1
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Xie S, Tang W, Zhang C, Wang J, Wang M, Zhou Y. Classification of breast edema on T2-weighted imaging for predicting sentinel lymph node metastasis and biological behavior in breast cancer. Clin Radiol 2024; 79:e1003-e1009. [PMID: 38763808 DOI: 10.1016/j.crad.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To determine whether preoperative classification of breast edema on T2-weighted imaging (T2WI) is useful for predicting sentinel lymph node (SLN) metastasis and biological behavior in patients with early-stage breast cancer. METHODS This retrospective study involved 341 women with breast cancer who underwent breast MRI from January 2019 to March 2022. Breast edema was scored on a scale of 1-4 on T2WI (1, no edema; 2, peritumoral edema; 3, prepectoral edema; and 4, subcutaneous edema). A logistic regression model was employed for univariate and multivariate analyses. A clinicopathological model was established using independent influencing factors identified in the multivariate analyses, excluding breast edema score (BES). Subsequently, BES was incorporated into this model to establish a combined BES model. The AUC and Delong test were used to examine the additional predictive value of the BES. RESULTS Logistic regression analysis showed that breast edema was an independent risk factor for SLN metastasis. The combined BES model significantly improved the predictive performance of SLN metastasis compared with the clinicopathological model alone (AUC, 0.77 vs. 0.71; p=0.005). In addition, the BES was significantly positively correlated with the tumor diameter (p<0.001), histologic grade (p=0.001), Ki-67 index (p<0.001), and non-luminal subtypes (p<0.001). CONCLUSION The BES on T2WI is useful for predicting SLN metastasis. A higher grade of breast edema is associated with breast cancer aggressiveness and increases the probability of SLN metastasis.
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Affiliation(s)
- S Xie
- Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China; Departments of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui, China
| | - W Tang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - C Zhang
- Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - J Wang
- Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - M Wang
- Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Y Zhou
- Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China.
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2
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Faleh S, Prakash I, Salehi A, Khan H, Basik M, Boileau JF, Tejera D, Panet F, Martel K, Meterissian S, Wong SM. Preoperative factors that predict pathologic nodal involvement in early-stage HER2+ breast cancer: selecting cT1cN0 patients for treatment with neoadjuvant chemotherapy versus upfront surgery. Breast Cancer Res Treat 2024; 205:303-312. [PMID: 38381275 DOI: 10.1007/s10549-024-07251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE The goal of this study was to identify the preoperative predictors of pathologic nodal metastases (pN+) in cT1cN0 HER2+ breast cancer undergoing upfront surgery. METHODS We retrospectively reviewed data from women with cT1-T2N0 HER2+ breast cancer treated with neoadjuvant therapy (NAC) or upfront surgery at our institution between 2012 and 2023. Factors associated with management strategy were evaluated, and in those undergoing upfront surgery, univariate analyses were performed to identify the clinicopathologic factors associated with nodal metastases. RESULTS Overall, 255 women with cT1-T2N0 HER2+ breast cancer met inclusion criteria, including 170 (68.6%) upfront surgery patients and 85 (31.4%) who underwent NAC. The median age at diagnosis was 59 years (range, 27-90 years). Younger age, larger clinical tumor size, high-grade disease, ER-PR-HER2+ subtype, and year of diagnosis after 2019 were significantly associated with receipt of NAC (p < 0.05). In those undergoing upfront surgery, 25.3% were pN+ , including 32.5% of cT1cN0 tumors. Factors associated with nodal involvement included age under 50, larger clinical tumor size, lymphovascular invasion (LVI), multifocality/multicentricity, and abnormal lymph nodes on axillary ultrasound (p < 0.05). In subset analysis of cT1cN0 HER2+ cases, LVI remained the strongest predictor of pN + disease (73.3% vs. 22.6%, p < 0.001). Patients with cT1cN0 HER2+ breast cancer under 50 years had a 47.1% likelihood of pN+ disease. CONCLUSION Patients with cT1cN0 breast cancer have a 32.5% likelihood of nodal metastases, with higher incidence with younger age, LVI, multifocality/multicentricity, and abnormal axillary ultrasound. The presence of these factors may identify the patients who would benefit from treatment with neoadjuvant chemotherapy.
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Affiliation(s)
- Sohayb Faleh
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- McGill University Health Centre Cedars Breast Clinic, Montreal, QC, Canada
| | - Ipshita Prakash
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Aida Salehi
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Haseeb Khan
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Mark Basik
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Jean Francois Boileau
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - David Tejera
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Francois Panet
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Karyne Martel
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada
- McGill University Health Centre Cedars Breast Clinic, Montreal, QC, Canada
| | - Stephanie M Wong
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada.
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada.
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3
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Coşkun Bilge A, Yaltırık Bilgin E, Bulut ZM, Esen Bostancı I, Bilgin E. Preoperative Dynamic Contrast-Enhanced and Diffusion-Weighted Breast Magnetic Resonance Imaging Findings for Prediction of Lymphovascular Invasion of the Lesions in Node-Negative Invasive Breast Cancer. Can Assoc Radiol J 2023:8465371231212893. [PMID: 38095635 DOI: 10.1177/08465371231212893] [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: 12/21/2023] Open
Abstract
Purpose: Our single-center retrospective study aimed to investigate the relationship between preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) findings and apparent diffusion coefficient (ADC) values and lymphovascular invasion (LVI) status of the lesions in patients with clinically-radiologically lymph node-negative invasive breast cancer. Methods: A total of 250 breast lesions diagnosed in preoperative magnetic resonance imaging were identified. All patients were divided into 2 subgroups: LVI-negative and LVI-positive according to the pathological findings of surgical specimens. The 2 groups' DCE-MRI findings, ADC values, and histopathological results of lesions were compared. Results: LVI was detected in 100 of 250 lesions. Younger age than 45 years and larger lesion size than 20 mm were found to be associated with the presence of LVI (P < .001). High histological and nuclear grade (P = .001), HER2-enriched molecular subtype (P = .001), and Ki-67 positivity (P = .016) were significantly associated with LVI. The LVI positivity rate was significantly higher in the lesions with medium-rapid initial phase kinetic curve and washout delayed phase kinetic curve (P = .001). The presence of LVI was significantly associated with the presence of peritumoral edema, sentinel lymph node metastasis, adjacent vessel sign, and increased whole breast vascularity (P < .001). When diffusion-weighted imaging findings were evaluated, it was determined that tumoral ADC values lower than 1068 × 10-6 mm2/second (P = .002) and peritumoral-tumoral ADC ratios higher than 1.5 (P = .001) statistically increased the probability of LVI. Conclusion: The patient's age, various histopathological and DCE-MRI findings, tumoral ADC value, and peritumoral-tumoral ADC ratio may be useful in the preoperative prediction of LVI status in breast cancer lesions.
