Surgical removal of the regional lymph nodes by a level I and level II axillary dissection remains the standard of care for patients with surgically resectable breast cancer. Axillary dissection provides accurate pathologic staging and excellent regional disease control, and likely provides a small benefit in patient survival. Axillary dissection, however, is associated with significant patient morbidity. Sentinel lymph node (SLN) biopsy procedures have been found to provide very accurate pathologic staging when compared to axillary dissection; however, their effect on regional disease control and patient survival is not yet known. The National Cancer Institute (NCI) has sponsored a Phase III prospective, randomized clinical trial (the B-32 trial) through the National Adjuvant Breast and Bowel Project (NSABP), to compare results of patients treated with SLN biopsy alone vs. SLN biopsy with completion axillary node dissection in patients with clinically node-negative breast cancer. Results of this trial will provide evidence of the safety of SLN biopsy procedures in the management of patients with breast cancer.
{"title":"Sentinel lymph node--why study it: implications of the B-32 study.","authors":"S. Harlow, D. Krag","doi":"10.1002/SSU.1037","DOIUrl":"https://doi.org/10.1002/SSU.1037","url":null,"abstract":"Surgical removal of the regional lymph nodes by a level I and level II axillary dissection remains the standard of care for patients with surgically resectable breast cancer. Axillary dissection provides accurate pathologic staging and excellent regional disease control, and likely provides a small benefit in patient survival. Axillary dissection, however, is associated with significant patient morbidity. Sentinel lymph node (SLN) biopsy procedures have been found to provide very accurate pathologic staging when compared to axillary dissection; however, their effect on regional disease control and patient survival is not yet known. The National Cancer Institute (NCI) has sponsored a Phase III prospective, randomized clinical trial (the B-32 trial) through the National Adjuvant Breast and Bowel Project (NSABP), to compare results of patients treated with SLN biopsy alone vs. SLN biopsy with completion axillary node dissection in patients with clinically node-negative breast cancer. Results of this trial will provide evidence of the safety of SLN biopsy procedures in the management of patients with breast cancer.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89351562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review describes the current knowledge and challenges of breast cancer staging and screening with MRI of the breast. Assessment of local disease extent, including tumor size, multicentricity, and chest wall invasion, can be obtained more accurately with MRI than with mammography. Moreover, international experts have established standardized reporting of MRI staging results, taking into account tumor size measurements and the number of breast quadrants involved. Results from MRI assessment of the axilla and skin are promising, but need further refinement. Preliminary results of the use of breast MRI in patients at high risk for breast cancer demonstrated a superiority of breast MRI over the combined use of mammography and high-frequency ultrasound. The role of MRI in this subset of patients may be confirmed by ongoing larger multicenter trials. Strict protocol conditions are mandatory to maintain a high standard of quality. Confirming the nature of "MRI-only" lesions with MRI-guided biopsy systems will allow changes in treatment planning. More accurate tumor diagnosis and tumor volume evaluation may allow minimally invasive treatment strategies.
{"title":"MR imaging: breast cancer staging and screening.","authors":"K. Kinkel, G. Vlastos","doi":"10.1002/SSU.1033","DOIUrl":"https://doi.org/10.1002/SSU.1033","url":null,"abstract":"This review describes the current knowledge and challenges of breast cancer staging and screening with MRI of the breast. Assessment of local disease extent, including tumor size, multicentricity, and chest wall invasion, can be obtained more accurately with MRI than with mammography. Moreover, international experts have established standardized reporting of MRI staging results, taking into account tumor size measurements and the number of breast quadrants involved. Results from MRI assessment of the axilla and skin are promising, but need further refinement. Preliminary results of the use of breast MRI in patients at high risk for breast cancer demonstrated a superiority of breast MRI over the combined use of mammography and high-frequency ultrasound. The role of MRI in this subset of patients may be confirmed by ongoing larger multicenter trials. Strict protocol conditions are mandatory to maintain a high standard of quality. Confirming the nature of \"MRI-only\" lesions with MRI-guided biopsy systems will allow changes in treatment planning. More accurate tumor diagnosis and tumor volume evaluation may allow minimally invasive treatment strategies.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73814572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Axillary node status is the single most important prognostic factor for patients with primary breast carcinoma. During the last decade, one of the major advances in breast cancer has been the development of techniques that make axillary staging less morbid and more conservative. The sentinel lymph node (SLN) biopsy technique has received much attention as a possible alternative to axillary lymph node dissection (ALND). The SLN is defined as the first node in the regional lymphatic basin that receives drainage of the primary tumor. We will review the different techniques of lymphatic mapping for breast carcinoma, including radioactive and/or blue dye indicators, timing and site of injection, and preoperative lymphoscintigraphy. The SLN technique involves a multidisciplinary team. It is therefore important that each surgeon validate the technique in his or her own institution to ensure the successful and accurate assessment of the axilla. The SLN technique has modified the surgical management of breast cancer patients, although questions as to its safety have yet to be answered.
