scholarly journals Improved detection of sentinel lymph node metastases allows reliable intraoperative identification of patients with extended axillary lymph node involvement in early breast cancer

2020 ◽  
Author(s):  
Cristina L. Cotarelo ◽  
Annemarie Zschöck-Manus ◽  
Marcus Schmidt ◽  
Arno Schad ◽  
Christoph Brochhausen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Breast Cancer ◽  
Axillary Lymph Node ◽  
Frozen Section ◽  
Histological Diagnosis ◽  
Axillary Lymph ◽  
Accurate Identification ◽  
Ki 67

Abstract Background An improved procedure that allows accurate detection of negative sentinel lymph node (SLN) and of SLN macrometastases during surgery would be highly desirable in order to protect patients from further surgery and to avoid unnecessary costs. We evaluated the accuracy of an intraoperative procedure that combines touch imprint cytology (TIC) and subsequent frozen section (FS) analysis. 2276 SLNs from 1072 patients with clinical node-negative early breast cancer were evaluated during surgery using TIC. Only cytologically-positive SLN were subsequently analysed with a single FS, preserving cytologically-negative SLN for the final postoperative histological diagnosis. Sensitivity, specificity and the accuracy of this approach were analysed by comparing the results from intra- and postoperative SLN and axillary node evaluation. This intraoperative method displayed 100% specificity for SLN metastases and was significantly more sensitive for prognostically relevant macrometastases (85%) than for micrometastases (10%). Sensitivity was highest for patients with two or more positive LNs (96%) than for those with only one (72%). 98% of the patients with final pN2a-pN3a were already identified during surgery. Patients who received primary axillary lymph node dissection had significantly more frequent metastases in further LNs (44.6%). Sensitivity was highest for patients with luminal-B, HER2+ and triple negative breast cancer and for any subtype if Ki-67 > 40%. TIC and subsequent FS of cytologically-positive SLNs is highly reliable for detection of SLN macrometastases, and allows accurate identification of patients with a high risk of extended axillary involvement during surgery, as well as accurate histological diagnosis of negative SLN.

scholarly journals Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy

2019 ◽  
Vol 18 ◽  
pp. 153303381882110 ◽  
Author(s):  
Willard Wong ◽  
Illana Rubenchik ◽  
Sharon Nofech-Mozes ◽  
Elzbieta Slodkowska ◽  
Carlos Parra-Herran ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Neoadjuvant Therapy ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Frozen Section ◽  
Axillary Lymph ◽  
Node Dissection

Background: Shift toward minimizing axillary lymph node dissection in patients with breast cancer post neoadjuvant therapy has led to the assessment of sentinel lymph nodes by frozen section intraoperatively to determine the need for axillary lymph node dissection. However, few studies have examined the accuracy of sentinel lymph node frozen section after neoadjuvant therapy. Our objective is to compare the accuracy of sentinel lymph node frozen section in patients with breast cancer with and without neoadjuvant therapy and to identify features that may influence accuracy. Design: We identified 161 sentinel lymph node frozen section from 77 neoadjuvant therapy patients and 255 sentinel lymph node frozen section from 88 non-neoadjuvant therapy patients diagnosed between 2010 and 2016 in 2 institutions. The frozen section diagnoses were compared to the final diagnoses, and clinicopathologic data were analyzed. Results: The sensitivity, specificity, and accuracy of frozen section analysis were comparable between neoadjuvant therapy patients and non-neoadjuvant therapy patients (71.9% vs 50%, 100% vs 100%, and 88.3% vs 81.8%). Nine (11.7%) of 77 neoadjuvant therapy patients had discordant results, most often due to undersampling (tumor absent on frozen section slide). Four of these patients subsequently underwent axillary lymph node dissection. Discordant results (all false negatives) were significantly more likely in neoadjuvant therapy patients with Estrogen Receptor-positive/HER2-negative status, and in sentinel lymph node with pN1mic and pN0i+ deposits; age, preneoadjuvant therapy lymph node status, histotype, nuclear grade, tumor size, and response to neoadjuvant therapy showed no significant differences. For non-neoadjuvant therapy cases, large tumor size, lobular histotype, and sentinel lymph node with pN1mic and pN0i+ were associated with false-negative frozen section assessment. Conclusion: Sentinel lymph node frozen section diagnosis post-neoadjuvant therapy has comparable sensitivity, specificity, and accuracy to the sentinel lymph node frozen section diagnosis in the non-neoadjuvant therapy setting.

