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Owusu-Brackett N, Facer B, Quiroga D, Pariser A, Grimm M, Beyer S, Jhawar S, Oppong BA. Axillary Management: How Much Is Too Much? Curr Oncol Rep 2024; 26:735-743. [PMID: 38748364 PMCID: PMC11224108 DOI: 10.1007/s11912-024-01539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE OF REVIEW To review the current management of the axilla in breast cancer. RECENT FINDINGS Axillary dissection is no longer indicated in patients with clinically node-negative axilla with 1-2 positive sentinel lymph nodes following upfront surgery or in patients with clinically node-negative axilla following neoadjuvant chemotherapy. Breast cancer has evolved away from routine axillary clearance to the less invasive sentinel lymph node biopsy to now complete omission of axillary sampling in select patients. We will review the most salient evidence that has shaped these practice changes over the last three decades. Current practice controversies are especially relevant for elderly populations and those receiving neoadjuvant therapy. Ongoing clinical trials will provide data to further guide breast cancer surgical management.
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Affiliation(s)
- Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Benjin Facer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Dionisia Quiroga
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Ashley Pariser
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Michael Grimm
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Sachin Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA.
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Jiang K, Ma C, Yang Y, McKevitt E, Pao JS, Warburton R, Dingee C, Bremang JN, Deban M, Bazzarelli A. Axillary ultrasonography for early-stage invasive breast cancer. Am J Surg 2024; 231:86-90. [PMID: 38490879 DOI: 10.1016/j.amjsurg.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Among women with early invasive breast cancer and 1-2 positive sentinel nodes, sentinel lymph node biopsy (SLNB) is non-inferior to axillary lymph node dissection (ALND).1-3 However, preoperative axillary ultrasonography (AxUS) may not be sensitive enough to discriminate burden of nodal metastasis in these patients, potentially leading to overtreatment.4-6 This study compares axillary operation rates in patients who did and did not receive preoperative AxUS, assessing its utility and risks for overtreatment. METHODS This is a retrospective cohort study of patients with clinical T1/T2 breast tumors who were clinically node negative and underwent an axillary operation. RESULTS Patients who had preoperative AxUS received more ALND compared to patients who did not (5.6% vs. 1.4%, p < 0.001). There was no significant difference in the number of additional axillary operations following SLNB (2.1% vs. 2.3%, p = 0.77). CONCLUSION Eliminating preoperative AxUS is associated with fewer invasive ALND procedures, without increased rate of axillary reoperations.
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Affiliation(s)
- Karen Jiang
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Crystal Ma
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Yuwei Yang
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jieun Newman- Bremang
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Melina Deban
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Duan Y, Zhu Y, Nie F, Guan L, Jia Y, Chen K, Wang W. Predictive value of combining clinicopathological, multimodal ultrasonic characteristics in axillary lymph nodal metastasis burden of patients with cT1-2N0 breast cancer. Clin Hemorheol Microcirc 2022; 81:255-269. [PMID: 35342081 DOI: 10.3233/ch-221398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Since the ACOSOG Z0011 trial, the clinical examination of axillary lymph node-negative early breast cancer patients (cT1-2N0) can be used to predict the burden of axillary lymph nodes (ALNs) by axillary ultrasound (AUS). To improving diagnosis of axillary lymph node metastasis (ALNM), we assessed the value of combining clinicopathological, conventional ultrasound, SWE features in the cT1-2N0 breast cancer patients. METHODS Retrospective analysis of 285 patients with cT1-2N0 breast cancer who underwent preoperative ultrasound examination of the lesion and axillary, with shear wave elastography (SWE) of the lesions. According to the postoperative pathological results, they were divided into ≤2 metastatic ALNs group (low nodal burden, LNB) and > 2 metastatic ALNs group (high nodal burden, HNB). Binary logistic regression analysis was used to screen independent risk factors and establish prediction models. The best cut-off value of continuous variables is determined by the receiver operating characteristic curve, and the performance of the prediction model is evaluated. RESULTS Presence of lymphovascular invasion (OR = 7.966, P = 0.010), tumor size (OR = 2.485, P = 0.019), Emean of intratumor (OR = 0.939, P = 0.002) and cortical thickness of lymph node (OR = 9.277, P < 0.001) were independent risk predictors for HNB of cT1-2N0 Group. The predictive model of combined method had better performance in predicting HNB of cT1-2N0 compared with models based on SWE and conventional ultrasound alone (area under the curve: 0.824 vs 0.658, P < 0.001; 0.824 vs 0.789, P = 0.035). CONCLUSIONS The predictive models of combined method obtained from significant clinicopathological and ultrasonographic features can potentially improve the diagnosis and individual treatment of ALNM in patients with cT1-2N0 breast cancer.
