1
|
Dolka I, Czopowicz M, Stopka D, Wojtkowska A, Kaszak I, Sapierzyński R. Risk factor analysis and clinicopathological characteristics of female dogs with mammary tumours from a single-center retrospective study in Poland. Sci Rep 2024; 14:5569. [PMID: 38448646 PMCID: PMC10917774 DOI: 10.1038/s41598-024-56194-z] [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: 11/18/2023] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
This is a comprehensive retrospective study to characterize female dogs with canine mammary tumors (CMTs) using a dataset retrieved from the archives of the Division of Animal Pathology, Institute of Veterinary Medicine in Warsaw, and to identify prognostic factors. Clinical and histopathological data of 1447 dogs with CMTs were included. Malignant tumours were found in 83.3% (n = 1206), benign tumours in 11.7% (n = 169), and non-neoplastic lesions in 5.0% (n = 72) of dogs. Dogs most often had grade II carcinomas (38.2%, 215/562) of a single histological subtype (88.5%, 1281/1447), mostly simple carcinoma (35.3%, 510/1447). Dogs with a median age of 10 years significantly often had larger (≥ 3 cm) and malignant CMTs, whereas intact females had smaller tumours (median size 2.0 cm). However, the threshold value for the age of the dog in the differentiation of malignant and non-neoplastic/benign masses could not be determined. Most females were hormonally active (76.4%, 372/487). Hormonally active dogs significantly more often had multiple tumours. Multiple tumours were significantly smaller (median 2.5 cm) than single ones. Among pedigree dogs, small-breed dogs were mostly recorded (43%, 428/1006). Twelve breeds had an increased risk of CMTs, regardless of tumour behaviour, compared with the theoretical distribution of pedigree dogs in Poland. Four breeds were often affected only by malignant and other four breeds only by non-neoplastic/benign CMT. Large-breed dogs were significantly younger and affected by larger CMT (median 4 cm) compared with small- and medium-breed dogs. Ninety dogs with a malignant CMT and complete records were included in the full analysis of CMT-specific survival (CMT-SS) with a median follow-up time of 20.0 months. We showed that the timing of ovariohysterectomy in relation to mastectomy was significantly associated with grade, CMT-SS, and CMT-related death. We indicated the low diagnostic accuracy of palpation of regional lymph nodes (RLN) in the prediction of their metastatic involvement. By multivariable analysis, dogs with neoplastic emboli, tumour ulceration, and simple or complex carcinoma had a significantly higher risk of local recurrence. Tumour size > 3 cm was as a strong independent predictor of lung metastases. Compared with dogs with an easily separated localized tumour, dogs with a multiple/diffuse malignant CMT pattern had a fivefold higher risk of death. The risk of death was significantly higher in the presence of neoplastic emboli (~ fivefold) and tumour ulceration (~ fourfold). Furthermore, the presence of neoplastic emboli and large tumour size were independent predictors of CMT-related death.
Collapse
Affiliation(s)
- Izabella Dolka
- Department of Pathology and Veterinary Diagnostics, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159C, 02-776, Warsaw, Poland.
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159C, 02-776, Warsaw, Poland
| | - Diana Stopka
- Department of Pathology and Veterinary Diagnostics, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159C, 02-776, Warsaw, Poland
| | - Agata Wojtkowska
- Department of Small Animal Diseases With Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159C, 02-776, Warsaw, Poland
| | - Ilona Kaszak
- Department of Small Animal Diseases With Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159C, 02-776, Warsaw, Poland
| | - Rafał Sapierzyński
- Department of Pathology and Veterinary Diagnostics, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159C, 02-776, Warsaw, Poland
| |
Collapse
|
2
|
Kaidar-Person O, Pfob A, Gentilini OD, Borisch B, Bosch A, Cardoso MJ, Curigliano G, De Boniface J, Denkert C, Hauser N, Heil J, Knauer M, Kühn T, Lee HB, Loibl S, Mannhart M, Meattini I, Montagna G, Pinker K, Poulakaki F, Rubio IT, Sager P, Steyerova P, Tausch C, Tramm T, Vrancken Peeters MJ, Wyld L, Yu JH, Weber WP, Poortmans P, Dubsky P. The Lucerne Toolbox 2 to optimise axillary management for early breast cancer: a multidisciplinary expert consensus. EClinicalMedicine 2023; 61:102085. [PMID: 37528842 PMCID: PMC10388578 DOI: 10.1016/j.eclinm.2023.102085] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Clinical axillary lymph node management in early breast cancer has evolved from being merely an aspect of surgical management and now includes the entire multidisciplinary team. The second edition of the "Lucerne Toolbox", a multidisciplinary consortium of European cancer societies and patient representatives, addresses the challenges of clinical axillary lymph node management, from diagnosis to local therapy of the axilla. Five working packages were developed, following the patients' journey and addressing specific clinical scenarios. Panellists voted on 72 statements, reaching consensus (agreement of 75% or more) in 52.8%, majority (51%-74% agreement) in 43.1%, and no decision in 4.2%. Based on the votes, targeted imaging and standardized pathology of lymph nodes should be a prerequisite to planning local and systemic therapy, axillary lymph node dissection can be replaced by sentinel lymph node biopsy ( ± targeted approaches) in a majority of scenarios; and positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema.
Collapse
Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - André Pfob
- Department of Obstetrics & Gynecology, Heidelberg University Hospital, Germany
- National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Bettina Borisch
- Department of Histopathology, University of Geneva, 1202 Geneva, Switzerland
| | - Ana Bosch
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lasarettsgatan 23A, 22241, Lund, Sweden
| | - Maria João Cardoso
- Breast Unit, Champalimaud Foundation and University of Lisbon Faculty of Medicine, Lisbon, Portugal
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141 Milano MI, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Jana De Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Breast Centre, Capio St Göran's Hospital, Stockholm, Sweden
| | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg, Germany
| | - Nik Hauser
- Breast Center, Hirslanden Clinic Aarau, Frauenarztzentrum Aargau AG, Baden, Switzerland
| | - Jörg Heil
- Department of Obstetrics & Gynecology, Heidelberg University Hospital, Germany
- Breast Center Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, University of Ulm, Germany
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Sibylle Loibl
- German Breast Group (GBG), C/o GBG Forschungs GmbH 63263 - Neu-Isenberg/, Germany
- Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | | | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katja Pinker
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Isabel T. Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Patrizia Sager
- Breast Center Bern-Biel, Hirslanden Clinic Salem, Bern, Switzerland
| | - Petra Steyerova
- Breast Cancer Screening and Diagnostic Center, Clinic of Radiology, General University Hospital in Prague, Prague, Czech Republic
| | | | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek & Amsterdam University Medical Center, Netherlands
| | - Lynda Wyld
- Department of Oncology and Metabolism, The University of Sheffield, The Medical School, Sheffield, UK
| | - Jong Han Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Walter Paul Weber
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp 2610, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Peter Dubsky
- Breast Center, Hirslanden Clinic St Anna, 6006, Lucerne, Switzerland
- University of Lucerne, Faculty of Health Sciences and Medicine, Lucerne, Switzerland
| |
Collapse
|
3
|
Augustine P, Dasu S, Nair SP, Bhargavan RV, Pradeep VM. Validation of Sentinel Lymph Node Biopsy Technique Using Dual Tracer Technique in Post Lumpectomy Early Breast Cancer Patients. Indian J Surg Oncol 2023; 14:434-439. [PMID: 37324305 PMCID: PMC10267054 DOI: 10.1007/s13193-020-01242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is the gold standard for the evaluation of axilla in clinically node-negative early breast cancers. There is limited data on the role and efficacy of the same in the post lumpectomy scenario. This prospective interventional study was conducted over 1 year on 30 post lumpectomy pT1/2 cN0 patients. SLNB was performed by preoperative lymphoscintigram using technetium-labeled human serum albumin followed by intraoperative blue dye injection. Sentinel nodes were identified based on blue dye uptake and gamma probe and sent for intra operative frozen section. Completion axillary nodal dissection was performed in all cases. The primary end point was sentinel node identification rate and accuracy of nodal frozen section. Sentinel node identification rate was 86.7% (n = 26/30) for scintigraphy alone and 96.7% (n = 29/30) using combined method. Average sentinel nodal yield/patient was 3.6 (range 0-7). Maximum yield was seen for hot and blue nodes (1.86). Sensitivity (n = 9/9) and specificity (n = 19/19) of frozen section were 100% with a false negative rate of 0% (0/19). Demographic factors such as age, body mass index, laterality, quadrant, biology, grade, and pathological T stage had no impact on the identification rate. Sentinel lymph node using dual tracer has a high identification rate and a low false negative rate post lumpectomy. Age, body mass index, laterality, quadrant, grade, biology, and pathological T size had no impact on the identification rate.
