1
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de Jonge C, Schipper RJ, Walstra CJEF, Van Riet YE, Verrijssen ASE, Voogd AC, van der Sangen MJC, Theuws J, Degreef E, Gielens MPM, Bloemen JG, van den Berg HA, Nieuwenhuijzen GAP. Breast conserving surgery with intraoperative electron beam radiation therapy for low-risk breast cancer: Five-year follow-up of 306 patients. Int J Cancer 2024; 155:1237-1247. [PMID: 38752603 DOI: 10.1002/ijc.35033] [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: 12/10/2023] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 08/03/2024]
Abstract
Recent studies have reported a higher than expected risk of ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) and a single dose of electron beam intra-operative radiotherapy (IORT). This finding was the rationale to perform a retrospective single center cohort study evaluating the oncologic results of consecutive patients treated with BCS and IORT. Women were eligible if they had clinical low-risk (N0, ≤2 cm unifocal, Bloom and Richardson grade 1-2), estrogen receptor-positive and human-epidermal-growth-factor-receptor-2-negative breast cancer. Prior to BCS, pN0 status was determined by sentinel lymph node biopsy. Data on oncologic follow-up were analyzed. Between 2012 and 2019, 306 consecutive patients were treated and analyzed, with a median age of 67 (50-86) years at diagnosis. Median follow-up was 60 (8-120) months. Five-year cumulative risk of IBTR was 13.4% (95% confidence interval [CI] 9.4-17.4). True in field recurrence was present in 3.9% of the patients. In 4.6% of the patients, the IBRT was classified as a local recurrence due to seeding of tumor cells in the cutis or subcutis most likely related to percutaneous biopsy. In 2.9% of the patients, the IBRT was a new outfield primary tumor. Three patients had a regional lymph node recurrence and two had distant metastases as first event. One breast cancer-related death was observed. Estimated 5-year overall survival was 89.8% (95% CI 86.0-93.6). In conclusion, although some of IBTR cases could have been prevented by adaptations in biopsy techniques and patient selection, BCS followed by IORT was associated with a substantial risk of IBTR.
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Affiliation(s)
- Charlotte de Jonge
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Coco J E F Walstra
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Yvonne E Van Riet
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - An-Sofie E Verrijssen
- Department of Radiotherapy, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Jacqueline Theuws
- Department of Radiotherapy, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Ellen Degreef
- Department of Pathology, Eurofins PAMM, Veldhoven, The Netherlands
| | - Maaike P M Gielens
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Hetty A van den Berg
- Department of Radiotherapy, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Jung JJ, Moon HG. ASO Author Reflections: Contralateral Axillary Metastasis in Breast Cancer: Prognostic Variability and Benefits of Surgical Treatment. Ann Surg Oncol 2024; 31:5951-5952. [PMID: 38900348 DOI: 10.1245/s10434-024-15440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Ji-Jung Jung
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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3
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Jung JJ, Cheun JH, Kang E, Shin I, Byeon J, Lee H, Kim HK, Lee HB, Han W, Moon HG. Survival After Contralateral Axillary Metastasis in Breast Cancer. Ann Surg Oncol 2024; 31:5189-5196. [PMID: 38695982 PMCID: PMC11236886 DOI: 10.1245/s10434-024-15370-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/11/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Despite stage IV categorization, survival outcomes for breast cancer patients who experience contralateral axillary lymph node metastasis (CAM) remain uncertain. This study aimed to investigate the clinical outcomes for patients with metachronous CAM to provide insights into its prognosis and treatment recommendations. METHODS This study retrospectively reviewed medical records of patients who underwent curative surgery for breast cancer and experienced CAM as the first site of distant metastasis (DM) during the follow-up period between January 2001 and April 2023. Survival outcomes of the CAM patients were compared with those of breast cancer patients with other DM via propensity score-matching (PSM). RESULTS The study identified 40 breast cancer patients with metachronous CAM. The estimated 5-year overall survival (OS) was 39.6%, and the progression-free survival was 39.4%. The patients with CAM exhibited marginally better OS than the patients with DM (p = 0.071), but survival similar to that of the patients with isolated supraclavicular node recurrence (SCN) (p = 0.509). Moreover, matching of CAM with DM using two PSM models showed a consistently insignificant survival difference (hazard ratio [HR], 1.47; p = 0.124 vs. HR, 1.19; p = 0.542). Ipsilateral breast tumor recurrences (IBTRs) were experienced by 12 patients before or concurrently with the CAM. These patients exhibited significantly better survival than the remaining patients (HR, 0.28; p = 0.024). CONCLUSION The breast cancer patients with CAM showed survival similar to that for the patients with DM, supporting the current stage IV classification of the CAM. However, CAM associated with IBTR exhibited superior survival outcomes, suggesting that this subset of CAM may benefit from treatments with curative intent.
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Affiliation(s)
- Ji-Jung Jung
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Ho Cheun
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eunhye Kang
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ikbeom Shin
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Byeon
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hwajeong Lee
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Byoel Lee
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonshik Han
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeong-Gon Moon
- Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Zhao Q, Yang F, Wu HL, Mo M, Ling YX, Liu GY. Contralateral axillary lymph node metastasis in breast cancer: An oligometastatic-like disease. Breast 2023; 72:103589. [PMID: 37839139 PMCID: PMC10582740 DOI: 10.1016/j.breast.2023.103589] [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: 07/14/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Contralateral axillary lymph node metastasis (CAM) is rare. It remains controversial whether CAM should be regarded as a regional or distant metastatic disease. Our study aims to investigate the accurate clinical orientation and management of CAM. METHODS Two hundred and ninety-nine female patients diagnosed with breast cancer from 2000 to 2014 and confirmed to develop CAM, oligometastasis (OM) or locoregional recurrence (LRR) at Fudan University Shanghai Cancer Center (FUSCC) were included in this study. Baseline information and survival outcomes were analyzed and compared among the three groups. RESULTS Patients with CAM exhibited similar overall survival (OS) and progression-free survival (PFS) to those with OM, but worse than those with LRR (HR: 0.47 [95 % CI: 0.27-0.85], p = 0.0097; HR:0.39 [95 % CI: 0.24-0.63], p < 0.0001, respectively). Considering the patients presented with CAM or OM as a whole, we found that local treatment combined with systemic treatment did not provide a superior survival benefit over systemic treatment alone. CONCLUSION CAM was similar to an oligometastatic-like disease, and patients with these diseases may benefit from systemic treatment. Adding local treatment failed to significantly improve OS.
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Affiliation(s)
- Qian Zhao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Fan Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Huai-Liang Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Miao Mo
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yun-Xiao Ling
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Guang-Yu Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
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5
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MacDonald T, Sittenfeld SMC. Goldilocks Solution Is Just Right for This Bear of a Case. Int J Radiat Oncol Biol Phys 2023; 117:527. [PMID: 37739601 DOI: 10.1016/j.ijrobp.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Taylor MacDonald
- Barrett Cancer Center, University of Cincinnati, Cincinnati, Ohio
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Jiao Y, Guo X, Wu H, Lv Q. Surgery on Metastatic Foci is a Better Strategy for Stage IV Breast Cancer Patients with only Nonregional Lymph Node Metastasis. Adv Ther 2023; 40:3247-3262. [PMID: 37270436 DOI: 10.1007/s12325-023-02557-3] [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: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Our study aims to explore whether breast cancer patients with non-regional lymph node (NRLN) metastasis benefit from surgery on distant nodes, and to determine the influencing factors affecting the prognosis of this type of patient. METHODS Information of invasive ductal carcinoma (IDC) patients from 2004 to 2016 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed by statistical methods, including multivariate Cox regression model, chi-squared test, propensity score matching (PSM), Kaplan-Meier plot, and log-rank test. RESULTS A total of 4236 M1 patients met the designated criteria. Among 847 patients with only NRLN metastasis who have detailed information, only 114 patients received surgery on metastatic distant lymph nodes. The Kaplan-Meier plot for overall survival (OS) showed that the prognosis of NRLN metastatic patients was superior to visceral metastasis (P < 0.0001) but similar to supraclavicular metastasis (P = 0.33). In addition, NRLN metastatic patients who underwent surgery on the NRLNs were found to have superior prognoses in terms of both OS (P = 0.041) and cancer-specific survival (P = 0.034) compared with those who did not undergo NRLN surgery. We have also demonstrated that NRLN metastatic patients who have received radiotherapy plus chemotherapy for primary tumors gain superior survival compared with those who only received chemotherapy apart from NRLN surgery. CONCLUSION Surgery on NRLN and radiotherapy for the primary tumor improved the prognosis of NRLN metastatic patients. Thus, the classification of NRLN, especially contralateral axillary lymph node metastasis (CAM), into the M1 breast cancer stage should be reconsidered. Different locoregional treatment strategies for metastatic foci should be recommended for patients with only NRLN and patients with visceral metastasis.
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Affiliation(s)
- Yile Jiao
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xinyi Guo
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hao Wu
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qing Lv
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China.
