scholarly journals Twenty-year experience of examining biopsies of signal lymph nodes in breast cancer

2020 ◽  
Vol 16 (1) ◽  
pp. 12-20 ◽  
Author(s):  
V. F. Semiglazov ◽  
P. V. Krivorotko ◽  
E. K. Zhiltsova ◽  
S. V. Kanaev ◽  
E. S. Trufanova ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Diagnostic Accuracy ◽  
Medical Research ◽  
Systemic Therapy ◽  
False Positive ◽  
Ministry Of Health ◽  
National Medical ◽  
Neoadjuvant Systemic Therapy ◽  
Oncology Center

Biopsy of signal (sentinel) lymph nodes (LN) has been performed at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia, for almost 20 years. In the first few years, contrast-visual method (1 % blue isosulfan and triphenyl methane control) was used in 640 patients with early (T1–2N0M0) breast cancer. In 150 patients from this cohort, standard axillary dissection was performed irrespectively of the results of signal (sentinel) biopsy. The rate of false positive responses varied between 4.6 and 6.6 %. Since 2012, radioisotope method of visualization of signal LN with intratumor administration of 99mТс-technephyte colloid particles has been used (in 708 patients with T1–3N0M0 breast cancer). This type of signal LN biopsy had the following diagnostic characteristics: sensitivity was 58.9 %, specificity was 96.2 %, diagnostic accuracy was 87.1 %.In parallel with this study, in 2016 a study of diagnostic accuracy and safety of biopsy of axillary LN after neoadjuvant systemic therapy was started. The study included 263 patients with T1N1–3M0, T2–3N0–3M0, T4N0–1M0 breast cancer. To evaluate clinical status of axillary LN, ultrasound, single-photon emission computed tomography, mammography at baseline and after completion of neoadjuvant chemotherapy ± targeted therapy (trastuzumab) were performed. In some patients, in the recent years a double method of signal LN labeling (radioisotope and fluorescent methods) was used.In patients with baseline cN+-status, the rate of false positive signal LN biopsy conclusions was 13.6 %, in patients with baseline cN0-status it was 7.7 %.The study of double contrast of axillary LN and targeted label of metastatic LN prior to neoadjuvant systemic therapy continues. In total, various modifications of biopsy of signal LN were performed in 2,000 patients with breast cancer.The study protocol was approved by the biomedical ethics committee of N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia.All patients gave written informed consent to participate in the study.

scholarly journals Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer

2019 ◽  
Vol 269 (3) ◽  
pp. 432-442 ◽  
Author(s):  
Janine M. Simons ◽  
Thiemo J. A. van Nijnatten ◽  
Carmen C. van der Pol ◽  
Ernest J. T. Luiten ◽  
Linetta B. Koppert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Surgical Procedures ◽  
Systemic Therapy ◽  
Axillary Staging ◽  
Node Positive ◽  
Neoadjuvant Systemic Therapy ◽  
Positive Breast Cancer

scholarly journals Diagnostic Accuracy of MRI in Evaluating Response After Neoadjuvant Systemic Therapy in Operable Breast Cancer

Cureus ◽  
2021 ◽  
Author(s):  
Abdullah R Khazindar ◽  
Dalia Abdulmonem L Hashem ◽  
Atlal Abusanad ◽  
Salwa I Bakhsh ◽  
Alya Bin Mahfouz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Systemic Therapy ◽  
Operable Breast Cancer ◽  
Neoadjuvant Systemic Therapy

scholarly journals Can axillary surgery be omitted in patients with breast pathologic complete response after neoadjuvant systemic therapy for breast cancer? A real-world retrospective study in China

2021 ◽  
Author(s):  
Rui Chen ◽  
Shuo Li ◽  
Yan Li ◽  
Qiannan Zhu ◽  
Xiaoqing Shi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Real World ◽  
Systemic Therapy ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Axillary Surgery ◽  
Neoadjuvant Systemic Therapy

Abstract Purpose Studies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 and ypTis subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown. This study was to evaluate the status of axillary lymph nodes for patients who achieved breast pCR after NST in the real-world study. Methods This retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR. Results The rate of breast pCR after NST was 27.1% (70/258). Among the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (100% vs. 85.7%, P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (82.7% vs. 22.9%, P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (94.3% vs. 58.8%, P = 0.0034). Conclusion Axillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN + who achieve ypT0 (not ypTis).

scholarly journals MRI-Based Radiomics Analysis for the Pretreatment Prediction of Pathologic Complete Tumor Response to Neoadjuvant Systemic Therapy in Breast Cancer Patients: A Multicenter Study

