Breast cancer surgery for the 21st century: the continuing evolution of minimally invasive treatments.
Since the 1950s, breast cancer surgery has been moving towards less invasive approaches for managing breast cancer, with sentinel lymph node biopsy (SLNB) and breast conservation therapy (BCT) now representing the standard of care for the majority of patients. Even as the use of SLNB is expanding to include patient groups that were previously thought to be poor candidates, questions remain about the optimal management of patients who are clinically node-negative but SLN-positive, since more than half of these patients will prove to be pathologically node-negative. Various approaches are being developed to identify and treat those SLN-positive patients who are likely to have additional positive lymph nodes. The clinical significance of microscopic lesions in the SLN detected by immunohistochemistry continues to be debated--current standards recommend that isolated tumor cells (lesions no larger than 0.2 mm) be classified as pN0--but a definitive answer to this question awaits the completion of further studies. The unresolved questions about the best use of SLNB could become irrelevant with the ongoing development of new molecular prognostic indicators that may replace axillary lymph node status. Similarly, researchers are exploring ways of replacing BCT with ablation techniques that can remove the primary tumor without surgery. Although radiofrequency ablation, focused ultrasound, cryosurgery, and other approaches have captured the imagination of patients and clinicians alike, many technical difficulties remain. Among the most significant of these is the lack of truly precise imaging to locate tumors, estimate their true size, and follow treatment in real-time. These deficits may be filled by future developments in functional imaging (e.g., positron emission tomography) and nanobiotechnology.
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Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030-4095, USA. esinglet@mdanderson.org
D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome