scholarly journals Quantifying the number of lymph nodes for examination in breast cancer

2019 ◽  
Vol 48 (2) ◽  
pp. 030006051987959
Author(s):  
Liping Sun ◽  
Ping Li ◽  
He Ren ◽  
Gang Liu ◽  
Lining Sun
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Tumor Stage ◽  
Median Number ◽  
Binomial Model ◽  
Nodal Staging ◽  
Breast Cancer Invasion ◽  
Positive Lymph Nodes

Objective Examining the correct number of lymph nodes when diagnosing breast cancer invasion is still a problem. This work aimed to develop a qualification model that estimates the possibility of missing nodes and the number of lymph nodes that need to be examined. Methods By analyzing lymph node invasion of 303,760 breast cancer samples with primary tumor stage and the number of examined and positive lymph nodes from the Surveillance, Epidemiology and End Results database using a beta-binomial model, the number of nodes that should be examined was quantified in different stages. Results In general, to reduce the possibility of missing positive nodes to less than 10%, 21 lymph nodes should be examined; thus, the current median of dissected nodes (12) is not adequate. The number of nodes needed to be dissected for stages T1, T2, and T3 are 8, 37, and 87, respectively. Currently, the median number of node dissections for these stages were 12, 13, and 14, respectively. The clinical significance of the nodal staging score was validated with survival information. Conclusion Currently, the number of lymph nodes dissected in breast cancer are excessive for T1 but insufficient for T2 and T3.

scholarly journals Real-world data: evaluation of sentinel lymph node biopsy after complete pathological response of breast cancer to neoadjuvant chemotherapy in patients with triple-negative and her2 positive breast cancer in a cohort from rio grande do sul, brazil

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Alessandra Borba Anton de Souza ◽  
Nathalia da Cunha Rossato ◽  
Felipe Pereira Zerwes ◽  
Tomas Reinert ◽  
Antonio Luiz Frasson
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Triple Negative ◽  
Pathological Response ◽  
Complete Pathological Response ◽  
Her2 Positive ◽  
Node Disease ◽  
Positive Lymph Nodes

Introduction: International publications show a high correlation of axillary response and complete pathological response (CPR) of breast cancer to neoadjuvant chemotherapy (NACT) in patients with triple-negative (TN) and HER2 positive (HER2+) tumors. The need for surgery is being questioned when percutaneous breast biopsy after NACT indicates CPR, despite recent presentations demonstrating high rates of false-negative (FN), ranging from 17–39%. The proper axillary management in patients with CPR of breast cancer is still discussed: is it possible to avoid the axillary evaluation? What is the axillary downstaging rate? Identifying any residual disease to adjust the adjuvant treatment is also a concern. Retrospective studies reveal a rate of positive lymph nodes lower than 2% in this population when CPR of breast cancer is reached. Objective: To identify the rate of complete axillary response in patients with CPR of breast cancer to NACT in TN and HER2+ tumors. Methods: This is a retrospective cohort study conducted in two health facilities in Southern Brazil. The sample consists of 130 patients who underwent NACT, followed by surgery between January 2016 and December 2018. The patients included were treated in the public health system (Sistema Único de Saúde – SUS) and private health system. Results: Among the 130 patients submitted to NACT, 76 (58%) had HER2+ and TN immunohistochemical subtypes – luminal HER2+: 23 patients, HER2+ pure: 15, TN: 38. Among these patients, 33 (43%) reached CPR of breast cancer, of which 9 corresponded to luminal HER2+, 10 to HER2+, and 14 to TN. In patients with CPR of breast cancer, 29 (87.8%) had no lymph node disease. Out of the 10 HER2+ pure with CPR of breast cancer, 100% had no lymph node disease, and 8 were positive pre-NACT. Among the 14 TN, only 1 patient had 2 positive lymph nodes (2+/10), and she was cN0 prior to NACT (with negative axillary ultrasound). Among the 5 pre-NACT clinically positive lymph nodes in TN patients (including 1 patient with cN2), all had CPR to NACT (3 axillary dissections and 2 sentinel lymph node biopsies – SLNB). Out of the 9 patients with luminal HER and CPR of breast cancer, 4 had clinically positive lymph nodes before NACT, and 3 remained positive (15% of conversion). Conclusion: In this study, CPR of breast cancer was highly correlated with negative axillary evaluation after NACT (87.8%), mainly in the TN and HER2+ pure subtypes (98%), even if the lymph node was clinically positive before NACT, with 100% of conversion of HER 2+ pure cases. SUS patients used trastuzumab as the single drug targeting anti HER2. These data agree with those found in the literature, despite the small sample. Larger studies are necessary, as around 70% of our population depend on SUS. With more published data, considering the performance of SLNB in HER2+ pure and TN patients submitted to NACT could become a common practice, reducing morbidity. The safety of this practice in the luminal HER+ subtype remains unclear.

