Clinicopathological Follow-up of Breast DCIS Diagnosed on Biopsies: A Single Institutional Study of 575 Patients

2021 ◽  
pp. 106689692110120
Author(s):  
Mingfei Yan ◽  
Phillip Bomeisl ◽  
Hannah Gilmore ◽  
Aparna Harbhajanka
Keyword(s):  
Lymph Node ◽  
Axillary Lymph Node ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Her2 Status ◽  
Axillary Lymph ◽  
Her2 Amplification ◽  
Therapeutic Implications ◽  
Microinvasive Carcinoma

Stratifying ductal carcinoma in situ (DCIS) patients into different upgrading risk groups is important in exploiting more precise therapeutic options. Evaluation of estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/HER2) status and axillary lymph node metastatic status for DCIS and their upgraded invasive counterparts can also provide diagnostic and therapeutic implications. We retrospectively studied 575 patients with first-time diagnosis of DCIS on biopsies, and followed up their final diagnosis, ER/PR/HER2 status, and axillary lymph node involvement on excisions. As a result, biopsy-diagnosed DCIS had an overall 19.1% risk to be upgraded on subsequent excisions, with 4.7% being upgraded to microinvasive carcinoma (pT1mi) and 14.4% to overt invasive carcinoma (⩾pT1a). Factors significantly associated with higher upgrading risk on multivariate analysis include biopsy guidance by ultrasound ( P <.001), DCIS with suspicious microinvasion ( P < .001), and DCIS diagnosed in left breast ( P = .026). DCIS diagnosed in younger patients (⩽40 years old) or DCIS with high nuclear grade showed higher upgrading risk only on univariate analysis. About 80% ER + /PR + and ER−/PR− DCIS remained the same ER/PR status after being upgraded, and ER + /PR −  DCIS had the highest risk (63.6%) of having HER2 amplification in upgraded invasive carcinoma. For upgraded DCIS, microinvasive carcinoma was more likely to have HER2 amplification (50%) than overt invasive carcinoma (29.5%). Besides, pure DCIS had a low risk of axillary lymph node macrometastasis (0.74%), while the risk increased in DCIS with microinvasion (4.4%) and was highest in overt invasive carcinoma (14.7%). The findings of this study are clinically relevant with respect to criteria that might be used in selecting patients for de-escalation trials.

scholarly journals Chyle Leak after Right Axillary Lymph Node Dissection in a Patient with Breast Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Ankita Sarawagi ◽  
Jessica Maxwell
Keyword(s):  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Ductal Carcinoma ◽  
Tissue Expander ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Chyle Leak ◽  
The Right

Background. A female patient was diagnosed with a right-sided chyle leak following right skin sparing mastectomy, axillary lymph node dissection, and immediate tissue expander placement in the setting of invasive ductal carcinoma status post neoadjuvant chemotherapy. Summary. Our patient underwent a level I and II right axillary lymph node dissection followed by an axillary drain placement. On the first postoperative day, a change from serosanguinous to milky fluid in this drain was noted. The patient was diagnosed with a chyle leak based on the milky appearance and elevated triglyceride levels in the fluid. While chyle leaks are rare after an axillary dissection and even rarer to present on the right side, it is a complication of which breast surgeons should be aware. The cause of this complication is thought to be due to injury of the main thoracic duct, its branches, the subclavian duct, or its tributaries. Management is usually conservative; however, awareness of this potential complication even on the right side is of the utmost importance Conclusion. Chyle leaks are an uncommon complication of axillary node dissections and even rarer for them to present on the right side. It can be diagnosed by monitoring the drainage for changes in appearance and volume and by conducting supporting laboratory tests. Conservative management is generally suggested.

Ductal Carcinoma In Situ Simultaneously Involving the Breast and Epithelial Inclusions in an Ipsilateral Axillary Lymph Node

2018 ◽  
Vol 26 (6) ◽  
pp. 564-568 ◽  
Author(s):  
Leah A. Commander ◽  
David W. Ollila ◽  
Siobhan M. O’Connor ◽  
Johann D. Hertel ◽  
Benjamin C. Calhoun
Keyword(s):  
Lymph Node ◽  
Ductal Carcinoma In Situ ◽  
Axillary Lymph Node ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Disease ◽  
Metastatic Carcinoma ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph

Benign cystic epithelial inclusions with squamous, glandular, or Müllerian phenotypes are known to occur in the axillary lymph nodes of patients with benign and malignant breast disease. Careful evaluation of hematoxylin and eosin–stained slides and correlation with the histologic findings in the ipsilateral breast are paramount in evaluation of suspected benign inclusions. In this case of ductal carcinoma in situ (DCIS) of the breast in a 73-year-old woman, DCIS also involved epithelial inclusions in an ipsilateral axillary lymph node. The recognition of these benign epithelial elements, and awareness that they can be involved by DCIS, is crucial to avoid the overdiagnosis of metastatic carcinoma.

Microinvasive carcinoma of the breast: Is axillary lymph node dissection indicated?

