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Jiang K, Ma C, Yang Y, McKevitt E, Pao JS, Warburton R, Dingee C, Bremang JN, Deban M, Bazzarelli A. Axillary ultrasonography for early-stage invasive breast cancer. Am J Surg 2024; 231:86-90. [PMID: 38490879 DOI: 10.1016/j.amjsurg.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Among women with early invasive breast cancer and 1-2 positive sentinel nodes, sentinel lymph node biopsy (SLNB) is non-inferior to axillary lymph node dissection (ALND).1-3 However, preoperative axillary ultrasonography (AxUS) may not be sensitive enough to discriminate burden of nodal metastasis in these patients, potentially leading to overtreatment.4-6 This study compares axillary operation rates in patients who did and did not receive preoperative AxUS, assessing its utility and risks for overtreatment. METHODS This is a retrospective cohort study of patients with clinical T1/T2 breast tumors who were clinically node negative and underwent an axillary operation. RESULTS Patients who had preoperative AxUS received more ALND compared to patients who did not (5.6% vs. 1.4%, p < 0.001). There was no significant difference in the number of additional axillary operations following SLNB (2.1% vs. 2.3%, p = 0.77). CONCLUSION Eliminating preoperative AxUS is associated with fewer invasive ALND procedures, without increased rate of axillary reoperations.
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Affiliation(s)
- Karen Jiang
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Crystal Ma
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Yuwei Yang
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jieun Newman- Bremang
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Melina Deban
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Song Q, diFlorio-Alexander RM, Sieberg RT, Dwan D, Boyce W, Stumetz K, Patel SD, Karagas MR, Mackenzie TA, Hassanpour S. Response to commentary on "Automated classification of fat-infiltrated axillary lymph nodes on screening mammograms". Br J Radiol 2024; 97:481-482. [PMID: 38306449 DOI: 10.1093/bjr/tqad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 02/04/2024] Open
Affiliation(s)
- Qingyuan Song
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, United States
| | | | - Ryan T Sieberg
- Department of Radiology, School of Medicine, University of California, San Francisco, 94143, United States
| | - Dennis Dwan
- Department of Internal Medicine, Carney Hospital, Dorchester, MA, 02124, United States
| | - William Boyce
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, United States
| | - Kyle Stumetz
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, United States
| | - Sohum D Patel
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, United States
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, United States
| | - Todd A Mackenzie
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, United States
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, United States
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, United States
- Department of Computer Science, Dartmouth College, Hanover, NH, 03755, United States
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Kim SM, Jang M, Yun BL, Shin SU, Rim J, Kang E, Kim EK, Shin HC, Park SY, Kim B. Automated Versus Handheld Breast Ultrasound for Evaluating Axillary Lymph Nodes in Patients With Breast Cancer. Korean J Radiol 2024; 25:146-156. [PMID: 38238017 PMCID: PMC10831296 DOI: 10.3348/kjr.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE Automated breast ultrasound (ABUS) is a relevant imaging technique for early breast cancer diagnosis and is increasingly being used as a supplementary tool for mammography. This study compared the performance of ABUS and handheld ultrasound (HHUS) in detecting and characterizing the axillary lymph nodes (LNs) in patients with breast cancer. MATERIALS AND METHODS We retrospectively reviewed the medical records of women with recently diagnosed early breast cancer (≤ T2) who underwent both ABUS and HHUS examinations for axilla (September 2017-May 2018). ABUS and HHUS findings were compared using pathological outcomes as reference standards. Diagnostic performance in predicting any axillary LN metastasis and heavy nodal-burden metastases (i.e., ≥ 3 LNs) was evaluated. The ABUS-HHUS agreement for visibility and US findings was calculated. RESULTS The study included 377 women (53.1 ± 11.1 years). Among 385 breast cancers in 377 patients, 101 had axillary LN metastases and 30 had heavy nodal burden metastases. ABUS identified benign-looking or suspicious axillary LNs (average, 1.4 ± 0.8) in 246 axillae (63.9%, 246/385). According to the per-breast analysis, the sensitivity, specificity, positive and negative predictive values, and accuracy of ABUS in predicting axillary LN metastases were 43.6% (44/101), 95.1% (270/284), 75.9% (44/58), 82.6% (270/327), and 81.6% (314/385), respectively. The corresponding results for HHUS were 41.6% (42/101), 95.1% (270/284), 75.0% (42/56), 82.1% (270/329), and 81.0% (312/385), respectively, which were not significantly different from those of ABUS (P ≥ 0.53). The performance results for heavy nodal-burden metastases were 70.0% (21/30), 89.6% (318/355), 36.2% (21/58), 97.3% (318/327), and 88.1% (339/385), respectively, for ABUS and 66.7% (20/30), 89.9% (319/355), 35.7% (20/56), 97.0% (319/329), and 88.1% (339/385), respectively, for HHUS, also not showing significant difference (P ≥ 0.57). The ABUS-HHUS agreement was 95.9% (236/246; Cohen's kappa = 0.883). CONCLUSION Although ABUS showed limited sensitivity in diagnosing axillary LN metastasis in early breast cancer, it was still useful as the performance was comparable to that of HHUS.
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Affiliation(s)
- Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jiwon Rim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunyoung Kang
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
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Carlson KA, Checka C, Hunt KK, Jung J, Bridges C, Singh P, Refinetti A, Moseley T, Perez F, Mayo C, Tamirisa N. Evaluation of a Surgical Navigation System for Localization and Excision of Nonpalpable Lesions in Breast and Axillary Surgery. Breast J 2023; 2023:9993852. [PMID: 38162957 PMCID: PMC10757656 DOI: 10.1155/2023/9993852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/21/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
Introduction Elucent Medical has introduced a novel EnVisio™ Surgical Navigation system which uses SmartClips™ that generate a unique electromagnetic signal triangulated in 3 dimensions for real-time navigation. The purpose of this study was to evaluate the efficacy and feasibility of the EnVisio Surgical Navigation system in localizing and excising nonpalpable lesions in breast and axillary surgery. Methods This pilot study prospectively examined patients undergoing breast and nodal localization using the EnVisio Surgical Navigation system. SmartClips were placed by designated radiologists using ultrasound (US) or mammographic (MMG) guidance. The technical evaluation focused on successful deployment and subsequent excision of all localized lesions including SmartClips and biopsy clips. Results Eleven patients underwent localization using 27 SmartClips which included bracketed multifocal disease (n = 4) and clipped lymph node (n = 1). The bracketed cases were each localized with 2 SmartClips. Mammography and ultrasound were used (n = 8 and n = 19, respectively) to place the SmartClips. All 27 devices were successfully deployed within 5 mm of the targeted lesion or biopsy clip. All SmartClip devices were identified and retrieved intraoperatively. No patients required a second operation for margin excision. Conclusion In a limited sample, the EnVisio Surgical Navigation system was a reliable technology for the localization of breast and axillary lesions planned for surgical excision. Further comparative studies are required to evaluate its efficacy in relation to the other existing localization modalities.
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Affiliation(s)
- Kjirsten A. Carlson
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cristina Checka
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer Jung
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christian Bridges
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Puneet Singh
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ana Refinetti
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tanya Moseley
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frances Perez
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cody Mayo
- Department of Breast Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nina Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Yan Y, Jiang T, Sui L, Ou D, Qu Y, Chen C, Lai M, Ni C, Liu Y, Wang Y, Xu D. Combined conventional ultrasonography with clinicopathological features to predict axillary status after neoadjuvant therapy for breast cancer: A case-control study. Br J Radiol 2023; 96:20230370. [PMID: 37750854 PMCID: PMC10646660 DOI: 10.1259/bjr.20230370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the value of a model combining conventional ultrasonography and clinicopathologic features for predicting axillary status after neoadjuvant therapy in breast cancer. METHODS This retrospective study included 329 patients with lymph node-positive who underwent neoadjuvant systemic treatment (NST) from June 2019 to March 2022. Ultrasound and clinicopathological characteristics of breast lesions and axillary lymph nodes were analyzed before and after NST. The diagnostic efficacy of ultrasound, clinicopathological characteristics, and combined model were evaluated using multivariate logistic regression and receiver operator characteristic curve (ROC) analyses. RESULTS The area under ROC (AUC) for the ability of the combined model to predict the axillary pathological complete response (pCR) after NST was 0.882, that diagnostic effectiveness was significantly better than that of the clinicopathological model (AUC of 0.807) and the ultrasound feature model (AUC of 0.795). In addition, eight features were screened as independent predictors of axillary pCR, including clinical N stage, ERBB2 status, Ki-67, and after NST the maximum diameter reduction rate and margins of breast lesions, the short diameter, cortical thickness, and fatty hilum of lymph nodes. CONCLUSIONS The combined model constructed from ultrasound and clinicopathological features for predicting axillary pCR has favorable diagnostic results, which allowed more accurate identification of BC patients who had received axillary pCR after NST. ADVANCES IN KNOWLEDGE A combined model incorporated ultrasound and clinicopathological characteristics of breast lesions and axillary lymph nodes demonstrated favorable performance in evaluating axillary pCR preoperatively and non-invasively.
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Affiliation(s)
| | | | | | | | - Yiyuan Qu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
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Deng Y, Deng Y, Wang H, Xie H, Zhang W. Solitary Axillary Lymph Node Metastasis From Bladder Cancer Detected by FDG PET/CT. Clin Nucl Med 2023; 48:976-977. [PMID: 37703444 DOI: 10.1097/rlu.0000000000004827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
ABSTRACT Solitary axillary lymph node metastasis from bladder cancer is rare. A 65-year-old woman with a history of bladder urothelial carcinoma presented to our hospital with an axillary mass. No abnormal lesion in FDG PET/CT was identified except a solitary soft tissue mass with significant FDG uptake in the right axilla. Puncture pathology of the mass confirmed the metastasis of differentiated urothelial carcinoma.
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Affiliation(s)
- Yan Deng
- From the Departments of Pediatrics
| | - Yujiao Deng
- Nuclear Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Wang
- Nuclear Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongjun Xie
- Nuclear Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Zhang
- Nuclear Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Wang X, Yi X, Zhang Q, Wang X, Zhang H, Peng S, Wang K, Liao L. Incorporating ultrasound-based lymph node staging significantly improves the performance of a clinical nomogram for predicting preoperative axillary lymph node metastasis in breast cancer. Biomol Biomed 2023; 23:680-688. [PMID: 36724018 PMCID: PMC10351098 DOI: 10.17305/bb.2022.8564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
Models for predicting axillary lymph node metastasis (ALNM) in breast cancer patients are lacking. We aimed to develop an efficient model to accurately predict ALNM. Three hundred fifty-five breast cancer patients were recruited and randomly divided into the training and validation sets. Univariate and multivariate logistic regressions were applied to identify predictors of ALNM. We developed nomograms based on these variables to predict ALNM. The performance of the nomograms was tested using the receiver operating characteristic curve and calibration curve, and a decision curve analysis was performed to assess the clinical utility of the prediction models. The nomograms that included clinical N stage (cN), pathological grade (pathGrade), and hemoglobin accurately predicted ALNM in the training and validation sets (area under the curve [AUC] 0.80 and 0.80, respectively). We then explored the importance of the cN and pathGradesignatures used in the integrated model and developed new nomograms by removing the two variables. The results suggested that the combine-pathGrade nomogram also accurately predicted ALNM in the training and validation sets (AUC 0.78 and 0.78, respectively), but the combine-cN nomogram did not (AUC 0.64 and 0.60, in training and validation sets, respectively). We described a cN-based ALNM prediction model in breast cancer patients, presenting a novel efficient clinical decision nomogram for predicting ALNM.
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Affiliation(s)
- Xiaomin Wang
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Cancer, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China
| | - Xiaoping Yi
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Zhang
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Cancer, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoxiao Wang
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Cancer, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hanghao Zhang
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Cancer, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuai Peng
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Cancer, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kuansong Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Pathology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Liqiu Liao
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Cancer, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Engel AJ, Shin K, Adrada BE, Moseley TW, Krishnamurthy S, Whitman GJ. Review of the Sonographic Features of Interpectoral (Rotter) Lymph Nodes in Breast Cancer Staging. Ultrasound Q 2023; 39:69-73. [PMID: 35439235 DOI: 10.1097/ruq.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This article reviews the ultrasound evaluation and staging of breast cancer with respect to the involvement of interpectoral (Rotter) lymph nodes. The primary objective is to demonstrate and assess the characteristic sonographic findings of interpectoral (Rotter) lymph nodes to help provide accurate nodal staging information. We aim to provide a comprehensive review and serve as an imaging guide for the identification and evaluation of Rotter lymph nodes. The detection of abnormalities and pathologic features of metastatic axillary nodal disease in the interpectoral region is reviewed, and the impact on clinical management and treatment is discussed. In the radiology literature, there is no comprehensive review of the sonographic appearance and evaluation of Rotter lymph nodes.
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Affiliation(s)
| | - Kyungmin Shin
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beatriz E Adrada
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Savitri Krishnamurthy
- Division of Pathology and Laboratory Medicine, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary J Whitman
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
When interpreting mammography, breast radiologists may identify radiopaque densities in the axilla on the mediolateral oblique or lateral projections. When such densities are encountered, true calcifications must be differentiated from pseudocalcifications (artifact). Using imaging, breast radiologists should be able to localize the finding as being dermal, within the soft tissues, within a lymph node, or intramuscular. By combining the anatomic location with the clinical presentation and any other imaging findings, breast radiologists will be able to determine the most appropriate management.
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Affiliation(s)
- Aayushi Rai
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Michael D C Fishman
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
| | - Anna F Rives
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
| | - Priscilla J Slanetz
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
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10
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Zhao R, Jiang H, Cao J, Li B, Xu L, Dai S. Prediction of Axillary Lymph Node Metastasis in Invasive Breast Cancer by Sound Touch Elastography. Ultrasound Med Biol 2022; 48:1879-1887. [PMID: 35691734 DOI: 10.1016/j.ultrasmedbio.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
The aims of this study were to investigate the value of sound touch elastography (STE) in predicting axillary lymph node metastasis (ALNM) in patients with invasive breast cancer (IBC) and to explore whether lysyl oxidase (LOX) is correlated with increasing stiffness and promotion of metastasis in IBC. A total of 142 lesions in 142 patients were assessed by STE. The STE values of IBCs in the two groups were compared and the best cutoff values for diagnosing ALNM determined. Immunohistochemistry was used to detect LOX expression. Collagen fiber and elastic fiber content was determined by Masson and Weigert elastic fiber staining. Correlation analyses were performed to identify the associations of the data. The optimal cutoff values of Emax (maximum stiffness value of the tumor) and Smax (maximum stiffness value of the shell) for predicting ALNM of IBC were 94.58 and 148.78 kPa. Immunohistochemistry and Masson and Weigert elastic fiber staining were performed on 67 samples. LOX expression and collagen volume fraction were significantly higher in the ALNM+ group than in the ALNM- group (p = 0.04 and 0.03), except for elastic fiber content (p = 0.628). Moreover, Emax, Smax and LOX expression were positively correlated with collagen volume fraction (r = 0.624, 0.512, and 0.533, respectively). Emax and Smax were found to be predictors for ALNM of IBC. STE could serve as a non-invasive method for assessing lymph node status before surgery. Overexpression of LOX and increased collagen fiber contributed to the increased stiffness in the lesions and metastases of IBC.
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Affiliation(s)
- Rui Zhao
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Huan Jiang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jingyan Cao
- Department of Internal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lili Xu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shaochun Dai
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.
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11
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Zhang M, Cao L, Chen J, Li B, Huang X, Cai G, Xu C. Mapping of PET/CT-based regional nodes distribution of recurrent/advanced breast cancer and comparison with current delineation atlas. Br J Radiol 2022; 95:20220382. [PMID: 35731844 PMCID: PMC10996945 DOI: 10.1259/bjr.20220382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To localize the distribution of regional nodes in recurrent/advanced breast cancer patients based on 18-fludeoxyglucose (FDG) positron emission tomography/CT (PET/CT) images and validate the coverage of clinical target volumes (CTVs) for regional nodes with current contouring guidelines. METHODS We enrolled 154 recurrent/advanced breast cancer patients with FDG-avid regional nodes who underwent PET/CT between January 2018 and June 2020. Involvement of lymph node regions including axillary lymph node level I-III (ALN-I, ALN-II, ALN-III), Rotter's nodes (RN), medial supraclavicular (SC-M), lateral supraclavicular (SC-L) and internal mammary nodes (IMN) was recorded respectively. Coverage of the CTVs in different atlases and the locations of out-of-field were evaluated. RESULTS A total of 348 lymph node regions containing disease were identified, including ALN-I 109, ALN-II 46, ALN-III 36, RN 17, SC-M 68, SC-L 36 and IMN 36. Recurrent ALNs mainly located cranially and ventrally to the axillary vein (AV). Ipsilateral cervical nodes were simultaneously affected in 33/76 SC positive patients. RADCOMP (306/348) and RUIJIN (291/348) guidelines had higher coverage compared with RTOG (205/348) and ESTRO (202/348) guidelines (p < 0.001, respectively). In primary non-metastastic and recurrent patients, major missings located in SC-L (7/7, 17/17) and IMN (7/10, 15/19) for RTOG guideline while SC-L (7/7, 17/17) for ESTRO guideline (p < 0.001, respectively). Among recurrent patients, SC-M (22/31) was another major missing area for ESTRO guideline (p < 0.001). CONCLUSION The current guidelines effectively cover most regional nodes in postoperative breast cancer patients. SC-L and IMN were the major missing regions. Recurrent ALNs were most often seen in cranial and ventral to the AV. The CTV of patients with clinically positive SC was recommended to extend up to the hyoid level. The CTVs should be adjusted based on risks of recurrence individually. ADVANCES IN KNOWLEDGE The difference of regional nodes delineation between current guidelines mainly located in SC and IMN regions. High axilla including subclavicular nodes and the RN above AV for recurrent patients and the region between cricoid and hyoid for positive SC patients should be meticulously contoured.
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Affiliation(s)
- Maochen Zhang
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao
Tong University, School of Medicine,
Shanghai, China
| | - Xinyun Huang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao
Tong University, School of Medicine,
Shanghai, China
| | - Gang Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
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12
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Kurt N, Binboga Kurt B, Gulsaran U, Uslu B, Celik AO, Sut N, Tastekin E, Karabulut D, Tuncbilek N. Diffusion tensor imaging and diffusion-weighted imaging on axillary lymph node status in breast cancer patients. Diagn Interv Radiol 2022; 28:329-336. [PMID: 35950277 PMCID: PMC9634923 DOI: 10.5152/dir.2022.21460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
PURPOSE This article will examine the usefulness of diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) on the assessment of axillary lymph nodes (ALN) of breast cancer patients. METHODS Axillary lymph nodes in 66 breast cancer patients were examined by DTI and DWI, and the largest lymph node with increased cortical thickness in axilla was selected. Morphological features, apparent diffusion coefficient (ADC), volume anisotropy, and fractional anisotropy values were measured by using a special software. Imaging findings and histopathological results were recorded. RESULTS Metastatic ALN were detected in 43 (65.1%) patients. Cortical thickness of the metastatic ALN was significantly higher than the non-metastatic ALNs (P < .001), and the long-axis-to-shortaxis ratio was significantly lower in metastatic ALNs (P < .001). There was a statistically significant difference between the ALN status and fatty hilum presence (P < .001). Apparent diffusion coefficient values of metastatic ALNs were statistically lower than those of non-metastatic ALNs (P < .001) using a cutoff value of 1.26 × 10-3 mm2 /s for b=500 ADC and 1.21 × 10-3 mm2 /s for b=800 ADC which had 97.7% sensitivity and 91.3% specificity. Fractional anisotropy and volume anisotropy values were significantly different between both groups. A cutoff value of 0.47 for b-500 fractional anisotropy had 83.7% sensitivity, 69.6% specificity 69.6% positive predictive value, and 83.7% negative predictive value. A cutoff value of 0.33 for b=500 volume anisotropy had 76.7% sensitivity, 78.3% specificity, 86.8% positive predictive value, and 64.3% negative predictive value. CONCLUSION Apparent diffusion coefficient value of metastatic ALNs was found to be significantly lower than those of non-metastatic ALN, and DTI metrics of metastatic ALN were found to be significantly higher than those of non-metastatic ALN. Overall, ADC had a better diagnostic performance than morphological features, fractional anisotropy, and volume anisotropy. Diffusion tensor imagingderived diffusion metrics may be used to complement breast magnetic resonance imaging in the future after further standardization of the imaging parameters.
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Affiliation(s)
- Nazmi Kurt
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Busem Binboga Kurt
- Department of Pathology, Trakya University School of Medicine, Edirne, Turkey
| | - Ugur Gulsaran
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Burak Uslu
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Ahmet Onur Celik
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Necdet Sut
- Department of Biostatistics, Trakya University School of Medicine, Edirne, Turkey
| | - Ebru Tastekin
- Department of Pathology, Trakya University School of Medicine, Edirne, Turkey
| | - Derya Karabulut
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Nermin Tuncbilek
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
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13
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Stowell JT, McComb BL, Mendoza DP, Cahalane AM, Chaturvedi A. Axillary Anatomy and Pathology: Pearls and "Pitfalls" for Thoracic Imagers. J Thorac Imaging 2022; 37:W28-W40. [PMID: 35142752 DOI: 10.1097/rti.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The axilla contains several important structures which exist in a relatively confined anatomic space between the neck, chest wall, and upper extremity. While neoplastic lymphadenopathy may be among the most common axillary conditions, many other processes may be encountered. For example, expanded use of axillary vessels for access routes for endovascular procedures will increase the need for radiologists to access vessel anatomy, patency, and complications that may arise. Knowledge of axillary anatomy and pathology will allow the imager to systematically evaluate the axillae using various imaging modalities.
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Affiliation(s)
| | | | - Dexter P Mendoza
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Health System, New York
| | | | - Abhishek Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
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14
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Affiliation(s)
- Diana L Lam
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - Meghan R Flanagan
- Department of Surgery, University of Washington School of Medicine, Seattle
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15
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Stefanescu BI, Munteanu IV, Radaschin DS, Constantin BG. Fetal axillary lymphangioma diagnosed on a 2D/4D ultrasound second trimester scan - a case report and short literature review. Med Ultrason 2021; 23:490-492. [PMID: 32905576 DOI: 10.11152/mu-2531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Fetal lymphangioma, also known as cystic hygroma, is a hamartomatous congenital tumor which involves the fetal skin and the subcutaneous tissue. The most common site of appearance is in the neck region. Location of the lesion in the axilla as well as in other anathomical sites is very rare.Prenatal diagnosis can be made on ultrasound examination. Other structural or chromosomal anomalies are frequently associated with this diagnosis. The antepartum management and type of delivery should be set up by a multidisciplinary team.We present a rare case diagnosed with axillary lymphangioma during the second trimester morphological ultrasound 2D/4D scan.
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Affiliation(s)
- Bogdan Ioan Stefanescu
- Department of Obstetrics and Gynecology Clinical Emergency Hospital "Sf. Ap. Andrei" Galati University "Dunarea de Jos", Faculty of Medicine and Pharmacy, Galati, Romania.
| | - Iulian Valentin Munteanu
- Department of Obstetrics and Gynecology Clinical Emergency Hospital "Sf. Ap. Andrei" Galati University "Dunarea de Jos", Faculty of Medicine and Pharmacy, Galati, Romania.
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16
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Sun C, Zhang X, Ji X, Yu P, Cai X, Yang H. Suprascapular nerve block and axillary nerve block versus interscalene nerve block for arthroscopic shoulder surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e27661. [PMID: 34871240 PMCID: PMC8568401 DOI: 10.1097/md.0000000000027661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/14/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) and axillary Nerve Block (ANB) has been reported as an alternative nerve block with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ANB with ISB during shoulder arthroscopy surgery. METHODS A meta-analysis was conducted to identify relevant randomized or quasirandomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. We searched Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database from 2010 through August 2021. RESULTS We identified 641 patients assessed in 10 randomized or quasirandomized controlled trials. Compared with the ISB group, the SSNB+ANB group had higher visual analog scale or numerical rating scale in PACU (P = .03), 4 hour (P = .001),6 hour after the operation (P = .002), and lower incidence of complications such as Numb/Tingling (P = .001), Weakness (P <.00001), Horner syndrome (P = .001) and Subjective dyspnea (P = .002). No significant difference was found for visual analog scale or numerical rating scale 8 hour (P = .71),12 hour (P = .17), 16 hour (P = .38),1day after operation (P = .11), patient satisfaction (P = .38) and incidence of complications such as hoarseness (P = .07) and nausea/vomiting (P = .41) between 2 groups. CONCLUSION Our high-level evidence has established SSNB+ ANB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis's relevant possible biases, we required more adequately powered and better-designed randomized controlled trial studies with long-term follow-up to reach a firmer conclusion.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University, No.168 Litang Road, Dongxiaokou Town,Changping District, Beijing, China
| | - Xiaolin Ji
- Department of Anesthesia, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Institutional address: No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Peng Yu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Huadong Yang
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
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Özler İ, Aydin H, Güler OC, Esen Bostancı I, Şahin Güner B, Karaman N, Doğan L, Özaslan C. Can preoperative axillary ultrasound and biopsy of suspicious lymph nodes be an alternative to sentinel lymph node biopsy in clinical node negative early breast cancer? Int J Clin Pract 2021; 75:e14332. [PMID: 33960070 DOI: 10.1111/ijcp.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
AIM The aim of this study was to assess the efficacy of preoperative axillary ultrasonography (AUS) and preoperative axillary fine-needle aspiration biopsy (FNAB) from suspicious lymph nodes in clinically node-negative breast cancer to compare with radiologically positive and sentinel lymph node biopsy (SLNB) positive involvement. METHOD Clinically node-negative early-stage breast cancer patients were included in the study. These patients underwent preoperative AUS examination, suspicious lymph nodes were evaluated with FNAB. AUS-FNAB results were compared with those of SLNB or axillary dissection. RESULTS Of 181 patients undergoing AUS, 32 were reported to have axillary metastasis, 25 suspicious, and 124 benign nodes. The suspicious group underwent FNAB examination and metastasis was found in 9 of them. The sensitivity of AUS-FNAB was found to be 64.06%, specificity 100%, positive predictive value 100%, and negative predictive value (NPV) 83.5%. The false negativity rate (FN) of this method was 16,4%. Lymphovascular invasion and tumour size were found statistically significant factors for false negativity. CONCLUSION It was concluded that axillary AUS-FNAB with its high NPV, low FN rate, may be a clinical alternative to SLNB for early-stage breast cancer patients.
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Affiliation(s)
- İsmail Özler
- General Surgery Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Hale Aydin
- Radiology Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Onur Can Güler
- General Surgery Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Işıl Esen Bostancı
- Radiology Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Bahar Şahin Güner
- Radiology Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Niyazi Karaman
- General Surgery Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Lütfi Doğan
- General Surgery Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Cihangir Özaslan
- General Surgery Clinics of University of Health Sciences, Ankara Oncology Education and Research Hospital, Ankara, Turkey
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18
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Kim K, Shim SR, Kim SJ. Diagnostic Values of 8 Different Imaging Modalities for Preoperative Detection of Axillary Lymph Node Metastasis of Breast Cancer: A Bayesian Network Meta-analysis. Am J Clin Oncol 2021; 44:331-339. [PMID: 33979099 DOI: 10.1097/coc.0000000000000831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to compare diagnostic performances of 8 different imaging modalities for preoperative detection of axillary lymph node (LN) metastasis in patients with breast cancer by performing a network meta-analysis (NMA) using direct comparison studies with 2 or more imaging techniques. MATERIALS AND METHODS PubMed, Cochrane, and Embase were searched for the studies evaluating the performances of 8 different imaging modalities for preoperative axillary LN staging in patients with breast cancer. The NMA was performed in patient-based analyses. The consistency was evaluated by examining the agreement between direct and indirect treatment effects, and publication bias was assessed by funnel plot asymmetry tests. The surface under the cumulative ranking curve (SUCRA) values were obtained to calculate the probability of each imaging modality being the most effective diagnostic method. RESULTS A total of 2197 patients from 22 direct comparison studies using 8 different imaging modalities for preoperative detection of axillary LN metastasis in patients with breast cancer were included. For preoperative detection of axillary LN metastasis of breast cancer, elastography showed the highest SUCRA values of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and diagnostic odds ratio. In addition, fluorine-18 fluorodeoxyglucose positron emission tomography (PET) or PET/computed tomography, fluorine-18 fluorodeoxyglucose PET/magnetic resonance, and contrast-enhanced computed tomography showed high SUCRA values. CONCLUSION Elastography showed the highest SUCRA values. Seven imaging modalities showed the complementary diagnostic roles for preoperative detection of axillary LN metastasis in patients with breast cancer, except mammography.
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Affiliation(s)
- Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan
| | - Sung-Ryul Shim
- Department of Preventive Medicine, School of Medicine, Korea University, Seoul
| | - Seong-Jang Kim
- Department of Nuclear Medicine, College of Medicine, Pusan National University
- Department of Nuclear Medicine
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Tasdoven I, Erdemir RU, Cakmak GK. Diagnostic Accuracy of Axillary Ultrasound for Prediction of Axillary Pathologic Response after Neoadjuvant Treatment in Breast Cancer. Chirurgia (Bucur) 2021; 116:45-58. [PMID: 33963694 DOI: 10.21614/chirurgia.116.2 suppl.s45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/23/2022]
Abstract
Background: In the era of NAT, to accurately predict pathologic response is a great challenge, which might influence surgical approach for breast and axilla. Axillary staging via imaging methods as an adjunct have long been used with various reported accuracy rates. However, the role of preoperative axillary ultrasonography (AUS) in clinical N0 patients after NAT is still controversial. The primary goal of the present study was to evaluate the precision of preoperative AUS for identifying pathologic complete response (ypCR = ypT0, ypN0) after NAT. Methods: A single-institution, retrospective review of a prospectively maintained database was analyzed to identify breast cancer patients treated with NAT. Only those patients who underwent AUS and 18F-FDG-PET/CT before and after NAT with documentation of clinical and radiological response were incorporated for outcome analysis. Results: In 253 consecutive invasive breast cancer patients axillary ypN0 disease was achieved in 67.19%. In 11.23% ynon-pCR patients AUS failed to detect residual disease presence 80% of which were ITCs and micrometastases. Macrometastasis was present in 21.73% (55/253) of the cases 98.18% (54/55) of which was determined by AUS. Overall accuracy for axillary pCR was found to be 89.32% for AUS and 76.28 % for 18-FDG-PET/CT. The false negative rate (FNR) of AUS and 18-FDG-PET/CT was 12.04% and 15.59%, respectively. The PPV of AUS was higher in Luminal-like tumors (%87.69), whereas HER-2 positive (%100) and triple-negative (93.47%) subtypes had higher NPV. Conclusions: AUS is a beneficial tool with the potential of accurate prediction of pCR in more than 80% of patients following NAT. Nevertheless, in cases of residual ITCs and micrometastasis the accuracy of US should be interrogated cautiously.
