The Role of Sentinel Lymph Node Biopsy in Paget’s Disease of the Breast

Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 04/2007; 14(3):1020-3. DOI: 10.1245/s10434-006-9056-2
Source: PubMed


Sentinel lymph node (SLN) biopsy has become a standard of care for axillary lymph node staging in breast cancer and appears suitable for virtually all patients with clinically node-negative (cN0) invasive disease. However, its role in Paget's disease of the breast, a condition in which invasion may or may not be present, remains undefined.
Among 7,083 consecutive SLN biopsy procedures, we retrospectively identified 39 patients with Paget's disease of the breast. Nineteen patients had no associated clinical/radiographic features ("Paget's only"), and 20 patients had associated clinical/radiographic findings ("Paget's with findings").
The mean ages for the Paget's alone and with findings groups were 63.6 and 49.6 years, respectively. The use of breast conservation therapy was 32% in the Paget's alone group and 10% in the Paget's with findings group. Invasive carcinoma was found in 27% of patients in the Paget's alone group and 55% of patients in the Paget's with findings group. The success rate of SLN biopsy was 98%, and the mean number of SLNs removed was 3 in both groups. In the entire cohort of Paget's disease, 28% (11/39) of the patients had positive SLNs (11%, Paget's alone; 45%, Paget's with findings).
In our "Paget's only" cohort, invasive cancer was found in 27% of cases and positive SLNs in 11%. SLN biopsy should be considered in all patients with Paget's disease of the breast, whether associated clinical/radiographic findings are present.

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    ABSTRACT: The presence or absence of lymph node metastases has been claimed as the single most important prognostic factor in breast cancer, what may not hold true for the smallest tumors detected through screening, which are often node-negative. Traditionally, this was assessed by the histological examination of the nodal content of the axilla removed during axillary lymph node dissection (ALND). Sentinel lymph node (SLN) biopsy (SLNB), a low morbidity surgical pathological staging procedure has now widely replaced ALND, especially in the earliest stages of the disease, where ALND often yielded a negative nodal status and therefore proved to be an unnecessary overtreatment. SLNB too, often yields negative results, and raises the question whether or not surgical nodal staging is required at all for small screen detected carcinomas. Although it is generally common to perform a completion axillary dissection when an SLN is involved by metastatic disease, further lymph nodes are only seldom affected by the disease. Therefore, the idea of omitting further axillary treatment after the finding of a positive SLN in these patients with generally favorable outcome needs to be seriously considered in order to reduce their morbidity and overtreatment. KeywordsAxillary lymph node dissection-In situ carcinoma-Invasive carcinoma-Sentinel lymph node
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