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Donahue MJ, Donahue PMC, Jones RS, Garza M, Lee C, Patel NJ, Cooper A, De Vis JB, Meszoely I, Crescenzi R. In vivo lymph node CEST-Dixon MRI in breast cancer patients with metastatic lymph node involvement. Magn Reson Med 2024; 91:670-680. [PMID: 37684712 DOI: 10.1002/mrm.29858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE Axillary lymph nodes (LNs) often present a reservoir for metastatic breast cancer, yet metastatic LN involvement cannot be discerned definitively using diagnostic imaging. This study investigated whether in vivo CEST may discriminate LNs with versus without metastatic involvement. METHODS 3T MRI was performed in patients with breast cancer before clinically-indicated mastectomy or lumpectomy with LN removal, after which LN metastasic involvement was determined using histological evaluation. Non-contrast anatomical imaging, as well as B0 and B1 field maps, were acquired in sequence with three-point CEST-Dixon (3D turbo-gradient-echo; factor = 25; TR/TE1/ΔTE = 851/1.35/1.1 ms; spatial-resolution = 2.5 × 2.5 × 6 mm; slices = 10; four sinc-gauss pulses with duty-cycle = 0.5, total saturation duration = 701.7 ms; B1 = 1.5 μT; saturation offsets = -5.5 to +5.5 ppm; stepsize = 0.2 ppm; scan duration = 6 min 30 s). The mean z-spectrum from LNs with (n = 20) versus without (n = 22) metastatic involvement were analyzed and a Wilcoxon rank-sum test (significance: p < 0.05) was applied to evaluate differences in B0, B1 , and magnetization transfer ratio (MTR) in differing spectral regions of known proton exchange (nuclear Overhauser effect [NOE], amide, amine, and hydroxyl) between cohorts. RESULTS No difference in axillary B1 (p = 0.634) or B0 (p = 0.689) was observed between cohorts. Elevated MTR was observed for the NOE (-1.7 ppm; MTR = 0.285 ± 0.075 vs. 0.248 ± 0.039; p = 0.048), amine (+2.5 ppm; MTR = 0.284 ± 0.067 vs. 0.234 ± 0.31; p = 0.005), and hydroxyl (+1 ppm; MTR = 0.394 ± 0.075 vs. 0.329 ± 0.055; p = 0.002) protons in LNs from participants with versus without metastatic involvement. CONCLUSIONS Findings are consistent with a unique metastatic LN microenvironment detectable by CEST-Dixon and suggest that CEST MRI may have potential for mapping LN metastasis non-invasively in vivo.
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Affiliation(s)
- Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paula M C Donahue
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Sky Jones
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maria Garza
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chelsea Lee
- Department of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Niral J Patel
- Department of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jill B De Vis
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ingrid Meszoely
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Xiang K, Chen J, Min Y, Chen H, Yang J, Hu D, Han Y, Yin G, Feng Y. A multi-dimensional nomogram to predict non-sentinel lymph node metastases in T1-2HR+ breast cancer. Front Endocrinol (Lausanne) 2023; 14:1121394. [PMID: 37476497 PMCID: PMC10354643 DOI: 10.3389/fendo.2023.1121394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Axillary lymph node dissection (ALND) could be omitted for T1-2 breast cancer patients with 1-2 positive sentinel lymph node (SLN) after breast-conserving surgery when radiation is planned. However, whether ALND could be replaced by radiation in patients with 1-3 positive SLNs when no more non-SLN metastasis were observed after mastectomy are still controversial. The aim of our study was to develop and validate a nomogram for predicting the possibility of non-SLN metastasis in T1-2 and hormone receptor (HR) positive breast cancer patients with 1-3 positive SLNs after mastectomy. Methods We retrospectively reviewed and analyzed the data including the basic information, preoperative sonographic characteristics, and pathological features in breast cancer patients with 1-3 positive SLNs in our medical center between Jan 2016 and Dec 2021. The Chi-square, Fisher's exact test, and t test were used for comparison of categorical and qualitative variables among patients with or without non-SLN metastasis. Univariate and multivariate logistic regression were used to determine the risk factors for non-SLN metastasis. These predictors were used to build the nomogram. The C-index and area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of the model. Results A total of 49 in 107 (45.8%) patients were identified with non-SLN metastasis. In multivariate analysis, four variables including younger age, lower estrogen receptor (ER) expression, higher histological score, and cortex thickening of the lymph nodes were determined to be significantly associated with non-SLN metastasis. An individualized nomogram was consequently established with a favorable C-index of 0.822 and verified via two internal validation cohorts. Conclusions The current study developed a nomogram predicting non-SLN metastasis for T1-2 and HR+ breast cancer with 1-3 positive SLNs after mastectomy and found that patients in the high-risk group exhibited worse relapse-free survival. The novel nomogram may further help surgeons to determine whether ALND could be omitted when 1-3 positive SLNs were observed in T1-2 and HR+ breast cancer patients.
