scholarly journals Decreased Survival of Invasive Ductal Breast Cancer Patients With Two Macrometastatic Lymph Nodes Among Few Resected Ones: Should Current Sentinel-Lymph-Node Guidelines Be Revised?

2021 ◽  
Vol 11 ◽  
Author(s):  
Felipe A. C. Luz ◽  
Rogério A. Araújo ◽  
Marcelo J. B. Silva
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Cox Regression ◽  
Ductal Carcinoma ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Poor Prognostic Factor ◽  
Survival Difference

PurposeSentinel-lymph-node (SLN) biopsy (SLB) is an efficient and safe axillary surgical approach with decreased morbidity than total axillary lymph node dissection (ALND) in initial patients (T1–T2). Current guidelines strongly suggest avoiding completion of ALND in patients with one or two positive SLNs that will be submitted to whole-breast radiation therapy, but must be done when three SLNs are affected.MethodsWe performed a SEER-based study with breast invasive ductal carcinoma patients treated between 2010 and 2015. Optimal cutoffs of positive LNs predictive of survival were obtained with ROC curves and survival as a continuous variable. Bias was reduced through propensity score matching. Cox regression was employed to estimate prognosis. Nomograms were constructed to analyze the predictive value of clinicopathological factors for axillary burden.ResultsOf 43,239 initial patients that had one to three analyzed LNs, only 425 had two positive LNs and matched analysis demonstrated no survival difference versus pN2 patients [HR: 0.960 (0.635–1.452), p = 0.846]. The positive-to-analyzed LN proportion demonstrated a strong prognostic factor for a low rate (1 positive to ≤1.5 analyzed) [HR = 1.567 (1.156–2.126), p = 0.004], and analysis derived from the results demonstrated that a “negative LN margin” improves survival. Nomograms shows that tumor size is the main factor of axillary burden.ConclusionMacrometastasis of two LNs is a poor prognostic factor, similar to pN2, in SLNB (-like) patients; more extensive studies including preconized therapies must be done in order to corroborate or refute the resistance of this prognostic difference in patients with two macrometastatic lymph nodes within few resected.

Predictors of positive axillary lymph nodes in breast cancer patients with metastatic sentinel lymph node

2005 ◽  
Vol 7 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Isabel Peixoto Callejo ◽  
José Américo Brito ◽  
José Wheinholtz Bivar ◽  
Fernando Jesus Fernandes ◽  
João Leal Faria ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients

Concordance of preoperative US-guided tattooing of axillary lymph nodes to sentinel lymph nodes and comparison of their pathologic results according to imaging modalities in breast cancer patients.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 28-28
Author(s):  
Hye Jung Kim ◽  
Jin Hyang Jung ◽  
Ho Yong Park ◽  
Ji-young Park
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Sentinel Nodes ◽  
Group I ◽  
Pet Ct ◽  
Group Ii

28 Background: We wanted to know the concordance of preoperative ultrasound (US)-guided tattooing of axillary lymph nodes (ALNs) to sentinel lymph node and to correlate MR and PET-CT findings with the final histologic results. Methods: Axillary US examination was performed for all breast cancer patients before sentinel lymph node biopsy. The detected lymph nodes in US were classified as negative (group I, enlarged but image-benign) or positive (group II, image-suspicious) finding for metastases based on US, MRI and PET-CT findings. US-guided tattooing for ALNs was performed preoperatively by injection of 3cc of activated charcoal into the cortex of lymph node and the adjacent soft tissue. We evaluated their concordance to sentinel lymph node and correlated the histologic results of US tattooed LN according to each imaging modality. Results: Forty ALNs were tattooed and sentinel nodes corresponded to tattooed nodes in all except one patient with a tattooed non-sentinel node. Ten in group I and 30 in group II on US, 18 in group I and 22 in group II on MR, and 19 in group I and 21 in group II on PET-CT. Eight cases had evidence of metastases in final histology, 2 (20.0%) in group I and 6 (20.0%) in group II on US, 4 (22.2%) in group I and 4 (18.1%) in group II on MR, and 6 (31.6%) in group I and 2 ( 9.5%) in group II on PET-CT. Conclusions: US-guided tattooing is a feasible method for marking ALNs. In addition, tattooed lymph nodes correlate well with sentinel nodes, which may obviate the need for additional localization for axillary staging.

scholarly journals Intra-mammary lymph nodes, an overlooked breast cancer prognostic tool?

