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Guzmán-Arocho YD, Collins LC. Pragmatic guide to the macroscopic evaluation of breast specimens. J Clin Pathol 2024; 77:204-210. [PMID: 38373781 DOI: 10.1136/jcp-2023-208833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 02/21/2024]
Abstract
The pathological assessment of a breast surgical specimen starts with macroscopic evaluation, arguably one of the most critical steps, as only a small percentage of the tissue is examined microscopically. To properly evaluate and select tissue sections from breast specimens, it is essential to correlate radiological findings, prior biopsies, procedures and treatment with the gross findings. Owing to its fatty nature, breast tissue requires special attention for proper fixation to ensure appropriate microscopic evaluation and performance of ancillary studies. In addition, knowledge of the information necessary for patient management will ensure that these data are collected during the macroscopic evaluation, and appropriate sections are taken to obtain the information needed from the microscopic evaluation. Herein, we present a review of the macroscopic evaluation of different breast specimen types, including processing requirements, challenges and recommendations.
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Affiliation(s)
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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2
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Zhang-Yin J, Mauel E, Talpe S. Update on Sentinel Lymph Node Methods and Pathology in Breast Cancer. Diagnostics (Basel) 2024; 14:252. [PMID: 38337768 PMCID: PMC10855371 DOI: 10.3390/diagnostics14030252] [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: 12/13/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
Breast cancer stands out as the most commonly diagnosed cancer among women globally. Precise lymph node staging holds critical significance for both predicting outcomes in early-stage disease and formulating effective treatment strategies to control regional disease progression in breast cancer patients. No imaging technique possesses sufficient accuracy to identify lymph node metastases in the early stages (I or II) of primary breast cancer. However, the sentinel node procedure emerges as a valuable approach for identifying metastatic axillary nodes. The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination, it is postulated that the sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor. The utilization of the sentinel node technique has brought about changes in the assessment of lymph nodes. It involves evaluating the sentinel node during surgery, enabling prompt lymph node dissection when the sentinel node procedure is positive. Additionally, histological ultra-stratification is employed to uncover occult metastases. This review aims to provide an update of this valuable technique, with focus on the practical aspects of the procedure and the different histological protocols of sentinel node evaluation in breast cancer.
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Affiliation(s)
- Jules Zhang-Yin
- Department of Nuclear Medicine, South Luxembourg Clinic, Vivalia, 6700 Arlon, Belgium
| | - Etienne Mauel
- Department of Surgery, South Luxembourg Clinic, Vivalia, 6700 Arlon, Belgium;
| | - Stéphanie Talpe
- Department of Pathology, South Luxembourg Clinic, Vivalia, 6700 Arlon, Belgium;
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3
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Zhou M, Liu P, Yin X, Deng C, Xiao Y, Lei M, Hu S, An F, Zhao M. A SPECT/NIR Fluorescence Dual-Modality Imaging Agent Composed of Drugs and Hospital Available Isotope for Preoperative Sentinel Lymph Node Mapping and Intraoperative Biopsy. Int J Nanomedicine 2023; 18:7637-7646. [PMID: 38106445 PMCID: PMC10725784 DOI: 10.2147/ijn.s430502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Background Sentinel lymph node (SLN) mapping-guided biopsy is crucial for cancer staging and treatment. Optical/nuclide dual-modality imaging agents for mapping SLN are ideal for preoperative planning and intraoperative biopsy, which are enabled by penetration-depth unlimited nuclide imaging and dynamic real-time optical imaging, respectively. However, commonly reported dual-modality imaging agents are composed of novel but safety-unproven materials, making their quick clinical translation challenging. Herein, we report a novel nanoparticle composed of facile hospital-available drugs and isotope for single-photon emission computed tomography (SPECT)/near-infrared (NIR) fluorescence imaging to detect SLNs. Methods Indocyanine green-human serum albumin (ICG-HSA) nanoparticles (NPs) were synthesized by ICG-induced HSA self-assembly and further 99mTc-labeling via a one-step, facile hospital-available method. After injecting 99mTc-ICG-HSA into the rats' forepaw pads, the rats' draining axillary lymph nodes were visualized by preoperative mapping with SPECT/CT and intraoperative biopsy with NIR fluorescence. The axillary lymph nodes of rats were identified by pathology and fluorescent staining after execution. Additionally, its toxicity testing and comparison with 99mTc-sulfur colloid imaging were also explored. Results The study reported a self-assembled 99mTc-ICG-HSA with a high radiochemical yield (85.6 ± 3.8%). Compared with conventional 99mTc-sulfur colloid, 99mTc-ICG-HSA NPs showed faster SLN identification, higher renal clearance, and lower hepatic retention. Furthermore, NIRF imaging allowed for the accurate visualization of the SLN and guided SLN biopsy intraoperatively. Notably, the 99mTc-ICG-HSA NPs were composed of hospital-available drugs and isotope, which are safe for acute toxicity evaluation by a certified institute. Conclusion The proposed 99mTc-ICG-HSA NPs are safe and capable of noninvasive SLN identification and biopsy guidance with multi-modal imaging strategies and could be a promising tool for clinically assisted SLN biopsy.
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Affiliation(s)
- Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Peng Liu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xiaoqin Yin
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Caiting Deng
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Science, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yi Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Meng Lei
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Feifei An
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Min Zhao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Department of Nuclear Medicine, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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4
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Milosevic B, Stojanovic B, Cvetkovic A, Jovanovic I, Spasic M, Stojanovic MD, Stankovic V, Sekulic M, Stojanovic BS, Zdravkovic N, Mitrovic M, Stojanovic J, Laketic D, Vulovic M, Cvetkovic D. The Enigma of Mammaglobin: Redefining the Biomarker Paradigm in Breast Carcinoma. Int J Mol Sci 2023; 24:13407. [PMID: 37686210 PMCID: PMC10487666 DOI: 10.3390/ijms241713407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
The continuous evolution of cancer biology has led to the discovery of mammaglobin, a potential novel biomarker for breast carcinoma. This review aims to unravel the enigmatic aspects of mammaglobin and elucidate its potential role in redefining the paradigm of breast carcinoma biomarkers. We will thoroughly examine its expression in tumoral and peritumoral tissues and its circulating levels in the blood, thereby providing insights into its possible function in cancer progression and metastasis. Furthermore, the potential application of mammaglobin as a non-invasive diagnostic tool and a target for personalized treatment strategies will be discussed. Given the increasing incidence of breast carcinoma worldwide, the exploration of novel biomarkers such as mammaglobin is crucial in advancing our diagnostic capabilities and treatment modalities, ultimately contributing to improved patient outcomes.
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Affiliation(s)
- Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.M.); (B.S.); (A.C.)
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.M.); (B.S.); (A.C.)
| | - Aleksandar Cvetkovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.M.); (B.S.); (A.C.)
| | - Ivan Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.M.); (B.S.); (A.C.)
| | - Milica Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.D.S.); (V.S.)
| | - Vesna Stankovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.D.S.); (V.S.)
