scholarly journals The St. Gallen 2019 Guidelines understages the Axilla in Lobular Breast Cancer a Population-Based Study

2021 ◽  
Author(s):  
Ulrik Narbe ◽  
Par-Ola Bendahl ◽  
Marten Ferno ◽  
Christian Ingvar ◽  
Looket Dihge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Axillary Lymph Node ◽  
Study Cohort ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Luminal A ◽  
National Quality

Background The St. Gallen 2019 guidelines recommend omission of completion axillary lymph node dissection (cALND) in breast cancer patients with 1-2 sentinel lymph node (SLN) metastases regardless of histopathology. Concurrently, adjuvant chemotherapy is endorsed for luminal A-like disease with ≥4 axillary lymph node (ALN) metastases. We aimed to estimate the proportion of patients with invasive lobular cancer (ILC) and invasive ductal cancer of no special type (NST) and 1-2 SLN metastases for whom cALND would indicate need of adjuvant chemotherapy. Methods Patients with ILC and NST histopathology undergoing primary surgery 2014-2017 were identified in the Swedish National Quality Breast Cancer register. After exclusion of patients with incongruent or missing data, 1886 patients who fulfilled the St. Gallen 2019 criteria for cALND omission were included in the study cohort. Results Patients with ILC (n = 329) had a higher metastatic nodal burden and more often a luminal A-like subtype compared with NST patients (n = 1507). The prevalence of ≥ 4 ALN metastases was higher in ILC (31%) than in NST (15%), corresponding to an adjusted odds of 2.26 (95% CI 1.59-3.21). Luminal A-like breast cancers with ≥4 ALN metastases were overrepresented in ILC cases (52/281 (19%)) compared to NST cases (43/1299 (3%)), P<0.001. Conclusions Patients with ILC more often had a luminal A-like breast cancer with ≥4 ALN metastases compared with NST patients. Abstaining cALND in patients with luminal A-like ILC with 1-2 SLN metastases warrants future attention as it risks nodal understaging and hence undertreatment in one-fifth of these patients.

Prediction of the non-sentinel node metastasis in patients without clinically axillary lymph node metastasis, with implication of breast cancer subtypes.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13060-e13060
Author(s):  
Shusei Tominaga
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Axillary Lymph Node ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Luminal A ◽  
Node Metastasis

e13060 Background: The accuracy of the nomogram about non-sentinel lymph node metastasis (NSLNM ) in breast cancer patients is still controversial to avoid axillary dissection particularly sentinel lymph node biopsy was positive. The aim of this study was to evaluate the necessity of adding breast cancer subtypes to the NSLNM nomgram variables. Methods: Between 2009 and 2011, consecutive breast cancer patients without clinically axillary lymph node metastasis (n=140) who received sentinel lymph node biopsy at Higashiosaka General Hospital were studied retrospectively. Twenty-two patients were turned out that breast cancer already spread to the sentinel nodes and all of 22 patients received complete axillary lymph node dissection. Results: Twelve patients had only sentinel lymph node metastases(Group S), 10 patients had non-SLN metastases (Group A). Patient characteristics and average probability of spread to additional lymph node developed by Memorial Sloan-Kettering Cancer Center (MSKCC) Nomogram were almost the same results in both groups. However, subtypes of Group S consisted of 8 HER2 positive , 2 triple negative, and 2 luminal A cases, subtypes of Group A consisted of 4 luminal A and 6 luminal B cases. Conclusions: Our data suggested that luminal type breast cancer tends to spread to non-sentinel lymph node metastasis and adding HER2, Ki-67, and intrinsic biological subtypes may improve predictivity of MSKCC nomogram.

Adjuvant chemotherapy for breast cancer patients with axillary lymph node micrometastases

2021 ◽  
Author(s):  
Madeleine Hetterich ◽  
Michael Gerken ◽  
Olaf Ortmann ◽  
Elisabeth C. Inwald ◽  
Monika Klinkhammer-Schalke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Lymph Node Micrometastases

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

2004 ◽  
Vol 87 (2) ◽  
pp. 75-79 ◽  
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

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.

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

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.

Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection

Breast Cancer ◽  
2019 ◽  
Vol 27 (2) ◽  
pp. 284-290 ◽  
Author(s):  
Yoshiteru Akezaki ◽  
Eiji Nakata ◽  
Masato Kikuuchi ◽  
Ritsuko Tominaga ◽  
Hideaki Kurokawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Dissection
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