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Qu L, Chen Q, Luo N, Zhao P, Zou Q, Mei X, Liu Z, Yi W. 3D reconstruction based novel methods are more effective than traditional clinical assessment in breast cancer axillary lymph node metastasis prediction. Sci Rep 2022; 12:12425. [PMID: 35858979 PMCID: PMC9300607 DOI: 10.1038/s41598-022-16380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
The status of axillary lymph node metastases determines the treatment and overall survival of breast cancer (BC) patients. Three-dimensional (3D) assessment methods have advantages for spatial localization and are more responsive to morphological changes in lymph nodes than two-dimensional (2D) assessment methods, and we speculate that methods developed using 3D reconstruction systems have high diagnostic efficacy. This exploratory study included 43 patients with histologically confirmed BC diagnosed at Second Xiangya Hospital of Central South University between July 2017 and August 2020, all of whom underwent preoperative CT scans. Patients were divided into a training cohort to train the model and a validation cohort to validate the model. A 3D axillary lymph node atlas was constructed on a 3D reconstruction system to create various methods of assessing lymph node metastases for a comparison of diagnostic efficacy. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic values of these methods. A total of 43 patients (mean [SD] age, 47 [10] years) met the eligibility criteria and completed 3D reconstruction. An axillary lymph node atlas was established, and a correlation between lymph node sphericity and lymph node metastasis was revealed. By continuously fitting the size and characteristics of axillary lymph nodes on the 3D reconstruction system, formulas and models were established to determine the presence or absence of lymph node metastasis, and the 3D method had better sensitivity for axillary lymph node assessment than the 2D method, with a statistically significant difference in the correct classification rate. The combined diagnostic method was superior to a single diagnostic method, with a 92.3% correct classification rate for the 3D method combined with ultrasound. In addition, in patients who received neoadjuvant chemotherapy (NAC), the correct classification rate of the 3D method (72.7%) was significantly higher than that of ultrasound (45.5%) and CT (54.5%). By establishing an axillary lymph node atlas, the sphericity formula and model developed with the 3D reconstruction system achieve a high correct classification rate when combined with ultrasound or CT and can also be applied to patients receiving NAC.
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Affiliation(s)
- Limeng Qu
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Qitong Chen
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Na Luo
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.,Department of General Surgery, The First People's Hospital of Changde City, Changde, China
| | - Piao Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiongyan Zou
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Xilong Mei
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ziru Liu
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.
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Welslau M, Müller V, Lüftner D, Schütz F, Stickeler E, Fasching PA, Janni W, Thomssen C, Witzel I, Fehm TN, Belleville E, Bader S, Seitz K, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Schneeweiss A, Harbeck N, Würstlein R, Hartkopf AD, Wöckel A, Seliger B, Massa C, Kolberg HC. Update Breast Cancer 2022 Part 1 – Early Stage Breast Cancer. Geburtshilfe Frauenheilkd 2022; 82:580-589. [PMID: 35903719 PMCID: PMC9315400 DOI: 10.1055/a-1811-6106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 10/26/2022] Open
Abstract
AbstractEvidence relating to the treatment of breast cancer patients with early-stage disease has increased significantly in the past year. Abemaciclib, olaparib, and pembrolizumab are new drugs
with good efficacy in the relevant patient groups. However, some questions remain unanswered. In particular, it remains unclear which premenopausal patients with hormone receptor-positive
breast cancer should be spared unnecessary treatment. The question of the degree to which chemotherapy exerts a direct cytotoxic effect on the tumor or reduces ovarian function through
chemotherapy could be of key importance. This group of patients could potentially be spared chemotherapy. New, previously experimental biomarker analysis methods, such as spatial analysis of
gene expression (spatial transcriptomics) are gradually finding their way into large randomized phase III trials, such as the NeoTRIP trial. This in turn leads to a better understanding of
the predictive factors of new therapies, for example immunotherapy. This review summarizes the scientific innovations from recent congresses such as the San Antonio Breast Cancer Symposium
2021 but also from recent publications.
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Affiliation(s)
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabell Witzel
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Simon Bader
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Katharina Seitz
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Genecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Bahriye Aktas
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Barbara Seliger
- Martin-Luther-Universitat Halle-Wittenberg, Institute of Medical Immunology, Halle (Saale), Germany
| | - Chiara Massa
- Martin-Luther-Universitat Halle-Wittenberg, Institute of Medical Immunology, Halle (Saale), Germany
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Friedrich M, Kühn T, Janni W, Müller V, Banys-Pachulowski M, Kolberg-Liedtke C, Jackisch C, Krug D, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Gerber B, Gluz O, Hanf V, Harbeck N, Heil J, Huober J, Kreipe HH, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Thill M, Ditsch N. AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update. Geburtshilfe Frauenheilkd 2021; 81:1112-1120. [PMID: 34629490 PMCID: PMC8494519 DOI: 10.1055/a-1499-8431] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022] Open
Abstract
For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives
during surgical staging of the axilla in pN+
CNB
stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.