| | - Marija Sekulic
- Department of Hygiene and Ecology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Bojana S. Stojanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Natasa Zdravkovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Minja Mitrovic
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Jasmina Stojanovic
- Department of Otorhinolaryngology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Darko Laketic
- Institute of Anatomy, Faculty of Medicine, University of Belgrade,11000 Belgrade, Serbia;
| | - Maja Vulovic
- Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Danijela Cvetkovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
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5
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Challa B, Tahir M, Hu Y, Kellough D, Lujan G, Sun S, Parwani AV, Li Z. Artificial Intelligence-Aided Diagnosis of Breast Cancer Lymph Node Metastasis on Histologic Slides in a Digital Workflow. Mod Pathol 2023; 36:100216. [PMID: 37178923 DOI: 10.1016/j.modpat.2023.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/03/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
Identifying lymph node (LN) metastasis in invasive breast carcinoma can be tedious and time-consuming. We investigated an artificial intelligence (AI) algorithm to detect LN metastasis by screening hematoxylin and eosin (H&E) slides in a clinical digital workflow. The study included 2 sentinel LN (SLN) cohorts (a validation cohort with 234 SLNs and a consensus cohort with 102 SLNs) and 1 nonsentinel LN cohort (258 LNs enriched with lobular carcinoma and postneoadjuvant therapy cases). All H&E slides were scanned into whole slide images in a clinical digital workflow, and whole slide images were automatically batch-analyzed using the Visiopharm Integrator System (VIS) metastasis AI algorithm. For the SLN validation cohort, the VIS metastasis AI algorithm detected all 46 metastases, including 19 macrometastases, 26 micrometastases, and 1 with isolated tumor cells with a sensitivity of 100%, specificity of 41.5%, positive predictive value of 29.5%, and negative predictive value (NPV) of 100%. The false positivity was caused by histiocytes (52.7%), crushed lymphocytes (18.2%), and others (29.1%), which were readily recognized during pathologists' reviews. For the SLN consensus cohort, 3 pathologists examined all VIS AI annotated H&E slides and cytokeratin immunohistochemistry slides with similar average concordance rates (99% for both modalities). However, the average time consumed by pathologists using VIS AI annotated slides was significantly less than using immunohistochemistry slides (0.6 vs 1.0 minutes, P = .0377). For the nonsentinel LN cohort, the AI algorithm detected all 81 metastases, including 23 from lobular carcinoma and 31 from postneoadjuvant chemotherapy cases, with a sensitivity of 100%, specificity of 78.5%, positive predictive value of 68.1%, and NPV of 100%. The VIS AI algorithm showed perfect sensitivity and NPV in detecting LN metastasis and less time consumed, suggesting its potential utility as a screening modality in routine clinical digital pathology workflow to improve efficiency.
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Affiliation(s)
- Bindu Challa
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Maryam Tahir
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yan Hu
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Kellough
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Giovani Lujan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shaoli Sun
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anil V Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Shimizu Y, Che Y, Murohara T. Therapeutic Lymphangiogenesis Is a Promising Strategy for Secondary Lymphedema. Int J Mol Sci 2023; 24:7774. [PMID: 37175479 PMCID: PMC10178056 DOI: 10.3390/ijms24097774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Secondary lymphedema is caused by lymphatic insufficiency (lymphatic drainage failure) following lymph node dissection during the surgical treatment or radiation therapy of breast or pelvic cancer. The clinical problems associated with lymphedema are reduced quality of life in terms of appearance and function, as well as the development of skin ulcers, recurrent pain, and infection. Currently, countermeasures against lymphedema are mainly physical therapy such as lymphatic massage, elastic stockings, and skin care, and there is no effective and fundamental treatment with a highly recommended grade. Therefore, there is a need for the development of a fundamental novel treatment for intractable lymphedema. Therapeutic lymphangiogenesis, which has been attracting attention in recent years, is a treatment concept that reconstructs the fragmented lymphatic network to recover lymphatic vessel function and is revolutionary to be a fundamental cure. This review focuses on the translational research of therapeutic lymphangiogenesis for lymphedema and outlines the current status and prospects in the development of therapeutic applications.
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Affiliation(s)
- Yuuki Shimizu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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7
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Nafissi N, Zareie B, Rezagholi P, Moayeri H. A Combined Nomogram Model to Preoperatively Predict Positive Sentinel Lymph Biopsy for Breast Cancer In Iranian Population. Adv Biomed Res 2022; 11:108. [PMID: 36660756 PMCID: PMC9843596 DOI: 10.4103/abr.abr_286_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/31/2021] [Accepted: 01/19/2022] [Indexed: 01/21/2023] Open
Abstract
Background Axillary dissection in breast cancer provides useful information on the degree of axillary nodule involvement, which serves as a reliable indicator for the prognosis and staging of breast cancer in patients. The aim of this study was to develop and validate the nomogram model by combining prognostic factors and clinical features to predict the node status of preoperative breast guard positive node cancer. Materials and Methods Subjects consisted of patients referring to hospitals with the diagnosis of breast cancer. Patients were allowed to substitute molecular subtypes with data on breast cancer diagnosis and prognosis as well as sentinel node status. The bootstrap review was used for internal validation. The predicted performance was evaluated based on the area under the receiver operating characteristic curve. According to the logistic regression analysis, the nomograms reported material strength between predictors and final status reliability. Results 1172 patients participated in the study, of whom only 539 patients had axillary lymph node involvement. The subtype, family history, calcification, and necrosis were not significantly related to axillary lymph node involvement. Tumor size, histological type, and lymphovascular invasion in multivariate logistic regression were significantly and directly correlated with axillary lymph node involvement. Conclusion Nomograms, depending on the population, help make decisions to prevent axillary surgery. It seems that the prediction model presented in this study, based on the results of the neuromography, can help surgeons make a more informed decision on underarm surgery. Moreover, in some cases, their surgical program will be informed by accurate medical care and preclusion of major surgeries such as ALND.
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Affiliation(s)
- Nahid Nafissi
- Department of General Surgery, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bushra Zareie
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Payman Rezagholi
- Department of Operating Room, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hassan Moayeri
- Department of Surgery, School of Medicine, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran,Address for correspondence: Dr. Hassan Moayeri, Department of Surgery, School of Medicine, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. E-mail:
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Manrique OJ, Bustos SS, Ciudad P, Adabi K, Chen WF, Forte AJ, Cheville AL, Jakub JW, McLaughlin SA, Chen HC. Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts. Mayo Clin Proc 2022; 97:1920-1935. [PMID: 32829905 DOI: 10.1016/j.mayocp.2020.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/17/2019] [Accepted: 01/06/2020] [Indexed: 12/16/2022]
Abstract
Lymphedema has historically been underrated in clinical practice, education, and scholarship to the detriment of many patients with this chronic, debilitating condition. The mechanical insufficiency of the lymphatic system causes the abnormal accumulation of protein-rich fluid in the interstitium, which triggers a cascade of adverse consequences such as fat deposition and fibrosis. As the condition progresses, patients present with extremity heaviness, itchiness, skin infections, and, in later stages, dermal fibrosis, skin papillomas, acanthosis, and other trophic skin changes. Correspondingly, lymphedema results in psychological morbidity, including anxiety, depression, social avoidance, and a decreased quality of life, encompassing emotional, functional, physical, and social domains. For this review, we conducted a literature search using PubMed and EMBASE and herein summarize the evidence related to the fundamental concepts of lymphedema. This article aims to raise awareness of this serious condition and outline and review the fundamental concepts of lymphedema.
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Affiliation(s)
- Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN.
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Kian Adabi
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
| | - Wei F Chen
- Division of Plastic and Reconstructive Surgery, University of Iowa, Iowa City
| | | | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | | | | | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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SPECT/CT Lymphoscintigraphy Guidance Simplifies and Improves Targeted Axillary Dissection of the Clipped Nodes After Neoadjuvant Chemotherapy in Initially Node-Positive Breast Cancer. Clin Nucl Med 2022; 47:e682-e688. [PMID: 35835147 DOI: 10.1097/rlu.0000000000004340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed the feasibility of SPECT/CT lymphoscintigraphy (99m Tc-nanocolloid) method to simplify and improve targeted axillary dissection of clipped axillary lymph node (axLN) after neoadjuvant chemotherapy (NAC) in initially node-positive breast cancer. PATIENTS AND METHODS Fifteen patients who had clip placement to biopsy-confirmed axLN metastasis due to clinically node-positive breast cancer before NAC and underwent SPECT/CT lymphoscintigraphy for surgery after NAC were included into the study. SPECT/CT lymphoscintigraphy was performed to localize the clipped node and to assess if the clipped lymph node (LN) had 99mTc-nanocolloid uptake or not. In case the clipped node had no uptake on SPECT/CT, the patient was referred to wire-guided localization procedure. Blue dye was also injected for dual mapping of sentinel LN biopsy. RESULTS All patients had only ipsilateral axLN metastasis. SPECT/CT lymphoscintigraphy showed that clipped LNs were radioavid in 12 of 15 patients (80%). Clipped LNs were not blue-stained in 5 patients (33.3%), and in 2 of them, clipped LNs were radioavid in SPECT/CT. Wire-guided localization was required in only 3 patients (20%) for nonradioavid/blue-stained clipped LNs. Removal of the clipped nodes was confirmed in all cases with a success rate of 100% by specimen graphy. CONCLUSION SPECT/CT lymphoscintigraphy seems feasible to determine the clipped LNs intraoperatively without requiring additional invasive methods in most of the patients. This technique simplifies and improves targeted axillary dissection of the clipped axLNs after NAC in initially node-positive breast cancer and can be adapted to clinical practice with further investigations.
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10
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Harrison B. Update on sentinel node pathology in breast cancer. Semin Diagn Pathol 2022; 39:355-366. [PMID: 35803776 DOI: 10.1053/j.semdp.2022.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
Pathologic examination of the sentinel lymph nodes (SLNs) in patients with breast cancer has been impacted by the publication of practicing changing trials over the last decade. With evidence from the ACOSOG Z0011 trial to suggest that there is no significant benefit to axillary lymph node dissection (ALND) in early-stage breast cancer patients with up to 2 positive SLNs, the rate of ALND, and in turn, intraoperative evaluation of SLNs has significantly decreased. It is of limited clinical significance to pursue multiple levels and cytokeratin immunohistochemistry to detect occult small metastases, such as isolated tumor cells and micrometastases, in this setting. Patients treated with neoadjuvant therapy, who represent a population with more extensive disease and aggressive tumor biology, were not included in Z0011 and similar trials, and thus, the evidence cannot be extrapolated to them. Recent trials have supported the safety and accuracy of sentinel lymph node biopsy (SLNB) in these patients when clinically node negative at the time of surgery. ALND remains the standard of care for any amount of residual disease in the SLNs and intraoperative evaluation of SLNs is still of value for real time surgical decision making. Given the potential prognostic significance of residual small metastases in treated lymph nodes, as well as the decreased false negative rate with the use of cytokeratin immunohistochemistry (IHC), it may be reasonable to maintain a low threshold for the use of cytokeratin IHC in post-neoadjuvant cases. Further recommendations for patients treated with neoadjuvant therapy await outcomes data from ongoing clinical trials. This review will provide an evidence-based discussion of best practices in SLN evaluation.
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Affiliation(s)
- Beth Harrison
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States.
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11
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Beyond Genetics: Metastasis as an Adaptive Response in Breast Cancer. Int J Mol Sci 2022; 23:ijms23116271. [PMID: 35682953 PMCID: PMC9181003 DOI: 10.3390/ijms23116271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 01/27/2023] Open
Abstract
Metastatic disease represents the primary cause of breast cancer (BC) mortality, yet it is still one of the most enigmatic processes in the biology of this tumor. Metastatic progression includes distinct phases: invasion, intravasation, hematogenous dissemination, extravasation and seeding at distant sites, micro-metastasis formation and metastatic outgrowth. Whole-genome sequencing analyses of primary BC and metastases revealed that BC metastatization is a non-genetically selected trait, rather the result of transcriptional and metabolic adaptation to the unfavorable microenvironmental conditions which cancer cells are exposed to (e.g., hypoxia, low nutrients, endoplasmic reticulum stress and chemotherapy administration). In this regard, the latest multi-omics analyses unveiled intra-tumor phenotypic heterogeneity, which determines the polyclonal nature of breast tumors and constitutes a challenge for clinicians, correlating with patient poor prognosis. The present work reviews BC classification and epidemiology, focusing on the impact of metastatic disease on patient prognosis and survival, while describing general principles and current in vitro/in vivo models of the BC metastatic cascade. The authors address here both genetic and phenotypic intrinsic heterogeneity of breast tumors, reporting the latest studies that support the role of the latter in metastatic spreading. Finally, the review illustrates the mechanisms underlying adaptive stress responses during BC metastatic progression.
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12
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Yin F, Wu ZH, Lai JP. New insights in diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms. World J Gastroenterol 2022; 28:1751-1767. [PMID: 35633912 PMCID: PMC9099195 DOI: 10.3748/wjg.v28.i17.1751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare epithelial neoplasms derived from pluripotent endocrine cells along the gastrointestinal tract and pancreas. GEP-NENs are classified into well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Despite overlapping morphological features, GEP-NENs vary in molecular biology, epigenetic, clinical behavior, treatment response, and prognosis features and remain an unmet clinical challenge. In this review, we introduce recent updates on the histopathologic classification, including the tumor grading and staging system, molecular genetics, and systemic evaluation of the diagnosis and treatment of GEP-NENs at different anatomic sites, together with some insights into the diagnosis of challenging and unusual cases. We also discuss the application of novel therapeutic approaches for GEP-NENs, including peptide receptor radionuclide therapy, targeted therapy, and immunotherapy with immune checkpoint inhibitors. These findings will help improve patient care with precise diagnosis and individualized treatment of patients with GEP-NENs.
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Affiliation(s)
- Feng Yin
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65212, United States
| | - Zi-Hao Wu
- Department of Surgery, University of Missouri, Columbia, MO 65212, United States
| | - Jin-Ping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA 95825, United States
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Zhu J, Liu M, Li X. Progress on deep learning in digital pathology of breast cancer: a narrative review. Gland Surg 2022; 11:751-766. [PMID: 35531111 PMCID: PMC9068546 DOI: 10.21037/gs-22-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/04/2022] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Pathology is the gold standard criteria for breast cancer diagnosis and has important guiding value in formulating the clinical treatment plan and predicting the prognosis. However, traditional microscopic examinations of tissue sections are time consuming and labor intensive, with unavoidable subjective variations. Deep learning (DL) can evaluate and extract the most important information from images with less need for human instruction, providing a promising approach to assist in the pathological diagnosis of breast cancer. To provide an informative and up-to-date summary on the topic of DL-based diagnostic systems for breast cancer pathology image analysis and discuss the advantages and challenges to the routine clinical application of digital pathology. METHODS A PubMed search with keywords ("breast neoplasm" or "breast cancer") and ("pathology" or "histopathology") and ("artificial intelligence" or "deep learning") was conducted. Relevant publications in English published from January 2000 to October 2021 were screened manually for their title, abstract, and even full text to determine their true relevance. References from the searched articles and other supplementary articles were also studied. KEY CONTENT AND FINDINGS DL-based computerized image analysis has obtained impressive achievements in breast cancer pathology diagnosis, classification, grading, staging, and prognostic prediction, providing powerful methods for faster, more reproducible, and more precise diagnoses. However, all artificial intelligence (AI)-assisted pathology diagnostic models are still in the experimental stage. Improving their economic efficiency and clinical adaptability are still required to be developed as the focus of further researches. CONCLUSIONS Having searched PubMed and other databases and summarized the application of DL-based AI models in breast cancer pathology, we conclude that DL is undoubtedly a promising tool for assisting pathologists in routines, but further studies are needed to realize the digitization and automation of clinical pathology.
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Affiliation(s)
- Jingjin Zhu
- School of Medicine, Nankai University, Tianjin, China
| | - Mei Liu
- Department of Pathology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
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14
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Santoro A, Inzani F, Angelico G, Martinelli F, Papadia A, Zannoni GF. Editorial: Future Perspectives of Sentinel Node Mapping in Gynecological Oncology. Front Oncol 2022; 12:809765. [PMID: 35280827 PMCID: PMC8913892 DOI: 10.3389/fonc.2022.809765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Angela Santoro
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Frediano Inzani
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppe Angelico
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione Istituto Nazionale Tumori Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale of Lugano, University of the Italian Switzerland (USI), Lugano, Switzerland
| | - Gian Franco Zannoni
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Roma, Italy
- *Correspondence: Gian Franco Zannoni,
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Christenhusz A, Pouw JJ, Simonis FFJ, Douek M, Ahmed M, Klaase JM, Dassen AE, Klazen CAH, van der Schaaf MC, Ten Haken B, Alic L. Breast MRI in patients after breast conserving surgery with sentinel node procedure using a superparamagnetic tracer. Eur Radiol Exp 2022; 6:3. [PMID: 35083595 PMCID: PMC8792114 DOI: 10.1186/s41747-021-00257-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A procedure for sentinel lymph node biopsy (SLNB) using superparamagnetic iron-oxide (SPIO) nanoparticles and intraoperative sentinel lymph node (SLN) detection was developed to overcome drawbacks associated with the current standard-of-care SLNB. However, residual SPIO nanoparticles can result in void artefacts at follow-up magnetic resonance imaging (MRI) scans. We present a grading protocol to quantitatively assess the severity of these artefacts and offer an option to minimise the impact of SPIO nanoparticles on diagnostic imaging. METHODS Follow-up mammography and MRI of two patient groups after a magnetic SLNB were included in the study. They received a 2-mL subareolar dose of SPIO (high-dose, HD) or a 0.1-mL intratumoural dose of SPIO (low-dose, LD). Follow-up mammography and MRI after magnetic SLNB were acquired within 4 years after breast conserving surgery (BCS). Two radiologists with over 10-year experience in breast imaging assessed the images and analysed the void artefacts and their impact on diagnostic follow-up. RESULTS A total of 19 patients were included (HD, n = 13; LD, n = 6). In the HD group, 9/13 patients displayed an artefact on T1-weighted images up to 3.6 years after the procedure, while no impact of the SPIO remnants was observed in the LD group. CONCLUSIONS SLNB using a 2-mL subareolar dose of magnetic tracer in patients undergoing BCS resulted in residual artefacts in the breast in the majority of patients, which may hamper follow-up MRI. This can be avoided by using a 0.1-mL intratumoural dose.
