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The aim of the study was to assess the value of a sentinel node biopsy with the use of a blue-dye-only technique as a tool for ultrastaging breast cancer in patients undergoing axillary lymphadenectomy. In order to maximize the efficacy of the method, we used a specific technique identifying blue-dyed lymph vessels during surgery. We took advantage of the wide surgical access to axillary lymph nodes.Material and methods. A blue dye technique for sentinel node biopsy was used during a modified radical mastectomy (Madden type) in 34 patients (85%) or during breast-conserving surgery with complete axillary dissection in six patients (15%).Results. The sentinel node(s) was identified in 39 of the 40 patients (97.5%). Metastases were detected in sentinel nodes in 14 out of these 39 patients. In one patient (1/39; 2.5%), micrometastasis was identified. The false-negative rate was 0%, sensitivity 100%, and negative-predictive value 100%.Conclusions. The blue dye method for sentinel node biopsy with wide access to the axilla is an effective and reliable tool for the identification of the sentinel node. The use of this simple technique permits ultrastaging of breast cancer patients undergoing complete axillary dissection.
Content available Changing paradigms in breast cancer treatment
In only the past century, the landscape of breast cancer treatment has completely changed. The Halstedian hypothesis of the “contiguous spread” of breast cancer has been replaced by a consideration of its systemic nature. Today, patients with early-stage breast cancer are managed with breast-conserving therapy, which is as effective as mastectomy. Sentinel lymph node biopsy has largely replaced axillary lymph node dissection. Post-operative radiotherapy, chemotherapy and endocrine therapy have increased survival. Pre-operative cytotoxic therapy allows for less extensive surgery and for a curative resection even in more advanced stages. Rapid progress in molecular oncology revealed a large heterogeneity of breast cancer, resulting in a more personalized approach. Targeted therapies directed against epidermal growth factor receptor type 2 (HER2) have improved survival in HER2-positive breast cancer, which was once a poor-prognosis entity. Multi-gene prognostic signatures better predict prognosis and allow many patients to avoid chemotherapy. Personalized treatment has resulted in decreased toxicity and an improved quality of life. Within the past decades, breast cancer has become a good-prognosis malignancy with a five-year survival in the range of 80-85%. Future development of personalized medicine may further refine treatment based on the tumor’s molecular features.
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