THE EVALUATION OF THE EFFECTS OF LYMPH NODE REVEALING SOLUTION ON AXILLARY DISSECTION MATERIAL

Authors

  • Tangul Bulut MD, Department of Pathology, University of Health Science, Antalya Training and Research Hospital, Antalya, Turkey
  • Ayse Arducoglu Merter MD, Department of General Surgery, University of Health Science, Antalya Training and Research Hospital, Antalya, Turkey
  • Betul Celik Associate Professor, Department of Pathology, University of Health Science, Antalya Training and Research Hospital, Antalya, Turkey

DOI:

https://doi.org/10.29121/granthaalayah.v7.i10.2019.397

Keywords:

Lymph Node Revealing Solution, LNRS, Nodal Staging, Prognosis, Dissection Material

Abstract [English]

Objective: Nodal status is still the most important independent prognostic factor in breast cancer. In this study, we aimed to investigate the effect of lymph node revealing solution (LNRS) on the number and diameter of removed lymph nodes and nodal staging.


Study Design: Consecutive 150 patients, diagnosed breast carcinoma, were included in the study. After excising the lymph nodes by the traditional method, remaining axillary tissue was immersed in LNRS for 6-12 hours. lymph nodes, which stood out as white chalky nodules, were excised and processed as usual.


Results: An increase of 5.80 (32.03%) in the number of lymph nodes per case was observed, which was statistically significant. The diameters of the lymph nodes removed with LNRS were smaller compared to the classical method, and this was statistically significant as well. Furthermore, the LINES changed nodal stage of the disease in five of the studied cases.


Conclusions: LNRS increases the number of lymph nodes that are removed and detects smaller lymph nodes. It may be an alternative method in cases with removed lymph nodes are critical number or under. Thus, accurate nodal staging and prognostic information will be obtained by using LNRS and more accurate treatment management will be provided.

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References

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68:394-424. doi: 10.3322/caac.21492. DOI: https://doi.org/10.3322/caac.21492

Allred DC. Issues and updates: evaluating estrogen receptor-alpha, progesterone receptor, and HER2 in breast cancer. Mod Pathol. 2010;23 Suppl 2:S52-9. doi: 10.1038/modpathol.2010.55. DOI: https://doi.org/10.1038/modpathol.2010.55

Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687-717. DOI: https://doi.org/10.1016/S0140-6736(05)66544-0

Stankov A, Bargallo-Rocha JE, Silvio AÑ, Ramirez MT, Stankova-Ninova K, Meneses-Garcia A. Prognostic factors and recurrence in breast cancer: experience at the national cancer institute of Mexico. ISRN Oncol. 2012; 2012:825258. doi: 10.5402/2012/825258. DOI: https://doi.org/10.5402/2012/825258

Pantel K, Brakenhoff RH. Dissecting the metastatic cascade. Nat Rev Cancer. 2004; 4:448-56. DOI: https://doi.org/10.1038/nrc1370

Wiechmann L, Sampson M, Stempel M, Jacks LM, Patil SM, King T, Morrow M. Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol. 2009; 16:2705-10. doi: 10.1245/s10434-009-0606-2. DOI: https://doi.org/10.1245/s10434-009-0606-2

Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, Weaver DL, Winchester DJ, Hortobagyi GN. Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67:290-303. doi: 10.3322/caac.21393. DOI: https://doi.org/10.3322/caac.21393

Vinh-Hung V, Cserni G, Burzykowski T, van de Steene J, Voordeckers M, Storme G. Effect of the number of uninvolved nodes on survival in early breast cancer. Oncol Rep. 2003; 10:363-8. DOI: https://doi.org/10.3892/or.10.2.363

Fisher ER, Costantino J, Fisher B, Redmond C. Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol 4). Discriminants for 15-year survival. National Surgical Adjuvant Breast and Bowel Project Investigators. Cancer. 1993;71(6 Suppl):2141-50. DOI: https://doi.org/10.1002/1097-0142(19930315)71:6+<2141::AID-CNCR2820711603>3.0.CO;2-F

