Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Altering time of breast biopsy may improve mastectomy reconstruction process

11.10.2005


Altering the standard step-by-step procedure that takes women facing a mastectomy from diagnosis to surgery to reconstruction can improve the process and help in determining if immediate reconstruction is the best course of action, according to new research from the University of North Carolina at Chapel Hill.



Key to the new approach is the use of sentinel lymph node biopsy (SLNB) performed as an outpatient procedure a week or so prior to mastectomy, rather then doing the SLNB at the same operation as the mastectomy and reconstruction.

According to the new study published in the October issue of the American Journal of Surgery, particular problems may arise with performing SLNB at the same time as the mastectomy with immediate reconstruction.


SLNB involves the removal of some of the first "sentinel" lymph nodes into which cancerous cells from the breast might drain. Studies have shown SLNB to be an effective way to determine the spread of disease to the lymph nodes under the arm.

In current practice using SLNB, the sentinel node is quick-frozen; a pathologist then examines the node under a microscope. This method quickly gives a diagnosis of cancer spread while the surgeon is waiting to complete the procedure. The diagnosis is confirmed a few days after surgery by a more detailed study called a permanent section.

"If the pathologist does not see tumor in the lymph node on frozen section, there is still a chance that tumor may be found in the lymph nodes on final pathology," said lead study author Dr. Nancy Klauber-DeMore, assistant professor of surgery in UNC’s School of Medicine and a member of the UNC Lineberger Comprehensive Cancer Center.

"There can be major consequences for a patient who has undergone immediate breast reconstruction if a metastasis is found on permanent section that was not recognized on frozen section."

There are two issues here, Klauber-DeMore said. The first is the need for another operation, axillary lymph node dissection, or removal of all the lymph nodes under the armpit. "Axillary lymph node dissection may present increased complications in a patient with a newly reconstructed breast."

The second is that some patients whose lymph nodes prove positive on final pathology may be recommended to undergo post-mastectomy radiation therapy. "And radiation can sometimes have adverse effects on the reconstruction that may lead to poorer cosmetic results, particularly if the reconstruction is with a tissue expander, a breast-shaped prosthetic that helps create a pocket for a breast implant," Klauber-DeMore said.

"That is why it would be optimal to know the final status of the sentinel node before committing the patient to a large operation, such as mastectomy and reconstruction."

In the study, 25 patients underwent outpatient sentinel node biopsy, the procedure taking generally less than an hour. The patients then went home. Two patients had cancer in both breasts; therefore, 27 SLNBs were performed. Patients returned for the final pathology results the following week.

"With the knowledge of the final pathology, the patient can make more informed decisions in discussion with the radiation oncologist and plastic surgeon, to determine whether or not the patient will need radiation after the mastectomy. This in turn will influence whether or not the patient should have immediate reconstruction," Klauber-DeMore said. "We also know definitively if the patient needs an axillary lymph node dissection at the time of mastectomy."

The study demonstrated that exact knowledge of positive versus negative sentinel lymph node prior to mastectomy helped physicians plan the optimal surgical procedure for the patient, the researchers said.

Of the 27 biopsies, nine patients (33 percent) had tumor-involved lymph nodes. All nine patients underwent an axillary lymph node dissection at the time of their mastectomy. Of these, three did not have immediate reconstruction because it was thought that would be detrimental, Klauber-DeMore said.

Of the remaining six node-positive patients, five underwent reconstruction with their own tissue instead of a tissue expander. In contrast, six of the 16 (37 percent) node-negative patients 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.

L. H. Lang | EurekAlert!
Further information:
http://www.med.unc.edu

More articles from Health and Medicine:

nachricht Vanishing capillaries
23.03.2017 | Technische Universität München

nachricht How prenatal maternal infections may affect genetic factors in Autism spectrum disorder
22.03.2017 | University of California - San Diego

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

When Air is in Short Supply - Shedding light on plant stress reactions when oxygen runs short

23.03.2017 | Life Sciences

Researchers use light to remotely control curvature of plastics

23.03.2017 | Power and Electrical Engineering

Sea ice extent sinks to record lows at both poles

23.03.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>