Colour Doppler-An Evaluation Tool for Assessment of Breast Tumour Size, Axillary Lymph Node Size and Chemotherapeutic Response

Background: The role of liver kinase B1 (LKB1), a serine/threonine kinase, has been described in the development of PeutzJagher’s syndrome, where a proportion (~45%) of patients have developed breast cancer in their lifetime. Cell line studies have linked LKB1 with oestrogen receptors (ER) and with the Adenosine monophosphate-activated protein kinase (AMPK) pathway for energy metabolism. However, limited studies have investigated protein expression of LKB1 in tumour tissues and its intracellular relationships. This study aimed to investigate the intracellular molecular relationships of LKB1 in older women with early operable primary breast cancer and its correlation with long-term clinical outcome. Methods: Between 1973 and 2010, a consecutive series of 1758 older (≥70 years) women with T0-2N0-1M0 breast carcinoma were managed in a dedicated facility. Of these, 813 patients underwent primary surgery, and 575 had good quality tumour samples available for tissue microarray construction. LKB1 was assessed in 407 cases by indirect immunohistochemistry (IHC). Tumours with 30% or more of cells with cytoplasmic LKB1 expression were considered positive. LKB1 expression was compared with tumour size, histological grade, axillary lymph node stage, ER, PgR, EGFR, HER2, HER3, HER4, BRCA1&2, p53, Ki67, Bcl2, Muc1, E-Cadherin, CD44, basal (CK5, CK5/6, CK14 and CK17) and luminal (CK7/8, CK18 and CK19) cytokeratins, MDM2 and MDM4, and correlated with long-term clinical outcome. Results: Positive LKB1 expression was seen in 318 (78.1%) patients, and was significantly associated with high tumour grade, high Ki67, over-expression of HER2, VEGF, HER4, BRCA2, MDM2 and negative expression of CD44 (p < 0.05). There was no significant correlation with tumour size, axillary lymph node status, ER, PgR, p53, basal or luminal cytokeratins, Bcl2, Muc1, EGFR, HER3, MDM4, E-cadherin and BRCA1. LKB1 did not show any significant influence on survival in the overall population; however, in those patients receiving adjuvant endocrine therapy for ER positive tumours, those with positive LKB1 had significantly better 5-year breast cancer specific survival when compared to those without such expression (93% versus 74%, p = 0.03). Conclusion: LKB1 expression has shown association with poor prognostic factors in older women with breast cancer. However, LKB1 expression appears to be associated with better survival outcome among those patients receiving adjuvant endocrine therapy. Further research is required to explore its potential role as a therapeutic target.

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IS TUMOUR SIZE AN INDEPENDENT PREDICTOR FOR AXILLARY LYMPH NODE METASTASIS IN INFILTRATING DUCT CARCINOMA BREAST IN T2 AND T3 TUMOURS : PROSPECTIVE REVIEW OF 256 CASES

10.36106/8603206 ◽

2021 ◽

pp. 12-14

Author(s):

Nimisha C. R. ◽

Ravindran Chirukandath ◽

Sharath K Krishnan ◽

Sancia Roy Fernandez ◽

Remani Remani ◽

...

Keyword(s):

Lymph Node ◽

Tumor Size ◽

Axillary Lymph Node ◽

Ductal Carcinoma ◽

Tumour Size ◽

Axillary Lymph Node Metastasis ◽

Nodal Status ◽

Axillary Lymph ◽

Duct Carcinoma ◽

Node Metastasis

Background: As breast cancer remains a major fraction of cancer cases worldwide, the options for minimalizing postoperative morbidity and mortality remain an area for ardent research and improvement. The ability to identify patients at low risk of axillary metastases, would be of great value in limiting extensive axillary dissection which causes signicant morbidity, thereby improving the postoperative quality of life amongst patients. We conducted a study to identify characteristics of primary tumors highly associated with axillary lymph node metastases by comparing various demographic and tumor characteristics against nodal status. Methodology: 288 cases of the axillary dissection specimens of all inltrating duct carcinoma cases who underwent MRM in Government Medical College, Thrissur for 5 consecutive years were studied (n=256). Pathology was interpreted by a select group of Pathologists and then reanalyzed by another set to avoid bias. Various other aspects were studied including age distribution, histology, tumour size and nodal status. Analysis was done using SPSS 26 software. Results: The mean age of the study population was 50.58 years. The most common histopathological type encountered was Invasive ductal carcinoma – NOS (89.58%). Most of the patients (78.29%) belonged to T2 stage, with most patients (76.39%) having 1- 3 nodes involved. On analysis, a signicant association between T status ( T2 ,T3 ) and N status (p = 0.001) was found. However, there was no signicant correlation between age against tumor size or nodal status (p = 0.528, and p = 0.614 respectively). Conclusions: This study found that while tumor size is independently can predict the amount of axillary lymph node metastasis especially in T2 and T3 tumors , there is no signicant predictor value for age in predicting the nodal status or tumor size in invasive ductal carcinoma. However, the factors which modifying tumor behavior like the grade, ER status, Her2 neu status and Cerb 2 will have an inuence on the prediction of Axillary Lymph node involvement that offers further scope of prospective research

