Breast Surgery

Introduction
At this Division, operable breast cancer patients with stage 0-IIIB are treated with surgical procedure and chemo-hormonal therapies. Since the opening of the National Cancer Center Hospital East in July 1992, about 1500 cases of primary breast cancer patients have been operated.

Routine Activities　
One hundred ninety-nine cases were treated surgically in 2001. We continue to investigate sentinel node biopsy (SNB) in clinically node-negative breast cancer since 1998. After the feasibility study on SNB followed by axillary lymph node dissection (ALND) in 200 cases during one and a half years, SNB is being examined in practice with vital blue dye (indigocarmine) or combined method of the dye and radiopharmaceuticals. In this year, 95 of the 128 cases who underwent SNB were managed with axilla-preserving surgery, because sentinel lymph nodes were proven histologically negative. Finally, modified radical mastectomy was performed in 56 cases (28%), partial mastectomy with ALND in 43 cases (22%), simple or partial mastectomy with SNB alone in95 cases (48%), and exicional biopsy alone in 5 cases (3%).
A worldwide consensus meeting on adjuvant therapies for high- risk breast cancer recommended adjuvant chemotherapy and hormonal therapy to prolong disease-free survival and overall survival. Adjuvant polychemotherapy given intravenously is recommended for node-negative high-risk, or node-positive breast cancer patients. In addition, primary chemo-hormonal therapies are one of the promising strategies for advanced breast cancer. Primary chemotherapy combined with anthracycline followed by taxan for advanced breast cancer patients is applied.

Research Activities
An international randomized clinical study of primary hormonal therapy is underway. The aim in this study is to compare tumor regression of a new aromatase inhibitor, anastazole, with that of tamoxifen, for postmenopausal breast cancer patients with positive hormonal receptor. Surgical treatment is done after primary hormonal therapy for 3 months, and the same hormonal therapy is continued for 5 years.

New Developments
SNB to minimize surgical procedure of cancer treatment is a promising surgical procedure in breast cancer. However, several clinical issues remains uncertain: optimization of SNB, management of micrometastasis in sentinel lymph nodes, radiation exposure regarding gamma-probe method, and cost benefits and quality of life after axilla-conserving surgery. Now two large randomized trials, which compare SNB with ALND are going on in the United States. However, SNB is being undergone for patients with clinically nodenegative breast cancer in practice. We must follow sentinel node-negative patients with SNB alone, and investigate the prognosis and clinical benefits in comparison to node-negative patients with ALND.

S. IMOTO

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