Collapse
Affiliation(s)
- Paul Augustine
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Sridhar Dasu
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, Telangana 500034 India
| | - Sindhu P. Nair
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Rexeena V. Bhargavan
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - V. M. Pradeep
- Department of Nuclear Medicine, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| |
Collapse
|
4
|
McCaffrey RL, Thompson JL, Oudsema RH, Sciallis AP, Cobain EF, Sabel MS, Jeruss JS. Management of early stage HER2 positive breast cancer and increased implementation of axillary imaging to improve identification of nodal metastasis. J Surg Oncol 2022; 125:1218-1223. [PMID: 35230701 DOI: 10.1002/jso.26840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Given the significant benefit of targeted therapies for HER2+ breast cancer patients in both the neoadjuvant and adjuvant settings, it is critical to identify all eligible patients for these treatments. We sought to investigate cT1cN0 HER2+ patients to determine the rate of postsurgical nodal positivity, and to identify presurgical factors associated with nodal positivity. We hypothesize there is a subset of underdiagnosed HER2+ patients who would benefit from preoperative axillary imaging and inclusion in neoadjuvant chemotherapy regimens. METHODS We performed a 10-year retrospective analysis of T1 HER2+ breast cancer patients. Clinicopathologic characteristics were evaluated based on surgical nodal data. RESULTS We identified 38 patients with cT1cN0 HER2+ cancer. Of this cohort, 24% had positive lymph nodes on final pathology. High tumor grade (p = 0.035) on core needle biopsy and the presence of lymphovascular invasion (p = 0.0036) were associated with an increased likelihood of lymph node positivity. The majority (66%) of lymph node positive patients were clinically T1c. CONCLUSIONS We identified a 24% nodal positivity rate in clinically node negative T1 HER2+ breast cancer patients. In particular, HER2+ patients with high-grade T1c cancers should undergo preoperative diagnostic axillary imaging to expand potential benefit from targeted therapies.
Collapse
Affiliation(s)
| | | | - Rebecca H Oudsema
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew P Sciallis
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin F Cobain
- Department of Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael S Sabel
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
5
|
Chen MY, Gillanders WE. Staging of the Axilla in Breast Cancer and the Evolving Role of Axillary Ultrasound. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:311-323. [PMID: 34040436 PMCID: PMC8139849 DOI: 10.2147/bctt.s273039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Abstract
Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically. As a result, staging of the axilla has always played a central role in the treatment of breast cancer. Anatomic staging was believed to be important for two reasons: 1) it predicts prognosis and guides medical therapy, and 2) it is a potential therapy for removal of disease in the axilla. This paradigm has now been called into question. Prognostic information is driven increasingly by tumor biology, and trials such as the ACOSOG Z0011 demonstrates removal of axillary disease is not therapeutic. Staging of the axilla has undergone a dramatic de-escalation; however, sentinel lymph node biopsy (SLNB) is still an invasive surgery and represents a large economic burden on the healthcare system. In this review, we outline the changing paradigms of axillary staging in breast cancer from emphasis on anatomic staging to tumor biology, and the evolving role of axillary ultrasound, bringing patients less invasive and more personalized therapy.
Collapse
Affiliation(s)
- Michael Y Chen
- Department of Surgery, Washington University, St Louis, MS, USA
| | - William E Gillanders
- Department of Surgery, Washington University, St Louis, MS, USA.,Siteman Cancer Center in St. Louis, St Louis, MS, USA
| |
Collapse
|
6
|
Keelan S, Heeney A, Downey E, Hegarty A, Roche T, Power C, Mhuircheartaigh NN, Duke D, Kerr J, Hambly N, Hill A. Breast cancer patients with a negative axillary ultrasound may have clinically significant nodal metastasis. Breast Cancer Res Treat 2021; 187:303-310. [PMID: 33837870 DOI: 10.1007/s10549-021-06194-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/12/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The non-invasive nature of the preoperative axillary ultrasound (AUS) fits the current trend of increasingly conservative axillary management. Recent publications suggest that early disease patients with clinically and radiologically negative axillae do not require sentinel lymph node biopsy (SLNB). This study aims to determine the true extent of axillary node disease in negative preoperative AUS patients. METHODS A 10-year breast cancer registry was reviewed to identify women with pathologically confirmed T1-2 invasive breast cancer and a negative preoperative AUS. Patients who received neoadjuvant chemotherapy were excluded. Combined positive lymph node count of SLNB ± ALND was used to determine total nodal burden (TNB). Axillae were classified into low nodal burden (LNB) defined as 1-2 positive nodes and high nodal burden (HNB) defined as ≥ 3 positive nodes. RESULTS 762 patients with negative AUS were included. There were 46.9% and 53.0% T1 and T2 tumours, respectively. 76.9% were node negative (0 LN +), 18.9% had LNB (1-2 LN +) and 4.2% had HNB (≥ 3LN +). Specifically, HNB disease was seen in 2% of T1 tumours and 6.2 % of T2 tumours with a negative AUS. In multivariate analysis, T2 strongly associated with ≥ 3 positive ALNs (OR 2.66 CI 1.09-6.51 p = 0.03) as did lymphovascular invasion (OR 3.56 CI 1.52-8.30 p = < 0.01). CONCLUSION This study shows that AUS in its current form cannot exclude HNB axillary metastasis to the extent of eliminating the need for surgical staging of the axilla. This may impact axillary local-regional recurrence and disease-free survival. We caution that a negative AUS has a rate of 4.2% of HNB. Therefore, in cases of negative AUS with a T2 tumour, we advocate continued use of SLNB.