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Affiliation(s)
- Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Wolfgang Janni
- Frauenklinik, Klinikum der Universität Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maggie Banys-Pachulowski
- Klinik für Frauenheilkunde und Geburtshilfe, UK-SH, Lübeck, Germany.,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | | | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - David Krug
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Campus Kiel, Kiel, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva M Fallenberg
- Klinikum der Universität München, Campus Großhadern, Institut für Klinische Radiologie, München, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Oleg Gluz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Volker Hanf
- Frauenklinik, Nathanstift Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Universitäts-Klinikum Heidelberg, Brustzentrum, Heidelberg, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik, St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Nina Ditsch
- Frauenklinik, Universitätsklinikum Augsburg, Augsburg, Germany
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Byon JH, Park YV, Yoon JH, Moon HJ, Kim EK, Kim MJ, You JK. Added Value of MRI for Invasive Breast Cancer including the Entire Axilla for Evaluation of High-Level or Advanced Axillary Lymph Node Metastasis in the Post-ACOSOG Z0011 Trial Era. Radiology 2021; 300:46-54. [PMID: 33904772 DOI: 10.1148/radiol.2021202683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background In the post-American College of Surgeons Oncology Group Z0011 trial era, radiologists have increasingly focused on excluding high-level or advanced axillary lymph node metastasis (ALNM) by using an additional MRI scan positioned higher than lower axillae; however, the value of these additional scans remains undetermined. Purpose To evaluate whether a standard MRI protocol is sufficient to exclude high-level or advanced ALNM in breast cancer or additional MRI of entire axilla is needed. Materials and Methods This retrospective study evaluated women with invasive breast cancer who underwent breast MRI from April 2015 to December 2016. Some underwent neoadjuvant chemotherapy (NAC) and others underwent upfront surgery. Standard (routine axial scans including the lower axillae) and combined (routine axial scans plus additional scans including the entire axilla) MRI protocols were compared for high-level or advanced ALNM detection. Clinical-pathologic characteristics were analyzed. Uni- and multivariable logistic regression was performed to identify predictors of high-level or advanced ALNM. Results A total of 435 women (mean age ± standard deviation, 52 years ± 11) were evaluated (65 in the NAC group, 370 in the non-NAC group). With the standard MRI protocol, predictors of high-level ALNM were peritumoral edema (odds ratio [OR], 12.3; 95% CI: 3.9, 39.4; P < .001) and positive axilla (OR, 5.9; 95% CI: 2.0, 15.2; P < .001). Only three of 289 women with negative axillae without peritumoral edema had high-level ALNM. Predictors of advanced ALNM were positive axillae (OR, 8.9; 95% CI: 3.7, 21.5; P < .001) and peritumoral edema (OR, 2.8; 95% CI: 1.1, 6.9; P = .03). Only six of 310 women who had negative axillae without peritumoral edema had advanced ALNM. Conclusion The performance of standard MRI was satisfactory in excluding high-level and advanced axillary lymph node metastasis in most patients with breast cancer. However, the presence of peritumoral edema or positive axillae in the MRI findings emphasizes the benefits of a combined MRI protocol. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Abe in this issue.
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Affiliation(s)
- Jung Hee Byon
- From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.)
| | - Youngjean Vivian Park
- From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.)
| | - Jung Hyun Yoon
- From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.)
| | - Hee Jung Moon
- From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.)
| | - Eun-Kyung Kim
- From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.)
| | - Min Jung Kim
- From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.)
| | - Jai Kyung You
- From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.)
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Li X, Chen S, Duan Y, Guo H, Jiang L, Kong X, Ma T, Yang Q. Identification and preservation of stained non-sentinel lymph nodes in breast cancer. Oncol Lett 2020; 20:373. [PMID: 33154771 PMCID: PMC7608050 DOI: 10.3892/ol.2020.12236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/11/2020] [Indexed: 01/25/2023] Open
Abstract
Sentinel lymph nodes (SLNs) are the first lymph nodes that receive lymphatic drainage from the breast. However, all stained lymph nodes are dissected as SLNs during surgery. The present study aimed to identify and preserve the stained non-SLNs and evaluate the safety during sentinel lymph node biopsy (SLNB) in breast cancer. SLNB was performed with a methylene blue and indocyanine green double-tracer technique. The first lymph node, which was connected with lymphatic vessels from the breast, was designated as the true SLN. The lymph node that was directly connected with the output lymphatic duct of the SLN was defined as post-SLN (poSLN), whereas the stained poSLN was designated as non-SLN. Both the stained SLN and non-SLN were sent to the pathological department for definitive diagnosis. The present study demonstrated that intraoperative dissection of the lymphatic network could distinguish true SLNs and stained non-SLNs. The number of stained lymph nodes was time-dependent. Not all stained lymph nodes were real SLNs, whereas the poSLNs would be stained if the staining time interval was inappropriate. The data indicated that the poSLNs were negative for metastasis when the SLNs were negative for metastasis. Stained lymph nodes may contain non-SLNs in addition to SLNs. Resection of all stained lymph nodes is not recommended. To reduce the morbidity due to SLNB complications, the identification and preservation of stained non-SLNs during SLNB is feasible and warrants further study in the era of precision medicine.
