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https://hdl.handle.net/2440/50637
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Type: | Journal article |
Title: | Sentinel-Lymph-Node-Based Management or Routine Axillary Clearance? One-Year Outcomes of Sentinel Node Biopsy Versus Axillary Clearance (SNAC): A Randomized Controlled Surgical Trial |
Author: | Gill, P. |
Citation: | Annals of Surgical Oncology, 2009; 16(2):266-275 |
Publisher: | Lippincott Williams & Wilkins |
Issue Date: | 2009 |
ISSN: | 1068-9265 1534-4681 |
Organisation: | The SNAC Trial Group of the Royal Australasian College of Surgeons (RACS), University of Sydney |
Abstract: | We sought the extent to which arm morbidity could be reduced by using sentinel-lymph-node-based management in women with clinically node-negative early breast cancer. One thousand eighty-eight women were randomly allocated to sentinel-lymph-node biopsy followed by axillary clearance if the sentinel node was positive or not detected (SNBM) or routine axillary clearance (RAC, sentinel-lymph-node biopsy followed immediately by axillary clearance). Sentinel nodes were located using blue dye, alone or with technetium-labeled antimony sulfide colloid. The primary endpoint was increase in arm volume from baseline to the average of measurements at 6 and 12 months. Secondary endpoints were the proportions of women with at least 15% increase in arm volume or early axillary morbidity, and average scores for arm symptoms, dysfunctions, and disabilities assessed at 6 and 12 months by patients with the SNAC Study-Specific Scales and other quality-of-life instruments. Sensitivity, false-negative rates, and negative predictive values for sentinel-lymph-node biopsy were estimated in the RAC group. The average increase in arm volume was 2.8% in the SNBM group and 4.2% in the RAC group (P = 0.002). Patients in the SNBM group gave lower ratings for arm swelling (P < 0.001), symptoms (P < 0.001), and dysfunctions (P = 0.02), but not disabilities (P = 0.5). Sentinel nodes were found in 95% of the SNBM group (29% positive) and 93% of the RAC group (25% positive). SNB had sensitivity 94.5%, false-negative rate 5.5%, and negative predictive value 98%. SNBM was successfully undertaken in a wide range of surgical centers and caused significantly less morbidity than RAC. |
Keywords: | SNAC Trial Group of the Royal Australasian College of Surgeons (RACS) and NHMRC Clinical Trials Centre Axilla Lymph Nodes Humans Breast Neoplasms Lymphatic Metastasis Radionuclide Imaging Sentinel Lymph Node Biopsy Neoplasm Staging Treatment Outcome Lymph Node Excision Mastectomy Morbidity Quality of Life Adult Aged Middle Aged Female |
Description: | © Society of Surgical Oncology 2008 |
DOI: | 10.1245/s10434-008-0229-z |
Published version: | http://dx.doi.org/10.1245/s10434-008-0229-z |
Appears in Collections: | Aurora harvest Surgery publications |
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