Application of sentinel node biopsy in patients with primary breast cancer in The Netherlands Implem

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Application of sentinel node biopsy in patients
with primary breast cancer in The
NetherlandsImplementationEffects on treatment
preliminary results

• Vincent Ho
• Margriet van der Heiden
• Comprehensive Cancer Centre Middle Netherlands
  (IKMN)

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Background

• The sentinel node biopsy (SNB) was introduced as
  a method for intra-operative mapping of lymph
  nodes for patients with breast cancer in 1994.
  (Cochran et al., 2003)
• SNB is considered an alternative for conventional
  axillary lymph node dissection in women who have
  small spreading breast cancers and clinically
  negative axillary lymph nodes.
• Advantage removal of as few lymph nodes as
  possible, thus reducing the risk of complications
  and side effects associated with removing all
  potentially cancerous lymph nodes.

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Background (2)
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Background (3)
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Background (4)
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Background (5)
Rudakewich, 1997
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Background (6)

• The SNB is described in the Dutch clinical
  practice guideline on breast cancer since 1999.
• The guideline was co-developed by the Dutch
  Association of Comprehensive Cancer Centres.
• (See also www.oncoline.nl)

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Objectives
The aims of this project are

• to provide insight in the extent of application
  of sentinel node biopsy in the regions of the
  Dutch Comprehensive Cancer Centres (CCC)
• to explore the implications of SNB introduction
  for treatment of patients.

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Objectives (2)

• FutureEstimation of the effect of introduction
  of SNB on staging of early breast cancer.
• Introduction of SNB may lead to improved
  detection of micrometastasis, which would
  possibly lead to an increased application of
  chemotherapy and radiotherapy after surgical
  treatment. (Van der Heiden, 2006)

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Methods

• Data extraction Dutch Cancer Registry, which
  consists of nine regional cancer registries.
• Descriptive analysis for the regions of the
  Comprehensive Cancer Centres in The Netherlands.
• Retrospective analysis 1998-2003.

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Patient selection / exclusion

• Inclusion women diagnosed with primary breast
  cancer in The Netherlands in 1998-2003.
•  
• Exclusion patients with a tumour larger than 5
  cm (Tgt2), patients who have clinically positive
  lymph nodes (cN1 and higher), and patients who
  show distant metastasis (M1) also excluded are
  patients who did not undergo surgical treatment
  or lymphatic mapping.

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Difficulties with the data

• No accurate data on SNB in some regions.
• No accurate data on radiotherapy.

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Results
Application of sentinel node biopsy in the
regions of the Dutch Comprehensive Cancer Centres

• Four regions Limburg, Eindhoven, East and Middle
  Netherlands.
• Number of cases 18,815 women.

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Results (2)
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Results (3)
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Work in progress

• Implications of SNB introduction for treatment of
  patients

• Eight regions 46,273 cases.
• Comparison treatment of node negative patients
  versus treatment of patients with micrometastasis
• Comparison treatment of patients with metastasis
  versus treatment of patients with micrometastasis

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Work in progress (2)
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Work in progress (3)

• Difficulty patients with micrometastasis among
  cases registered with pN1.
• Any suggestions?

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Conclusion

• SNB became gradually implemented in four regions
  of Comprehensive Cancer Centres in 1998-2003.

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