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Uren RF, Howman-Giles R, Chung DKV, Thompson JF. Metastatic occlusion of a lymphatic collecting vessel in a patient with cutaneous melanoma and clinically normal lymph nodes. Clin Nucl Med 2007; 32:312-3. [PMID: 17413584 DOI: 10.1097/01.rlu.0000257178.54240.90] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Roger F Uren
- Nuclear Medicine and Diagnostic Ultrasound, RPAH Medical Centre, Newton, NSW, Australia.
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Odling-Smee GW, Osborne MP. Properative detection of axillary lymph node metastases in breast cancer by isotope things. Br J Surg 2005. [DOI: 10.1002/bjs.1800700725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G W Odling-Smee
- The Queen's University of Belfast, Department of Surgery, Institute of Clinical Science, Grosvenor Road, Belfast BT12 6BJ
| | - M P Osborne
- Memorial Sloan-Kettering Cancer, 1275 York Avenue, New York 10021, USA
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Uematsu T, Sano M, Homma K. In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. AJR Am J Roentgenol 2001; 176:1069-74. [PMID: 11264113 DOI: 10.2214/ajr.176.4.1761069] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study seeks to determine whether high-resolution in vitro helical CT can show the internal structure of small axillary nodes and to establish the CT characteristics of benign versus metastatic axillary nodes in patients with breast cancer. SUBJECTS AND METHODS We obtained in vitro helical CT images of 212 nodes excised from 19 patients with breast cancer. The longest mean size was 5.9 mm, and the range was 0.5 to 26.5 mm. The hilar and cortical characteristics, the size, and the ratio of the longest axis to the shortest axis were evaluated. CT findings were correlated with histologic findings. RESULTS Pathologic assessment of excised nodes with a central low-density hilum visualized on CT showed arteries, veins, lymphatic sinuses, and fatty tissue. A peripheral high-density cortex on CT contained mostly lymphatic tissue. Abnormal (eccentric, irregular) cortices were observed in malignant nodes (p<0.0001). Marked differences were observed among the proportions of benign and malignant nodes when the ratio of the longest axis to the shortest axis was less than 2 and an abnormal cortex was observed. CT could also detect extracapsular lymph node extension. CONCLUSION In vitro high-resolution helical CT can detect the internal structure of small nodes. Morphologic changes detected on helical CT help distinguish benign from malignant nodes.
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Affiliation(s)
- T Uematsu
- Department of Radiology, Niigata Cancer Center Hospital, 2-15-3, Niigatashi, Kawagishicho, Niigata 951-8566, Japan
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Chetty U, Jack W, Prescott RJ, Tyler C, Rodger A. Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial. Edinburgh Breast Unit. Br J Surg 2000; 87:163-9. [PMID: 10671921 DOI: 10.1046/j.1365-2168.2000.01345.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the treatment of operable breast cancer by breast conservation, the extent of axillary dissection, the need for radiotherapy to the axilla and the morbidity associated with these procedures have not been assessed adequately. METHODS Patients with operable breast cancer were randomized to have level III axillary node clearance (232 patients) or axillary node sample (234 patients). Radiotherapy to the axilla was given selectively. Radiotherapy was not given to those who had an axillary clearance. In the early part of the study all patients who had node sample were treated by radiotherapy (54 patients); subsequently this was modified to include only those who were node positive. The morbidity to the shoulder and arm was assessed before and after operation by measuring upper limb volume and circumference, and combined glenohumeral and scapular movement and muscle power. RESULTS Comparing the two surgical policies, no difference was found in local (axillary clearance 14 versus sample 15), axillary (eight versus seven) or distant (29 versus 29) recurrence. There was no statistically significant difference in 5-year survival rate (clearance 82.1 versus sample 88.6 per cent). Morbidity was least in those who had a node sample and no radiotherapy to the axilla. Radiotherapy to the axilla in patients who had a node sample resulted in a significant reduction in range of movement of the shoulder, e.g. mean(s.e.) 2.2(0.6) cm reduction in lateral rotation at 3 years. Surgical axillary clearance was associated with significant lymphoedema of the upper limb, e.g. 4.1(0.7) per cent increase in arm volume at 3 years. CONCLUSION A selective policy for the management of the axilla is associated with no increase in axillary recurrence or mortality rate compared with routine axillary node clearance. Patients who are node negative after axillary sample can avoid radiotherapy or axillary clearance.