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Affiliation(s)
- Ying Duan
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China.,Department of Ultrasound, Gansu Cancer Hospital, Lanzhou, China
| | - Yangyang Zhu
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Ling Guan
- Department of Ultrasound, Gansu Cancer Hospital, Lanzhou, China
| | - Yingying Jia
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Kundi Chen
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Weili Wang
- Department of Ultrasound, Gansu Cancer Hospital, Lanzhou, China
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Ou X, Zhu J, Qu Y, Wang C, Wang B, Xu X, Wang Y, Wen H, Ma A, Liu X, Zou X, Wen Z. Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis. BMC Med Imaging 2021; 21:193. [PMID: 34911489 PMCID: PMC8675471 DOI: 10.1186/s12880-021-00722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Accurately assessing axillary lymph node (ALN) status in breast cancer is vital for clinical decision making and prognosis. The purpose of this study was to evaluate the predictive value of sentinel lymph node (SLN) mapped by multidetector-row computed tomography lymphography (MDCT-LG) for ALN metastasis in breast cancer patients. METHODS 112 patients with breast cancer who underwent preoperative MDCT-LG examination were included in the study. Long-axis diameter, short-axis diameter, ratio of long-/short-axis and cortical thickness were measured. Logistic regression analysis was performed to evaluate independent predictors associated with ALN metastasis. The prediction of ALN metastasis was determined with related variables of SLN using receiver operating characteristic (ROC) curve analysis. RESULTS Among the 112 cases, 35 (30.8%) cases had ALN metastasis. The cortical thickness in metastatic ALN group was significantly thicker than that in non-metastatic ALN group (4.0 ± 1.2 mm vs. 2.4 ± 0.7 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of > 3.3 mm (OR 24.53, 95% CI 6.58-91.48, P < 0.001) had higher risk for ALN metastasis. The best sensitivity, specificity, negative predictive value(NPV) and AUC of MDCT-LG for ALN metastasis prediction based on the single variable of cortical thickness were 76.2%, 88.5%, 90.2% and 0.872 (95% CI 0.773-0.939, P < 0.001), respectively. CONCLUSION ALN status can be predicted using the imaging features of SLN which was mapped on MDCT-LG in breast cancer patients. Besides, it may be helpful to select true negative lymph nodes in patients with early breast cancer, and SLN biopsy can be avoided in clinically and radiographically negative axilla.
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Affiliation(s)
- Xiaochan Ou
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Jianbin Zhu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Yaoming Qu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Chengmei Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Baiye Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Xirui Xu
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510828, Guangdong, China
| | - Yanyu Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Haitao Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Andong Ma
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Xinzi Liu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Xia Zou
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, 510282, Guangdong, China.
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Contrast-Enhanced Ultrasound for Precise Sentinel Lymph Node Biopsy in Women with Early Breast Cancer: A Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11112104. [PMID: 34829452 PMCID: PMC8624576 DOI: 10.3390/diagnostics11112104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB), as a common method for axillary staging of early breast cancer, has gradually attracted people's attention to the false-negative rate and postoperative complications. The aim of the study is to investigate the clinical value of preoperative contrast-enhanced ultrasound (CEUS) for intraoperative SLNB in early breast cancer patients. METHODS A total of 201 patients scheduled for SLNB from September 2018 to April 2021 were collected consecutively. Preoperative CEUS was used to identify sentinel lymph nodes (SLN) and lymphatic drainage in breast cancer patients. RESULTS The SLN identification rate of CEUS was 93.0% (187/201) and four lymphatic drainage patterns were found: single LC to single SLN (70.0%), multiple LCs to single SLN (8.0%), single LC to multiple SLNs (10.2%), and multiple LCs to multiple SLNs (11.8%). The Sen, Spe, PPV, NPV, AUC of CEUS, US and CEUS + US in diagnosis of SLNs were 82.7%, 80.4%, 73.8%, 87.4%, 0.815; 70.7%, 77.7%, 68.0%, 79.8%, 0.742; and 86.7%, 77.7%, 72.2%, 89.7%, 0.822, respectively. There was no statistically significant difference between the diagnostic performance of CEUS and CEUS + US (p = 0.630). CONCLUSIONS CEUS can be used to preoperatively assess the lymphatic drainage patterns and the status of the SLNs in early breast cancer to assist precision intraoperative SLNB.
