Problems concerning patients’ qualification for surgical procedures allowing for evaluation of the condition of axillary fossa lymph nodes in the radical treatment of breast cancer

2015 ◽  
Vol 87 (6) ◽  
Author(s):  
Tomasz Nowikiewicz ◽  
Ewa Śrutek ◽  
Wojciech Zegarski
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Surgical Procedures ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Metastatic Lesions ◽  
Axillary Lymphadenectomy ◽  
Method Of Evaluation

AbstractThe presence of metastases in the lymph nodes of the axillary fossa is the most important prognostic factor in patients with breast cancer. The surgical treatment option required for evaluation of the condition of the axillary lymph nodes depends on the results of a preoperative physical examination of the patients.The aim of the study was to evaluate the correctness of breast cancer patients’ qualification to surgical procedures allowing for evaluation of the condition of the axillary lymph nodes.Material and methods. A retrospective analysis of a group of 963 patients with a diagnosed malignancy of the breast, treated surgically in the period from 01 Jan 2011 to 29 Feb 2012. Depending on the result of evaluation of the axillary lymph node clinical condition, the patients underwent sentinel lymph node biopsy or elective axillary lymphadenectomy.Results. In 27.4% of patients subjected to excision of the sentinel lymph node, metastatic lesions were found in the lymph nodes removed during the procedure. In most cases (98.1%) that concerned the lymph nodes of the lower part of the axilla. In 17.4% of patients, metastases were located also in the middle or upper part (9%). In the group of patients primarily qualified to lymphadenectomy, the metastatic lesions in the axillary lymph nodes were diagnosed in 67.2% of patients. They were most commonly located in the lower part of the axillary fossa (in 96.7% of cases), and in 68.8% of patients in the middle or upper part (35.8%).Conclusions. Biopsy of the sentinel lymph node in patients with clinically advanced breast cancer is an effective and safe method of evaluation of the condition of the axillary fossa lymph nodes. A high rate of false positive results concerning the clinical stage of the disease requires changing the rules of patients’ qualification to elective axillary lymphadenectomy.

scholarly journals Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 127 ◽  
Author(s):  
Dalia Rukanskienė ◽  
Vincentas Veikutis ◽  
Eglė Jonaitienė ◽  
Milda Basevičiūtė ◽  
Domantas Kunigiškis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Nodes ◽  
False Negative ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Negative Results ◽  
False Negative Results

Background and objectives: With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50–75% to 15–30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. Materials and Methods: A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. Results: Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, p < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), p = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, p < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, p < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.

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.

scholarly journals Positive non-sentinel axillary lymph nodes in breast cancer with 1-2 sentinel lymph node metastases

Medicine ◽  
2018 ◽  
Vol 97 (44) ◽  
pp. e13015 ◽  
Author(s):  
Jianwei Zheng ◽  
Shuyan Cai ◽  
Huimin Song ◽  
Yunlei Wang ◽  
Xiaofeng Han ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Metastases ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Metastases

scholarly journals Sentinel lymph node detection through radioguided surgery in patients with breast cancer

2008 ◽  
Vol 51 (spe) ◽  
pp. 57-61
Author(s):  
Benedita Andrade Leal de Abreu ◽  
Adriana de Morais Santos ◽  
Lívia de Almeida Soares ◽  
Antônio Ricardo dos Santos ◽  
Idna de Carvalho Barros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Gamma Probe ◽  
Axillary Lymph Nodes ◽  
Lymph Node Status ◽  
Radioguided Surgery ◽  
Axillary Lymph ◽  
Drainage Pattern ◽  
Axillary Lymphadenectomy

Biopsy of the sentinel lymphnode (SLNB), the first lymphnode to receive lymphatic drainage from the primary tumor, accurately predicts the axillary lymph node status and, when negative, obviates the need for axillary lymphadenectomy (AL). The aim of this study was, to verify the SLN localization in breast cancer through preoperative lymphoscintigraphy and intraoperative gamma-probe, as well as to demonstrate the benefits of such techniques in preventing complications of AL. Medical records of 228 patients with breast carcinoma, who were underwent SLN localization and, radioguided surgery, from March 2005 to December 2007 were analyzed retrospectively. Data regarding age, tumor characteristic, breast involved, type of surgery, radiopharmaceutical drainage pattern, axillary assessment (SLNB or AL) and number of lymph nodes dissected were collected. It was ascertained that radioguided surgery is a selective method of axillary assessment in breast cancer, which makes this technique a safe alternative to radical assessment of total dissection of axillary lymph nodes and its subsequent complications.

