Conservative surgery: new research
A large study ofEuropean Institute of Oncology shows that more than half of breast cancer patients who are candidates for extensive armpit surgery can actually be treated with conservative surgery, which has fewer complications and safeguards arm function. The research, recently published in the journal Future Oncologyinvolved 30,508 patients in the period 2000-2017.
The objective of the study was to determine the clinical significance of the lack of visualization of the sentinel lymph node. The sentinel lymph node is a bulwark of breast-conserving surgery and it is the first of the lymph nodes of the lymphatic network which branches off from the mammary gland. The sentinel lymph node biopsy checks for the presence of cancer cells in this lymph node and it is thus possible to know if the tumor originating in the breast has started to spread into the armpit. The state of the lymph node therefore indicates to the breast surgeon whether or not to proceed with axillary emptying, after having removed the tumor from the mammary gland. This precious lymph node is identified with a preoperative lymphoscintigraphy, a non-invasive diagnostic test; however, there are cases in which it is not displayed on the scintigraphic images, so the problem arises of understanding which clinical conclusions to draw from this lack of detection.
“Some studies have hypothesized that the lack of visualization of the sentinel lymph node was a sign of metastasis,” he explains Giovanni Corso, IEO breast surgeon, Researcher at the University of Milan, co-author and promoter of the study – and therefore an indication for the surgeon to proceed with axillary emptying. In the absence of definitive data and with the aim of avoiding unnecessary surgery, at IEO we decided not to stop at the results of lymphoscintigraphy, but to continue the search for the sentinel lymph node in the operating room “. “We therefore applied an already known Nuclear Medicine procedure during the surgery – he specifies Francesca Magnoni, IEO breast surgeon and first signature of the work – which makes it possible to identify the sentinel lymph node thanks to the signal, detectable by a probe, of the radioactive tracer injected into the mammary gland. The tracer follows the same path as cancer cells through the lymphatic system and, like them, it positions itself in the first lymph node it encounters: the sentinel lymph node. Our study showed that out of a total of 30,508 patients, within the group of 525 (1.7%) in which the sentinel node was not identified during lymphoscintigraphy, in 385 (73%) it was subsequently visualized in the intra phase. -operative. In the latter subgroup, as many as 280 (72.7%) had a negative sentinel lymph node and therefore the surgeon did not perform the axillary dissection. In conclusion, we have shown that over half of the patients in whom the sentinel lymph node is not visible, has no axillary metastases and can avoid emptying the armpit ”.
“The results of this study represent an important contribution of the IEO to breast-conserving surgery, a field in which we are proud to be a world reference. The protection of the body image of every woman is a value that guides our clinical and research choices. Millions of women around the world have avoided unnecessary axillary dissection surgery thanks to the sentinel lymph node procedure that was developed and tested here in the late 1990s. This new study will avoid dissection to thousands and thousands of other women. It is also a demonstration of how breast cancer treatment, including surgical treatment, is increasingly personalized, thanks to the multidisciplinary nature and the availability of advanced technologies ”concludes Paolo Veronesi, Director of the IEO Breast Program and co-author of the study.