27 Jan Breast Cancer ꓽ The Right Decision For Lumpectomy, Quadrectomy, or Mastectomy And The Role Of The Sentinel Lymph Node
Lumpectomy,also called wide local resection, is the removal of the tumor with a margin of resection of healthy tissue. It is suitable for ꓽ
- tumors of small size if the breast is small.
- larger volumes if the breast is more voluminous.
It is performed on early-stage tumors. A lumpectomy may require lumpoplasty surgery to reshape the breast. A lumpectomy is a conservative surgery: the operation saves the majority of the breast that is not affected by the cancer. Lumpectomy combined with adjunctive radiotherapy gives the same survival rate as the more invasive mastectomy surgery according to studies.
In a quadrectomy (also called a segmental excision), a “quadrant” of the breast is removed, which corresponds to about a quarter of the breast parenchyma and is a more invasive surgery than a lumpectomy but much less invasive than a mastectomy. It is performed when the tumor is confined to the same breast quadrant. Oncoplasty techniques combine surgical removal of tumors with plastic surgery to achieve the best result from an aesthetic point of view but also to guarantee the best treatment for the tumor. These techniques allow the preservation and symmetry of the breasts.
Mastectomy involves the removal of the entire breast with preservation of the nipple and areola, when possible, using sophisticated surgical techniques. It is a more invasive type of surgery compared to a quadrectomy or lumpectomy.
A mastectomy may be indicated in the following cases:
- the patient’s breast is very small and probably the conservative surgery will not have a good aesthetic result.
- the tumor occupies a large area of the breast.
- the tumor affects multiple areas of the breast (multicentric).
Sentinel Lymph Node
Lymph nodes are filters present in various parts of our body, rich in macrophages (cells capable of incorporating and digesting pathogenic and modified cells) and lymphocytes or white blood cells.
All tissues are composed of the lymphatic system, a dense network of vessels similar to the blood system. The main difference between the two systems lies in their function: the blood is responsible for supplying the cells of our body with oxygen and the various nutrients they need while the lymph nodes collect the products of cellular waste, water and all other substances.
Lymph contains water, electrolytes and proteins, it flows through the lymphatic system in a composition very similar to that of plasma. Lymph has a higher content of white blood cells, cellular waste and foreign particles.
The lymphatic system is made up of capillaries and veins, which drain lymph to all the tissues of our body. Along this network are the lymph nodes responsible for filtering out foreign particles such as viruses, bacteria or abnormal cells (such as tumors).
The lymphatic system is heavily exploited by cancer cells to move around the body and cause metastases, or secondary tumors created by the detachment of mutated cells from the original tumor.
They allow themselves to be passively transported, both in the form of single cells and small clots, through the lymph until they reach the first available lymph station. Here they can be attacked by the immune system, they can lie dormant for a long time, or they can multiply immediately. Thus, tumor spread depends on the reactivity of the immune system.
The sentinel lymph node is the first lymph node or group of lymph nodes to receive lymph directly from the tumor. The sentinel lymph node method is able to identify even minimal metastatic involvement (micrometastasis) in patients with a clinically negative axilla. The method in clinical practice should be performed by an experienced breast surgeon. Methods considered valid for finding the sentinel lymph node include the use of a dye for example patent blue or indocyanine or the use of a radioactive tracer or a combination of methods.
The pigment can be injected under the skin in an amount of 0.2-0.4 ml by performing a gentle massage of the injection area. If the radioactive tracer method is used, colloidal particles of human albumin, 20 to 80 m in size (Nanocoll) labeled with 99mTc are used. The solution is inoculated with a 25 G needle by injection under the dermis into the breast lesion. To detect the sentinel lymph node the surgeon makes a small incision in the armpit.κοιλότητα.