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Affiliation(s)
- Anke Christenhusz
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Joost J Pouw
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Frank F J Simonis
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Muneer Ahmed
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Joost M Klaase
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anneriet E Dassen
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Bernard Ten Haken
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Lejla Alic
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Okoye CL, Ezeome ER. Use of methylene blue dye for lymphatic basin mapping and sentinel lymph node biopsy in breast cancer patients in Enugu, Nigeria. Niger J Clin Pract 2022; 25:1805-1811. [DOI: 10.4103/njcp.njcp_154_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Kurochkin MA, German SV, Abalymov A, Vorontsov DА, Gorin DA, Novoselova MV. Sentinel lymph node detection by combining nonradioactive techniques with contrast agents: State of the art and prospects. JOURNAL OF BIOPHOTONICS 2022; 15:e202100149. [PMID: 34514735 DOI: 10.1002/jbio.202100149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/21/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
The status of sentinel lymph nodes (SLNs) has a substantial prognostic value because these nodes are the first place where cancer cells accumulate along their spreading route. Routine SLN biopsy ("gold standard") involves peritumoral injections of radiopharmaceuticals, such as technetium-99m, which has obvious disadvantages. This review examines the methods used as "gold standard" analogs to diagnose SLNs. Nonradioactive preoperative and intraoperative methods of SLN detection are analyzed. Promising photonic tools for SLNs detection are reviewed, including NIR-I/NIR-II fluorescence imaging, photoswitching dyes for SLN detection, in vivo photoacoustic detection, imaging and biopsy of SLNs. Also are discussed methods of SLN detection by magnetic resonance imaging, ultrasonic imaging systems including as combined with photoacoustic imaging, and methods based on the magnetometer-aided detection of superparamagnetic nanoparticles. The advantages and disadvantages of nonradioactive SLN-detection methods are shown. The review concludes with prospects for the use of conservative diagnostic methods in combination with photonic tools.
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Affiliation(s)
| | - Sergey V German
- Skolkovo Institute of Science and Technology, Moscow, Russia
- Institute of Spectroscopy of the Russian Academy of Sciences, Moscow, Russia
| | | | - Dmitry А Vorontsov
- State Budgetary Institution of Health Care of Nizhny Novgorod "Nizhny Novgorod Regional Clinical Oncological Dispensary", Nizhny Novgorod, Russia
| | - Dmitry A Gorin
- Skolkovo Institute of Science and Technology, Moscow, Russia
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Ya G, Wen F, Xing-ru L, Zhuan-zhuan G, Jun-qiang L. Difference of DCE-MRI Parameters at Different Time Points and Their Predictive Value for Axillary Lymph Node Metastasis of Breast Cancer. Acad Radiol 2022; 29 Suppl 1:S79-S86. [PMID: 33504446 DOI: 10.1016/j.acra.2021.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES To assess differences of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters at different postcontrast time points (TPs), and to explore the predictive value of DCE-MRI parameters for axillary lymph node (ALN) metastasis of breast cancer. MATERIALS AND METHODS A total of 107 breast cancer patients were included retrospectively, and 50 phases were collected on DCE-MRI for each patient. DCE-MRI parameters Ktrans, Kep, Ve, TTP, Peak, Washin, Washout, and AUC were extracted from the images at 67.8 seconds, 128.5 seconds, 189.2 seconds, 249.9 seconds, and 310.5 seconds (regard as TP1, 2, 3, 4, and 5). Wilcoxon signed rank test was used to compare DCE-MRI parameters at different postcontrast TPs. Logistic regression was performed to analyze the predictive value of DCE-MRI parameters for ALN metastasis of breast cancer, and receiver operating characteristic (ROC) curve was constructed to evaluate the predictive performance. RESULTS The difference of DCE-MRI parameters between TP1, 2, 3, 4, and 5 was statistically significant (p < 0.01) in breast cancer. The TPs are considered as the optimal TPs when DCE-MRI parameters values reach the maximum. The optimal TPs of Ktrans, Kep, and Ve were respectively at TP2, TP2, and TP4 (Ktrans2, Kep2, and Ve4). The optimal TPs of TTP, Peak, and AUC were at TP5 (TTP5, Peak5, and AUC5). AUC5 showed the ability to predict ALN metastasis of breast cancer (area under ROC curve = 0.656, p < 0.05). CONCLUSIONS DCE-MRI parameters values were different at different postcontrast TPs. AUC5 may be an independent predictor of ALN metastasis in breast cancer.
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Chang YC, Tzen CY. Intraoperative Sentinel Lymph Node Imprint Cytology Diagnosis in Breast Cancer Patients by General Surgical Pathologists: A Single-Institution Experience of 4327 Cases. J Cytol 2022; 39:20-25. [PMID: 35341111 PMCID: PMC8955698 DOI: 10.4103/joc.joc_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Context Sentinel lymph node (SLN) biopsy is the standard of care for breast cancer (BC) patient staging. The axillary node status can be evaluated by frozen section (FS) or imprint cytology (IC). Despite the major disadvantages of tissue loss and freezing artifact in FS, many pathologists consider SLN IC a more difficult task requiring special expertise and prefer FS to IC. Aims To conduct a large cohort study to evaluate the results of intraoperative SLN IC, compare them with those of FS and permanent section (PS), and determine the best method for general pathologists. Settings and Design A very large cohort study with many pathologists engaged was designed and the diagnostic results were compared. Materials and Methods With 12 pathologists engaged, we conducted the largest patient cohort study of SLN IC to date, including 4,327 consecutive BC patients undergoing SLN biopsy during the past 15 years. The touch imprints were stained using three different methods and evaluated. The PS was used as the gold standard for evaluation. Statistical Analysis The false positivity, false negativity, accuracy, sensitivity, and specificity of the IC and FS for each pathologist were evaluated and compared. Results Our results showed an overall sensitivity of 82.7%, specificity of 99.3%, and an accuracy rate of 95.9% for SLN IC, which were comparable to those of FS. The accuracy rate did not correlate with the length of working experience and the staining method. Conclusions Intraoperative hematoxylin and eosin (H&E)-stained IC preparation was found to be the best SLN examination method for general pathologists.
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Affiliation(s)
- Yi-Chin Chang
- Department of Pathology, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Chi-Yuan Tzen
- Department of Pathology, MacKay Memorial Hospital, Taipei, Taiwan,Address for correspondence: Dr. Chi-Yuan Tzen, 92, Sec. 2, Chung-Shan North Road, Taipei 10449, Taiwan. E-mail:
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20
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Pulappadi VP, Paul S, Hari S, Dhamija E, Manchanda S, Kataria K, Mathur S, Mani K, Gogia A, Deo S. Axillary ultrasonography combined with pre-operative wire localisation of clipped node in nodal restaging after neoadjuvant chemotherapy in node positive breast cancer patients: a pilot study. Br J Radiol 2021; 94:20210788. [PMID: 34491822 DOI: 10.1259/bjr.20210788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the role of axillary ultrasonography (axUS) and ultrasound-guided pre-operative wire localisation of pre-treatment positive clipped node (CN) for prediction of nodal response to neoadjuvant chemotherapy (NACT) in node positive breast carcinoma patients. METHODS AND MATERIALS A prospective study was conducted between June 2018 and August 2020 after Ethics Committee approval. Breast carcinoma patients (cT1-cT4b) with palpable axillary nodes (cN1-cN3) and suitable for NACT were recruited after written informed consent. Single, most suspicious node was biopsied and clipped. Nodal response to NACT was assessed on axUS. Wire localisation of CN was performed prior to axillary lymph node dissection (ALND). Diagnostic performances of axUS and CN excision were assessed. RESULTS Of the 69 patients evaluated, 32 patients (mean age, 43.5 ± 11.8 years; females, 31/32 [97%]; pre-menopausal, 18/32 [56.3%]) with metastatic nodes who received NACT were included. Nodal pathological complete response rate was 34.4% (11/32) overall and 70% (7/10) in patients with ≤2 suspicious nodes on pre-NACT axUS. False-negative rates (FNRs) of axUS and CN excision were 4.8% and 28.6% respectively. Combination of post-NACT axUS and CN excision had an FNR of 4.8% overall and 0% in patients with ≤2 suspicious nodes on pre-NACT axUS. CONCLUSION Combination of AxUS and ultrasound-guided wire localisation of pre-treatment positive CN has high diagnostic accuracy for nodal restaging after NACT in node positive breast cancer patients. ADVANCES IN KNOWLEDGE Addition of axUS assessment to wire localisation of CN reduces its FNR for detecting residual metastasis after NACT.
