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Sample records for axillary lymph nodes

  1. Axillary lymph node analysis using Raman spectroscopy

    Science.gov (United States)

    Smith, Jenny; Christie-Brown, Jonathan; Sammon, Alastair; Stone, Nicholas

    2004-07-01

    Raman Spectroscopy is an optical diagnostic technique applied in this study to classify axillary lymph nodes from breast cancer patients as positive or negative for metastases. The mapping technique in this study is 81% sensitive and 97% specific for the correct classification of positive lymph nodes. Raman spectral images of lymph node sections are constructed to facilitate interpretation of tissue features.

  2. Axillary recurrence after sentinel lymph node biopsy

    NARCIS (Netherlands)

    van der Vegt, B; Doting, MHE; Jager, PL; Wesseling, J; de Vries, J

    2004-01-01

    Sentinel lymph node biopsy (SLNB) without further axillary dissection in patients with sentinel node-negative breast carcinoma appears to be a safe procedure to ensure locoregional control. During a median follow-up of 35 months the false-negative rate was 1% in our study population of 185 patients.

  3. Clinical implications of contralateral axillary sentinel lymph nodes.

    Science.gov (United States)

    Carmon, Moshe; Mintz, Alexander; Hain, Daniel; Olsha, Oded

    2006-04-01

    Extra-axillary sentinel lymph nodes can only be detected if radioactive tracer is used and pre-operative scans are carried out. The presence of metastatic sentinel lymph nodes in most extra-axillary sites will upstage patients if the ipsilateral axillary sentinel lymph node is normal. Paradoxically, the presence of metastatic sentinel lymph nodes in the contralateral axilla has the potential to prevent upstaging to stage IV, but only if detected as a sentinel node at the initial surgery rather than as a systemic recurrence at some later time. We describe a case of bilateral axillary sentinel lymph nodes detected by pre-operative lymphoscintigraphy in a patient with a medial quadrant breast cancer and discuss the possible implications of such a finding. PMID:16005230

  4. Variability in axillary lymph node dissection for breast cancer

    NARCIS (Netherlands)

    Schaapveld, M; Otter, R; De Vries, EGE; Fidler, [No Value; Van der Graaf, WTA; De Vogel, PL; Willemse, PHB

    2004-01-01

    Background: The axillary nodal status may influence the prognosis and the choice of adjuvant treatment of individual breast cancer patients. The variation in number of reported axillary lymph nodes and its effect on the axillary nodal stage were studied and the implications are discussed. Methods: B

  5. Axillary sentinel lymph node biopsy after mastectomy: a case report

    OpenAIRE

    Hahm George; Henry Leonard R; Vicente Diego A; Soballe Peter W; Smart DeeDee

    2010-01-01

    Abstract Background Sentinel lymph node biopsy has been established as the preferred method for staging early breast cancer. A prior history of mastectomy is felt to be a contraindication. Case presentation A patient with recurrent breast cancer in her skin flap was discovered to have positive axillary sentinel nodes by sentinel lymph node biopsy five years after mastectomy for ductal carcinoma in situ. Conclusion A prior history of mastectomy may not be an absolute contraindication to sentin...

  6. The Accuracy of Sentinel Lymph Node Biopsy Compared with Axillary Lymph Node Dissection in Breast Cancer

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    Abdolrasul Talei

    2011-10-01

    Full Text Available Background: Sentinel lymph node biopsy is used as an accurate staging procedure to detect early breast cancer. Several studies have documented that sentinel lymph node biopsy can accurately determine the status of axillary nodes. Sentinel node biopsy offers the advantage of accurately staging the axilla and eliminating the need for a full axillary dissection for patients who have a negative sentinel node. The aim of this study is to determine the predictors of non-sentinel lymph node metastasis by sentinel node biopsy.Methods: In this study, all patients (n=88 who underwent sentinel node biopsy for invasive breast cancer from June 2005 to June 2010 in Shahid Faghihi Hospital, Shiraz, Iran were enrolled. We reviewed the medical files of patients and their tumor characteristics. Statistical analysis was performed to determine whether any of thesecharacteristics alone could accurately predict the remaining non-sentinel node status. SPSS statistical package was used.Results: The mean age of the patients was 46.1 years. Tumor size was 2.73 cm. Of the 88 patients who underwent complete axillary node dissection, 34 had metastases in the non-sentinel nodes, with a mean of 4 positive non-sentinel nodes in each patient. Statistically, neither the patient’s age nor the clinicopathological features of the tumor were significantly associated with non-sentinel node metastases (all: P>0.05.Conclusion: Our study shows that neither the primary tumor characteristics nor the size of metastasis in the sentinel lymph node can predict the status of non-sentinel nodes. However, further investigation is necessary. Complete axillary node dissection shouldremain the most appropriate management for patients with positive sentinel lymph nodes.

  7. Axillary lymph nodes in breast cancer patients: sonographic evaluation*

    Science.gov (United States)

    Pinheiro, Denise Joffily Pereira da Costa; Elias, Simone; Nazário, Afonso Celso Pinto

    2014-01-01

    Axillary staging of patients with early-stage breast cancer is essential in the treatment planning. Currently such staging is intraoperatively performed, but there is a tendency to seek a preoperative and less invasive technique to detect lymph node metastasis. Ultrasonography is widely utilized for this purpose, many times in association with fine-needle aspiration biopsy or core needle biopsy. However, the sonographic criteria for determining malignancy in axillary lymph nodes do not present significant predictive values, producing discrepant results in studies evaluating the sensitivity and specificity of this method. The present study was aimed at reviewing the literature approaching the utilization of ultrasonography in the axillary staging as well as the main morphological features of metastatic lymph nodes. PMID:25741091

  8. Isolated Axillary Lymph Node Metastasis from Serous Ovarian Cancer

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    Hemant Goyal

    2012-01-01

    Full Text Available A 68-year-old female with past medical history of stage IIIc serous ovarian cancer after cytoreductive surgery and adjuvant chemotherapy came to clinic for regular follow-up visit. Physical examination was completely normal except for an isolated left axillary lymph node enlargement. Patient's abdominal sonogram and CT scan of abdomen and pelvis did not show any other new metastasis. Surgical excisional biopsy of the lymph node was performed and pathology revealed features of metastatic serous ovarian carcinoma.

  9. Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation

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    Park, Shin Hyung; Kim, Jae Chul; Lee, Jeong Eun; Park, In Kyu [Dept.of Radiation Oncology, Kyungpook National University Hospital, Daegu(Korea, Republic of)

    2015-03-15

    To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

  10. Redefining ultrasound appearance criteria of positive axillary lymph nodes

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    Duchesne, N. [Ottawa Hospital, Dept. of Radiology, Ottawa, Ontario (Canada)]. E-mail: nathalie_duchesne_22@yahoo.ca; Jaffey, J. [Ottawa Hospital Research Inst., Ottawa, Ontario (Canada); Florack, P. [Ottawa Regional Women' s Breast Health Centre, Ottawa, Ontario (Canada); Duchesne, S. [McGill Univ., Biomedical Engineering Dep., Montreal, Quebec (Canada)

    2005-12-15

    To determine objective criteria for ultrasonography (US) appearance in the diagnosis of abnormal axillary lymph nodes (ALNs) and to assess retrospectively their accuracy in preoperative staging of patients with Breast Imaging Reporting and Data System (BI-RADS) Category 5 breast lesion. US-guided axillary fine-needle aspiration biopsy (FNAB) was performed for preoperative staging of BI-RADS Category 5 lesions in breast cancer patients seen at the Ottawa Regional Women's Breast Health Centre. Retrospectively, ALN morphology was classified into 3 categories based on US appearance: mass-like appearance, focal nodular cortical thickening (FNCT), and diffuse cortical thickening (DCT), the latter 2 with fatty hilum preservation and cortical thickening greater than 2 mm. Cytologic results from the FNAB were compared with axillary lymph node dissection (ALND) or sentinel lymph node procedure (SLNP), when available. Retrospective image-based classification was performed blind to pathology results and analyzed with Pearson's correlation coefficient, receiver operating characteristic (ROC) curves, and chi-square and Hosmer-Lemeshow tests against the cytologic ground truth. Eighty-six ALNs in 84 patients were sampled with an 18-gauge needle under US guidance. The number of passes per sample was related to adequate sampling of positive ALNs having mass-like morphology but not DCT or FNCT (p < 0.001). The most frequent morphologic presentation of the 86 ALNs was mass-like appearance of lymph nodes (45%), followed by DCT (35%) and FNCT (20%). Metastatic involvement was found in 34 (87%) of 39 ALNs that were mass-like, in 9 (53%) of 17 ALNs with FNCT, and in 9 (30%) of 30 ALNs with DCT. The kappa agreement between FNAB and ALND or SLNP was 0.64 for mass-like lymph nodes, 0.7 for lymph nodes with DCT, and 1.0 for FNCT. Overall sensitivity and specificity were 94% and 89%, respectively, with a positive predictive value of 97% and negative predictive value of 80%. Using a 2

  11. Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol

    OpenAIRE

    Goyal Amit; Duley Lelia; Fakis Apostolos

    2013-01-01

    Abstract Background For patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients....

  12. The Clinical Value of Axillary Ultrasonogra- phy for Detection of Axillary Lymph Node Metastasis in Cases with Breast Cancer

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    Sedigheh Tahmasebi

    2014-10-01

    Full Text Available Background: The axillary lymph node stage is one of the single most important determinants in the prognosis of breast cancer patients. The disadvantages of the two previous methods used for evaluating axillary node metastasis, i.e., axillary lymph node dissection and sentinel lymph node biopsy, have directed researchers to investigate new techniques for this purpose. The aim of the current study was to evaluate the clinical usefulness of axillary ultrasonography in detecting axillary metastasis. Methods: This study was conducted during a 12-month period. The breast cancer cases included in this study were all clinically diagnosed as stages I and II, with no prior treatment to the axillary region by surgery and/or chemo-radiotherapy. Excluded from the study group were patients with palpable axillary lymph nodes, those who had major organ failure or concomitant malignancy. All included patients with non-palpable axillary lymph nodes underwent axillary ultrasound examination. An ultrasound- guided core needle biopsy was performed on patients with suspected metastasis. Results: There were 125 female patients with a mean age of 49.6 years included in this study. From these, 16 (12.8% cases had positive axillary sonographic findings. Pathologic evaluation of tissue specimens (taken by ultrasound-guided core needle biopsy in 10 (62.5% out of 16 patients were positive, and in the patient group of 6 (37.5% cases, studies were negative. Axillary ultrasonography had a sensitivity of 35.7%, specificity of 93.8%, positive predictive value of 62.5%, and negative predictive value of 83.5%. Conclusion: The axillary ultrasonogram is a reliable technique in the determination of axillary nodal metastatic involvement in breast cancer patients. By use of this method a significant amount of complications and costs related to the previous techniques can be avoided.

  13. Sparing sentinel node biopsy through axillary lymph node fine needle aspiration in primary breast cancers

    OpenAIRE

    Cheng, Yu-Shu; Kuo, Shou-Jen; Chen, Dar-Ren

    2013-01-01

    Background Axillary lymph node status is an important staging and prognostic factor in breast cancer. This study aimed to evaluate the efficacy of axilla fine needle aspiration cytology (FNAC) in primary breast cancer without a palpable node and even without image characteristics of a metastatic node. Methods From June 2008 to January 2012, 77 patients met the inclusion criteria of having received a FNAC procedure during the diagnostic protocol of primary breast cancer with the characteristic...

  14. Contribution of minute axillary lymph nodes to accurate staging for patients with breast cancer

    Institute of Scientific and Technical Information of China (English)

    JIANG Jun; HE Qing-qing; YANG Xin-hua; LIANG Yan; FAN Lin-jun; ZHANG Yi; GUO Mei-qin

    2007-01-01

    Background Axillary lymph node metastasis is a very important metastatic pathway in breast cancer and its accurate detection is important for staging tumour and guiding therapy. However, neither the accuracy of routine detection of lymph node in surgical specimens nor the significance of minute lymph node with metastases in breast cancer is clear. A modified method for conveniently detecting minute lymph node in specimens of axillary dissections in patients with breast cancer was used to analyze their influence on staging breast cancer.Methods Lymph nodes in fresh, unfixed, specimens of axillary dissections from 127 cases of breast cancer were detected routinely. Then the axillary fatty tissues were cut into 1 cm thick pieces, soaked in Carnoy's solution for 6 to 12 hours, taken out and put on a glass plate. Minute lymph nodes were detected by light of bottom lamp and examined by routine pathology.Results Lymph nodes (n= 2483, 19.6±8.0 per case) were found by routine method. A further 879 lymph nodes up to 6 mm (781 < 3 mm, 6.9±5.3 per case, increasing mean to 26.5±9.7) were found from the axillary tissues after soaking in Carnoy's solution. By detection of minute lymph nodes, the stages of lymph node metastasis in 7 cases were changed from pathological node (pN) stage pN0 to pN1 in 4 cases, from pN1 to pN2 in 2 and from pN2 to pN3 in 1.Conclusions The accurate staging of axillary lymph node metastasis can be obtained routinely with number of axillary lymph nodes in most cases of breast cancer. To avoid neglecting minute lymph nodes with metastases, small axillary nodes should be searched carefully in the cases of earlier breast cancer with no swollen axillary nodes. Treatment with Carnoy's solution can expediently detect minute axillary nodes and improve the accurate staging of lymph nodes in breast cancer.

  15. Nonimage-guided fine needle aspiration biopsy of palpable axillary lymph nodes in breast cancer patients.

    Science.gov (United States)

    Marti, Jennifer L; Ayo, Diego; Levine, Pascale; Hernandez, Osvaldo; Rescigno, John; Axelrod, Deborah M

    2012-01-01

    We report the utility of office-based, nonimaged guided fine needle aspiration of palpable axillary lymph nodes in breast cancer patients. We examine the sensitivity and specificity of this procedure, and examine factors associated with a positive fine needle aspiration biopsy result. Although the utility of ultrasound-guided fine needle aspiration biopsy (FNA) of axillary lymph nodes is well established, there is little data on nonimage guided office-based FNA of palpable axillary lymphadenopathy. We investigated the sensitivity and specificity of nonimage-guided FNA of axillary lymphadenopathy in patients presenting with breast cancer, and report factors associated with a positive FNA result. Retrospective study of 94 patients who underwent office-based FNA of palpable axillary lymph nodes between 2004 and 2008 was conducted. Cytology results were compared with pathology after axillary sentinel node or lymph node dissection. Nonimage-guided axillary FNA was 86% sensitive and 100% specific. On univariate analysis, patients with positive FNA cytology had larger breast tumors (p = 0.007), more pathologic positive lymph nodes (p benefits select patients, permitting avoidance of axillary ultrasound, sentinel lymph node biopsy, or delay in receiving neoadjuvant therapy. This results in time and cost savings for the health care system, and expedites definitive management. PMID:22098412

  16. Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol

    Directory of Open Access Journals (Sweden)

    Goyal Amit

    2013-01-01

    Full Text Available Abstract Background For patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients. With improvements in adjuvant therapy, routine axillary treatment may no longer offer any overall advantage. Objectives To assess the short and long term benefits and adverse effects of routine axillary treatment (axillary lymph node clearance or axillary radiotherapy for patients with lymph node positive early-stage breast cancer. Methods/Design Criteria for potentially eligibility for the study will be that the participants are men and women with early breast cancer and lymph nodes with metastasis. The study compares either axillary treatment with no axillary treatment, or axillary node clearance with axillary radiotherapy, and the study is a randomized trial. Primary outcomes are axillary recurrence, disease-free and overall survival. Secondary outcomes include breast or chest wall recurrence, distant metastasis, time to axillary recurrence, axillary recurrence-free survival, arm morbidity, quality of life and health economic costs. The search strategy will include the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform (ICTRP search portal. Two independent reviewers will assess studies for inclusion in the review, assess study quality and extract data. Characteristics of included studies will be described. Meta-analysis will be conducted using ReVman software. Comment This review addresses an important clinical question, and results will inform clinical practice and health care policy.

  17. Endosalpingiosis of Axillary Lymph Nodes: A Rare Histopathologic Pitfall with Clinical Relevance for Breast Cancer Staging

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    Laila Nomani

    2016-01-01

    Full Text Available Establishment of accurate axillary lymph node status is of essential importance in determining both prognosis and the potential need for adjuvant therapy in patients with invasive breast cancer. Axillary lymph node heterotopias can in some cases result in overdiagnosis of metastatic disease. Nodal endosalpingiosis is perhaps the least commonly reported type of axially lymph node heterotopia. We herein illustrate a case in which second opinion pathologic interpretation combined with ancillary immunohistochemical studies allowed for a specific diagnosis of axillary nodal müllerian-type inclusions, confirming ypN0 staging and resulting in appropriate disease management and prognostication.

  18. Endosalpingiosis of Axillary Lymph Nodes: A Rare Histopathologic Pitfall with Clinical Relevance for Breast Cancer Staging

    Science.gov (United States)

    Nomani, Laila; Calhoun, Benjamin C.; Biscotti, Charles V.; Grobmyer, Stephen R.; Sturgis, Charles D.

    2016-01-01

    Establishment of accurate axillary lymph node status is of essential importance in determining both prognosis and the potential need for adjuvant therapy in patients with invasive breast cancer. Axillary lymph node heterotopias can in some cases result in overdiagnosis of metastatic disease. Nodal endosalpingiosis is perhaps the least commonly reported type of axially lymph node heterotopia. We herein illustrate a case in which second opinion pathologic interpretation combined with ancillary immunohistochemical studies allowed for a specific diagnosis of axillary nodal müllerian-type inclusions, confirming ypN0 staging and resulting in appropriate disease management and prognostication. PMID:27088025

  19. Intradermal administration of fluorescent contrast agents for delivery to axillary lymph nodes

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    Rasmussen, John C.; Meric-Berstam, Funda; Krishnamurthy, Savitri; Tan, I.-Chih; Zhu, Banghe; Wagner, Jamie L.; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Sevick-Muraca, Eva M.

    2014-05-01

    In this proof-of-concept study we seek to demonstrate the delivery of fluorescent contrast agent to the tumor-draining lymph node basin following intraparenchymal breast injections and intradermal arm injection of micrograms of indocyanine green in 20 breast cancer patients undergoing complete axillary lymph node dissection. Individual lymph nodes were assessed ex vivo for presence of fluorescent signal. In all, 88% of tumor-negative lymph nodes and 81% of tumor-positive lymph nodes were fluorescent. These results indicate that future studies utilizing targeted fluorescent contrast agents may demonstrate improved surgical and therapeutic intervention.

  20. Multi-detector row CT in the assessment of axillary lymph node metastasis in breast cancer

    International Nuclear Information System (INIS)

    The purpose of this study is to evaluate the diagnostic capability instead of clinical efficacy of multi-detector row CT (MDCT) in the assessment of axillary lymph node metastasis in breast cancer. MDCT was performed in 63 patients with breast cancer, and multiplanar reformation (MPR) and volume rendering (VR) images were reconstructed for the evaluation of bilateral axillary lymph nodes. Two hundred sixty eight lymph nodes were depicted with MDCT, and correlation with pathological findings was performed. The short axis length of lymph node was measured on MPR image, and the shape of the nodes was analyzed with the pathological results statistically. The diagnostic criteria on size and shape of lymph node metastasis were discussed Dynamic study with contrast media was also performed, and the CT value ratios (CTVR) of the lymph nodes and breast tumors were calculated. No relevance of axillary lymph node metastasis was noted to the pathological types of breast cancer. The average short axis length of the ipsilateral axillary nodes was 8.9 mm±3.8 (SD) while that of the contralateral nodes was 4.9 mm±1.1 (SD) showing significant difference. More than 6.5 mm in short length of the lymph node was thought to be an effective criterion for positive metastasis, and its sensitivity was 96%. Soybean-shape lymph node was statistically common in metastasis, while non-metastatic nodes were commonly demonstrated as letter ''c'' shape or ring-like shape. Statistical relevance was obtained between the CTVR of axillary lymph nodes and that of breast tumors, suggesting clinical usefulness of dynamic study using contrast media in the evaluation of lymph node metastasis. With MPR and VR images using MDCT, more accurate morphological evaluation of axillary lymph nodes was possible. When soybean-shape node with more than 6.5 mm in short axis is depicted in the axillar region on MDCT metastasis should be the consideration. Comparison with the contralateral side as a control in coronal

  1. Calcific deposits in axillary lymph nodes mimicking microcalcifications; Depositos auricos en ganglios axilares simulando microcalcificaciones

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    Ubeda, B.; Paraira, M.; Alert, E.; Monzon, M. [Institut Universitari Dexeus. Barcelona (Spain)

    2002-07-01

    Breast cancer frequently presents with microcalcifications arranged in characteristic calcific patterns. The presence of microcalcifications in axillary lymph nodes is an unusual finding, particularly when they are secondary to nodal metastasis produced by primary breast cancer. We report the case of a patient with a history of rheumatoid arthritis in whom routine mammography disclosed the presence of microcalcifications in axillary lymph nodes, describing the radiological features and differential diagnosis and reviewing the literature. (Author) 9 refs.

  2. Contribution of Kinetic Characteristics of Axillary Lymph Nodes to the Diagnosis in Breast Magnetic Resonance Imaging

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    Teoman Coşkun

    2012-09-01

    Full Text Available Objective: To assess the contribution of kinetic characteristics in the discrimination of malignant-benign axillary lymph nodes. Material and Methods: One hundred fifty-five female patients were included in the study. Following magnetic resonance imaging (MRI examinations post-processing applications were applied, dynamic curves were obtained from subtracted images. Types of dynamic curves were correlated with histopathological results in malignant cases or final clinical results in patients with no evidence of malignancy. Sensitivity, specificity, positive likehood ratio (+LHR, negative (-LHR of dynamic curves characterizing the axillary lymph nodes were calculated.Results: A total of 178 lymph nodes greater than 8 mm were evaluated in 113 patients. Forty-six lymph nodes in 24 cases had malignant axillary involvement. 132 lymph nodes in 89 patients with benign diagnosis were included in the study. The sensitivity of type 3 curve as an indicator of malignancy was calculated as 89%. However the specificity, +LHR, -LHR were calculated as 14%, 1.04, 0.76 respectively. Conclusion: Since kinetic analysis of both benign and malignant axillary lymph nodes, rapid enhancement and washout (type 3 they cannot be used as a discriminator, unlike breast lesions. MRI, depending on the kinetic features of the axillary lymph nodes, is not high enough to be used in the clinical management of breast cancer patients.

  3. CXCR4 and Axillary Lymph Nodes: Review of a Potential Biomarker for Breast Cancer Metastasis

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    David Hiller; Quyen D. Chu

    2011-01-01

    CXCR4 is a 7-transmembrane G-protein chemokine receptor that allows for migration of hematopoietic cells from the bone marrow to the peripheral lymph nodes. Research has shown CXCR4 to be implicated in the invasion and metastasis of several cancers, including carcinoma of the breast. CXCL12 is the ligand for CXCR4 and is highly expressed in areas common for breast cancer metastasis, including the axillary lymph nodes. Axillary lymph nodes positive for breast carcinoma have been an important c...

  4. CXCR4 and Axillary Lymph Nodes: Review of a Potential Biomarker for Breast Cancer Metastasis

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    David Hiller

    2011-01-01

    Full Text Available CXCR4 is a 7-transmembrane G-protein chemokine receptor that allows for migration of hematopoietic cells from the bone marrow to the peripheral lymph nodes. Research has shown CXCR4 to be implicated in the invasion and metastasis of several cancers, including carcinoma of the breast. CXCL12 is the ligand for CXCR4 and is highly expressed in areas common for breast cancer metastasis, including the axillary lymph nodes. Axillary lymph nodes positive for breast carcinoma have been an important component of breast cancer diagnosis, treatment, and subsequent research. The goal of this paper is to analyze the literature that has explained the pathways from CXCR4 expression to breast cancer metastasis of the lymph nodes and the prognostic and/or predictive implications of lymph node metastases in the presence of elevated CXCR4.

  5. CXCR4 and Axillary Lymph Nodes: Review of a Potential Bio marker for Breast Cancer Metastasis

    International Nuclear Information System (INIS)

    CXCR4 is a 7-transmembrane G-protein chemokine receptor that allows for migration of hematopoietic cells from the bone marrow to the peripheral lymph nodes. Research has shown CXCR4 to be implicated in the invasion and metastasis of several cancers, including carcinoma of the breast. CXCL12 is the ligand for CXCR4 and is highly expressed in areas common for breast cancer metastasis, including the axillary lymph nodes. Axillary lymph nodes positive for breast carcinoma have been an important component of breast cancer diagnosis, treatment, and subsequent research. The goal of this paper is to analyze the literature that has explained the pathways from CXCR4 expression to breast cancer metastasis of the lymph nodes and the prognostic and/or predictive implications of lymph node metastases in the presence of elevated CXCR4

  6. Axillary lymph nodes siliconoma in a woman with intracapsular implant rupture

    International Nuclear Information System (INIS)

    Full text: Introduction: Siliconoma, or silicone granuloma is the migration of silicon particles in the axillary lymph nodes, muscle and other non- ruptured or intact silicone implant. The latter is a relatively rare finding, and usually occurs in patients with extracapsular rupture of silicone prosthesis and has a typical ultrasound image. We present a case of a young woman with bilateral silicone prostheses placed 5 years ago, where in the right axilla are enlarged, structurally altered lymph nodes in the clinical and ultrasonography studies. Subsequent magnetic resonance examination shows intracapsular rupture ipsilateral silicone prosthesis and migration of silicon particles in the axillary lymph nodes. What you will learn: In this case we present twenty-three year old woman who reported pain and ‘swelling’ in the right axilla. The patient is with bilateral silicone prosthesis, she is not febrile and not reported other illness. After physical examination enlarged and tender lymph nodes in the right axilla was found. Several structurally altered and enlarged lymph nodes were visualized by ultrasound. These lymph nodes are hypoechogenic with obliterated fatty hilus. Due to the suspicion of silicone ‘extravasation’ in axillary lymph nodes, a magnetic resonance study of both mammary glands was performed. The images show intracapsular rupture of the right prosthesis without reliable data on silicone gel outside the fibrous capsule. Discussion: Siliconoma is a complication after plastic surgery of the breast and can affect both the axillary lymph nodes, and other lymphatic chains and also muscle and lung. Most frequently it occurs at damage of the extracapsular silicone prostheses. More rarely siliconoma occurs in siliconoma intracapsular damage, as in the presented case or in a silicone gel microbleed. Conclusion: The presence of siliconoma in axillary lymph nodes is relatively rare complication in plastic surgery of the breast. Methods of imaging diagnostic

  7. The role of ultrasonography and FDG-PET in axillary lymph node staging of breast cancer

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    Ahn, Jhii-Hyun; Son, Eun Ju; Kim, Jeong-Ah; Youk, Ji Hyun; Kim, Eun-Kyung; Kwak, Jin Young (Dept. of Radiology, Yonsei Univ. College of Medicine, Research Inst. of Radiological Science, Seoul (Korea)), e-mail: ejsonrd@yuhs.ac; Ryu, Young Hoon (Dept. of Nuclear Medicine, Yonsei Univ. College of Medicine, Research Inst. of Radiological Science, Seoul (Korea)); Jeong, Joon (Dept. of General Surgery, Yonsei Univ. College of Medicine, Research Inst. of Radiological Science, Seoul (Korea))

    2010-10-15

    Background: The presence of axillary lymph node metastasis is the most important prognostic factor and an essential part of staging and prognosis of breast cancer. Purpose: To elucidate the usefulness and accuracy of ultrasonography (United States), fluorodeoxyglucose positron emission tomography (FDG-PET) scan, and combined analysis for axillary lymph node staging in breast cancer. Material and Methods: A total of 250 consecutive breast cancer patients who had undergone US, FDG-PET, and sentinel lymph node biopsy (SLNB) before surgery from January 2005 to December 2006 were included in the study. If an axillary lymph node had a length to width ratio =1.5 or cortical thickening =3 mm or compression of the hilum on US, focal hot uptake (maximal standardized uptake value, SU V{sub max} =2.0) in the ipsilateral axilla on FDG-PET, it was considered to be a metastatic lymph node. In combined analysis of US and FDG-PET, the interpretation was considered positive if at least two of any of the criteria were met. Each imaging finding was compared with a pathologic report regarding the presence of axillary lymph node metastasis, the number of metastatic lymph nodes, and the T stage of the breast mass. Results: Pathologically confirmed axillary lymph node metastasis was noted in 73 cases (29.2%). The mean number of metastatic lymph nodes in pathology was 3.1 +- 3.2, and the size of breast cancer was 2.0 +- 1.04 cm. In the detection of lymph node metastasis, the diagnostic accuracy of US was 78.8% and that of FDG-PET was 76.4%. On combined US and FDG-PET, accuracy was improved (91.6%). The number of metastatic lymph nodes on pathology was correlated with the positivity of US and FDG-PET (P < 0.01). Conclusion: Combined evaluation of US and FDG-PET was a sensitive and accurate method for axillary lymph node staging in breast cancer

  8. Detection of axillary lymph node involvement of breast cancer by Tc-99m MIBI scintimammography

    International Nuclear Information System (INIS)

    Breast cancer is the most common malignancy among women, leading to hundreds of thousands of deaths annually around the world. Lymph node status is the most important prognostic indicator in newly diagnosed breast cancer. The presence of axillary lymph node metastases has major prognostic implications in breast cancer patients, and it is an important criterion in determining the need for adjuvant chemotherapy. There is not an accurate anatomical test for detecting axillary lymph node metastasis and clinical examination has inappropriate diagnostic values. Routine lymph node dissection is the only accepted method for therapeutic decisions but it is invasive and produces significant morbidity such as lymphedema and infections. On the other hand, an important proportion of breast cancer patients are nodenegative. Ultrasonography has also been reported to be helpful, especially in conjunction with fine needle aspiration biopsy

  9. Computed tomography image of the mediastinal and axillary lymph nodes in clinically sound Rottweilers

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    Ana Carolina B. Fonseca Pinto

    2013-03-01

    Full Text Available Trough computed tomography (CT, it is possible to evaluate lymph nodes in detail and to detect changes in these structures earlier than with radiographs and ultrasound. Lack of information in the veterinary literature directed the focus of this report to normal aspects of the axillary and mediastinal lymph nodes of adult dogs on CT imaging. A CT scan of 15 normal adult male and female Rottweilers was done. To define them as clinically sound, anamnesis, physical examination, complete blood count, renal and hepatic biochemistry, ECG, and thoracic radiographs were performed. After the intravenous injection of hydrosoluble ionic iodine contrast medium contiguous 10mm in thickness thoracic transverse images were obtained with an axial scanner. In the obtained images mediastinal and axillary lymph nodes were sought and when found measured in their smallest diameter and their attenuation was compared to musculature. Mean and standard deviation of: age, weight, body length and the smallest diameter of the axillary and mediastinal lymph nodes were determined. Mean and standard deviation of parameters: age 3.87±2.03 years, weight 41.13±5.12, and body length 89.61±2.63cm. Axillary lymph nodes were seen in 60% of the animals, mean of the smallest diameter was 3.58mm with a standard deviation of 2.02 and a minimum value of 1mm and a maximum value of 7mm. From 13 observed lymph nodes 61.53% were hypopodense when compared with musculature, and 30.77% were isodense. Mediastinal lymph nodes were identified in 73.33% of the dogs; mean measure of the smallest diameter was 4.71mm with a standard deviation of 2.61mm and a minimum value of 1mm, and a maximum value of 8mm. From 14 observed lymph nodes 85.71% were isodense when compared with musculature and 14.28% were hypodense. The results show that it is possible to visualize axillary and mediastinal lymph nodes in adult clinically sound Rottweilers with CT using a slice thickness and interval of 10mm. The

  10. Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection.

    Science.gov (United States)

    Cook, Kyung Hoon; Park, Myong Chul; Lee, Il Jae; Lim, Seong Yoon; Jung, Yong Sik

    2016-03-01

    Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation. PMID:27064862

  11. Diagnostic value of ultrasound and color Doppler in identifying axillary lymph node metastases in patients with breast cancer

    OpenAIRE

    Couto, D.; M. Dias; Gonçalo, Manuela; Pinto, E.; Oliveira, CF

    2004-01-01

    PURPOSE: The aim of this study was to evaluate the diagnostic ability of ultrasound and color Doppler in axillary lymph node metastases of patients with breast cancer. MATERIAL AND METHODS: A prospective study including 55 patients with primitive, invasive, node negative breast cancer who underwent preoperative axillary ultrasound and color Doppler. Doppler and morphologic ultrasound criteria were applied to the identification of axillary lymph node metastases. RESULTS: The imagery study of a...

  12. Prognostic Significance of Axillary Lymph Node Micrometastases and Microvessel Count in Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    RuiHui; FengyunZhao

    2004-01-01

    OBJECTIVE To investigate the influence of axillary lymph node micrometastases and the microvessel count on the prognosis of patients with breast cancer. METHODS Forty-eight patients with breast cancer, who had no tumor cells in their regional lymph nodes based on conventional histopathologic examination, were re-examined with immunohistochemical LSAB techniques. H&E, anti-EMA, CK 19 and FVlII factor staining was used to identify tumor cells in both lymph nodes and tumor tissues and to count the microvessels. A total of 882 lymph nodes were examined. RESULTS Immunostaining-positive tumor cells were found in 9.0 %(79/882) of the dissected lymph nodes. The positive rates were not significantly different between a surviving group and a deceased group (P>0.05). The microvessel count was significantly higher in group that had died (P<0.001). CONCLUSION The lymph node micrometastases did not show any correlation with patients'survival, but the microvessel density had a negative correlation with the survival period in breast cancer patients who had negative axillary lymph nodes.

  13. Discordance of Intraoperative Frozen Section Analysis with Definitive Histology of Sentinel Lymph Nodes in Breast Cancer Surgery : Complementary Axillary Lymph Node Dissection is Irrelevant for Subsequent Systemic Therapy

    NARCIS (Netherlands)

    Geertsema, D.; Gobardhan, P. D.; Madsen, E. V. E.; Albregts, M.; van Gorp, J.; de Hooge, P.; van Dalen, Th

    2010-01-01

    Background. In breast cancer surgery, intraoperative frozen section (FS) analysis of sentinel lymph nodes (SLNs) enables axillary lymph node dissection (ALND) during the same operative procedure. In case of discordance between a "negative" FS analysis and definitive histology, an ALND as a second op

  14. Technological evolution of axillary lymph nodes: Radiological visualisation in breast cancer patients

    International Nuclear Information System (INIS)

    Full text: In patients with breast cancer, detection of axillary lymph node spread has a great prognostic significance. Visualisation of lymphatic glands is attracting attention of radiologists since long. Lymphogram usually shows 4-9 lymph glands as compared to 8 to 50 identified during surgical intervention. Lymphography is a laborious and complicated process requiring specific skills. Likewise, the evaluation and interpretation of results depends upon the experience of the specialist. We evaluated 234 breast cancer patients and found that lymphograms of these patients initially detected 1-2 central axillary lymph nodes followed by others. During surgical intervention, the total number of lymphatic glands removed from these patients was 3,241 of which only 2,693 (83.1%) were seen on lymphography. On further evaluation it was found that the largest groups of lymphatic nodes were seen in the following pattern (i) central axillary (ii) subclavicular (iii) lateral, with central axillary lymph nodes being the biggest (1.5 - 2 cm) and subclavicular the smallest (0.2 - 0.5 cm). Sternal lymph nodes receive lymph from medial quadrants of the breast and / or if the axillary lymph nodes are obstructed by metastases. The results of lymphography and post-operative examination matched in 71.7-75 % of cases. False positivity was seen in 19.2 % and false negative 9.1 % instances. As this method was not sufficiently selective and specific, its relative upsurge receded backwards and was forgotten. The last decade of the twentieth century saw a sentinel node (SN) concept. In advanced countries, the possibility to detect breast cancer of up to 1 cm diameter corresponding to T1A category, when the axillary lymph nodes still are not involved in malignant growth, accounts about 50%. Hence the search of lymphatic spread vis-a-vis sentinel node detection has gained more importance. Earlier, SN detection involved colour contrast methods, which was reasonably sensitive and specific in

  15. A mechanistic breast cancer survival modelling through the axillary lymph node chain.

    Science.gov (United States)

    Cobre, Juliana; Castro Perdoná, Gleici S; Peria, Fernanda M; Louzada, Francisco

    2013-04-30

    In this paper, we proposed a mechanistic breast cancer survival model based on the axillary lymph node chain structure, considering lymph nodes as a potential dissemination arrangement. We assume a naive breast cancer treatment protocol consisting of exposing patients first to a chemotherapy treatment on r intervals at k-cycles separated by equal time intervals, and then they proceed to surgery. Our model, different from former ones, accommodates a quantity of contaminated lymph nodes, which is observed during surgery. We assume a generalised negative binomial survival distribution for the unknown number of contaminated lymph nodes after surgery, which, during an unknown period, may potentially propagate the disease. Estimation is based on a maximum likelihood approach. A simulation study assesses the coverage probability of asymptotic confidence intervals when small or moderate samples are considered. A Brazilian breast cancer data illustrate the applicability of our modelling.

  16. Predicting axillary lymph node metastasis from kinetic statistics of DCE-MRI breast images

    Science.gov (United States)

    Ashraf, Ahmed B.; Lin, Lilie; Gavenonis, Sara C.; Mies, Carolyn; Xanthopoulos, Eric; Kontos, Despina

    2012-03-01

    The presence of axillary lymph node metastases is the most important prognostic factor in breast cancer and can influence the selection of adjuvant therapy, both chemotherapy and radiotherapy. In this work we present a set of kinetic statistics derived from DCE-MRI for predicting axillary node status. Breast DCE-MRI images from 69 women with known nodal status were analyzed retrospectively under HIPAA and IRB approval. Axillary lymph nodes were positive in 12 patients while 57 patients had no axillary lymph node involvement. Kinetic curves for each pixel were computed and a pixel-wise map of time-to-peak (TTP) was obtained. Pixels were first partitioned according to the similarity of their kinetic behavior, based on TTP values. For every kinetic curve, the following pixel-wise features were computed: peak enhancement (PE), wash-in-slope (WIS), wash-out-slope (WOS). Partition-wise statistics for every feature map were calculated, resulting in a total of 21 kinetic statistic features. ANOVA analysis was done to select features that differ significantly between node positive and node negative women. Using the computed kinetic statistic features a leave-one-out SVM classifier was learned that performs with AUC=0.77 under the ROC curve, outperforming the conventional kinetic measures, including maximum peak enhancement (MPE) and signal enhancement ratio (SER), (AUCs of 0.61 and 0.57 respectively). These findings suggest that our DCE-MRI kinetic statistic features can be used to improve the prediction of axillary node status in breast cancer patients. Such features could ultimately be used as imaging biomarkers to guide personalized treatment choices for women diagnosed with breast cancer.

  17. Drug concentrations in axillary lymph nodes after lymphatic chemotherapy on patients with breast cancer

    International Nuclear Information System (INIS)

    Lymph node status is one of the decisive prognostic factors in breast cancer. Chemotherapy targeting regional lymphatic tissues has emerged as a promising therapy for the treatment of malignancies with a high tendency to disseminate lymphatically. The present study determined the drug concentrations in axillary lymph nodes after lymphatic chemotherapy (LC) in patients with breast cancer and compared the results with those receiving intravenous chemotherapy (VC) to investigate whether LC could improve the accumulation of anticancer drug in regional lymph nodes. Sixty patients with breast carcinoma confirmed by preoperative puncture-biopsy were divided into two groups at random. The LC group (n = 30) received a subcutaneous injection of 4 ml of carboplatin-activated carbon suspension, containing 20 mg of carboplatin, adjacent to the primary tumour. The VC group (n = 30) received an intravenous administration of an equal dose of aqueous carboplatin. At 1, 12, 24, 36 and 48 hours after administration, modified radical mammectomies were performed on 12 patients at each time point, with 6 from each group. Axillary lymph nodes were removed for pathological examination. The platinum concentrations in nodes were determined by Zeeman atomic absorption spectrometry. A total of 275 axillary lymph nodes were resected, with 154 in the LC group and 121 in the VC group. Of the 275 lymph nodes, 136 (49.5%) from 23 patients (38.3%) had histopathologically detected metastases. At 1, 12, 24, 36 and 48 hours after injection, the carboplatin concentrations in the LC group were 11.82 ± 3.50, 23.58 ± 7.34, 18.22 ± 4.93, 16.70 ± 5.15 and 14.62 ± 4.29 μg/g (means ± SD), respectively, whereas those in the VC group were 0.06 ± 0.02, 0.11 ± 0.05, 0.10 ± 0.02, 0.05 ± 0.02 and 0 μg/g, respectively. Significant differences were found in each corresponding comparison (P < 0.001). Lymph node metastasis was uncorrelated with drug concentration (P > 0.05). LC can effectively and

  18. Meta-analysis of ultrasound-guided biopsy of suspicious axillary lymph nodes in the selection of patients with extensive axillary tumour burden in breast cancer

    NARCIS (Netherlands)

    Wely, B.J. van; Wilt, J.H.W. de; Francissen, C.; Teerenstra, S.; Strobbe, L.J.A.

    2015-01-01

    BACKGROUND: Recent studies show that not all patients with breast cancer and positive axillary lymph nodes need additional axillary surgery. A systematic review and meta-analysis of the literature was performed to test the hypothesis that ultrasound-guided biopsy of suspicious nodes can be a useful

  19. FDG uptake in axillary lymph nodes after vaccination against pandemic (H1N1)

    International Nuclear Information System (INIS)

    To alert the imaging community to potential false positive findings related to current immunization programmes against H1N1 influenza virus. We reviewed 10 patients referred for positron emission tomography/computed tomography (PET/CT) who had undergone recent vaccination. All studies showed18F-fluorodeoxyglucose (FDG) uptake in the draining axillary lymph nodes close to the vaccination site, while low-dose CT revealed lymph nodes ranged between 0.5 cm and 1.2 cm at the same site. This potential pitfall in PET/CT should be borne in mind during current vaccination programmes. (orig.)

  20. FDG uptake in axillary lymph nodes after vaccination against pandemic (H1N1)

    Energy Technology Data Exchange (ETDEWEB)

    Panagiotidis, Emmanouil; Exarhos, Demetrios; Housianakou, Irene; Bournazos, Apostolos; Datseris, Ioannis [General Hospital, PET/CT Unit, Athens (Greece)

    2010-05-15

    To alert the imaging community to potential false positive findings related to current immunization programmes against H1N1 influenza virus. We reviewed 10 patients referred for positron emission tomography/computed tomography (PET/CT) who had undergone recent vaccination. All studies showed{sup 18}F-fluorodeoxyglucose (FDG) uptake in the draining axillary lymph nodes close to the vaccination site, while low-dose CT revealed lymph nodes ranged between 0.5 cm and 1.2 cm at the same site. This potential pitfall in PET/CT should be borne in mind during current vaccination programmes. (orig.)

  1. Observation of the Primo Vessel Approaching the Axillary Lymph Node with the Fluorescent Dye, DiI

    Directory of Open Access Journals (Sweden)

    Su Youn Park

    2014-01-01

    Full Text Available The primo vascular system (PVS floating in lymph fluid has mostly been observed in large caliber ducts around the caudal vena cava and the thoracic duct of rabbits, rats, and mice. But the PVS has not been traced up to the lymph nodes. It has not been established whether the PVS leaves the lymph vessel through the lymph vessel wall or it enters the lymph nodes. Therefore, observing the PVS entering a lymph node, for example, the axillary node, is desirable. In the current work, we traced the PVS approaching up to the surface of axillary node of a rat. The method used for this study was based upon a method that was recently developed to detect the PVS in the lymph duct from the inguinal to the axillary nodes in the skin of a rat by injecting Alcian blue into the inguinal node. However, the Alcian blue blurred near the lymph nodes and tracing the PVS up to the lymph nodes has not been possible. The current method clearly showed the PVS approaching the axillary node.

  2. Evaluation of the metastatic status of lymph nodes identified using axillary reverse mapping in breast cancer patients

    OpenAIRE

    Ikeda Katsumi; Ogawa Yoshinari; Komatsu Hisateru; Mori Yoshihiro; Ishikawa Akira; Nakajima Takayoshi; Oohira Gou; Tokunaga Shinya; Fukushima Hiroko; Inoue Takeshi

    2012-01-01

    Abstract Background Axillary reverse mapping (ARM) is a new technique to preserve upper extremity lymphatic pathways during axillary lymph node dissection (ALND), thereby preventing lymphedema patients with breast cancer. However, the oncologic safety of sparing the nodes identified by ARM (ARM nodes), some of which are positive, has not been verified. We evaluated the metastatic status of ARM nodes and the efficacy of fine needle aspiration cytology (FNAC) in assessing ARM node metastasis. M...

  3. Axillary lymph node core biopsy for breast cancer metastases - How many needle passes are enough?

    Energy Technology Data Exchange (ETDEWEB)

    Macaskill, E.J., E-mail: ejanemacaskill@nhs.net [Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY (United Kingdom); Purdie, C.A.; Jordan, L.B. [Department of Pathology, Ninewells Hospital and Medical School, Dundee DD1 9SY (United Kingdom); Mclean, D.; Whelehan, P. [Department of Breast Imaging, Ninewells Hospital and Medical School, Dundee DD1 9SY (United Kingdom); Brown, D.C. [Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY (United Kingdom); Evans, A. [Department of Breast Imaging, Ninewells Hospital and Medical School, Dundee DD1 9SY (United Kingdom)

    2012-05-15

    Aim: To determine the diagnostic yield of each of three core passes when sampling abnormal lymph nodes in patients presenting with breast cancer. Materials and methods: All patients suspected of having breast cancer had axillary ultrasound as part of initial assessment. Radiologically abnormal nodes (cortical thickness >2.3 mm or round shape) were biopsied with three passes of a 22 mm throw 14 G core biopsy needle and sent for histopathology in separate numbered pots. Data were collected prospectively, and analysis performed on the data of 55 consecutive patients who had positive nodes on at least one core biopsy needle pass. Results: Of 55 patients with a positive node on core biopsy, tumour was noted in all three cores taken in 39 (70.9%). Lymph node metastasis was detected in 45 (81.8%) first core biopsies. With the first two cores taken, positive results were detected in 53 of 55 cases (96.4%). In both cases where tumour was only found on a third core biopsy pass, no lymph node tissue was present in the first two biopsy passes. Conclusion: Two well-directed 14 G core biopsy samples from an abnormal axillary node are adequate for diagnosis of breast cancer metastasis.

  4. Mucinous carcinoma with axillary lymph node metastasis in a male breast: A case report

    Directory of Open Access Journals (Sweden)

    Faten Hammedi

    2010-01-01

    Full Text Available Context : Pure mucinous carcinoma of the male breast is an extremely rare neoplasm. It is characterized by a lower incidence of metastatic nodal involvement and a higher survival rate than invasive ductal carcinomas. Case Report : We report the case of a 75-year-old male who presented with a retroareolar mass of the right breast. The patient underwent radical mastectomy including right axillary lymph node dissection. The tumor was well demarcated and had a friable consistency with a gelatinous appearance. Histologically, the diagnostic of pure mucinous carcinoma with lymph node metastasis was performed. After surgery, the patient received chemotherapy, radiotherapy, and hormonotherapy (Tamoxifen. The patient remained free of disease for 36 months after surgery. Conclusion : Pure mucinous carcinoma of the male breast is a very rare tumor; in which axillary nodal disease is exceptional.

  5. Contribution of Kinetic Characteristics of Axillary Lymph Nodes to the Diagnosis in Breast Magnetic Resonance Imaging

    OpenAIRE

    Teoman Coşkun; Gökhan Pekindil; Işıl Başara; Şebnem Örgüç

    2012-01-01

    Objective: To assess the contribution of kinetic characteristics in the discrimination of malignant-benign axillary lymph nodes. Material and Methods: One hundred fifty-five female patients were included in the study. Following magnetic resonance imaging (MRI) examinations post-processing applications were applied, dynamic curves were obtained from subtracted images. Types of dynamic curves were correlated with histopathological results in malignant cases or final clinical results in patients...

  6. Solitary axillary lymph node metastasis without breast involvement from ovarian Cancer: Case report and brief literature review

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ji In; Kim, Soo Jin; Park, Sung Hee; Kim, Hee Sung [Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

    2014-11-15

    Axillary lymph node metastasis without breast involvement from ovarian cancer is rare. We report a case of a 68-year-old woman proven as ovarian serous papillary carcinoma and metastatic papillary carcinoma of the omentum on surgical diagnostic laparoscopy. In addition, a hypermetabolic lymph node was detected in left axilla and was considered a reactive benign lesion. Mammography and ultrasonography showed no focal lesion in both breasts, but ultrasonography-guided core needle biopsy for the lymph node revealed metastatic serous papillary carcinoma from ovarian origin. Even with a low incidence of axillary lymph node metastasis without breast involvement from ovarian cancer and only marginally elevated standardized uptake value in positron emission tomography, the possibility of metastasis at axillary lymph node in patients with known primary ovarian cancer must be considered.

  7. Breast MRI for Evaluating Patients with Metastatic Axillary Lymph Node and Initially Negative Mammography and Sonography

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Eun Young; Han, Boo Kyung; Shin, Jung Hee; Kang, Seok Seon [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2007-10-15

    We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.

  8. Long-term follow-up of axillary recurrences after negative sentinel lymph node biopsy: effect on prognosis and survival.

    NARCIS (Netherlands)

    Bulte, J.P.; Wely, B.J. van; Kasper, S.; Kuijt, G.P.; Wildenberg, F.J. van den; Strobbe, L.J.; Wilt, J.H.W. de

    2013-01-01

    As axillary recurrence (AR) after a negative sentinel lymph node biopsy (SLNB) is rare, the prognosis of these patients is unknown. Since treatment paradigms for patients with breast cancer are shifting toward less axillary surgery, the number of ARs might increase. In this study, we evaluated prima

  9. Improved false negative rate of axillary status using sentinel lymph node biopsy and ultrasound-suspicious lymph node sampling in patients with early breast cancer

    International Nuclear Information System (INIS)

    The false negative rate of sentinel lymph node biopsy (SLNB) is 5-10%, and results in improper patient management. The study was to assess the value of ultrasound-suspicious axillary lymph node biopsy (USALNB) in patients with early breast cancer, and to compare SLNB combined with USALNB (SLNB + USALNB) with SLNB alone. From January 2010 to July 2013, 216 patients with early breast cancer were enrolled consecutively at the Department of Breast and Thyroid Surgery, Qianfoshan Hospital, Shandong University. All patients underwent wire localization of the suspicious node by color Doppler ultrasonography, followed by SLNB 2–3 hours later, suspicious node lymphadenectomy, and level ≥ II axillary dissection (as the gold standard). The predictive values of node status between SLNB + USALNB and SLNB alone were compared. The success rate of SLNB was 99.1% (214/216). After axillary dissection, 71 patients were confirmed with axillary lymph node metastases by pathological examinations. Eight false negatives were observed using SLNB alone, resulting in sensitivity of 88.7%, specificity of 100%, false negative rate of 11.3%, and false positive rate of 0% in predicting the axillary node status. SLNB + USALNB resulted in sensitivity of 97.2%, specificity of 100%, false negative rate of 2.8%, and false positive rate of 0%. The false negative rate of SLNB + USALNB was significantly different from that of SLNB alone (P = 0.031). SLNB + USALNB seems to be a low-risk procedure that might be useful in reducing the false negative rate of SLNB, improving the accuracy of axillary nodes evaluation in early breast cancer

  10. International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases

    DEFF Research Database (Denmark)

    Meretoja, Tuomo J; Audisio, R A; Heikkilä, P S;

    2013-01-01

    Recently, many centers have omitted routine axillary lymph node dissection (ALND) after metastatic sentinel node biopsy in breast cancer due to a growing body of literature. However, existing guidelines of adjuvant treatment planning are strongly based on axillary nodal stage. In this study, we a...

  11. Simple Prediction Model of Axillary Lymph Node Positivity After Analyzing Molecular and Clinical Factors in Early Breast Cancer.

    Science.gov (United States)

    Chung, Mi Joo; Lee, Jong Hoon; Kim, Sung Hwan; Suh, Young Jin; Choi, Hyun Joo

    2016-05-01

    The aim of this study was to evaluate the association between pretreatment molecular and clinical factors and axillary lymph node metastases in early breast cancer. A total of 367 consecutive breast cancer patients with cT1-2NxM0 who underwent breast conserving surgery and axillary lymph node dissection followed by whole breast irradiation were enrolled. We evaluated the pathologic tumor and node status, tumor differentiation, calcification, and lymphovascular invasion, the status of estrogen receptor (ER), progesterone receptor (PR), epidermal growth factor receptor 1 (EGFR1), and human epidermal growth factor receptor 2 (HER2), the expression of E-cadherin, P53, and Ki-67 index. Totally, 108 (29.4%) of the 367 patients had positive axillary lymph nodes. An increased tumor size (P = 0.024), the presence of lymphovascular invasion (P 20% (P = 0.038) were significantly associated with axillary lymph node metastases on the multivariate analysis. In our study, 86.2% of the patients with all the unfavorable factors had an involvement of axillary nodal metastases, and only 12.2% of the patients with all the favorable predictors had positive axillary nodes. The predictive power was significant on the receiver operating curve (P positive ALNM on multivariate analysis for the patients with cT1-2 breast cancer. Clinicians simply could predict the probability of ALNM after verifying the molecular and clinical factors in early breast cancer. PMID:27196477

  12. Regional radiotherapy versus an axillary lymph node dissection after lumpectomy: a safe alternative for an axillary lymph node dissection in a clinically uninvolved axilla in breast cancer. A case control study with 10 years follow up

    Directory of Open Access Journals (Sweden)

    Elferink Marloes AG

    2007-10-01

    Full Text Available Abstract Background The standard treatment of the axilla in breast cancer used to be an axillary lymph node dissection. An axillary lymph node dissection is known to give substantial risks of morbidity. In recent years the sentinel node biopsy has become common practice. Future randomized study results will determine whether the expected decrease in morbidity can be proven. Methods Before the introduction of the sentinel node biopsy, we conducted a study in which 180 women of 50 years and older with T1/T2 cN0 breast cancer were treated with breast conserving therapy. Instead of an axillary lymph node dissection regional radiotherapy was given in combination with tamoxifen (RT-group. The study group was compared with 341 patients, with the same patient and tumour characteristics, treated with an axillary lymph node dissection (S-group. Results The treatment groups were comparable, except for age. The RT-group was significantly older than the S-group. The median follow up was 7.2 years. The regional relapse rates were low and equal in both treatment groups, 1.1% in RT-group versus 1.5% in S-group at 5 years. The overall survival was similar; the disease free survival was significant better in the RT-group. Conclusion Regional recurrence rates after regional radiotherapy are very low and equal to an axillary lymphnode dissection.

  13. Regional radiotherapy versus an axillary lymph node dissection after lumpectomy: a safe alternative for an axillary lymph node dissection in a clinically uninvolved axilla in breast cancer. A case control study with 10 years follow up

    International Nuclear Information System (INIS)

    The standard treatment of the axilla in breast cancer used to be an axillary lymph node dissection. An axillary lymph node dissection is known to give substantial risks of morbidity. In recent years the sentinel node biopsy has become common practice. Future randomized study results will determine whether the expected decrease in morbidity can be proven. Before the introduction of the sentinel node biopsy, we conducted a study in which 180 women of 50 years and older with T1/T2 cN0 breast cancer were treated with breast conserving therapy. Instead of an axillary lymph node dissection regional radiotherapy was given in combination with tamoxifen (RT-group). The study group was compared with 341 patients, with the same patient and tumour characteristics, treated with an axillary lymph node dissection (S-group). The treatment groups were comparable, except for age. The RT-group was significantly older than the S-group. The median follow up was 7.2 years. The regional relapse rates were low and equal in both treatment groups, 1.1% in RT-group versus 1.5% in S-group at 5 years. The overall survival was similar; the disease free survival was significant better in the RT-group. Regional recurrence rates after regional radiotherapy are very low and equal to an axillary lymphnode dissection

  14. Diagnostic Yield of Fine-Needle Aspiration for Axillary Lymph Nodes During Screening Breast Ultrasound.

    Science.gov (United States)

    Youn, Inyoung; Kim, Eun-Kyung; Yoon, Jung Hyun; Moon, Hee Jung; Kim, Min Jung

    2016-06-01

    The purpose of our study was to assess the positive predictive value (PPV) of ultrasound (US)-guided fine-needle aspiration (FNA) and the cancer detection rate for incidentally detected abnormal axillary lymph node (LN) in patients who underwent screening US. We retrospectively reviewed 72 LNs of 69 patients (mean age, 44.9 years) who underwent US-FNA for incidentally detected abnormal axillary LNs on 50,488 screening US from January 2005 to December 2011. The PPV of US-FNA and the cancer detection rate were calculated. We evaluated US images for lymph node size, abnormal findings (hilum loss, eccentric cortical thickening, round shape, extranodal extension, or marked hypoechoic cortex), and mammography for the identification of abnormal LNs. The PPV of each finding was also calculated. The PPV of US-FNA and the cancer detection rate were 2.8% (2/72) and 0.004% (2/50,488), respectively. The mean (SD) measurements for long-axis, short-axis, and cortical thickening of the LNs were 14.9 (5.9) mm, 8.5 (3.5) mm, and 5.8 (2.8) mm, respectively. Of the positive LNs, US findings of hilum loss, eccentric cortical thickening, and extranodal extension were found, and each corresponding PPV was 6.3% (1/16), 1.8% (1/56), and 14.3% (1/7), respectively. The PPV of mammography was 14.3% (1/7). Our results suggest that the PPVs of US-FNA and the cancer detection rate for incidentally detected abnormal axillary LNs during screening US are too low to recommend axillary US during breast US screening and that follow-up is acceptable for abnormal LNs detected during screening breast US that do not have extranodal extension or are negative on mammography. PMID:27054655

  15. Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Heusner, Till A.; Hahn, Steffen; Forsting, Michael; Antoch, Gerald [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Kuemmel, Sherko; Koeninger, Angela; Kimmig, Klaus R. [University Hospital Essen, Department of Gynecology and Obstetrics, Essen (Germany); Otterbach, Friedrich [University Hospital Essen, Department of Pathology and Neuropathology, Essen (Germany); Hamami, Monia E.; Bockisch, Andreas; Stahl, Alexander [University Hospital Essen, Department of Nuclear Medicine, Essen (Germany)

    2009-10-15

    The aims of this study were (1) to evaluate FDG PET/CT and CT for the detection of axillary lymph node metastases in breast cancer (BC) patients and (2) to evaluate FDG PET/CT as a pre-test for the triage to sentinel lymph node biopsy (SLNB) versus axillary lymph node dissection (ALND). The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy of FDG PET/CT and CT for axillary lymph node metastases were determined in 61 patients (gold standard: histopathology). According to the equation NPV = specificity .(1-prevalence)/[specificity.(1-prevalence)+(1-sensitivity).prevalence] FDG PET/CT was evaluated as a triage tool for SLNB versus ALND. The sensitivity, specificity, PPV, NPV and accuracy of FDG PET/CT was 58,92,82,77 and 79% and of CT 46,89,72,71 and 72%, respectively. Patients with an up to {proportional_to}60% risk for axillary lymph node metastases appear to be candidates for SLNB provided that the axilla is unremarkable on FDG PET/CT. FDG PET/CT cannot replace invasive approaches for axillary staging but may extend the indication for SLNB. (orig.)

  16. Is sentinel lymph node biopsy more accurate than axillary dissection for staging nodal involvement in breast cancer patients?

    Science.gov (United States)

    Marrazzo, Antonio; Taormina, Pietra; Gebbiab, Vittorio; David, Massimo; Riili, Ignazio; Lo Gerfo, Domenico; Casà, Luigi; Noto, Antonio

    2007-01-01

    Today evaluation of axillary involvement can be routinely performed with the technique of sentinel lymph node biopsy (SLNB). One of the greatest advantages of SLNB is the nearly total absence of local postoperative complications. It is important to understand whether SLNB is better than axillary lymph-node dissection (ALND) for staging axillary nodal involvement. The aim of the study was to evaluate the axillary staging accuracy comparing three different methods: axillary dissection, sentinel node biopsy with the traditional 4-6 sections and sentinel node biopsy with complete analysis of the lymph node. 527 consecutive patients (525 females and 2 males) with invasive breast cancer < or = 3 cm and clinically negative axillary nodes were divided into 3 different groups: group A treated with axillary dissection, group B treated with sentinel nodal biopsy analysed with 4-6 sections, and group C treated with sentinel node biopsy with analysis of the entire node. All patients underwent a quadrantectomy to treat the tumor. Group differences and statistical significance were assessed by ANOVA. The percentages of N+ in group A and group B were 25.80% and 28% respectively, while in the third group it rose to 45%, or almost half the patients. The differences among the three groups were statistically significant (p = 0.02). From our analysis of the data it emerges that axillary dissection and sentinel node biopsy with analysis of 4-6 sections have the same accuracy in staging the nodal status of the axilla; analysis of the entire sentinel lymph node revealed an increased number of patients with axillary nodal involvement, proving more powerful in predicting nodal stage. SLNB with complete examination of the SLN removed can be considered the best method for axillary staging in breast cancer patients with clinical negative nodes. In our study, the percentage of metastases encountered after complete examination of SLN was 45% compared to the accuracy of axillary dissection that

  17. Ki-67 expression in axillary lymph node metastases in breast cancer is prognostically significant.

    Science.gov (United States)

    Tawfik, Kareem; Kimler, Bruce F; Davis, Marilyn K; Fan, Fang; Tawfik, Ossama

    2013-01-01

    Several studies have documented the prognostic significance of cell proliferation in breast cancer and its positive relationship with tumor grade, size, mitotic activity, hormonal and Her-2 status, and tumor progression. The Ki-67 antigen provides an accurate measure of the growth fraction of a tumor. Ki-67 expression in 103 primary breast carcinomas and their corresponding axillary lymph node metastases was correlated with age, tumor grade, size, estrogen receptor (ER), progesterone receptor (PgR), p53, epidermal growth factor receptor (EGFR), Bcl-2, Her-2 status, and patients' overall survival. Median Ki-67 expression in primary and metastatic tumors was 20% and 15%, respectively. Although there was no difference in overall survival (P = .65, log-rank test) between primary tumors with less than or at least 10% Ki-67 expression, there was significantly better overall survival when Ki-67 expression in lymph nodes was less than 10% (P = .040). For patients whose primary tumors exhibited Ki-67 expression less than 10%, most of their metastatic lesions had a similar low Ki-67; these patients had a favorable outcome. A small subgroup was noted to have a nodal Ki-67 of 10% or more and worse survival (P = .047). For patients whose primary tumors had a Ki-67 of 10% or more, most of their metastatic lesions had similar high Ki-67 values; however, a group of 12 patients had lymph node Ki-67 less than 10% and had a better overall survival (P = .092). Our results showed that measurement of Ki-67 in lymph node is superior to its evaluation in primary tumors. Identification of subgroups of patients in whom Ki-67 expression in lymph nodes differs from expression in primary tumor may assist in the selection of therapeutic options.

  18. Role of ultrasound-guided core needle biopsy of axillary lymph nodes in the initial staging of breast carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Topal, Ugur [Uludag University Medical School, Department of Radiology, Gorukle Campus 16059, Bursa (Turkey)]. E-mail: utopal@uludag.edu.tr; Punar, Sehri [Uludag University Medical School, Department of Radiology, Gorukle Campus 16059, Bursa (Turkey); Tasdelen, Ismet [Uludag University Medical School, Department of Surgery, Gorukle Campus 16059, Bursa (Turkey); Adim, S. Balaban [Uludag University Medical School, Department of Pathology, Gorukle Campus 16059, Bursa (Turkey)

    2005-12-15

    Objective: To evaluate the role of US-guided core biopsy in detection of metastatic axillary lymph nodes in preoperative staging of breast cancer. Materials and methods: US-guided core biopsy of suspicious axillary lymph nodes was performed in 39 patients with breast cancer. Biopsy results were compared to the axillary dissection results. Sensitivity, specificity and accuracy of the core biopsy in the detection of malignancy were calculated. Results: Thirty-nine patients were assessed with biopsy; 30 patients were found to have metastatic carcinoma and nine had benign reactive hyperplasia. In 26 of 30 cases with biopsy-proven metastatic disease, there were malignant lymph nodes detected at axillary dissection. Four cases that had positive biopsy results and negative axillary dissection were accepted as complete response to chemotherapy. In three of nine cases with benign reactive hyperplasia, axillary dissection revealed metastatic disease. No significant complications were observed other than pain responding to analgesics. The sensitivity, specificity and accuracy of core biopsy in detection of malignancy were 90%, 100% and 92%, respectively. The results were statistically significant (p < 0.001). Conclusion: Ultrasonographically detected lymph nodes can be easily assessed by US-guided biopsy. Core biopsy is a reliable and easily performed method without significant complications.

  19. Infrared micro-spectral imaging: distinction of tissue types in axillary lymph node histology

    Directory of Open Access Journals (Sweden)

    Stone Nicholas

    2008-08-01

    Full Text Available Abstract Background Histopathologic evaluation of surgical specimens is a well established technique for disease identification, and has remained relatively unchanged since its clinical introduction. Although it is essential for clinical investigation, histopathologic identification of tissues remains a time consuming and subjective technique, with unsatisfactory levels of inter- and intra-observer discrepancy. A novel approach for histological recognition is to use Fourier Transform Infrared (FT-IR micro-spectroscopy. This non-destructive optical technique can provide a rapid measurement of sample biochemistry and identify variations that occur between healthy and diseased tissues. The advantage of this method is that it is objective and provides reproducible diagnosis, independent of fatigue, experience and inter-observer variability. Methods We report a method for analysing excised lymph nodes that is based on spectral pathology. In spectral pathology, an unstained (fixed or snap frozen tissue section is interrogated by a beam of infrared light that samples pixels of 25 μm × 25 μm in size. This beam is rastered over the sample, and up to 100,000 complete infrared spectra are acquired for a given tissue sample. These spectra are subsequently analysed by a diagnostic computer algorithm that is trained by correlating spectral and histopathological features. Results We illustrate the ability of infrared micro-spectral imaging, coupled with completely unsupervised methods of multivariate statistical analysis, to accurately reproduce the histological architecture of axillary lymph nodes. By correlating spectral and histopathological features, a diagnostic algorithm was trained that allowed both accurate and rapid classification of benign and malignant tissues composed within different lymph nodes. This approach was successfully applied to both deparaffinised and frozen tissues and indicates that both intra-operative and more conventional

  20. Quantitative molecular analysis of sentinel lymph node may be predictive of axillary node status in breast cancer classified by molecular subtypes.

    Directory of Open Access Journals (Sweden)

    Simonetta Buglioni

    Full Text Available To determine the performance of intraoperative one-step nucleic acid amplification (OSNA assay in detecting sentinel lymph node metastases compared to postoperative histology taking into account breast cancer molecular classification and to evaluate whether the level of cytokeratin 19 mRNA copy number may be useful in predicting the likelihood of a positive axillary lymph node dissection. OSNA assay was performed in a prospective series of 903 consecutive sentinel lymph nodes from 709 breast cancer patients using 2 alternate slices of each sentinel lymph node. The remaining 2 slices were investigated by histology. Cytokeratin 19 mRNA copy number, which distinguishes negative cases (5000 copies, was compared to axillary lymph node dissection status and to the biological tumor profile. Concordance between OSNA and histopathology was 95%, specificity 95% and sensitivity 93%. Multiple Corresponce Analysis and logistic regression evidenced that positive axillary lymph node dissection was significantly associated with a higher cytokeratin 19 mRNA copy number (>5000; p<0.0001, HER2 subtype (p = 0.007 and lymphovascular invasion (p<0.0001. Conversely, breast cancer patients with cytokeratin 19 mRNA copy number <2000 mostly presented a luminal subtype and a negative axillary lymph node dissection. We confirmed that OSNA assay can provide standardized and reproducible results and that it represents a fast and quantitative tool for intraoperative evaluation of sentinel lymph node. Omission of axillary lymph node dissection could be proposed in patients presenting a sentinel lymph node with a cytokeratin 19 mRNA copy number <2000 and a Luminal tumor phenotype.

  1. Quantum dots in axillary lymph node mapping: Biodistribution study in healthy mice

    Directory of Open Access Journals (Sweden)

    Guillemin François

    2008-04-01

    Full Text Available Abstract Background Breast cancer is the first cause of cancer death among women and its incidence doubled in the last two decades. Several approaches for the treatment of these cancers have been developed. The axillary lymph node dissection (ALND leads to numerous morbidity complications and is now advantageously replaced by the dissection and the biopsy of the sentinel lymph node. Although this approach has strong advantages, it has its own limitations which are manipulation of radioactive products and possible anaphylactic reactions to the dye. As recently proposed, these limitations could in principle be by-passed if semiconductor nanoparticles (quantum dots or QDs were used as fluorescent contrast agents for the in vivo imaging of SLN. QDs are fluorescent nanoparticles with unique optical properties like strong resistance to photobleaching, size dependent emission wavelength, large molar extinction coefficient, and good quantum yield. Methods CdSe/ZnS core/shell QDs emitting around 655 nm were used in our studies. 20 μL of 1 μM (20 pmol QDs solution were injected subcutaneously in the anterior paw of healthy nude mice and the axillary lymph node (ALN was identified visually after injection of a blue dye. In vivo fluorescence spectroscopy was performed on ALN before the mice were sacrificed at 5, 15, 30, 60 min and 24 h after QDs injection. ALN and all other organs were removed, cryosectioned and observed in fluorescence microscopy. The organs were then chemically made soluble to extract QDs. Plasmatic, urinary and fecal fluorescence levels were measured. Results QDs were detected in ALN as soon as 5 min and up to 24 h after the injection. The maximum amount of QDs in the ALN was detected 60 min after the injection and corresponds to 2.42% of the injected dose. Most of the injected QDs remained at the injection site. No QDs were detected in other tissues, plasma, urine and feces. Conclusion Effective and rapid (few minutes detection of

  2. A Nomogram for Predicting the Pathological Response of Axillary Lymph Node Metastasis in Breast Cancer Patients.

    Science.gov (United States)

    Jin, Xi; Jiang, Yi-Zhou; Chen, Sheng; Shao, Zhi-Ming; Di, Gen-Hong

    2016-01-01

    The value of sentinel lymph node biopsy (SLNB) in post-neoadjuvant chemotherapy (NCT) patients is still controversial. We aimed to identify predictors and construct a nomogram for predicting the pathologically complete response (pCR) of axillary lymph nodes (ALNs) after NCT in node positive breast cancer patients. In total, 426 patients with pathologically proven ALN metastasis before NCT were enrolled, randomized 1:1 and divided into a training set and a validation set. We developed a nomogram based on independent predictors for ALN pCR identified by multivariate logistic regression as well as clinical significant predictors. The multivariate logistic regression analysis showed that hormone receptor (HR) status, human epidermal growth factor 2 (HER2) status and Ki67 index were independent predictors. The nomogram was thereby constructed by those independent predictors as well as tumor size and NCT regimens. The areas under the receiver operating characteristic curve of the training set and the validation set were 0.804 and 0.749, respectively. We constructed a nomogram for predicting ALN pCR in patients who received NCT. Our nomogram can improve risk stratification, accurately predict post-NCT ALN status and avoid unnecessary ALN dissection. PMID:27576704

  3. The use of Raman spectroscopy for the intra-operative assessment of axillary lymph nodes in breast cancer

    Science.gov (United States)

    Horsnell, Jonathan

    Breast cancer remains a significant cause of morbidity and mortality. Assessment of the axillary lymph nodes is part of the staging of the disease. Advances in surgical management of breast cancer have seen a move towards intra-operative lymph node assessment that facilitates an immediate axillary clearance if it is indicated. Raman spectroscopy, a technique based on the inelastic scattering of light, has previously been shown to be capable of differentiating between normal and malignant tissue. These results, based on the biochemical composition of the tissue, potentially allow for this technique to be utilised in this clinical context. The aim of this study was to evaluate the facility of Raman spectroscopy to both assess axillary lymph node tissue within the theatre setting and to achieve results that were comparable to other intra-operative techniques within a clinically relevant time frame. Initial experiments demonstrated that these aims were feasible within the context of both the theatre environment and current surgical techniques. A laboratory based feasibility study involving 17 patients and 38 lymph node samples achieved sensivities and specificities of >90% in unsupervised testing. 339 lymph node samples from 66 patients were subsequently assessed within the theatre environment. Chemometric analysis of this data demonstrated sensitivities of up to 94% and specificities of up to 99% in unsupervised testing. The best results were achieved when comparing negative nodes from N0 patients and nodes containing macrometastases. Spectral analysis revealed increased levels of lipid in the negative nodes and increased DNA and protein levels in the positive nodes. Further studies highlighted the reproducibility of these results using different equipment, users and time from excision. This study uses Raman spectroscopy for the first time in an operating theatre and demonstrates that the results obtained, in real-time, are comparable, if not superior, to current

  4. Sites of failure in breast cancer patients with extra-capsular invasion of axillary lymph node metastases. No need for axillary irradiation?.

