Incidence of axillary recurrence after a negative sentinel lymph node result in early stages of breast cancer: A 5-year follow-up | Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

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"apellidos" => "Martín de Arriba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia de recurrencia axilar tras un ganglio centinela negativo en cáncer de mama en estadios iniciales: seguimiento de 5 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1764 "Tamanyo" => 123710 ] ] "descripcion" => array:1 [ "en" => "Survival of the 258 patients pN0." ] ] ] "textoCompleto" => "IntroductionComplete axillary lymph node dissection or axillary lymphadenectomy (AL) is considered the standard technique in the management of early stage breast cancer to obtain appropriate staging and design adjuvant systemic therapy.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Selective sentinel lymph node (SLN) biopsy was developed with the aim of avoiding unnecessary AL in patients without lymph node involvement. Based on the histopathological results of the SLN, the status of the remaining lymph nodes may be predicted with a high sensitivity and diagnostic precision without extirpation.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Different studies have demonstrated the safety of this technique, hence its recognition years ago by scientific consensus as the method of choice in early stage breast cancer with no clinical evidence of axillary involvement.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> One important aspect regarding SLN biopsy is the appearance of false negative results which carry early progression of malignant disease. The scientific data currently available on mid- and long-term follow-up are quite limited, although one randomized study with a 10-year follow-up reported promising results.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In 2001 the Unit of Breast Disease of the Hospital Universitario de Salamanca began staging this type of cancer by biopsy of the SLN.The aim of the present study was to determine our rate of false negatives based on axillary recurrences during a minimum follow-up period of 5 years in 258 consecutive patients with early stage breast cancer who underwent intervention from January 2001 to December 2005 and presented a negative SLN result and in whom AL was not performed.Material and methodsInclusion criteriaWe included patients with clinically negative (cN0) T1–T2 breast cancer according to clinical examination and ultrasonography but were classified as pN0 following SLN biopsy and in whom AL was not carried out. Cases with micrometastasis were ruled out in order to exclusively evaluate the pN0. All the patients provided signed informed consent for the SLN protocol approved by our hospital.Sentinel lymph node biopsy procedureTo perform SLN biopsy the combined technique of radioisotope with blue staining was used to identify and localize the SLN. Previous lymphoscintigraphy was carried out in all the cases (66% of the cases the same day, 34% the previous day). The injection was peritumoral in palpable lesions, periareolar in non-palpable lesions and on both sides of the surgical scar in cases with previous diagnostic biopsy or excision. The dose of the radiotracer was 74-111MBq of 99mTc-colloid rhenium sulfide (nanocis®). The images were obtained in anterior projection including the thorax, and lateral projection so that on visualization in the axilla, the internal mammary chain or both territories, the projection of the SLN was marked on the skin. After induction of anesthesia in the operating room, isosulfan blue (Lymphazurin®) was injected into the subareolar region approximately 20min prior to the surgical incision. The most commonly used surgical approach was transversal incision of the axilla, although in the case of tumors located in the superoexternal quadrant of the breast or in cases with mastectomy without immediate reconstruction, the breast incision itself was used to carry out the excision of the SLN. The localization of the SLN was possible either by presenting significant radioactivity detected by the portable gamma probe and/or blue staining. In addition, a SLN was considered as any other suspicious lymph node after digital inspection of the axilla. In the case of multiple points of uptake in the lymphoscintigraphy, the use of blue staining was used as a reference, with extirpation of less than 3 SLN.Histopathological analysis of the SLN was then performed after fixation in paraffin, sectioned and stained with hematoxylin and eosin and also by performing immunohistochemistry studies which were deferred in most of the cases. The SLN was classified as negative (those included in this study), isolated tumoral cells (≤0.2mm), micrometastasis (>0.2mm and ≤2mm), and macrometastasis (>2mm). At present, the analyses are performed with the OSNA amplification method which provides definitive intraoperative results.Follow-upThe patients were followed at 15 days after surgery, every 3 months during the first 2 years, every 6 months in the 3 following years and annually after 5 years. Each consultation involved physical examination as well as the corresponding biochemical analysis with tumor markers and imaging techniques according to the follow-up protocol for breast cancer. False negative results of the technique were considered as those presenting axillary recurrence during the follow-up period until December 31, 2010. Likewise, local recurrence in the intervened breast was reported as was the presence of distant metastasis with the aim of evaluating the disease-free survival of the patients. The tumors were classified according to the TNM 2010 classification of the American Joint Committee on Cancer.Statistical analysis was performed using the SPSS 15.0 program for Windows. A p value less than 0.05 was considered as significant. The analysis of survival was performed using Kaplan Meier curves and log rank results.ResultsThe clinical and pathological characteristics of the 258 consecutive patients included and classified as pN0 are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The most frequent histological type was infiltrating ductal carcinoma (80.6%), with multifocal tumors in 13 patients. The localization was in the superoexternal quadrant in 17.2%, being superointernal in 17.2%, inferointernal in 13.6%, inferoexternal in 13.2% and retroareolar in 8.4%. The lesions were palpable in 69.4%, with a mean final tumor diameter of 23.3mm (range 0.5–30mm). Eighty-five cases had undergone previous excision of the breast tumor. The surgical approach was conservative in 212 cases (82%) and immediate reconstruction of the breast was performed in 44% of those who underwent mastectomy. The mean in-hospital stay was 2.69 days.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Localization and sentinel lymph node resultsAt least one SLN was localized in the axilla of all the patients and thus, the best results related to detection were observed on combining the isotopic technique with blue staining, with improvement in the results if performed separately (isotopic 98.1%, blue staining 91.9%, p=0.000). A mean number of 1.68 SLN were obtained per patient (range: 1–3) with no differences between the groups with or without previous surgery of the tumor (Kruskal–Wallis, p=0.794). Internal mammary drainage was observed in 15.5% of the cases on lymphoscintigraphy. Taking the technical complexity of the surgical approach of these lymph nodes into account, in situ tumors and those in which the gamma probe detector was not able to specifically discriminate the intercostal space on the skin were excluded since hybrid SPECT-CT was not available at that time. In total SLN were extirpated in 10 patients, all with negative results for metastasis. No case presented only internal mammary drainage without drainage to the axilla.Adjuvant treatmentThe patients either received or did not receive adjuvant treatment according to the age, type of surgery, hormonal status of the tumor and the final stage achieved, among other factors of each patient. Thus, adjuvant chemotherapy (CT) was administered in 180 (69.8%) of the patients, with radiotherapy in 195 (75.6%), and hormone therapy in 202 (78.3%) following the protocols of the Department of Medical and Radiotherapy Oncology of our hospital.Follow-up, events registered and analysis of survivalIn this study the final point of follow-up was considered on December 31, 2010. Analysis of survival and events was achieved in all the 258 cases. The mean follow-up in the patients who did not die was 81 months, with a minimum time of 5 years (range: 60–119 months). The events registered were: 3 axillary recurrences representing 1.1% of the 258 cases with negative SLN, 12 local recurrences in the affected breast (4.7%), distant metastasis (bone, liver, brain, and lung) in 16 (6.2%), and cancer-related death in 16 (6.2%). Involvement of the contralateral breast was also reported in 6 cases (2.3%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The 3 axillary recurrences or false negative results detected were found in young women of 35, 37 and 42 years of age with removal of 3, 2, and 3 axillary SLN, respectively. All were detected with both the gamma probe and blue staining and histologically corresponded to infiltrating ductal carcinomas, two of which were multifocal and were treated with mastectomy followed by breast reconstruction. The time from surgery until recurrence was of 10, 11 and 29 months, respectively performing AL in all of the cases. The youngest patient with longer time-related axillary recurrence developed bone metastasis at 4 years after surgery, while the other two patients are in complete remission. Local breast recurrence was observed in 12 patients (2 in the mastectomy bed) who underwent adjuvant treatment with CT. The time from surgery until recurrence was a mean of 3.31 years (range: 9 months −5.8 years). Of these patients, 6 died due to metastatic disease progression, and the others remain in complete remission. Distant metastasis developed in 16 cases (6.2%), most with bone involvement in the first case, followed by liver, lung and brain metastasis. The mean time after surgery was 2.45 years, with 12 having died at the end of the follow-up of this study.