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Affiliation(s)
- Almıla Coşkun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ezel Yaltırık Bilgin
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Zarife Melda Bulut
- Department of Pathology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Işıl Esen Bostancı
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Erkan Bilgin
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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4
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Liu G, Xing Z, Guo C, Dai Q, Cheng H, Wang X, Tang Y, Wang Y. Identifying clinicopathological risk factors for regional lymph node metastasis in Chinese patients with T1 breast cancer: a population-based study. Front Oncol 2023; 13:1217869. [PMID: 37601676 PMCID: PMC10436470 DOI: 10.3389/fonc.2023.1217869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To analyze clinicopathological risk factors and regular pattern of regional lymph node metastasis (LNM) in Chinese patients with T1 breast cancer and the effect on overall survival (OS) and disease-free survival (DFS). Materials and methods Between 1999 and 2020, breast cancer patients meeting inclusion criteria of unilateral, no distant metastatic site, and T1 invasive ductal carcinoma were reviewed. Clinical pathology characteristics were retrieved from medical records. Survival analysis was performed using Kaplan-Meier methods and an adjusted Cox proportional hazards model. Results We enrolled 11,407 eligible patients as a discovery cohort to explore risk factors for LNM and 3484 patients with stage T1N0 as a survival analysis cohort to identify the effect of those risk factors on OS and DFS. Compared with patients with N- status, patients with N+ status had a younger age, larger tumor size, higher Ki67 level, higher grade, higher HR+ and HER2+ percentages, and higher luminal B and HER2-positive subtype percentages. Logistic regression indicated that age was a protective factor and tumor size/higher grade/HR+ and HER2+ risk factors for LNM. Compared with limited LNM (N1) patients, extensive LNM (N2/3) patients had larger tumor sizes, higher Ki67 levels, higher grades, higher HR- and HER2+ percentages, and lower luminal A subtype percentages. Logistic regression indicated that HR+ was a protective factor and tumor size/higher grade/HER2+ risk factors for extensive LNM. Kaplan-Meier analysis indicated that grade was a predictor of both OS and DFS; HR was a predictor of OS but not DFS. Multivariate survival analysis using the Cox regression model demonstrated age and Ki67 level to be predictors of OS and grade and HER2 status of DFS in stage T1N0 patients. Conclusion In T1 breast cancer patients, there were several differences between N- and N+ patients, limited LNM and extensive LNM patients. Besides, HR+ plays a dual role in regional LNM. In patients without LNM, age and Ki67 level are predictors of OS, and grade and HER2 are predictors of DFS.
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Affiliation(s)
- Gang Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeyu Xing
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changyuan Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qichen Dai
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Cheng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- GCP center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yipeng Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5
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Faleh S, Prakash I, Eisenberg E, Basik M, Boileau JF, Tejera D, Panet F, Buhlaiga N, Meterissian S, Wong SM. Predictors of nodal metastases in early stage HER2+ breast cancer: Deciding on treatment approach with neoadjuvant chemotherapy vs. upfront surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1411-1416. [PMID: 37031045 DOI: 10.1016/j.ejso.2023.03.226] [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: 11/09/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The purpose of this study is to evaluate preoperative predictors of nodal metastases in patients with early-stage, HER2-positive (HER2+) breast cancer. METHODS The SEER Database was queried to identify women with a first diagnosis of stage I-II (T1-T2) HER2-positive breast cancer treated with upfront surgery in 2018. Multivariable logistic regression was used to identify clinical characteristics independently associated with nodal involvement. RESULTS Overall, 3333 women with stage I-II HER2+ breast cancer met inclusion criteria and were included in the study. The median age at diagnosis was 59 years (IQR, 51-69 years). Most patients underwent breast-conserving surgery (60.9%), with a median of 3 (IQR 2-4) axillary lymph nodes removed. On final pathology, 762 (22.9%) of T1-T2 HER2+ patients were node positive; 2.7% pN0[i+], 3.7% pN1mi, 15.1% pN1, and 1.4% pN2. Women less than 40 years and those between 40 and 49 years showed the highest proportion of axillary lymph node metastasis, in 33.7% and 30.7% respectively, and declining with age (p < 0.001). Patients with triple-positive breast cancer had the highest rates of nodal involvement (24.8%), compared to 20.7% ER+/PR-/HER2+ and 19.6% of HER2-enriched patients (p = 0.006). On adjusted analysis, age, biologic subtype, tumour size, and type of surgery remained independent predictors of nodal involvement. On subgroup analysis, women under age 50 with T1c HER2-enriched or triple-positive breast cancer had a 33% and 35% incidence of nodal involvement, which declined with age. CONCLUSIONS The likelihood of pathologic nodal involvement in early-stage HER2+ breast cancer is contingent on age, ER/PR status, and tumour size.
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Affiliation(s)
- Sohayb Faleh
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada; Department of Surgery, University of Jeddah Medical School, Jeddah, Saudi Arabia
| | - Ipshita Prakash
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Elisheva Eisenberg
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
| | - Mark Basik
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Jean Francois Boileau
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - David Tejera
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Francois Panet
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Najwa Buhlaiga
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada; McGill University Health Centre Cedars Breast Clinic, Montreal, QC, Canada
| | - Stephanie M Wong
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada.
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6
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Takada K, Kashiwagi S, Iimori N, Kouhashi R, Yabumoto A, Goto W, Asano Y, Tauchi Y, Morisaki T, Ogisawa K, Shibutani M, Tanaka H, Maeda K. Impact of oral statin therapy on clinical outcomes in patients with cT1 breast cancer. BMC Cancer 2023; 23:224. [PMID: 36894884 PMCID: PMC9999569 DOI: 10.1186/s12885-023-10631-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE A previous meta-analysis examining the relationship between statin use and breast cancer reported that the inhibitory effect of statins on breast cancer may be more pronounced in early-stage cases. In this study, we aimed to investigate the effects of hyperlipidemia treatment at the time of breast cancer diagnosis and to examine its correlation with metastasis to axillary lymph nodes among patients with so-called cT1 breast cancer whose primary lesion was 2 cm or less and was pathologically evaluated by sentinel lymph node biopsy or axillary lymph node dissection. We also investigated the effects of hyperlipidemic drugs on the prognosis of patients with early-stage breast cancer. METHODS After excluding cases that did not meet the criteria, we analyzed data from 719 patients who were diagnosed with breast cancer, with a primary lesion of 2 cm or less identified by preoperative imaging, and who underwent surgery without preoperative chemotherapy. RESULTS Regarding hyperlipidemia drugs, no correlation was found between statin use and lymph node metastasis (p = 0.226), although a correlation was found between lipophilic statin use and lymph node metastasis (p = 0.042). Also, the disease-free survival periods were prolonged following treatment of hyperlipidemia (p = 0.047, hazard ratio: 0.399) and statin administration (p = 0.028, hazard ratio: 0.328). CONCLUSION In cT1 breast cancer, the results suggest that oral statin therapy may contribute to favorable outcomes.