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tarek Hashem ◽  
Ahmed Abdelmoez ◽  
Ahmed Mohamed Rozeka ◽  
Hazem Abdelazeem
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Ductal Carcinoma ◽  
Percutaneous Biopsy ◽  
Preoperative Imaging ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Surgical Data

Abstract Background Due to the high variability of incidence and prevalence of intra-mammary lymph nodes (IMLNs), they might be overlooked during clinical and radiological examinations. Properly characterizing pathological IMLNs and detecting the factors that might influence their prevalence in different stages of breast cancer might aid in proper therapeutic decision-making and could be of possible prognostic value. Methods Medical records were reviewed for all breast cancer patients treated at the National Cancer Institute of Cairo University between 2013 and 2019. Radiological, pathological, and surgical data were studied. Results Intra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phyllodes tumors and two cases had ductal carcinoma in situ (DCIS). All ten cases were excluded. The remaining 90 cases all had invasive breast cancer and were divided into two groups: one group for patients with malignant IMLNs (48) and another for patients with benign IMLNs (42). Pathological features of the malignant IMLN group included larger mean tumor size in pathology (4.7 cm), larger mean size of the IMLN in pathology (1.7 cm), higher incidence of lympho-vascular invasion (65.9%), and higher rate of extracapsular extension in axillary lymph nodes (57.4%). In addition, the pathological N stage was significantly higher in the malignant IMLN group. Conclusion Clinicians frequently overlook intra-mammary lymph nodes. More effort should be performed to detect them during preoperative imaging and during pathological processing of specimens. A suspicious IMLN should undergo a percutaneous biopsy. Malignant IMLNs are associated with advanced pathological features and should be removed during surgery.

scholarly journals An AN OBSERVATIONAL STUDY OF SLN MAPPING IN PATIENTS OF LOCALLY ADVANCED BREAST CANCER FOLLOWING NCT

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Ankur Garg ◽  
Udbhav Kathpalia ◽  
Shweta Bansal ◽  
Manoj Andley ◽  
Sudipta Saha
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Lymph Node Biopsy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Biopsy ◽  
Neo Adjuvant Chemotherapy

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3) Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5) Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed.   Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy.   Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.

scholarly journals Rate of sentinel lymph node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand

2014 ◽  
Vol 8 (4) ◽  
pp. 517-524
Author(s):  
Kampol Ratchaworapong ◽  
Sarawut Thanawut ◽  
Sirisanpang Yodavudh ◽  
Suthat Chottanapund
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Cancer Patients ◽  
Primary Breast Tumor ◽  
Blue Dye ◽  
Axillary Lymph ◽  
Isosulfan Blue ◽  
Breast Cancer Patients ◽  
Isosulfan Blue Dye

Abstract Background: The sentinel lymph node (SLN) is the first lymph node to receive lymphatic drainage from a primary breast tumor. If the SLN contains no metastatic tumor, then it is unlikely other lymph nodes will contain breast cancer metastasis. When the SLN does contains metastasis, an axillary lymph node dissection (ALND) is recommended to further stage the axilla and to maintain locoregional control. SLNs can be identified by using a dye, radioisotope, or combined techniques. Objective: To determine the rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand, and factors that affect it. Methods: This prospective study of 106 consecutive cases breast cancer enrolled 105 women (1 bilateral breast cancer case) between October 2011 and October 2013 at Charoenkrung Pracharak Hospital. Clinical and pathological features were analyzed for the effectiveness of SLN identification using isosulfan blue dye. Results: The rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital was 92%. The method was safe and well tolerated in early-stage breast cancer patients. Conclusion: The effectiveness of sentinel node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital is consistent with that shown in studies from other countries.

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