scholarly journals Practical consensus recommendations regarding the management of sentinel lymph node issues in early breast cancer

2018 ◽  
Vol 07 (02) ◽  
pp. 132-136
Author(s):  
Vedant Kabra ◽  
R. Aggarwal ◽  
S. Vardhan ◽  
M. Singh ◽  
R. Khandelwal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Breast Cancer ◽  
Axillary Lymph Node ◽  
Clinical Staging ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Poor Prognostic Factor ◽  
Consensus Recommendations

AbstractAxillary lymph node involvement is a very important poor prognostic factor in the clinical staging and management of breast cancer patients. Traditionally, axillary lymph node dissection (ALND) has been used for determining the status of the axillary lymph nodes. More recently the sentinel lymph node biopsy (SLNB) procedure has gained wider acceptance as the standard of care, having the advantage of being less invasivewhile providing good accuracy. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of the two different procedures and other issues in patients with early breast cancer for the benefit of community oncologists.

Evaluating One Day versus Two Days Preoperative Lymphoscintigraphy Protocols for Sentinel Lymph Node Biopsy in Breast Cancer

2015 ◽  
Vol 81 (5) ◽  
pp. 454-457 ◽  
Author(s):  
Michael G. Mount ◽  
Nicholas R. White ◽  
Christophe L. Nguyen ◽  
Richard K. Orr ◽  
Robert B. Hird
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Axillary Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Node Biopsy ◽  
Node Negative Breast Cancer

Sentinel lymph node biopsy (SLNB) is used to detect axillary lymph node metastases in breast cancer. Preoperative radiocolloid injection with lymphoscintigraphy (PL) is performed before SLNB. Few comparisons between 1- and 2-day PL protocols exist. Opponents of a 2-day protocol have expressed concerns of radiotracer washout to nonsentinel nodes. Proponents cite lack of scheduling conflicts between PL and surgery. A total of 387 consecutive patients with clinically node-negative breast cancer underwent SLNB with PL. Lymphoscintigraphy images were obtained within 30 minutes of radio-colloid injection. Axillary lymph node dissection was performed if the sentinel lymph node (SLN) could not be identified. Data were collected regarding PL technique and results. In all, 212 patients were included in the 2-day PL group and 175 patients in the 1-day PL group. Lymphoscintigraphy identified an axillary sentinel node in 143/212 (67.5%) of patients in the 2-day group and 127/175 (72.5%) in the 1-day group ( P = 0.28). SLN was identified at surgery in 209/212 (98.6%) patients in the 2-day group and 174/175 (99.4%) in the 1-day group ( P = 0.41). An average of 3 SLN was found at surgery in the 2-day group compared with 3.15 in the 1-day group ( P = 0.43). SLN was positive for metastatic disease in 54/212 (25.5%) patients in the 2-day group compared with 40/175 (22.9%) in the 1-day group ( P = 0.55). A 2-day lymphoscintigraphy protocol allows reliable detection of the SLN, of positive SLN and equivalent SLN harvest compared with a 1-day protocol. The timing of radiocolloid injection before SLNB can be left at the discretion of the surgeon.

Expression of CXCR4 is associated with axillary lymph node status in patients with early breast cancer

The Breast ◽  
2006 ◽  
Vol 15 (4) ◽  
pp. 533-539 ◽  
Author(s):  
Y.-C. Su ◽  
M.-T. Wu ◽  
C.-J. Huang ◽  
M.-F. Hou ◽  
S.-F. Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Early Breast Cancer ◽  
Axillary Lymph Node ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Axillary Lymph Node Status ◽  
Node Status

scholarly journals The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

2020 ◽  
Author(s):  
Na Liu ◽  
Liu Yang ◽  
Xinle Wang ◽  
Meiqi Wang ◽  
Ruoyang Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
Histological Grade ◽  
False Negative ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Ki 67 ◽  
Axillary Surgery

