Selective use of sentinel lymph node surgery during prophylactic mastectomy

Judy C Boughey, Nazanin Khakpour, Funda Meric-Bernstam, Merrick I. Boss, Henry M. Kuerer, Sonja E. Singletary, Gildy V. Babiera, Banu Arun, Kelly K. Hunt, Isabelle Bedrosian

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

BACKGROUND. Patients with invasive cancer identified at the time of prophylactic mastectomy (PM) will require axillary lymph node dissection for staging; therefore, many surgeons advocate sentinel lymph node (SLN) surgery at the time of PM. The current study investigates the invasive cancer rate in PM and evaluates factors associated with invasive cancer to guide SLN surgery use. METHODS. Patients undergoing PM at the M. D. Anderson Cancer Center between January 2000 and July 2005 were identified from a prospective database. Clinical, radiographic, and pathologic data were collected. RESULTS. A total of 409 patients (436 PM cases) were identified; 382 underwent contralateral PM (CPM) and 27 underwent bilateral PM (BPM). Cancer was identified in 22 of 436 PM cases (5%). Of these, 14 patients (64%) had ductal carcinoma in situ (DCIS). Only 8 patients (1.8%) had invasive cancer, with a mean tumor size of 5 mm (range, 2-9 mm). There was no difference in the occult cancer rate between CPM and BPM. No cases of invasive cancer were identified in the 23 patients with BRCA mutations. Significantly increased risk of invasive cancer in the PM breast was seen in postmenopausal patients (3.7%; P =.007), patients age >60 years (7.5%; P = .008), and patients with history of invasive lobular carcinoma (9.7%; P = .0002) or lobular carcinoma in situ (LCIS) (7.7%; P = .008). CONCLUSIONS. The frequency of cancer in PM is very low and the majority represents DCIS. Therefore, routine use of SLN surgery in all patients undergoing PM is not warranted. However, patients at higher risk for whom SLN surgery should be considered include older women and patients with a history of lobular cancer or LCIS.

Original languageEnglish (US)
Pages (from-to)1440-1447
Number of pages8
JournalCancer
Volume107
Issue number7
DOIs
StatePublished - Oct 1 2006
Externally publishedYes

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Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Sentinel Lymph Node
Prophylactic Mastectomy
Lobular Carcinoma
Lymph Node Excision
Breast
Databases
Mutation
Breast Carcinoma In Situ

Keywords

  • Breast cancer
  • Invasive
  • Prophylactic mastectomy
  • Sentinel lymph node surgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Boughey, J. C., Khakpour, N., Meric-Bernstam, F., Boss, M. I., Kuerer, H. M., Singletary, S. E., ... Bedrosian, I. (2006). Selective use of sentinel lymph node surgery during prophylactic mastectomy. Cancer, 107(7), 1440-1447. https://doi.org/10.1002/cncr.22176

Selective use of sentinel lymph node surgery during prophylactic mastectomy. / Boughey, Judy C; Khakpour, Nazanin; Meric-Bernstam, Funda; Boss, Merrick I.; Kuerer, Henry M.; Singletary, Sonja E.; Babiera, Gildy V.; Arun, Banu; Hunt, Kelly K.; Bedrosian, Isabelle.

In: Cancer, Vol. 107, No. 7, 01.10.2006, p. 1440-1447.

Research output: Contribution to journalArticle

Boughey, JC, Khakpour, N, Meric-Bernstam, F, Boss, MI, Kuerer, HM, Singletary, SE, Babiera, GV, Arun, B, Hunt, KK & Bedrosian, I 2006, 'Selective use of sentinel lymph node surgery during prophylactic mastectomy', Cancer, vol. 107, no. 7, pp. 1440-1447. https://doi.org/10.1002/cncr.22176
Boughey JC, Khakpour N, Meric-Bernstam F, Boss MI, Kuerer HM, Singletary SE et al. Selective use of sentinel lymph node surgery during prophylactic mastectomy. Cancer. 2006 Oct 1;107(7):1440-1447. https://doi.org/10.1002/cncr.22176
Boughey, Judy C ; Khakpour, Nazanin ; Meric-Bernstam, Funda ; Boss, Merrick I. ; Kuerer, Henry M. ; Singletary, Sonja E. ; Babiera, Gildy V. ; Arun, Banu ; Hunt, Kelly K. ; Bedrosian, Isabelle. / Selective use of sentinel lymph node surgery during prophylactic mastectomy. In: Cancer. 2006 ; Vol. 107, No. 7. pp. 1440-1447.
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title = "Selective use of sentinel lymph node surgery during prophylactic mastectomy",
abstract = "BACKGROUND. Patients with invasive cancer identified at the time of prophylactic mastectomy (PM) will require axillary lymph node dissection for staging; therefore, many surgeons advocate sentinel lymph node (SLN) surgery at the time of PM. The current study investigates the invasive cancer rate in PM and evaluates factors associated with invasive cancer to guide SLN surgery use. METHODS. Patients undergoing PM at the M. D. Anderson Cancer Center between January 2000 and July 2005 were identified from a prospective database. Clinical, radiographic, and pathologic data were collected. RESULTS. A total of 409 patients (436 PM cases) were identified; 382 underwent contralateral PM (CPM) and 27 underwent bilateral PM (BPM). Cancer was identified in 22 of 436 PM cases (5{\%}). Of these, 14 patients (64{\%}) had ductal carcinoma in situ (DCIS). Only 8 patients (1.8{\%}) had invasive cancer, with a mean tumor size of 5 mm (range, 2-9 mm). There was no difference in the occult cancer rate between CPM and BPM. No cases of invasive cancer were identified in the 23 patients with BRCA mutations. Significantly increased risk of invasive cancer in the PM breast was seen in postmenopausal patients (3.7{\%}; P =.007), patients age >60 years (7.5{\%}; P = .008), and patients with history of invasive lobular carcinoma (9.7{\%}; P = .0002) or lobular carcinoma in situ (LCIS) (7.7{\%}; P = .008). CONCLUSIONS. The frequency of cancer in PM is very low and the majority represents DCIS. Therefore, routine use of SLN surgery in all patients undergoing PM is not warranted. However, patients at higher risk for whom SLN surgery should be considered include older women and patients with a history of lobular cancer or LCIS.",
keywords = "Breast cancer, Invasive, Prophylactic mastectomy, Sentinel lymph node surgery",
author = "Boughey, {Judy C} and Nazanin Khakpour and Funda Meric-Bernstam and Boss, {Merrick I.} and Kuerer, {Henry M.} and Singletary, {Sonja E.} and Babiera, {Gildy V.} and Banu Arun and Hunt, {Kelly K.} and Isabelle Bedrosian",
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AU - Boughey, Judy C