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20
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Jamaris S, Jamaluddin J, Islam T, See MH, Fadzli F, Rahmat K, Bhoo-Pathy N, Taib NAM. Is pre-operative axillary ultrasound alone sufficient to determine need for axillary dissection in early breast cancer patients? Medicine (Baltimore) 2021; 100:e25412. [PMID: 34106588 PMCID: PMC8133266 DOI: 10.1097/md.0000000000025412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
Pre-operative status of axillary lymph node (ALN) in early breast cancer is usually initially assessed by pre-operative ultrasound, followed by ultrasound-guided needle biopsy (UNB) confirmation. Patients with positive nodal status will undergo axillary lymph node dissection (ALND), while those with negative nodal status will have sentinel lymph node biopsy. ALND is associated with higher morbidity than Sentinel lymph node biopsy. The objective of this study is to determine if axillary ultrasound alone without UNB is predictive enough to assign patients to ALND and to identify ultrasound features that are significantly associated with pathologically positive ALN.383 newly diagnosed primary breast cancer patients between 2012 and 2014, and who had undergone pre-operative axillary ultrasound in University Malaya Medical Centre with a complete histopathology report of the axillary surgery were retrospectively reviewed. ALN was considered positive if it had any of these features: cortical thickening > 3 mm, loss of fatty hilum, hypoechoic solid node, mass-like appearance, round shape and lymph node size > 5 mm. Post-operative histopathological reports were then analyzed for nodal involvement.The overall sensitivity, specificity, and accuracy of pre-operative axillary ultrasound in detecting diseased nodes were 45.5%, 80.7%, and 60.3% respectively. The positive (PPV) and negative predictive values were 76.5% and 51.8%. Round shape, loss of fatty hilum and mass-like appearance had the highest PPVs of 87%, 83% and 81.6% respectively and significant odds ratios (ORs) of 5.22 (95% confidence interval [CI]: 1.52 - 17.86), ORs of 4.77 (95% CI: 2.62 - 8.70) and ORs of 4.26 (95% CI: 2.37 - 7.67) respectively (P-value < .05). Cortical thickness of > 3 mm was identified to have low PPV at 69.1%, ORs of 1.71 (95% CI: 0.86 - 3.41, P = .126).There are features on axillary ultrasound that confer high PPV for axillary involvement i.e. round shape, loss of fatty hilum, and mass-like appearance. In a low resource setting, these features may benefit from ALND without further pre-operative biopsies. However, pre-operative UNB for features with low PPV that is, cortical thickness > 3 mm should be considered to obviate the unnecessary morbidity associated with ALND.
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Affiliation(s)
| | | | | | | | | | | | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Teichgraeber DC, Perez F, Guirguis MS, Kapoor MM, Whitman GJ. Ultrasound Evaluation of the Axilla in the Breast Imaging Setting. Ultrasound Q 2021; 37:43-51. [PMID: 33464028 DOI: 10.1097/ruq.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Ultrasound evaluation of the axilla plays a critical role in the setting of newly diagnosed breast cancer as surgical management evolves toward more targeted axillary nodal resection. Regional nodal involvement by metastatic carcinoma is one of most important prognostic factors in breast cancer and guides local, regional, and systemic treatment. Ultrasound also evaluates response to neoadjuvant chemotherapy. This article will review ultrasound techniques and the anatomy and the morphology of axillary lymph nodes. Lymph node staging in breast cancer will also be discussed. Ultrasound-guided interventions and localizations and emerging technologies of elastography and contrast-enhanced ultrasound will be discussed. In addition, this article will discuss the role of ultrasound as it applies to management of the axilla since the American College of Surgeons Oncology Group Z011 and Z1071 trials. Finally, other causes of benign and malignant axillary lymphadenopathy, not related to breast cancer, are discussed.
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Affiliation(s)
- Davis C Teichgraeber
- Department of Breast Imaging, The University of Texas MD Anderson Cancer, Houston, TX
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22
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Nielsen Moody A, Cox K, Haigh I, Chen Y, Sharma N. Does Contrast Enhanced Ultrasound (CEUS) of Normal/Benign Axillary Lymph Nodes in Patients with Breast Cancer Identify Significant Axillary Nodal Burden? Eur J Radiol 2020; 132:109311. [PMID: 33017774 DOI: 10.1016/j.ejrad.2020.109311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Contrast enhanced ultrasound (CEUS) of the axilla allows preoperative identification and biopsy of the sentinel lymph node. Our aims were to evaluate the accuracy of the CEUS procedure for identifying axillary lymph node metastases preoperatively and compare the volume of axillary metastases in patients with malignant versus benign CEUS guided core biopsy at end of primary surgical treatment. METHODS Retrospective analysis of prospectively collected data on patients with breast cancer with normal axillary ultrasound or benign axillary FNAC undergoing preoperatively CEUS guided sentinel lymph node biopsy between 2013 and 2018. RESULTS SLN was successfully identified by CEUS in 186 (90.7%) of patients with definitive diagnosis obtained in 163 (87.6%). Overall sensitivity was 55.77%, but significantly higher for high volume disease (77.78%) than for low volume disease (32.00%, odds ratio = 7.44, 95% CI = 2.16 to 25.62, p = .001) Specificity was 100%. NPV was 82.84% overall, 86.72% for low volume disease and 94.87 % for high volume disease. 72.4% of patients with initial malignant CEUS guided SLN core biopsy had two or more macrometastases at end of surgical treatment compared to 4.47% of patients with initial benign CEUS guided core biopsy. CONCLUSION When disease was present, CEUS guided sentinel lymph node core biopsy identify nodal metastases in 55.77% of patients with normal axillary grey scale ultrasound. This study suggests that the likelihood of extensive axillary disease at end of surgical treatment is low with an initial benign CEUS guided SLN core biopsy.
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Affiliation(s)
- Anne Nielsen Moody
- Breast Radiology, Breast Imaging Department, St James's University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK.
| | - Karina Cox
- Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Maidstone, Kent, UK
| | - Isobel Haigh
- Breast Radiology, Breast Imaging Department, St James's University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Yan Chen
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Nisha Sharma
- Breast Radiology, Breast Imaging Department, St James's University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK
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Qiu X, Jiang Y, Zhao Q, Yan C, Huang M, Jiang T. Could Ultrasound-Based Radiomics Noninvasively Predict Axillary Lymph Node Metastasis in Breast Cancer? J Ultrasound Med 2020; 39:1897-1905. [PMID: 32329142 PMCID: PMC7540260 DOI: 10.1002/jum.15294] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This work aimed to investigate whether quantitative radiomics imaging features extracted from ultrasound (US) can noninvasively predict breast cancer (BC) metastasis to axillary lymph nodes (ALNs). METHODS Presurgical B-mode US data of 196 patients with BC were retrospectively studied. The cases were divided into the training and validation cohorts (n = 141 versus 55). The elastic net regression technique was used for selecting features and building a signature in the training cohort. A linear combination of the selected features weighted by their respective coefficients produced a radiomics signature for each individual. A radiomics nomogram was established based on the radiomics signature and US-reported ALN status. In a receiver operating characteristic curve analysis, areas under the curves (AUCs) were determined for assessing the accuracy of the prediction model in predicting ALN metastasis in both cohorts. The clinical value was assessed by a decision curve analysis. RESULTS In all, 843 radiomics features per case were obtained from expert-delineated lesions on US imaging in this study. Through radiomics feature selection, 21 features were selected to constitute the radiomics signature for predicting ALN metastasis. Area under the curve values of 0.778 and 0.725 were obtained in the training and validation cohorts, respectively, indicating moderate predictive ability. The radiomics nomogram comprising the radiomics signature and US-reported ALN status showed the best performance for ALN detection in the training cohort (AUC, 0.816) but moderate performance in the validation cohort (AUC, 0.759). The decision curve showed that both the radiomics signature and nomogram displayed good clinical utility. CONCLUSIONS This pilot radiomics study provided a noninvasive method for predicting presurgical ALN metastasis status in BC.
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Affiliation(s)
- Xiaoying Qiu
- Departments of UltrasonographyFirst Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Yongluo Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Qiyu Zhao
- Departments of UltrasonographyFirst Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
- Hepatobiliary and Pancreatic SurgeryFirst Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Chunhong Yan
- Departments of UltrasonographyFirst Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Min Huang
- Departments of UltrasonographyFirst Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Tian'an Jiang
- Departments of UltrasonographyFirst Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
- Hepatobiliary and Pancreatic SurgeryFirst Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
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Peng L, Zhao J, Mao F, Sun Q. 68Ga-NEB PET/CT can be a new method for diagnosing chylous fistula: Case reports of a rare complication after breast cancer surgery. Medicine (Baltimore) 2020; 99:e21201. [PMID: 32702884 PMCID: PMC7373633 DOI: 10.1097/md.0000000000021201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided. Ga-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. PATIENT CONCERNS A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. DIAGNOSES The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method, Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. INTERVENTIONS We successfully obtained clear images to locate the fistula using Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the Ga-NEB activity during PET/CT. OUTCOMES Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. LESSONS Ga-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.
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Tong YY, Sun PX, Zhou J, Shi ZT, Chang C, Li JW. The Association Between Ultrasound Features and Biological Properties of Invasive Breast Carcinoma Is Modified by Age, Tumor Size, and the Preoperative Axilla Status. J Ultrasound Med 2020; 39:1125-1134. [PMID: 31875336 DOI: 10.1002/jum.15196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To investigate the value of ultrasound (US) feature-based models in predicting the proliferation and invasiveness of invasive breast cancer (IBC) and to compare the performance of models based solely on US features with models that combined US features, patient age, tumor size, and axilla status from US. METHODS With ethical approval, 746 patients with a pathologic diagnosis of IBC were reviewed for preoperative clinical, US, and postoperative pathologic data. The proliferation and invasiveness properties of the IBC included the histologic grade and Ki-67 status and lymphovascular invasion (LVI) and axillary lymph node metastasis (ALNM), respectively. Logistic regression analyses were used to identify independent risk factors for tumor proliferation and invasiveness. RESULTS Posterior echo enhancement, calcification, a tumor size larger than 2 cm, and suspicion of ALNM from axillary US were independent risk factors for a high histologic grade and high Ki-67 expression of IBC (P < .05). A posterior echo shadow, patient age younger than 45 years, and suspicious findings on axillary US imaging were independent variables for predicting the presence of LVI and ALNM in IBC (P < .05). Calcification was the independent factor for predicting LVI (P = .013). The predictive performance of the combined models was improved compared with the US feature-based models, with a higher accuracy rate and negative predictive value. The area under curve of the combined models was also significantly higher than that of the single models (P < .05). CONCLUSIONS Compared with the US feature-based models, the combined models yielded better predictive performance. This may provide a more robust model to predict the tumor biological properties of IBC before surgery.