Collapse
Affiliation(s)
- Stephen Keelan
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland. .,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland.
| | - Anna Heeney
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Eithne Downey
- Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Aisling Hegarty
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Trudi Roche
- Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Deirdre Duke
- Department of Radiology, Beaumont Hospital, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Kerr
- Department of Radiology, Beaumont Hospital, Beaumont Hospital, Dublin, Ireland
| | - Niamh Hambly
- Department of Radiology, Beaumont Hospital, Beaumont Hospital, Dublin, Ireland
| | - Arnold Hill
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
7
|
Reddy A, Nair NS, Mokal S, Parmar V, Shet T, Pathak R, Chitkara G, Thakkar P, Joshi S, Badwe RA. Can We Avoid Axillary Lymph Node Dissection (ALND) in Patients with 1-2 Positive Sentinel/Low Axillary Lymph Nodes (SLN/LAS+) in the Indian Setting? Indian J Surg Oncol 2021; 12:272-278. [PMID: 34295070 DOI: 10.1007/s13193-021-01297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022] Open
Abstract
The ACOSOG Z0011 study, heralded as a "practice changing" trial, suggested that women with T1-2 breast cancer with 1-2 SLN+, undergoing breast conservation therapy, need not be offered further ALND. However, whether these results are applicable to all women in the Indian setting, it remains debatable. A retrospective audit of all cN0 operated from 2013 to 2018 was conducted. We analyzed the percentage of additional LN positive (LN+) in the ALND group and compared it to the ACOZOG Z11 trial. Of the 2350 cN0 with EBC who underwent LAS, 687 (29%) had positive lymph nodes on final histopathology. Five hundred ninety-seven (86.9%) patients had 1-2 LN+, 40 (5.8%) patients had 3 LN+, and 50 (7.3%) had 4 or more nodes positive. Demographic features in the ACOSOG Z11 are different from those in our study, looking at ACOZOG Z11 versus our cohort-median pT 1.7 cm versus 3 cm, 45% micrometastasis versus 99.16% macrometastasis, and 28-30% grade 3 tumors versus 73.7%. In our cohort 31.82% of the 1-2 LN positive had additional LN+ on ALND. Keeping in mind the difference in clinicopathological features between our cohort and that of ACOZOG Z0011 and that 31.82% of women had additional LN+ on ALND, it may not be appropriate to apply the results of the ACOSOG Z0011 trial directly to our general population. Possibly, only a select subset of patients who match the trial population of the ACOSOG Z11 could be offered observation of the axilla and validated nomograms can be used to identify high-risk patients.
Collapse
Affiliation(s)
- A Reddy
- Department of Surgical Oncology, Breast Service, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nita S Nair
- Department of Surgical Oncology, Breast Service, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Smruti Mokal
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - V Parmar
- Department of Surgical Oncology, Breast Service, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Shet
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - R Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Chitkara
- Department of Surgical Oncology, Breast Service, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Thakkar
- Department of Surgical Oncology, Breast Service, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Joshi
- Department of Surgical Oncology, Breast Service, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - R A Badwe
- Department of Surgical Oncology, Breast Service, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
8
|
Zeng D, Lin HY, Zhang YL, Wu JD, Lin K, Xu Y, Chen CF. A negative binomial regression model for risk estimation of 0-2 axillary lymph node metastases in breast cancer patients. Sci Rep 2020; 10:21856. [PMID: 33318591 PMCID: PMC7736885 DOI: 10.1038/s41598-020-79016-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023] Open
Abstract
Extensive clinical trials indicate that patients with negative sentinel lymph node biopsy do not need axillary lymph node dissection (ALND). However, the ACOSOG Z0011 trial indicates that patients with clinically negative axillary lymph nodes (ALNs) and 1-2 positive sentinel lymph nodes having breast conserving surgery with whole breast radiotherapy do not benefit from ALND. The aim of this study is therefore to identify those patients with 0-2 positive nodes who might avoid ALND. A total of 486 patients were eligible for the study with 212 patients in the modeling group and 274 patients in the validation group, respectively. Clinical lymph node status, histologic grade, estrogen receptor status, and human epidermal growth factor receptor 2 status were found to be significantly associated with ALN metastasis. A negative binomial regression (NBR) model was developed to predict the probability of having 0-2 ALN metastases with the area under the curve of 0.881 (95% confidence interval 0.829-0.921, P < 0.001) in the modeling group and 0.758 (95% confidence interval 0.702-0.807, P < 0.001) in the validation group. Decision curve analysis demonstrated that the model was clinically useful. The NBR model demonstrated adequate discriminative ability and clinical utility for predicting 0-2 ALN metastases.
Collapse
Affiliation(s)
- De Zeng
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and Treatment, Shantou, 515031, China
| | - Hao-Yu Lin
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Yu-Ling Zhang
- Department of Information, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
| | - Jun-Dong Wu
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and Treatment, Shantou, 515031, China
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
| | - Kun Lin
- Department of Public Health and Preventive Medicine, Shantou University Medical College, Shantou, 515041, China
| | - Ya Xu
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
| | - Chun-Fa Chen
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China.
| |
Collapse
|
9
|
Yoo TK, Kang BJ, Kim SH, Song BJ, Ahn J, Park WC, Chae BJ. Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis. Breast Cancer Res Treat 2020; 181:403-409. [PMID: 32328848 DOI: 10.1007/s10549-020-05636-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The ACOSOG Z0011 trial demonstrated that axillary lymph node dissection (ALND) is unnecessary in select patients with cT1-2N0 tumors undergoing breast-conserving therapy with 1-2 positive sentinel lymph nodes (SLNs). However, patients with preoperatively confirmed ALN metastasis were not included and may be subjected to unnecessary ALND. The aim of this study is to identify patients who can be considered for ALND omission when the preoperative ALN biopsy results are positive. METHODS Breast cancer patients who underwent preoperative ALN biopsy and primary surgery were retrospectively reviewed. Among patients with positive ALN biopsy results, clinicopathological and imaging characteristics were compared according to LN disease burden (1-2 positive LNs vs. ≥ 3 positive LNs). RESULTS A total of 542 patients were included in the analysis. Among them, 225 (41.5%) patients had a preoperative positive ALN biopsy. More than 40% of the patients (n = 99, 44.0%) with a positive biopsy had only 1-2 positive ALNs. The association between nodal burden and imaging factors was strongest when ≥ 2 suspicious LNs were identified on PET/CT images (HR 8.795, 95% CI 4.756 to 13.262). More than one imaging modality showing ≥ 2 suspicious LNs was also strongly correlated with ≥ 3 positive ALNs (HR 5.148, 95% CI 2.881 to 9.200). CONCLUSIONS Nearly half of patients with a preoperative biopsy-proven ALN metastasis had only 1-2 positive LNs on ALND. Patients meeting ACOSOG Z0011 criteria with only one suspicious LN on PET/CT or those presenting with few abnormal ALNs on only one imaging modality appear appropriate for SLNB and consideration of ALND omission.
