Accuracy of Ultrasound Examination of Loco-Regional Lymph Nodes in Breast Cancer Follow-Up and Its Role in the Axillary Surgical Management

ABSTRACT To improve the homogeneity and conformity of the irradiation dose for postoperative breast cancer including regional lymph nodes, we planned Hybrid volumetric-modulated arc therapy (VMAT), which combines conventional tangential field mainly for the chest area and VMAT mainly for the supraclavicular area and marginal zone. In this study, we compared the dosimetric impact between traditional 3D conformal radiotherapy (3DCRT) and Hybrid VMAT and observed toxicities following Hybrid VMAT. A total of 70 patients indicated between October 2016 and December 2017 were included. The prescribed dose was 50 Gy/25 fractions. For the dosimetric impact, 3DCRT and Hybrid VMAT plans were compared in each patient with respect to the dosimetric parameters. Toxicities were followed using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up duration was 319 days. For the dosimetric impact, the homogeneity index (HI) and conformity index (CI) of PTV were significantly improved in the Hybrid VMAT plan compared with that in the 3DCRT plan (HI, 0.15 ± 0.07 in Hybrid VMAT vs 0.41 ± 0.19 in 3DCRT, P < 0.001; CI, 1.61 ± 0.44 in Hybrid VMAT vs 2.10 ± 0.56 in 3DCRT, P < 0.001). The mean irradiated ipsilateral lung dose was not significantly different in both plans (12.0 ± 2.4 Gy in Hybrid VMAT vs 11.8 ± 2.8 Gy in 3DCRT, P < 0.533). Regarding toxicity, there were no patients who developed ≥grade 3 acute toxicity and ≥grade 2 pneumonitis during the follow-up. Hybrid VMAT for postoperative breast cancer including regional lymph nodes was a reasonable technique that improved the homogeneity and conformity of the irradiation dose to the planning target volume while keeping the irradiation dose to organs at risk to a minimum.

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Scintigraphy and SPECT/CT of Sentinel Lymph Nodes for Planning of Operative Intervention in Breast Cancer

Medical Radiology and radiation safety ◽

10.12737/article_5b83bc2b3c3ef1.05312079 ◽

2018 ◽

pp. 50-59

Author(s):

А. Рыжков ◽

A. Ryzhkov ◽

М. Билик ◽

M. Bilik ◽

А. Крылов ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Histological Examination ◽

Surgical Management ◽

Sentinel Nodes ◽

Planar Scintigraphy ◽

Regional Lymphadenectomy ◽

Quality Of Surgery

Purpose: To increase the effectiveness and quality of surgery treatment for patients with early stages of breast cancer. Material and methods: Since 2016, 25 patients with breast cancer were examined and went through surgery. A lymphotropic colloidal radiopharmaceutical labeled with 99mTc was used; it was administered (150 MBq) the day before the operation. 20 patients received this injection intradermally into periareolar zone, 4 patients received it peritumourally (under control of ultrasound), 1 – paratumorally. Lymphoscintigraphy was performed 3 hours after injection, the images were acquired using dual-head gamma camera Symbia E (Siemens, Germany). A static multiplanar imaging (scintigraphy) (anterior, posterior, lateral projections) was performed for the sentinel nodes (SN) mapping. 25 planar examinations were performed. In 3 cases additional SPECT/CT study was performed using a hybrid SPECT/CT Symbia T2 (Siemens, Germany). Surgical intervention was done on the next day after scintigraphy. During the surgery the hand-held gamma probe NEO 2000 (Johnson & Johnson, USA) was used to localize radioactivity. The lymph nodes with the highest count (hot lymph nodes) were removed and sent for immediate histological examination. The results of immediate histological examination were evaluated again during next studies of gross specimen and slides. Results: During scintigraphy studies planar and SPECT/CT, 26 SN were detected in 20 women (80 %). In 15 patients only one SN lymph node was found, in 4 patients – 2, and in one case 3 SN were found. Intraoperative search of SN and immediate histological examination was conducted in 22 cases, 33 SN were found, while during planar scintigraphy only 26. In three cases, after histological examination (after obtaining examination results), patient surveillance was changed, these patients did not undergo through intraoperative radiometry and a decision was to conduct a one-stage mastectomy with regional lymphadenectomy. 10 out of 22 patients which underwent intraoperative radiometry and sentinel node biopsy, with immediate histological examination had metastases in the removed nodes, therefore lymphadenectomy had been performed. In the rest 12 patients after immediate histological examination of SN no evidence of tumor growth was found, thus lymphadenectomy was not performed. In case of three patients which did not undergo through intraoperative radiometry, lymphadenectomy was performed and after histological examination only two patients had tumor-involved SN, and one patient was clear. All intraoperative results were confirmed with next follow-up histological examinations. In 5 out of 25 patients (20 %) sentinel nodes were not founded. In these 5 cases during follow up period metastases were found in regional lymph nodes, and one patient had tumor emboli in lymphatic vessels, this considered being the cause of negative scintigraphy result. In 12 cases out of 25 (48 %) it was possible to minimize surgical management, and 13 (52 %) undergo lymphadenectomy. Conclusion: 1) The integration of SPECT/CT method of sentinel nodes search allows to plan an optimal surgical management, and can positively affect the long-term follow-up result of treatment of patients with breast cancer, and improve the quality of life. 2) The sensitivity and positive prognostic value (PPV) of planar scintigraphy and intraoperative radiometry of searching for SN are 80, 100 and 73.3, 100 %, respectively. 3) Thanks to the method of lymphoscintigraphy, 12 (48 %) of 25 women it was possible to minimize surgical management without lymphadenectomy.