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Analysis of survivalAt 5 years the global survival was 88.4% (228/258), with a cancer-related survival of 93% (240/258) and a disease-free survival of 89.1% (230/258). No differences were observed in survival between the presence of a false negative by axillary recurrence and the group without oncological events. The appearance of cancer in the contralateral breast had no effect on patient survival. However, the appearance of local breast recurrence or distant metastasis did imply a reduction in survival compared with the patients without events (Log rank, p=0.000 Kaplan–Meier curves; <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionThere is currently great interest in the development of SLN biopsy as an alternative to axillary lymph node dissection. The high index of detection with the techniques available and the high percentage of concordance between the SLN and the non SLN both indicates that it is now feasible to replace AL in the surgical management of breast cancer, thereby avoiding the complications of the latter approach.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> The indications for SLN biopsy have extended from T1–T2 tumors <3cm to larger tumors,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> tumors treated with previous CT<a class="elsevierStyleCrossRef" href="#bib0045">9</a> or even patients who have undergone previous surgery for breast tumor.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>After more than 10 years of experience in the application of this technique in the Unit of Breast Disease of the Hospital Universitario de Salamanca in more than 1200 patients, we believed it was a good time to evaluate the rate of false negative results over a minimum follow-up of 5 years to analyze the safety and precision of this technique. Our group, similar to many others,<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> prefers the combined radioisotopic technique with blue staining due to the improvement in the percentage of overall detection even, as reported previously, in patients who have undergone primary tumor resection.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Our percentage of false negative results after a mean follow-up of 6.8 years was of 1.1%, being found in 3 out of the 258 patients classified as pN0 with a view to staging of the cancer. This percentage has fallen from the 3.2% obtained in the validation phase of the technique and is similar to what has been described by other groups with axillary recurrence ratios between 0 and 1.4%,<a class="elsevierStyleCrossRefs" href="#bib0070">14–18</a> with mean follow-up times between 3 and 5 years. Although this relationship may be raised, several authors have reported that more than 75% of the cases occur in the first 3 years after surgery.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> It is of note that the presence of axillary recurrence did not influence patient survival. The presence of local recurrence in the same breast was also evaluated and was found to take place in 4.7%, despite having received radiotherapy in 11 out of the 12 cases detected and in the contralateral breast (2.3%). These results are similar to those recently published by the group of Giuliano AE.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Moreover, although recent publications<a class="elsevierStyleCrossRefs" href="#bib0105">21,22</a> have suggested that the tumoral grade is the most important factor implicated in local recurrence, within the limitation of including only pN0 patients, we did not find a statistical relationship between the characteristics of the patient, tumor state (receptors, tumoral grade, HER2 expression) or the adjuvant treatment received and this event. The appearance of local recurrence, which carries a high probability of distant dissemination, and the presence of distant metastasis led to a significant reduction in survival, despite the adjuvant therapies implemented (surgery and CT). Our data on overall oncologic survival of 93% and disease-free survival of 89.1% are similar to those recently published in the randomized phase 3 NSABP B-32 trial (91.8% and 82.4%, respectively).<a class="elsevierStyleCrossRef" href="#bib0115">23</a>ConclusionsThe risk of developing axillary recurrence after obtaining negative SLN without complete dissection of the axilla is sufficiently low to consider this procedure as the best in axillary staging in early stage breast cancer. This staging technique achieves adequate local disease control without diminishing patient survival and avoids the secondary effects derived from more invasive surgery.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres120352" "titulo" => array:4 [ 0 => "Abstract" 1 => "Methods" 2 => "Results" 3 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec107633" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres120351" "titulo" => array:4 [ 0 => "Resumen" 1 => "Método" 2 => "Resultados" 3 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec107632" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Inclusion criteria" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Sentinel lymph node biopsy procedure" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Follow-up" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Localization and sentinel lymph node results" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Adjuvant treatment" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Follow-up, events registered and analysis of survival" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Analysis of survival" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack37612" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-10-07" "fechaAceptado" => "2011-11-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec107633" "palabras" => array:5 [ 0 => "Breast cancer" 1 => "Sentinel lymph node" 2 => "Axillary recurrence" 3 => "Prognosis" 4 => "Survival" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec107632" "palabras" => array:5 [ 0 => "Cáncer mama" 1 => "Ganglio centinela" 2 => "Recurrencia axilar" 3 => "Pronóstico" 4 => "Supervivencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The sentinel lymph node (SLN) biopsy is currently the procedure of choice for axillary node staging in initial stages of breast cancer. The purpose of this study is to establish our false negative rate within a 5-year follow-up period in 258 patients with breast cancer staged with this procedure. MethodsA retrospective study on 258 consecutive T1–T2<3cm pN0 staged breast carcinomas treated from January 1, 2001 to December 31, 2005 was performed. The combined technique of isotope plus blue dye was used for detection. The subjects underwent a minimum follow-up of 5 years, mean 81 months, with an end of follow-up at December 31, 2010. Evidence of axillary recurrence, tumor recurrence in the breast and signs of disease progression or death were the events collected and analyzed. ResultsOf the 258 patients, 3 false negatives (1.1%) with axillary recurrence were detected at 10, 11 and 29 months of the surgery. This did not have a significant repercussion in the survival analysis on the contrary to the existence of breast recurrence or the appearance of distant metastasis in 4.7% and 6.2% patients, respectively. Global survival related with the cancer was 93.0 (240/258) and disease free survival was 89.1% (230/258). ConclusionThe risk of developing axillary recurrence after a negative SLN without axillary node dissection is low enough to consider the SLN procedure to be the best approach for axilla staging in early breast cancer. This staging technique also makes it possible to achieve local disease control without diminishing the survival of the patients." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La biopsia selectiva del ganglio centinela (GC) es en la actualidad el procedimiento de elección en la estadificación axilar en cánceres de mama en estadios iniciales. El objetivo de este trabajo es establecer nuestra tasa de falsos negativos a lo largo de un período mínimo de 5 años de seguimiento de 258 pacientes con cáncer de mama estadificados mediante este procedimiento. MétodoEstudio retrospectivo de 258 pacientes con cáncer de mama consecutivos T1-T2<3cm estadificados como pN0 mediante GC entre enero-2001 y diciembre-2005.Se empleó la técnica combinada isotópica y colorante para la detección. Fueron sometidos a seguimiento con un período mínimo de 5 años, la media fue 81 meses, siendo el punto final del seguimiento el 31 de diciembre de 2010. La evidencia de recurrencia axilar, recidiva tumoral en la mama, presencia de enfermedad a distancia, y muerte fueron los eventos recogidos y analizados. ResultadosDe las 258 pacientes, se detectaron 3 falsos negativos (1,1%), con recurrencia axilar a los 10, 11 y 29 meses de la cirugía. En el análisis de supervivencia este hecho no tuvo repercusión significativa, a diferencia de la existencia de recidiva mamaria o la aparición de metástasis a distancia que ocurrieron en un 4,7 y un 6,2% de las pacientes. La supervivencia global relacionada con el cáncer fue de un 93,0% (240/258) y la supervivencia libre de enfermedad del 89,1% (230/258). ConclusiónEl riesgo de recurrencia axilar tras un ganglio centinela negativo sin vaciamiento linfático completo es lo suficientemente bajo como para considerar a este procedimiento como de elección en la estadificación axilar del cáncer de mama en estadios iniciales. Además, permite alcanzar un adecuado control local de la enfermedad sin disminuir la supervivencia de los pacientes." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ruano Pérez R, et al. Incidencia de recurrencia axilar tras un ganglio centinela negativo en cáncer de mama en estadios iniciales: seguimiento de 5 años. Rev Esp Med Nucl. 2012;31:173–7." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1764 "Tamanyo" => 123710 ] ] "descripcion" => array:1 [ "en" => "Survival of the 258 patients pN0." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31–89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family history of breast cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (17.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family history of breast cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Palpable lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">179 (69.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-palpable lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (30.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous tumor surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 (33%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of breast surgery</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tumorectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">212 (82.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mastectomy+reconstruction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (7.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mastectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (10.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isotope injection</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">169 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. removed SN (average) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Histological type</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Invasive ductal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">211 (80.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Invasive lobular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In situ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (8.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Receptors study</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Estrogenic+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Progesterone+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P53+++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mib1+++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HER2+++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tumor size</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T1a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T1b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T1c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Final stage</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">161 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab208259.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and pathological characteristics of 258 patients pN0." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Events \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Axillary recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ipsilateral recurrence of breast cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contralateral breast cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distant metastasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breast cancer deaths \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total deaths \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab208258.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Events occurring during follow-up." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patients with early breast cancer benefit from effective axillary treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.R. Harris" 1 => "R.T. Osteen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Breast Cancer Res Treat" "fecha" => "1985" "volumen" => "5" "paginaInicial" => "17" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3978244" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized comparison of sentinel node biopsy with routine axillary dissection in breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U. Veronesi" 1 => "G. Paganelli" 2 => "G. Viale" 3 => "A. Luini" 4 => "S. Zurrida" 5 => "V. Galimberti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa012782" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "349" "paginaInicial" => "546" "paginaFinal" => "553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12904519" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast. April 19–22, 2001, Philadelphia, PA" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Consensus Conference Committee" "etal" => false "autores" => array:3 [ 0 => "G.F. Schwartz" 1 => "A.E. Giuliano" 2 => "U. Veronesi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2002" "volumen" => "94" "paginaInicial" => "2542" "paginaFinal" => "2551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12173319" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel node in breast cancer procedural guidelines" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "European Association of Nuclear Medicine Oncology Committee and Dosimetry Committee" "etal" => true "autores" => array:6 [ 0 => "J. Buscombe" 1 => "G. Paganelli" 2 => "Z.E. Burak" 3 => "W. Waddington" 4 => "J. Maublant" 5 => "E. 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Galimberti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e3181c0e92a" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2010" "volumen" => "251" "paginaInicial" => "595" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20195151" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative morbidity of axillary lymph node dissection and the sentinel lymph node technique: implications for patients with breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.W. Silberman" 1 => "C. McVay" 2 => "J.S. Cohen" 3 => "J.F. Altura" 4 => "S. Brackert" 5 => "G.P. Sarna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2004" "volumen" => "240" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15213610" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality of life at 2 years follow-up after sentinel node biopsy, immediate or delayed axillary dissection for breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Al Nakib" 1 => "M. Buttarelli" 2 => "L. Huiart" 3 => "M. Martino" 4 => "C. Tarpin" 5 => "J.M. Extra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4741.2010.00956.x" "Revista" => array:6 [ "tituloSerie" => "Breast J" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "555" "paginaFinal" => "557" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21054645" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel node biopsy in T2 breast cancers larger than 3cm and clinically negative axilla compared with the T1–T2<3cm standard indication" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Ruano" 1 => "M. Ramos" 2 => "J.R. García-Talavera" 3 => "M.C. Garcia Macias" 4 => "A. Martin de Arriba" 5 => "J. 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Original article