Collapse
MESH Headings
- Axilla
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymph Nodes/pathology
- Lymph Nodes/surgery
- Lymphatic Metastasis
- Mastectomy, Segmental/methods
- Middle Aged
- Positron Emission Tomography Computed Tomography
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Sentinel Lymph Node Biopsy/methods
Collapse
Affiliation(s)
- Tae-Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Byung Joo Song
- Division of Breast-Thyroid Surgery, Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Gyeonggi-do, 14647, Republic of Korea
| | - Juneyoung Ahn
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woo-Chan Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Byung Joo Chae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
10
|
Sun Q, Lin X, Zhao Y, Li L, Yan K, Liang D, Sun D, Li ZC. Deep Learning vs. Radiomics for Predicting Axillary Lymph Node Metastasis of Breast Cancer Using Ultrasound Images: Don't Forget the Peritumoral Region. Front Oncol 2020; 10:53. [PMID: 32083007 PMCID: PMC7006026 DOI: 10.3389/fonc.2020.00053] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Axillary lymph node (ALN) metastasis status is important in guiding treatment in breast cancer. The aims were to assess how deep convolutional neural network (CNN) performed compared with radiomics analysis in predicting ALN metastasis using breast ultrasound, and to investigate the value of both intratumoral and peritumoral regions in ALN metastasis prediction. Methods: We retrospectively enrolled 479 breast cancer patients with 2,395 breast ultrasound images. Based on the intratumoral, peritumoral, and combined intra- and peritumoral regions, three CNNs were built using DenseNet, and three radiomics models were built using random forest, respectively. By combining the molecular subtype, another three CNNs and three radiomics models were built. All models were built on training cohort (343 patients 1,715 images) and evaluated on testing cohort (136 patients 680 images) with ROC analysis. Another prospective cohort of 16 patients was enrolled to further test the models. Results: AUCs of image-only CNNs in both training/testing cohorts were 0.957/0.912 for combined region, 0.944/0.775 for peritumoral region, and 0.937/0.748 for intratumoral region, which were numerically higher than their corresponding radiomics models with AUCs of 0.940/0.886, 0.920/0.724, and 0.913/0.693. The overall performance of image-molecular CNNs in terms of AUCs on training/testing cohorts slightly increased to 0.962/0.933, 0.951/0.813, and 0.931/0.794, respectively. AUCs of both CNNs and radiomics models built on combined region were significantly better than those on either intratumoral or peritumoral region on the testing cohort (p < 0.05). In the prospective study, the CNN model built on combined region achieved the highest AUC of 0.95 among all image-only models. Conclusions: CNNs showed numerically better overall performance compared with radiomics models in predicting ALN metastasis in breast cancer. For both CNNs and radiomics models, combining intratumoral, and peritumoral regions achieved significantly better performance.
Collapse
Affiliation(s)
- Qiuchang Sun
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiaona Lin
- Department of Ultrasonic Imaging, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yuanshen Zhao
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | | | - Kai Yan
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Peng Cheng Laboratory, Shenzhen, China
| | - Dong Liang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Desheng Sun
- Department of Ultrasonic Imaging, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhi-Cheng Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| |
Collapse
|
11
|
Fisher CS, Margenthaler JA, Hunt KK, Schwartz T. The Landmark Series: Axillary Management in Breast Cancer. Ann Surg Oncol 2019; 27:724-729. [PMID: 31863417 DOI: 10.1245/s10434-019-08154-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Indexed: 11/18/2022]
Abstract
The evolution in axillary management for patients with breast cancer has resulted in multiple dramatic changes over the past several decades. The end result has been an overall deescalation of surgery in the axilla. Landmark trials that have formed the basis for the current treatment guidelines are reviewed herein.
Collapse
Affiliation(s)
- Carla S Fisher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | |
Collapse
|
12
|
Marino MA, Avendano D, Zapata P, Riedl CC, Pinker K. Lymph Node Imaging in Patients with Primary Breast Cancer: Concurrent Diagnostic Tools. Oncologist 2019; 25:e231-e242. [PMID: 32043792 PMCID: PMC7011661 DOI: 10.1634/theoncologist.2019-0427] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022] Open
Abstract
The detection of lymph node metastasis affects the management of patients with primary breast cancer significantly in terms of staging, treatment, and prognosis. The main goal for the radiologist is to determine and detect the presence of metastatic disease in nonpalpable axillary lymph nodes with a positive predictive value that is high enough to initially select patients for upfront axillary lymph node dissection. Features that are suggestive of axillary adenopathy may be seen with different imaging modalities, but ultrasound is the method of choice for evaluating axillary lymph nodes and for performing image-guided lymph node interventions. This review aims to provide a comprehensive overview of the available imaging modalities for lymph node assessment in patients diagnosed with primary breast cancer. IMPLICATIONS FOR PRACTICE: The detection of lymph node metastasis affects the management of patients with primary breast cancer. The main goal for the radiologist is to detect lymph node metastasis in patients to allow for the selection of patients who should undergo upfront axillary lymph node dissection. Features that are suggestive of axillary adenopathy may be seen with mammography, computed tomography, and magnetic resonance imaging, but ultrasonography is the imaging modality of choice for evaluating axillary lymph nodes. A normal axillary lymph node is characterized by a reniform shape, a maximal cortical thickness of 3 mm without focal bulging, smooth margins, and, depending on size, a discernable central fatty hilum.
Collapse
Affiliation(s)
- Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of MessinaMessinaItaly
| | - Daly Avendano
- Department of Breast Imaging, Breast Cancer Center TecSalud, Instituto Tecnológico de Estudios Superiores (ITESM) MonterreyNuevo LeonMexico
| | - Pedro Zapata
- Department of Radiology, San Felipe de Jesus HospitalMonterreyNuevo LeonMexico
| | - Christopher C. Riedl
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Katja Pinker
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Molecular and Gender Imaging Service, Department of Biomedical Imaging and Image‐guided Therapy, Medical University of ViennaViennaAustria
| |
Collapse
|
13
|
Expression of PD-1/PD-L1 in primary breast tumours and metastatic axillary lymph nodes and its correlation with clinicopathological parameters. Sci Rep 2019; 9:14356. [PMID: 31591439 PMCID: PMC6779893 DOI: 10.1038/s41598-019-50898-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/19/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to compare the expression of PD-1/PD-L1 in primary breast tumours to that in metastatic axillary lymph nodes and to determine the correlation between the PD-1/PD-L1 status and clinicopathologic characteristics. In total, 47 paired breast tumour and metastatic axillary lymph node samples were collected in this study. Immunohistochemical technology was used to determine the positivity or negativity of PD-1/PD-L1. Other patient information was retrieved from medical records. Significant differences in PD-L1 expression were observed between primary breast tumours and paired axillary lymph nodes. We also observed that the presence of PD-1/PD-L1 positivity in metastatic lymph nodes was significantly associated with poor prognostic features, such as a high Ki-67 index (p = 0.048), a high TNM stage (p = 0.012), a large number of metastatic lymph nodes (p = 0.002), and a high histology grade (p = 0.029). Since heterogeneity exists, it is necessary to determine the PD-L1 status in both the primary tumour and metastatic lymph nodes.
Collapse
|
14
|
Is preoperative ultrasound of the axilla necessary in screen-detected breast cancer? Eur J Surg Oncol 2019; 46:85-88. [PMID: 31582322 DOI: 10.1016/j.ejso.2019.09.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Axillary ultrasound (US) with fine needle aspiration biopsy (FNAB) of suspicious lymph nodes helps identify patients with axillary metastases preoperatively avoiding a 2-step axillary procedure. However, it does not accurately differentiate between low and high axillary tumour burden. Our aim was to determine the rationale of preoperative axillary US in screen-detected breast cancer. METHODS We retrospectively analysed patients, aged between 50 and 69 years, which had an invasive breast cancer diagnosed in the Slovenian National Breast Cancer Screening program between January 2012 and June 2017. Proportion of patients that proceeded directly to ALND and the proportion of patients with unnecessary ALND as a result of positive US-FNAB were calculated. RESULTS Altogether 892 patients were eligible for analysis. Preoperative US of the axilla was performed in 856/892 (96%) patients, while 36/892 patients (4%) did not undergo US of the axilla. We have found out that upfront ALND due to positive US-FNAB was performed in 91/856 (10.6%) patients. 116/856 patients (13.6%) had tumours in inner quadrants and maximal mammographic tumour size ≤ 2 cm. Among them only 1/116 (0.9%) proceeded directly to ALND due to positive US-FNAB.The final pathology of those who underwent upfront ALND due to positive US-FNAB showed low axillary tumour burden not meeting the indications for ALND in 13/91 (14.3%) patients.Among patients without preoperative axillary US, only 1/36 (2.8%) met the indications for ALND. CONCLUSION Our results showed that performing US of the axilla is not justified in screen detected breast cancer patients.