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Affiliation(s)
- Vishnu Prasad Pulappadi
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Paul
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
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A New Look into Cancer-A Review on the Contribution of Vibrational Spectroscopy on Early Diagnosis and Surgery Guidance. Cancers (Basel) 2021; 13:cancers13215336. [PMID: 34771500 PMCID: PMC8582426 DOI: 10.3390/cancers13215336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Cancer is a leading cause of death worldwide, with the detection of the disease in its early stages, as well as a correct assessment of the tumour margins, being paramount for a successful recovery. While breast cancer is one of most common types of cancer, head and neck cancer is one of the types of cancer with a lower prognosis and poor aesthetic results. Vibrational spectroscopy detects molecular vibrations, being sensitive to different sample compositions, even when the difference was slight. The use of spectroscopy in biomedicine has been extensively explored, since it allows a broader assessment of the biochemical fingerprint of several diseases. This literature review covers the most recent advances in breast and head and neck cancer early diagnosis and intraoperative margin assessment, through Raman and Fourier transform infrared spectroscopies. The rising field of spectral histopathology was also approached. The authors aimed at expounding in a more concise and simple way the challenges faced by clinicians and how vibrational spectroscopy has evolved to respond to those needs for the two types of cancer with the highest potential for improvement regarding an early diagnosis, surgical margin assessment and histopathology. Abstract In 2020, approximately 10 million people died of cancer, rendering this disease the second leading cause of death worldwide. Detecting cancer in its early stages is paramount for patients’ prognosis and survival. Hence, the scientific and medical communities are engaged in improving both therapeutic strategies and diagnostic methodologies, beyond prevention. Optical vibrational spectroscopy has been shown to be an ideal diagnostic method for early cancer diagnosis and surgical margins assessment, as a complement to histopathological analysis. Being highly sensitive, non-invasive and capable of real-time molecular imaging, Raman and Fourier transform infrared (FTIR) spectroscopies give information on the biochemical profile of the tissue under analysis, detecting the metabolic differences between healthy and cancerous portions of the same sample. This constitutes tremendous progress in the field, since the cancer-prompted morphological alterations often occur after the biochemical imbalances in the oncogenic process. Therefore, the early cancer-associated metabolic changes are unnoticed by the histopathologist. Additionally, Raman and FTIR spectroscopies significantly reduce the subjectivity linked to cancer diagnosis. This review focuses on breast and head and neck cancers, their clinical needs and the progress made to date using vibrational spectroscopy as a diagnostic technique prior to surgical intervention and intraoperative margin assessment.
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22
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Hidar S, Alimi A, Khlifi A, Chachia S, Kaabia O, Bouguizane S, Bibi M, Khairi H. Indocyanine Green Fluorescence-Guided Sentinel Node Biopsy in Breast Cancer Within a North African Population: A Retrospective Study. Eur J Breast Health 2021; 17:352-355. [PMID: 34651114 DOI: 10.4274/ejbh.galenos.2021.2021-4-11] [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: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 12/01/2022]
Abstract
Objective Radio isotopes and blue dyes alone or in combination are the most commonly used tracer agents in sentinel node (SN) biopsy for early breast cancer. Recent studies have found fluorescence method using indocyanine green (ICG) as a promising technology with fewer disadvantages. Materials and Methods Retrospective analysis of our database that included patients with clinically node-negative breast cancer scheduled for breast surgery and SN biopsy between 2016 and January 2021. Patients who underwent detection using fluorescence-ICG were included in this study. Results A total of 47 patients were included. Median age was 50 (range: 24-78) years. Mean tumor size was 3.4 ± 1.5 cm. All patients received ICG injection and 11 received a combination of ICG and blue dye. Forty-five successful SN identifications with ICG were performed and 99 nodes retrieved. Eleven procedures were undertaken after initial systemic therapy. Twenty-four patients had at least one positive SN for malignancy. Mean follow up was 29.2 months and no axillary recurrence was noted during the study period. Conclusion ICG appears to be a feasible and accurate method for SN biopsy with high identification rate. This is the first study of ICG in sentinel node biopsy in a North African population.
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Affiliation(s)
- Samir Hidar
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
| | - Amal Alimi
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
| | - Abdejlil Khlifi
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
| | - Selma Chachia
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
| | - Ons Kaabia
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
| | - Sassi Bouguizane
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
| | - Mohamed Bibi
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
| | - Hédi Khairi
- Department of Obstetrics and Gynaecology, F. Hached University Teaching Hospital, Sousse, Tunisia
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Comparison of Ultrasound-Guided Fine Needle Aspiration Cytology and Ultrasound-Guided Core Biopsy in Preoperative Axillary Staging for Early Breast Cancer. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fozza A, Giaj-Levra N, De Rose F, Ippolito E, Silipigni S, Meduri B, Fiorentino A, Gregucci F, Marino L, Di Grazia A, Cucciarelli F, Borghesi S, De Santis MC, Ciabattoni A. Lymph nodal radiotherapy in breast cancer: what are the unresolved issues? Expert Rev Anticancer Ther 2021; 21:827-840. [PMID: 33852379 DOI: 10.1080/14737140.2021.1917390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Sentinel lymph node biopsy (SLNB) is the gold standard in invasive breast cancer. Axillary dissection (ALND) is controversial in some presentations.Areas covered: Key questions were formulated and explored focused on four different scenarios in adjuvant axillary radiation management in early and locally advanced breast cancer. Answers to these questions were searched in MEDLINE, PubMed from June 1946 to August 2020. Clinical trials, retrospective studies, international guidelines, meta-analysis, and reviews were explored.Expert opinion: Analysis according to biological disease characteristics is necessary to establish the impact of ALND avoidance in unexpectedly positive SLNB (pN1) in cN0 patients. A low-risk probability of axillary recurrence was observed if axillary radiotherapy (ART) or ALND were offered without impact on outcomes. Adjuvant RNI in pT1-3 pN1 treated with mastectomy or BCS should be proposed in unfavorable disease and risk factors. In ycN0 after NACT, SLNB can be offered in selected cases or ALND should be performed. After SLNB post-NACT (ypN1), ALND and adjuvant radiotherapy are mandatory.
