DNA content and phases cells fraction in breast cancer patients without nodal involvement

Background. Breast cancer treatment has rapidly changed in the last few years. Particularly, treatment of patients with axillary nodal involvement has evolved after publication of several randomized clinical trials. Omitting axillary lymph node dissection in selected early breast cancer patients with one or two positive sentinel nodes did not compromise overall survival nor regional disease control in these trials. Hence, either excluding or identifying extensive axillary nodal involvement becomes increasingly important. Purpose. To evaluate whether the current diagnostic modalities can accurately identify or exclude extensive axillary nodal involvement. Evaluated modalities were axillary ultrasound, ultrasound-guided needle biopsy, MRI, and PET/CT. Methods. A literature search was performed in the Cochrane Library, EMBASE, and PubMed databases up to June 2019. The search strategy included terms for breast cancer, lymph nodes, and the different imaging modalities. Only articles that reported pathological N-stage or the total number of positive axillary lymph nodes were considered for inclusion. Studies with patients undergoing neoadjuvant systemic therapy were excluded. Conclusion. There is no evidence that any of the current preoperative axillary imaging modalities can accurately exclude or identify breast cancer patients with extensive nodal involvement. Both negative PET/CT and negative MRI scans (with gadolinium-based contrast agents) are promising in excluding extensive nodal involvement. Larger studies should be performed to strengthen this conclusion. False-negative rates of axillary ultrasound and ultrasound-guided needle biopsy are too high to rely on negative results of these modalities in excluding extensive nodal involvement.

Download Full-text

Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy

The Breast ◽

10.1016/j.breast.2015.07.016 ◽

2015 ◽

Vol 24 (5) ◽

pp. 637-641 ◽

Cited By ~ 5

Author(s):

Jae Myoung Noh ◽

Kyung Hwan Kim ◽

Won Park ◽

Chang Ok Suh ◽

Seung Jae Huh ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Systemic Treatment ◽

Clinical Stage ◽

Prognostic Significance ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

Stage Iiic ◽

Treatment Surgery

Download Full-text

Re-evaluating the efficacy of axillary ultrasound in the detection of nodal metastasis and its impact on clinical practice.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.4 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 4-4

Author(s):

B. Lee ◽

A. Lim ◽

J. Krell ◽

K. Satchithananda ◽

J. S. Lewis ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Cortical Thickness ◽

Axillary Node ◽

Axillary Node Dissection ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

Node Dissection ◽

Axillary Ultrasound

4 Background: Recent reports have indicated a lack of overall survival benefit for axillary node dissection versus sentinel lymph node biopsy in early breast cancer. To study this further, we wished to assess the accuracy and effectiveness of ultrasound guided fine needle aspiration (FNA) cytology in detecting lymph node involvement in breast cancer patients, in order to refine and evaluate our current clinical pathways as newly diagnosed invasive breast cancer patients routinely undergo pre-surgical axillary ultrasound. Methods: An FNA was taken from nodes of consecutive patients, which appeared abnormal on ultrasonography based on size, morphology, fatty hilum and cortical thickness measurements. Ultrasound and FNA cytological findings were correlated with histology following axillary node dissection. Of 260 cases, 123 (47.3%) had metastatic nodal involvement. Of these cases, only 66 (53.7%) were reported as positive on US findings. Results: The overall positive predictive value (PPV) of ultrasound for detecting metastatic nodal involvement measured 0.82, and the negative predictive value (NPV) was 0.60. The sensitivity was 0.54, specificity measured 0.85 and the accuracy was 0.68. The ultrasound morphological nodal features with the greatest correlation with malignancy were absence of a fatty hilum (p=0.003) and an increased cortical thickness (p=0.03). Cases with a metastatic nodal burden density of a least 20% were also more likely to be detected as abnormal on axillary ultrasound. (p=0.009). Conclusions: Axillary ultrasound has a low NPV and negative sonographic results do not exclude node metastases with sufficient sensitivity in most cases, to justify its routine clinical use. [Table: see text]

Download Full-text

Implications prognostics of methylation 14-3-3 sigma promoter in peripheral blood cell DNA with nodal involvement status and tumor size for breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.33 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 33-33

Author(s):

Joaquina Martínez-Galán ◽

Cynthia S. González Rivas ◽

Julia Ruiz Vozmediano ◽

Pedro Ballesteros ◽

Juan Ramón Delgado ◽

...