Collapse
|
15
|
Schwartz T, Margenthaler J. Flipping a Coin? Predicting Nodal Status After Neoadjuvant Chemotherapy. Ann Surg Oncol 2019; 26:4168-4170. [PMID: 31555938 DOI: 10.1245/s10434-019-07868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Theresa Schwartz
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Julie Margenthaler
- Department of Surgery, Washington University in Saint Louis, St. Louis, MO, USA
| |
Collapse
|
16
|
Almerey T, Villacreses D, Li Z, Patel B, McDonough M, Gibson T, Maimone S, Gray R, McLaughlin SA. Value of Axillary Ultrasound after Negative Axillary MRI for Evaluating Nodal Status in High-Risk Breast Cancer. J Am Coll Surg 2019; 228:792-797. [PMID: 30797947 DOI: 10.1016/j.jamcollsurg.2019.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is assumed that axillary ultrasound (AxUS) is the best method for axillary nodal evaluation in newly diagnosed breast cancer patients. However, few have evaluated the efficacy of preoperative axillary MRI. We compared the statistical accuracy of AxUS and MRI in detecting nodal metastases among breast cancer patients who were selected for neoadjuvant chemotherapy. STUDY DESIGN We retrospectively analyzed 219 breast cancer patients undergoing neoadjuvant chemotherapy from 2007 to 2015, all of whom had AxUS and breast MRI before chemotherapy. Two breast radiologists, blinded to clinical, pathologic, and AxUS findings, re-reviewed all breast MRIs, specifically focusing on axillary nodal characteristics. We correlated clinico-pathologic characteristics, AxUS, and MRI findings, and quantified predictive values of both imaging modalities. RESULTS Overall, 101 of 219 (47%) patients had T2 tumors. The most common abnormal nodal finding was size >10 mm. Axillary ultrasound and MRI agreed on nodal status in 192 of 219 patients (87.6%). When correlated with pre-chemotherapy needle biopsy in 129 patients, AxUS and axillary MRI performed similarly (sensitivity of 99.1% vs 97.4% and specificity 15.4% vs 15.4%, respectively). Only 4 of 129 (3.1%) patients had a negative MRI and positive AxUS; 3 of 4 of these patients (75%) had a positive biopsy and 2 of 3 had positive lymph nodes on final pathology, therefore suggesting MRI missed clinically significant disease in only 2 of 129 (1.5%) patients. CONCLUSIONS In a high-risk patient population, AxUS and MRI have similar statistical profiles in evaluating axillary nodal status. Routine use of AxUS after a normal axillary MRI is not warranted.
Collapse
Affiliation(s)
- Tariq Almerey
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL
| | | | - Zhuo Li
- Department of Health Sciences Research and Biostatistics, Mayo Clinic Florida, Jacksonville, FL
| | - Bhavika Patel
- Department of Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Tammeza Gibson
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL
| | - Santo Maimone
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL
| | - Richard Gray
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | | |
Collapse
|
17
|
Helfgott R, Mittlböck M, Miesbauer M, Moinfar F, Haim S, Mascherbauer M, Schlagnitweit P, Heck D, Knauer M, Fitzal F. The influence of breast cancer subtypes on axillary ultrasound accuracy: A retrospective single center analysis of 583 women. Eur J Surg Oncol 2018; 45:538-543. [PMID: 30366878 DOI: 10.1016/j.ejso.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Axillary ultrasound staging (AUS) is an important tool to guide clinical decisions in breast cancer therapy, especially regarding axillary surgery but also radiation therapy. It is unknown whether biological subtypes influence axillary staging using ultrasound (AUS). METHOD This is a retrospective single center analysis. All patients with breast cancer, a preoperative axillary ultrasound and a complete surgical axillary staging were included between 1999 and 2014, except patients with neoadjuvant chemotherapy (NACT). The results of the AUS were compared with final pathological results. Biological subtypes were identified by immunohistochemistry. RESULTS 583 women were included in the study. Sensitivity, Specificity, positive and negative predictive value for AUS were 39%, 96%, 91% and 83%. While sensitivity was significantly lower in Luminal A and B patients (25.0%; 39.8%) as compared to non Luminal breast cancer patients (TN 68.8%; Her2+ 71.4%; p = 0.0032), there were no significant differences between the groups with respect to specificity, PPV and NPV. CONCLUSION Solely regarding sensitivity of AUS, our study could show significant differences between biological subtypes of breast cancer with lower sensitivity in Luminal patients. While PPV was excellent, standing for a low overtreatment rate using AUS for clinical decision making, sensitivity was poor overall, comparable to the results of other studies.
Collapse
Affiliation(s)
- Ruth Helfgott
- Sisters of Charity, Breast Health Center and Department of Surgery, Linz, Austria.
| | - Martina Mittlböck
- Medical University Vienna and Cancer Comprehensive Center, Department of Bioinformatic and Statistic, Austria
| | | | | | - Silke Haim
- Department of Nuclear Medicine, Linz, Austria
| | - Maria Mascherbauer
- Sisters of Charity, Breast Health Center and Department of Surgery, Linz, Austria
| | - Paul Schlagnitweit
- Sisters of Charity, Breast Health Center and Department of Surgery, Linz, Austria
| | - Dietmar Heck
- Sisters of Charity, Breast Health Center and Department of Surgery, Linz, Austria
| | | | - Florian Fitzal
- Medical University Vienna and Cancer Comprehensive Center, Department of Surgery, Austria
| |
Collapse
|
18
|
Lazzaretti MG, Ponti A, Mano MP, Barca A, Casella D, Frigerio A, Giordano L, Mantellini P, Paduos A, Pitarella S, Ravaioli A, Taffurelli M, Tomatis M, Segnan N. Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy. Breast 2018; 42:15-22. [PMID: 30138762 DOI: 10.1016/j.breast.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/16/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Available evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care. MATERIAL AND METHODS This is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50-69 between years 2000 and 2015 in twelve Italian Regions. RESULTS In pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45% of low grade, small DCIS over the whole time period had some form of axillary surgery. CONCLUSION This large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.
