contribution to journalArticle

McLaughlin, SA, Stempel, M, Morris, EA, Liberman, L & King, TA 2008, 'Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy?', Cancer, vol. 112, no. 6, pp. 1214-1221. https://doi.org/10.1002/cncr.23298
McLaughlin, Sarah A. ; Stempel, Michelle ; Morris, Elizabeth A. ; Liberman, Laura ; King, Tari A. / Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy?. In: Cancer. 2008 ; Vol. 112, No. 6. pp. 1214-1221.
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abstract = "BACKGROUND. Sentinel lymph node biopsy (SLNB) in the setting of prophylactic mastectomy (PM) remains controversial. In the current study, recent experience with PM was described and the value of preoperative magnetic resonance imaging (MRI) was analyzed in selecting patients for PM with or without SLNB. METHOOS. Between January 1999 and January 2006, 529 patients underwent 613 PMs. Both preoperative magnetic resonance imaging (MRI) and SLNB were performed selectively at the discretion of the surgeon. RESULTS. Occult cancer was identified in 33 of 613 PMs (5{\%}) (10 invasive and 23 ductal carcinoma in situ cases). PM with SLNB was performed in 393 of 529 patients (74{\%}), 178 of whom underwent MRI. Of these, occult cancer was found in 6 of 178 patients (3{\%}), all of whom had negative SLNB. Preoperative MRI was concordant with PM in 4 of 6 cases with occult carcinoma. The remaining 215 of 393 patients (55{\%}) underwent PM with SLNB without MRI. Occult cancer was found in 18 of 215 patients (8{\%}); 3 had positive SLNB. Overall, PM with SLNB spared 4 of 393 patients (1{\%}) from axillary lymph node dissection (ALND). Among 136 patients undergoing PM alone, 57 had preoperative MRI. MRI detected 5 cancers and PM revealed an additional 4 occult carcinomas not detected by MRI. Overall, 9 of 136 patients (7{\%}) undergoing PM alone were found to have occult cancer, 3 of which were invasive, raising the decision of reoperation with ALND. CONCLUSIONS. Occult cancer was identified in 5{\%} of PMs. PM with or without SLNB spared only 4 of 393 patients (1{\%}) from undergoing ALND, whereas PM alone identified unsuspected invasive disease in 3 of 136 patients (2{\%}). When performed, MRI accurately ruled out the presence of an invasive cancer in the prophylactic breast, suggesting that MRI can be used to select patients for PM without SLNB.",
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T1 - Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy?

AU - McLaughlin, Sarah A.

AU - Stempel, Michelle

AU - Morris, Elizabeth A.

AU - Liberman, Laura

AU - King, Tari A.

PY - 2008/3/15

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N2 - BACKGROUND. Sentinel lymph node biopsy (SLNB) in the setting of prophylactic mastectomy (PM) remains controversial. In the current study, recent experience with PM was described and the value of preoperative magnetic resonance imaging (MRI) was analyzed in selecting patients for PM with or without SLNB. METHOOS. Between January 1999 and January 2006, 529 patients underwent 613 PMs. Both preoperative magnetic resonance imaging (MRI) and SLNB were performed selectively at the discretion of the surgeon. RESULTS. Occult cancer was identified in 33 of 613 PMs (5%) (10 invasive and 23 ductal carcinoma in situ cases). PM with SLNB was performed in 393 of 529 patients (74%), 178 of whom underwent MRI. Of these, occult cancer was found in 6 of 178 patients (3%), all of whom had negative SLNB. Preoperative MRI was concordant with PM in 4 of 6 cases with occult carcinoma. The remaining 215 of 393 patients (55%) underwent PM with SLNB without MRI. Occult cancer was found in 18 of 215 patients (8%); 3 had positive SLNB. Overall, PM with SLNB spared 4 of 393 patients (1%) from axillary lymph node dissection (ALND). Among 136 patients undergoing PM alone, 57 had preoperative MRI. MRI detected 5 cancers and PM revealed an additional 4 occult carcinomas not detected by MRI. Overall, 9 of 136 patients (7%) undergoing PM alone were found to have occult cancer, 3 of which were invasive, raising the decision of reoperation with ALND. CONCLUSIONS. Occult cancer was identified in 5% of PMs. PM with or without SLNB spared only 4 of 393 patients (1%) from undergoing ALND, whereas PM alone identified unsuspected invasive disease in 3 of 136 patients (2%). When performed, MRI accurately ruled out the presence of an invasive cancer in the prophylactic breast, suggesting that MRI can be used to select patients for PM without SLNB.

AB - BACKGROUND. Sentinel lymph node biopsy (SLNB) in the setting of prophylactic mastectomy (PM) remains controversial. In the current study, recent experience with PM was described and the value of preoperative magnetic resonance imaging (MRI) was analyzed in selecting patients for PM with or without SLNB. METHOOS. Between January 1999 and January 2006, 529 patients underwent 613 PMs. Both preoperative magnetic resonance imaging (MRI) and SLNB were performed selectively at the discretion of the surgeon. RESULTS. Occult cancer was identified in 33 of 613 PMs (5%) (10 invasive and 23 ductal carcinoma in situ cases). PM with SLNB was performed in 393 of 529 patients (74%), 178 of whom underwent MRI. Of these, occult cancer was found in 6 of 178 patients (3%), all of whom had negative SLNB. Preoperative MRI was concordant with PM in 4 of 6 cases with occult carcinoma. The remaining 215 of 393 patients (55%) underwent PM with SLNB without MRI. Occult cancer was found in 18 of 215 patients (8%); 3 had positive SLNB. Overall, PM with SLNB spared 4 of 393 patients (1%) from axillary lymph node dissection (ALND). Among 136 patients undergoing PM alone, 57 had preoperative MRI. MRI detected 5 cancers and PM revealed an additional 4 occult carcinomas not detected by MRI. Overall, 9 of 136 patients (7%) undergoing PM alone were found to have occult cancer, 3 of which were invasive, raising the decision of reoperation with ALND. CONCLUSIONS. Occult cancer was identified in 5% of PMs. PM with or without SLNB spared only 4 of 393 patients (1%) from undergoing ALND, whereas PM alone identified unsuspected invasive disease in 3 of 136 patients (2%). When performed, MRI accurately ruled out the presence of an invasive cancer in the prophylactic breast, suggesting that MRI can be used to select patients for PM without SLNB.

KW - Breast cancer

KW - Breast magnetic resonance imaging

KW - Prophylactic mastectomy

KW - Sentinel lymph node biopsy

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