- Breast Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Takemoto N, Koyanagi A, Yasuda M, Shimanaka K, Yamamoto H. Breast cancer dermal lymphatic invasion recurrence and contralateral axillary lymph nodes metastasis after complete response to neoadjuvant therapy: A case report. Int J Surg Case Rep 2023; 106:108292. [PMID: 37167687 DOI: 10.1016/j.ijscr.2023.108292] [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: 03/20/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Non-luminal type breast cancer patients with pathological complete response (pCR) by neoadjuvant chemotherapy (NAC) usually have a good prognosis, but occasionally recurrence occurs. CASE PRESENTATION A 61-year-old woman was diagnosed with breast cancer T2N2aM0 stage IIIA and its intrinsic type was non-luminal type. After NAC, the patient achieved pCR and underwent breast-conserving surgery and axillary lymph node dissection (ALND). Radiotherapy and trastuzumab of one-year duration was added. However, six years and two months later, local recurrence and contralateral axillary lymph node (CLALN) metastasis were identified. After resection, anti-human epidermal growth factor receptor 2 (HER-2) therapy was done, however, six months after operation, purpura was observed on the right chest and tended to increase. One and a half years after re-operation, dermal lymphatic invasion (DLI) recurrence without clinical inflammatory signs was diagnosed. A skin resection was performed >1.5 cm away from the purpura, and the surgical margins were negative but four months later, a recurrence re-emerged. CLINICAL DISCUSSION CLALN metastasis is considered distant metastasis based on the current TNM classification. However, as previous ALND or radiotherapy can change lymphatic flow, the resulting CLALN may not be distant metastasis. DLI recurrence without clinical inflammatory signs is likely to be resistant to anti-HER2 even in non-luminal type, and even a 2-cm margin for skin surgical lines may result in positive margins. CONCLUSION There are cases where CLALN after ALND should also be considered possible metastasis. In DLI recurrence, the skin excision margin line should be set very generously.
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Affiliation(s)
- Nobuyuki Takemoto
- Department of Breast & Thyroid Surgery, Japan Medical Alliance East Saitama General Hospital, 5-517, Yoshino, Satte-City, Saitama-Pref, Japan.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, ISCIII, Sant Boi de Llobregat, Barcelona, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, 1-1397, Yamane, Hidaka-City, Saitama-Pref, Japan
| | - Kousuke Shimanaka
- Department of Plastic Surgery, Japan Medical Alliance Ebina General Hospital, 1320, Kawaraguchi, Ebina-City, Kanagawa-Pref, Japan
| | - Hiroshi Yamamoto
- Department of Breast & Thyroid Surgery, Japan Medical Alliance East Saitama General Hospital, 5-517, Yoshino, Satte-City, Saitama-Pref, Japan
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Zwimpfer TA, Schwab FD, Steffens D, Kaul F, Schmidt N, Geiger J, Geissler F, Heinzelmann-Schwarz V, Weber WP, Kurzeder C. Contralateral lymph node metastasis in recurrent ipsilateral breast cancer with Lynch syndrome: a locoregional event. World J Surg Oncol 2023; 21:40. [PMID: 36755294 PMCID: PMC9909893 DOI: 10.1186/s12957-023-02918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Contralateral axillary lymph node metastasis (CALNM) in breast cancer (BC) is considered a distant metastasis, marking stage 4cancer. Therefore, it is generally treated as an incurable disease. However, in clinical practice, staging and treatment remain controversial due to a paucity of data, and the St. Gallen 2021 consensus panel recommended a curative approach in patients with oligometastatic disease. Aberrant lymph node (LN) drainage following previous surgery or radiotherapy is common. Therefore, CALNM may be considered a regional event rather than systemic disease, and a re-sentinel procedure aided by lymphoscintigraphy permits adequate regional staging. CASE REPORT Here, we report a 37-year-old patient with Lynch syndrome who presented with CALNM in an ipsilateral relapse of a moderately differentiated invasive ductal BC (ER 90%, PR 30%, HER2 negative, Ki-67 25%, microsatellite stable), 3 years after the initial diagnosis. Lymphoscintigraphy detected a positive sentinel LN in the contralateral axilla despite no sign of LN involvement or distant metastases on FDG PET/CT or MRI. The patient underwent bilateral mastectomy with sentinel node dissection, surgical reconstruction with histological confirmation of the CALNM, left axillary dissection, adjuvant chemotherapy, and anti-hormone therapy. In addition to her regular BC follow-up visits, the patient will undergo annual colonoscopy, gastroscopy, abdominal, and vaginal ultrasound screening. In January 2023, the patient was free of progression for 23 months after initiation of treatment for recurrent BC and CALNM. CONCLUSION This case highlights the value of delayed lymphoscintigraphy and the contribution of sentinel procedure for local control in the setting of recurrent BC. Aberrant lymph node drainage following previous surgery may be the underlying cause of CALNM. We propose that CALNM without evidence of systemic metastasis should be considered a regional event in recurrent BC, and thus, a curative approach can be pursued. The next AJCC BC staging should clarify the role of CALNM in recurrent BC to allow for the development of specific treatment guidelines.
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Affiliation(s)
- Tibor A. Zwimpfer
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, Australia ,grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Fabienne D. Schwab
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland ,grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
| | - Daniel Steffens
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland ,grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
| | - Felix Kaul
- grid.410567.1Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Noemi Schmidt
- grid.410567.1Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - James Geiger
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Franziska Geissler
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland
| | - Walter P. Weber
- grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
| | - Christian Kurzeder
- grid.410567.1Department of Obstetrics and Gynaecology, University Hospital of Basel, 4056 Basel, Switzerland ,grid.410567.1Breast Centre, University Hospital Basel, Basel, Switzerland
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9
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Merloni F, Palleschi M, Casadei C, Romeo A, Curcio A, Casadei R, Stella F, Ercolani G, Gianni C, Sirico M, Cima S, Sarti S, Cecconetto L, Di Menna G, De Giorgi U. Oligometastatic breast cancer and metastasis-directed treatment: an aggressive multimodal approach to reach the cure. Ther Adv Med Oncol 2023; 15:17588359231161412. [PMID: 36950272 PMCID: PMC10026139 DOI: 10.1177/17588359231161412] [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: 07/27/2022] [Accepted: 02/16/2023] [Indexed: 03/20/2023] Open
Abstract
Metastatic breast cancer (BC) is considered an incurable disease and is usually treated with palliative intent. However, about 50% of metastatic BCs present with only a few metastatic lesions and are characterized by longer overall survival. These patients, defined as oligometastatic, could benefit from a multimodal approach, which combines systemic therapy with metastasis-directed treatment (stereotactic ablative therapy or surgery). The current definition of oligometastatic seems incomplete since it is based only on imaging findings and does not include biological features, and the majority of relevant data supporting this strategy comes from retrospective or non-randomized studies. However, the chance of reaching long-term complete remission or even a cure has led to the development of randomized trials investigating the impact of combined treatment in oligometastatic BC (OMBC). The SABR-COMET trial, the first randomized study to include BC patients, showed promising results from a combination of stereotactic ablative radiotherapy and systemic therapy. Considering the randomized trial's results, multidisciplinary teams should be set up to select OMBC patients who could achieve long-term survival with aggressive multimodal treatment.
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Affiliation(s)
| | - Michela Palleschi
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
| | - Chiara Casadei
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
| | - Antonino Romeo
- Radiotherapy Unit, IRCCS Istituto Romagnolo per
lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Annalisa Curcio
- Breast Surgery Unit, Pierantoni-Morgagni
Hospital Forlì and Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Roberto Casadei
- Orthopedic Unit, Morgagni-Pierantoni Hospital,
Ausl Romagna, Forlì, Italy
| | - Franco Stella
- Division of Thoracic Surgery, Department of
Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater
Studiorum, University of Bologna, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical
Sciences-DIMEC, Alma Mater Studiorum – University of Bologna, Bologna,
Italy
- General and Oncology Surgery,
Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Caterina Gianni
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
| | - Marianna Sirico
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
| | - Simona Cima
- Radiotherapy Unit, IRCCS Istituto Romagnolo
per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Samanta Sarti
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
| | - Lorenzo Cecconetto
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
| | - Giandomenico Di Menna
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto
Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola,
Italy
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10
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Coopey SB. Supraclavicular and Contralateral Axillary Lymph Node Involvement in Breast Cancer Patients. Ann Surg Oncol 2022; 29:6100-6105. [PMID: 35794365 DOI: 10.1245/s10434-022-12134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022]
Abstract
Ipsilateral supraclavicular disease was reclassified from Stage IV, distant metastatic disease, to Stage IIIC, locally advanced breast cancer 20 years ago. Treatment with curative intent with multimodality therapy has led to improved outcomes over time. In contrast, metastatic disease to contralateral axillary lymph nodes remains as Stage IV distant disease. Despite this, in the absence of other distant metastases, many patients with contralateral axillary disease are treated more aggressively than other Stage IV patients. Outcomes of patients with contralateral axillary disease treated with curative intent are more like patients with ipsilateral supraclavicular disease and other locally advanced breast cancers than patients with de novo distant metastases elsewhere. Therefore, some favor reclassification of contralateral axillary metastases without distant metastasis from Stage IV to Stage III breast cancer similar to ipsilateral supraclavicular metastases.