    Energy Technology Data Exchange (ETDEWEB)

    Gruber, G.; Menzi, S.; Forster, A.; Greiner, R.H. [Bern Univ. (Switzerland). Dept. of Radiation Oncology; Berclaz, G. [Bern Univ. (Switzerland). Dept. of Gynecology; Altermatt, H.J. [Institute of Pathology, Bern (Switzerland)

    2005-09-15

    Extracapsular spread (ECS) is frequent, but the specific sites of relapse are seldom given in the literature. In this study it was evaluated, if ECS might be an indicator for axillary irradiation. After a retrospective review of pathology reports, the information about ECS was available in 254 lymph node-positive patients: ECS was absent in 34% (ECS-negative; n=87) and present in 66% (ECS-positive; n=167). All patients were irradiated locally, 78 patients got periclavicular and 74 axillary irradiation (median total dose: 50.4 Gy). 240/254 patients (94.5%) received systemic treatment/s. Mean follow-up was 46 months. The regional relapse rate was 4.6% without ECS versus 9.6% with ECS. The 5-year axillary relapse-free survival was 100% in ECS-negative and 90% in ECS-positive patients (p=0.01), whereas corresponding values for periclavicular relapse-free survival (with ECS: 91%{+-}4%; without ECS: 94%{+-}3%; p=0.77) and local relapse-free survival (with ECS: 86%{+-}4%; without ECS: 91%{+-}3%; p=0.69) were not significantly different. {chi}{sup 2}-tests revealed a high correlation of ECS with T-stage, number of positive lymph nodes and progesterone receptor status, comparisons with estrogen receptor, grade, or age were not significant. In multivariate analysis number of positive lymph nodes was solely significant for regional failure. Dividing the patients into those with one to three and those with four or more positive lymph nodes, ECS lost its significance for axillary failure. ECS was accompanied by an enhanced axillary failure rate in univariate analysis, which was no longer true after adjusting for the number of positive lymph nodes. (orig.)

  5. Clinical significance of the negative lymph node count after the axillary dissection of breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    Yufeng Yao; Jinhai Tang; Jianwei Qin; Jianping Gong

    2012-01-01

    Objective: The purpose of this study was to evaluate the impact of the negative lymph node (LN) count on the survival of the breast cancer patients in early stage after the axillary dissection. Methods: The breast cancer patients with T1–2N0–1M0 stage between January 2001 and December 2005 in Jiangsu Cancer Hospital, who underwent the axillary LNs dissection, were enrolled in this study. We analyzed the data of these patients including information of follow-up and postop-erative pathological results. All patients were divided into two groups according to the axillary LN status and each group was divided into four subgroups according to the negative LN count. Cox regression analysis was performed to screen the patho-logical factor including the negative LN count on the survival and to compare the different negative LN count on the survival. Results: COX proportional hazard regression model showed that the survival of the breast cancer was significantly associ-ated with the negative LN count. In T1–2N0 group, when the negative LN count was 3 or less, 4 to 5, 6 to 9 and 10 or more, the median survival time was (82.6 ± 4.1) months, (101.5 ± 1.3) months, (104.7 ± 1.0) months, and (110.5 ± 0.9) months respectively (P < 0.05). In T1–2N1 group, when the negative LN count was 6 or less, 7 to 8, 9 to 10 and 11 or more, the median survival time was (95.4 ± 1.9) months, (101.8 ± 1.1) months, (104.9 ± 1.0) months, and (106.5 ± 0.9) months respectively (P < 0.05). Conclusion: The negative LN count can reflect the adequacy of the axillary dissection. Increasing negative LN count is independently associated with improved survival in pT1–2N0M0 or pT1–2N1M0 staging breast cancer patients. The negative LN count should be considered for incorporation into staging for breast cancer with the axillary LN dissection.

  6. Comparison of intraoperative frozen section analysis of sentinel node with preoperative positron emission tomography in the diagnosis of axillary lymph node status in breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jung-Hyun; Nam, Seok-Jin; Lee, Hae-Kyung; Kim, Byung-Tae [Sungkyunkwan Univ., Seoul (Korea, Republic of); Lee, Tae-Seung; Jung, Sung-Hoo

    2001-01-01

    Although axillary lymph node status is an important prognostic factor and axillary dissection is regarded as the gold standard for staging, it requires radical surgery which is accompanied by considerable postoperative problems such as lymphedema. This study was carried out to evaluate the diagnostic accuracy of preoperative positron emission tomography (PET) and intraoperative frozen biopsy of sentinel lymphadenectomy (SLND) in detecting axillary lymph node metastasis. We studied 18 patients who had preoperative PET and SLND for breast cancer in the Department of Surgery at Samsung Medical Center. They all had preoperative PET with a radiolabeled glucose analogue ([{sup 18}F]FDG) to visualize primary tumors and metastatic nodes. Isosulphan blue dye was used for intraoperative SLND. Frozen and permanent biopsies were then compared after full axillary dissection. In 18 cases, six had positive metastatic nodes in the permanent biopsy of full axillary dissection but were negative in three cases by preoperative PET. There was one false negative result by frozen biopsy of SLND which was later shown to be positive by permanent biopsy. The sensitivity and specificity of SLND and PET for detecting axillary node metastasis were 83, 100% and 50, 100%, respectively. Although both methods are good for axillary nodal status, the intraoperative frozen biopsy result of SLND was superior to preoperative PET in our preliminary study. (author)

  7. Comparison of intraoperative frozen section analysis of sentinel node with preoperative positron emission tomography in the diagnosis of axillary lymph node status in breast cancer patients

    International Nuclear Information System (INIS)

    Although axillary lymph node status is an important prognostic factor and axillary dissection is regarded as the gold standard for staging, it requires radical surgery which is accompanied by considerable postoperative problems such as lymphedema. This study was carried out to evaluate the diagnostic accuracy of preoperative positron emission tomography (PET) and intraoperative frozen biopsy of sentinel lymphadenectomy (SLND) in detecting axillary lymph node metastasis. We studied 18 patients who had preoperative PET and SLND for breast cancer in the Department of Surgery at Samsung Medical Center. They all had preoperative PET with a radiolabeled glucose analogue ([18F]FDG) to visualize primary tumors and metastatic nodes. Isosulphan blue dye was used for intraoperative SLND. Frozen and permanent biopsies were then compared after full axillary dissection. In 18 cases, six had positive metastatic nodes in the permanent biopsy of full axillary dissection but were negative in three cases by preoperative PET. There was one false negative result by frozen biopsy of SLND which was later shown to be positive by permanent biopsy. The sensitivity and specificity of SLND and PET for detecting axillary node metastasis were 83, 100% and 50, 100%, respectively. Although both methods are good for axillary nodal status, the intraoperative frozen biopsy result of SLND was superior to preoperative PET in our preliminary study. (author)

  8. Optical characterization of ex-vivo axillary lymph nodes of breast-cancer patients using a custom-built spectrophotometer

    Science.gov (United States)

    Sampathkumar, Ashwin; Saegusa-Beecroft, Emi; Mamou, Jonathan; Chitnis, Parag V.; Machi, Junji; Feleppa, Ernest J.

    2014-03-01

    Quantitative photoacoustics is emerging as a new hybrid modality to investigate diseases and cells in human pathology and cytology studies. Optical absorption of light is the predominant mechanism behind the photoacoustic effect. Therefore, a need exits to characterize the optical properties of specimens and to identify the relevant operating wavelengths for photoacoustic imaging. We have developed a custom low-cost spectrophotometer to measure the optical properties of human axillary lymph nodes dissected for breast-cancer staging. Optical extinction curves of positive and negative nodes were determined in the spectral range of 400 to 1000 nm. We have developed a model to estimate tissue optical properties, taking into account the role of fat and saline. Our results enabled us to select the optimal optical wavelengths for maximizing the imaging contrast between metastatic and noncancerous tissue in axillary lymph nodes.

  9. Intramammary lymph nodes.

    Science.gov (United States)

    Egan, R L; McSweeney, M B

    1983-05-15

    Radiographic, gross, and histopathologic studies on 158 whole breasts with primary operable carcinoma revealed intramammary lymph nodes in 28%, and of these breasts, 10% contained a metastatic deposit of carcinoma. Cancerous and noncancerous nodes were found in all quadrants of the breast with the positive ones being in the same quadrant as the carcinoma only 50% of the time. There was no demonstrable connection with the usual lymphatic drainage of the breast. With Stage II carcinoma, positive intramammary lymph nodes had no direct effect on prognosis, merely representing advanced disease and indicating a greater likelihood of axillary metastatic disease. There was a trend toward poorer prognosis in Stage I lesions with positive intramammary lymph nodes. This may indicate the Stage I carcinomas that have a similar prognosis as Stage II tumors. Conceivably, a Stage Ia, positive intramammary lymph node(s) but normal axillary lymph nodes, could be defined and used.

  10. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    He, Ni, E-mail: 61684754@qq.com [Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060 (China); Xie, Chuanmiao, E-mail: xiechm@sysucc.org.cn [Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060 (China); Wei, Weidong, E-mail: weiwd@sysucc.org.cn [Department of Breast, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060 (China); Pan, Changchuan, E-mail: 1253719670@qq.com [Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060 (China); Wang, Wenyan, E-mail: 7344362@qq.com [College of Electronic Engineering, Guangxi Normal University, Guilin 541004 (China); Lv, Ning, E-mail: 409109980@qq.com [Department of Breast, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060 (China); Wu, Peihong, E-mail: mit@caca.sina.net [Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060 (China)

    2012-10-15

    Objective: Malignant axillary lymph nodes are an important predictor for breast cancer recurrence, but invasive dissection or biopsy is required for the diagnosis. We determined whether and how malignant nodes could be diagnosed preoperatively with magnetic resonance (MR) imaging. Materials and methods: We obtained MR images of all women evaluated for breast cancer at the Sun Yat-Sen University Cancer Center in 2010 and correlated the image characteristics of each axillary node with the pathologic diagnosis of the same node. Results: We analyzed 251 nodes (117 benign; 134 malignant) from 136 women (mean age, 44 years; range, 20–67). Mean diameter of the nodes was 18 mm (range, 5–58 mm). With pathologic diagnosis as the reference standard, MRI-based interpretations were 66.4% sensitive, 94% specific, and 79% accurate. Diameter, pathologic type, apparent diffusion coefficient value (ADC, b = 500 and 800), time-intensity curve (TIC) type of breast tumors correlated with node metastasis; ADC value (b = 500 and 800), TIC type, early enhancement rate, long-axis, short-axis, shape, margin and the location of nodes correlated with node metastasis (P < 0.001 for all). Tumor immunohistochemistry results for estrogen receptors, progesterone receptors, c-erbB-2, vascular endothelial growth factor, and Ki67 were not. An MRI-based lymph node scoring system based on these correlations had a specificity of 91%, a sensitivity of 93%, and an area under the ROC curve of 0.95 (P < 0.001). Conclusion: Metastatic axillary lymph nodes can be accurately diagnosed by MR in women with early breast cancer preoperatively and non-invasively. The scoring system appears to be superior to current methods.

  11. Role of fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in the evaluation of axillary lymph node involvement in operable breast cancer in comparison with sentinel lymph node biopsy

    International Nuclear Information System (INIS)

    Role of (18(F)fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer and compare results with sentinel lymph node biopsy (SLNB). SLN was identified in 32 of 37 patients with an identification rate of 86.48% (32/37). With combined technique SLN identification rate was 100% (6/6) while with blue dye alone; it was 83.8% (26/31). Among 37 patients, 16 had axillary metastases of which 12 had macrometastases and four had micrometastases detected by immunohistochemistry (IHC). Of 12 patients with axillary macrometastases, skip metastases were present in two patients in whom SLN was negative and in two patients SLN was not identified, but axillary dissection showed metastases. PET-CT had shown sensitivity, specificity, negative predictive value and positive predictive value of 56%, 90%, 73%, and 81.8%, respectively. IHC of SLN detected four patients with micrometastases upstaging the disease by 11% (4/37). Because FDG PET-CT has a high specificity in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer patients according to the results of this study if FDG PET-CT is positive in axillary lymph nodes, axillary lymph node dissection may be considered instead of SLNB

  12. Outcomes of a population-based series of early breast cancer patients with micrometastases and isolated tumour cells in axillary lymph nodes

    NARCIS (Netherlands)

    Heiden-van der Loo, van der M.; Schaapveld, M.; Ho, V.K.Y.; Siesling, S.; Rutgers, E.J.T.; Peeters, P.H.M.

    2013-01-01

    Background Axillary lymph node staging is traditionally important to provide prognostic information to guide further treatment. However, the relevance of isolated tumour cells (ITC) or micrometastases in axillary nodes and the need for adjuvant treatment remain uncertain. Patients and methods Data

  13. Using quantitative image analysis to classify axillary lymph nodes on breast MRI: A new application for the Z 0011 Era

    Energy Technology Data Exchange (ETDEWEB)

    Schacht, David V., E-mail: dschacht@radiology.bsd.uchicago.edu; Drukker, Karen, E-mail: kdrukker@uchicago.edu; Pak, Iris, E-mail: irisgpak@gmail.com; Abe, Hiroyuki, E-mail: habe@radiology.bsd.uchicago.edu; Giger, Maryellen L., E-mail: m-giger@uchicago.edu

    2015-03-15

    Highlights: •Quantitative image analysis showed promise in evaluating axillary lymph nodes. •13 of 28 features performed better than guessing at metastatic status. •When all features were used in together, a considerably higher AUC was obtained. -- Abstract: Purpose: To assess the performance of computer extracted feature analysis of dynamic contrast enhanced (DCE) magnetic resonance images (MRI) of axillary lymph nodes. To determine which quantitative features best predict nodal metastasis. Methods: This institutional board-approved HIPAA compliant study, in which informed patient consent was waived, collected enhanced T1 images of the axilla from patients with breast cancer. Lesion segmentation and feature analysis were performed on 192 nodes using a laboratory-developed quantitative image analysis (QIA) workstation. The importance of 28 features were assessed. Classification used the features as input to a neural net classifier in a leave-one-case-out cross-validation and evaluated with receiver operating characteristic (ROC) analysis. Results: The area under the ROC curve (AUC) values for features in the task of distinguishing between positive and negative nodes ranged from just over 0.50 to 0.70. Five features yielded AUCs greater than 0.65: two morphological and three textural features. In cross-validation, the neural net classifier obtained an AUC of 0.88 (SE 0.03) for the task of distinguishing between positive and negative nodes. Conclusion: QIA of DCE MRI demonstrated promising performance in discriminating between positive and negative axillary nodes.

  14. Prognostic value of Ki-67 in breast cancer patients with positive axillary lymph nodes: a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Feng-yan Li

    Full Text Available INTRODUCTION: Ki-67 expression is a biomarker for proliferation. Its prognostic value is recognized in breast cancer (BC patients with negative axillary nodes, but is less clear in BC patients with positive axillary lymph nodes. METHODS: We retrospectively reviewed the medical records of 1131 Chinese BC patients treated from January 2002 to June 2007 and 450 patients met the inclusion criteria: positive nodes, adjuvant therapy, and complete biomarker profile (estrogen receptor (ER, progesterone receptor (PR, HER2, p53, Ki-67. Univariate and multivariate regression analysis were used to correlate biomarkers and tumor characteristics with metastasis free survival (MFS and overall survival (OS. RESULTS: Median follow-up time was 46 months (range 5-76 months. The Ki-67 expression was associated significantly with histological grade, ER, PR, HER2, and P53 status (P<0.05. Tumor stage, nodal stage, and ER status were independent prognostic factors for MFS. Ki-67 status was associated significantly with OS but not MFS. To determine whether the extent of LN involvement in the BC patients influenced the role of Ki-67 in survival rates, we compared these variables in patients with 1-3 positive lymph nodes (N1 to those of patients with ≥ 4 positive lymph nodes. Ki-67 status was an independent prognostic factor for MFS (Hazard Ratio, 3.27, P = 0.026 and overall survival (HR, 10.64, P = 0.007 in patients with 1-3 positive nodes (N1. CONCLUSIONS: The possibility that Ki-67 expression together with clinical factors can improve prediction of the prognosis of BC patients with 1 ∼ 3 positive axillary lymph nodes warrants further studies.

  15. Postoperative irradiation in breast cancer patients with one to three positive axillary lymph nodes. Is there an impact of axillary extranodal tumor extension on locoregional and distant control?

    Energy Technology Data Exchange (ETDEWEB)

    Stranzl, H. [Dept. of Radiotherapy-Radiooncology, Univ. Medical School, Graz (Austria); Ofner, P. [Inst. for Medical Informatics, Statistics and Documentation, Univ. Medical School, Graz (Austria); Peintinger, F. [Div. of Gynecology, Leoben (Austria)

    2006-10-15

    Background and purpose: to evaluate the impact of extracapsular extension (ECE) on locoregional and distant control in breast cancer patients with one to three positive axillary lymph nodes treated with postoperative irradiation. As shown in literature, ECE is diagnosed in up to 30% of node-positive breast cancer patients. Consequences of ECE and prognosis of these patients are unclear. Patients and methods: the medical records of 1,142 node-positive females with a carcinoma of the breast, postoperatively irradiated between 1994 and 2003, were retrospectively reviewed. Of the 274 patients presenting with one to three positive axillary lymph nodes, 91 (33.2%) showed ECE, While all patients were irradiated using tangential fields, only eight out of 274 patients received additional nodal irradiation. Results: patients' mean age was 58.2 years (range, 28-96 years), and the mean observation period 42.9 months (range, 6.6-101 months). In 93.4% of patients, locoregional control was achieved. On multivariate analysis of metastases-free survival, the hazard ratios for ECE and histological grade 3 were 2.71 (95% confidence interval [CI], 1.316-5.581; p = 0.007) and 2.435 (95% CI, 1.008-5.885; p = 0.048), respectively. The 3-year and 5-year metastases-free survival rates for patients with ECE were 78% and 66%, compared to 90% and 87% in patients without ECE (p = 0.0048). Conclusion: locoregional recurrence remains low in breast cancer patients (one to three positive axillary lymph nodes {+-} ECE) treated with surgery, adequate axillary dissection, and tangential field irradiation only. However, ECE is significantly linked to a considerable risk for subsequent distant failure. (orig.)

  16. Contralateral Axillary Lymph Node Metastases at the Time of Primary Breast Cancer Diagnosis: Curative or Palliative Intent?

    OpenAIRE

    Zhou, C.; Richir, M.C.; Leenders, M. W. H.; Langenhorst, B. L. A. M.; Knol, H. P.; Schreurs, W.H.

    2013-01-01

    Contralateral axillary lymph node metastases (CAMs) in breast cancer patients are uncommon. CAM can be found at the time of primary breast cancer diagnosis or following prior treatment of breast cancer as a recurrence. This distinction may have important implications for disease staging and treatment selection. We report the case of a premenopausal woman with synchronous CAM. Despite extensive multimodality treatment, a recurrence was found 27 months after primary surgery. We reviewed the lit...

  17. Toxoplasmosis presenting as a swelling in the axillary tail of the breast and a palpable axillary lymph node mimicking malignancy: a case report

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    Kamel Dia

    2011-08-01

    Full Text Available Abstract Introduction Lymphadenopathy is a common finding in toxoplasmosis. A breast mass due to toxoplasmosis is very rare, and only a few cases have been reported. We present a case of toxoplasmosis that presented as a swelling in the axillary tail of the breast with a palpable axillary lymph node which mimicked breast cancer. Case presentation A 45-year-old otherwise healthy Caucasian woman presented with a lump on the lateral aspect of her left breast. Her mother had breast cancer that was diagnosed at the age of 66 years. During an examination, we discovered that our patient had a discrete, firm lump in the axillary tail of her left breast and an enlarged, palpable lymph node in her left axilla. Her right breast and axilla were normal. The clinical diagnosis was malignancy in the left breast. Ultrasound and mammographic examinations of her breast suggested a pathological process but were not conclusive. She had targeted fine-needle aspiration cytology (FNAC and core biopsy of the lesions. FNAC was indeterminate (C3 but suggested a possibility of toxoplasmosis. The core biopsy was not suggestive of malignancy but showed granulomatous inflammation. She had a wide local excision of the breast lump and an axillary lymph node biopsy. Histopathology and immunohistochemical studies excluded carcinoma or lymphoma but suggested the possibility of intramammary and axillary toxoplasmic lymphadenopathy. The results of Toxoplasma gondii IgM and IgG serology tests were positive, supporting a diagnosis of toxoplasmosis. Conclusions Toxoplasmosis rarely presents as a pseudotumor of the breast. FNAC and histology are valuable tools for a diagnosis of toxoplasmosis, and serology is an important adjunct for confirmation.

  18. Lymphangiogenesis and Axillary Lymph Node Metastases Correlated with VEGF-C Expression in Two Immunocompetent Mouse Mammary Carcinoma Models

    Directory of Open Access Journals (Sweden)

    Yuko Ito

    2011-01-01

    Full Text Available Lymphangiogenesis and the expression of vascular endothelial cell growth factor C (VEGF-C in tumors have been considered to be causally promoting lymphatic metastasis. There are only a few studies on lymphatic metastasis in immunocompetent allograft mouse models. To study the relationship between VEGF-C-mediated lymphangiogenesis and axillary lymph node metastasis, we used two mouse mammary carcinoma cell lines; the BJMC338 has a low metastatic propensity, whereas the BJMC3879 has a high metastatic propensity although it originated from the former cell line. Each cell line was injected separately into two groups of female BALB/c mice creating in vivo mammary cancer models. The expression level of VEGF-C in BJMC3879 was higher than BJMC338. As the parent cell line, BJMC3879-derived tumors showed higher expression of VEGF-C compared to BJMC338-derived tumors. This higher expression of VEGF-C in BJMC3879-derived tumors was associated with marked increase in infiltrating macrophages and enhanced expression of lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1 reflecting increased tumoral lymphatic density and subsequent induction of axillary lymph node metastasis. Our mouse mammary carcinoma models are allotransplanted tumors showing the same axillary lymph node metastatic spectrum as human breast cancers. Therefore, our mouse models are ideal for exploring the various molecular mechanisms of cancer metastasis.

  19. Sentinel lymph node detection after trans axillary augmentation mammoplasty: a prospective controlled study utilizing lymphoscintigraphy in 43 breasts

    Energy Technology Data Exchange (ETDEWEB)

    Sado, Heitor Naoki; Timi, Jorge Rufino Ribas; Matias, Jorge Eduardo Fouto [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Program of Post-Graduation in Surgical Practice]. E-mail: heitor@cermen.com.br; Graf, Ruth Maria [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Hospital de Clinicas; Urban, Cicero Andrade [UnicenP, Curitiba, PR (Brazil); Yamada, Airton Seiji [CERMEN - Centro de Radioimunoensaio e Medicina Nuclear de Curitiba, PR (Brazil); Woellner, Luiz Carlos [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Hospital de Clinicas. Unit of Nuclear Medicine; Ferreira, Eduardo de Castro [Universidade Federal do Maranhao (UFMA), Sao Luis, MA (Brazil). Hospital de Clinicas

    2008-09-15

    Objective: to evaluate the potential influence of trans axillary augmentation mammoplasty on future detection of sentinel lymph node. Materials and methods: prospective controlled study where 22 patients were selected and divided into two groups (post-mammoplasty and control) corresponding to 43 breasts (22 in the post-mammoplasty group and 21 in the control group) evaluated by lymphoscintigraphy immediately after periareolar {sup 99m}Tc-phytate injections. In the statistical analysis, p values < 0.05 were considered as significant. Results: all the breasts in the post-mammoplasty group presented lymphatic drainage to the axillary chain, with no difference as compared with the control group (p 0.488). The average number of hot lymph nodes was 1.27 {+-} 0.46 in the post-mammoplasty group, and 1.33 {+-} 0.58 in the control group (p = 0.895). The mean time required to visualize the first lymph node was 3.14 {+-} 4.42 minutes in the post mammoplasty group, and 5.48 {+-} 5.06 minutes in the control group (p 0.136). Conclusion: transaxillary augmentation mammoplasty did not affect the future detection of sentinel lymph node. (author)

  20. Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Riegger, Carolin; Heusner, Till A. [Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf (Germany); Univ Duisburg-Essen, Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany)], E-mail: Heusner@med.uni-duesseldorf.de; Koeninger, Angela; Kimmig, Rainer [Univ Duisburg-Essen, Medical Faculty, Department of Gynecology and Obstetrics, Essen (Germany); Hartung, Verena; Bockisch, Andreas [Univ Duisburg-Essen, Medical Faculty, Department of Nuclear Medicine, Essen (Germany); Otterbach, Friedrich [Univ Duisburg-Essen, Institute of Pathology and Neuropathology, Essen (Germany); Forsting, Michael [Univ Duisburg-Essen, Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Antoch, Gerald [Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf (Germany)

    2012-12-15

    Background. FDG-PET/CT is increasingly being used for breast cancer staging. Its diagnostic accuracy in comparison to ultrasound as the standard non-invasive imaging modality for the evaluation of axillary lymph nodes has yet not been evaluated. Purpose. To retrospectively compare the diagnostic value of full-dose, intravenously contrast-enhanced FDG-PET/CT and ultrasound for the detection of lymph node metastases in breast cancer patients. Material and Methods. Ninety patients (one patient with a bilateral carcinoma) (89 women, one man; mean age, 55.5 {+-} 16.6 years) suffering from primary breast cancer underwent whole-body FDG-PET/CT and axillary ultrasound. The ipsilateral axillary fossa (n = 91) was evaluated for metastatic spread. The sensitivity, specificity, the positive predictive value (PPV), negative predictive value (NPV), and accuracy of both methods were calculated. The sensitivity and accuracy were statistically compared using the McNemar Test (P <0.05). Analyses were made on a patient basis. The number of patients with extra-axillary locoregional lymph node metastases exclusively detected by FDG-PET/CT was evaluated. For axillary lymph node metastases histopathology served as the reference standard. Results. The sensitivity, specificity, PPV, NPV, and accuracy of FDG-PET/CT for the detection of axillary lymph node metastases were 54%, 89%, 77%, 74%, and 75%, respectively. For ultrasound it was 38%, 78%, 54%, 65%, and 62%, respectively. FDG-PET/CT was significantly more accurate than ultrasound for the detection of axillary lymph node metastases (P = 0.019). There was no statistically significant difference between the sensitivity of both modalities (P = 0.0578). FDG-PET/CT detected extra-axillary locoregional lymph node metastases in seven patients (8%) that had not been detected by another imaging modality. Conclusion. Though more accurate compared to ultrasound for evaluating the axillary lymph node status FDG-PET/CT is only as sensitive as

  1. Postoperative periclavicular radiotherapy in breast cancer patients with 1-3 positive axillary lymph nodes. Outcome and morbidity

    Energy Technology Data Exchange (ETDEWEB)

    Biancosino, A.; Bremer, M.; Karstens, J.H.; Meyer, A. [Medical School Hannover (Germany). Clinic of Radiation Oncology; Biancosino, C. [Dr. Horst-Schmidt-Clinic Wiesbaden, Wiesbaden (Germany). Dept. of Thoracic Surgery

    2012-05-15

    The goal of this work was to examine the possible influence of periclavicular irradiation on outcome of breast cancer patients with 1-3 positive lymph nodes with special emphasis on late toxicity rates. Between 1997 and 2000, 235 breast cancer patients (T1-2, 1-3 involved lymph nodes) were treated at our department following breast conservative surgery: 139 patients (59.1%) had one, 62 patients (26.4%) two, and 34 patients (14.5%) three positive lymph nodes. Extracapsular spread (ECS) was described in 72 patients (30.6%). There were 67 patients (28.5%) who received additional radiotherapy to the ipsilateral periclavicular lymph nodes (PCLNI), while 168 patients did not (noPCLNI). Patients were re-examined or contacted by phone with regard to treatment-related late effects. After a median follow-up of 78 months (range 7-107 months), 22 patients (9.4%) developed local, 9 (3.8%) axillary, 4 periclavicular (1.7%), and 41 distant failure (17.4%). The actuarial 8-year locoregional recurrence-free (LRRFS), disease-free (DFS), and overall survival rates (OS) were 83%, 67%, and 74%, respectively. Survival data for the PCLNI vs. noPCLNI group were 72% vs. 89% (p = 0.3), 56% vs. 73% (p = 0.4), and 86% vs. 70% (p = 0.3), respectively. No higher toxicity rates were reported in the PCLNI group compared to the noPCLNI group. We could not demonstrate any difference in outcome in breast cancer patients with 1-3 positive axillary lymph node metastases with or without periclavicular lymph node irradiation. In addition, patients with PCLNI did not complain about higher rates of late toxicities. However, patients with ECS, which may predict for locoregional failure, may benefit from adjuvant periclavicular irradiation. (orig.)

  2. Axillary lymph node dose with tangential whole breast radiation in the prone versus supine position: a dosimetric study

    Directory of Open Access Journals (Sweden)

    Leonard Kara

    2012-05-01

    Full Text Available Abstract Background Prone breast positioning reduces skin reaction and heart and lung dose, but may also reduce radiation dose to axillary lymph nodes (ALNs. Methods Women with early stage breast cancer treated with whole breast irradiation (WBI in the prone position were identified. Patients treated in the supine position were matched for treating physician, laterality, and fractionation. Ipsilateral breast, tumor bed, and Level I, II, and III ALNs were contoured according to the RTOG breast atlas. Clips marking surgically removed sentinel lymph nodes (SLNs were contoured. Treatment plans developed for each patient were retrospectively analyzed. V90% and V95% was calculated for each axillary level. When present, dose to axillary surgical clips was calculated. Results Treatment plans for 46 women (23 prone and 23 supine were reviewed. The mean V90% and V95% of ALN Level I was significantly lower for patients treated in the prone position (21% and 14%, respectively than in the supine position (50% and 37%, respectively (p p % of SLN clips was 47% for patients treated in the supine position and 0% for patients treated in the prone position (p % to SLN clips was 96% for women treated in the supine position but only 13% for women treated in the prone position. Conclusions Standard tangential breast irradiation in the prone position results in substantially reduced dose to the Level I axilla as compared with treatment in the supine position. For women in whom axillary coverage is indicated such as those with positive sentinel lymph node biopsy who do not undergo completion axillary dissection, treatment in the prone position may be inappropriate.

  3. False-positive axillary lymph node on F-18 FDG PET/CT due to moxibustion therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Shin Young; Lee, Sang Woo; Ahn, Byeong Cheol; Lee, Jae Tae [Kyungpook National University Hospital, Daegu (Korea, Republic of); Seo, Ji Hyoung [Inje University Haeundae Paik Hospital, Busan (Korea, Republic of)

    2010-12-15

    A 30-year-old female was diagnosed with papillary thyroid cancer and underwent total thyroidectomy and high-dose radioiodine ablation. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for recurrence detection of thyroid carcinoma was performed at 3 years after total thyroidectomy. Moxibustion is a traditional Chinese medicine therapy using moxa or the mugwort herb. Moxibustion is the burning of a small, thimble-sized, smoldering plug of dried leaves such as moxa or mugwort on the skin at an acupuncture point. Acupuncture and moxibustion induce hyperemia and a local inflammatory reaction. Complications associated with moxibustion such as skin bums or infection of the site have been reported previously. False-positive FDG uptake in PET may result from inflammation, infection, and variations in physiological uptake. In the present case, the hypermetabolic axillary lymph node disappeared without any treatment. Well-known of false-positive FDG uptake in axillary lymph noes such as arthritis of the upper extremity, extravasation of injected FDG, and vaccination were not found. Thus, left axillary lymph node uptake was

  4. False-positive axillary lymph node on F-18 FDG PET/CT due to moxibustion therapy

    International Nuclear Information System (INIS)

    A 30-year-old female was diagnosed with papillary thyroid cancer and underwent total thyroidectomy and high-dose radioiodine ablation. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for recurrence detection of thyroid carcinoma was performed at 3 years after total thyroidectomy. Moxibustion is a traditional Chinese medicine therapy using moxa or the mugwort herb. Moxibustion is the burning of a small, thimble-sized, smoldering plug of dried leaves such as moxa or mugwort on the skin at an acupuncture point. Acupuncture and moxibustion induce hyperemia and a local inflammatory reaction. Complications associated with moxibustion such as skin bums or infection of the site have been reported previously. False-positive FDG uptake in PET may result from inflammation, infection, and variations in physiological uptake. In the present case, the hypermetabolic axillary lymph node disappeared without any treatment. Well-known of false-positive FDG uptake in axillary lymph noes such as arthritis of the upper extremity, extravasation of injected FDG, and vaccination were not found. Thus, left axillary lymph node uptake was

  5. Lymph Drainage Studied by Lymphoscintigraphy in the Arms after Sentinel Node Biopsy Compared with Axillary Lymph Node Dissection Following Conservative Breast Cancer Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Celebioglu, F.; Perbeck, L.; Frisell, J.; Groendal, E.; Svensson, L.; Danielsson, R. [Dept. of Molecular Medicine and Surgery, Karolinska Inst., Karolinska Univ Hospital Solna, Stockholm (Sweden)

    2007-07-15

    Purpose: To investigate lymphatic drainage as measured by lymphoscintigraphy in the arms of patients undergoing either sentinel lymph node biopsy (SNB) or axillary lymph node dissection (ALND). Material and Methods: From January 2001 to December 2002, 30 patients with unilateral invasive breast carcinoma underwent breast-conserving surgery with SNB and 30 patients with ALND. All patients received radiotherapy to the breast. Lymphoscintigraphy was performed, and skin circulation, skin temperature, and arm volume were measured 2-3 years after radiotherapy. Results: None of the 30 patients who underwent SNB showed any clinical manifestation of lymphedema. Of the 30 patients undergoing ALND, six (20%) had clinical lymphedema, with an arm volume that was >10% larger on the operated than on the non-operated side (P<0.01). Scintigraphically, visual analysis revealed lymphatic dysfunction in three patients, manifested as forearm dermal back flow. Two of these patients also had an increased arm volume. Quantitative analysis showed no differences between the groups, apart from a smaller amount of isotope in the axilla in the ALND group. There was no difference in skin circulation or skin temperature. Conclusion: Our study shows that lymph drainage in the operated arm compared with the non-operated arm was less affected by SNB than by ALND, and that morbidity associated with SNB was lower than with ALND. However, the results do not confirm our hypothesis that lymphoscintigraphy can reveal differences in lymph circulation that are not evident clinically in the form of manifest lymphedema. The most sensitive clinical method of assessing lymph drainage seems to be measurement of arm volume.

  6. Differential Diagnosis of Axillary Inflammatory and Metastatic Lymph Nodes in Rabbit Models by Using Diffusion-Weighted Imaging: Compared with Conventional Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jun Ping; Zhang, Yun Ting; Yu, Chunshui; Bai, Renju; Sun, Haoran [Tianjin Medical University General Hospital, Tianjin (China); Liao, Qian [The First Affiliated Hospital of Nanchang University, Jiangxi (China)

    2012-07-15

    This experiment aims to determine the diagnostic value of diffusion-weighted imaging (DWI) in the differentiation of axillary inflammatory lymph nodes from metastatic lymph nodes in rabbit models in comparison with conventional magnetic resonance imaging (MRI). Conventional MRI and DWI were performed at 4 weeks after successful inoculation into the forty female New Zealand white rabbits' mammary glands. The size-based and signal-intensity-based criteria and the relative apparent diffusion coefficient (rADC) value were compared between the axillary inflammatory lymph nodes and metastatic lymph nodes, with histopathological findings as the reference standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the aforementioned criteria and rADC value in differentiating the axillary inflammatory lymph nodes from metastatic lymph nodes. Thirty-two axillary inflammatory lymph nodes and 46 metastatic ones were successfully isolated and taken into pathological analysis. The differences of the aforementioned criteria between the two groups were not statistically significant (p > 0.05). However, the rADC value of the inflammatory lymph nodes (0.9 {+-} 0.14) was higher than that of metastatic ones (0.7 {+-} 0.18), with significant difference (p = 0.016). When the rADC value was chosen as 0.80, the area under the ROC curve is greater than all other criteria, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for differentiating two groups were 86.2%, 79.3%, 81.2%, 84.2%, and 85.6%, respectively. Diffusion-weighted imaging is a promising new technique for differentiating axillary inflammatory lymph nodes from metastatic lymph nodes. Compared with routine magnetic resonance sequences, DWI could provide more useful physiological and functional information for diagnosis.

  7. The number of tumor-free axillary lymph nodes removed as a prognostic parameter for node-negative breast cancer

    Institute of Scientific and Technical Information of China (English)

    Fei Gao; Ni He; Pei-Hong Wu

    2014-01-01

    Recently, there has been controversy about the relationship between the number of lymph nodes removed and survival of patients diagnosed with lymph node-negative breast cancer. To assess this relationship, 603 cases of lymph node-negative breast cancer with a median of 126 months of follow-up data were studied. Patients were stratified into two groups (Group A, 10 or fewer tumor-free lymph nodes removed; Group B, more than 10 tumor-free lymph nodes removed). The number of tumor-free lymph nodes in ipsilateral axilary resections as wel as 5 other disease parameters were analyzed for prognostic value. Our results revealed that the risk of death from breast cancer was significantly associated with patient age, marital status, histologic grade, tumor size, and adjuvant therapy. The 5- and 10-year survival rates for patients with 10 or fewer tumor-free lymph nodes removed was 88.0% and 66.4%, respectively, compared with 69.2% and 51.1%, respectively, for patients with more than 10 tumor-free lymph nodes removed. For patients with 10 or fewer tumor-free lymph nodes removed, the adjusted hazard ratio (HR) for risk of death from breast cancer was 0.579 (95% confidence interval, 0.492-0.687,P < 0.001), independent of patient age, marital status, histologic grade, tumor size, and adjuvant therapy. Our study suggests that the number of tumor-free lymph nodes removed is an independent predictor in cases of lymph node-negative breast cancer.

  8. The detection of axillary lymph node metastases from breast cancer by radiolabelled monoclonal antibodies: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Tjandra, J.J. (Melbourne Univ., Parkville (Australia) Royal Melbourne Hospital, Parkville (Australia)); Sacks, N.P.M.; Thompson, C.H. (Melbourne Univ., Parkville (Australia)) (and others)

    1989-02-01

    Two murine monoclonal antibodies that react with human breast cancer (3E1.2 and RCC-1) were labelled with {sup 131}iodine, and the radiolabelled antibody was injected into 40 patients, 36 of whom had breast cancer and the remaining four of whom had fibroadenoma (the normal, contralateral axilla was used as a control). Immunoscintigraphy had an overall sensitivity of 33% (23% with {sup 131}I-3E1.2 and 5% with {sup 131}I-RCC-1) for the detection of lymph node metastases and a specificity of 63% (67% with {sup 131}I-3E1.2 and 60% with {sup 131}I-RCC-1) with problems of non-specific uptake by presumably normal lymph nodes. The results of immunoscintigraphy obtained with {sup 131}I-RCC-1 (IgG) were superior to {sup 131}I-3E1.2 (IgM) although the accuracy of immunoscintigraphy using {sup 131}I-RCC-1 (56%) was not much better than preoperative clinical assessment (50%). However, there were cases when immunoscintigraphy using radiolabelled antibody (IgM or IgG) detected axillary lymph node metastases not suspected by clinical examination. Thus it appears that while immunoscintigraphy may be a useful adjunct to preoperative clinical assessment and is simple and safe, a major improvement in its accuracy is needed before it can replace axillary dissection and histological examination in the accurate staging of axilla in breast cancer. (author).

  9. Is ultrasound-guided fine-needle aspiration cytology of adequate value in detecting breast cancer patients with three or more positive axillary lymph nodes?

    Science.gov (United States)

    Kramer, G M; Leenders, M W H; Schijf, L J; Go, H L S; van der Ploeg, T; van den Tol, M P; Schreurs, W H

    2016-04-01

    This study evaluated the accuracy of ultrasound-guided fine-needle aspiration cytology of the sonographically most suspicious axillary lymph node (US/FNAC) to select early breast cancer patients with three or more tumour-positive axillary lymph nodes. Between 2004 and 2014, a total of 2130 patients with histologically proven early breast cancer were evaluated and treated in the Noordwest Clinics Alkmaar. US/FNAC was performed preoperatively in all these patients. We analysed the results of US/FNAC retrospectively. Pathological axillary node status (sentinel node biopsy and/or axillary lymph node dissection) was used as reference standard. A total of 634 (29.8 %) of 2130 patients had axillary lymph node metastases on final histology. 248 node positive patients (11.6 %) had three or more positive lymph nodes. The accuracy of US/FNAC to detect three or more positive lymph nodes was 89.8 %, sensitivity was 44.8 %, specificity was 95.7 %, PPV was 58.1 %, and NPV was 92.9 %. This study shows a more than adequate accuracy of preoperative US/FNAC to detect three or more positive lymph nodes (89.8 %). However, when US/FNAC was chosen as the only axillary staging method, 6.4 % of all patients (false negative group) would have been undertreated and 3.8 % of all patients (false positive group) would have been overtreated according to the ACOSOG Z0011 criteria. PMID:26995283

  10. The value of T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer--a preliminary in vivo study.

    Directory of Open Access Journals (Sweden)

    Chuanming Li

    Full Text Available BACKGROUND: Accurate detection and determination of axillary lymph node metastasis are crucial for the clinical management of patients with breast cancer. Noninvasive imaging methods including ultrasound (US, computed tomography (CT, or conventional magnetic resonance imaging (MRI are not yet accurate enough. The purpose of this study was to investigate the value of in vivo T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer. METHODOLOGY/PRINCIPAL FINDINGS: In this institutional review board approved study, 35 women with breast cancer underwent multi-echo T2* weighted imaging (T2*WI of the axillary area on a 3.0 T clinical magnetic resonance (MR imaging system. T2* values of pathologically proven benign and metastatic axillary lymph nodes were calculated and compared. Receiver operating characteristics (ROC analysis was conducted to evaluate the diagnostic ability. The areas under the ROC curve (AUCs and the confidence intervals (CIs were assessed. In total, 56 metastatic and 65 benign axillary lymph nodes were identified in this study. For metastatic lymph nodes, the average T2* value (55.96±11.87 ms was significantly longer than that of the benign lymph nodes (26.00±5.51 ms, P<0.05. The AUC of T2* in differentiating benign from metastatic lymph nodes was 0.993. The cut-off value of 37.5 milliseconds (ms gave a sensitivity of 94.6%, a specificity of 98.5%, a positive predictive value of 98.17 and a negative predictive value 95.54. CONCLUSIONS: In vivo T2* can differentiate benign from metastatic axillary lymph nodes in patients with breast cancer. The high sensitivity and specificity as well as the easiness suggest its high potential for use in clinical practice.

  11. Is there a requirement for axillary lymph node dissection following identification of micro-metastasis or isolated tumour cells at sentinel node biopsy for breast cancer?

    LENUS (Irish Health Repository)

    Joyce, D P

    2012-02-29

    INTRODUCTION: Recent decades have seen a significant shift towards conservative management of the axilla. Increasingly, immunohistochemical analysis of sentinel nodes leads to the detection of small tumour deposits, the significance of which remains uncertain. The aims of this study are to examine patients whose sentinel lymph nodes are positive for macro-metastasis, micro-metastasis or isolated tumour cells (ITCs) and to determine the rate of further nodal disease after axillary lymph node dissection (ALND). METHODS: A retrospective analysis of all patients undergoing a sentinel lymph node biopsy (SLNB) between January 2007 and December 2010 in a tertiary referral breast unit was performed. Patients who underwent an axillary lymph node dissection for macro-metastasis, micro-metastasis or ITCs were identified. Demographics, histological data and the rate of further axillary disease were examined. RESULTS: In total, 664 breast cancer patients attended the symptomatic breast unit during the study period, 360 of whom underwent a SLNB. Seventy patients had a SLNB positive for macro-metastasis. All of these patients underwent ALND. A positive SLNB with either micro-metastasis or ITCs was identified in 58 patients. Only 41 of the 58 patients went on to have an ALND, due primarily to variations in surgeons\\' preferences. Nineteen patients with micro-metastasis underwent an ALND. Four patients had further axillary disease (21%). Twenty-two patients had ITCs identified, of whom only one had further disease (4.5%). No statistically significant difference was found between the two groups in terms of tumour size, grade, lymphovascular invasion or oestrogen receptor status. CONCLUSION: ALND should be considered in patients with micro-metastasis at SLNB. It should rarely be employed in the setting of SLNB positive for ITCs.

  12. Breast cancer with axillary lymph node involvement; Cancer du sein avec atteinte ganglionnaire axillaire

    Energy Technology Data Exchange (ETDEWEB)

    Belaid, A.; Kanoun, S.; Kallel, A.; Ghorbel, I.; Azoury, F.; Heymann, S.; Marsiglia, H.; Bourgier, C. [Departement de radiotherapie, Unite fonctionnelle de Senologie, institut Gustave-Roussy, 94 - Villejuif (France); Belaid, A.; Ghorbel, I. [Service de radiotherapie Carcinologique, institut Salah-Azaiez, Tunis (Tunisia); Kanoun, S. [Service de radiotherapie, hopital Farhat-Hached, Sousse (Tunisia); Kallel, A. [dUnite de radiotherapie, clinique Ennasr (Tunisia); Pichenot, C.; Verstraet, R. [Departement de physique, institut Gustave-Roussy, 94 - Villejuif (France); Marsiglia, H. [Universite de Florence (Italy)

    2010-07-01

    Breast cancer is the most frequent cancer of women in western countries. There are one million new cases per year in the world which represents 22% of all female cancers, and more than 370.000 deaths due to breast cancer per year (14% of cancer mortality). More than half of breast cancers are associated with axillary nodal involvement. Post-operative radiation therapy (XRT) is a crucial part of locoregional treatment in axillary nodal involvement breast cancer owing to a 15-years risk reduction of locoregional recurrence of 70% and to a 5.4% risk reduction of specific mortality. In 3D-conformal irradiation in such breast cancers, target volumes are chest wall when mastectomy was performed or breast and boost of tumor bed in case of breast conservative surgery, and supra-clavicular and/or axillary and/or internal mammary node areas. The main organs at risk are ipsilateral lung, heart and brachial plexus. The aim of this article is to describe epidemiologic, radio anatomic and prognostic features of axillary nodal involvement breast cancer and to propose guidelines for 3D-conformal treatment planning in locally advanced breast cancers. This review is illustrated by a case report. (authors)

  13. Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens

    Directory of Open Access Journals (Sweden)

    Ahmad Zubair

    2009-10-01

    Full Text Available Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise. Objective: The aim of this study was to acquire information about the extent and spread of breast carcinoma in our patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI scoring on the available material. Materials and Methods: One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases. Results: Out of the 120 cases, 5 (4.17 were grade 1, 91 (75.83 were grade 2, and 24 (20% were grade 3. Also, 9 cases (7.5% were T1 (4 were T1b, and 5 were T1c; 53 (44.16% were T2; 50 (41.66% were T3; and 8 (6.66% were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23% lymph nodes were negative for metastases pN0; 29 (27.10% cases were pN1; 26 (24.30 were pN2; and 25 cases (23.36% were pN3. Extranodal spread was present in 56 (70% out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001. Tumor necrosis was present in 76 out of 120 cases (63.33%. Vascular invasion was present in 43 out of

  14. The prognostic effect of the number of histologically examined axillary lymph nodes in breast cancer : Stage migration or age association?

    NARCIS (Netherlands)

    Schaapveld, M; de Vries, EGE; van der Graaf, WTA; Otter, R; de Vries, J; Willemse, PHB

    2006-01-01

    Background: The number of pathologically examined axillary nodes has been associated with breast cancer survival, and examination of >= 10 nodes has been advocated for reliable axillary staging. The considerable variation observed in axillary staging prompted this population-based study, which evalu

  15. MRI and P-31 Magnetic Resonance Spectroscopy Hardware for Axillary Lymph Node Investigation at 7T

    NARCIS (Netherlands)

    Rivera, Debra S.; Wijnen, Jannie P.; van der Kemp, Wybe J. M.; Raaijmakers, Alexander J.; Luijten, Peter R.; Klomp, DWJ

    2015-01-01

    PurposeNeoadjuvant treatment response in lymph nodes predicts patient outcome, but existing methods do not track response during therapy accurately. In this study, specialized hardware was used to adapt high-field (7T) P-31 magnetic resonance spectroscopy (MRS), which has been shown to track treatme

  16. Comparison of molecular analysis and histopathology for axillary lymph node staging in primary breast cancer: results of the B-CLOSER-I study.

    Science.gov (United States)

    Vegué, Laia Bernet; Rojo, Federico; Hardisson, David; Iturriagagoitia, Alicia Córdoba; Panadés, Maria José; Velasco, Ana; Bonet, Eugeni López; Muñoz, Rafael Cano; Polo, Luis

    2012-06-01

    In breast cancer, the number of lymph node metastases is the strongest predictor of outcome. However, histopathology may underestimate the frequency of metastasis. Here we compare automated molecular detection of cytokeratin 19 mRNA by one-step nucleic acid amplification (OSNA) with histopathology of single tissue sections for the staging of axillary lymph nodes in patients with breast cancer. Axillary lymph nodes were collected from 55 patients with primary breast cancer and sentinel lymph node (SLN) metastases. The central 1-mm portion of each node was processed for hematoxylin-eosin staining, and the remaining tissue was analyzed by OSNA. According to OSNA, histopathology misclassified 41.8% of patients as negative for axillary node metastasis (P=0.007). Of the individual nodes considered negative by histopathology, 4.5% contained micrometastases and 2.5% contained macrometastases according to OSNA. Furthermore, 80% of micrometastases identified by histopathology were reclassified as macrometastases by OSNA. Histopathology failed to identify 81.1% of nodes shown to contain metastasis by OSNA. However, OSNA yielded no false-negative results. On the basis of OSNA results, 3 patients were reclassified to a higher pathologic stage. The number of SLN and non-SLN metastases was unrelated according to OSNA (P=0.891). These results show that, compared with molecular detection, histopathology of single tissue sections significantly underestimates the frequency of axillary node metastases. We discuss the implications of these findings in light of current recommendations on the staging of breast cancer.

  17. Five-year follow-up of treatment outcomes in patients with early-stage breast cancer and clinically negative axillary nodes treated with no lymph node dissection or axillary clearance

    Directory of Open Access Journals (Sweden)

    Yamamoto D

    2012-08-01

    Full Text Available Daigo Yamamoto,1 Kanji Tanaka,2 Yu T subota,1 Noriko Sueoka,1 Tetsuji Shoji,3 Kayoko Kuwana,1 A-Hon Kwon11Department of Surgery, Kansai Medical University, Hirakata, 2Ribon-Rose Tanaka Kanji Breast Clinic, 3Shoji Clinic, Osaka, JapanBackground: Sentinel lymph node biopsy has steadily replaced axillary lymph node dissection (ALND for staging clinically node-negative breast cancer. However, ALND remains standard management of the axilla when a tumor-positive sentinel lymph node is identified.Methods: We identified 460 patients with breast cancer (clinically T1/T2N0M0 from the database for 1999–2004. Patient age ranged from 26 to 81 (median 50 years. Patients who underwent mastectomy or breast-conserving surgery with or without ALND were compared for regional recurrence, disease-free survival, and overall survival.Results: Patients with ALND (n = 308 were compared with the no ALND group (n = 152. Five-year overall survival and disease-free survival were not significantly different between the two groups, while there was a significant difference between them for regional recurrence. Of the 152 patients who did not undergo axillary dissection, four developed ipsilateral axillary disease, most of whom were rescued by delayed axillary dissection. Further, the criterion for identifying lymphedema was used, ie, a 2 cm circumferential change at any measured location. As a result, the incidence of lymphedema in the ALND group was 12.7%, while it was not seen in the non ALND group.Conclusion: There is a possibility that ALND may be omitted for cT1/T2N0M0 breast cancer through a combination of hormone therapy and adjuvant chemotherapy.Keywords: breast cancer, axillary lymph node dissection

  18. CT-based Evaluation of Axillary Sentinel Lymph Node Status in Breast Cancer: Value of Added Contrast-Enhanced Study

    Energy Technology Data Exchange (ETDEWEB)

    Yuen, S.; Yamada, K.; Goto, M.; Sawai, K.; Nishimura, T. [Graduate School of Medical Science Kyoto Prefectural Univ. of Medicine (Japan). Dept. of Radiology and Dept. of Breast and Endocrine Surgery

    2004-11-01

    Purpose: To evaluate the diagnostic reliability of CT-based sentinel lymph node (SLN) size criteria for selecting the candidates for direct axillary dissection without SLN biopsy and to determine the value of added contrast-enhanced study. Material and Methods: Breast cancer patients (n=107) underwent triple phasic (1-min, 3-min, 8-min) contrast-enhanced 5 mm-computed tomography (CT) of the breasts and axillae. In the CT image, the most inferior lymph node in the axilla was designated the SLN. Axillary status was judged based on SLN size criteria. CT density, enhancement rate, and peak enhancement time of each SLN were correlated with histopathological results. Results: SLN size criteria demonstrated a sensitivity of 76% and a positive predictive value of 95% in predicting SLN metastasis. The density values at each scanning time-point were significantly different for metastatic and non-metastatic SLN. However, their enhancement rates differed significantly only at 1 min. Their peak enhancement occurred primarily at 1 min. The use of contrast-enhancement criteria improved the predictive sensitivity, but failed to decrease the false-positive rate of the SLN size criteria. Conclusion: The enhancement rate at 1 min proved to be the most useful parameter in contrast-enhanced CT studies; however, it failed in improving the accuracy of the SLN size criteria.

  19. Tangential vs. defined radiotherapy in early breast cancer treatment without axillary lymph node dissection. A comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Nitsche, Mirko [Zentrum fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Universitaet Kiel, Klinik fuer Strahlentherapie, Karl-Lennert-Krebscentrum, Kiel (Germany); Temme, Nils; Foerster, Manuela; Reible, Michael [Zentrum fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Hermann, Robert Michael [Zentrum fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Medizinische Hochschule Hannover, Abteilung Strahlentherapie und Spezielle Onkologie, Hannover (Germany)

    2014-08-15

    Recent studies have demonstrated low regional recurrence rates in early-stage breast cancer omitting axillary lymph node dissection (ALND) in patients who have positive nodes in sentinel lymph node dissection (SLND). This finding has triggered an active discussion about the effect of radiotherapy within this approach. The purpose of this study was to analyze the dose distribution in the axilla in standard tangential radiotherapy (SRT) for breast cancer and the effects on normal tissue exposure when anatomic level I-III axillary lymph node areas are included in the tangential radiotherapy field configuration. We prospectively analyzed the dosimetric treatment plans from 51 consecutive women with early-stage breast cancer undergoing radiotherapy. We compared and analyzed the SRT and the defined radiotherapy (DRT) methods for each patient. The clinical target volume (CTV) of SRT included the breast tissue without specific contouring of lymph node areas, whereas the CTV of DRT included the level I-III lymph node areas. We evaluated the dose given in SRT covering the axillary lymph node areas of level I-III as contoured in DRT. The mean V{sub D95} {sub %} of the entire level I-III lymph node area in SRT was 50.28 % (range, 37.31-63.24 %), V{sub D45} {sub Gy} was 70.1 % (54.8-85.4 %), and V{sub D40} {sub Gy} was 83.5 % (72.3-94.8 %). A significant difference was observed between lung dose and heart toxicity in SRT vs. DRT. The V{sub 20} {sub Gy} and V{sub 30} {sub Gy} of the right and the left lung in DRT were significantly higher in DRT than in SRT (p < 0.001). The mean heart dose in SRT was significantly lower (3.93 vs. 4.72 Gy, p = 0.005). We demonstrated a relevant dose exposure of the axilla in SRT that should substantially reduce local recurrences. Furthermore, we demonstrated a significant increase in lung and heart exposure when including the axillary lymph nodes regions in the tangential radiotherapy field set-up. (orig.) [German] Aktuelle Studien zeigen

  20. International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases.

    Science.gov (United States)

    Meretoja, Tuomo J; Audisio, R A; Heikkilä, P S; Bori, R; Sejben, I; Regitnig, P; Luschin-Ebengreuth, G; Zgajnar, J; Perhavec, A; Gazic, B; Lázár, G; Takács, T; Kővári, B; Saidan, Z A; Nadeem, R M; Castellano, I; Sapino, A; Bianchi, S; Vezzosi, V; Barranger, E; Lousquy, R; Arisio, R; Foschini, M P; Imoto, S; Kamma, H; Tvedskov, T F; Jensen, M-B; Cserni, G; Leidenius, M H K

    2013-04-01

    Recently, many centers have omitted routine axillary lymph node dissection (ALND) after metastatic sentinel node biopsy in breast cancer due to a growing body of literature. However, existing guidelines of adjuvant treatment planning are strongly based on axillary nodal stage. In this study, we aim to develop a novel international multicenter predictive tool to estimate a patient-specific risk of having four or more tumor-positive axillary lymph nodes (ALN) in patients with macrometastatic sentinel node(s) (SN). A series of 675 patients with macrometastatic SN and completion ALND from five European centers were analyzed by logistic regression analysis. A multivariate predictive model was created and validated internally by 367 additional patients and then externally by 760 additional patients from eight different centers. All statistical tests were two-sided. Prevalence of four or more tumor-positive ALN in each center's series (P = 0.010), number of metastatic SNs (P < 0.0001), number of negative SNs (P = 0.003), histological size of the primary tumor (P = 0.020), and extra-capsular extension of SN metastasis (P < 0.0001) were included in the predictive model. The model's area under the receiver operating characteristics curve was 0.766 in the internal validation and 0.774 in external validation. Our novel international multicenter-based predictive tool reliably estimates the risk of four or more axillary metastases after identifying macrometastatic SN(s) in breast cancer. Our tool performs well in internal and external validation, but needs to be further validated in each center before application to clinical use. PMID:23558360

  1. Real-time ultrasound elastography in 180 axillary lymph nodes: elasticity distribution in healthy lymph nodes and prediction of breast cancer metastases

    Directory of Open Access Journals (Sweden)

    Wojcinski Sebastian

    2012-12-01

    Full Text Available Abstract Background To determine the general appearance of normal axillary lymph nodes (LNs in real-time tissue sonoelastography and to explore the method′s potential value in the prediction of LN metastases. Methods Axillary LNs in healthy probands (n=165 and metastatic LNs in breast cancer patients (n=15 were examined with palpation, B-mode ultrasound, Doppler and sonoelastography (assessment of the elasticity of the cortex and the medulla. The elasticity distributions were compared and sensitivity (SE and specificity (SP were calculated. In an exploratory analysis, positive and negative predictive values (PPV, NPV were calculated based upon the estimated prevalence of LN metastases in different risk groups. Results In the elastogram, the LN cortex was significantly harder than the medulla in both healthy (p=0.004 and metastatic LNs (p=0.005. Comparing healthy and metastatic LNs, there was no difference in the elasticity distribution of the medulla (p=0.281, but we found a significantly harder cortex in metastatic LNs (p=0.006. The SE of clinical examination, B-mode ultrasound, Doppler ultrasound and sonoelastography was revealed to be 13.3%, 40.0%, 14.3% and 60.0%, respectively, and SP was 88.4%, 96.8%, 95.6% and 79.6%, respectively. The highest SE was achieved by the disjunctive combination of B-mode and elastographic features (cortex >3mm in B-mode or blue cortex in the elastogram, SE=73.3%. The highest SP was achieved by the conjunctive combination of B-mode ultrasound and elastography (cortex >3mm in B-mode and blue cortex in the elastogram, SP=99.3%. Conclusions Sonoelastography is a feasible method to visualize the elasticity distribution of LNs. Moreover, sonoelastography is capable of detecting elasticity differences between the cortex and medulla, and between metastatic and healthy LNs. Therefore, sonoelastography yields additional information about axillary LN status and can improve the PPV, although this method is still

  2. The diagnostic accuracy of multidetector row CT for evaluating the axillary lymph nodes in patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Doo Kyung; Kim, Jun Man; Yim, Hyun Ee [Ajou University, College of Medicine, Suwon (Korea, Republic of)

    2007-08-15

    We investigated the CT (computed tomography) findings of metastatic lymph nodes (LNs), and we analyzed the diagnostic performance of multidetector row CT (MDCT) for detecting axillary LN metastases in patients with breast cancer. We investigated 59 patients who preoperatively underwent chest MDCT, and they underwent sentinel LN biopsy ro whole axillary LN dissection. We analyzed the morphologic features, the degree of enhancement and the delayed enhancement pattern. We classified the patients into the non-metastatic LN group and the metastatic LN group, and we calculated the diagnostic performance of MDCT for detecting metastatic LNs. When both the morphologic and quantitative criteria were consistent, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 58.1%, 100%, 100% and 68.3%, respectively, and MDCT accurately detected metastatic LNs in 2 patients that were false negative on sentinel LN biopsy. When the morphologic and quantitative criteria were consistent, the sensitivity, specificity, PPV and NPV were 87.1%, 53.6%, 67.5% and 78.9%, respectively. However, MDCT could not detect metastatic LNs, including two micrometastases (a total of 8 micrometastases) that were in each of four patients. MDCT can be used to perform the morphology and quantitative analysis of axillary LNs, and this modality has excellent specificity and a PPV for detecting metastatic LNs when the both of the diagnostic criteria are consistent.

  3. Feasibility of FDG PET/CT to monitor the response of axillary lymph node metastases to neoadjuvant chemotherapy in breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Straver, Marieke E.; Rutgers, Emiel J.T.; Peeters, Marie-Jeanne T.F.D.V. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Amsterdam (Netherlands); Aukema, Tjeerd S.; Olmos, Renato A.V.; Vogel, Wouter V. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Gilhuijs, Kenneth G.A. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiology, Amsterdam (Netherlands); Schot, Margaret E. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam (Netherlands)

    2010-06-15

    The aim of this study was to assess the accuracy of {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT to visualize lymph node metastases before the start of neoadjuvant chemotherapy and to determine how often the visualization is sufficiently prominent to allow monitoring of the axillary response. Thirty-eight patients with invasive breast cancer of >3 cm and/or lymph node metastasis underwent FDG PET/CT before neoadjuvant chemotherapy. The results of the FDG PET/CT were compared with those from ultrasonography with fine-needle aspiration (FNA) cytology or sentinel node biopsy. Patients suitable for response monitoring of the axilla were defined as having either a maximum standardized uptake value (SUV{sub max}){>=}2.5 or a tumour to background ratio {>=}5 in the most intense lymph node. The sensitivity and specificity of FDG PET/CT in detecting axillary involvement were 97 and 100%, respectively. No difference existed between the SUV{sub max} of the primary tumour and that from the related most intense lymph node metastasis. Moreover, the mean tumour to background ratio was 90% higher in the lymph nodes compared to the primary tumour (p=0.006). Ninety-three per cent of the patients had sufficient uptake in the lymph nodes to qualify for subsequent response monitoring of the axilla. A considerable distinction in metabolic activity was observed between the different subtypes of breast cancer. The mean SUV{sub max} in lymph node metastases of oestrogen receptor (ER)-positive, triple-negative and human epidermal growth factor receptor 2 (HER2)-positive tumours was 6.6, 11.6 and 6.6, respectively. The high accuracy in visualizing lymph node metastases and the sufficiently high SUV{sub max} and tumour to background ratio at baseline suggest that it is feasible to monitor the axillary response with FDG PET/CT, especially in triple-negative tumours. (orig.)

  4. 前哨淋巴结阳性乳腺癌的腋窝淋巴结清扫%The extent of axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes

    Institute of Scientific and Technical Information of China (English)

    韦丽光; 康骅; 海涛; 朱江; 王亚军

    2014-01-01

    目的 探讨乳腺癌前哨淋巴结阳性时腋窝淋巴结的清扫范围.方法 回顾性分析前哨淋巴结阳性并实行全腋窝淋巴结清扫(观察组)以及直接施行部分腋窝淋巴结清扫(对照组)的病例,总结不同腋窝淋巴结清扫范围对手术并发症、肿瘤分期的影响.结果 在观察组95例患者中,Ⅰ+Ⅱ水平非前哨淋巴结的阳性率为68.4%,Ⅲ水平淋巴结的阳性率为29.5%.前哨淋巴结活检阳性时施行部分腋窝淋巴结清扫可使57.9%的病例由pN1改变为pN2或pN3,而进一步行Ⅲ水平淋巴结清扫,只有2.1%的病例由pN2改变为pN3.多因素logistic回归分析显示前哨淋巴结阳性数及阳性率是Ⅲ水平淋巴结阳性的危险因素(OR分别为2.157、10.374).与部分腋窝淋巴结清扫相比,全腋窝淋巴结清扫会延长手术时间,增加术后引流时间及引流量.结论 乳腺癌前哨淋巴结阳性数≥3个时,建议进行全腋窝淋巴结清扫.%Objective To explore the extent of axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes.Methods In this series,95 patients underwent complete axillary lymph node dissection (CALND) following positive sentinel lymph nodes identified and 97 patients underwent partial axillary lymph node dissection (PALND) at the absence of positive sentinel lymph nodes.The influence of different extent of axillary lymph node dissection was evaluated.Results The positive rate of level(Ⅰ + Ⅱ) non-sentinel lymph nodes (NSLN) and level Ⅲ lymph nodes was 68.4% and 29.5%,respectively,in CALND group.In PALND situation,57.9% CALND cases would have changed pathologic stage from pN1 to pN2 or pN3.But with level Ⅲ lymph node dissection followed PALND,only 2.1% cases had changed pathologic stage from pN2 to pN3.Multivariate logistic regression showed that the number of positive SLNs (OR =2.157) and positive rate of SLNs (OR =10.374) were risk factors for having positive level

  5. Expression of the Apoptosis Inhibitor Survivin and its correlation with Thymidine Kinase and Axillary Lymph Node Metastasis in Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    Jian-Ping WU; Yun-Feng ZHOU; Zhi-Guo LUO; Ming-Sheng ZHANG

    2005-01-01

    @@ 1 Introduction Many molecular factors have been demonstrated to interfere with cellular proliferation and programmed cell death. One of these factors is a recently discovered member of the "inhibitor of apoptosis protein(IAP)" called survivin. Survivin is abundantly expressed in most solid and hematologic malignancies, but undetectable in normal adult tissues. Interference with survivin function induces pleiotropic cell-division defects and apoptosis. Cytosolic thymidine kinase (TK) is a marker for proliferating cells and TK is one of several key enzymes involved in DNAmetabolism that phosphorylates thymidine to thymidine mono-phosphate. This study was aimed to detect the expression of suvivin and TK in breast cancer, and to explore a possible relationship between survivin expression and axillary lymph node metastasis.

  6. Effects of postmastectomy radiotherapy on prognosis in different tumor stages of breast cancer patients with positive axillary lymph nodes

    Institute of Scientific and Technical Information of China (English)

    Miao-Miao Jia; Zhi-Jie Liang; Qin Chen; Ying Zheng; Ling-Mei Li; Xu-Chen Cao

    2014-01-01

    Objective: To explore the effects of postmastectomy radiotherapy (PMRT) on the locoregional failure-free survival (LRFFS) and overall survival (OS) of breast cancer patients under different tumor stages and with one to three positive axillary lymph nodes (ALNs). Methods: We conducted a retrospective review of 527 patients with one to three positive lymph nodes who underwent modiifed radical or partial mastectomy and axillary dissection from January 2000 to December 2002. hTe patients were divided into the T1-T2 N1 and T3-T4 N1 groups. hTe effects of PMRT on the LRFFS and OS of these two patient groups were analyzed using SPSS 19.0, Pearson’s χ2-test, Kaplan-Meier method, and Cox proportional hazard model. Results: For T1-T2 N1 patients, no statistical signiifcance was observed in the effects of PMRT on LRFFS [hazard ratio (HR)=0.726; 95% conifdence interval (CI): 0.233-2.265;P=0.582] and OS (HR=0.914; 95% CI: 0.478-1.745;P=0.784) of the general patients. Extracapsular extension (ECE) and high histological grade were the risk factors for LRFFS and OS with statistical significance in multivariate analysis. Stratification analysis showed that PMRT statistically improved the clinical outcomes in high-risk patients [ECE (+), LRFFS:P=0.026, OS:P=0.007; histological grade III, LRFFS:P Conclusion: PMRT could reduce ECE (+), histological grade III-related LRR, and total mortality of T1-T2 N1 patients. T3-T4 N1 patients with ER/PR (-) could beneift from PMRT by improving LRFFS and OS. However, PMRT could only reduce LRR but failed to improve OS for T3-T4 N1 patients with ER/PR (+) who received endocrine therapy.

  7. Diagnostic accuracy of dual-time-point 18F-FDG PET/CT for the detection of axillary lymph node metastases in breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Steffen; Forsting, Michael [Dept. of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Hospital Essen, Univ. at Duisburg-Essen, Essen (Germany)], e-mail: steffen.hahn@uk-essen.de; Hecktor, Jennifer; Kimmig, Rainer [Dept. of Gynecology and Obstetrics, Univ. Hospital Essen, Univ. at Duisburg-Essen, Essen (Germany); Grabellus, Florian [Institute of Pathology and Neuropathology, Univ. Hospital Essen, Univ. at Duisburg-Essen, Essen (Germany); Hartung, Verena; Poeppel, Thorsten [Dept. of Nuclear Medicine, Univ. Hospital Essen, Univ. at Duisburg-Essen, Essen (Germany); Antoch, Gerald; Heusner, Till A. [Univ. of Dusseldorf, Medical Faculty, Dept. of Diagnostic and Interventional Radiology, Dusseldorf (Germany)

    2012-06-15

    Background: The diagnostic accuracy of FDG-PET/CT for the detection of axillary lymph node metastases in breast cancer patients acquired 60 min after FDG administration is reported to be only moderate, especially due to low sensitivity. Purpose: To test whether a delayed scan 90 min after FDG administration could enhance the diagnostic accuracy of FDG-PET/CT for the detection of axillary lymph node metastases. Material and Methods: Thirty-eight women suffering from primary breast cancer (mean age 52 years; range 25-78 years; standard deviation 14 years) underwent a pre-therapeutic dual-time-point FDG-PET/CT scan. The maximum standardized uptake value (SUVmax) of axillary lymph nodes was measured at two different time points (time point T1: 60 min after FDG injection, time point T2: 90 min after FDG injection). SUVmax of axillary lymph nodes at T1 and T2 were assessed for statistical significance using a paired Wilcoxon-Test (P < 0.05). At T1 a qualitative analysis of the FDG-PET/CT scan was performed to define physiologic and metastatic lymph nodes. At T2 an increase of the SUVmax of at least 3.75% over time was rated as indicating malignancy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the accuracy of FDG-PET/CT for the detection of axillary lymph node metastases was calculated at time points T1 and T2. Statistically significant differences were determined using Fisher's exact test (P < 0.05). Histopathology served as the standard of reference. A compartment based analysis was done. Results: Axillary lymph nodes had a mean SUVmax of 1.6 (range 0.6-10.8; SD 1.9) at T1 and a mean SUVmax of 1.8 (range 0.5-17.9; SD 3.5) at T2. This difference was statistically significant (P = 0.047). The sensitivity, specificity, PPV, NPV, and accuracy of FDG-PET/CT for the detection of axillary lymph node metastases was 81%, 100%, 100%, 88%, and 92% at T1, and 88%, 50%, 56%, 85%, and 66% at T2, respectively. This

  8. Prognostic value of metastatic axillary lymph node ratio for Chinese breast cancer patients.

    Directory of Open Access Journals (Sweden)

    San-Gang Wu

    Full Text Available OBJECTIVE: The prevalence of breast cancer varies among countries and regions. This retrospective study investigated the prognostic value of the lymph node ratio (LNR compared with the number of positive lymph nodes (pN in Chinese breast cancer patients. METHODS: The medical records of female breast cancer patients (N = 2591 were retrospectively evaluated. The association of LNR and TMN staging system were compared with respect to overall, disease-free, and distant metastasis-free survival. RESULTS: Out of 2591 patients, 2495 underwent modified radical surgery and 96 received breast conserving surgery. All patients had adjuvant chemotherapy following surgery. The median follow up period 66.9 months (range 5-168 months. The 5-year and 10-year overall survival rates were 89.3% and 78.8%, respectively, and 5-year disease-free survival and distant metastasis-free survival rates were 81.6% and 83.5%, respectively. Univariate analysis indicated that in general T, pN, LNR, as well as tumor expression of the estrogen receptor, progesterone receptor, and HER2 were associated with overall, disease-free, and distant metastasis-free survival (all P-values <0.05. Mutlivariate analysis found pN stage and LNR were independent predictors of overall, disease-free, and distant metastasis-free survival (all P-values <0.001. If pN stage and LNR were both included in a multivariate analysis, LNR was still an independent prognostic factor for overall, disease-free, and distant metastasis-free survival (all P-values <0.001. CONCLUSION: Our findings support the use of LNR as a predictor of survival in Chinese patients with breast cancer, and that LNR is superior to pN stage in determining disease prognosis.

  9. Sentinel Lymph Node Biopsy

    Science.gov (United States)

    ... Ask about Your Diagnosis Research Sentinel Lymph Node Biopsy On This Page What are lymph nodes? What ... lymph node? What is a sentinel lymph node biopsy? What happens during an SLNB? What are the ...

  10. Lymph node biopsy

    Science.gov (United States)

    Biopsy - lymph nodes; Open lymph node biopsy; Fine needle aspiration biopsy; Sentinel lymph node biopsy ... A lymph node biopsy is done in an operating room in a hospital. Or, it is done at an outpatient surgical center. The ...

  11. Prediction of axillary lymph node metastasis in primary breast cancer patients using a decision tree-based model

    Directory of Open Access Journals (Sweden)

    Takada Masahiro

    2012-06-01

    Full Text Available Abstract Background The aim of this study was to develop a new data-mining model to predict axillary lymph node (AxLN metastasis in primary breast cancer. To achieve this, we used a decision tree-based prediction method—the alternating decision tree (ADTree. Methods Clinical datasets for primary breast cancer patients who underwent sentinel lymph node biopsy or AxLN dissection without prior treatment were collected from three institutes (institute A, n = 148; institute B, n = 143; institute C, n = 174 and were used for variable selection, model training and external validation, respectively. The models were evaluated using area under the receiver operating characteristics (ROC curve analysis to discriminate node-positive patients from node-negative patients. Results The ADTree model selected 15 of 24 clinicopathological variables in the variable selection dataset. The resulting area under the ROC curve values were 0.770 [95% confidence interval (CI, 0.689–0.850] for the model training dataset and 0.772 (95% CI: 0.689–0.856 for the validation dataset, demonstrating high accuracy and generalization ability of the model. The bootstrap value of the validation dataset was 0.768 (95% CI: 0.763–0.774. Conclusions Our prediction model showed high accuracy for predicting nodal metastasis in patients with breast cancer using commonly recorded clinical variables. Therefore, our model might help oncologists in the decision-making process for primary breast cancer patients before starting treatment.

  12. {sup 18}F-FDG PET/CT with Contrast Enhancement for Evaluation of Axillary Lymph Node Involvement in T1 Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kong, Eun Jung; Chun, Kyung Ah; Cho, Ihn Ho; Lee, Soo Jung [Yeungnam University Hospital, Daegu (Korea, Republic of)

    2010-09-15

    Background {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) position emission tomography ((PET) safely predicts axillary status in patients with breast cancer, but is not sufficiently accurate in early breast cancer patients. This study analyzed the value of {sup 18}F-FDG PET/computed tomography (CT) with contrast enhancement in detecting axillary lymph node involvement in T1 breast cancer patients. Contrast-enhanced {sup 18}F-FDG PET/CT was performed within 20 days of surgery in 143 breast cancer patients with tumors {<=}2 cm in size. The patients underwent either axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB), and histopathology reports were used to provide the definitive diagnosis against which the contrast-enhanced {sup 18}F-FDG PET/CT study results were compared. The sensitivity, specificity, and negative and positive predictive values of contrast-enhanced {sup 18}F-FDG PET/CT in detecting axillary involvement were 70.0%, 92.2%, 88.8%, and 77.8%, respectively, in the entire series of 143 patients, with eight false-positive and 12 false negative results. The false-negative results were associated with the number of metastatic lymph nodes and the rate of FDG uptake. Contrast-enhanced {sup 18}F-FDG PET/CT cannot replace histologic staging using SLNB in patients with breast cancer, but {sup 18}F-FDG PET/CT increases the sensitivity for predicting axillary node metastasis, and allows for a selective approach to either ALND or SLNB, even in patients with T1 breast cancer.

  13. The value of preoperative ultrasound guided fine-needle aspiration cytology of radiologically suspicious axillary lymph nodes in breast cancer

    Directory of Open Access Journals (Sweden)

    Torill Sauer

    2014-01-01

    Full Text Available Background: Preoperative ultrasound (US and eventually US-guided fine-needle aspiration cytology (FNAC of suspicious axillary lymph nodes (ALN is a standard procedure in the work-up of suspicious breast lesions. Preoperative US FNAC may prevent sentinel node biopsy (SNB procedure in 24-30% of patients with early stage breast carcinoma. The aim of this study was to evaluate the institutional results of this preoperative diagnostic procedure. Materials and Methods: A total of 182 cases of preoperative FNAC of suspicious ALN where retrieved from the pathology files. The results were compared with the final histology and staging. False negative (FN FNAC cases were reviewed and possibly missed metastatic cases (2 were immunostained with the epithelial marker AE1/AE3. Results: There were no false positives, whereas 16 cases were FN. In all but one case the FN′s represented sampling error. Half of the 16 FN cases in this series were macrometastases. Discussion: About 83% of the preoperatively aspirated cases were N+, indicating that a radiologically suspicious ALN has a very high risk of being metastatic. Preoperative US guided FNAC from radiologically suspicious ALN is highly efficient in detecting metastases. Depending on national guidelines, a preoperative, positive ALN FNAC might help to stratify the patients as to SNB and/or ALN dissection.

  14. Tattoo pigment in an axillary lymph node simulating metastatic malignant melanoma

    OpenAIRE

    Jack, CM; Adwani, A; Krishnan, H

    2005-01-01

    We report a case of axillary lymphadenopathy thirty years after a decorative tattoo clinically mimicking metastatic melanoma. The importance of relying on histological confirmation of metastatic disease before altering extent of surgery is discussed. The importance of recording presence of decorative tattoos is stressed.

  15. Coverage of Axillary Lymph Nodes with Tangential Breast Irradiation in Korea: A Multi-Institutional Comparison Study

    Directory of Open Access Journals (Sweden)

    Jinhong Jung

    2016-01-01

    Full Text Available Introduction. To evaluate the dose distribution and coverage of axilla using only tangential field for whole breast radiotherapy (RT at three institutions in Korea. Methods. We used computed tomography (CT images of nine consecutive 1-2 sentinel lymph node-positive patients who underwent breast conserving surgery and whole breast RT without axillary lymph node (ALN dissection for clinical T1-2N0 breast cancer. The CT data were transferred to three radiation oncologists in 3 institutions and each radiation oncologist created treatment plans for all nine patients; a total of 27 treatment plans were analyzed. Results. The mean doses delivered to levels I and II were 31.9 Gy (9.9–47.9 Gy and 22.3 Gy (3.4–47.7 Gy. Ninety-five percent of levels I and II received a mean dose of 11.8 Gy (0.4–43.0 Gy and 3.0 Gy (0.3–40.0 Gy. The percent volumes of levels I and II covered by 95% of the prescribed dose were only 29.0% (0.2–74.1% and 11.5% (0.0–70.1%. The dose distribution and coverage of axilla were significantly different between three institutions (p=0.001. Conclusion. There were discrepancies in ALN coverage between three institutions. A standardization of whole breast RT technique through further research with a nationwide scale is needed.

  16. Coverage of Axillary Lymph Nodes with Tangential Breast Irradiation in Korea: A Multi-Institutional Comparison Study.

    Science.gov (United States)

    Jung, Jinhong; Kong, Moonkyoo; Kim, Su Ssan; Yoon, Won Sup

    2016-01-01

    Introduction. To evaluate the dose distribution and coverage of axilla using only tangential field for whole breast radiotherapy (RT) at three institutions in Korea. Methods. We used computed tomography (CT) images of nine consecutive 1-2 sentinel lymph node-positive patients who underwent breast conserving surgery and whole breast RT without axillary lymph node (ALN) dissection for clinical T1-2N0 breast cancer. The CT data were transferred to three radiation oncologists in 3 institutions and each radiation oncologist created treatment plans for all nine patients; a total of 27 treatment plans were analyzed. Results. The mean doses delivered to levels I and II were 31.9 Gy (9.9-47.9 Gy) and 22.3 Gy (3.4-47.7 Gy). Ninety-five percent of levels I and II received a mean dose of 11.8 Gy (0.4-43.0 Gy) and 3.0 Gy (0.3-40.0 Gy). The percent volumes of levels I and II covered by 95% of the prescribed dose were only 29.0% (0.2-74.1%) and 11.5% (0.0-70.1%). The dose distribution and coverage of axilla were significantly different between three institutions (p = 0.001). Conclusion. There were discrepancies in ALN coverage between three institutions. A standardization of whole breast RT technique through further research with a nationwide scale is needed. PMID:27525123

  17. Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group

    DEFF Research Database (Denmark)

    Husted, Madsen A.; Haugaard, K.; Soerensen, J.;

    2008-01-01

    BACKGROUND: Sentinel lymph node biopsy was implemented in the treatment of early breast cancer with the aim of reducing shoulder and arm morbidity. Relatively few prospective studies have been published where the morbidity was assessed by clinical examination. Very few studies have examined the i...

  18. Fine-Needle Aspirates CYFRA 21-1 is a Useful Tumor Marker for Detecting Axillary Lymph Node Metastasis in Breast Cancer Patients

    OpenAIRE

    Jung Hyun Yoon; Kyung Hwa Han; Eun-Kyung Kim; Hee Jung Moon; Min Jung Kim; Young Joo Suh; Ji Soo Choi; Byeong-Woo Park

    2013-01-01

    INTRODUCTION: To assess whether the value of CYFRA21-1 in the aspirates of ultrasonography-guided fine-needle aspiration biopsy (US-FNAB) can contribute to improving the performances of US-FNAB in the diagnosis of axillary lymph node (LN) metastasis in breast cancer patients. METHODS: US-FNAB was performed in 156 axillary LNs in 152 breast cancer patients (mean age: 51.4 years, range: 17-92 years). Concentrations of CYFRA21-1 were measured from washouts of the syringe used during US-FNAB. Tum...

  19. Role of axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast

    Directory of Open Access Journals (Sweden)

    Capitanio Giovanni

    2005-03-01

    Full Text Available Abstract Background Sentinel lymph node (SLN biopsy is an effective tool for axillary staging in patients with invasive breast cancer. This procedure has been recently proposed as part of the treatment for patients with ductal carcinoma in situ (DCIS, because cases of undetected invasive foci and nodal metastases occasionally occur. However, the indications for SLN biopsy in DCIS patients are controversial. The aim of the present study was therefore to assess the incidence of SLN metastases in a series of patients with a diagnosis of pure DCIS. Methods A retrospective evaluation was made of a series of 102 patients who underwent SLN biopsy, and had a final histologic diagnosis of pure DCIS. Patients with microinvasion were excluded from the analysis. The patients were operated on in five Institutions between 1999 and 2004. Subdermal or subareolar injection of 30–50 MBq of 99 m-Tc colloidal albumin was used for SLN identification. All sentinel nodes were evaluated with serial sectioning, haematoxylin and eosin staining, and immunohistochemical analysis for cytocheratin. Results Only one patient (0.98% was SLN positive. The primary tumour was a small micropapillary intermediate-grade DCIS and the SLN harboured a micrometastasis. At pathologic revision of the specimen, no detectable focus of microinvasion was found. Conclusion Our findings indicate that SLN metastases in pure DCIS are a very rare occurrence. SLN biopsy should not therefore be routinely performed in patients who undergo resection for DCIS. SLN mapping can be performed, as a second operation, in cases in which an invasive component is identified in the specimen. Only DCIS patients who require a mastectomy should have SLN biopsy performed at the time of breast operation, since in these cases subsequent node mapping is not feasible.

  20. Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora? Intramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?

    Directory of Open Access Journals (Sweden)

    René Aloisio da Costa Vieira

    2012-10-01

    Full Text Available A pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS extra-axilar e intramamário (IM ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação.The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM sentinel lymph node (SLN occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

  1. Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora? Intramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?

    Directory of Open Access Journals (Sweden)

    René Aloisio da Costa Vieira

    2012-01-01

    Full Text Available A pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS extra-axilar e intramamário (IM ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação.The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM sentinel lymph node (SLN occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

  2. Partial axillary lymph node dissection inferior to the intercostobrachial nerves complements sentinel node biopsy in patients with clinically node-negative breast cancer

    OpenAIRE

    Li, Jianyi; Jia, Shi; Zhang, Wenhai; QIU, FANG; Zhang, Yang; Gu, XI; Xue, Jinqi

    2015-01-01

    Background The practice of breast cancer diagnosis and treatment in China varies to that in western developed countries. With the unavailability of radioactive tracer technique for sentinel lymph nodes biopsy (SLNB), using blue dye alone has been the only option in China. Also, the diagnosis of breast malignant tumor in most Chinese centres heavily relies on intraoperative instant frozen histology which is normally followed by sentinel lymph nodes mapping, SLNB and the potential breast and ax...

  3. Contouring Guidelines for the Axillary Lymph Nodes for the Delivery of Radiation Therapy in Breast Cancer: Evaluation of the RTOG Breast Cancer Atlas

    Energy Technology Data Exchange (ETDEWEB)

    Gentile, Michelle S. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States); Usman, Asad A.; Neuschler, Erin I. [Department of Radiology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States); Sathiaseelan, Vythialinga; Hayes, John P. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States); Small, William, E-mail: WMSMALL@lumc.edu [Department of Radiation Oncology, Loyola University, Chicago, Illinois (United States)

    2015-10-01

    Purpose: The purpose of this study was to identify the axillary lymph nodes on pretreatment diagnostic computed tomography (CT) of the chest to determine their position relative to the anatomic axillary borders as defined by the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Methods and Materials: Pretreatment diagnostic CT chest scans available for 30 breast cancer patients with clinically involved lymph nodes were fused with simulation CT. Contouring of axillary levels I, II, and III according to the RTOG guidelines was performed. Measurements were made from the area of distal tumor to the anatomic borders in 6 dimensions for each level. Results: Of the 30 patients, 100%, 93%, and 37% had clinical involvement of levels I, II, and III, respectively. The mean number of lymph nodes dissected was 13.6. The mean size of the largest lymph node was 2.4 cm. Extracapsular extension was seen in 23% of patients. In 97% of patients, an aspect of the involved lymph node lay outside of the anatomic border of a level. In 80% and 83% of patients, tumor extension was seen outside the cranial (1.78 ± 1.0 cm; range, 0.28-3.58 cm) and anterior (1.27 ± 0.92 cm; range, 0.24-3.58 cm) borders of level I, respectively. In 80% of patients, tumor extension was seen outside the caudal border of level II (1.36 ± 1.0 cm, range, 0.27-3.86 cm), and 0% to 33% of patients had tumor extension outside the remaining borders of all levels. Conclusions: To cover 95% of lymph nodes at the cranial and anterior borders of level I, an additional clinical target volume margin of 3.78 cm and 3.11 cm, respectively, is necessary. The RTOG guidelines may be insufficient for coverage of axillary disease in patients with clinical nodal involvement who are undergoing neoadjuvant chemotherapy, incomplete axillary dissection, or treatment with intensity modulated radiation therapy. In patients with pretreatment diagnostic CT chest scans, fusion with

  4. Contralateral axillary lymph node metastases at the time of primary breast cancer diagnosis: curative or palliative intent?

    Science.gov (United States)

    Zhou, C; Richir, M C; Leenders, M W H; Langenhorst, B L A M; Knol, H P; Schreurs, W H

    2013-01-01

    Contralateral axillary lymph node metastases (CAMs) in breast cancer patients are uncommon. CAM can be found at the time of primary breast cancer diagnosis or following prior treatment of breast cancer as a recurrence. This distinction may have important implications for disease staging and treatment selection. We report the case of a premenopausal woman with synchronous CAM. Despite extensive multimodality treatment, a recurrence was found 27 months after primary surgery. We reviewed the literature on histopathological tumor characteristics associated with CAM, lymphatic drainage of the breast to other sites than the ipsilateral axilla, and outcome of cases with CAM. This case contradicts current conceptions that CAM only develops from tumors with poor histopathological features. Emerging evidence shows that altered lymphatics play a central role in development of synchronous CAM. It is precisely this etiology that supports the concept that synchronous CAM occurs by lymphatic spread and not by hematogenous spread. Although controversial, treatment of synchronous CAM (without evidence of distant metastases) should therefore be of curative intent. PMID:23607036

  5. Contralateral Axillary Lymph Node Metastases at the Time of Primary Breast Cancer Diagnosis: Curative or Palliative Intent?

    Directory of Open Access Journals (Sweden)

    C. Zhou

    2013-01-01

    Full Text Available Contralateral axillary lymph node metastases (CAMs in breast cancer patients are uncommon. CAM can be found at the time of primary breast cancer diagnosis or following prior treatment of breast cancer as a recurrence. This distinction may have important implications for disease staging and treatment selection. We report the case of a premenopausal woman with synchronous CAM. Despite extensive multimodality treatment, a recurrence was found 27 months after primary surgery. We reviewed the literature on histopathological tumor characteristics associated with CAM, lymphatic drainage of the breast to other sites than the ipsilateral axilla, and outcome of cases with CAM. This case contradicts current conceptions that CAM only develops from tumors with poor histopathological features. Emerging evidence shows that altered lymphatics play a central role in development of synchronous CAM. It is precisely this etiology that supports the concept that synchronous CAM occurs by lymphatic spread and not by hematogenous spread. Although controversial, treatment of synchronous CAM (without evidence of distant metastases should therefore be of curative intent.

  6. Persistent mediastinal and axillary lymph node tuberculosis in a renal transplant patient with successful outcome.

    Science.gov (United States)

    Oguz, Y; Yilmaz, M I; Eyileten, T; Caglar, K; Yenicesu, M; Kaya, A; Tasar, M; Saglam, M; Doganci, L; Gulec, B; Oner, K; Oktenli, C; Vural, A

    2006-06-01

    Tuberculosis is an opportunistic infection that carries substantial morbidity and mortality in renal transplant recipients. We report here about a 21 year-old man with a living related renal transplant from his mother who developed persistent extra-pulmonary tuberculosis. The disease showed aggressive invasion to the axillary and mediastinal regions with abscess formations, despite standard antituberculosis treatment. During the course of the disease, immunosuppressive therapy was stopped, and the patient received extraordinary doses of multiple antituberculosis drugs. The patient then showed an uneventful course with good clinical and radiological responses.

  7. Characterization of internodal collecting lymphatic vessel function after surgical removal of an axillary lymph node in mice.

    Science.gov (United States)

    Kwon, Sunkuk; Price, Roger E

    2016-04-01

    Secondary lymphedema is an acquired lymphatic disorder, which occurs because of damage to the lymphatic system from surgery and/or radiation therapy for cancer treatment. However, it remains unknown how post-nodal collecting lymphatic vessels (CLVs) draining to the surgical wound area change in response to lymphadenectomy. We investigated functional and architectural changes of inguinal-to-axillary internodal CLVs (ICLVs) in mice after a single axillary LN (ALN) dissection using near-infrared fluorescence imaging. Our data showed no lymph flow in the ICLVs draining from the inguinal LN (ILN) at 2 days post-surgery. External compression enabled visualization of a small segment of contractile fluorescent ICLVs, but not all the way to the axillary region. At day 6, abnormal lymphatic drainage patterns, including lateral and retrograde lymph flow via vessels branching off the ICLVs were observed, which started to disappear beginning 9 days after surgery. The administration of vascular endothelial growth factor (VEGF)-C into the wound increased resolution of altered lymphatic drainage. Lymphatic drainage from the base of the tail to the ILN did not significantly change over time. These results demonstrate that lymph flow in the CLVs is dramatically affected by a LN dissection and long-term interruption of lymph flow might cause CLV dysfunction and thus contribute to chronic lymphatic disorders. PMID:27446639

  8. Study of Axillary Reverse Mapping and Lymph Node Metastasis during an Axillary Dissection%乳腺癌腋窝清扫术中上肢淋巴结定位及转移规律的研究

    Institute of Scientific and Technical Information of China (English)

    贾实; 李建一; 张文海; 张扬; 费翔

    2012-01-01

    目的 在乳腺癌腋窝清扫术中利用上肢淋巴结反转定位(ARM)技术对引流上肢的淋巴管及淋巴结进行定位,分析其转移可能性及对上肢淋巴水肿的影响.方法 选取乳腺癌改良根治术20例.美兰法进行术前定位.术中行淋巴结清扫,蓝染淋巴结单独分组,行免疫组化方法病理检测.结果 在20例患者中术中发现16例患者存在蓝染淋巴管及淋巴结,4例未发现蓝染的淋巴管或淋巴结.术中发现蓝染的上肢淋巴结均位于腋静脉下方,肋间臂神经上方这一区域内;在施行上肢淋巴结清除的患者中,术后短期内上肢水肿的发生率高于表进行上肢淋巴结清扫的患者;上肢淋巴结可能出现转移.结论 利用美兰法能够对腋窝处的上肢淋巴结进行定位;上肢淋巴结在腋窝的位置相对固定;肿瘤如仅在Level 1水平淋巴结发生转移,上肢淋巴结可能不会受累.%Objective In breast cancer axillary lymph node dissection,reverse positioning aim (ARM) technology is used for the upper limb lymphatic drainage and lymph nodes, This paper aimed to analyze the possibility of transfer and its impact on upper extremity lym-phedema. Methods Twenty patients undergoing modified radical mastectomy were chosen whose axillary lymph nodes could be palpable or be found by breast ultrasound and enhanced CT examinations. All the patients did not receive preopeian've neoadjuvant chemotherapy and neoadjuvant endocrine therapy. Methylene blue method was employed for preoperan've localization. During operation,lymph node dissection was performed. Blue-stained lymph nodes weie grouped and examined using the immunohistoeheimeal method. Results (X the 20 patients, 16 had blue-stained lymphatic vessels and lymph nodes,4 did not show blue-stained lymphatic vessels or lymph nodes. Blue-stained lymph nodes were found to have been located in the region below the axillary vein and over the Intercostal brachial nerves. The

  9. HER2 expression in fine needle aspirates of lymph nodes detected by preoperative axillary ultrasound in breast cancer patients.

    Directory of Open Access Journals (Sweden)

    Ji Soo Choi

    Full Text Available The purpose of this study was to assess the usefulness of HER2 levels in ultrasonographically guided fine-needle aspiration biopsy (US-FNA aspirates of axillary lymph nodes (ALNs in the determination of lymph node metastasis or the characterization of primary breast cancer, and to correlate the HER2 levels in US-FNA aspirates (FNA-HER2s of metastatic ALNs with the HER2 statuses of corresponding primary breast cancers. An institutional review board approved the study. Between January and October 2010, 164 patients with 167 ALNs examined by US-FNA were included. FNA-HER2s of ALNs were measured by chemiluminescence immunoassay, and they were correlated with cytologic/final diagnoses. Receiver operating characteristics (ROC curve analysis was performed to evaluate the diagnostic ability to differentiate benign and metastatic ALNs. Additionally, FNA-HER2s of metastatic ALNs were correlated with HER2 status and other clinicopathologic variables of the primary breast cancers. Among the 167 ALNs, 138 were metastatic and 29 were benign. The mean FNA-HER2 (6.3 ng/ml of metastatic ALNs was higher than that of benign ALNs. All 29 benign ALNs showed no measurable value of FNA-HER2 (0.0 ng/ml. The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis. The FNA-HER2 statuses of 108 metastatic ALNs (79.4% were concordant with the HER2 statuses of the corresponding primary breast cancers. In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P = 0.04. Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers. Additionally, FNA-HER2 analysis of ALN may help to develop more personalized treatment protocol for breast

  10. Preoperative estimate for axillary in breast cancer and different selection in axillary lymph node dissection%乳腺癌术前腋窝评估与淋巴结清扫方式的选择

    Institute of Scientific and Technical Information of China (English)

    张文海

    2015-01-01

    乳腺癌手术腋窝处理有不同方式。作者提出采用医生触诊+2种影像学检查作为评估腋窝的方法。根据评估结果采用相应的腋窝处理方式。(1)腋窝评估阴性,只做前哨淋巴结活检(SLNB),前哨淋巴结(SLN)无转移则不做腋窝淋巴结清扫(ALND)。(2)腋窝评估倾向阴性,如果SLN阴性,则不做腋窝清扫。如果SLN阳性,做功能性腋窝清扫。(3)腋窝评估可疑阳性,功能性腋窝淋巴结清扫。如果多个淋巴结转移,需要做level1或level2的淋巴结清扫。(4)术前评估腋窝阳性,在腋窝反向制图(ARM)基础上做腋窝level 1、level2甚至level3水平的腋窝淋巴结清扫。尽量保留被蓝染的引流上肢的淋巴通路。%There are several surgical treatments in axillary of breast cancer. Author suggests that axillary assessment should be depend upon the doctor’s palpation and other two kinds of image inspection. On the base of the assessment, the different operative procedure should be selected. (1)Axillary estimate is negative, sentinel lymph node (SLN) biopsy (SLNB) is only done. If no metastasis is in SLN, don’t do axillary lymph node dissection (ALND). (2)Axillary estimate is apt to negative, firstly SLNB, if positive in SLN, functional axillary lymph node dissection (FALND) should be done. (3)Axillary estimate is inclined to positive, FALND should be selected. If multi-metastases would be found, the dissection to level 1 or level 2 needed. (4)Axillary estimate is positive, total ALND should be done at the basis of axillary reverse mapping. Blue-dyed lymphatic passageway draining the arm should be preserved as far as possible.

  11. CT-Guided Wire Localization for Involved Axillary Lymph Nodes After Neo-adjuvant Chemotherapy in Patients With Initially Node-Positive Breast Cancer.

    Science.gov (United States)

    Trinh, Long; Miyake, Kanae K; Dirbas, Frederick M; Kothary, Nishita; Horst, Kathleen C; Lipson, Jafi A; Carpenter, Catherine; Thompson, Atalie C; Ikeda, Debra M

    2016-07-01

    Resection of biopsy-proven involved axillary lymph nodes (iALNs) is important to reduce the false-negative rates of sentinel lymph node (SLN) biopsy after neo-adjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer. Preoperative wire localization for iALNs marked with clips placed during biopsy is a technique that may help the removal of iALNs after NAC. However, ultrasound (US)-guided localization is often difficult because the clips cannot always be reliably visible on US. Computed tomography (CT)-guided wire localization can be used; however, to date there have been no reports on CT-guided wire localization for iALNs. The aim of this study was to describe a series of patients who received CT-guided wire localization for iALN removal after NAC and to evaluate the feasibility of this technique. We retrospectively analyzed five women with initially node-positive breast cancer (age, 41-52 years) who were scheduled for SLN biopsy after NAC and received preoperative CT-guided wire localization for iALNs. CT visualized all the clips that were not identified on post-NAC US. The wire tip was deployed beyond or at the target, with the shortest distance between the wire and the index clip ranging from 0 to 2.5 mm. The total procedure time was 21-38 minutes with good patient tolerance and no complications. In four of five cases, CT wire localization aided in identification and resection of iALNs that were not identified with lymphatic mapping. Residual nodal disease was confirmed in two cases: both had residual disease in wire-localized lymph nodes in addition to SLNs. Although further studies with more cases are required, our results suggest that CT-guided wire localization for iALNs is a feasible technique that facilitates identification and removal of the iALNs as part of SLN biopsy after NAC in situations where US localization is unsuccessful. PMID:27061012

  12. The significance of one positive axillary node.

    NARCIS (Netherlands)

    Kuijt, G.P.; Poll-Franse, L.V. van de; Roumen, R.M.H.; Beek, M.W. van; Voogd, A.C.

    2006-01-01

    AIMS: The aim of this study was to identify a subgroup of patients with breast cancer that can safely avoid axillary dissection. METHODS: Using data collected by the Eindhoven Cancer Registry, we compared the clinico-pathological features of 489 patients with only one positive lymph node to those of

  13. Early breast cancer without axillary lymph node involvement; Cancer du sein sans atteinte ganglionnaire axillaire

    Energy Technology Data Exchange (ETDEWEB)

    Ghorbel, I.; Kanoun, S.; Kallel, A.; Belaid, A.; Azoury, F.; Heymann, S.; Marsiglia, H.; Bourgier, C. [Departement de Radiotherapie, Unite fonctionnelle de Senologie, institut Gustave-Roussy, 94 - Villejuif (France); Ghorbel, I.; Belaid, A. [Service de Radiotherapie Carcinologique, institut Salah-Azaiz. Tunis (Tunisia); Kanoun, S. [Service de Radiotherapie, hopital Farhat-Hached, Sousse (Tunisia); Kallel, A. [Service de Radiotherapie, clinique Ennasr, Tunis (Tunisia); Pichenot, E.; Verstraet, R. [Departement de Physique, institut Gustave-Roussy, 94 - Villejuif (France); Marsiglia, H. [Universite de Florence (Italy)

    2010-07-01

    Breast cancer is the most common cancer in women. In France, breast cancer incidence was 88.9 per 100, 000 women in 2000. Early detection of breast tumours by screening mammography allows a breast conserving treatment, i.e., breast irradiation preceded by a lumpectomy and a sentinel node biopsy. The standard irradiation of early breast cancers consists in delivering 50 Gy to the whole breast in 2 Gy fractions over a five-week period followed by an additional dose targeting the tumour bed of 16 Gy in eight fractions. The 3D-conformal treatment planning optimizes dose distribution to the whole breast and to the tumour bed and lessens the normal tissue irradiation (heart and ipsilateral lung). The aim of this article is to describe epidemiologic, radio anatomic and prognostic features of early stage breast cancer and to propose guidelines for 3D-conformal treatment planning in early breast cancers. This review is illustrated by a case report. (authors)

  14. Application of Endoscopic Axillary Lymph Node Dissection in Breast Cancer%乳腺癌腔镜腋窝淋巴结清扫术的应用

    Institute of Scientific and Technical Information of China (English)

    马冬; 李小荣; 张翼; 李皇保; 岳红

    2011-01-01

    Objective To compare the recent clinical effects between the laparoscopic axillary lymph node dissection and conventional axillary lymph node dissection. Methods Clinical data of 56 breast cancer patients underwent axillary lymph node dissection in the Second Department of General Surgery, the Third Xiangya Hospital from January to September,2010 were retrospectively analyzed. The recent clinical effects were compared between laparoscopic group and conventional group. Results The average amount of bleeding in laparoscopic group was less than that in conventional group (44.3ml vs 89.4ml, P<0.05). The average operation time of conventional group was shorter than that of laparoscopic group (70.5 min vs 92.5 min, P<0.05). No statistically significant difference was found in the average number of lymph nodes and the average number of positive lymph nodes between conventional group and laparoscopic group ( 16.9 vs 16.1, 3. 8 vs 3.5; P>0.05). One case of postoperative wound infection was found in laparoscopic group. Lymphatic fistula occurred in two cases of conventional group. Conclusions As compared with conventional axillary lymph node dissection, laparoscopic axillary lymph node dissection not only has the same effect in lymph node dissection but also has the advantages of minimal invasion,cosmetic surgery, and less complications. This method is worthy to be popularized in clinical application.%目的 比较腔镜腋窝淋巴结清扫术和常规手术近期临床疗效的差异.方法 回顾性分析2010年1-9月在中南大学湘雅三医院普外二科收治的56例行腋窝淋巴结清扫术的乳腺癌患者,比较腔镜组和常规组的近期临床疗效.结果 与常规组相比较,腔镜组平均手术出血量较少(44.3 ml vs 89.4 ml,P0.05).术后并发症中腔镜组有一例出现术后伤口感染,常规组有两例出现术后淋巴瘘.结论 乳腺癌腔镜腋窝淋巴结清扫术与传统手术相比较不但同样能彻底的清扫腋窝淋巴

  15. Cytological and Pathological Correlation of FNAC in Assessing Breast Lumps and Axillary Lymph Node Swellings in a Public Sector Hospital in India

    Directory of Open Access Journals (Sweden)

    Vasu Reddy Challa

    2013-01-01

    Full Text Available Background. Breast lumps have varied pathology, and there are different techniques to prove the diagnosis. The aim of the present study is to analyze the role of fine needle aspiration cytology (FNAC of the breast lesions at our center. Methods. We had retrospectively analysed 854 patients who underwent FNAC for primary breast lumps and 190 patients who underwent FNAC for an axillary lymph node in the year 2010. Results. Of 854 patients, histological correlation was available in 723 patients. The analysis was done for 812 patients as medical records were not available for 42 patients. FNAC was false negative in seven cases; 2 cases of phyllodes were reported as fibroadenoma, and 5 cases of carcinoma were diagnosed as atypical hyperplasia. The sensitivity, specificity, and false negative value of FNAC in diagnosing breast lumps were 99% (715/723, 100%, and 1%, respectively. Of 190 patients for whom FNAC was performed for axilla, 170 had proven to have axillary lymph node metastases, and the rest had reactive hyperplasia or inflammatory cells. Conclusions. FNAC is rapid, accurate, outpatient based, and less complicated procedure and helps in diagnosis of breast cancer, benign diseases, and axillary involvement in experienced hands with less chance of false results.

  16. A Multicenter-based phase II study on the safety of sentinel lymph node biopsy for primary breast cancer without clinical axillary lymph node metastases

    International Nuclear Information System (INIS)

    Recently, sentinel lymph node biopsy (SNB) has become a standard procedure in early breast cancer treatment worldwide, with the same trend in Japan. However, Tc99m-thin colloid, Tc99m-Stannous phytate, Indocyanine green (ICG), and Indigocarmine, which are commonly used as tracers in Japan, are not covered by health insurance in the country. Therefore, a large cohort study was conducted to confirm the identification rate and safety of SNB using these drugs. Among cases resistered from Mar. 2008 to Nov. 2008, the identification rate using both radioisotope (RI) and dye was 98.6%, compared with 97.10% employing the single dye method. There were cases of Grade I (0.06%) adverse events, but no grade III and IV events. Therefore, SNB using the above 4 drugs was safely performed, and the identification rate was preferable for screening. Several controversial issues regarding SNB will also be investigated in a future study. (author)

  17. Impact of axillary nodal metastases on lymphatic mapping and sentinel lymph node identification rate in patients with early stage breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pelosi, Ettore [Ospedale S. Giovanni Battista, S.C.D.U. Medicina Nucleare 2, Turin (Italy); Universita Torino, Dottorato di Ricerca Radioimmunolocalizzazione dei Tumori Umani, Turin (Italy); Ala, Ada; Bussone, Riccardo [Ospedale S. Giovanni Battista, Reparto di Chirurgia Oncologica 10, Turin (Italy); Bello, Marilena; Douroukas, Anastasios; Varetto, Teresio [Ospedale S. Giovanni Battista, S.C.D.U. Medicina Nucleare 2, Turin (Italy); Migliaretti, Giuseppe [Universita di Torino, Dipartimento di Sanita Pubblica e Microbiologia, Turin (Italy); Berardengo, Ester [Ospedale S. Giovanni Battista, Servizio di Anatomia Patologica 4, Turin (Italy); Bisi, Gianni [Ospedale S. Giovanni Battista, S.C.D.U. Medicina Nucleare 2, Turin (Italy); Universita di Torino, Dipartimento di Medicina Interna, SCDU Medicina Nucleare 2, Turin (Italy)

    2005-08-01

    The aim of this study was to define the impact of the presence of axillary nodal metastases on lymphatic mapping and sentinel lymph node (SLN) identification rate in patients with early breast cancer. Two hundred and forty-six lymphatic mapping procedures were performed with both labelled nanocolloid and blue dye, followed by SLN biopsy and/or complete axillary dissection. The following parameters were recorded: patient's age, tumour laterality and location, tumour size, tumour histology, tumour stage, tumour grade, lymphovascular invasion, radiotracer injection site (subdermal-peritumoural/peri-areolar), SLN visualisation at lymphoscintigraphy, SLN metastases (presence/absence, size) and other axillary metastases (presence/absence, number). Discriminant analysis was used to analyse the data. SLNs were identified by labelled nanocolloid alone in 94.7% of tumours, by blue dye alone in 93.5% and by the combined technique in 99.2%. Discriminant analysis showed the gamma probe SLN identification rate to be significantly limited by the presence of axillary nodal metastases. In particular, the size of SLN metastases and the number of other axillary metastases were the most important variables in reducing the gamma probe SLN identification rate (p=0.004 and p=0.002, respectively). On the other hand, high tumour grade was the only parameter limiting the blue dye SLN identification rate. The accuracy of lymphatic mapping with labelled nanocolloid is limited by the presence of axillary nodal metastases, and particularly by the degree of SLN tumoural invasion and the presence and number of other axillary nodal metastases. Neither of these elements seems to interfere with the blue dye identification rate. The combination of the two tracers maximises the SLN identification rate. (orig.)

  18. Sentinel node biopsy should be supplemented by axillary sampling in patients with small breast cancers

    OpenAIRE

    Adwani, A; Ebbs, SR; Burton, S.; Lowe, S

    2005-01-01

    Axillary clearance provides important prognostic information but is associated with significant morbidity. Sentinel node biopsy can provide staging .141 patients with node negative early breast cancers-tumour size less than 1.5 cm measured clinically or by imaging had guided axillary sampling (sentinel lymph node biopsy in combination with axillary sampling). Four node axillary sampling improved the detection rate of axillary node metastases by 13.6% as compared to blue dye sentinel node biop...

  19. Using Tc-99m MIBI scintimammography to differentiate nodular lesions in breast and detect axillary lymph node metastases from breast cancer

    Institute of Scientific and Technical Information of China (English)

    王景; 吴华; 周健; 胡健

    2003-01-01

    Objective To test the clinical value of using Tc-99m MIBI scintimammography (Tc-99m MIBI SMM) to differentiate nodular lesions in breasts and detect axillary lymph node metastases of breast cancer. Methods The subjects consisted of sixty female patients exhibiting unilateral palpable breast mass. The early and delay static acquisitions were undertaken in all subjects at 10 and 90 min after injection with Tc-99m MIBI. The acquisition included three positions: anterior supine, left lateral prone and right lateral prone. A special device for SMM which was developed by our laboratory was used. The ratio of [(T-B)/(NT-B)] was calculated as radioactivity of mass to that of opposite corresponding tissue, and [(T-B)/(NT-B)]≥1.21 was used as the cut-off for semi-quantitative discrimination of malignancy from benignity in semi-quantitative analysis. The final diagnosis was obtained from histology examination in all subjects. Results Using Tc-99m MIBI SMM to differentiate between nodular lesions in breasts, the diagnostic sensitivity and specificity were 92.9% and 90.6% respectively, the positive predictive value 89.7%, the negative predictive value 93.5%, and the accuracy 91.7%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained with Tc-99m MIBI SMM for detecting axillary lymph node metastases were 83.3%, 86.1%, 80%, 88.6% and 85% respectively. Conclusions It is suggested that Tc-99m MIBI SMM may be not only valuable in differentiating malignant lesions from benign nodular masses of breast, but also helpful in detecting axillary lymph node metastases of breast cancer.

  20. Fine-Needle Aspirate CYFRA 21-1, an Innovative New Marker for Diagnosis of Axillary Lymph Node Metastasis in Breast Cancer Patients

    OpenAIRE

    Choi, Ji Soo; Han, Kyung Hwa; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung

    2015-01-01

    Abstract To compare the value of cytokeratin fragment 21-1 (CYFRA 21-1) concentration in the fine-needle biopsy aspirates (fine needle aspirate [FNA] CYFRA 21-1) with cytopathology of fine-needle aspiration biopsy (FNA cytology) and to assess whether CYFRA 21-1 concentrations from ultrasound-guided fine-needle aspiration biopsy (US-FNAB) specimens (FNA CYFRA 21-1) is not inferior to FNA cytology in the diagnosis of axillary lymph node (ALN) metastasis of breast cancer patients. This study rec...

  1. Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, K., E-mail: kathryn.taylor@addenbrookes.nhs.uk [Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom); O' Keeffe, S.; Britton, P.D.; Wallis, M.G. [Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom); Treece, G.M.; Housden, J. [Department of Engineering, University of Cambridge, Cambridge (United Kingdom); Parashar, D.; Bond, S. [Cambridge Cancer Trials Centre, Department of Oncology, University of Cambridge, Addenbrookes Hospital, Cambridge (United Kingdom); Cambridge Hub in Trials Methodology Research, MRC Biostatics Unit, University Forvie Site, Cambridge (United Kingdom); Sinnatamby, R. [Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom)

    2011-11-15

    Aims: To compare the performance of ultrasound elastography with conventional ultrasound in the assessment of axillary lymph nodes in suspected breast cancer and whether ultrasound elastography as an adjunct to conventional ultrasound can increase the sensitivity of conventional ultrasound used alone. Materials and methods: Fifty symptomatic women with a sonographic suspicion for breast cancer underwent ultrasound elastography of the ipsilateral axilla concurrent with conventional ultrasound being performed as part of triple assessment. Elastograms were visually scored, strain measurements calculated and node area and perimeter measurements taken. Theoretical biopsy cut points were selected. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated and receiver operating characteristic (ROC) analysis was performed and compared for elastograms and conventional ultrasound images with surgical histology as the reference standard. Results: The mean age of the women was 57 years. Twenty-nine out of 50 of the nodes were histologically negative on surgical histology and 21 were positive. The sensitivity, specificity, PPV, and NPV for conventional ultrasound were 76, 78, 70, and 81%, respectively; 90, 86, 83, and 93%, respectively, for visual ultrasound elastography; and for strain scoring, 100, 48, 58 and 100%, respectively. There was no significant difference between any of the node measurements Conclusions: Initial experience with ultrasound elastography of axillary lymph nodes, showed that it is more sensitive than conventional ultrasound in detecting abnormal nodes in the axilla in cases of suspected breast cancer. The specificity remained acceptable and ultrasound elastography used as an adjunct to conventional ultrasound has the potential to improve the performance of conventional ultrasound alone.

  2. Regional nodal recurrence in the management of breast cancer patients with one to three positive axillary lymph nodes. Outcome of patients following tangential irradiation without a separate nodal field

    Energy Technology Data Exchange (ETDEWEB)

    Stranzl, H.; Prettenhofer, U.; Mayer, R.; Hackl, A. [Dept. of Radiotherapy, Univ. Medical School, Graz (Austria); Peintinger, F. [Div. of Gynecology, Leoben (Austria); Ofner, P. [Dept. of Medical Informatics, Statistics and Documentation, Univ. Medical School, Graz (Austria)

    2004-10-01

    Purpose: to examine the prognosis of breast cancer patients (T1-3, one to three positive axillary lymph nodes) and locoregional failure rate after breast-conserving therapy/modified radical mastectomy and adequate axillary dissection following tangential radiotherapy without irradiation of the regional lymph nodes. Patients and methods: from 1994 to 2002, the medical records of 183 breast cancer patients (T1-3, one to three involved axillary lymph nodes) were examined in order to identify those experiencing regional nodal recurrence, with or without local recurrence. The median age of the patient population was 58 years (range, 28-86 years). All patients underwent surgical treatment, either breast-conserving therapy (n = 146) or modified radical mastectomy (n = 37). The median number of lymph nodes removed was twelve (range, seven to 26 nodes). Irradiation was given to the breast through tangential fields. Chemotherapy was administered to 101 patients (55%), hormonal therapy to 124 (60%), and combined systemic treatment to 47 (26%). Results: the median observation time was 44.4 months (range, 11-102 months). Of the 14 patients (7.7%) with a relapse, six (3.3%) had a local recurrence, five (2.8%) a regional relapse, and three (1.6%) a simultaneous recurrence. Nine out of 14 patients with locoregional relapse developed distant failure subsequently and seven of them (78%) died of the disease. Conclusion: regional recurrence is uncommon among patients with one to three positive axillary lymph nodes treated with surgery, adequate axillary dissection, and tangential field irradiation only. The authors conclude that regional nodal irradiation should not routinely be given following adequate axillary dissection when only one to three lymph nodes are positive. (orig.)

  3. Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection

    Directory of Open Access Journals (Sweden)

    Summayah Fallatah

    2016-01-01

    Full Text Available Background: Postoperative pain after breast cancer surgery is not uncommon. Narcotic based analgesia is commonly used for postoperative pain management. However, the side-effects and complications of systemic narcotics is a significant disadvantage. Different locoregional anesthetic techniques have been tried including, single and multiple levels paravertebral block (PVB, which seems to have a significant reduction in immediate postoperative pain with fewer side-effects. The aim of this study was to compare unilateral multiple level PVB versus morphine patient-controlled analgesia (PCA for pain relief after breast cancer surgery with unilateral lumpectomy and axillary lymph nodes dissection. Materials and Methods: Forty patients scheduled for breast cancer surgery were randomized to receive either preoperative unilateral multiple injections PVB at five thoracic dermatomes (group P, 20 patients or postoperative intravenous PCA with morphine (group M, 20 patients for postoperative pain control. Numerical pain scale, mean arterial pressure, heart rate, Time to first analgesic demand, 24-h morphine consumption side-effects and length of hospital stay were recorded. Results: PVB resulted in a significantly more postoperative analgesia, maintained hemodynamic, more significant reduction in nausea and vomiting, and shorter hospital stay compared with PCA patients. Conclusion: Multiple levels PVB is an effective regional anesthetic technique for postoperative pain management, it provides superior analgesia with less narcotics consumption, and fewer side-effects compared with PCA morphine for patients with breast cancer who undergo unilateral lumpectomy, with axillary lymph nodes dissection.

  4. [A Case of Glycogen-Rich Clear Cell Carcinoma of the Breast with Extensive Intraductal Components and Micrometastases to the Axillary Lymph Node].

    Science.gov (United States)

    Seki, Hirohito; Sasaki, Kenichi; Morinaga, Shojiro; Asanuma, Fumiki; Yanaihara, Hisashi; Kaneda, Munehisa; Suzuki, Keiichi; Ishii, Yoshiyuki; Kamiya, Noriki; Osaku, Masayoshi; Ikeda, Tadashi

    2016-02-01

    A 48-year-old woman had a left breast mass identified during routine breast cancer screening. The mammogram showed pleomorphic-segmental microcalcifications in the mediolateral-oblique view of the left breast. Ultrasonography showed a hypoechoic mass approximately 3.7 cm in diameter with multiple calcifications. Contrast-enhanced magnetic resonance imaging of the breast showed non-mass like enhancement of approximately 4 cm in diameter in the C area of the left breast. She was diagnosed with glycogen-rich clear cell carcinoma (GRCC) by ultrasound-guided vacuum-assisted biopsy. Nipplesparing mastectomy was performed along with sentinel lymph node biopsy. The intraoperative consultation suggested sentinel lymph node metastasis and we therefore performed axillary lymph node dissection. Pathological examination reported microinvasive carcinomas, 0.4 cm in maximum diameter, and extensive intraductal components, 5 cm in size. The tumor cells were stained on PAS staining, but the stains were digested with diastase. The cells were negative for adipophilin. GRCC was first reported by Hull et al. This is a rare type of breast carcinoma. There is no standard therapy for this disease or any data on the prognosis of breast cancer patients with GRCC. PMID:27067690

  5. The clinical significance of axillary sentinel lymph node biopsy in different clinical stages breast cancer patients after neoadjuvant chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Juan Xu; Xinhong Wu; Yaojun Feng; Feng Yuan; Wei Fan

    2013-01-01

    Objective:We aimed to study the success and false negative rate of sentinel lymph node biopsy (SLNB) in dif-ferent clinical stages breast cancer patients being carried out with neoadjuvant chemotherapy (NAC), and the clinical signifi-cance of SLNB, we conducting this trial. Methods:One hunderd and thirty-seven cases were enrol ed in this clinical research from March 2003 to March 2007. Al of the patients’ sentinel lymph nodes were detected with 99mTc-Dx and methylene blue. There were 61 patients with stage T1-2N0M0 carried SLNB without NAC (group A), 76 cases were carried out NAC 3-4 cycles before SLNB, including 39 T2-4N0-1M0 cases (group B) and 27 T2-4N2-3M0 cases (group C). The success and false negative rate of SLNB were analysed with chi-square test. Results:In group A, the successful and false negative rate of SLNB were 92.31%(36/39), 8.57%(3/35), and in group B and C were 92.31%(36/39), 8.57%(3/35) and 74.07%(20/27), 18.52%(5/27), respectively. The successful rate of group C decreased and false negative rate increased significantly compared with group A and B (P0.05). Conclusion:The SLNB can accurately predict lymph node status of axil ary lymph node in N0-1 stage patients with NAC, but in N2-3 stage patients the success rate decreased and false rate increased negative significantly.

  6. Computed tomography image of the mediastinal and axillary lymph nodes in clinically sound Rottweilers Imagem por tomografia computadorizada dos linfonodos axilares e mediastinais de cães rottweilers clinicamente saudáveis

    OpenAIRE

    Ana Carolina B. Fonseca Pinto; Elisângela Aneli; Andreza C. Patara; Carla A.B. Lorigados; Gabriela Paola R. Banon; Claudia Figueiredo

    2013-01-01

    Trough computed tomography (CT), it is possible to evaluate lymph nodes in detail and to detect changes in these structures earlier than with radiographs and ultrasound. Lack of information in the veterinary literature directed the focus of this report to normal aspects of the axillary and mediastinal lymph nodes of adult dogs on CT imaging. A CT scan of 15 normal adult male and female Rottweilers was done. To define them as clinically sound, anamnesis, physical examination, complete blood co...

  7. 单个前哨淋巴结阳性保腋窝在乳腺癌改良根治术中应用的可行性研究%Feasibility study on the application of omitting axillary lymph node dissection with single sentinel lymph node metastasis in modified radical mastectomy

    Institute of Scientific and Technical Information of China (English)

    罗国庆; 胡宁东; 刘秋华; 丁明云

    2015-01-01

    Objective To analyze the application of the feasibility study on omitting axillary lymph node dissection with single sentinel lymph node metastasis in modify radical mastectomy. Methods 45 patients with single sentinel lymph node metastasis and 45 patients without sentinel lymph node metastasis diagnosed as breast cancer in our department were selected. All the patients were handled with axillary lymph node dissection after sentinel lymph node biopsy. The positive rate of non-sen-tinel lymph node in these two groups were compared. Results Singel sentinel lymph node positive group had 3 non-sentinel lymph node positive patients (6.7%,3/45), but one (2.2%,1/45) in negative sentinel lymph node group. There was no statisti-cal difference between the two groups (χ2=0.26,P>0.05). Conclusion There was no significant difference in the positive rate of non-sentinel lymph node between the two groups with single sentinel lymph node metastasis and no sentinel lymph node metastasis. It's possible that axillary lymph node dissection can be omitted in patients with single sentinel lymph node metastasis.%目的:分析单个SLN阳性保腋窝在乳腺癌改良根治术中的应用可行性。方法收集来我科就诊的临床诊断为乳腺癌且伴随单个SLN阳性的患者45例,SLN阴性的患者45例。两组患者均行腋窝淋巴结清扫。对比两者NSLN阳性率的差异。结果单个SLN阳性组的NSLN阳性3例,阳性率为6.7%(3/45)。 SLN阴性组的NSLN阳性率为2.2%(1/45)。两组NSLN阳性率差异无统计学意义(χ2=0.26,P>0.05)。结论单个SLN阳性患者与SLN阴性患者NSLN阳性率无差异,单个SLN阳性保腋窝在乳腺癌改良根治术中的应用有可行性。

  8. 乳腺浸润性导管癌腋窝淋巴结转移的相关因素分析%Analysis of related factors of axillary lymph node metastasis in breast invasive ductal carcinoma

    Institute of Scientific and Technical Information of China (English)

    王丰; 宋苏云; 张锐

    2011-01-01

    Objective To study related factors of axillary lymph node metastasis in breast invasive ductal carcinoma and using ultrasound and pathology exams to predict axillary lymph node metastasis status. Methods One hundred and seventy-five breast invasive ductal carcinoma patients confirmed pathologically were retrospectively analyzed. All patients were examined by color Doppler ultrasound to estimate breast tumor position, tumor diameter. tumor Adler grade of blood flow. number of axillary lymph node. axillary lymph node diameter.longitudinal-transverse axis ratio of axillary lymph node. cortical thickness and blood flow grade of axillary lymph node. Pathology examinations after surgery was performed to observe tumor histological grade and expression of estrogen receptor (ER) , progesterone receptor ( PR) . Ki67 antibody and c-erbB-2. Chi-square test and univariate and multivariate logistic regression analysis were used. ROC curve was drawn and the area under the ROC curves was calculated. Results Of the 175 patients, 107 were proved with axillary lymph node metastasis. Breast tumor diameter. tumor Adler grade of blood flow. number of axillary lymph node. axillary lymph node diameter, longitudinal-transverse axis ratio of axillary lymph node. cortical thickness of axillary lymph node. blood flow grade of axillary lymph node. tumor histological grade, the expression of Ki67 antibody, and c-erbB-2 positive expression were correlated with axillary lymph node metastasis ( P < 0. 050) . Five factors finally entered the multivariate logistic regression model. including breast tumor diameter,cortical thickness of axillary lymph node, longitudinal-transverse axis ratio of axillary lymph node. tumor histological grades Ⅱ and Ⅲ and Ki67 antibody positive expression. The area under the ROC curve was 0.964. Conclusions Low longitudinal-transverse axis ratio of axillary lymph node. the cortical thickness of axillary lymph node ≥ mm. breast tumor diameter≥ cm. tumor

  9. Prognostic significance of lymph node ratio in axillary lymph node positive breast cancer%淋巴结转移率对腋窝淋巴结阳性乳腺癌的预后意义

    Institute of Scientific and Technical Information of China (English)

    陈宏亮; 丁昂; 王懋莉; 张征

    2016-01-01

    目的 探讨淋巴结转移率(LNR)对腋窝淋巴结阳性的乳腺癌的预后意义.方法 选取2006-2014年在我院进行系统治疗的腋窝淋巴结阳性的乳腺癌803例作为研究对象,无远处转移,且清扫淋巴结数目至少为10枚.统计5年无病生存率(5y-DFSR)及5年总生存率(5y-OSR);通过单因素方法分析影响预后的各项因素;分析腋窝淋巴结病理分期(pN分期)中不同LNR分级的病例的预后差异;通过多因素分析比较pN及LNR对预后的影响作用.结果 803例腋窝淋巴结阳性乳腺癌患者平均清扫淋巴结总数为(15.47±4.70)枚,中位阳性淋巴结数目为4枚.中位随访61个月,期间发生局部复发和远处转移共159例,发生乳腺癌相关性死亡共99例.5y-DFSR为77%,5y-OSR为83%.通过Log-rank单因素分析得出肿瘤直径(pT)、淋巴结分期(pN)、LNR、脉管侵犯以及雌激素受体状态是DFS及OS的影响因素.pN1、pN2、pN3的5y-DFSR和5y-OSR分别为:89%、68%、59%和93%、78%、63%;LNR1、LNR2、LNR3的5y-DFSR和5y-OSR分别为:90%、69%、56%和94%、80%、57%.pN1及pN2中,不同LNR分级病例的预后差异具有统计学意义(pN1:DFS:P=0.005,OS:P=0.024;pN2:DFS:P=0.017,OS:P=0.000),而pN3中不同LNR分级病例的预后尽管在生存曲线中显示出差异趋势,但尚未达到统计学意义(DFS:P=0.165,OS:P=0.075).将pN与LNR分别纳入多因素分析,两者均是DFS和OS独立的预后因素(P均<0.001);将pN与LNR同时纳入多因素分析,LNR依然是DFS和OS独立的预后因素(P<0.001),而pN则不再是其独立的预后因素(DFS:P=0.461,OS:P=0.162).结论 LNR是淋巴结阳性的乳腺癌独立的预后因素.%Objective To evaluate the prognostic significance of lymph node ratio (LNR) in axillary lymph node positive breast cancer.Methods Eight hundred and three cases axillary lymph node positive breast cancer patients without distant metastasis were systematically treated in the Obstetrics and

  10. Standard, controversy and consensus of axillary lymph nodes dissection in breast cancer%乳腺癌行腋窝淋巴结清扫规范、争议与共识

    Institute of Scientific and Technical Information of China (English)

    马榕; 张凯

    2015-01-01

    There are many effective methods for breast cancer treatment, surgery is the basis of management of breast cancer. Local control is the symbol of a successful operation. Lymph node status is not only the most important factor in predicting survival in breast cancer, but also the guider of further treatment. Axillary lymph node dissection and pathological examination remains standard management of the axilla and assessment of breast cancer patients. For clinical axillary lymph node metastasis patients, axillary lymph node dissection is critical. Sentinel lymph node biopsy has become standard care for management of the axilla in clinical axillary node-negative early breast cancer patients. It is clear that axillary lymph node dissection should be strongly considered in the management of the sentinel lymph node positive axilla. Omission of axillary lymph node dissection for breast cancer patients with 1-2 positive sentinel lymph nodes is still controversial .%乳腺癌的有效治疗方法很多,但外科手术是公认的乳腺癌治疗的基础。手术成功与否的最根本标志是肿瘤手术区域的局部控制。腋窝淋巴结受累的程度是预测乳腺癌术后复发和生存,指导进一步个体化治疗的最为重要指标。规范的腋窝淋巴结清扫和病理检查对乳腺癌的治疗至关重要。术前判断存在腋窝淋巴结转移的乳腺癌病人,腋窝淋巴结清扫是乳腺癌手术的规范和要求。术前临床诊断无腋窝淋巴结转移(cN0)的早期乳腺癌病人,如果前哨淋巴结活检阴性可不做进一步的腋窝淋巴结清扫也已成为共识。对于前哨淋巴结1或2枚阳性的乳腺癌病人可以不行腋窝淋巴结的清扫的观点仍然存在争论。

  11. Non-invasive imaging modalities for preoperative axillary lymph node staging in patients with breast cancer; Nichtinvasive bildgebende Verfahren zum praeoperativen axillaeren Lymphknotenstaging beim Mammakarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Wasser, K.; Schnitzer, A.; Schoenberg, S.O. [Universitaetsmedizin Mannheim, Institut fuer Klinische Radiologie und Nuklearmedizin, Mannheim (Germany); Brade, J. [Universitaetsmedizin Mannheim, Institut fuer Medizinische Statistik, Mannheim (Germany)

    2010-11-15

    In the last decade sentinel lymph node biopsy has become a well-established method for axillary lymph node staging in patients with breast cancer. Using preoperative imaging modalities it can be tested whether patients are suitable for sentinel node biopsy or if they should directly undergo an axillary dissection. The imaging modalities used must be mainly characterized by a high positive predictive value (PPV). For this question B-mode ultrasound is the best evaluated method and provides clear morphological signs for a high PPV (>90%) but the sensitivity barely exceeds 50%. It has not yet been proven whether other modalities such as duplex sonography, magnetic resonance imaging, computed tomography (CT) or scintigraphy might achieve a higher sensitivity while still maintaining a high PPV. There is only some evidence that positron emission tomography (PET) might achieve a higher sensitivity. This should be confirmed by further studies because PET or PET/CT will play an increasing role for an initial whole body staging in patients with breast cancer in the near future. (orig.) [German] Die Waechterlymphknotenbiopsie hat sich in den letzten 10 Jahren fuer das axillaere Lymphknotenstaging des Mammakarzinoms fest etabliert. Durch praeoperative bildgebende Verfahren kann getestet werden, ob sich Patientinnen fuer eine Waechterlymphknotenbiopsie eignen oder direkt einer axillaeren Dissektion unterzogen werden sollten. Diese bildgebenden Verfahren muessen sich in erster Linie durch einen hohen positiven Vorhersagewert (PVW) auszeichnen. Die B-Bild-Sonographie ist diesbezueglich bisher am besten evaluiert. Sie liefert eindeutige morphologische Kriterien fuer einen hohen PVW (>90%). Die Sensitivitaet liegt dabei allerdings kaum ueber 50%. Bisher ist nicht erwiesen, dass andere Verfahren wie die Duplexsonographie, die MRT, die CT oder Szintigraphie eine bessere Sensitivitaet bei hohem PVW liefern. Lediglich fuer die Positronenemissionstomographie (PET) bestehen Hinweise

  12. Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity

    International Nuclear Information System (INIS)

    The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity. From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34–83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59 %), luminal-B 24 pts (24 %), basal-like 10 pts (10 %), Her-2 like 7 pts (7 %). 82 pts (82 %) received hormonal therapy, 9 pts (9 %) neo-adjuvant chemotherapy, 81pts (81 %) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation. Within a median follow-up of 50 months (range 19–82), 6 (6 %) pts died, 1 pt (1 %) had local progression disease, 2 pts (2 %) developed distant metastasis and 1 subject (1 %) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27 %) presented lymphedema, but only 10 cases (10 %) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis. Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related

  13. Beyond Axillary Lymph Node Metastasis, BMI and Menopausal Status Are Prognostic Determinants for Triple-Negative Breast Cancer Treated by Neoadjuvant Chemotherapy.

    Directory of Open Access Journals (Sweden)

    Hélène Bonsang-Kitzis

    Full Text Available Triple-negative breast cancers (TNBC are a specific subtype of breast cancers with a particularly poor prognosis. However, it is a very heterogeneous subgroup in terms of clinical behavior and sensitivity to systemic treatments. Thus, the identification of risk factors specifically associated with those tumors still represents a major challenge. A therapeutic strategy increasingly used for TNBC patients is neoadjuvant chemotherapy (NAC. Only a subset of patients achieves a pathologic complete response (pCR after NAC and have a better outcome than patients with residual disease.The aim of this study is to identify clinical factors associated with the metastatic-free survival in TNBC patients who received NAC.We analyzed 326 cT1-3N1-3M0 patients with ductal infiltrating TNBC treated by NAC. The survival analysis was performed using a Cox proportional hazard model to determine clinical features associated with prognosis on the whole TNBC dataset. In addition, we built a recursive partitioning tree in order to identify additional clinical features associated with prognosis in specific subgroups of TNBC patients.We identified the lymph node involvement after NAC as the only clinical feature significantly associated with a poor prognosis using a Cox multivariate model (HR = 3.89 [2.42-6.25], p<0.0001. Using our recursive partitioning tree, we were able to distinguish 5 subgroups of TNBC patients with different prognosis. For patients without lymph node involvement after NAC, obesity was significantly associated with a poor prognosis (HR = 2.64 [1.28-5.55]. As for patients with lymph node involvement after NAC, the pre-menopausal status in grade III tumors was associated with poor prognosis (HR = 9.68 [5.71-18.31].This study demonstrates that axillary lymph node status after NAC is the major prognostic factor for triple-negative breast cancers. Moreover, we identified body mass index and menopausal status as two other promising prognostic factors in

  14. Feasibility of telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine needle aspiration of axillary lymph nodes in a remote breast care center

    Directory of Open Access Journals (Sweden)

    Kamal K Khurana

    2012-01-01

    Full Text Available Background: In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA of axillary lymph nodes in a remote breast care center. Materials and Methods: Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of the preliminary diagnosis was compared with the final diagnosis, retrospectively. Results: A total of 39 female patients (mean age: 50.5 years seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases. Conclusions: This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate

  15. Preoperative evaluation of axillary lymph node in breast cancer%乳腺癌腋窝淋巴结的术前评估

    Institute of Scientific and Technical Information of China (English)

    贾实; 薛今琦; 张文海; 李建一; 张扬

    2015-01-01

    Objective To evaluate diagnostic value of the combined examination of ultrasound , contrast-enhanced CT and physical examination in axillary lymph node status in breast cancer .Methods 316 cases of breast cancer were studied from Jan .2012 to Dec.2013.The axillary lymph nodes were divided into negative group, suspicious negative group , suspicious positive group and positive group by physical examination , axillary ultrasound , and contrast-enhanced breast CT imaging .ROC curve was used to evaluate diagnostic value and the sensitivity,specificity,and accuracy were analyzed .Results The evaluation model presented the AUC of 0.859. The accuracy, sensitivity, specificity, positive and negative predictive value was 91.3%, 93.8%, 92.5%, 94.0%and 90.9%in negative group and positive group .Conclusion This evaluation method can accurately predict the axillary lymph node status and may be instructive to clinical operation mode selection .%目的:探讨超声、增强CT结合临床体格检查的综合评估方法对乳腺癌腋窝淋巴结转移情况的诊断价值。方法选择中国医科大学附属盛京医院乳腺外科2012至2013年316例女性乳腺癌患者。采用临床触诊、乳腺彩超及乳腺增强CT等方法,对腋窝淋巴结的情况分为阴性组、倾向阴性组,可疑阳性组及阳性组进行分析。 ROC曲线法评价诊断效能,并分析敏感度、特异度、准确率等指标。结果本评估方法ROC曲线阴影下面积为0.859。其中在对淋巴结阴性组和阳性组的评估中腋窝淋巴结诊断的准确度、敏感度、特异度、阳性预测值及阴性预测值为91.3%、93.8%、92.5%、94.0%及90.9%。结论本评估方法的诊断效能可较为准确的评估腋窝淋巴结状况并对临床手术方式的选择有一定的指导意义。

  16. Epitrochlear Sentinel Lymph Nodes in Melanoma: Interval or Independent?

    OpenAIRE

    Kidner, Travis; Yoon, Jeong; Faries, Mark; Morton, Donald

    2012-01-01

    Most primary melanomas on the distal upper extremity metastasize to a sentinel lymph node (SLN) in the axillary basin, but occasionally a primary melanoma will drain to the epitrochlear basin. The relationship between tumor-draining axillary and epitrochlear SLNs is unclear. We hypothesize that the epitrochlear SLN functions in an interval manner with the axillary lymph node basin. We queried our melanoma database to identify patients who underwent SLN biopsy for a distal upper-extremity mela...

  17. Assessment of metastases status of axillary lymph nodes of breast disease patients ’ under ultrasound examination%B超判断乳腺癌腋窝淋巴结转移状态的临床研究

    Institute of Scientific and Technical Information of China (English)

    胡鹏遥; 尉承泽; 郝晓鹏; 柳伟伟; 白玲; 唐瑛; 陈子安; 陈雪梅; 宋聪睿

    2015-01-01

    分患者腋窝淋巴结转移状态;假阴性患者腋窝淋巴结转移负荷较低;纵径≥1 cm、纵横比≤1.5、皮质厚度≥3 mm及出现中央型或混合型血流信号与淋巴结转移相关。对于早期乳腺癌,B超可能是潜在的替代前哨腋窝淋巴结活检进行腋窝淋巴结分期的手段。%Objective To assess the clinical application value of axillary lymph node staging of breast cancer by B ultrasound.Methods From February to December 2014, 200 female breast disease patients in Department of Breast Surgery Affiliated Hospital of Academy of Military Medical Sciences, were enrolled, with median age 50 years old, including 153 cases of breast cancer, 44 cases of fibroadenoma, 2 cases of mastitis and a case of huge fibroma.The state of axillary lymph node was assessed by doctor with more than twenty years experience in B ultrasound diagnosis.According to the characteristics of the ultrasound image of lymph node and experience of the B ultrasound doctor, the patients were divided into axillary lymph node metastasis group, suspicious group and no metastasis group.The axillary lymph nodes were staged by sentinel lymph node biopsy or axillary lymph node dissection.Based on pathological diagnosis and results of the ultrasound, the sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, and metastasis burden of axillary lymph nodes in false negative patients were analyzed.The relationship between the B ultrasound characteristics and axillary lymph node metastasis was also studied by univariate analysis.Results The metastasis rate of above-mentioned 3 groups by B ultrasound was 84.51%, 45.16% and 7.14%, respectively.The sensitivity, specificity, positive predictive value and negative predictive value of screening for axillary lymph node metastasis by B ultrasound were 89.6%, 89.1%, 84.5% and 92.7%, respectively in metastasis group and no metastasis group. According to consistency analysis

  18. Sentinel Lymph Nodes for Breast Carcinoma A Paradigm Shift

    Science.gov (United States)

    Maguire, Aoife; Brogi, Edi

    2016-01-01

    Context Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes. Objective To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes. Data Sources Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. Conclusions The main goal of sentinel lymph node examination should be to detect all macrometastases (>2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin–stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non–sentinel lymph node involvement. This information is important to decide on further axillary treatment. PMID:27472237

  19. Influence of subclavian lymph node dissection on the prognosis of breast cancer patients with positive axillary lymph nodes%乳腺癌腋窝淋巴结阳性患者锁骨下淋巴结清扫对其预后的影响

    Institute of Scientific and Technical Information of China (English)

    袁志勇; 石枫; 马慧

    2014-01-01

    Objective To investigate the influence of subclavian lymph node dissection on the prognosis of breast cancer patients with positive axillary lymph nodes .Methods Totally 158 breast cancer patients with positive axillary lymph nodes were divided into two groups:group A ( subclavian lymph nodes were not dissected ) and group B ( subclavian lymph nodes were dissected ) .The clinic pathological features of the two groups were compared .Kaplan-Meier method and Cox proportional hazard method were respectively used to make univariate and multivariate survival analysis for disease -free sur-vival ( DFS) .Results Univariate and multivariate survival analysis showed that tumor size , lymph nodes metastasis rate , the level of HER-2 expression and the dissection of subclavian lymph nodes were factors that influenced DFS ( all P<0.05).Conclusion Subclavian lymph node dissection in breast cancer patients with positive axillary lymph node is rec -ommended for patients whose tumor size is more than 5cm, the lymph node metastasis rate is more than 0.4 and the level of HER-2 expression is high .%目的:探讨锁骨下淋巴结清扫对乳腺癌腋窝淋巴结阳性患者预后的影响。方法将158例腋窝淋巴结阳性乳腺癌患者随机分为锁骨下淋巴结未清扫组( A组)和锁骨下淋巴结清扫组( B组),分别用Kaplan-Meier法和Cox风险模型对两组临床病理因素与患者无病生存( DFS)时间的关系进行单因素和多因素生存分析。结果单因素和多因素分析均显示,患者的中位DFS时间与肿瘤大小、腋窝淋巴结阳性比率、人类表皮生长因子受体2( HER-2)表达状态及锁骨下淋巴结是否清扫显著性相关(P均<0.05)。结论对乳腺癌腋窝淋巴结阳性患者中原发肿瘤>5 cm、HER-2高表达状态或腋窝淋巴结转移率>0.4者进行锁骨下淋巴结清扫,可使其DFS明显延长。

  20. High-resolution fiber optic microscopy with fluorescent contrast enhancement for the identification of axillary lymph node metastases in breast cancer: a pilot study

    OpenAIRE

    Rosbach, Kelsey J; Shin, Dongsuk; Muldoon, Timothy J.; Quraishi, Mohammad A.; Middleton, Lavinia P.; Kelly K Hunt; Meric-Bernstam, Funda; Yu, Tse-Kuan; Richards-Kortum, Rebecca R.; Yang, Wei

    2010-01-01

    This prospective pilot study evaluates the potential of high-resolution fiber optic microscopy (HRFM) to identify lymph node metastases in breast cancer patients. 43 lymph nodes were collected from 14 consenting breast cancer patients. Proflavine dye was topically applied to lymph nodes ex vivo to allow visualization of nuclei. 242 images were collected at 105 sites with confirmed histopathologic diagnosis. Quantitative statistical features were calculated from images, assessed with one-way A...

  1. The application of dissecting level Ⅲ lymph nodes in modified radical mastectomy of breast cancer with positive axillary lymph nodes%Level Ⅲ组淋巴结清扫在腋下淋巴结阳性乳腺癌改良根治术中的应用

    Institute of Scientific and Technical Information of China (English)

    潘成武; 肖劲松; 陈刚; 李辉

    2014-01-01

    Objective:To evaluate the value of dissecting levelⅢlymph nodes in modified radical mastectomy of breast cancer patient with positive axillary lymph nodes. Methods:The breast carcinoma patients with positive axillary lymph nodes were screened by physical examination or ultrasound imaging. The patients were treated with the modified radical mastectomy or modified radical mastectomy combined with level Ⅲ lymph nodes dissection. The clinical effects of two kinds of operations were compared. Results:Forty-two patients were treated with level Ⅲ lymph nodes dissection. Among 42 patients, the positive axillary lymph nodes in 41 cases ( accompanied by postive level Ⅲ lymph nodes in 13 cases ) were found. The rates of 3-year distant metastasis and supraclavicular lymph node metastasis were 9. 5% and 2. 4%,respectively. Seventeen patients were treated with the modified radical mastectomy,the rates of 3-year distant metastasis and supraclavicular lymph node metastasis were 35. 3% and 23. 5%,respectively. The differences of the rates of 3-year distant metastasis and supraclavicular lymph node metastasis between two kinds of operations were statistically significant(P0. 05). Conclusions:Dissecting level Ⅲ lymph nodes in the treatment of the patients with positive axillary lymph nodes can thoroughly clean the axillary lymph nodes,and improve the postoperative treatment and prognosis.%目的:探讨Level Ⅲ组淋巴结清扫在腋下淋巴结阳性乳腺癌改良根治术中的应用价值。方法:对术前通过体检或超声影像学检查发现腋下淋巴结阳性59例,行单纯乳腺癌改良根治术或结合Ⅲ组淋巴结清扫术,比较2种术式的治疗效果。结果:Ⅲ组淋巴结清扫患者42例,其中41例腋下淋巴结阳性,伴有Ⅲ组淋巴结阳性者13例,3年远处转移率为9.5%,锁骨上淋巴结转移率2.4%;单纯乳腺癌改良根治患者17例,3年远处转移率为35.3%,锁骨上淋巴结转移率23.5%,2组

  2. Lymph node culture

    Science.gov (United States)

    Culture - lymph node ... or viruses grow. This process is called a culture. Sometimes, special stains are also used to identify specific cells or microorganisms before culture results are available. If needle aspiration does not ...

  3. Axillary lymph node characterization in breast cancer patients using magnetic resonance mammography: A prospective comparative study with FDG PET-CT and healthy women

    Energy Technology Data Exchange (ETDEWEB)

    Krammer, J., E-mail: Julia.Krammer@medma.uni-heidelberg.de; Wasser, K.; Schnitzer, A.; Henzler, T.; Schoenberg, S.O.; Kaiser, C.G.

    2013-12-01

    Objective: The aim of this study was to evaluate the capability of dynamic contrast enhanced MR-mammography (MRM) for the interpretation of axillary lymph nodes (LNs) in patients with breast cancer. Material and methods: 25 patients with breast cancer preoperatively underwent both FDG positron emission computed tomography (PET-CT) and dynamic contrast enhanced MRM. The maximum signal increase (SI{sub max}) and curve shape (types I–III) of contrast enhanced LNs ≥0.5 cm (short-axis) were analyzed in MRM and correlated to the maximum standard uptake value (SUV{sub max}) of FDG PET-CT. 29 healthy women with MRM served as control group. Enhancement kinetics of all malignant LNs were compared to LN findings of the healthy control group. Results: Overall 33 contrast enhanced LNs on preoperative MRM had a corresponding FDG uptake on PET-CT. 30 of the PET positive LNs were classified as surely malignant (mean SUV{sub max} 7.3 (±5.4)). The mean SI{sub max} of these LNs was not significantly different to the control group (222% vs 197%), but malignant LNs had a significantly higher rate of type III curves with rapid washout (93% vs 66%, p = 0.008). Conclusion: The maximum signal increase is not capable of differentiating malignant from benign axillary LNs. However, since malignant LNs showed a higher frequency of rapid washout curves (type III curves) on corresponding MRM future studies should concentrate on the analysis of this parameter. In clinical routine the curve shape still should be taken with care as there is a high overlap with benign LNs.

  4. 乳腺癌腋窝淋巴结声像图联合免疫组织化学与淋巴结转移的相关性研究%Correlation between axillary lymph node metastases and ultrasonographic characteristics of axillary lymph node combined with immunohistochemistry in breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    孔祥崇; 程文; 郭存丽; 尚海涛; 张娜

    2016-01-01

    背景与目的:乳腺癌腋窝淋巴结转移对于乳腺癌患者的预后及治疗方案的选择有重要的指导意义。本研究旨在探讨乳腺癌腋窝淋巴结声像图表现联合免疫组织化学与腋窝淋巴结转移的相关性。方法:回顾性分析应用超声检出的366例乳腺癌患者共计728枚腋窝淋巴结的声像图表现,采用单因素分析、多因素logistic回归及受试者工作特征(receiver operating characteristic,ROC)曲线分析的方法,分别检验乳腺癌腋窝淋巴结皮质最大厚度、长短径之比、皮髓质之比和淋巴结血流特征,联合乳腺癌术后免疫组织化学结果,研究其与病理学腋窝淋巴结转移的相关性。结果:依据单因素分析,腋窝淋巴结皮质最大厚度、长短径之比、血流特征以及乳腺癌病灶p53的阳性表达率与淋巴结转移有关(P3 mm (42.78%) of axillary lymph node was signiifcantly higher than that in patients with maximum cortex thickness≤3 mm (25.82%) (P<0.01).Conclusion:Ultrasonographic characteristics of axillary lymph node and immunohistochemistry method are closely correlated with axillary lymph node metastasis in patients with breast cancer, which is important in diagnostic and treatment in clinic.

  5. The Prognostic Significance of a Combined Determination of Cathepsin D and Estrogen Receptors in Breast Carcinomas with Positive Axillary Lymph Nodes

    Institute of Scientific and Technical Information of China (English)

    Yun Niu; Xue Yang; Yu Fan; Ajuan Lü; Tieju Liu; Xilin Fu

    2006-01-01

    OBJECTIVE The aim of this study was to investigate the correlation between cathepsin D (Cath-D) and estrogen receptor (ER)expression in breast cancer tissue and to explore the prognostic significance of their combined determination in breast carcinoma patients with positive axillary lymph nodes. METHODS One hundred and thirty-eight cases of breast carcinoma were examined by immunohistochemistry (IHC) and the results relating to patient follow-up analyzed.RESULTS The overall 5-year disease-free survival rate (DFS) was 60.9% (84/138) in the series. The positive rate of Cath-D expression in the tumor cells was 55.07% and the positive ER staining was 51.4%. A definite significant negative correlation was found between the positive rates for Cath-D and ER (r=-0.294, P=0.001) The Cath-D expression for the cases in clinical Stage Ⅱ, ≥10 positive-node and recurrence or distant metastasis, was higher than that those cases in clinical Stage Ⅱ with fewer node-metastasis and with 5 year DFS (χ2=13.926, P=0.000;χ2=13.070, P=0.001; χ2=10.545, P=0.001). However, there was no significant difference of Cath-D expression between 2 groups of patients with different ages or among the different histopathologic types of the nonspecific invasive carcinoma. In the combined examination of Cath-D and ER, the cases that were ER (+) and Cath-D (-) had the highest 5-year DFS compared to other situations. In contrast, the cases that were reversed in expression, ie, ER(-) and Cath-D(+), had a lower 5-year DFS.There was a significant difference between the 2 conditions (χ2=18.675,P=0.000).CONCLUSION A combined determination and analysis of Cath-D and ER expression may be more useful to establish a prognosis than the biological characteristics of carcinomas with positive lymph nodes.

  6. Analysis on correlation between the characteristic of breast cancer MRI and axillary lymph node metastasis%乳腺癌MRI的特征性表现与腋窝淋巴结转移的相关性分析

    Institute of Scientific and Technical Information of China (English)

    谢龙龙; 刘晟; 王维; 刘文; 简练; 彭和香

    2015-01-01

    Objective: To explore the relationship between the characteristic of breast cancer MRI and axillary lymph node metastasis, thus offering therapeutic schedule and prognosis in treating breast cancer.Materials and Methods:Forty-four cases of breast cancer were conifrmed by pathology and preoperative MR scan, twenty-six cases of these patients were conifrmed with ipsilateral axillary lymph node metastasis. Two experts read MRI image, and analyze the relationship between the ratio of different masses' short axis over long axis, dynamic enhanced MR features and the axillary lymph node metastasis of breast cancer.Results:(1) MR morphology analysis shows that the ratio of breast lumps' short axis over long axis has a negaive correlation with axillary lymphnode matastasis (t=5.892,P<0.05). (2) Edge reinforcement tumors' early intensive rate of breast cancer has positive correlation with axillary lymph node metastasis (t=3.966,P<0.01).Conclusion:The larger the ratio of breast lumps' short axis over long axis is, the smaller the possibility of axillary lymph node metastasis will be, the bigger edge reinforcement tumors' early intensive rate is, the greater the possibility of lymph node metastasis will be, and associated with poor prognosis. Therefore, axillary lymph node metastasis of breast cancer has good correlation with MR characteristic. MR examination can judge prognosis of breast cancer and axillary lymph node properties, then provide reference for effective treatment.%目的:探讨乳腺癌MRI的特征性表现与腋窝淋巴结转移的相关性,为乳腺癌淋巴结阳性患者治疗方案的选择及预后评估提供理论依据。材料与方法44例经病理证实为乳腺癌且均术前行MR扫描,其中26例患者证实有同侧腋窝淋巴结转移。由2名有经验的影像科医师阅读MRI,分析不同肿块的短径与长径之比、动态增强的特征与乳腺癌腋窝淋巴结转移的相关性。结果(1)MR形态学分析乳腺肿块短径

  7. Ultrasonography evaluation of axillary lymph nodes in patients with breast cancer%彩色多普勒超声对乳腺癌腋窝淋巴结转移的预测价值

    Institute of Scientific and Technical Information of China (English)

    常莹; 杨敬春; 冷振鹏; 王萍

    2014-01-01

    Objective To investigate the predictive value of color doppler ultrasound for node metastases of breast cancer axillary lymph.Methods The collection of Xuanwu Hospital of Capital Medical University in 2011 January to 2014 December,236 female patients with breast cancer who underwent surgical treatment; clinical data of patients with axillary lymph node metastasis was analyzed retrospectively.Ultrasonic detection included tumour size,ratio of length and breadth,edge features(spiculations),classification and type of color doppler flow imaging; peak systolic velocity; resistance index and status of axillary lymph node were recorded.Results All 236 cases were female patients.The results of operation showed that 115 cases had axillary lymph node metastasis and 121 cases had no metastasis.The analysis of axillary lymph nodes metastases showed:tumor size > 3 cm(OR =10.767,P =0.000),tumor location (mammary areolar region) and multiple tumor foci (OR =4.092,P =0.004) were risk factors of axillary lymph nodes metastases.Spicule sign(OR =2.120,P =0.006),grade of blood flow (OR =4.030,P =0.007),type of blood vessel(OR =3.051,P =0.008) and the numbers of axillary lymph node (OR =2.687,P =0.001) were the factors for evaluating the correlated with axillary lymph node metastases.Conclusions Breast cancer with axillary lymph node metastasis is associated with multiple factors,such as tumor size,location and numbers.For judgment of axillary lymph node metastase in patients with primary breast cancer,the position of tumour,type of blood and number of axillary lymph node detected by ultrasound are associated with axillary lymph node metastasis.%目的 探讨彩色多普勒超声对乳腺癌腋窝淋巴结转移的预测价值.方法 收集首都医科大学宣武医院2011年1月至2014年12月236例女性乳腺癌手术患者的临床资料,对患者腋窝淋巴结转移情况进行回顾性分析.记录肿块大小、纵横比、边缘特征(毛刺征)

  8. 高频彩色超声在乳腺癌淋巴结转移诊断中的价值%Ultrasonographic diagnosis of axillary lymph node metastasis in patients with breast cancer

    Institute of Scientific and Technical Information of China (English)

    张锦

    2010-01-01

    目的 分析乳腺癌原发灶及腋窝淋巴结转移的高频彩色超声声像图以及相关因素.方法 回顾性分析132例乳腺癌患者的超声、手术及病理资料,利用ROC曲线评价诊断指标.结果 132例乳腺癌腋窝淋巴结转移阳性率42.4%(56/132).超声诊断符合率92.9%(52/56);淋巴结转移阴性率57.6%(76/132),超声诊断符合率85.5%(65/76).结论 综合考虑乳腺癌原发灶与腋窝淋巴结,有助于提高超声诊断腋窝淋巴结转移的正确率,判断淋巴结状态,为临床分期及制定手术方案提供有价值的信息.%Objective To analyze the ultrasonographic features of breast cancer and axillary lymph, and improve the accuracy rate of diagnosing axillary lymph node metastasis by ultrasonography. Methods The data of ultrasound, operation and pathology in 132 patients with breast cancer were analyzed retrospectively. The ROC curve was made to determine the relationship of the tumor size with axillary lymph node nature. Results The positive rate of axillary lymph node metastasis of 132 cases was 42.4%(56/132), and the accuracy rate of ultrasonographic diagnosis was 92.9%( 52/56). The negative rate of lymph node was 57.6%( 76/132 ),and the accuracy rate of ultrasonographic diagnosis was 85.5%( 65/76). Conclusions The primary tumor and axillary lymph nodes are the main features to determine whether metastatic involvement is present or not. Ultrasonography can provide valuable reference for clinic and operation.

  9. Fine-needle aspirates CYFRA 21-1 is a useful tumor marker for detecting axillary lymph node metastasis in breast cancer patients.

    Directory of Open Access Journals (Sweden)

    Jung Hyun Yoon

    Full Text Available INTRODUCTION: To assess whether the value of CYFRA21-1 in the aspirates of ultrasonography-guided fine-needle aspiration biopsy (US-FNAB can contribute to improving the performances of US-FNAB in the diagnosis of axillary lymph node (LN metastasis in breast cancer patients. METHODS: US-FNAB was performed in 156 axillary LNs in 152 breast cancer patients (mean age: 51.4 years, range: 17-92 years. Concentrations of CYFRA21-1 were measured from washouts of the syringe used during US-FNAB. Tumor marker concentrations, US-FNAB, intraoperative sentinel node biopsy (SNB, and surgical pathology results were reviewed and analyzed. For comparison, the values of CEA and CA15-3 were also measured from washouts. RESULTS: Among the 156 LNs, 75 (48.1% were benign, and 81 (51.9% were metastases. Mean concentrations of CYFRA21-1 were significantly higher in metastasis compared to benign LNs (P<0.001. US-FNAB combined to CYFRA21-1 showed significantly higher sensitivity, NPV, and accuracy compared to US-FNAB alone (all values P<0.05. All diagnostic indices of US-FNAB combined to CYFRA21-1 were significantly higher compared to US-FNAB combined with CEA or CA15-3 (all P<0.001. Of the 28 metastatic LNs which showed metastasis on SNB, CYFRA21-1 showed higher positive rate of 75.0% (CEA or CA15-3∶60.7%, P = 0.076. CONCLUSION: Measuring CYFRA 21-1 concentrations from US-FNAB aspirates improves sensitivity, NPV, and accuracy of US-FNAB alone, and may contribute to reducing up to 75.0% of unnecessary intraoperative SNB. Compared to CEA or CA15-3, CYFRA21-1 shows significantly higher performances when combined to US-FNAB in the preoperative diagnosis of LN metastasis in breast cancer patients.

  10. Locoregional recurrence risk factors in breast cancer patients with positive axillary lymph nodes and the impact of postmastectomy radiotherapy

    International Nuclear Information System (INIS)

    Locoregional recurrence (LRR) after mastectomy reduces the patient's quality of life and survival. There is a consensus that postmastectomy radiotherapy (PMRT) helps establish locoregional control and reduces LRR in patients with ≥4 metastatic nodes. However, in patients with 1-3 metastatic nodes, the incidence of LRR and the role of PMRT have been the subject of substantial controversy. This study assessed the risk factors for LRR and the efficacy of PMRT in Japanese breast cancer patients with metastatic nodes. This study analyzed 789 cases of invasive breast carcinoma with metastatic nodes from 1998 to 2008. We divided the study population into 4 groups: 1-3 positive nodes with/without chemotherapy and ≥4 positive nodes with/without chemotherapy. Risk factors for LRR were identified and the relationship between LRR and PMRT was analyzed. During the median follow-up of 59.6 months, 61 (7.7%) patients experienced LRR. In patients who received chemotherapy, independent LRR risk factors were high nuclear grade, severe lymphatic invasion, vascular invasion, and progesterone receptor-negative status in patients with 1-3 positive nodes, and severe lymphatic invasion and estrogen receptor-negative status in patients with ≥4 nodes. Although patients treated with PMRT had good outcomes, there was no significant difference, and PMRT did not significantly improve the outcome of the patients with all risk factors. With systemic therapy and adequate dissection, PMRT by itself was of limited value in establishing locoregional control. The indication for PMRT in patients with 1-3 positive nodes remains controversial. (author)

  11. The application of simplified axillary lymph nodes dissection on the treatment of early breast cancer%简化腋窝淋巴结清扫术在早期乳腺癌治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    黄炜; 王亚兵; 殷照才; 刘三保; 陈洁; 陈晓林

    2015-01-01

    目的:探讨简化腋窝淋巴结清扫术( axillary lymph node dissection, ALND)在乳腺癌手术中的应用及效果。方法分析2009年1月至2013年6月间行前哨淋巴结活检( sentinel lymph node bi-opsy,SLNB)327例乳腺癌患者的临床资料,行亚甲蓝染色法 SLNB后根据前哨淋巴结( sentinel lymph node, SLN)冰冻病理结果,对 SLN阳性者行规范的 ALND, SLN阴性则行简化的 ALND (只清扫 LevelⅠ),比较两组在手术时间、术后住院时间、腋窝引流时间及术后并发症的差异。结果327例患者中,314例成功进行了SLNB,119例SLN阳性者行标准的ALND,195例SLN阴性者行简化的ALND,11例SLN阴性患者出现LevelⅠ组织淋巴结转移;简化组手术时间、术后住院时间、腋窝引流时间明显缩短,术后腋窝积液、肌力减退、活动受限、疼痛、麻木、肿胀等并发症明显减少。术后随访3~60个月,患者无腋窝淋巴结复发及远处转移。结论蓝染法SLNB是乳腺癌患者腋窝淋巴结转移状态的重要检测技术,对SLN阴性行简化的ALND,可节省医疗资源、减少术后并发症。%Objective To explore the application and effect of simplified axillary lymph node dissection ( ALND) in the operation of breast cancer . Methods Through the analysis of 327 cases of breast cancer pa-tients with clinical data in our department from Jan. 2009 to Jun. 2013 receiving sentinel lymph node biopsy (SLNB), according to the sentinel lymph node (SLN) frozen pathological results which were used methylene blue staining of SLNB , the patients who were SLN positive did the standard ALND, and the SLN negative pa-tients did the simplified ALND ( only clean up Level I) , Differences on operative time, postoperative hospitali-zation time, axillary drainage time and postoperative complications were compared between the two groups. Re-sults Among 327 cases, 314 cases successfully carried out SLNB, ALND in 119 cases with SLN positive and 195 cases of ALND

  12. Predictive value of tumor load in breast cancer sentinel lymph nodes for second echelon lymph node metastases.

    NARCIS (Netherlands)

    van Deurzen, C.H.M.; van Hillegersberg, R.; Hobbelink, M.G.G.; Seldenrijk, C.A.; Koelemij, R.; van Diest, P.J.

    2007-01-01

    Background: The need for routine axillary lymph node dissection (ALND) in patients with invasive breast cancer and low-volume sentinel node (SN) involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND.Me

  13. The Extent of Axillary Surgery Is Associated With Breast Cancer-specific Survival in T1-2 Breast Cancer Patients With 1 or 2 Positive Lymph Nodes: A SEER-Population Study.

    Science.gov (United States)

    Li, Shunrong; Liu, Fengtao; Chen, Kai; Rao, Nanyan; Xie, Yufen; Su, Fengxi; Zhu, Liling

    2016-04-01

    This study aimed to compare the breast cancer-specific survival (BCSS) of a nonclinical trial population of T1-2 breast cancer patients with 1 to 2 positive lymph nodes who received breast-conserving surgery and either sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND).We used the Surveillance, Epidemiology and End Results (SEER) database to identify 17,028 patients with a median follow-up of 7.1 years. We assigned the patients into a SLNB-cohort (≤5 nodes) and an ALND-cohort (>5 nodes) based on the number of removed lymph nodes. We used Kaplan-Meier analysis to estimate the cumulative BCSS and used Cox-regression analysis to study the risk factors. We also performed subgroup analysis by the patients' age and hormonal receptor (HR) status.The cumulative BCSS and Overall Survival (OS) of the entire population were 94.4% and 91.4% at 5 years and 88.2% and 79.9% at 10 years, respectively. Axillary surgery (ALND vs SLNB) had no association with BCSS when adjusted for stage, HR status, tumor grade, or other factors. In subgroup analysis by age and HR status, ALND was associated with a significantly improved BCSS relative to SNLB (HR = 0.70, HR = 0.026, 95% confidence interval 0.51-0.96) only in patients younger than 50 years with HR- disease (N = 1281), but not in other subgroup of patients.In early-stage breast cancer patients with limited lymph node metastasis, ALND had better BCSS than SLNB only in patients younger than 50 years and with HR- disease. More studies are needed to confirm our findings. PMID:27057872

  14. Multivariate analysis in predicting axillary lymph node metastasis in breast cancer%超声预测乳腺癌腋窝淋巴结转移的多因素分析

    Institute of Scientific and Technical Information of China (English)

    王丰; 张锐; 肖芳; 唐熙

    2011-01-01

    目的 探寻预测乳腺癌腋窝淋巴结转移的超声相关因素,建立超声预测乳腺癌腋窝淋巴结转移的多因素Logistic 回归模型.方法 利用乳腺和腋窝超声观察227 例病理证实的乳腺癌患者,分析影响腋窝淋巴结转移率的超声相关因素,将这些因素引入单因素及多因素Logistic 回归模型,计算回归模型ROC 曲线下面积及准确度等评价指标.结果 肿瘤大小、肿瘤边界、肿瘤血流分级、超声检出淋巴结数目、淋巴结皮质最大厚度、淋巴结血流分型和淋巴结纵横比是影响乳腺癌腋窝淋巴结转移率的因素(P <0.05),多因素Logistic 回归模型显示肿瘤大小≥2 cm、淋巴结皮质最大厚度≥3 mm、淋巴结血流Ⅲ型和较小的淋巴结纵横比是乳腺癌腋窝淋巴结转移的危险因素.多因素回归模型ROC 曲线下面积为0.847,准确度、敏感度、特异度、阳性预测值和阴性预测值分别为79.3%、85.9%、68.2%、81.9%和74.4%,较单因素回归模型在没有明显降低敏感度基础上显著提高了特异度,避免了过多假阴性出现.结论 多因素Logistic 回归模型能够较好地预测乳腺癌腋窝淋巴结转移情况.%Objective To estimated the related factor of axillaiy lymph node metastasis in breast cancer patients. The multivariate logistic regression model was established for predicting axillary lymph node metastasis. Methods Breast and axillary ultrasound were recorded in 227 hreast cancer patients diagnosed hy pathology. To analyse the relationship between ultrasonographic characteristics and axillary lymph node metastasis rate in breast cancer patients. Use univariate and multivariate logistic regression analysis to calculate which ultrasonographic characteristics related to axillary lymph node metastasis . and ROC curve was drawn to appraise the value of logistic regression , then evaluated accuracy for each logistic regression. Results Breast tumor diameter,edge of tumor

  15. Re-emphasizing the concept of adequacy of intraoperative assessment of the axillary sentinel lymph nodes for identifying nodal positivity during breast cancer surgery

    Directory of Open Access Journals (Sweden)

    Agnese Doreen M

    2007-02-01

    Full Text Available Abstract Background Although sentinel lymph node (SLN biopsy is a standard of care for the evaluation of the axillary lymph nodes during breast cancer surgery, a substantial degree of variation exists among individual surgeons as to what represents an adequate assessment. The aim of the current study was to assess when metastatic disease was first identified within consecutively harvested SLN candidates for invasive breast cancers demonstrating a positive SLN. Methods We retrospectively analyzed a series of 400 breast cancers from a recently published prospective randomized clinical trial. A combined radiocolloid and blue dye technique was used. All potential SLN candidates, containing counts of at least 10% of the hottest SLN and/or containing blue dye, were harvested and were consecutively numbered in the order of the decreasing level of counts (with the hottest SLN representing SLN #1. Results Among 371 invasive breast cancers, a SLN was identified within 353 cases (95%. Mean number of SLNs identified was 2.5 (range, 1 to 9, with a single SLN identified in 104 (29% cases, two identified in 110 (31%, three identified in 73 (21%, four identified in 35 (10%, five identified in 16 (5%, and six or more identified in 15 (4%. A positive SLN was found in 104 (29% cases. SLN #1 was the first positive SLN in 86 (83%. SLN #2 was the first positive SLN in 15 (14%. SLN #3, SLN #4, and SLN #5 were the first positive SLN in one case (1% each. A positive SLN was found in 18% (19/104 of cases when a single SLN was identified, as compared to in 34% (85/249 when two or more SLNs were identified (P = 0.003. Conclusion The accurate and optimal assessment of the axilla during breast cancer surgery requires persistence and diligence for attempting to identify all potential SLN candidates in order to avoid failing to recognize a positive SLN. The scenario in which only a single negative SLN candidate is intraoperatively identified is one that should raise some

  16. Fine-needle aspirate CYFRA 21-1, an innovative new marker for diagnosis of axillary lymph node metastasis in breast cancer patients.

    Science.gov (United States)

    Choi, Ji Soo; Han, Kyung Hwa; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung

    2015-05-01

    To compare the value of cytokeratin fragment 21-1 (CYFRA 21-1) concentration in the fine-needle biopsy aspirates (fine needle aspirate [FNA] CYFRA 21-1) with cytopathology of fine-needle aspiration biopsy (FNA cytology) and to assess whether CYFRA 21-1 concentrations from ultrasound-guided fine-needle aspiration biopsy (US-FNAB) specimens (FNA CYFRA 21-1) is not inferior to FNA cytology in the diagnosis of axillary lymph node (ALN) metastasis of breast cancer patients.This study received institutional review board approval, and written informed consent was obtained from all patients. US-FNAB was performed in 373 ALNs from 358 patients with invasive breast cancer. Concentrations of CYFRA 21-1 were measured from washouts of the syringe used during US-FNAB (FNA CYFRA 21-1), and ALN metastasis was determined using a cutoff value of 1.93 ng/mL. FNA cytology, intraoperative sentinel lymph node biopsy, and surgical pathology results were reviewed and analyzed. The noninferiority margin for the difference in accuracies between FNA cytology and FNA CYFRA 21-1 was set as 5%.Among 373 ALNs, 136 (36.5%) were benign, and 237 (63.5%) were metastatic. The mean FNA CYFRA 21-1 was significantly higher in metastatic ALNs compared to that in benign ALNs (P = 0.001). For the diagnosis of ALN metastasis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNA CYFRA 21-1 (cutoff value 1.93 ng/mL) were not significantly different from those of FNA cytology (P > 0.05). FNA CYFRA 21-1 reached statistical noninferiority to FNA cytology in terms of diagnostic accuracy for ALN metastasis. Of the 20 ALNs (8 metastasis, 12 benign) that showed insufficient results on FNA cytology, FNA CYFRA 21-1 accurately diagnosed 15 ALNs (4 metastasis, 11 benign).The diagnostic performance of FNA CYFRA 21-1 is comparable with that of FNA cytology for breast cancer ALN metastasis. Our results indicate that FNA CYFRA 21-1, using an US-FNAB specimen

  17. 超声下乳腺癌腋下淋巴结转移的图像特征分析%Ultrasonographic Features of Axillary Lymph Node Metastasis in Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    孙薇薇

    2015-01-01

    Objective To analyze the ultrasonographic features of axillary lymph node metastasis in breast cancer. Methods A retrospective analysis was conducted on 101 cases of patients with breast cancer,and the ultrasonographic features of axillary lymph node metastasis in breast cancer were summarized.Results Single factor analysis showed that calcification,tumor number,maximum diameter and richness of blood flow between axillary lymph node metastasis positive or negative patients had significant difference(P<0.05).Multiple-factor Logistic regression analysis showed that the number of tumors of multiple or dif-fuse,calcification,rich blood levelⅡtoⅢlevel and the maximum diameter of more than 2 cm were the independent risk factors that lead to axillary lymph node metastasis positive (P<0.05).Conclusion The number of tumors of multiple or diffuse,calci-fication,rich blood levelⅡtoⅢlevel and the maximum diameter of more than 2 cm are the high risk factors lead to axillary lymph node metastasis,which should be considered so as to improve the accuracy of the ultrasonic inspection.%目的:探讨超声下乳腺癌腋下淋巴结转移的图像特征。方法回顾性分析101例乳腺癌患者临床资料,总结腋下淋巴结转移的超声图像特征。结果单因素分析发现腋下淋巴结转移病理阳性和病理阴性的患者在钙化灶、肿瘤数量、最大径及血流丰富程度等方面差异有统计学意义(P<0.05)。 Logistic回归分析发现肿瘤数量多发或弥散、有钙化灶、血流丰富程度Ⅱ~Ⅲ级以及最大径>2 cm是腋下淋巴结转移病理阳性的独立危险因素(P<0.05)。结论对肿瘤数量多发或弥散、有钙化灶、血流丰富程度Ⅱ~Ⅲ级以及最大径>2 cm乳腺癌患者行超声检查时应综合考虑以提高腋下淋巴结转移的正确率。

  18. Clinical analysis of liposuction for preventing lymphatic fluid leakage after axillary lymph nodes dissection in breast cancer%脂肪溶解液预防乳腺癌术后淋巴漏的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    张珂; 钱军; 金鑫; 喻大军; 陈邦领

    2015-01-01

    目的::探讨脂肪溶解液辅助腋窝淋巴结清扫对乳腺癌术后淋巴漏发生率的影响。方法:行乳腺癌改良根治术患者86例,其中常规行乳腺癌改良根治术清扫腋窝淋巴结的52例为对照组,术中加用脂肪溶解液辅助腋窝淋巴结清扫的34例为观察组。比较2组术后3d引流管引流量、腋窝引流管留置时间、皮下积液的发生率。结果:观察组术后第2天、第3天引流量和腋窝引流管留置时间均较对照组明显减少(P<0.01),皮下积液的发生率低于对照组(P<0.05)。结论:乳腺癌改良根治术中使用脂肪溶解液辅助腋窝淋巴结清扫可以预防术后淋巴漏的发生。%Objective:To investigate the effect of postoperative lymphatic fluid leakage after the axillary lymph nodes dissection by liposuction. Methods:Eighty-six breast cancer patients were included in this study,which were divided into two groups,the patients with dissection of axillary lymph nodes by liposuction ( n=34 ) were in observation group, and the patients with traditional axillary lymph node dissection( n=52 ) were in control group. The draining volume in the postoperative 3 days, draining time and the incidence of subcutaneous fluid were compared between the two groups. Results:The postoperative drainage volume and drainage time in the second day and the third day in observation group were less than in control group(P <0. 01). The incidence of subcutaneous fluid in observation group was lower than that in control group(P<0. 05). Conclusions:The axillary lymph nodes dissection by liposuction can reduce the incidence of postoperative lymphatic leakage,it can be applied widely in axillary lymph nodes dissection in breast cancer.

  19. High-resolution fiber optic microscopy with fluorescent contrast enhancement for the identification of axillary lymph node metastases in breast cancer: a pilot study.

    Science.gov (United States)

    Rosbach, Kelsey J; Shin, Dongsuk; Muldoon, Timothy J; Quraishi, Mohammad A; Middleton, Lavinia P; Hunt, Kelly K; Meric-Bernstam, Funda; Yu, Tse-Kuan; Richards-Kortum, Rebecca R; Yang, Wei

    2010-01-01

    This prospective pilot study evaluates the potential of high-resolution fiber optic microscopy (HRFM) to identify lymph node metastases in breast cancer patients. 43 lymph nodes were collected from 14 consenting breast cancer patients. Proflavine dye was topically applied to lymph nodes ex vivo to allow visualization of nuclei. 242 images were collected at 105 sites with confirmed histopathologic diagnosis. Quantitative statistical features were calculated from images, assessed with one-way ANOVA, and were used to develop a classification algorithm with the goal of objectively discriminating between normal and metastatic tissue. A classification algorithm using mean image intensity and skewness achieved sensitivity of 79% (27/34) and specificity of 77% (55/71). This study demonstrates the technical feasibility and diagnostic potential of HRFM with fluorescent contrast in the ex vivo evaluation of lymph nodes from breast cancer patients. PMID:21258518

  20. Study of the optimal threshold for predicting axillary lymph nodes metastasis in women with breast cancer by 18F-FDG PET/CT

    International Nuclear Information System (INIS)

    Objective: The presence of axillary lymph nodes(ALN)metastasis was the most important prognostic factor in women with breast cancer. The ability of 18F-fluorodeoxyglucose (FDG) PET determining axillary status was argued. The aim of this study was to explore the optimal threshold and ability of semiquantitative analysis to determine axillary status by 18F-FDG PET/CT. Methods: Fifty-six patients with invasive breast cancer who underwent ALN biopsy (ALNB) were divided into 2 groups:positive group (with axillary metastasis), control group(no axillary metastasis).All the patients underwent 18F-FDG PET/CT scanning for their preoperative evaluation. The maximum standardized uptake values of primary tumor (SUV-T) of ALN (SUV-T) and of mirror imaging background of ALN (SUV-T) were measured. The ratio of L/B was calculated (L/B=SUV-L/SUV-B). With the histopathologic standards of reference for each ALN, the optimal threshold of SUV-T, and SUV-L L/B were identified by receiver operating characteristic (ROC) curve analysis. Using the optimal threshold, the sensitivities, specificities, positive predictive values, negative predictive values and accuracies were calculated and compared with pathologic diagnosis (Kappa test was performed), respectively. Results: Of 56 cases,there were 56 breast primary tumors. The average of size was (30 ± 19) mm and SUV-T Was 5.5 ± 3.5. There were 38 cases (68%) in positive group and 18 eases (32%) in control group. The values in positive group[primary tumor size: (36 ± 19) mm, SUV-T (6.3 ± 3.5) ]were higher significantly than control group (t=4.060, P-T). Of all 628 ALN(565 in level I, 49 in level II and 14 in level III)were histopathologic dissected. 182 (29%) ALN were metastasis and 446 (71%) were negative. Only 145 (23%) were found in PET/CT. and of them 116(103, 11 and 2 in level I, II and III, respectively) were metastasis. In level I, the size, SUV-L, L/B of metastasis nodes were higher significantly than benign nodes (t=6.701, 7.020, 1

  1. The role of sentinel lymph-node biopsy (SLNB) in the treatment of breast cancer.

    Science.gov (United States)

    Marrazzo, Antonio; Taormina, Pietra; David, Massimo; Casà, Luigi; Lo Gerfo, Domenico; Noto, Antonio; Riili, Ignazio; Ficola, Umberto; Russo, Leila

    2006-01-01

    Sentinel lymph-node biopsy is an innovative method for axillary staging in breast cancer patients, based on the concept that information about the status of the entire lymphatic drainage from a tumour site could be obtained by identification and sampling of a "sentinel node". The aim of the study was to evaluate the impact of sentinel lymph-node biopsy in the management of patients with early invasive breast carcinoma. Three hundred and forty-one patients with primary invasive breast carcinoma measuring less than 2 cm (less than 3 cm from January 2001) and clinically negative axillary nodes were recruited into the study. Sentinel lymph-nodes were positive for metastases in 108/341 cases (31.7%). Micrometastases were found in 22 patients and isolated tumour cells in 1 case. The mean number of sentinel lymph-nodes removed was 1.8 per patient. The sentinel lymph-node was the only positive node in 57 of 108 patients (52.8%). The percentage of axillary recurrence in sentinel lymph-node-negative patients was 0%. The accuracy of sentinel lymph-node biopsy for axillary staging has been confirmed in many studies. Axillary recurrences after sentinel lymph-node biopsy range from 0 to 1.6% in many series, while axillary recurrence after axillary lymph-node dissection is about 0-3%. In our experience we observed no axillary recurrences in 233 patients with sentinel lymph-node biopsy alone, with a median follow-up of 33 months, confirming the accuracy of the procedure, and sentinel lymph-node-negative patients with sentinel lymph-node biopsy alone are no more at risk for axillary recurrences than those undergoing axillary lymph-node dissection. PMID:16845865

  2. CD44、CD24和PCNA与乳腺癌腋窝淋巴结转移关系研究﹡%Relationship among CD44, CD24, PCNA and axillary lymph node metastasis in breast cancer

    Institute of Scientific and Technical Information of China (English)

    焦伟; 王人颢

    2016-01-01

    目的:探讨CD44、CD24和增殖细胞核抗原( PCNA)与乳腺癌淋巴结转移之间的关系。方法乳腺癌切除组织标本120例,分为①前哨淋巴结阴性病例组、②前哨淋巴结阳性腋窝淋巴结未转移病例组、③前哨淋巴结阳性腋窝淋巴结转移病例组。分别对乳腺癌病理石蜡存档组织标本进行CD44、CD24和PCNA免疫组化标记,分析CD44、CD24及PCNA与淋巴结转移之间的关系。结果腋窝淋巴结转移组中:PCNA及CD44+/CD24-/loW同时表达阳性细胞病例数与其他两组比较明显增高,差异具有统计学意义(P<0.05);CD44、PCNA、CD24阳性表达例数均显著高于无腋窝淋巴结转移的其他两组,差异具有统计学意义(P均<0.05)。结论乳腺癌组织中CD44、CD24、PCNA阳性表型细胞比例决定腋窝淋巴结转移程度。%Objective To explore the relationship among CD44, CD24, proliferating cell nuclear antigen (PCNA) and lymph node metastasis of breast cancer .Methods A total of 120 breast cancer samples were divided into the follow-ing groups:a sentinel lymph node negative group , a sentinel lymph node group where no metastasis was found in the posi-tive axillary lymph nodes , and a sentinel lymph node where metastasis was found in the positive axillary lymph nodes . Then, CD44, CD24 and PCNA within the samples were immunohistochemically stained , in order to analyze the relation-ship among CD44, CD24, PCNA and lymph node metastasis .Results Patients with metastasis in the axillary lymph node produced a remarkably higher number of cells with positive staining of PCNA and CD 44 +/CD24 -/low than those in other two groups (P<0.05) and their number of cells with positive CD 44, CD24 and PCNA staining was significantly higher than those in other two groups (P<0.05).Conclusion The proportion of cells with CD44, CD24 and PCNA positive phenotypes in breast cancer determines the degree of axillary lymph node metastasis .

  3. The value of delayed {sup 18}F-FDG PET/CT imaging for differentiating axillary lymph nodes in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Young Sik; Son, Ju Cheol [Dept. of Nuclear Medicine, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan (Korea, Republic of); Park, Cheol Woo [Dept. of Radiological Technology Dong-Eui Institute of Technology, Busan (Korea, Republic of)

    2013-12-15

    Positron emission tomography/computed tomography (PET/CT) imaging with fluorodeoxyglucose (FDG) have been used as a powerful fusion modality in nuclear medicine not only for detecting cancer but also for staging and therapy monitoring. Nevertheless, there are various causes of FDG uptake in normal and/or benign tissues. The purpose of present study was to investigate whether additional delayed imaging can improve the diagnosis to differentiate the rates of FDG uptake at axillary lymph nodes (ALN) between malignant and benign in breast cancer patients. 180 PET/CT images were obtained for 27 patients with ALN uptake. The patients who had radiotherapy and chemotherapy were excluded from the study. {sup 18}F-FDG PET/CT scan at 50 min (early phase) and 90 min (delayed phase) after {sup 18}F-FDG injection were included in this retrospective study. The staging of cancers was confirmed by final clinical according to radiologic follow-up and pathologic findings. The standardized uptake value (SUV) of ALN was measured at the Syngo Acquisition Workplace by Siemens. The 27 patients included 18 malignant and 9 ALN benign groups and the 18 malignant groups were classified into the 3 groups according to number of metastatic ALN in each patient. ALNs were categorized less than or equal 3 as N1, between 4 to 9 as N2 and more than 10 as N3 group. Results are expressed as the mean ± standard deviation (S.D.) and statistically analyzed by SPSS. As a result, Retention index (RI-SUV max) in metastasis was significantly higher than that in non-metastasis about 5 fold increased. On the other hand, RI-SUV max in N group tended to decrease gradually from N1 to N3. However, we could not prove significance statistically in malignant group with ANOVA. As a consequence, RI-SUV max was good indicator for differentiating ALN positive group from node negative group in breast cancer patients. These results show that dual-time-point scan appears to be useful in distinguishing malignant from benign.

  4. Risk factors for non-sentionel lymph node metastases in brdeast cancer patients with positive sentionel lymph ondes

    Institute of Scientific and Technical Information of China (English)

    ZHANG Tao; WANG Hong; CHEN Bao-ping; ZHANG Hai-song; WEI Xi-liang; FU Ying; LI Zhong; HU Geng-kun

    2008-01-01

    @@ The presence or absence of metastases in the axillary lymph nodes has remained the most powerful prognostic factor in breast carcinoma. Axillary lymph node dissection (ALND) is the standard procedure for obtaining this information. However, postoperative complications are common. Sentinel lymph node (SLN) biopsy has been proposed as a potential alternative to ALND for staging breast carcinoma. This technique has been shown to be sensitive and specific for predicting the status of the axillary lymph nodes.1 Furthermore, it has the potential advantage of decreasing the morbidity associated with ALND.

  5. Early and delayed prediction of axillary lymph node neoadjuvant response by {sup 18}F-FDG PET/CT in patients with locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Vicente, Ana Maria; Soriano Castrejon, Angel; Jimenez Londono, German Andres [University General Hospital, Nuclear Medicine Department, Ciudad Real (Spain); Leon Martin, Alberto [University General Hospital, Investigation Unit, Ciudad Real (Spain); Relea Calatayud, Fernanda [University General Hospital, Pathology Department, Ciudad Real (Spain); Munoz Sanchez, Maria del Mar [Virgen de la Luz Hospital, Oncology Department, Cuenca (Spain); Cruz Mora, Miguel Angel [Virgen de la Salud Hospital, Oncology Department, Toledo (Spain); Espinosa Aunion, Ruth [La Mancha Centro Hospital, Oncology Department, Ciudad Real (Spain)

    2014-07-15

    To determine the utility of {sup 18}F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer. FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1-2 and SUV1-3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen's kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found. Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p = 0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict

  6. 彩色多普勒超声在乳腺癌腋窝淋巴结转移中的应用价值%Application Value of Color Doppler Ultrasound in Axillary Lymph Node Metastasis of Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    黄诗进; 罗利萍

    2015-01-01

    目的:探究彩色多普勒超声(CDFI)在乳腺癌腋下淋巴结转移中的应用价值。方法用CDFI和二维超声分析我院50例乳腺癌腋下淋巴结患者的声像图,对淋巴结的大小、形态、数目、血流参数、血流信号的分布、淋巴门以及纵横比进行分析。结果转移组的淋巴结大多数是多发性的,可以融成团,血流信号较紊乱、丰富,淋巴门消失或者偏心,周边型较多见。结论CDFI以及二维超声检查有利于鉴定良性以及恶性的淋巴结,是最为方便简单的方法之一。%Objective To explore the application value of color Doppler ultrasound in axillary lymph node metastasis of breast cancer. Methods With CDFI and two-dimensional ultrasonography analyzing sonogram echogram of 50 cases of patients of Axillary lymph nodes of breast cancer, including the size, form amount, blood flow parameters, the distribution of blood flow signals and aspect ratio. Result Most of lymph gland of transfer group were characteristic. Most of signals were peripheral pattern, and blood flow signals were displayed. Conclusions CDFI and two-dimensional ultrasonography is in favor of identifying benign and malignant lymph gland. It is one of the simplest ways in checking the axillary lymphatic metastasis of breast cancer.

  7. 1枚前哨淋巴结阳性早期乳腺癌保腋窝的可行性分析%Probablity of omitting axillary dissection in early stage breast cancer with one positive sentinel lymph node

    Institute of Scientific and Technical Information of China (English)

    陈卓荣; 沈三弟; 张凯; 李敏; 吴家豪

    2013-01-01

    目的 探讨1枚前哨淋巴结(sentinel lymph node,SLN)阳性的早期乳腺癌患者保腋窝(omitting axillary dissection,OAD)的可行性.方法用美蓝作为示踪剂先行乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy,SLNB),根据快速冰冻病理结果分为SLN阴性组与1枚SLN阳性组,随后两组均行常规腋窝淋巴结清扫(axillary lymph node dissection,ALND)以解剖出非前哨淋巴结(non-sentinel lymph node,NSLN),比较两组间NSLN的阳性率.结果 SLN阴性组30例,1例NSLN阳性,阳性率为3.3%,准确性为96.7%(29/30);1枚SLN阳性组30例,仅3例NSLN阳性,阳性率为10.0%;两组阳性率差异无统计学意义(χ2=1.071,P=0.612).全组随访1~48个月,均无区域淋巴结复发.结论 1枚SLN阳性的早期乳腺癌患者可考虑OAD.

  8. Axillary node metastasis from primary ovarian carcinoma

    Directory of Open Access Journals (Sweden)

    Trupti S Patel

    2014-01-01

    Full Text Available Metastasization and distinction from mammary carcinoma is of great clinical importance because of different treatment modalities. Here, we discuss a case of stage IIIC ovarian serous carcinoma, presenting with bilateral axillary nodes metastasis after 25 months interval of its initial presentation. Increased serum CA-125 level caused clinical suspicion. Computed tomography scan of abdomen and pelvis showed no residual disease or any abdominal lymphadenopathy. Mammography of both breast were normal. Bilateral axillary nodes were noted. Guided fine needle aspiration cytology (FNAC and biopsy of ovarian carcinoma to axillary node is a rare event. Its recogn done. Cytomorphology revealed poorly differentiated carcinoma, compatible to that of primary ovarian tumor. Thus, metastatic carcinoma to axillary node from ovary was confirmed. This case illustrates a rare metastatic presentation of ovarian carcinoma and unequivocal role of FNAC to provide rapid diagnosis and preferred to be first line diagnostic procedure.

  9. Solution to axillary lymph node imaging problems during breast MRI scaning using the body matrix coil%体部线圈解决MRI乳腺扫描中腋窝淋巴结成像问题

    Institute of Scientific and Technical Information of China (English)

    陈富珍; 钟华; 刘立红

    2015-01-01

    目的:探讨体部相控阵线圈(Body matrix Coil)在解决常规M RI乳腺检查中腋窝淋巴结成像问题的价值。方法搜集2011年7月~2013年6月间来我院做M RI乳腺检查患者50例,在使用常规乳腺线圈做乳腺扫描的同时,加盖BODY matrix线圈扫描腋窝部位,观察腋窝淋巴结显示情况及对整个图像质量,诊断结果的影响。结果加盖BODY matrix线圈对常规乳腺扫描图像质量无明显影响,且可以根据需要加做冠状位或横轴位显示双侧腋窝淋巴结,对诊断的价值具有统计学意义。结论利用乳腺线圈加BODY matrix线圈的方法既不影响常规乳腺成像,又可以以不同切面显示双侧腋窝组织,对诊断是否有腋窝淋巴结侵润具有很大价值。%Objective To study the value of body matrix coil in solving axillary lymph node imaging problems during breast MRI scaning .Methods In this work ,50 patients ,who were are reffered for examination in our hospital from July , 2011 to June ,2013 ,simultaneously underwent routine breast MRI scaning as well as the MRI scaning with a body matrix coil placed under armpits .Then ,imaging status of axillary lymph nodes ,the quality of image ,and diagnostic effect were observed .Results The addition of BODY Matrix Coil had no significant effect on image quality of conventional MRI sca‐ning .Also ,MRI scan with BODY Matrix Coil can be performed at coronal position or axial position to show axillary lymph nodes ,which had significant value for the diagnosis .Conclusion Breast MRI scan with Coil and BODY Matrix Coil not only exerts no effect on normal breast imaging ,but also ,displays bilateral armpits in different sections ,which has great value in diagnosing whether or not axillary lymph node invasion occurs .

  10. Frozen section analysis of sentinel lymph nodes in patients with breast cancer does not impair the probability to detect lymph node metastases

    NARCIS (Netherlands)

    E.V.E. Madsen (Eva V. E.); J. van Dalen (Jan); P.J. van Gorp (Patrick); P.M.P. Van Oort (Poultje M. P.)

    2012-01-01

    textabstractIntra-operative frozen section analysis (FS analysis) of sentinel lymph nodes (SLNs) in patients with breast cancer can prevent a second operation for axillary lymph node dissection. In contrast, loss of tissue during FS analysis may impair the probability to detect lymph node metastases

  11. Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging - initial findings

    Energy Technology Data Exchange (ETDEWEB)

    Stadnik, Tadeusz W.; Makkat, Smitha [Academisch Ziekenhuis Vrije Universiteit Brussel, Department of Radiology, Brussels (Belgium); Everaert, Hendrik [Academisch Ziekenhuis Vrije Universiteit Brussel, Department of Nuclear Medicine, Brussels (Belgium); Sacre, Robert; Lamote, Jan [Academisch Ziekenhuis Vrije Universiteit Brussel, Department of Surgery, Brussels (Belgium); Bourgain, Claire [Academisch Ziekenhuis Vrije Universiteit Brussel, Department of Anatomopathology, Brussels (Belgium)

    2006-10-15

    Magnetic resonance (MR) imaging after ultra-small super paramagnetic iron oxide (USPIO) injection and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for preoperative axillary lymph node staging in patients with breast cancer were evaluated using histopathologic findings as the reference standard. USPIO-enhanced MR and FDG-PET were performed in ten patients with breast cancer who were scheduled for surgery and axillary node resection. T2-weighted fast spin echo, T1-weighted three-dimensional (3D) gradient echo, T2*-weighted gradient echo and gadolinium-enhanced T1-weighted 3D gradient echo with spectral fat saturation were evaluated. MR imaging before USPIO infusion was not performed. The results were correlated with FDG-PET (acquired with dedicated PET camera, visual analysis) and histological findings. The histopathologic axillary staging was negative for nodal malignancy in five patients and positive in the remaining five patients. There was one false positive finding for USPIO-enhanced MR and one false negative finding for FDG-PET. A sensitivity (true positive rate) of 100%, specificity (true negative rate) of 80%, positive predictive value of 80%, and negative predictive value of 100% were achieved for USPIO-enhanced MR and of 80%, 100%, 100%, 80% for FDG-PET, respectively. The most useful sequences in the detection of invaded lymph nodes were in the decreasing order: gadolinium-enhanced T1-weighted 3D gradient echo with fat saturation, T2*-weighted 2D gradient echo, T1-weighted 3D gradient echo and T2-weighted 2D spin echo. In our study, USPIO-enhanced T1 gradient echo after gadolinium injection and fat saturation emerged as a very useful sequence in the staging of lymph nodes. The combination of USPIO-enhanced MR and FDG-PET achieved 100% sensitivity, specificity, PPV and NPV. If these results are confirmed, the combination of USPIO MR with FDG-PET has the potential to identify the patient candidates for axillary dissection versus sentinel node

  12. Research progress of axillary management approach for 1-2 sentinel lymph node positive early stage breast cancer patients%前哨淋巴结1~2个阳性早期乳腺癌患者腋窝淋巴结管理办法研究进展

    Institute of Scientific and Technical Information of China (English)

    张丽; 俞晓立; 郭小毛

    2016-01-01

    前哨淋巴结活检术是临床腋窝阴性乳腺癌患者的标准治疗方法。前哨淋巴结阴性患者可省略腋窝清扫手术,而前哨淋巴结1~2个阳性患者腋窝最佳治疗手段却存在争议。本文总结了前哨淋巴结1~2个阳性的早期乳腺癌患者腋窝管理模式的最新进展。%Sentinel lymph node biopsy has been the standard axillary intervention for breast cancer patients with clinical negative axillary lymph nodes.Complete axillary dissection could be omitted for patients with negative sentinel lymph nodes.While, the optimal axillary intervention for patients with 1-2 positive sentinel lymph nodes remained controversial.This review introduced the latest research results of the axillary management for early stage breast cancer patients with 1-2 positive sentinel lymph nodes.

  13. A grid matrix-based Raman spectroscopic method to characterize different cell milieu in biopsied axillary sentinel lymph nodes of breast cancer patients.

    Science.gov (United States)

    Som, Dipasree; Tak, Megha; Setia, Mohit; Patil, Asawari; Sengupta, Amit; Chilakapati, C Murali Krishna; Srivastava, Anurag; Parmar, Vani; Nair, Nita; Sarin, Rajiv; Badwe, R

    2016-01-01

    Raman spectroscopy which is based upon inelastic scattering of photons has a potential to emerge as a noninvasive bedside in vivo or ex vivo molecular diagnostic tool. There is a need to improve the sensitivity and predictability of Raman spectroscopy. We developed a grid matrix-based tissue mapping protocol to acquire cellular-specific spectra that also involved digital microscopy for localizing malignant and lymphocytic cells in sentinel lymph node biopsy sample. Biosignals acquired from specific cellular milieu were subjected to an advanced supervised analytical method, i.e., cross-correlation and peak-to-peak ratio in addition to PCA and PC-LDA. We observed decreased spectral intensity as well as shift in the spectral peaks of amides and lipid bands in the completely metastatic (cancer cells) lymph nodes with high cellular density. Spectral library of normal lymphocytes and metastatic cancer cells created using the cellular specific mapping technique can be utilized to create an automated smart diagnostic tool for bench side screening of sampled lymph nodes. Spectral library of normal lymphocytes and metastatic cancer cells created using the cellular specific mapping technique can be utilized to develop an automated smart diagnostic tool for bench side screening of sampled lymph nodes supported by ongoing global research in developing better technology and signal and big data processing algorithms.

  14. A grid matrix-based Raman spectroscopic method to characterize different cell milieu in biopsied axillary sentinel lymph nodes of breast cancer patients.

    Science.gov (United States)

    Som, Dipasree; Tak, Megha; Setia, Mohit; Patil, Asawari; Sengupta, Amit; Chilakapati, C Murali Krishna; Srivastava, Anurag; Parmar, Vani; Nair, Nita; Sarin, Rajiv; Badwe, R

    2016-01-01

    Raman spectroscopy which is based upon inelastic scattering of photons has a potential to emerge as a noninvasive bedside in vivo or ex vivo molecular diagnostic tool. There is a need to improve the sensitivity and predictability of Raman spectroscopy. We developed a grid matrix-based tissue mapping protocol to acquire cellular-specific spectra that also involved digital microscopy for localizing malignant and lymphocytic cells in sentinel lymph node biopsy sample. Biosignals acquired from specific cellular milieu were subjected to an advanced supervised analytical method, i.e., cross-correlation and peak-to-peak ratio in addition to PCA and PC-LDA. We observed decreased spectral intensity as well as shift in the spectral peaks of amides and lipid bands in the completely metastatic (cancer cells) lymph nodes with high cellular density. Spectral library of normal lymphocytes and metastatic cancer cells created using the cellular specific mapping technique can be utilized to create an automated smart diagnostic tool for bench side screening of sampled lymph nodes. Spectral library of normal lymphocytes and metastatic cancer cells created using the cellular specific mapping technique can be utilized to develop an automated smart diagnostic tool for bench side screening of sampled lymph nodes supported by ongoing global research in developing better technology and signal and big data processing algorithms. PMID:26552923

  15. Multivariate Analysis of the Ultrasonic Diagnosis in Axillary Lymph Node Metastasis of Breast Cancer%超声诊断乳腺癌腋窝淋巴结转移的多因素分析

    Institute of Scientific and Technical Information of China (English)

    金占强; 徐晓红

    2011-01-01

    目的 分析乳腺癌原发病灶与腋窝淋巴结的灰阶及彩色多普勒超声表现,探讨声像表现与腋窝淋巴结转移的相关性.资料与方法 120例乳腺癌患者及其132个腋窝淋巴结,观察原发病灶的血流分布、最大径、数目、微钙化及淋巴结的血流特征、横径/纵径和皮质厚度.采用单因素和logistic多因素回归分析检验观察指标与乳腺癌腋窝淋巴结转移的相关性.结果 单因素分析结果 显示,所有影像学观察指标与LNM有相关性,差异有统计学意义(P<0.05).多因素logistic回归分析表明,原发病灶的最大径、数目、丰富血供和淋巴结的皮质厚度、血流分布与LNM有相关性(P<0.05).结论 依据乳腺癌原发病灶和腋窝淋巴结声像图特征评判腋窝淋巴结的性质,具有重要临床意义.%Purpose To analyse the gray-scale and color Doppler ultrasonic features of the primary lesions and axillary lymph node (ALN) of breast cancer and explore the factors related to axillary lymph node metastasis (ALNM) .Materials and methods Grey-scale and color Doppler ultrasound were performed in 120 cases with breast carcinomas who had been detected 132 axillary lymph nodes Blood supply, maximum diameter, micro-calcification as well as the number of lesions were evaluated for the primary cancer; blood flow characteristics, cortical thickness and the transverse to longitudinal diameter ratio were assessed for ALN.. Univariate and multivariate logistic regression analyses were conducted to determine the relation between the ultrasonic indicators and ALNM. Results Univariate analysis revealed significant correlation between each ultrasonic feature and axillary lymph node metastasis (P<0.05). The size and number of primary lesion, the abundance of blood supply and blood flow characteristics of lymph node as well as its cortical thickness were proved to be significantly related to ALNM by multivariate logistic regression analysis (P<0

  16. Clinical Research of Complementary Low Level Axillary Lymph Node Dissection for Patients with Negative Sentinel Lymph Node%前哨淋巴结阴性患者补充低位腋淋巴结清扫的临床研究

    Institute of Scientific and Technical Information of China (English)

    张月秋; 李勇; 孙宝臣; 张海青; 杨晓洲

    2013-01-01

    目的:研究前哨淋巴结假阴性患者腋窝阳性淋巴结的分布情况,在腋淋巴结清扫和替代腋淋巴结清扫术以外,探寻一种既可保留腋窝功能,又可不遗漏腋窝阳性淋巴结的新术式的可能性。方法:选取80例前哨淋巴结阴性患者同时行腋淋巴结清扫,将腋窝标本以肋间臂神经最上支为标志分成腋上下两区,并分别病检。结果:术后病理证实前哨淋巴结假阴性5例,腋窝阳性淋巴结9枚,均位于腋下区。结论:本研究显示前哨淋巴结假阴性遗漏的腋窝阳性淋巴结均位于腋下区,对前哨淋巴结阴性患者补充施行低位腋淋巴结清扫,既可保留肋间臂神经在内的腋窝功能,又可全部清除前哨淋巴结假阴性遗漏的腋窝阳性淋巴结。%Objective: To study the distribution of positive axillary lymph node(LN) of the breast cancer patients with false negative (FN) sentinel lymph node(SLN) and seek the possibility of a new operating type which could reserve the axillary functions but could not omit positive LN beyond the axillary lymph node dissection(ALND)and SLN.Method: A total of 80 breast cancer patients with negative SLN were performed ALND simultaneously. Axillary specimens were divided into two sections of the upper and the lower according to the highest branch of nervi intercostobrachiales, and were taken for pathological examination respectively.Result:Five cases were proved to be FN SLN by pathology after operation. The total of 9 positive LN were located in the lower section of axilla.Conclusion:This study demonstrated that the positive LN omittance in patients with FN SLN are all located in lower section of axilla, and can be completely remove by complementary low level ALND which can preserve the axillary functions including nervi intercostobrachiales.

  17. Metastatic axillary lymph node ratio (LNR) is prognostically superior to pN staging in patients with breast cancer--results for 804 Chinese patients from a single institution.

    Science.gov (United States)

    Xiao, Xiang-Sheng; Tang, Hai-Lin; Xie, Xin-Hua; Li, Lai-Sheng; Kong, Ya-Nan; Wu, Min-Qing; Yang, Lu; Gao, Jie; Wei, Wei-Dong; Xie, Xiaoming

    2013-01-01

    The number of axillary lymph nodes involved and retrieved are important prognostic factors in breast cancer. The purpose of our study was to investigate whether the lymph node ratio (LNR) is a better prognostic factor in predicting disease-free survival (DFS) for breast cancer patients as compared with pN staging. The analysis was based on 804 breast cancer patients who had underwent axillary lymph node dissection between 1999 and 2008 in Sun Yat-Sen University Cancer Center. Optimal cutoff points of LNR were calculated using X-tile software and validated by bootstrapping. Patients were then divided into three groups (low-, intermediate-, and high-risk) according to the cutoff points. Predicting risk factors for relapse were performed according to Cox proportional hazards analysis. DFS was estimated using the Kaplan-Meier method and compared by the log-rank test. The 5-year DFS rate decreased significantly with increasing LNRs and pN. Univariate analysis found that the pT , pN, LNR, molecule type, HER2, pTNM stage and radiotherapy well classified patients with significantly different prognosis. By multivariate analysis, only LNR classification was retained as an independent prognostic factor. Furthermore, there was a significant prognostic difference among different LNR categories for pN2 category, but no apparent prognostic difference was seen between different pN categories in any LNR category. Therefore, LNR rather than pN staging is preferable in predicting DFS in node positive breast cancer patients, and routine clinical decision-making should take the LNR into consideration.

  18. Preoperative assessment value of enhanced CT for axillary lymph node in breast cancer%增强CT对乳腺癌腋窝淋巴结术前评估的价值

    Institute of Scientific and Technical Information of China (English)

    高洋; 张文海; 李建一; 张扬; 贾实

    2013-01-01

    Objective To study the assessment value of enhanced CT for axillary lymph node in breast cancer.Methods 71 patients meeting the inclusion criteria in our hospital were reviewed.They had level Ⅲ lymph nodes pathologically confirmed for almost 2 years.CT scan by a 64-detector row scanner were performed from the lower edge of breast to neck.CT images were analyzed from these aspects:with or without lymph node enlargement; the size and shape of the lymph nodes; lymph node with or without enhancement.Through the determination of CT net increase value,the metastasizing lymph node signs were explored.Diagnostic index of axillary lymph nodes imaged by breast sonography and enhanced CT were calculated separately.The size of level Ⅲ lymph node and CT net increase value were statistically analyzed.The correlation of metastasizing level Ⅲ lymph node and tumor location was analyzed.Results The accuracy,sensitivity,specificity,and positive predictive value of diagnosed axillary lymph node was 70.4%,85.7%,64.0%,and 50.0% by three-dimensional ultrasound and 88.7%,90.6%,83.3%,and 94.1% by enhanced CT.The accuracy,sensitivity,specificity,and positive predictive value of diagnosed level Ⅲ lymph node was 95.8%,90.5%,98.0%,and 95.0% by enhanced CT.The maximal diameter of level Ⅲ lymph node was > (8.7 ± 1.3) mm and the short diameter was > (5.3 ±0.5) mm.CT net increase value was > (50.0 ±9.0) HU.The shape of lymph nodes was mainly round or oval solid.Conclusions The diagnosis rate for level Ⅲ lymph node is obviously higher by enhanced CT than by three-dimensional ultrasound.There is no obvious correlation between level Ⅲ lymph node and tumor location.%目的 研究增强CT对乳腺癌腋窝淋巴结评估的价值.方法 选择中国医科大学附属盛京医院乳腺外科近2年71例已病理证实第三站淋巴结(LevelⅢ)有转移的女性乳腺癌患者.采用Siemens64排CT,扫描范围自颈部至乳房下缘.分析增强CT影像:

  19. 乳腺癌腔镜下腋窝前哨淋巴结活检术的可行性研究%Feasibility study of the axillary sentinel lymph node biopsy of breast cancer under endoscopy

    Institute of Scientific and Technical Information of China (English)

    刘峰

    2014-01-01

    Objective To investigate the clinical feasibility of the axillary sentinel lymph node biopsy under endos-copy for breast cancer. Methods From January 2010 to October 2012,45 patients with early breast cancer in people’s hospital of Rizhao were chose. The patients were performed with ESLNB at first,and the obtained sentinel lymph nodes were sended for intraoperative rapid pathologic and postoperative pathologic examination,and then the axillary lymph nodes were obtained by axillary lymph node dissection(ALND),the obtained axillary lymph nodes were sended for postoperative pathologic examination. The sensitivity,accuracy,false negative rate and false positive rate of ESLNB was evaluated. The assessment results of axillary lymph node metastasis situation by ESLNB and ALND were compared. Results Forty-three sentinel lymph nodes were successfully detected,the success rate was 95. 6% . The sensitivity of ESLNB intraoperative fast pathologic examination was 90. 1% ,and the accuracy rate was 88. 4% ;the false negative rate was 9. 1% ,and false posi-tive rate was 6. 06% ;The sensitivity of ESLNB postoperative pathologic examination was 93. 9% ,and the accuracy rate was 90. 1% ;the false negative rate was 6. 06% ,and the false positive rate was 6. 06% . There was no significant differ-ence in the evaluation results of axillary lymph node metastasis status between ESLNB intraoperative rapid / postoperative pathologic examination and ALND postoperative pathologic examination(P ﹥ 0. 05). Conclusions The axillary sentinel lymph node biopsy of breast cancer by endoscopic surgery through methylene blue staining is feasible and safe. It opens a new route for narrowing the operation scope of breast cancer.%目的:探讨乳腺癌腔镜下腋窝前哨淋巴结活检术(ESLNB)的临床可行性。方法选取2010年1月至2013年10月日照市人民医院外科收治住院的45例早期乳腺癌患者。首先行 ESLNB,所获前哨淋巴结送术中快速病理和术后病

  20. Computed tomography image of the mediastinal and axillary lymph nodes in clinically sound Rottweilers Imagem por tomografia computadorizada dos linfonodos axilares e mediastinais de cães rottweilers clinicamente saudáveis

    Directory of Open Access Journals (Sweden)

    Ana Carolina B. Fonseca Pinto

    2013-03-01

    Full Text Available Trough computed tomography (CT, it is possible to evaluate lymph nodes in detail and to detect changes in these structures earlier than with radiographs and ultrasound. Lack of information in the veterinary literature directed the focus of this report to normal aspects of the axillary and mediastinal lymph nodes of adult dogs on CT imaging. A CT scan of 15 normal adult male and female Rottweilers was done. To define them as clinically sound, anamnesis, physical examination, complete blood count, renal and hepatic biochemistry, ECG, and thoracic radiographs were performed. After the intravenous injection of hydrosoluble ionic iodine contrast medium contiguous 10mm in thickness thoracic transverse images were obtained with an axial scanner. In the obtained images mediastinal and axillary lymph nodes were sought and when found measured in their smallest diameter and their attenuation was compared to musculature. Mean and standard deviation of: age, weight, body length and the smallest diameter of the axillary and mediastinal lymph nodes were determined. Mean and standard deviation of parameters: age 3.87±2.03 years, weight 41.13±5.12, and body length 89.61±2.63cm. Axillary lymph nodes were seen in 60% of the animals, mean of the smallest diameter was 3.58mm with a standard deviation of 2.02 and a minimum value of 1mm and a maximum value of 7mm. From 13 observed lymph nodes 61.53% were hypopodense when compared with musculature, and 30.77% were isodense. Mediastinal lymph nodes were identified in 73.33% of the dogs; mean measure of the smallest diameter was 4.71mm with a standard deviation of 2.61mm and a minimum value of 1mm, and a maximum value of 8mm. From 14 observed lymph nodes 85.71% were isodense when compared with musculature and 14.28% were hypodense. The results show that it is possible to visualize axillary and mediastinal lymph nodes in adult clinically sound Rottweilers with CT using a slice thickness and interval of 10mm. The

  1. 前哨淋巴结活检对乳腺癌患者腋窝淋巴结清扫的临床指导价值%The role of sentinel lymph node biopsy on advising axillary lymph node dissection in breast cancer

    Institute of Scientific and Technical Information of China (English)

    李志红

    2013-01-01

    目的 探讨前哨淋巴结活检(SLNB)对乳腺癌患者腋窝淋巴结(ALN)转移状态的预测价值,为乳腺癌患者是否行腋窝淋巴结清扫(ALND)提供科学指导.方法 选取2010-2012年于本院手术治疗的乳腺癌患者65例,术中行前哨淋巴结活检,随后行包括ALND在内的不同方式的根除术.结果 根据术中切片病理和术后腋窝淋巴结病理,SLN检出成功率为95.4%(62/65); SLN预测ALN转移的准确性为95.2%(59/62);灵敏度为88.9%(24/27);特异性为100%(35/35),假阴性率为11.1%(3/27),总阳性、总阴性预测值分别为100%(24/24)和9.2%(35/38).结论 亚甲蓝法和放射性示踪法联合应用能准确检测出SLN,SLN能反映腋窝淋巴结的状态.%Objective To explore the clinical value of sentinel lymph node biopsy(SLNB) to predictaxillary lymph nodemetastasis so as to perform axillary lymph node dissection(ALND) in breast canceroperation.Methods Sixty-five breast cancer patients with surgical treatment in our hospital from 2010 to 2012 were selected.Intraoperative sentinel lymph node biopsy,then eradication of the different ways and ALND were executed.Results According to intraoperative biopsy and postoperative pathologic axillary lymph node pathology,SLN detection success rate was 95.4 % (62/65),SLN prediction accuracy of ALN metastasis was 95.2% (59/62),sensitivity was 88.9% (24/27),specificity was 100% (35/35),false-negative rate was 11.1% (3/27),and the total positive and negative predictive value were 100% (24/24) and 9.2% (35/38).Conclusion Methylene blue method combined with radioactive tracer method could accurately detect the SLN.SLN could reflect the status ofaxillary lymph nodes.

  2. 临床腋窝淋巴结阳性乳腺癌患者内乳区前哨淋巴结活检术研究%Internal mammary sentinel lymph node biopsy in breast cancer pa-tients with clinically positive axillary lymph nodes

    Institute of Scientific and Technical Information of China (English)

    孙晓; 王永胜; 丛斌斌; 邱鹏飞; 张朝蓬; 周正波; 刘雁冰; 陈鹏; 赵桐; 王春建

    2015-01-01

    Objective:This study was conducted to evaluate the roles of internal mammary sentinel lymph node biopsy (IM-SL-NB) in the treatment of breast cancer patients with clinically positive axillary lymph nodes. Methods:This study is a one-armed clini-cal research conducted from June 2013 to October 2014. A total of 64 breast cancer patients from Shandong Cancer Hospital with clini-cally positive axillary lymph nodes were enrolled in the study. All patients underwent axillary lymph node dissection. Meanwhile, IM-SLNB was performed in all patients using the new injection method of radiotracer. Results:Among the 64 enrolled patients, the visual-ization rate of internal mammary lymph node was 59.4%(38/64). For the 38 patients who were subjected to visualization of the internal mammary node, the detection rate was 100%(38/38), and the incidence of complications was 7.9%(3/38). The metastasis rate of inter-nal mammary lymph node was 21.1%(8/38). Patients with upper inner quadrant tumors and metastasis of more axillary lymph nodes had a significantly higher chance of developing sentinel lymph node metastasis (P<0.001 and P=0.017, respectively) than the other pa-tients. The clinical benefit rate of the above mentioned treatment was 59.4%. Among the patients, 12.5%(8/64) received extra internal mammary radiotherapy, whereas 46.9%(30/64) patients avoided the unnecessary internal mammary radiotherapy. Conclusion:IM-SL-NB should be performed in breast cancer patients with clinically positive axillary lymph nodes because IM-SLNB could provide the ac-curate indication of radiation to the internal mammary area, especially for the patients with upper inner quadrant tumors and those with a suspiciously high level of axillary lymph node metastasis.%目的:评估临床腋窝淋巴结阳性乳腺癌患者行内乳区前哨淋巴结活检术(IM-SLNB)的临床意义。方法:2013年6月至2014年10月对山东省肿瘤医院乳腺病中心就诊的64例临

  3. Re-dissection of axillary lymph nodes in 36 cases with recurrent breast cancer%乳腺癌再次腋窝淋巴结清扫36例分析

    Institute of Scientific and Technical Information of China (English)

    左怀全; 夏冬; 权毅; 付华; 吴斌; 王元正

    2012-01-01

    Objective To explore the feasibility of re-operation for the cases with postoperative axillary lymph nodes metastases and regional residual because of non-standard surgery. Methods From June 2001 to August 2010, 36 patients with re-dissection of axillary lymph nodes were included, and their clinical pathological data, perioperative comprehensive treatment measures, and 1,3, 5-year follow-up data were retrospectively analyzed. Results Nineteen cases were treated with non-standard surgery (52. 78% , axillary residual mass re-dissection in 11 cases vs. Recurrent chest wall mass excision plus axillary lymph node dissection in 8 cases). Another 17 cases received axillary lymph node dissection or plus chest wall mass resection (modified radical mastectomy in 11 cases vs. Hals tod in 6 cases; axillary recurrence in 12 cases vs. Axillary and chest wall recurrence in 5 cases). Total 346 axillary lymph nodes were found in all the cases, with an average number of 17. 78 (7 -35), in which positive lymph nodes were 16.76% (58, 1 - 13). After the second time operation, all the cases were treated with 4-6 cycles of chemotherapy or radiotherapy, and some with immunotherapy. For the post-operative follow up, 2 patients died within 1 year, 10 cases died within 3 year, and 15 patients died within 5 year. And the 1, 3, 5-year survival rates were 94% , 72% , 58% , respectively. Conclusions Standardized surgery is a crucial and effective procedure for the cases with breast cancer to prevent recurrence and metastasis. For the patients with local recurrence and/or axillary lymph node metastasis, re-operation would help to control the advancement, and perioperative standardized treatment would also help to improve the quality of life.%目的 探讨乳腺癌手术后腋窝淋巴结转移以及不规范性手术后残留实施再手术的可行性.方法 制定纳入标准,回顾性分析我院2001年6月至2010年8月间再次腋窝淋巴结清扫手术的36例乳腺癌患者的临床病

  4. Clinical significance of locoregional and systemic treatment in operable high-risk breast cancer patients with more than four positive axillary lymph nodes

    Directory of Open Access Journals (Sweden)

    Yin K

    2015-09-01

    Full Text Available Kai Yin,1 Liheng Zhou,2 Zhimin Shao,1 Wenjin Yin,1 Jinsong Lu2 1Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 2Breast Cancer Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China Purpose: Breast cancer cases with four or more involved axillary lymph nodes (ALNs feature an aggressive clinical history despite intensive treatment. However, therapies for improving the prognosis for these high-risk patients and the prognostic role of clinical characteristics have been little investigated. Therefore, we sought to assess potential prognostic factors for these patients in female Chinese patients and identify the treatment modalities they might benefit from, which offers implications for clinical practice. Patients and methods: A total of 518 patients with four or more involved ALNs were retrospectively analyzed. Survival-curve analysis was performed with the Kaplan–Meier method, and Cox proportional hazard regression was applied to identify independent variables for disease-free survival (DFS and overall survival (OS. Results: The patients were divided into groups depending on the number of ALNs, with 38.22% having four to six positive ALNs and 61.78% having seven or more ALNs. Compared with the seven or more-positive ALN subgroup, patients with four to six positive ALNs tended to have smaller tumors and were more likely to undergo modified radical mastectomy rather than radical mastectomy (both P<0.001. Univariate analysis revealed that a fluorouracil/doxorubicin (epirubicin/cyclophosphamide (CA[E]F regimen or a CA(EF followed by docetaxel (CA[E]F > T regimen conferred significantly better DFS (P=0.0075 and OS (P<0.0001 than those achieved from a cyclophosphamide/methotrexate/fluorouracil regimen, which was almost completely generated by the seven or more ALN

  5. Can the addition of regional radiotherapy counter-balance important risk factors in breast cancer patients with extracapsular invasion of axillary lymph-node metastases?

    International Nuclear Information System (INIS)

    Purpose: To evaluate if locoregional radiotherapy (RT) versus local irradiation only can alter the pattern of failure in breast cancer patients with extranodal invasion. Patients and Methods: From 08/1988 to 06/1998, 81 patients with extranodal invasion were treated with adjuvant RT (median total dose: 50.4 Gy), 46/81 only locally, 35/81 locoregionally due to presumed adverse parameters. The mean number of resected (positive) lymph nodes was 17 (seven). 78 patients received adjuvant systemic treatment(s). Results: Patients treated with locoregional RT had significantly more often lymphatic vessel invasion (LVI; 63% vs. 28%; p = 0.003), T3/T4 tumors (43% vs. 17%; p = 0.014), and four or more positive lymph nodes (91% vs. 46%; p < 0.001) than patients irradiated only locally. Disease progression occurred in 24/81 patients (locoregional RT: 26% vs. local RT: 33%). The above risk factors were highly significant of worse outcome. Despite their overrepresentation in the locoregional RT group, no difference was found between both groups in regard to disease-free survival (DFS; p = 0.83) and overall survival (OS; p = 0.56), suggesting that regional RT was able to counterbalance the increased risk. There was even a trend toward a better 3-year DFS, 61% in locoregional RT and 37% in local RT, in the subgroup of patients with four or more positive lymph nodes. In a Cox regression model, higher T-stage, four or more positive lymph nodes, and LVI remained significant. For DFS and distant metastasis-free survival (DMFS), the absence of estrogen receptors and the omission of regional RT were also significant. Conclusion: Our data suggest that the addition of regional RT might be beneficial in selected subgroups of patients with extranodal invasion and other poor prognostic factors. (orig.)

  6. Evaluation of the tracing effect of carbon nanoparticle and carbon nanoparticle-epirubicin suspension in axillary lymph node dissection for breast cancer treatment

    OpenAIRE

    Du, Junze; Zhang, Yongsong; Ming, Jia; Liu, Jing; Zhong, Ling; Liang, Quankun; Fan, Linjun; Jiang, Jun

    2016-01-01

    Abstracts Background Carbon nanoparticle suspension, using smooth carbon particles at a diameter of 21 nm added with suspending agents, is a stable suspension of carbon pellets of 150 nm in diameter. It is obviously inclined to the lymphatic system. There were some studies reporting that carbon nanoparticles are considered as superior tracers for sentinel lymph nodes because of their stability and operational feasibility. However, there were few study concerns about the potential treatment ef...

  7. The Value in The Assessment of Axillary Status after Neoadjuvant Chemotherapy Sentinel Lymph Node Biopsy%前哨淋巴结活检在乳腺癌新辅助化疗后腋窝状况评估中的价值

    Institute of Scientific and Technical Information of China (English)

    王越

    2013-01-01

    Objective To investigate the clinical value of sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer patients. Methods Retrospective analysis of sentinel lymph node biopsy and axillary lymph node dissection in 50 cases of breast cancer patients with clinical data admitted to our hospital from January 2009 to May 2012 line of methylene blue track line 2 to 3 of the 27 patients cycles of neoadjuvant chemotherapy after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection, and another 23 patients directly to do sentinel lymph node biopsy axillary lymph node dissection. Results Neoadjuvant chemotherapy group SLN (sentinel lymph node) number, SLN detection rate, SLN false negative rate, and average axillary lymph nodes with neoadjuvant chemotherapy group compared with no significant difference (P>0.05). Conclusion Sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients to be able to accurately predict the axillary lymph node status.%  目的探讨对于乳腺癌患者采用新辅助化疗后其前哨淋巴结活检的临床价值。方法回顾性分析我院于2009年1月至2012年5月所收治的行亚甲蓝跟踪前哨淋巴结活检术及腋窝淋巴结清扫术的50例乳腺癌患者临床资料,其中27例患者行2~3个疗程的新辅助化疗后再进行前哨淋巴结活检(SLNB)及腋窝淋巴结清扫术,另外23例患者直接做前哨淋巴结活检腋窝淋巴结清扫术。结果新辅助化疗组SLN(前哨淋巴结)数、SLN检出率、SLN假阴性率以及平均腋窝淋巴结数与非新辅助化疗组相比较无明显差异(P>0.05)。结论前哨淋巴结活检对新辅助化疗后的乳腺癌患者能够准确的预测其腋窝淋巴结的状况。

  8. Internal mammary sentinel lymph node biopsy: abandon or persist?

    Directory of Open Access Journals (Sweden)

    Qiu PF

    2016-06-01

    Full Text Available Peng-Fei Qiu, Yan-Bing Liu, Yong-Sheng Wang Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, People’s Republic of China Abstract: Although the 2009 American Joint Committee on Cancer incorporated the internal mammary sentinel lymph node biopsy (IM-SLNB concept, there has been little change in surgical practice patterns due to the low visualization rate of internal mammary sentinel lymph nodes with the traditional injection technique. Meanwhile, as internal mammary lymph nodes (IMLN metastases are mostly found concomitantly with axillary lymph nodes (ALN metastases, previous IM-SLNB clinical trials fail to evaluate the status of IMLN in patients who are really in need (only in clinically ALN negative patients. Our modified injection technique (periareolar intraparenchymal, high volume, and ultrasonographic guidance significantly improved the visualization rate of internal mammary sentinel lymph nodes, making the routine IM-SLNB possible in daily practice. IM-SLNB could provide individual minimally invasive staging, prognosis, and decision-making for breast cancer patients, especially for patients with clinically positive ALN. Moreover, IMLN radiotherapy should be tailored and balanced between the potential benefit and toxicity, and IM-SLNB-guided IMLN radiotherapy could achieve this goal. In the era of effective adjuvant therapy, within the changing treatment approach – more systemic therapy, less loco-regional therapy – clinicians should deliberate the application of regional IMLN therapy. Keywords: breast cancer, internal mammary lymph node, axillary lymph node, sentinel lymph node biopsy 

  9. Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer

    DEFF Research Database (Denmark)

    Axelsson, C K; Düring, M; Christiansen, P M;

    2009-01-01

    -negative primary breast cancer treated solely by surgery. Median follow-up was 9 years. RESULTS: The number of lymph nodes removed correlated with a reduction in the rate of subsequent axillary recurrence (from 2.1 to 0.4 per cent; P = 0.037), local recurrence (from 7.4 to 3.8 per cent; P < 0.001) distant......BACKGROUND: This study examined whether axillary lymph node dissection (ALND) with removal of many normal lymph nodes resulted in a reduced rate of axillary recurrence and better survival, as reported in recent studies. METHODS: The follow-up analyses were based on 8657 patients with node...

  10. Factors Predicting Non-Sentinel Lymph Node Involvement in Sentinel Node Positive Breast Carcinoma

    Directory of Open Access Journals (Sweden)

    Merih GÜRAY DURAK

    2011-09-01

    Full Text Available Objective: In routine practice, axillary lymph node dissection is performed in early invasive breast cancer patients with positive sentinel node biopsy. However, sentinel node is the only involved axillary node in 40-70% of patients, and determining factors that predict axillary non-sentinel node involvement will therefore prevent unnecessary axillary lymph node dissection and decrease morbidity.Material and Method: In this study, 119 invasive breast cancer patients with sentinel node metastasis who underwent axillary lymph node dissection between 1998-2009 at our institution were studied. Primary tumor characteristics and features of the metastatic tumors in sentinel nodes, such as microanatomic location, size of metastasis, and the ratio of metastatic tumor area to the total sentinel node area were evaluated. Student's t-test and multivariate logistic regression were used for statistical analysis.Results: The mean age of the patients was 50.7 years (28-80. Forty-three patients (36% had invasive ductal and 25 patients (21% had invasive lobular carcinoma. Most of the patients had either pT1 (44% or pT2 (54% tumors. Fifty-four patients (45% had no further positive nodes in the axilla. The metastatic deposits in the sentinel node were subcapsular in 16 patients (13%. The percent area of sentinel node occupied by tumor (p<0.001, number of sentinel nodes (p=0.041, and microanatomic location of metastatic tumor (p=0.002 were significantly associated with non-sentinel node metastasis in univariate analysis. The percent area of sentinel node occupied by tumor (p<0.001 and number of sentinel nodes (p=0.033 remained significantly associated with non-sentinel node involvement in multivariate analysis.Conclusion: In patients with invasive breast cancer and positive sentinel node, area percent of sentinel node occupied by tumor, and the number of sentinel nodes removed are independently predictive of non-sentinel node involvement.

  11. Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients?

    Directory of Open Access Journals (Sweden)

    Nakul Saxena

    Full Text Available INTRODUCTION: Lymph node ratio (LNR, i.e. the ratio of the number of positive nodes to the total number of nodes excised is reported to be superior to the absolute number of nodes involved (pN stage in classifying patients at high versus low risk of death following breast cancer. The added prognostic value of LNR over pN in addition to other prognostic factors has never been assessed. METHODS: All patients diagnosed with lymph node positive, non-metastatic invasive breast cancer at the National University Hospital (Singapore and University of Malaya Medical Center (Kuala Lumpur between 1990-2007 were included (n = 1589. Overall survival of the patients was estimated by the Kaplan Meier method for LNR [categorized as low (>0 and 0.65-1] and pN staging [pN1, pN2 and pN3]. Adjusted overall relative mortality risks associated with LNR and pN were calculated by Cox regression. The added prognostic value of LNR over pN was evaluated by comparing the discriminating capacity (as indicated by the c statistic of two multivariate models, one including pN and one including LNR. RESULTS: LNR was superior to pN in categorizing mortality risks for women ≥60 years, those with ER negative or grade 3 tumors. In combination with other factors (i.e. age, treatment, grade, tumor size and receptor status, substituting pN by LNR did not result in better discrimination of women at high versus low risk of death, neither for the entire cohort (c statistic 0.72 [0.70-0.75] and 0.73 [0.71-0.76] respectively for pN versus LNR, nor for the subgroups mentioned above. CONCLUSION: In combination with other prognosticators, substitution of pN by LNR did not provide any added prognostic value for South East Asian breast cancer patients.

  12. Real-time MRI navigated US: Role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US

    Energy Technology Data Exchange (ETDEWEB)

    Pons, Elena Pastor, E-mail: elenapastorpons@gmail.com; Azcón, Francisco Miras, E-mail: frmiaz00@gmail.com; Casas, María Culiañez, E-mail: mariacc1980@gmail.com; Meca, Salvador Martínez, E-mail: isalvaa@hotmail.com; Espona, José Luis García, E-mail: gespona@hotmail.com

    2014-06-15

    Objectives: To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI). Materials and methods: Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher’ exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated. Results: Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) (p < 0.001). Agreement between both techniques was low (k = 0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes. Conclusions: Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign.

  13. Breast lymphoscintigraphy for sentinel node identification in clinically axillary node negative breast cancer: A preliminary report of 35 cases

    International Nuclear Information System (INIS)

    Full text: Lymphoscintigraphy is a sensitive, minimally invasive method for identifying sentinel lymph node (SLN). It has been extensively validated in malignant melanoma, penile cancer and recently in breast cancer. The aims of this study were to analyze and determine the clinical value of lymphoscintigraphy in SLN localization in woman undergoing surgery for breast cancer and to evaluate the predictive value of SLN versus axillary lymph node status in these patients. Pre-operative breast lymphoscintigraphy were preformed in 35 female patients with breast cancer and clinically negative axillary node. Mean age was 52.8 years (range 38 to 73 years). Prior to surgery, 74 MBq of Tc-99m nanocolloid in 0.2 to 0.5 ml was injected intra-dermally over the tumor mass. Immediately after injection, anterior dynamic images were acquired for 20 minutes, followed by anterior and lateral views static images at 30 minute, 1 hour and 2 hour using single-head gamma camera until SLN visualized. The SLN location was marked externally on skin. All patients underwent standard modified radical mastectomy with axillary node dissection. All lymph nodes were examined carefully by a skilled histopathologist. SLNs were assessed by visual inspection of both dynamic and static images. Comparison of SLN and axillary lymph node histopathologic results was done in order to define the means of SLN biopsy's ability to reflect the final status of axilla. The mean size of the primary breast tumor mass was 2.54 cm (1.0 to 4.0 cm). In 20/35 (57.1%), the SLNs were visualized in 20-minute dynamic imaging. In 12 patients, the SLNs were seen after delayed imaging and/or repositioning the patient. Overall estimated SLN identification rate was 91.43%. Of those 32 cases in whom the SLNs were localized on lymphoscintigraphy, 9 cases were positive for metastatic tumors and the rest were negative for tumor involvement. Four out of these 9 cases, SLN was the only node that contained metastatic tumor cells and in 5

  14. Current status of methodology research on nuclear medicine on sentinel lymph node biopsy in breast cancer

    International Nuclear Information System (INIS)

    Breast cancer is the most common malignancy of the female,and axillary lymph node dissection has been considered as the basic method in breast cancer surgery. Sentinel lymph node biopsy (SLNB) in recent years is accepted gradually both at home and abroad because it not only can avoid complications but also has the advantages of safe and simple operation, high accuracy, and slight trauma. It has taken the place of axillary lymph node dissection in the treatment of axillary node-negative patients. Nuclear medicine inspection has played a crucial role in SLNB, and radiotracers, injecting techniques,detecting methods and standards have great influence upon the accuracy and false-negative rate of axillary lymph nodes and internal mammary lymph nodes detection. In this review, the current methodology status of nuclear medicine is summarized on SLNB in breast cancer at home and abroad. (authors)

  15. Prediction of additional lymph node involvement in breast cancer patients with positive sentinel lymph nodes.

    Science.gov (United States)

    Pohlodek, K; Bozikova, S; Meciarova, I; Mucha, V; Bartova, M; Ondrias, F

    2016-01-01

    Axillary lymph node dissection (ALND) has traditionally been the principal method for evaluating axillary lymph node status in breast cancer patients. In the past decades sentinel lymph nodes biopsy after lymphatic mapping has been used to stage the disease. The majority of sentinel lymph nodes (SLN) positive patients do not have additional metastases in non-sentinel nodes (non-SLN) after additional ALND. These patients are exposed to the morbidity of ALND without any benefit from additional axillary clearence. In the present study we would like to asses the criteria for selecting those patients, who have high risk for non-SLN metastases in the axilla in cases of positive SLN. In this retrospective analysis, clinical and pathologic data from 163 patients who underwent SLN biopsy followed by ALND were collected. Following clinical and pathological characteristics were analyzed to predict the likehood of non-SLN metastases: age, staging, histologic type and grading of the tumors, hormonal receptor status, HER-2 receptor status and Ki-67 protein, angioinvasion, metastases in SLN and non-SLN. Relative frequencies of individual characteristics between sample groups were statistically tested by Chi-square test at significance level p=0.5, when sample sizes in groups were small (≤5) by Fisher´s exact test. Metastasis in SLN were present in 67 (41%) of patients, 48 patients (29,4%) had metastasis also in non-SLN. The ratio between non-SLN positive / non-SLN negative lymph nodes in patients with positive SLN increases with the stage of the disease, the difference between values for the pT1c and pT2 stadium was statistically significant (p = 0.0296). The same applies to grading, but the differences were not significant (p>0.05). We could not find significant differences for angioinvasion of the tumor, probably for small number of patients with angioinvasion (p>0.05).Only the stage of the tumor was shown to be significant in predicting the metastasis in non-SLN in our

  16. Contrast-enhanced ultrasound of axillary lymph node for prediction of breast cancer response to neoadjuvant chemotherapy%腋窝淋巴结超声造影预测乳腺癌新辅助化疗的疗效

    Institute of Scientific and Technical Information of China (English)

    欧阳秋芳; 赵红佳; 谢良地; 林清萍

    2010-01-01

    Objective To explore the predictive value of response to neoadjuvant chemotherapy(NAC)in local advanced breast cancer with contrast-enhanced ultrasound(CEUS)of axillary lymph node.Methods CEUS of metastatic axillary lymph nodes in 58 patients stacng Ⅱ-Ⅲ breast cancer was performed before and after NAC treatment. The enhancement patterns and parameters of time-intensity curve were assessed and compared with the pathology.Results The clinic response evaluation were drug-effective in 35 cases and no change in 23 ones.There Were no significant differences in enhancement patterns between no-change and drugeffective groups.Lymph node cortex arriving time was longer in drug-effective cases than that in no-change ones after NAC,whereas it showed no significant differences before NAC.Statistical significant difierence in enhancement duration(ED)was found between the two groups before NAC,which decreased markedly in drug-effective case8 after NAC.Histopatholngic response could be predicted with a sensitivity of 77% and a specificity of 90% by standardized ED below 275 seconds after NAC.No significant difference was found in time to peak(TP),peak intensity(PI)between the two groups.Conclusion The perfusion pattern of axillary lymph node CEUS after NAC Was insufficient to predict curative effect.But the lymph node cortex arriving time and enhancement duration may be of value in the prediction of clinical response to chemotherapy.%目的探讨腋窝淋巴结超声造影对浸润型乳腺癌新辅助化疗(NAC)疗效的预测价值.方法对58例Ⅱ、Ⅲ期浸润型乳腺癌患者的腋窝转移性淋巴结于NAC前、后进行超声造影检查,观察造影增强方式并进行时间强度分析,然后与手术病理对照.结果临床评价35例有效,23例化疗无变化.NAC有效组和无变化组两组之间灌注模式差异无统计学意义.到达淋巴结皮质时间化疗前两组间比较差异无统计学意义,化疗后有效组大于化疗无变化组.化疗

  17. Contralateral axillary node metastasis from recurrence after conservative breast cancer surgery.

    Science.gov (United States)

    Nishimura, Satoko; Koizumi, Mitsuru; Kawakami, Junko; Koyama, Masamichi

    2014-02-01

    Sentinel lymph node detection (SLND) with radiocolloid has become widely used for evaluation of nodal metastasis in primary breast cancer. However, the procedure for recurrent breast cancer is not well established. Contralateral axillary node metastasis is uncommon. We report 2 cases of contralateral axillary node metastasis with recurrent breast cancer. In the first case, contralateral node metastasis was found by SLND. In the other case without SLND, contralateral node metastasis developed after resection of local recurrence. FDG-avid contralateral node was pathologically diagnosed as metastasis. The SLND might be useful in patients with local recurrence after conservative breast cancer surgery. PMID:24368539

  18. Micrometástases de carcinoma da mama em linfonodos axilares: detecção por imunoistoquímica versus hematoxilina e eosina Micrometastasis in axillary lymph node in breast cancer: immunohistochemistry versus hematoxylin and eosin detection

    Directory of Open Access Journals (Sweden)

    Vanessa Fortes Zschaber Marinho

    2004-04-01

    Full Text Available INTRODUÇÃO: Os métodos de detecção e o significado prognóstico das micrometástases (Mic-Met em linfonodos axilares (LA de pacientes com carcinoma mamário invasor são controversos na literatura. OBJETIVOS: Comparar a detecção de micrometástases de carcinoma mamário em LA através de segunda revisão de lâminas coradas por hematoxilina e eosina (HE e comparar com a detecção imunoistoquímica (IHQ e seu impacto no restadiamento das pacientes. MATERIAIS E MÉTODOS: Foram estudados 190 casos de carcinoma mamário inicialmente diagnosticados como linfonodo-negativos, com reavaliação dos linfonodos em lâminas coradas por HE e IHQ para pancitoqueratina (clone AE1/AE3 e método streptavidina-biotina-peroxidase (LSAB+. RESULTADOS: Foram revistos 2.868 linfonodos corados por HE (média = 15,1 linfonodos/paciente e 2.444 linfonodos corados por IHQ (média = 12,9 linfonodos/paciente. Micrometástases foram detectadas em 28/190 casos, sendo que a detecção por IHQ (25/190 casos; 13,2% foi superior à detecção por HE (14/190 casos; 7,4%. A revisão de lâminas coradas por HE apresentou boa especificidade (98,2%, mas baixa sensibilidade (44% em relação à IHQ (considerada padrão-ouro. Conclusão: A detecção de Mic-Met foi maior por imunoistoquímica do que por segunda leitura de lâminas, e gerou mudança no estadiamento de 28 pacientes (14,7%.INTRODUCTION: The methods of detection and prognostic significance of micrometastasis (Mic-Met are still controversial in the literature. AIMS: The aim of our study was to compare micrometastasis detection of invasive mammary carcinomas (IMC in axillary lymph nodes using a second review (double review of hematoxylin and eosin (HE stained slides using immunohistochemistry (IHC and the impact of micrometastasis detection in re-staging patients. MATERIAL AND METHODS: We studied 190 cases of IMC with no axillary metastasis described in the original reports. We reviewed the available HE stained

  19. The Sentinel Lymph Node Concept

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    The sentinel lymph node concept is meeting with steadily growing interest and is being extended to the different sites of the primaries. In addition, the concept is being applied in an increasingly sophisticated manner. In this book the practical

  20. Evaluation of the effect of neoadjuvant chemotherapy on tumor and axillary lymph nodes in locally advanced breast cancer:a study of 50 patients

    Institute of Scientific and Technical Information of China (English)

    Ali H.Meebed; Ihab S.Fayek; Amany Saber; Reda H.Tabashy; Mona A.Sakr

    2014-01-01

    The purpose of the study was to correlate between ef ect of pre neoadjuvant chemotherapy (NACT) and post NACT clinical, sonographic and pathologic features of the tumor and axil ary lymph nodes (ALNs) and to raise the possibility of applying the concept of sentinel lymph node biopsy (SLNB) in patients with initial y positive ALNs before NACT. Methods:A prospective study of 50 female patients with local y advanced breast cancer (LABC) with clinical y palpable and cytological y (under ultrasonographic guidance) positive ALNs. Al patients received NACT and then referred for ultrasono graphic assessment of the axil a regarding any detectable sonographic criteria of metastatic deposits in ALNs as wel as the tumor size in relation to its pre chemotherapy size. Al patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results:Patients’ mean age was 47.7 ± 9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm;stage IIIA that was presented in 32 patients (64%) and IIIB was presented in 18 patients (36%). Chemotherapy was given for a median of 4 cycles. there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm (P<0.001). Clinical response was complete in 5 (10%) tumors, complete pathological tumor response (post neoadjuvant) was detected in 8 (16%) of patients. Complete clinical nodal response (post neoadjuvant) in 23 (46%) axil ae, on sonographic assessment of the axil a, response was complete in 17 (34%) axil ae. Complete pathological nodal response occurred in 16 (32%) axil ae. Out of 17 axil ae that showed complete sonographic response 11 axil ae showed complete pathological nodal response (P<0.001). Conclusion:Formal axil ary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with LABC with metastatic ALNs if there were complete

  1. 腋窝前哨淋巴结活检在原发性乳腺癌患者中的应用价值%Application value of sentinel lymph node biopsy in clinical examination of primary breast cancer with positive axillary node

    Institute of Scientific and Technical Information of China (English)

    冯宇; 赵霞; 吕淑贞; 穆颖; 王丹丹; 李艳萍

    2016-01-01

    目的:探讨前哨淋巴结活检在临床检查腋窝淋巴结阳性的原发性乳腺癌患者中的应用价值。方法回顾性分析255例临床检查腋窝淋巴结阳性的原发性乳腺癌患者的临床资料,对比临床查体、超声影像学检查、超声影像异常的淋巴结穿刺病理学检查对于腋窝淋巴结状态判断的可靠性。结果255例乳腺癌患者中,199例(78.0%)经病理学检查证实存在腋窝淋巴结转移。245例(96.1%)在超声检查时发现异常淋巴结;通过超声结合影像异常淋巴结穿刺病理学检查确诊腋窝淋巴结转移172例,占所有腋窝淋巴结转移患者的86.4%。125例临床查体cN1的患者中,18例(14.8%)穿刺病理学检查及前哨淋巴结活检均未见癌转移。结论对于临床检查腋窝淋巴结阳性的原发性乳腺癌患者,特别是穿刺未获得阳性结果者,应行前哨淋巴结活检,以避免不必要的腋窝淋巴结清扫。%Objective To investigate the application value of sentinel lymph node biopsy ( SLNB) in clinical exami-nation of primary breast cancer with positive axillary node .Methods The clinical data of 255 patients with primary breast cancer whose axillary nodes were positive were retrospectively analyzed .The reliability of using clinical physical examina-tion, ultrasound imaging , and ultrasonic imaging abnormalities of lymph node biopsy pathology inspection for judging the axillary lymph node was compared .Results A total of 199 (78.0%) of 255 patients were confirmed the presence of axil-lary lymph node metastases.Totally 245 (96.1%) patients had abnormal lymph nodes .86.4%(172/199) patients were confirmed metastases by fine-needle aspiration cytology ( FNAC ) .During 125 patients with palpable lymph nodes , 18 (14.8%) patients had negative results in both FNA and SLNB .Conclusion For patients who have primary breast cancer with positive axillary in clinical examination , especially who

  2. Mesenteric lymph node cavitation syndrome

    Institute of Scientific and Technical Information of China (English)

    Hugh; James; Freeman

    2010-01-01

    The mesenteric lymph node cavitation syndrome consists of central necrosis of mesenteric lymph nodes and may occur with either celiac disease or a sprue-like intestinal disease that fails to respond to a gluten-free diet. Splenic hypofunction may also be present. The cause is not known but its development during the clinical course of celiac disease is usually indicative of a poor prognosis for the intestinal disorder, a potential for signif icant compli-cations including sepsis and malignancy, particularly...

  3. 背阔肌解剖变异在乳腺癌腋窝淋巴结清扫术中的临床意义%Clinical Significance of Latissimus Dorsi Mutation in Axillary Lymph Node Dissection for Breast Carcinoma

    Institute of Scientific and Technical Information of China (English)

    张钢龄; 张培礼; 朱敬军; 杨七玉; 祁燕云; 杜华

    2012-01-01

    目的:通过对腋窝处变异的背阔肌进行详尽解剖,为降低乳腺癌腋窝淋巴结清扫术中腋窝处重要神经血管损伤,减少手术并发症提供依据.方法:收集128例行腋窝淋巴结清扫术的乳腺癌患者中发生背阔肌解剖变异19例,对该19例患者的背阔肌变异肌束进行详尽的大体解剖,找到其起点与止点,并测量长、宽、厚度,观察与腋窝神经、血管、淋巴结的毗邻关系.结果:19例发生背阔肌解剖变异的肌束均从背阔肌外侧缘发出一束肌腱,向内上走行,横跨腋血管神经束,在其上方,呈“扇形”腱膜延续为喙锁胸筋膜的一部分止于喙突.其中14例为单肌束走行,5例变异肌束从背阔肌发出后与胸大肌外缘发出一肌束会合,再并行向上.该变异肌束与背阔肌止端健呈“丫”型夹持着腋血管神经束.肋间臂神经从其表面或深面通过.其内下侧毗邻胸背神经及肩胛下血管,后外毗邻肩胛下血管外淋巴组织.结论:背阔肌变异肌束可造成腋窝淋巴结清扫术的解剖混淆,给腋淋巴结清扫术时的定位带来困难.因此,了解此种变异在腋窝淋巴结清扫术中具有重要意义.%This study aimed to provide the basic surgical guidelines for important injured nerves and vessels in the axilla during axillary lymph node dissection and reduce surgery-related complications by dissecting the variant latissimus dorsi (LATS) in the axilla. Methods: Data of 19 cases with LATS mutation from 128 breast carcinoma cases who underwent axillary lymph node dissection were collected and studied. The start and end points of the variation of muscle bundle (VOMB) were found by analyzing a full gross anatomy of the variant muscle bundle of LATS in the 19 cases. Length, width, and depth of VOMB were measured. Adjacent relationship among the axillary nerve, blood vessels, and lymph nodes in the axilla was observed. Results: Among the 19 cases with LATS mutation, each VOMB

  4. Dose to level I and II axillary lymph nodes and lung by tangential field radiation in patients undergoing postmastectomy radiation with tissue expander reconstruction

    International Nuclear Information System (INIS)

    To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. The mean coverage of the level I/II axillary volume by the 95% isodose line (VD95%) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung VD50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary VD95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung VD50% correlated with angle of the expander from midline (p = 0.05). In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated

  5. Lymphoscintigraphy and intraoperative gamma probe guided biopsy of the sentinel lymph node in breast cancer

    International Nuclear Information System (INIS)

    Objective: To evaluate the role of lymphoscintigraphy and intraoperative gamma probe in sentinel lymph node identification and biopsy for breast cancer. Methods: 99Tcm labelled dextran (Dx) was injected intra-dermis at the skin surface center of breast tumor before mastectomy. The sentinel lymph nodes identified by lymphoscintigraphy and intraoperative gamma probe were dissected out from the axillary tissue. All sentinel and non-sentinel lymph nodes were sent to a pathologist for histological examination. The specimens were examined with hematoxylin and eosin (H and E) staining. Results: In 31 cases studied, sentinel lymph nodes were all identified by lymphoscintigraphy and intraoperative gamma probe, with a detection rate of 100%. Metastases were detected in sentinel lymph nodes in 10 patients, however, 12 cases showed positive axillary lymph nodes but for 3 cases, sentinel lymph nodes were negative. The sensitivity of the sentinel lymph node biopsy in the study was 83.33%, the accuracy was 87.09%, the false positive rate was 0, and the false negative rate was 25%. Conclusions: Intraoperative gamma probe detection is the best approach to identify sentinel lymph nodes in breast cancer. The attempt that substitution of sentinel lymph node biopsy for routine axillary lymph node dissection in breast cancer deserves further study

  6. Comparison of clinicopathological characteristics of lymph node positive and lymph node negative breast cancer

    Science.gov (United States)

    Hadi, Naila Irum; Jamal, Qamar

    2016-01-01

    Objective: To record various clinicopathological characteristics of breast cancer (BC) in our population and to find an association between these characteristics and axillary nodal metastasis. Methods: This cross-sectional study included 150 BC patients from two tertiary care centers in Karachi from 15th February, 2013 to 31st March, 2015. Frequencies, percentages, and odds ratio were estimated to find out an association between various clinicopathological characteristics and lymph node status using SPSS version 20. Results: Approximately 75.4% patients had axillary lymph node metastasis (‘1-3’ LN = 34.4% and ‘>3’ LN = 44%). Menopausal status (p 3’ LN metastasis. Association of these variables with ‘1-3’ LN involvement was insignificant. Conclusion: Clinical spectrum of BC remains unchanged in 2016 with most of the patients presenting with high-grade, late-stage advanced disease. Moreover, clinicopathological variables, especially primary tumor size, tumor stage and lymphovascular invasion were significant predictors of >3 lymph node metastasis with high accuracy.

  7. LYMPHATIC MAPPING AND SENTINEL LYMPH NODE BIOPSY IN THE PATIENTS WITH BREAST CANCER

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary node. Methods: 33 patients with breast cancer intraoperatively and postoperatively underwent a lymphatic mapping and the SNB using Patent Blue. Results: The SLNs were found in 30 of 33 patients (90.9%), the SLN accurately predicted the status of the axillary in 29 (96.7%). In one case the SLN was negative, but other axillary nodes were tumor positive. Conclusion: This study confirmed that the procedure of lymphatic mapping and SNB in the patients with breast cancer is feasibility, and that the histological characteristics of the SLN accurately predict the status of the axillary node. We believe that this technique might replace axillary lymph node dissection for breast cancer patients with negative axillae in the future.

  8. 前哨淋巴结阳性乳腺癌患者不行腋窝淋巴结清扫预后的Meta分析%A Meta-analysis of the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection

    Institute of Scientific and Technical Information of China (English)

    殷益飞; 刘晓; 陆玉琴; 宋勇罡; 黄选东

    2015-01-01

    Objective To compare the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection.Methods A systematic literature search (Medline,Embase,Cochrane Library)ended in April 2014 was performed to identify all eligible articles.Two reviewers independently screened and extracted data.RevMan5 was used for statistical analysis.Results A total of 1026 abstracts were retrieved and 18 clinical controlled studies finally included,the total number of patients were 47 894,7389 had micrometastases in sentinel lymph node,35 217 had macrometastases in sentinel lymph node and 5288 had positive sentinel lymph node regardless of micrometastases or macrometastases.For patients with MIC,the 5-year axillary recurrence rate,5-year disease free survival and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.78;95% CI:0.72-4.39,P=0.21),(OR =0.76,95%CI:0.56-1.04,P=0.08),(OR=0.77,95%CI:0.43-1.40,P=0.39).For patients with MAC,the 5-year axillary recurrence rate had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.21;95% CI:O.76-1.91,P =0.42).For patients with positive sentinel lymph node regardless of micrometastases or macrometastases,the 5-year axillary recurrence rate and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.29;95% CI:0.92-1.80,P =0.14),(OR =0.96,95% CI:0.64-1.45,P =0.84).Conclusions Among patients with limited positive SLN of breast cancer,patients forgoing ALND compared with ALND did not have obvious affect on long-term survival.%目的 评价不行腋窝淋巴结清扫对前哨淋巴结阳性乳腺癌患者预后的影响.方法 系统检

  9. 乳腺癌腋窝清扫术后淋巴结解剖方法临床研究%Clinical research of the method of lymph node anatomy after axillary dissection in breast cancer

    Institute of Scientific and Technical Information of China (English)

    张琴琴; 王宁霞

    2014-01-01

    目的:探讨脂肪溶解液预处理乳腺癌腋淋巴组织标本对解剖的影响。方法选取暨南大学第一附属医院2011年3月至2013年10月收治的临床分期为Ⅱ期并行乳腺癌改良根治术的病人共82例,术后腋窝淋巴组织标本予脂肪溶解液浸泡15~20 min后再进行解剖(实验组),将解剖淋巴结的数目、最小径及解剖时间等各指标与传统解剖方法(对照组)对比。结果实验组解剖淋巴结的数目(23.10枚)多于对照组(18.38枚)(P=0.000),最小径(0.16 cm)小于对照组(0.25 cm)(P=0.000),解剖时间(19.95 min)少于对照组(24.02 min)(P=0.000)。肥胖病人中两组间淋巴结数目上的差值(7.00枚)要较非肥胖病人显著(3.52枚)。两组病人病理切片比较无明显差别。结论对乳腺癌腋淋巴结标本的解剖,用脂解液预处理的方法可增加淋巴结检出的数目,降低解剖难度以及缩短解剖时间,该法尤其适用于肥胖病人。%Objective To explore the effect of pretreating the axillary lymphatic tissue by liposuction before the anatomy in breast cancer patients. Methods A total of 82 cases of stage Ⅱ breast cancer were performed modified radical mastectomy between March 2011 and October 2013 in the First Affiliated Hospital of Jinan University. The axillary lymphatic tissue was soaked in liposuction by 15-20 minutes after the modified radical mastectomy (experimental group). The number of lymph node, the minimum diameter and the time of anatomy in experimental group were compared with those in control group (traditional anatomy method). Results The mean number of lymph node in experimental group was higher than that in control group (23.10 vs. 18.38, P=0.000). The mean minimum diameter in experimental group was less than that in control group (0.16cm vs. 0.25 cm, P=0.000). The median time of the duration of anatomy in experimental group was shorter than that in control

  10. 乳腺癌腋窝清扫术后淋巴结解剖方法临床研究%Clinical research of the method of lymph node anatomy after axillary dissection in breast cancer

    Institute of Scientific and Technical Information of China (English)

    张琴琴; 王宁霞

    2014-01-01

    Objective To explore the effect of pretreating the axillary lymphatic tissue by liposuction before the anatomy in breast cancer patients. Methods A total of 82 cases of stage Ⅱ breast cancer were performed modified radical mastectomy between March 2011 and October 2013 in the First Affiliated Hospital of Jinan University. The axillary lymphatic tissue was soaked in liposuction by 15-20 minutes after the modified radical mastectomy (experimental group). The number of lymph node, the minimum diameter and the time of anatomy in experimental group were compared with those in control group (traditional anatomy method). Results The mean number of lymph node in experimental group was higher than that in control group (23.10 vs. 18.38, P=0.000). The mean minimum diameter in experimental group was less than that in control group (0.16cm vs. 0.25 cm, P=0.000). The median time of the duration of anatomy in experimental group was shorter than that in control group (19.95 min vs. 24.02 min, P =0.000). The difference in the number of lymph node between the two groups was more significant in the obese patients than in the non-obese patients (7.00 vs. 3.52). There was no significant difference in the pathological section between two groups. Conclusion The method of pretreating the axillary lymphatic tissue by liposuction in breast cancer can increase the number of detection, make the anatomy easily and shorten the time of anatomy, which is particularly recommended for obese patients.%目的:探讨脂肪溶解液预处理乳腺癌腋淋巴组织标本对解剖的影响。方法选取暨南大学第一附属医院2011年3月至2013年10月收治的临床分期为Ⅱ期并行乳腺癌改良根治术的病人共82例,术后腋窝淋巴组织标本予脂肪溶解液浸泡15~20 min后再进行解剖(实验组),将解剖淋巴结的数目、最小径及解剖时间等各指标与传统解剖方法(对照组)对比。结果实验组解剖淋巴结的数目(23.10

  11. Clinical research between axillary lymph node metastasis of breast cancer and tumor size and molecular classification%乳腺癌患者腋淋巴结转移与肿瘤大小及分子分型间关系的临床研究

    Institute of Scientific and Technical Information of China (English)

    王锡宏; 马小鹏; 孔源

    2012-01-01

    目的 探讨乳腺癌患者腋窝淋巴结转移与肿瘤分子分型及肿瘤大小的关系.方法回顾性分析246例乳腺癌患者手术方式、有无腋窝淋巴结转移、转移淋巴结数目、肿瘤大小及肿瘤的分子分型.结果 246例乳腺癌患者中,术后病理证实淋巴结转移者108例.其中Luminal A型28例,淋巴结转移4例,转移率14.29%;Luminal B型156例,淋巴结转移92例,转移率58.97%;HER-2阳性型56例,淋巴结转移12例,转移率21.43%;三阴性乳腺癌(Basal-like型)6例,淋巴结均无转移.随肿瘤体积的增大,腋窝淋巴结转移率明显增高.结论乳腺癌患者腋窝淋巴结转移与肿瘤分子分型及肿瘤大小有相关性.%Objective To explore the relationship between axillary lymph nodes metastasis (ALNM) and the tumor size and molecular classification. Methods The clinical data of 246 patients of breast cancer, the surgical methods, and the axillary lymph nodes were retrospectively analysed and discussed. Results 108 cases developed axillary lymph node metastases, 4 of 28 cases in Luminal A had lymph node metastases(58.97%), and 92 of 156 cases in Luminal B had lymph node metastases(21.43%), 6 cases of Basal-like had not lymph node metas- tases. The bigger the tumor, the more metastases of lymph nodes. Conclusion There is relevance between axillary lymph node metastasis of breast cancer and molecular classification and the tumor size.

  12. Sentinel Lymph Node Detection in Contralateral Axilla at Initial Presentation of a Breast Cancer Patient: Case Report

    Directory of Open Access Journals (Sweden)

    Gülin Uçmak Vural

    2010-06-01

    Full Text Available The main basin for breast lymphatic drainage is ipsilateral axilla. However, extra-axillary drainage may be seen in some patients. The most common extra-axillary site is internal mammary chain, while contralateral axillary drainage is an extremely rare situation in previously untreated patients. We describe a case of untreated right breast retroareolar carcinoma with contralateral axillary drainage detected on preoperative lymphoscintigraphy. Contralateral axillary dissection was performed based on the result of frozen section examination of the sentinel lymph node (SLN which turned out to burden micrometastasis. Postoperative histopathological examination revealed invasive ductal carcinoma metastasis in 17 out of 22 lymph nodes from the ipsilateral axillary dissection, whereas 14 lymph nodes from contralateral axillary dissection other than the SLN were nonmetastatic. In our opinion, determination of contralateral axillary metastasis in primary staging process had a major contribution to the management of the patient

  13. Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients

    Science.gov (United States)

    Tanis, P J; Nieweg, O E; Valdés Olmos, R A; Peterse, J L; Rutgers, E J Th; Hoefnagel, C A; Kroon, B B R

    2002-01-01

    The purpose of this study was to evaluate the occurrence of lymphatic drainage to non-axillary sentinel nodes and to determine the implications of this phenomenon. A total of 549 breast cancer patients underwent lymphoscintigraphy after intratumoural injection of 99mTc-nanocolloid. The sentinel node was intraoperatively identified with the aid of intratumoural administered patent blue dye and a gamma-ray detection probe. Histopathological examination of sentinel nodes included step-sectioning at six levels and immunohistochemical staining. A sentinel node outside level I or II of the axilla was found in 149 patients (27%): internal mammary sentinel nodes in 86 patients, other non-axillary sentinel nodes in 44 and both internal mammary and other non-axillary sentinel nodes in nineteen patients. The intra-operative identification rate was 80%. Internal mammary metastases were found in seventeen patients and metastases in other non-axillary sentinel nodes in ten patients. Staging improved in 13% of patients with non-axillary sentinel lymph nodes and their treatment strategy was changed in 17%. A small proportion of clinically node negative breast cancer patients can be staged more precisely by biopsy of sentinel nodes outside level I and II of the axilla, resulting in additional decision criteria for postoperative regional or systemic therapy. British Journal of Cancer (2002) 87, 705–710. doi:10.1038/sj.bjc.6600359 www.bjcancer.com © 2002 Cancer Research UK PMID:12232750

  14. Prognostic value of lymph node ratio in node-positive breast cancer in Egyptian patients

    International Nuclear Information System (INIS)

    Background: Breast cancer in Egypt is the most common cancer among women and is the leading cause of cancer mortality. Traditionally, axillary lymph node involvement is considered among the most important prognostic factors in breast cancer. Nonetheless, accumulating evidence suggests that axillary lymph node ratio should be considered as an alternative to classical pN classification. Materials and methods: We performed a retrospective analysis of patients with operable node positive breast cancer, to investigate the prognostic significance of axillary lymph node ratio. Results: Five-hundred patients were considered eligible for the analysis. Median follow-up was 35 months (95% Cl 32-37 months), the median disease-free survival (DFS) was 49 months (95% Cl, 46.4-52.2 months). The classification of patients based on pN staging system failed to prognosticate DFS in the multivariate analysis. Conversely, grade 3 tumors, and the intermediate (> 0.20 to <0.65) and high (>0.65) LNR were the only variables that were independently associated with adverse DFS. The overall survival (OS) in this series was 69 months (95% Cl 60-77). Conclusion: The analysis of outcome of patients with early breast cancer in Egypt identified the adverse prognostic effects of high tumor grade, ER negativity and intermediate and high LNR on DFS. If the utility of the LNR is validated in other studies, it may replace the use of absolute number of axillary lymph nodes.

  15. STUDY ON THE METASTASIS OF AXILLARY LYMPH NODE POSITIVE EARLY BREAST CANCER SENTINEL LYMPH NODES%前哨淋巴结阳性早期乳腺癌其腋窝淋巴结转移状况的研究

    Institute of Scientific and Technical Information of China (English)

    陈卓荣; 罗智辉; 沈三弟

    2014-01-01

    目的:探讨早期乳腺癌前哨淋巴结( sentinel lymphnode ,SLN)阴性患者、1枚阳性SLN患者与2枚以上阳性SLN患者的非前哨淋巴结( non-sentinel lymphnode,NSLN)转移状况。方法:对90例T1-2N0M0乳腺癌患者应用美蓝为示踪剂行前哨淋巴结活检术( sentinel lymphnode biopsy,SLNB),进再行常规腋窝淋巴结清扫术( axillary lymph node dissection,ALND),根据检查结果将患者分成SLN(-)组、SLN(+)=1组及SLN(+)≥2组,并对各组的NSLN阳性率进行比较。结果:32例SLN (-)组检出NSLN阳性1例,阳性率3.1%,39例SLN(+)=1组检出NSLN阳性4例,阳性率为10.3%,19例SLN(+)≥2组检出NSLN阳性9例,阳性率为47.4%,SLNB检查假阴性1例,准确率为96.9%;SLN(+)=1组的NSLN阳性率略高于SLN阴性组,但差异无统计学意义P>0.05;SLN(+)≥2组患者的NSLN阳性率显著高于SLN(-)组及SLN(+)=1组,差异均具有统计学意义P<0.05。结论:研究结果提示1枚SLN阳性患者可仅行SLNB免行ALND,但≥2枚SLN阳性患者则需常规行ALND。%Objective:To explore the early sentinel lymph node in breast cancer ( sentinel, lymphnode, SLN) non sentinel lymph node negative patients, 1 positive in SLN patients with more than 2 pieces of SLN patients with positive nodes ( non-sentinel lymph-node, NSLN) metastasis.Methods:90 T1-2N0M0 patients with breast cancer using methylene blue as tracer for sentinel lymph node biopsy ( sentinel lymphnode biopsy, SLNB ) , and enter the routine axillary lymphadenectomy ( axillary lymph node dissection, ALND) , according to the test results of the patients were divided into SLN ( -) group, =1 group and SLN ( +) SLN ( +) ≥2 groups, and each group of NSLN positive rates were compared.Results:32 cases of SLN (-) group was 1 cases with positive NSLN, the positive rate was 3.1%, 39 cases of SLN (+) =1 was detected in 4

  16. Anatomy and nomenclature of murine lymph nodes: Descriptive study and nomenclatory standardization in BALB/cAnNCrl mice.

    Science.gov (United States)

    Van den Broeck, Wim; Derore, Annie; Simoens, Paul

    2006-05-30

    Murine lymph nodes are intensively studied but often assigned incorrectly in scientific papers. In BALB/cAnNCrl mice, we characterized a total of 22 different lymph nodes. Peripheral nodes were situated in the head and neck region (mandibular, accessory mandibular, superficial parotid, cranial deep cervical nodes), and at the forelimb (proper axillary, accessory axillary nodes) and hindlimb (subiliac, sciatic, popliteal nodes). Intrathoracic lymph nodes included the cranial mediastinal, tracheobronchal and caudal mediastinal nodes. Abdominal lymph nodes were associated with the gastrointestinal tract (gastric, pancreaticoduodenal, jejunal, colic, caudal mesenteric nodes) or were located along the major intra-abdominal blood vessels (renal, lumbar aortic, lateral iliac, medial iliac and external iliac nodes). Comparative and nomenclative aspects of murine lymph nodes are discussed. The position of the lymph nodes of BALB/cAnNCrl mice is summarized and illustrated in an anatomical chart containing proposals for both an official nomenclature according to the Nomina Anatomica Veterinaria and English terms.

  17. Influencing Factors of Disease-free Survival Rate and Clinical Significance of The Number of Axillary Lymph Node Detection in Breast Cancer%乳腺癌术后无瘤生存率的影响因素及腋窝淋巴结检测数目的临床意义

    Institute of Scientific and Technical Information of China (English)

    朱亚东

    2014-01-01

    Objective To investigate the relative factors influencing disease-free survival(DFS)rate in breast cancer and clinical significance of the number of axillary lymph node dissection .Methods Clinical data of 138 cases of breast cancer pa-tients who received modified radical mastectomy and axillary lymph node dissection were studied retrospectively .Positive axillary lymph nodes and disease-free survival time and influencing factors of patients with negative axillary lymph node were analyzed by Kaplan-Meier and multivariate logistic regression analysis .Results 5-year overall survival rate and DFS rate in patients with negative lymph nodes were 90.7% and 86.7%,respectively.5-year overall survival rate and DFS rate in patients with positive lymph nodes were 72.6%and 64.7%,respectively.There had statistical difference(P<0.05).Single factor analysis and multi-variate logistic regression analysis showed that the number of positive lymph node ,the number of lymph node dissection ,HER-2 were risk factors influencing the 5-year DFS of patients with positive lymph node .HER-2 was the main risk factor influencing the 5-year DFS of patients with negative lymph node .Conclusion Axillary lymph node metastasis and HER-2 are major factors in-fluencing the 5-year DFS of breast cancer patients .Increase the number of lymph nodes detection could improve the 5-year DFS of breast cancer patients .%目的:探讨乳腺癌术后无瘤生存率的影响因素及腋窝淋巴结清扫及检测个数的临床意义。方法回顾性分析138例行乳腺癌手术并腋窝淋巴结清扫患者的临床资料,采用Kaplan-Meier法和Logistic多因素回归分析腋窝淋巴结阳性和腋窝淋巴结阴性患者的无瘤生存时间及影响因素。结果淋巴结阴性患者5年总生存率为90.7%,5年无瘤生存率为86.7%,淋巴结阳性患者5年总生存率为72.6%,5年无瘤生存率为64.7%,2组差异具有统计学意义( P<0.05)。单因素分析

  18. PREDICTION OF NON-SENTINEL LYMPH NODE METASTASES IN BREAST CANCER

    Institute of Scientific and Technical Information of China (English)

    张杰; 沈坤炜; 尼尔马; 柳光宇; 吴炅; 邵志敏; 沈镇宙

    2003-01-01

    Objective. To identify a subset of breast cancer patients in whom metastatic disease is confined on- ly to the sentinel lymph node(SLn). Methods. Sentinel lymph node biopsy is performed with the injecetion of Tc99m-SC, and a gamma probe. Sentinel node biopsy was compared with standard axillary dissection for its ability to reflect the final pathological status of the axillary nodes. The factors associated with non-SLN metastases were assessed in the univariate and multivariate analysis. Result. We successfully identified 91 out of 95 patients for SLN(95.8%). The accuracy of sentinel lymph node to predict the axillary lymph node status was 93.4%. Clinical tumor size and tumor grade were proved to be the independent predictive factors for non-SLN metastases by logistic regression model. Conclusio.In most cases, the gamma probe guided method is technically feasible for detecting sentinel nodes, accurately predicting the axillary lymph node status. A subset of the patients identified who have a low risk of non-SLN metastases may not require axillary lymph node dissection.

  19. Sentinel lymph node detection through radioguided surgery in patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, Benedita Andrade Leal de; Santos, Adriana de Morais; Soares, Livia de Almeida; Santos, Antonio Ricardo dos; Barros, Idna de Carvalho; Abreu, Everardo Leal de; Cruz Filho, Alexandre Jorge Gomes da; Abreu, Joao Batista de; Vieira, Sabas Carlos [Universidade Estadual do Piaui, Teresina, PI (Brazil); Centro Federal de Educacao Tecnologica do Piaui (CEFET-PI), Teresina, PI (Brazil); Faculdade Sao Gabriel, PI (Brazil); Hospital Sao Marcos, PI (Brazil); Universidade Federal do Piaui (UFPI), Teresina, PI (Brazil)

    2008-12-15

    Biopsy of the sentinel lymphnode (SLNB), the first lymphnode to receive lymphatic drainage from the primary tumor, accurately predicts the axillary lymph node status and, when negative, obviates the need for axillary lymphadenectomy (AL). The aim of this study was, to verify the SLN localization in breast cancer through preoperative lymphoscintigraphy and intraoperative gamma-probe, as well as to demonstrate the benefits of such techniques in preventing complications of AL. Medical records of 228 patients with breast carcinoma, who were underwent SLN localization and, radioguided surgery, from March 2005 to December 2007 were analyzed retrospectively. Data regarding age, tumor characteristic, breast involved, type of surgery, radiopharmaceutical drainage pattern, axillary assessment (SLNB or AL) and number of lymph nodes dissected were collected. It was ascertained that radioguided surgery is a selective method of axillary assessment in breast cancer, which makes this technique a safe alternative to radical assessment of total dissection of axillary lymph nodes and its subsequent complications. (author)

  20. Risk factor analysis of axillary lymph node metastasis in patients with breast ductal carcinoma in situ with microinvasion%乳腺导管原位癌伴微浸润发生腋窝淋巴结转移的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    张琴琴; 唐军; 邱超学; 范平; 黄毓珍; 冯乐平; 杨名添

    2012-01-01

    目的探讨乳腺导管原位癌伴微浸润(breast ductal carcinoma in situ with microinvasion,DCIS-Mi)患者发生腋窝淋巴结转移的危险因素.方法 应用回顾性调查方法收集2000年1月至2008年10月可手术乳腺DCIS-Mi病例共174例,分析有无腋窝淋巴结转移患者的不同分子病理特征,并通过χ2检验、Spearman检验以及Logistic回归分析筛选腋窝淋巴结转移的危险因素.结果 174例DCIS-Mi患者中,有腋窝淋巴结转移者9例(5.17%).DCIS-Mi病灶中,DCIS级别与腋窝淋巴结转移呈正相关(r=0.262,P=0.000),激素受体状态与腋窝淋巴结转移呈负相关(r=-0.192,P=0.011).经Logistic回归分析各因素相互调整后,DCIS高级别(OR=37.191,P=0.005)和肿瘤直径≥4.0 cm(OR=29.634,P=0.023)是DCIS-Mi病灶发生转移的高危因素.结论在DCIS-Mi患者中,DCIS级别高和肿瘤直径≥4.0 cm者容易发生腋窝淋巴结转移,对此类患者进行个体化治疗是必要的.%Objective To study the risk factors of axillary lymph node metastasis in patients with breast ductal carcinoma in situ with microinvasion ( DCIS-Mi). Methods Totally 174 cases of DCIS-Mi from January 2000 to December 2008 were involved for retrospective survey. The molecular pathologic features were compared between the patients with axillary lymph node metastasis and the patients without. The risk factors of axillary lymph node metastasis were screened out by Chi-square test, Spearman test and Logistic regression analysis. Results In 174 cases of DCIS-Mi,9 (5. 17% ) cases were observed with axillary lymph node metastasis. The tumor grade of DCIS was found to be positively correlated with the risk of axillary lymph node metastasis ( r = 0. 262 , P = 0. 000 ). Patients with hormone receptor positive had decreased risk of axillary lymph node metastasis ( r = -0. 192 ,P = 0. 011). After adjusted by various factors in Logistic regression analysis, high grade and tumor diameter ≥ 4. 0 cm were the high risk factors of

  1. Diagnostic Value of 18F-FDG Coincidence SPECT/CT Imaging for Axillary Lymph Node Metastasis in Breast Cancer%18F-FDG符合线路SPECT/CT显像对乳腺癌腋窝淋巴结转移的诊断价值

    Institute of Scientific and Technical Information of China (English)

    陈鹏; 汪瑞; 刘永; 陆武; 宋长祥; 杜鹏

    2013-01-01

      目的探讨18F-FDG 符合线路 SPECT/CT 显像半定量分析法预测乳腺癌腋窝淋巴结转移的最佳阈值.资料与方法以58例行腋窝淋巴结清扫术的乳腺癌患者为研究对象,18F-FDG 符合线路 SPECT/CT 测量腋窝淋巴结(L)与对侧相应部位腋窝本底(B)最大放射性计数比值(L/B 值).以病理为“金标准”,通过 ROC曲线建立预测乳腺癌腋窝淋巴结转移的最佳阈值,将最佳阈值下的判定结果与病理结果行一致性检验.结果58例患者共检测到119枚与手术区匹配的淋巴结(直径≥8 mm).L/B 值的 ROC 曲线下面积为0.938,最佳阈值为2.22.采用 L/B 值≥2.22预测腋窝淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值分别为88.9%、97.9%、98.5%、85.2%,与病理诊断的一致性较好(Kappa=0.862, P<0.05).结论采用 L/B 值≥2.22作为预测直径≥8 mm 的腋窝淋巴结转移的标准具有较高的准确性,可用于腋窝淋巴结转移的评估.%Purpose To investigate the optimal threshold of 18F-FDG coincidence SPECT/CT imaging using semiquantitative analysis method in the prediction of axillary lymph node metastasis in breast cancer. Materials and Methods Fifty-eight patients with breast cancer confirmed by axillary lymph node dissection were enrolled. Maximum radioactive count ratio (L/B value) of axillary lymph node (L) and the corresponding areas of contralateral axillary background (B) were measured by the 18F-FDG coincidence SPECT/CT. ROC curve was established to predict the optimal threshold of axillary lymph node metastasis in breast cancer, and Kappa analysis was used to do consistency test of judgment results under optimal threshold and pathologic findings (gold standard). Results 119 lymph nodes in 58 patients matched with operation area ( ≥ 8 mm diameter) were detected. The area under the ROC curve of L/B value was 0.938, the optimum threshold value was 2.22. Sensitivity, specificity, positive predictive value

  2. Elective ilioingunial lymph node irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, R.H.; Parsons, J.T.; Morgan, L.; Million, R.R.

    1984-06-01

    Most radiologists accept that modest doses of irradiation (4500-5000 rad/4 1/2-5 weeks) can control subclinical regional lymph node metastases from squamous cell carcinomas of the head and neck and adenocarcinomas of the breast. There have been few reports concerning elective irradiation of the ilioinguinal region. Between October 1964 and March 1980, 91 patients whose primary cancers placed the ilioinguinal lymph nodes at risk received elective irradiation at the University of Florida. Included are patients with cancers of the vulva, penis, urethra, anus and lower anal canal, and cervix or vaginal cancers that involved the distal one-third of the vagina. In 81 patients, both inguinal areas were clinically negative; in 10 patients, one inguinal area was positive and the other negative by clinical examination. The single significant complication was a bilateral femoral neck fracture. The inguinal areas of four patients developed mild to moderate fibrosis. One patient with moderate fibrosis had bilateral mild leg edema that was questionably related to irradiation. Complications were dose-related. The advantages and dis-advantages of elective ilioinguinal node irradiation versus elective inguinal lymph node dissection or no elective treatment are discussed.

  3. Lymph node staging in prostate cancer.

    Science.gov (United States)

    Sankineni, Sandeep; Brown, Anna M; Fascelli, Michele; Law, Yan Mee; Pinto, Peter A; Choyke, Peter L; Turkbey, Baris

    2015-05-01

    Nodal staging is important in prostate cancer treatment. While surgical lymph node dissection is the classic method of determining whether lymph nodes harbor malignancy, this is a very invasive technique. Current noninvasive approaches to identifying malignant lymph nodes are limited. Conventional imaging methods rely on size and morphology of lymph nodes and have notoriously low sensitivity for detecting malignant nodes. New imaging techniques such as targeted positron emission tomography (PET) imaging and magnetic resonance lymphography (MRL) with iron oxide particles are promising for nodal staging of prostate cancer. In this review, the strengths and limitations of imaging techniques for lymph node staging of prostate cancer are discussed.

  4. Fluorescence imaging to study cancer burden on lymph nodes

    Science.gov (United States)

    D'Souza, Alisha V.; Elliott, Jonathan T.; Gunn, Jason R.; Samkoe, Kimberley S.; Tichauer, Kenneth M.; Pogue, Brian W.

    2015-03-01

    Morbidity and complexity involved in lymph node staging via surgical resection and biopsy calls for staging techniques that are less invasive. While visible blue dyes are commonly used in locating sentinel lymph nodes, since they follow tumor-draining lymphatic vessels, they do not provide a metric to evaluate presence of cancer. An area of active research is to use fluorescent dyes to assess tumor burden of sentinel and secondary lymph nodes. The goal of this work was to successfully deploy and test an intra-nodal cancer-cell injection model to enable planar fluorescence imaging of a clinically relevant blue dye, specifically methylene blue along with a cancer targeting tracer, Affibody labeled with IRDYE800CW and subsequently segregate tumor-bearing from normal lymph nodes. This direct-injection based tumor model was employed in athymic rats (6 normal, 4 controls, 6 cancer-bearing), where luciferase-expressing breast cancer cells were injected into axillary lymph nodes. Tumor presence in nodes was confirmed by bioluminescence imaging before and after fluorescence imaging. Lymphatic uptake from the injection site (intradermal on forepaw) to lymph node was imaged at approximately 2 frames/minute. Large variability was observed within each cohort.

  5. A level III sentinel lymph node in breast cancer

    Directory of Open Access Journals (Sweden)

    Ghesani Nasrin

    2006-06-01

    Full Text Available Abstract Background For accurate nodal staging, all blue and radioactive lymph nodes should be sampled during the sentinel lymph node biopsy for breast cancer. We report a case of anomalous drainage in which one of the sentinel lymph nodes was unexpectedly found in the level III axillary space. Case presentation A 40-year-old female underwent mastectomy for extensive high-grade ductal carcinoma in-situ (DCIS with micro-invasion. The index lesion was located in the right upper inner quadrant. Lymphoscintigraphy was performed on the morning of surgery. Two sentinel lymph nodes were identified. At operation, 5 mls of isosulfan blue dye was injected at the same site of the radio-colloid injection. The first sentinel lymph node was found at level I and was blue and radioactive. The second sentinel node was detected in an unexpected anomalous location at level III, medial to the pectoralis minor. Both sentinel nodes were negative. Conclusion Sentinel node staging can lead to unexpected patterns of lymphatic drainage. For accurate staging, it is important to survey all potential sites of nodal metastasis either with preoperative lymphoscintigraphy and/or rigorous examination of regional nodal basins with the intra-operative gamma probe.

  6. Plasma D-dimer levels in breast cancer patients correlate with axillary lymph node status%血浆D-二聚体水平与乳腺癌腋窝淋巴结转移的相关性研究

    Institute of Scientific and Technical Information of China (English)

    柴源; 王娟娟; 刘斌

    2015-01-01

    Objective:The purpose of this study is to explore the relationship between plasma D-dimer level and axillary lymph node metastasis of breast cancer, and to provide the basis for predicting axillary lymph node metastasis. Methods:73 cases of breast cancer (breast cancer group), 36 cases of benign breast disease (benign breast disease group) and 50 cases of healthy women (normal control) were collected. Plasma D-dimer levels of the three groups were detected. Histopathologic variables (tumor size, pathological type, lymph node metastasis, number of lymph node metastasis, etc.) were classified and analyzed systematically. Results:Plasma D-dimer levels in breast cancer patients are higher than those in benign breast disease group and normal control group, and the differences are statistically signiifcant (P0.05). Plasma D-dimer levels in the positive axillary lymph node metastasis group are higher than the negative axillary lymph node metastasis group, and the differences are statistically signiifcant (P0.05);腋窝淋巴结转移阳性患者D–二聚体水平高于腋窝淋巴结转移阴性患者,差异有统计学意义(P<0.01);肿瘤大小、病理类型、血浆D–二聚体水平与腋窝淋巴结转移个数显著相关(P<0.01);原发肿瘤的病理类型、血浆D–二聚体水平是腋窝淋巴结转移的危险因素(OR =7.464、6.470);血浆D–二聚体水平诊断乳腺癌腋窝淋巴结转移时的ROC曲线下面积(area under concentration-time,AUC)为0.689,以0.455μg/mL为最佳诊断分界点,灵敏度为52.3%,特异度为86.2%。结论:血浆D–二聚体水平与乳腺癌腋窝淋巴结转移状态及转移个数有关,其对判断乳腺癌腋窝淋巴结转移状态有一定临床价值。

  7. Staging of women with breast cancer after introduction of sentinel node guided axillary dissection

    DEFF Research Database (Denmark)

    Tvedskov, Tove Filtenborg

    2012-01-01

    Today, sentinel lymph node dissection (SLND) has replaced axillary lymph node dissection (ALND) as standard procedure for staging of the axilla in the treatment of breast cancer. SLND can accurately stage the axilla by removing on average only two lymph nodes. Only in case of metastatic spread...... at diagnosis, increasing tumor size and increasing proportion of positive sentinel nodes in a multivariate analysis. If patients were ≥ 40 years at diagnosis with tumor size ≤ 2 cm as well as one or more negative sentinel nodes, NSN metastases were found in only 2%. Omission of ALND in this group would spare 1...... and increasing proportion of positive sentinel nodes in a multivariate analysis. However, a model based on these traditional prognostic markers could not identify a subgroup of patients with a risk of NSN metastases less than 10%. We then investigated whether the biochemical prognostic markers TIMP-1, Ki67...

  8. Role of axillary lymph node ultra-sound and large core biopsy in the preoperative assessment of patients selected for sentinel node biopsy; Ruolo dell'ecografia e della microbiopsia istologica nella valutazione del cavo ascellare in pazienti candidate a biopsia del linfonodo sentinella

    Energy Technology Data Exchange (ETDEWEB)

    Nori, Jacopo; Boeri, Cecilia; Vanzi, Ermanno; Nori Bufalini, Filippo; Masi, Andrea [Azienda Ospedaliero-Universitaria Careggi, Firenze (Italy). Diagnostica senologica; Bazzocchi, Massimo; Londero, Viviana [Udine Univ., Udine (Italy). Istituto di radiologia universitaria; Mangialavori, Giuseppe [Ospedale di Merano, Bolzano (Italy). Servizio di radiologia; Distante, Vito; Simoncini, Roberta [Firenze Univ., Firenze (Italy). Clinica chirurgica I

    2005-04-01

    Purpose: To aim of this study was to evaluate the diagnostic accuracy of axillary lymph node sonography, if necessary in collaboration with US-guided large core biopsy, in the preoperative evaluation of breast cancer patients scheduled for quadrantectomy and sentinel lymph node excision. Materials and methods: From July 2001 to December 2002, we evaluated 117 breast cancer patients with ultrasound and, where indicated, FNAB. Breast lesions has diameters between 4 and 26 mm (mean diameter 11 mm). Fifteen (13%) of the 117 patients were excluded from the series as they did not found fulfil the criteria for preliminary sonography of the axilla: in 9 patients fewer than 4 nodes were detected and in 6 patients the breast lesions were intraoperatively found to be benign. Eleven patients (10.7%) with sonographically suspicious axillary nodes were sampled by US-guided core biopsy using a 14 or 16 Gauge Tru-Cut needle. Results: The ultrasound study aims to evaluate the dimensions and morphology of the breast lesion as well as detect and assess at least 4 axillary nodes. These were evaluated for hilar and cortical thickening and radio between the sinus diameter and the total longitudinal diameter. Lymph nodes with hilar diameters equal to or greater than 50% of the longitudinal diameter were considered normal. Of the 102 patients evaluated, 77 (75.7%) had normal axillary nodes according to the US criteria adopted. Negativity was confirmed by histology in 56 cases (72.7%, true negative); 21 (27.3%, false negative) were found to be positive, in contrast with the sonographic appearance. The false negative cases were due to lymph node micrometastasis which probably did not cause morphologic alterations perceptible at ultrasound. The remaining 25 patients (24.5%) had axillary lymph nodes classified as suspicious. In 13 cases of (52%, true positive) there was agreement with histology, whereas in 12 cases (48%, false positive) the US suspicion was not confirmed at surgery. The most

  9. Relationship of ER and HER-2 expression in primary tumor and axillary lymph node metastases of invasive ductal breast cancer%乳腺浸润性导管癌病灶与腋窝转移淋巴结中ER和HER-2表达的关系

    Institute of Scientific and Technical Information of China (English)

    田枫; 张建国; 仲雷

    2012-01-01

    目的:探讨雌激素受体(ER)和人表皮生长因子受体(HER-2)在人乳腺浸润性导管癌肿瘤病灶与腋窝转移淋巴结中表达的关系.方法:检测80例乳腺癌肿瘤病灶和转移淋巴结中ER(免疫组化法)和HER-2(荧光原位杂交法)的表达情况,并分析两者相关性与一致性.结果:80例患者中,乳腺癌肿瘤病灶ER阳性34例(42.50%),HER-2阳性26例(32.50%);腋窝淋巴结转移灶ER阳性37例(46.25%),HER-2阳性27例(33.75%),两者在肿瘤病灶与腋窝淋巴结的阳性率差异均无统计学意义(P=0.750,P=1.000).肿瘤病灶与腋窝转移淋巴结ER均阳性32例,HER-2均阳性22例,肿瘤病灶与腋窝转移淋巴结两种受体表达情况总符合率为83.75%,两者在原发灶与腋窝淋巴结转移灶的表达具有较好的相关性和一致性(r=0.825,0.746;x=0.823,0.764).结论:人乳腺浸润性导管癌肿瘤病灶与腋窝转移淋巴结中ER和HER-2表达具有较好的相关性与一致性.%Objective: To investigate the relationship of the expressions of estrogen receptor (ER) and human epidermal growth factor receptor-2 (HER-2) between the primary tumor and axillary lymph node metastases in invasive ductal breast cancer. Methods: Expressions of ER and HER-2 in the primary tumors and axillary lymph node metastases of 80 patients with invasion ductal carcinoma were determined by immunohistochemical method (for ER) and fluorescence in situ hybridization (FISH, for HER-2), respectively, and the correlation and consistency between them were analyzed. Results: Of the 80 breast cancer patients, ER- and HER-2-positivity in the primary lesions were found in 34 (42.50%) and 26 (32.50%) cases, and in axillary lymph node metastases were found in 37 (46.25%) and 27 (33.75%) cases, respectively. The positive rates of either ER or HER-2 between the primary lesions and axillary lymph node metastases exhibited no statistical difference (P=0.750 and P=1.000). The overall coincidence rate of the

  10. Clinical Research on the Expressin of BRMS1 and the Micro-metastasis of Axillary Lymph Node in Breast Cancer%BRMS1与乳腺癌腋窝淋巴结微转移的临床研究

    Institute of Scientific and Technical Information of China (English)

    吴海燕; 何雄斌; 胡玉林; 李晓杰; 曹慧秋; 蒋莎莉; 陈灿斌; 谢志斌

    2012-01-01

    Objective: To investigate micro-metastasis in axillary lymph nodes and its relationship with BRMS1 genes expressin of the tumor tissue in breast cancer. Methods: Identifying the micro-metastases situation of the lymph node by serial sectioning and the expression of CK-19 in 89 cases of breast cancer tissue with lymph node metastasis-negative confirmed by conventional pathological findings, the postoperative follow-up was performed for 16 to 80 months. At the same time, detected the expression of BRMS1 protein by immunohistochemistry and analyzed its relationship with lymph node micrometastasis and recurrence rate. Results: There were 48 (6.97%) detected micrometastases among the 689 lymph node from 86 cases of breast cancer axillary lymph node metastasis. 22 cases (25.58%) were positive, BRMS1 expression-negative breast cancer patients with axillary lymph node micrometastases in cases (43.24%) and recurrence rate (54.05%) is much higher than BRMS1 expression-positive breast cancer patients (12.24%, 8.16%), the difference was significant,and there was a significant negative correlation. Conclusion: The expressin of BRMS1 is Closely related to axillary lymph nodes Micro-metastases in breast cancer, BRMS1 can become a molecular indicator of breast cancer's axillary lymph node micro-metastases, and it is great significance to breast cancer staging, prognosis, and treatment.%目的:探讨BRMS1的表达与乳腺癌腋窝淋巴结微转移的关系.方法:采用连续切片和CK-19联合检测86例腋窝淋巴结转移阴性的所有淋巴结微转移灶的情况,术后随访其复发情况,免疫组化检测乳腺癌组织中BRMS1的表达并分析其与淋巴结微转移及术后复发率的关系.结果:86例乳腺癌腋窝淋巴结转移阴性的689淋巴结中有48粒(6.97%)检测到微转移,其中阳性病例22例(25.58%),BRMS1的表达阴性的乳腺癌患者腋窝淋巴结微转移病例率(43.24%)和术后复发率(54.05%)远高于BRMS1

  11. Anatomical discussion of paresthesia mechanisms after axillary lymph node dissection in breast cancer%探讨乳腺癌腋窝淋巴结清扫术后感觉异常的解剖学机制

    Institute of Scientific and Technical Information of China (English)

    郑桓; 徐卫国; 唐照鹏; 陈源水; 张世伟; 石畅; 周洪霞; 张志勇; 田增有; 张宇新

    2015-01-01

    目的:为乳腺癌腋窝淋巴结清扫术中预防侧胸壁、腋窝及上臂后内侧感觉异常提供解剖学基础认识。方法解剖30具成人尸体的60侧腋区,观察肋间臂神经(ICBN )及其毗邻关系,详细测量并记录其起源、走行、分支、分布及交通支。结果本组60侧中侧胸壁以第三肋间神经(50侧)和ICBN(29侧)分布为主,未观察到臂内侧皮神经(MBCN)分布至此;腋窝区第三肋间神经、ICBN和MBCN均有分布,但以ICBN分布为主(42侧);上臂后内侧ICBN(42侧)和MBCN(44侧)的分布基本持平,未观察到第三肋间神经分布至此。81.7%(49侧)的ICBN与臂丛存在交通支。63.3%(38侧)的ICBN穿出胸壁时存在伴行血管。结论乳腺癌腋窝淋巴结清除术中找到ICBN及相关神经及其间的交通支,并完整保留,可能更有利于预防患者腋窝淋巴结清扫术后感觉异常的发生。%Objective To provide anatomical basis for preventing paresthesia that appear in the lateral thoracic wall ,the arm‐pit and the inside of the upper arm during axillary lymph node dissection for breast cancer .Methods The intercostobrachial nerve (ICBN) and its contiguous relationship were observed ,besides the origin ,ramus and branch were measured and recorded by anato‐mizing 30 adult embalmed cadavers (60 sides) .Results Three intercostals nerve (50 sides) and the ICBN (29 sides) were the mainly nerves in lateral thoracic wall ,the medical brachial cutaneous nerve(MBCN) was not observed .Three intercostals nerve , ICBN(42 sides)and MBCN(44 sides) were found in armpit ,but mainly was intercostobrachial nerve (42 sides) .ICBN and the MB‐CN equally distributed in the dorsal and medical of the upper arm ,but the three intercostals nerve was not observed .81 .7% (49 sides) of intercostal nerve and all of the brachial plexus presenced filament .They existenced blood vessel accompanied when the ICBN pierced the

  12. Tumour 18 F-FDG Uptake on preoperative PET/CT may predict axillary lymph node metastasis in ER-positive/HER2-negative and HER2-positive breast cancer subtypes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin You; Lee, Suck Hong; Kim, Suk [Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Department of Radiology, Seo-gu, Busan (Korea, Republic of); Kang, Taewoo [Pusan National University Hospital, Busan Cancer Center, Busan (Korea, Republic of); Bae, Young Tae [Pusan National University Hospital, Department of Surgery, Busan (Korea, Republic of)

    2015-04-01

    To evaluate the association between tumour FDG uptake on preoperative PET/CT and axillary lymph node metastasis (ALNM) according to breast cancer subtype. The records of 671 patients with invasive breast cancer who underwent {sup 18} F-FDG PET/CT and surgery were reviewed. Using immunohistochemistry, tumours were divided into three subtypes: oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive, and triple-negative. Tumour FDG uptake, expressed as maximum standardized uptake value (SUV{sub max}), and clinicopathological variables were analysed. ALNM was present in 187 of 461 ER-positive/HER2-negative, 54 of 97 HER2-positive, and 38 of 113 triple-negative tumours. On multivariate analysis, high tumour SUV{sub max} (≥4.25) (P < 0.001), large tumour size (>2 cm) (P = 0.003) and presence of lymphovascular invasion (P < 0.001) were independent variables associated with ALNM. On subset analyses, tumour SUV{sub max} maintained independent significance for predicting ALNM in ER-positive/HER2-negative (adjusted odds ratio: 3.277, P < 0.001) and HER2-positive tumours (adjusted odds ratio: 14.637, P = 0.004). No association was found for triple-negative tumours (P = 0.161). Tumour SUV{sub max} may be an independent prognostic factor for ALNM in patients with invasive breast cancer, especially in ER-positive/HER2-negative and HER2-positive subtypes, but not in those with triple-negative subtype. (orig.)

  13. Targeted Delivery of Immunomodulators to Lymph Nodes

    Directory of Open Access Journals (Sweden)

    Jamil Azzi

    2016-05-01

    Full Text Available Active-targeted delivery to lymph nodes represents a major advance toward more effective treatment of immune-mediated disease. The MECA79 antibody recognizes peripheral node addressin molecules expressed by high endothelial venules of lymph nodes. By mimicking lymphocyte trafficking to the lymph nodes, we have engineered MECA79-coated microparticles containing an immunosuppressive medication, tacrolimus. Following intravenous administration, MECA79-bearing particles showed marked accumulation in the draining lymph nodes of transplanted animals. Using an allograft heart transplant model, we show that targeted lymph node delivery of microparticles containing tacrolimus can prolong heart allograft survival with negligible changes in tacrolimus serum level. Using MECA79 conjugation, we have demonstrated targeted delivery of tacrolimus to the lymph nodes following systemic administration, with the capacity for immune modulation in vivo.

  14. Axillary node metastasis from differentiated thyroid carcinoma with hürthle and signet ring cell differentiation. A case of disseminated thyroid cancer with peculiar histologic findings

    Directory of Open Access Journals (Sweden)

    Chiofalo Maria

    2012-02-01

    Full Text Available Abstract Background Differentiated thyroid cancer is usually associated with an excellent prognosis and indolent course. Distant metastases are rare events at the onset of thyroid cancer. Among these presentations, metastasis to the axillary lymph nodes is even more unusual: only few cases were previously reported in the literature; there has been no report of axillary lymph node metastasis from follicular thyroid carcinoma. Axillary lymph node metastasis generally arises in the context of disseminated disease and carries an ominous prognosis. Case presentation Here we present a case of axillary lymph node metastasis in the context of disseminated differentiated thyroid cancer. The patient underwent near total thyroidectomy and neck and axillary lymph node dissection. A histopathological diagnosis of poorly differentiated follicular carcinoma with "signet ring cells" and Hürthle cell features was established. The patient received radioactive iodine therapy and TSH suppression therapy. Subsequently his serum thyroglobulin level decreased to 44.000 ng/ml from over 100.000 ng/ml. Discussion and Conclusion Currently there are only few reported cases of axillary node metastases from thyroid cancer, and to our knowledge, this is the first report on axillary lymph node metastasis from follicular thyroid carcinoma. "Signet ring cell" is a morphologic feature shared by both benign and, more rarely, malignant follicular thyroid neoplasm, and it generally correlates with an arrest in folliculogenesis. Our case is one of the rare "signet ring cells" carcinomas so far described.

  15. Axillary node metastasis from differentiated thyroid carcinoma with hürthle and signet ring cell differentiation. A case of disseminated thyroid cancer with peculiar histologic findings

    International Nuclear Information System (INIS)

    Differentiated thyroid cancer is usually associated with an excellent prognosis and indolent course. Distant metastases are rare events at the onset of thyroid cancer. Among these presentations, metastasis to the axillary lymph nodes is even more unusual: only few cases were previously reported in the literature; there has been no report of axillary lymph node metastasis from follicular thyroid carcinoma. Axillary lymph node metastasis generally arises in the context of disseminated disease and carries an ominous prognosis. Here we present a case of axillary lymph node metastasis in the context of disseminated differentiated thyroid cancer. The patient underwent near total thyroidectomy and neck and axillary lymph node dissection. A histopathological diagnosis of poorly differentiated follicular carcinoma with 'signet ring cells' and Hürthle cell features was established. The patient received radioactive iodine therapy and TSH suppression therapy. Subsequently his serum thyroglobulin level decreased to 44.000 ng/ml from over 100.000 ng/ml. Currently there are only few reported cases of axillary node metastases from thyroid cancer, and to our knowledge, this is the first report on axillary lymph node metastasis from follicular thyroid carcinoma. 'Signet ring cell' is a morphologic feature shared by both benign and, more rarely, malignant follicular thyroid neoplasm, and it generally correlates with an arrest in folliculogenesis. Our case is one of the rare 'signet ring cells' carcinomas so far described

  16. 保留肋间臂神经在乳腺癌腋窝淋巴结清扫术中的临床价值%Applied value of preservation of intercostobrachial nerve during axillary lymph node dissection for breast cancer

    Institute of Scientific and Technical Information of China (English)

    江维; 齐立强; 张印春; 顾林

    2011-01-01

    Objective To evaluate the applied value of preservation of the intercostobrachial nerve(ICBN) during axillary lymph node dissection for breast cancer. Methods Eighty eases of breast cancer with stage I and stage H were selected and randomly divided into experimental group(50 cases,complete preservation of ICBNs during axillary lymph node dissection)and control group(30 cases, dissection of ICBNs during axillary lymph node dissection). The feelings of ipsilateral upper limbs and axillary area were evaluated and compared between the two groups after operation. Results The incidence of paresthesia of ipsilateral upper limbs and armpit was significantly lower in experimental group than in control group at the I st,3rd and 6th month after operation (P < 0. Ol ). Conclusion Preservation of ICBN during axillary lymph node dissection for breast cancer can effectively reduce the incidence of paresthesia of ipsilateral upper limbs and armpit, improve the quality of life and have high applied value.%目的 探讨保留肋间臂神经在乳腺癌腋窝淋巴结清扫术中的临床价值.方法 选择Ⅰ、Ⅱ期乳腺癌患者80例,随机分为两组,实验组50例,在腋窝淋巴结清扫时完整保留肋间臂神经;对照组30例,采用常规方法切除不保留肋间臂神经.术后对两组患者进行随访,观察患侧腋窝及上臂感觉情况并作比较.结果 术后3d、1个月、3个月及6个月实验组患侧腋窝及上臂感觉障碍发生率均小于对照组,且差异有统计学意义(P<0.05).结论 在Ⅰ、Ⅱ期乳腺癌腋窝淋巴结清扫术中保留肋间臂神经,能够有效地防止患侧腋窝及上臂皮肤感觉障碍,改善患者生活质量,具有较高的临床价值.

  17. Internal mammary sentinel lymph node biopsy: abandon or persist?

    Science.gov (United States)

    Qiu, Peng-Fei; Liu, Yan-Bing; Wang, Yong-Sheng

    2016-01-01

    Although the 2009 American Joint Committee on Cancer incorporated the internal mammary sentinel lymph node biopsy (IM-SLNB) concept, there has been little change in surgical practice patterns due to the low visualization rate of internal mammary sentinel lymph nodes with the traditional injection technique. Meanwhile, as internal mammary lymph nodes (IMLN) metastases are mostly found concomitantly with axillary lymph nodes (ALN) metastases, previous IM-SLNB clinical trials fail to evaluate the status of IMLN in patients who are really in need (only in clinically ALN negative patients). Our modified injection technique (periareolar intraparenchymal, high volume, and ultrasonographic guidance) significantly improved the visualization rate of internal mammary sentinel lymph nodes, making the routine IM-SLNB possible in daily practice. IM-SLNB could provide individual minimally invasive staging, prognosis, and decision-making for breast cancer patients, especially for patients with clinically positive ALN. Moreover, IMLN radiotherapy should be tailored and balanced between the potential benefit and toxicity, and IM-SLNB-guided IMLN radiotherapy could achieve this goal. In the era of effective adjuvant therapy, within the changing treatment approach - more systemic therapy, less loco-regional therapy - clinicians should deliberate the application of regional IMLN therapy. PMID:27390528

  18. 多层螺旋CT和正电子发射计算机体层成像-CT评价乳腺癌腋窝淋巴结状态的对照研究%Comparative analysis of multi-slice spiral CT and positron emission tomography-CT in evaluation of axillary lymph nodes in breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    孙宪昶; 刘庆伟; 赵素红; 祖德贵; 张如意; 李昕

    2008-01-01

    Objective To evaluate and compare spiral CT and positron emission tomography-CT (PET-CT) in characterization of of axillary lymph nodes in breast cancer patients.Methods Forty patients with pathologically proven breast Cancer underwent contrast-enhanced spiral CT of tbe breast and axilla,13 of them also underwent PET-CT examination.One hundred and fifty-eight axillary lymph nodes were found in the 40 patients through contrast enhanced spiral CT,while 57 lymph nodes were found in the 13 patients through PET-CT.Three radiologists rated the lymph nodes found in CT images on a five-point scale.If the score was equal to or greater than 3,it was defined as positive (metastatic),otherwise negative.Visual observation and semiquantitative analysis were used to classify lymph nodes in PET-CT images.The results of spiral CT observation and PET-CT observation of lymph nodes were compared with pathological results.The relative value of CT and PET-CT was analyzed.Exact probability statistics were employed.Results One hundred and fifty eight lymph nodes of 40 patients were detected by spiral CT,91 of them were diagnosed as positive and 67 as negative Among the lymph nodes found in spiral CT,99 were positive and 59 were negative pathologicall.A total of 57 lymph nodes were found by PET-CT.Thirty-nine of them were defined as positive and 18 as negative.Among the lymph nodes found in PET-CT,39 were positive and 18 were negative pathologically.The sensitivity,specificity,accuracy,positive and negative predictive values in CT prediction in axillary lymph nodes metastases were 88.89%,94.91%,91.14%,96.70%,and 83.58%,respectively.The sensitivity,specificity,accuracy,positive and negative predictive values in PET-CT prediction in axillary lymph nodes metastases were 97.44%,94.44%,96.49%,97.44%,and 94.44%,respectively.PET-CT had no significant difference with spiral CT in sensitivity,accuracy,positive and negative predictive values for detection of axillary lymph nodes in breast cancer

  19. 乳腺癌超声征象联合血管内皮因子C在老年乳腺癌腋窝淋巴结转移中的诊断价值%Research of clinical value of ultrasonic manifestations of breast cancer combined with vascular endothelial factor C in older axillary lymph node metastasis of breast cancer

    Institute of Scientific and Technical Information of China (English)

    魏莉; 孟宪杰

    2015-01-01

    目的 探讨乳腺癌超声征象联合肿瘤组织血管内皮生长因子( VEGF)-C在老年乳腺癌腋窝淋巴结转移中的诊断价值. 方法 选择老年乳腺癌患者50 例,利用免疫组织化学染色检测标本中VEGF-C的表达水平,分析乳腺癌超声征象与 VEGF-C 表达与乳腺癌患者腋窝淋巴结状态. 结果 50例老年乳腺癌患者中,腋窝淋巴结转移28例,未转移22例,乳腺癌病灶最小为0.7 cm×0.6 cm,最大为7.0 cm×6.3 cm;其中大于2 cm的35例,具有较为典型的恶性肿瘤超声特征,表现为形态不规则的较低回声区,呈"蟹足样",无包膜回声,后方回声衰减,内部回声不均匀;肿瘤>2 cm患者淋巴结转移率明显高于肿瘤≤2 cm者,肿瘤边界不清楚或有毛刺者淋巴结转移率明显高于肿瘤边界清楚者( P2 cm was significantly higher than that of the tumor≤2 cm.Lymph node metastasis rate of the tumor boundary unclear or with burr was significant-ly higher than that of the tumor boundary clear(P<0.05).Lower grade of breast cancer lesions ultrasound blood flow signals,the smaller the breast lesions( P<0.05) .Higher grade of breast cancer lesions ultrasound blood flow signals, higher the rate of lymph node metastasis( P<0. 05).There were 28 patients with positive expression of VEGF-C,including 24 cases with lymph node metastasis.VEGF-C positive expression rate of lymph node metastasis was significantly higher than that of patients with without lymph node metastasis(P<0.05).Conclusions Ax-illary lymph node metastasis of breast cancer is mainly characterized by changes in the structure of lymph nodes,consolidation occurs when the axillary lymph nodes,uneven thickness of substance,suspicious for metastatic lymph nodes.Senile breast cancer tumors of ultrasonic color doppler signal richness and VEGF-C positive expression rate are closely related to the axillary lymph node metastasis.

  20. Sentinel lymph node biopsy: technique validation at the Setúbal Medical Centre, Portugal

    Science.gov (United States)

    Ferreira, P; Baía, R; António, A; Almeida, J; Simões, J; Amaro, JC; Quintana, C; Branco, L; Rigueira, MV; Gonçalves, M; Pereira, EV; Ferreira, LM

    2009-01-01

    Aims: To evaluate the accuracy of sentinel lymph node biopsy in breast cancer patients at this institution, using combined technetium-99m (99mTc) sulphur colloid and patent blue vital dye. Methods: From March 2007 to July 2008, 50 patients with a tumour of less than 3 cm and with clinically negative axillary lymph nodes underwent sentinel lymph node biopsy (SLNB), followed by axillary lymph node dissection (ALND). Sub-areolar 99mTc sulphur colloid injection was performed the day before surgery, and patent blue vital dye was also injected sub-areolarly at least 5 minutes before surgery. Sentinel lymph node was identified during the surgical procedure, using a gamma probe and direct vision. All sentinel nodes underwent frozen section analysis. Later haematoxylin and eosin staining and immunohistochemical analysis were performed. Finally, SLNB was compared with standard ALND for its ability to accurately reflect the final pathological status of the axillary nodes. Results: The sentinel lymph node (SLN) was identified in 48 of 50 patients (96%). The number of sentinel lymph nodes ranged from one to four (mean 1.48) and non-sentinel nodes ranged from seven to 27 (mean 14.33). Of the 48 patients with successfully identified SLNs, 29.17% (14/48) were histologically positive. Sensivity of the SLN to predict axilla was 93.75%; accuracy was 97.96%. The SLN was falsely negative in one patient—6.25% (1/16). Conclusions: The SLNB represents a major advance in the surgical treatment of breast cancer as a minimally invasive procedure predicting the axillary lymph node status. This validation study demonstrates the accuracy of the SLNB and its reasonable false negative rate when performed in our institute. It can now be used as the standard method of staging in patients with early breast cancer at this institution. PMID:22275996

  1. Sentinel lymph node biopsy in breast cancer--the Aarhus experience

    DEFF Research Database (Denmark)

    Lauridsen, M C; Garne, J P; Hessov, I;

    2000-01-01

    Eighty patients, with newly diagnosed unifocal breast cancer and with no axillary metastases verified by ultrasonography, underwent sentinel lymph node (SLN) and subsequent axillary lymph node dissection. To identify the SLN, we used a combination of Tc-99m labelled colloid (Albures) and blue dye...... as SLNs that tested negative but with higher nodes that tested positive. If SLN biopsy is accepted as a routine procedure and when the exact indications are defined, the method described probably could be offered to the majority of breast cancer patients....

  2. 乳腺癌肿大腋窝淋巴结中BCSCs相关基因表达与肿瘤复发、转移的关系%Relation between expression of BCSCs associated genes from swelling axillary lymph nodes of breast cancer with recurrence and metastasis of tumor

    Institute of Scientific and Technical Information of China (English)

    余天雾; 龚建平; 郭丹; 周健

    2016-01-01

    目的:探索乳腺癌干细胞(BCSCs)相关基因CD44、Twist1、OCT4在乳腺癌患者癌组织、腋窝肿大淋巴结中的表达与乳腺癌转移及复发的关系。方法以免疫组化法和组织免疫荧光聚合酶链反应(RT-PCR)分别检测乳腺癌患者癌组织、腋窝淋巴结中BCSCs相关因子CD44、CD24、Twist1和OCT4的基因和抗原表达。结果在术前和术中确诊为乳腺癌的14例患者中均有癌细胞腋窝淋巴结转移。免疫组化法测得乳腺癌癌组织、腋窝肿大淋巴结BCSCs相关因子CD44、Twist1和OCT4抗原阳性过表达,而CD24呈低表达;RT-PCR检测乳腺癌组织、腋窝淋巴结中BCSCs相关因子CD44、Twist1和OCT4的基因表达增强(P<0.05),CD24基因低表达(P>0.05)。结论乳腺癌伴腋窝淋巴结肿大者BCSCs相关因子CD44、Twist1和OCT4的基因、抗原表达明显增高,可能表明BCSCs相关因子与乳腺癌细胞易早期转移、复发有关。%Objective To explore the relation between the expression of breast cancer stem cells(BCSCs) related gene CD44 , OCT4 and Twist1 in breast cancer tissues and swelling axillary lymph nodes with the recurrence and metastasis of breast cancer . Methods The genes and antigen expressions of BCSCs relative factors CD44 ,CD24 ,OCT4 and Twist1 in th breast cancer tissue and axillary lymph nodes were detected by the immunohistochemical method and RT‐PCR .Results Totally 14 cases of preopera‐tively and intraoperatively diagnosed breast cancer had axillary lymph nodes metastasis of cancer cells .The over expression of BC‐SCs relative factors CD44 ,OCT4 and Twist1 antigen positive in the breast cancer tissue and axillary lymph nodes were detected by the immunohistochemical method ,while CD24 was lowly expressed;the gene expressions of BCSCs relative factors CD44 ,OCT4 and Twist1 in the breast cancer tissue and axillary lymph nodes were enhanced by the RT‐PCR detection (P0 .05) .Conclusion The genes and

  3. Predictors to assess non-sentinel lymph node status in breast cancer patients with only one sentinel lymph node metastasis

    Institute of Scientific and Technical Information of China (English)

    YANG Ben; YANG Li; ZUO Wen-shu; GE Wen-kai; ZHENG Gang; ZHENG Mei-zhu; YU Zhi-yong

    2013-01-01

    Background The purpose of this study was to investigate the feasibility of avoiding axillary lymph node dissection (ALND) for patients with only one sentinel lymph node (SLN) metastasis.The characteristics and predictive factors for non-sentinel lymph node (NSLN) metastasis of patients with single positive SLN were also analyzed.Methods Patients with no and only one SLN metastasis (0/n and 1/n group,n ≥2) were selected from 1228 cases of invasive breast carcinoma,who underwent axillary dissection in Shandong Cancer Hospital between November 1999 and December 2011,to compare the characteristics of NSLN metastasis between them.For the 1/n group,the factors that influenced the NSLN metastasis were analyzed by univariate and multivariate analysis.Results Differences of the NSLN metastasis between the 0/n and the 1/n groups were significant (P <0.001).There was no significant difference between the axillary lymph node metastasis on level Ⅲ in 1/n group and 0/n group (P=0.570).When the total SLN number was ≥4 and with one positive case,the NSLN metastasis was not significantly different from that in the 0/n group (P=0.118).In the 1/n group,clinical tumor size (P =0.012),over-expression of Her-2 (P=0.003),tumor grade (P=-0.018) and the total number of SLN (P=-0.047) significantly correlated with non-SLN metastasis.Clinical tumor size (P=-0.015) and the expression of Her-2 (P=0.01) were independent predictive factors for non-SLN metastasis by the Logistic regression model.Conclusion Under certain conditions,breast cancer patients with single SLN metastasis could avoid ALND.

  4. [Bilateral axillary nodes. 30-year-old patient, housewife].

    Science.gov (United States)

    Rodak, R; Ramseier, E

    2007-11-14

    A 20-year old patient who had been adequately treated for lymph node tuberculosis 14 years ago presented 1 week after giving birth to a healthy daughter. She complained about painful lumps in both axillae. During pregnancy the patient suffered from hyperemesis gravidarum, lost 6 kg of weight, and had night sweats. During the last three months of her pregnancy she had a deep vein thrombosis in her right lower leg. The clinical examination showed soft axillary lumps up to 3 cm. The lab showed the following pathological findings: blood sedimentation rate 51 mm/h, CRP 44.8 mg/l, LDH 221 U/l and INR 1.3 (indicating insufficient anticoagulation with phenprocoumon). The chest x-ray showed no infiltrate or indications of a past tuberculosis. A fine needle aspiration cytology was performed on an accessible node. Gram stain, Ziehl Neelsen stain, as well as the bacteriological cultures were all negative. An ultrasound examination of the axilla showed a thickened subcutis without a mass. Cytology showed lobular epithelium, consistent wih ductal mamma epithelium without atypical cells. The diagnosis of an accessory mamma tissue in both axillae was made. During the course of the following weeks the glands decreased in size and the patient was free of symptoms.

  5. Localized Lymph Node Light Chain Amyloidosis

    Directory of Open Access Journals (Sweden)

    Binod Dhakal

    2015-01-01

    Full Text Available Immunoglobulin-derived light chain amyloidosis can occasionally be associated with localized disease. We present a patient with localized lymph node light chain amyloidosis without an underlying monoclonal protein or lymphoproliferative disorder and review the literature of lymph node amyloidosis discussing work-up and risk factors for systemic progression.

  6. Sentinel lymph node biopsy in breast cancer--experience with the combined use of dye and radioactive tracer at Aarhus University Hospital

    DEFF Research Database (Denmark)

    Lauridsen, Mette Cathrine; Garne, Jens Peter; Sørensen, Flemming Brandt;

    2004-01-01

    One hundred and twenty-four patients with palpable tumours underwent sentinel lymph node biopsy (SLNB) and subsequent axillary lymph node dissection. Ultrasound of the axilla was used as part of the diagnostic work-up on all patients and those with lymph node metastasis verified by fine-needle as...

  7. Imaging of human lymph nodes using optical coherence tomography: potential for staging cancer.

    Science.gov (United States)

    McLaughlin, Robert A; Scolaro, Loretta; Robbins, Peter; Hamza, Saud; Saunders, Christobel; Sampson, David D

    2010-04-01

    Histologic assessment is the gold standard technique for the identification of metastatic involvement of lymph nodes in malignant disease, but can only be performed ex vivo and often results in the unnecessary excision of healthy lymph nodes, leading to complications such as lymphedema. Optical coherence tomography (OCT) is a high-resolution, near-IR imaging modality capable of visualizing microscopic features within tissue. OCT has the potential to provide in vivo assessment of tissue involvement by cancer. In this morphologic study, we show the capability of OCT to image nodal microarchitecture through an assessment of fresh, unstained ex vivo lymph node samples. Examples include both benign human axillary lymph nodes and nodes containing metastatic breast carcinoma. Through accurate correlation with the histologic gold standard, OCT is shown to enable differentiation of lymph node tissue from surrounding adipose tissue, reveal nodal structures such as germinal centers and intranodal vessels, and show both diffuse and well circumscribed patterns of metastatic node involvement. PMID:20233873

  8. The sentinel lymph node in breast cancer patients : an evaluation of new developments in clinical practice

    NARCIS (Netherlands)

    Smidt, M.L.

    2006-01-01

    At the moment, one in nine women has a lifetime risk for developing breast cancer. The most important prognostic factor is the histologic status of the axillary lymph nodes. Removal of these nodes might lead to morbidity in terms of lymphedema and shoulder complaints. In the nineties, the sentinel l

  9. [Sentinel lymph node biopsy in pregnancy-associated breast cancer].

    Science.gov (United States)

    Mátrai, Zoltán; Bánhidy, Ferenc; Téglás, Melinda; Kovács, Eszter; Sávolt, Akos; Udvarhelyi, Nóra; Bartal, Alexandra; Kásler, Miklós

    2013-12-01

    The incidence of pregnancy-associated breast cancer is rising. Sentinel lymph node biopsy is the method of choice in clinically node negative cases as the indicated minimally invasive regional staging procedure. Some reports have linked radioisotope and blue dye required for lymphatic mapping to teratogenic effects, the idea of which has become a generalized statement and, until recently, contraindication for these agents was considered during pregnancy. Today, there are many published reports of successful interventions with low-dose 99mTc-labeled human albumin nanocolloid, based on dosimetric modeling demonstrating a negligible radiation exposure of the fetus. These results contributed to the seemingly safe and successful use of sentinel lymph node biopsy during pregnancy, though generally it can not replace axillary lymphadenectomy in the absence of high-quality evidence. The possibility of sentinel lymph node biopsy should be offered to pregnancy-associated early breast cancer patients with clinically negative axilla, and patients should be involved in the decision making following extensive counselling. This paper presents the successful use of sentinel lymph node biopsy with low-dose tracer during two pregnancies (in the first and third trimesters) and, for the first time in Hungarian language, it offers a comprehensive literature review on this topic. Orv. Hetil., 154(50), 1991-1997. PMID:24317358

  10. Are there other axillary lymph node metastasis than positive sentinel lymph nodes containing micrometnstmes and isolated tumor cells in patients with breast csncer%乳腺癌患者腋窝前哨淋巴结微转移及孤立癌细胞的评价

    Institute of Scientific and Technical Information of China (English)

    周雷; 宋新; 鲁瑶; 刘治滨; 李启东; 王文跃; 王正康; 贾振庚; 高島茂树

    2008-01-01

    目的 评价连续切片及免疫组化技术在乳腺癌前哨淋巴结(SLN)转移诊断中的价值,探讨微转移和孤立癌细胞的临床意义.方法 对80例腋窝淋巴结阴性的乳腺癌患者,用99mTc-SC和异硫蓝联合法进行前哨淋巴结活检(SLNB),对所有SLN和非SLN进行常规HE染色及免疫组织化学分析.结果 78例(97.5%)成功检出SLN,其中76.5%的SLN同位素和染料检查均为阳性.32例(41%)SLN转移阳性,其中13例(40.6%)为微转移.共有14例(43.8%)患者SLN是惟一阳性的淋巴结.SLN预测腋窝状态的敏感性、特异性和准确性分别为96.9%,100%和98.7%.SLN转移的患者,其SLN之外的转移率明显高于仅有微转移的患者(78.9%vs.23.1%).结论 连续切片及免疫组化技术是乳腺癌SLN转移诊断的敏感方法.仅有SLN微转移患者的SLN之外的腋窝淋巴结转移率低,但其预后意义及对手术方案的影响尚待进一步研究.%Objective The purpose of this study was to assess the value of serial sectioning and immunohistoehemistry(IHC)for the diagnosis of senfinel lymph node(SLNs)metastases in patients with breast cancer,and to evaluate the significance of mierometastases and isolated tunlor cells(ITCs)in the SLNs. Methods Eighty pailents with clinically node-negative breast cancer underwent SLN biopsy with both99mTc-labeled sulfur colloid and iBosulfan blue dye for SLN identification.All SLNS and non-SLNs were evalnated with standard H&E stain and IHC analysis. Results SLNs were successfully identified in 78 of 80 patients(97.5%),the isotope/blue dye concordanee rate was 76.5%for all SLNs.Thirty two patients (41%)had histologically positive SLNs,and 13(40.6%)of these patients hod SLNS with micrometastatic disease.In 14(43.8%)of these patients,the SLNs were the only nodes involved.The sensitivity,specificity and accuracy of SLN biopsy in predicting axillary node stams were 96.9%,100%and 98.7%,reslaeetively.Patients with positive SLNs metastasis had a markedly

  11. 腋窝淋巴结阳性乳腺癌中多西他赛序贯吡柔比星/环磷酰胺应用的临床观察%The Clinical Use of Docetaxel Followed by Doxorubicin and Cyclophosphamide in Axillary Lymph Node Positive Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    李春鸣; 余更生; 林秀欣; 周颖

    2012-01-01

      目的观察多西他赛序贯吡柔比星/环磷酰胺在腋窝淋巴结阳性乳腺癌辅助化疗中的应用。方法收集41例病理证实的腋窝淋巴结阳性的乳腺癌术后患者,予多西他赛序贯吡柔比星/环磷酰胺治疗,记录和分析治疗过程发生的毒不良反应。结果全组41例病例,有37例完成化疗,血液学毒性主要表现为白细胞的下降;非血液学毒性主要为脱发和胃肠道反应;其他包括转氨酶升高、心脏毒性及周围神经毒性等,经对症治疗后,所有毒不良反应均能缓解。结论多西他赛序贯吡柔比星/环磷酰胺在腋窝淋巴结阳性乳腺癌辅助化疗的临床应用中不良反应可耐受。%  Objective To evaluate the clinical use and toxicities of docetaxel followed by doxorubicin and cyclophosphamide as adjuvant chemotherapy for axillary lymph node positive breast cancer. Methods 41 patients with histologically proven, axillary lymph node positive breast cancer were enrolled into the study, and treated with docetaxel followed by doxorubicin and cyclophosphamide. All the toxicities produced by the regimen were recorded. Results 37 of 41 patients received all planed treatment. Neutropenia was the most frequent hematologic toxicity, and the most frequent nonhematologic toxicities included alopecia and gastrointestinal reaction, the other nonhematologic toxicities were hepatotoxicity, cardiotoxicity and peripheral neuropathy. Conclusions Toxicities of docetaxel followed by doxorubicin and cyclophosphamide as adjuvant chemotherapy for axillary lymph node positive early breast cancer were tolerable, and the regimen may be used in patients with axillary lymph node positive breast cancer.

  12. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01)

    DEFF Research Database (Denmark)

    Galimberti, Viviana; Cole, Bernard F; Zurrida, Stefano;

    2013-01-01

    For patients with breast cancer and metastases in the sentinel nodes, axillary dissection has been standard treatment. However, for patients with limited sentinel-node involvement, axillary dissection might be overtreatment. We designed IBCSG trial 23-01 to determine whether no axillary dissectio...

  13. Elastography in the assessment of sentinel lymph nodes prior to dissection

    Energy Technology Data Exchange (ETDEWEB)

    Tourasse, Christophe, E-mail: christophe.tourasse@radiologie-lyon.com [Radiology Department, Hopital Prive Jean Mermoz, 55 avenue Jean Mermoz, 69008 Lyon (France); Denier, Jean Francois [Anatomopathology Department, Technipath, 41 allee des Cypres, 69760 Limonest (France); Awada, Azzam; Gratadour, Anne-Christel; Nessah-Bousquet, Karima [Gynaecological and Breast Surgery Department, Hopital Prive Jean Mermoz, 69008 Lyon (France); Gay, Joeel [SuperSonic Imagine, Les Jardins de la Duranne - Bat. F, 510, rue Rene Descartes, 13857 Aix-en-Provence Cedex (France)

    2012-11-15

    Objective: Breast cancer starts as a local tumor but can become metastatic and spread via the lymph nodes. When the pre-operative assessment of the axillary lymph nodes is negative patients generally undergo sentinel node biopsy (SNB), followed by a secondary surgical axillary lymph node dissection (ALND) if the SNB is positive. The extemporaneous anatomo-pathological analysis of the sentinel lymph node enables metastases to be detected and an ALND at the same time of the SNB. The goal of this study was to evaluate the added value of ShearWave Elastography (SWE), compared with the conventional pre-operative assessment, in the screening of sentinel lymph nodes with a high metastatic risk, which could then benefit from an extemporaneous anatomo-pathological analysis. Patients and methods: Women undergoing breast surgery with SNB were prospectively enrolled. Before surgery, they underwent ultrasound and elastography imaging of axillary lymph nodes using the SuperSonic Imagine device and its ShearWave Trade-Mark-Sign elastography mode (SWE Trade-Mark-Sign ). The results obtained were compared to the immunohistochemical results for the removed lymph nodes. Results: 65 patients were enrolled. From the 103 lymph nodes examined by elastography and the 185 lymph nodes removed we were able to pair 81; 70 were healthy and 11 were malignant. The stiffness measurements (mean and maximal values) were significantly different between the healthy and metastatic lymph nodes, (p < 0.05). The areas under the ROC curves were 0.76 (95% confidence interval (CI): 0.58-0.94) and 0.75 (95%CI: 0.55-0.95) for the mean and the maximal stiffness, respectively. Conclusion: These encouraging results show a correlation between the metastatic risk of lymph nodes and their increased mean stiffness. Elasticity variables and potential thresholds that seem to predict the metastatic status of axillary lymph nodes were identified. If confirmed by further larger studies, these results could be useful in

  14. Adjuvant radiotherapy for melanoma metastatic to axillary and inguinal nodes: Regional tumor control and late effects

    OpenAIRE

    Ahmed SK; Kottschade LA; Markovic SN; Garces YI; Foote RL

    2014-01-01

    Background: Adjuvant radiotherapy reduces nodal recurrence in metastatic melanoma. The purpose of this study was to examine the effects of adjuvant radiotherapy on in-field nodal control of melanoma metastatic to axillary and inguinal lymph nodes. Methods: The medical records of patients who received adjuvant radiotherapy from January 1, 2003, through December 31, 2011, at Mayo Clinic were reviewed. Results: In the 20 patients identified, the rates of 2-year overall survival, nodal control, a...

  15. The value of completion axillary treatment in sentinel node positive breast cancer patients undergoing a mastectomy : a Dutch randomized controlled multicentre trial (BOOG 2013-07)

    NARCIS (Netherlands)

    van Roozendaal, L. M.; de Wilt, J. H. W.; van Dalen, T.; van der Hage, J. A.; Strobbe, L. J. A.; Boersma, L. J.; Linn, S. C.; Lobbes, M. B. I.; Poortmans, P. M. P.; Tjan-Heijnen, V. C. G.; Van de Vijver, K. K. B. T.; de Vries, J.; Westenberg, A. H.; Kessels, A. G. H.; Smidt, M. L.

    2015-01-01

    Background: Trials failed to demonstrate additional value of completion axillary lymph node dissection in case of limited sentinel lymph node metastases in breast cancer patients undergoing breast conserving therapy. It has been suggested that the low regional recurrence rates in these trials might

  16. The value of completion axillary treatment in sentinel node positive breast cancer patients undergoing a mastectomy: a Dutch randomized controlled multicentre trial (BOOG 2013-07)

    NARCIS (Netherlands)

    Roozendaal, L.M. van; Wilt, J.H.W. de; Dalen, T. van; Hage, J.A. van der; Strobbe, L.J.A.; Boersma, L.J.; Linn, S.C.; Lobbes, M.B.; Poortmans, P.M.P.; Tjan-Heijnen, V.C.; Vijver, K.K. Van de; Vries, J de; Westenberg, A.H.; Kessels, A.G.; Smidt, M.L.

    2015-01-01

    BACKGROUND: Trials failed to demonstrate additional value of completion axillary lymph node dissection in case of limited sentinel lymph node metastases in breast cancer patients undergoing breast conserving therapy. It has been suggested that the low regional recurrence rates in these trials might

  17. The value of completion axillary treatment in sentinel node positive breast cancer patients undergoing a mastectomy : A Dutch randomized controlled multicentre trial (BOOG 2013-07)

    NARCIS (Netherlands)

    Roozendaal, L.M.; de Wilt, J.H.; van Dalen, T.; van der Hage, J.A.; Strobbe, L.J.; Boersma, L.J.; Linn, S.C.; Lobbes, M.B.; Poortmans, P.M.P.; Tjan-Heijnen, V. C. G.; van de Vijver, K.K.; Westenberg, A.G.; Kessels, A.G.; Smidt, M.L.; de Vries, J.

    2015-01-01

    BACKGROUND: Trials failed to demonstrate additional value of completion axillary lymph node dissection in case of limited sentinel lymph node metastases in breast cancer patients undergoing breast conserving therapy. It has been suggested that the low regional recurrence rates in these trials might

  18. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer.

    NARCIS (Netherlands)

    Deurloo, E.E.; Tanis, P.J.; Gilhuijs, K.G.; Muller, S.H.; Kroger, R.; Peterse, J.L.; Rutgers, E.; Valdes Olmos, R.A.; Schultze Kool, L.J.

    2003-01-01

    Currently, breast cancer patients without clinically suspicious lymph nodes are candidates for sentinel lymph node procedures (SLNPs). The aims of this study were to investigate whether preoperative axillary ultrasonography and fine-needle aspiration cytology (FNA) can reduce the number of the more

  19. The study for breast lymphoscintigraphy of sentinal lymph node in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hwa Gon; Kim, Chang Soo; Kim, Myung Jun [College of Health Sciences, Catholic University of Pusan, Busan (Korea, Republic of)

    2006-06-15

    In the past, most patient of breast cancer suffered side effects due to the useless removement of Axillary Lymph Node, but there is no need to remove it because of the result in this study. The purpose of this study is to save surgery time and side effects after surgical operation for patients with breast cancer by making decisions of operation range for metastasis in first Stenosis Lymph Node using the {sup 99m}Tc-Tincolloid Scintigraphy and the Micro Probe for radioisotope. As a result of this study, 15 among 20 patients became objects of this study could reduced side effects for operation because there were no axillary lymph node operations. However there is no standard for method of this treatment. It should be standardize where inject point is, how much {sup 99m}Tc-Tincolloid should be injected (radioactivity value), and the need of massage and Lymph Scintigraphy. Nevertheless I think that this result of study is useful to reduce suffering and side effects from breast cancer and also we should try to do that continuously. The objects for this study were 20 patients diagnosed as breast cancer by Ultrasonography, Mammography and Biopsy. The average of patient age was 45.4 years and its range was between 31 and 71 years. In case of clinical period there were 9 patients of Period I and 11 patients of Period II. The equipment for this study were {sup 99m}Tc-Tincolliod describing the Stenosis Lymph Node as a tracer. Micro Probe: Neoprobe 2000 (the rest is Gamma Probe) tracing the location, and MS-II Gamma Camera: SIEMENS (the rest is MS-II Gamma Camera) describing the image. There were 3 methods for this study, after selecting one of those methods all 20 patients were performed Stenosis Lymph Node diagnosis and Gamma Probe in operation room. The result was that I imaged all the 20 patients, and seek the Stenosis Lymph Node by using Gamma Probe. Metastasis in Stenosis Lymph Node was 5 and Metastasis in Axillary Lymph Node was 3 between Metastasis in Stenosis Lymph

  20. The Axillary Nodal Harvest in Breast Cancer Surgery Is Unchanged by Sentinel Node Biopsy or the Timing of Surgery

    Directory of Open Access Journals (Sweden)

    B. E. Byrne

    2012-01-01

    Full Text Available Introduction. Patients with a positive sentinel lymph node biopsy may undergo delayed completion axillary dissection. Where intraoperative analysis is available, immediate completion axillary dissection can be performed. Alternatively, patients may undergo primary axillary dissection for breast cancer, historically or when preoperative assessment suggests axillary metastases. This study aims to determine if there is a difference in the total number of lymph nodes or the number of metastatic nodes harvested between the 3 possible approaches. Methods. Three consecutive comparable groups of 50 consecutive patients who underwent axillary dissection in each of the above contexts were identified from the Portsmouth Breast Unit Database. Patient demographics, clinicopathological variables, and surgical treatment were recorded. The total pathological nodal count and the number of metastatic nodes were compared between the groups. Results. There were no differences in clinico-pathological features between the three groups for all features studied with the exception of breast surgical procedure (P<0.001. There were no differences in total nodal harvest (P=0.822 or in the number of positive nodes harvested (P=0.157 between the three groups. Conclusion. The three approaches to axillary clearance yield equivalent nodal harvests, suggesting oncological equivalence and robustness of surgical technique.

  1. Tattoo-pigmented cervical lymph node that masqueraded as the sentinel lymph node in oral squamous cell carcinoma.

    Science.gov (United States)

    Pinto, Amith; Wieshmann, Hulya; Triantafyllou, Asterios; Shaw, Richard

    2015-11-01

    We describe a case of a pigmented cervical lymph node mimicking the sentinel node during sentinel lymph node biopsy (SLNB) on a patient with oral squamous cell carcinoma (OSCC). The patient had extensive tattoos on his neck. This pigmented lymph node was not identified to be the sentinel lymph node using static and dynamic lymphoscintigraphy. Subsequent histological analysis revealed tattoo pigment within this lymph node. It is important during cervical SLNB to be aware that cutaneous tattoos can pigment lymph nodes. PMID:26188933

  2. Sentinel lymph node mapping of a breast cancer of the vulva: Case report and literature review

    OpenAIRE

    Cripe, James; Eskander, Ramez; Tewari, Krishnansu

    2015-01-01

    Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with locally advanced breast carcinoma arising in the vulva demonstrates the utilization of sentinel lymph node mapping to identify metastatic lymph nodes previously unable to be identified via traditional surgical exploration. Our case supports the principles of adjuvant therapy for bre...

  3. Combined Methylene Blue Dye andRadioactive Tracer Technique for Sentinel Lymph Node Localization in Early Breast Cancer

    Directory of Open Access Journals (Sweden)

    Abdolrasoul Talei

    2010-10-01

    Full Text Available Background: Sentinel lymph node biopsy is a technique used to identify the axillary node most likely to contain tumor cells that have metastasized from a primarycarcinoma of the breast. This technique provides accurate staging with fewer complications than axillary dissection and may result in decreased costs. We designed the present study to determine the accuracy and success rate of a combined blue dyeand radioactive tracer technique in sentinel node localization. Methods: This prospective study included 70 patients with early stage (tumor>5cm; T1, T2 operable breast cancer and nonpalpable axillary lymphadenopathy seen between 2005 and 2009. Patients underwent sentinel lymph node localization using 4mL of blue dye combined with radioactive colloid. After identification and removal of the sentinel node(s, the axilla was checked for any residual radioactivity. A sentinelnode was defined as any node that was hot, hot and blue or only blue.Results:The sentinel node was identified in 66 patients with a detection rate of 94.2%,and a mean of 1.5 sentinel nodes were identified and harvested (range of 1-4. In 23cases, the sentinel lymph node contained metastatic disease on pathological assessment.There was no pathological evidence of any metastases in the sentinel node in the remaining 43 patients. All sentinel lymph nodes were located in level I of the axillary region. In four patients, no sentinel lymph node was found, so axillary dissection was performed. The sensitivity of the procedure in predicting further axillary disease was 95.6% with a specificity of 97.6%.Conclusion: The present study describes the blue dye and radioisotope localization technique as successful in identifying the sentinel lymph node in early-stage breast cancer patients.

  4. Analysis on related factors of axillary lymph node metastasis in patients with cT1-2 N0 breast cancer%cT1-2 N0期乳腺癌腋窝淋巴结转移相关因素分析

    Institute of Scientific and Technical Information of China (English)

    崔竹山; 杜烨; 朱珠; 高品; 李佳娓; 范志民

    2015-01-01

    Objective To investigate the relationships between axillary lymph node metastasis and clinicopathologic features in the patients with cT1-2 N0 breast cancer and clarify the law of axillary lymph node metastasis,and to find the risk factor,and provide the theoretical basis for individuation therapy.Methods 687 patients with cT1-2 N0 breast cancer were divided into negative group and positive group according to the pathological results of axillary lymph node,and the clinicopathologic features were layered.The risk factors of axillary lymph node metastasis were screened out by Chi-square test and Logistic regression analysis.Results In 687 cases of cT1-2 N0 breast cancer,156 (22.7%)cases were observed with axillary lymph node metastasis. The age,cT stage,pT stage, pathological type,vascular invasion,perineural invasion estrogen receptor (ER),progesterone receptor (PR), and molecular subtyping were the factors that influenced axillary lymph node metastasis in univariate analyses.The age < 35 years, cT2 , invasive ductal carcinoma, vascular invasion positive and Luminal subtyping were the independent risk factors of axillary lymph nodes metastasis in multivariate analyses (r = 3.440,P = 0.010;r =1.770,P =0.007;r = 3.397,P = 0.001;r = 7.434,P = 0.000;r = 2.212,P = 0.015).Conclusion In the patients with cT1-2 N0 breast cancer,the age,cT,pathological type,vascular invasion and molecular subtyping are important predictors of axillary lymph node metastasis and vascular invasion was the most important predictor.The preoperative comprehensive analysis and evaluation of clinical data and preoperative pathological results obtained will help to select the right surgical operation.%目的:探讨 cT1-2 N0期乳腺癌患者临床及病理因素与腋窝淋巴结转移的关系,阐明乳腺癌腋窝淋巴结转移规律,发现乳腺癌腋窝淋巴结转移的危险因素,为乳腺癌个体化治疗提供理论依据。方法:选取 cT1-2 N0期乳腺癌患者687例,根

  5. [Prospect and guideline update of sentinel lymph node biopsy for patients with early-stage breast carcinoma].

    Science.gov (United States)

    Zhou, Mei-qi; Chen, Hai-long; Hu, Yue; Deng, Yong-chuan; Zheng, Shu

    2014-07-01

    Axillary lymph nodes are the most common and initial site of metastasis of breast carcinoma. Precise axillary staging of breast carcinoma before initial treatment is crucial as it allows efficient identification for local and systemic treatment options, and provides prognostic information. Sentinel lymph node biopsy (SLNB) is an accurate minimally invasive technology for axillary staging. Although top evidence of high-quality clinical trials showed that SLNB could safely and effectively replace axillary lymph node dissection (ALND) for axillary negative patients with decrease in complications and improvement in quality of life, there are specific indications and contraindications for SLNB. Clinicians should balance the compliance of guideline and native clinical practice, especially for the circumstance of multifocal/multicentric lesion, breast biopsy history, and neoadjuvant chemotherapy. With the accumulation of clinical practice and new results of clinical trials, axillary therapy has changed from unique surgery to patient-tailored multi-disciplinary intervention, although ALND should be recommended traditionally if SLNB is positive. Intensive and accurate preoperative axillary staging is gradually valued by clinicians. Development of imaging modality especially ultrasonography and ultrasound-guided biopsy can identify some extra lymph node positive patients directly to ALND with avoidance of unnecessary SLNB. Thus, the positive rate of SLNB will decline significantly. It seems possible that axillary management will step into a noninvasive era abandoning SLNB in some patients with small breast cancer. In this article we review the prospect and guideline update of SLNB for patients with early-stage breast cancer.

  6. Nanoparticles in Sentinel Lymph Node Assessment in Breast Cancer

    Directory of Open Access Journals (Sweden)

    Michael Douek

    2010-11-01

    Full Text Available The modern management of the axilla in breast cancer relies on surgery for accurate staging of disease and identifying those patients at risk who would benefit from adjuvant chemotherapy. The introduction of sentinel lymph node biopsy has revolutionized axillary surgery, but still involves a surgical procedure with associated morbidity in many patients with no axillary involvement. Nanotechnology encompasses a broad spectrum of scientific specialities, of which nanomedicine is one. The potential use of dual-purpose nanoprobes could enable imaging the axilla simultaneous identification and treatment of metastatic disease. Whilst most applications of nanomedicine are still largely in the laboratory phase, some potential applications are currently undergoing clinical evaluation for translation from the bench to the bedside. This is an exciting new area of research where scientific research may become a reality.

  7. Enhancement characteristics of retroperitoneal lymphomatous lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Hagtvedt, Trond; Smith, Hans-Joergen; Kolbenstvedt, Alf [Dept. of Radiology and Nuclear Medicine, Oslo Univ. Hospital, Oslo (Norway); Faculty of Medicine, Univ. of Oslo, Oslo (Norway); Aaloekken, Trond Mogens [Dept. of Radiology and Nuclear Medicine, Oslo Univ. Hospital, Oslo (Norway)], e-mail: trond.mogens.aalokken@rikshospitalet.no; Graff, Bjoern Anton [Div. of Diagnostics, Vestre Viken Hospital Trust, Drammen (Norway); Kongsberg Hospital, Vestre Viken Hospital Trust, Drammen (Norway); Holte, Harald [Dept. of Oncology, Oslo Univ. Hospital, Oslo (Norway)

    2013-04-15

    Background: Previous studies of CT enhancement of lymphomatous lymph nodes (LLN) of the neck and the mediastinum showed that the LLN had lower enhancement values than normal lymph nodes. Purpose: To elucidate the contrast medium enhancement curves of LLN in the retroperitoneum by comparing the curves of LLN with those of normal lymph nodes, to test whether differences between these curves could be of diagnostic value, and to compare the present enhancement curves of LLN of the retroperitoneum with the curves of LLN of the neck and the mediastinum from previous similar investigations. Material and Methods: Twenty-eight consecutive patients with LLN of the retroperitoneum (three with Hodgkin's lymphoma [HL]) and 21 control patients with sarcomas and thus presumably normal retroperitoneal nodes underwent dynamic CT examinations. The previous, similar investigation of lymph nodes of the neck comprised 28 patients with LLN and the investigation of mediastinal lymph nodes comprised 24 patients with LLN. Results: The enhancement curves of the retroperitoneal LLN had significantly lower attenuation than those of the retroperitoneal control nodes. A combination of peak contrast value and time to peak adjusted to total body weight yielded a diagnostic accuracy which at the best showed a sensitivity of 90.5% with a specificity of 82.6%. The LLN of the retroperitoneum had higher attenuation values than corresponding nodes of the mediastinum but no significant difference was found between LLN of the retroperitoneum and LLN of the neck in previous similar investigations. Conclusion: The comparison of enhancement curves of retroperitoneal LLN with retroperitoneal control nodes showed a marked similarity with and substantiates our previous findings in lymph nodes of the neck and of the mediastinum. The best diagnostic accuracy was achieved by combining the parameters peak contrast value and time to peak and adjusting these values to the body weight. Peak enhancement of the

  8. Inguinal Lymph Node Anthracosis: A Case Report.

    Science.gov (United States)

    Biguria, Rafael; Soto, Carlos Alberto

    2016-07-01

    Anthracosis is defined as black, dense pigments in tissues, usually carbon deposits. We, as surgeons, have to make decisions during surgery to the best of our knowledge and based on what the literature provides us. We present the case of a 30-year-old female patient who underwent abdominoplasty. During surgery, bilateral inguinal pigmented and enlarged lymph nodes were seen. Biopsy of the nodes was done to rule out any malignancy. The results showed tattoo pigments on all lymph nodes. We present this case as tattoo pigment migration, which has been rarely described. PMID:27536493

  9. Sentinel lymph node biopsy in pregnant patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gentilini, Oreste; Toesca, Antonio; Sangalli, Claudia; Veronesi, Paolo; Galimberti, Viviana [European Institute of Oncology, Division of Senology, Milan (Italy); Cremonesi, Marta; Pedroli, Guido [European Institute of Oncology, Unit of Medical Physics, Milan (Italy); Colombo, Nicola [European Institute of Oncology, Unit of Cardiology, Milan (Italy); Peccatori, Fedro [European Institute of Oncology, Division of Haematology-Oncology, Milan (Italy); Sironi, Roberto [S. Pio X Hospital, Unit of Obstetrics and Gynecology, Milan (Italy); Rotmensz, Nicole [European Institute of Oncology, Division of Epidemiology and Biostatistics, Milan (Italy); Viale, Giuseppe [European Institute of Oncology, Division of Pathology, Milan (Italy); University of Milan School of Medicine, Milan (Italy); Goldhirsch, Aron [European Institute of Oncology, Department of Medicine, Milan (Italy); Veronesi, Umberto [European Institute of Oncology, Division of Senology, Milan (Italy); European Institute of Oncology, Milan (Italy); Paganelli, Giovanni [European Institute of Oncology, Division of Nuclear Medicine, Milano (Italy)

    2010-01-15

    Sentinel lymph node biopsy (SLNB) is currently not recommended in pregnant patients with breast cancer due to radiation concerns. Twelve pregnant patients with breast cancer received low-dose (10 MBq on average) lymphoscintigraphy using {sup 99m}Tc human serum albumin nanocolloids. The sentinel lymph node (SLN) was identified in all patients. Of the 12 patients, 10 had pathologically negative SLN. One patient had micrometastasis in one of four SLN. One patient had metastasis in the SLN and underwent axillary clearance. From the 12 pregnancies, 11 healthy babies were born with no malformations and normal weight. One baby, whose mother underwent lymphatic mapping during the 26th week of gestation, was operated on at the age of 3 months for a ventricular septal defect and at 43 months was in good health. This malformation was suspected at the morphological US examination during week 21, well before lymphoscintigraphy, and was confirmed a posteriori by a different observer based on videotaped material. No overt axillary recurrence appeared in the patients with negative SLNs after a median follow-up of 32 months. Our experience supports the safety of SLNB in pregnant patients with breast cancer, when performed with a low-dose lymphoscintigraphic technique. (orig.)

  10. Expression and clinical significance of P-gp, MMP-2 and c-erbB-2 in infiltrating ductal breast cancer and metastatic axillary lymph nodes%P-gP、MMP-2、C-erbB-2在乳腺癌原发灶和转移淋巴结中的表达对比研究

    Institute of Scientific and Technical Information of China (English)

    王晔; 王建丰; 仇生龙; 项富海; 李克

    2011-01-01

    目的:探讨乳腺癌侵袭转移和多药耐药之间的关系,为治疗方案的个体化提供依据.方法:采用免疫组化方法检测46例乳腺浸润性导管癌患者乳腺原发灶及相应腋淋巴结转移灶中P-gp、MMP-2、c-erbB-2的表达,结合临床表现、病理学指标,分析其相关性.结果:46例原发灶P-gp阳性表达35例(76.1%),MMP-2阳性表达25例(54.3%),c-erbB-2高表达18例(39.1%);相应腋淋巴结转移灶P-gp阳性表达28例(60.9%),MMP-2阳性表达16例(34.8%),c-erbB-2高表达16例(34.8%);P-gp、MMP-2蛋白表达水平与肿块大小、淋巴结转移数目均呈正相关(P<0.05),c-erbB-2蛋白表达水平与腋窝淋巴结转移数量呈正相关,与ER、PR表达呈负相关,P-gp阳性表达与MMP-2和c-erbB-2的表达呈正相关(P<0.05).结论:肿瘤原发灶与转移灶存在异质性,P-gp、MMP-2、c-erbB-2的表达与乳腺癌的多药耐药和侵袭转移有关,检测上述基因在原发灶与转移灶的表达,为乳腺癌选择个体化的化疗、内分泌治疗及分子靶向治疗提供了分子生物学依据.%Objective: To observe the expression of P-gp,MMP-2 and c-erbB-2 in primary tumor and their metastatic axillary lymph nodes and study the relationship with clinicopathology characteristics and also the correlation between P-gp,MMP-2 and c-erbB-2. Methods: Immunohistochemical technique was performed to detect the expression of P-gp, MMP-2 and c-erbB-2 in 46 cases of infiltrating ductal breast cancer with primary tumor and their metastatic axillary lymph nodes without undergoing neo-adjuvent therapy.Their clinical and pathological indices and follow up data were analyzed. Results: The positive rate of P-gp in primary tumor was 76.1% (35/46)and in metastatic axillary lymph nodes was 60.9 % (28/46), the expression of Pg-p was significantly correlated with the tumor size and lymph node metastasis (P <0.05). The positive rate of MMP-2 in primary tumor was 54.3 % (25/46)and in metastatic axillary

  11. Duration of (18)F-FDG avidity in lymph nodes after pandemic H1N1v and seasonal influenza vaccination

    DEFF Research Database (Denmark)

    Thomassen, Anders; Lerberg Nielsen, Anne; Gerke, Oke;

    2011-01-01

    'reference' (i.e. contralateral, non-vaccinated) axillary lymph nodes were evaluated in 61 patients (19 of 61 patients were scanned twice). The maximal intensity in FDG uptake (SUV(max)) in draining lymph nodes was 5 g/ml body weight (BW), whereas the maximal intensity in reference lymph nodes was 1.9 g....../ml BW. The SUV(max) was normalized approximately 40 days after vaccination. No significant enlargement of metabolically active draining lymph nodes could be demonstrated on CT scan. Chemotherapy or immunosuppressive drugs given within 2 weeks from vaccination did not affect SUV(max) in the axillary...

  12. Black sentinel lymph node and 'scary stickers'.

    Science.gov (United States)

    Yang, Arthur S; Creagh, Terrence A

    2013-04-01

    An unusual case is presented of a young adult patient with two black-stained, radio-nucleotide tracer-active sentinel lymph nodes biopsied following her primary cutaneous melanoma treatment. This was subsequently confirmed to be secondary to cutaneous tattoos, averting the need of an elective regional node dissection. History of tattooing and tattoo removal should therefore be obtained as a routine in all melanoma patients considered for sentinel node biopsy (SLN). SLN biopsy and any subsequent completion node dissection should be strictly staged so that proper histologic diagnosis of the sentinel node is available for correct decision making and treatment. PMID:23010587

  13. Altered lymphatic drainage after breast-conserving surgery and axillary node dissection: local recurrence with contralateral intramammary nodal metastases.

    Science.gov (United States)

    Wellner, Rachel; Dave, Jasmine; Kim, Unsup; Menes, Tehillah S

    2007-02-01

    A review of the literature shows that lymphoscintigraphy and sentinel node biopsy are feasible in patients with previous breast and axillary surgery and could be especially warranted because in these patients, lymphatic drainage might not include the axillary basin. We report a case of a woman with recurrent breast cancer after breast-conserving surgery. The patient was found to have metastases in the contralateral intramammary lymph nodes. Demonstrating that such patterns do occur after previous treatment for breast cancer carries implications for the staging and management of these patients. PMID:17386126

  14. Expression of mammaglobin in preoperatively aspirated breast cancer and axillary lymph node tissues and clinical significance%乳腺球蛋白在术前乳腺癌和腋窝淋巴结细针穿刺吸取组织中的表达及临床意义

    Institute of Scientific and Technical Information of China (English)

    方先勇; 朱立强; 江涛; 朱玉秋

    2011-01-01

    目的 探讨乳腺球蛋白(mammaglobin,MAM)在术前乳腺癌及腋窝淋巴结细针穿刺吸取组织中的表达及临床意义.方法 对91例原发性乳腺癌行术前细针穿刺,将吸取的组织制备涂片,采用免疫组织化学方法(EnVision法)检测MAM表达,观察MAM表达与临床病理指标的关系.同时另收集15例原发性肺癌腋窝淋巴结转移患者,分析乳腺癌腋窝淋巴结转移、乳腺癌增生性淋巴结炎和肺癌腋窝淋巴结转移三者间术前腋窝淋巴结MAM表达的区别.统计分析采用χ2检验.结果 在91例原发性乳腺癌患者中MAM的阳性表达率为74.72%(68/91).MAM的阳性表达与雌激素受体(ER)、孕激素受体(PR)、组织学分级、细胞学分级有关(P0.05).腋窝淋巴结观察结果显示,MAM在乳腺癌腋窝淋巴结转移患者中呈阳性表达,在乳腺癌增生性腋窝淋巴结炎和肺癌腋窝淋巴结转移患者中均为阴性表达.结论 MAM可表达于原发性和转移性乳腺癌,细针穿刺细胞学检查结合MAM的测定对乳腺癌的诊断及鉴别具有一定辅助判断价值.MAM阳性表达与ER、PR状态、细胞学分级、组织学分级有关,有利于了解肿瘤的生物学指标及判断预后.%Objective To investigate the expression of mammaglobin ( MAM ) in preoperative breast carcinoma and axillary lymph node tissues using fine-needle aspiration (FNA) biopsy and its clinical significance. Methods Ninety-one cases of primary breast carcinoma were enrolled into the study. All cases received preoperative fine-needle aspiration biopsy. Immunocytochemistry for testing MAM was performed in all the cases using EnVision method to observe the relation between MAM positive expression and cytologic grading and clinicopathological parameters. In the meantime, 15 primary lung cancer patients were collected, with an intention of comparing the MAM expression in metastatic axillary lymph node of breast cancer, hyperplastic axillary lymphadenitis of breast

  15. Prognostic Implications of Lymph Node Yield and Lymph Node Ratio in Papillary Thyroid Carcinoma

    NARCIS (Netherlands)

    Nunes, Jonathan H. Vas; Clark, Jonathan R.; Gao, Kan; Chua, Elizabeth; Campbell, Peter; Niles, Navin; Gargya, Ash; Elliott, Michael S.

    2013-01-01

    Background: The lymph node yield (LNY) and the lymph node ratio (LNR) have been shown to be important prognostic factors in oral, colon, and gastric cancers. The role of the LNY and LNR in papillary thyroid cancer (PTC) is unclear. The aims of this study were to determine if a high LNR and a low LNY

  16. A retrospective study of axillary and internal mammary sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy%乳腺癌新辅助化疗后腋窝及内乳前哨淋巴结活检研究

    Institute of Scientific and Technical Information of China (English)

    曹晓珊; 丛斌斌; 孙晓; 邱鹏飞; 刘雁冰; 赵桐; 陈鹏; 王春建; 王永胜

    2015-01-01

    Background and purpose:Whether axillary sentinel lymph node biopsy (ASLNB) could replace axillary lymph node dissection (ALND) in patients who converted after neoadjuvant chemotherapy (NAC) from cN+ to ycN0 is still contentious, and the previous study only evaluated the pathological status of ALN without internal mammary lymph node (IMLN) condition. This study is to evaluate roles of ASLNB and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC.Methods:From Jan. 2012 to Dec. 2014, 60 breast cancer cT1-4N0-3M0patients who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept surgery after NAC from our department were enrolled into the retrospective study. Patients with cN0 before NAC and ycN0 after NAC underwent ASLNB (group A). Patients with cN+ received NAC and ycN0 after NAC (group B) were treated with ASLNB and ALND. Only patients whose clinical nodal status remained positive (ycN+) after NAC underwent ALND without ASLNB (group C). All the patients received radiotracer injection and patients in group A and group B received blue dye injection additionally. Meanwhile, IM-SLNB would be performed for all patients with IM-SLN visualization.Results:The number of patients enrolled in group A, group B and group C was 6, 45 and 9 cases respectively. The accuracy rate of ASLNB in group A was 100% (6/6). Only one patient was axillary sentinel lymph node (ASLN) positive performed ALND. With combination of blue dye and radiolabeled colloid, the accuracy rate of ASLNB in group B was 100% (48/48) and the false negative rate (FNR) was 17.9% (5/28). The FNR in patients with 1, 2 and>2 SLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/7). All of the ALNs were positive in group C. The visualization rate of IM-SLN was 63.3% (38/60). The detection rate of IM-SLNB was 97.4% (37/38) and the metastasis rate was 8.1% (3/37). The incidence of complications was 5.3% (2/38).Conclusion:ASLNB can be performed either before or after

  17. Validation of Six Nomograms for Predicting Non-sentinel Lymph Node Metastases in a Dutch Breast Cancer Population

    OpenAIRE

    Dingemans, Siem A; de Rooij, Peter D.; van der Vuurst de Vries, Roos M.; Budel, Leo M.; Contant, Caroline M.; van der Pool, Anne E. M.

    2015-01-01

    Background The usefulness of axillary lymph node dissection (ALND) in patients with positive sentinel nodes (SN) is still an ongoing debate. Several nomograms have been developed for predicting non-sentinel lymph node metastases (NSLNM). We validated six nomograms using data from 10 years of breast cancer surgery in our hospital. Methods We retrospectively analyzed all patients with a proven breast malignancy and a SN procedure between 2001 and 2011 in our hospital. Results Data from 1084 pat...

  18. Contraindications of sentinel lymph node biopsy: Áre there any really?

    Directory of Open Access Journals (Sweden)

    Zografos George

    2007-01-01

    Full Text Available Abstract Background One of the most exciting and talked about new surgical techniques in breast cancer surgery is the sentinel lymph node biopsy. It is an alternative procedure to standard axillary lymph node dissection, which makes possible less invasive surgery and side effects for patients with early breast cancer that wouldn't benefit further from axillary lymph node clearance. Sentinel lymph node biopsy helps to accurately evaluate the status of the axilla and the extent of disease, but also determines appropriate adjuvant treatment and long-term follow-up. However, like all surgical procedures, the sentinel lymph node biopsy is not appropriate for each and every patient. Methods In this article we review the absolute and relative contraindications of the procedure in respect to clinically positive axilla, neoadjuvant therapy, tumor size, multicentric and multifocal disease, in situ carcinoma, pregnancy, age, body-mass index, allergies to dye and/or radio colloid and prior breast and/or axillary surgery. Results Certain conditions involving host factors and tumor biologic characteristics may have a negative impact on the success rate and accuracy of the procedure. The overall fraction of patients unsuitable or with multiple risk factors that may compromise the success of the sentinel lymph node biopsy, is very small. Nevertheless, these patients need to be successfully identified, appropriately advised and cautioned, and so do the surgeons that perform the procedure. Conclusion When performed by an experienced multi-disciplinary team, the SLNB is a highly effective and accurate alternative to standard level I and II axillary clearance in the vast majority of patients with early breast cancer.

  19. Study of the techniques for the sentinel lymph node in breast cancer

    International Nuclear Information System (INIS)

    Axillary lymphadenectomy for the treatment of breast carcinoma can benefit the patient only if there is lymph nodes metastasis. Methods used to evaluate lymph node status were inefficient in the majority of cases of invasive carcinoma. The search for the sentinel lymph node has presented a high negative predictive value. Acknowledge of its use and limitations is important. The objective is the analysis of various techniques to search for sentinel lymph node (SLN). The method: 81 cases of breast carcinoma were studied with clinically negative axilla. Of these, the dyeing technique was used in 36 cases, the probe technique was used in 6 cases and 39 both techniques were used simultaneously. A total axillary dissection was done in every case, except for two. The results were: the SLN was found in 74 cases and of these, 35 with axillary metastases. There were two false-negative results. Of the 36 cases where the dyeing technique was used, the SLN was found in 32 cases and of these, 21 presented axillary metastases and there were one false-negative result. The SLN was found in all 6 cases using the probe technique, two had axillary metastases and there were no false-negative results. The SLN was found in 36 of the 39 cases using the two different techniques. In 34 cases it was found by the two methods and there were one false-negative. In the other two cases there was a disagreement between the two methods and of these, two were false-negative (these two cases are contained in the first six using the probe. Conclusion: the predictive negative value of the SLN is very high in the different techniques and will be used as a method to avoid axillary dissection in certain cases. (author)

  20. 99mTc-甲氧基异丁基异腈显像对乳腺肿物及腋淋巴结转移的诊断%99mTc-methoxyisobutyl isonitrile imaging in identification of benign and malignant breast lesions and detection of metastatic axillary lymph node

    Institute of Scientific and Technical Information of China (English)

    张致峰; 毕建威; 孔令山; 张晏玲; 苏金莲; 梁丽

    2001-01-01

    Objective: To identify benign and malignant breast lesions and detect metastatic axillary lymph nodes using99mTc-methoxyisobutyl isonitrile(MIBI) imaging. Methods: Fifty-one women with a palpable breast lesions and 11 patients suspicious of metastatic lymph node after primary breast cancer operation were studied with planar imaging 10 min and 60 min after injection of 99mTc-MIBI. Semiquantitative analysis of uptake ratio(UR) of 99mTc-MIBI in locations of tumour and lymph nodes were performed. All the results were compared with pathologic study. Results: In palpable lesions, the sensitivity of 99mTc-MIBI planar imaging for detecting primary breast cancer was 93.3% and the specificity was 95.2%;The positive predictive value was 96.6%. The negative predictive value was 90.9%. The sensitivity of 99mTc-MIBI planar imaging to detect metastatic axillary lymph nodes was 64.0% and the specificity was 94.1%;The positive predictive value was 94.1%. The negative predictive value was 64.0%. Conclusion: 99mTc-MIBI planar imaging has high sensitivity and specificity for differentiation of breast tumors and detection of axillary lymph node involvement.%目的:研究99mTc-甲氧基异丁基异腈(99mTc- MIBI)显像鉴别诊断乳腺肿物的良、恶性及探测腋淋巴结转移的情况。方法:对51例可触及的乳腺肿物及11例乳腺癌术后疑腋淋巴结转移患者分别于注射99mTc-MIBI后10和60 min行平面显像,半定量分析肿物部位的摄取比值(uptake ratio,UR),均与病理结果对比。结果:99mTc-MIBI平面显像对可触及的乳腺肿物诊断乳腺癌的敏感性为93.3%,特异性为95.2%;阳性预测值为96.6%,阴性预测值为90.9%。探测腋淋巴结转移的敏感性为64.0%,特异性为94.1%;阳性预测值为94.1%,阴性预测值为64.0%。结论:99mTc-MIBI平面显像鉴别乳腺肿物的良、恶性及探测腋淋巴结转移有较高的敏感性和特异性。

  1. Analysis on Correlation Between Gene Expression of C-erbB-2, Ki67, nm23 and Axillary Lymph Node Metastasis in Breast Cancer%C-erbB-2、Ki67、nm23基因表达与乳腺癌腋窝淋巴结转移的相关性分析

    Institute of Scientific and Technical Information of China (English)

    刘广舒; 高云; 郭鹏; 张文芳; 孙小英

    2013-01-01

    目的 探讨乳腺癌C-erbB-2、Ki67、nm23基因表达与腋窝淋巴结转移的相关性及判断乳腺癌预后价值的临床意义. 方法 对260例乳腺癌术后组织标本采用免疫组化S-P法进行C-erbB-2、Ki67、nm23基因检测. 结果 在260例中C-erbB-2、Ki67、nm23的阳性表达率分别为54.62%、53.85%、53.08%.在有腋窝淋巴结转移的152例(152/260)中,C-erbB-2的阳性表达率为77.63%;在无腋窝淋巴结转移组108例(108/260)中C-erbB-2的阳性表达率为20.37%(OR=13.57,P<0.01);Ki67在两组中的阳性表达率分别为71.05%、29.63%(OR=5.58,P<0.01);nm23在两组中阳性表达率分别为40.79%、70.37%(OR=0.29,P<0.01). 结论 C-erbB-2、Ki67在乳腺癌中的阳性表达与乳腺癌的腋窝淋巴结转移呈正相关,nm23基因阳性表达与乳腺癌腋窝淋巴结转移呈负相关,检测C-erbB-2、Ki67及nm23基因的表达情况并结合腋窝淋巴结是否转移等,综合分析它们之间的相互关系,不仅是评估乳腺癌患者预后的重要指标,而且还有助于选择制定合理的治疗方案.%Objective To explore the relation between the gene expression of C- erbB- 2, Ki67, nm23 and axillary lymph node metastasis in breast cancer, and to study their clinical significance in evaluating the prognoses of patients with breast cancer. Methods Immunohistochemical staining method was used to determine the gene expression of C - erbB - 2, Ki67, and nm23 in the postoperative specimens from 260 cases of breast cancer. Results Among the 260 cases, the positive expression rates of C - erbB - 2, Ki67, and nm23 were 54.62 % , 53.85 % , and 53.08 % , respectively. The positive expression rate of C - erbB - 2 in 152 cases of axillary lymph node metastasis was 77.63 % , while the positive expression rate of C - erbB - 2 in 108 cases without axillary lymph node metastasis was 20.37% (OR = 13. 57, P<0.01). The positive expression rates of Ki67 of the two groups were 71.05 % and 29

  2. Clinical outcomes after sentinel lymph node biopsy in clinically node-negative breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Han, Hee Ji; Keun Ki Chang; Suh, Chang Ok; Kim, Yong Bae [Dept.of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Ju Ree [Dept.of Radiation Oncology, Cheil General Hospital, Seoul (Korea, Republic of); Nam, Hee Rim [Dept.of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2014-09-15

    To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

  3. Inguinal lymph node metastasis of colon cancer

    Directory of Open Access Journals (Sweden)

    Sloane McGraw

    2011-01-01

    Full Text Available We present a case of adenocarcinoma of colon with unusual metastasis to inguinal lymph nodes. Our patient is a young male with bilateral inguinal lymphadenopathy, bone pains, and jaundice who presented as carcinoma of unknown primary. He was diagnosed as widely metastatic adenocarcinoma of colon for which he received chemotherapy and has had a good response to the treatment.