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Affiliation(s)
- Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Min
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Chen
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaxin Yang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuling Han
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guobing Yin
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Madekivi V, Karlsson A, Boström P, Salminen E. Are Breast Cancer Nomograms Still Valid to Predict the Need for Axillary Dissection? Oncology 2021; 99:397-401. [PMID: 33691330 DOI: 10.1159/000514616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nomograms can help in estimating the nodal status among clinically node-negative patients. Yet their validity in external cohorts over time is unknown. If the nodal stage can be estimated preoperatively, the need for axillary dissection can be decided. OBJECTIVES The aim of this study was to validate three existing nomograms predicting 4 or more axillary lymph node metastases. METHOD The risk for ≥4 lymph node metastases was calculated for n = 529 eligible breast cancer patients using the nomograms of Chagpar et al. [Ann Surg Oncol. 2007;14:670-7], Katz et al. [J Clin Oncol. 2008;26(13):2093-8], and Meretoja et al. [Breast Cancer Res Treat. 2013;138(3):817-27]. Discrimination and calibration were calculated for each nomogram to determine their validity. RESULTS In this cohort, the AUC values for the Chagpar, Katz, and Meretoja models were 0.79 (95% CI 0.74-0.83), 0.87 (95% CI 0.83-0.91), and 0.82 (95% CI 0.76-0.86), respectively, showing good discrimination between patients with and without high nodal burdens. CONCLUSION This study presents support for the use of older breast cancer nomograms and confirms their current validity in an external population.
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Affiliation(s)
- Vilma Madekivi
- Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland,
| | - Antti Karlsson
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Pia Boström
- Department of Pathology, Turku University Hospital and University of Turku, Turku, Finland
| | - Eeva Salminen
- Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland.,Finnish Nuclear and Radiation Safety, Helsinki, Finland
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Liang F, Qu H, Lin Q, Yang Y, Ruan X, Zhang B, Liu Y, Yu C, Zhang H, Fang X, Hao X. Molecular biomarkers screened by next-generation RNA sequencing for non-sentinel lymph node status prediction in breast cancer patients with metastatic sentinel lymph nodes. World J Surg Oncol 2015; 13:258. [PMID: 26311227 PMCID: PMC4551378 DOI: 10.1186/s12957-015-0642-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/03/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Non-sentinel lymph node (NSLN) status prediction with molecular biomarkers may make some sentinel lymph node (SLN) positive breast cancer patients avoid the axillary lymph node dissection, but the available markers remain limited. METHODS SLN positive patients with and without NSLN invasion were selected, and genes differentially expressed or fused in SLN metastasis were screened by next-generation RNA sequencing. RESULTS Six candidates (all ER/PR+, HER2-, Ki-67 <20%) with metastatic SLNs selected from 305 patients were equally categorized as NSLN negative and positive. We identified 103 specifically expressed genes in the NSLN negative group and 47 in the NSLN positive group. Among them, FABP1 (negative group) and CYP2A13 (positive group) were the only 2 protein-encoding genes with expression levels in the 8th to 10th deciles. Using a false discovery rate threshold of <0.05, 62 up-regulated genes and 98 down-regulated genes were discovered in the NSLN positive group. Furthermore, 10 gene fusions were identified in this group with the most frequently fused gene being IGLL5. CONCLUSIONS The biomarkers screened in present study may broaden our understanding of the mechanisms of breast cancer metastasis to the lymph nodes and contribute to the axillary surgery selection for SLN positive patients.