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Affiliation(s)
- Yu-Yang Tong
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Pei-Xuan Sun
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhou
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhao-Ting Shi
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jia-Wei Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Han P, Yang H, Liu M, Cheng L, Wang S, Tong F, Liu P, Zhou B, Cao Y, Liu H, Wang C, Peng Y, Shen D, Wang S. Lymph Node Predictive Model with in Vitro Ultrasound Features for Breast Cancer Lymph Node Metastasis. Ultrasound Med Biol 2020; 46:1395-1402. [PMID: 32146007 DOI: 10.1016/j.ultrasmedbio.2020.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/17/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
Ultrasound diagnosis of axillary lymph nodes has the advantages of ease, convenience and low cost; however, most previous studies evaluated lymph node metastasis of the entire axilla rather than the association between the ultrasound features of a single lymph node and its pathology. This prospective study was performed to explore the ultrasound features of lymph nodes observed in bionic medium in vitro and to develop a lymph node-specific model for prediction of metastasis based on analysis of the association between the ultrasound features and pathology of each lymph node. From November 1, 2017 to December 19, 2017, 373 nodes (54 patients) were enrolled into the modeling group; from December 20, 2017 to January 12, 2018, 139 lymph nodes (22 patients) were enrolled into the validation group. Lymph nodes from sentinel lymph node biopsy or axillary lymph node dissection were enrolled. Individual lymph nodes were placed in bionic medium and observed separately using ultrasound. Traditional ultrasound features of metastatic nodes (long axis, short axis, cortical thickness and hilum loss) were recorded, and the longitudinal-to-transverse axis ratio (L/T) and cortical proportion were calculated. Pathologic results specific to each lymph node were recorded. On the basis of two-level binary logistic regression, independent predictors of lymph node metastasis in the modeling group were lymph node long axis (p = 0.004), short axis (p < 0.001), L/T (p = 0.006), cortical thickness (p = 0.001) and hilum loss (p < 0.001). When analysis was done at the node level, the areas under the curve of the modeling and validation groups were 0.97 and 0.75, respectively. When validation was done at the patient level, the areas under the curve of the modeling and validation groups were 0.96 and 0.93, respectively. The model for prediction of metastasis based on the ultrasound features and pathology of each lymph node is of good predictive value for lymph node metastasis.
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Affiliation(s)
- Pu Han
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Houpu Yang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Miao Liu
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Lin Cheng
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Siyuan Wang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Fuzhong Tong
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Peng Liu
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Bo Zhou
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Yingming Cao
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Hongjun Liu
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Chaobin Wang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Yuan Peng
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Danhua Shen
- Pathology Department, Peking University People's Hospital Beijing, China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Beijing, China.
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Rukanskienė D, Veikutis V, Jonaitienė E, Basevičiūtė M, Kunigiškis D, Paukštaitienė R, Čepulienė D, Poškienė L, Boguševičius A. Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer. Medicina (Kaunas) 2020; 56:medicina56030127. [PMID: 32183080 PMCID: PMC7143354 DOI: 10.3390/medicina56030127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50–75% to 15–30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. Materials and Methods: A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. Results: Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, p < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), p = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, p < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, p < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.
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Affiliation(s)
- Dalia Rukanskienė
- Department of Radiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
- Correspondence: ; Tel.: +370-68-219472
| | - Vincentas Veikutis
- Institute of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50162 Kaunas, Lithuania;
| | - Eglė Jonaitienė
- Department of Radiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Milda Basevičiūtė
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (M.B.); (D.K.)
| | - Domantas Kunigiškis
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (M.B.); (D.K.)
| | - Renata Paukštaitienė
- Department of Physics, Mathematics and Biophysics, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania;
| | - Daiva Čepulienė
- Department of Surgery, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (D.Č.); (A.B.)
| | - Lina Poškienė
- Department of Pathological Anatomy, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Algirdas Boguševičius
- Department of Surgery, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (D.Č.); (A.B.)
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Iwamoto N, Miyamoto H, Horiguchi S, Honda Y, Aruga T. Application of the Z1071 criteria: classification of axillary lymph nodes on ultrasound after neoadjuvant chemotherapy in initially node-positive breast cancer. J Med Ultrason (2001) 2020; 47:299-303. [PMID: 32112307 DOI: 10.1007/s10396-020-01010-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/17/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial assessed the accuracy of sentinel lymph node biopsies in clinically node-positive patients who underwent neoadjuvant chemotherapy (NAC). Axillary ultrasound (US) images after NAC were reviewed, and the accuracy of classifying nodes into six types according to the ACOSOG Z1071 trial was determined. METHODS This study included 69 patients who underwent NAC followed by curative surgery for breast cancer including axillary lymph node dissection between January 2010 and July 2019. All patients were pathologically confirmed as being initially node positive. Lymph nodes were retrospectively classified into one of six types based on the appearance of the nodal cortex and hilum. Types I and II were classified as having normal nodal morphology, whereas types III, IV, V, and VI were classified as having suspicious nodal morphology. These node types on US images after NAC were compared between patients with an axillary complete response (Ax-pCR) and those with residual metastatic lymph nodes (Ax-non-pCR) using Chi-square tests. RESULTS Twenty-four (35%) of the 69 patients achieved Ax-pCR. Patients with nodes classified as type I or II were more likely to achieve Ax-pCR (83% vs. 36%, p = 0. 0002). CONCLUSION The classification of six node types was associated with nodal status.
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Affiliation(s)
- Naoko Iwamoto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Hiromi Miyamoto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Shinichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yayoi Honda
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tomoyuki Aruga
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Verhaegen F, Debeer P, Moyaert M. The Accessory muscles of the Axilla. Acta Orthop Belg 2019; 85:421-428. [PMID: 32374231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The axilla is a region of clinical and surgical importance with plenty of anatomical variations. One of these is the presence of accessory muscles. The literature was reviewed in order to identify the different supernumerary muscles that are described in the axilla. Variant muscle slips arising from the pectoral muscle or latissimus dorsi muscle have been described. There still remains controversy regarding the phylogenetic origin of these different muscles. We described the most frequently reported muscles, their origin, and course. Further research is required regarding the innervation and influence on glenohumeral and scapulothoracic kinematics.
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Coronado-Gutiérrez D, Santamaría G, Ganau S, Bargalló X, Orlando S, Oliva-Brañas ME, Perez-Moreno A, Burgos-Artizzu XP. Quantitative Ultrasound Image Analysis of Axillary Lymph Nodes to Diagnose Metastatic Involvement in Breast Cancer. Ultrasound Med Biol 2019; 45:2932-2941. [PMID: 31444031 DOI: 10.1016/j.ultrasmedbio.2019.07.413] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to assess the potential of state-of-the-art ultrasound analysis techniques to non-invasively diagnose axillary lymph nodes involvement in breast cancer. After exclusion criteria, 105 patients were selected from two different hospitals. The 118 lymph node ultrasound images taken from these patients were divided into 53 cases and 65 controls, which made up the study series. The clinical outcome of each node was verified by ultrasound-guided fine needle aspiration, core needle biopsy or surgical biopsy. The achieved accuracy of the proposed method was 86.4%, with 84.9% sensitivity and 87.7% specificity. When tested on breast cancer patients only, the proposed method improved the accuracy of the sonographic assessment of axillary lymph nodes performed by expert radiologists by 9% (87.0% vs 77.9%). In conclusion, the results demonstrate the potential of ultrasound image analysis to detect the microstructural and compositional changes that occur in lymph nodes because of metastatic involvement.
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Affiliation(s)
- David Coronado-Gutiérrez
- Transmural Biotech S. L., Barcelona, Spain; Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic de Barcelona (University of Barcelona) and Hospital Sant Joan de Deu, Barcelona, Spain.