Incidence of axillary recurrence after a negative sentinel lymph node result in early stages of breast cancer: A 5-year follow-up

Incidencia de recurrencia axilar tras un ganglio centinela negativo en cáncer de mama en estadios iniciales: seguimiento de 5 años

R. Ruano Péreza,

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richardrua@hotmail.com

Corresponding author.

, M. Ramos Boyerob, J.R. García-Talavera Fernándeza, T. Ramos Grandeb, J.M. González-Orúsb, F. Gómez-Caminero Lópeza, M.C. García Maciasc, A. Martín de Arribaa

a Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, Spain

b Servicio de Cirugía, Hospital Universitario de Salamanca, Salamanca, Spain

c Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Complete axillary lymph node dissection or axillary lymphadenectomy &#40;AL&#41; is considered the standard technique in the management of early stage breast cancer to obtain appropriate staging and design adjuvant systemic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Selective sentinel lymph node &#40;SLN&#41; biopsy was developed with the aim of avoiding unnecessary AL in patients without lymph node involvement&#46; Based on the histopathological results of the SLN&#44; the status of the remaining lymph nodes may be predicted with a high sensitivity and diagnostic precision without extirpation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Different studies have demonstrated the safety of this technique&#44; hence its recognition years ago by scientific consensus as the method of choice in early stage breast cancer with no clinical evidence of axillary involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> One important aspect regarding SLN biopsy is the appearance of false negative results which carry early progression of malignant disease&#46; The scientific data currently available on mid- and long-term follow-up are quite limited&#44; although one randomized study with a 10-year follow-up reported promising results&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In 2001 the Unit of Breast Disease of the Hospital Universitario de Salamanca began staging this type of cancer by biopsy of the SLN&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of the present study was to determine our rate of false negatives based on axillary recurrences during a minimum follow-up period of 5 years in 258 consecutive patients with early stage breast cancer who underwent intervention from January 2001 to December 2005 and presented a negative SLN result and in whom AL was not performed&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Inclusion criteria</span><p id="par0015" class="elsevierStylePara elsevierViewall">We included patients with clinically negative &#40;cN0&#41; T1&#8211;T2 breast cancer according to clinical examination and ultrasonography but were classified as pN0 following SLN biopsy and in whom AL was not carried out&#46; Cases with micrometastasis were ruled out in order to exclusively evaluate the pN0&#46; All the patients provided signed informed consent for the SLN protocol approved by our hospital&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sentinel lymph node biopsy procedure</span><p id="par0020" class="elsevierStylePara elsevierViewall">To perform SLN biopsy the combined technique of radioisotope with blue staining was used to identify and localize the SLN&#46; Previous lymphoscintigraphy was carried out in all the cases &#40;66&#37; of the cases the same day&#44; 34&#37; the previous day&#41;&#46; The injection was peritumoral in palpable lesions&#44; periareolar in non-palpable lesions and on both sides of the surgical scar in cases with previous diagnostic biopsy or excision&#46; The dose of the radiotracer was 74-111MBq of 99mTc-colloid rhenium sulfide &#40;nanocis<span class="elsevierStyleSup">&#174;</span>&#41;&#46; The images were obtained in anterior projection including the thorax&#44; and lateral projection so that on visualization in the axilla&#44; the internal mammary chain or both territories&#44; the projection of the SLN was marked on the skin&#46; After induction of anesthesia in the operating room&#44; isosulfan blue &#40;Lymphazurin<span class="elsevierStyleSup">&#174;</span>&#41; was injected into the subareolar region approximately 20<span class="elsevierStyleHsp" style=""></span>min prior to the surgical incision&#46; The most commonly used surgical approach was transversal incision of the axilla&#44; although in the case of tumors located in the superoexternal quadrant of the breast or in cases with mastectomy without immediate reconstruction&#44; the breast incision itself was used to carry out the excision of the SLN&#46; The localization of the SLN was possible either by presenting significant radioactivity detected by the portable gamma probe and&#47;or blue staining&#46; In addition&#44; a SLN was considered as any other suspicious lymph node after digital inspection of the axilla&#46; In the case of multiple points of uptake in the lymphoscintigraphy&#44; the use of blue staining was used as a reference&#44; with extirpation of less than 3 SLN&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Histopathological analysis of the SLN was then performed after fixation in paraffin&#44; sectioned and stained with hematoxylin and eosin and also by performing immunohistochemistry studies which were deferred in most of the cases&#46; The SLN was classified as negative &#40;those included in this study&#41;&#44; isolated tumoral cells &#40;&#8804;0&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; micrometastasis &#40;&#62;0&#46;2<span class="elsevierStyleHsp" style=""></span>mm and &#8804;2<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; and macrometastasis &#40;&#62;2<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; At present&#44; the analyses are performed with the OSNA amplification method which provides definitive intraoperative results&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Follow-up</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patients were followed at 15 days after surgery&#44; every 3 months during the first 2 years&#44; every 6 months in the 3 following years and annually after 5 years&#46; Each consultation involved physical examination