Koren R1, Kyzer S, Paz A, Veltman V, Klein B, Gal R. Lymph Node Revealing Solution: A New Method for Detection of Minute Axillary Lymph Nodes in Breast Cancer Specimens. Am J Surg Pathol. 1997; 21:1387-90. DOI: https://doi.org/10.1097/00000478-199711000-00016

Ghoncheh M, Pournamdar Z, Salehiniya H. Incidence and Mortality and Epidemiology of Breast Cancer in the World. Asian Pac J Cancer Prev. 2016; 17:43-6. DOI: https://doi.org/10.7314/APJCP.2016.17.S3.43

Michaelson JS, Silverstein M, Sgroi D, Cheongsiatmoy JA, Taghian A, Powell S, Hughes K, Comegno A, Tanabe KK, Smith B. The effect of tumor size and lymph node status on breast carcinoma lethality. Cancer. 2003; 98:2133-43. DOI: https://doi.org/10.1002/cncr.11765

Vinh-Hung V, Burzykowski T, Cserni G, Voordeckers M, Van De Steene J, Storme G. Functional form of the effect of the numbers of axillary nodes on survival in early breast cancer. Int J Oncol. 2003;22:697-704.

Haffty BG, Ward B, Pathare P, Salem R, McKhann C, Beinfield M, Fischer D, Reiss M. Reappraisal of the Role of Axillary Lymph Node Dissection in the Conservative Treatment of Breast Cancer. J Clin Oncol. 1997;15:691-700. DOI: https://doi.org/10.1200/JCO.1997.15.2.691

Valagussa P, Bonadonna G, Veronesi U. Patterns of relapse and survival following radical mastectomy. Analysis of 716 consecutive patients. Cancer. 1978; 41:1170-78. DOI: https://doi.org/10.1002/1097-0142(197803)41:3<1170::AID-CNCR2820410355>3.0.CO;2-I

Ponzone R, Maggiorotto F, Mariani L, Jacomuzzi ME, Magistris A, Mininanni P, Biglia N, Sismondi P. Comparison of two models for the prediction of nonsentinel node metastases in breast cancer. Am J Surg. 2007; 193:686-92. DOI: https://doi.org/10.1016/j.amjsurg.2006.09.031

Gurleyik G, Aker F, Aktekin A, Saglam A. Tumor characteristics influencing non-sentinel lymph node involvement in clinically node negative patients with breast cancer. J Breast Cancer. 2011;14:124-8. doi: 10.4048/jbc.2011.14.2.124. DOI: https://doi.org/10.4048/jbc.2011.14.2.124

Somner JE, Dixon JM, Thomas JS. Node retrieval in axillary lymph node dissections: recommendations for minimum numbers to be confident about node negative status. J Clin Pathol. 2004 Aug;57(8):845-8. DOI: https://doi.org/10.1136/jcp.2003.015560

Cserni G. Pathological evaluation of sentinel lymph nodes. Surg Oncol Clin N Am. 2007;16:17-34. DOI: https://doi.org/10.1016/j.soc.2006.10.002

Weaver DL, Le UP, Dupuis SL, Weaver KA, Harlow SP, Ashikaga T, Krag DN. Metastasis detection in sentinel lymph nodes: comparison of a limited widely spaced (NSABP protocol B-32) and a comprehensive narrowly spaced paraffin block sectioning strategy. Am J Surg Pathol. 2009;33:1583-9. doi: 10.1097/PAS.0b013e3181b274e7. DOI: https://doi.org/10.1097/PAS.0b013e3181b274e7

Fisher B, Redmond C, Fisher ER, Bauer M, Wolmark N, Wickerham DL, Deutsch M, Montague E, Margolese R, Foster R. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med. 1985;312:674-81. DOI: https://doi.org/10.1056/NEJM198503143121102

Grabau DA, Jensen MB, Blichert-Toft M, Andersen JA, Dyreborg U, Carstensen B, Al-Suliman NN, Graversen HP, Rose C. The importance of surgery and accurate axillary staging for survival in breast cancer. Eur J Surg Oncol. 1998 Dec;24(6):499-507. DOI: https://doi.org/10.1016/S0748-7983(98)93320-0

Fisher B, Wolmark N, Bauer M, Redmond C, Gebhardt M. The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast. Surg Gynecol Obstet. 1981;152:765-72.