AU - Khakpour, Nazanin

AU - Meric-Bernstam, Funda

AU - Boss, Merrick I.

AU - Kuerer, Henry M.

AU - Singletary, Sonja E.

AU - Babiera, Gildy V.

AU - Arun, Banu

AU - Hunt, Kelly K.

AU - Bedrosian, Isabelle

PY - 2006/10/1

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N2 - BACKGROUND. Patients with invasive cancer identified at the time of prophylactic mastectomy (PM) will require axillary lymph node dissection for staging; therefore, many surgeons advocate sentinel lymph node (SLN) surgery at the time of PM. The current study investigates the invasive cancer rate in PM and evaluates factors associated with invasive cancer to guide SLN surgery use. METHODS. Patients undergoing PM at the M. D. Anderson Cancer Center between January 2000 and July 2005 were identified from a prospective database. Clinical, radiographic, and pathologic data were collected. RESULTS. A total of 409 patients (436 PM cases) were identified; 382 underwent contralateral PM (CPM) and 27 underwent bilateral PM (BPM). Cancer was identified in 22 of 436 PM cases (5%). Of these, 14 patients (64%) had ductal carcinoma in situ (DCIS). Only 8 patients (1.8%) had invasive cancer, with a mean tumor size of 5 mm (range, 2-9 mm). There was no difference in the occult cancer rate between CPM and BPM. No cases of invasive cancer were identified in the 23 patients with BRCA mutations. Significantly increased risk of invasive cancer in the PM breast was seen in postmenopausal patients (3.7%; P =.007), patients age >60 years (7.5%; P = .008), and patients with history of invasive lobular carcinoma (9.7%; P = .0002) or lobular carcinoma in situ (LCIS) (7.7%; P = .008). CONCLUSIONS. The frequency of cancer in PM is very low and the majority represents DCIS. Therefore, routine use of SLN surgery in all patients undergoing PM is not warranted. However, patients at higher risk for whom SLN surgery should be considered include older women and patients with a history of lobular cancer or LCIS.

AB - BACKGROUND. Patients with invasive cancer identified at the time of prophylactic mastectomy (PM) will require axillary lymph node dissection for staging; therefore, many surgeons advocate sentinel lymph node (SLN) surgery at the time of PM. The current study investigates the invasive cancer rate in PM and evaluates factors associated with invasive cancer to guide SLN surgery use. METHODS. Patients undergoing PM at the M. D. Anderson Cancer Center between January 2000 and July 2005 were identified from a prospective database. Clinical, radiographic, and pathologic data were collected. RESULTS. A total of 409 patients (436 PM cases) were identified; 382 underwent contralateral PM (CPM) and 27 underwent bilateral PM (BPM). Cancer was identified in 22 of 436 PM cases (5%). Of these, 14 patients (64%) had ductal carcinoma in situ (DCIS). Only 8 patients (1.8%) had invasive cancer, with a mean tumor size of 5 mm (range, 2-9 mm). There was no difference in the occult cancer rate between CPM and BPM. No cases of invasive cancer were identified in the 23 patients with BRCA mutations. Significantly increased risk of invasive cancer in the PM breast was seen in postmenopausal patients (3.7%; P =.007), patients age >60 years (7.5%; P = .008), and patients with history of invasive lobular carcinoma (9.7%; P = .0002) or lobular carcinoma in situ (LCIS) (7.7%; P = .008). CONCLUSIONS. The frequency of cancer in PM is very low and the majority represents DCIS. Therefore, routine use of SLN surgery in all patients undergoing PM is not warranted. However, patients at higher risk for whom SLN surgery should be considered include older women and patients with a history of lobular cancer or LCIS.

KW - Breast cancer

KW - Invasive

KW - Prophylactic mastectomy

KW - Sentinel lymph node surgery

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