as well as the corresponding biochemical analysis with tumor markers and imaging techniques according to the follow-up protocol for breast cancer&#46; False negative results of the technique were considered as those presenting axillary recurrence during the follow-up period until December 31&#44; 2010&#46; Likewise&#44; local recurrence in the intervened breast was reported as was the presence of distant metastasis with the aim of evaluating the disease-free survival of the patients&#46; The tumors were classified according to the TNM 2010 classification of the American Joint Committee on Cancer&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the SPSS 15&#46;0 program for Windows&#46; A <span class="elsevierStyleItalic">p</span> value less than 0&#46;05 was considered as significant&#46; The analysis of survival was performed using Kaplan Meier curves and log rank results&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical and pathological characteristics of the 258 consecutive patients included and classified as pN0 are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The most frequent histological type was infiltrating ductal carcinoma &#40;80&#46;6&#37;&#41;&#44; with multifocal tumors in 13 patients&#46; The localization was in the superoexternal quadrant in 17&#46;2&#37;&#44; being superointernal in 17&#46;2&#37;&#44; inferointernal in 13&#46;6&#37;&#44; inferoexternal in 13&#46;2&#37; and retroareolar in 8&#46;4&#37;&#46; The lesions were palpable in 69&#46;4&#37;&#44; with a mean final tumor diameter of 23&#46;3<span class="elsevierStyleHsp" style=""></span>mm &#40;range 0&#46;5&#8211;30<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Eighty-five cases had undergone previous excision of the breast tumor&#46; The surgical approach was conservative in 212 cases &#40;82&#37;&#41; and immediate reconstruction of the breast was performed in 44&#37; of those who underwent mastectomy&#46; The mean in-hospital stay was 2&#46;69 days&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Localization and sentinel lymph node results</span><p id="par0045" class="elsevierStylePara elsevierViewall">At least one SLN was localized in the axilla of all the patients and thus&#44; the best results related to detection were observed on combining the isotopic technique with blue staining&#44; with improvement in the results if performed separately &#40;isotopic 98&#46;1&#37;&#44; blue staining 91&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46; A mean number of 1&#46;68 SLN were obtained per patient &#40;range&#58; 1&#8211;3&#41; with no differences between the groups with or without previous surgery of the tumor &#40;Kruskal&#8211;Wallis&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;794&#41;&#46; Internal mammary drainage was observed in 15&#46;5&#37; of the cases on lymphoscintigraphy&#46; Taking the technical complexity of the surgical approach of these lymph nodes into account&#44; <span class="elsevierStyleItalic">in situ</span> tumors and those in which the gamma probe detector was not able to specifically discriminate the intercostal space on the skin were excluded since hybrid SPECT-CT was not available at that time&#46; In total SLN were extirpated in 10 patients&#44; all with negative results for metastasis&#46; No case presented only internal mammary drainage without drainage to the axilla&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Adjuvant treatment</span><p id="par0050" class="elsevierStylePara elsevierViewall">The patients either received or did not receive adjuvant treatment according to the age&#44; type of surgery&#44; hormonal status of the tumor and the final stage achieved&#44; among other factors of each patient&#46; Thus&#44; adjuvant chemotherapy &#40;CT&#41; was administered in 180 &#40;69&#46;8&#37;&#41; of the patients&#44; with radiotherapy in 195 &#40;75&#46;6&#37;&#41;&#44; and hormone therapy in 202 &#40;78&#46;3&#37;&#41; following the protocols of the Department of Medical and Radiotherapy Oncology of our hospital&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Follow-up&#44; events registered and analysis of survival</span><p id="par0055" class="elsevierStylePara elsevierViewall">In this study the final point of follow-up was considered on December 31&#44; 2010&#46; Analysis of survival and events was achieved in all the 258 cases&#46; The mean follow-up in the patients who did not die was 81 months&#44; with a minimum time of 5 years &#40;range&#58; 60&#8211;119 months&#41;&#46; The events registered were&#58; 3 axillary recurrences representing 1&#46;1&#37; of the 258 cases with negative SLN&#44; 12 local recurrences in the affected breast &#40;4&#46;7&#37;&#41;&#44; distant metastasis &#40;bone&#44; liver&#44; brain&#44; and lung&#41; in 16 &#40;6&#46;2&#37;&#41;&#44; and cancer-related death in 16 &#40;6&#46;2&#37;&#41;&#46; Involvement of the contralateral breast was also reported in 6 cases &#40;2&#46;3&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The 3 axillary recurrences or false negative results detected were found in young women of 35&#44; 37 and 42 years of age with removal of 3&#44; 2&#44; and 3 axillary SLN&#44; respectively&#46; All were detected with both the gamma probe and blue staining and histologically corresponded to infiltrating ductal carcinomas&#44; two of which were multifocal and were treated with mastectomy followed by breast reconstruction&#46; The time from surgery until recurrence was of 10&#44; 11 and 29 months&#44; respectively performing AL in all of the cases&#46; The youngest patient with longer time-related axillary recurrence developed bone metastasis at 4 years after surgery&#44; while the other two patients are in complete remission&#46; Local breast recurrence was observed in 12 patients &#40;2 in the mastectomy bed&#41; who underwent adjuvant treatment with CT&#46; The time from surgery until recurrence was a mean of 3&#46;31 years &#40;range&#58; 9 months &#8722;5&#46;8 years&#41;&#46; Of these patients&#44; 6 died due to metastatic disease progression&#44; and the others remain in complete remission&#46; Distant metastasis developed in 16 cases &#40;6&#46;2&#37;&#41;&#44; most with bone involvement in the first case&#44; followed by liver&#44; lung and