scholarly journals Axillary Imaging Following a New Invasive Breast Cancer Diagnosis—A Radiologist’s Dilemma

2021 ◽  
Author(s):  
Vandana Dialani ◽  
Basak Dogan ◽  
Katerina Dodelzon ◽  
Brian N Dontchos ◽  
Neha Modi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Molecular Subtype ◽  
Treatment Plan ◽  
Clinical Stage ◽  
Breast Cancer Diagnosis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Axillary Metastasis ◽  
Image Guided

Abstract Traditionally, patients with newly diagnosed invasive breast cancer underwent axillary US to assess for suspicious axillary lymph nodes (LNs), which were then targeted for image-guided needle biopsy to determine the presence of metastasis. Over the past decade, there has been a shift towards axillary preservation. For patients with palpable lymphadenopathy, the decision to perform axillary imaging with documentation of the number and location of abnormal LNs in preparation for image-guided LN sampling is straightforward. Since LN involvement correlates with cancer size, it is reasonable to image the axilla in patients with tumors larger than 5 cm; however, for tumors smaller than 5 cm, axillary imaging is often deferred until after the tumor molecular subtype and treatment plan are established. Over the last decade, neoadjuvant chemotherapy (NACT) is increasingly used for smaller cancers with more aggressive molecular subtypes. In most cases, detecting axillary metastasis is critical when deciding whether the patient would benefit from NACT. There is increasing evidence that abnormal axillary US findings correlates with LN metastases and reliably establishes a baseline to monitor response to NACT. Depending on hormone receptor status, practices may choose to image the axilla in the setting of clinical stage T1 and T2 cancers to evaluate nodal status and help determine further steps in care. Radiologists should understand the nuances of axillary management and the scope and challenges of LN marking techniques that significantly increase the precision of limited axillary surgery.

scholarly journals Fat-enlarged axillary lymph nodes are associated with node-positive breast cancer in obese patients

2021 ◽  
Author(s):  
Roberta M. diFlorio-Alexander ◽  
Qingyuan Song ◽  
Dennis Dwan ◽  
Judith A. Austin-Strohbehn ◽  
Kristen E. Muller ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Invasive Breast Cancer ◽  
Breast Mri ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Obese Women ◽  
Axillary Metastases ◽  
Node Positive ◽  
Positive Breast Cancer

Abstract Purpose Obesity associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer. Methods This retrospective case–control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-treatment and pre-operative breast MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion. Results A strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting axillary metastasis, and this increased to 0.77 when combined with patient and tumor characteristics. Conclusion Fat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

scholarly journals Fat-enlarged Axillary Lymph Nodes are Associated with Node-Positive Breast Cancer in Obese Patients

2021 ◽  
Author(s):  
Roberta M. diFlorio-Alexander ◽  
Qingyuan Song ◽  
Dennis Dwan ◽  
Judith A. Austin-Strohbehn ◽  
Kristen E. Muller ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Invasive Breast Cancer ◽  
Breast Mri ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Obese Women ◽  
Axillary Metastases ◽  
Node Positive ◽  
Positive Breast Cancer

AbstractPurposeObesity-associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer.MethodsThis retrospective case-control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-operative MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer diagnosed between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion.ResultsA strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI: 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting node-positive breast cancer and this increased to 0.80 when combined with patient and tumor characteristics.ConclusionFat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

Measuring standards of care for early breast cancer in an insured population.

1997 ◽  
Vol 15 (4) ◽  
pp. 1401-1408 ◽  
Author(s):  
B E Hillner ◽  
M K McDonald ◽  
L Penberthy ◽  
C E Desch ◽  
T J Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ct Scan ◽  
Bone Scan ◽  
Best Practice ◽  
Clinical Stage ◽  
Primary Treatment ◽  
Standards Of Care ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
International Consensus

