scholarly journals Molecular genetic predictors of metastatic lesions of regional lymph nodes in patients with breast cancer

2021 ◽  
Vol 17 (3) ◽  
pp. 24-36
Author(s):  
V. V. Rodionov ◽  
O. V. Burmenskaya ◽  
V. V. Kometova ◽  
D. Yu. Trofimov ◽  
M. V. Rodionova ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Molecular Genetic ◽  
Tumor Location ◽  
Axillary Lymph ◽  
Regional Lymph Nodes ◽  
Genetic Predictors

Objective: to identify molecular genetic predictors of metastatic spread to regional lymph nodes in patients with breast cancer (BC) based on the analysis of gene expression profile of the primary tumor.Materials and methods. The study included 358 patients with BC who underwent surgical treatment in breast cancer department of Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia. Among all included into the study patients, 132 (36.9 %) had metastases in at least one axillary lymph node. Molecular genetic examination of the tumor tissue was carried out using reverse transcription polymerase chain reaction; the diagnostic panel consisted of 45 functional and 3 reference genes. Results. Patients with metastases to regional lymph nodes were generally younger (p = 0.006), had larger primary tumor (p<0.001) and higher total malignancy score (p<0.001). The groups were also significantly different in tumor location (p = 0.005). Comparative analysis of transcriptome tumor profiling revealed statistically significant differences between groups in the level of expression of three genes: TMEM45A (p = 0.016), CCND1 (p = 0.019), and MIA (p = 0.046). Based on the data obtained we used mathematical modeling and created a predictive model, which with a high degree of probability (AUC = 0.791) allowed to predict the presence of regional lymph nodes metastases in patients with BC.Conclusion. TMEM45A, CCND1 and MIA gene expression in the primary tumor were the markers of lymph node involvement in BC. The developed predictive genetic signature can become an additional diagnostic tool to predict the risk of lymph node metastases at the point of planning the volume of axillary surgery in patients with BC.

scholarly journals Clinical, morphological, and molecular genetic predictors of metastatic lesions in the regional lymph nodes in breast cancer

2018 ◽  
Vol 5 (3) ◽  
pp. 8-16
Author(s):  
Yu. A. Dergunova ◽  
V. V. Podionov ◽  
V. K. Bozhenko ◽  
V. V. Kometova ◽  
M. V. Dardyk
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Molecular Genetic ◽  
Regional Lymph Nodes ◽  
Genetic Characteristics ◽  
Metastatic Lesions ◽  
Genetic Predictors ◽  
Node Metastases ◽  
High Degree

Despite the sufficient amount of data accumulated in the literature, there are still no factors, on the basis of which it would be possible to estimate the regional lymph nodes status in breast cancer with a high degree of accuracy. The review presents literature data relating to the influence of clinicopathological, molecular-biological and genetic characteristics of primary tumor on lymph node metastases. Data of 66 foreign and Russian articles are included.

scholarly journals Predictive Value of Tumor Load in Breast Cancer Sentinel Lymph Nodes for Second Echelon Lymph Node Metastases

2007 ◽  
Vol 29 (6) ◽  
pp. 497-505
Author(s):  
C. H. M. van Deurzen ◽  
R. van Hillegersberg ◽  
M. G. G. Hobbelink ◽  
C. A. Seldenrijk ◽  
R. Koelemij ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Invasive Breast Cancer ◽  
Primary Tumor ◽  
Lymph Node Involvement ◽  
Consecutive Series ◽  
Axillary Lymph ◽  
Tumor Load ◽  
Node Involvement