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11
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Ling DC, Ye JC. Making the Right Choice: Radiate Only What's Left, the Rest is Left. Int J Radiat Oncol Biol Phys 2022; 113:491. [PMID: 35777392 DOI: 10.1016/j.ijrobp.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, California
| | - Jason C Ye
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, California
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12
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Zhang L, Wang XZ, Li C, Yu Q, Liu Z, Yu ZY. Contralateral Axillary Lymph Node Metastasis of Breast Cancer: Retrospective Analysis and Literature Review. Front Oncol 2022; 12:869397. [PMID: 35494019 PMCID: PMC9047860 DOI: 10.3389/fonc.2022.869397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundContralateral axillary lymph node metastasis (CAM) is classified as distant metastasis in guidelines, but the prognosis is better than that of stage IV patients. It is controversial to classify CAM as a distant metastasis or a regional metastasis, and the optimal treatment strategy for CAM is unknown.Patients and MethodsBreast cancer patients who were confirmed by pathology and treated at Shandong Cancer Hospital between January 2012 and July 2021 were included in our study. We retrospectively reviewed the medical records of the patients for their clinical features, pathological diagnosis, treatment strategy, and follow-up data. Survival analysis was calculated by Kaplan–Meier analysis, and patient matching was performed by case–control matching.ResultsA total of 60 patients were included, and there were 49 metachronous CAM cases and 11 synchronous CAM cases. The prognosis of isolated CAM patients was better than that of patients with other distant metastases in terms of CAM-OS and PFS with significant differences (median CAM-OS 71.0 vs. 30.0 months, P=0.022; median PFS 42.0 vs. 11.0 months, P=0.009) and OS without significant differences (median OS 126.0 vs. 79.0 months, P=0.111). The five-year survival rate of isolated CAM patients was 67.4%, and the five-year disease-free survival (DFS) rate was 52.9%. The prognosis of CAM patients was similar to that of N3M0 patients in terms of OS (mean OS 82.4 vs. 65.6 months, P=0.537) and DFS (mean PFS 54.5 vs. 52.6 months, P=0.888). Axillary lymph node dissection (ALND) or low-middle level ALND significantly improved the OS (mean OS 237.4 vs. 111.0 months, P=0.011), CAM-OS (mean CAM-OS 105.2 vs. 46.6 months, P = 0.002), and PFS (mean PFS 92.3 vs. 26.9 months, P = 0.001) of isolated CAM patients. Axillary radiotherapy improved PFS, CAM-OS, and OS but without significant differences (mean PFS 80.0 vs. 46.6 months, P = 0.345; mean CAM-OS 86.8 vs. 72.1 months, P = 0.338; mean OS 147.6 vs. 133.0 months, P = 0.426).ConclusionCAM should be diagnosed as local recurrence and treated with aggressive and curative rather than palliative strategies. Contralateral axillary surgery and radiotherapy are recommended for isolated CAM patients.
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Affiliation(s)
- Liang Zhang
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xin zhao Wang
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chao Li
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Yu
- Interventional Radiology, University of Chicago, Chicago, IL, United States
| | - Zhaoyun Liu
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhi yong Yu
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Zhi yong Yu,
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13
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Lin H, Lin J, Wu Y, Liang G, Sun J, Chen L. Exploring the Prognosis of Breast Cancer with Synchronous Distant Nonregional Lymph Node Metastasis and Establishing a Predictive Model: A Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5027457. [PMID: 35071594 PMCID: PMC8769852 DOI: 10.1155/2022/5027457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND We aimed to explore the prognosis of breast cancer patients with synchronous isolated distant-lymph node metastasis (SDLNM). METHODS We extracted information from the Surveillance, Epidemiology, and End Results Program. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS). Fine-Gray test was utilized to compare breast cancer-specific survival (BCSS). We applied propensity score matching (PSM) to balance confounders. In total, 692 SDLNM patients were allocated into training and validation cohorts. Univariate and multivariate analyses were implemented to determine independent prognostic variables. A nomogram predicting OS of SDLNM patients was constructed. Calibration curves and receiver operating characteristic curves were utilized to access the predictive model. RESULTS Cox regression and PSM analysis showed that the prognosis of SDLNM patients was similar to breast cancer patients in stage TnN3cM0 and superior to patients with other oligometastasis (SDLNM vs. TnN3cM0, p = 0.778; SDLNM vs. other oligometastasis: HR 0.767, 95% CI, 0.672-0.875, p < 0.001). A nomogram was established to predict 1-, 3-, and 5-year OS for SDLNM patients. All C-indexes and AUCs were greater than 0.7. Calibration curves implied accurate prediction. For patients receiving mastectomy, postoperative chemotherapy and radiotherapy were significant. CONCLUSIONS Breast cancer with SDLNM has a similar OS and BCSS with locally advanced disease. Comprehensive treatment was associated with better prognosis compared with palliative therapy. We constructed a predictive model for SDLNM breast cancer. It will be necessary to design large-scale prospective trials to confirm our results and validate the predictive model.
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Affiliation(s)
- Hong Lin
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jianxiong Lin
- Department of Hematology and Oncology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yanxuan Wu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Guoxi Liang
- Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jiating Sun
- Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Liming Chen
- Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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14
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Kim J, Jung HK, Kim W. Metachronous Contralateral Axillary Lymph Node Metastasis from Invasive Breast Carcinoma: A Case Report with Imaging Findings. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:239-245. [PMID: 36237360 PMCID: PMC9238203 DOI: 10.3348/jksr.2021.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/12/2021] [Accepted: 04/24/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Jieun Kim
- Department of Diagnostic Radiology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyun Kyung Jung
- Department of Diagnostic Radiology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Woogyeong Kim
- Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea
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15
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Vicini E, Leonardi MC, Fontana SKR, Pagan E, Bagnardi V, Gilardi L, Cardillo A, Rafaniello Raviele P, Sargenti M, Morigi C, Intra M, Veronesi P, Galimberti V. How to Perform Repeat Sentinel Node Biopsy Safely After a Previous Mastectomy: Technical Features and Oncologic Outcomes. Ann Surg Oncol 2021; 29:1750-1760. [PMID: 34750715 DOI: 10.1245/s10434-021-10986-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/05/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The latest National Comprehensive Cancer Network Breast Cancer Guidelines still discourage repeat sentinel node biopsy (SNB) after mastectomy, and the largest multicentric study available reports only 35 cases in the absence of previous axillary dissection (AD). METHODS From January 2003 to November 2018, 89 patients of the European Institute of Oncology with local recurrence of breast cancer after mastectomy, free of distant metastases, with a clinically negative axilla and a negative axillary ultrasound, in absence of AD, underwent lymphatic mapping before wide local excision. RESULTS During surgery, SNB was successful for 99% of the patients, with 14% being metastatic. Additional metastatic nodes removed by AD after a positive sentinel node occurred in 82% of cases. After a medium follow-up period of 3.7 years, the overall survival rate was 96.7%, and the disease-free survival rate was 84.4%. No axillary relapse after AD was recorded. One patient who refused human epidermal growth factor receptor 2 (HER2)-targeted treatment experienced ipsilateral axillary recurrence after a negative repeat SNB. The first axillary level was never directly irradiated because all the patients with positive repeat SNB underwent AD. For invasive luminal-like HER2-negative recurrences, the metastatic sentinel node was significantly associated with the choice to prescribe adjuvant chemotherapy (p = 0.003). CONCLUSIONS In specialized centers, repeat axillary SNB for patients with local recurrence after mastectomy in the absence of previous AD can represent a safe option for detection and removal of occult axillary disease that would otherwise not be excised/irradiated to achieve better local control and could possibly influence the choice of adjuvant treatments.
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Affiliation(s)
- Elisa Vicini
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.
| | | | | | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Cardillo
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Manuela Sargenti
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Consuelo Morigi
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
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16
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Systematic review of synchronous contralateral axillary metastases in breast cancer: really M1 disease? Breast Cancer 2021; 29:9-18. [PMID: 34652689 DOI: 10.1007/s12282-021-01293-2] [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: 06/24/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of the study is to assess and quantify the effect of the appearance of synchronous contralateral axillary on breast cancer survival. Breast cancer with contralateral axillary metastases (CAM) is classified as a metastatic disease. There are few cases reported and a lack of evidence of the significance of CAM when synchronous appearance with a primary tumor and no other site of disease. METHODS A systematic review following PRISMA guidelines to evaluate the prognosis of patients with synchronous CAM without other metastatic diseases comparing with metastatic disease is conducted through a search in PubMed, Embase, Clinical Key, and Cochrane Library databases. We present one case. The median age, follow-up, clinico-pathological characteristics, status of lymph nodes, treatments, and outcomes are analyzed. RESULTS A total of 23 articles (10 case reports and 13 case series) with a total 68 patients, including our case. Median age was 48 years old. Median follow-up was 27 months. Overall survival of the series was 71.4%. Twenty-one of 49 patients reported (36.2%) were alive without disease, fourteen (28.6%) were alive with disease while the rest fourteen (28.6%) died. Inflammatory presentation and ipsilateral axilla status were related to overall survival. CONCLUSIONS Synchronous CAM in breast cancer show better outcomes in terms of overall survival than other metastatic diseases. The absence of comparative studies may not allow definitive conclusions, meanwhile, together with other authors we suggest treatment with curative intention. More studies may lead to consider a modification of TNM system.
