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Initial Sentinel Lymph Node Biopsy Should Be Separate From Total Mastectomy And Reconstruction
A DGReview of :"Sentinel lymph node biopsy followed by delayed mastectomy and reconstruction."
American Journal of Surgery
02/07/2003
By Mark Greener
Initial sentinel lymph node biopsy should done separately for women who are undergoing total mastectomies with reconstructions, say researchers.
Surgeons from Baylor University Medical Center, Dallas, Texas, United States, reviewed 40 patients who underwent sentinel lymph node biopsy followed by staged mastectomies and reconstructions. Infiltrating ductal carcinoma, the most common tumour, was present in 28 patients. High-grade carcinoma in situ and invasive lobular carcinoma were each present in four patients. The remaining patients had mucinous carcinoma, adenoid cystic carcinoma or mixed ductal and lobular carcinoma.
Thirty-one biopsies were taken using a needle. The remainder were open biopsies. Twenty-five patients showed negative sentinel lymph node biopsies and underwent delayed total mastectomies with immediate reconstructions.
Fifteen patients (37%) showed positive sentinel lymph node biopsies. Eight patients with macroscopic nodal metastases underwent delayed modified radical mastectomy and immediate reconstruction. Seven patients showed microscopic nodal metastases and three refused further axillary dissection. These patients underwent total mastectomy and immediate reconstruction.
The authors concluded that a substantial proportion of women treated with sentinel lymph node biopsy, simple mastectomy and reconstruction show positive sentinel lymph nodes.
The authors suggested that in women undergoing total mastectomy who want reconstruction, the initial sentinel lymph node biopsy should be a separate procedure. Patients with benign sentinel lymph node biopsy can undergo total mastectomy with immediate reconstruction. Patients with a positive sentinel lymph node biopsy can be managed with a modified radical mastectomy and immediate reconstruction. The authors commented that this approach avoids an axillary re-operation after reconstruction, which can prove difficult.
Am J Surg 2003;185:2:114-7.
"Sentinel lymph node biopsy followed by delayed mastectomy and reconstruction."
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