Nodal status assessment in breast cancer: strategies of clinical grounds and quality of life implications

Abstract

Even in the era of gene-expression profiling, the nodal status still remains the primary prognostic discriminant in breast cancer patients. The exclusion of node involvement using noninvasive methods could reduce the rate of axillary surgery, thereby preventing from suffering complications. However, lymphatic mapping with sentinel node biopsy (SNB) is one of the most interesting recent developments in surgical oncology. Optimization of procedure could be implemented by dual mapping injection site skills, resection of all hot or blue nodes through tracer combination, and improvement in atypical drainage patterns mapping. This anatomical analysis suggests safety measures in patients with high probability of node metastasis through a renewed interest in surgical management. The perspective of a guided axillary sampling (GAS) could represent a potential development of recent anatomical and functional acquisitions, offering a dynamic technique shared according to clinical and anatomical disease parameters. Furthermore, the surgical staging procedures may adopt a conservative approach through the evaluation of upper arm lymphatics, thus defining a functional model aimed at the reduction of short- and long-term adverse events. Quality results in breast cancer surgery need to generate oncological safety devoid of complications through renewed clinical experience.

Figure 1

Intraoperative lymphoscintigraphy of patient with nonpalpable left breast cancer 3 hours after peritumoral injection of radiotracer (^99mTC-labelled human albumin microcolloid). Anterior view shows 2 axillary sentinel nodes.

Figure 2

Intraoperative lymphoscintigraphy (^99mTC-labelled human albumin microcolloid, subdermally injection) of patient with palpable left breast cancer (red circles) 1 h after previous axillary reverse mapping through a lower dose of radiotracer injected subcutaneously in the intramuscular groove of inner ipsilateral arm (white circles). Anterior view shows the progressive acquisition of two different patterns of lymphatic drainage carried out in separate times.