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Affiliation(s)
- Alessandra Fozza
- Department of Radiation Oncology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Italy
| | | | - Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sonia Silipigni
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Bruno Meduri
- Radiation Oncology Department, University Hospital of Modena, Modena, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | - Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | | | | | - Francesca Cucciarelli
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G.Salesi, Ancona, Italy
| | - Simona Borghesi
- Unit of Radiation Oncology, S.Donato Hospital, Arezzo, Italy
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Jimenez-Heffernan JA, Valdivia-Mazeyra M, Muñoz-Hernández P, López-Elzaurdia C. Cytologic Features of Lipogranulomatous Reaction in an Axillary Sentinel Lymph Node. Acta Cytol 2021; 65:272-275. [PMID: 33706306 DOI: 10.1159/000513982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Multinucleated giant cells (MGC) are a rare finding when evaluating axillary sentinel lymph nodes. Some are described as foreign body-type MGC accompanied by foamy macrophages. They have been rarely reported in nodes from patients in which a previous breast biopsy was performed. The tissue damage induced by biopsy results in secondary changes including fat necrosis and hemorrhage that can migrate to axillary nodes. In this report, we illustrate a lipogranulomatous reaction in cytologic samples obtained during a sentinel lymph node examination of a woman previously biopsied because of breast carcinoma. We have found no previous cytologic descriptions and consider it an interesting finding that should be known to avoid diagnostic misinterpretations. CASE A 51-year-old woman underwent mastectomy of the right breast with a sentinel lymph node biopsy at our medical center. One month before, a control mammography revealed suspicious microcalcifications and a vacuum-assisted breast biopsy resulted in a diagnosis of high-grade intraductal carcinoma with comedonecrosis. Surgery with a sentinel lymph node biopsy was performed. The sentinel node was processed as an intraoperative consultation. Frozen sections and air-dried Diff-Quik stained samples were obtained. They showed abundant lymphocytes with MGC and tumoral cells. MGC showed ample cytoplasm with evident vacuoles of variable size. Occasional hemosiderin-laden macrophages were also present. The complete histologic analysis and immunohistochemical studies revealed no malignant cells. Histologic analysis showed, in subcapsular location, occasional MGC phagocyting lipid droplets. Hemosiderin-laden macrophages were a common finding. CONCLUSION Lipogranulomas may appear at axillary sentinel lymph nodes because of fat necrosis induced by previous breast biopsy. The most important consideration is not confounding MGC with epithelial cell clusters. This can occur with not well-processed samples, especially if unmounted.
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丁 妍, 韩 梦, 刘 月. [AI-assisted Prediction of Lymph Node Metastasis of Breast Cancer: Current and Prospective Research]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2021; 52:162-165. [PMID: 33829685 PMCID: PMC10408927 DOI: 10.12182/20210360102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 11/23/2022]
Abstract
One of the most important application of artificial intelligence (AI) in pathology is prediction, using morphological features, of patient prognosis and response to specific treatments. As one of the most common kinds of malignancies in the world and the crucial important cause of death due to malignant tumor among women, breast cancer has become the center of attention in clinical services. Axillary lymph node metastasis is an important prognostic factor in breast cancer. The accuracy of the assessment of axillary lymph node metastasis bears heavily on clinical diagnosis and treatment. At present, based on the principle of non-invasive procedures, many studies have been done to develop models that can be used to predict sentinel lymph node metastasis of breast cancer. However, different clinical and pathological parameters are used in these predictive models. How to analyze the clinical and pathological data of breast cancer patients in a more comprehensive way and how to establish a prediction model with better precision have become the future direction of development. In this paper, we describe the research progress of AI in pathology and the current status of its use in breast cancer research. We have conducted in-depth reflection and looked into the future of ways to predict effectively breast cancer lymph node metastasis and to establish more accurate and effective deep-learning algorithm based on AI assistance so as to continuously improve the diagnosis and treatment of breast cancer.
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Affiliation(s)
- 妍 丁
- 河北医科大学第四医院 病理科 (石家庄 050011)Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - 梦雪 韩
- 河北医科大学第四医院 病理科 (石家庄 050011)Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - 月平 刘
- 河北医科大学第四医院 病理科 (石家庄 050011)Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
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Cotarelo CL, Zschöck-Manus A, Schmidt M, Schad A, Brochhausen C, Kirkpatrick CJ, Thaler S. Improved detection of sentinel lymph node metastases allows reliable intraoperative identification of patients with extended axillary lymph node involvement in early breast cancer. Clin Exp Metastasis 2020; 38:61-72. [PMID: 33249518 PMCID: PMC7882580 DOI: 10.1007/s10585-020-10065-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
An improved procedure that allows accurate detection of negative sentinel lymph node (SLN) and of SLN macrometastases during surgery would be highly desirable in order to protect patients from further surgery and to avoid unnecessary costs. We evaluated the accuracy of an intraoperative procedure that combines touch imprint cytology (TIC) and subsequent frozen section (FS) analysis. 2276 SLNs from 1072 patients with clinical node-negative early breast cancer were evaluated during surgery using TIC. Only cytologically-positive SLN were subsequently analysed with a single FS, preserving cytologically-negative SLN for the final postoperative histological diagnosis. Sensitivity, specificity and the accuracy of this approach were analysed by comparing the results from intra- and postoperative SLN and axillary node evaluation. This intraoperative method displayed 100% specificity for SLN metastases and was significantly more sensitive for prognostically relevant macrometastases (85%) than for micrometastases (10%). Sensitivity was highest for patients with two or more positive LNs (96%) than for those with only one (72%). 98% of the patients with final pN2a-pN3a were already identified during surgery. Patients who received primary axillary lymph node dissection had significantly more frequent metastases in further LNs (44.6%). Sensitivity was highest for patients with luminal-B, HER2+ and triple negative breast cancer and for any subtype if Ki-67 > 40%. TIC and subsequent FS of cytologically-positive SLNs is highly reliable for detection of SLN macrometastases, and allows accurate identification of patients with a high risk of extended axillary involvement during surgery, as well as accurate histological diagnosis of negative SLN.
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Affiliation(s)
- Cristina L Cotarelo
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany.
| | - Annemarie Zschöck-Manus
- Institute of Pathology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | | | | - Sonja Thaler
- European Centre for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Czaja R, Wu R, Jorns JM. Breast Sentinel Lymph Node Frozen Section Practice: An Enterprise Audit as a Guide for Moving Forward. Arch Pathol Lab Med 2020; 145:1018-1024. [PMID: 33212474 DOI: 10.5858/arpa.2020-0411-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— In recent years, there has been a shift to less aggressive surgical management of the axilla in breast cancer. Consequently, sentinel lymph node evaluation by frozen section (FS) has declined. Additionally, there has been an impetus to decrease efforts in identifying small sentinel lymph node metastases. OBJECTIVES.— To critically evaluate our enterprise performance in evaluating axillary sentinel lymph nodes submitted for FS prior to considering changes in processing. DESIGN.— A retrospective review (August 1, 2017-July 31, 2019) was conducted to identify sentinel and nonsentinel lymph nodes from 1 academic institution and 2 community sites. Cases were evaluated for grossing technique and discordance between FS and permanent section (PS) due to sampling and/or interpretive error. Clinicopathologic features were assessed. RESULTS.— Lymph nodes from 426 patients with 432 neoplasms were sent for FS. Serial sectioning at 2-mm intervals was adhered to in 338 of 432 (78.2%). Serial sectioning was significantly lower at the community sites (14 of 60; 23.3%) versus at the academic institution (324 of 372; 87.1%; P < .001). Discordant cases were all false negatives (21 of 432; 4.8%). A total of 7 of 21 false negatives (33.3%) had macrometastatic (>2 mm) disease; of these, 3 were post-neoadjuvant chemotherapy, 3 were neither serially sectioned nor posttherapy, and 1 was a small (0.3-cm) focus. A total of 15 of 16 false negatives due to sampling error were detected on the first permanent section level. CONCLUSIONS.— Standard serial sectioning of sentinel lymph nodes at 2-mm intervals resulted in infrequent false negatives due to macrometastatic disease. A single additional permanent section level is reasonable, given adherence to serial sectioning.
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Affiliation(s)
- Rebecca Czaja
- From the Department of Pathology (Czaja, Jorns), Medical College of Wisconsin, Milwaukee
| | - Ruizhe Wu
- Department of Biostatistics (Wu), Medical College of Wisconsin, Milwaukee
| | - Julie M Jorns
- From the Department of Pathology (Czaja, Jorns), Medical College of Wisconsin, Milwaukee
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Murray C, Al Shehhi A, Ó'Riain C, Dunne B, Maguire A. Evaluation of an enhanced pathological examination protocol for sentinel lymph nodes from patients with breast carcinoma. J Clin Pathol 2020; 74:746-749. [PMID: 33093180 DOI: 10.1136/jclinpath-2020-206629] [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: 04/07/2020] [Revised: 08/17/2020] [Accepted: 10/01/2020] [Indexed: 11/04/2022]
Abstract
Clinical trials have shown that many patients with breast cancer with limited sentinel lymph node (SLN) metastatic disease can safely avoid axillary lymph node dissection. Ultra-staging of initially negative SLNs may not confer additional clinical benefit. Despite this, protocols of 'enhanced pathological examination' (EPE) are still widely used. We evaluated the impact of our EPE protocol. If initial SLN H&Es are negative, we cut three additional H&E levels at 500 µm intervals with two spare sections at each level, to allow for immunohistochemistry if necessary. Occult micrometastases or isolated tumour cells were identified, using this protocol, in 3.4%, resulting in change of N stage in 3%. 1% of patients had further axillary surgery based on these findings. Our SLN-EPE protocol provided additional information in a small number of cases and changed axillary management in a minority. It represented a significant workload for scientists and pathologists, and had time and cost implications. We concluded that emphasising careful gross examination along with judicious use of additional levels and immunohistochemistry may be more beneficial than our current protocol.