PURPOSE To demonstrate the use of a combined data base to evaluate the care for local/regional invasive breast cancer in a large insured population of women aged less than 64 years. PATIENTS AND METHODS We linked the procedural and hospital claims from Blue Cross Blue Shield (BCBS) of Virginia with clinical stage data from the Virginia Cancer Registry (VCR) from 1989 to 1991. A total of 918 women were assessed with a median age of 50 years; 68% had tumors less than 2 cm, 30% had positive axillary nodes, and 68% were assessed as having local summary stage. A quality-of-care "report card" was used based on standards of care from international Consensus Conferences. RESULTS Eight percent had a mastectomy as the initial biopsy procedure. Sixty-nine percent of women ultimately underwent mastectomy. Of those women who underwent lumpectomy, 86% had subsequent radiation. Within 3 months of diagnosis, 43% had a bone scan and 20% a computed tomography (CT) scan. Of women with positive axillary lymph nodes, 83% aged less than 51 years and 52% aged 51 to 64 years received chemotherapy. Fifty-six percent of all women had claims from a medical oncologist. Of women having a total mastectomy, 27% had claims from a plastic surgeon. Sixty-six percent to 76% of women had a mammogram, 24% a bone scan, and 14% a CT scan in the 0-18 and 18-36 month intervals following primary treatment. CONCLUSION This study confirms the feasibility of linking sources of data that provide complementary information needed to develop measurements regarding standards of quality and efficiency of oncologic care. This report should serve as an initial benchmark while we await reports from other populations to define the best practice.

Cathepsin D in Breast Cancer Tissue

1990 ◽  
Vol 5 (4) ◽  
pp. 203-206 ◽  
Author(s):  
P. Gonzalez Gancedo ◽  
M.L. G-Casaus ◽  
J. Ruiz Cacho ◽  
F. Calero ◽  
J.M. Inocente ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cathepsin D ◽  
Clinical Stage ◽  
Point Of View ◽  
Axillary Lymph Nodes ◽  
Cancer Tissue ◽  
Axillary Lymph ◽  
Statistical Point ◽  
High Concentrations ◽  
Dependent State

The cathepsin D concentration in 18 women with benign breast pathology has a cut-off value of 43 pmol/mg of protein. High values have been detected in two cases of chronic mastitis. These high values of cathepsin D were found in a study of 62 patients suffering from breast cancer and are independent of the hormone dependent state of the tumour. The cathepsin D concentration may have a prognostic function in breast cancer determination, as high concentrations are found in combination with other prognostic factors such as clinical stage, size of the tumour, state of the axillary lymph nodes and in the histological differentiation grade, where from a statistical point of view, the combination is important.

Preoperative Sonographic Assessment of Axillary Lymph Nodes in Newly Diagnosed Invasive Breast Cancer

2019 ◽  
Vol 22 (2) ◽  
pp. 130-141
Author(s):  
Kin Hoi Wong ◽  
Yan Lin Li ◽  
Max Kai Ho Yam ◽  
Hillary Ka Ying Tam ◽  
Godfrey Kwok Fai Tam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Invasive Breast Cancer ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Newly Diagnosed ◽  
Sonographic Assessment

scholarly journals c-Met overexpression in breast cancer with positive axillary lymph node

2019 ◽  
Vol 7 (10) ◽  
pp. 3627
Author(s):  
Huswatun Hasanah ◽  
Rina Masadah ◽  
Berti J. Nelwan ◽  
Djumadi Achmad ◽  
Upik A. Miskad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Tumor Cells ◽  
Invasive Breast Cancer ◽  
Breast Cancer Incidence ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Metastasis

Background: Breast cancer is the second most common cancer in the world and is the most epidemic cancer in women, with approximately 1.67 million cases. Metastasis of tumor cells to other organs is a major cause of the increasing trend of mortality in breast cancer. This study aims to analyze the expression of c-Met associated with metastasis to axillary lymph nodes in invasive breast cancer.Method: The research was conducted at the Laboratory of Anatomical Pathology of Hasanuddin University Hospital. Stratified sampling was performed from January 2014 - January 2019. Immunohistochemical staining technique was applied upon 66 collected samples, followed by evaluating the c-Met expression score in invasive breast cancer group with positive and negative lymph node status.Result: c-Met overexpression was found among the invasive breast cancer incidence with lymph node metastasis. Among 50 cases with c-Met overexpression (c-Met positive), 40 cases (80%) of invasive breast cancer with lymph node metastasis were identified, while 10 cases (20%) were found in invasive breast cancer without metastasis to lymph nodes. On 16 cases with negative c-Met, 3 cases (18.8%) were found in invasive breast cancer with lymph node metastasis, and 13 cases (81.3%) in invasive breast cancer without metastasis to the lymph nodes. The statistical test results indicated a significant correlation between c-Met expression scores and metastasis to axillary lymph nodes in invasive breast cancer (p <0.001).Conclusion: As one of biomarkers, c-Met overexpression plays a vital role in the treatment of patients with invasive breast cancer to predict patient outcomes and to determine modalities. It is possible to apply c-Met overexpression to investigate aggressiveness of metastatic tumor cells in the future.

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