scholarly journals Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer

2019 ◽  
Vol 15 (2) ◽  
pp. 76-84 ◽  
Author(s):  
Fabiana Tonellotto ◽  
◽  
Anke Bergmann ◽  
Karen de Souza Abrahao ◽  
Suzana Sales de Aguiar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Node Positive ◽  
Node Ratio ◽  
Positive Lymph Nodes ◽  
Positive Breast Cancer

scholarly journals Breast Cancer Care in South India: Is Practice Concordant With National Guidelines?

2019 ◽  
pp. 1-7 ◽  
Author(s):  
D.K. Vijaykumar ◽  
Sujana Arun ◽  
Aswin G. Abraham ◽  
Wilma Hopman ◽  
Andrew G. Robinson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Cancer Care ◽  
Adjuvant Radiotherapy ◽  
South India ◽  
Breast Cancer Care ◽  
Adjuvant Trastuzumab ◽  
Positive Lymph Nodes

PURPOSE The National Cancer Grid (NCG) of India has recently published clinical practice guidelines that are relevant in the Indian context. We evaluated the extent to which breast cancer care at a teaching hospital in South India was concordant with NCG guidelines. METHODS All patients who had surgery for breast cancer at a single center from January 2014 to December 2015 were included. Demographic, pathologic, and treatment characteristics were extracted from the electronic medical record. Patients were classified as being concordant with six elements selected from the NCG guideline. The indicators related to appropriate use of sentinel lymph node (SLN) biopsy, lymph node harvest, adjuvant radiotherapy, adjuvant chemotherapy, human epidermal growth factor receptor 2 (HER2) testing, and delivery of adjuvant trastuzumab. RESULTS A total of 401 women underwent surgery for breast cancer; mean age (standard deviation) was 57 (12) years. Lymph node involvement was present in 47% (188 of 401) of the cohort; 23% (94 of 401) had T1 disease. Ninety-two percent (368 of 401) underwent radical modified mastectomy. SLN biopsy was performed in 75% (167 of 222) of eligible patients. Eighty percent (208 of 261) of patients with a positive SLN biopsy or no SLN biopsy had a lymph node harvest of more than 10. Adjuvant chemotherapy with an anthracycline and a taxane was delivered to 67% of patients (118 of 177) with node-positive disease. Adjuvant radiotherapy was delivered to 84% (180 of 213) of patients with breast-conserving surgery, T4 tumors, or 3+ positive lymph nodes. Fluorescent in situ hybridization testing was performed in 59% of patients (43 of 73) with 2+ HER2-positive lymph nodes on immunohistochemistry. Among patients with HER2 overexpression, 40% (36 of 91) received adjuvant trastuzumab. CONCLUSION Concordance with NCG guidelines for breast cancer care ranged from 40% to 84%. Guideline concordance was lowest for those elements of care associated with the highest direct costs to patients.

