Isolated tumor cells versus micro-metastasis in sentinel lymph node biopsy for T1, T2 breast cancer compared to macro-metastasis: Significance after complete axillary dissection

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e12028-e12028
Author(s):  
Y. A. Alabdulkarim ◽  
E. Nassif
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Tumor Cells ◽  
Axillary Dissection ◽  
Lymph Node Biopsy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Isolated Tumor Cells ◽  
Lymph Node Examination

e12028 Background: Evaluating the axillary lymph nodes is extremely important in the management of breast cancer, with the recent improvement in histopathology techniques detection of micro-metastasis and even isolated cancer cells (ITC) in a setting of sentinel lymph node examination is feasible. In this study we aim to compare the outcome and significance of; positive SLN for macro versus Micro-metastasis, and ITCs. Methods: We reviewed all the patients who had SLN for breast cancer of stage T 1–2 between April 2006 and November 2008. Identifying all those who had positive macro-metastasis, micro-metastasis, or isolated tumor cells, pathology results of the full axillary LN dissection was evaluated for each type. Results: 350 patients had SLN of these 226 had a disease of T1–2, thirty seven patients (16.3%) had full axillary dissection, of these 27/37 had positive SLN for macro-metastasis, six had micro-metastasis and 3/37 had only ITCs. The presence of other LN metastasis was detected in 8 cases (21.6%); all of them were in the macro-metastasis group. No metastasis was found in either the micro-metastasis or the ITC groups. The ITC was only detected with DCIS; while micro-metastasis was present in DCIS or IDC. No relation was identified between the histopathology grade with ITC or micro-metastasis. Conclusions: Our findings did not show any presence of lymphatic metastasis after full axillary dissection, in case of positive micro-metastasis or ITCs in SLN, compared to the group of macro-metastasis. No significant financial relationships to disclose.

Axillary lymph node status in breast cancer staging: What patient and tumor factors affect the accuracy of ultrasound-guided fine needle aspiration?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1126-1126
Author(s):  
Celin Chacko ◽  
Beatriu Reig ◽  
Tova Koenigsberg
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Predictive Value ◽  
Axillary Dissection ◽  
Lymph Node Biopsy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Ultrasound Guided

1126 Background: The purpose of the study is to evaluate the accuracy of ultrasound-guided fine needle aspiration (FNA) of axillary lymph nodes(ALNs) in patients with breast cancer and to determine factors that influence accuracy of ultrasound-guided FNA. Methods: Retrospective review of patients with breast cancer who had FNA of ALNs as well as sentinel lymph node excision or complete axillary dissection. Patients treated with neoadjuvant chemotherapy were excluded. 55 axillary FNAs in 54 patients were included in the final analysis. Pathology reports were reviewed for size of the primary tumor, FNA results, number of positive ALNs, and greatest tumor size in ALNs. FNA was performed if a suspicious lymph node was identified. Surgical sentinel lymph node biopsy or full axillary dissection were the reference standard. Micrometastases (< 0.2 mm) and isolated tumor cells in the lymph node were included in the negative group. Atypical and nondiagnostic FNA results were considered negative cytologic results. Significance was analyzed using the Mann-Whitney test. Results: Size of the primary cancer ranged from 0.3 mm to 8.5 cm. The sensitivity of FNA was 73%, with positive predictive value of 97% and negative predictive value of 52%. The NPV of FNA for primary tumors <1 cm, 1.1-2, 2.1-5 and >5 cm is 100%, 36%, 50% and 66% respectively. Correlation of primary tumor size with sensitivity of FNA was not statistically significant. The sensitivity of FNA for lymph nodes with metastatic deposit < 5mm, 6-10mm, 11-15mm, 16-20mm, and 21mm+ is 0%, 57%, 59%, 89%, and 100%, which is statistically significant (p = 0.007). The number of positive ALNs at axillary dissection is not correlated to the sensitivity of FNA. The sensitivity of FNA for 1-3, 4-9 and 10+ positive ALNs is 78%, 64% and 80%. Conclusions: Our findings indicate that FNA of suspicious axillary lymph nodes is valuable even in small tumors, which differs from the literature. The overall negative predictive value of FNA is 52%, so sentinel lymph node biopsy is essential after negative FNA. Sensitivity of FNA increases with the size of the metastatic deposit in the lymph node, but is not correlated to the number of positive ALNs found at dissection.

scholarly journals Preoperative Nomogram for Predicting Sentinel Lymph Node Metastasis Risk in Breast Cancer: A Potential Application on Omitting Sentinel Lymph Node Biopsy

2021 ◽  
Vol 11 ◽  
Author(s):  
Xi’E Hu ◽  
Jingyi Xue ◽  
Shujia Peng ◽  
Ping Yang ◽  
Zhenyu Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Biopsy ◽  
Curve Analysis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Large Tumor ◽  
Invasive Approach ◽  
Decision Curve Analysis