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Affiliation(s)
- Koji Takada
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shinichiro Kashiwagi
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Nozomi Iimori
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Rika Kouhashi
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Akimichi Yabumoto
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Wataru Goto
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yuka Asano
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yukie Tauchi
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tamami Morisaki
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kana Ogisawa
- Department of Breast Surgical Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Tanaka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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7
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Gao X, Luo W, He L, Yang L. Nomogram models for stratified prediction of axillary lymph node metastasis in breast cancer patients (cN0). Front Endocrinol (Lausanne) 2022; 13:967062. [PMID: 36111297 PMCID: PMC9468373 DOI: 10.3389/fendo.2022.967062] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To determine the predictors of axillary lymph node metastasis (ALNM), two nomogram models were constructed to accurately predict the status of axillary lymph nodes (ALNs), mainly high nodal tumour burden (HNTB, > 2 positive lymph nodes), low nodal tumour burden (LNTB, 1-2 positive lymph nodes) and negative ALNM (N0). Accordingly, more appropriate treatment strategies for breast cancer patients without clinical ALNM (cN0) could be selected. Methods From 2010 to 2015, a total of 6314 patients with invasive breast cancer (cN0) were diagnosed in the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to the training and internal validation groups at a ratio of 3:1. As the external validation group, data from 503 breast cancer patients (cN0) who underwent axillary lymph node dissection (ALND) at the Second Affiliated Hospital of Chongqing Medical University between January 2011 and December 2020 were collected. The predictive factors determined by univariate and multivariate logistic regression analyses were used to construct the nomograms. Receiver operating characteristic (ROC) curves and calibration plots were used to assess the prediction models' discrimination and calibration. Results Univariate analysis and multivariate logistic regression analyses showed that tumour size, primary site, molecular subtype and grade were independent predictors of both ALNM and HNTB. Moreover, histologic type and age were independent predictors of ALNM and HNTB, respectively. Integrating these independent predictors, two nomograms were successfully developed to accurately predict the status of ALN. For nomogram 1 (prediction of ALNM), the areas under the receiver operating characteristic (ROC) curve in the training, internal validation and external validation groups were 0.715, 0.688 and 0.876, respectively. For nomogram 2 (prediction of HNTB), the areas under the ROC curve in the training, internal validation and external validation groups were 0.842, 0.823 and 0.862. The above results showed a satisfactory performance. Conclusion We established two nomogram models to predict the status of ALNs (N0, 1-2 positive ALNs or >2 positive ALNs) for breast cancer patients (cN0). They were well verified in further internal and external groups. The nomograms can help doctors make more accurate treatment plans, and avoid unnecessary surgical trauma.
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Affiliation(s)
- Xin Gao
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenpei Luo
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingyun He
- Scientific Research and Education Section, Chongqing Health Center for Women and Children, Chongqing, China
| | - Lu Yang
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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8
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Chinnappan S, Chandra P, Kumar S, Sridev M, Jain D, Chandran G, Nath S. Prediction of Sentinel Lymph Node Biopsy Status in Breast Cancers with PET/CT Negative Axilla. World J Nucl Med 2022; 21:120-126. [PMID: 35865159 PMCID: PMC9296246 DOI: 10.1055/s-0042-1750333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Aim
Prior knowledge of axillary node status can spare a lot of patients with early breast cancer morbidity due to an unnecessary axillary dissection. Our study compared various metabolic and pathological features that can predict the sentinel lymph node biopsy (SLNB) status in patients with positron emission tomography/computed tomography (PET/CT) negative axilla.
Patients and Methods
All consecutive patients with early breast cancers (< 5 cm) with PET/CT negative axilla who underwent breast surgery and SLNB from November 2016 to February 2020 were included. Various primary tumor (PT) pathological variables and metabolic variables on PET/CT such as maximum standardized uptake value (PT-SUV
max
), metabolic tumor volume (PT-MTV), and total lesion glycolysis (PT-TLG) were compared using univariate and multivariate analyses for prediction of SLNB status.
Results
Overall 70 patients, all female, with mean age 55.6 years (range: 33–77) and mean tumor size 2.2 cm (range: 0.7–4.5), were included. SLNB was positive in 20% of patients (
n
= 14) with nonsentinel nodes positive in 4% (
n
= 3) patients. Comparing SLNB positive and negative groups, univariate analysis showed significant association of SLNB with low tumor grade, positive lymphovascular invasion (LVI), positive estrogen receptor (ER) status with lower mean K
i
-67 index (34.41 vs. 52.02%;
p
= 0.02), PT-SUV
max
(5.40 vs. 8.68;
p
= 0.036), PT-MTV (4.71 cc vs. 7.46 cc;
p
= 0.05), and PT-TLG (15.12 g/mL.cc vs. 37.10 g/mL.cc;
p
= 0.006). On multivariate analysis, only LVI status was a significant independent predictor of SLNB status (odds ratio = 6.23; 95% confidence interval: 1.15–33.6;
p
= 0.033).
Conclusion
SLNB is positive in approximately 20% of early breast cancers with PET/CT negative axilla and SLNB status appears to be independent of PT size. SLNB+ PTs were more likely to be LVI+ and ER + ve, with lower grade/K
i
-67/metabolic activity (SUV
max
/MTV/TLG) compared with SLNB–ve tumors. Logistic regression analysis revealed LVI status as the only significant independent predictor of sentinel lymph node status.
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Affiliation(s)
- Sheela Chinnappan
- Department of Radio-diagnosis, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Piyush Chandra
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | - Senthil Kumar
- Department of Surgical Oncology, MIOT International, Chennai, Tamil Nadu, India
| | - M.B. Sridev
- Department of Surgical Oncology, MIOT International, Chennai, Tamil Nadu, India
| | - Deepti Jain
- Department of Pathology, MIOT International, Chennai, Tamil Nadu, India
| | - Ganesan Chandran
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | - Satish Nath
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
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Sun S, Mutasa S, Liu MZ, Nemer J, Sun M, Siddique M, Desperito E, Jambawalikar S, Ha RS. Deep learning prediction of axillary lymph node status using ultrasound images. Comput Biol Med 2022; 143:105250. [PMID: 35114444 DOI: 10.1016/j.compbiomed.2022.105250] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the ability of our convolutional neural network (CNN) to predict axillary lymph node metastasis using primary breast cancer ultrasound (US) images. METHODS In this IRB-approved study, 338 US images (two orthogonal images) from 169 patients from 1/2014-12/2016 were used. Suspicious lymph nodes were seen on US and patients subsequently underwent core-biopsy. 64 patients had metastatic lymph nodes. A custom CNN was utilized on 248 US images from 124 patients in the training dataset and tested on 90 US images from 45 patients. The CNN was implemented entirely of 3 × 3 convolutional kernels and linear layers. The 9 convolutional kernels consisted of 6 residual layers, totaling 12 convolutional layers. Feature maps were down-sampled using strided convolutions. Dropout with a 0.5 keep probability and L2 normalization was utilized. Training was implemented by using the Adam optimizer and a final SoftMax score threshold of 0.5 from the average of raw logits from each pixel was used for two class classification (metastasis or not). RESULTS Our CNN achieved an AUC of 0.72 (SD ± 0.08) in predicting axillary lymph node metastasis from US images in the testing dataset. The model had an accuracy of 72.6% (SD ± 8.4) with a sensitivity and specificity of 65.5% (SD ± 28.6) and 78.9% (SD ± 15.1) respectively. Our algorithm is available to be shared for research use. (https://github.com/stmutasa/MetUS). CONCLUSION It's feasible to predict axillary lymph node metastasis from US images using a deep learning technique. This can potentially aid nodal staging in patients with breast cancer.