brain metastasis&#46; The mean time after surgery was 2&#46;45 years&#44; with 12 having died at the end of the follow-up of this study&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Analysis of survival</span><p id="par0060" class="elsevierStylePara elsevierViewall">At 5 years the global survival was 88&#46;4&#37; &#40;228&#47;258&#41;&#44; with a cancer-related survival of 93&#37; &#40;240&#47;258&#41; and a disease-free survival of 89&#46;1&#37; &#40;230&#47;258&#41;&#46; No differences were observed in survival between the presence of a false negative by axillary recurrence and the group without oncological events&#46; The appearance of cancer in the contralateral breast had no effect on patient survival&#46; However&#44; the appearance of local breast recurrence or distant metastasis did imply a reduction in survival compared with the patients without events &#40;Log rank&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000 Kaplan&#8211;Meier curves&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">There is currently great interest in the development of SLN biopsy as an alternative to axillary lymph node dissection&#46; The high index of detection with the techniques available and the high percentage of concordance between the SLN and the non SLN both indicates that it is now feasible to replace AL in the surgical management of breast cancer&#44; thereby avoiding the complications of the latter approach&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> The indications for SLN biopsy have extended from T1&#8211;T2 tumors &#60;3<span class="elsevierStyleHsp" style=""></span>cm to larger tumors&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> tumors treated with previous CT<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> or even patients who have undergone previous surgery for breast tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">After more than 10 years of experience in the application of this technique in the Unit of Breast Disease of the Hospital Universitario de Salamanca in more than 1200 patients&#44; we believed it was a good time to evaluate the rate of false negative results over a minimum follow-up of 5 years to analyze the safety and precision of this technique&#46; Our group&#44; similar to many others&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> prefers the combined radioisotopic technique with blue staining due to the improvement in the percentage of overall detection even&#44; as reported previously&#44; in patients who have undergone primary tumor resection&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Our percentage of false negative results after a mean follow-up of 6&#46;8 years was of 1&#46;1&#37;&#44; being found in 3 out of the 258 patients classified as pN0 with a view to staging of the cancer&#46; This percentage has fallen from the 3&#46;2&#37; obtained in the validation phase of the technique and is similar to what has been described by other groups with axillary recurrence ratios between 0 and 1&#46;4&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;18</span></a> with mean follow-up times between 3 and 5 years&#46; Although this relationship may be raised&#44; several authors have reported that more than 75&#37; of the cases occur in the first 3 years after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> It is of note that the presence of axillary recurrence did not influence patient survival&#46; The presence of local recurrence in the same breast was also evaluated and was found to take place in 4&#46;7&#37;&#44; despite having received radiotherapy in 11 out of the 12 cases detected and in the contralateral breast &#40;2&#46;3&#37;&#41;&#46; These results are similar to those recently published by the group of Giuliano AE&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Moreover&#44; although recent publications<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> have suggested that the tumoral grade is the most important factor implicated in local recurrence&#44; within the limitation of including only pN0 patients&#44; we did not find a statistical relationship between the characteristics of the patient&#44; tumor state &#40;receptors&#44; tumoral grade&#44; HER2 expression&#41; or the adjuvant treatment received and this event&#46; The appearance of local recurrence&#44; which carries a high probability of distant dissemination&#44; and the presence of distant metastasis led to a significant reduction in survival&#44; despite the adjuvant therapies implemented &#40;surgery and CT&#41;&#46; Our data on overall oncologic survival of 93&#37; and disease-free survival of 89&#46;1&#37; are similar to those recently published in the randomized phase 3 NSABP B-32 trial &#40;91&#46;8&#37; and 82&#46;4&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">The risk of developing axillary recurrence after obtaining negative SLN without complete dissection of the axilla is sufficiently low to consider this procedure as the best in axillary staging in early stage breast cancer&#46; This staging technique achieves adequate local disease control without diminishing patient survival and avoids the secondary effects derived from more invasive surgery&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Introduction"
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              "identificador" => "sec0015"
              "titulo" => "Inclusion criteria"
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              "titulo" => "Sentinel lymph node biopsy procedure"
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          "titulo" => "References"
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    "fechaRecibido" => "2011-10-07"
    "fechaAceptado" => "2011-11-11"
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      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec107633"
          "palabras" => array:5 [
            0 => "Breast cancer"
            1 => "Sentinel lymph node"
            2 => "Axillary recurrence"
            3 => "Prognosis"
            4 => "Survival"
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          "palabras" => array:5 [
            0 => "C&#225;ncer mama"
            1 => "Ganglio centinela"
            2 => "Recurrencia axilar"
