Use of Memorial Sloan Kettering Cancer Center nomogram to guide intraoperative sentinel lymph node frozen sections in patients with early breast cancer.

BACKGROUND: We implemented selective use of frozen section (FS) to optimize accuracy and cost control in the intraoperative diagnosis of sentinel lymph node (SLN) in patients with breast cancer, guided by the Memorial Sloan Kettering Cancer Center (MSKCC) nodal metastasis risk prediction nomogram. METHODS: Surgical pathology records were reviewed, examining 2582 consecutive biopsies from 2552 patients with breast cancer to compare intraoperative FS diagnoses with postoperative final reports. We calculated sensitivity, specificity, and false-negative rates (FNRs) for various MSKCC risk levels, also analyzing axillary reoperation rates, with and without FS, and the number needed to treat (NNT) to avoid separate axillary lymph node dissection. RESULTS: The sensitivity, specificity, and FNR of FS were 84.7%, 99.9%, and 15.3%, respectively. FNR and MSKCC risk level negatively correlated (r = -0.86; P = .002). Axillary reoperation rate significantly declined if FS was done (FS: 4.0%; no FS: 36.4%; P = .002). In grouping patients by quartile of MSKCC risk, axillary reoperation rates were 16.7%, 25.1%, 38.7%, and 58.7% without FS, compared with 4.3%, 3.2%, 5.6%, 3.3% with FS and NNT correspondingly fell from 8.1 to 4.6, 3.0, and 1.8. CONCLUSIONS: A stratified decision-making algorithm based on the MSKCC risk prediction model improved the effectiveness of FS during SLN biopsy to avoid axillary reoperation.

[Clinical significance of the relationship between expression of survivin and effects of neoadjuvant chemotherapy in locally advanced breast cancer].

OBJECTIVE: Explore the relationship between the expression intensity of survivin and the effectiveness of neoadjuvant chemotherapy in locally advanced breast cancer patients. METHODS: Neoadjuvant chemotherapy with epirubicin plus paclitaxel was administered to 76 patients in locally advanced breast cancer (including 25 cases of stage IIa, 26 of stage IIb, 16 of stage IIIa, and 9 of stage IIIb), the mean age is 52.8(33-79)years old. All patients were female. They were treated with epirubicin 60 mg/m(2), on day 1, by i. v. followed paclitaxel 175 mg/m(2) by 3 hours continues infusion on day 2 and every 3 weeks repeatedly. Premedication of dexamethasone, ondansetron, diphenhydramine and cimetidine were administered to prevent gastroenteric and allergic reactions before chemotherapy. Four cycles were used. The expression of survivin in breast cancer tissue was detected with SDS-PAGE, western-immunoblotting and immunohistochemistry (IHC), and then that were immunological stained by anti survivin monoclonal antibody, and also the results were analyzed for the relationship between the expressed intensity of survivin and the effect of neoadjuvant chemotherapy in locally advanced breast cancer patients. RESULTS: Nineteen out of 76 patients had a clinical complete response, 36 had clinical partial response, and 21 had no change. The response rate was 72.37%(55/76). We found survivin could be differently expressed in 76 patients with SDS-PAGE, western-immunoblotting and IHC and then immune stain by anti survivin monoclonal antibody. Forty six patients were low expressed of survivin and 9 patients were high expressed in all response patients. Eight patients were low expressed, only 1 patient was high expressed of survivin in 9 patients had pCR. But no finding the relationship between the expression of survivin and TNM stage, ER, PgR, HER-2. CONCLUSION: The patients have high response rate of low expression of survivin after neoadjuvant chemotherapy with TE regimen in locally advanced breast cancer patients. This results shows that survivin is an important predictive factor for effectiveness of neoadjuvant chemotherapy with TE regimen in locally advanced breast cancer.