scholarly journals Neoadjuvant Chemotherapy Effect on Predictive Value of Sentinel Lymph Node Biopsy using Single Method Methylene Blue in Breast Cancer Patients at Low-resource Country

2021 ◽  
Vol 9 (B) ◽  
pp. 191-195
Author(s):  
Muhammad David Perdana Putra ◽  
Kristanto Yuli Yarso ◽  
Brian Wasita
Keyword(s):  
Breast Cancer ◽  
Methylene Blue ◽  
Cancer Patients ◽  
Predictive Value ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Single Method

AIM: This study aimed to examine the application of neoadjuvant chemotherapy (NAC) effect on sentinel lymph node biopsy (SLNB) using single method methylene blue 1% in breast cancer patients at low-resource country. METHODS: This analytical observational study employed a retrospective case–control approach. The total sampling method was used by involving the entire population of Stage-I and -II breast cancer patients after performed core biopsy or open biopsy with clinically negative axillary lymph nodes that had performed SLNB and axillary lymph nodes dissection at several hospitals in Surakarta from January to May 2020. The descriptive data were presented in the frequency table. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic values were reported with 95% confidence of interval (CI). RESULTS: From a total of 161 patients, 100 patients were given NAC. The identification rate of the non-NAC was 91.3% and the NAC group 80.6%. Non-NAC group obtained a false-negative rate of 24.4% with NPV of 94.4% (95% CI 85–100), while the false-negative rate of the NAC group was 10.8% with NPV of 74% (95% CI 65–80). CONCLUSIONS: NAC with single method methylene blue 1% injection in SLNB can reduce the identification and false-negative rates in breast cancer patients.

A prospective study to evaluate the accuracy of axillary staging using ultrasound and USG-guided fine needle aspiration cytology in early breast cancer patients in a high-volume center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12060-e12060
Author(s):  
Rashpal Singh ◽  
Ekta Dhamija ◽  
SVS Deo ◽  
Sandeep Mathur ◽  
Sanjay Thulkar
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
False Negative ◽  
False Negative Rate ◽  
High Volume ◽  
Axillary Staging ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Developing Nation

e12060 Background: In breast cancer, axillary lymph node involvement directly impacts the patient survival and prognosis.Sentinel lymph node biopsy (SLNB) is a procedure of choice for axillary staging in early breast cancer. Currently, management options for axilla management are ALND & SLNB in node positive & in node negative respectively. In developing nation like India,where resource constraints, logistics issues and over burden health institutes create difficulty in managing patients, our study address this issue by implementing USG and USG-FNAC in early breast cancer patients in developing nation. Methods: All early breast cancer patients were screend by ultrasound axilla to categorise the nodes as suspicious or non suspicious. Suspicious nodes underwent USG & FNAC using vascualr pedicle based nodal mapping for node targeted on USG-FNAC, if node found to be positive, patient underwent ALND & negative node patients underwent SLNB.All non-suspicious nodes patient underwent SLNB. Final histopathology was taken as gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value, accuacy and false negative rate calculated for USG & USG-FNAC. Results: Total 100 patients included in which 58 were non-suspicious and 42 suspicious nodes on USG. Among suspicious group, 24 were positive on USG-FNAC & 18 were negative.In non suspicious SLNB done in all. False negative rate of USG & USG-FNAC was 38% and 17% respectively. Conclusions: Our study indicates the feasibility of USG & USG-FNAC in a high volume centre with good accuracy of around 70- 80%.Overall, 24 % of total patients can be taken up for ALND without performing SLNB.This study can guide us to utilize ultrasound and ultrasound-guided FNAC as a routine evaluation tool in the pre operative assessment of axillary lymph nodes in early breast cancer. Our study showed good and acceptable result (75%) in isolating and retrieving the targeted node by just following the Vascular pedicle based node mapping of axilla to locate the suspicious node without using any tagging or marking of node from where FNAC was performed. This finding can act as a good practicing tool in a busy high volume, logistics issue and and resource constraint hospitals.[Table: see text]

scholarly journals 18F-Alfatide II for the evaluation of axillary lymph nodes in breast cancer patients: comparison with 18F-FDG