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Qu W, He N, Yang X, Yuan C. Clinical and ultrasound features correlated with a heavy axillary nodal tumor burden in colon cancer. Future Oncol 2021; 17:4289-4297. [PMID: 34676783 DOI: 10.2217/fon-2020-1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to investigate the correlation between the pathologic and ultrasound (US) characteristics of colon cancer and the heavy axillary nodal burden. Methods: In total, 631 patients diagnosed with invasive colon cancer were recruited with ethical ratification. Results: The unitary pathologic features correlated with heavy axillary lymph nodal burden included the age of patient (p = 0.035), tumor size (p = 0.001), lymph node metastasis (p = 0.001), lymphovascular invasion (p = 0.020) and pathology type (p = 0.012). The independent US characteristics correlated with heavy axillary nodal burden included posterior acoustic enhancement (p = 0.006). Heavy axillary nodal burden was correlated with tumor size, lymph node metastasis, lymphovascular invasion and pathology type. Conclusion: Tumor size, lymph node metastasis and posterior acoustic can be used to predict the axillary lymph node tumor burden.
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Affiliation(s)
- Wenjuan Qu
- Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, Guangde Road, Hefei 230011, Anhui, China.,Department of Ultrasound, Anhui Provincial Hospital Affiliated to Anhui Medical University (The First Affiliated Hospital of University of Science & Technology of China), Lujiang Road, Hefei 230001, Anhui, China
| | - Nianan He
- Department of Ultrasound, Anhui Provincial Hospital Affiliated to Anhui Medical University (The First Affiliated Hospital of University of Science & Technology of China), Lujiang Road, Hefei 230001, Anhui, China
| | - Xiao Yang
- Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, Guangde Road, Hefei 230011, Anhui, China
| | - Changhe Yuan
- Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, Guangde Road, Hefei 230011, Anhui, China
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Le Boulc’h M, Gilhodes J, Steinmeyer Z, Molière S, Mathelin C. Pretherapeutic Imaging for Axillary Staging in Breast Cancer: A Systematic Review and Meta-Analysis of Ultrasound, MRI and FDG PET. J Clin Med 2021; 10:jcm10071543. [PMID: 33917590 PMCID: PMC8038849 DOI: 10.3390/jcm10071543] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/07/2021] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This systematic review aimed at comparing performances of ultrasonography (US), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (PET) for axillary staging, with a focus on micro- or micrometastases. METHODS A search for relevant studies published between January 2002 and March 2018 was conducted in MEDLINE database. Study quality was assessed using the QUality Assessment of Diagnostic Accuracy Studies checklist. Sensitivity and specificity were meta-analyzed using a bivariate random effects approach; Results: Across 62 studies (n = 10,374 patients), sensitivity and specificity to detect metastatic ALN were, respectively, 51% (95% CI: 43-59%) and 100% (95% CI: 99-100%) for US, 83% (95% CI: 72-91%) and 85% (95% CI: 72-92%) for MRI, and 49% (95% CI: 39-59%) and 94% (95% CI: 91-96%) for PET. Interestingly, US detects a significant proportion of macrometastases (false negative rate was 0.28 (0.22, 0.34) for more than 2 metastatic ALN and 0.96 (0.86, 0.99) for micrometastases). In contrast, PET tends to detect a significant proportion of micrometastases (true positive rate = 0.41 (0.29, 0.54)). Data are not available for MRI. CONCLUSIONS In comparison with MRI and PET Fluorodeoxyglucose (FDG), US is an effective technique for axillary triage, especially to detect high metastatic burden without upstaging majority of micrometastases.
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Affiliation(s)
- Morwenn Le Boulc’h
- Department of Oncologic Radiology, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse-Oncopole, 31100 Toulouse, France;
| | - Julia Gilhodes
- Clinical Trials, Institut Universitaire du Cancer de Toulouse-Oncopole, 31100 Toulouse, France;
| | - Zara Steinmeyer
- Internal Medicine and Oncogeriatry Unit, Geriatric Department, University Hospital, Place du Docteur Baylac, CEDEX 9, 31059 Toulouse, France;
| | - Sébastien Molière
- Department of Women’s Imaging, University Hospitals of Strasbourg, 67200 Strasbourg, France;
| | - Carole Mathelin
- Surgery at ICANS Cancer Institute (Institute of Cancerology Strasbourg Europe), CEDEX, 67033 Strasbourg, France
- Correspondence: ; Tel.: +33-3-6876-7332
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Chang JM, Leung JWT, Moy L, Ha SM, Moon WK. Axillary Nodal Evaluation in Breast Cancer: State of the Art. Radiology 2020; 295:500-515. [PMID: 32315268 DOI: 10.1148/radiol.2020192534] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Axillary lymph node (LN) metastasis is the most important predictor of overall recurrence and survival in patients with breast cancer, and accurate assessment of axillary LN involvement is an essential component in staging breast cancer. Axillary management in patients with breast cancer has become much less invasive and individualized with the introduction of sentinel LN biopsy (SLNB). Emerging evidence indicates that axillary LN dissection may be avoided in selected patients with node-positive as well as node-negative cancer. Thus, assessment of nodal disease burden to guide multidisciplinary treatment decision making is now considered to be a critical role of axillary imaging and can be achieved with axillary US, MRI, and US-guided biopsy. For the node-positive patients treated with neoadjuvant chemotherapy, restaging of the axilla with US and MRI and targeted axillary dissection in addition to SLNB is highly recommended to minimize the false-negative rate of SLNB. Efforts continue to develop prediction models that incorporate imaging features to predict nodal disease burden and to select proper candidates for SLNB. As methods of axillary nodal evaluation evolve, breast radiologists and surgeons must work closely to maximize the potential role of imaging and to provide the most optimized treatment for patients.