How many lymph nodes may serve as a guideline for a sufficient extended lymph node dissection during radical prostatectomy?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16102-e16102
Author(s):  
G. Pomara ◽  
G. Campo ◽  
C. Milesi ◽  
P. Casale ◽  
F. Francesca
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Median Number ◽  
Node Dissection ◽  
Extended Lymph Node Dissection ◽  
Experienced Surgeon ◽  
Node Metastasis ◽  
Positive Lymph Nodes

e16102 Background: Recent data suggest that extended lymph node (LN) dissection at radical prostatectomy (RP) may be necessary to detect occult positive lymph nodes, and that extended dissection may also have a positive impact on disease progression and long-term disease-free survival. However, evaluation of lymphadenectomy to be complete and sufficient as judged by the number of removed lymph nodes is sometimes difficult. Some authors reported that approximately 20 pelvic lymph nodes may serve as a guideline for a sufficient extended lymph node dissection during RP. The purposes of this study were 1) to assess the reproducibility of this number (20 LN) in experienced hands; 2) to evaluate the effect of the number of LNs removed on lymph node metastasis. Materials and Methods: Data from 293 consecutives patients undergone to RP with extended lymphadenectomy were prospectively analyzed [median age 66 (35–79), median PSA 7.98 ng/ml (2.5–35)]. The number of lymph nodes extracted and the number of patients with positive lymph nodes detected were analyzed and compared. Moreover we distinguished and analyzed RPs data of most experienced surgeon: 124 patients [median age 65aa (44–79), median PSA 6.7(2.5–19)]. Results: Analyzing all the population, the median number of removed lymph nodes was 15 (1–39). Analyzing only the most experienced surgeon results, the median number of removed lymph nodes was 20 (range 6–39). The effect of the number of LNs removed on lymph node metastasis is shown in the Table . Conclusions: Compared to limited lymph node dissection (< 10 removed LNs), extended pelvic lymphadenectomy appears to identify men with positive lymph nodes more frequently. Although very experienced surgeons remove approximately 20 pelvic lymph nodes (comparable to the literature), our results seem to underline that 15 removed LNs are sufficient as a guideline for an extended lymph node dissection during RP. [Table: see text] No significant financial relationships to disclose.

Can primary tumor markers of cancer-initiating cells predict lymph node positivity in breast cancer patients?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1121-1121
Author(s):  
Anees B. Chagpar ◽  
Veronique Neumeister ◽  
Donald R. Lannin ◽  
David Rimm
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Tumor Markers ◽  
Tumor Size ◽  
Primary Tumor ◽  
Poor Prognosis ◽  
Tissue Microarrays ◽  
Median Number ◽  
Breast Cancer Patients

1121 Background: Cancer initiating cells, characterized by ALDH1 positivity and/or colocalization of ALDH1 and CD44, have been shown to be associated with poor prognosis in breast cancer patients. The prognostic value of these tumor markers with respect to prediction of lymph node (LN) status remains unclear. Methods: Tissue microarrays from a cohort of 223 breast cancer patients diagnosed between 2003 and 2007 were evaluated using the AQUA method for quantitative immunofluorescence for CD44 and ALDH1. These data, along with other clinicopathologic data, were correlated with LN positivity. Results: The median patient age of the cohort was 56 (range; 26-89), with a median tumor size of 1.5 cm. 72 (32.0%) patients were LN positive. The median number of LNs excised was 3 (range; 1-27). Of the LN positive patients, the median number of positive LNs was 1.5 (range; 1-24). Levels of CD44, ALDH1, and ALDH1 colocalizing with CD44 did not correlate with number of positive LNs (Spearman rho coefficients: -0.042, 0.131, and 0.058, respectively), nor overall LN status. Tumor size and lymphovascular invasion (LVI) were the only factors found to be significantly correlated with LN status. Conclusions: While ALDH1 colocalized with CD44 has been found to be associated with poor prognosis in breast cancer patients, these markers do not predict LN status. Given that the only factors that reliably predict LN status are tumor size and LVI, further work is required to find primary tumor markers that may predict LN status in order to spare patients axillary surgery. [Table: see text]

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