  4. Groin surgery and the sentinel lymph node

    NARCIS (Netherlands)

    de Hullu, JA; van der Zee, AGJ

    2003-01-01

    Vulvar cancer is a rare disease. Squamous-cell carcinomas account for 90% of vulvar cancers. The main mode of spread is lymphogenic to the inguinofemoral lymph nodes. Therefore, elective unior bilateral inguinofemoral lymphadenectomy is part of the standard treatment in combination with radical (wid

  5. Can high frequency ultrasound predict metastatic lymph nodes in patients with invasive breast cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Clough, Gillian R. [University of Bradford, Unity Building, 25 Trinity Road, Bradford BD5 0BB (United Kingdom)]. E-mail: g.r.clough@bradford.ac.uk; Truscott, John [University of Leeds (United Kingdom); Haigh, Isobel [Leeds Teaching Hospitals NHS Trust (United Kingdom)

    2006-05-15

    Purpose: Use high frequency ultrasound to predict the presence of metastatic axillary lymph nodes, with a high specificity and positive predictive value, in patients with invasive breast cancer. The clinical aim is to improve the surgical management and possible survival rate of groups of patients who would not normally have conventional axillary dissections. Materials and methods: The ipsilateral and contralateral axillas of 42 consecutive patients with invasive breast cancer were scanned prior to treatment using a B-mode frequency of 13 MHz and a Doppler frequency of 7 MHz. The presence or absence of an echogenic centre for each lymph node detected was recorded, measurements were also taken to determine the L/S (long axis/short axis) ratio of the node and the widest and narrowest part of the cortex. Power Doppler was also used to determine vascularity. The contralateral axilla was used as a control for each patient. Results: In this study of patients with invasive breast cancer, where ipsilateral lymph nodes had a cortical bulge of {>=}3 mm and/or at least two lymph nodes had absent echogenic centres, all had disease spread to the axillary lymph nodes (10 patients). Sensitivity and specificity were 52.6% and 100%, respectively, positive and negative predictive values were 100% and 71.9%, respectively, the P-value was 0.001 and the Kappa score was 0.55. Conclusion: This would indicate that high frequency ultrasound could be used to accurately predict metastatic lymph nodes in a proportion of patients with invasive breast cancer, which may alter patient management.

  6. [Lymph node staging in gastrointestinal cancer. Combination of methylene blue-assisted lymph node dissection and ex vivo sentinel lymph node mapping].

    Science.gov (United States)

    Märkl, B; Arnholdt, H

    2012-11-01

    The histopathological lymph node staging is of crucial importance for the prognosis estimation and therapy stratification in gastrointestinal cancer. However, the recommended numbers of lymph nodes that should be evaluated are often not reached in routine practice. Methylene blue assisted lymph node dissection was introduced as a new, simple and efficient technique to improve lymph node harvest in gastrointestinal cancer. This method is inexpensive, causes no delay and needs no toxic substances. All studies performed revealed a highly significantly improved lymph node harvest in comparison to the conventional technique. Moreover, this technique can be combined with a new ex vivo sentinel lymph node mapping that for the first time is based on histological sentinel lymph node detection. The success rate of this method is similar to conventional techniques and it enables an efficient application of extended investigation methods, such as immunohistochemistry or the polymerase chain reaction.

  7. Lymph Node Metastases and Prognosis in Penile Cancer

    Institute of Scientific and Technical Information of China (English)

    Yao Zhu; Ding-wei Ye

    2012-01-01

    Lymph node status is a key prognostic factor in penile squamous cell carcinoma.Recently,growing evidence indicates a multimodality approach consisting of neoadjuvant chemotherapy followed by consolidation surgery improves the outcome of locally advanced penile cancer.Thus,accurate estimation of survival probability in node-positive penile cancer is critical for treatment decision making,counseling of patients and follow-up scheduling.This article reviewed evolving developments in assessing the risk for cancer progression based on lymph node related variables,such as the number of metastatic lymph nodes,bilateral lymph node metastases,the ratio of positive lymph nodes,extracapsular extension of metastatic lymph nodes,pelvic lymph node metastases,metastatic deposit in sentinel lymph nodes and N stage in TNM classification.Controversial issues surrounding the prognostic value of these nodal related predictors were also discussed.

  8. Imaging Classification of Cervical Lymph Nodes

    Directory of Open Access Journals (Sweden)

    Gh. Bakhshandepour

    2008-01-01

    Full Text Available Nearly four decades, Rouviere classification, which is a clinically based system, was the only system for cervical adenopathy classification. The best possible classification of cervical nodal disease may be accomplished by using both clinical palpation and also informations provided by imaging, because imaging can reveal clinically silent lymph nodes. most head and neck tumors spread to the neck nodes as a part of their natural history ,depending on the primary site. Up to 80% of patients with upper aerodigestive mucosal malignancies will have cervical nodal metastasis"nat presentation.The occurrence of nodal metastasis has a profound effect on the management and prognosis of the patients .nodal metastasis is the most important prognostic factor in squamous cell carcinoma of the head and neck. In general it decreases the overall survival by half, and extracapsular spread worsens the prognosis by another half. Our purpose in this presentation is to review imaging classification of cervical lymph nodes.

  9. Volume-Based Parameters of {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Improve Disease Recurrence Prediction in Postmastectomy Breast Cancer Patients With 1 to 3 Positive Axillary Lymph Nodes

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Naomi, E-mail: haruhi0321@gmail.com [Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Department of Radiology, Ehime University, Ehime (Japan); Kataoka, Masaaki [Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Sugawara, Yoshifumi [Department of Diagnostic Radiology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Ochi, Takashi [Department of Radiology, Ehime University, Ehime (Japan); Kiyoto, Sachiko; Ohsumi, Shozo [Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Mochizuki, Teruhito [Department of Radiology, Ehime University, Ehime (Japan)

    2013-11-15

    Purpose: To determine whether volume-based parameters on pretreatment {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer patients treated with mastectomy without adjuvant radiation therapy are predictive of recurrence. Methods and Materials: We retrospectively analyzed 93 patients with 1 to 3 positive axillary nodes after surgery, who were studied with {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography for initial staging. We evaluated the relationship between positron emission tomography parameters, including the maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinical outcomes. Results: The median follow-up duration was 45 months. Recurrence was observed in 11 patients. Metabolic tumor volume and TLG were significantly related to tumor size, number of involved nodes, nodal ratio, nuclear grade, estrogen receptor (ER) status, and triple negativity (TN) (all P values were <.05). In receiver operating characteristic curve analysis, MTV and TLG showed better predictive performance than tumor size, ER status, or TN (area under the curve: 0.85, 0.86, 0.79, 0.74, and 0.74, respectively). On multivariate analysis, MTV was an independent prognostic factor of locoregional recurrence-free survival (hazard ratio 34.42, 95% confidence interval 3.94-882.71, P=.0008) and disease-free survival (DFS) (hazard ratio 13.92, 95% confidence interval 2.65-103.78, P=.0018). The 3-year DFS rate was 93.8% for the lower MTV group (<53.1; n=85) and 25.0% for the higher MTV group (≥53.1; n=8; P<.0001, log–rank test). The 3-year DFS rate for patients with both ER-positive status and MTV <53.1 was 98.2%; and for those with ER-negative status and MTV ≥53.1 it was 25.0% (P<.0001). Conclusions: Volume-based parameters improve recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive nodes. The addition of MTV to ER status or TN has

  10. Sentinel Lymph Node Biopsy Results in Early-Stage Breast Cancer

    Directory of Open Access Journals (Sweden)

    Ahmet Kocakuflak

    2011-06-01

    Full Text Available Aim: Sentinel lymph node biopsy (SLNB in breast cancer patients targets the evaluation of the initial lymph node (SLN which drains the primary tumor. The morbidity of unnecessary axillary dissection can be avoided by intensive preoperative assessment of SLN. Methods: Twenty-six consecutive patients who had been surgically treated for early-stage breast cancer between March 2005 and August 2007 were evaluated. Blue dye (methylene blue method was used to detect SLN. All patients underwent axillary lymph node dissection following SLNB. NCSS program was used for statistical analysis. Chi-square test was used in the comparison of binary groups. Results: Except for one, all patients were female. The mean age of the patients was 56 (29-76 years. While 13 patients underwent modified radical mastectomy (=mastectomy+axillary dissection, the remaining 13 patients underwent breast preserving surgery (lumpectomy+axillary dissection. SLN could not be found in 2 patients (7.6%.The male patient was one of these 2 patients and both of them were positive for axillary node metastases. The detection rate of SLN, specificity, negative predictive value, positive predictive value, sensitivity, false negativity, and reliability were 92.3%, 92.8%, 86%, 90.9%, 83.3%, 16.6%, and 88.4%, respectively. Conclusion: Our result support the hypothesis that SLNB with blue dye alone is a reliable technique and, surgery clinics should use it prior to axillary dissection to test their own success during the learning curve. (The Medical Bulletin of Haseki 2011; 49: 67-72

  11. Popliteal lymph node metastasis of tibial osteoblastic osteosarcoma

    Directory of Open Access Journals (Sweden)

    Yalın Dirik

    2014-01-01

    CONCLUSION: Lymph node metastasis of osteosarcoma is a rare entity and metastatic patterns could not be clearly explained. On the other hand, the effects of lymph node metastasis on prognosis are also not clearly defined and further studies are needed.

  12. The lymph node in chronic lymphocytic leukemia.

    Science.gov (United States)

    Dick, F R; Maca, R D

    1978-01-01

    Lymph nodes were examined from 41 cases of typical chronic lymphocytic leukemia (CLL). Degree of immaturity was graded as absent to minimal (Grade I), moderate (Grade II) and marked (Grade III). A moderate degree of immaturity was found in the lymph node in 14 of 41 cases even though the cells seen on the initial bone marrow and peripheral blood smears obtained from these patients were essentially all mature. The morphology of these nodes could be confused with poorly differentiated lymphocytic or mixed lymphocytic-histiocytic lymphoma in terms of the degree of immaturity present. A marked degree of immaturity present. A marked degree of immaturity was found in 5 cases; the morphology of these cases resembled histiocytic lymphoma. In the remaining 22 cases immaturity was essentially absent. The morphology of these cases was similar to that of diffuse well differentiated lymphocytic lymphoma. Our studies suggest that a moderate degree of immaturity in the lymph node of patients with CLL does not indicate that these patients will have a marked shortening of their survival. PMID:580071

  13. Experimental studies of metastases of esophageal carcinoma to lymph nodes

    International Nuclear Information System (INIS)

    Marked progress has been made in surgery for esophageal carcinoma, however, when compared to results of surgery for other carcinomas of the digestive tract, much research remains to be done. The author transplanted VX2 carcinoma, a transplantable tumor of the rabbit, to the esophagus in attempt to determine the mode of metastases of esophageal carcinoma to lymph nodes and also to observe the effect of chemotherapy (Bleomycin) and radiotherapy (Betatron). Carcinoma of the cervical esophagus metastasized to the cervical lymph nodes and then to the paratracheal lymph nodes. Carcinoma of the upper thoracic esophagus metastasized to the paratracheal lymph nodes and then to the cervical lymph nodes. Carcinoma of the mid-thoracic esophagus metastasized to the intrathoracic lymph nodes and then to the intraperitoneal lymph nodes. Carcinoma of the abdominal esophagus metastasized to the intraperitoneal lymph nodes and then to the intrathoracic lymph nodes. Skipping metastasis was rarely observed. Carcinoma of the thoracic esophagus with metastases of lymph nodes in the cervical or abdominal portion was considerably advanced, therefore it is considered that cleaning of the intrathoracic lymph nodes and simultaneous chemotherapy are required when such cases are encountered clinically. Irradiation resulted in regression in the size of the tumor and metastases to lymph nodes and there was a decrease in metastases to the distant lymph nodes. Effects of irradiation were similar on tumors and lymph nodes with positive metastases located within the field of irradiation. Bleomycin medication resulted in regression in the size of tumor and metastases to lymph nodes. Effects of Bleomycin medication were similar on tumors and lymph nodes with positive metastases. (auth.)

  14. The positive sentinel lymph node biopsy- can we predict which patients will benefit from further surgery?

    Directory of Open Access Journals (Sweden)

    Dash I

    2015-02-01

    Full Text Available Introduction: Although sentinel lymph node biopsy (SLNB is the gold standard for clinical and radiological negative axillae in breast cancer, the subsequent management of positive nodes is currently under scrutiny with the Z0011 trial publication causing much debate. Our aim was to determine whether there were any predictive factors in our cohort of patients that could assist in the decision of whether the patient required a further axillary lymph node clearance. Methods: A retrospective analysis of a prospectively maintained database of patients who underwent SLNB and their histology was performed. Univariate and multivariate analysis was performed to identify any predictive factors. Results: Our Breast Unit performed 457 SLNB over the three years. The mean age of patients was 61.9 years (range 31-89 years. Of these 457 SLNB, 122 (26.7% were positive for metastatic involvement, and of these patients only 34% were found to have further lymph node involvement after axillary lymph node clearance (ALNC. Only 8% of our total patient cohort had non sentinel node involvement at completion ALNC. Using univariate analysis, lymphovascular invasion (p=0.009, grade (p=0.007 and size (p=0.006 were all significant predictors for having a positive ALNC. Conclusion: Only 8% of the total number of patients had an additional positive lymph node found in their completion axillary clearance. Our results add to this existing knowledge on the subject, and show that there are certain factors which should be carefully considered pre-operatively in order to help inform patient and surgeon choice regarding management of the axilla.

  15. Cytological evaluation of enlarged lymph nodes in metastatic disease: A hospital-based assessment

    Directory of Open Access Journals (Sweden)

    Ghazala Mehdi

    2015-01-01

    Full Text Available Background: Lymphadenopathy is a heterogeneous entity with many underlying causes, ranging from self-limiting benign disease to severe neoplastic proliferations. Fine-needle aspiration is a cost-effective and reliable tool for initial investigation of enlarged lymph nodes. Materials and Methods: A study was conducted on 326 patients with metastatic disease in order to evaluate the efficacy of cytology in diagnosing malignancies metastatizing to the lymph node and predicting their primary origin as well as to find the relative frequency of different malignancies. The findings were also correlated with histopathology. Results: Cervical lymph nodes were the most frequently involved group, followed by axillary, supraclavicular, and inguinal lymph nodes. Squamous cell carcinoma (SCC and adenocarcinoma were the most common cytological diagnosis. Among the cases with known primary tumors, head and neck was the most common site followed by breast carcinoma. Most common lymph node group to be aspirated in cases with unknown primary was cervical lymph node, and SCC was most frequently diagnosed cases. Sensitivity and positive predictive value of cytological diagnosis were calculated to be 100% and 93.1%, respectively. Conclusion: Fine-needle aspiration cytology has a very high sensitivity and positive predictive value and hence, a presumptive diagnosis can be made along with the detection of the primary site in case of metastatic disease.

  16. High-frequency Ultrasound Imaging of Mouse Cervical Lymph Nodes.

    Science.gov (United States)

    Walk, Elyse L; McLaughlin, Sarah L; Weed, Scott A

    2015-01-01

    High-frequency ultrasound (HFUS) is widely employed as a non-invasive method for imaging internal anatomic structures in experimental small animal systems. HFUS has the ability to detect structures as small as 30 µm, a property that has been utilized for visualizing superficial lymph nodes in rodents in brightness (B)-mode. Combining power Doppler with B-mode imaging allows for measuring circulatory blood flow within lymph nodes and other organs. While HFUS has been utilized for lymph node imaging in a number of mouse  model systems, a detailed protocol describing HFUS imaging and characterization of the cervical lymph nodes in mice has not been reported. Here, we show that HFUS can be adapted to detect and characterize cervical lymph nodes in mice. Combined B-mode and power Doppler imaging can be used to detect increases in blood flow in immunologically-enlarged cervical nodes. We also describe the use of B-mode imaging to conduct fine needle biopsies of cervical lymph nodes to retrieve lymph tissue for histological  analysis. Finally, software-aided steps are described to calculate changes in lymph node volume and to visualize changes in lymph node morphology following image reconstruction. The ability to visually monitor changes in cervical lymph node biology over time provides a simple and powerful technique for the non-invasive monitoring of cervical lymph node alterations in preclinical mouse models of oral cavity disease. PMID:26274059

  17. HISTOPATHOLOGICAL CHARACTERISTICS OF LYMPH NODE SINUS CONTAINING BLOOD

    Institute of Scientific and Technical Information of China (English)

    YIN Tong; JI Xiao-long

    2001-01-01

    This study is to find out the histopathological characteristics of lymph node sinus containing blood. Routine autopsy was carried out in the randomly selected 102 patients(among them,100 patients died of various diseases, and 2 of non-diseased causes),their superficial lymph nodes locating in the bilateral neck, axilla, inguina, thorax and abdomen were sampled. Haematoxylin-eosin staining was performed on 10% formalin-fixed and paraffin-embedded lymph node tissue sections(5μm).The histological characteristics of the lymph node sinuses containing blood were observed under light microscope. Among the 1362 lymph nodes sampled from the 100 autopsies, lymph sinuses containing blood were found in 809 lymph nodes sampled from 91 cases, but couldn't be seen in the lymph nodes sampled from the non-diseased cases. According to histology, five kinds of lymph sinuses containing blood were found:vascular-opening sinus, blood-deficient sinus, erythrophago-sinus, blood-abundant sinus, and vascular-formative sinus. It is concluded that in the state of disease, the phenomenon of blood in the lymph sinus is not uncommon. Blood could possibly enter into lymph sinus through lymphatic-venous communications between the veins and sinuses in the node. Lymph circulation and blood circulation could communicate with each other in the lymph sinus.

  18. 99mTc-硫胶体淋巴结显像联合亚甲蓝在乳腺癌前哨淋巴结活检中的临床研究%Clinical study of the axillary conservative surgery by sentinel lymph node biopsy using preoperative lymphoscintigraph technique with 99mTc-SC and methylene blue in breast cancer surgical therapy

    Institute of Scientific and Technical Information of China (English)

    冯尧军; 吴新红; 潘翠萍; 马彪

    2011-01-01

    目的 探讨99mTc-硫胶体(99mTc-SC)淋巴结显像联合亚甲蓝行乳腺癌前哨淋巴结活检(SLNB),对前哨淋巴结(SLN)阴性者避免行腋窝淋巴结清扫(ALND)的可行性及其临床应用价值.方法 187例乳腺癌患者术前行99mTc-SC淋巴结显像,并进行体表定位,术中加用亚甲蓝示踪SLN,切除后快速冰冻切片.其中51例SLN转移患者行改良根治术,将136例SLN阴性患者分为两组,A组[为腋窝淋巴结阳性患者,58例为术中检测阳性,2例为SLNB术后淋巴结常规病理检查阳性,再次行ALND,共60例]行乳腺切除或象限切除加ALND,B组(术中检测阴性78例,除去术后检测阳性2例,共76例)行SLNB,未行ALND.结果 A组术后上肢麻木、上肢水肿、上肢功能障碍分别为36、8、45例,B组分别为2、0、0例,两组比较差异有统计学意义(P0.05).结论 99mTc-SC淋巴结显像联合亚甲蓝行SLNB方法 简便,准确率高,疗效确实可靠.%Objective To evaluate the clinical significance of the axillary conservative surgery by sentinel lymph node biopsy (SLNB) using preoperative lymphoscintigraph technique with 99mTc-SC and methylene blue in early-stage breast cancer patients. Methods The sentinel lymph node (SLN) of 187 patients were located with preoperative lymphoscintigraph technique with 99mTc-SC and labeled with methylene blue during the operations. The metastasis of SLN was detected using frozen section technique. There were 51 patients whose SLN were positive having been carried with modified radical mastectomy of breast cancer and axillary lymph node dissection (ALND), 136 patients' SLN were negative,58 patients of those were carried with mammectomy or partial mastcctomy and ALND (group A),while 78 patients were carried out with mammectomy or partial mastectomy only (group B). The sentinel lymph nodes were detected with HE stain after surgery. All the patients were treated with chemotherapy,and the patients with partial mastcctomy must be treated with

  19. [Interest of preoperative lymphoscintigraphy on sentinel lymph node identification in patients with breast cancer].

    Science.gov (United States)

    Tulpin, L; Morel, O; Akerman, G; Malartic, C; Desfeux, P; Barranger, E

    2008-01-01

    Sentinel lymph node biopsy is nowadays an accepted method of staging breast cancer patients. In case of an injection of radioactive colloid, preoperative lymphoscintigraphy is recommended to establish a lymphatic mapping and to predict the number of sentinel lymph nodes identified during surgery. Preoperative lymphoscintigraphy does not decrease the false-negative rate. However, positive preoperative lymphoscintigraphy significantly improves the identification rate of intraoperative sentinel nodes comparing with negative preoperative lymphoscintigraphy. Detecting extra-axillary sentinel lymph nodes, because of its minimal therapeutic consequences, does not appear to be an indication for preoperative lymphoscintigraphy. Given logistics and cost required, preoperative lymphoscintigraphy should be only performed for patients with a high risk of intraoperative failed localization. In case of negative preoperative lymphoscintigraphy, sentinel lymph node biopsy must be tried because sentinel nodes are still identified in the majority of these patients. Another possibility, with important cost and logistic, should consist in performing a later lymphoscintigraphy on the day after radioactive injection to ameliorate sentinel lymph nodes identification.

  20. Cost-effectiveness of a 21-gene recurrence score assay versus Canadian clinical practice in women with early-stage estrogen- or progesterone-receptor-positive, axillary lymph-node negative breast cancer

    International Nuclear Information System (INIS)

    A 21-gene recurrence score (RS) assay may inform adjuvant systematic treatment decisions in women with early stage breast cancer. We sought to investigate the cost effectiveness of using the RS-assay versus current clinical practice (CCP) in women with early-stage estrogen- or progesterone-receptor-positive, axilliary lymph-node negative breast cancer (ER+/ PR + LN- ESBC) from the perspective of the Canadian public healthcare system. We developed a Markov model to project the lifetime clinical and economic consequences of ESBC. We evaluated adjuvant therapy separately in post- and pre-menopausal women with ER+/ PR + LN- ESBC. We assumed that the RS-assay would reclassify pre- and post-menopausal women among risk levels (low, intermediate and high) and guide adjuvant systematic treatment decisions. The model was parameterized using 7 year follow up data from the Manitoba Cancer Registry, cost data from Manitoba administrative databases, and secondary sources. Costs are presented in 2010 CAD. Future costs and benefits were discounted at 5%. The RS-assay compared to CCP generated cost-savings in pre-menopausal women and had an ICER of $60,000 per QALY gained in post-menopausal women. The cost effectiveness was most sensitive to the proportion of women classified as intermediate risk by the RS-assay who receive adjuvant chemotherapy and the risk of relapse in the RS-assay model. The RS-assay is likely to be cost effective in the Canadian healthcare system and should be considered for adoption in women with ER+/ PR + LN- ESBC. However, ongoing assessment and validation of the assay in real-world clinical practice is warranted

  1. Cat scratch disease and lymph node tuberculosis in a colon patient with cancer

    OpenAIRE

    Matias, M.; Marques, T.; Ferreira, M.A.; Ribeiro, L.

    2013-01-01

    A 71-year-old man operated for a sigmoid tumour remained in the surveillance after adjuvant chemotherapy. After 3 years, a left axillary lymph node was visible on CT scan. The biopsy revealed a necrotising and abscessed granulomatous lymphadenitis, suggestive of cat scratch disease. The patient confirmed having been scratched by a cat and the serology for Bartonella henselae was IgM+/IgG−. Direct and culture examinations for tuberculosis were negative. The patient was treated for cat scratch ...

  2. [Lymph node preparation in colorectal cancer. Ex vivo methylene blue injection as a novel technique to improve lymph node visualization].

    Science.gov (United States)

    Märkl, B; Kerwel, T; Jähnig, H; Anthuber, M; Arnholdt, H

    2008-07-01

    The UICC requires investigation of a minimum of 12 lymph nodes for adequate lymph node staging in colorectal cancer. Despite that, many authors recommend investigation of a larger number, and different techniques, such as fat clearance, have therefore been developed. In this study we introduce a novel technique involving ex vivo lymph node staining with intraarterial methylene blue injection in colon cancer. We compared 14 cases in which methylene injection was used with 14 cases from our records in which conventional investigation techniques were applied. The lymph node harvest differed highly significantly (pmethylene blue group and the unstained group, respectively. The largest difference occurred in the size group 2-4 mm (191 vs 70 lymph nodes). In 6 cases in the unstained group additional embedding of fatty tissue was necessary to reach an adequate number of investigated lymph nodes. Methylene blue injection is a novel and highly effective method that will improve lymph node preparation in colorectal cancer.

  3. 逆行腋窝淋巴结示踪术对预防乳腺癌术后上肢淋巴水肿的作用探讨%Discussion on Retrograde Tracing Axillary Lymph Node Surgery for Prevention of Upper Extremity Lymphedema after Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    覃天

    2015-01-01

    Objective: TAnalysis of upper limb lymphedema after breast cancer surgery take tracer technique of axillary lymph node in the value of clinical application of retrograde.Methods:50 cases of breast cancer patients in our hospital fromOctober 2008 to January 2013, Divided into the intervention and the control groups, The control group received ALND treatment of patients, The control group received ARM treatment of patients ,compared the Upper extremity lymphedema with the two group.Results:A year after surgery, the incidence of lymphedema in the intervention group was significantly lower than the control group, the difference was statistically significant (P<0.05).Conclusion:Breast cancer patients taking retrograde tracing after axillary lymph node, you can make change significantly reduce the chances of lymphedema.%目的:分析研究乳腺癌术后上肢淋巴水肿采取逆行腋窝淋巴结示踪术的临床应用价值。方法:选取2008年10月~2013年1月在我院接收的患有乳腺癌的病人50例,随机分为干预组、对照组。对照组对病人采取ALND(腋窝淋巴结清扫术)治疗,干预组对病人采取ARM(逆行腋窝淋巴结示踪术)治疗,对干预组和对照组手术以后发生上肢淋巴水肿情况给予分析研究。结果:干预组临床手术成功率96%,手术以后一年,干预组淋巴水肿发生率显著低于对照组,差异具有明显的统计学意义(P<0.05)。结论:乳腺癌采取逆行腋窝淋巴结示踪术以后,可以使发生淋巴水肿的几率明显减少。

  4. Sentinel lymph node in 90 patients with breast cancer: patent blue and radio detection evaluation

    International Nuclear Information System (INIS)

    The aim of this study was to ascertain in breast cancer patients i) the accuracy of the sentinel node biopsy to correctly predict the status of the remaining axillary lymph nodes, ii) the feasibility and accuracy of sentinel lymph node (SLN) identification using Radio-detection (RD: preoperative lymphoscintigraphy and per-operative gamma-probe detection) and blue dye lymphatic mapping (BLM). SLN biopsy along with axillary lymphadenectomy was performed on 90 patients with breast cancer. RD and BLM were performed on 90 and 75 patients respectively. Before surgery, the technique involved the injection of Tc99m Rhenium sulfur colloid (37 MBq) into the breast around the tumor, then scintigraphic images were recorded. During surgery, patent blue (2 ml) was injected around the tumor and gamma-probe detection was performed after tumor excision. SLN were found at surgery in 84 of the 90 patients. SLN were identified with RD in 12 of the 15 patients who underwent RD alone. Of the 75 patients who underwent RD and BLM, SLN were identified with both RD and BLM in 56, with only BLM in 5, and with only RD in 11. None of the 3 patients with a negative preoperative lymphoscintigraphy had a positive per-operative radio-detection. Of these 75 patients, 21 had axillary nodal metastasis. SLN were not identified in 2 of these 21 patients (extensive metastatic involvement) and the remaining 19 had SLN metastasis. In 11 of these 21 patients with axillary nodal metastases, SLN were the only metastatic nodes. For optimal localization of the SLN in breast cancer patients, surgeons should use the combined technique of RD and BLM. Thus, SLN were identified in more than 90% of patients and SLN reliably predicted the status of the remaining axillary nodes. (author)

  5. Lymphatic mapping and sentinel lymph node detection in patients with breast cancer

    International Nuclear Information System (INIS)

    Objectives: To localize sentinel lymph node (SLN) and to test the hypothesis that the histologic characteristics of the SLN can predict the histologic characteristic of the remaining lymph nodes along the lymphatic chain. To calculate the absorbed dose of patients, doctors and nurses. Methods: Seventy-one patients with early-stage breast cancer underwent SLN localization using filtered technetium-99m labeled sulfur colloid, blue dye, or combination of them. SLN was identified as a blue lymph node and/or a 'hot lymph node' detected by ex vivo gamma probe. A 'hot lymph node' is the lymph node the radioactivity of which was 10 times higher than that of background. Pathological examination was performed with all resected lymph nodes. The approximate absorbed dose of the patients, doctors and nurses was calculated by using MIRD techniques. Results: For patients who were injected with only blue dye, the sensitivity, accuracy and false negative rate was 80.0%, 90.7% and 20.0% respectively. For patients who were injected with only radioactive colloids, the sensitivity, accuracy and false negative rate was 100%, 100% and 0% respectively. For patients who were injected with both blue dye and radioactive colloids, the sensitivity, accuracy and false negative rate was 100%, 100% and 100% respectively. The absorbed dose of breast tissue was 26.52 rad. The absorbed dose of nuclear medicine doctors, surgeons, nurses and pathologists was 1.9x10-2 rad, 9.6x10-3 rad, 3.8x10-4 rad and 9.6x10-3 rad respectively. Conclusions: Lymphatic mapping and SLN biopsy were the most effective when a combination of blue dye and radio-labeled sulfur colloid was used. Radio-labeled sulfur colloid was safe to patients and the medical staff. SLN biopsy had the potential value for avoiding unnecessary axillary lymph nodes resection for patients with early-stage breast cancer

  6. ER-poor and HER2-positive: a potential subtype of breast cancer to avoid axillary dissection in node positive patients after neoadjuvant chemo-trastuzumab therapy.

    Directory of Open Access Journals (Sweden)

    Jian-Wei Li

    Full Text Available PURPOSE: The study was to estimate the likelihood of axillary downstaging and to identify the factors predicting a pathologically node negative status after neoadjuvant chemotherapy (NAC with or without trastuzumab in HER2-positive breast cancer. METHODS: Patients with HER2-positive, stage IIa-IIIc breast cancer were enrolled. Axillary status was evaluated by palpation and fine needle aspiration (FNA before NAC. All patients received 4-6 cycles of PCrb (paclitaxel 80 mg/m2 and carboplatin AUC = 2 d1, 8, and 15 of a 28-day cycle, or paclitaxel 175 mg/m2 and carboplatin AUC = 6 every-3-week and were non-randomly administered trastuzumab (2 mg/kg weekly or 6 mg/kg every-3-week or not. After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy. And some patients received sentinel lymph node biopsy (SLNB before axillary dissection. RESULTS: Between November-2007 and June-2013, 255 patients were enrolled. Of them, 157 were confirmed as axillary node positive by FNA (group-A and 98 as axillary node negative either by FNA or impalpable (group-B. After axillary dissection, the overall pathologically node negative rates (pNNR were 52.9% in group-A and 69.4% in group-B. The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively and the lowest rate of residual with ≥4 nodes involvement (1.9% and 3%, respectively after PCrb plus trastuzumab. In multivariate analysis, trastuzumab added and ER-poor status were independent factors in predicting a higher pNNR in HER2-positive breast cancer. Forty-six tested patients showed that the ER-poor/HER2-positive subtype acquired a considerable high pNNR and axillary status with SLNB was well macthed with the axillary dissection. CONCLUSIONS: ER-poor/HER2-positive subtype of breast cancer is a potential candidate for undergoing sentinel lymph node biopsy instead of regional node dissection for

  7. Greater auricular nerve masquerading as lymph node.

    Science.gov (United States)

    Saxena, Shilpi; Deb, Prabal; Nijhawan, Vijay Shrawan; Kharayat, Veena; Verma, Rajesh

    2015-01-01

    Hansen's disease is on the verge of being eliminated from India and often missed by clinicians due to low index of suspicion. We present an unusual case in which greater auricular nerve thickening masqueraded as enlarged lymph node in the neck. The patient was referred for fine needle aspiration cytology, which revealed epithelioid cell granulomas suggestive of Hansen's disease. Further clinical examination and investigations including the skin biopsy confirmed the disease, highlighting the role of pathologist in the management of such unusual presentation of a common disease. PMID:26229249

  8. Preoperative diagnosis of lymph node metastasis in thoracic esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Eguchi, Reiki; Yamada, Akiyoshi; Ueno, Keiko; Murata, Yoko [Tokyo Women`s Medical Coll. (Japan)

    1996-10-01

    From 1994 to 1995, to evaluate the utility of preoperative CT, EUS (endoscopic ultrasonography) and US in the diagnosis of lymph node metastasis in thoracic esophageal cancer, 94 patients with thoracic esophageal cancer who underwent esophagectomy were studied clinicopathologically. The sensitivity of EUS diagnosis of upper mediastinal lymph node metastasis (85%), left-sided paragastrin lymph node metastasis (73-77%), and especially lower paraesophageal lymph node metastasis (100%) were good. But due to their low-grade specificity in EUS diagnosis, their overall accuracy was not very good. On the other hand, the overall accuracy of the CT diagnosis of lymph node metastasis was fine. However, sensitivity, the most important clinical factor in the CT diagnosis of lymph node metastasis was considerably inferior to EUS. The assessment of the diagnosis of lymph node metastasis around the tracheal bifurcation and the pulmonary hilum and the left para-cardial lesion by CT or EUS was poor. It was concluded that lymph node metastasis of these area must be the pitfall in preoperative diagnosis. The average diameter of the lymph nodes and the proportion of cancerous tissue in the lymph nodes diagnosed as metastatic lymph nodes by CT was larger than that of the false negative lymph nodes. However, the lymph nodes diagnosed as true positives by EUS showed no such tendency. This must be the reason the sensitivity of the EUS diagnosis and specificity of the CT diagnosis were favorable, but the specificity of the EUS diagnosis and especially the sensitivity of the CT diagnosis were not as good. (author)

  9. Sentinel Lymph Node Identification in Endometrial Cancer

    Institute of Scientific and Technical Information of China (English)

    Bin Li; Lingying Wu; Xiaoguang Li; Haizhen Lu; Ping Bai; Shumin Li; Wenhua Zhang; Juzhen Gao

    2009-01-01

    OBJECTIVE To evaluate the feasibility of intra-operative detection of sentinel lymph nodes (SLN) in the patient with endometrial cancer (EC).METHODS Thirty-one patients with Stage Ⅰ and Ⅱ endometrial cancer, who underwent a hysterectomy and a lymphadenectomy,were enrolled in the study. At laparotomy, methylene blue dye tracer was injected into the subserosal myometrium of corpus uteri at multiple sites, and dye uptake into the lymphatic channels was observed. The blue nodes which were identified as SLNs were traced and excised. The other nodes were then removed. All of the excised nodes were submitted for pathological hematoxylin and eosin (H&E) staining examination.RESULTS Failure of dye uptake occurred in 4 of the 31 cases (12.9%) because of spillage, and no lymphatic coloration was observed there. Lymphatic staining was clearly observable as blue dye diffused to the lymphatic channels of the uterine surface and the infundibulopelvic ligaments in 27 (87.1%) cases. Concurrent coloration in the pelvic lymphatic vessels was also observed in 22of the 27 patients. The SLNs were identified in 23 of the 27 (85.2%)cases with a lymphatic staining, with a total number of 90 SLNs,and a mean of 3.9 in each case (range, 1-10). Besides one SLN (1.1%)in the para-aortic area, the other 89 (98.9%) were in the nodes of the pelvis. The most dense locations of SLNs included obturator in 38 (42.2%) and interiliac in 19 (21.1%) cases. In our group, pelvic lymphadenectomy was conducted in 27 (87.1%) patients and pelvic nodal sampling in 4 (12.9%). Of the 31 cases, a concurrent abdominal para-aortic lymph node sampling was conducted in 7. A total of 926 nodes were harvested, with an average of 39.8 in each case (range, 14-55). Nodal metastases occurred in 3 patients (9.7%), 2 of them with SLN involvement and the other without SLN involvement. Adverse reactions or injury related to the study was not found.CONCLUSION Application of methylene blue dye is feasible in an intra

  10. Lymph Node Metastasis of Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Akagi, Tomonori, E-mail: tomakagi@med.oita-u.ac.jp [Oita University Faculty of Medicine, Department of Gastroenterological Surgery, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593 (Japan); Shiraishi, Norio [Surgical division, Center for community medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593 (Japan); Kitano, Seigo [Oita University Faculty of Medicine, Department of Gastroenterological Surgery, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593 (Japan)

    2011-04-26

    Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of cancer death worldwide [1]. In areas without screening for gastric cancer, it is diagnosed late and has a high frequency of nodal involvement [1]. Even in early gastric cancer (EGC), the incidence of lymph node (LN) metastasis exceeds 10%; it was reported to be 14.1% overall and was 4.8 to 23.6% depending on cancer depth [2]. It is important to evaluate LN status preoperatively for proper treatment strategy; however, sufficient results are not being obtained using various modalities. Surgery is the only effective intervention for cure or long-term survival. It is possible to cure local disease without distant metastasis by gastrectomy and LN dissection. However, there is no survival benefit from surgery for systemic disease with distant metastasis such as para-aortic lymph node metastasis [3]. Therefore, whether the disease is local or systemic is an important prognostic indicator for gastric cancer, and the debate continues over the importance of extended lymphadenectomy for gastric cancer. The concept of micro-metastasis has been described as a prognostic factor [4-9], and the biological mechanisms of LN metastasis are currently under study [10-12]. In this article, we review the status of LN metastasis including its molecular mechanisms and evaluate LN dissection for the treatment of gastric cancer.

  11. Nanoparticle Transport from Mouse Vagina to Adjacent Lymph Nodes

    OpenAIRE

    Byron Ballou; Andreko, Susan K.; Elvira Osuna-Highley; Michael McRaven; Tina Catalone; Bruchez, Marcel P.; Hope, Thomas J.; Labib, Mohamed E.

    2012-01-01

    To test the feasibility of localized intravaginal therapy directed to neighboring lymph nodes, the transport of quantum dots across the vaginal wall was investigated. Quantum dots instilled into the mouse vagina were transported across the vaginal mucosa into draining lymph nodes, but not into distant nodes. Most of the particles were transported to the lumbar nodes; far fewer were transported to the inguinal nodes. A low level of transport was evident at 4 hr after intravaginal instillation,...

  12. Detection of micrometastases in bone marrow and sentinel lymph nodes of breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    Jia Zhao; Xiaoan Liu; Lijun Ling

    2007-01-01

    Objective: To study the sensitivity and clinical significance of HE-staining,IHC and RT-PCR in detecting breast cancer micrometastases in bone marrow and sentinel lymph nodes (SLNs). Methods:After general anesthesia, all patients underwent bone marrow puncture and sentinel lymph node biopsy (SLNB) by 1% isosulfan blue, and then HE-staining,IHC and RT-PCR were used to detect micrometastases. Results:Of 62 patients with breast cancer whose axillary lymph nodes showed negative HE-staining results, 15 cases presented with positive RT-PCR and 9 cases showed positive IHC results positive in bone marrow micrometastases detection. PT-PCR and IHC showed good uniformity(kappa=0.6945)and there was significant difference in detective rate between these two methods (χ2=4.1667,P=0.0412). In SLN samples, 13 showed positive RT-PCR results, while 7 showed positive IHC results. PT-PCR and IHC showed good uniformity (kappa=0.6483)and significant difference was also found in detective rate between these two methods (χ2=4.1667,P=0.0412). Both bone marrow and SLN samples were RT-PCR positive in 3 cases,which indicated that bone marrow micrometastases did not always accompany SLN micrometastases(χ2=0.067,P=0.796). Conclusion: Even if no axillary lymph node involvement or distant metastases are present in routine preoperative examination, micrometastases can still be detected in bone marrow or SLNs. Because the bone marrow micrometastases and axillary node micrometastses are not present simultaneously, combination test of multiple indicators will detect micrometastases more accurately.

  13. A dual-modal magnetic nanoparticle probe for preoperative and intraoperative mapping of sentinel lymph nodes by magnetic resonance and near infrared fluorescence imaging.

    Science.gov (United States)

    Zhou, Zhengyang; Chen, Hongwei; Lipowska, Malgorzata; Wang, Liya; Yu, Qiqi; Yang, Xiaofeng; Tiwari, Diana; Yang, Lily; Mao, Hui

    2013-07-01

    The ability to reliably detect sentinel lymph nodes for sentinel lymph node biopsy and lymphadenectomy is important in clinical management of patients with metastatic cancers. However, the traditional sentinel lymph node mapping with visible dyes is limited by the penetration depth of light and fast clearance of the dyes. On the other hand, sentinel lymph node mapping with radionucleotide technique has intrinsically low spatial resolution and does not provide anatomic details in the sentinel lymph node mapping procedure. This work reports the development of a dual modality imaging probe with magnetic resonance and near infrared imaging capabilities for sentinel lymph node mapping using magnetic iron oxide nanoparticles (10 nm core size) conjugated with a near infrared molecule with emission at 830 nm. Accumulation of magnetic iron oxide nanoparticles in sentinel lymph nodes leads to strong T2 weighted magnetic resonance imaging contrast that can be potentially used for preoperative localization of sentinel lymph nodes, while conjugated near infrared molecules provide optical imaging tracking of lymph nodes with a high signal to background ratio. The new magnetic nanoparticle based dual imaging probe exhibits a significant longer lymph node retention time. Near infrared signals from nanoparticle conjugated near infrared dyes last up to 60 min in sentinel lymph node compared to that of 25 min for the free near infrared dyes in a mouse model. Furthermore, axillary lymph nodes, in addition to sentinel lymph nodes, can be also visualized with this probe, given its slow clearance and sufficient sensitivity. Therefore, this new dual modality imaging probe with the tissue penetration and sensitive detection of sentinel lymph nodes can be applied for preoperative survey of lymph nodes with magnetic resonance imaging and allows intraoperative sentinel lymph node mapping using near infrared optical devices.

  14. Desempenho da ultra-sonografia na detecção das metástases em linfonodos axilares em mulheres com câncer de mama Performance of ultrasound in the detection of axillary lymph node metastases in breast cancer patients

    Directory of Open Access Journals (Sweden)

    Rodrigo Menezes Jales

    2005-09-01

    morphological (12 and Doppler velocimetry (17 ultrasonographic features, in the detection of lymph node metastases in breast cancer patients. METHODS: 179 women (181 axillary cavities were included in the study from January to December 2004. The ultrasonographic examinations were performed with a real-time linear probe (Toshiba-Power Vision-6000 (model SSA-370A. The morphological parameters were studied with a frequency of 7.5-12 MHz. A frequency of 5 MHz was used for the Doppler velocimetry parameters. Subsequently, the women were submitted to level I, II and III axillary dissection (158, or to the sentinel lymph node technique (23. Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. The decision tree test was used for parameter association. The cutoff points were established by the ROC curve. RESULTS: at least one lymph node was detected in 173 (96% of the women by the ultrasonographic examinations. Histological examination detected lymph node metastases in 87 women (48%. The best sensitivity among the morphological paramenters was found with the volume (62%, the antero-posterior diameter (62% and the fatty hilum placement (56%. Though the specificity of the extracapsular invasion (100%, border regularity (92% and cortex echogenicity (99% were high, the sensitivity of these features was too low. None of the Doppler velocimetry parameters reached 50% sensitivity. The decision tree test selected the ultrasonographic parametners: fatty hilum placement, border regularity and cortex echogenicity, as the best parameter association. CONCLUSION: the detection of axillary cavity lymph node stage by a noninvasive method still remains an unfulfilled goal in the treatment of patients with breast cancer.

  15. Lymph Node Metastasis in Breast Carcinoma: Clinico pathologic Correlations in 3747 Patients

    International Nuclear Information System (INIS)

    Histological axillary node involvement (ANI) evaluated by axillary dissection remains the most accurate predictive factor for patients with invasive breast cancer. Axillary node involvement implies the necessity of systemic adjuvant treatment and locoregional irradiation. Aim of the study: Is to detect the relative frequency of node positivity in relation to histopathology through studying a large mastectomy series. Material and methods: This study included 3747 mastectomy specimens performed at NCI Cairo in the period 1993-2003. In each case we assessed the age at time of diagnosis, pathologic tumor size and number, histologic subtype (including grade), tumor location, number of lymph nodes dissected and number of positive nodes (burden of node positivity). Females constituted 96.8% of cases, 60.7% of them were premenopausal. The mean age was 47.l ± 10.5 years. Tumor size ranged from 0.5 to 20 cm. The global ANI rate in the entire cohort was 70.6%. ]n univariate analysis, five variables were significantly correlated to ANI, these were laterality, multiplicity. tumor size, histologic subtype and grade, while multiplicity, tumor size, histologic subtype and grade correlated significantly with metastatic burden. Multivariate analysis showed that older women (40-60 and> 60 years) have at least half the risk of developing LN metastasis compared to those 2 em put the women with breast cancer at 3 (if 2 -5 cm) to 9 (if> 5 cm) folds of developing lymph node (LN) metastasis. Tumor size> 5 em increases the likelihood of higher metastatic burden (> 3 +ve nodes) with odds of I. 5 (1.24-1. 9). Unfavorable histology also, increases the likelihood of more positive nodes to the double when compared to favourable histology. The result of this study reflected the unfortunate presentation of breast cancer patients. In addition, some factors could be used as useful guidelines in the management of those patients. These factors include age, tumor size and histologic type of the tumor

  16. Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

    Directory of Open Access Journals (Sweden)

    Atakan Sezer

    2011-06-01

    Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

  17. Detection of Lymph Node Metastases with SERRS Nanoparticles

    Science.gov (United States)

    Spaliviero, Massimiliano; Harmsen, Stefan; Huang, Ruimin; Wall, Matthew A.; Andreou, Chrysafis; Eastham, James A.; Touijer, Karim A.; Scardino, Peter T.; Kircher, Moritz F.

    2016-01-01

    Purpose The accurate detection of lymph node metastases in prostate cancer patients is important to direct treatment decisions. Our goal was to develop an intra-operative imaging approach to distinguish normal from metastasized lymph nodes. We therefore developed and tested gold-silica surface-enhanced resonance Raman spectroscopy (SERRS) nanoparticles that demonstrate high uptake within normal lymphatic tissue, and negligible uptake in areas of metastatic replacement. Procedures We evaluated the ability of SERRS nanoparticles to delineate lymph node metastases in an orthotopic prostate cancer mouse model using PC-3 cells transduced with mCherry fluorescent protein. Tumor bearing mice (n = 6) and non-tumor bearing control animals (n = 4) were injected intravenously with 30 fmol/g SERRS nanoparticles. After 16–18 hours, the retroperitoneal lymph nodes were scanned in situ and ex vivo with a Raman imaging system and a hand-held Raman scanner and data corroborated with fluorescence imaging for mCherry protein expression and histology. Results The SERRS nanoparticles demonstrated avid homing to normal lymph nodes, but not to metastasized lymph nodes. In cases where lymph nodes were partially infiltrated by tumor cells, the SERRS signal correctly identified, with sub-millimeter precision, healthy from metastasized components within the same lymph node. Conclusions This study serves as a first proof-of-principle that SERRS nanoparticles enable high precision and rapid intraoperative discrimination between normal and metastasized lymph nodes. PMID:26943129

  18. Validation of the Memorial Sloan Kettering Cancer Center nomogram for predicting non-sentinel lymph node metastasis in sentinel lymph node-positive breast-cancer patients

    Directory of Open Access Journals (Sweden)

    Bi X

    2015-02-01

    MSKCC nomogram can provide an accurate prediction of the probability of non-SLN metastasis, and offers a reference basis about axillary lymph node dissection. Axillary lymph node dissection could be avoided in patients with predictive values lower than 10%. Keywords: MSKCC nomogram, probability, SLN, axillary lymph node dissection, risk factors

  19. Endoscopic ultrasound: Elastographic lymph node evaluation.

    Science.gov (United States)

    Dietrich, Christoph F; Jenssen, Christian; Arcidiacono, Paolo G; Cui, Xin-Wu; Giovannini, Marc; Hocke, Michael; Iglesias-Garcia, Julio; Saftoiu, Adrian; Sun, Siyu; Chiorean, Liliana

    2015-01-01

    Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives. PMID:26374575

  20. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.

  1. Fatores clínico-patológicos de predição do acometimento axilar em pacientes com metástases de câncer de mama no linfonodo sentinela Clinicopathological predictor factors of axillary involvement in patients with metastatic breast cancer in the sentinel lymph node

    Directory of Open Access Journals (Sweden)

    Edison Mantovani Barbosa

    2010-03-01

    nodes in patients with breast carcinoma undergoing sentinel lymph node biopsy (SLNB. METHODS: a retrospective study carried out with 1,000 successive patients with SLNB from 1998 to 2008. Age, tumor size, histological grade, lymphovascular invasion, hormone receptor status and HER-2, size of metastasis and number of positive SLN were evaluated. The associations between the characteristics of the tumors and the types of metastases were evaluated through χ2 corrected likelihood ratio tests for insufficient samples. RESULTS: mean age was 57.6 years and mean tumor size was 1.85 cm. A total of 72.2% SLN were negative and 27.8% were positive, but in 61.9% of the cases, the SLN was the only positive one, with 78.4% having macrometastases, 17.3% micrometastases and 4.3% isolated tumor cells (CTI. Tumor size was predictive of metastases in non-sentinel lymph nodes. After 54 months of follow-up, there were no recurrences in patients with CTI, but one local recurrence and two systemic recurrences were observed in the micrometastasis group, as well as four local and 30 distant metastases in the macrometastasis group. CONCLUSIONS: among the clinical parameters studied, only tumor size was correlated with metastatic involvement in axillary lymph nodes. The size of the metastases and the number of positive SLN also directly increased the possibility of systemic recurrence. The different rates of recurrence indicate that the biological significance of these types of metastases is different and that patients with SLN metastases may also have different risks of metastatic involvement of other axillary lymph nodes.

  2. Adjuvant radiotherapy for melanoma metastatic to axillary and inguinal nodes: Regional tumor control and late effects

    Directory of Open Access Journals (Sweden)

    Ahmed SK

    2014-09-01

    Full Text Available Background: Adjuvant radiotherapy reduces nodal recurrence in metastatic melanoma. The purpose of this study was to examine the effects of adjuvant radiotherapy on in-field nodal control of melanoma metastatic to axillary and inguinal lymph nodes. Methods: The medical records of patients who received adjuvant radiotherapy from January 1, 2003, through December 31, 2011, at Mayo Clinic were reviewed. Results: In the 20 patients identified, the rates of 2-year overall survival, nodal control, and freedom from distant metastases were 53%, 54%, and 44%, respectively. Intensity-modulated radiotherapy was used in 15 patients (75% and 3-dimensional conformal radiotherapy in 5 (25%. Disease progression was documented in 13 patients, with a total of 10 distant metastases and 6 in-field nodal recurrences. Treatment complications occurred in 14 patients: lymphedema, 9; lymphedema and fibrosis, 1; lymphedema and wound dehiscence, 1; wound dehiscence, 1; lymphedema and seroma, 1; and lymphedema, seroma, and fibrosis, 1. Conclusion: Patients with axillary and inguinal nodal metastases from melanoma have poor overall survival. Surgery and adjuvant radiotherapy provided a 54% nodal control rate. No plexopathy or grade 3 lymphedema complications were seen; however, 20% developed wound dehiscence.

  3. Prospective study found thatperipheral lymph node sampling reduced the false-negative rate ofsentinel lymph node biopsy forbreast cancer

    Institute of Scientific and Technical Information of China (English)

    ChaoHan; BenYang; WenShuZuo; YanSongLiu; GangZheng; LiYang; MeiZhuZheng

    2016-01-01

    Background:Although sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false‑negative rate (FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND). The purpose of this study was to evaluate the clinical signiifcance of SLNB combined with peripheral lymph node (PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of “skip metastasis” on the FNR of SLNB. Methods:At Shandong Cancer Hospital Affliated to Shandong University between March 1, 2012 and June 30, 2015, the sentinel lymph nodes (SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer. First, the SLNs were removed; then, the area surrounding the original SLNs was selected, and the visible lymph nodes in a ifeld of 3–5cm in diameter around the center (i.e., PLNs) were removed, avoiding damage to the structure of the breast. Finally, ALND was performed. The SLNs, PLNs, and remaining ALNs underwent pathologic examination, and the relationship between them was analyzed. Results:The identiifcation rate of SLNs in the 596 patients was 95.1% (567/596); the metastasis rate of ALNs was 33.7% (191/567); the FNR of pure SLNB was 9.9% (19/191); and after the SLNs and PLNs were eliminated, the FNR was 4.2% (8/191), which was signiifcantly decreased compared with the FNR before removal of PLNs (P=0.028). According to the detected number (N) of SLNs, the patients were divided into four groups of N=1, 2, 3, and≥4; the FNR in these groups was 19.6, 9.8, 7.3, and 2.3%, respectively. For the patients with≤2 or≤3 detected SLNs, the FNR after removal of PLNs was signiifcantly decreased compared with that before removal of PLNs (N≤2: 14.0% vs. 4.7%, P=0.019; N≤3: 12.2% vs. 4.7%,P=0.021), whereas for patients with≥4 detected SLNs, the decrease in FNR was not statistically signiifcant (P=1.000). In the entire cohorts

  4. Sentinel lymph nodes in cancer of the oral cavity

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Christensen, Rikke Kølby; Sørensen, Jens Ahm;

    2007-01-01

    when compared with (B) step-sectioning and immunostaining of the entire sentinel lymph node at 250 microM levels. METHODS: Forty patients with T1/T2 cN0 oral cancer were enrolled. Three patients were excluded. In one patient no sentinel lymph node was identified. The remaining two had unidentified...

  5. Sentinel lymph node biopsy in breast cancer and melanoma

    NARCIS (Netherlands)

    Doting, Meintje Hylkje Edwina

    2007-01-01

    Summary and conclusions In the introduction, a short overview of the development of the sentinel lymph node biopsy concept is presented. In addition to melanoma and breast cancer, the usefulness of sentinel lymph node biopsy as a surgical assessment method for squamous cell carcinoma of penis and vu

  6. Sentinel lymph nodes in cancer of the oral cavity

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Sørensen, Jens Ahm; Krogdahl, Annelise

    2005-01-01

    with T1/T2 cN0 oral cancer were re-classified histologically to find possible ITC and to describe technical pitfalls. RESULTS: Primarily we found metastatic spread in 12 of 108 sentinel lymph nodes: five macrometastasis and seven micrometastasis. After re-classification, we found seven lymph nodes...

  7. Effects of transuranics on pulmonary lymph nodes of rodents

    International Nuclear Information System (INIS)

    Pulmonary lymph nodes have been suggested as the ''critical'' tissue for insoluble, inhaled transuranic compounds owing to the high concentration of transuranics in these lymph nodes. About 800 rats were given from 0.2 to 3600 nCi of 238PuO2 or 239PuO2 by inhalation, intratracheal instillation, intrapleural injection, or intraperitoneal injection. From about 1 to 10 percent of deposited plutonium was translocated to pulmonary lymph nodes, the amount depending on the time after deposition and the route of administration; 238PuO2 was cleared from pulmonary lymph nodes faster than 239PuO2 owing to the greater in vivo solubility of 238PuO2. No primary tumors of pulmonary lymph nodes were observed, indicating that this tissue was not the critical tissue for carcinogenic induction

  8. Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Vasques, Paulo Henrique Diogenes; Aquino, Ranniere Gurgel Furtado de; Pinheiro, Luiz Gonzaga Porto, E-mail: luizgporto@uol.com.br [Universidade Federal do Ceara (UFC), Fortaleza, CE (Brazil). Departamento de Cirurgia; Alves, Mayara Maia [Rede Nordeste de Biotecnologia (RENORBIO/UFC), Fortaleza, CE (Brazil); Torres, Roberto Vitor Almeida; Bezerra, Jose Lucas Martins [Universidade Federal do Ceara (UFC), Fortaleza, CE (Brazil). Faculdade de Medicina; Brasileiro, Luis Porto [Faculdades INTA, Sobral, CE (Brazil). Faculdade de Medicina

    2015-11-15

    Purpose: To assess the safety and potential equivalence of the use of hemosiderin compared to the Technetium-99 in sentinel lymph node biopsy in human breast cancer. Methods: Non-random sample of 14 volunteer women diagnosed with breast cancer with primary tumors (T1/T2) and clinically tumor-free axilla were submitted to the identification of sentinel lymph node using hemosiderin obtained from autologous blood injected in the periareolar region 24h before surgery on an outpatient basis. Patients received preoperative subareolar intradermal injection of Technetium-99 in the immediate preoperative period. Patients were submitted to sentinel lymph node biopsy, with incision in the axillary fold guided by Gamma-Probe, dissection by planes until the identification of the point of maximum uptake of Technetium-99, identifying the marked nodes and their colors. All surgical specimens were sent for pathological and immunohistochemical study. Results: The results showed no evidence of side effects and/or allergic and non-allergic reactions in patients submitted to SLNB with hemosiderin. The SLN identification rate per patient was 100%. SLNB identification rate per patient with hemosiderin was the same as that of Technetium, with a concordance rate of 100% between the methods. Conclusion: Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy. (author)

  9. Nanoparticle transport from mouse vagina to adjacent lymph nodes.

    Directory of Open Access Journals (Sweden)

    Byron Ballou

    Full Text Available To test the feasibility of localized intravaginal therapy directed to neighboring lymph nodes, the transport of quantum dots across the vaginal wall was investigated. Quantum dots instilled into the mouse vagina were transported across the vaginal mucosa into draining lymph nodes, but not into distant nodes. Most of the particles were transported to the lumbar nodes; far fewer were transported to the inguinal nodes. A low level of transport was evident at 4 hr after intravaginal instillation, and transport peaked at about 36 hr after instillation. Transport was greatly enhanced by prior vaginal instillation of Nonoxynol-9. Hundreds of micrograms of nanoparticles/kg tissue (ppb were found in the lumbar lymph nodes at 36 hr post-instillation. Our results imply that targeted transport of microbicides or immunogens from the vagina to local lymph organs is feasible. They also offer an in vivo model for assessing the toxicity of compounds intended for intravaginal use.

  10. Nanoparticle transport from mouse vagina to adjacent lymph nodes.

    Science.gov (United States)

    Ballou, Byron; Andreko, Susan K; Osuna-Highley, Elvira; McRaven, Michael; Catalone, Tina; Bruchez, Marcel P; Hope, Thomas J; Labib, Mohamed E

    2012-01-01

    To test the feasibility of localized intravaginal therapy directed to neighboring lymph nodes, the transport of quantum dots across the vaginal wall was investigated. Quantum dots instilled into the mouse vagina were transported across the vaginal mucosa into draining lymph nodes, but not into distant nodes. Most of the particles were transported to the lumbar nodes; far fewer were transported to the inguinal nodes. A low level of transport was evident at 4 hr after intravaginal instillation, and transport peaked at about 36 hr after instillation. Transport was greatly enhanced by prior vaginal instillation of Nonoxynol-9. Hundreds of micrograms of nanoparticles/kg tissue (ppb) were found in the lumbar lymph nodes at 36 hr post-instillation. Our results imply that targeted transport of microbicides or immunogens from the vagina to local lymph organs is feasible. They also offer an in vivo model for assessing the toxicity of compounds intended for intravaginal use. PMID:23284844

  11. Axillary node metastatic carcinoma without definitive primary: a case report

    Directory of Open Access Journals (Sweden)

    Spencer R. Anderson

    2016-01-01

    Full Text Available Cancer of unknown primary (CUP is the finding of a metastatic cancerous lesion without an established primary source localized within the body. CUP can be of any cancer cell type, however, adenocarcinoma is most often identified by histology. Up to 5% of all malignant diagnoses are classified as CUP. PET is an imaging modality often utilized to distinguish a primary source in the setting of CUP, yet often a primary is never identified. CUP can be further stratified using specific qualifiers as favorable and unfavorable, indicating the potential therapeutic response to treatment regimens. Treatment approach to CUP relies heavily on the cell type identified by histology, the location of the lesion, and the amount of spread within the body. In the typical setting and presentation, per current literature, CUP arises in the 7th decade of life in patients with multiple comorbidities, and often has a poor prognostic value. This case report identifies an atypical presentation of CUP, a 38-year-old Caucasian female with an axillary mobile mass, and no associated systemic symptoms. Biopsy of the node and immunohistochemical staining showed histology consistent with metastatic carcinoma. Mammography, MRI, and PET scan found no evidence of tumor primary or distant metastasis. Further staining confirmed metastatic carcinoma consistent with breast origin, without an established breast primary. As in this case, CUP may present in an atypical manner, warranting a thorough investigation aiming to identify the tumor primary to aid in identification of a proper treatment regimen and approach.

  12. Study of internal mammary sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy

    Directory of Open Access Journals (Sweden)

    Cao XS

    2015-10-01

    Full Text Available Xiao-Shan Cao,1,2 Bin-Bin Cong,1,2 Xiao Sun,1 Peng-Fei Qiu,1 Yong-Sheng Wang1 1Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, People’s Republic of China; 2School of Medicine and Life Sciences, Jinan University-Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of ChinaInternal mammary lymph node (IMLN metastasis has a similar prognostic importance as axillary lymph nodal involvement in breast cancer patients.1 Patients with both axillary- and internal mammary-positive nodes have a very poor prognosis.2 Reliable data for internal mammary nodal metastases are reported to be present in 18%–33% (mean 23.4% of patients who have not been treated with neoadjuvant chemotherapy (NAC mostly concomitant with axillary metastases, and metastases exclusively situated in the internal mammary chain occur in 2%–11% of patients,3 but limited data are available in the context of NAC.

  13. The surgical importance of an axillary arch in sentinel node biopsy.

    LENUS (Irish Health Repository)

    Ridgway, P F

    2011-03-01

    When Carl Langer described the aberrant axillary arch in 1846 its relevance in sentinel node biopsy (SNB) surgery could not have been contemplated. The authors define an incidence and elucidate relevance of the arch in SNB of the axilla.

  14. In vivo photoacoustic and ultrasonic mapping of rat sentinel lymph nodes with a modified commercial ultrasound imaging system

    Science.gov (United States)

    Erpelding, Todd N.; Kim, Chulhong; Pramanik, Manojit; Guo, Zijian; Dean, John; Jankovic, Ladislav; Maslov, Konstantin; Wang, Lihong V.

    2010-02-01

    Sentinel lymph node biopsy (SLNB) has become the standard method for axillary staging in breast cancer patients, relying on invasive identification of sentinel lymph nodes (SLNs) following injection of blue dye and radioactive tracers. While SLNB achieves a low false negative rate (5-10%), it is an invasive procedure requiring ionizing radiation. As an alternative to SLNB, ultrasound-guided fine needle aspiration biopsy has been tested clinically. However, ultrasound alone is unable to accurately identify which lymph nodes are sentinel. Therefore, a non-ionizing and noninvasive detection method for accurate SLN mapping is needed. In this study, we successfully imaged methylene blue dye accumulation in vivo in rat axillary lymph nodes using a Phillips iU22 ultrasound imaging system adapted for photoacoustic imaging with an Nd:YAG pumped, tunable dye laser. Photoacoustic images of rat SLNs clearly identify methylene blue dye accumulation within minutes following intradermal dye injection and co-registered photoacoustic/ultrasound images illustrate lymph node position relative to surrounding anatomy. To investigate clinical translation, the imaging depth was extended up to 2.5 cm by adding chicken breast tissue on top of the rat skin surface. These results raise confidence that photoacoustic imaging can be used clinically for accurate, noninvasive SLN mapping.

  15. Differentiation of hyperplastic from metastatic lymph nodes using a lymph node specific MR contrast agent gadofluorine M

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Joo Hee; Cheon, Jung Eun [Seoul Municipal Boramae Hospital, Seoul (Korea, Republic of); Moon, Woo Kyung [Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Seoul (Korea, Republic of)] (and others)

    2006-08-15

    We wanted to evaluate the value of a lymph node specific MR contrast agent, Gadofluorine M, for the differentiation of hyperplastic and metastatic lymph nodes. This study included thirty-one rabbits. In ten rabbits, an injection of egg yolk or feces of rat into the calf muscles induced hyperplasia of the lymph node. In sixteen rabbits, metastasis of the lymph node was induced by implantation of VX2 tumor. Five rabbits were normal control models. We acquired the T1-, T2-weighted and SPGR coronal imaging before enhancement with 1.5 T MR. After injection of Gadofluorine M (5 {mu}mol/mL, total amount: 4 mL) interstitially into the interdigital skin fold of the hind limb, we acquired the SPGR coronal imaging at 15, 30, 60 and 90 minutes. We calculated the signal-to-noise ratios on the sequential images, and we recorded the number, size and location of the popliteal and iliac lymph nodes. Three readers assessed the state of the lymph nodes according to the pattern of enhancement: they were deemed hyperplastic nodes when totally enhanced and as metastatic nodes when there was no or partial enhancement. We also compared the imaging patterns with the histopathological results. Among the 26 hyperplasia- or metastasis-induced rabbits, two rabbits were excluded because of failure to be enhanced. Histopathologic evaluation of the 24 rabbits detected one hundred seventeen lymph nodes: forty-six lymph nodes in nine hyperplasia-induced rabbits and seventy-one (metastasis in twenty-eight) lymph nodes in fifteen metastasis-induced rabbits. Out of one hundred two lymph nodes that were larger than 5 mm in size, MR enabled us to detect one hundred one lymph nodes (99.1%). The means of sensitivity, specificity, and the positive and negative predictive values for the diagnosis of lymph node metastasis by three readers were 97.6% (82/84), 98.2% (215/219), and 95.3% (82/86), and 99.1% (215/217), respectively ({rho} < 0.05). Interstitial MR lymphography using Gadofluorine M showed excellent

  16. Duration of 18F-FDG avidity in lymph nodes after pandemic H1N1v and seasonal influenza vaccination

    International Nuclear Information System (INIS)

    The aim of our study was to investigate the occurrence of fluorodeoxyglucose (FDG) avidity in draining axillary lymph nodes after vaccination against influenza (H1N1v pandemic and seasonal) and to determine the period of increased FDG uptake. During December 2009, patients referred for 18F-FDG positron emission tomography (PET)/CT scans (n = 293) filled in a questionnaire concerning vaccination type (seasonal and/or H1N1v), time and anatomical localization of vaccination. Only injections in deltoid regions were evaluated, thus ensuring that draining lymph nodes were axillary. If more vaccinations had been given, only the latest vaccination was evaluated in each deltoid region. Of all patients who underwent PET/CT scans during December 2009, 26% had been vaccinated with at least one influenza vaccination in the deltoid region. A total of 92 'draining' and 60 'reference' (i.e. contralateral, non-vaccinated) axillary lymph nodes were evaluated in 61 patients (19 of 61 patients were scanned twice). The maximal intensity in FDG uptake (SUVmax) in draining lymph nodes was 5 g/ml body weight (BW), whereas the maximal intensity in reference lymph nodes was 1.9 g/ml BW. The SUVmax was normalized approximately 40 days after vaccination. No significant enlargement of metabolically active draining lymph nodes could be demonstrated on CT scan. Chemotherapy or immunosuppressive drugs given within 2 weeks from vaccination did not affect SUVmax in the axillary lymph nodes. Influenza vaccination may lead to FDG-avid draining lymph nodes beyond 1 month. (orig.)

  17. Duration of {sup 18}F-FDG avidity in lymph nodes after pandemic H1N1v and seasonal influenza vaccination

    Energy Technology Data Exchange (ETDEWEB)

    Thomassen, Anders; Lerberg Nielsen, Anne; Gerke, Oke; Johansen, Allan; Petersen, Henrik [OUH, Odense University Hospital, Department of Nuclear Medicine, Odense C (Denmark)

    2011-05-15

    The aim of our study was to investigate the occurrence of fluorodeoxyglucose (FDG) avidity in draining axillary lymph nodes after vaccination against influenza (H1N1v pandemic and seasonal) and to determine the period of increased FDG uptake. During December 2009, patients referred for {sup 18}F-FDG positron emission tomography (PET)/CT scans (n = 293) filled in a questionnaire concerning vaccination type (seasonal and/or H1N1v), time and anatomical localization of vaccination. Only injections in deltoid regions were evaluated, thus ensuring that draining lymph nodes were axillary. If more vaccinations had been given, only the latest vaccination was evaluated in each deltoid region. Of all patients who underwent PET/CT scans during December 2009, 26% had been vaccinated with at least one influenza vaccination in the deltoid region. A total of 92 'draining' and 60 'reference' (i.e. contralateral, non-vaccinated) axillary lymph nodes were evaluated in 61 patients (19 of 61 patients were scanned twice). The maximal intensity in FDG uptake (SUV{sub max}) in draining lymph nodes was 5 g/ml body weight (BW), whereas the maximal intensity in reference lymph nodes was 1.9 g/ml BW. The SUV{sub max} was normalized approximately 40 days after vaccination. No significant enlargement of metabolically active draining lymph nodes could be demonstrated on CT scan. Chemotherapy or immunosuppressive drugs given within 2 weeks from vaccination did not affect SUV{sub max} in the axillary lymph nodes. Influenza vaccination may lead to FDG-avid draining lymph nodes beyond 1 month. (orig.)

  18. [Intraoperative detection of the sentinel lymph nodes in lung cancer].