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Affiliation(s)
- Shawn Sun
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Simukayi Mutasa
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Michael Z Liu
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | | | - Mary Sun
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Maham Siddique
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Elise Desperito
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Richard S Ha
- Breast Imaging Section Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA.
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Wang C, Chen X, Luo H, Liu Y, Meng R, Wang M, Liu S, Xu G, Ren J, Zhou P. Development and Internal Validation of a Preoperative Prediction Model for Sentinel Lymph Node Status in Breast Cancer: Combining Radiomics Signature and Clinical Factors. Front Oncol 2021; 11:754843. [PMID: 34820327 PMCID: PMC8606782 DOI: 10.3389/fonc.2021.754843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To develop and internally validate a nomogram combining radiomics signature of primary tumor and fibroglandular tissue (FGT) based on pharmacokinetic dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and clinical factors for preoperative prediction of sentinel lymph node (SLN) status in breast cancer patients. Methods This study retrospectively enrolled 186 breast cancer patients who underwent pretreatment pharmacokinetic DCE-MRI with positive (n = 93) and negative (n = 93) SLN. Logistic regression models and radiomics signatures of tumor and FGT were constructed after feature extraction and selection. The radiomics signatures were further combined with independent predictors of clinical factors for constructing a combined model. Prediction performance was assessed by receiver operating characteristic (ROC), calibration, and decision curve analysis. The areas under the ROC curve (AUCs) of models were corrected by 1,000-times bootstrapping method and compared by Delong's test. The added value of each independent model or their combinations was also assessed by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. This report referred to the "Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis" (TRIPOD) statement. Results The AUCs of the tumor radiomic model (eight features) and the FGT radiomic model (three features) were 0.783 (95% confidence interval [CI], 0.717-0.849) and 0.680 (95% CI, 0.604-0.757), respectively. A higher AUC of 0.799 (95% CI, 0.737-0.862) was obtained by combining tumor and FGT radiomics signatures. By further combining tumor and FGT radiomics signatures with progesterone receptor (PR) status, a nomogram was developed and showed better discriminative ability for SLN status [AUC 0.839 (95% CI, 0.783-0.895)]. The IDI and NRI indices also showed significant improvement when combining tumor, FGT, and PR compared with each independent model or a combination of any two of them (all p < 0.05). Conclusion FGT and clinical factors improved the prediction performance of SLN status in breast cancer. A nomogram integrating the DCE-MRI radiomics signature of tumor and FGT and PR expression achieved good performance for the prediction of SLN status, which provides a potential biomarker for clinical treatment decision-making.
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Affiliation(s)
- Chunhua Wang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoyu Chen
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongbing Luo
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanyuan Liu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ruirui Meng
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Wang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Siyun Liu
- Pharmaceutical Diagnostics, General Electric (GE) Company (Healthcare), Beijing, China
| | - Guohui Xu
- Department of Interventional Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Ren
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Takada K, Kashiwagi S, Asano Y, Goto W, Kouhashi R, Yabumoto A, Morisaki T, Shibutani M, Takashima T, Fujita H, Hirakawa K, Ohira M. Prediction of lymph node metastasis by tumor-infiltrating lymphocytes in T1 breast cancer. BMC Cancer 2020; 20:598. [PMID: 32590956 PMCID: PMC7318528 DOI: 10.1186/s12885-020-07101-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background Lymph node metastasis is more likely in early-stage breast cancer with lower tumor-infiltrating lymphocyte (TIL) density. Therefore, we investigated the correlation between TILs and lymph node metastasis in cT1 breast cancer patients undergoing surgery and the usefulness of TILs in predicting sentinel lymph node metastasis (SLNM) in cT1N0M0 breast cancer. Methods We investigated 332 breast cancer patients who underwent surgery as the first-line treatment after preoperative diagnosis of cT1. A positive diagnosis of SLNM as an indication for axillary clearance was defined as macrometastasis in the sentinel lymph node (SLN) (macrometastasis: tumor diameter > 2 mm). Semi-quantitative evaluation of lymphocytes infiltrating the peritumoral stroma as TILs in primary tumor biopsy specimens prior to treatment was conducted. Results For SLN biopsy (SLNB), a median of 2 (range, 1–8) SLNs were pathologically evaluated. Sixty cases (19.4%) of SLNM (macrometastasis: 46, micrometastasis: 16) were observed. Metastasis was significantly greater in breast cancers with tumor diameter > 10 mm than in those with diameter ≤ 10 mm (p = 0.016). Metastasis was significantly associated with lymphatic invasion (p < 0.001). These two clinicopathological factors correlated with SLNM even in patients diagnosed with cN0 (tumor size; p = 0.017, lymphatic invasion; p = 0.002). Multivariate analysis for SLNM predictors revealed lymphatic invasion (p = 0.008, odds ratio [OR] = 2.522) and TILs (p < 0.001, OR = 0.137) as independent factors. Conclusions Our results suggest a correlation between lymph node metastasis and tumor immune-microenvironment in cT1 breast cancer. TIL density may be a predictor of SLNM in breast cancer without lymph node metastasis on preoperative imaging.
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Affiliation(s)
- Koji Takada
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yuka Asano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Wataru Goto
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Rika Kouhashi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Akimichi Yabumoto
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tamami Morisaki
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatsune Shibutani
- Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tsutomu Takashima
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hisakazu Fujita
- Department of Scientific and Linguistic Fundamentals of Nursing, Osaka City University Graduate School of Nursing, 1-5-17 Asahi-machi, Abeno-ku, Osaka, 545-0051, Japan
| | - Kosei Hirakawa
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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12
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Choi EJ, Youk JH, Choi H, Song JS. Dynamic contrast-enhanced and diffusion-weighted MRI of invasive breast cancer for the prediction of sentinel lymph node status. J Magn Reson Imaging 2020; 51:615-626. [PMID: 31313393 DOI: 10.1002/jmri.26865] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although sentinel lymph node biopsy (SLNB) is the current standard for identifying lymph metastasis in breast cancer patients, there are complications of SLNB. PURPOSE To evaluate preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) of invasive breast cancer for predicting sentinel lymph node metastasis. STUDY TYPE Retrospective. POPULATION In all, 309 patients who underwent clinically node-negative invasive breast cancer surgery FIELD STRENGTH/SEQUENCE: 3.0T, DCE-MRI, DWI. ASSESSMENT We collected clinicopathologic variables (age, histologic and nuclear grade, extensive intraductal carcinoma component, lymphovascular invasion, and immunohistochemical profiles) and preoperative MRI features (tumor size, background parenchymal enhancement, internal enhancement, adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, kinetic curve types, quantitative kinetic parameters, tumoral apparent diffusion coefficient [ADC], peritumoral maximal ADC, and peritumoral-tumoral ADC ratio). STATISTICAL TESTS Multivariate logistic regressions were performed to determine independent variables associated with SLN metastasis, and the area under the receiver operating characteristic curve (AUC) was analyzed for those variables. RESULTS 41 (13.3%) of the patients showed SLN metastasis. With MRI, tumor size (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.06-1.17), heterogeneous (OR, 5.33; 95% CI, 1.71-16.58), and rim (OR, 15.54; 95% CI, 2.12-113.72) enhancement and peritumoral-tumoral ADC ratio (OR, 72.79; 95% CI, 7.15-740.82) were independently associated with SLN metastasis. Clinicopathologic variables independently associated with SLN metastasis included age (OR, 0.96; 95% CI, 0.92-0.99) and CD31 (OR, 2.90; 95% CI, 1.04-8.92). The area under the curve (AUC) of MRI features (0.80; 95% CI, 0.73-0.87) was significantly higher than for clinicopathologic variables (0.68; 95% CI, 0.60-0.77; P = 0.048) and was barely below statistical significance for combined MRI features with clinicopathologic variables (0.84; 95% CI 0.78-0.90, P = 0.057). DATA CONCLUSION Preoperative internal enhancement on DCE-MRI and peritumoral-tumoral ADC ratio on DWI might be useful for predicting SLN metastasis in patients with invasive breast cancer. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:615-626.
