Rudi M. H. Roumen

Determinants of prognosis were studied in patients with breast cancer with histologically proven tumor extension to the skin without clinical evidence of distant metastases (i.e., pT4b N0–3 M0). Data were collected retrospectively on 77 consecutive patients diagnosed in one community teaching hospital over the period from 1980 to 1995. The prognostic factor of tumor size showed a 5‐year survival rate for patients with a tumor ≤3 cm of 81% compared to 45% for patients with tumors larger than 3 cm (p = 0.002). Achievement of complete remission resulted in a 5‐year survival rate of 66%, compared to 27% when complete remission was not achieved (p = 0.005). Another important prognostic factor was the development of local‐regional recurrence: the 5‐year survival rates for patients with and without local‐regional recurrence were 39% and 87%, respectively (p < 0.001). Development of local‐regional recurrence was also significantly related to tumor size (p = 0.02). Pathologic tumor size and the achievement of complete remission and local‐regional control appear to be the most important prognostic factors for survival in patients with pT4b breast cancer without distant metastases. We conclude that the finding of a pT4b breast cancer does not always imply a dismal prognosis, especially for those patients with a tumor ≤3 cm. A favorable prognosis can be expected when treatment is effective in achieving complete remission and in preventing the development of local‐regional recurrence.

Background: The sentinel node biopsy technique for breast cancer has been validated extensively in phase I and II studies. However, no data from phase III randomized clinical studies are available. It remains controversial whether a histologically negative sentinel node biopsy without further axillary dissection can be considered to be good clinical practice. Methods: One hundred consecutive patients with breast cancer who had a negative sentinel node biopsy without additional axillary dissection were studied prospectively between 1997 and 2000 in order to identify tumour recurrence and to assess the morbidity of the sentinel node procedure. Special attention was paid to axillary or locoregional recurrence, distant metastases and overall survival. One year after the procedure patients were sent a questionnaire to assess any functional impairment of the arm or shoulder. Results: Median follow-up was 24 (range 16–40) months. One patient had an axillary relapse 14 months after the initial diagnosis of breast cancer. She died after 2 years from metastatic disease. There were no other local axillary recurrences. There was a 94 per cent response rate to the questionnaire. Twelve patients developed mild disabilities, of whom two said that they had to change their hobbies, sports or daily activities owing to the sentinel node procedure. No patient developed lymphoedema or needed physiotherapy after the operation. Conclusion: When strict criteria for the sentinel node biopsy procedure are used, the sentinel node biopsy without further axillary dissection after a negative histological investigation is a safe procedure. It may therefore be considered to be the standard of care for the treatment of patients with breast cancer.