Management of the Axilla in Breast Cancer Flashcards
What is the size of macrometastases in breast lymph nodes?
> 2mm, N1
What is the size of micrometastases in breast lymph nodes?
0.2-2 mm, N1mic
What is the size of isolated tumor cells when staging breast cancer?
<0.2 mm, NO[i+]
Can you do a repeat SLNBx after prior SNBx or dissection?
Yes, with lower rates of success. But the results are reliable if a new SLN is identified.
Why is SLNBx contraindicated in patients with inflammatory breast cancer?
SLNBx results are unreliable. Suspect that lymphatic tumor deposits imede dye mapping.
When is a completion axillary dissection indicated following a SLNBx?
When a patient has either macro- or micrometastatic disease. Not for isolated tumor cells
When is axillary XRT a reasonable alternative to axillary dissection?
In pts whose nodal pathology results will not change treatment plans
A standard axillary dissection takes out what levels of LNs?
Levels I and II
When is an axillary level III dissection performed?
Only whne palpable nodes are present.
Why is a level III axillary dissection typically not done?
Increased risk of lymphadema
How does aggressive post-op pain control facilitate a decrease in morbidity following an axillary dissection?
Pain releife facilitates early post-op mobilization of the arm -> hopefully results in reduced shoulder stiffness and lymphedema
Following axillary dissection, lymphedema occurs in what % of patients?
10-25%
How many Gy are given for axillary XRT following an axillary dissection?
45-50. Given daily in 1.8-2 Gy fractions
What is the rate of brachial plexus injury after axillary XRT?
1%
What is the rate of lymphadema following an axillary dissection and XRT?
15-30%
After a core bx dx of DCIS, what % of pts will have invasive CA after definitive excision?
20%
What % of pts w/ DCIS will have tumor deposits in SLNBx on standard H&E?
1-3%
What % of pts w/DCIS will have tumor deposits on keratin staining of SLNBx?
9-13%
With a + SLNBx, is there an increase in local or distant recurrence in pts with pure DCIS w/ or w/o microinvasion?
No.
Should pts undergoing a mastectomy for DCIS receive a SLNBx?
Yes. The mastectomy will affect lymphatic mapping to the sentinel lymph node.
When should the elderly undergo an axillary dissection?
Clinically positive LN, in those chemotherapy will be considered, or those who are at high risk for + LN
What % of breast CA present as enlarged ax LN without a detectable primary?
0.3-1%
What imaging study should be used for pts. with ax LNA, but no detectable primary?
MRI. Will detect 50% of the primaries.
If no primary breast lesion is found with a pt with metastatic LN dz, and metastatic dz from other sites is ruled out, what is the next step?
Axillary dissection to remove nodes. Whole breast XRT.