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Colour Doppler ultrasonography in the diagnosis of axillary lymph node metastases in breast cancer

The Breast ◽

10.1016/s0960-9776(96)90043-0 ◽

1996 ◽

Vol 5 (1) ◽

pp. 10-12 ◽

Cited By ~ 4

Author(s):

C.I. Perre ◽

V.C.M. Koot ◽

P. de Hooge ◽

T. Weits ◽

P. Leguit

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Axillary Lymph Node ◽

Doppler Ultrasonography ◽

Axillary Lymph ◽

Colour Doppler ◽

Axillary Lymph Node Metastases ◽

Colour Doppler Ultrasonography ◽

Node Metastases

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Prediction of Axillary Lymph Node Response to Neoadjuvant Chemotherapy (Nac) By Changes in Maximum Standard Uptake Values (Suvmax) with 18Fdg-Pet (Pet) Imaging of the Primary Breast Tumour

Annals of Oncology ◽

10.1093/annonc/mdu328.1 ◽

2014 ◽

Vol 25 ◽

pp. iv110

Author(s):

M. Alamgeer ◽

M. White ◽

J. Stuckey ◽

M. Harris ◽

B. Kumar ◽

...

Keyword(s):

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Pet Imaging ◽

Axillary Lymph Node ◽

Breast Tumour ◽

Axillary Lymph ◽

Primary Breast Tumour ◽

18Fdg Pet ◽

Response To Neoadjuvant Chemotherapy

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Determinants of False-Negative Fine-Needle Aspirates of Axillary Lymph Nodes in Women with Breast Cancer: Lymph Node Size, Cortical Thickness and Hilar Fat Retention

Acta Cytologica ◽

10.1159/000440797 ◽

2015 ◽

Vol 59 (4) ◽

pp. 311-314 ◽

Cited By ~ 11

Author(s):

D. Eric Ewing ◽

Lester J. Layfield ◽

Christopher L. Joshi ◽

Mark D. Travis

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Cortical Thickness ◽

False Negative ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

True Positive ◽

False Negatives ◽

Lymph Node Size ◽

Node Size

Objective: Ultrasound-guided fine-needle aspiration (UG-FNA) is utilized to sample axillary lymph nodes in breast cancer patients. Diagnostic sensitivity is good but few data exist regarding the causes of false-negative results. Study Design: Fifty-four UG-FNAs of sentinel lymph nodes with histologic follow-up were identified. Gross and radiographic lymph node size, the percentage replaced by carcinoma and the cortical thickness were correlated with false-negative rates. Results: Thirty-seven aspirates were negative, 5 of these being false-negative (9%). True-positive lymph nodes averaged 1.3 cm in dimension while false-negatives averaged 0.92 cm. Percentage involvement by carcinoma for true-positive FNAs averaged 69% while false-negatives averaged 25%. Cortical thickness averaged 5.6 mm in true-positive FNAs but 2.9 mm in false-negatives. Conclusion: A relationship exists between lymph node size and the likelihood of a false-negative FNA. Lymph nodes <1.2 cm have a higher incidence of false-negative results. Lymph nodes with <30% involvement demonstrated a higher percentage of false-negatives than those with >30% replacement. Sentinel lymph nodes <1 cm appear to be relatively poor candidates for UG-FNA. Lymph nodes with a cortical thickness <3.5 mm are more often associated with a false-negative result than nodes with a thicker cortex.

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Giant Fibroadenoma in a Middle-Aged Woman Requiring Mastectomy: A Case Report

Annals of Health Research ◽

10.30442/ahr.0604-11-109 ◽

2020 ◽

Vol 6 (4) ◽

pp. 456-462

Author(s):

NJ Nwashilli ◽

I Obahiagbon

Keyword(s):

Lymph Node ◽

Axillary Lymph Node ◽

Breast Tumour ◽

Lymph Node Excision ◽

Normal Breast ◽

Main Concern ◽

Axillary Lymph ◽

Aged Woman ◽

Large Breast ◽

Operative Specimen

Fibroadenomas are benign tumours of the breast. They are usually single, firm, rubbery masses, slow-growing and well encapsulated. Giant fibroadenomas are fibroadenomas at least 5cm in size or at least 500g in weight. The peculiarities of the index case include the massive size and weight of the breast, causing asymmetry and tissue distortion with little or no normal breast tissue on ultrasound scan. Also, such massive weight has not been reported in the literature as suggested by extensive search on databases such as Pubmed and Google Scholar. The main concern of the patient was the rapid growth over a year, with the attendant risk of malignancy. The mass was firm, lobulated, with a solitary axillary lymph node. An initial clinical diagnosis of phyllodes tumour was made. However, pre-operative Tru-cut biopsy histology suggested fibroadenoma and was confirmed using the excised post-operative specimen. Simple mastectomy with axillary lymph node excision was carried out. In conclusion, a large breast tumour may not be malignant. However, mastectomy may be a treatment option despite the benign nature of the tumour.

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