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Affiliation(s)
- U Chetty
- Correspondence to: Mr U. Chetty, Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK
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Abstract
BACKGROUND The value of surgical staging and treatment of the axillary lymph nodes with either surgery or radiotherapy in the initial management of patients with Stage I or II invasive breast cancer is controversial. METHODS A review of retrospective and prospective clinical studies was performed to assess the risks of axillary lymph node involvement and the effectiveness and morbidity of various treatment options. RESULTS The risk of axillary lymph node involvement is substantial for most patients, even those with small tumors. The morbidity resulting from a careful Level I/II axillary dissection or moderate-dose axillary radiotherapy is limited. Such treatment is highly effective in preventing axillary recurrence. The symptoms resulting from axillary failure can be controlled in many, but not all, patients. The available data suggest, but do not prove, that the initial use of effective axillary treatment may result in a small improvement in long term outcome in some patient subgroups. CONCLUSIONS Most patients should be treated with either axillary surgery or irradiation. Highly selected subgroups of patients may have such low risks of involvement that specific axillary treatment is of little value. However, such subgroups have not yet been well defined. Treatment approaches that do not involve specific axillary treatment should be considered investigational at present, and the patients should be informed as to their potential risks. Prospective clinical studies of these issues should be pursued.
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Affiliation(s)
- A Recht
- Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA, USA
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10
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Abstract
In the diagnosis of clinically inapparent breast cancer, mammography remains the most effective imaging modality, which is due in large part to its ability to detect microcalcifications. Of the ancillary modalities, sonography is the most useful because it readily differentiates cysts from other breast lesions. Internal mammary and axillary node imaging have been tried with varying levels of success, but false-positive and false-negative rates remain high with available techniques. Pulmonary metastases are best evaluated by chest X-ray with specificity increased by other imaging techniques. Liver and bone metastases may be screened for with isotope scans with computerized tomography, sonography, and magnetic resonance imaging, increasing the specificity of abnormal scans. CT and MRI are the most effective tools for evaluating CNS disease.
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Affiliation(s)
- D D Dershaw
- Department of Medical Imaging, Memorial Sloan Kettering Cancer Center, New York, NY 10021
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Recht A, Siddon RL, Kaplan WD, Andersen JW, Harris JR. Three-dimensional internal mammary lymphoscintigraphy: implications for radiation therapy treatment planning for breast carcinoma. Int J Radiat Oncol Biol Phys 1988; 14:477-81. [PMID: 3343155 DOI: 10.1016/0360-3016(88)90263-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Conservative surgery combined with radiation therapy for the treatment of early breast carcinoma has been shown to achieve both a high rate of local tumor control and good cosmetic results with a minimum of complications. Whether the internal mammary lymph nodes (IMNs) should be included in the treatment volume is a topic of considerable controversy. Radionuclide internal mammary node lymphoscintigraphy (IMN-LS) can locate these nodes in three dimensions. We have analyzed the results of IMN-LS in 167 patients imaged at the Dana-Farber Cancer Institute and treated at the Joint Center for Radiation Therapy between 1977 and 1980. The location of the IMNs was found variable from patient to patient. At least one IMN was not included within tangential fields arbitrarily arranged to have a medial entrance point 3.0 cm across the midline in 17% of evaluable patients. However, 48% and 66% of patients had IMNs that could be adequately treated with fields positioned only 1.0 cm or 2.0 cm across midline, respectively. We conclude that when treatment of the IMNs is warranted, IMN-LS not only assures their complete coverage in the majority of patients but also may help reduce the amount of heart and lung irradiated.