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Recurrence rate in regional lymph nodes in 737 patients with follicular or Hürthle cell neoplasms

Radiology and Oncology ◽

10.1515/raon-2016-0025 ◽

2016 ◽

Vol 50 (3) ◽

pp. 269-273 ◽

Cited By ~ 3

Author(s):

Andrej Vogrin ◽

Hana Besic ◽

Nikola Besic ◽

Maja Marolt Music

Keyword(s):

Lymph Nodes ◽

Preoperative Diagnosis ◽

Ultrasound Examination ◽

Follicular Neoplasm ◽

Lateral Neck ◽

Regional Lymph Nodes ◽

Neck Ultrasound ◽

Hürthle Cell ◽

Cell Neoplasm

Abstract Background Preoperative ultrasound (US) evaluation of central and lateral neck compartments is recommended for all patients undergoing a thyroidectomy for malignant or suspicious for malignancy cytologic or molecular findings. Our aim was to find out how frequent was recurrence in regional lymph nodes in patients with follicular or Hürthle cell neoplasm and usefulness of preoperative neck US investigation in patients with neoplasm. Patients and methods Altogether 737 patients were surgically treated because of follicular or Hürthle cell neoplasms from 1995 to 2014 at our cancer comprehensive center, among them 207 patients (163 females, 44 males; mean age 52 years) had thyroid carcinoma. Results Carcinoma was diagnosed in follicular and Hürthle cell neoplasm in 143/428 and 64/309 of cases, respectively. A recurrence in regional lymph nodes occurred in 12/207 patients (6%) during a median follow-up of 55 months. Among patients with carcinoma a recurrence in regional lymph nodes was diagnosed in follicular and Hürthle cell neoplasms in 2% and 14%, respectively (p = 0.002). Recurrence in regional lymph nodes was diagnosed in 3/428 of all patients with follicular neoplasm and 9/309 of all patients with Hürthle cell neoplasm. Conclusions Recurrence in lymph nodes was diagnosed in 0.7% of patients with a preoperative diagnosis of follicular neoplasm and 3% of patients with a Hürthle cell neoplasm. A recurrence in regional lymph nodes is rare in patients with carcinoma and preoperative diagnosis of follicular neoplasm. Preoperative neck ultrasound examination in patients with a follicular neoplasm is probably not useful, but in patients with Hurtle cell neoplasm it may be useful.

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Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma

Cancer ◽

10.1002/1097-0142(20000601)88:11<2534::aid-cncr15>3.0.co;2-2 ◽

2000 ◽

Vol 88 (11) ◽

pp. 2534-2539 ◽

Cited By ~ 123

Author(s):

Andreas Blum ◽

Bettina Schlagenhauff ◽

Waltraud Stroebel ◽

Helmut Breuninger ◽

Gernot Rassner ◽

...

