scholarly journals Pregnancy-associated breast cancer – Case report

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Vanessa Monteiro Sanvido ◽  
Mary Miyazawa Simomoto ◽  
Afonso Celso Pinto Nazário
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Histological Grade ◽  
Percutaneous Biopsy ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Axillary Lymphadenectomy ◽  
The Right

Introduction: Mammographic screening is recommended yearly after the age of 40; however, many pregnant women are younger and should undergo the test. In these cases, anamnesis and clinical examination of the breasts are essential to detect any breast change. In case of clinical suspicion, it is recommended to undergo mammography with abdominal protection, and breast ultrasound is the examination of choice to assess the extension of the injury and guide the percutaneous biopsy. Breast surgery is safe, and can be performed in the three trimesters of pregnancy. It is important to emphasize the importance of the type of surgery according to gestational age. The reference axillary surgery during pregnancy is axillary lymphadenectomy. However, some articles present the safety of the sentinel lymph node biopsy. The use of technetium (Tc-99m) with lymphoscintigraphy is an acceptable technique, with fetal exposure to radiation inferior to the teratogenic limit of 50 mGv. Objective: To emphasize the importance of mammary propedeutics during pregnancy. Case report: 37 year-old patient, primiparous, of 34 weeks, referred a nodule in the right breast for 1 year. She denies having family history of carcinoma. At clinical examination, she presented with turgid breasts, absence of palpable nodules and negative axilla. Current mammography with presence of architectural distortion in the inferolateral quadrant of the right breast, and ultrasound with irregular and spiculated 2 cm nodule , both BIRADS category 5. Percutaneous biopsy showed invasive breast carcinoma of no special type, histological grade 2, and immunohistochemical with positive hormone receptors (estrogen and progesterone receptor with 90%), negative HER2 and Ki 67 of 20%> The conduct was conserving surgery (excision of the breast injury and radio-guided sentinel lymph node biopsy) on the 36th week of pregnancy. The intraoperative assessment of the sentinel lymph node showed presence of macrometastasis and, as a consequence of the exclusion of pregnancy in the ACOSOG Z0011 study, the patient was submitted to axillary lymphadenectomy. The definitive anatomopathological result was invasive breast carcinoma of no special type, histological grade 3, measuring 2.1 cm, and 1 lymph node compromised by macrometastasis of 15 dissected nodes (pT2 pN1a). The multidisciplinary team chose to wait for delivery, from 2 to 4 weeks, and a Cesarean section was performed after 40 weeks of pregnancy. The chemotherapy was scheduled to begin 4 weeks after delivery. The patient was referred to genetic counselling. Conclusions: The treatment of breast cancer during pregnancy is challenging for the multidisciplinary team, which must focus on maternal and fetal well-being. Therapy should be carried out similarly to non-pregnant patients, respecting the procedures that are allowed in each gestational trimester. It is important to mention how essential it is to not delay the treatment, in order to not compromise the patient’s prognosis.

Intratumoral versus subareolar injection in breast cancer sentinel lymph node biopsy. A case report

2011 ◽  
Vol 30 (3) ◽  
pp. 171-173
Author(s):  
I. Lanchas Alfonso ◽  
M.B. Miguel Martínez ◽  
J.F. CuezvaGuzmán ◽  
P. Rupérez Arribas ◽  
S. Martínez Blanco ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Node Biopsy ◽  
Subareolar Injection ◽  
Node Biopsy

scholarly journals Sentinel lymph node biopsy in pregnancy-associated breast cancer

2013 ◽  
Vol 154 (50) ◽  
pp. 1991-1997 ◽  
Author(s):  
Zoltán Mátrai ◽  
Ferenc Bánhidy ◽  
Melinda Téglás ◽  
Eszter Kovács ◽  
Ákos Sávolt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Low Dose ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Breast Cancer Patients ◽  
Node Biopsy ◽  
Axillary Lymphadenectomy

The incidence of pregnancy-associated breast cancer is rising. Sentinel lymph node biopsy is the method of choice in clinically node negative cases as the indicated minimally invasive regional staging procedure. Some reports have linked radioisotope and blue dye required for lymphatic mapping to teratogenic effects, the idea of which has become a generalized statement and, until recently, contraindication for these agents was considered during pregnancy. Today, there are many published reports of successful interventions with low-dose 99mTc-labeled human albumin nanocolloid, based on dosimetric modeling demonstrating a negligible radiation exposure of the fetus. These results contributed to the seemingly safe and successful use of sentinel lymph node biopsy during pregnancy, though generally it can not replace axillary lymphadenectomy in the absence of high-quality evidence. The possibility of sentinel lymph node biopsy should be offered to pregnancy-associated early breast cancer patients with clinically negative axilla, and patients should be involved in the decision making following extensive counselling. This paper presents the successful use of sentinel lymph node biopsy with low-dose tracer during two pregnancies (in the first and third trimesters) and, for the first time in Hungarian language, it offers a comprehensive literature review on this topic. Orv. Hetil., 154(50), 1991–1997.