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Affiliation(s)
- Ciara Murray
- Department of Histopathology, Saint James's Hospital, Dublin, Ireland
| | - Asmaa Al Shehhi
- Department of Histopathology, Saint James's Hospital, Dublin, Ireland
| | - Ciarán Ó'Riain
- Department of Histopathology, Saint James's Hospital, Dublin, Ireland
| | - Barbara Dunne
- Department of Histopathology, Saint James's Hospital, Dublin, Ireland
| | - Aoife Maguire
- Department of Histopathology, Saint James's Hospital, Dublin, Ireland
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New technologies in breast cancer sentinel lymph node biopsy; from the current gold standard to artificial intelligence. Surg Oncol 2020; 34:324-335. [DOI: 10.1016/j.suronc.2020.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 01/14/2023]
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Uno Y, Akiyama N, Yuzawa S, Kitada M, Takei H. The value and practical utility of intraoperative touch imprint cytology of sentinel lymph node(s) in patients with breast cancer: A retrospective cytology-histology correlation study. Cytojournal 2020; 17:11. [PMID: 32547631 PMCID: PMC7294180 DOI: 10.25259/cytojournal_80_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/09/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: Intraoperative evaluation of sentinel lymph nodes (SLNs) for patients with breast cancer is widely performed with frozen section (FS), cytology, or a combination of both. Touch imprint cytology (TIC) reportedly has an equivalent sensitivity to FS. We studied its diagnostic utility to detect SLN metastases. Materials and Methods: Cases of 367 patients with breast cancer who underwent intraoperative valuation of SLNs (507 LNs) were evaluated. All FS and corresponding TIC slides of SLNs of each case were reviewed microscopically for the presence of metastases of any size. If present, the metastatic focus was measured on the FS. Results: Of these 507 SLNs, 82 LNs (16.2%) from 69 women were found to have metastases in the FS and consisted of 5 LNs of isolated tumor cells, 15 of micrometastasis, and 62 of macrometastasis. TIC identified metastases in 69 of these 82 SLNs (sensitivity: 84.1%, specificity: 100%, and accuracy: 97.4%). All macrometastases could be detected by TIC, whereas TIC identified approximately 50% of micrometastases and none of isolated tumor cells. The size detection limit of metastatic foci, defined as the smallest dimension of metastasis detected without false negatives, was 2 mm. The smallest metastatic focus identified was 0.8 mm. Conclusions: TIC of SLNs is of great use given its negative predictive value of 100% for identification of macrometastasis in our study. For intraoperative evaluation of SLNs, based on our data, a practical two-step approach is proposed: SLN evaluation should be initially performed by TIC and then proceed to FS histological analysis only when cytologically positive to determine the size of metastatic focus.
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Affiliation(s)
- Yuji Uno
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Naoko Akiyama
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Masahiro Kitada
- Breast Center, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Hidehiro Takei
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
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Choi EJ, Youk JH, Choi H, Song JS. Dynamic contrast-enhanced and diffusion-weighted MRI of invasive breast cancer for the prediction of sentinel lymph node status. J Magn Reson Imaging 2020; 51:615-626. [PMID: 31313393 DOI: 10.1002/jmri.26865] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although sentinel lymph node biopsy (SLNB) is the current standard for identifying lymph metastasis in breast cancer patients, there are complications of SLNB. PURPOSE To evaluate preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) of invasive breast cancer for predicting sentinel lymph node metastasis. STUDY TYPE Retrospective. POPULATION In all, 309 patients who underwent clinically node-negative invasive breast cancer surgery FIELD STRENGTH/SEQUENCE: 3.0T, DCE-MRI, DWI. ASSESSMENT We collected clinicopathologic variables (age, histologic and nuclear grade, extensive intraductal carcinoma component, lymphovascular invasion, and immunohistochemical profiles) and preoperative MRI features (tumor size, background parenchymal enhancement, internal enhancement, adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, kinetic curve types, quantitative kinetic parameters, tumoral apparent diffusion coefficient [ADC], peritumoral maximal ADC, and peritumoral-tumoral ADC ratio). STATISTICAL TESTS Multivariate logistic regressions were performed to determine independent variables associated with SLN metastasis, and the area under the receiver operating characteristic curve (AUC) was analyzed for those variables. RESULTS 41 (13.3%) of the patients showed SLN metastasis. With MRI, tumor size (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.06-1.17), heterogeneous (OR, 5.33; 95% CI, 1.71-16.58), and rim (OR, 15.54; 95% CI, 2.12-113.72) enhancement and peritumoral-tumoral ADC ratio (OR, 72.79; 95% CI, 7.15-740.82) were independently associated with SLN metastasis. Clinicopathologic variables independently associated with SLN metastasis included age (OR, 0.96; 95% CI, 0.92-0.99) and CD31 (OR, 2.90; 95% CI, 1.04-8.92). The area under the curve (AUC) of MRI features (0.80; 95% CI, 0.73-0.87) was significantly higher than for clinicopathologic variables (0.68; 95% CI, 0.60-0.77; P = 0.048) and was barely below statistical significance for combined MRI features with clinicopathologic variables (0.84; 95% CI 0.78-0.90, P = 0.057). DATA CONCLUSION Preoperative internal enhancement on DCE-MRI and peritumoral-tumoral ADC ratio on DWI might be useful for predicting SLN metastasis in patients with invasive breast cancer. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:615-626.
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Affiliation(s)
- Eun Jung Choi
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju City, South Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyemi Choi
- Department of Statistics, Research Institute of Applied Statistics, Chonbuk National University, Jeonbuk, 54896, South Korea
| | - Ji Soo Song
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju City, South Korea
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Hamdy O, El-Badrawy A, Saleh GA, Metwally IH, Abdelwahab K, Farouk O, Denewer A, Setit A. Preoperative localization of sentinel lymph node in breast cancer patients by silver wire insertion or liquid charcoal injection guided by CT lymphography. Breast J 2019; 26:617-624. [PMID: 31448502 DOI: 10.1111/tbj.13511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 12/23/2022]
Abstract
Dual localization of SLN in breast cancer patients using isotope & dye is the best-approved modality with limitations such as high cost of radioactive materials, complex logistic preparations & scheduling issues, especially in developing countries. We investigated the feasibility & accuracy of a novel technique for SLN localization using silver wire insertion or liquid charcoal injection guided by CT lymphography. 120 patients with clinically node-negative breast cancer were enrolled. In the test group, SLN was localized using preoperative CTLG guided injection of liquid charcoal or by placing a 3 cm silver wire. In addition, intraoperative SLN mapping was performed using methylene blue dye followed by searching for the SLN localized by both methods. In the control group, SLN was localized by the blue dye only. Feasibility, accuracy, detection rates, and number of SLNs retrieved were reported as well as matching between the LN detected with the CTLG and that detected with the dye technique. SLN could be detected in 59 out of 60 patients (98.3%) in the test group and in 54 out of 60 patients (90%) in the control group (P = .057). In self-controlled analysis of the test group comparing CTLG only to dye only was significant (P = .050). Comparing charcoal to silver wire in detection was statistically insignificant (P = .5). This novel method can offer advantages which are as follows: being more accurate than the dye alone, saving operative time, abandoning complex logistic preparations for the radioisotope, and solving the problem of timing.