| | - Gorane Santamaría
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Sergi Ganau
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Xavier Bargalló
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Stefania Orlando
- Radiology Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - M Eulalia Oliva-Brañas
- Radiology Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - Alvaro Perez-Moreno
- Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic de Barcelona (University of Barcelona) and Hospital Sant Joan de Deu, Barcelona, Spain
| | - Xavier P Burgos-Artizzu
- Transmural Biotech S. L., Barcelona, Spain; Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic de Barcelona (University of Barcelona) and Hospital Sant Joan de Deu, Barcelona, Spain
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Khoury T, Mendez ALR, Peng X, Yan L, Racila E. Clinicopathologic characteristics of malignant non-hematopoietic tumors first presented as an axillary mass with emphasis on occult breast carcinoma. Int J Clin Oncol 2019; 25:292-300. [PMID: 31584107 DOI: 10.1007/s10147-019-01555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Non-hematopoietic malignancies first presented as an axillary mass constitute a unique clinical presentation. We investigated the incidence of various types of malignancies and aimed to define clinicopathologic variables that may assist in the diagnosis, with focus on occult breast carcinoma (OBC). DESIGN We reviewed the pathology reports of cases with non-hematopoietic malignancies of the axillary region in our institution between 2000 and 2016. We included patients who presented first with axillary mass and with the absence of a known primary. We recorded patients' age and gender, tumor characteristics including size, histologic type, number of positive lymph nodes, and the clinical management. Then we focused on BC which were divided into OBC or primary BC (PBC). RESULTS There were 100 cases that met our criteria (28 melanoma, 7 sarcoma and 65 carcinoma). For carcinoma cases, there were 42 BC (19 OBC, 17 PBC, and 6 possible OBC), 17 non-BC, and 6 carcinoma of unknown primary (CUP). Tumors found incidentally were more likely to be of breast primary (p = 0.01). Larger tumor size (in mm) favored melanoma or sarcoma over BC, non-BC carcinoma or CUP with median and range 61 (15, 180), 60 (23, 80), 30 (15, 75), 31 (17, 90), 26 (20, 55), respectively (p < 0.001). There were no differences in the histopathologic findings or clinical presentation. CONCLUSIONS More than half of the patients with axillary malignancy have a tumor of non-breast origin. Therefore, clinical and pathologic studies are warranted to identify the primary site.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | | | - Xuan Peng
- Department of Biostatics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Li Yan
- Department of Biostatics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Emilian Racila
- Department of Pathology, University of Minnesota, Minneapolis, MN, USA
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Yu FH, Wang JX, Ye XH, Deng J, Hang J, Yang B. Ultrasound-based radiomics nomogram: A potential biomarker to predict axillary lymph node metastasis in early-stage invasive breast cancer. Eur J Radiol 2019; 119:108658. [PMID: 31521878 DOI: 10.1016/j.ejrad.2019.108658] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/20/2019] [Accepted: 09/01/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To establish a radiomics nomogram integrating clinical factors and radiomics features from ultrasound for the preoperative diagnosis axillary lymph node (ALN) status in patients with early-stage invasive breast cancer (EIBC). MATERIALS AND METHODS Between September 2016 and December 2018, four hundred twenty-six ultrasound manually segmented images of patients with EIBC were enrolled in our retrospective study, which were divided into a primary cohort (n = 300) and a validation cohort (n = 126). A radiomics signature was built with the least absolute shrinkage and selection operator (LASSO) algorithm in the primary cohort. Multivariable logistic regression analysis was used to establish a radiomics nomogram model based on radiomics signature and clinical variables. The performance of nomogram was quantified with respect to discrimination and calibration. The radiomics model was further evaluated in the internal validation cohort. RESULTS The radiomics signature, consisted of fourteen selected ALN-status-related features, achieved moderate prediction efficacy with an area under the curve (AUC) of 0.78 and 0.71 in the primary and validation cohorts respectively. The radiomics nomogram, comprising tumor size, US-reported LN status and radiomics signature, showed good calibration and favorite performance for ALN detection (AUC 0.84 and 0.81 in the primary and validation cohort). The decision curve which was demonstrated the radiomics nomogram displayed good clinical utility. CONCLUSION The radiomics nomogram could hold promise as a non-invasive and reliable tool in predicting ALN metastasis and may facilitate to develop more effective preoperative decision-making.
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Affiliation(s)
- Fei-Hong Yu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian-Xiang Wang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin-Hua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Hang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Yang
- Department of Ultrasound, Jinling Clinical Medical College, Nanjing Medical University, Nanjing, China.
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Hankó-Bauer O, Podoleanu C, Georgescu R, Stolnicu S. The Accuracy of the Preoperative Axillary Ultrasound Examination in Predicting the Status of the Sentinel Lymph Node Involvement in Patients with Infiltrating Breast Carcinoma. Chirurgia (Bucur) 2019; 114:384-391. [PMID: 31264577 DOI: 10.21614/chirurgia.114.3.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2019] [Indexed: 11/23/2022]
Abstract
Background: we aimed to determine the accuracy of preoperative axillary ultrasound (US) in predicting the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. Methods and Results: out of 54 cases, visible nodes on US were identified in 35 cases of which, 15 had metastasis. In 19 cases no axillary lymph nodes were visible on US. Of these, only 3 had metastasis. Moreover, our results demonstrated that neither the maximum diameter (p=0.738 Fisher exact test) nor the ratio between the longitudinal and transverse axes (p=0.728 Fisher exact test) can predict the positivity of the SLN. Conclusion: US cannot predict the positivity of the SLN.
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Li JW, Tong YY, Jiang YZ, Shui XJ, Shi ZT, Chang C. Clinicopathologic and Ultrasound Variables Associated With a Heavy Axillary Nodal Tumor Burden in Invasive Breast Carcinoma. J Ultrasound Med 2019; 38:1747-1755. [PMID: 30480341 DOI: 10.1002/jum.14863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To identify clinicopathologic and ultrasound (US) variables that were associated with a heavy nodal tumor burden, which was defined as 3 or more lymph nodes involved with metastasis to the axilla after invasive breast carcinoma. METHODS With ethical approval, 621 patients with a pathologic diagnosis of invasive breast carcinoma were retrospectively analyzed for clinical, pathologic, and US data. Pathologic findings were ascertained by the final paraffin pathologic analysis. Ultrasound characteristics were evaluated on the basis of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS). Univariate and multivariate logistic regression analyses were used to assess the clinicopathologic and US variables that were associated with a heavy nodal tumor burden at the axilla. RESULTS There were 107 cases (17.2%) of invasive breast carcinoma with a heavy tumor burden at the axilla. The independent clinicopathologic variables for a heavy tumor burden at the axilla included a tumor size of 2 to 5 cm (odds ratio [OR], 1.86; P = .036), the presence of lymphovascular invasion (OR, 23.52; P < .001), the presence of papillary invasion (OR, 2.93; P = .043), and a non-triple-negative subtype (OR, 2.34; P = .04). The independent US features of breast tumors that were associated with a heavy tumor burden at the axilla included BI-RADS category 5 (OR, 5.50; P = .024) and a posterior acoustic shadow (OR, 1.94; P = .024). CONCLUSIONS A large tumor size, lymphovascular invasion, papillary invasion, and a non-triple-negative subtype on the pathologic analysis as well as BI-RADS category 5 and a posterior acoustic shadow on a US assessment were associated with a heavy nodal tumor burden at the axilla. These US characteristics of the primary breast carcinoma might provide additional information to axillary US for the prediction of axillary nodal tumor loads.
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Affiliation(s)
- Jia-Wei Li
- Departments of Medical Ultrasound, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Yang Tong
- Departments of Medical Ultrasound, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Zhou Jiang
- Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu-Juan Shui
- Department of Medical Ultrasound, Wenzhou People's Hospital, Third Clinical Institute, affiliated with Wenzhou Medical University, Wenzhou, China
| | - Zhao-Ting Shi
- Departments of Medical Ultrasound, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Departments of Medical Ultrasound, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Almerey T, Villacreses D, Li Z, Patel B, McDonough M, Gibson T, Maimone S, Gray R, McLaughlin SA. Value of Axillary Ultrasound after Negative Axillary MRI for Evaluating Nodal Status in High-Risk Breast Cancer. J Am Coll Surg 2019; 228:792-797. [PMID: 30797947 DOI: 10.1016/j.jamcollsurg.2019.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is assumed that axillary ultrasound (AxUS) is the best method for axillary nodal evaluation in newly diagnosed breast cancer patients. However, few have evaluated the efficacy of preoperative axillary MRI. We compared the statistical accuracy of AxUS and MRI in detecting nodal metastases among breast cancer patients who were selected for neoadjuvant chemotherapy. STUDY DESIGN We retrospectively analyzed 219 breast cancer patients undergoing neoadjuvant chemotherapy from 2007 to 2015, all of whom had AxUS and breast MRI before chemotherapy. Two breast radiologists, blinded to clinical, pathologic, and AxUS findings, re-reviewed all breast MRIs, specifically focusing on axillary nodal characteristics. We correlated clinico-pathologic characteristics, AxUS, and MRI findings, and quantified predictive values of both imaging modalities. RESULTS Overall, 101 of 219 (47%) patients had T2 tumors. The most common abnormal nodal finding was size >10 mm. Axillary ultrasound and MRI agreed on nodal status in 192 of 219 patients (87.6%). When correlated with pre-chemotherapy needle biopsy in 129 patients, AxUS and axillary MRI performed similarly (sensitivity of 99.1% vs 97.4% and specificity 15.4% vs 15.4%, respectively). Only 4 of 129 (3.1%) patients had a negative MRI and positive AxUS; 3 of 4 of these patients (75%) had a positive biopsy and 2 of 3 had positive lymph nodes on final pathology, therefore suggesting MRI missed clinically significant disease in only 2 of 129 (1.5%) patients. CONCLUSIONS In a high-risk patient population, AxUS and MRI have similar statistical profiles in evaluating axillary nodal status. Routine use of AxUS after a normal axillary MRI is not warranted.
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Affiliation(s)
- Tariq Almerey
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL
| | | | - Zhuo Li
- Department of Health Sciences Research and Biostatistics, Mayo Clinic Florida, Jacksonville, FL
| | - Bhavika Patel
- Department of Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Tammeza Gibson
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL
| | - Santo Maimone
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL
| | - Richard Gray
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
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Tandon M, Ball W, Kirby R, Soumian S, Narayanan S. A comparative analysis of axillary nodal burden in ultrasound/biopsy positive axilla vs ultrasound negative sentinel lymph node biopsy positive axilla. Breast Dis 2019; 38:93-96. [PMID: 30909179 DOI: 10.3233/bd-160230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Axillary Ultrasound (AUS) is now performed as a protocol in every newly diagnosed breast cancer in most European countries. It is an inexpensive and sensitive tool in hands of a trained operator. All AUS negative patients undergo Sentinel Lymph Node Biopsy (SLNB), while AUS positive patients bypass SLNB and undergo axillary nodal clearance (ANC) as a standard protocol. We wish to analyse these two groups to see if ANC can be foregone in these patients. AIMS AND OBJECTIVES To compare and analyse the axillary disease burden in early breast cancer patients, with positive axilla, detected by AUS+ Biopsy versus those patients with normal axillary ultrasound or negative axillary biopsy that underwent ANC due to positive SLNB. MATERIAL AND METHODS A retrospective review of all patients who underwent axillary lymph node clearance following histologically confirmed positive ultrasound (US) axilla (year 2009-2014) was performed and was compared with data collected for patients with USG negative but SLNB (OSNA- One Step Nucleic Acid Amplification) positive axilla. RESULTS Axillary clearances performed for positive US axilla yielded significantly more positive lymph nodes than SLNB/OSNA positive axilla (p = 0.00496). These patients also had larger primary tumours (median 33 mm versus 21 mm, p = 0.01242) of a higher grade. Almost half of the patients in AUS positive group (49%) had high axillary nodal burden (>4 LNs). This is in great contrast with AUS negative, SLNB/OSNA positive group where 82.7% of patients had <4 positive nodes with more than half patients (51.7%) having no further positive nodes in their final histopathology specimen. CONCLUSIONS ANC should be a standard protocol in AUS positive patients as they invariably have high axillary disease burden while ANC can be omitted in case of select AUS negative and SLNB patients. However, further studies with more subjects may be require to substantiate the findings.
