"Staged" Biopsy Helps Plan Breast Cancer Surgery

NEW YORK (Reuters Health) - Performing sentinel lymph node biopsy (SLNB) one week before mastectomy, known as a "staged" operation, can facilitate surgical planning for breast cancer patients who are considering immediate breast reconstruction, according to a report in The American Journal of Surgery.

With SLNB, lymph nodes are removed from the armpit to determine if the breast cancer has spread, which can influence the treatment given.

Typically, SLNB is performed at the time of mastectomy and reconstruction. The lymph node specimen is sent to the lab and analyzed as a "frozen section" while the surgeon waits in the OR for the results before completing the operation. Unfortunately, studies have shown that the frozen section analysis often misses cancerous nodes that are detected on the final analysis, which is available about one week after surgery.

Missed cancer in the lymph nodes may adversely affect reconstruction. Having to go back and remove the remaining lymph nodes in a newly reconstructed breast can increase the risk of complications. Likewise, discovering that there is actually cancer in the nodes could mean that radiation after mastectomy is needed, which again could raise the risk of complications.

By allowing time for the final node results to come in, performing a SLNB one week before mastectomy could improve surgical planning in breast cancer patients. In the present study, Dr. Nancy Klauber-DeMore and colleagues, from the University of North Carolina at Chapel Hill, looked at the effect staged SLNB had on subsequent cancer and reconstructive operations.

The researchers searched their sentinel node database for patients who underwent SLNB with subsequent mastectomy from 2001 to 2004. A total of 25 patients with 27 breast cancers were identified.

Nine patients had cancerous nodes and all of them underwent mastectomy. Six of these patients underwent immediate reconstruction and three did not.

One of the six patients with cancerous nodes who underwent immediate reconstruction was reconstructed with a tissue expander, a device used to help form the new breast. By comparison, 6 of the 16 patients without cancerous nodes underwent reconstruction with a tissue expander.

"We conclude that performing a sentinel node biopsy as a staged procedure prior to definitive mastectomy and reconstruction gives the treating physicians more information to guide the patient regarding the best surgical procedure for them," Klauber-DeMore said in a statement.

SOURCE: The American Journal of Surgery, October 2005.