Collapse
Affiliation(s)
| | - Antonio Ponti
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Maria Piera Mano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alessandra Barca
- Area Prevenzione e Promozione della Salute, Ufficio Screening, Regione Lazio, Italy
| | - Denise Casella
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Frigerio
- SSD Screening, AOU Città della Salute e della Scienza, Torino, Italy
| | - Livia Giordano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paola Mantellini
- SC Prevenzione Secondaria Screening, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | - Adriana Paduos
- Department of Surgery, ASL Biella, Italy, and Fondazione Edo Tempia, Italy
| | - Sabina Pitarella
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Mario Taffurelli
- Chief of Breast Surgery, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Mariano Tomatis
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy; Director of WHO Collaborating Centre for Cancer Early Detection and Screening, Torino, Italy
| |
Collapse
|
19
|
Tawfik O, Kimler BF, Karnik T, Shehata P. Clinicopathological correlation of PD-L1 expression in primary and metastatic breast cancer and infiltrating immune cells. Hum Pathol 2018; 80:170-178. [PMID: 29936058 DOI: 10.1016/j.humpath.2018.06.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/30/2018] [Accepted: 06/09/2018] [Indexed: 12/31/2022]
Abstract
Few studies have evaluated the expression of the programmed cell death-1 and its ligand-1 (PD-L1) in breast cancer. In this study, we correlated differential expression of PD-L1 in breast cancer (BC) and its microenvironment from a cohort of patients with BC, paired locally metastatic disease to regional lymph nodes (LNs) and nonpaired distantly metastatic disease (mets). PD-L1 expression was correlated with several pathologic and clinical parameters in tumor and tumor immune cells (ICs; CD3, CD4, CD8, CD20, and CD68) using the Ventana antibody (SP263) in 41 BCs, 46 paired mets in LNs, and 46 distant mets. There was 100% agreement for PD-L1 expression on tumor and ICs between BC and matched LN. PD-L1 is differentially expressed in primary BC and regional nodal disease. Expression correlated with higher grade, hormone receptor negativity, and highly proliferative tumors (P < .001). In LNs, the high positivity rate was driven by triple-negative status (70% versus 5%; P < .0001). In contrast, there was significantly near-total absence of PD-L1 expression in distant mets compared with BC and LNs (2%-4% in mets versus 17%-20% in BC and LN, P = .009). IC density varied in BC and metastatic tumors with predominance of CD3 and CD68 and near total absence of CD20 cells. PD-L1 expression was mainly associated with CD68 cells. There were consistent higher numbers of CD3 (CD8 > CD4) than CD20 cells in primary and metastatic tumors. Correlation of PD-L1 expression in BC and its microenvironment may be useful for the development of new treatment strategies.
Collapse
Affiliation(s)
- Ossama Tawfik
- Department of Pathology and Laboratory Medicine, the University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Bruce F Kimler
- Department of Radiation Oncology, the University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Tejashree Karnik
- Department of Pathology and Laboratory Medicine, the University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Peter Shehata
- Department of Pathology and Laboratory Medicine, the University of Kansas Medical Center, Kansas City, KS 66160, USA
| |
Collapse
|
20
|
Ganglion sentinelle et chimiothérapie néoadjuvante dans le cancer du sein. Bull Cancer 2017; 104:892-901. [DOI: 10.1016/j.bulcan.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/21/2022]
|
21
|
Zhou J, Guo FJ, Hao XP, Chen CJ, Jiang ZF, Li GJ. Use of Breast Magnetic Resonance Imaging and Ultrasonography for Identifying Nonpalpable Axillae Metastases in Newly Diagnosed Breast Cancer Patients. Clin Breast Cancer 2017; 18:e65-e71. [PMID: 28867444 DOI: 10.1016/j.clbc.2017.06.015] [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: 06/06/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The metastasis of axillary lymph node (ALNs) is a critical step in the initial cancer staging of newly diagnosed breast cancer (BC) patients. Various imaging modalities can enhance the sensitivity of clinical examination in assessing the ALN status. PATIENTS AND METHODS We enrolled 135 patients with BC, confirmed via histopathology, including 4 bilateral BC cases. A total of 139 ipsilateral ALNs adjacent to the breast lesion were examined via physical examination, ultrasonography (US), and magnetic resonance imaging (MRI); of these, 100 were nonpalpable ALNs, as determined by experienced breast surgeons and physicians. The relative size parameters on MRI and US images were recorded. Receiver operating characteristic (ROC) analyses were conducted, and the area under the ROC curve (AUC) was compared. RESULTS Of 139 ALNs, 67 (48%) were malignant and 72 (52%) were benign on pathological examination. In all of the ALNs, the US short diameter appeared to be the most discriminative quantitative measurement for detecting positive findings (AUC, 0.854). In nonpalpable ALNs as well, the US short diameter exhibited the greatest discriminability (AUC, 0.746). However, the 2-dimensional and 3-dimensional parameters on MRI did not exhibit any significant differences between the enrolled and nonpalpable ALNs (P > .05). CONCLUSION The shortest diameter on US exhibited better discriminative ability than MRI for predicting positive ALNs in nonpalpable axillae. Moreover, the 2-dimensional and 3-dimensional parameters on MRI did not differ in terms of discriminability.
Collapse
Affiliation(s)
- Juan Zhou
- Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Feng-Juan Guo
- Department of Ultrasound, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Xiao-Peng Hao
- Department of Breast Surgery, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Cui-Jing Chen
- Department of Ultrasound, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
| | - Ze-Fei Jiang
- Department of Breast Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
| | - Gong-Jie Li
- Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
| |
Collapse
|
22
|
Yoo TK, Chang JM, Shin HC, Han W, Noh DY, Moon HG. An objective nodal staging system for breast cancer patients undergoing neoadjuvant systemic treatment. BMC Cancer 2017; 17:389. [PMID: 28569197 PMCID: PMC5452603 DOI: 10.1186/s12885-017-3380-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we aimed to develop an objective staging system to determine the degree of nodal metastasis in breast cancer patients undergoing neoadjuvant systemic treatment (NST). METHODS We reviewed the pretreatment computed tomography (CT) images of 392 breast cancer patients who received NST. The association between the patterns of the enlarged regional lymph nodes and treatment outcome was analyzed. RESULTS In the development cohort of 260 patients, 88 (33.8%) patients experienced tumor recurrence and had a significantly higher number of enlarged lymph nodes on the pretreatment CT compared to patients with no recurrence. When patients were classified according to the numbers and locations of enlarged lymph nodes on pretreatment CT, the number of lymph nodes larger than 1 cm was most significantly associated with tumor recurrence. The accuracy of the CT-based nodal staging system was validated in an independent cohort of 132 patients. The presence of the enlarged supraclavicular nodes was associated with worse outcome, but the effect seemed to originate from the accompanied extensive axillary nodal burden. The prognostic effect of the objectively measured axillary nodal metastasis was more pronounced in hormone receptor-negative tumors. CONCLUSIONS We have developed and validated an objective method of nodal staging in breast cancer patients who undergo NST based on the number of enlarged axillary lymph nodes. Our system can improve the current subjective approach, which uses physical examination alone.
Collapse
Affiliation(s)
- Tae-Kyung Yoo
- Department of Surgery, Seoul National University College of Medicine, 03080, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Present address: Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hee-Chul Shin
- Department of Surgery, Chung-Ang University College of Medicine, 84 Heukseouk-ro, Dongjak-gu, Seoul, Republic of Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, 03080, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, 03080, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, 03080, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea. .,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| |
Collapse
|
23
|
Coutant C, Jankowski C, Portha H, Barranger E. [Assessment of sentinel lymph node biopsy in patients receiving neoadjuvant chemotherapy in breast cancer: before or after?]. ACTA ACUST UNITED AC 2016; 44:345-9. [PMID: 27234216 DOI: 10.1016/j.gyobfe.2016.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/15/2016] [Indexed: 11/26/2022]
Abstract
The main goal of preoperative chemotherapy is to reduce the size of the tumor and allow conservative treatment. Neoadjuvant treatment can affect axillary status with a downstaging in one third of the cases. For these patients, the benefit of axillary node dissection is questioned and the sentinel node biopsy (SLNB) seems to be a relevant option. However, the timing of performing SLNB is still debated especially for clinical negative patients with negative axillary ultrasound before preoperative chemotherapy. For axillary positive nodes proved by biopsy/cytology before preoperative chemotherapy, SLNB can be an option if there is a good clinical and radiological response.