2021 ◽  
Author(s):  
Jiang Wu ◽  
Jihong Tian ◽  
Yiyan Zhang ◽  
Hengshan Ji ◽  
Jingjing Sun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Visual Analysis ◽  
False Negative ◽  
Standardized Uptake Value ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Luminal B

Abstract 18F-Alfatide II has been translated into clinical use and been proven to have good performance in identifying breast cancer. In this study, we investigated 18F-Alfatide II for evaluation of axillary lymph nodes (ALN) in breast cancer patients and compared the performances with 18F-FDG. Methods: A total of 44 female patients with clinically suspected breast cancer were enrolled and underwent 18F-Alfatide II and 18F-FDG PET/CT within a week. Tracer uptakes in ALN were evaluated by visual analysis, semiquantitative analysis with maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and SUVmax ratio of target/non-target (T/NT). Results: Among 44 patients, 37 patients were pathologically diagnosed with breast cancer with metastatic (17 cases) or non-metastatic (20 cases) ALN. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of visual analysis were 70.59%, 90.00%, 81.08%, 85.71% and 78.26% for 18F-Alfatide II, 64.71%, 90.00%, 78.38%, 84.62% and 75.00% for 18F-FDG, respectively. By combining 18F-Alfatide II and 18F-FDG, the sensitivity significantly increased to 82.35%, the specificity was 85.00%, the accuracy increased to 83.78%, the PPV was 82.35% and the NPV significantly increased to 85.00%. Three cases of luminal B subtype were false negative for both 18F-Alfatide II and 18F-FDG. The other 2 false negative cases of 18F-Alfatide II were triple-negative subtype and 3 false negative cases of 18F-FDG were luminal B subtype too. The AUCs of three semi-quantitative parameters (SUVmax, SUVmean, T/NT) for 18F-Alfatide II were between 0.8 and 0.9, whereas those for 18F-FDG were more than 0.9. 18F-Alfatide II T/NT had the highest Youden index (76.5%), specificity (100%), accuracy (89.19%) and PPV (100%) among these semi-quantitative parameters. 18F-Alfatide II uptake as well as 18F-FDG uptake in metastatic axillary lymph nodes (MALN) was significantly higher than that in benign axillary lymph nodes (BALN). Both 18F-Alfatide II and 18F-FDG did not show difference in primary tumor uptake irrespective of ALN status. Conclusion: 18F-Alfatide II can be used in breast cancer patients to detect metastatic ALN, however, like 18F-FDG, with high specificity but relatively low sensitivity. The combination of 18F-Alfatide II and 18F-FDG can significantly improve sensitivity and NPV. 18F-Alfatide II T/NT may serve as the most important semi-quantitative parameter to evaluate ALN.

Validity of sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11023-11023
Author(s):  
H. Jinno ◽  
S. Asaga ◽  
M. Sakata ◽  
T. Kubota ◽  
M. Kitajima ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Cancer Patients ◽  
False Negative ◽  
False Negative Rate ◽  
Control Group ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Negative Rate

11023 Background: Sentinel lymph node biopsy (SLNB) is a potential alternative procedure to conventional axillary lymph node dissection (ALND) in clinically node-negative breast cancer patients. Neoadjuvant chemotherapy (NAC) is a standard of care for patients with locally advanced breast cancer and indications of NAC have been widespread to operable breast cancer patients to facilitate breast conserving surgery. However, the validity of SLNB in breast cancer patients who received NAC is still controversial. Methods: Forty-six patients with stage II or III breast cancer who were treated with NAC from January 2002 to May 2006 were included in the study. Consecutive 122 patients who had SLNB without NAC during the same period were used as a control group. All patients underwent SLNB followed by completion ALND. Sentinel lymph node (SLN) was detected using a combined method of injecting isosulfan blue dye and small-sized technetium- 99m-labeled tin colloid (particle size: 200–400 nm in diameter) peritumorally and subcutaneously. SLNs were evaluated by means of H&E and immunohistochemical staining. Results: SLNs were successfully identified in 42/46 patients (91.3%) treated with NAC and 112/113 patients (99.1%) without NAC (p=0.01). Metastases in the SLNs were found in 16/42 patients (38.1%) with NAC and 32/112 patients (28.6%) without NAC (p=0.2). There were 5 false negative cases (false negative rate: 23.8%) in the NAC group and 2 false negative cases (false negative rate: 5.9%) in the control group (p=0.05). Accuracy of SLNB in the NAC group was also significantly inferior to the control group (88.1% vs. 98.2%, p<0.01). The presence of clinically positive axillary lymph nodes before NAC was not correlated with false negative rate. Conclusions: These data suggest that NAC might be considered a contraindication to SLNB even in patients with clinically negative axillary lymph nodes before NAC. No significant financial relationships to disclose.

