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Home: Oncology Leader Commentary: David Krag, MD

Click on the topic below for comments by Dr David Krag to comment on. You will also find links to related articles and clinical trials.

NSAPB sentinel node trial: Eligibility
NSAPB study
Immunohistochemistry
NSABP sentinel node trial: Survival endpoints
NSABP sentinel node trial: Morbiditiy endpoints
Morbidity of axillary dissection
NSABP sentinel node trial: Training surgeons to participate
Rationale for axillary dissection
NSABP sentinel node trial: Accrual
Should Sentinel node biopsies be done outside a clinical trial setting?
American College of Surgeons sentinel node trial

NSABP sentinel node trial: Accrual

Interview with Neil Love, MD from Breast Cancer Update for Surgeons, Program 1 2000

Play Audio Below:

The challenge to researchers and clinicians today is that a lot of the low hanging fruits, so to speak, has been picked. We’re being held to standards which are extremely challenging. So, a study that has to do thousands of patients is an enormous undertaking. A lot of women have to be willing to step up to the plate to do these studies, and the doctors have to play ball.

Relevant Articles:

Radioguided sentinel node biopsy to avoid axillary dissection in breast cancer.
Zurrida, S.; Galimberti, V.; Orvieto, E.; Robertson, C.; Ballardini, B.; Cremonesi, M.; De Cicco, C., and Luini, A.. Annals of Surgical Oncology. 7(1):28-31, 2000 Jan-Feb.

Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma - A multicenter study.
Weaver, D. L.; Krag, D. N.; Ashikaga, T.; Harlow, S. P., and O'Connell, M.. Cancer. 88(5):1099-1107, 2000 Mar 1.

Pathologic features associated with nonsentinel lymph node metastases i patients with metastatic breast carcinoma in a sentinel lymph node.
Turner, R. R.; Chu, K. U.; Qi, K.; Botnick, L. E.; Hansen, N. M.; Glass, E. C., and Giuliano, A. E.. Cancer. 89(3):574-581, 2000 Aug 1.

Should internal mammary nodes be sampled in the sentinel lymph node era?
Sugg, S. L.; Ferguson, D. J.; Posner, M. C., and Heimann, R. Annals of Surgical Oncology. 7(3):188-192, 2000 Apr.

Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma.
Schrenk, P.; Rieger, R.; Shamiyeh, A., and Wayand, W.. Cancer. 88(3):608-614, 2000 Feb 1.

Sentinel node biopsy in ductal carcinoma in situ patients.
Pendas, S.; Dauway, E.; Giuliano, R.; Ku, N. N.; Cox, C. E., and Reintgen, D. S. Annals of Surgical Oncology. 7(1):15-20, 2000 Jan-Feb.

Internal mammary chain sentinel lymph node identification in breast cancer.
Noguchi, M.; Tsugawa, K., and Miwa, K.. Journal of Surgical Oncology. 73(2):75-80, 2000 Feb.

Unfiltered sulfur colloid and sentinel node biopsy for breast cancer: Technical and kinetic considerations.
Moffat, F. L.; Gulec, S. A.; Sittler, S. Y.; Serafini, A. N.; Sfakianakis, G. N.; Boggs, J. E.; Franceschi, D.; Pruett, C. S.; Pop, R.; Gurkok, C.; Livingstone, A. S., and Krag, D. N.. Annals of Surgical Oncology. 6(8):746-755, 1999 Dec.

Sentinel lymph node biopsy for breast cancer: A suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used.
McMasters, K. M.; Tuttle, T. M.; Carlson, D. J.; Brown, C. M.; Noyes, R. D.; Glaser, R. L.; Vennekotter, D. J.; Turk, P. S.; Tate, P. S.; Sardi, A.; Cerrito, P. B., and Edwards, M. J. Journal of Clinical Oncology. 18(13):2560-2566, 2000 Jul.