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Affiliation(s)
- Megha Tandon
- University Hospital of North Midlands and Keele University, Stoke On Trent, UK
| | - William Ball
- University Hospital of North Midlands and Keele University, Stoke On Trent, UK
| | - Robert Kirby
- Breast Unit, University Hospital of North Midlands and Keele University, Stoke On Trent, UK
| | - Soni Soumian
- Breast Unit, University Hospital of North Midlands and Keele University, Stoke On Trent, UK
| | - Sankaran Narayanan
- Breast Unit, University Hospital of North Midlands and Keele University, Stoke On Trent, UK
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Nurudeen S, Hunt KK. Contemporary management of the axilla in breast cancer. Clin Adv Hematol Oncol 2018; 16:823-831. [PMID: 30843891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The care of patients with breast cancer in the modern era involves a multimodal approach to treating locoregional and distant disease. Recent studies have demonstrated that the extent of surgical intervention in both the breast and axilla can be minimized through a personalized approach based on breast cancer stage, subtype, and planned adjuvant therapies. The older approach focused on complete removal of the axillary contents for appropriate staging and to determine the need for adjuvant systemic therapy and radiation. This approach has been replaced by sentinel lymph node biopsy, which allows for axillary staging with the removal of only the nodes most likely to contain metastatic disease. Sentinel lymph node biopsy obviates the need for complete axillary lymph node dissection in patients with node-negative disease. Clinical trials have also shown that axillary dissection can be avoided in those patients with low axillary disease burden in the sentinel nodes who are undergoing breast-conserving therapy. Radiation can also be used as an alternative to axillary dissection in patients with positive sentinel nodes, without increasing the risk for regional recurrence. Further studies are needed in patients undergoing mastectomy to determine the optimal strategy for axillary management in the setting of limited disease in the sentinel nodes. The use of neoadjuvant chemotherapy allows the ability to evaluate an individual tumor's response to therapy, thereby increasing the possibility of breast-conserving surgery and reduction in the extent of axillary surgery. This review will explore the evolution of management of the axilla in patients with clinically node-negative and node-positive disease, and will provide insights into future directions in breast cancer care.
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Affiliation(s)
- Suliat Nurudeen
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Kelly K Hunt
- University of Texas MD Anderson Cancer Center, Houston, Texas
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38
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Michelin P, Legrand J, Lee KS, Leleup G, Etancelin M, Banse C, Dacher JN, Duparc F. Axillary Sonography of the Shoulder: An Adjunctive Approach. J Ultrasound Med 2018; 37:2707-2715. [PMID: 29575005 DOI: 10.1002/jum.14601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
Sonography of the shoulder is widely used to assess various disorders, including tendinous diseases of the rotator cuff and the long head of the biceps brachii muscle. The shoulder is commonly explored through anterior, superior, and posterior approaches, but the inferior axillary approach is rarely considered in the literature. However, this technique allows the direct visualization of relevant anatomic structures. The aim of this pictorial essay is, first, to technically describe this approach and the normal musculoskeletal sonographic anatomy of the region and, second, to present the sonographic findings of shoulder disorders that may be helpfully explored this technique.
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Affiliation(s)
- Paul Michelin
- Department of Radiology, Rouen University Hospital, Rouen, France
- Laboratory of Anatomy, Faculty of Medicine and Pharmacy of Rouen, University of Normandie, Rouen, France
- CETAPS Laboratory, Faculty of Sports Science of Rouen, University of Normandie, Rouen, France
| | - Julie Legrand
- Department of Radiology, Rouen University Hospital, Rouen, France
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Grégoire Leleup
- Department of Radiology, Rouen University Hospital, Rouen, France
| | | | - Christopher Banse
- Department of Rheumatology, Rouen University Hospital, Rouen, France
| | | | - Fabrice Duparc
- Department of Orthopedic Surgery and Traumatology, Rouen University Hospital, Rouen, France
- Laboratory of Anatomy, Faculty of Medicine and Pharmacy of Rouen, University of Normandie, Rouen, France
- CETAPS Laboratory, Faculty of Sports Science of Rouen, University of Normandie, Rouen, France
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Chen TJ, Tsai YF, Chou YH, Chen LK, Chiou HJ, Lai YC, Lin YH, Wang HK, Tiu CM. Shoulder joint synovial chondromatosis presenting as multiple axillary masses: A case report. J Clin Ultrasound 2018; 46:361-363. [PMID: 29159809 DOI: 10.1002/jcu.22555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/25/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue, tenosynovium, or bursal lining. We describe the case of a patient who initially presented with multiple axillary masses. Breast ultrasound (US) was requested due to the concern of a breast tumor with axillary lymph node metastases. US study was helpful and provided adequate information to suggest the diagnosis.
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Affiliation(s)
- Tai-Jui Chen
- Department of Radiology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Yuh-Feng Tsai
- Department of Radiology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Kuang Chen
- Department of Radiology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yung-Hui Lin
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chui-Mei Tiu
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
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Fricke IB, De Souza R, Costa Ayub L, Francia G, Kerbel R, Jaffray DA, Zheng J. Spatiotemporal assessment of spontaneous metastasis formation using multimodal in vivo imaging in HER2+ and triple negative metastatic breast cancer xenograft models in mice. PLoS One 2018; 13:e0196892. [PMID: 29723251 PMCID: PMC5933713 DOI: 10.1371/journal.pone.0196892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background Preclinical breast cancer models recapitulating the clinical course of metastatic disease are crucial for drug development. Highly metastatic cell lines forming spontaneous metastasis following orthotopic implantation were previously developed and characterized regarding their biological and histological characteristics. This study aimed to non-invasively and longitudinally characterize the spatiotemporal pattern of metastasis formation and progression in the MDA-MB-231-derived triple negative LM2-4 and HER2+ LM2-4H2N cell lines, using bioluminescence imaging (BLI), contrast enhanced computed tomography (CT), fluorescence imaging, and 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography ([18F]FDG-PET). Material and methods LM2-4, LM2-4H2N, and MDA-MB-231 tumors were established in the right inguinal mammary fat pad (MFP) of female SCID mice and resected 14–16 days later. Metastasis formation was monitored using BLI. Metabolic activity of primary and metastatic lesions in mice bearing LM2-4 or LM2-4H2N was assessed by [18F]FDG-PET. Metastatic burden at study endpoint was assessed by CT and fluorescence imaging following intravenous dual-modality liposome agent administration. Results Comparable temporal metastasis patterns were observed using BLI for the highly metastatic cell lines LM2-4 and LM2-4H2N, while metastasis formed about 10 days later for MDA-MB-231. 21 days post primary tumor resection, metastases were detected in 86% of LM2-4, 69% of LM2-4H2N, and 60% of MDA-MB-231 inoculated mice, predominantly in the axillary region, contralateral MFP, and liver/lung. LM2-4 and LM2-4H2N tumors displayed high metabolism based on [18F]FDG-PET uptake. Lung metastases were detected as the [18F]FDG-PET uptake increased significantly between pre- and post-metastasis scan. Using a liposomal dual-modality agent, CT and fluorescence confirmed BLI detected lesions and identified additional metastatic nodules in the intraperitoneal cavity and lung. Conclusions The combination of complementary anatomical and functional imaging techniques can provide high sensitivity characterization of metastatic disease spread, progression and overall disease burden. The described models and imaging toolset can be implemented as an effective means for quantitative treatment response evaluation in metastatic breast cancer.
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Affiliation(s)
- Inga B. Fricke
- TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Raquel De Souza
- TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lais Costa Ayub
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Giulio Francia
- Biological Sciences Platform, Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Robert Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - David A. Jaffray
- TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jinzi Zheng
- TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Tongsong T, Luewan S, Khorana J, Sirilert S, Charoenratana C. Natural Course of Fetal Axillary Lymphangioma Based on Prenatal Ultrasound Studies. J Ultrasound Med 2018; 37:1273-1281. [PMID: 29119576 DOI: 10.1002/jum.14473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/13/2017] [Indexed: 06/07/2023]
Abstract
This series and literature review aimed to prenatally characterize the nature of axillary lymphangioma. A total of 30 cases, including our 5 cases, were analyzed. Insights gained from this review are as follows: Septate and nonseptate cysts seem to be different entities. The nonseptate type tends to be small and transient but more highly associated with aneuploidies. Septate cysts are very rarely associated with other abnormalities and hydrops fetalis, unlike cystic hygroma colli, but are more progressive with gestational age and associated with adverse outcomes. The cases with high flow have a higher risk of intralesional hemorrhage. Prenatal diagnosis is important for the route of timely delivery and possibly prenatal interventions. Shoulder dystocia is common and should always be taken into account for decisions on the route of delivery.
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Affiliation(s)
- Theera Tongsong
- Departments of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | - Suchaya Luewan
- Departments of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | - Jiraporn Khorana
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinart Sirilert
- Departments of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
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Abstract
RATIONALE The ultrasound manifestations of granular cell tumor (GCT) is a consequence of the histopathological characteristic of the tumor and can be distinguished from breast cancer. PATIENT CONCERNS A GCT is a rare, benign, hyperplasia-based lesion. Approximately 1% to 2% of GCTs are malignant. About 5% to15% of the cases occur in the breast, and it is relatively rare in the axillary accessory breast. There are no effective preventive measures for GCTs, early detection combined with a thorough and wide complete resection of the tumor remains the best treatment for a favorable outcome. DIAGNOSES A 45-year-old female patient with an axillary mass of more than 3 months duration was examined through physical examination, color Doppler ultrasound and postoperative pathology. INTERVENTIONS A provisional diagnosis of left axillary lymph node enlargement was made and necessary investigations were advised. OUTCOMES A differential diagnosis of accessory breast in the left arm pit, possibly malignant, or a solid mass in the left arm pit secondary to chronic inflammation. Postoperative pathology: GCT of axillary accessory breast, with tumor-free margins. Immunohistochemical staining showed strong S-100 positivity, CD68 positivity, and negative periodic acid-Schiff staining. LESSONS The ultrasound examination can detect GCT mass in the breast/accessory breast and is not easy to misdiagnosis.