Background: The need for routine axillary lymph node dissection (ALND) in patients with invasive breast cancer and low-volume sentinel node (SN) involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND.Methods: A consecutive series of 317 patients with invasive breast cancer and a tumor positive axillary SN followed by ALND was reviewed. Clinicopathologic features of the primary tumor and the SN were assessed as possible predictors of second echelon lymph node involvement.Results: Second echelon metastases were found in 116/317 cases (36.6%). Frequency of second echelon lymph node involvement in patients with isolated tumor cells (ITC, N = 23), micro- (N = 101) and macrometastases (N = 193) was 13%, 20% and 48%, respectively (p < 0.001). Based on the area % of SN occupied by tumor no subgroup of patients could be selected with less than 20% second echelon lymph node involvement. However, none of the patients with SN ITC or micrometastases and a primary tumor size ≤1 cm (N = 12, 3.8%) had second echelon lymph node involvement.Conclusions: Accurately measured SN tumor load predicts second echelon lymph node involvement. However, even in patients with ITC, the second echelon lymph nodes are involved in 13% justifying ALND.

Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20106-20106
Author(s):  
R. K. Shahid ◽  
I. Ahmad ◽  
S. Yadav ◽  
A. Sami ◽  
K. Haider ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Axillary Lymph Node ◽  
Primary Breast Cancer ◽  
Fish Analysis ◽  
Axillary Lymph ◽  
Her 2

20106 Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu & ER. No significant financial relationships to disclose.

scholarly journals Lymph Node Radiotherapy Instead of Extended Axillary Surgery - the New Standard

Breast Care ◽  
2018 ◽  
Vol 13 (3) ◽  
pp. 173-175 ◽  
Author(s):  
Peter Niehoff ◽  
Silla Hey-Koch
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Dissection ◽  
Early Stage ◽  
Axillary Staging ◽  
Lymph Node Staging ◽  
Axillary Lymph ◽  
Regional Lymph Nodes

Breast cancer treatment has undergone major changes in the last 20 years. Specifically, the role of axillary lymph node dissection has changed from radical axillary dissection with excision of a high number of lymph nodes to sentinel lymph node biopsy (SLNB). This paradigm shift is associated with a controversial debate regarding the significance of axillary staging, the need for surgery, and the role of radiotherapy. Looking ahead, lymph node staging and axillary treatment might shift from SLNB and/or axillary dissection to ultrasound-guided needle biopsy and irradiation of regional lymph nodes in order to reduce treatment-related sequelae in early-stage breast cancer.

scholarly journals Modern view on the issues of diagnosis and verification of axillary lymph nodes involvement in early breast cancer

2020 ◽  
Vol 22 (1) ◽  
pp. 46-52
Author(s):  
Irina V. Kolyadina ◽  
Tatiana Yu. Danzanova ◽  
Svetlana V. Khokhlova ◽  
Oksana P. Trofimova ◽  
Ekaterina V. Kovaleva ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Early Breast Cancer ◽  
Regional Lymph Node ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
High Quality ◽  
Regional Lymph Nodes

The involvement of axillary lymph nodes is one of the most important prognostic factors, significantly affecting the treatment strategy for early breast cancer (BC). The risk of axillary lymph node metastases depends directly on a number of factors (age of women, size of tumor, presence of lymphovascular invasion and biological characteristics of cancer). The evaluation of regional lymph node status in patients with early BC includes the clinical examination of regional zones and the ultrasound study (US), using these methods can help to study lymph nodes shape, borders, margins and structure. The sensitivity of ultrasound in the evaluation of regional lymph nodes status directly depends on the biological subtype of the tumor; the minimum level of ultrasound sensitivity in the evaluation of lymph nodes status is detected for luminal HER2-negative cancer (less than 40%), and maximum sensitivity is detected for triple negative and HER2-positive subtypes (6871%). Clinical examination and modern ultrasound are the most accessible methods for the evaluation of regional lymph nodes status, but the possibility to misjudge metastatic process can be detected in 1/4 of patients. Verification of the diagnosis in the preoperative phase (fine-needle aspiration biopsy/core-needle biopsy under ultrasound guidance) allows minimize the number of errors for the regional staging. The sentinel lymph node biopsy (SLNB) is the gold standard of regional treatment in patients with early stage BC, nowadays. The randomized trials (NSABP B-32, ACOSOG q0011) show the safety of recession of performing regional lymph node dissection in favor of SLNB not only in case of clinically negative lymph nodes, but also in patients with metastases in 2 sentinel lymph nodes, upon condition that organ-conservative treatment and subsequent radiation therapy will be used. High-quality regional staging, the choice of the therapeutic algorithm in accordance with the biological characteristics of carcinoma, the application of the most effective modern drug regimes, the optimal radiation therapy allow not only minimize the extent of surgery, but also achieve high long-term survival results, provide excellent functional results and high quality of life in patients with the involvement of axillary lymph nodes.