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Affiliation(s)
- A Recht
- Department of Radiation Therapy, Harvard Medical School, Boston, MA 02115
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Matsubara S, Umehara I, Shibuya H, Okuyama T, Horiuchi J, Suzuki S, Suzuki H, Ebuchi M. Radionuclide lymphoscintigraphy performed on the mastectomized chest wall. Cancer 1986; 58:1225-30. [PMID: 3742448 DOI: 10.1002/1097-0142(19860915)58:6<1225::aid-cncr2820580609>3.0.co;2-#] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Lymphatic flow in the anterior chest wall of 64 patients who underwent surgery for breast carcinoma was studies on images of lymphoscintigraphy using 99mTc-rhenium colloid. Scintigraphic images taken 4 hours after the intradermal injection of radionuclides along both sides of the surgical wound frequently made it possible to visualize the contralateral axillary lymph nodes. In particular, among 20 patients with local chest wall recurrence after the mastectomy, the contralateral axillary nodes were demonstrated in 13. Stimulated lymphatic flow seems to be manifested around the site of local recurrence over the chest wall. On the precise analysis of lymphographic images, faint lymphatic drainages were occasionally identified up to the contralateral axillary lymph nodes at various levels of the anterior chest wall. It is essential that the radiation field be made large towards the area including the downstream of the lymphatic flow. Additionally, accumulation of radionuclides in the lymph nodes appeared to be slowly impaired by the postoperative irradiation after the completion of radiotherapy.
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Abstract
The clinical assessment of patients with stage I and II breast cancer is limited to a history and physical examination supplemented by a chest radiograph and serum alkaline phosphatase determination. In the absence of positive clinical findings or elevation of the alkaline phosphatase, routine scintigraphy of the skeletal system and liver is not indicated. In contrast, routine scintigraphy of the skeletal system and liver is indicated in patients with stage III disease, even in the absence of clinical evidence of systemic metastasis.
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Osborne MP, Payne JH, Richardson VJ, McCready VR, Ryman BE. The preoperative detection of axillary lymph node metastases in breast cancer by isotope imaging. Br J Surg 1983; 70:141-4. [PMID: 6831154 DOI: 10.1002/bjs.1800700303] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Axillary lymphoscintigraphy using 99Tcm-labelled liposomes was carried out in 40 patients with breast cancer as a part of pretreatment staging in an attempt to improve the accuracy of axillary evaluation. Patients were injected interstitially in the periareolar region of each breast with 250–300 μCi of 99Tcm-labelled liposomes. Subsequently the patients were imaged with a gamma-camera using computerized data processing. Interpretation of images was based on prior experimental data; a diminished uptake of isotope by the primary regional lymph node (PRLN) and the group of axillary regional lymph nodes (RLN) draining the tumour, when compared to the control side, was considered to be abnormal and to suggest node metastases. An equal or enhanced uptake by the PRLN or RLN draining the tumour, when compared to the control side, was considered normal, indicating an absence of lymph node metastases. Eighteen patients (45 per cent) had abnormal scans and 14 patients (35 per cent) had normal scans. Eight patients (20 per cent) had technically unsatisfactory images where axillary nodes could not be identified. Twenty-two patients of the 32 with evaluable scans had correlation of preoperative images with postsurgical axillary lymph node histopathology. One patient out of 12 with an abnormal scan had normal lymph nodes on serial sectioning, and 2 patients out of 10 with normal scans had lymph node metastases. Eight of the 32 patients (25 per cent) with evaluable images had enhanced uptake of isotope by the PRLN and RLN draining the tumour. In 3 of these cases a marked reactive hyperplasia only was shown on histopathological examination, in 2 cases the reactive hyperplasia was associated with lymph node metastases, accounting for the 2 false negative interpretations. This preliminary study suggests that axillary lymphoscintigraphy may be of value in preoperative staging in breast cancer. Long term studies are needed to evaluate the prognostic potential of such a test as a measure of macrophage function. Further studies, by blind replication, are required to evaluate the accuracy of axillary lymph node imaging.