            3 => "Pron&#243;stico"
            4 => "Supervivencia"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The sentinel lymph node &#40;SLN&#41; biopsy is currently the procedure of choice for axillary node staging in initial stages of breast cancer&#46; The purpose of this study is to establish our false negative rate within a 5-year follow-up period in 258 patients with breast cancer staged with this procedure&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study on 258 consecutive T1&#8211;T2<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm pN0 staged breast carcinomas treated from January 1&#44; 2001 to December 31&#44; 2005 was performed&#46; The combined technique of isotope plus blue dye was used for detection&#46; The subjects underwent a minimum follow-up of 5 years&#44; mean 81 months&#44; with an end of follow-up at December 31&#44; 2010&#46; Evidence of axillary recurrence&#44; tumor recurrence in the breast and signs of disease progression or death were the events collected and analyzed&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 258 patients&#44; 3 false negatives &#40;1&#46;1&#37;&#41; with axillary recurrence were detected at 10&#44; 11 and 29 months of the surgery&#46; This did not have a significant repercussion in the survival analysis on the contrary to the existence of breast recurrence or the appearance of distant metastasis in 4&#46;7&#37; and 6&#46;2&#37; patients&#44; respectively&#46; Global survival related with the cancer was 93&#46;0 &#40;240&#47;258&#41; and disease free survival was 89&#46;1&#37; &#40;230&#47;258&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The risk of developing axillary recurrence after a negative SLN without axillary node dissection is low enough to consider the SLN procedure to be the best approach for axilla staging in early breast cancer&#46; This staging technique also makes it possible to achieve local disease control without diminishing the survival of the patients&#46;</p>"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La biopsia selectiva del ganglio centinela &#40;GC&#41; es en la actualidad el procedimiento de elecci&#243;n en la estadificaci&#243;n axilar en c&#225;nceres de mama en estadios iniciales&#46; El objetivo de este trabajo es establecer nuestra tasa de falsos negativos a lo largo de un per&#237;odo m&#237;nimo de 5 a&#241;os de seguimiento de 258 pacientes con c&#225;ncer de mama estadificados mediante este procedimiento&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 258 pacientes con c&#225;ncer de mama consecutivos T1-T2<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm estadificados como pN0 mediante GC entre enero-2001 y diciembre-2005&#46;Se emple&#243; la t&#233;cnica combinada isot&#243;pica y colorante para la detecci&#243;n&#46; Fueron sometidos a seguimiento con un per&#237;odo m&#237;nimo de 5 a&#241;os&#44; la media fue 81 meses&#44; siendo el punto final del seguimiento el 31 de diciembre de 2010&#46; La evidencia de recurrencia axilar&#44; recidiva tumoral en la mama&#44; presencia de enfermedad a distancia&#44; y muerte fueron los eventos recogidos y analizados&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De las 258 pacientes&#44; se detectaron 3 falsos negativos &#40;1&#44;1&#37;&#41;&#44; con recurrencia axilar a los 10&#44; 11 y 29 meses de la cirug&#237;a&#46; En el an&#225;lisis de supervivencia este hecho no tuvo repercusi&#243;n significativa&#44; a diferencia de la existencia de recidiva mamaria o la aparici&#243;n de met&#225;stasis a distancia que ocurrieron en un 4&#44;7 y un 6&#44;2&#37; de las pacientes&#46; La supervivencia global relacionada con el c&#225;ncer fue de un 93&#44;0&#37; &#40;240&#47;258&#41; y la supervivencia libre de enfermedad del 89&#44;1&#37; &#40;230&#47;258&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El riesgo de recurrencia axilar tras un ganglio centinela negativo sin vaciamiento linf&#225;tico completo es lo suficientemente bajo como para considerar a este procedimiento como de elecci&#243;n en la estadificaci&#243;n axilar del c&#225;ncer de mama en estadios iniciales&#46; Adem&#225;s&#44; permite alcanzar un adecuado control local de la enfermedad sin disminuir la supervivencia de los pacientes&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Ruano P&#233;rez R&#44; et al&#46; Incidencia de recurrencia axilar tras un ganglio centinela negativo en c&#225;ncer de mama en estadios iniciales&#58; seguimiento de 5 a&#241;os&#46; Rev Esp Med Nucl&#46; 2012&#59;31&#58;173&#8211;7&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Survival of the 258 patients pN0&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Invasive lobular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estrogenic&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P53&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1b&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1c&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Events&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Axillary recurrence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ipsilateral recurrence of breast cancer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Contralateral breast cancer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distant metastasis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Breast cancer deaths&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Total deaths&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Events occurring during follow-up&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Patients with early breast cancer benefit from effective axillary treatment"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;R&#46; Harris"
                            1 => "R&#46;T&#46; Osteen"
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                      "Revista" => array:6 [
                        "tituloSerie" => "Breast Cancer Res Treat"
                        "fecha" => "1985"
                        "volumen" => "5"
                        "paginaInicial" => "17"
                        "paginaFinal" => "21"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3978244"
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Article information

