Early stage breast cancer lymph nodes
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Early-Stage Breast Cancer and Lymph Node Management
Sentinel Lymph Node Biopsy (SNB) in Early-Stage Breast Cancer
Sentinel lymph node biopsy (SNB) has become a standard procedure for staging and managing early-stage breast cancer. The American Society of Clinical Oncology (ASCO) guidelines recommend SNB as an initial alternative to axillary lymph node dissection (ALND) for patients with clinically negative axillary nodes. This recommendation is based on evidence showing that SNB is a safe and accurate method for identifying early-stage breast cancer without axillary involvement.
Recommendations for Axillary Lymph Node Dissection (ALND)
For women without sentinel lymph node (SLN) metastases, ALND is not recommended . In cases where one or two metastatic SLNs are identified, and the patient is planning to undergo breast-conserving surgery with whole-breast radiotherapy, ALND is generally not necessary . However, for women with SLN metastases who will undergo mastectomy, ALND should be offered .
Special Considerations for SNB
SNB may be offered to women with operable breast cancer and multicentric tumors, ductal carcinoma in situ (DCIS) undergoing mastectomy, those who previously had breast or axillary surgery, or those who received preoperative/neoadjuvant systemic therapy . However, SNB is not recommended for women with large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or DCIS when breast-conserving surgery is planned, or for pregnant women .
Prognostic Value of Tumor-Infiltrating Lymphocytes (TILs)
In early-stage triple-negative breast cancer (TNBC), the presence of tumor-infiltrating lymphocytes (TILs) has been shown to have significant prognostic value. Higher levels of stromally located TILs (sTILs) are associated with better invasive disease-free survival (iDFS), distant disease-free survival (D-DFS), and overall survival (OS). This suggests that sTILs could be integrated into prognostic models for patients with TNBC.
Deep Learning Radiomics for Predicting Axillary Lymph Node Status
Recent advancements in deep learning radiomics (DLR) have shown promise in predicting axillary lymph node (ALN) status preoperatively. Combining clinical parameters with DLR of conventional ultrasound and shear wave elastography can accurately predict ALN involvement, potentially reducing the need for invasive procedures.
Evolution of Lymph Node Spread
Understanding the spatiotemporal evolution of lymph node spread in early breast cancer is crucial. Studies using spatial multiregion sequencing have shown that lymph node metastasis often occurs early in the disease process, with significant implications for treatment and prognosis.
Real-World Evidence Post-Z0011 Trial
The Z0011 trial significantly influenced the management of early-stage breast cancer with limited SLN metastasis. Real-world evidence supports the safety and efficacy of avoiding ALND in favor of SLN biopsy alone, showing no significant difference in overall survival, disease-free survival, or recurrence rates, but a lower incidence of lymphedema.
Conclusion
The management of lymph nodes in early-stage breast cancer has evolved significantly, with sentinel lymph node biopsy becoming a standard practice. Current guidelines and evidence support the selective use of axillary lymph node dissection, emphasizing less invasive approaches while maintaining effective disease control. Advances in radiomics and a deeper understanding of lymph node metastasis further refine patient management strategies, aiming to improve outcomes and reduce treatment-related morbidity.
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