Collapse
Affiliation(s)
- C Coutant
- Département de chirurgie oncologique, Centre de lutte contre le cancer Georges-François Leclerc (CGFL), 1, rue du Professeur-Marion, 21000 Dijon, France; UFR des sciences de santé, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
| | - C Jankowski
- Département de chirurgie oncologique, Centre de lutte contre le cancer Georges-François Leclerc (CGFL), 1, rue du Professeur-Marion, 21000 Dijon, France; UFR des sciences de santé, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - H Portha
- Département de chirurgie oncologique, Centre de lutte contre le cancer Georges-François Leclerc (CGFL), 1, rue du Professeur-Marion, 21000 Dijon, France
| | - E Barranger
- Pôle de chirurgie oncologique générale, gynécologique et mammaire, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Diagnostic value of preoperative axillary lymph node ultrasound assessment in patients with breast cancer qualified for sentinel lymph node biopsy. Wideochir Inne Tech Maloinwazyjne 2015; 10:170-7. [PMID: 26240616 PMCID: PMC4520848 DOI: 10.5114/wiitm.2015.52264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/28/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Sentinel lymph node biopsy (SLNB) is a standard procedure in the therapeutic management of patients with non-advanced breast cancer. Aim To analyse the utility of ultrasound scan (USS) examination in the process of patient qualification for SLNB and to estimate the optimal time to perform USS in the clinical preoperational assessment of axillary lymph nodes. Material and methods A prospective analysis of 702 patients with invasive breast cancer treated with SLNB between 7.03.2012 and 27.05.2013 was performed. The patients were divided into three groups: I (USS < 8 weeks before SLNB), II (USS > 8 weeks before SLNB and another one on the day before SLNB) and III (USS > 8 weeks before SLNB without perioperative USS). In these patients the percentage of metastases in the sentinel lymph node and the clinical factors influencing the diagnostic value of preoperative ultrasound scan were assessed. Results Metastatic lesions in sentinel lymph nodes were found in 154 (21.9%) patients. The highest percentage of metastases was noted in patients operated on in the second and third month from the beginning of preoperative diagnostics. None of the factors tested (size of the original tumour, histological malignancy grading, kind of preoperative diagnostics, Ki-67 value, biological type of the tumour, age) had a statistically significant influence on the diagnostic value of perioperative USS examination in the analysed time span. Conclusions The lowest percentage of metastases in the sentinel lymph node was noted in the patients qualified for SLNB who had the ultrasound performed directly before the surgical procedure (not more than 4 weeks before the surgery).
Collapse
|
27
|
Omair M, Al-Azawi D, Mann GB. Sentinel node biopsy in breast cancer revisited. Surgeon 2014; 12:158-65. [PMID: 24548701 DOI: 10.1016/j.surge.2013.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/23/2013] [Accepted: 12/23/2013] [Indexed: 01/17/2023]
Abstract
The axilla has long been a focus of clinicians' attention in the management of breast cancer. The approach to the axilla has undergone dramatic changes over the last century, from radical and extended radical excisions, through the introduction of sentinel node biopsy for node negative patients to the current situation where selective management of those with nodal involvement is being introduced. The introduction of lymphatic mapping and sentinel node biopsy in the 1990's has been key to the major changes that have occurred. In less than 20 years it has moved from a hypothesis to a situation where it is the default approach to almost all clinically node negative patients and is being considered in other situations where axillary clearance was previously considered standard. This article reviews the development and introduction of sentinel node biopsy, its current uncertainties and limitations, and possible future developments.
Collapse
Affiliation(s)
- Mohammad Omair
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Dhafir Al-Azawi
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia; St James's Hospital, Trinity College, Dublin, Ireland
| | - Gregory Bruce Mann
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia; The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia.
| |
Collapse
|
28
|
Accuracy of individual descriptors and grading of nodal involvement by axillary ultrasound in patients of breast cancer. Int J Breast Cancer 2014; 2013:930596. [PMID: 24455284 PMCID: PMC3880710 DOI: 10.1155/2013/930596] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/26/2013] [Accepted: 11/28/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Four-node sampling is a useful substitute for sentinel node biopsy in low resource settings. USG is being increasingly used as a preoperative tool to evaluate axilla. We conducted this study to assess the accuracy of different descriptors of axillary ultrasound and to formulate a model on grading of axillary involvement. Material and Methods. Thirty-four patients with clinically negative axilla underwent preoperative axillary ultrasound. The suspicious nodes were marked and details of various descriptors were noted. These nodes were sampled during axillary dissection and correlation of ultrasonographic findings with histopathological report was done to calculate accuracy of different descriptors. Based on this, a grading system of axillary lymph nodes involvement was formulated. Results. Based on the presence of various descriptors, five grades of nodal involvement could be defined. The most accurate descriptors to indicate nodal involvement were loss of hilar fat and hypoechoic internal echoes with specificity of 83% and positive predictive value of 92% each. The combination of descriptors of round shape with loss of hilar fat and hypoechoic internal echos had 100% specificity and positive predictive value. Conclusions. Grading of nodal involvement on axillary USG can be useful for selecting the most suspicious nodes for sampling during axillary dissection.
Collapse
|
29
|
Classe JM, Houvenaeghel G, Barranger E. L’exploration et le traitement de la région axillaire des tumeurs infiltrantes du sein (RPC 2013). ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2339-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
30
|
|
31
|
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.
Collapse
Affiliation(s)
- Hee Yong Kwak
- Department of Surgery, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Lee MC, Joh JE, Chau A. Axillary Staging Prior to Neoadjuvant Chemotherapy: The Roles of Sentinel Lymph Node Biopsy and Axillary Ultrasonography. Cancer Control 2012; 19:277-285. [DOI: 10.1177/107327481201900404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Marie Catherine Lee
- Comprehensive Breast Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Division of Oncologic Sciences at the University of South Florida, Tampa, Florida
| | - Jennifer E. Joh
- Comprehensive Breast Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Hoffberger Breast Center at Mercy, Mercy Medical Center, Baltimore, Maryland
| | - Alec Chau
- Diagnostic Imaging Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Division of Oncologic Sciences at the University of South Florida, Tampa, Florida
| |
Collapse
|
33
|
Majid S, Tengrup I, Manjer J. Clinical Assessment of Axillary Lymph Nodes and Tumor Size in Breast Cancer Compared with Histopathological Examination: A Population-Based Analysis of 2,537 Women. World J Surg 2012; 37:67-71. [DOI: 10.1007/s00268-012-1788-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
|
35
|
|
36
|
Gerber B, Heintze K, Stubert J, Dieterich M, Hartmann S, Stachs A, Reimer T. Axillary lymph node dissection in early-stage invasive breast cancer: is it still standard today? Breast Cancer Res Treat 2011; 128:613-24. [PMID: 21523451 DOI: 10.1007/s10549-011-1532-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 04/16/2011] [Indexed: 12/26/2022]
Abstract
Evaluation of axillary lymph node status by sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection (ALND) are an inherent part of breast cancer treatment. Increased understanding of tumor biology has changed the prognostic and therapeutic impact of lymph node status. Non-invasive imaging techniques like axillary ultrasound, FDG-PET, or MRI revealed moderate sensitivity and high specificity in evaluation of lymph node status. Therefore, they are not sufficient for lymph node staging. Otherwise, the impact of remaining micrometastases and even macrometastases for prognosis and treatment decisions is overestimated. Considering tumor biology, the distinction of axillary metastases in isolated tumor cells (ITC, pN0(i+)); micrometastases (pN1mi), and macrometastases (pN1a) is not comprehensible. Increasing data support the thesis that remaining axillary metastases neither increase the axillary recurrence rate nor decrease overall survival. It is doubtful that axillary tumor cells are capable to complete the complex multistep metastatic process. If applied, axillary metastases are sensitive to systemic treatment and are targeted by postoperative tangential breast irradiation. Therefore, the controversy about the clinical relevance of tumor cell clusters or micrometastases in SLN is a sophisticated but not contemporary discussion. Currently, there is no indication for axillary surgery in elderly patients with favorable tumors and clinically tumor-free lymph nodes. Nonetheless, a rational and evidence-based approach to the management of clinically and sonographically N0 patients with planned breast-conserving surgery and limited tumor size is needed now.