{"title":"Techniques of sentinel lymph node biopsy.","authors":"I. Rubio, V. Klimberg","doi":"10.1002/SSU.1036","DOIUrl":"https://doi.org/10.1002/SSU.1036","url":null,"abstract":"Axillary node status is the single most important prognostic factor for patients with primary breast carcinoma. During the last decade, one of the major advances in breast cancer has been the development of techniques that make axillary staging less morbid and more conservative. The sentinel lymph node (SLN) biopsy technique has received much attention as a possible alternative to axillary lymph node dissection (ALND). The SLN is defined as the first node in the regional lymphatic basin that receives drainage of the primary tumor. We will review the different techniques of lymphatic mapping for breast carcinoma, including radioactive and/or blue dye indicators, timing and site of injection, and preoperative lymphoscintigraphy. The SLN technique involves a multidisciplinary team. It is therefore important that each surgeon validate the technique in his or her own institution to ensure the successful and accurate assessment of the axilla. The SLN technique has modified the surgical management of breast cancer patients, although questions as to its safety have yet to be answered.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76730052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Technological advances in breast cancer diagnosis and treatment","authors":"V. Klimberg","doi":"10.1002/SSU.1030","DOIUrl":"https://doi.org/10.1002/SSU.1030","url":null,"abstract":"","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74600176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Image-guided breast biopsy has become an attractive alternative to wire-localized excisional biopsy to evaluate women with nonpalpable abnormalities detected by breast imaging. We have organized a database from our institution that includes over 3,500 procedures. We have reviewed our institutional results and the literature pertaining to image-guided breast biopsy. Discussed in this review are the indications and contraindications for image-guided biopsy, common techniques employed, accuracy based on pathology, reimbursement issues, and the multidisciplinary approach used at our institution. The results of our review affirm our position that image-guided breast biopsy is the preferred technique to evaluate women with nonpalpable breast imaging abnormalities.
{"title":"Image-guided breast biopsy.","authors":"T. King, G. Fuhrman","doi":"10.1002/SSU.1034","DOIUrl":"https://doi.org/10.1002/SSU.1034","url":null,"abstract":"Image-guided breast biopsy has become an attractive alternative to wire-localized excisional biopsy to evaluate women with nonpalpable abnormalities detected by breast imaging. We have organized a database from our institution that includes over 3,500 procedures. We have reviewed our institutional results and the literature pertaining to image-guided breast biopsy. Discussed in this review are the indications and contraindications for image-guided biopsy, common techniques employed, accuracy based on pathology, reimbursement issues, and the multidisciplinary approach used at our institution. The results of our review affirm our position that image-guided breast biopsy is the preferred technique to evaluate women with nonpalpable breast imaging abnormalities.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90156321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article reviews the available information on digital mammography for surgeons who care for patients with breast cancer. The limitations of the current film-based technology and why digital mammography promises to improve breast cancer detection and breast lesion diagnosis are described. The basics of digital imaging technology are reviewed, including a description of image contrast and spatial resolution and its variance from currently available clinical digital mammography systems. The results of clinical trials completed to date are reported. An upcoming large screening trial for digital mammography, sponsored by the National Cancer Institute, is described. Future technological developments, including improvements in softcopy display, image processing, computer-aided detection and diagnosis (CADD), tomosynthesis, and digital subtraction mammography (DSM), are briefly discussed.
{"title":"What every surgical oncologist should know about digital mammography.","authors":"E. Pisano, C. Kuzmiak, M. Koomen, W. Cance","doi":"10.1002/SSU.1032","DOIUrl":"https://doi.org/10.1002/SSU.1032","url":null,"abstract":"This article reviews the available information on digital mammography for surgeons who care for patients with breast cancer. The limitations of the current film-based technology and why digital mammography promises to improve breast cancer detection and breast lesion diagnosis are described. The basics of digital imaging technology are reviewed, including a description of image contrast and spatial resolution and its variance from currently available clinical digital mammography systems. The results of clinical trials completed to date are reported. An upcoming large screening trial for digital mammography, sponsored by the National Cancer Institute, is described. Future technological developments, including improvements in softcopy display, image processing, computer-aided detection and diagnosis (CADD), tomosynthesis, and digital subtraction mammography (DSM), are briefly discussed.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89452565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Henry-Tillman, A. Johnson, L. F. Smith, V. Klimberg
Over the past few decades new procedures and technologies have been introduced into clinical practice for the evaluation and management of breast disease. Ultrasound is rapidly becoming a valued tool in the armamentarium of the breast surgeon. The use of ultrasound by radiologists and breast surgeons to evaluate nonpalpalable detected breast lesions has increased dramatically. With its easy portability and improvements in the technology, the use of ultrasound has now expanded into the operating room. In this work we review the value of intraoperative ultrasound and other techniques in obtaining and assessing margin status.