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Affiliation(s)
- Xiaoyan Li
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Sisi Chen
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yi Duan
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hanyin Guo
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Liyu Jiang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaoli Kong
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Tingting Ma
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China.,Department of Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Central Review of Radiation Therapy Planning Among Patients with Breast-Conserving Surgery: Results from a Quality Assurance Process Integrated into the INSEMA Trial. Int J Radiat Oncol Biol Phys 2020; 107:683-693. [PMID: 32437921 DOI: 10.1016/j.ijrobp.2020.04.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE After publication of the radiation field design in the American College of Surgeons Oncology Group Z0011 trial, a radiation therapy quality assurance review was integrated into the Intergroup-Sentinel-Mamma (INSEMA) trial. We aimed to investigate the role of patient characteristics, extent of axillary surgery, and radiation techniques for dose distribution in ipsilateral axillary levels. METHODS AND MATERIALS INSEMA (NCT02466737) has randomized 5542 patients who underwent breast-conserving surgery. Of these, 276 patients from 108 radiation therapy facilities were included in the central review, using the planning records of the first 3 patients treated at each site. RESULTS Of the 276 patients, 41 had major deviations (ie, no axillary contouring or submission of insufficient records) leading to exclusion. A total of 235 (85.1%) radiation therapy planning records were delineated according to the INSEMA protocol, including 9 (3.8%) cases with minor deviations. At least 25% of INSEMA patients were unintentionally treated with ≥95% of the prescribed breast radiation dose in axillary level I. Approximately 50% of patients were irradiated with a median radiation dose of more than 85% of prescription dose in level I. Irradiated volumes and applied doses were significantly lower in levels II and III compared with level I. However, 25% of patients still received a median radiation dose of ≥75% of prescription dose to level II. Subgroup analysis revealed a significant association between incidental radiation dose in the axilla and obesity. Younger age, boost application, and fractionation schedule showed no impact on axillary dose distribution. CONCLUSIONS Assuming ≥80% of prescribed breast dose as the optimal dose for curative radiation of low-volume disease in axillary lymph nodes, at least 50% of reviewed INSEMA patients received an adequate dose in level I, even with contemporary 3-dimensional techniques. Dose coverage was much less in axillary levels II and III, and far below therapeutically relevant doses.
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7
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Poodt IGM, Schipper RJ, Vugts G, Woensdregt K, van der Sangen M, Voogd AC, Nieuwenhuijzen GAP. The rationale for and long-term outcome of incomplete axillary staging in elderly women with primary breast cancer. Eur J Surg Oncol 2018; 44:1714-1719. [PMID: 30082177 DOI: 10.1016/j.ejso.2018.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 07/08/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The proportion of elderly women diagnosed with breast cancer is rising. Standard treatment, including axillary staging, is often not given to these patients. This study aimed to investigate reasons to omit any surgical axillary staging or to refrain from completion axillary lymph node dissection (cALND) after positive-sentinel lymph node biopsy (SLNB); so-called "incomplete staging". Furthermore, the impact of incomplete staging on regional control and survival in patients aged 75 or older was evaluated. METHODS A retrospective cohort study was conducted including all primary breast cancer patients aged 75 or older, diagnosed between 2001 and 2008, and documented by the Netherlands Cancer Registry (NCR). Patients with incomplete staging were compared to patients with complete axillary staging. Survival analyses were used to determine the risk of local, regional and distant recurrence and overall survival. RESULTS In total, 1467 of 2116 (69%) patients were considered eligible, of whom 258 (17.2%) had incomplete axillary staging. For 93 patients, diagnosed in 6 of the 10 hospitals in the NCR-area, examination of clinical records revealed that age, comorbidities and patient preferences were the main reason for omitting complete axillary staging. The 10-year axillary recurrence rate in these 93 patients was 5.2% (95% CI, 0.03-10.1). Of the 77 patients who had died, 64 (83%) died of non-breast-cancer-related causes. No significant difference in overall survival was observed between patients with or without complete axillary staging. CONCLUSION This study demonstrates that the omission of complete axillary staging is common in selected elderly breast cancer patients with ≥2 comorbidities, with no apparent impact on regional control and 10-year overall survival.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
| | | | - Guusje Vugts
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - Karlijn Woensdregt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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8
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Maráz R, Zombori T, Ambrózay É, Cserni G. The role of preoperative axillary ultrasound and fine-needle aspiration cytology in identifying patients with extensive axillary lymph node involvement. Eur J Surg Oncol 2017; 43:2021-2028. [DOI: 10.1016/j.ejso.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022] Open
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9
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Reimer T, Stachs A, Nekljudova V, Loibl S, Hartmann S, Wolter K, Hildebrandt G, Gerber B. Restricted Axillary Staging in Clinically and Sonographically Node-Negative Early Invasive Breast Cancer (c/iT1-2) in the Context of Breast Conserving Therapy: First Results Following Commencement of the Intergroup-Sentinel-Mamma (INSEMA) Trial. Geburtshilfe Frauenheilkd 2017; 77:149-157. [PMID: 28331237 DOI: 10.1055/s-0042-122853] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Axillary lymph node status remains an important prognostic factor in early breast cancer. It is regarded as an indicator for (neo)adjuvant systemic treatment and postoperative radiotherapy of the regional lymphatics. Commenced in September 2015, the INSEMA trial is investigating whether operative determination of nodal status as part of breast conserving therapy (BCT) for early stage breast cancer (c/iT1-2 c/iN0) can be avoided without reducing oncological safety. After inclusion of 1001 patients there was general acceptance of the complex study design by patients and study doctors so that recruitment for the first randomisation (axillary sentinel lymph node biopsy [SLNB]: yes or no) achieved predicted case numbers. The second randomisation however (SLNB alone versus complete axillary dissection when one or two macrometastases are present at SLNB) recruited fewer cases than expected for the following three reasons: a) the 13 % rate of one or two macrometastases after SLNB in the INSEMA trial collective was lower than expected; b) around 20 % of patients refused the second randomisation; c) there was delayed inclusion of the Austrian study centres, which only recruited for the second randomisation. Lack of knowledge of nodal status when SLNB is avoided represents a new challenge for the postoperative tumour board. In particular decisions on chemotherapy for luminal-like tumours and irradiation of the lymphatics (excluding axilla) must be guided by tumour biological parameters. The INSEMA trial does not provide answers to some important questions, e.g. it remains unclear whether patients without SLNB can be offered partial breast irradiation alone in low-risk situations and whether SLNB can also be avoided in patients with stage T1-2 tumours who have a mastectomy indication.