scholarly journals Metastasis of neuroendocrine tumor mimicking primary breast cancer: case report

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Yuki Tany Hirakawa Vieira ◽  
Andre Luiz de Freitas Perina ◽  
Daniela Ferreira Vieira Vendramini ◽  
Thatyanne Cunha Esposito Gallo ◽  
Felipe Eduardo Martins Andrade
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Neuroendocrine Tumor ◽  
Axillary Lymph Node ◽  
Cervical Lymph Node ◽  
Ileocecal Valve ◽  
Axillary Lymph ◽  
Regional Lymph Nodes ◽  
The Right

Introduction: Neuroendocrine tumor has an annual incidence of 2–5 cases/100,000 inhabitants, most of them asymptomatic, and may clinically present as carcinoid syndrome: facial flushing, diarrhea, and bronchospasm. It has a great tendency to metastasize to regional lymph nodes and liver, being unusual in the breast. Clinical case: A black 47-year-old woman without comorbidities presented a nodule with progressive growth for 2 years in the right upper inner quadrant (RUIQ), biopsied and diagnosed as breast cancer, without a specific subtype or immunohistochemistry (IHC). Physical examination revealed a 3 cm nodule, hard and fixed axillary lymph node, and enlarged yet fibroelastic and mobile anterior cervical lymph node. Ultrasound (US) identified two irregular nodules in the RUIQ and the junction of the right outer quadrants (JROQ) measuring 2.5 cm and 0.7 cm, respectively, and level I axillary lymph node with cortical thickening. The JROQ nodule and the axillary lymph node were biopsied. The cervical lymph node did not show loss of hilum or suspicious abnormalities on US and was not biopsied. Anatomopathological results of the nodule were compatible with invasive carcinoma without a specific subtype, with estrogen receptor weakly positive (10%), Ki-67 7%, and negative for other markers. The axillary lymph node was negative for metastasis. During staging, an abdominal computed tomography identified a 1.9 cm lesion of likely neuroendocrine origin in the ileocecal valve with metastasis to the liver, regional lymph nodes, and breast. Complementary IHC of the biopsy slide was later performed with chromogranin, synaptophysin, and CDX-2, and the diagnosis reached was breast metastasis of neuroendocrine tumor. An external review of biopsy slides of the RUIQ nodule was requested, and the patient was referred to the oncology department to continue treatment. Conclusion: Metastasis of gastrointestinal tumors to the breast corresponds to less than 0.5% of cancers, with 15 reports in the literature, of which only 7 were asymptomatic, and their clinical presentation started with breast lesion, as in the case described herein. Given its rarity, as well as the clinical and radiological difficulties in differentiating these lesions, special attention must be paid to differential diagnoses, especially in cases of discrepancies between the tumor histology and IHC or lack of correlation between image and clinical condition.

scholarly journals Dedicated Axillary MRI-Based Radiomics Analysis for the Prediction of Axillary Lymph Node Metastasis in Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 757
Author(s):  
Sanaz Samiei ◽  
Renée W. Y. Granzier ◽  
Abdalla Ibrahim ◽  
Sergey Primakov ◽  
Marc B. I. Lobbes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Mr Images ◽  
Node Metastasis