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Affiliation(s)
- Eun Jung Choi
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju City, South Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyemi Choi
- Department of Statistics, Research Institute of Applied Statistics, Chonbuk National University, Jeonbuk, 54896, South Korea
| | - Ji Soo Song
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju City, South Korea
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Predictors of non-sentinel lymph node metastasis in clinical early stage (cT1-2N0) breast cancer patients with 1-2 metastatic sentinel lymph nodes. Asian J Surg 2019; 43:538-549. [PMID: 31519397 DOI: 10.1016/j.asjsur.2019.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/23/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the risk factors that caused non-sentinel lymph nodes (nonSLNs) metastasis by considering the clinicopathological characteristics of patients who have 1-2 sentinel lymph node (SLN) metastasis in the clinical early stage (T1-2, N0) breast cancer. METHODS The demographic and clinicopathological characteristics of the patients were recorded retrospectively. Among these, age, size of the primary breast tumor, tumor localization and multifocality/multicentricity status, preoperative serum Neutrophil/Lymphocyte rate (NLR), c-erbB2/HER2-neu status, Estrogen Receptor (ER) and Progesterone Receptor (PR) status, primary tumor proliferation index (Ki-67), histopathological grade, molecular subtypes, histopathological subtypes, nipple/areola infiltration, Lymphatic Invasion (LI), Vascular Invasion (VI), Perineural Invasion (PNI), number of metastatic SLN m(SLN), mSLN diameter, SLN Extranodal Extension (ENE) status, and number of metastatic nonSLNs were recorded. RESULTS According to the univariate analysis, the HER2 positivity, Ki-67≥%20, mSLN diameter, LI, VI, PNI, ENE and molecular subtypes were found to be significant. However, the age, tumor localization, multifocality/multicentricity, T stage, ER and PR status, tumor size, histopathological grade and subtypes, nipple/areola infiltration and NLR were not found to be significant. In the multivariate analysis, significant independent predictors in nonSLN metastasis development were found to be HER2 positivity, PNI, mSLN diameter ≥10,5 mm and ENE. CONCLUSION The HER2 positivity, ENE, PNI and mSLN diameter ≥10,5 mm were found to be very strong predictors in nonSLN metastasis development. The findings of this study have the potential to be a guideline for surgeons and oncologists when determining their patients' treatment plan. These components are candidates for inclusion among the clinicopathological factors that may be used in the new nomograms due to their higher sensitivity and specificity.
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Üreyen O, Çavdar DK, Adıbelli ZH, İlhan E. Axillary metastasis in clinically node-negative breast cancer. J Egypt Natl Canc Inst 2018; 30:159-163. [PMID: 30327215 DOI: 10.1016/j.jnci.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/14/2018] [Accepted: 09/21/2018] [Indexed: 12/12/2022] Open
Abstract
AIM OF WORK This study investigates the factors related to metastasis detection in a sentinel lymph node biopsy (SLN) in patients without clinical axillary involvement. PATIENTS AND METHODS The medical records of patients who underwent an SLN biopsy after diagnosis with early-stage breast cancer were evaluated retrospectively. The study sample included 64 patients divided into two groups according to the histopathological examination of the SLN biopsy: Group I (positive for axillary metastasis) and Group II (negative for axillary metastasis). RESULTS The frequency of lymphovascular invasion was significantly higher in Group I (57%) than in Group II (13%) (p = 0.003). The progesterone receptor status (p = 0.036), tumor T-stage(p = 0,047), and Ki-67 index differed significantly (p = 0.045) between the two groups. While in univariate analysis, lymphovascular invasion, T-stage and KI-67 index were significant, in multivariate analysis only lymphovascular invasion was found to be significant. No significant differences were found in terms of estrogen receptor and HER2 considering tumor invasion type, histologic grade, vascular invasion, neural invasion, multifocality or bilaterality, hormone receptor status, menopause status, total number of lymph nodes, presence of non-sentinel lymph nodes and the number of SLNs in the groups (p > 0.05). CONCLUSIONS The results of this study indicate that lymphovascular invasion is associated with axillary metastasis, based on an SLN biopsy.
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Affiliation(s)
- Orhan Üreyen
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Department of General Surgery, Izmir, Turkey.
| | - Demet Kocatepe Çavdar
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Department of Medical Pathology, Izmir, Turkey
| | - Zehra Hilal Adıbelli
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Clinic of Radiology, Izmir, Turkey
| | - Enver İlhan
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Department of General Surgery, Izmir, Turkey
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Sandoughdaran S, Malekzadeh M, Mohammad Esmaeil ME. Frequency and Predictors of Axillary Lymph Node Metastases in Iranian Women with Early Breast Cancer. Asian Pac J Cancer Prev 2018; 19:1617-1620. [PMID: 29936787 PMCID: PMC6103571 DOI: 10.22034/apjcp.2018.19.6.1617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Axillary lymph node metastasis is the most important predictive factor for recurrence risk and survival in patients with invasive breast carcinoma. The aim of this study was to determine factors associated with metastatic involvement of axillary lymph nodes in Iranian women with early breast cancer. Methods: This article reports a retrospective study of 774 patients with T1-T2 breast cancer who underwent resection of the primary tumor and axillary staging by SLNB and/or ALND between 2005 and 2015 at our institution. Results: Of the 774 patients included in this study, 35.5% (275 cases) had axillary lymph node involvement at the time of diagnosis. Factors associated with nodal involvement in univariate analyses were tumor size, lymphovascular invasion (LVI), tumor grade, ER/PR status and HER2 expression. All factors identified with univariate analyses were entered into a multivariate logistic regression model and tumor size (OR= 3.01, CI 2.01–4.49, P <0.001), ER/PR positivity (OR = 1.74, CI 1.1.16–2.62, P = 0.007) and presence of LVI (OR = 3.3.8, CI 2.31–4.95, P <0.001) remained as independent predictors of axillary lymph node involvement. Conclusions: In conclusion, the results of this study suggests that positive hormonal receptor status, LVI and tumor size are predictive factors for ALNM in Iranian women with early breast cancer.