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Affiliation(s)
- T Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - A Stachs
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | | | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - S Hartmann
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - K Wolter
- Department of Radiotherapy, University of Rostock, Rostock, Germany
| | - G Hildebrandt
- Department of Radiotherapy, University of Rostock, Rostock, Germany
| | - B Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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10
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Cai X, Liu X, Liao LD, Bandla A, Ling JM, Liu YH, Thakor N, Bazan GC, Liu B. Encapsulated Conjugated Oligomer Nanoparticles for Real-Time Photoacoustic Sentinel Lymph Node Imaging and Targeted Photothermal Therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2016; 12:4873-4880. [PMID: 27439884 DOI: 10.1002/smll.201600697] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/18/2016] [Indexed: 06/06/2023]
Abstract
Noninvasive and nonionizing imaging of sentinel lymph nodes (SLN) is highly desirable for the detection of breast cancer metastasis through sentinel lymph node biopsy. Photoacoustic (PA) imaging is an emerging imaging technique that can serve as a suitable approach for SLN imaging. Herein, novel conjugated oligomer based nanoparticles (NPs) with strong NIR absorption, good biocompatibility, excellent PA contrast, and good photothermal conversion efficiency are reported. Real-time PA imaging of SLN reveals high resolution of the NPs via injection from the left forepaw pad. In addition, the surface functionalized NPs can target breast cancer cells and kill them efficiently and specifically through photothermal therapy upon 808 nm laser irradiation. This work shows great potential of the nanoparticle PA contrast agent to serve as a multifunctional probe for photothermal therapy at SLNs to achieve the inhibition of cancer cell metastasis in the near future.
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Affiliation(s)
- Xiaolei Cai
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore, 117585, Singapore
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, 28 Medical Drive, #05-01, Singapore, 117456, Singapore
| | - Xiaofeng Liu
- Department of Chemistry and Biochemistry, Center for Polymers and Organic Solids, University of California, Santa Barbara, CA, 93107, USA
| | - Lun-De Liao
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan
| | - Aishwarya Bandla
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore
- Department of Biomedical Engineering, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore
| | - Ji Min Ling
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore
- National Neuroscience Institute (NNI), 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Yu-Hang Liu
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore
| | - Nitish Thakor
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore
- Department of Biomedical Engineering, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore
| | - Guillermo C Bazan
- Department of Chemistry and Biochemistry, Center for Polymers and Organic Solids, University of California, Santa Barbara, CA, 93107, USA.
| | - Bin Liu
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore, 117585, Singapore.
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11
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Application of positron emission tomography (PET/CT) in diagnosis of breast cancer. Part I. Diagnosis of breast cancer prior to treatment. Contemp Oncol (Pozn) 2016; 20:8-12. [PMID: 27095933 PMCID: PMC4829744 DOI: 10.5114/wo.2016.58496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/14/2015] [Indexed: 11/17/2022] Open
Abstract
Positron emission tomography with computed tomography (PET/CT) is gaining popularity as a method for overall staging assessment of breast cancer. Currently, it is not a part of the routine workup before the beginning of treatment, because of insufficient sensitivity for the detection of small tumors (due to its limited spatial resolution), the heterogeneity of radiotracer uptake by the primary tumor, and unsatisfactory sensitivity in detection of lymph node metastases (particularly when they are small). Nevertheless, it should be considered when there is a high risk of metastases, because then initial PET/CT examination allows for accurate staging and may change the treatment algorithm in up to almost 50% of stage III patients, due to detection of distant and lymph node metastases throughout the whole body. Despite the discussed limitations of PET/CT, there is ongoing research concerning the recommendations for the examination prior to treatment. For a particular group of patients with high risk of metastases, PET/CT may be expected to become a part of the routine workup as the most appropriate staging method.
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12
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Nieciecki M, Dobruch-Sobczak K, Wareluk P, Gumińska A, Białek E, Cacko M, Królicki L. The role of ultrasound and lymphoscintigraphy in the assessment of axillary lymph nodes in patients with breast cancer. J Ultrason 2016; 16:5-15. [PMID: 27103998 PMCID: PMC4834366 DOI: 10.15557/jou.2016.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/08/2016] [Accepted: 02/15/2016] [Indexed: 01/01/2023] Open
Abstract
Breast cancer is the most common malignancy and the leading cause of death due to cancer in European women. Mammography screening programs aimed to increase the detection of early cancer stages were implemented in numerous European countries. Recent data show a decrease in mortality due to breast cancer in many countries, particularly among young women. At the same time, the number of sentinel node biopsy procedures and breast-conserving surgeries has increased. Intraoperative sentinel lymph node biopsy preceded by lymphoscintigraphy is used in breast cancer patients with no clinical signs of lymph node metastasis. Due to the limited sensitivity and specificity of physical examination in detecting metastatic lesions, developing an appropriate diagnostic algorithm for the preoperative assessment of axillary lymph nodes seems to be a challenge. The importance of ultrasound in patient qualification for sentinel lymph-node biopsy has been discussed in a number of works. Furthermore, different lymphoscintigraphy protocols have been compared in the literature. The usefulness of novel radiopharmaceuticals as well as the methods of image acquisition in sentinel lymph node diagnostics have also been assessed. The aim of this article is to present, basing on current guidelines, literature data as well as our own experience, the diagnostic possibilities of axillary lymph node ultrasound in patient qualification for an appropriate treatment as well as the role of lymphoscintigraphy in sentinel lymph node biopsy.