ISSN: 22538089
Original language: English

DOI:10.1016/j.remnie.2012.06.011

The statistics are updated each day

Year/Month	Html	Pdf	Total

2018 February	2	0	2
2018 January	8	0	8
2017 December	2	1	3
2017 November	7	0	7
2017 October	9	3	12
2017 September	10	1	11
2017 August	14	2	16
2017 July	22	1	23
2017 June	15	8	23
2017 May	23	0	23
2017 April	28	1	29
2017 March	18	28	46
2017 February	6	1	7
2017 January	6	1	7
2016 December	19	6	25
2016 November	13	3	16
2016 October	24	2	26
2016 September	16	5	21
2016 August	11	3	14
2016 July	16	2	18
2016 June	16	5	21
2016 May	18	10	28
2016 April	15	7	22
2016 March	19	7	26
2016 February	18	9	27
2016 January	18	9	27
2015 December	15	4	19
2015 November	18	1	19
2015 October	13	7	20
2015 September	30	1	31
2015 August	11	2	13
2015 July	4	4	8
2015 June	8	4	12
2015 May	12	2	14
2015 April	31	3	34
2015 March	26	3	29
2015 February	27	2	29
2015 January	40	3	43
2014 December	41	8	49
2014 November	13	0	13
2014 October	21	5	26
2014 September	14	0	14
2014 August	13	2	15
2014 July	15	1	16
2014 June	10	2	12
2014 May	10	3	13
2014 April	6	2	8
2014 March	18	4	22
2014 February	14	13	27
2014 January	19	1	20
2013 December	19	5	24
2013 November	19	4	23
2013 October	31	3	34
2013 September	18	1	19
2013 August	24	0	24
2013 July	10	2	12

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