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Prophylactic mastectomy
Sentinel
lymph node (SLN) surgery is routinely used to stage patients with early
stage breast cancer. Many surgeons are extending its indication to
patients with ductal carcinoma in situ and also patients undergoing
prophylactic mastectomy (PM). Historically patients undergoing PM did not
undergo routine axillary staging. This paper evaluates whether SLN surgery
has a place in prophylactic mastectomy
(1)
. The
frequency of occult invasive cancer in 436 prophylactic mastectomy
specimens from patients undergoing surgery at the University of Texas M.
D. Anderson Cancer Center was evaluated. The overall rate of occult
invasive cancer in PM was 1.8%. This rate was the same for patients
undergoing contralateral PM for a personal history of breast cancer and
for patients undergoing bilateral PM for high risk of breast cancer. The
frequency of invasive carcinoma in this series is therefore lower than the
complication rate for SLN surgery which has been reported to be upwards of
5%. Therefore for most patients undergoing PM, the likelihood of
complication from SLN surgery is higher than the risk of finding invasive
cancer. However, subgroups of patients were identified who were at a
higher risk (> 1.8%) of occult invasive cancer in the PM; these
included patients who were postmenopausal, over 60 years of age, and in
particular those patients that had a history of invasive lobular carcinoma
or lobular carcinoma in situ associated with their index breast cancer.
These patients could be considered for SLN surgery at the time of PM. The
question of whether to routinely perform SLN surgery in patients
undergoing prophylactic mastectomy is asked clinically whenever patients
undergo PM, however there have been few studies to date addressing this
issue. Our study indicates that SLN surgery is not routinely indicated in
all patients undergoing PM and identifies some subgroups of patients in
whom SLN surgery at time of PM can be considered.
Reference:
Judy
C. Boughey Department
of Surgery,
Mayo
Clinic Isabelle Bedrosian Department
of of Surgical Oncology, University
of Texas, M.D. Anderson Cancer Center
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