BackgroundSentinel lymph node (SLN) biopsy is feasible for breast cancer (BC) patients with clinically negative axillary lymph nodes; however, complications develop in some patients after surgery, although SLN metastasis is rarely found. Previous predictive models contained parameters that relied on postoperative data, thus limiting their application in the preoperative setting. Therefore, it is necessary to find a new model for preoperative risk prediction for SLN metastasis to help clinicians facilitate individualized clinical decisions.Materials and MethodsBC patients who underwent SLN biopsy in two different institutions were included in the training and validation cohorts. Demographic characteristics, preoperative tumor pathological features, and ultrasound findings were evaluated. Multivariate logistic regression was used to develop the nomogram. The discrimination, accuracy, and clinical usefulness of the nomogram were assessed using Harrell’s C-statistic and ROC analysis, the calibration curve, and the decision curve analysis, respectively.ResultsA total of 624 patients who met the inclusion criteria were enrolled, including 444 in the training cohort and 180 in the validation cohort. Young age, high BMI, high Ki67, large tumor size, indistinct tumor margins, calcifications, and an aspect ratio ≥1 were independent predictive factors for SLN metastasis of BC. Incorporating these parameters, the nomogram achieved a robust predictive performance with a C-index and accuracy of 0.92 and 0.85, and 0.82 and 0.80 in the training and validation cohorts, respectively. The calibration curves also fit well, and the decision curve analysis revealed that the nomogram was clinically useful.ConclusionsWe established a nomogram to preoperatively predict the risk of SLN metastasis in BC patients, providing a non-invasive approach in clinical practice and serving as a potential tool to identify BC patients who may omit unnecessary SLN biopsy.

Influence of Imaging Features and Technique on US-guided Tattoo Ink Marking of Axillary Lymph Nodes Removed at Sentinel Lymph Node Biopsy in Women With Breast Cancer

2021 ◽  
Vol 3 (5) ◽  
pp. 583-590
Author(s):  
Marlen Pajcini ◽  
Irene Wapnir ◽  
Jacqueline Tsai ◽  
Joanne Edquilang ◽  
Wendy DeMartini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Nodes ◽  
Lymph Node Biopsy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Biopsy ◽  
Initial Biopsy

Abstract Objective To describe tattoo ink marking of axillary lymph nodes (TIMAN) and the elements leading to successful removal at sentinel lymph node biopsy (SLNB). Methods An IRB-approved retrospective image review was conducted of breast cancer patients who underwent SLNB after TIMAN from February 2013 to August 2017, noting patient and tattooed lymph node (TLN) features, initial biopsy type, time to surgery, if the TLN was identified at surgery, and correlation with the SLN. Cases were divided into two groups: the presurgical group, which had primary surgery, and the pre-neoadjuvant chemotherapy (NACT) group, which underwent surgery after completing NACT. Results Of 30 patients who underwent 32 TIMAN procedures, 10 (33.3%) were presurgical and 20 (66.7%) were pre-NACT. The average lymph node (LN) depth from the skin was 1.6 cm, with an average of 0.3 mL of tattoo ink injected. Of 32 procedures, 29 (90.6%) had US images demonstrating the injection. Of these, 10 (34.5%) were injected in the LN cortex surface and 19 (65.5%) in the middle cortex. Seven (24.1%) were injected in the LN lateral aspect, 12 (41.4%) in the mid aspect, and 10 (34.5%) in the medial aspect. Of 32 LNs, 28 (87.5%) were tattooed immediately after initial biopsy and 4 (12.5%) at a later date. At SLNB, all 32 (100%) TLNs were identified, all correlated with the SLN, and 10 (31.3%) were positive for cancer. Conclusion Using an average of 0.3 mL of tattoo ink, all TLNs were successfully identified for removal at surgery, despite variability in LN and injection factors.

Is There a Need for Axillary Dissection in Breast Cancer?

2011 ◽  
Vol 9 (2) ◽  
pp. 225-230 ◽  
Author(s):  
Jason P. Wilson ◽  
David Mattson ◽  
Stephen B. Edge
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Prognostic Factor ◽  
Axillary Dissection ◽  
Small Volume ◽  
Significant Prognostic Factor ◽  
Axillary Lymph ◽  
Isolated Tumor Cells ◽  
Micrometastatic Disease

The involvement of axillary nodes remains a significant prognostic factor in breast cancer. However, management has changed from complete surgical staging to sentinel lymph node biopsies. Although little controversy exists regarding patients with negative sentinel lymph node biopsies, some remains regarding what to do with patients with small volume of axillary disease. This article focuses on the examination of recent evidence in management of the axilla. It focuses on both the prognostic and therapeutic information gleaned from isolated tumor cells and micrometastatic disease and on the use of completion axillary lymph node dissections or axillary radiation in preventing regional recurrence.

Breast Cancer Survival in Relation to the Metastatic Tumor Burden in Axillary Lymph Nodes

2010 ◽  
Vol 28 (17) ◽  
pp. 2868-2873 ◽  
Author(s):  
Yvette Andersson ◽  
Jan Frisell ◽  
Maria Sylvan ◽  
Jana de Boniface ◽  
Leif Bergkvist
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Tumor Cells ◽  
Prognostic Significance ◽  
Axillary Lymph Nodes ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Isolated Tumor Cells ◽  
Node Negative ◽  
Survival Difference

Purpose The aim of this study was to determine the prognostic significance of lymph node micrometastases in patients with breast cancer. Patients and Methods Between September 2000 and January 2004, 3,369 patients with breast cancer were included in a prospective cohort. According to their lymph node status, they were classified in the following four groups: 2,383 were node negative, 107 had isolated tumor cells, 123 had micrometastases, and 756 had macrometastases. Median follow-up time was 52 months. Kaplan-Meier estimates and the multivariate Cox proportional hazard regression model were used to analyze survival. Results Five-year cause-specific and event-free survival rates were lower for patients with micrometastases (pN1mi) than for node-negative (pN0) patients (94.1% v 96.9% and 79.6% v 87.1%, respectively; P = .020 and P = .032, respectively). There was no significant survival difference between node-negative patients and those with isolated tumor cells. The overall survival of pN1mi and pN0 patients did not differ. Conclusion This study demonstrates a worse prognosis for patients with micrometastases than for node-negative patients.

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