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Affiliation(s)
- Michał Nieciecki
- Department of Diagnostic Imaging, Mazovian Bródno Hospital, Warsaw, Poland
| | - Katarzyna Dobruch-Sobczak
- Department of Radiology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Paweł Wareluk
- Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland
| | - Anna Gumińska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Ewa Białek
- Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland
| | - Marek Cacko
- Department of Diagnostic Imaging, Mazovian Bródno Hospital, Warsaw, Poland
| | - Leszek Królicki
- Department of Diagnostic Imaging, Mazovian Bródno Hospital, Warsaw, Poland; Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
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Usmani S, Ahmed N, Al Saleh N, abu Huda F, Amanguno HG, Amir T, al Kandari F. The clinical utility of combining pre-operative axillary ultrasonography and fine needle aspiration cytology with radionuclide guided sentinel lymph node biopsy in breast cancer patients with palpable axillary lymph nodes. Eur J Radiol 2015; 84:2515-20. [PMID: 26474908 DOI: 10.1016/j.ejrad.2015.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/26/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Clinically palpable lymph nodes (CPLN) are usually considered a contraindication to sentinel lymph node biopsy (SLNB) but one third of these patients are node negative. The aim of the present study is to evaluate the clinical usefulness of combining SLNB and preoperative axillary ultrasonography (AUS) with FNAC in patients with clinically palpable but indeterminate axillary lymph nodes. MATERIALS AND METHODS Fifty three patients with primary breast cancer and CPLN (mean age, 51.6 years; median age 51 years; age range, 28-73 years) were included in the study. All patients underwent AUS and fine needle aspiration (FNAC) followed by SLNB in FNAC negative patients (Group A). Patients with proven metastasis subsequently had axillary lymph node dissection (ALND) (Group B). Standard SLN scintigraphy was performed 2-4h before surgery by injecting Tc-99m labeled nano-colloid intra-dermally in the periareolar region. RESULTS Nodal metastases were documented at FNAC in 26 (49%) of the 53 patients with subsequent ALND (Group B). All 27 patients (51%) with negative FNAC results (Group A) underwent SLNB, which revealed metastasis in 6 (11%) patients. The remaining 21 (40%) patients were tumor negative and all these patients remain disease free during the follow-up period of 12-36 months with NPV of 100%. SLN was identified in all patients (100% success rate). Preoperative AUS sensitivity was 78%, specificity 76%, PPV 83%, NPV 69% and accuracy 77% (p=0.001). In comparison, ultrasound guided FNAC sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 81%, 100%, 100%, 78%, 89% respectively (p=0.001). CONCLUSIONS The inaccuracy of clinical assessment allows widening of indication of SLNB. Preoperative ultrasonography and guided FNAC can help in selecting the patients suitable for ALND or SLNB. Patients who are FNAC positive can proceed to ALND whilst FNAC negative samples can undergo SLNB. This combination strategy may be helpful in avoiding unnecessary ALND.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khiatan, Kuwait.
| | - Najeeb Ahmed
- Jack Brignall PET/CT Centre, Castle Hill Hosptial, Cottingham, UK
| | - Noha Al Saleh
- Department of Surgery, Kuwait Cancer Control Center (KCCC), Khiatan, Kuwait
| | - Fawaz abu Huda
- Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khiatan, Kuwait
| | - Henney G Amanguno
- Department of Pathology, Kuwait Cancer Control Center (KCCC), Khiatan, Kuwait
| | - Thasneem Amir
- Department of Pathology, Kuwait Cancer Control Center (KCCC), Khiatan, Kuwait
| | - Farida al Kandari
- Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khiatan, Kuwait
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14
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Ergul N, Kadioglu H, Yildiz S, Yucel SB, Gucin Z, Erdogan EB, Aydin M, Muslumanoglu M. Assessment of multifocality and axillary nodal involvement in early-stage breast cancer patients using 18F-FDG PET/CT compared to contrast-enhanced and diffusion-weighted magnetic resonance imaging and sentinel node biopsy. Acta Radiol 2015; 56:917-23. [PMID: 25013091 DOI: 10.1177/0284185114539786] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 05/23/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Non-invasive evaluation of the extent of axillary nodal involvement in early-stage breast cancer (ESBC) patients and accurate assessment of multifocality are both challenging. Few reports have explored whether 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) might be more useful than other diagnostic methods in these contexts. PURPOSE To prospectively evaluate the diagnostic utility of FDG PET/CT, contrast-enhanced, and diffusion-weighted magnetic resonance imaging (DCE-MRI and DWI), and sentinel lymph node biopsy (SNB), in detection of axillary metastatic lymph nodes in ESBC patients; and to explore the utilities of FDG PET/CT and DCE-MRI for identification of multifocality. MATERIAL AND METHODS Twenty-four female patients (mean age, 47 ± 9.9 years; range, 24-68 years) with ESBC underwent whole-body FDG PET/CT and breast MRI prior to operation. SNB and axillary lymph node dissection (ALND) were performed on all patients, as was mastectomy or wide local tumor excision. Histopathological findings served as the gold standard when evaluating either multifocality or axillary nodal involvement. RESULTS The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of PET/CT and DCE-MRI, used to detect multifocality, were as follows: 67% versus 78%, 100% versus 53%, 100% versus 50%, 83% versus 80%, and 88% versus 63%. SNB afforded the highest sensitivity (93%) in terms of detection of axillary metastasis. The sensitivity, NPV, and accuracy of PET/CT were 67%, 62%, and 75% respectively, thus higher than the equivalent values of either DCE-MRI or DWI. CONCLUSION For assessment of multifocality in ESBC patients, highly specific results of PET/CT should be taken into account along with DCE-MRI findings. For evaluation of axillary nodal involvement, PET/CT has higher sensitivity, NPV, and accuracy values than DCE-MRI and DWI and may guide a surgical decision to proceed or not to SNB or ALND.