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Affiliation(s)
- Jung Min Chang
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Jessica W T Leung
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Su Min Ha
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Woo Kyung Moon
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
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9
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Can We Identify or Exclude Extensive Axillary Nodal Involvement in Breast Cancer Patients Preoperatively? JOURNAL OF ONCOLOGY 2019; 2019:8404035. [PMID: 31885585 PMCID: PMC6893267 DOI: 10.1155/2019/8404035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 09/23/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
Background Breast cancer treatment has rapidly changed in the last few years. Particularly, treatment of patients with axillary nodal involvement has evolved after publication of several randomized clinical trials. Omitting axillary lymph node dissection in selected early breast cancer patients with one or two positive sentinel nodes did not compromise overall survival nor regional disease control in these trials. Hence, either excluding or identifying extensive axillary nodal involvement becomes increasingly important. Purpose To evaluate whether the current diagnostic modalities can accurately identify or exclude extensive axillary nodal involvement. Evaluated modalities were axillary ultrasound, ultrasound-guided needle biopsy, MRI, and PET/CT. Methods A literature search was performed in the Cochrane Library, EMBASE, and PubMed databases up to June 2019. The search strategy included terms for breast cancer, lymph nodes, and the different imaging modalities. Only articles that reported pathological N-stage or the total number of positive axillary lymph nodes were considered for inclusion. Studies with patients undergoing neoadjuvant systemic therapy were excluded. Conclusion There is no evidence that any of the current preoperative axillary imaging modalities can accurately exclude or identify breast cancer patients with extensive nodal involvement. Both negative PET/CT and negative MRI scans (with gadolinium-based contrast agents) are promising in excluding extensive nodal involvement. Larger studies should be performed to strengthen this conclusion. False-negative rates of axillary ultrasound and ultrasound-guided needle biopsy are too high to rely on negative results of these modalities in excluding extensive nodal involvement.
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Patel R, MacKerricher W, Tsai J, Choy N, Lipson J, Ikeda D, Pal S, De Martini W, Allison KH, Wapnir IL. Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node. Ann Surg Oncol 2019; 26:2452-2458. [PMID: 31087176 DOI: 10.1245/s10434-019-07419-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tattooing is an alternative method for marking biopsied axillary lymph nodes (ALNs) before initiation of treatments for newly diagnosed breast cancer. Detection of black ink-stained nodes is performed under direct visualization at surgery and is combined with sentinel node (SLN) mapping procedures. METHODS Women with newly diagnosed breast cancer who underwent fine or core-needle biopsy of suspicious ALNs were recruited. The nodal cortex and perinodal soft tissue was injected with 0.1-1.0 ml of Spot™ (GI Supply) black ink under ultrasound guidance. Intraoperatively, black stained nodes were removed along with SLNs, noting concordance between the two. RESULTS Sixty-six evaluable patients were enrolled (2013-2017). Nineteen received surgery first (Group 1) and 47 neoadjuvant therapy (NAT, Group 2). The average number of nodes tattooed was 1.16 for Group 1 and 1.04 for Group 2. The average interval from tattoo to surgery was 21 days (range 1-62) for Group 1 and 148 days (range 71-257) for Group 2. The tattooed node(s) were visually identified at surgery and corresponded to the sentinel lymph node(s) in 98.5% of cases (18/19 in Group 1 and 47/47 in Group 2). Of the 14 patients in Group 2 whose nodes remained positive following NAT, the tattooed node was the SLN associated with carcinoma. CONCLUSIONS Tattooing is an alternative method for marking biopsied ALNs. Tattooed nodes coincided with SLNs in 98.5% of cases. This technique is advantageous, because it allows for fewer procedures and lower costs compared with other methods.
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Affiliation(s)
- Rupa Patel
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Wendy MacKerricher
- Department of Pathology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Jacqueline Tsai
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Nicole Choy
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Jafi Lipson
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Debra Ikeda
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Sunita Pal
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Wendy De Martini
- Department of Radiology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Irene L Wapnir
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA.
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