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17
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Abstract
OPINION STATEMENT Oligometastatic breast cancer, typically defined as the presence of 1-5 metastases, represents an intermediate state between locally advanced and widely metastatic disease. Emerging research suggests that oligometastatic cancer has a unique molecular signature distinct from widely metastatic disease, and that it carries a superior prognosis. Owing to its more limited capacity for widespread progression, oligometastatic disease may benefit from aggressive ablative therapy to known metastases. Options for ablation include surgical excision, radiofrequency ablation, and hypofractionated image-guided radiotherapy (HIGRT). The phase II SABR-COMET trial, which enrolled patients with oligometastatic disease of multiple histologies and randomized them to HIGRT vs. standard of care, found a notable survival advantage in favor of HIGRT. Other data suggest that HIGRT may synergize with immunotherapy by releasing powerful cytokines that increase anti-tumor immune surveillance and by recruiting tumor infiltrating lymphocytes, helping to overcome resistance to therapy. There are many ongoing trials exploring the role of ablative therapy, most notably HIGRT, with or without immunotherapy, for the treatment of oligometastatic breast cancer.We believe that patients with oligometastatic breast cancer should be offered enrollment on prospective clinical trials when possible. Outside the context of a clinical trial, we recommend that select patients with oligometastatic breast cancer be offered treatment with a curative approach, including ablative therapy to all sites of disease if it can be safely accomplished. Currently, selection criteria to consider for ablative therapy include longer disease-free interval from diagnosis to metastasis (>2 years), fewer metastases, and fewer involved organs. Undoubtedly, new data will refine or even upend our understanding of the definition and optimal management of oligometastatic disease.
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18
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Breast Cancer Skip Metastases: Frequency, Associated Tumor Characteristics, and Role of Staging Nodal Ultrasound in Detection. AJR Am J Roentgenol 2021; 217:835-844. [PMID: 32997506 DOI: 10.2214/ajr.20.24371] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND. Staging nodal ultrasound (US) evaluates locations beyond those assessed during routine surgical dissection and has an increasing role in breast cancer management given the growing use of neoadjuvant systemic therapy before surgical staging. OBJECTIVE. The purpose of this study is to identify the patterns of nodal spread of breast cancer observed at staging nodal US and to determine the frequency of skip metastases and associated tumor characteristics. METHODS. This retrospective study included 1269 consecutive patients (31 with bilateral synchronous cancers) who had 1300 newly diagnosed, untreated, invasive breast cancers and underwent US examination of the ipsilateral regional nodal basins from January 2016 through March 2017. Cases with suspicious nodes on US underwent fine-needle aspiration (FNA) biopsy. Cases with benign results on FNA and no suspicious nodes on US underwent sentinel lymph node biopsy. Results of US with FNA were compared with final surgical pathology. Skip metastases were defined as spread across discontiguous nodal levels or distant metastases in the absence of ipsilateral nodal metastases. The incidence and patterns of spread of skip metastases were summarized; associations with tumor characteristics were tested using the Fisher exact test. RESULTS. A total of 591 metastatic cases (45.5%) were confirmed by needle biopsy or sentinel lymph node biopsy, comprising 463 nodal metastases (N+) confirmed by FNA, 121 nodal metastases (N+) confirmed by sentinel lymph node biopsy, and seven distant organ metastases without nodal metastases (N0M1) confirmed by CT-guided biopsy. US with FNA had sensitivity of 86.0%, specificity of 100.0%, PPV of 100.0%, NPV of 89.5%, and accuracy of 93.6%. There were 34 skip metastases, for an incidence of 2.6% (34/1300) (95% CI, 1.8-3.6%) among all invasive cancers and 7.2% (34/470) (95% CI, 5.1-9.9%) among metastatic cancers detected by US and FNA. Skip metastases occurred to axillary level III (n = 4), the supraclavicular nodal basin (n = 21), the contralateral axilla (n = 2), and distant organs (n = 7). Cancers with skip metastases, compared with those with nonskip metastases, had higher rates (p = .005) of lobular histology (23.5% vs 6.7%) and mixed ductal and lobular histology (11.8% vs 6.7%). Skip metastases were not associated with grade, T category, or molecular subtype (p > .05). CONCLUSION. Skip metastases to locations beyond standard surgical axillary dissection occur in 7.2% of metastatic breast cancers. CLINICAL IMPACT. Staging nodal US identifies skip metastases that otherwise would be undetected, helping to achieve more accurate staging and minimize undertreatment.
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19
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Nash AL, Thomas SM, Plichta JK, Fayanju OM, Hwang ES, Greenup RA, Rosenberger LH. Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer? Ann Surg Oncol 2021; 28:5544-5552. [PMID: 34287787 DOI: 10.1245/s10434-021-10461-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contralateral axillary nodal metastases (CAM) is classified as stage IV disease, although many centers treat CAM with curative intent. We hypothesized that patients with CAM, treated with multimodality therapy, would have improved overall survival (OS) versus patients with distant metastatic disease (M1) and similar OS to those with locally advanced breast cancer (LABC). METHODS Using the NCDB (2004-2016), we categorized adult patients with node-positive breast cancer into three study groups: LABC, CAM, and M1. Kaplan-Meier curves were used to visualize the unadjusted OS. Cox proportional hazards models were used to estimate the association of study group with OS. RESULTS A total of 94,487 patients were identified: 122 with CAM, 12,325 with LABC, and 82,040 with M1 (median follow-up 63.6 months). LABC and CAM patients had similar histology and rates of chemotherapy and endocrine therapy receipt. However, the CAM group had significantly larger tumors, more estrogen-receptor expression, higher T-stage, and more mastectomies than the LABC group. Compared with M1 patients, CAM patients were more likely to have grade 3 and cT4 tumors. Patients with CAM and LABC had similar 5-year unadjusted OS and significantly improved OS vs M1 patients. After adjustment, LABC and CAM patients continued to have similar OS and better OS vs M1 patients. CONCLUSIONS CAM patients who receive multi-modal therapy with curative intent may have OS more comparable to LABC patients than M1 patients. Out data support a reevaluation of whether CAM should remain classified as M1, as N3 may better reflect disease prognosis and treatment goals.
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Affiliation(s)
- Amanda L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute, Duke University, Durham, NC, USA.
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20
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Postlewait LM, Teshome M, Adesoye T, DeSnyder SM, Lim B, Kuerer HM, Bedrosian I, Sun SX, Woodward WA, Le-Petross HT, Valero V, Ueno NT, Lucci A. Contralateral Axillary Metastasis in Patients with Inflammatory Breast Cancer. Ann Surg Oncol 2021; 28:8610-8621. [PMID: 34125346 DOI: 10.1245/s10434-021-10148-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/25/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Nearly one-third of patients with inflammatory breast cancer (IBC) present with de novo stage IV disease. There are limited data on frequency and clinical outcomes of contralateral axillary metastasis (CAM) in IBC with no consensus diagnostic and treatment guidelines. PATIENTS AND METHODS Frequency of synchronous CAM was calculated in unilateral IBC patients at a single center (10/2004-6/2019). Clinicopathologic variables, diagnostic evaluation, treatment received, and overall survival (OS) were assessed and compared. RESULTS Of 588 unilateral IBC patients, 49 (8.3%) had synchronous CAM. Of these, 32 (65.3%) also presented with metastatic disease at another distant site. CAM was not associated with age, tumor laterality, breast cancer subtype, grade, or cN stage (p > 0.05). The sensitivity/specificity to detect CAM was as follows: mammography (18.2%/99.2%), ultrasound (92.3%/95.5%), PET (90.1/99.1%), and MRI (76.0%/98.6%). Following systemic therapy, 22 patients had contralateral axillary surgery, and 18 received adjuvant contralateral nodal radiation. On multivariable analysis including tumor receptor subtypes, patients with stage IV-isolated CAM has statistically similar survival to stage III patients (HR 1.37, 95% CI 0.70-2.69, p = 0.36). Patients with Stage IV non-CAM (HR 2.18, 95% CI 1.66-2.85, p < 0.001) and stage IV-CAM plus other distant metastasis (HR 2.57, 95% CI 1.59-4.16, p < 0.001) had higher risk of death (reference: stage III disease). CONCLUSIONS CAM in IBC was diagnosed in 8.3% of patients at presentation and was best identified by ultrasound and PET. We recommend routine contralateral axillary ultrasound as part of staging for all IBC patients. Diagnosis of CAM is a key first step toward much-needed prospective clinical trials evaluating management and outcomes of CAM in IBC.
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Affiliation(s)
- Lauren M Postlewait
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Mediget Teshome
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Taiwo Adesoye
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah M DeSnyder
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bora Lim
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabelle Bedrosian
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susie X Sun
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy A Woodward
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Huong T Le-Petross
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Diagnostic Radiology, Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vicente Valero
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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21
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Al-Khalili R, Alzeer A, Nguyen GK, Crane EP, Song JH, Jeon JL, Nellamattathil M, Makariou EV, Mango VL. Palpable Lumps after Mastectomy: Radiologic-Pathologic Review of Benign and Malignant Masses. Radiographics 2021; 41:967-989. [PMID: 33989071 DOI: 10.1148/rg.2021200161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients who have undergone mastectomy, with or without reconstruction, are not universally screened with mammography or US. Therefore, clinical breast examination by the physician and patient-detected palpable abnormalities are crucial for detecting breast cancer or recurrence. Diagnostic US is the first-line modality for evaluation of postmastectomy palpable masses, with occasional adjunct use of diagnostic mammography for confirming certain benign masses. In the setting of a negative initial imaging evaluation with continued clinical concern, diagnostic MRI may aid in improving sensitivity. Knowledge of the typical multimodality imaging appearances and locations of malignant palpable abnormalities-such as invasive carcinoma recurrence, cancer in residual breast tissue, radiation-induced sarcoma, and metastatic disease-is crucial in diagnosis and treatment of these entities. In addition, familiarity with the range of benign palpable postmastectomy processes-including fat necrosis, fat graft, seroma, granuloma, neuroma, fibrosis, and infection-may help avoid unnecessary biopsies and reassure patients. The authors review common and rare benign and malignant palpable masses in mastectomy patients, describe multimodality diagnostic imaging evaluation of each entity, review radiologic and pathologic correlation, and acquaint the radiologist with management when these findings are encountered. ©RSNA, 2021.