{"title":"Intraoperative ultrasound and other techniques to achieve negative margins.","authors":"R. Henry-Tillman, A. Johnson, L. F. Smith, V. Klimberg","doi":"10.1002/SSU.1035","DOIUrl":"https://doi.org/10.1002/SSU.1035","url":null,"abstract":"Over the past few decades new procedures and technologies have been introduced into clinical practice for the evaluation and management of breast disease. Ultrasound is rapidly becoming a valued tool in the armamentarium of the breast surgeon. The use of ultrasound by radiologists and breast surgeons to evaluate nonpalpalable detected breast lesions has increased dramatically. With its easy portability and improvements in the technology, the use of ultrasound has now expanded into the operating room. In this work we review the value of intraoperative ultrasound and other techniques in obtaining and assessing margin status.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86484248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast conservation therapy has largely replaced mastectomy as the surgical treatment of choice for early-stage breast cancer. As the sentinel lymph node mapping procedure, rather than routine axillary node dissection, becomes the standard of care, the next challenge is how to treat the primary tumor without surgery. Minimally invasive ablation of the primary tumor is possible with a variety of approaches; the goal is to either excise the tumor percutaneously or cool it (with cryotherapy) or heat it (with radiofrequency ablation (RFA), focused ultrasound, or laser interstitial therapy) sufficiently to cause complete cell death. These developing technologies may provide treatment options that are psychologically and cosmetically more acceptable to the patient than traditional therapies, but they need further investigation to prove that they are oncologically sound. This new frontier of surgery without scalpels will require surgeons to develop radiologic expertise and to acquire a basic understanding of molecular biology.
{"title":"Minimally invasive techniques in breast cancer treatment.","authors":"S. Singletary","doi":"10.1002/SSU.1040","DOIUrl":"https://doi.org/10.1002/SSU.1040","url":null,"abstract":"Breast conservation therapy has largely replaced mastectomy as the surgical treatment of choice for early-stage breast cancer. As the sentinel lymph node mapping procedure, rather than routine axillary node dissection, becomes the standard of care, the next challenge is how to treat the primary tumor without surgery. Minimally invasive ablation of the primary tumor is possible with a variety of approaches; the goal is to either excise the tumor percutaneously or cool it (with cryotherapy) or heat it (with radiofrequency ablation (RFA), focused ultrasound, or laser interstitial therapy) sufficiently to cause complete cell death. These developing technologies may provide treatment options that are psychologically and cosmetically more acceptable to the patient than traditional therapies, but they need further investigation to prove that they are oncologically sound. This new frontier of surgery without scalpels will require surgeons to develop radiologic expertise and to acquire a basic understanding of molecular biology.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77234978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A concise review is presented of the current applications and techniques of magnetic resonance imaging (MRI) in the field of diagnostic imaging of oncologic disease of the gastrointestinal tract, with a summary of the diagnostic possibilities of MRI in the various types of tumor pathology of the gastrointestinal tract. We conclude with a review of the specific situations in which MRI presents distinct advantages over other diagnostic imaging methods (such as computed tomography and ultrasound).
{"title":"Role of magnetic resonance imaging in the staging of gastrointestinal neoplasms.","authors":"R. Ferraris, Amalia del Piano, J. Galli","doi":"10.1002/SSU.1025","DOIUrl":"https://doi.org/10.1002/SSU.1025","url":null,"abstract":"A concise review is presented of the current applications and techniques of magnetic resonance imaging (MRI) in the field of diagnostic imaging of oncologic disease of the gastrointestinal tract, with a summary of the diagnostic possibilities of MRI in the various types of tumor pathology of the gastrointestinal tract. We conclude with a review of the specific situations in which MRI presents distinct advantages over other diagnostic imaging methods (such as computed tomography and ultrasound).","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74287671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Angelelli, A. Ianora, A. Scardapane, P. Pedote, M. Memeo, A. Rotondo
Gastrointestinal neoplasms are very common diseases, and the first challenge for clinicians is to define the extent of the tumor in order to plan the best treatment. The role of computerized tomography in assessing this kind of patient is well established worldwide. This article reviews the capabilities and the limits of this imaging technique in the staging of the tumors of the digestive tract (liver, gallbladder, biliary tract, pancreas, esophagus, stomach, small bowel, and colon).
{"title":"Role of computerized tomography in the staging of gastrointestinal neoplasms.","authors":"G. Angelelli, A. Ianora, A. Scardapane, P. Pedote, M. Memeo, A. Rotondo","doi":"10.1002/SSU.1024","DOIUrl":"https://doi.org/10.1002/SSU.1024","url":null,"abstract":"Gastrointestinal neoplasms are very common diseases, and the first challenge for clinicians is to define the extent of the tumor in order to plan the best treatment. The role of computerized tomography in assessing this kind of patient is well established worldwide. This article reviews the capabilities and the limits of this imaging technique in the staging of the tumors of the digestive tract (liver, gallbladder, biliary tract, pancreas, esophagus, stomach, small bowel, and colon).","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2001-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89840389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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