    Science.gov (United States)

    Akopov, A L; Papayan, G V; Chistyakov, I V

    2015-01-01

    An analysis of the scientific data was made. It was used the literature devoted to the intraoperative visualization of the sentinel lymph nodes in patients with lung cancer. Correct detection of such lymph nodes with following pathologic investigation allowed limiting the volume of lympho-dissection in a number of patients. There is the possibility of maximal in-depth study of the sentinel lymph nodes by purposeful application of most sensible pathologic and molecular methods for detection their micrometastatic lesions. At the same time the treatment strategy and prognosis could be determined. The authors present the results of an application of dye techniques, radioactive preparation and fluorescence imaging for sentinel lymph node detection. Advantages and disadvantages of the methods are shown in the article. There are validated the prospects of technical development, study of information value of new applications and the most perspective method of fluorescence indocyanine green visualization by lymph outflow. PMID:25962306

  19. Results of a sentinel lymph node biopsy for primary breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Yasuteru; Hiratsuka, Masafumi; Baba, Miki; Beppu, Richiko; Maekawa, Takafumi; Kawahara, Katsunobu; Shirakusa; Takayuki; Fujimitsu, Ritsuko [Fukuoka Univ. (Japan). School of Medicine

    2003-03-01

    Although the role of an axillary lymph node dissection for the primary breast cancer is considered to be a prognostic indicator, regarding the determination of the treatment strategy after surgery, and the best modality for regional control, this procedure is harmful rather than ineffective in cases with a histologically negative node. The sentinel lymph node (SLN) biopsy is a procedure used to assess the degree of nodal involvement before and/or during surgery. From June, 1999 to January, 2002, we performed an SLN biopsy for 47 primary breast cancer patients (T1-2N0-1M0) using either a dye or combined (dye and gamma probe guided) method with a back up conventional axillary node dissection at the Second Department of Surgery, Fukuoka University School of Medicine. The dye method was performed on 39 patients, and it resulted in the accurate identification of the SLN in 74.4% of patients, compared with 94.7% in latter series of 19 patients. In addition, the dye method demonstrated a sensitivity of 66.6%, a specificity of 100% and an accuracy of 96.6%. Eight patients received the combined method, and the SLN was identified in 100% of these patients. This combined method showed a sensitivity of 80%, a specificity of 100% and an accuracy of 87.5%. On the other hand an intraoperative examination using frozen sections resulted in a sensitivity of 50%, a specificity of 100% and an accuracy in the diagnosis of 83.3%. These data suggest that an SLN biopsy for early breast cancer (T1N0) can be performed to eliminate any unnecessary axillary node dissection in cases with negative SLN. However, the successful results of this method depend on the cooperation of the multidisciplinary team (surgeons, pathologists and nuclear radiologists) and the informed consent of all patients. (author)

  20. Histopathological Evaluation of Lymph Node Biopsies: A Hospital Based Study

    Directory of Open Access Journals (Sweden)

    Syeda Tasfia Siddika

    2012-07-01

    Full Text Available Background: Lymphadenopathy is a common manifestation of a large variety of disorders,both benign and malignant. It is essential to define the pattern of disorders presenting primarily as lymph node enlargement in a particular environment. Histopathological examination of the lymph node biopsies is a gold standard test in the distinction between reactive and malignant lymphoid proliferations as well as for detailed subtyping oflymphomas. We designed this study in our population for histopathological evaluation of lymph nodes that might be helpful for clinical management of these lesions. Objective: Histopathological evaluation of lymphadenopathy from excised specimen, in relation to ageand sex of the patients, and distribution of the lymph nodes. Materials and Methods: It was a retrospective cross sectional study conducted in the department of Pathology, Enam Medical College & Hospital, Savar, Dhaka during the period from January 2006 to December 2010. Lymph node biopsies of all patients of both sexes and all age groups were included.Metastatic lymph nodes associated with evidence of primaries elsewhere in the body were excluded from the study. Total 191 lymph node biopsies were selected for histopathological evaluation. Among these 90 (47.12% were from males and 101 (52.88% were from females with male to female ratio being 1:2.1. The age of the patients ranged from 2 to 85 years with a mean age of 35.73 ± 18 years. Results: Cervical lymph nodes were the most common (56% biopsied group. Of the 191 cases 59 cases (30.89% were reactive lymphadenitis, 64 cases (33.5% were tuberculosis, 2 cases (1.05% were non-caseous granuloma, 11 cases (5.76% were Hodgkin lymphoma, 22 cases (11.52% were non-Hodgkin lymphoma, 24 cases (12.57% were metastatic neoplasm and 9 cases (4.7% were other lesions. Conclusion: Tuberculosis was the most common cause of lymphadenopathy, followed by reactive lymphadenitis and the cervical group of lymph nodes was most

  1. Risk Factors for Regional Nodal Relapse in Breast Cancer Patients With One to Three Positive Axillary Nodes

    Energy Technology Data Exchange (ETDEWEB)

    Yates, Lucy, E-mail: lucy.yates@gstt.nhs.uk [Guy' s, King' s, St Thomas' Cancer Centre, Guy' s Hospital, London (United Kingdom); Kirby, Anna [Guy' s, King' s, St Thomas' Cancer Centre, Guy' s Hospital, London (United Kingdom); Department of Clinical Oncology, Royal Marsden Hospital, Sutton (United Kingdom); Crichton, Siobhan [Department of Statistics, Kings College London (United Kingdom); Gillett, Cheryl [Breast Pathology, Kings College London (United Kingdom); Cane, Paul [Department of Histopathology, Guy' s and St Thomas' Foundation Trust, London (United Kingdom); Fentiman, Ian; Sawyer, Elinor [Guy' s, King' s, St Thomas' Cancer Centre, Guy' s Hospital, London (United Kingdom)

    2012-04-01

    Purpose: In many centers, supraclavicular fossa radiotherapy (SCF RT) is not routinely offered to breast cancer patients with one to three positive lymph nodes. We aimed to identify a subgroup of these patients who are at high risk of supra or infraclavicular fossa relapse (SCFR) such that they can be offered SCFRT at the time of diagnosis to improve long term locoregional control. Methods and Materials: We performed a retrospective analysis of the pathological features of 1,065 cases of invasive breast cancer with one to three positive axillary lymph nodes. Patients underwent radical breast conserving surgery or mastectomy. A total of 45% of patients received adjuvant chest wall/breast RT. No patients received adjuvant SCFRT. The primary outcome was SCFR. Secondary outcomes were chest wall/breast recurrence, distant metastasis, all death, and breast-cancer specific death. Kaplan-Meier estimates were used to calculate actuarial event rates and survival functions compared using log-rank tests. Multivariate analyses (MVA) of factors associated with outcome were conducted using Cox proportional hazards models. Results: Median follow-up was 9.7 years. SCFR rate was 9.2%. Median time from primary diagnosis to SCFR was 3.4 years (range, 0.7-14.4 years). SCFR was associated with significantly lower 10-year survival (18% vs. 65%; p < 0.001). Higher grade and number of positive lymph nodes were the most significant predictors of SCFR on MVA (p < 0.001). 10 year SCFR rates were less than 1% in all patients with Grade 1 cancers compared with 30% in those having Grade 3 cancers with three positive lymph nodes. Additional factors associated with SCFR on univariate analysis but not on MVA included larger nodal deposits (p = 0.002) and proportion of positive nodes (p = 0.003). Conclusions: Breast cancer patients with one to three positive lymph nodes have a heterogenous risk of SCFR. Patients with two to three positive axillary nodes and/or high-grade disease may warrant

  2. Risk Factors for Regional Nodal Relapse in Breast Cancer Patients With One to Three Positive Axillary Nodes

    International Nuclear Information System (INIS)

    Purpose: In many centers, supraclavicular fossa radiotherapy (SCF RT) is not routinely offered to breast cancer patients with one to three positive lymph nodes. We aimed to identify a subgroup of these patients who are at high risk of supra or infraclavicular fossa relapse (SCFR) such that they can be offered SCFRT at the time of diagnosis to improve long term locoregional control. Methods and Materials: We performed a retrospective analysis of the pathological features of 1,065 cases of invasive breast cancer with one to three positive axillary lymph nodes. Patients underwent radical breast conserving surgery or mastectomy. A total of 45% of patients received adjuvant chest wall/breast RT. No patients received adjuvant SCFRT. The primary outcome was SCFR. Secondary outcomes were chest wall/breast recurrence, distant metastasis, all death, and breast-cancer specific death. Kaplan-Meier estimates were used to calculate actuarial event rates and survival functions compared using log–rank tests. Multivariate analyses (MVA) of factors associated with outcome were conducted using Cox proportional hazards models. Results: Median follow-up was 9.7 years. SCFR rate was 9.2%. Median time from primary diagnosis to SCFR was 3.4 years (range, 0.7–14.4 years). SCFR was associated with significantly lower 10-year survival (18% vs. 65%; p < 0.001). Higher grade and number of positive lymph nodes were the most significant predictors of SCFR on MVA (p < 0.001). 10 year SCFR rates were less than 1% in all patients with Grade 1 cancers compared with 30% in those having Grade 3 cancers with three positive lymph nodes. Additional factors associated with SCFR on univariate analysis but not on MVA included larger nodal deposits (p = 0.002) and proportion of positive nodes (p = 0.003). Conclusions: Breast cancer patients with one to three positive lymph nodes have a heterogenous risk of SCFR. Patients with two to three positive axillary nodes and/or high-grade disease may warrant

  3. The Significance of CXCR4 Expression for the Prediction of Lymph Node Metastasis in Breast Cancer Patients

    Institute of Scientific and Technical Information of China (English)

    Yongxing Ding; Chenghua Li; Qingling Yang; Changjie Chen; Zenong Cheng

    2008-01-01

    OBJECTIVE The chemokine receptor (CXCR4) CXC chemokine receptor 4) plays an important role in cancer metastasis. We therefore studied differential expression of the CXCR4, as well as that of the biomarker HER2, so as to evaluate whether these biomarkers can be used to predict axillary lymph node metastasis in breast cancer patients.METHODS Immunohistochemistry was used to evaluate the CXCR4 and HER2 expressions and to examine the paraffin sections of the breast cancers at various stages. Positive lymph node expression was found in 80 of the cases, and in 7 there was negative expression.RESULTS Compared to the cases with negative lymph nodes,there was a high expression of CXCR4 (26.3% vs. 14.3%, P = 0.013),and an over-expression of HER2 (28.8% vs. 14.3%, P = 0.011).Moreover, there was a direct correlation between the CXCR4 and HER2 expressions and the tumor staging (P = 0.000) and lymph node metastasis (P = 0.032). When the two biomarkers, I.e. CXCR4 and HER2, were concurrently labeled, a high expression of one of the biomarkers could be seen in the cases with positive lymph nodes (51.3% vs. 28.6%, P < 0.003).CONCLUSION The chemokine receptor, CXCR4, is a new-type biomarker in predicting axillary lymph-node metastasis in breast cancers. Compared with the other markers, such as HER2 etc.,assessment of CXCR4 can improve the prediction of the presence and extent of lymph node involvement.

  4. Histological step sectioning of pelvic lymph nodes increases the number of identified lymph node metastases

    DEFF Research Database (Denmark)

    Engvad, Birte; Poulsen, Mads H; Staun, Pia W;

    2014-01-01

    Pathological examinations of lymph nodes (LN) in prostate cancer patients are handled differently at various institutions. The objective of this study is to provide means to improve the guidelines by examining the impact of step sectioning on LN status in patients with intermediate and high...... at the standard examination, whereas the extended examination gave additional 7,110 slides and detected 5 additional patients with LN metastasis. In all, 1,158 LN were removed. The additional LN metastases were smaller than the LN metastases found at the standard examination, mean 1.2 mm vs. 7.8 mm.Our results...

  5. Predicting Likelihood of Having Four or More Positive Nodes in Patient With Sentinel Lymph Node-Positive Breast Cancer: A Nomogram Validation Study

    International Nuclear Information System (INIS)

    Purpose: Katz suggested a nomogram for predicting having four or more positive nodes in sentinel lymph node (SLN)-positive breast cancer patients. The findings from this formula might influence adjuvant radiotherapy decisions. Our goal was to validate the accuracy of the Katz nomogram. Methods and Materials: We reviewed the records of 309 patients with breast cancer who had undergone completion axillary lymph node dissection. The factors associated with the likelihood of having four or more positive axillary nodes were evaluated in patients with one to three positive SLNs. The nomogram developed by Katz was applied to our data set. The area under the curve of the corresponding receiver operating characteristics curve was calculated for the nomogram. Results: Of the 309 patients, 80 (25.9%) had four or more positive axillary lymph nodes. On multivariate analysis, the number of positive SLNs (p < .0001), overall metastasis size (p = .019), primary tumor size (p = .0001), and extracapsular extension (p = .01) were significant factors predicting for four or more positive nodes. For patients with <5% probability, 90.3% had fewer than four positive nodes and 9.7% had four or more positive nodes. The negative predictive value was 91.7%, and sensitivity was 80%. The nomogram was accurate and discriminating (area under the curve, .801). Conclusion: The probability of four or more involved nodes is significantly greater in patients who have an increased number of positive SLNs, increased overall metastasis size, increased tumor size, and extracapsular extension. The Katz nomogram was validated in our patients. This nomogram will be helpful to clinicians making adjuvant treatment recommendations to their patients.

  6. Sentinel lymph node biopsy in local recurrence of cutaneous melanoma

    International Nuclear Information System (INIS)

    Full text: Locally recurrent disease in patients with melanoma is usually defined as cutaneous or subcutaneous arising within 5 cm of the primary site after complete excision of the primary lesion. It may represent residual disease not excised with the primary tumor or the outgrowth of the satellite lesions, which are common with melanoma. Lymphatic mapping and sentinel lymph node (SLN) biopsy is highly accurate in staging nodal basins at risk of regional metastases in primary melanoma patients and identifies those who may benefit from earlier lymphadenectomy. Our purpose was to evaluate the efficacy of sentinel lymph node mapping and biopsy in local recurrence of cutaneous melanoma when the primary lesion was less than 1.0mm thick. Three patients with local recurrence of cutaneous melanoma underwent sentinel lymph node mapping and biopsy. All patients underwent preoperative lymphoscintigraphy to identify the lymphatic basin and the site of the sentinel node. All patients subsequently underwent intra-operative lymphatic mapping and selective lymph node biopsy with vital blue dye and hand-held gamma probe. Excised SLN were analysed by conventional histological staining (H and E) and immunohistochemical staining. In all patients the lymphatic mapping and sentinel lymph node biopsy was successful. The SLN biopsy was negative in two patients and positive in one who underwent therapeutic lymph node dissection. Our results indicate that the SLN mapping and biopsy is also possible in patients having local recurrence of cutaneous melanoma. Although long-term results are not available, early results are promising. (author)

  7. Evaluation of the lymph flow to the sentinel lymph node (SLN) in breast cancer using CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Boasquevisque, Edson; Boasquevisque, Gustavo [National Cancer Institute (INCA), Rio de Janeiro, RJ (Brazil). Radiology Dept.]. E-mail: Boasquevisque@gmail.com; Pinto, Renata Reis [Universidade Federal de Sao Paulo (UNIFESP-EPM), SP (Brazil); Cavalcante Filho, Augusto; Millen, Eduardo C. [Santa Casa de Misericordia de Barra Mansa, RJ (Brazil). Radiology and Pathology Dept.; Silva, Jorge Wagner Esteves da [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Fac. de Ciencias Medicas. Laboratory and Pathology

    2008-01-15

    Background: axillary nodal status remains the best survival predictor for patients with early stage breast cancer. Accurate identification of sentinel lymph node (SLN) is the first step for biopsy. Purpose: To evaluate the lymph flow to SLN with Computerized Tomography using small volume of low molecular iodinated contrast medium. Material and methods: thin section and 3D CT images of the breast and axilla were acquired from 20 patients with early stage breast cancer. Images were acquired before subcutaneous injection of a small volume of water soluble iodinated contrast medium in the periareolar region and 1-7 minutes latter. Location of SLN and CT density were assessed at CT lymphography and the positive group was compared with negative one. Results: in all patients, CT lymphography allowed localization of SLN and its afferent lymphatic vessel, as well as measuring the contrast medium uptake and washout from SLN. The negative group presented grater and faster contrast medium uptake and washout compared to the positive one. Conclusion: CT lymphography provides good anatomical localization of SLN and may be useful for its lymph flow analysis, allowing a better distinction of positive from negative metastatic nodes. (author)

  8. A dual-modality photoacoustic and ultrasound imaging system for noninvasive sentinel lymph node detection: preliminary clinical results

    Science.gov (United States)

    Erpelding, Todd N.; Garcia-Uribe, Alejandro; Krumholz, Arie; Ke, Haixin; Maslov, Konstantin; Appleton, Catherine; Margenthaler, Julie; Wang, Lihong V.

    2014-03-01

    Sentinel lymph node biopsy (SLNB) has emerged as an accurate, less invasive alternative to axillary lymph node dissection, and it has rapidly become the standard of care for patients with clinically node-negative breast cancer. The sentinel lymph node (SLN) hypothesis states that the pathological status of the axilla can be accurately predicted by determining the status of the first (i.e., sentinel) lymph nodes that drain from the primary tumor. Physicians use radio-labeled sulfur colloid and/or methylene blue dye to identify the SLN, which is most likely to contain metastatic cancer cells. However, the surgical procedure causes morbidity and associated expenses. To overcome these limitations, we developed a dual-modality photoacoustic and ultrasound imaging system to noninvasively detect SLNs based on the accumulation of methylene blue dye. Ultimately, we aim to guide percutaneous needle biopsies and provide a minimally invasive method for axillary staging of breast cancer. The system consists of a tunable dye laser pumped by a Nd:YAG laser, a commercial ultrasound imaging system (Philips iU22), and a multichannel data acquisition system which displays co-registered photoacoustic and ultrasound images in real-time. Our clinical results demonstrate that real-time photoacoustic imaging can provide sensitive and specific detection of methylene blue dye in vivo. While preliminary studies have shown that in vivo detection of SLNs by using co-registered photoacoustic and ultrasound imaging is feasible, further investigation is needed to demonstrate robust SLN detection.

  9. Computed tomography (CT) of cervical lymph nodes in patients with oral cancer. Comparison of low-attenuation areas in lymph nodes on CT images with pathological findings

    International Nuclear Information System (INIS)

    The objective of this study was to clarify the histopathological features of low-attenuation areas in computed tomography (CT) images of cervical metastatic and benign lymph nodes in patients with oral squamous cell carcinoma (SCC). CT images of 230 lymph nodes from 37 patients with oral SCC were classified into four categories and compared with histopathological findings. Metastatic lymph nodes were evaluated in terms of focal necrosis, keratinization, fibrous tissue, and the proportion of the lymph node showing focal necrosis. Benign lymph nodes were evaluated in terms of adipose tissue, follicular hyperplasia, sinus histiocytosis, hyperemia, focal hemorrhaging, and the amount of adipose tissue. Histopathologically, all 13 metastatic lymph nodes with rim enhancement on CT images included focal necrosis. However, most of the lymph nodes showed no focal necrosis. In addition, tumor cells, keratinization, and fibrous tissue were observed in the lymph nodes. Of the 26 metastatic lymph nodes with a heterogeneous appearance on CT images, four did not show focal necrosis. These lymph nodes showed keratinization or accumulation of lymph fluid. Histopathologically, 20 of 24 benign lymph nodes with a heterogeneous appearance on CT images (83.3%) had accompanying adipose tissue. Focal necrosis was the most important factor contributing to low attenuation in metastatic lymph nodes. However, other factors, such as tumor cells, keratinization, fibrous tissue, and accumulation of lymph fluid, also contributed. In benign lymph nodes, the presence of adipose tissue was a contributing factor in low-attenuation areas, as was focal hemorrhaging. (author)

  10. Ultrasound elastography for evaluation of cervical lymph nodes

    Directory of Open Access Journals (Sweden)

    Young Jun Choi

    2015-07-01

    Full Text Available Ultrasound (US elastography has been introduced as a noninvasive imaging technique for evaluating cervical lymph nodes. US elastography techniques include strain elastography and shear wave-based elastography. The application of this technique is based on the fact that stiff tissues tend to deform less and show less strain than compliant tissues when the same force is applied. In general, metastatic lymph nodes demonstrate higher stiffness than benign lymph nodes. Overall, preliminary studies suggest that US elastography may be useful in differentiating benign and malignant cervical lymph nodes, thereby informing decisions to perform a biopsy and facilitating follow-up. For US elastography to be accepted into clinical practice, however, its techniques, associated diagnostic criteria, and reliability need to be further refined.

  11. Predictive factors for lymph node metastasis in early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Chang-Mu; Sung; Chen-Ming; Hsu; Jun-Te; Hsu; Ta-Sen; Yeh; Chun-Jung; Lin; Tse-Ching; Chen; Cheng-Tang; Chiu

    2010-01-01

    AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors ...

  12. Internal mammary lymph node biopsy guided by computed tomography

    OpenAIRE

    Irving, Henry C; Hardy, Graham J.

    1982-01-01

    Internal mammary lymph node enlargement may be demonstrated using computed tomography (CT), and a confirmatory tissue diagnosis of metastatic involvement may be obtained using fine needle aspiration biopsy with needle tip placement guided by the CT scanner. A case history is described to illustrate how a patient presented 9 years after mastectomy with an internal mammary lymph node metastasis and how cytopathological diagnosis of this metastasis was achieved by CT guided biopsy.

  13. What next? Managing lymph nodes in men with penile cancer

    OpenAIRE

    Leveridge, Michael; Siemens, D. Robert; Morash, Christopher

    2008-01-01

    The management of patients with squamous cell carcinoma of the penis is often daunting given its rarity and subsequent lack of high-level evidence to support our decision-making. This culminates in the complex surgical issues involving the management of the regional lymph nodes, which is of critical importance to both quantity and quality of life for these patients. This review aims to highlight the decisive issues surrounding the management of the pelvic and inguinal lymph nodes in the setti...

  14. Clinicopathological features of lymph node metastatic EMPNST: a case report and review of literatures

    Directory of Open Access Journals (Sweden)

    LIU Xue-yong

    2012-04-01

    Full Text Available Background Mesenchymal malignancies prefer hematogenous spread, while epithelial malignancies tend to prefer lymphatic spread. However, mesenchymal malignancies occasionally generate lymphatic metastases. Objective To investigate the clinicopathological features of the epithelioid malignant peripheral nerve sheath tumor (EMPNST. Methods The clinical data, histopathological, histochemical and immunohistochemical features in one case of EMPNST with lymph node metastases were retrospectively analyzed, and the related literatures were reviewed. Results A 42-year-old woman presented right upper arm and shoulder numbness with a right axillary nodule measuring 4 cm × 4 cm × 3 cm for 2 months. Type-B ultrasonic examination showed substantive lesions in right axillary which appeared to be a neurofibroma. CT scan showed soft tissue masses in right axillary with multiple enlarged lymph nodes were considered to be malignant lesions. MR image showed nodules in right armpit muscles were considered to be malignant tumor. The multiple nodules were identified in right axillary and the largest one was about 5 cm × 3 cm × 3 cm intraoperatively. The section of specimen was hard, gray-red and sallow in color with focal necrosis. The nodules were partly circumvoluted with blood vessel and without distinct border. The surrounding nerves were not obviously compressed. Microscopically, the structure of lymph node was damaged. The tumor invaded the surrounding fibrous connective tissue and adipose tissue with focal hemorrhage and necrosis. Tumor cells arranged in sheets, nests, and were separated by thin fibrous and blood vessels tissue. Most tumor cells were epithelioid. They were large in size with abundant cytoplasm. Cell border was indistinct, and the cytoplasm consisted of fine granules. Nuclei were invariably intensely hyperchromatic with coarse chromatin, and were vacuolated with prominent nucleoli in the center of the nuclei. Tumor cells showed frequent

  15. Endobronchial Ultrasound Elastography for Diagnosing Mediastinal and Hilar Lymph Nodes

    Institute of Scientific and Technical Information of China (English)

    Hai-Yan He; Mao Huang; Jie Zhu; Hang Ma; Xue-Dong Lyu

    2015-01-01

    Background:Pathophysiological processes,such as malignancy,can lead to the formation of stiffer tissue in lung cancers.Endobronchial ultrasound (EBUS) elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration (EBUS-TBNA).The current study was conducted to investigate the diagnostic value of EBUS elastography for mediastinal and hilar lymph node metastasis in lung cancers.Methods:From January 2014 to January 2015,40 patients suspected of lung cancer were enrolled,and a total of 68 lymph nodes were evaluated by EBUS-TBNA.EBUS-guided elastography of lymph nodes was performed prior to EBUS-TBNA.Standard EBUS characteristics were also described.Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study.If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy,patients were referred for a surgical procedure.Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes.Results:Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes (P =0.000).The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria.The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933.The best cut-offpoint of the strain ratio for differentiating malignant from benign lymph nodes was 32.07.The elastography strain ratio had a sensitivity of 88.1%,the specificity of 80.8%,positive predictive value of 88.1%,and negative predictive value of 80.8% for distinguishing malignant from benign nodes.The overall accuracy of elastography strain ratio was 85.3%.The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score (r =0.561,P =0.000).Conclusions

  16. Endobronchial Ultrasound Elastography for Diagnosing Mediastinal and Hilar Lymph Nodes

    Directory of Open Access Journals (Sweden)

    Hai-Yan He

    2015-01-01

    Full Text Available Background: Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound (EBUS elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration (EBUS-TBNA. The current study was conducted to investigate the diagnostic value of EBUS elastography for mediastinal and hilar lymph node metastasis in lung cancers. Methods: From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was performed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results: Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes (P = 0.000. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score (r = 0

  17. Unusual metachronous isolated inguinal lymph node metastasis from adenocarcinoma of the sigmoid colon

    Directory of Open Access Journals (Sweden)

    Parodo Giuseppina

    2011-10-01

    Full Text Available Abstract This study aimed to describe an unusual case of metachronous isolated inguinal lymph nodes metastasis from sigmoid carcinoma. A 62-year-old man was referred to our department because of an obstructing sigmoid carcinoma. Colonoscopy showed the obstructing lesion at 30 cm from the anal verge and abdominal CT revealed a sigmoid lesion infiltrating the left lateral abdominal wall. The patient underwent a colonic resection extended to the abdominal wall. Histology showed an adenocarcinoma of the colon infiltrating the abdominal wall with iuxtacolic nodal involvement. Thirty three months after surgery abdominal CT and PET scan revealed a metastatic left inguinal lymph node involvement. The metastatic lymph node was found strictly adherent to the left iliac-femoral artery and encompassing the origin of the left inferior epigastric artery. Histology showed a metachronous nodal metastasis from colonic adenocarcinoma. Despite metastastic involvement of inguinal lymph node from rectal cancer is a rare but well known clinical entity, to the best of our knowledge, this is the first report of inguinal metastasis from a carcinoma of the left colon. Literature review shows only three other similar reported cases: two cases of inguinal metastasis secondary to adenocarcinoma of the cecum and one case of axillary metastasis from left colonic carcinoma. A metastatic pathway through superficial abdominal wall lymphatic vessels could be possible through the route along the left inferior epigastric artery. The solitary inguinal nodal involvement from rectal carcinoma could have a more favorable prognosis. In the case of nodal metastasis to the body surface lymph nodes from colonic carcinoma, following the small number of such cases reported in the literature, no definitive conclusions can be drawn.

  18. Pre-prostatic tissue removed in robotic assisted lymph node dissection for prostate cancer contains lymph nodes

    Directory of Open Access Journals (Sweden)

    J Blarer

    2013-01-01

    Conclusions: Pre-prostatic tissue might contain lymph nodes that potentially harbour metastases. In the intention to perform the most accurate staging this tissue should be considered for histopathological evaluation.

  19. The optimal number of lymph nodes removed in maximizing the survival of breast cancer patients

    Science.gov (United States)

    Peng, Lim Fong; Taib, Nur Aishah; Mohamed, Ibrahim; Daud, Noorizam

    2014-07-01

    The number of lymph nodes removed is one of the important predictors for survival in breast cancer study. Our aim is to determine the optimal number of lymph nodes to be removed for maximizing the survival of breast cancer patients. The study population consists of 873 patients with at least one of axillary nodes involved among 1890 patients from the University of Malaya Medical Center (UMMC) breast cancer registry. For this study, the Chi-square test of independence is performed to determine the significant association between prognostic factors and survival status, while Wilcoxon test is used to compare the estimates of the hazard functions of the two or more groups at each observed event time. Logistic regression analysis is then conducted to identify important predictors of survival. In particular, Akaike's Information Criterion (AIC) are calculated from the logistic regression model for all thresholds of node involved, as an alternative measure for the Wald statistic (χ2), in order to determine the optimal number of nodes that need to be removed to obtain the maximum differential in survival. The results from both measurements are compared. It is recommended that, for this particular group, the minimum of 10 nodes should be removed to maximize survival of breast cancer patients.

  20. Can methylene blue only be used in sentinel lymph node biopsy for breast cancer?

    Science.gov (United States)

    Golshan, Mehra; Nakhlis, Faina

    2006-01-01

    Sentinel lymph node biopsy (SLNB) has become an accepted standard of care to stage the axilla for clinically node-negative early stage breast cancer. In experienced hands, studies have shown an acceptable rate of identification of the sentinel lymph node (SLN) with blue dye only. Lymphazurin is occasionally associated with severe allergic reaction, including anaphylaxis and death. The use of methylene blue alone as a method of identifying the SLN in breast cancer has been reported once previously in the literature. Methylene blue may be an acceptable alternative with fewer deleterious side effects. Medical records of patients, who underwent sentinel node mapping between September 2003 and March 2005 by two surgeons at an academic medical center were reviewed. SLN mapping was performed by periareolar injection of 5 cc of 1% methylene blue. All patients with positive SLNs underwent completion axillary node dissection. During the study period, 141 consecutive patients with clinically node-negative axillas and without evidence of inflammatory breast cancer underwent SLNB with injection of methylene blue only. A SLN was identified in 136 of 141 patients (96.5%). Thirty-three of 136 SLNs (24%) harbored metastatic disease. No cases of anaphylaxis were noted. In experienced hands, methylene blue alone is a highly sensitive method of detecting SLNs. Avoiding the greater frequency of allergic reactions seen with lymphazurin is an important advantage of methylene blue.

  1. In vivo carbon nanotube-enhanced non-invasive photoacoustic mapping of the sentinel lymph node

    Science.gov (United States)

    Pramanik, Manojit; Song, Kwang Hyun; Swierczewska, Magdalena; Green, Danielle; Sitharaman, Balaji; Wang, Lihong V.

    2009-06-01

    Sentinel lymph node biopsy (SLNB), a less invasive alternative to axillary lymph node dissection (ALND), has become the standard of care for patients with clinically node-negative breast cancer. In SLNB, lymphatic mapping with radio-labeled sulfur colloid and/or blue dye helps identify the sentinel lymph node (SLN), which is most likely to contain metastatic breast cancer. Even though SLNB, using both methylene blue and radioactive tracers, has a high identification rate, it still relies on an invasive surgical procedure, with associated morbidity. In this study, we have demonstrated a non-invasive single-walled carbon nanotube (SWNT)-enhanced photoacoustic (PA) identification of SLN in a rat model. We have successfully imaged the SLN in vivo by PA imaging (793 nm laser source, 5 MHz ultrasonic detector) with high contrast-to-noise ratio (=89) and good resolution (~500 µm). The SWNTs also show a wideband optical absorption, generating PA signals over an excitation wavelength range of 740-820 nm. Thus, by varying the incident light wavelength to the near infrared region, where biological tissues (hemoglobin, tissue pigments, lipids and water) show low light absorption, the imaging depth is maximized. In the future, functionalization of the SWNTs with targeting groups should allow the molecular imaging of breast cancer.

  2. In vivo carbon nanotube-enhanced non-invasive photoacoustic mapping of the sentinel lymph node

    International Nuclear Information System (INIS)

    Sentinel lymph node biopsy (SLNB), a less invasive alternative to axillary lymph node dissection (ALND), has become the standard of care for patients with clinically node-negative breast cancer. In SLNB, lymphatic mapping with radio-labeled sulfur colloid and/or blue dye helps identify the sentinel lymph node (SLN), which is most likely to contain metastatic breast cancer. Even though SLNB, using both methylene blue and radioactive tracers, has a high identification rate, it still relies on an invasive surgical procedure, with associated morbidity. In this study, we have demonstrated a non-invasive single-walled carbon nanotube (SWNT)-enhanced photoacoustic (PA) identification of SLN in a rat model. We have successfully imaged the SLN in vivo by PA imaging (793 nm laser source, 5 MHz ultrasonic detector) with high contrast-to-noise ratio (=89) and good resolution (∼500 μm). The SWNTs also show a wideband optical absorption, generating PA signals over an excitation wavelength range of 740-820 nm. Thus, by varying the incident light wavelength to the near infrared region, where biological tissues (hemoglobin, tissue pigments, lipids and water) show low light absorption, the imaging depth is maximized. In the future, functionalization of the SWNTs with targeting groups should allow the molecular imaging of breast cancer.

  3. Clinical axillary recurrence after sentinel node biopsy in breast cancer: a follow-up study of 220 patients

    Energy Technology Data Exchange (ETDEWEB)

    Sanjuan, A. [University of Barcelona, Department of Gynecology and Obstetrics, Breast Pathology Unit (Spain); Hospital Clinic Provincial, Barcelona (Spain); Vidal-Sicart, S.; Pons, F. [University of Barcelona, Department of Nuclear Medicine, Hospital Clinic (Spain); Zanon, G.; Pahisa, J.; Vanrell, J.A. [University of Barcelona, Department of Gynecology and Obstetrics, Breast Pathology Unit (Spain); Velasco, M.; Santamaria, G. [University of Barcelona, Department of Radiology, Breast Pathology Unit, Hospital Clinic (Spain); Fernandez, P.L. [University of Barcelona, Department of Pathology, Breast Pathology Unit, Hospital Clinic (Spain); Farrus, B. [University of Barcelona, Department of Radiation Oncology, Breast Pathology Unit, Hospital Clinic (Spain); Munoz, M.; Albanell, J. [University of Barcelona, Department of Medical Oncology, Breast Pathology Unit, Hospital Clinic (Spain)

    2005-08-01

    The aim of this study was to evaluate the frequency of false-negative (FN) sentinel node procedures in patients with breast cancer and the subsequent clinical outcome in such patients. A total of 325 breast cancer patients underwent sentinel lymph node biopsy at our institution between June 1998 and May 2004. A 2-day protocol was used to localise the sentinel node with the injection of{sup 99m}Tc-nanocolloid. There were two phases in the study: the learning phase (105 patients) and the application phase (220 patients). In the learning phase, a complete lymphadenectomy was always performed. In the application phase, sentinel nodes were studied intraoperatively and lymphadenectomy was performed when considered warranted by the pathological intraoperative results. The median follow-up duration in the 220 patients studied during the application phase was 21.2 months (range 4-45 months). In this phase a total of 427 sentinel nodes were obtained (range 1-5 per patient, median 1.99), with 66 positive sentinel nodes in 56 patients (26%). The lymphadenectomies performed were also positive in 25% of cases (14 patients). We observed a total of two false-negative sentinel lymph node results (3.45%). One of them was found during the surgical excision of non-sentinel nodes, and the other presented as an axillary recurrence 17 months postoperatively (1.72% clinical false-negative rate). The latter patient died 1 year after the first recurrence. After a median follow-up of 21.2 months we observed only one clinical recurrence among 220 patients. Our results indicate that adequate local control is achieved by application of the sentinel node protocol. (orig.)

  4. Whole genome sequence analysis suggests intratumoral heterogeneity in dissemination of breast cancer to lymph nodes.

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    Kevin Blighe

    Full Text Available BACKGROUND: Intratumoral heterogeneity may help drive resistance to targeted therapies in cancer. In breast cancer, the presence of nodal metastases is a key indicator of poorer overall survival. The aim of this study was to identify somatic genetic alterations in early dissemination of breast cancer by whole genome next generation sequencing (NGS of a primary breast tumor, a matched locally-involved axillary lymph node and healthy normal DNA from blood. METHODS: Whole genome NGS was performed on 12 µg (range 11.1-13.3 µg of DNA isolated from fresh-frozen primary breast tumor, axillary lymph node and peripheral blood following the DNA nanoball sequencing protocol. Single nucleotide variants, insertions, deletions, and substitutions were identified through a bioinformatic pipeline and compared to CIN25, a key set of genes associated with tumor metastasis. RESULTS: Whole genome sequencing revealed overlapping variants between the tumor and node, but also variants that were unique to each. Novel mutations unique to the node included those found in two CIN25 targets, TGIF2 and CCNB2, which are related to transcription cyclin activity and chromosomal stability, respectively, and a unique frameshift in PDS5B, which is required for accurate sister chromatid segregation during cell division. We also identified dominant clonal variants that progressed from tumor to node, including SNVs in TP53 and ARAP3, which mediates rearrangements to the cytoskeleton and cell shape, and an insertion in TOP2A, the expression of which is significantly associated with tumor proliferation and can segregate breast cancers by outcome. CONCLUSION: This case study provides preliminary evidence that primary tumor and early nodal metastasis have largely overlapping somatic genetic alterations. There were very few mutations unique to the involved node. However, significant conclusions regarding early dissemination needs analysis of a larger number of patient samples.

  5. New concept for the prevention and treatment of metastatic lymph nodes using chemotherapy administered via the lymphatic network

    Science.gov (United States)

    Kodama, Tetsuya; Matsuki, Daisuke; Tada, Asuka; Takeda, Kazu; Mori, Shiro

    2016-01-01

    Intravenous chemotherapy has poor access to metastatic lymph nodes (LNs) and is limited by short-lived drug concentrations. Here, we describe the administration of chemotherapy via the lymphatic network as a new concept for the prevention and treatment of metastatic LNs. A metastatic LN can be treated by the injection of drugs into an upstream LN, either the sentinel LN (SLN) or another upstream LN. In a mouse model, tumor cells were inoculated into the subiliac LN (SiLN) to induce metastasis to the proper axillary LN (PALN). Two routes were used for drug delivery to the PALN, namely from the SiLN and from the accessory axillary LN (AALN). We found that tumor masses were formed in lymphatic vessels between the SiLN and PALN. The flow of fluorescent solution injected into the SiLN towards the PALN decreased with tumor mass formation. Delivery from the AALN (free of metastatic tumor cells) to the PALN was identified as an alternative route. Intranodal injection can deliver high concentrations of drugs to secondary metastatic LNs. The study advocates a new concept for the prevention and treatment of metastatic lymph nodes whereby drugs injected into upstream lymph nodes can reach metastatic lymph nodes via the lymphatic network. PMID:27581921

  6. Controlled delivery of Gd-containing liposomes to lymph nodes: surface modification may enhance MRI contrast properties.

    Science.gov (United States)

    Trubetskoy, V S; Cannillo, J A; Milshtein, A; Wolf, G L; Torchilin, V P

    1995-01-01

    Surface modification of liposomes containing Gd-diethylenetriaminepentaacetyl-phosphatidylethanolamine (Gd-DTPA-PE) as an amphiphilic paramagnetic label influences their contrast properties as MRI agents. Liposomes with the mean diameter ca. 220 nm and 10% mol content of Gd-DTPA-PE were modified with dextran (molecular weight 6 kDa) or polyethyleneglycol (PEG, molecular weight 5 kDa). The preparations obtained were used for MR visualization of axillary and subscapular lymph nodes after SC injection into rabbit's paw. Dextran-modified liposomes were found to have limited or no effect on lymph node/muscle MR signal intensity ratio during the first 2 h after the administration when compared to nonmodified plain liposomes, whereas the liposomes modified with PEG demonstrated a 3-3.5-fold enhancement of lymph node signal. However, the partial biodistribution studies with the 111In-labeled liposomes revealed that PEG-modified vesicles accumulated in the axillary lymph node at half the amount comparing with nonmodified and dextran-modified liposomes. The phenomenon found might be explained by noticeably increased relaxivity of PEG-modified Gd-liposomes.

  7. The Nodal Location of Metastases in Melanoma Sentinel Lymph Nodes

    DEFF Research Database (Denmark)

    Riber-Hansen, Rikke; Nyengaard, Jens; Hamilton-Dutoit, Stephen;

    2009-01-01

    BACKGROUND: The design of melanoma sentinel lymph node (SLN) histologic protocols is based on the premise that most metastases are found in the central parts of the nodes, but the evidence for this belief has never been thoroughly tested. METHODS: The nodal location of melanoma metastases in 149...

  8. Molecular and functional imaging for detection of lymph node metastases in prostate cancer

    NARCIS (Netherlands)

    Fortuin, A.S.; Rooij, M. de; Zamecnik, P.; Haberkorn, U.; Barentsz, J.

    2013-01-01

    Knowledge on lymph node metastases is crucial for the prognosis and treatment of prostate cancer patients. Conventional anatomic imaging often fails to differentiate benign from metastatic lymph nodes. Pelvic lymph node dissection is an invasive technique and underestimates the extent of lymph node

  9. Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection

    OpenAIRE

    Cook, Kyung Hoon; Park, Myong Chul; Lee, Il Jae; Lim, Seong Yoon; Jung, Yong Sik

    2016-01-01

    Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vasculariz...

  10. Whole proteome analysis of mouse lymph nodes in cutaneous anthrax.

    Directory of Open Access Journals (Sweden)

    Taissia G Popova

    Full Text Available This study aimed to characterize a soluble proteome of popliteal lymph nodes during lymphadenitis induced by intradermal injection of Bacillus anthracis Sterne spores in mice using tandem LC-MS/MS and reverse-phase protein microarray with antibodies specific to epitopes of phosphorylated proteins. More than 380 proteins were detected in the normal intra-nodal lymph, while the infectious process resulted in the profound changes in the protein abundances and appearance of 297 unique proteins. These proteins belong to an array of processes reflecting response to wounding, inflammation and perturbations of hemostasis, innate immune response, coagulation and fibrinolysis, regulation of body fluid levels and vascular disturbance among others. Comparison of lymph and serum revealed 83 common proteins. Also, using 71 antibodies specific to total and phosphorylated forms of proteins we carried initial characterization of circulating lymph phosphoproteome which brought additional information regarding signaling pathways operating in the lymphatics. The results demonstrate that the proteome of intra-nodal lymph serves as a sensitive sentinel of the processes occurring within the lymph nodes during infection. The acute innate response of the lymph nodes to anthrax is accompanied by cellular damage and inflammation with a large number of up- and down-regulated proteins many of which are distinct from those detected in serum. MS data are available via ProteomeXchange with identifier PXD001342.

  11. Sentinel lymph node biopsy in oral cancer

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Sørensen, Jens Ahm; Grupe, Peter;

    2005-01-01

    AND METHODS: Forty patients (17 F and 23 M, aged 32-90) with 24 T1 and 16 T2 squamous cell carcinoma of the oral cavity. Planar lymphoscintigraphy, emission and transmission tomography were performed. Detection and excision of the sentinel nodes were guided by a gamma probe. The sentinel nodes were step...

  12. 乳腺癌患者腋窝淋巴结清扫术中保留肋间臂神经的临床意义%Clinical significance of preserving intercostobrachial nerve in axillary lymph node dissection for breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    王立兵; 冯亮; 何静; 刘博; 田会萍

    2015-01-01

    Objective To investigate the clinical significance of preserving intercostobrachial nerve ( ICBN) in axillary lymph node dissection ( ALND) for breast cancer patients. Methods The clinical data of 228 cases of breast cancer in the First Hospital of Shijiazhuang City from 2011 January to 2013 June were prospectively analyzed. ICBN was preserved in 90 cases ( ICBN preservation group) and was resected in the other 138 cases ( ICBN dissection group) in ALND. The skin sensation inside the affected upper arm and at axillary fossa was recorded at 1, 6 and 12 months after surgery. The rates of skin paresthesia and edema of the upper extremity between two groups were compared usingχ2 test, the number of detected axillary nodes using t test. Results At 1,6 and 12 months after surgery,the incidence of skin paresthesia in ICBN preservation group was 42. 2%(38/90),43. 3%(39/90)and 33. 3%(30/90)respectively, which was significantly lower than that in ICBN dissection group [84. 1%(116/138),81. 2%(112/138),80. 4%(111/138);χ2=43. 491,34. 847, 51. 214;all P<0. 001 ] . The incidence of subjective paresthesia in ICBN preservation group was significantly lower than that in ICBN dissection group at one month after surgery [ 27. 8%( 25/90 ) vs 46. 4%( 64/138 ) ,χ2=7. 918,P=0. 005]. There was no significant difference in the incidence of subjective paresthesia between the two groups at 6 and 12 months after surgery (13. 3%(12/90) vs 21. 0%(29/138),χ2=2. 179,P=0. 140;8. 9%(8/90) vs 15. 2%(21/138),χ2=1. 965,P= 0. 161). The incidence of objective paresthesia in ICBN preservation group was significantly lower than that in ICBN dissection group at 1,6 and 12 months after surgery [35. 6%(32/90) vs 76. 8%(106/138), 41. 1%(37/90) vs 76. 8%(106/138), 31. 1% (28/90) vs 76. 8%(106/138);χ2=38. 807, 29. 693, 46. 953,all P<0. 001]. No significant difference was found in the numbers of detected axillary nodes [(19±4) vs (18±3),t=1. 848,P=0. 066] and in the incidences of the upper extremity

  13. Enhancing regional lymph nodes from endoscopic ultrasound images

    Science.gov (United States)

    Nwogu, Ifeoma; Chaudhary, Vipin

    2008-03-01

    Esophageal ultrasound (EUS) is particularly useful for isolating lymph nodes in the N-staging of esophageal cancer, a disease with very poor overall prognosis. Although EUS is relatively low-cost and real time, and it provides valuable information to the clinician, its usefulness to less trained "users" including opportunities for computer-aided diagnosis is still limited due to the strong presence of spatially correlated interference noise called speckles. To this end, in this paper, we present a technique for enhancing lymph nodes in EUS images by first reducing the spatial correlation of the specular noise and then using a modified structured tensor-based anisotropic filter to complete the speckle reduction process. We report on a measure of the enhancement and also on the extent of automatic processing possible, after the speckle reduction process has taken place. Also, we show the limitations of the enhancement process by extracting relevant lymph node features from the despeckled images. When tested on five representative classes of esophageal lymph nodes, we found the despeckling process to greatly reduce the specularity of the original EUS images, therefore proving very useful for visualization purposes. But it still requires additional work for the complete automation of the lymph node characterizing process.

  14. Modeling lymphocyte homing and encounters in lymph nodes

    Directory of Open Access Journals (Sweden)

    Bernaschi Massimo

    2009-11-01

    Full Text Available Abstract Background The efficiency of lymph nodes depends on tissue structure and organization, which allow the coordination of lymphocyte traffic. Despite their essential role, our understanding of lymph node specific mechanisms is still incomplete and currently a topic of intense research. Results In this paper, we present a hybrid discrete/continuous model of the lymph node, accounting for differences in cell velocity and chemotactic response, influenced by the spatial compartmentalization of the lymph node and the regulation of cells migration, encounter, and antigen presentation during the inflammation process. Conclusion Our model reproduces the correct timing of an immune response, including the observed time delay between duplication of T helper cells and duplication of B cells in response to antigen exposure. Furthermore, we investigate the consequences of the absence of dendritic cells at different times during infection, and the dependence of system dynamics on the regulation of lymphocyte exit from lymph nodes. In both cases, the model predicts the emergence of an impaired immune response, i.e., the response is significantly reduced in magnitude. Dendritic cell removal is also shown to delay the response time with respect to normal conditions.

  15. The feasibility of breast cancer sentinel lymph node mapping at CT lymphography

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility of sentinel lymph node (SLN) mapping with CT lymphography (CT-LG). Methods: Twenty-five patients with confirmed breast cancer and no palpably axillary lymph node underwent CT-LG examination. The first one or more lymph nodes along the lymph duct draining from the injection sites to axilla were defined as SLNs, and then the LG results were compared with sentinel lymph node biopsy (SLNB). The over- and underestimation of LG were evaluated. The quality of LG imaging was classified Grade I and II according to lymph duct appearance on volume rendering (VR). The body mass index (BMI) > 25 was considered obesity. Fisher exact test was used for the statistics. Results: (1) Of 25 patients, 5 had local mastectomy history. BMI < 25 was found in 20 cases, and ≥25 was in 5 cases. (2) All SLNs were showed by CT-LG, and Grade I and II imaging quality were achieved in 21 cases (84.0%) and 4 cases (16.0%), respectively. The obese patient tended to have a poor imaging quality (P<0.05). (3) Fifty-six SLNs and 45 lymph ducts in all 25 patients were identified on CT-LG. Compared with the results of SLNB, 7 cases (28.0%) and 9 cases (36.0%) were over- and underestimated respectively by CT-LG due to obesity and local mastectomy (P<0.05). (4) Fifty-two negative SLNs in 18 patients and 15 positive SLNs in 7 patients were confirmed by pathology through SLNB, while 56 SLNs were delineated on CT-LG with 43 negative and 13 positive. The shape in 32.6% of the negative SLNs (14/43) and 76.9% of the positive SLNs (10/13) was round, the difference was significant (P<0.05). The filling defect on the center in 9. 3% of negative SLNs (4/43) and 23.1% of positive SLNs (3/13) was demonstrated, and irregular filling defect on the margin was found only in 30. 8% of positive SLNs (4/13). 3 SLNs in 2 patients combined with small satellite lymph nodes on CT-LG were also confirmed to have tumor infiltration. Conclusion: CT-LG can clearly demonstrate the breast

  16. DETECTION OF SENTINEL LYMPH NODE IN EARLY CERVICAL CANCER

    Institute of Scientific and Technical Information of China (English)

    刘琳; 李斌; 章文华

    2004-01-01

    Objective: To assess the value of sentinel lymph node (SLN) localization by lymphoscintigraphy and gamma probe detection in early cervical cancer. Methods: A total of 27 patients with operable invasive early cervical cancer and clinically proved negative pelvic lymph nodes were included in this study. The 99Tcm-dextran of 74 MBq (2 mCi) was injected around the cervix at 2( and 10(. Lymphoscintigraphy and gamma probe detection were used to find the SLN. Results: The SLN was identified in 27 patients. The sensitivity and specificity of the SLN detection to predict the metastasis of the pelvic lymph node were 100% and 100% respectively. Conclusion: Identification of the SLN using radionuclide is feasible and possible in women with early cervical cancer.

  17. Angiosarcoma of the Thyroid and Regional Lymph Node Metastasis

    Directory of Open Access Journals (Sweden)

    Lutfi Dogan

    2013-10-01

    Full Text Available Thyroid angiosarcomas are typically infiltrative and large tumors with very similar clinical findings of anaplastic carcinoma of thyroid. Early hematogenous metastasis is very frequent, but regional lymph node metastasis is quite rare. We present a case of angiosarcoma of the thyroid gland in a 68 years old man with regional lymph node metastasis. Total thyroidectomy with right modified radical neck dissection was applied. Four out of 19 lymph nodes dissected were seen to contain metastasis. Metastatic tumor was composed of sarcomatous areas containing large numbers of blood filled clefts. There after the surgery PET-CT was performed and multiple metastatic involvements were reported. Thyroid angiosarcomas are completely different tumors from angiomatoid anaplastic carcinomas. Longer survival with these tumors is only possible with agressive surgery and in case of regional LN metastasis, neck dissection should be done.

  18. Molecular subtype classification is a determinant of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes.

    Directory of Open Access Journals (Sweden)

    Wenbin Zhou

    Full Text Available BACKGROUND: Previous studies suggested that the molecular subtypes were strongly associated with sentinel lymph node (SLN status. The purpose of this study was to determine whether molecular subtype classification was associated with non-sentinel lymph nodes (NSLN metastasis in patients with a positive SLN. METHODOLOGY AND PRINCIPAL FINDINGS: Between January 2001 and March 2011, a total of 130 patients with a positive SLN were recruited. All these patients underwent a complete axillary lymph node dissection. The univariate and multivariate analyses of NSLN metastasis were performed. In univariate and multivariate analyses, large tumor size, macrometastasis and high tumor grade were all significant risk factors of NSLN metastasis in patients with a positive SLN. In univariate analysis, luminal B subgroup showed higher rate of NSLN metastasis than other subgroup (P = 0.027. When other variables were adjusted in multivariate analysis, the molecular subtype classification was a determinant of NSLN metastasis. Relative to triple negative subgroup, both luminal A (P = 0.047 and luminal B (P = 0.010 subgroups showed a higher risk of NSLN metastasis. Otherwise, HER2 over-expression subgroup did not have a higher risk than triple negative subgroup (P = 0.183. The area under the curve (AUC value was 0.8095 for the Cambridge model. When molecular subtype classification was added to the Cambridge model, the AUC value was 0.8475. CONCLUSIONS: Except for other factors, molecular subtype classification was a determinant of NSLN metastasis in patients with a positive SLN. The predictive accuracy of mathematical models including molecular subtype should be determined in the future.

  19. Robotic Salvage Lymph Node Dissection After Radical Prostatectomy

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    Fabio C. M. Torricelli

    2015-08-01

    Full Text Available ABSTRACTIntroduction and objective:Radical prostatectomy is a first-line treatment for localized prostate cancer. However, in some cases, biochemical recurrence associated with imaging-detected nodal metastases may happen. Herein, we aim to present the surgical technique for salvage lymph node dissection after radical prostatectomy.Materials and Methods:A 70 year-old asymptomatic man presented with a prostate-specific antigen (PSA of 7.45ng/ mL. Digital rectal examination was normal and trans-rectal prostate biopsy revealed a prostate adenocarcinoma Gleason 7 (3+4. Pre-operative computed tomography scan and bone scintigraphy showed no metastatic disease. In other service, the patient underwent a robotic-assisted radical prostatectomy plus obturador lymphadenectomy. Pathologic examination showed a pT3aN0 tumor. After 6 months of follow-up, serum PSA was 1.45ng/mL. Further investigation with 11C–Choline PET/CT revealed only a 2-cm lymph node close to the left internal iliac artery. The patient was counseled for salvage lymph node dissection.Results:Salvage lymph node dissection was uneventfully performed. Operative time was 1.5 hour, blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. After 12 months of follow-up, his PSA was undetectable with no other adjuvant therapy.Conclusion:Robotic salvage pelvic lymph node dissection is an effective option for treatment of patients with biochemical recurrence after radical prostatectomy and only pelvic lymph node metastasis detected by C11-Choline PET/CT.

  20. Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer.

    Science.gov (United States)

    Märkl, Bruno; Schaller, Tina; Krammer, Ines; Cacchi, Claudio; Arnholdt, Hans M; Schenkirsch, Gerhard; Kretsinger, Hallie; Anthuber, Matthias; Spatz, Hanno

    2013-09-01

    Lymph node staging is of paramount importance for prognosis estimation and therapy stratification in colorectal cancer. A high number of harvested lymph nodes is associated with an improved outcome. Methylene blue-assisted lymph node dissection effectively improves the lymph node harvest and ensures sufficient staging. Now, the effect on node positivity rate and stage-related outcome was investigated. The study cohort with advanced lymph node dissection consisted of 669 colorectal cancer cases of all stages, which were collected between 2007 and 2012. A historical collection of 663 cases investigated with conventional techniques between 2002 and 2004 served as control. Lymph node harvest was dramatically improved in the study group with mean lymph node numbers of 34 ± 17 vs 13 ± 5 (Pcancer and is therefore extremely helpful. The hypothesis that it also provides a higher sensitivity in detecting metastases, however, could be not proved.

  1. THE PROGNOSIS SIGNIFICANCE OF CATHEPSIN-D EXPRESSION IN THE DIFFERENT LOCATIONS IN AXILLARY NODES NEGATIVE CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: The aim of this study was to investigate Cathepsin-D (Cath-D) expression in different location and its relationship with prognosis in the axillary lymph nodes negative (ANN) breast cancer patients. Methods: Cath-D expression in 192 cases of breast carcinoma were examined by immunohistochemistry. Depending on different parts of expression, three evaluating methods were used, compared and analysed. Results: The positive rate of Cath-D expression in ANN breast cancer with poor prognosis group and axillary nodes positive (ANP) group were significantly higher than that in ANN breast cancer with good prognosis group (x2=23.20, P0.05). Cath-D expression in stromal cells had no statistical difference among the three groups (x2=1.56, P>0.05). When the Cath-D expression in cancer and stromal cells were counted into the positive rate, it was near the same (u1=0.47, u2=1.41, P>0.05). Conclusion: These results suggest that Cath-D expression is one of the powerful prognostic markers in ANN breast cancer. It's a reliable, practical, and convenient method to observe and evaluate Cath-D expression in cancer cells.

  2. Does extended lymph node dissection affect the lymph node density and survival after radical cystectomy?

    Directory of Open Access Journals (Sweden)

    A Dharaskar

    2011-01-01

    Full Text Available Background : Diagnostic and therapeutic importance of pelvic lymph node (LN dissection (PLND in radical cystectomy (RC has gained recent attention. A method of pathological analysis of LN affects total number of LN removed, number of LN involved, and LN density. Objective : To compare extended lymphadenectomy to standard lymphadenectomy in terms of LN yield, density, and effect on survival. Materials and Methods : From Jan 2004 - July 2009, 78 patients underwent RC whose complete histopathological report was available for analysis. All were transitional cell carcinoma. From July 2007 onward extended LN dissection was started and LNs were sent in six packets. Twenty-eight patients of standard PLND kept in group I. Group II had 23 patients of standard PLND (LN sent in four packets, and group III had 23 patients of extended PLND (LN sent in six packets. SPSS 15 software used for statistical calculation. Results : Distribution of T-stage among three groups is not statistically significant. Median number of LN harvested were 5 (range, 1-25 in group I, 9 (range, 3-28 in group II, and 16 (range, 1-25 in group III. Although this is significant, we did not find significant difference in number of positive LN harvested. We did not find any patient with skip metastasis to common iliac LN in group 3. Conclusions : Separate package LN evaluation significantly increased the total number of LN harvested without increasing the number of positive LN and survival.

  3. Computerized tomographic evaluation of upper mediastinal lymph node metastasis from esophageal carcinoma. For decision of therapeutics

    Energy Technology Data Exchange (ETDEWEB)

    Matsubara, Toshiki; Kinoshita, Iwao; Nakagawa, Ken; Ohashi, Ichiro; Hori, Masaharu; Kajiya, Tamaki; Kaneda, Koichi; Kato, Hiroshi

    1985-01-01

    Computed tomography (CT) was performed in patients with esophageal carcinoma including 76 preoperative patients, 11 with upper mediastinal lymph node metastasis after radical surgery, and 10 with unresectable advanced tumors of the lymph nodes. CT was useful in diagnosing metastasis of the most upper part of the right mediastinal lymph nodes and the left paratracheal lymph nodes. During preoperative irradiation, enlargement of paratracheal lymph node metastasis was seen outside the irradiated field on CT images. An enlarged pretracheal lymph node was not seen on CT images even in cases of far advanced carcinoma. Nodal failures frequently occurred at the upper part of the right mediastinal lymph nodes, the left paratracheal lymph nodes and the left tracheobronchial lymph nodes in the 11 patients with upper mediastinal recurrence. CT seems to be of great value in the decision of therapeutics for esophageal carcinioma.

  4. Risk factors for metastasis to No.14v lymph node and prognostic value of positive 14v lymph node for gastric cancer patients after surgery

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:Lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), while necessity No.14v lymph node dissection for lower GC is still controversial.Methods: A total of 311 GC patients receiving D1+ (D1+7, 8a, 9) or D2 plus No.14v lymph node dissection in our center were enrolled. Patients were categorized into two groups based on No.14v lymph node status: positive group (PG) and negative group (NG).Results:Fifty patients (16.1%) had No.14v lymph node metastasis. Metastasis to No.4d, No.6 lymph node and distant metastasis were independent variables affecting No.14v lymph node metastasis. Patients with positive No.14v lymph node had a significant lower overall survival (OS) rate than those without (3-year OS, 34.0% vs. 67.0%,P<0.001).Conclusion:GC patients with positive No.4d and No.6 lymph node often metastasis to No.14v lymph node. Status of No.14v lymph node was an independent prognostic factor for GC staged TNM III. Patients with positive No.14v lymph node usually have a poor prognosis, while such patients without distant metastasis may beneift from a curative surgery.

  5. Regional lymph nodes of liver and spleen: topographic evaluation based on CT examinations of Thorotrast patients

    International Nuclear Information System (INIS)

    The formerly used contrast medium Thorotrast is stored in liver (60 %), spleen (30 %) and their regional lymph nodes. CT scans of 22 Thorotrast patients were reviewed regarding the evaluation of the abdominal lymph nodes. Due to the high density of Thorotrast-accumulating lymph nodes (> 500 HU) and the excellent contrast sensitivity of CT, lymph nodes less than 0.4 cm in diameter can be imaged. In all more than 1300 lymph nodes could be detected (mean 63 ± 24 per patient). The goal of the study was to describe the normal topographic anatomy of the regional lymph nodes of liver and spleen, which can not be visualised by bipedal lymphography. (orig.)

  6. Metastasis in the subcarinal lymph node with unknown primary tumor

    DEFF Research Database (Denmark)

    Eckardt, J.; Olsen, K. E.; Petersen, H.;

    2011-01-01

    A 59-year-old man with previous anaplastic large cell T-cell lymphoma stage 3A was admitted with an isolated positron emission tomography(PET)-positive spot in a subcarinal lymph node. Diagnosis was achieved with endobronchial ultrasound-guided fine-needle aspiration demonstrating a well...

  7. Advances in Lymph Node Metastasis and the Modes of Lymph Node 
Dissection in Early Stage Non-small Cell Lung Caner

    Directory of Open Access Journals (Sweden)

    Ningning DING

    2016-06-01

    Full Text Available Lung cancer ranks the first position in morbidity and mortality among all malignances in China. Non-small cell lung cancer (NSCLC accounts for nearly 80% of all lung malignancies. Surgical resection is still the current major treatment method for early stage NSCLC. Lymph node stages together with the extent of lymph node dissection directly affect the prognosis. Anatomical lobectomy with systematic mediastinal lymph node dissection have been the standard surgical treatment for NSCLC. However, it is controversial in the extent of lymph node dissection for early stage NSCLC. Accurate nodes stage and the extent of mediatinal nodes dissection affect the peri-operative complications and the prognosis of NSCLC greatly. In the past decade, more and more surgeons demostrated that lobe-specific or selective mediastinal lymph node dissection is suitable for clinical stage I NSCLC, especially the stage Ia lesions, and may become the standard lymph node dissection mode in the future.

  8. Relapse of leprosy presenting as nodular lymph node swelling

    Directory of Open Access Journals (Sweden)

    Kiran K

    2009-01-01

    Full Text Available Lymphadenopathy is known to be associated with lepromatous leprosy and has also been observed as a feature of type-2 lepra reaction. However, nodular lymph node enlargement is not commonly reported in leprosy patients or as a feature of relapse. We herewith are presenting a case of bacteriological relapse in a patient of lepromatous leprosy treated 22 years before till smear negativity with WHO multidrug therapy (MDT multibacillary type (MB. She presented with prominent nodular swelling of the cervical group of lymph nodes along with generalized lymphadenopathy, which was mistakenly treated as tubercular lymphadenopathy. A diagnosis of late bacteriological relapse of lepromatous leprosy presenting with prominent lymphadenopathy and ENL was made after relevant investigations. The patient was started on treatment with WHO MDT MB (daily dapsone and clofazimine and monthly rifampicin and thalidomide (200 mg/day. Nerve pain regressed within 2 weeks of therapy. The lymph nodal swelling regressed within 3 months of starting treatment.

  9. LCP nanoparticle for tumor and lymph node metastasis imaging

    Science.gov (United States)

    Tseng, Yu-Cheng

    A lipid/calcium/phosphate (LCP) nanoparticle formulation (particle diameter ˜25 nm) has previously been developed to delivery siRNA with superior efficiency. In this work, 111In was formulated into LCP nanoparticles to form 111In-LCP for SPECT/CT imaging. With necessary modifications and improvements of the LCP core-washing and surface-coating methods, 111In-LCP grafted with polyethylene glycol exhibited reduced uptake by the mononuclear phagocytic system. SPECT/CT imaging supported performed biodistribution studies, showing clear tumor images with accumulation of 8% or higher injected dose per gram tissue (ID/g) in subcutaneous, human-H460, lung-cancer xenograft and mouse-4T1, breast cancer metastasis models. Both the liver and the spleen accumulated ˜20% ID/g. Accumulation in the tumor was limited by the enhanced permeation and retention effect and was independent of the presence of a targeting ligand. A surprisingly high accumulation in the lymph nodes (˜70% ID/g) was observed. In the 4T1 lymph node metastasis model, the capability of intravenously injected 111In-LCP to visualize the size-enlarged and tumor-loaded sentinel lymph node was demonstrated. By analyzing the SPECT/CT images taken at different time points, the PK profiles of 111In-LCP in the blood and major organs were determined. The results indicated that the decrement of 111In-LCP blood concentration was not due to excretion, but to tissue penetration, leading to lymphatic accumulation. Larger LCP (diameter ˜65 nm) nanoparticles were also prepared for the purpose of comparison. Results indicated that larger LCP achieved slightly lower accumulation in the tumor and lymph nodes, but much higher accumulation in the liver and spleen; thus, larger nanoparticles might not be favorable for imaging purposes. We also demonstrated that LCP with a diameter of ˜25 nm were better able to penetrate into tissues, travel in the lymphatic system and preferentially accumulate in the lymph nodes due to 1) small

  10. Using the lymph nodal ratio to predict the risk of locoregional recurrence in lymph node-positive breast cancer patients treated with mastectomy without radiation therapy

    International Nuclear Information System (INIS)

    To evaluate the prognostic value of axillary lymph node ratio (LNR) as compared to the number of involved nodes (pN stage) in patients with axillary lymph node-positive breast cancer treated with mastectomy without radiation. We performed a retrospective analysis of the clinical data of patients with stage II-III node-positive breast cancer (N=1068) between 1998 and 2007. Locoregional recurrence-free survival (LRFS) and overall survival (OS) were compared based on the LNR and pN staging. A total of 780 cases were classified as pN1, 183 as pN2, and 105 as pN3. With respect to LNR, 690 cases had a LNR from 0.01-0.20, 269 cases a LNR from 0.21-0.65, and 109 cases a LNR > 0.65. The median follow-up time was 62 months. Univariate analysis showed that both LNR and pN stage were prognostic factors of LRFS and OS (p<0.05). Multivariate analysis indicated that LNR was an independent prognostic factor of LRFS and OS (p<0.05). pN stage had no significant effect on LRFS or OS (p>0.05). In subgroup analysis, the LNR identified groups of patients with different survival rates based on pN stage. LNR is superior to pN staging as a prognostic factor in lymph node-positive breast cancer after mastectomy, and should be used as one of the indications for adjuvant radiation therapy

  11. Axillary recurrence in DCIs: is axillary lymphadenectomy warranted?

    Science.gov (United States)

    Trisal, Vijay; Qian, Dajun; Wagman, Lawrence D

    2004-10-01

    Widespread use of screening mammography has resulted in a remarkable increase in the incidence (or detection rate) of ductal carcinoma in situ (DCIS). Axillary lymph node involvement in DCIS is reported to occur at a frequency of 1-12 per cent. Over the past few years, however, there has been increasing emphasis on axillary sampling, limited axillary dissection, and the potential role of sentinel lymph node biopsy. The clinical relevance of axillary lymph node biopsy or dissection remains unanswered. This retrospective analysis was performed on 171 patients who underwent treatment for DCIS at a tertiary care center over a period of 14 years. Clinical and tumor factors were evaluated, and the local, axillary, and systemic recurrence rates were noted. No axillary recurrences from the primary DCIS diagnosis were noted in the entire group of 171 patients. During a mean follow-up of 70 months, 10 patients (6%) developed recurrence in the ipsilateral breast. Six of these recurrences were in the form of DCIS, whereas, four recurred as invasive cancers. Nine patients developed a new primary (seven DCIS and two invasive) in the same breast but in a different quadrant. Two patients with ipsilateral invasive disease also developed systemic disease and eventually died of disease. During the same period, 10 patients (6%) developed DCIS, and seven patients (4%) developed invasive cancer in the contralateral breast. The data show that the risk of axillary recurrence in pure DCIS is, at most, extremely low and support the position that nodal sampling or dissection is unwarranted. PMID:15529841

  12. Lymph Node Assessment in Endometrial Cancer: Towards Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Fabien Vidal

    2013-01-01

    Full Text Available Endometrial cancer (EC is the most common malignancy of the female reproductive tract and is increasing in incidence. Lymphovascular invasion and lymph node (LN status are strong predictive factors of recurrence. Therefore, the determination of the nodal status of patients is mandatory to optimally tailor adjuvant therapies and reduce local and distant recurrences. Imaging modalities do not yet allow accurate lymph node staging; thus pelvic and aortic lymphadenectomies remain standard staging procedures. The clinical data accumulated recently allow us to define low- and high-risk patients based on pre- or peroperative findings that will allow the clinician to stratify the patients for their need of lymphadenectomies. More recently, several groups have been introducing sentinel node mapping with promising results as an alternative to complete lymphadenectomy. Finally, the use of peroperative algorithm for risk determination could improve patient's staging with a reduction of lymphadenectomy-related morbidity.

  13. Early experiences of breast-conservation treatment without axillary dissection for breast cancer patients with clinically-negative axillary nodes

    International Nuclear Information System (INIS)

    Nineteen patients with breast cancer who had clinically negative axillary nodes were treated with breast-conservation treatment, consisting of lumpectomy, irradiation, endocrine therapy (tamoxifen), and adjuvant chemotherapy. They were all women, whose ages ranged from 35 to 84 years with a mean of 53.8 years. Preoperative UICC staging was I in 10 patients, IIA in 8, and IIB in one; and postoperative staging was I in 7 and IIA in 12. Among evaluable 13 patients, 5 (38.5%) had microscopically positive margin. Radiation therapy was started within two to three weeks after breast-conserving surgery. Patients received irradiation to the ipsilateral breast and chest wall, including the ipsilateral axillary region, using opposed tangential fields to a dose of 4400 cGy at 275 cGy per fraction. Boost irradiation using an electron beam was delivered with a dose of 1000 cGy in 2 fractions in the last week of radiotherapy in all patients. In addition, adjuvant chemotherapy (cyclophosphamide, pirarubicin or epirubicin, 5-fluorouracil) and endocrine therapy (tamoxifen) were given. With a mean follow up of 20.7 months, one patient aged 80 died of cardiac failure and pneumonia without evidence of breast cancer progression. The other 18 patients are alive without either local failure or distant metastases. Cosmetic evaluation showed each 9 patients to be 'excellent' or 'good'. No patients have serious adverse effects as of this writing. Although the follow-up period is short and the number of patients is limited, the preliminary results of breast-conservation treatment for axillary negative breast cancer seem to be sufficiently good. (N.K.)

  14. Sentinel lymph node (Sln) detection in vulvar cancer

    International Nuclear Information System (INIS)

    Full text: The purpose of the study is to verify the feasibility of the sentinel lymph node (SLN) procedure in patients with evidence of vulva cancer. We studied 13 women with early stage (T1/T2) carcinoma of the vulva. One day before surgery a lymphoscintigraphy was done. We injected intradermally an average 76 MBq of 99mTc-labelled human colloides (Albu-Res(r) in 0.4-0.6 ml NaCI at 4 locations round the tumor regarding the midline. Because of the large particles the colloid was filtered before to obtain the small particle fraction between 200-450 nm. Immediately alter injection a dynamic scintigraphy was performed with 28 images, 1 minute per frame. Additional we made static images, 5 minutes per image, 30 and 120 minutes after injection. The location of the SLN was marked on the skin. The SLN was intraoperatively identified using a hand-held gamma probe. In every case a complete inguino-femoral lymph node dissection was done. In all cases we could show one or more (on average 3) SLN by means of lymphoscintigraphy and in 11/13 cases we could detect SLN by using the gamma probe. Lymph channels were seen in 7/13 dynamic studies. 4/13 patients had lymph node metastasis in the SLN (3/4 cases only the SLN and in 1/4 cases the SLN and one additional lymph node were positive). We did not found any tumor-positive non-sentinel lymph node in case of tumor-negative SLN. The morbidity after operation of patients with vulva cancer is considerable and related to the groin dissection. The selective SLN-biopsy instead of radical groin dissection is feasible to reduce the morbidity without a loss of staging and prognostic factors. This method should be restricted to patients with early stage vulva cancer with clinically uninvolved lymph nodes. Further studies are needed to evaluate the accuracy and clinical validity of this procedure. (author)

  15. The Prognostic Value of Lymph Nodes Dissection Number on Survival of Patients with Lymph Node-Negative Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Wu Song

    2014-01-01

    Full Text Available Objective. The study was designed to explore the prognostic value of examined lymph node (LN number on survival of gastric cancer patients without LN metastasis. Methods. Between August 1995 and January 2011, 300 patients who underwent gastrectomy with D2 lymphadenectomy for LN-negative gastric cancer were reviewed. Patients were assigned to various groups according to LN dissection number or tumor invasion depth. Some clinical outcomes, such as overall survival, operation time, length of stay, and postoperative complications, were compared among all groups. Results. The overall survival time of LN-negative GC patients was 50.2±30.5 months. Multivariate analysis indicated that LN dissection number (P30. Besides, it was not correlated with operation time, transfusion volume, length of postoperative stay, or postoperative complication incidence (P>0.05. Conclusions. The number of examined lymph nodes is an independent prognostic factor of survival for patients with lymph node-negative gastric cancer. Sufficient dissection of lymph nodes is recommended during surgery for such population.

  16. Chest CT findings in EBUS-TBNA-proven anthracosis in enlarged mediastinal lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Kirchner, J. [Allgemeines Krankenhaus Hagen (Germany). Dept. of Interventional and Diagnostic Radiology; Mueller, P. [Allgemeines Krankenhaus H