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Affiliation(s)
- Nurhan Ergul
- Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Huseyin Kadioglu
- Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Seyma Yildiz
- Department of Radiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Serap Baskaya Yucel
- Department of Radiation Oncology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Zuhal Gucin
- Department of Pathology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ezgi Basak Erdogan
- Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mehmet Aydin
- Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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15
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Management of idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment. BMC Surg 2014; 14:66. [PMID: 25189179 PMCID: PMC4159557 DOI: 10.1186/1471-2482-14-66] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 08/20/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease. Because of it's uncommon etiology and rareness, diagnosis and treatment is still a challenge. Owing to wide spectrum of IGM it is difficult to standardize and optimize the treatment. The aim of this study was to report and describe the clinical signs, radiological findings, management, clinical course and the recurrence rate of the patients which were treated due to IGM. METHODS In this retrospective review of patients diagnosed with IGM histopathologically between January 2006 and December 2011, medical reports, ultrasonography (US) and mammograhy (MMG) findings, follow-up information and recurrence were obtained from records. RESULTS Painful, firm and ill defined mass was the symptom of all patients. While parenchymal heterogeneity, abscess and mass were the findings of US, increased asymmetric density was the main finding of MMG. Wide local excision was performed in 15 (62.5%) patients, incisional biopsy with abscess drainage was performed in 9 (37.5%) patients. Median follow-up was 34.8 (range 10-66) months. CONCLUSIONS While the physical examination give rise to thought of breast carcinoma, the appearance of parenchymal heterogeneity and abscess formation on US especially with enlarged axillary lymph nodes support the presence of an inflammatory process. But these findings do not exclude carcinoma. Hereby, histopathologic confirmation is mandatory to ensure that a malignancy is not missed.
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16
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Agresti R, Crippa F, Sandri M, Martelli G, Tagliabue E, Alessi A, Pellitteri C, Maccauro M, Maugeri I, Barbara P, Rampa M, Moscaroli A, Ferraris C, Carcangiu ML, Bianchi G, Greco M, Bombardieri E. Different biological and prognostic breast cancer populations identified by FDG-PET in sentinel node-positive patients: results and clinical implications after eight-years follow-up. Breast 2014; 23:334-40. [PMID: 24485802 DOI: 10.1016/j.breast.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/23/2013] [Accepted: 01/05/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sentinel node (SN) biopsy is the standard method to evaluate axillary node involvement in breast cancer (BC). Positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG-PET) provides a non-invasive tool to evaluate regional nodes in BC in a metabolic-dependent, biomolecular-related way. In 1999, we initiated a prospective non-randomized study to compare these two methods and to test the hypothesis that FDG-PET results reflect biomolecular characteristics of the primary tumor, thereby yielding valuable prognostic information. PATIENTS AND METHODS A total of 145 cT1N0 BC patients, aged 24-70 years, underwent FDG-PET and lymphoscintigraphy before surgery. SN biopsy was followed in all cases by complete axillary dissection. Pathologic evaluation in tissue sections for involvement of the SN and other non-SN nodes served as the basis of the comparison between FDG-PET imaging and SN biopsy. RESULTS FDG-PET and SN biopsy sensitivity was 72.6% and 88.7%, respectively, and negative predictive values were 80.5% and 92.2%, respectively. A subgroup of more aggressive tumors (ER-GIII, Her2+) was found mainly in the FDG-PET true-positive (FDG-PET+) patients, whereas LuminalA, Mib1 low-rate BCs were significantly undetected (p = 0.009) in FDG-PET false-negative (FDG-PET-) patients. Kaplan-Meier survival estimates after a median follow-up of more than 8 years showed significantly worse overall survival for FDG-PET+ patients in node-positive (N+) patients (p = 0.035) as compared to N+/FDG-PET- patients, which overlapped with survival curves of N- and FDG-PET+ or - patients. CONCLUSIONS Our findings suggest that FDG-PET results reflect intrinsic biologic features of primary BC tumors and have prognostic value with respect to nodal metastases. FDG-PET false negative cases appear to identify less aggressive indolent metastases. The possibility to identify a subgroup of N+ BC patients with an outcome comparable with N- BC patients could reduce the surgical and adjuvant therapeutic intervention.