A decision analysis of the effect of avoiding axillary lymph mode dissection i low risk women with invasive breast carcinoma.
Jackson, J. S. H.; Olivotto, I. A.; Wai, E.; Grau, C.; Mates, D., and Ragaz, J. Cancer. 88(8):1852-1862, 2000 Apr 15.

Pilot study on sentinel node biopsy in breast cancer.
Imoto, S.; Fukukita, H.; Murakami, K.; Ikeda, H., and Moriyama, N.. Journal of Surgical Oncology. 73(3):130-133, 2000 Mar.

Challenging the myth of exercise-induced lymphedema following breast cancer: A series of case reports.
Harris, S. R. and Niesen-Vertommen, S. L. (Reprint available from: Harris SR Univ British Columbia, Fac Med, Sch Rehabil Sci T325-2211 Wesbrook Mall Vancouver BC V6T 2B5 Canada). Journal of Surgical Oncology. 74(2):95-98, 2000 Jun.

Biopsy method and excision volume do not affect success rate of subsequent sentinel lymph node dissection in breast cancer.
Haigh, P. I.; Hansen, N. M.; Qi, K., and Giuliano, A. E. Annals of Surgical Oncology. 7(1):21-27, 2000 Jan-Feb.

Prospective observational study of sentinel lymphadenectomy without furthe axillary dissection in patients with sentinel node-negative breast cancer.
Giuliano, A. E.; Haigh, P. I.; Brennan, M. B.; Hansen, N. M.; Kelley, M. C.; Ye, W.; Glass, E. C., and Turner, R. R.. Journal of Clinical Oncology. 18(13):2553-2559, 2000 Jul.

Patient preferences for axillary dissection in the management of early-stage breast cancer.
Galper, S. R.; Lee, S. J.; Tao, M. L.; Troyan, S.; Kaelin, C. M.; Harris, J. R., and Weeks, J. C. (Reprint available from: Weeks JC Dana Farber Canc Inst, Dept Adult Oncol 44 Binney St Boston, MA 02115 USA).. Journal of the National Cancer Institute. 92(20):1681-1687, 2000 Oct 18.

Lymphatic mapping with intralesional tracer administration in breast carcinoma patients.
Doting, M. H. E.; Jansen, L.; Nieweg, O. E.; Piers, D. A.; Tiebosch ATMG; Koops, H. S.; Rutgers, E. J. T.; Kroon, B. B. R.; Peterse, J. L.; Olmos, R. A. V., and de Vries, J.. Cancer. 88(11):2546-2552, 2000 Jun 1.

Sentinel node metastasis in patients with breast carcinoma accurately predicts immunohistochemically detectable nonsentinel node metastasis.
Chu, K. U.; Turner, R. R.; Hansen, N. M.; Brennan, M. B., and Giuliano, A. E.. Annals of Surgical Oncology. 6(8):756-761, 1999 Dec.

Pattern of lymphatic drainage to the sentinel lymph node in breast cancer patients.
Canavese, G.; Gipponi, M.; Catturich, A.; Di Somma, C.; Vecchio, C.; Rosato, F.; Tomei, D.; Nicolo, G.; Carli, F.; Villa, G.; Agnese, G.; Bianchi, P.; Buffoni, F.; Mariani, G., and Badellino, F. Journal of Surgical Oncology. 74(1):69-74, 2000 May.

Sentinel lymph node mapping in early-stage breast cancer: Technical issues and results with vital blue dye mapping and radioguided surgery.
Canavese, G.; Gipponi, M.; Catturich, A.; Di Somma, C.; Vecchio, C.; Rosato, F.; Percivale, P.; Moresco, L.; Nicolo, G.; Spina, B.; Villa, G.; Bianchi, P., and Badellino, F. Journal of Surgical Oncology. 74(1):61-68, 2000 May.

Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer.
Breslin, T. M.; Cohen, L.; Sahin, A.; Fleming, J. B.; Kuerer, H. M.; Newman, L. A.; Delpassand, E. S.; House, R.; Ames, F. C.; Feig, B. W.; Ross, M. I.; Singletary, S. E.; Buzdar, A. U.; Hortobagyi, G. N., and Hunt, K. K. Journal of Clinical Oncology. 18(20):3480-3486, 2000 Oct 15.

Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors.
Bedrosian, I.; Reynolds, C.; Mick, R.; Callans, L. S.; Grant, C. S.; Donohue, J. H.; Farley, D. R.; Heller, R.; Conant, E.; Orel, S. G.; Lawton, T.; Fraker, D. L., and Czerniecki, B. J. Cancer. 88(11):2540-2545, 2000 Jun 1.

A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb.
Badger, C. M. A.; Peacock, J. L., and Mortimer, P. S.. Cancer. 88(12):2832-2837, 2000 Jun 15.

Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile Weiser, M. R.; Montgomery, L. L.; Susnik, B.; Tan, L. K.; Borgen, P. I., and Cody, H. S.? Annals of Surgical Oncology. 7(9):651-655, 2000 Oct. In progress

Micrometastatic nodal disease in breast cancer - The dilemma continues.
Rose, M. D. and Giuliano, A. E. (Reprint available from: Giuliano AE St Johns Hlth Ctr, John Wayne Canc Inst 2200 Santa Monica Blvd Santa Monica, CA 90404 USA). Journal of Surgical Oncology. 74(2):87-89, 2000 Jun. No abstract

Variation in axillary node dissection influences the degree of nodal involvement in breast cancer patients.
Saha, S.; Farrar, W. B.; Young, D. C.; Ferrara, J. J., and Burak, W. E.. Journal of Surgical Oncology. 73(3):134-137, 2000 Mar.

A multicenter validation study of sentinel lymph node biopsy by the Japanese Breast Cancer Society.
Noguchi, M.; Motomura, K.; Imoto, S.; Miyauchi, M.; Sato, K.; Iwata, H.; Ohta, M.;
Kurosumi, M., and Tsugawa, K. (Reprint available from: Noguchi M Kanazawa Univ Hosp, Operat Ctr Takara Machi 13-1 Kanazawa Ishikawa 9208641 Japan).. Breast Cancer Research & Treatment. 63(1):31-40, 2000 Sep. In process

Sentinel-node biopsy sampling in breast cancer.
Nieweg, O. E.; Tanis, P. J.; Olmos, R. A. V.; Rutgers, E. J. T., and Kroon, B. B. R. (Reprint available from: Nieweg OE Netherlands Canc Inst, Antoni Van Leeuwenhoek Hosp, Dept Surg Plesmanlaan 121 NL-1066 CX Amsterdam Netherlands).. Lancet. 356(9243): 1770, 2000 Nov 18. In process

Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma
Nason, K. S.; Anderson, B. O.; Byrd, D. R.; Dunnwald, L. K.; Eary, J. F.; Mankoff, D. A.; Livingston, R.; Schmidt, R. A.; Jewell, K. D.; Yeung, R. S., and Moe, R. E.. Cancer. 89(11):2187-2194, 2000 Dec 1. In process

Pathologic analysis of sentinel lymph nodes in breast carcinoma.
Liberman, L. (Reprint available from: Liberman L Mem Sloan Kettering Canc Ctr, Dept Radiol, Breast Imaging Sect 1275 York Ave New York, NY 10021 USA). Cancer. 88(5):971-977, 2000 Mar 1. No abstract

Long-term morbidity following axillary dissection in breast cancer patients - clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors.
Kuehn, T.; Klauss, W.; Darsow, M.; Regele, S.; Flock, F.; Maiterth, C.; Dahlbender, R.; Wendt, I., and Kreienberg, R. Breast Cancer Research & Treatment. 64(3):275-286, 2000 Dec.