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Affiliation(s)
- Feng Liang
- Affiliated Hospital of Academy of Military Medical Sciences, 8 Dongdajie, Fengtai District, Beijing, 100071, China.
| | - Hongzhu Qu
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, 1-104 Beichen West Road, Chaoyang District, Beijing, 100101, China.
| | - Qiang Lin
- Affiliated Hospital of Academy of Military Medical Sciences, 8 Dongdajie, Fengtai District, Beijing, 100071, China.
| | - Yadong Yang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, 1-104 Beichen West Road, Chaoyang District, Beijing, 100101, China.
| | - Xiuyan Ruan
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, 1-104 Beichen West Road, Chaoyang District, Beijing, 100101, China.
| | - Bo Zhang
- Affiliated Hospital of Academy of Military Medical Sciences, 8 Dongdajie, Fengtai District, Beijing, 100071, China.
| | - Yi Liu
- Affiliated Hospital of Academy of Military Medical Sciences, 8 Dongdajie, Fengtai District, Beijing, 100071, China.
| | - Chengze Yu
- Affiliated Hospital of Academy of Military Medical Sciences, 8 Dongdajie, Fengtai District, Beijing, 100071, China.
| | - Hongyan Zhang
- General Hospital of Beijing Military Area, 5 Nanmencang, Dongcheng District, Beijing, 100700, China.
| | - Xiangdong Fang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, 1-104 Beichen West Road, Chaoyang District, Beijing, 100101, China.
| | - Xiaopeng Hao
- Affiliated Hospital of Academy of Military Medical Sciences, 8 Dongdajie, Fengtai District, Beijing, 100071, China.
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Surgical management for early-stage bilateral breast cancer patients in China. PLoS One 2015; 10:e0122692. [PMID: 25874699 PMCID: PMC4395376 DOI: 10.1371/journal.pone.0122692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/12/2015] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to investigate the current surgical management strategy for bilateral breast cancer (BBC) patients and to assess the changes in this strategy in China. Methods This is a retrospective review of all patients with early-stage BBC who underwent surgical treatment at the Fudan University Shanghai Cancer Center between June 2007 and June 2014. Results A total of 15,337 patients with primary breast cancer were identified. Of these patients, 218 (1.5%) suffered from synchronous bilateral breast cancer (sBBC), and 296 (2.0%) suffered from metachronous bilateral breast cancer (mBBC). Patients with a lobular carcinoma component, those with estrogen receptor-positive cancer, and those with an accompanying sclerosing adenosis in the affected breast tended to develop BBC. The rates of bilateral mastectomy, breast conserving therapy, reconstruction, and combined surgeries were 86.2%, 6.4%, 3.7%, and 3.7%, respectively, for patients with sBBC and 81.1%, 4.4%, 3.0%, and 11.5%, respectively, for patients with mBBC. The interval between bilateral cancers, age at first diagnosis of breast cancer, histopathological type, and stage have significant impacts on the choice of surgery for patients with BBC. Conclusions Bilateral mastectomy was the dominant surgical management for patients with BBC in China, despite the increased application of breast reconstruction surgery observed in recent years. Bilateral prosthetic breast reconstruction was the ideal choice for patients with sBBC. Chinese surgeons should take responsibility for patient education and inform their patients about their surgical options.
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Chung A, Gangi A, Mirocha J, Giuliano A. Applicability of the ACOSOG Z0011 Criteria in Women with High-Risk Node-Positive Breast Cancer Undergoing Breast Conserving Surgery. Ann Surg Oncol 2014; 22:1128-32. [DOI: 10.1245/s10434-014-4090-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 01/17/2023]
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Bernet L, Cano R. Metastatic sentinel node and axillary lymphadenectomy revisited. Gland Surg 2014; 1:7-8. [PMID: 25083420 DOI: 10.3978/j.issn.2227-684x.2012.04.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 04/30/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Laia Bernet
- 1 Pathology Service, Hospital Lluís Alcanyís, Xàtiva, Spain ; 2 Pathology Service, Hospital Universitario de la Ribera, Alzira, Spain
| | - Rafael Cano
- 1 Pathology Service, Hospital Lluís Alcanyís, Xàtiva, Spain ; 2 Pathology Service, Hospital Universitario de la Ribera, Alzira, Spain
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Tausch C, Baege A, Rageth C. Mapping lymph nodes in cancer management - role of (99m)Tc-tilmanocept injection. Onco Targets Ther 2014; 7:1151-8. [PMID: 25028560 PMCID: PMC4077853 DOI: 10.2147/ott.s50394] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Two decades ago, lymphatic mapping of sentinel lymph nodes (SLN) was introduced into surgical cancer management and was termed sentinel node navigated surgery. Although this technique is now routinely performed in the management of breast cancer and malignant melanoma, it is still under investigation for use in other cancers. The radioisotope technetium (99mTc) and vital blue dyes are among the most widely used enhancers for SLN mapping, although near-infrared fluorescence imaging of indocyanine green is also becoming more commonly used. 99mTc-tilmanocept is a new synthetic radioisotope with a relatively small molecular size that was specifically developed for lymphatic mapping. Because of its small size, 99mTc-tilmanocept quickly migrates from its site of injection and rapidly accumulates in the SLN. The mannose moieties of 99mTc-tilmanosept facilitate its binding to mannose receptors (CD206) expressed in reticuloendothelial cells of the SLN. This binding prevents transit to second-echelon lymph nodes. In Phase III trials of breast cancer and malignant melanoma, and Phase II trials of other malignancies, 99mTc-tilmanocept had superior identification rates and sensitivity compared with blue dye. Trials comparing 99mTc-tilmanocept with other 99mTc-based agents are required before it can be routinely used in clinical settings.