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Affiliation(s)
- Roberto Agresti
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Flavio Crippa
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Sandri
- Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Martelli
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elda Tagliabue
- Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Alessi
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Pellitteri
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Maccauro
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Maugeri
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Padovano Barbara
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Rampa
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Moscaroli
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Ferraris
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Giulia Bianchi
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Greco
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilio Bombardieri
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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17
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Grootendorst DJ, Steenbergen W, Manohar S, Ruers TJM. Optical techniques for the intraoperative assessment of nodal status. Future Oncol 2013; 9:1741-55. [PMID: 24156334 DOI: 10.2217/fon.13.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The lymphatic system is an important pathway in the metastatic spread of many malignancies and a key prognostic indicator. Nondestructive assessment of the nodal status during surgery could limit the amount of lymph nodes that need to be resected and allow for immediate regional lymphadenectomy during sentinel lymph node biopsy procedures. This review looks into the possibilities of conventional medical imaging methods that are capable of intraoperative nodal assessment and discusses multiple newly developed optical techniques. The physical background behind these techniques is reviewed and a concise overview of their main advantages and disadvantages is provided. These recent innovations show that while the application of optical modalities for intraoperative nodal staging is not yet applied routinely, there is reason enough to expect their introduction in the near future.
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Affiliation(s)
- Diederik J Grootendorst
- Biomedical Photonic Imaging Group, MIRA Institute for Biomedical Technology & Technical Medicine, Science & Technology, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
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18
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Stachs A, Göde K, Hartmann S, Stengel B, Nierling U, Dieterich M, Reimer T, Gerber B. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer - size of metastases as limiting factor. SPRINGERPLUS 2013; 2:350. [PMID: 23961414 PMCID: PMC3733074 DOI: 10.1186/2193-1801-2-350] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/02/2013] [Indexed: 11/10/2022]
Abstract
Since the performance of surgical procedures of the axilla in the treatment of early breast cancer is decreasing, the role of axillary ultrasound (AUS) as staging procedere has newly to be addressed. The aim of this study was to determine which patient or histopathological characteristics are related to false-negative AUS. In a retrospective study design data of 470 women with primary breast cancer were collected from patient charts and imaging and pathology records were reviewed. True positive and false negative axillary ultrasound groups were compared in terms of tumor size, histological subtype, grade, estrogen receptor (ER) and HER2 status, proliferation index, number and size of nodal metastases, extracapsular extension (ECE) and lymphovascular invasion (LVI). Of 470 patients, 166 (35%) were node positive, 79 of them with suspicious AUS. Factors associated with false negative AUS by univariate analysis were included in a multivariate model. By multivariate analysis, only size of nodal metastases was an independent factor for false negative AUS. In the sentinel lymph node biopsy (SLNB) subgroup, 45% of patients had nodal metastasis size less than or equal to 5 mm. In conclusion, AUS in preoperative staging of early stage breast cancer is limited by small size of metastases in a substantial number of patients. Prospective studies have to show whether small metastatic deposits leaving in patients in case of no axillary surgery have no negative effect on disease free and overall survival.
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Affiliation(s)
- Angrit Stachs
- Department of Gynecology and Obstetrics, University of Rostock, Südring 81, Rostock, 18059 Germany
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19
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Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth 2013; 110:690-701. [PMID: 23599512 DOI: 10.1093/bja/aet068] [Citation(s) in RCA: 306] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Debate on appropriate triggers for transfusion of allogeneic blood products and their effects on short- and long-term survival in surgical and critically ill patients continue with no definitive evidence or decisive resolution. Although transfusion-related immune modulation (TRIM) is well established, its influence on immune competence in the recipient and its effects on cancer recurrence after a curative resection remains controversial. An association between perioperative transfusion of allogeneic blood products and risk for recurrence has been shown in colorectal cancer in randomized trials; whether the same is true for other types of cancer remains to be determined. This article focuses on the laboratory, animal, and clinical evidence to date on the mechanistic understanding of inflammatory and immune-modulatory effects of blood products and their significance for recurrence in the cancer surgical patient.
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Affiliation(s)
- J P Cata
- Department of Anaesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Centre, 1515 Holcombe Blvd, Unit 409, Houston, TX 77030, USA.
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20
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Preoperative FDG PET/CT in breast cancer patients: where are we going? Eur J Nucl Med Mol Imaging 2013; 39:1667-9. [PMID: 22976500 DOI: 10.1007/s00259-012-2245-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Imagerie préopératoire de l’extension ganglionnaire initiale et locorégionale des cancers du sein. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Kwak HY, Chae BJ, Bae JS, Kim EJ, Chang EY, Kim SH, Jung SS, Song BJ. Feasibility of sentinel lymph node biopsy in breast cancer patients clinically suspected of axillary lymph node metastasis on preoperative imaging. World J Surg Oncol 2013; 11:104. [PMID: 23693028 PMCID: PMC3663684 DOI: 10.1186/1477-7819-11-104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/12/2013] [Indexed: 11/29/2022] Open
Abstract
Background Generally, sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI). Methods A prospectively maintained database of 767 breast cancer patients enrolled between January 2006 and December 2009 was reviewed. All patients were offered preoperative breast ultrasound, magnetic resonance imaging, and positron emission tomography scanning. SI patients were regarded as those for whom preoperative imaging was “suspicious for axillary LN metastasis” and NSI as “non-suspicious for axillary LN metastasis” on preoperative imaging techniques. Patients were subgrouped by presence of SI and types of axillary operation, and analyzed. Results For 323 patients who received SLNB, there was no statistically significant difference in axillary recurrence (P=0.119) between SI and NSI groups. There also was no significant difference in axillary recurrence between SLNB and axillary lymph node dissection (ALND) groups in 356 SI patients (P=0.420). The presence of axillary LN metastasis on preoperative imaging carried 82.1% sensitivity and 45.9% specificity for determining axillary LN metastasis on the final pathology. Conclusions SLNB in SI patents is safe and feasible. Complications might be avoided by not performing ALND. Therefore, we recommend SLNB, instead of a direct ALND, even in SI patients, for interpreting the exact nodal status and avoiding unnecessary morbidity by performing ALND.