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Affiliation(s)
- Rend Al-Khalili
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Ali Alzeer
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Giang-Kimthi Nguyen
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Erin P Crane
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Judy H Song
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Janice L Jeon
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Michael Nellamattathil
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Erini V Makariou
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Victoria L Mango
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
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22
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Salih AM, Hammood ZD, Hassan MN, Baba HO, Muhialdeen AS, Abdullah IY, Abdulla BA, Kakamad FH, Mustafa SM, Mohammed SH, Mustafa MQ. Breast cancer metastasizing to the contralateral axilla several years after treatment: A case report with literature review. Int J Surg Case Rep 2021; 82:105900. [PMID: 33962262 PMCID: PMC8113825 DOI: 10.1016/j.ijscr.2021.105900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Lymph node metastasis is the most prominent prognostic factor in breast cancer. The aim of this paper is to report a case of contralateral axillary lymph node metastasis (CAM) which look like metachronous initially, but histopathologicaly confirmed as synchronous CAM. Case presentation A-44-year old female was a known case of left breast cancer five years prior to this presentation (T2,N2,M0, grade III, Triple negative, multifocal invasive ductal carcinoma). On follow up, multiple contralateral axillary suspicious lymph nodes were discovered. Fine Needle Aspiration Cytology from the lesion revealed grade III, Triple negative, invasive ductal carcinoma consistent with metastasis from the left invasive ductal carcinoma. Bilateral mastectomy and right axillary dissection were performed. The histopathological examination and immunohistochemistry showed left breast recurrent 0.5 cm grade III, Triple negative invasive ductal carcinoma. Discussion If a cancer is found in the contralateral axilla, three main potential sources should be considered: contralateral spread from the original breast tumor, metastasis from an occult primary in the ipsilateral breast, and metastasis from an extramammary site. Conclusion Although CAM in patients with breast cancer is an uncommon condition, it is still possible to occur. There is a controversy regarding the appropriate management. Lymph node metastasis is the most prominent prognostic factor in breast cancer. Ipsilateral axillary lymphnode metastasis is the most common site of involvement. Contralateral axillary lymphnode metastasis is an unusual finding. In this paper, a case of synchronous contralateral axillary lymph node metastasis has been discussed.
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Affiliation(s)
- Abdulwahid M Salih
- Faculty of Medical Sciences, School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Zuhair D Hammood
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Marwan N Hassan
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Hiwa O Baba
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Aso S Muhialdeen
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Ismael Y Abdullah
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Berwn A Abdulla
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq.
| | - Shevan M Mustafa
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Mohammed Q Mustafa
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; Department of Medical Analysis, Tishk International University, Erbil, Kurdistan Region, Iraq
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23
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Maseki H, Takayama S, Yoshida M, Nakadaira U, Watase C, Shiino S, Murata T, Jimbo K, Suto A. A case of lymph node dissection for contralateral axillary lymph node metastasis of ipsilateral breast tumor recurrence after identifying the primary lymphatic drainage by lymphoscintigraphy. Int Cancer Conf J 2021; 10:154-158. [PMID: 33786290 PMCID: PMC7947167 DOI: 10.1007/s13691-021-00470-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022] Open
Abstract
We report a case of total mastectomy and contralateral axillary lymph node dissection (ALND) in a patient with ipsilateral breast tumor recurrence (IBTR) and contralateral axillary lymph node metastasis (ALNM), with lymphoscintigraphy, confirming that the primary lymphatic flow was directed to the contralateral ALNM. The patient in the present case study is a 63-year-old woman. At the age of 46 years, the patient underwent lumpectomy and sentinel lymph node biopsy (SLNB) for left breast cancer. After surgery, she underwent whole-breast irradiation and hormone therapy (tamoxifen) for 5 years. On follow-up, she did not have recurrence. When she underwent breast ultrasound examination at the 17-year checkup after the initial surgery, she was diagnosed with tumor recurrence in the left conserved breast and with contralateral ALNM, without distant metastasis to any other organ. When re-SLNB is performed in patients with IBTR, the primary lymphatic flow is directed toward a lymph node other than the ipsilateral axillary lymph node (ALN). Therefore, it is necessary to discuss whether or not the contralateral ALNM in our case should be treated as stage IV. Therefore, we performed ALND after confirming that the primary lymphatic flow was directed toward the contralateral ALN as observed on lymphoscintigraphy and considering the contralateral ALNM as a localized lesion. Lymphoscintigraphy and intraoperative fluorescence imaging aid in the identification of the primary lymphatic flow. Lymph node metastases beyond the altered primary lymphatic flow are treated as localized lesions, and aggressive surgery is expected to be effective. There is a need to formulate guidelines on the treatment of IBTR considering changes in primary lymphatic flow.
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Affiliation(s)
- Haruhi Maseki
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Shin Takayama
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Uta Nakadaira
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Chikashi Watase
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Sho Shiino
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Takeshi Murata
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Kenjiro Jimbo
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Akihiko Suto
- Department of Breast Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
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24
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Herrera-Martínez Y, Acevedo-Bañez I, De-Bonilla-Damiá Á, Fernández-Rodríguez P, Sousa JM, Jiménez-Hoyuela García JM. Contralateral Axillary Lymph Node Metastasis in a Patient with Relapsed Breast Cancer: Locoregional Event or Distant Metastasis Disease? Oncol Res Treat 2021; 44:128-131. [PMID: 33440391 DOI: 10.1159/000513661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contralateral axillary lymph node metastasis (CAM) is a rare clinical condition in patients with breast cancer. It can be explained from hematogenous spread from the original primary tumor (stage IV) to aberrant regional lymphatic drainage to the contralateral axilla. However, according to the current clinical guidelines, regardless of its origin, CAM is considered as metastatic disease. CASE PRESENTATION A 68-year-old woman presented with relapsed right breast cancer; lymphoscintigraphy showed only one sentinel lymph node (SLN) in the contralateral axilla (left region). Twenty-four hours later, the patient underwent upper internal quadrantectomy and bilateral selective lymph node biopsy. The final pathological analysis revealed one contralateral macrometastasis (>4 mm) in one left SLN. Subsequently, second-level left lymphadenectomy was performed. Currently the patient is being treated with chemotherapy, with appropriate clinical response. DISCUSSION Our patient was considered to be node-positive rather than having metastatic disease since the preoperative lymphoscintigraphy demonstrated contralateral lymphatic drainage. Through preoperative scan in patients with relapsed breast cancer with clinically negative lymph nodes and CAM, it is possible to identify those cases that would benefit from therapy with curative intention.
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Affiliation(s)
| | - Irene Acevedo-Bañez
- Department of Nuclear Medicine, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - José María Sousa
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen del Rocío, Seville, Spain
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25
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Guru SD, Loprinzi CL, Yan E, Hoskin TL, Jakub JW. Contralateral Axillary Metastases in Breast Cancer: Stage IV Disease or a Locoregional Event? Am Surg 2020. [DOI: 10.1177/000313481908501235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contralateral axillary metastasis (CAM) in breast cancer is presently treated as a stage IV disease. We hypothesized that this disease pattern is a manifestation of direct aberrant lymphatic drainage and would behave more similar to advanced locoregional disease. This is a single-site, retrospective review of patients with biopsy-proven CAM from 2008–2017. Descriptive analysis was performed. Twenty-three patients met the inclusion criteria. The median disease-free interval from primary tumor treatment to diagnosis of CAM was 68 months (range, 36–155 months). This population had aggressive disease (74% local recurrences and 61% clinical evidence of cutaneous or underlying muscular invasion) and extensive locoregional therapy (70% radiated, 57% mastectomy, and 65% axillary lymph node dissection) before their presentation with CAM. Fifteen (65.2%) patients recurred after treatment of CAM; the median recurrence-free interval was 11 months (range, 5–23 months), and 12 (52.2%) patients developed distant metastases. The median distant metastasis-free survival was 14 months (range, 11–23 months), and the median overall survival was 31 months (range, 22–67.5 months). Development of CAM is associated with aggressive disease and extensive prior locoregional surgery and/or radiation. The short recurrence-free interval and high progression to additional stage IV disease suggest these patients behave similar to traditional stage IV patients with resected oligometastatic disease.