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Affiliation(s)
- Saleh Sandoughdaran
- Department of Radiation Oncology, Shohada-e-Tajrish Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Zhu Y, Zhou W, Jia XH, Huang O, Zhan WW. Preoperative Axillary Ultrasound in the Selection of Patients With a Heavy Axillary Tumor Burden in Early-Stage Breast Cancer: What Leads to False-Positive Results? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1357-1365. [PMID: 29424451 DOI: 10.1002/jum.14545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine whether imaging and clinicopathologic features could predict false-positive axillary ultrasound (US) results in the selection of patients with breast cancer who had a heavy axillary tumor burden (≥3 tumor-involved nodes). METHODS Among 788 patients with histologically confirmed invasive breast cancer at Ruijin Hospital from October 2014 to September 2015, 162 patients (cT1-T2, cN0) with 167 axillae had suspicious axillary US findings. Ultrasound findings were considered suspicious for metastasis if cortical thickening of greater than 3 mm or effacement of the fatty hilum was present. The false-positive rate of suspicious axillary US results for identifying 3 or more positive lymph nodes in the final pathologic examination was calculated. Univariate and multivariate analyses were used to evaluate imaging and clinicopathologic factors related to the false-positive results. RESULTS Axillary US showed a false-positive rate of 60.5% (101 of 167) in the patients with breast cancer and a heavy nodal burden. By logistic regression analyses, we found false-positive axillary US results more frequently in patients who had a T1 stage tumor (P = .005), an estrogen receptor/progesterone receptor-negative tumor (P < .001), solitary suspicious nodes identified on axillary US (P < .001), and a cortical thickness of the most suspicious lymph node of 3.5 mm or less (P = .015). CONCLUSIONS Imaging and clinicopathologic features can be used to identify axillae with less than 3 metastatic nodes in patients with early-stage breast cancer who have positive axillary US results. In the post-American College of Surgeons Oncology Group Z0011 trial era, conducting a secondary evaluation either clinically or by axillary imaging before the use of a US-guided biopsy of suspicious nodes can potentially avoid the additional morbidity of axillary lymph node dissection and reduce the preoperative workload.
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Affiliation(s)
- Ying Zhu
- Department of Ultrasound, Shanghai Ruijin Hospital, affiliated with the Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Shanghai Ruijin Hospital, affiliated with the Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Xiao-Hong Jia
- Department of Ultrasound, Shanghai Ruijin Hospital, affiliated with the Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Ou Huang
- Comprehensive Breast Health Center, Shanghai Ruijin Hospital, affiliated with the Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Wei-Wei Zhan
- Department of Ultrasound, Shanghai Ruijin Hospital, affiliated with the Medical School of Shanghai Jiaotong University, Shanghai, China
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Watanabe Y, Anan K, Saimura M, Koga K, Fujino M, Mine M, Tamiya S, Nishihara K, Nakano T, Mitsuyama S. Upstaging to invasive ductal carcinoma after mastectomy for ductal carcinoma in situ: predictive factors and role of sentinel lymph node biopsy. Breast Cancer 2018; 25:663-670. [PMID: 29786772 DOI: 10.1007/s12282-018-0871-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to investigate preoperative factors associated with ductal carcinoma in situ (DCIS) upstaged to invasive ductal carcinoma (IDC) and sentinel lymph node (SLN) status in patients who underwent mastectomy for a preoperative diagnosis of DCIS. METHODS The medical records of 220 patients who underwent mastectomy for a preoperative diagnosis of DCIS were retrospectively reviewed. RESULTS Fifty-one (22.6%) of 226 lesions were upgraded to IDC after mastectomy. Preoperative factors associated with upstaging to IDC included patient-reported signs and symptoms, a clinically palpable mass, ultrasound findings classified as category 4 or 5, the ultrasound appearance of a mass or widely distributed non-mass abnormality (NMA), and a high Ki67 index. The prevalence of SLN macrometastasis was 0.9%. IDC was diagnosed for 10.9% of lesions of a preoperative ultrasound category of 0-3, 13.0% of those with no mass or NMA detected by ultrasonography, and 14.1% of lesions preoperatively diagnosed by methods other than core needle biopsy (CNB). Of those lesions, none was associated with SLN metastasis. CONCLUSIONS Routinely performing SLN biopsy for patients undergoing mastectomy for a preoperative diagnosis of DCIS is overtreatment, because the prevalence of SLN metastasis was low. SLN biopsy can be omitted for most patients. In particular, we suggest omitting SLN biopsy for patients who have lesions of ultrasound category 0-3, who have neither a mass nor NMA detected by ultrasound, or whose initial diagnosis was made based on a specimen obtained by methods other than CNB.
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Affiliation(s)
- Yusuke Watanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan.
| | - Keisei Anan
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Michiyo Saimura
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Kenichiro Koga
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Minoru Fujino
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Mari Mine
- Department of Pathology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
| | - Shoshu Mitsuyama
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan
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Majid S, Rydén L, Manjer J. Predictive factors for sentinel node metastases in primary invasive breast cancer: a population-based cohort study of 2552 consecutive patients. World J Surg Oncol 2018. [PMID: 29530065 PMCID: PMC5848524 DOI: 10.1186/s12957-018-1353-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Axillary lymph node status is one of the most important prognostic factors for breast cancer. The aim of this study was to determine predictive factors for metastasis to sentinel node (SN) in primary invasive breast cancer. METHOD This is a study of 3979 patients with primary breast cancer during 2008-2013 in Malmö and Lund scheduled for surgery and included in the information retrieved from Information Network for Cancer Care (INCA). The final study population included 2552 patients with primary invasive breast cancer. The risk of metastases to SN were examined in relation to potential clinicopathological factors such as age, screening mammography, tumor size, tumor type, histological grade, estrogen status, progesterone status, Her-2 status, multifocality, and lymphovascular invasion. Binary logistic regression was used; adjusted analyses yielded odds ratio (OR) with 95% confidence interval. RESULTS Tumors detected by mammography screening were less likely to be associated with metastases to SN compared to those not found by mammography screening (0.63; 0.51-0.80). Negative hormonal status for estrogen associated with lower risk for SN metastases compared to tumor with positive estrogen status (0.64; 0.42-0.99). Tumors with a size more than 20 mm had higher risk to metastasize to SN (1.84; 1.47-2.33) compared to tumors less than 20 mm. Multifocality (1.90; 1.45-2.47) and lymphovascular invasion (3.74; 2.66-5.27) were also strong predictive factors for SN metastases. CONCLUSION SN metastasis is less likely to occur in women with invasive breast cancer diagnosed by screening mammogram. Tumors with negative estrogen status are associated with low risk for SN metastases. Tumors larger than 20 mm, multifocality, or lymphovascular invasion are also factors associated with high risk for SN metastases.