scholarly journals Chyle leak following an axillary sentinel lymph node biopsy for breast cancer in a patient with superior vena caval thrombosis – a case report and review of the literature

2018 ◽  
Vol 100 (6) ◽  
pp. e147-e149 ◽  
Author(s):  
Z Al-Ishaq ◽  
S Gupta ◽  
MA Collins ◽  
T Sircar
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Superior Vena ◽  
Lymph Node Biopsy ◽  
Superior Vena Caval ◽  
Chyle Leak ◽  
Node Biopsy

Chyle leak is a very rare complication following an axillary lymph node dissection. We report a case of chyle leak following sentinel lymph node biopsy in a patient with breast cancer with superior vena caval thrombosis. To our knowledge, this is the first case report of chyle leakage following axillary sentinel lymph node biopsy. We describe the aetiology, prevention and treatment strategy that can be adopted in these patients.

Axillary lymphadenectomy can be safely avoided in patients with breast cancer and negative sentinel lymph node biopsy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10787-10787
Author(s):  
E. Millastre ◽  
M. Ruiz-Echarri Sr. ◽  
M. Ortega ◽  
J. I. Mayordomo ◽  
R. Lastra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Lymph Node Biopsy ◽  
Node Dissection ◽  
Node Biopsy ◽  
Axillary Lymphadenectomy

10787 Background: Patients with breast cancer in which sentinel lymph node biopsy is histologically negative for tumor cells, have a low probability of having involvement of additional regional lymph nodes. Lymph node dissection may be avoided in these cases. Methods: Ninety-six consecutive patients with invasive breast cancer and tumour size less than 2 centimeters by mammography, had lymphoscintigraphy with colloidal 99Tc and radioisotope-guided sentinel lymph node biopsy in the University Hospital of Zaragoza from 1999 to 2005.Pathological assessment included serial sections of the sentinel lymph node with immunohistochemistry for cytokeratins in selected cases. Results: Sentinel lymph node biopsy was negative in 57 patients. There were 56 females and 1 male. Median age was 57 years (range 24–87). Median pathological tumor size was 15 mm (range 5–31). Location of the sentinel lymph node was axillary in 47patients, internal mammary in 0 patients, and both in 10 patients. Median number of resected lymph nodes was 2 (range 1–4). With median follow-up of 33 months, no local or systemic relapses have occurred. Conclusions: Avoidance of regional lymph node dissection is safe in patients with breast cancer and histologically negative sentinel lymph node biopsy. No significant financial relationships to disclose.

scholarly journals Anaphylactic reaction to patent blue dye during sentinel lymph node biopsy in breast cancer

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Flavio Rocha Gil ◽  
Mariane de Melo Silveira ◽  
Giovana Vilela Rocha ◽  
Plinio Resende de Melo
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Surgical Treatment ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Patent Blue ◽  
Node Biopsy

Introduction: Sentinel lymph node biopsy is indicated as gold standard in the surgical treatment of initial breast cancer, presenting as a more conservative approach and preventing total lymphadenectomy. Dyes or technetium radiopharmaceuticals can be used to identify the sentinel lymph node. The most used dyes for the identification of the sentinel lymph node are patent blue and isosulfan blue, and, in lower frequency, methylene blue. However, hypersensitivity reactions to blue dye have been described, estimating its prevalence in 0.6%‒2.7%. The clinical status that characterizes the allergic reaction to the dye can range from mild skin changes to the severe condition, with circulatory collapse. Objectives: To present a severe case of allergic reaction to patent blue in a patient submitted to surgical treatment for breast cancer. Method: This is a case report study based on the analysis of medical records and literature review. Case report: T.L.O.M, female, 49-year old woman, white, married, born in Patos de Minas, MG. Patient diagnosed with Breast cancer, T1N0A0, with indication for sentinel lymph node analysis with blue patent and segmental resection of the tumor. ASA 1 pre-anesthetic evaluation, without history of allergy. The patient was submitted to general inhalation anesthesia and subcutaneous injection in the left breast of 2ml of patent blue, followed by massage. During the anesthetic plan, after 40 minutes of surgery, the patient was hypotensive (40x20 mmHg), with low saturation (ETCO2 28), tachycardia (120 bpm), associated with bluish urticariform papules, and major edema in the ear lobes, being immediately assisted with adrenaline bolus, metaraminol, and decadron. The patient became stable, and it was possible to conclude the procedure. Then, she was referred to the intensive care unit, under sedation and intubated due to the risk of laryngospasm. She evolved hemodynamically stable, and was extubated without intercurrences. Conclusions: A severe anaphylactic reaction to patent blue can risk the life of a patient in an unpredictable manner. Considering this case, it is essential that the entire staff involved in the sentinel lymph node biopsy be aware of the possibility of a hypersensitive reaction to the dye, being prepared to recognize and immediately handle the possible repercussions.

scholarly journals Is it always necessary to perform an axillary lymph node dissection after neoadjuvant chemotherapy for breast cancer?