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Affiliation(s)
- Hee Yong Kwak
- Department of Surgery, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
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23
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Ultrasound-guided diffuse optical tomography (DOT) of invasive breast carcinoma: Does tumour total haemoglobin concentration contribute to the prediction of axillary lymph node status? Eur J Radiol 2012; 81:3185-9. [DOI: 10.1016/j.ejrad.2012.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/04/2011] [Accepted: 01/23/2012] [Indexed: 01/08/2023]
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24
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Brouckaert O, Reynders A, Vanderstappen K, Smeets A, Hoeben A, Paridaens R, Christiaens MR, Floris G, Moerman P, Neven P. Sentinel lymph node involvement in ductal carcinoma in-situ of the breast: two different causes. Clin Breast Cancer 2012; 12:378-81. [PMID: 23040005 DOI: 10.1016/j.clbc.2012.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 05/16/2012] [Accepted: 07/09/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Olivier Brouckaert
- University Hospitals Leuven, Multidisciplinary Breast Centre, Leuven, Belgium
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25
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Pan D, Cai X, Kim B, Stacy AJ, Wang LV, Lanza GM. Rapid synthesis of near infrared polymeric micelles for real-time sentinel lymph node imaging. Adv Healthc Mater 2012. [PMID: 23184793 DOI: 10.1002/adhm.201200087] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this manuscript a synthetic methodology for developing sub 20 nm sized polymeric micellar nanoparticles designed for extravascular imaging and therapy is revealed. A simple, one-pot method is followed, which involves a rapid co-self-assembly of an amphiphilic diblock copolymer (PS-b-PAA) and polyoxyethylene (80) sorbitan monooleate in water. Sorbitan monooleate imparts stability to the micelles and helps to drive down the particle size below 20 nm. The particles are incorporated with a water soluble dye ADS832WS, which absorbs in the near infrared range (λ(ex) = 832 nm) for sensitive detection with optical and photoacoustic imaging techniques. A candidate lipophilic anti-angiogenic therapeutic agent fumagillin was also incorporated with high entrapment (>95%) efficiency. The effectiveness of this theranostic platform for real-time, high-resolution intraoperative photoacoustic imaging for facilitating direct assessment of the sentinel lymph nodes (SLN) in breast cancer staging is demonstrated. The technique offers huge potential providing faster resection of SLN and may minimize complications caused by axillary exploration due to mismarking with dyes or low-resolution imaging techniques. Finally, the biodistribution and organ accumulation of the intravenously and intradermally injected particles are studied in a rodent model by optical imaging. Data suggest that intraveneously injected NIR-polymeric nanoparticles follow a typical bio-distribution clearance path through the reticuloendothelial (RES) system. For the intradermally injected particles, a slower mechanism of clearance is noticed.
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Affiliation(s)
- Dipanjan Pan
- C-TRAIN and Division of Cardiology, Washington University School of Medicine, 4320 Forest Park Avenue, Saint Louis, Missouri 63108, USA.
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Journal Club. Breast Care (Basel) 2012. [DOI: 10.1159/000341595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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27
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Surgical treatment of early stage breast cancer in elderly: an international comparison. Breast Cancer Res Treat 2011; 132:675-82. [PMID: 22119939 PMCID: PMC3303082 DOI: 10.1007/s10549-011-1892-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/18/2011] [Indexed: 10/28/2022]
Abstract
Over 40% of breast cancer patients are diagnosed above the age of 65. Treatment of these elderly patients will probably vary over countries. The aim of this study was to make an international comparison (several European countries and the US) of surgical and radiation treatment for elderly women with early stage breast cancer. Survival comparisons were also made. Data were obtained from national or regional population-based registries in the Netherlands, Switzerland, Ireland, Belgium, Germany, and Portugal. For the US patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Early stage breast cancer patients aged ≥ 65 diagnosed between 1995 and 2005 were included. An international comparison was made for breast and axillary surgery, radiotherapy after breast conserving surgery (BCS), and relative or cause-specific survival. Overall, 204.885 patients were included. The proportion of patients not receiving any surgery increased with age in many countries; however, differences between countries were large. In most countries more than half of all elderly patients received breast conserving surgery (BCS), with the highest percentage in Switzerland. The proportion of elderly patients that received radiotherapy after BCS decreased with age in all countries. Moreover, in all countries the proportion of patients who do not receive axillary surgery increased with age. No large differences in survival between countries were recorded. International comparisons of surgical treatment for elderly women with early stage breast cancer are scarce. This study showed large international differences in treatment of elderly early stage breast cancer patients, with the most striking result the large proportion of elderly who did not undergo surgery at all. Despite large treatment differences, survival does not seem to be affected in a major way.
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