Abstract
Background
Over the last decade, rates of risk-reducing prophylactic mastectomy (PM) have risen
dramatically. A topic of debate regarding the procedure is whether to use sentinel
lymph node biopsy (SLNB) at the time of PM and what factors might predict for such
need. In order to assess the rate of identifying presence of occult invasive breast
cancer in the PM specimen, we performed a retrospective review of the pathology findings
from a single-surgeon case-series of PM.
Methods
Patients undergoing PM between January 2013 and June 2019 at Orlando Health Cancer
Institute were identified for a retrospective chart review. Demographic, clinical,
and histopathological data from the surgical procedure were collected and analyzed
for the incidence of occult invasive breast cancer in the PM specimen.
Results
A total of 146 consecutive patients with PM were identified; 120 (82.2%) underwent
contralateral PM (CPM) and 26 (17.8%) underwent bilateral PM (BPM). Final pathology
of the 172 PM specimens identified 4 (3.3%) with lobular carcinoma in situ, 3 (2.5%)
with atypical ductal hyperplasia, and 2 (1.7%) with atypical lobular hyperplasia and
2 (1.7%) with intraductal papilloma. No invasive malignancy was detected in any of
the 172 PM specimens.
Conclusions: The absence of occult invasive carcinoma in 172 consecutive PM specimens
suggests a limited clinical utility in routinely performing SLNB in this setting.
This study also suggests that use of preoperative breast MRI imaging could offer a
potential non-invasive tool to detect occult malignancy and select patients who can
safely undergo omission of SLNB at the time of PM.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Breast CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment.J Clin Oncol. 2007; 25: 5203-5209
- Age at first primary as a determinant of the incidence of bilateral breast cancer. Cumulative and relative risks in a population-based case-control study.Cancer. 1985; 55: 643-647
- Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation: the Hereditary Breast Cancer Clinical Study Group.J Clin Oncol. 2008; 26: 1093-1097
- Exploring reasons for overuse of contralateral prophylactic mastectomy in Canada.Curr Oncol. 2019; 26: e439-e457
- Perceptions of contralateral breast cancer: an overestimation of risk.Ann Surg Oncol. 2011; 18: 3129-3136
- Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy.Cancer Prev Res (Phila). 2010; 3: 1026-1034
- Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer.N Engl J Med. 1999; 340: 77-84
- Predictors of contralateral breast cancer in patients with unilateral breast cancer undergoing contralateral prophylactic mastectomy.Cancer. 2009; 115: 962-971
- Re: Survival outcomes after contralateral prophylactic mastectomy: a decision analysis.J Natl Cancer Inst. 2015; 107
- Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer.Ann Surg. 1998; 227: 645-651
- Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis.Cancer. 2006; 106: 4-16
- Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study.Ann Surg. 2010; 251: 595-600
- Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection.J Am Coll Surg. 1998; 186: 275-283
- Contralateral prophylactic mastectomy. Predictors of significant histologic findings.Cancer. 2004; 101: 1977-1986
- Occult malignancy in patients undergoing contralateral prophylactic mastectomy.Ann Surg. 2011; 254: 2-7
- Prophylactic mastectomy in patients at high risk: is there a role for sentinel lymph node biopsy?.Clin Breast Cancer. 2013; 13: 180-187
- Lymphedema after sentinel lymphadenectomy for breast carcinoma.Cancer. 2001; 92: 748-752
- Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial.Ann Surg Oncol. 2006; 13: 491-500
- Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer.J Clin Oncol. 2008; 26: 3248-3258
- Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy?.Cancer. 2008; 112: 1214-1221
- Occult contralateral breast carcinoma incidentally detected by breast magnetic resonance imaging.Breast J. 2002; 8: 145-148
- Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer.Ann Intern Med. 2008; 148: 671-679
- Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma.Cancer. 2000; 88: 608-614
- Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases: Long-term Follow-up From the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial.Ann Surg. 2016; 264: 413-420
- Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial.J Natl Cancer Inst. 2006; 98: 599-609
- Sentinel lymph node biopsy in breast cancer: a clinical review and update.J Breast Cancer. 2017; 20: 217-227
- The role of sentinel lymph node biopsy in women undergoing prophylactic mastectomy.Am J Surg. 2000; 180: 274-277
- Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast.Can J Surg. 2011; 54: 300-306
- Routine prophylactic sentinel lymph node biopsy is not indicated in women undergoing prophylactic mastectomy.J Surg Oncol. 2012; 105: 650-654
- Is Sentinel Lymph Node Biopsy Necessary in Patients Undergoing Prophylactic Mastectomy? A Systematic Review and Meta-Analysis.Breast J. 2016; 22: 158-165
- Indications for sentinel lymph node biopsy in the setting of prophylactic mastectomy.J Am Coll Surg. 2009; 209: 746-752
Nasser SM, Smith SG, Chagpar AB: The role of sentinel node biopsy in women undergoing prophylactic mastectomy. J Surg Res 164:188-92.
- Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG Multicentre Trial.Ann Surg Oncol. 2014; 21: 1237-1245
- Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG Multicentre Trial.Ann Surg Oncol. 2014; 21: 1237-1245
- Superparamagnetic iron oxide nanoparticles as the sole method for sentinel node biopsy detection in patients with breast cancer.Br J Surg. 2017; 104: 1675-1685
- The superparamagnetic iron oxide is equivalent to the Tc99 radiotracer method for identifying the sentinel lymph node in breast cancer.Eur J Surg Oncol. 2015; 41: 46-51
- Sentinel lymph node identification using superparamagnetic iron oxide particles versus radioisotope: The French Sentimag feasibility trial.J Surg Oncol. 2016; 113: 501-507
- The Central-European SentiMag study: sentinel lymph node biopsy with superparamagnetic iron oxide (SPIO) vs. radioisotope.Breast. 2014; 23: 175-179
- The value of breast MRI in high-risk patients with newly diagnosed breast cancer to exclude invasive disease in the contralateral prophylactic mastectomy: Is there a role to choose wisely patients for sentinel node biopsy?.Cancer Med. 2016; 5: 1031-1036
- Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions.Radiology. 2007; 243: 670-680
- MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer.N Engl J Med. 2007; 356: 1295-1303
- Detecting occult malignancy in prophylactic mastectomy: preoperative MRI versus sentinel lymph node biopsy.Ann Surg Oncol. 2007; 14: 2477-2484
Article info
Publication history
Published online: December 07, 2022
Accepted:
December 4,
2022
Received in revised form:
November 30,
2022
Received:
October 25,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
