Positive Axillary Lymph Node Number Rather Than Total Lymph Node Number Removed Associates With Arm Lymphedema Among Postoperative Breast Cancer Patients Over Radiation Therapy Course

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.

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False-Negative Frozen Section of Sentinel Nodes in Early Breast Cancer Patients

10.21203/rs.3.rs-307059/v1 ◽

2021 ◽

Author(s):

Zhu-Jun Loh ◽

Kuo-Ting Lee ◽

Ya-Ping Chen ◽

Yao-Lung Kuo ◽

Wei-Pang Chung ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Frozen Section ◽

False Negative ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Frozen Sections ◽

Sentinel Nodes ◽

Tumor Emboli

Abstract Background: Sentinel lymph node biopsy (SLNB) is the standard approach of the axillary region for early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes of intraoperative frozen section (FNSNs) in real-world data.Methods: A case–control study with a 1:3 ratio was conducted. FNSN was diagnosed when sentinel nodes (SNs) are negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections.Results: A total of 20 FNSN cases and 60 matched controls were enrolled from 333 SLNB patients between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had larger tumor sizes in preoperative mammography (P = 0.033) and more lymphatic tumor emboli in core biopsy (P < 0.001). Four FNSN patients had metastasis in the non-relevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from the FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in non-relevant SNs were recognized in two patients. All FNSN patients received a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were not inferior to the controls.Conclusions: The patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, outcomes of FNSN patients after completing ALND were noninferior to those without metastasis in SNs. ALND provides a correct diagnosis of patients with metastasis in non-sentinel axillary lymph nodes.

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EARLY COMPLICATIONS AFTER RADICAL OPERATIONS IN BREAST CANCER PATIENTS

EUREKA Health Sciences ◽

10.21303/2504-5679.2020.001119 ◽

2020 ◽

Vol 1 ◽

pp. 3-9

Author(s):

Yuri Vinnyk ◽

Vadym Vlasenko ◽

Anna Baranova

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Wound Infection ◽

Cancer Patients ◽

Lymph Node Dissection ◽

Early Period ◽

Radical Mastectomy ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Node Dissection

Breast cancer is one of the most common malignancies in women. In many cases, a major component of complex treatment for breast cancer is surgery - radical mastectomy or radical breast resection. The aim of the work – to investigate the frequency and structure of complications after radical surgery with dissection of axillary lymph nodes in breast cancer patients. Material and methods. The baseline and surgical results of 147 women with breast cancer who underwent radical mastectomy or radical breast resection with lymph node dissection were analysed. Results. Complications in the early period after surgery for breast cancer were found in 76 (51.7 %), including postoperative extremity edema in 60 (40.8 %); lymphorrhea – in 37 (25.2 %), seroma – in 33 (22.4 %); wound infection in 18 (12.2 %), necrosis of the wound edges – in 15 (10.2 %) patients. Correlation of postoperative edema with almost all other complications was found, lymphorrhea and seroma were most associated with swelling and with each other; necrosis of edges with postoperative edema. Wound infection was significantly associated with lymphorrhea. Patients' age, stage of disease, and immunohistochemical type of tumour did not affect the development of complications. With increasing BMI, the incidence of complications increased significantly (χ2=9.530; p=0.009). The tendency to decrease the frequency of complications during reconstructive surgery was revealed (42.6 % versus 58.1 %, p=0.064), and adjuvant radiotherapy, on the contrary, contributed to the increase of complications (57.8 % versus 43.8 %, p=0.090). Conclusion. Radical operations with lymph node dissection in patients with breast cancer are characterized by a high frequency of early postoperative complications, mainly associated with disorders of lymphatic outflow, which indicates the need for a set of measures of preoperative preparation, improvement of surgical technique.

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Rate of sentinel lymph node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand

Asian Biomedicine ◽

10.5372/1905-7415.0804.322 ◽

2014 ◽

Vol 8 (4) ◽

pp. 517-524

Author(s):

Kampol Ratchaworapong ◽

Sarawut Thanawut ◽

Sirisanpang Yodavudh ◽

Suthat Chottanapund

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Cancer Patients ◽

Primary Breast Tumor ◽

Blue Dye ◽

Axillary Lymph ◽

Isosulfan Blue ◽

Breast Cancer Patients ◽

Isosulfan Blue Dye

Abstract Background: The sentinel lymph node (SLN) is the first lymph node to receive lymphatic drainage from a primary breast tumor. If the SLN contains no metastatic tumor, then it is unlikely other lymph nodes will contain breast cancer metastasis. When the SLN does contains metastasis, an axillary lymph node dissection (ALND) is recommended to further stage the axilla and to maintain locoregional control. SLNs can be identified by using a dye, radioisotope, or combined techniques. Objective: To determine the rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand, and factors that affect it. Methods: This prospective study of 106 consecutive cases breast cancer enrolled 105 women (1 bilateral breast cancer case) between October 2011 and October 2013 at Charoenkrung Pracharak Hospital. Clinical and pathological features were analyzed for the effectiveness of SLN identification using isosulfan blue dye. Results: The rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital was 92%. The method was safe and well tolerated in early-stage breast cancer patients. Conclusion: The effectiveness of sentinel node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital is consistent with that shown in studies from other countries.

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