scholarly journals Sentinel lymph node biopsy in breast cancer surgery

2011 ◽  
Vol 2 (2) ◽  
pp. 101-112
Author(s):  
Mario Taffurelli
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Lymphatic System ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph

Axillary lymph node status is one of the most reliable prognostic factors of long-term survival in breast cancer surgery. Metastatic involvement of the axillary lymph nodes is also crucial in the decision making of potentially useful adjuvant treatment. Until the last decade, Axillary Lymph Nodes Dissection (ALND) was performed in order to obtain the regional lymphatic system staging. In case of non-metastatic spread, that kind of surgery was limited only to this purpose; no further oncological benefits were obtained and the patients were exposed to several comorbidities affecting this type of surgery. Complications after ALND are reported in 15-30% of cases. They are well known and range from early bleeding, infection, symptomatic nerve damage, and longstanding limb lymph-edema with an incredible impairment of the quality of life.The Sentinel Lymph Node (SLN) theory holds that the SLNs are the first nodes draining lymph from an anatomic region (i.e. the breast) where metastatic disease will most likely to be found. If that node is found to be cancer free, the entire lymphatic system is likely to be cancer free; if it is metastatic, there is an elevated chance of finding more metastatic nodes. Thanks to the application of this hypothesis, several patients over the last 10-15 years have avoided unnecessary major demolitive surgery. To obtain accurate evaluation of the SLN a multidisciplinary dedicated team is necessary. This procedure has been internationally validated and the false negative rate is nowadays less than 5% when performed by expert hands. Dedicated breast surgeons working in a high-volume centres are necessary to reach satisfactory confidence in performing this very specialised procedure in order to obtain an accurate staging. The number of women presenting to the breast oncology units is continuously increasing and the implementation of screening programs has been crucial in detecting numerous patients (more than 75%) with early disease and non-metastatic axillary lymph nodes. The practice of the SLN is clearly able to offer those patients an accurate staging with low comorbidities, preserving their quality of life.

Study of Sentinel Lymph Node in Breast Cancer: Our Experience in 46 Cases

2000 ◽  
Vol 86 (4) ◽  
pp. 317-319 ◽  
Author(s):  
Alessandra Galli ◽  
Lauretta Massaza ◽  
Luca Chiappo ◽  
Adriana Paduos ◽  
Giorgio Rosso
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Gamma Probe ◽  
False Negative ◽  
Case Series ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Negative Results

At the Surgery Department of Biella 46 patients were enrolled in a study on the sentinel lymph node (SN) in the period from 1 January 1999 to 30 September 1999. The aim of the study was to determine, on the basis of our own experience, the percentages of accuracy and concordance, and compare them with case series abroad and in Italy; in addition, we sought to establish a possible correlation between certain features of breast cancer and positivity of the axilla. The method utilized was lymphoscintigraphy and gamma probe. Fifteen cases with positive axillary lymph nodes and 12 cases with positive sentinel lymph nodes were found; there were no false positive and three false negative results. No migration of the tracer was observed with lymphoscintigraphy in two cases. The percentage of concordance obtained was 93.2% in the complete series and 96.5% in the subseries that excluded the learning curve. Comparing the percentage of concordance of our case series with those abroad and in Italy, an average overlapping percentage was obtained. The percentage of accuracy obtained in our study was 95.7%, which is slightly higher than the average of percentages of the case series abroad and in Italy.

Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer

2001 ◽  
Vol 182 (4) ◽  
pp. 316-320 ◽  
Author(s):  
Shahab F Abdessalam ◽  
Emmanuel E Zervos ◽  
Manju Prasad ◽  
William B Farrar ◽  
Lisa D Yee ◽  
...  
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
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