MRI Findings Suggestive of Metastatic Axillary Lymph Nodes in Patients with Invasive Breast Cancer

Abstract Purpose Obesity associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer. Methods This retrospective case–control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-treatment and pre-operative breast MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion. Results A strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting axillary metastasis, and this increased to 0.77 when combined with patient and tumor characteristics. Conclusion Fat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

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Fat-enlarged Axillary Lymph Nodes are Associated with Node-Positive Breast Cancer in Obese Patients

10.1101/2021.02.17.20246504 ◽

2021 ◽

Author(s):

Roberta M. diFlorio-Alexander ◽

Qingyuan Song ◽

Dennis Dwan ◽

Judith A. Austin-Strohbehn ◽

Kristen E. Muller ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Invasive Breast Cancer ◽

Breast Mri ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Obese Women ◽

Axillary Metastases ◽

Node Positive ◽

Positive Breast Cancer

AbstractPurposeObesity-associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer.MethodsThis retrospective case-control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-operative MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer diagnosed between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion.ResultsA strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI: 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting node-positive breast cancer and this increased to 0.80 when combined with patient and tumor characteristics.ConclusionFat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

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Ultrasound Imaging for Detecting Metastasis to Level II and III Axillary Lymph Nodes after Axillary Lymph Node Dissection for Invasive Breast Cancer

Journal of Ultrasound in Medicine ◽

10.1002/jum.14998 ◽

2019 ◽

Vol 38 (11) ◽

pp. 2925-2934

Author(s):

Xi Lin ◽

Xin An ◽

Huiling Xiang ◽

Xiaoqing Pei ◽

Anhua Li ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Ultrasound Imaging ◽

Invasive Breast Cancer ◽

Axillary Lymph Node ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Dissection ◽

Level Ii

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Preoperative Sonographic Assessment of Axillary Lymph Nodes in Newly Diagnosed Invasive Breast Cancer

Hong Kong Journal of Radiology ◽

10.12809/hkjr1916924 ◽

2019 ◽

Vol 22 (2) ◽

pp. 130-141

Author(s):

Kin Hoi Wong ◽

Yan Lin Li ◽

Max Kai Ho Yam ◽

Hillary Ka Ying Tam ◽

Godfrey Kwok Fai Tam ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Invasive Breast Cancer ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Newly Diagnosed ◽

Sonographic Assessment

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c-Met overexpression in breast cancer with positive axillary lymph node

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194159 ◽

2019 ◽

Vol 7 (10) ◽

pp. 3627

Author(s):

Huswatun Hasanah ◽

Rina Masadah ◽

Berti J. Nelwan ◽

Djumadi Achmad ◽

Upik A. Miskad ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Tumor Cells ◽

Invasive Breast Cancer ◽

Breast Cancer Incidence ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Metastasis

Background: Breast cancer is the second most common cancer in the world and is the most epidemic cancer in women, with approximately 1.67 million cases. Metastasis of tumor cells to other organs is a major cause of the increasing trend of mortality in breast cancer. This study aims to analyze the expression of c-Met associated with metastasis to axillary lymph nodes in invasive breast cancer.Method: The research was conducted at the Laboratory of Anatomical Pathology of Hasanuddin University Hospital. Stratified sampling was performed from January 2014 - January 2019. Immunohistochemical staining technique was applied upon 66 collected samples, followed by evaluating the c-Met expression score in invasive breast cancer group with positive and negative lymph node status.Result: c-Met overexpression was found among the invasive breast cancer incidence with lymph node metastasis. Among 50 cases with c-Met overexpression (c-Met positive), 40 cases (80%) of invasive breast cancer with lymph node metastasis were identified, while 10 cases (20%) were found in invasive breast cancer without metastasis to lymph nodes. On 16 cases with negative c-Met, 3 cases (18.8%) were found in invasive breast cancer with lymph node metastasis, and 13 cases (81.3%) in invasive breast cancer without metastasis to the lymph nodes. The statistical test results indicated a significant correlation between c-Met expression scores and metastasis to axillary lymph nodes in invasive breast cancer (p <0.001).Conclusion: As one of biomarkers, c-Met overexpression plays a vital role in the treatment of patients with invasive breast cancer to predict patient outcomes and to determine modalities. It is possible to apply c-Met overexpression to investigate aggressiveness of metastatic tumor cells in the future.

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Characteristics of Invasive Breast Cancer Detected by Digital Breast Tomosynthesis on Screening and Diagnostic Mammograms

Canadian Association of Radiologists Journal ◽

10.1177/0846537119888389 ◽

2020 ◽

pp. 084653711988838

Author(s):

Serine E. Baydoun ◽

Limin Yang ◽

Jinhu Xiong ◽

Laurie L. Fajardo

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cancer Detection ◽

Invasive Breast Cancer ◽

Axillary Lymph Nodes ◽

Lymph Node Status ◽

Axillary Lymph ◽

Screening Population ◽

Aggressive Tumors

Objective: To determine whether there is added benefit for 3D mammography in the context of screening and diagnostic imaging, particularly relating to known prognostic characteristics, including histopathology, receptor status, and axillary lymph node involvement. Methods: An institutional review board–approved retrospective review was performed of our mammography and pathology databases from October 2012 to May 2015 to identify biopsy-proven invasive breast carcinoma detected on screening and diagnostic mammograms by 2D plus 3D (2D + 3D) imaging. Percentages of cancer detection by 2D and 3D were compared. Correlation with histopathology and lymph node status was analyzed. Results: Of 53 cancers diagnosed on 12 543 screening mammograms, 36 (67.9%) were better visualized on 3D (not visualized, equivocal, or only seen in retrospect on 2D). Of the 62 cancers diagnosed on 4090 diagnostic mammograms, 24 (38.7%) cancers were better detected on 3D. A statistically significant greater number of cancers were better detected on 3D in the screening compared to the diagnostic mammograms (67.9% vs 38.7%, P < .05). A significantly higher frequency of less aggressive tumors (grade I and grade II, positive estrogen/progesterone receptor, Her2 negative) was detected by 3D, with higher significance in the screening population. Additionally, there was a higher frequency of positive axillary lymph nodes in cancers detected by 3D in the screening group. Conclusion: Three-dimension increases invasive breast cancer detection, particularly pathologically less aggressive tumors, in both screening and diagnostic mammograms with more benefit for the screening population. Three-dimensional mammography detected more breast cancer associated with metastatic axillary lymph nodes in the screening population.

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