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Affiliation(s)
- Omar Hamdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Adel El-Badrawy
- Radiology Department, Faculty of medicine, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- Radiology Department, Faculty of medicine, Mansoura University, Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Khaled Abdelwahab
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Adel Denewer
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Setit
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
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Ahmed SH. Safety of neoadjuvant chemotherapy for the treatment of breast cancer. Expert Opin Drug Saf 2019; 18:817-827. [DOI: 10.1080/14740338.2019.1644318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Li J, Ma W, Jiang X, Cui C, Wang H, Chen J, Nie R, Wu Y, Li L. Development and Validation of Nomograms Predictive of Axillary Nodal Status to Guide Surgical Decision-Making in Early-Stage Breast Cancer. J Cancer 2019; 10:1263-1274. [PMID: 30854136 PMCID: PMC6400691 DOI: 10.7150/jca.32386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose: To develop and validate nomogram models using noninvasive imaging parameters with related clinical variables to predict the extent of axillary nodal involvement and stratify treatment options based on the essential cut-offs for axillary surgery according to the ACOSOG Z0011 criteria. Materials and Methods: From May 2007 to December 2017, 1799 patients who underwent preoperative breast and axillary magnetic resonance imaging (MRI) were retrospectively studied. Patients with data on axillary ultrasonography (AUS) were enrolled. The MRI images were interpreted according to Breast Imaging Reporting and Data system (BI-RADS). Using logistic regression analyses, nomograms were developed to visualize the associations between the predictors and each lymph node (LN) status endpoint. Predictive performance was assessed based on the area under the receiver operating characteristic curve (AUC). Bootstrap resampling was performed for internal validation. Goodness-of-fit of the models was evaluated using the Hosmer-Lemeshow test. Results: Of 397 early breast cancer patients, 200 (50.4%) had disease-free axilla, 119 (30.0%) had 1 or 2 positive LNs, and 78 (19.6%) had ≥3 positive LNs. Patient age, MRI features (mass margin, LN margin, presence/absence of LN hilum, and LN symmetry/asymmetry), and AUS descriptors (presence of cortical thickening or hilum) were identified as predictors of nodal disease. Nomograms with these predictors showed good calibration and discrimination; the AUC was 0.809 for negative axillary node (N0) vs. any LN metastasis, 0.749 for 1 or 2 involved nodes vs. N0, and 0.874 for ≥3 nodes vs. ≤2 metastatic nodes. The predictive ability of the 3 nomograms with additional pathological variables was significantly greater. Conclusion: The nomograms could predict the extent of ALN metastasis and facilitate decision-making preoperatively.
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Affiliation(s)
- Jiao Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Weimei Ma
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Xinhua Jiang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Chunyan Cui
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Hongli Wang
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jiewen Chen
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Runcong Nie
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Yaopan Wu
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Li Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
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Wong W, Rubenchik I, Nofech-Mozes S, Slodkowska E, Parra-Herran C, Hanna WM, Lu FI. Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy. Technol Cancer Res Treat 2019; 18:1533033818821104. [PMID: 30803394 PMCID: PMC6373999 DOI: 10.1177/1533033818821104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/04/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shift toward minimizing axillary lymph node dissection in patients with breast cancer post neoadjuvant therapy has led to the assessment of sentinel lymph nodes by frozen section intraoperatively to determine the need for axillary lymph node dissection. However, few studies have examined the accuracy of sentinel lymph node frozen section after neoadjuvant therapy. Our objective is to compare the accuracy of sentinel lymph node frozen section in patients with breast cancer with and without neoadjuvant therapy and to identify features that may influence accuracy. DESIGN We identified 161 sentinel lymph node frozen section from 77 neoadjuvant therapy patients and 255 sentinel lymph node frozen section from 88 non-neoadjuvant therapy patients diagnosed between 2010 and 2016 in 2 institutions. The frozen section diagnoses were compared to the final diagnoses, and clinicopathologic data were analyzed. RESULTS The sensitivity, specificity, and accuracy of frozen section analysis were comparable between neoadjuvant therapy patients and non-neoadjuvant therapy patients (71.9% vs 50%, 100% vs 100%, and 88.3% vs 81.8%). Nine (11.7%) of 77 neoadjuvant therapy patients had discordant results, most often due to undersampling (tumor absent on frozen section slide). Four of these patients subsequently underwent axillary lymph node dissection. Discordant results (all false negatives) were significantly more likely in neoadjuvant therapy patients with Estrogen Receptor-positive/HER2-negative status, and in sentinel lymph node with pN1mic and pN0i+ deposits; age, preneoadjuvant therapy lymph node status, histotype, nuclear grade, tumor size, and response to neoadjuvant therapy showed no significant differences. For non-neoadjuvant therapy cases, large tumor size, lobular histotype, and sentinel lymph node with pN1mic and pN0i+ were associated with false-negative frozen section assessment. CONCLUSION Sentinel lymph node frozen section diagnosis post-neoadjuvant therapy has comparable sensitivity, specificity, and accuracy to the sentinel lymph node frozen section diagnosis in the non-neoadjuvant therapy setting.
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Affiliation(s)
- Willard Wong
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Illana Rubenchik
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, North York General Hospital, Toronto, Ontario Canada
| | - Sharon Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
| | - Elzbieta Slodkowska
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
| | - Wedad M. Hanna
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
| | - Fang-I Lu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
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Nielsen Moody A, Bull J, Culpan AM, Munyombwe T, Sharma N, Whitaker M, Wolstenhulme S. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol 2017; 72:959-971. [DOI: 10.1016/j.crad.2017.06.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
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Holten-Rossing H, Talman MLM, Jylling AMB, Laenkholm AV, Kristensson M, Vainer B. Application of automated image analysis reduces the workload of manual screening of sentinel lymph node biopsies in breast cancer. Histopathology 2017; 71:866-873. [DOI: 10.1111/his.13305] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Henrik Holten-Rossing
- Department of Pathology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Maj-Lis Møller Talman
- Department of Pathology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | | | | | | | - Ben Vainer
- Department of Pathology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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Zhou YT, Du ZG, Zhang D, Lv Q. Retrospective observational study about reducing the false negative rate of the sentinel lymph node biopsy: Never underestimate the effect of subjective factors. Medicine (Baltimore) 2017; 96:e7787. [PMID: 28834882 PMCID: PMC5572004 DOI: 10.1097/md.0000000000007787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Reducing the false negative rate of sentinel lymph node biopsy (SLNB) for breast cancer patients has always been a focus of clinical research. We aimed to map the sentinel lymph nodes (SLNs) in detail, and analyze the factors related to SLNs located at locations that are often ignored by surgeons, to reduce the rate of false negatives from SLNB. A retrospective analysis involving 545 breast cancer patients who underwent SLNB in west China hospital between August 2010 and February 2016 was performed. Blue dye, radioisotope, or combined methods were used for tracing SLNs. Using blue dye, radioisotope, and a combination of blue dye and radioisotope successfully traced SLNs in 479, 507, and 525 patients, the detection rate was 88.2%, 93.9%, and 97.4%, respectively. Among the 1559 detected SLNs, 139 (9.6%) were located at the latissimus dorsi lateral margin, and 108 (6.9%) were located at level 2. Subcutaneous injection of radioisotope (P = .004) and intradermal injection of blue dye (P = .002) were independent factors associated with SLNs distributed at level 2 and the latissimus dorsi lateral margin, respectively. It was noteworthy that 2 of 7 patients had skipping metastasis in level 2, so subcutaneous injection of the isotope is strongly recommended for tracing SLNs distributed in level 2 because of the possibility of skipping metastasis. Though intradermal injection of blue dye was superior methods for tracing SLNs located at the latissimus dorsi lateral margin, we surprisingly found those patients with metastasis to the latissimus dorsi lateral margin nodes also could have metastasis to level 1 (expect for the latissimus dorsi lateral margin) nodes, it seemed that maybe there is no need to excise SLNs at the latissimus dorsi lateral margin in SLNB, whether such nodes should be regarded as useful for SLNB still needs to be determined by further large, multicenter clinical studies.
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Affiliation(s)
- Yu-ting Zhou
- Department of Breast Surgery
- Laboratory of Breast Disease
| | - Zheng-gui Du
- Department of Breast Surgery
- Laboratory of Breast Disease
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Di Zhang
- Department of Breast Surgery
- Laboratory of Breast Disease
| | - Qing Lv
- Department of Breast Surgery
- Laboratory of Breast Disease
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Naidoo K, Pinder SE. Micro- and macro-metastasis in the axillary lymph node: A review. Surgeon 2017; 15:76-82. [DOI: 10.1016/j.surge.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
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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.
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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
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