Sentinel lymph node biopsy: Is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion?
Klauber-DeMore, N.; Tan, L. K.; Liberman, L.; Kaptain, S.; Fey, J.; Borgen, P.; Heerdt, A.; Montgomery, L.; Paglia, M.; Petrek, J. A.; Cody, H. S., and Van Zee, K. J. Annals of Surgical Oncology. 7(9):636-642, 2000 Oct. In process

Intraoperative lymphatic mapping and sentinel lymph node dissection in breast cancer.
Hsueh, E. C.; Hansen, N., and Giuliano, A. E. Ca: a Cancer Journal for Clinicians. 50(5):279-291, 2000 Sep-Oct.

Pilot study on sentinel node biopsy in breast cancer - Commentary
Greene, F. L. (Reprint available from: Greene FL Carolinas Med Ctr, Dept Gen Surg Charlotte, NC 28203 USA).. Journal of Surgical Oncology. 73(3):133, 2000 Mar.

Impact of sentinel lymph node mapping on relative charge in patients with early-stage breast cancer.
Gemignani, M. L.; Cody, H. S.; Fey, J. V.; Tran, K. N.; Venkatraman, E., and Borgen, P. I. Annals of Surgical Oncology. 7(8):575-580, 2000 Sep. In process

Does sentinel lymphadenectomy improve staging and alter therapy in elderly women with breast cancer?
DiFronzo, L. A.; Hansen, N. M.; Stern, S. L.; Brennan, M. B., and Giuliano, A. E. Annals of Surgical Oncology. 7(6):406-410, 2000 Jul. In process

A high number of tumor free axillary lymph nodes from patients with lymph node negative breast is associated with poor outcome.
Cody, H. S. and Van Zee, K. J. (Reprint available from: Cody HS Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol 1275 York Ave New York, NY 10021 USA).. Cancer. 89(1):218, 2000 Jul 1. No abstract

Challenging the myth of exercise-induced lymphedema following breast cancer: A series of case reports — Commentary.
(Reprint available from: Cady B Brown Univ, Women & Infants Hosp, Breast Hlth Ctr Providence, RI 02908 USA).. Journal of Surgical Oncology. 74(2):98-99, 2000 Jun. No abstract

Should irradiation replace dissection for patients with breast cancer with clinically negative axillary lymph nodes?
Recht, A. (Reprint available from: Recht A Beth Israel Deaconess Med Ctr, Dept Radiat Oncol East Campus,Finard Bldg B25,330 Brookline Ave Boston, MA 02215 USA). Journal of Surgical Oncology. 72(4):184-192, 1999 Dec. No abstract

Lymphedema: Current issues in research and management.
Petrek, J. A.; Pressman, P. I., and Smith, R. A. Ca: a Cancer Journal for Clinicians. 50(5):292-307, 2000 Sep-Oct.

Relevant Clinical Trials:

Phase III Randomized Study of Sentinal Node Dissection With or Without Conventional Axillary Dissection in Women With Clinically Node Negative Breast Cancer

Phase III Prognostic Study of Sentinel Node and Bone Marrow Micrometastases in Women With Stage I or IIA Breast Cancer

Phase III Randomized Study of Axillary Lymph Node Dissection in Women With Stage I or IIA Breast Cancer Who Have a Positive Sentinel Node

Phase II Study of Sentinel Node Biopsy to Assess Axillary Nodal Status in Patients With Resectable Stage I or II Breast Cancer

Phase III Randomized Trial of Quadrantectomy with vs without Axillary Lymph Node Dissection in Women Over 65 Years Old with Stage I Breast Cancer

Phase III Randomized Study of Surgery with or without Axillary Node Clearance Followed by Adjuvant Tamoxifen in Elderly Women with Breast Cancer

Randomized Study of Drainage of the Axilla After Lymph Node Dissection in Women With Stage I or II Breast Cancer

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