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Affiliation(s)
| | | | - Elizabeth Yan
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota; and
| | - Tanya L. Hoskin
- Division of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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26
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Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, Santomauro G, Jereczek-Fossa BA, Veronesi P, Galimberti V, Sacchini V, Intra M. Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging? Ann Surg Oncol 2020; 27:4488-4499. [PMID: 32436193 DOI: 10.1245/s10434-020-08605-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contralateral axillary lymph node metastasis (CAM) is an infrequent clinical condition currently considered an M1, stage IV, disease. Due to the absence of shared data on CAM significance and on its therapeutic approach, be it curative or simply palliative, its management is still uncertain and undoubtedly represents a clinical challenge. PATIENTS AND METHODS Patients with pathologically confirmed metachronous CAM were retrospectively evaluated. All patients had been managed at the European Institute of Oncology, Milan, Italy, from 1997. Patients with distant metastases at the time of CAM were excluded. Possible treatments included surgery, systemic therapy and RT (radiotherapy). Outcomes were evaluated as rates of disease-free survival (DFS) and of overall survival (OS). RESULTS Forty-seven patients with CAM were included in the study. Metachronous CAM occurred 73 months (range 5-500 months) after diagnosis of the primary tumor. The median follow-up time was 5.4 years (interquartile range 2.9-7.0 years). The estimated OS was 72% at 5 years (95% CI 54-83), and 61% at 8 years (95% CI 43-75). The estimated DFS was 61% at 5 years (95% CI 44-74), and 42% at 8 years (95% CI 25-59). CONCLUSION These findings, together with those from previous studies, show that CAM outcome, particularly if measured as OS, appear better than at other sites of distant dissemination, when CAM is subjected to surgical and systemic treatments with a curative intent. Therefore, a new clinical scenario is suggested where, in the TNM system, CAM is no longer classified as a stage IV, but as an N3 disease.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - M Colleoni
- Division of Breast Cancer Medical Treatments, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - D Mattar
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Corso
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - S Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - G Santomauro
- Service of Data Management, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - B A Jereczek-Fossa
- Faculty of Medicine, University of Milan, Milan, Italy.,Division of Radiotherapy, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - P Veronesi
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - V Sacchini
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - M Intra
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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27
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Magnoni F, Intra M. ASO Author Reflections: Future View: A Recent Scientific Contribution Towards a Staging Revision of Contralateral Axillary Lymph Node Metastases from Breast Cancer. Ann Surg Oncol 2020; 27:4500-4501. [PMID: 32430751 DOI: 10.1245/s10434-020-08612-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Francesca Magnoni
- Division of Breast Cancer Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Mattia Intra
- Department of Surgery, European Institute of Oncology, IRCCS, Milan, Italy
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28
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Walstra CJEF, Schipper RJ, Poodt IGM, Maaskant-Braat AJG, Luiten EJT, Vrancken Peeters MJTFD, Smidt ML, Degreef E, Voogd AC, Nieuwenhuijzen GAP. Multifocality in ipsilateral breast tumor recurrence - A study in ablative specimens. Eur J Surg Oncol 2020; 46:1471-1476. [PMID: 32402507 DOI: 10.1016/j.ejso.2020.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/24/2020] [Accepted: 04/17/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The incidence and clinical significance of multifocality in ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) are unclear. With growing interest in repeat BCT, this information has become of importance. This study aimed to gain insight in the incidence of multifocality in IBTR, to identify patient- and tumor-related predicting factors and to investigate the prognostic significance of multifocality. METHODS Two hundred and fifteen patients were included in this analysis. All had an IBTR after BCT and were treated by salvage mastectomy and appropriate adjuvant therapy. Predictive tumor- and patient-related factors for multifocality in IBTR were identified using X2 test and univariate logistic regression analyses. Prognostic outcomes were calculated using Kaplan Meier analysis and compared using the log rank test. RESULTS Multifocality was present in 50 (22.9%) of IBTR mastectomy specimens. Axillary positivity in IBTR was significantly associated with multifocality in IBTR. Chest wall re-recurrences occurred more often after multifocal IBTR (14% versus 7% after unifocal IBTR, p = 0.120). Regional re-recurrences did not differ significantly between unifocal and multifocal IBTR (8% vs. 6%, p = 0.773). Distant metastasis after salvage surgery occurred more frequently after multifocal IBTR (15% vs. 24%, p = 0.122). Overall survival was 132 months after unifocal IBTR and 112 months after multifocal IBTR (p = 0.197). CONCLUSION The prevalence of multifocality in IBTR is higher than in primary breast cancer. Axillary positivity in IBTR was associated with a multifocal IBTR. Chest wall re-recurrences and distant metastasis were, although not statistically significant, more prevalent after multifocal IBTR.
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Affiliation(s)
| | | | - Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands
| | | | | | | | - Marjolein L Smidt
- Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands
| | - Ellen Degreef
- Department of Pathology, Catharina Hospital Eindhoven, the Netherlands
| | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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29
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Préat F, Rondelli M, Delrue P, Anne-Sophie H, Vanden Houte K, Baeyens L. Contralateral axillary sentinel node: The hidden pathway in breast cancer. Breast J 2020; 26:1912-1914. [PMID: 32072711 DOI: 10.1111/tbj.13777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Fanny Préat
- Department of Gynecological Surgery and Oncology, Brugmann University Hospital, Brussels, Belgium
| | - Melissa Rondelli
- Department of Gynecological Surgery and Oncology, Brugmann University Hospital, Brussels, Belgium
| | - Pauline Delrue
- Department of Gynecological Surgery and Oncology, Brugmann University Hospital, Brussels, Belgium
| | - Hambye Anne-Sophie
- Department of Nuclear Medicine, Brugmann University Hospital, Brussels, Belgium
| | | | - Luc Baeyens
- Department of Gynecological Surgery and Oncology, Brugmann University Hospital, Brussels, Belgium
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30
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Poodt IGM, Vugts G, Schipper RJ, Roumen RMH, Rutten HJT, Maaskant-Braat AJG, Voogd AC, Nieuwenhuijzen GAP. Prognostic impact of repeat sentinel lymph node biopsy in patients with ipsilateral breast tumour recurrence. Br J Surg 2019; 106:574-585. [PMID: 30908615 DOI: 10.1002/bjs.11097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/27/2018] [Accepted: 11/20/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ipsilateral breast tumour recurrence (IBTR) has an unfavourable prognosis, with a significant subsequent risk of distant recurrence. Repeat sentinel lymph node biopsy (rSLNB) has recently been demonstrated to be technically feasible and useful in tailoring adjuvant treatment plans in patients with IBTR. The prognostic impact of rSLNB in patients with IBTR remains unclear. This study analysed the risk of distant recurrence after IBTR, and evaluated the prognostic impact of rSLNB and other patient and tumour characteristics on distant recurrence-free survival. METHODS Data were obtained from the SNARB (Sentinel Node and Recurrent Breast Cancer) study. Cox proportional hazards analyses were performed to assess the prognostic effect of tumour, patient and treatment factors on distant recurrence-free survival. RESULTS Of the 515 included patients, 230 (44·7 per cent) had a tumour-negative rSLNB and 46 (8·9 per cent) a tumour-positive rSLNB. In 239 patients (46·4 per cent) the rSLNB procedure was unsuccessful. After a median follow-up of 5·1 years, 115 patients (22·3 per cent) had developed a recurrence. The overall 5-year distant recurrence-free survival rate was 84·2 (95 per cent c.i. 80·7 to 87·7) per cent. An interval of less than 2 years between primary breast cancer treatment and ipsilateral recurrence (P = 0·018), triple-negative IBTR (P = 0·045) and absence of adjuvant chemotherapy after IBTR (P = 0·010) were independently associated with poor distant recurrence-free survival. The association between the outcome of rSLNB and distant recurrence-free survival was not statistically significant (P = 0·682). CONCLUSION The outcome of rSLNB is not an important prognostic factor for distant recurrence, and its value as a staging tool in patients with IBTR seems disputable.
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Affiliation(s)
- I G M Poodt
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - G Vugts
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - R J Schipper
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - R M H Roumen
- Department of Surgery, Maxima Medical Centre, Veldhoven/Eindhoven, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A J G Maaskant-Braat
- Department of Surgery, Maxima Medical Centre, Veldhoven/Eindhoven, the Netherlands
| | - A C Voogd
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
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31
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Sato A, Sakai T, Iwase T, Kano F, Kimura K, Ogiya A, Koizumi M, Tanabe M, Horii R, Akiyama F, Ueno T, Ohno S. Altered lymphatic drainage patterns in re-operative sentinel lymph node biopsy for ipsilateral breast tumor recurrence. Radiat Oncol 2019; 14:159. [PMID: 31477153 PMCID: PMC6720389 DOI: 10.1186/s13014-019-1367-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/22/2019] [Indexed: 01/21/2023] Open
Abstract
Background This study aimed to evaluate the impact of previous local treatment on lymphatic drainage patterns in ipsilateral breast tumor recurrence (IBTR) based on our data on re-operative sentinel lymph node biopsy (re-SLNB) for IBTR. Methods Between April 2005 and December 2016, re-SLNB using lymphoscintigraphy with Tc-99 m phytate was performed in 136 patients with cN0 IBTR. Patients were categorized into two groups: the AX group included 55 patients with previous axillary lymph node dissection; the non-AX group included 69 patients with previous SLNB and 12 patients with no axillary surgery. The whole breast irradiation (RT) after initial surgery had performed in 17 patients in the AX group and 27 patients in the non-AX group. Results Lymphatic drainage was visualized in 80% of the AX group and 95% of the non-AX group (P < 0.01). The visualization rate of lymphatic drainage was associated with the number of removed lymph nodes in prior surgery. In the non-AX group, lymphatic drainage was visualized in 96% of patients without RT and 93% with RT. Lymphatic drainage was observed at the ipsilateral axilla in 98% of patients without RT and in 64% with RT (P < 0.0001). Aberrant drainage was significantly more common in patients with RT than without RT (60% vs. 19%, P < 0.001); it was observed mostly to the contralateral axilla (52% vs. 2%, P < 0.0001). In the AX group, patients with previous RT showed decreased lymphatic drainage to the ipsilateral axilla compared to those without RT (29% vs. 63%, P < 0.05) and increased aberrant drainage to the contralateral axilla (64% vs. 5%, P < 0.0001). Conclusion Lymphatic drainage patterns altered in re-SLNB in patients with IBTR and previous ALND and RT were associated with alterations in lymphatic drainage patterns.