Durkin K, Haagemen CD. An improved technique for the study of lymph nodes in surgical specimen. Ann Surg1980;191:419-429. DOI: https://doi.org/10.1097/00000658-198004000-00006

Morrow M, Evans J, Rosen PP, Kinne DW. Does clearing of axillary lymph nodes contribute to accurate staging of breast carcinoma? Cancer.1984;53:1329-1332. DOI: https://doi.org/10.1002/1097-0142(19840315)53:6<1329::AID-CNCR2820530618>3.0.CO;2-U

Hartveit F, Samsonsen G, Tangen M, Halvorsen JF. Routine histological investigation of the axillary nodes in breast cancer. Clin Oncol. 1982;8:121-6.

Horne J, Bateman AC, Carr NJ, Ryder I. Lymph node revealing solutions in colorectal cancer: should they be used routinely? J Clin Pathol. 2014;67:383-8. doi: 10.1136/jclinpath-2013-202146. DOI: https://doi.org/10.1136/jclinpath-2013-202146

Dias AR, Pereira MA, Mello ES, Zilberstein B, Cecconello I, Ribeiro Junior U. Carnoy's solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial. Gastric Cancer. 2016;19:136-42. doi: 10.1007/s10120-014-0443-2. DOI: https://doi.org/10.1007/s10120-014-0443-2

Peethambaram PP, Hoskin TL, Day CN, Goetz MP, Habermann EB, Boughey JC. Use of 21-gene recurrence score assay to individualize adjuvant chemotherapy recommendations in ER+/HER2- node positive breast cancer-A National Cancer Database study. NPJ Breast Cancer. 2017;3:41. DOI: https://doi.org/10.1038/s41523-017-0044-4

Grabau D, Jensen MB, Rank F, Blichert-Toft M. Axillary lymph node micrometastases in invasive breast cancer: national figures on incidence and overall survival. APMIS. 2007;115:828-37. DOI: https://doi.org/10.1111/j.1600-0463.2007.apm_442.x

Donald L Weaver. Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale. Modern Pathology volume23, pagesS26–S32 (2010). DOI: https://doi.org/10.1038/modpathol.2010.36

NCCN clinical Practice guidelines in oncology V.2.2018. Breast Cancer. (2018) Available online at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf [Access OCT 21, 2018].

Andersson Y, Bergkvist L, Frisell J, de Boniface J. Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. Breast Cancer Res Treat. 2018;171:359-69. DOI: https://doi.org/10.1007/s10549-018-4820-0

Iqbal J, Ginsburg O, Giannakeas V, Rochon PA, Semple JL, Narod SA. The impact of nodal micrometastasis on mortality among women with early-stage breast cancer. Breast Cancer Res Treat. 2017;161:103-15. DOI: https://doi.org/10.1007/s10549-016-4015-5

Koren R, Paz A, Lask D, Kyzer S, Klein B, Schwartz A, Gal R. Lymph-node revealing solution: a new method for detecting minute lymph nodes in cystectomy specimens. Br J Urol. 1997 Jul;80:40-3. DOI: https://doi.org/10.1046/j.1464-410X.1997.00154.x

Koren R, Shvero J, Yaniv E, Veltman V, Konichezky M, Groushko I, Sadov R, Feinmesser R, Gal R. Neck-dissection surgical specimens treated by lymph node revealing solution. Otolaryngol Head Neck Surg. 2001;124:72-5. DOI: https://doi.org/10.1067/mhn.2001.111290

Jan YJ, Huang PC, Chen JT, Ho WL. Lymph node revealing solution and traditional 10% buffered formaldehyde for detecting lymph nodes in colorectal carcinoma. Zhonghua Yi Xue Za Zhi (Taipei). 2000;63:131-7.

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Published

2019-10-31

How to Cite

Bulut, T., Merter, A. A., & Celik, B. (2019). THE EVALUATION OF THE EFFECTS OF LYMPH NODE REVEALING SOLUTION ON AXILLARY DISSECTION MATERIAL. International Journal of Research -GRANTHAALAYAH, 7(10), 269–279. https://doi.org/10.29121/granthaalayah.v7.i10.2019.397