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2447
Author(s):  
Renée W. Y. Granzier ◽  
Abdalla Ibrahim ◽  
Sergey P. Primakov ◽  
Sanaz Samiei ◽  
Thiemo J. A. van Nijnatten ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Tumor Response ◽  
Added Value ◽  
Breast Cancer Patients ◽  
Neoadjuvant Systemic Therapy ◽  
Clinical Models ◽  
Combined Models ◽  
Complete Tumor

This retrospective study investigated the value of pretreatment contrast-enhanced Magnetic Resonance Imaging (MRI)-based radiomics for the prediction of pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients. A total of 292 breast cancer patients, with 320 tumors, who were treated with neo-adjuvant systemic therapy and underwent a pretreatment MRI exam were enrolled. As the data were collected in two different hospitals with five different MRI scanners and varying acquisition protocols, three different strategies to split training and validation datasets were used. Radiomics, clinical, and combined models were developed using random forest classifiers in each strategy. The analysis of radiomics features had no added value in predicting pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients compared with the clinical models, nor did the combined models perform significantly better than the clinical models. Further, the radiomics features selected for the models and their performance differed with and within the different strategies. Due to previous and current work, we tentatively attribute the lack of improvement in clinical models following the addition of radiomics to the effects of variations in acquisition and reconstruction parameters. The lack of reproducibility data (i.e., test-retest or similar) meant that this effect could not be analyzed. These results indicate the need for reproducibility studies to preselect reproducible features in order to properly assess the potential of radiomics.

Clinical Course of Breast Cancer Patients with Local-Regional Progression During Neoadjuvant Systemic Therapy

2021 ◽  
Author(s):  
Leisha C. Elmore ◽  
Henry M. Kuerer ◽  
Carlos H. Barcenas ◽  
Benjamin D. Smith ◽  
Makesha V. Miggins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Clinical Course ◽  
Breast Cancer Patients ◽  
Neoadjuvant Systemic Therapy

scholarly journals The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. Whitehead ◽  
◽  
G. W. Irwin ◽  
F. Bannon ◽  
C. E. Coles ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Tumour Response ◽  
Multidisciplinary Teams ◽  
Diverse Range ◽  
Radiological Monitoring ◽  
Original Tumour ◽  
Neoadjuvant Systemic Therapy ◽  
Axillary Node Clearance ◽  
The Uk

Abstract Background Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.

scholarly journals Challenge for Diagnostic Assessment of Deep Learning Algorithm for Metastases Classification in Sentinel Lymph Nodes on Frozen Tissue Section Digital Slides in Women with Breast Cancer

2020 ◽  
Author(s):  
Young-Gon Kim ◽  
In Hye Song ◽  
Hyunna Lee ◽  
Dong Hyun Yang ◽  
Namkug Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Deep Learning ◽  
Lymph Nodes ◽  
Learning Algorithm ◽  
Medical Center ◽  
Characteristic Curve ◽  
Lobular Carcinoma ◽  
Sentinel Lymph Nodes ◽  
Neoadjuvant Systemic Therapy ◽  
Frozen Tissue

Abstract Assessing the status of metastasis in sentinel lymph nodes (SLNs) by pathologists is an essential task for the accurate staging of breast cancer. However, histopathological evaluation of sentinel lymph nodes by a pathologist is not easy and is a tedious and time-consuming task. The purpose of this study is to review a challenge competition (HeLP 2018) to develop automated solutions for the classification of metastases in hematoxylin and eosin–stained frozen tissue sections of SLNs in breast cancer patients. A total of 297 digital slides were obtained from frozen SLN sections, which include post–neoadjuvant cases (n = 144, 48.5%) in Asan Medical Center, South Korea. The slides were divided into training, development, and validation sets. All of the imaging datasets have been manually segmented by expert pathologists. A total of 10 participants were allowed to use the Kakao challenge platform for six weeks with two P40 GPUs. The algorithms were assessed in terms of the AUC (area under receiver operating characteristic curve). The top three teams showed 0.986, 0.985, and 0.945 AUCs for the development set and 0.805, 0.776, and 0.765 AUCs for the validation set. Micrometastatic tumors, neoadjuvant systemic therapy, invasive lobular carcinoma, and histologic grade 3 were associated with lower diagnostic accuracy. In a challenge competition, accurate deep learning algorithms have been developed, which can be helpful in making frozen diagnosis of intraoperative sentinel lymph node biopsy. Whether this approach has clinical utility will require evaluation in a clinical setting.

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