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Affiliation(s)
- Ayaka Sato
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.,Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takehiko Sakai
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takuji Iwase
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Fumiko Kano
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Kiyomi Kimura
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.,Division of Gene regulation, Institute of Advanced Medical Research, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akiko Ogiya
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Mitsuru Koizumi
- Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Horii
- Department of Pathology, Clinicopathology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.,Division of Pathology, Clinicopathology Center, The Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Futoshi Akiyama
- Division of Pathology, Clinicopathology Center, The Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takayuki Ueno
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Shinji Ohno
- Department of Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
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Adra J, Lundstedt D, Killander F, Holmberg E, Haghanegi M, Kjellén E, Karlsson P, Alkner S. Distribution of Locoregional Breast Cancer Recurrence in Relation to Postoperative Radiation Fields and Biological Subtypes. Int J Radiat Oncol Biol Phys 2019; 105:285-295. [PMID: 31212042 DOI: 10.1016/j.ijrobp.2019.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate incidence and location of locoregional recurrence (LRR) in patients who have received postoperative locoregional radiation therapy (LRRT) for primary breast cancer. LRR-position in relation to applied radiotherapy and the primary tumor biological subtype were analyzed with the aim of evaluating current target guidelines and radiation therapy techniques in relation to tumor biology. METHODS AND MATERIALS Medical records were reviewed for all patients who received postoperative LRRT for primary breast cancer in southwestern Sweden from 2004 to 2008 (N = 923). Patients with LRR as a first event were identified (n = 57; distant failure and death were considered competing risks). Computed tomographic images identifying LRR were used to compare LRR locations with postoperative LRRT fields. LRR risk and distribution were then related to the primary breast cancer biologic subtype and to current target guidelines. RESULTS Cumulative LRR incidence after 10 years was 7.1% (95% confidence interval [CI], 5.5-9.1). Fifty-seven of the 923 patients in the cohort developed LRR (30 local recurrences and 30 regional recurrences, of which 3 cases were simultaneous local and regional recurrence). Most cases of LRR developed fully (56%) or partially (26%) within postoperatively irradiated areas. The most common location for out-of-field regional recurrence was cranial to radiation therapy fields in the supraclavicular fossa. Patients with an estrogen receptor negative (ER-) (hazard ratio [HR], 4.6; P < .001; 95% CI, 2.5-8.4) or HER2+ (HR, 2.4; P = .007; 95% CI, 1.3-4.7) primary breast cancer presented higher risks of LRR compared with those with ER+ tumors. ER-/HER2+ tumors more frequently recurred in-field (68%) rather than marginally or out-of-field (32%). In addition, 75% of in-field recurrences derived from an ER- or HER+ tumor, compared with 45% of marginal or out-of-field recurrences. A complete pathologic response in the axilla after neoadjuvant treatment was associated with a lower degree of LRR risk (P = .022). CONCLUSIONS Incidence and location of LRR seem to be related to the primary breast cancer biologic subtype. Individualized LRRT according to tumor biology may be applied to improve outcomes.
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Affiliation(s)
- Jamila Adra
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahgrenska University Hospital, Gothenburg, Sweden
| | - Dan Lundstedt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahgrenska University Hospital, Gothenburg, Sweden
| | - Fredrika Killander
- Division of Oncology and Pathology, Institute of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahgrenska University Hospital, Gothenburg, Sweden
| | - Mahnaz Haghanegi
- Division of Oncology and Pathology, Institute of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Elisabeth Kjellén
- Division of Oncology and Pathology, Institute of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahgrenska University Hospital, Gothenburg, Sweden
| | - Sara Alkner
- Division of Oncology and Pathology, Institute of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
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Poodt IGM, Schipper RJ, de Greef BTA, Vugts G, Maaskant-Braat AJG, Jansen FH, Wyndaele DNJ, Voogd AC, Nieuwenhuijzen GAP. Screening for distant metastases in patients with ipsilateral breast tumor recurrence: the impact of different imaging modalities on distant recurrence-free interval. Breast Cancer Res Treat 2019; 175:419-428. [PMID: 30955183 PMCID: PMC6533220 DOI: 10.1007/s10549-019-05205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
Purpose In patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with 18F-FDG PET-CT or no imaging at all. Methods This study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used. Results Of the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with 18F-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N = 168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as first event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the different staging methods had no significant impact on the DRFI. Conclusions This study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically significant impact of the different imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using 18F-FDG PET-CT over conventional imaging techniques. Electronic supplementary material The online version of this article (10.1007/s10549-019-05205-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Bianca T A de Greef
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Dirk N J Wyndaele
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands.,Utrecht Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Poodt IGM, Walstra CJEF, Vugts G, Maaskant-Braat AJG, Voogd AC, Schipper RJ, Nieuwenhuijzen GAP. Low Risk of Development of a Regional Recurrence After an Unsuccessful Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence. Ann Surg Oncol 2019; 26:2417-2427. [PMID: 30850903 DOI: 10.1245/s10434-019-07272-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unlike sentinel lymph node biopsy (SLNB) in the primary setting, the repeat SLNB (rSLNB) in patients with ipsilateral breast tumor recurrence (IBTR) is challenging, because it is difficult to visualize and/or harvest a sentinel lymph node in every patient. Regional treatments options and safety in terms of regional disease control after such an unsuccessful rSLNB remain unclear. This study assesses factors associated with the performance of axillary lymph node dissection (ALND) after unsuccessful rSLNB and evaluates the occurrence of regional recurrences. METHODS Data were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 239 patients, the rSLNB was unsuccessful, of whom 60 patients underwent ipsilateral ALND. RESULTS A shorter time interval between primary treatment and IBTR, and a primary negative SLNB were significantly associated with a higher probability to be treated with ALND after unsuccessful rSLNB (P < 0.001). The 5-year regional-recurrence rate was 0.0% in the ALND group compared with 3.7% in the group treated without ALND (P = 0.113). Of the 179 patients treated without ALND, after a median follow-up of 5.1 years (range 0.3-13.2), 7 (3.9%) developed a regional recurrence as first event after unsuccessful rSLNB. None of the seven recurrences occurred in the ipsilateral axilla. Univariable analysis showed no factors associated with regional recurrence as first event after unsuccessful rSLNB (P > 0.05). CONCLUSIONS The present study demonstrates that the risk of regional recurrence in patients with an IBTR and an unsuccessful rSLNB is negligible, irrespective of the use of ALND. This suggests that there is no need for additional treatment of the axilla after an unsuccessful rSLNB.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands.
| | - Coco J E F Walstra
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands
| | | | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands
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Strazzanti A, Gangi S, Trovato C, Pacini N, Basile F. Contralateral lymph node metastasis in a woman with new primary breast cancer: Systemic desease or locoregional diffusion? Int J Surg Case Rep 2018; 53:400-402. [PMID: 30567054 PMCID: PMC6259044 DOI: 10.1016/j.ijscr.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Contralateral axillary lymph node metastases (CAMs) in patients with breast cancer are rare (Daoud et al., 1998); however, CAMs may be already detected at the time of primary breast cancer diagnosis (synchronous CAM) or after a previous treatment of breast cancer as a recurrence if not as an ipsilateral breast recurrence (IBR) (metasynchronous CAM) (Zhou and Richir, 2013). The involvement of the contralateral axilla could be caused by a systemic disease (stage IV), a regional metastasis from a new occult primary tumor (T0N1, stage II) or a breast cancer recurrence It may also arise from a locally advanced disease in a patient who has suffered from a primary breast cancer. PRESENTATION OF CASE This report focuses on the case of a 50-year-old woman who has developed a new primary breast cancer, breast skin invasion and CAMs. DISCUSSION We intend to show that an altered lymphatic drainage may result from CAMs; in fact, patients who have previously undergone axillary lymph node dissection (ALND) are more likely to develop contralateral lymph drainage (Maaskant-Braat et al., 2013). CONCLUSION Along with that, we want to support the theory that CAMs should be treated with curative intent rather than as a stage IV disease, as we believe that CAMs are due to a locoregional extension of the disease.
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Affiliation(s)
- Angela Strazzanti
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, Surgery Catania, 95124, Sicily, Italy.
| | - Santi Gangi
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, General Surgery Catania, 95124, Sicily, Italy
| | - Claudio Trovato
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, General Surgery Catania, 95124, Sicily, Italy
| | - Nicola Pacini
- Azienda Sanitaria Provinciale di Reggio Calabria, Biochemistry Reggio Calabria, 89125, Calabria, Italy
| | - Francesco Basile
- Universita degli Studi di Catania, Scuola di Facolta di Medicina, General Surgery Catania, 95124, Sicily, Italy
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Stüber TN, Stangl S, Jackisch C, Janni W, Brucker SY, Hartkopf A, Gerber B, Budach W, Lux MP, Wöckel A. Implementation of a Systematic Literature Search Strategy in a National Breast Cancer Guideline: The Relevance of Systemic Therapy in Lymph Node Recurrent Disease. Oncol Res Treat 2018; 41:554-559. [PMID: 30114683 DOI: 10.1159/000490501] [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: 04/16/2018] [Accepted: 05/30/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Our aim was to implement a structured literature search using PICO (patient/intervention/comparison/outcome) questions and a standardized consensus method for the German Guideline 'Detection, diagnostics, therapy and follow-up of Breast Cancer' using, as an example, the significance of systemic therapy in lymph node recurrent disease (LNRD). METHODS We defined specified PICO questions according to the clinical significance of a recommendation for systemic therapies in locoregional LNRD. A methodologist performed a systematic literature search including randomized controlled trials, systematic reviews and observational studies (2007-2016). In a consensus conference, the level of evidence and consensus was determined and the clinical recommendation was adopted. RESULTS In total 143 publications were identified according to the search strategy including 14 duplicates, which were excluded. 4 publications were included based on experts' choice. The team excluded 119 publications, leaving 14 that were then screened by a full text search. Finally, 1 publication was found to be of methodologically and clinically reliable content. The conclusion of this publication in favor of systemic therapy for LNRD received strong consent from the consensus conference. CONCLUSIONS The literature search strategy using PICO questions helped to achieve a fast and standardized selection of publications. The recommendation concerning systemic treatment of LNRD was first implemented in the update of the German Breast Cancer guideline.
