Update on management of the axilla скачать в хорошем качестве

Update on management of the axilla

Dr Mamounas talks to ecancertv at SABCS 2015 about the optimal surgical management of the axilla and how sentinel lymph node biopsy (SLNB) has increasingly become the standard of care over complete axillary lymph node dissection (ALND), even in some node-positive patients. There has been significant evolution during the past 20 years, he notes in the interview. This started with the recognition of the importance of the sentinel lymph node (SLN) concept and it becoming an established method used for cancer staging. This challenged a century-old concept of complete removal of the axillary lymph nodes and meant that complete dissection was not always necessary. This had the advantage of reducing the side effects seen with complete dissection such as lymphedema, numbness and tingling. Dr Mamounas explains that if the SLNB is negative then ALND is not performed. The use of the biopsy has been extended to include patients who present with clinically (or biopsy proven) involvement of the axillary nodes. If the SLNB is clinically node-negative after neoadjuvant chemotherapy then complete axillary dissection is not performed. Provided that certain procedures are followed (removal of three or more SLNs, dual-agent lymphatic mapping, localization and removal of previously biopsied positive nodes and even the use of immunohistochemistry in the SLN evaluation), the false-negative rate of SLNB drops to below 10%. Adoption of this approach has the potential to further decrease the use of ALND in patients who present with documented axillary lymph node involvement, Dr Mamounas says.