scholarly journals Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients

2014 ◽  
Vol 12 (1) ◽  
Author(s):  
Emerson Wander Silva Soares ◽  
Hildebrando Massahiro Nagai ◽  
Luis César Bredt ◽  
Ademar Dantas da Cunha ◽  
Reginaldo José Andrade ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients

scholarly journals The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

2020 ◽  
Author(s):  
Na Liu ◽  
Liu Yang ◽  
Xinle Wang ◽  
Meiqi Wang ◽  
Ruoyang Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
Histological Grade ◽  
False Negative ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Ki 67 ◽  
Axillary Surgery

Abstract Background: Axillary lymph node dissection can be avoided in early stage breast cancer patients with negative sentinel lymph node biopsy. However, the possibility of avoiding axillary surgery in patients without axillary lymph node metastasis (ALNM) by preoperative imaging is still under exploration. Thus, the objectives of this study were to investigate the high-risk factors of false negative of ALNM diagnosed by preoperative ultrasound (US) and to find out who could be avoided axillary surgery in the US negative ALNM patients.Methods: This study retrospectively analyzed 3,361 patients with primary early breast cancer diagnosed in the Breast Center of the Fourth Hospital of Hebei Medical University from January 2010 to December 2012. All patients had undergone routine preoperative US and then axillary lymph node dissected. This study investigated the clinicopathological features of axillary lymph node (ALN) negative patients diagnosed by preoperative US and its correlation with prognosis. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 2,357 patients. Results: The sensitivity, specificity and accuracy of axillary US in this cohort were 66.24%, 76.62% and 73.87%. The proportion of patients in the false negative group was higher than that in true negative in the group of age < 50 years old (P = 0.002), tumor size > 2cm (P = 0.008), estrogen receptor (ER) positive (P = 0.005), progesterone receptor (PR) high expression (P = 0.007), nuclear-associated antigen Ki-67 (Ki-67) >20% (P = 0.030), visible vascular tumor thrombus (P < 0.001) and histological grade>2 (P < 0.001). Prognostic analysis of false negative and true negative ultrasonographic diagnosis of ALN metastasis: when ALNM was not found by preoperative ultrasound, there was no significant difference in patients with ALNM≤3 compared with patients without lymph node metastasis in patients of age ≥ 50 years old, tumor size ≤ 2cm, Ki-67 ≤ 20%, or histological grade ≤ 2. Conclusion: The surgery of ALN may be avoided for the preoperative US diagnosed ALNs negative in early breast cancer patients who had advanced age, small tumor size, low expression of Ki-67 and low histological grade.

scholarly journals False-Negative Frozen Section of Sentinel Nodes in Early Breast Cancer Patients

2021 ◽  
Author(s):  
Zhu-Jun Loh ◽  
Kuo-Ting Lee ◽  
Ya-Ping Chen ◽  
Yao-Lung Kuo ◽  
Wei-Pang Chung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Frozen Section ◽  
False Negative ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Frozen Sections ◽  
Sentinel Nodes ◽  
Tumor Emboli

Abstract Background: Sentinel lymph node biopsy (SLNB) is the standard approach of the axillary region for early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes of intraoperative frozen section (FNSNs) in real-world data.Methods: A case–control study with a 1:3 ratio was conducted. FNSN was diagnosed when sentinel nodes (SNs) are negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections.Results: A total of 20 FNSN cases and 60 matched controls were enrolled from 333 SLNB patients between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had larger tumor sizes in preoperative mammography (P = 0.033) and more lymphatic tumor emboli in core biopsy (P < 0.001). Four FNSN patients had metastasis in the non-relevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from the FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in non-relevant SNs were recognized in two patients. All FNSN patients received a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were not inferior to the controls.Conclusions: The patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, outcomes of FNSN patients after completing ALND were noninferior to those without metastasis in SNs. ALND provides a correct diagnosis of patients with metastasis in non-sentinel axillary lymph nodes.

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