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Chkheidze R, Sanders MAG, Haley B, Leitch AM, Sahoo S. Isolated Contralateral Axillary Lymph Node Involvement in Breast Cancer Represents a Locally Advanced Disease Not Distant Metastases. Clin Breast Cancer 2018; 18:298-304. [DOI: 10.1016/j.clbc.2017.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/17/2017] [Accepted: 10/31/2017] [Indexed: 12/11/2022]
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Poodt IGM, Schipper RJ, Vugts G, Woensdregt K, van der Sangen M, Voogd AC, Nieuwenhuijzen GAP. The rationale for and long-term outcome of incomplete axillary staging in elderly women with primary breast cancer. Eur J Surg Oncol 2018; 44:1714-1719. [PMID: 30082177 DOI: 10.1016/j.ejso.2018.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 07/08/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The proportion of elderly women diagnosed with breast cancer is rising. Standard treatment, including axillary staging, is often not given to these patients. This study aimed to investigate reasons to omit any surgical axillary staging or to refrain from completion axillary lymph node dissection (cALND) after positive-sentinel lymph node biopsy (SLNB); so-called "incomplete staging". Furthermore, the impact of incomplete staging on regional control and survival in patients aged 75 or older was evaluated. METHODS A retrospective cohort study was conducted including all primary breast cancer patients aged 75 or older, diagnosed between 2001 and 2008, and documented by the Netherlands Cancer Registry (NCR). Patients with incomplete staging were compared to patients with complete axillary staging. Survival analyses were used to determine the risk of local, regional and distant recurrence and overall survival. RESULTS In total, 1467 of 2116 (69%) patients were considered eligible, of whom 258 (17.2%) had incomplete axillary staging. For 93 patients, diagnosed in 6 of the 10 hospitals in the NCR-area, examination of clinical records revealed that age, comorbidities and patient preferences were the main reason for omitting complete axillary staging. The 10-year axillary recurrence rate in these 93 patients was 5.2% (95% CI, 0.03-10.1). Of the 77 patients who had died, 64 (83%) died of non-breast-cancer-related causes. No significant difference in overall survival was observed between patients with or without complete axillary staging. CONCLUSION This study demonstrates that the omission of complete axillary staging is common in selected elderly breast cancer patients with ≥2 comorbidities, with no apparent impact on regional control and 10-year overall survival.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
| | | | - Guusje Vugts
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - Karlijn Woensdregt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Özkurt E. Surgical Highlights from the 40 th San Antonio Breast Cancer Symposium: 5-9 December 2017, San Antonio, Texas. Eur J Breast Health 2018; 14:74-79. [PMID: 29774314 DOI: 10.5152/ejbh.2018.0202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 02/06/2023]
Abstract
This year San Antonio Breast Cancer Symposium (SABCS) celebrated its 40th anniversary. As in the past years, this year's conference was held in Henry B. Gonzalez Convention Centre, San Antonio, Texas, on 5-9 December 2017. The conference highlighted many different topic on breast cancer including basic science, translational research, local therapies, systemic therapies, survivorship, early clinical trials, and surgical topics. Even though SABCS evolved towards basic science and systemic therapy based manner in recent years, there were some important topics about local therapies and surgical approach. In this conference report, presentations and keynote talks about surgical field and local therapies will be summarised.
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Affiliation(s)
- Enver Özkurt
- Breast Surgical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.,Department of General Surgery, Breast Unit, Istanbul University Istanbul School of Medicine, İstanbul, Turkey
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40
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Poodt IGM, Vugts G, Maaskant-Braat AJG, Schipper RJ, Voogd AC, Nieuwenhuijzen GAP. Risk of Regional Recurrence After Negative Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence. Ann Surg Oncol 2018; 25:1312-1321. [PMID: 29497910 PMCID: PMC5891565 DOI: 10.1245/s10434-018-6384-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 01/17/2023]
Abstract
Background Repeat sentinel lymph node biopsy (rSLNB) has increasingly been used in patients with ipsilateral breast tumor recurrence (IBTR). The safety in terms of regional disease control after this procedure remains unclear. This study evaluates occurrence of regional recurrence as first event in patients with IBTR and negative rSLNB, treated without additional lymph node dissection. Patients and Methods Data were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 201 patients, tumor-negative rSLNB was obtained without performing additional lymph node dissections. Results With median follow-up of 4.7 (range 0.9–12.7) years, regional recurrence occurred after median time of 3.0 (range 0.4–6.7) years in 4.5% (N = 9) of patients as first event after IBTR and rSLNB. In four of these nine patients, the site of recurrence was in concordance with the anatomical location of rSLNB. Two of the nine recurrences were reported in the ipsilateral axilla, resulting in an ipsilateral axillary regional recurrence rate of 1.0%. In the other seven patients, regional recurrence occurred in aberrant basins. Univariable analysis showed that triple-negative IBTR and lower amount of radioactive-labeled tracer (99mtechnetium) used during rSLNB were associated with developing regional recurrence as first event after negative rSLNB (P < 0.05). Conclusions The risk of developing regional recurrence after negative rSLNB is low. The low relapse rate supports the safety of rSLNB as primary nodal staging tool in IBTR. The time has come for clinical guidelines to adopt rSLNB as axillary staging tool in patients with IBTR. Electronic supplementary material The online version of this article (10.1245/s10434-018-6384-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Poodt IGM, Vugts G, Schipper RJ, Nieuwenhuijzen GAP. Repeat Sentinel Lymph Node Biopsy for Ipsilateral Breast Tumor Recurrence: A Systematic Review of the Results and Impact on Prognosis. Ann Surg Oncol 2018; 25:1329-1339. [DOI: 10.1245/s10434-018-6358-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/18/2022]
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Unusual Contralateral Axillary Lymph Node Metastasis in a Second Primary Breast Cancer Detected by FDG PET/CT and Lymphoscintigraphy. Nucl Med Mol Imaging 2017; 51:350-353. [PMID: 29242730 DOI: 10.1007/s13139-017-0485-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022] Open
Abstract
Contralateral metastatic axillary lymph nodes in a patient with breast cancer is a rare condition. Here, we present a 55-year-old woman with a second primary breast cancer. The patient underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for staging work-up. Additionally, preoperative lymphoscintigraphy was performed to detect sentinel lymph nodes. FDG PET/CT demonstrated increased FDG uptake in the left nipple and right axillary lymph nodes. Lymphoscintigraphy identified the right axillary lymph nodes which was consistent with the FDG PET/CT findings. This case emphasizes the usefulness of FDG PET/CT and lymphoscintigraphy for identifying unpredictable contralateral axillary lymph node metastasis from a second primary breast cancer.
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Ahmed M, Baker R, Rubio IT. Meta-analysis of aberrant lymphatic drainage in recurrent breast cancer. Br J Surg 2016; 103:1579-1588. [DOI: 10.1002/bjs.10289] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/19/2016] [Accepted: 07/03/2016] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Sentinel node biopsy (SNB) in recurrent breast cancer offers targeted axillary staging compared with axillary lymph node dissection (ALND) or no treatment. The evidence for lymphatic mapping in recurrent breast cancer is reviewed, focusing on aberrant drainage and its implications for patient management.
Methods
A meta-analysis of studies evaluating lymphatic mapping in recurrent breast cancer was performed. Outcomes included sentinel node identification, aberrant lymphatic pathways and metastatic node rates in aberrant drainage and ipsilateral axilla. Pooled odds ratios (ORs) and 95 per cent confidence intervals (c.i.) were estimated using fixed-effect analyses, or random-effects analyses in the event of statistically significant heterogeneity.
Results
Seven studies reported data on lymphatic mapping in 1053 patients with recurrent breast cancer. The intraoperative sentinel node identification rate was 59·6 (95 per cent c.i. 56·7 to 62·6) per cent, and significantly greater when the original axillary surgery was SNB compared with ALND (OR 2·97, 95 per cent c.i. 1·66 to 5·32). The rate of aberrant lymphatic drainage identification was 25·7 (23·0 to 28·3) per cent, and significantly greater when the original axillary surgery was ALND (OR 0·27, 0·19 to 0·38). The metastatic sentinel node rate was 10·4 (8·6 to 12·3) per cent, and a significantly greater metastatic nodal burden was identified in the ipsilateral axilla (OR 6·31, 1·03 to 38·79).
Conclusion
Lymphatic mapping is feasible in recurrent breast cancer. It avoids ALND in over 50 per cent of patients who have undergone SNB, and allows the 4 per cent of patients with metastatically involved aberrant nodes to receive targeted surgical and adjuvant therapies.
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Affiliation(s)
- M Ahmed
- Research Oncology, Division of Cancer Studies, King's College London, London
| | - R Baker
- Department of Statistics, School of Business 612, University of Salford, Salford, UK
| | - I T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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