Keyword(s):

Breast Cancer ◽

Cell Cycle ◽

Tumor Suppressor ◽

Cancer Patients ◽

Tumor Size ◽

Cell Cycle Checkpoint ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

M Cell ◽

Frequent Event

33 Background: Expression of 14-3-3 σ is a tumor suppressor gene induced in response to DNA damage, and has been implicated in G2/M cell cycle arrest by p53. Hypermethylation of CpG islands located in the promoter regions of tumor suppressor genes is now firmly established as an important mechanism for gene inactivation. To correlation methylation levels of promoter 14-3-3σ with association prognostic factors in breast cancer. Methods: This is a prospective study we quantified methylation levels of promoter 14-3-3σ gene in 107 women with breast cancer and 108 control subjects by Real Time QMS-PCR SYBR green and analyzed association with prognostics factor in breast cancer. Results: Median age was 58 years (32-88); 69% were postmenopausal women. Nodal involvement N0; 63%,N1;30%,N2;7%), tumor size (T1;58%,T2;35%,T3;4%,T4;4%) and grade G1; 20%,G2;37%,G3;30%). The methylation of 14-3-3σ were 60% of sporadic breast cancer patients and were 34% of normal breast (p=0.0047). The methylation of 14-3-3σ gene in serum was markedly related with T3-4 stage (p<0.05),nodal positive status (p<0.05) and poor outcome. With a median follow up 6 years we saw more probability of developing distance metastasis in patients with methylation 14-3-3σ (p>0.05). Conclusions: Hypermethylation of the 14-3-3σ a promoter is an early and frequent event in breast neoplastic transformation, leading to the suggestion that silencing of 14-3-3σ may be an important event in tumor progression and particularly in breast carcinogenesis.Therefore, it is possible that loss of σ expression contributes to malignant transformation by impairing the G2 cell cycle checkpoint function, thus allowing an accumulation of genetic defects. Perhaps in the detection of CpG methylation of 14-3-3σ may be used for diagnostic and prognostic purposes.

Download Full-text

The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e21137 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e21137-e21137

Author(s):

Belinda Lee ◽

Adrian K. Lim ◽

Jonathan Krell ◽

Keshthra Satchithananda ◽

Jacqueline S Lewis ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Cortical Thickness ◽

Predictive Value ◽

Clinical Pathways ◽

Axillary Node ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

Axillary Ultrasound

e21137 Background: Recent reports indicate a lack of survival benefit for axillary node dissection (ALND) versus sentinel lymph node biopsy in early breast cancer. To study this further we assessed the accuracy and effectiveness of ultrasound in detecting axillary nodal involvement in breast cancer patients, aimed at refining and evaluating our current clinical pathways as newly diagnosed invasive breast cancer patients routinely undergo pre-surgical axillary ultrasound. Methods: Ultrasound data were collected from consecutive breast cancer cases over 3 years. Images were reviewed by experienced radiologists and made the following assessments on size, morphology, fatty hilum and cortical thickness of the ipsilateral axillary nodes. The findings were correlated with histology outcomes following ALND. Results: 260 cases were included in the analysis, 113 (43.5%) had evidence of metastatic nodal involvement at final histology. Of these, 59/113 (52.2%) reported positive findings on ultrasonography. The overall positive predictive value of ultrasound for detecting metastatic nodal involvement measured 0.70. The negative predictive value was 0.61. The sensitivity was 52%, specificity measured 78% and the accuracy was 65%. The ultrasound morphological lymph node features with the greatest correlation with malignancy were absence of a fatty hilum (p=0.003) and increased cortical thickness (p=0.03). Cases with a metastatic nodal burden density of a least 20% were more likely to report an abnormal axillary ultrasound. (p=0.009). Conclusions: Axillary ultrasound has a low NPV and negative sonographic results do not exclude axillary node metastases with sufficient sensitivity, to justify its routine clinical use. Clinical pathways need to consider an evidence-based approach, focusing on the criteria by which we select breast cancer patients for axillary nodal dissection.

Download Full-text