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When is a completion axillary lymph node dissection necessary in the presence of a positive sentinel lymph node? Eur J Cancer 2014; 50:690-7. [DOI: 10.1016/j.ejca.2013.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/15/2013] [Accepted: 11/23/2013] [Indexed: 01/17/2023]
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Can axillary reverse mapping avoid lymphedema in node positive breast cancer patients? Eur J Surg Oncol 2013; 39:880-6. [PMID: 23735162 DOI: 10.1016/j.ejso.2013.05.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 04/03/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tracing lymphatic drainage of the ipsilateral arm of node positive breast cancer patients, termed "axillary reverse mapping" (ARM), has recently been described in several reports. We analyzed our experience with this new technique in patients scheduled for axillary lymph node dissection (ALND) and evaluated its usefulness for reducing the incidence of lymphedema. METHODS Blue dye was injected subcutaneously along the intermuscular groove of the upper inner arm; radioisotope was injected subcutaneously in the interdigital webspace of the hand. All blue and radioactive lymph vessels and lymph nodes were recorded. Only unsuspicious "ARM lymph nodes" located in the lateral part of the axillary basin were preserved. All other level I and II axillary lymph nodes were removed. Resected ARM nodes were immediately separated from all other lymph nodes. RESULTS ARM was performed in 143 patients subsequently undergoing ALND. ARM lymph nodes were successfully identified in 112 cases (78%). In 55 patients at least one ARM lymph node had to be removed. In 14 of these, tumor involvement was confirmed. In 71 patients one or more ARM nodes were preserved. During a median follow-up time of 19 months no axillary recurrence was noted. 35 of 114 evaluated patients developed lymphedema. Preservation of ARM lymph nodes did not significantly decrease the incidence of lymphedema. CONCLUSION ARM is feasible for patients with node positive breast cancer. However, we found no evidence that it reduces the incidence of lymphedema.
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Zeng J, Xie H, Lu Y, Feng Z, Li F. Clinical Implications of Micrometastasis Detection in Internal Mammary Nodes of Breast Cancer Patients. Breast Care (Basel) 2012; 7:216-219. [PMID: 22872795 PMCID: PMC3409387 DOI: 10.1159/000339686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND: The aim of this study was to assess the efficiency of step-serial sectioning (SSS) combined with hematoxylin and eosin (H&E) and immunohistochemical (IHC) staining in detecting micrometastasis of internal mammary lymph nodes (IMLNs). PATIENTS AND METHODS: 135 IMLNs from 88 breast cancer patients were re-examined by SSS, combined with either H&E or IHC staining of the biomarkers cytokeratin-19 and epithelial membrane antigen. RESULTS: Of the 135 IMLNs, 6 nodes from 5 cases displayed 1 or more micrometastases. Histological grade and lymphovascular invasion status were significantly correlated with micrometastasis in the IMLNs (p = 0.018 and 0.001, respectively). Of the 6 nodes positive for micrometastasis, 1 node was detected by both H&E and IHC staining. The remaining 5 nodes from 4 cases showed evident tumor cells only by IHC staining. Finally 8 of the 83 patients (9.64%) without IMLN metastasis showed distant metastasis, while 2 of the 5 patients (40%) with IMLN metastasis showed distant metastasis within 28 months of operation. CONCLUSION: SSS combined with H&E and IHC staining is more efficient in detecting micrometastasis than classic routine single-slice H&E only.
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Affiliation(s)
- Jian Zeng
- *Dr. Jian Zeng, Department of Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China, Tel. +77 1535-0100, Fax −2627,
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McGhan L, Dueck A, Gray R, Wasif N, McCullough A, Pockaj B. The changing landscape of axillary surgery: Which breast cancer patients may still benefit from complete axillary lymph node dissection? J Surg Oncol 2011; 106:254-9. [DOI: 10.1002/jso.22131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/04/2011] [Indexed: 01/17/2023]
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