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Affiliation(s)
- Shabaz Majid
- Department of Surgery, Central Hospital of Kristianstad, SE-291 85, Kristianstad, Sweden. .,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Lisa Rydén
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Manjer
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
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Kondov B, Isijanovska R, Milenkovikj Z, Petrusevska G, Jovanovski-Srceva M, Bogdanovska-Todorovska M, Kondov G. Impact of Size of the Tumour, Persistence of Estrogen Receptors, Progesterone Receptors, HER2Neu Receptors and Ki67 Values on Positivity of Axillary Lymph Nodes in Patients with Early Breast Cancer with Clinically Negative Axillary Examination. Open Access Maced J Med Sci 2017; 5:825-830. [PMID: 29362604 PMCID: PMC5771280 DOI: 10.3889/oamjms.2017.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/22/2022] Open
Abstract
AIM: The study aimed to identify factors that influence the positivity of axillary lymph nodes in patients with early breast cancer and clinically negative axillary lymph nodes, who were subjected for modified radical mastectomy and axillary lymphadenectomy. MATERIAL AND METHODS: This study included 81 surgically treated, early breast cancer patients during the period from 08-2015 to 05-2017. All the cases have been analysed by standard histological analysis including macroscopic and microscopic examination by routine H&E staining. For determination of molecular receptors, immunostaining by PT LINK immunoperoxidase has been done for HER2neu, ER, PR, p53 and Ki67. RESULTS: Patients age ranged between 31-73 years, an average of 56.86 years. The mean size of a primary tumour in the surgically treated patient was 20.33 ± 6.0 mm. Axillary dissection revealed from 5 to 32 lymph nodes, with an average of 14. Metastases have been found in 1 to 7 lymph nodes, with an average 0.7. Only 26 (32.1%) of the patients showed metastases in the axillary lymph nodes. The univariant regression analysis showed that the size of a tumour and presence of HER2neu receptors on cancer cells influence the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors have no influence on the positivity for metastatic deposits of lymph nodes. Multivariant model and logistic regression analysis as significant independent factors or predictors of positivity of the axillary lymph nodes are influenced by the tumour size only. CONCLUSION: Our study showed that the metastatic involvement of the axillary lymph nodes is mainly influenced by the size of a tumour and presence of HER2neu receptors in the univariant analysis. This point to the important influence of positivity of the axillary lymph nodes but, in multi-variant regressive analysis the lymph node status correlates with the tumour size only.
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Affiliation(s)
- Borislav Kondov
- University Clinic for Thoracic and Vascular Surgery, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Rosalinda Isijanovska
- Institute for Epidemiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Zvonko Milenkovikj
- University Clinic for Infective Diseases and Febrile Conditions, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Gordana Petrusevska
- Institute for Pathology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Marija Jovanovski-Srceva
- University Clinic for Anesthesia and Reanimation, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | | | - Goran Kondov
- University Clinic for Thoracic and Vascular Surgery, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Jakub JW, Murphy BL, Gonzalez AB, Conners AL, Henrichsen TL, Maimone S, Keeney MG, McLaughlin SA, Pockaj BA, Chen B, Musonza T, Harmsen WS, Boughey JC, Hieken TJ, Habermann EB, Shah HN, Degnim AC. A Validated Nomogram to Predict Upstaging of Ductal Carcinoma in Situ to Invasive Disease. Ann Surg Oncol 2017; 24:2915-2924. [DOI: 10.1245/s10434-017-5927-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 12/20/2022]
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21
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Omission of axillary dissection after a positive sentinel lymph-node: Implications in the multidisciplinary treatment of operable breast cancer. Cancer Treat Rev 2016; 48:1-7. [DOI: 10.1016/j.ctrv.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/08/2016] [Accepted: 05/12/2016] [Indexed: 02/06/2023]
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22
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Karahallı Ö, Acar T, Atahan MK, Acar N, Hacıyanlı M, Kamer KE. Clinical and Pathological Factors Affecting the Sentinel Lymph Node Metastasis in Patients with Breast Cancer. Indian J Surg 2016; 79:418-422. [PMID: 29089701 DOI: 10.1007/s12262-016-1500-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/28/2016] [Indexed: 12/16/2022] Open
Abstract
Sentinel lymph node biopsy has become the routine procedure in axilla-negative breast cancer patients at most medical centers for axillary staging and local control in the recent years. Sentinel lymph node is the only focus in axillary lymph metastasis in a large portion of patients. In our trial, we investigated the clinical and pathological factors that affect the positive status of sentinel lymph node. We included 89 patients, who underwent sentinel lymph node biopsy (SLNB) with methylene blue and/or technetium-99 m Sulphur Colloid due to early-stage breast cancer. Five patients, in whom SLN was not detected and who underwent axillary dissection, were excluded from the trial. The patient age, location of the tumor, the type of the tumor, the T stage by the TNM staging system, the histological grade and type of the tumor, the status of multifocality, the lymphovascular invasion status of the tumor, and the ER, PR, and HER-neu2 status were recorded. The median age of the 89 patients was 52, 9 (±10) years. Fifty-seven (64 %) and 32 (36 %) of the 89 patients were detected to have positive and negative SLN, respectively. Assessing the SLNB positivity and the patient age, tumor size, tumor grade, multifocality, tumor localization, the T stage by the TNM staging, the ER/PR positivity/negativity, and the HER/neu2 and p53 status, the data revealed no statistically significant results with respect to SLN metastasis. The lymphovascular invasion status (LVI) was observed to statistically affect the SLN positivity (p < 0.016). We showed that LVI could be an important marker in predicting the SLN positivity in patients with axilla-negative early-stage breast cancer. In the future, upon introduction of new biomarkers and with relevant studies, it may be possible to predict the SLNB status of patients at an adequately high accuracy and a low risk.
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Affiliation(s)
- Önder Karahallı
- General Surgery Clinic, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, 172. Sokak no: 3 Daire: 3 Basın Sitesi, İzmir, Turkey
| | - Turan Acar
- General Surgery Clinic, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, 172. Sokak no: 3 Daire: 3 Basın Sitesi, İzmir, Turkey
| | - Murat Kemal Atahan
- General Surgery Clinic, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, 172. Sokak no: 3 Daire: 3 Basın Sitesi, İzmir, Turkey
| | - Nihan Acar
- General Surgery Clinic, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, 172. Sokak no: 3 Daire: 3 Basın Sitesi, İzmir, Turkey
| | - Mehmet Hacıyanlı
- General Surgery Clinic, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, 172. Sokak no: 3 Daire: 3 Basın Sitesi, İzmir, Turkey
| | - Kemal Erdinç Kamer
- General Surgery Clinic, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, 172. Sokak no: 3 Daire: 3 Basın Sitesi, İzmir, Turkey
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Solà M, Recaj M, Castellà E, Puig P, Gubern JM, Julian JF, Fraile M. Sentinel Node Biopsy in Special Histologic Types of Invasive Breast Cancer. THE JOURNAL OF BREAST HEALTH 2016; 12:78-82. [PMID: 28331738 DOI: 10.5152/tjbh.2016.2929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/07/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the feasibility of sentinel node biopsy (SNB) in ductal and lobular invasive breast cancer, a group of tumors known as special histologic type (SHT) of breast cancer. MATERIALS AND METHODS Between January 1997 and July 2008, 2253 patients from 6 affiliated hospitals underwent SNB who had early breast cancer and clinically negative axilla. The patients' data were collected in a multicenter database. For lymphatic mapping, all patients received an intralesional dose of radiocolloid Tc-99m (4mCi in 0.4 mL saline), at least two hours before the surgical procedure. SNB was performed by physicians from the same nuclear medicine department in all cases. RESULTS Of the 2253 patients in the database, the SN identification rate was 94.5% (no radiotracer migration in 123 patients), and positive sentinel node prevalence was 22%. SHT was reported in 144 patients (6.4%) of the whole series. In this subgroup, migration of radiotracer was unsuccessful in 8 patients (identification rate was 94.4%) and SNs were positive in 7.4%. SN positivity prevalence in these tumors was variable across the subtypes. Higher probability of lymphatic spread seemed to be related to tumor invasiveness (20% of positivity in micropapillary, 15% in cribriform subtypes, and 0% in adenoid-cystic). CONCLUSION Sentinel node biopsy is feasible in special histologic subtypes of breast carcinoma with a good identification rate. Lower migration rates, however, might be associated with special histologic features (colloid subtype). Complete axillary dissection after a positive sentinel node cannot be omitted in patients with SHT breast cancer because they can be associated with further axillary disease; the reported very low incidence of axillary metastases would justify avoiding axillary dissection only in the adenoid-cystic subtype.