2019 ◽  
Vol 101 (3) ◽  
pp. 186-192 ◽  
Author(s):  
I Osorio-Silla ◽  
A Gómez Valdazo ◽  
J I Sánchez Méndez ◽  
E York ◽  
M Díaz-Almirón ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Neoadjuvant Chemotherapy ◽  
Complete Response ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Axillary Lymphadenectomy ◽  
Positive Breast Cancer

Introduction Recent prospective studies support the feasibility of performing sentinel lymph node biopsy following neoadjuvant chemotherapy in initially fine-needle aspiration cytology or ultrasound-guided biopsy-proven node-positive breast cancer. The main aid is to identify preoperative features that help us predict a complete axillary response to neoadjuvant chemotherapy in these patients and thus select the candidates for sentinel lymph node biopsy post-neoadjuvant chemotherapy to avoid unnecessary axillary lymphadenectomy. Materials and methods A retrospective observational study with a total of 150 patients, biopsy-proven node-positive breast cancer who underwent neoadjuvant chemotherapy followed by breast surgery and axillary lymphadenectomy were included and retrospectively analysed. A predictive model was generated by a multivariate logistic regression analysis for pathological complete response-dependent variable. Results The response of the primary lesion to neoadjuvant chemotherapy according to post-treatment magnetic resonance imaging, Her2/neu overexpression and a low estrogen receptor expression are associated with a higher rate of nodal pathologically complete response. The multivariant model generated a receiver operating characteristic curve with an area under the curve of 0.79 and a confidence interval of 0.72–0.87 at a 95% level of significance. Conclusions This model could be a helpful tool for the surgeon to help in predicting which cases have a higher likelihood of achieving a pathologically complete response and therefore selecting those who may benefit from a post-neoadjuvant chemotherapy sentinel lymph node biopsy and avoid unnecessary axillary lymphadenectomy.

scholarly journals Sentinel Lymph Node Biopsy Performed for Axillary Accessory Breast Cancer—A Case Report—

2019 ◽  
Vol 80 (12) ◽  
pp. 2142-2147
Author(s):  
Saaya KOMATSU ◽  
Michiko YAMASHITA ◽  
Kana TAGUCHI ◽  
Akari MURAKAMI ◽  
Riko KITAZAWA ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Accessory Breast

scholarly journals Assessment of prognosis in patients with invasive breast cancer and metastatic sentinel lymph node treated with or without axillary lymphadenectomy

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Vanessa Monteiro Sanvido ◽  
Simone Elias ◽  
Gil Facina ◽  
Afonso Celso Pinto Nazário
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Locoregional Recurrence ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Axillary Lymphadenectomy ◽  
The Mean ◽  
Global Survival

Introduction: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial was a landmark in axillary surgical treatment. Its results brought significant contributions to the reduction of the extension of breast cancer surgery. However, this approach was questioned at first. Objectives: To assess the global survival and the locoregional recurrence in patients with metastatic sentinel lymph node biopsy treated with or without axillary lymphadenectomy (AL). Method: A historical cohort study was carried out with patients with primary invasive breast carcinoma and clinically negative axilla who underwent breast-conserving surgery and SLNB between February 2008 and December 2018. Results: We included 415 patients who were submitted to conserving surgery. In 23.3% (97 patients), SLNB was positive, 56 patients were submitted only to SLNB, and 41 patients were treated with AL. The groups were homogeneous regarding the variables: age group (p=0.279), anatomopathological diagnosis (p=0.210), histological grade (p=0.983), hormone receptor expression (p=0.708), HER 2 expression (p=0.695) and pT (p=0.334). Global survival, in the mean period of 5 years, was 80.1% in the SLNB group, and 87.5% in the AL group (p=0.376). The locoregional recurrence was a rare event; in the mean period of 5 years, there was 1.8% in the SLNB group, and 7.7% in the AL group (p=0.196). Only 4 locoregional recurrences were described, and all took place in up to 18 months of follow-up. Conclusions: Global survival and locoregional recurrence in patients with metastatic axillary sentinel lymph node treated only with sentinel lymph node biopsy did not present differences in relation to patients who underwent axillary lymphadenectomy, which corroborates the data from ACOSOG Z0011. The omission of axillary lymphadenectomy and the implantation of such a practice in our service benefitted the patients treated with less aggressive surgery, and, potentially, with lower morbidity.

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