Collapse
Affiliation(s)
- Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, Rostock, Germany.
| | | | | | | | | | | | | |
Collapse
|
37
|
The value of axillary ultrasound with fine needle aspiration as a pre-operative staging procedure in breast cancer: Northern Irish experience. Ir J Med Sci 2011; 180:509-11. [PMID: 21279459 DOI: 10.1007/s11845-011-0684-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In our unit sentinel lymph node biopsy (SLNB) is performed without intra-operative pathological nodal assessment. If node biopsies are positive the patients have to return at a later date for a complete axillary node clearance (ANC). METHODS We conducted a retrospective study to ascertain if the use of pre-operative ultrasound assessment of the axilla with fine needle aspiration (FNA) sampling could identify patients with nodal metastases and therefore identify patients who should proceed primarily to ANC. RESULTS Our study showed that 40 patients out of 119 had nodal metastases, and ultrasound correctly identified 19 of those patients.
Collapse
|
38
|
Schiettecatte A, Bourgain C, Breucq C, Buls N, De Wilde V, de Mey J. Initial axillary staging of breast cancer using ultrasound-guided fine needle aspiration: a liquid-based cytology study. Cytopathology 2011; 22:30-5. [DOI: 10.1111/j.1365-2303.2010.00738.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Luschin G. [Sentinel lymph node biopsy in breast cancer]. Wien Med Wochenschr 2010; 160:497-500. [PMID: 20936365 DOI: 10.1007/s10354-010-0830-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 09/08/2010] [Indexed: 11/27/2022]
Abstract
Complete axillary lymph node dissection has been the traditional operation to determine whether cancer has spread beyond the breast. In the large majority of patients with breast cancer, lymphatic mapping and γ-probe-guided and/or blue dye sentinel node biopsy can be used to locate the first node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel node biopsy routinely. Thus, they may be spared complete axillary dissection if the sentinel node is negative. Decreased arm swelling and pain are associated with sentinel lymph node biopsy compared with axillary lymph node dissection.
Collapse
Affiliation(s)
- Gero Luschin
- Klinische Abteilung für Gynäkologie, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Österreich.
| |
Collapse
|
40
|
Cheng G, Kurita S, Torigian DA, Alavi A. Current status of sentinel lymph-node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging 2010; 38:562-75. [PMID: 20700739 DOI: 10.1007/s00259-010-1577-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 07/18/2010] [Indexed: 12/17/2022]
Abstract
Axillary node status is the most important prognostic indicator for patients with invasive breast cancer. Sentinel lymph-node biopsy (SLNB) is widely accepted and the preferred procedure for identifying lymph-node metastasis. SLNB allows focused excision and pathological examination of the most likely axillary lymph nodes to receive tumor metastases while avoiding morbidities associated with complete axillary nodal dissection. Since its introduction in the early 1990s, the process of SLNB has undergone continual modification and refinement; however, the procedure varies between institutions and controversies remain. In this review, we examine the technical issues that influence the success of lymph node mapping, discuss the controversies, and summarize the indications and contraindications for axillary node mapping and biopsy in clinical practice.
Collapse
Affiliation(s)
- Gang Cheng
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | | | |
Collapse
|
41
|
Heuts EM, van der Ent FWC, van der Pol HAG, von Meyenfeldt MF, Voogd AC. Additional Tracer Injection to Improve the Technical Success Rate of Lymphoscintigraphy for Sentinel Node Biopsy in Breast Cancer. Ann Surg Oncol 2009; 16:1156-63. [DOI: 10.1245/s10434-009-0403-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 02/06/2023]
|
42
|
Lee MC, Kilbride KE. Timing of Axillary Staging. Ann Surg Oncol 2009; 16:1065. [DOI: 10.1245/s10434-009-0352-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 01/09/2009] [Indexed: 12/20/2022]
|
43
|
Haron NH, Taib NA, Yip CH. Is clinical assessment of the axilla a reliable indicator for lymph node metastases in breast cancer? ANZ J Surg 2008; 78:943-4. [PMID: 18959689 DOI: 10.1111/j.1445-2197.2008.04709.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nur Hashim Haron
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
44
|
Ali R, Hanly AM, Naughton P, Castineira CF, Landers R, Cahill RA, Watson RG. Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer. World J Surg Oncol 2008; 6:69. [PMID: 18582366 PMCID: PMC2443144 DOI: 10.1186/1477-7819-6-69] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 06/26/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maximisation of the potential of sentinel lymph node biopsy as a minimally invasive method of axillary staging requires sensitive intraoperative pathological analysis so that rates of re-operation for lymphatic metastases are minimised. The aim of this study was to describe the test parameters of the frozen section evaluation of sentinel node biopsy for breast cancer compared to the gold standard of standard permanent pathological evaluation at our institution. METHODS The accuracy of intraoperative frozen section (FS) of sentinel nodes was determined in 94 consecutive women undergoing surgery for clinically node negative, invasive breast cancer (37:T1 disease; 43:T2; 14:T3). Definitive evidence of lymphatic spread on FS indicated immediate level II axillary clearance while sentinel node "negativity" on intraoperative testing led to the operation being curtailed to allow formal H&E analysis of the remaining sentinel nodal tissue. RESULTS Intraoperative FS correctly predicted axillary involvement in 23/30 patients with lymphatic metastases (76% sensitivity rate) permitting definitive surgery to be completed at the index operation in 87 women (93%) overall. All SN found involved on FS were confirmed as harbouring tumour cells on subsequent formal specimen examination (100% specificity and positive predictive value) with 16 patients having additional non-sentinel nodes found also to contain tumour. Negative Predictive Values were highest in women with T1 tumours (97%) and lessened with more local advancement of disease (T2 rates: 86%; T3: 75%). Of those with falsely negative FS, three had only micrometastatic disease. CONCLUSION Intraoperative FS reliably evaluates the status of the sentinel node allowing most women complete their surgery in a single stage. Thus SN can be offered with increased confidence to those less likely to have negative axillae hence expanding the population of potential beneficiaries.
Collapse
Affiliation(s)
- Rohanna Ali
- Department of General Surgery, Waterford Regional Hospital, Waterford, Ireland.
| | | | | | | | | | | | | |
Collapse
|