Sentinel lymph node biopsy
http://www.100md.com
《英国医生杂志》
EDITOR—As we said, numerous issues about sentinel lymph node biopsy will be answered only by prospective clinical trials. The technique is a very important minimally invasive predictive prognostic indicator in breast cancer and melanoma. In these conditions performing either no lymphatic surgery or lymphatic clearance surgery on all patients would be neither evidence based nor safe.
We agree with Thomas and Clark that there is a degree of nihilistic predetermination in melanoma owing to the lack of an appropriate therapeutic intervention, but the concept of sentinel lymph node biopsy leading to in transit and more aggressive local disease is counterintuitive and not supported by current literature.
We agree with Long and Read in principle, though we have quoted the current seminal article on sentinel lymph node biopsy micrometastases, which examines almost 1000 patients compared with a more recent paper with fewer than half this number.1 2 The definitive answer will hopefully be answered by ACOSOG Z10, which will examine the clinical outcome of breast cancer patients with sentinel lymph node biopsy micrometastases.3
In our experience of performing several hundred sentinel lymph node biopsies for both melanoma and breast cancer we have not found false positive lymphadenopathy after the biopsy to be a real clinical concern. We believe that there is no evidence in the literature to support this either.
Patients should be given the most accurate prognostic information available. The evidence base for widespread utilisation of the best prognostic test (sentinel lymph node biopsy) has led to the use of this technique in north America and many other countries; enthusiasm is beginning to grow in the United Kingdom.
Malcolm R Kell, senior specialist registrar
malcolmkell@eircom.net
Michael J Kerin, consultant surgeon
Department of Surgery, National Breast Cancer Screening Programme, Eccles Unit, Mater Misericordiae Hospital, Dublin 7, Republic of Ireland
Competing interests: None declared.
References
International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet 1990;335: 1565-8.
Millis RR, Springall R, Lee AHS, Ryder K, Rytina ERC, Fentiman IS. Occult axillary lymph node metastases are of no prognostic significance in breast cancer. Br J Cancer 2002;86: 396-401.
American College of Surgeons Oncology Group. A prognostic trial of sentinel node and bone marrow micrometastases in women with clinical T1 or T2 N0 M0 breast cancer. www.acosog.org/studies/synopses/Z0010_Synopsis.pdf (accessed 24 Jun 2004).
We agree with Thomas and Clark that there is a degree of nihilistic predetermination in melanoma owing to the lack of an appropriate therapeutic intervention, but the concept of sentinel lymph node biopsy leading to in transit and more aggressive local disease is counterintuitive and not supported by current literature.
We agree with Long and Read in principle, though we have quoted the current seminal article on sentinel lymph node biopsy micrometastases, which examines almost 1000 patients compared with a more recent paper with fewer than half this number.1 2 The definitive answer will hopefully be answered by ACOSOG Z10, which will examine the clinical outcome of breast cancer patients with sentinel lymph node biopsy micrometastases.3
In our experience of performing several hundred sentinel lymph node biopsies for both melanoma and breast cancer we have not found false positive lymphadenopathy after the biopsy to be a real clinical concern. We believe that there is no evidence in the literature to support this either.
Patients should be given the most accurate prognostic information available. The evidence base for widespread utilisation of the best prognostic test (sentinel lymph node biopsy) has led to the use of this technique in north America and many other countries; enthusiasm is beginning to grow in the United Kingdom.
Malcolm R Kell, senior specialist registrar
malcolmkell@eircom.net
Michael J Kerin, consultant surgeon
Department of Surgery, National Breast Cancer Screening Programme, Eccles Unit, Mater Misericordiae Hospital, Dublin 7, Republic of Ireland
Competing interests: None declared.
References
International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet 1990;335: 1565-8.
Millis RR, Springall R, Lee AHS, Ryder K, Rytina ERC, Fentiman IS. Occult axillary lymph node metastases are of no prognostic significance in breast cancer. Br J Cancer 2002;86: 396-401.
American College of Surgeons Oncology Group. A prognostic trial of sentinel node and bone marrow micrometastases in women with clinical T1 or T2 N0 M0 breast cancer. www.acosog.org/studies/synopses/Z0010_Synopsis.pdf (accessed 24 Jun 2004).