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Affiliation(s)
| | - Meiying Tao
- VIP Ward, Qianfoshan Hospital of Shandong University, Jinan, Shandong, China
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Abstract
RATIONALE Occult breast cancer (OBC) is extremely rare in males with neither symptoms in the breast nor abnormalities upon imaging examination. PATIENT CONCERNS This current case report presents a young male patient who was diagnosed with male OBC first manifesting as axillary lymph node metastasis. The physical and imaging examination showed no primary lesions in either breasts or in other organs. DIAGNOSES The pathological results revealed infiltrating ductal carcinoma in the axillary lymph nodes. Immunohistochemical (IHC) staining was negative for estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK)20 and thyroid transcription factor-1 (TTF-1), positive for CK7, gross cystic disease fluid protein-15 (GCDFP-15), epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), and suspicious positive for human epidermal receptor-2 (Her-2). On basis of IHC markers, particularly such as CK7, CK20 and GCDFP-15, and eliminating other malignancies, male OBC was identified in spite of negativity for hormone receptors. INTERVENTIONS The patient underwent left axillary lymph node dissection (ALND) but not mastectomy. After the surgery, the patient subsequently underwent chemotherapy and radiotherapy. OUTCOMES The patient is currently being followed up without any signs of recurrence. LESSONS Carefully imaging examination and pathological analysis were particularly essential in the diagnosis of male OBC. The guidelines for managing male OBC default to those of female OBC and male breast cancer.
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MESH Headings
- Adult
- Axilla/diagnostic imaging
- Axilla/pathology
- Breast Neoplasms, Male/diagnostic imaging
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Humans
- Lymph Node Excision
- Lymphatic Metastasis
- Male
- Neoplasms, Unknown Primary/diagnostic imaging
- Neoplasms, Unknown Primary/pathology
- Neoplasms, Unknown Primary/therapy
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Affiliation(s)
- Ruixin Xu
- Medicine and Life Sciences College of Shandong Academy of Medical Sciences, University of Jinan
- Department of Radiation Oncology
| | | | | | - Hongbiao Jing
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Youzhe Zhu
- Medicine and Life Sciences College of Shandong Academy of Medical Sciences, University of Jinan
- Department of Radiation Oncology
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Park JU, Bae HS, Lee SM, Bae J, Park JW. Removal of a subdermal contraceptive implant (Implanon NXT) that migrated to the axilla by C-arm guidance: A case report and review of the literature. Medicine (Baltimore) 2017; 96:e8627. [PMID: 29310336 PMCID: PMC5728737 DOI: 10.1097/md.0000000000008627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE To report the distant migration of a subdermal contraceptive implant and to suggest that C arm-guided technique is one of the feasible options for removal of the device migrated to the axilla. PATIENT CONCERNS A 41-year-old multipara with tingling sensation in the left axilla was referred for removal of an Implanon NXT which could not be palpated by physical examination or detected by ultrasound scanning. Finally, the device was detected by computed tomography and found migrating to the left axilla. DIAGNOSIS Migration of Implanon NXT to the left axilla abutting the brachial plexus. INTERVENTIONS The device was removed by C arm-guiding. OUTCOMES The patient went home without any procedure-related complications. LESSONS The incidence of distant migration of a subdermal implant is possible and should be checked up regularly. If the device cannot be palpated or detected by ultrasound at the original implanting site, this should be concerned. Since the single-rod subdermal implant is radiopaque, it can be detected by roentgenography. In this case the distant migration was detected in the axilla, therefore using C arm-guided technique is feasible for the removal of the migrating device. After reviewing the literature, totally 10 cases of distant migration were reported including 2 cases of migration which were advanced further to the pulmonary artery as an embolization.
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Affiliation(s)
- Ji Ung Park
- Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul
| | - Han Sol Bae
- Department of Plastic and Reconstructive Surgery
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
| | - Jaehoon Bae
- Korea Association of Health Promotion Medicheck
| | - Jeong Woo Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju, Republic of Korea
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Chang KV, Lin CP, Lin CS, Wu WT, Özçakar L. A Novel Approach for Ultrasound Guided Axillary Nerve Block: The Inferior Axilla Technique. Med Ultrason 2017; 19:457-461. [PMID: 29197927 DOI: 10.11152/mu-1232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chia-Shiang Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, and Mackay Medical College, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
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Ozturk O, Tezcan AH, Bilge A, Ateş H, Yagmurdur H, Erbas M. Evaluation of the relationship between the topographical anatomy in the axillary region of the brachial plexus and the body mass index. J Clin Monit Comput 2017; 32:779-784. [PMID: 28871408 DOI: 10.1007/s10877-017-0062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
To investigate the topographic anatomy of the median, musculocutaneous, radial and ulnar nerves with respect to the axillary artery and to seek whether these configurations are associated with baseline descriptive data including age, gender, and body-mass index. This cross-sectional trial was carried out on 199 patients (85 women, 114 men; average age: 46.78 ± 15.45 years) in the department of anaesthesiology and reanimation of a tertiary care center. Topographic anatomy of the median, musculocutaneous, radial and ulnar nerves was assessed with ultrasonography. Localization of these nerves with respect to the axillary artery was marked on the map demonstrating 16 zones around the axillary artery. Frequencies of localizations of every nerve in these zones were recorded, and the correlation of these locations with descriptive data including age, gender and BMI was investigated. There was no difference between women and men for the distribution of the median (p = 0.74), ulnar (p = 0.35) and radial (p = 0.64) nerves. However, the musculocutaneous nerve was more commonly located in Zone A13 in men compared to women (p = 0.02). The localization of the median (p = 0.85), ulnar (p = 0.27) and radial (p = 0.88) nerves did not differ remarkably between patients with BMI < 25 kg/m2 and patients with BMI ≥ 25 kg/m2. Notably, the musculocutaneous nerve was more often determined in Zone A10 in cases with BMI ≥ 25 kg/m2 (p = 0.001). Our results imply that the alignment of the musculocutaneous nerve may vary in men and overweight people. This fact must be considered by the anaesthetist before planning the axillary block of brachial plexus. All these informations may enlighten the planning stages of the brachial plexus blockade.
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Affiliation(s)
- Omur Ozturk
- Department of Anaesthesiology and Reanimation, Canakkale 18 Mart University, Canakkale, Turkey.
| | - Aysu Hayriye Tezcan
- Department of Anaesthesiology and Reanimation, Kafkas University, Kars, Turkey
| | - Ali Bilge
- Department of Orthopedics and Traumatology, Kafkas University, Kars, Turkey
| | - Hakan Ateş
- Department of Anaesthesiology and Reanimation, Ahi Evran University, Kırşehir, Turkey
| | - Hatice Yagmurdur
- Department of Anaesthesiology and Reanimation, Kafkas University, Kars, Turkey
| | - Mesut Erbas
- Department of Anaesthesiology and Reanimation, Canakkale 18 Mart University, Canakkale, Turkey
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Karabulut D, Kula O, Ustabasioglu FE, Tastekin E, Tunçbilek N. Imaging findings of axillary cystic lymphangioma in adult. Diagn Interv Imaging 2017; 99:111-113. [PMID: 28735807 DOI: 10.1016/j.diii.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 11/19/2022]
Affiliation(s)
- D Karabulut
- Uzunkopru State Hospital, Department of Radiology, Edirne, Turkey
| | - O Kula
- Fatih Sultan Mehmet Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - F E Ustabasioglu
- Çanakkale State Hospital, Department of Radiology, 17100 Merkez-Çanakkale, Turkey.
| | - E Tastekin
- Trakya University, Medical School, Department of Pathology, Edirne, Turkey
| | - N Tunçbilek
- Trakya University, Medical School, Department of Radiology, Edirne, Turkey
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48
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Lim HS, Kim SJ, Baek JM, Kim JW, Shin SS, Seon HJ, Heo SH. Sonographic Findings of Accessory Breast Tissue in Axilla and Related Diseases. J Ultrasound Med 2017; 36:1469-1478. [PMID: 28370098 DOI: 10.7863/ultra.16.06056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/23/2016] [Indexed: 06/07/2023]
Abstract
Accessory breast tissue results from failed regression of primitive mammary tissue and is most often located in the axilla. Accessory breast tissue itself is normal and should not be misdiagnosed as an abnormality. Both benign and malignant diseases that occur in the normal breast can also develop in accessory breast tissue in the axilla. In this pictorial essay, we show sonographic findings of normal accessory breast tissue in the axilla and various lesions that occur in accessory axillary breast tissue, along with other imaging findings and pathologic features.
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Affiliation(s)
- Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Shin Jung Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jang Mi Baek
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Jin Woong Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Seon
- Department of Radiology, Chosun University School of Medicine, Gwangju, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
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Grama F, Voiculescu Ș, Vîrga E, Burcoş T, Cristian D. Bilateral Axillary Accessory Breast Tissue Revealed by Pregnancy. Chirurgia (Bucur) 2017; 111:527-531. [PMID: 28044958 DOI: 10.21614/chirurgia.111.6.527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 11/23/2022]
Abstract
We illustrate a rare case of a 28 year-old woman with bilateral axillary masses, which were uncovered during her first pregnancy only and grew progresively in size ever since. On local examination, there were two 5/3/5 cm masses with benign clinical characteristics, developed apparently on the axillary extension of the mammary gland. During lactation, a milk-like liquid was evacuated through a brownish, rudimentary, nipple located in the center of each axillary masses. One year after parturition, the MRI showed bilateral axillary breast tissue appearance, separated from the eutopic mammary gland, but having similar signal intensity. Due to aesthetic reasons and the additional risk for subsequent malignant or benign breast disease, the ectopic breast tissues were completely surgically removed. The histology report showed normal glandular breast tissue.
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50
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Mema E, Cho E, Ha R, Taback B. Cystic metastatic lymph nodes in malignant melanoma: a case report. Clin Imaging 2016; 42:158-160. [PMID: 28012358 DOI: 10.1016/j.clinimag.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/08/2016] [Accepted: 12/13/2016] [Indexed: 11/20/2022]
Abstract
Melanoma is a rare type of skin cancer with a high mortality rate. Local invasion and metastatic spread are primarily responsible for the morbidity and mortality of melanoma. While metastatic lesions vary from cystic to solid, cystic metastases can be challenging to diagnose. Up to date, there are only a few published studies that describe cystic metastases in melanoma and other conditions such as lymphoma, squamous cell carcinoma and thyroid papillary carcinoma. We describe a case of cystic metastatic axillary lymph nodes in a patient with subungual acral lentiginous melanoma and the challenges to reaching an accurate diagnosis.
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Affiliation(s)
- Eralda Mema
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
| | - Emma Cho
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
| | - Richard Ha
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
| | - Bret Taback
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032, United States.
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