Source: DGNews  |  Posted 5 years ago

By Crystal Phend

SAN DIEGO, C.A. -- March 27, 2006 -- Sentinel lymph node biopsy should not be routine for patients undergoing prophylactic mastectomy, according to a study presented here at the annual meeting of the Society of Surgical Oncology (SSO).

?Just because we can do it doesn?t mean we should,? said lead author Judy C. Boughey, MD, surgical oncology fellow, University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States. ?This is a procedure that should just be used in selected patients.?

In the study, which she presented on March 24[^]th[], 409 patients undergoing prophylactic mastectomy were identified from the cancer center?s prospective breast surgery database. To be included in the study, patients had to undergo bilateral mastectomy or contralateral mastectomy for those with a personal history of breast cancer, either invasive or ductal carcinoma in situ.

Occult cancer was detected in 5% of prophylactic mastectomy specimens with an overall incidence of 1.8%. The majority were ductal carcinoma in situ (64%). There were 6 invasive lobular carcinomas and 2 invasive ductal carcinomas. All invasive tumors were T1 stage and had an average size of 5 mm.

The incidence of all occult cancers was significantly lower in patients who received chemotherapy prior to prophylactic mastectomy (2.4% vs. 7.0%). This difference was primarily due to a decrease in ductal carcinoma in situ in those that received chemotherapy (0.6% versus 5.1%), Dr. Boughey said.

Of the 108 patients who had sentinel lymph node surgery, 1 had invasive cancer detected in the mastectomy specimen. However, the sentinel lymph node procedure missed the diagnosis.

Two patients with a positive sentinel lymph node finding did not have occult cancer in the prophylactic mastectomy specimen.

Subgroups that may benefit from sentinel lymph node surgery with prophylactic mastectomy include patients over 60 years of age, postmenopausal women, and those with index tumors that are lobular carcinoma or associated with lobular carcinoma in situ.

Dr. Boughey said oncologists and institutions that routinely use sentinel lymph node surgery for prophylactic mastectomy ?may want to reconsider the risk-benefit ratio? because the biopsy is not without complications.

[Presentation title: The Routine Use of Sentinel Lymph Node Surgery in Prophylactic Mastectomy is Not Warranted. Poster 64]