Axillary Management
Our research focuses on best-practices for axillary management, including approaches to improve surgical outcomes, decision-making, and reduce morbidity.
Journal: Annals of Surgical Oncology
Considering the clinical significance of determining the
status of a biopsy-proven metastatic lymph node after
NAC, we sought to provide practice recommendations
informed from our database review to improve patient
outcomes and reduce litigation risk.
Journal: Annals of Surgical Oncology
The benefits that neoadjuvant chemotherapy (NAC) provides in treating patients with breast cancer are well known. However, its effects on axillary lymph nodes and lymph node yield (LNY) following axillary lymph node dissection (ALND) remain unclear. Given the importance of LNY for accurate axillary staging in patients with breast cancer, we retrospectively reviewed a large national cancer database to determine if NAC has an effect on LNY following axillary surgery.
Journal: Surgical Oncology
The Beth Israel Deaconess Medical Center (BIDMC) is one of a few centers in the United States offering routine ILR to patients with breast cancer undergoing ALND. The approach is multidisciplinary and involves careful coordination between the breast surgical oncology team performing the ALND and the plastic surgery team performing the lymphatic reconstruction. Preservation of the superficial veins during ALND is critical to the success of lymphatic reconstruction.
Journal: Annals of Surgical Oncology
Oncotype DX® recurrence score (RS) is well-recognized for guiding decision making in adjuvant chemotherapy; however, the predictive capability of this genomic assay in determining axillary response to neoadjuvant chemotherapy (NCT) has not been established.
Journal: Annals of Surgical Oncology
Microinvasive ductal carcinoma (DCISM), defined as DCIS with a focus on invasive carcinoma ≤ 1 mm, can be managed similarly to pure DCIS; however, management of the axilla in DCISM has been a subject of debate. Reports in the literature differ on the utility and necessity of sentinel lymph node biopsy (SLNB) for DCISM. The aim of the present study was to identify risk factors for nodal disease in patients with DCISM, which can help develop a selective approach to SLNB in this patient population.
Journal: The American Journal of Surgery
The role of sentinel lymph node biopsy (SLNB) for patients with ductal carcinoma in-situ (DCIS) is limited given the rarity of nodal metastasis in non-invasive disease. Although SLNB is typically a safe procedure, there are potential complications and associated costs. The purpose of this study is to assess national surgical practice patterns and clinical outcomes with respect to the use of SLNB for DCIS in patients undergoing breast conserving surgery (BCS).
Journal: Annals of Surgical Oncology
Performing a sentinel lymph node biopsy (SLNB) is the standard of care for axillary nodal staging in patients with invasive breast cancer and clinically negative nodes. The procedure provides valuable staging information with few complications when performed by experienced
surgeons. However, variation in proficiency exists for this procedure, and a great amount of experience is required to master the technique, especially when faced with challenging cases. The purpose of this paper was to provide a troubleshooting guide for commonly encountered technical difficulties in SLNB, and offer potential solutions so that surgeons can improve their own technical performance from the collective knowledge of experienced specialists in the field.