scholarly journals Peritumoral immune infiltrates in primary tumours are not associated with the presence of axillary lymph node metastasis in breast cancer: a retrospective cohort study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9779
Author(s):  
Carlos López ◽  
Ramón Bosch-Príncep ◽  
Guifré Orero ◽  
Laia Fontoura Balagueró ◽  
Anna Korzynska ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Immune Response ◽  
Histological Grade ◽  
The Body ◽  
Multivariate Logistic Regression Model ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Immune Markers ◽  
Body Regions

Background The axillary lymph nodes (ALNs) in breast cancer patients are the body regions to where tumoral cells most often first disseminate. The tumour immune response is important for breast cancer patient outcome, and some studies have evaluated its involvement in ALN metastasis development. Most studies have focused on the intratumoral immune response, but very few have evaluated the peritumoral immune response. The aim of the present article is to evaluate the immune infiltrates of the peritumoral area and their association with the presence of ALN metastases. Methods The concentration of 11 immune markers in the peritumoral areas was studied in 149 patients diagnosed with invasive breast carcinoma of no special type (half of whom had ALN metastasis at diagnosis) using tissue microarrays, immunohistochemistry and digital image analysis procedures. The differences in the concentration of the immune response of peritumoral areas between patients diagnosed with and without metastasis in their ALNs were evaluated. A multivariate logistic regression model was developed to identify the clinical-pathological variables and the peritumoral immune markers independently associated with having or not having ALN metastases at diagnosis. Results No statistically significant differences were found in the concentrations of the 11 immune markers between patients diagnosed with or without ALN metastases. Patients with metastases in their ALNs had a higher histological grade, more lymphovascular and perineural invasion and larger-diameter tumours. The multivariate analysis, after validation by bootstrap simulation, revealed that only tumour diameter (OR = 1.04; 95% CI [1.00–1.07]; p = 0.026), lymphovascular invasion (OR = 25.42; 95% CI [9.57–67.55]; p < 0.001) and histological grades 2 (OR = 3.84; 95% CI [1.11–13.28]; p = 0.033) and 3 (OR = 5.18; 95% CI [1.40–19.17]; p = 0.014) were associated with the presence of ALN metastases at diagnosis. This study is one of the first to study the association of the peritumoral immune response with ALN metastasis. We did not find any association of peritumoral immune infiltrates with the presence of ALN metastasis. Nevertheless, this does not rule out the possibility that other peritumoral immune populations are associated with ALN metastasis. This matter needs to be examined in greater depth, broadening the types of peritumoral immune cells studied, and including new peritumoral areas, such as the germinal centres of the peritumoral tertiary lymphoid structures found in extensively infiltrated neoplastic lesions.

Evaluation of the Esthetic Results of Conservative Treatment of Breast Cancer

1993 ◽  
Vol 79 (4) ◽  
pp. 258-261 ◽  
Author(s):  
Gregorio Moro ◽  
Emanuele Ciambellotti
Keyword(s):  
Breast Cancer ◽  
Conservative Treatment ◽  
The Body ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Tumor Bed ◽  
Boost Irradiation ◽  
Tumor Bed Boost ◽  
Almost All

Aims and backgrounds This paper describes the evaluation of a personal series of 106 breast cancer patients, aged 28-75 years (average, 54), treated between 1988 and 1971, to determine the success of a conservative protocol proposed as a means of combining radicality with a better cosmetic result, less alteration of the body image and an improved quality of life. Methods All the patients were operated with quadrantectomy and excision of axillary lymph nodes, followed by radiotherapy: 50 Gy to the whole breast plus 10 Gy on the tumor bed (boost irradiation). Adjuvant hormone and/or chemotherapy was also administered in 71/106 cases. The mean follow-up was 22.3 months. Cosmetic assessment was subjective and objective (asymmetry, loss of volume, retraction). All patients were photographed. Results The subjective judgements were: excellent 79, satisfactory 25, and poor 2, compared with objective assessments of 72, 20 and 14, respectively. Patients with poor esthetic results were almost all either T2 or treated with chemotherapy. Conclusions Conservative treatment of breast cancer using integrated irradiation and surgery can therefore attain the required objective of eradication of the cancer while maintaining a satisfactory esthetic and therefore good psychologic outcome.

scholarly journals Assessment of axillary lymph nodes involvement in patients with breast cancer depending on the tumor size and its histological and nuclear grades

2012 ◽  
Vol 69 (5) ◽  
pp. 414-419 ◽  
Author(s):  
Toplica Bojic ◽  
Nebojsa Djordjevic ◽  
Aleksandar Karanikolic ◽  
Sladjana Filipovic ◽  
Miroslav Granic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Tumor Size ◽  
Histological Grade ◽  
Radical Mastectomy ◽  
Nuclear Grade ◽  
Breast Cancer Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients

Background/Aim. There are a lot of studies aiding to the opinion that the involvement degree of axilla lymph nodes grows depending on increase of breast tumor size, and its histological and nuclear grades. The aim of this study was to assess the risk of axillary lymph nodes involvement, as well as the relation between the tumor size, histological and nuclear grades in a group of female patients who underwent breast cancer surgery, including levels 1-3 axillary dissection. Methods. Investigation covered 900 patients operated on during 2005-2008 who underwent modified radical mastectomy including axillar dissection. We assessed a number of involved lymph nodes, depending on tumor macroscopic size (T), histological grade (HG) and nuclear grade (NG). Results. A total number of examined lymph nodes was 9977. The incidence of involved lymph nodes was from 18.6% with T1 tumor size up to 60.2% with T4 tumor size. Concerning histological grade, the number of involved lymph nodes ranged from 14.2% (HGI) to 45.1% (HGIII); while in terms of nuclear grade, the number of involved lymph nodes ranged from 17.4% (NGI) to 54.5% (NGIV). By using ?2-test for trend and odds ratio (OR), the results showed that the axillary lymph nodes involvement degree was increased with the increase of the tumor size and its histological and nuclear grades. The risk of axillary lymphatic nodes involvement was 1.43 times higher in the group of T2 tumors size compared to the smaller tumors T1 size, and even up to 6.62 times higher in case of T4 tumor size. It was also increasied from 1.79 times for HGII to even 4.98 times for HGIII, and from 1.44 times for NGII to 5.71 times for NGIV. Conclusion. In breast cancer patients, there is a strong correlation between tumor size, its histological and nuclear grades and the risk of axillary lymph nodes involvement.

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 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 Intra-mammary Lymph Nodes, an Overlooked Prognostic Tool?

2020 ◽  
Author(s):  
Tarek Hashem ◽  
Ahmed Abdel Moez ◽  
Ahmed Rozeka ◽  
Hazem Abdel Azeem
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Tumour Size ◽  
Preoperative Imaging ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Duct Carcinoma ◽  
Surgical Data

Abstract BackgroundDue 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 2013-2019. Radiological, pathological and surgical data were studied.ResultsIntra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phylloides tumors and two cases had duct carcinoma in situ. All ten cases were excluded. The remaining 90 cases had all 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 tumour size (4.7 cm) , larger mean size of the IMLN (1.4 cm), higher incidence of lymphovascular invasion( 65.9%) and a higher rate of extracapsular extension in axillary lymph nodes (57.4%). All these criteria were statistically significant. In addition the pathological N stage was significantly higher in the malignant IMLNs group.ConclusionIntra-mammary lymph nodes are frequently overlooked by clinicians. More effort should be done to detect them during preoperative imaging, and during pathological processing of specimens. A suspicious IMLN should be biopsied by FNAC . Malignant IMLN are associated with advanced pathological features and should be removed during surgery.

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