Radiomics features may contribute to increased diagnostic performance of MRI in the prediction of axillary lymph node metastasis. The objective of the study was to predict preoperative axillary lymph node metastasis in breast cancer using clinical models and radiomics models based on T2-weighted (T2W) dedicated axillary MRI features with node-by-node analysis. From August 2012 until October 2014, all women who had undergone dedicated axillary 3.0T T2W MRI, followed by axillary surgery, were retrospectively identified, and available clinical data were collected. All axillary lymph nodes were manually delineated on the T2W MR images, and quantitative radiomics features were extracted from the delineated regions. Data were partitioned patient-wise to train 100 models using different splits for the training and validation cohorts to account for multiple lymph nodes per patient and class imbalance. Features were selected in the training cohorts using recursive feature elimination with repeated 5-fold cross-validation, followed by the development of random forest models. The performance of the models was assessed using the area under the curve (AUC). A total of 75 women (median age, 61 years; interquartile range, 51–68 years) with 511 axillary lymph nodes were included. On final pathology, 36 (7%) of the lymph nodes had metastasis. A total of 105 original radiomics features were extracted from the T2W MR images. Each cohort split resulted in a different number of lymph nodes in the training cohorts and a different set of selected features. Performance of the 100 clinical and radiomics models showed a wide range of AUC values between 0.41–0.74 and 0.48–0.89 in the training cohorts, respectively, and between 0.30–0.98 and 0.37–0.99 in the validation cohorts, respectively. With these results, it was not possible to obtain a final prediction model. Clinical characteristics and dedicated axillary MRI-based radiomics with node-by-node analysis did not contribute to the prediction of axillary lymph node metastasis in breast cancer based on data where variations in acquisition and reconstruction parameters were not addressed.

scholarly journals The Findings of SPECT/CT Concerning Bypass Lymph Circulation in Lymphedema Following Breast Cancer Surgery

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 471
Author(s):  
Min Young Lee ◽  
Eunjung Kong ◽  
Dong Gyu Lee
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymphatic Drainage ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Positive Group

This study aimed to determine whether bypass circulation was present in lymphedema and its effect. This was a retrospective, cross-sectional study. Patients who underwent unilateral breast cancer surgery with axillary lymph node dissection were recruited and underwent single-photon emission tomography/computed tomography (SPECT/CT). SPECT/CT was performed to detect the three-dimensional locations of radio-activated lymph nodes. Patients with radioactivity in anatomical locations other than axillary lymph nodes were classified into a positive group. All patients received complete decongestive therapy (CDT). Exclusion criteria were as follows: History of bilateral breast cancer surgery, cervical lymph node dissection history, and upper extremity amputation. The difference in the upper extremity circumference (cm) was measured at four points: Mid-point of the upper arm, elbow, and 10 and 15 cm below the elbow. Twenty-nine patients were included in this study. Fifteen patients (51.7%) had bypass lymphatic systems on the affected side, six (20.7%) had a bypass lymphatic system with axillary lymph nodes on the unaffected side, and 11 (37.9%) showed new lymphatic drainage. The positive group showed significantly less swelling than the negative group at the mid-arm, elbow, and 15 cm below the elbow. Bypass lymphatic circulation had two patterns: Infraclavicular lymph nodes and supraclavicular and/or cervical lymph nodes. Changes in lymph drainage caused by surgery triggered the activation of the superficial lymphatic drainage system to relieve lymphedema. Superficial lymphatic drainage has a connection through the deltopectoral groove.

scholarly journals Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Xiaokai Ma ◽  
Shishuai Wen ◽  
Baofeng Liu ◽  
Dumin Li ◽  
Xiaolong Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Upper Extremity ◽  
Axillary Lymph Node ◽  
Lymphatic Drainage ◽  
Sentinel Lymph Nodes ◽  
Blue Dye ◽  
Axillary Lymph ◽  
Axillary Reverse Mapping

Purpose. The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients.Methods. Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping.Results. ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs.Conclusions. The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema.Clinical Trial Registration. This trial is registered with ClinicalTrial.gov:NCT02651142.

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