Evaluation of Breast and Axillary Lymph Node Specimens in Breast Cancer Patients Treated With Neoadjuvant Systemic Therapy

140 Background: Sentinel lymph node biopsy (SLNB) is a more sensitive and accurate nodal staging procedure than axillary lymph node dissection (ALND). Because of detailed pathologic evaluation in SLNs, more nodal micrometastases have been identified. However, it remains controversial whether to perform ALND for patients with micrometastases in SLNs and their prognostic significance is also a matter of debate. The purpose of this study is to determine the non-sentinel lymph node (NSLN) status and prognosis of the patients with micrometastatic SLNs. Methods: A prospective database of 1,012 clinically node-negative, T1-T2 breast cancer patients, who underwent SLNB from January 2002 to Dec 2010 at Keio University Hospital was analyzed. SLNs were detected using a combined method of isosulfun blue dye and small-sized technetium-99m-labeled tin colloid. Intraoperative frozen examination was performed with hematoxylin and eosin (HE) staining. SLNs, fixed and embedded in paraffin, were additionally diagnosed with HE staining and immunohistochemical (IHC) analysis. Results: Micrometastases in SLNs were found in 69 (6.8%) of 1,012 patients. Thirty eight (55.1%) of 69 patients with micrometastatic SLNs underwent immediate or delayed ALND and revealed no NSLN metastasis. Among 31 (44.9%) patients with micrometastatic SLNs who omitted ALND and axillary radiation therapy, no axillary lymph node recurrence has been observed after a median follow-up of 50 months, although 29 patients (93.5%) in these 31 patients received adjuvant systemic therapy. There is no significant difference in recurrence free survival between the patients with micrometastatic and negative SLNs (98.0% vs. 95.7%, respectively). Conclusions: These date suggested that it may not be necessary to perform ALND for the patients with micrometastatic SLNs and the presence of micrometastases in SLNs may not worsen prognosis with proper systemic therapy.

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Coverage of axillary lymph node levels using standard radiotherapy fields for breast cancer patients – what are we actually treating?

Clinical Oncology ◽

10.1016/j.clon.2016.04.028 ◽

2016 ◽

Vol 28 ◽

pp. S10

Author(s):

A. Ranger ◽

A. Kirby ◽

A. Dunlop ◽

M. Maclennan ◽

C. Coles

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Axillary Lymph Node ◽

Axillary Lymph ◽

Breast Cancer Patients

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IV-DSA is a new diagnostic tool for axillary lymph node metastasis in breast cancer patients

Journal of Surgical Oncology ◽

10.1002/jso.20088 ◽

2004 ◽

Vol 87 (2) ◽

pp. 75-79 ◽

Cited By ~ 1

Author(s):

Osamu Watanabe ◽

Tadao Shimizu ◽

Hiroshi Imamura ◽

Jun Kinoshita ◽

Yoshihito Utada ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Cancer Patients ◽

Diagnostic Tool ◽

Axillary Lymph Node ◽

Axillary Lymph Node Metastasis ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Node Metastasis

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Predictors for extensive nodal involvement in breast cancer patients with axillary lymph node metastases

The Breast ◽

10.1016/j.breast.2016.02.006 ◽

2016 ◽

Vol 27 ◽

pp. 175-181 ◽

Cited By ~ 11

Author(s):

N.C. Verheuvel ◽

H.W.A. Ooms ◽

V.C.G. Tjan-Heijnen ◽

R.M.H. Roumen ◽

A.C. Voogd

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Lymph Node Metastases ◽

Axillary Lymph Node ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

Axillary Lymph Node Metastases ◽

Node Metastases

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

10.21203/rs.3.rs-81453/v1 ◽

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.

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Role of Ultrasound in the Diagnosis of Lymph Node Status in Axillary Lymph Node Metastases in Breast Cancer undergoing Neoadjuvant Chemotherapy

10.21203/rs.2.17922/v2 ◽

2020 ◽

Author(s):

Yizhen Zhou ◽

Lei Zhang ◽

Zining Jin ◽

Hailan Yu ◽

Siyu Ren ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Axillary Lymph Node ◽

Lymph Node Status ◽

Axillary Lymph ◽

Short Axis ◽

Breast Cancer Patients ◽

Axillary Ultrasound

Abstract Background:Axillary ultrasound (AUS) is one of the important bases for evaluating the axillary status of breast cancer patients. And it would be helpful for the reassessment of axillary lymph node status in these patients after neoadjuvant chemotherapy(NAC) and guide the selection of their axillary surgical options.The purpose of this study was to evaluate the diagnostic performance of ultrasound,and to find out the factors related to the outcome of ultrasound.Methods:In this retrospective analysis, 172 patients (one bilateral breast cancer) with breast cancer and clinical positive axillary nodes, were enrolled. After NAC, all patients received mastectomy and axillary lymph node dissection (ALND). AUS was used before and after NAC to assess the axilla status. Results:Of the 173 axillae, 137 (79.19%) had pathological metastasis after NAC. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of axillary ultrasound in this cohort were 68.21%, 69.34%, 63.89%, 87.96% and 35.38% respectively. Univariate analysis showed that primary axillary lymph node(ALN) short axis, progesterone receptors, hormone receptors, the tumor status after NAC, tumor reduction rate, ALN short axis after NAC, physical examination of axilla after NAC and pN impacted the results of AUS(P = 0.000 ~ 0.040). Multivariate analysis of the above indicators showed that ALN short axis after NAC and pN associated with AUS results independently. Conclusion:AUS can accurately assess axilla status after NAC in most breast cancer patients. If the short axis of ALN≥10mm and AUS negative, SLNB could be chosen. However, AUS cannot detect residual lymph node disease after NAC in a short axis of the ALN <10mm.

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