Abstract Background: Axillary lymph node dissection can be avoided in early stage breast cancer patients with negative sentinel lymph node biopsy. However, the possibility of avoiding axillary surgery in patients without axillary lymph node metastasis (ALNM) by preoperative imaging is still under exploration. Thus, the objectives of this study were to investigate the high-risk factors of false negative of ALNM diagnosed by preoperative ultrasound (US) and to find out who could be avoided axillary surgery in the US negative ALNM patients.Methods: This study retrospectively analyzed 3,361 patients with primary early breast cancer diagnosed in the Breast Center of the Fourth Hospital of Hebei Medical University from January 2010 to December 2012. All patients had undergone routine preoperative US and then axillary lymph node dissected. This study investigated the clinicopathological features of axillary lymph node (ALN) negative patients diagnosed by preoperative US and its correlation with prognosis. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 2,357 patients. Results: The sensitivity, specificity and accuracy of axillary US in this cohort were 66.24%, 76.62% and 73.87%. The proportion of patients in the false negative group was higher than that in true negative in the group of age < 50 years old (P = 0.002), tumor size > 2cm (P = 0.008), estrogen receptor (ER) positive (P = 0.005), progesterone receptor (PR) high expression (P = 0.007), nuclear-associated antigen Ki-67 (Ki-67) >20% (P = 0.030), visible vascular tumor thrombus (P < 0.001) and histological grade>2 (P < 0.001). Prognostic analysis of false negative and true negative ultrasonographic diagnosis of ALN metastasis: when ALNM was not found by preoperative ultrasound, there was no significant difference in patients with ALNM≤3 compared with patients without lymph node metastasis in patients of age ≥ 50 years old, tumor size ≤ 2cm, Ki-67 ≤ 20%, or histological grade ≤ 2. Conclusion: The surgery of ALN may be avoided for the preoperative US diagnosed ALNs negative in early breast cancer patients who had advanced age, small tumor size, low expression of Ki-67 and low histological grade.

Developing and validating deep learning-based heterogeneous model to improve diagnostic performance of ultrasound elastography for axillary lymph node metastasis of early breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12583-e12583
Author(s):  
Jian Li ◽  
Cai Nian ◽  
Xie Ze-Ming ◽  
Zhou Jingwen ◽  
Huang Kemin
Keyword(s):  
Breast Cancer ◽  
Deep Learning ◽  
Lymph Node ◽  
Early Breast Cancer ◽  
Predictive Value ◽  
Axillary Lymph Node ◽  
Diagnostic Performance ◽  
Ultrasound Elastography ◽  
Axillary Lymph ◽  
Heterogeneous Model

e12583 Background: To improve the performance of ultrasound (US) for diagnosing metastatic axillary lymph node (ALN), machine learning was used to reveal the inherently medical hints from ultrasonic images and assist pre-treatment evaluation of ALN for patients with early breast cancer. Methods: A total of 214 eligible patients with 220 breast lesions, from whom 220 target ALNs of ipsilateral axillae underwent ultrasound elastography (UE), were prospectively recruited. Based on feature extraction and fusion of B-mode and shear wave elastography (SWE) images of 140 target ALNs using radiomics and deep learning, with reference to the axillary pathological evaluation from training cohort, a proposed deep learning-based heterogeneous model (DLHM) was established and then validated by a collection of B-mode and SWE images of 80 target ALNs from testing cohort. Performance was compared between UE based on radiological criteria and DLHM in terms of areas under the receiver operating characteristics curve (AUC), sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for diagnosing ALN metastasis. Results: DLHM achieved an excellent performance for both training and validation cohorts. In the prospectively testing cohort, DLHM demonstrated the best diagnostic performance with AUC of 0.911(95% confidence interval [CI]: 0.826, 0.963) in identifying metastatic ALN, which significantly outperformed UE in terms of AUC (0.707, 95% CI: 0.595, 0.804, P<0.001). Conclusions: DLHM provides an effective, accurate and non-invasive preoperative method for assisting the diagnosis of ALN metastasis in patients with early breast cancer.[Table: see text]

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