The role of micrometastatic disease in sentinel lymph node in breast cancer.

Sentinel lymph node (SLN) biopsy is the standard procedure for axillary node staging in breast cancer. Improvements in histopathological analysis and immunohistochemistry have recently increased the rate of detection of lymph nodal micrometastases. The clinical implications and prognostic significance of micrometastases in SLN still remain a controversial issue. Literature review was analyzed by searches of Medline and PubMed data bases. Whereas most studies carried on small groups of patients did not show differences in survival, recently some studies with longer follow-up and with larger populations demonstrated that prognosis of patients with micrometastases is worse compared to that of patients with SLN free of disease. To date, completion axillary dissection remains the standard option when a macro or micrometastasis (0.2-2 mm) in the SLN is found. However, in absence of level-1 evidence guidelines, each case requires discussion in the context of a multi-disciplinary team.

Breast cancer diagnosis: the role of stereotactic vacuum-assisted aspiration biopsy.

AIM: The aim of this study is to evaluate the diagnostic accuracy and impact of the stereotactic vacuum-assisted aspiration biopsy (VAB) as a surgical treatment for non-palpable breast lesions. METHODS: A retrospective analysis of the diagnostic and therapeutic management of lesions having undergone VAB treatment was conducted. From February 2003 to September 2007, 525 stereotactic VABs were performed on 504 women using an 11-gauge needle device. Of these, 201 lesions were treated surgically. The concordance between VAB results and final pathology report after surgical excision was evaluated. Also examined was the impact of VAB on the quality of the surgical treatment. RESULTS: Stereotactic VABs performed with an 11-gauge device showed an underestimation rate of 23.8% for atypical ductal or lobular hyperplasia (AH). For ductal carcinoma in situ (DCIS) the underestimation rate was 31% and the underestimation rate for lobular carcinoma in situ (LCIS) was 14%. Only 38.2% of the patients with non-palpable lesions (201/525) were treated surgically and only 4% (20/504) of the patients underwent more than one surgical intervention. The VAB underestimation caused mistakes in the planning of the surgical therapy in only 9 out of 201 interventions (4.4%). CONCLUSIONS: This study confirms the efficacy of the VAB procedure in the diagnosis of non-palpable breast lesions and demonstrates its usefulness in therapeutic surgical planning. VAB treatment allows for the reduction of the number of surgical procedures required to diagnose and treat non-palpable breast lesions.