1998 ◽  
Vol 34 ◽  
pp. S49
Author(s):  
F. Penault-Llorca ◽  
G. Le Bouëdec ◽  
C. Pomel ◽  
V. Feillel ◽  
J. Dauplat ◽  
...  
Keyword(s):  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Carcinoma Of The Breast ◽  
Microinvasive Carcinoma

Predicting axillary lymph node metastases in patients with T1infiltrating ductal carcinoma of the breast

The Breast ◽  
2001 ◽  
Vol 10 (2) ◽  
pp. 155-159 ◽  
Author(s):  
S.P. Harden ◽  
A.J. Neal ◽  
N. Al-Nasiri ◽  
S. Ashley ◽  
G. Querci della Rovere
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Axillary Lymph Node ◽  
Ductal Carcinoma ◽  
Axillary Lymph ◽  
Carcinoma Of The Breast ◽  
Axillary Lymph Node Metastases ◽  
Node Metastases

scholarly journals Prognostic Value of Extranodal Extension in Axillary Lymph Node-positive Breast Cancer

2020 ◽  
Author(s):  
Xiaoxi Ma ◽  
Xia Yang ◽  
Wentao Yang ◽  
Ruohong Shui
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Axillary Lymph Node ◽  
Univariate Analysis ◽  
Disease Recurrence ◽  
Axillary Lymph ◽  
Extranodal Extension ◽  
N Stage ◽  
Nodal Burden

Abstract Background Several studies have demonstrated that extranodal extension (ENE) is associated with prognosis in breast cancer. Whether this association should be described in pathological reports warrants further investigation.Objective In this research, we evaluated the predictive value of ENE in axillary lymph nodes (ALNs) in invasive breast cancer and explored the feasibility of employing ENE to predict clinicopathological features, nodal burden, disease recurrence-free survival (DRFS) and overall survival (OS) in clinical practice. In addition, the cutoff values of perpendicular diameter (PD-ENE) and circumferential diameter (CD-ENE) of ENE were investigated.Methods A total of 402 cases of primary invasive breast cancer were extracted from Fudan University Shanghai Cancer Center; these patients underwent axillary lymph node dissection (ALND) between 2010 and 2015. ENE in the axillary lymph node (ALN) was defined as the tumor cells breaking through the lymph node capsule into peripheral adipose tissue and causing connective tissue reactions. Relationships between ENE and clinicopathological features, nodal burden, disease recurrence-free survival (DRFS) and overall survival (OS) were analyzed. PD-ENE was defined by measuring from the point where tumor tissue broke the node capsule to the highest point of the tumor cells in the perinodal adipose tissue. The average PD-ENE was 1.8 mm; therefore, we divided ENE-positive patients into two groups: PD-ENE no greater than 2 mm and PD-ENE greater than 2 mm. CD-ENE was defined as measuring along the nodal capsule as the distance between peripheral edges of the ENE area. According to the average circumferential diameter (CD-ENE), we classified ENE-positive patients into two groups: CD-ENE no greater than 3 mm and CD-ENE greater than 3 mm. Correlations between ENE cutoffs and prognosis were analyzed.Results In this cohort of patients, 158 (39.3%) cases were positive for ENE in ALN.98 (24.4%) cases had PD-ENE no larger than 2 mm, and 60 (14.9%) cases had PD-ENE larger than 2 mm. Also, 112 (27.9%) cases had CD-ENE no larger than 3 mm, and 46 (11.4%) cases had CD-ENE larger than 3 mm. Statistical analysis indicated that histological grade, N stage, and HER2 overexpression subtype were associated with ENE. The presence of ENE had significant statistical correlations with nodal burden, including N stage, median metastatic tumor diameter and peri-lymph node vascular invasion (p < 0.001, p < 0.001, p = 0.001, respectively). Cox regression analysis demonstrated that patients with ENE exhibited significantly reduced DRFS in both univariate analysis (HR 2.126, 95% CI 1.453 - 3.112, p < 0.001) and multivariate analysis (HR 1.745, 95% CI 1.152 - 2.642, p = 0.009) compared with patients without ENE. For overall survival (OS), patients with ENE were associated with OS in univariate analysis (HR 2.505, 95% CI 1.337 - 4.693, p = 0.004) but not in multivariate analysis (HR 1.639, 95% CI 0.824 - 3.260, p = 0.159). Kaplan–Meier curves and log-rank test showed that patients with ENE in ALN had lower DRFS and OS (for DRFS: p < 0.0001; and for OS: p = 0.002, respectively). However, neither the PD-ENE group (divided by 2 mm) nor the CD-ENE group (divided by 3 mm) exhibited significant differences regarding nodal burden and prognosis.Conclusions Our study indicated that ENE in the ALN was a predictor of prognosis in breast cancer. ENE was an independent prognostic factor for DRFS and was associated with OS. ENE in the ALN was associated with a higher nodal burden. The size of ENE, which was classified by a 3-mm (CD-ENE) or 2-mm (PD-ENE) cutoff value, had no significant prognostic value in this study. Based on our findings, the presence of ENE should be included in routine pathological reports of breast cancers. However, the cutoff values of ENE warrant further investigation.

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

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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