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Abstract
In patients with genitourinary cancers, it is critically important that lymph node metastases be detected prior to surgery. Information regarding the status of these nodes will influence the type and extent of therapy. Radiologic tests currently available for lymph node imaging--contrast lymphangiography, ultrasound, and computed tomography--are sometimes associated with a high false-negative rate. Iliopelvic lymphoscintigraphy, when performed following bilateral perianal injections of 99mTc-antimony trisulfide colloid, offers a physiologic method for visualizing these nodes and allows demonstration of the internal iliac chain, often not visualized on contrast lymphangiographic studies. Additionally, data from initial patient trials suggest that this technique offers a clinically acceptable level of sensitivity and specificity. This article details the methodology of the technique, and addresses reproducibility, sensitivity, specificity, and image interpretation.
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Frühling JG, Bourgeois P. Axillary lymphoscintigraphy: current status in the treatment of breast cancer. Crit Rev Oncol Hematol 1983; 1:1-20. [PMID: 6394166 DOI: 10.1016/s1040-8428(83)80002-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Postoperative axillary lymphoscintigraphy has been performed after time-differentiated intercostal and interdigital injections of a 99Tc-labeled sulfur microcolloid in 313 patients suffering from breast cancer who underwent radical surgery with axillary dissection. As demonstrated by the absence of visualized lymph nodes after both injections, the axillary dissection could be considered as complete in only 34.6% of the investigated patients. The greatest part of lymph nodes, remaining after surgery, corresponds to the inferior and central groups (after interdigital injection). In 15% of the cases the intercostal injection leads to the demonstration of external mammary lymph nodes. According to the analysis of 202 cases with at least 1 year follow-up, the existence of visualized residual lymph nodes represents a factor of risk to develop nodal relapse especially in patients with positive peroperative axillary lymph node status who did not receive postoperative X-ray treatment. Upper limb edema occurs in 22.5% of the cases; mainly in patients with negative lymphoscintigraphic findings (demonstrating the interruption of the axillary lymphatic flux) and without nodal irradiation. Postoperative axillary lymphoscintigraphic findings should be evaluated in connection with the peroperative axillary lymph node status as established according to the histological analysis, and should take into account the number of removed lymph nodes. Preoperative axillary lymphoscintigraphy seems to be a less contributive examination technique.
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Rosenblum I, Wischnitzer T, Stadler JA, Bar-On J. Lymphography of the breast as an accessory in the early diagnosis and detection of carcinoma of the breast: lymphography as a prognostic tool. World J Surg 1982; 6:126-9. [PMID: 7090390 DOI: 10.1007/bf01656386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ingoldby CJ. Axillary lymphoscintigraphy. Br J Surg 1981; 68:670. [PMID: 7272701 DOI: 10.1002/bjs.1800680924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Peyton JW, Crosbie J, Bell TK, Roy AD, Odling-Smee W. High colloidal uptake in axillary nodes with metastatic disease. Br J Surg 1981; 68:507-9. [PMID: 7248724 DOI: 10.1002/bjs.1800680721] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Axillary lymphoscintigraphy using 99Tcm antimony sulphide colloid has been carried out in 29 patients with suspected breast cancer and was correlated with histology. Of the 23 with proved tumour, axillary node metastases were found in 19 and, although 10 did have diminished uptake on the side of the lesion, 5 had an equal uptake in both sides and 4 had an increased uptake on the side of the lesion. Further, some of the nodes in which the high uptake had occurred were those heavily infiltrated by tumour. It is concluded that: a, lymphoscintigraphy with antimony sulphide colloid is not a reliable technique for the detection of metastatic disease in the regional nodes; b, any lymphoscintigraphy with this or any other agent requires more meticulous histological correlation than hitherto before it can be assumed to have any proved clinical value.
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Merrick MV, Stone AR, Chisholm GD. Nuclear Medicine. Prostate Cancer 1981. [DOI: 10.1007/978-3-642-81621-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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