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Affiliation(s)
- Montserrat Solà
- Germans Trias Pujol Hospital, Nuclear Medicine, Badalona, Spain
| | | | - Eva Castellà
- Germans Trias Pujol H, Pathology, Badalona, Spain
| | - Pere Puig
- Sant Jaume Calella H, Surgery, Calella, Spain
| | | | | | - Manel Fraile
- Germans Trias Pujol Hospital, Nuclear Medicine, Badalona, Spain
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24
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Kim H, Kim M, Kwak C, Kim HH, Ku JH. Prognostic significance of lymphovascular invasion in radical cystectomy on patients with bladder cancer: a systematic review and meta-analysis. PLoS One 2014; 9:e89259. [PMID: 24586637 PMCID: PMC3931717 DOI: 10.1371/journal.pone.0089259] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/16/2014] [Indexed: 12/26/2022] Open
Abstract
Purpose The objective of the present study was to conduct a systematic review and meta-analysis of published literature to appraise the prognostic value of lymphovascular invasion (LVI) in radical cystectomy specimens. Materials and Methods Following the PRISMA statement, PubMed, Cochrane Library, and SCOPUS database were searched from the respective dates of inception until June 2013. Results A total of 21 articles met the eligibility criteria for this systematic review, which included a total of 12,527 patients ranging from 57 to 4,257 per study. LVI was detected in 34.6% in radical cystectomy specimens. LVI was associated with higher pathological T stage and tumor grade, as well as lymph node metastasis. The pooled hazard ratio (HR) was statistically significant for recurrence-free survival (pooled HR, 1.61; 95% confidence interval [CI], 1.26–2.06), cancer-specific survival (pooled HR, 1.67; 95% CI, 1.38–2.01), and overall survival (pooled HR, 1.67; 95% CI, 1.38–2.01), despite the heterogeneity among included studies. On sensitivity analysis, the pooled HRs and 95% CIs were not significantly altered when any one study was omitted. The funnel plot for overall survival demonstrated a certain degree of asymmetry, which showed slight publication bias. Conclusions This meta-analysis indicates that LVI is significantly associated with poor outcome in patients with bladder cancer who underwent radical cystectomy. Adequately designed prospective studies are required to provide the precise prognostic significance of LVI in bladder cancer.
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Affiliation(s)
- Hwanik Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Myong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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25
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Ku JH, Byun SS, Jeong H, Kwak C, Kim HH, Lee SE. Lymphovascular invasion as a prognostic factor in the upper urinary tract urothelial carcinoma: A systematic review and meta-analysis. Eur J Cancer 2013; 49:2665-80. [PMID: 23721778 DOI: 10.1016/j.ejca.2013.04.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 04/06/2013] [Accepted: 04/22/2013] [Indexed: 12/30/2022]
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26
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van la Parra RFD, Francissen CMTP, Peer PGM, Ernst MF, de Roos WK, Van Zee KJ, Bosscha K. Assessment of the Memorial Sloan-Kettering Cancer Center nomogram to predict sentinel lymph node metastases in a Dutch breast cancer population. Eur J Cancer 2012; 49:564-71. [PMID: 22975214 DOI: 10.1016/j.ejca.2012.04.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 03/31/2012] [Accepted: 04/28/2012] [Indexed: 10/27/2022]
Abstract
AIM Sentinel lymph node (SLN) biopsy is an accepted alternative to axillary lymph node dissection to assess the axillary tumour status in breast cancer patients. Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram to predict the likelihood of SLN metastases in breast cancer patients. Nomogram performance was tested on a Dutch population. METHODS Data of 770 breast cancer patients who underwent successful SLN biopsy were collected. SLN metastases were present in 222 patients. A receiver operating characteristic (ROC) curve was drawn and the area under the curve was calculated to assess the discriminative ability of the MSKCC nomogram. A calibration plot was drawn to compare actual versus nomogram-predicted probabilities. RESULTS The area under the ROC curve for the predictive nomogram was 0.67 (95% confidence interval 0.63-0.72) as compared to 0.75 in the original population. The nomogram was well-calibrated in the Dutch population. CONCLUSIONS In a Dutch population, the MSKCC nomogram estimated risk of sentinel node metastases in breast cancer patients well (i.e. calibration) with reasonable discrimination (area under ROC curve). Nomogram performance on core needle biopsy data has to be evaluated prospectively.
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Godfrey MS, Badalato GM, Hruby GW, Razmjoo M, McKiernan JM. Prognostic indicators for upper tract urothelial carcinoma after radical nephroureterectomy: the impact of lymphovascular invasion. BJU Int 2012; 110:798-803. [DOI: 10.1111/j.1464-410x.2011.10893.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Lorand S, Lavoué V, Tas P, Foucher F, Mesbah H, Rouquette S, Bendavid C, Coué O, Porée P, Leveque J. Intraoperative touch imprint cytology of axillary sentinel nodes for breast cancer: A series of 355 procedures. Breast 2011; 20:119-23. [DOI: 10.1016/j.breast.2010.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/05/2010] [Accepted: 08/17/2010] [Indexed: 11/26/2022] Open
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29
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Gwak G, Park K, Shin E, Han S, Kim JY, Kim H, Kim YD, Kim HJ, Kim KW, Bae BN, Yang KH, Park SJ, Lim SW. Lymphovascular Invasion and HER2/neuAmplification as Predictive Factors for Axillary Lymph Node Metastasis in Early Breast Cancer Patients. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.3.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Geumhee Gwak
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kyeongmee Park
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Eunah Shin
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sehwan Han
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Ji-Young Kim
- Department of Radiology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hongyong Kim
- Department of Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Young Duk Kim
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hong Ju Kim
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Ki Whan Kim
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byung Noe Bae
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Keun Ho Yang
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sung Jin Park
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seung Woo Lim
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
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