Keyword(s):

Early Detection ◽

Lymph Nodes ◽

Cutaneous Melanoma ◽

Ultrasound Examination ◽

Regional Lymph Nodes

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The efficacy of neoadjuvant chemotherapy and survival in older patients with stages II to III triple-negative breast cancer

Modern Oncology ◽

10.26442/18151434.2019.3.190477 ◽

2019 ◽

Vol 21 (3) ◽

pp. 46-51

Author(s):

Olga O Gordeeva ◽

Irina V Kolyadina ◽

Liudmila G Zhukova ◽

Inna P Gan'shina ◽

Dmitrii V Komov ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Triple Negative ◽

Locally Advanced ◽

Disease Diagnosis ◽

Regional Lymph Nodes ◽

Timely Initiation ◽

Leading Position

Background. Breast cancer (BC) maintains the leading position in the structure of the morbidity and mortality from malignancies. Triple-negative BC (TNBC) is the most aggressive subtype among all types of BC. The adequate and timely initiation of neoadjuvant chemotherapy (NAC) determines the further prognosis of the disease in case of early and locally advanced TNBC. Patients over 60 years old are the special subgroup, but it has not been previously considered separately. Aim. To determine the efficacy of NAC and survival in elderly patients with stages II to III TNBC. Materials and methods. Since 2014, 92 patients with histologically verified early and locally advanced TNBC have received NAC, followed by surgery ± adjuvant therapy. NAC was conducted under the following scheme: cisplatin 75 mg/m2 on day 1, paclitaxel 80 mg/m2 on days 1, 8 and 15 of 28-day cycle, for six cycles. After the end of NAC, patients underwent surgery and a follow-up assessment of the degree of therapeutic pathomorphism in the primary tumor and regional lymph nodes. Further on, the correlation analysis was carried out between clinical characteristics and the degree of therapeutic pathomorphism. Results. We analyzed the data from the 92 patients, 22 (23.9%) patients of them were in older age group. At the time of disease diagnosis, the patients older than 60 years of age had a greater involvement of regional lymph nodes (N3: 40.9% vs. 20.0%, p

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Breast Cancer Clinical Regional Lymph Nodes TNM Finding v8

10.32388/akyy54 ◽

2020 ◽

Author(s):

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Regional Lymph Nodes

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Surgical component of lateral and central breast cancer treatment

Kazan medical journal ◽

10.17816/kmj2021-479 ◽

2021 ◽

Vol 102 (4) ◽

pp. 479-485

Author(s):

Z M Abdurakhmanova ◽

M R Ramazanov ◽

E I Sigal

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Oxygen Saturation ◽

Cancer Treatment ◽

Comparison Group ◽

Breast Cancer Treatment ◽

Main Group ◽

Regional Lymph Nodes ◽

Hemoglobin Oxygen Saturation ◽

Arterial Blood

Aim. To improve the results of the surgical component in the treatment of a nodular form of breast cancer with lateral and central localization by analyzing hemoglobin oxygen saturation of arterial blood in the foci of breast cancer, regional lymph nodes and resection line of the breast. Methods. The study involved 175 patients with a nodular form of breast cancer with lateral and central localization (T23N12M0), including 86 in the main group and 89 in the comparison group. In the main group, hemoglobin oxygen saturation in arterial blood of the foci of breast cancer, parenchyma, pectoral muscles and regional lymph nodes was examined for spread of cancer during surgery for nodular breast cancer by using a device developed by us (patent RU 2581266). This examination was not performed in the comparison group. Histopathological examination of resection specimens revealed confirmation of the main foci of breast cancer and the presence of metastases in the regional lymph nodes and pectoral muscles of the breast. Statistical analysis of the data was performed by using the Statistica 10 software. The arithmetic mean, the standard error of the mean and the standard deviation were calculated for the quantitative indicators. Results. In the main group, 86 patients had no recurrence and metastases in the follow-up, while in the comparison group, cancer recurrence was identified in 89 patients and metastases was found during cytological and histological studies in 9 patients. Conclusion. Determination of hemoglobin oxygen saturation of arterial blood during surgery in the subclavian, axillary and subscapular lymph nodes as well as in the pectoralis major and minor muscles allows clarifying the distribution of breast cancer, specifying the scope of the operation and improving the results of the surgical component of breast cancer treatment (T23N12M0).

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

Advances in molecular oncology ◽

10.17650/2313-805x-2018-5-3-8-16 ◽

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.

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