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Zhou WJ, Zhang YD, Kong WT, Zhang CX, Zhang B. Preoperative prediction of axillary lymph node metastasis in patients with breast cancer based on radiomics of gray-scale ultrasonography. Gland Surg 2021; 10:1989-2001. [PMID: 34268083 DOI: 10.21037/gs-21-315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
Background To investigate the performance of a radiomics model based on gray-scale ultrasonography (US) for the preoperative non-invasive prediction of ipsilateral axillary lymph node (ALN) metastasis in patients with breast cancer (BC). Methods A total of 192 pathologically confirmed BC patients were included in this study. The training set was comprised of 132 patients from hospital 1 and the test set was comprised of 60 patients from hospital 2. All patients underwent US before percutaneous core biopsy and the results of ALN status reported by a radiologist with 12 years of experience were recorded. Radiomic features were extracted from the gray-scale US images. Max-relevance and min-redundancy (MRMR) and least absolute shrinkage and selection operator (LASSO) were used for data dimension reduction and feature selection. A radiomics model was constructed using LASSO and was validated using the leave group out cross-validation (LGOCV) method. The performance of the model was validated with receiver operating characteristic (ROC), calibration curve, and decision curve analysis. Results A total of 860 features were extracted from the gray-scale US images of each breast lesion, and 9 radiomic features were selected for model construction. The area under the curve (AUC), sensitivity, and specificity of the model for predicting ALN metastasis were 0.85, 78.9%, and 77.3% in the training set and 0.65, 68.0%, and 79.4% in the test set, respectively. The prediction performance of the model was significantly higher than that of the radiologist (AUC: 0.85 vs. 0.59, P<0.01) in the training set and was slightly higher than that of the radiologist (AUC: 0.65 vs. 0.63, P>0.05) in the test set. Conclusions The non-invasive radiomics model has the ability to predict ALN metastasis for patients with breast cancer and may outperform US-reported ALN status performed by the radiologist.
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Affiliation(s)
- Wei-Jun Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yi-Dan Zhang
- Department of Ultrasound, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Wen-Tao Kong
- Department of Ultrasound, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Chao-Xue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
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Lee SE, Sim Y, Kim S, Kim EK. Predictive performance of ultrasonography-based radiomics for axillary lymph node metastasis in the preoperative evaluation of breast cancer. Ultrasonography 2020; 40:93-102. [PMID: 32623841 PMCID: PMC7758097 DOI: 10.14366/usg.20026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the predictive performance of ultrasonography (US)-based radiomics for axillary lymph node metastasis and to compare it with that of a clinicopathologic model. METHODS A total of 496 patients (mean age, 52.5±10.9 years) who underwent breast cancer surgery between January 2014 and December 2014 were included in this study. Among them, 306 patients who underwent surgery between January 2014 and August 2014 were enrolled as a training cohort, and 190 patients who underwent surgery between September 2014 and December 2014 were enrolled as a validation cohort. To predict axillary lymph node metastasis in breast cancer, we developed a preoperative clinicopathologic model using multivariable logistic regression and constructed a radiomics model using 23 radiomic features selected via least absolute shrinkage and selection operator regression. RESULTS In the training cohort, the areas under the curve (AUC) were 0.760, 0.812, and 0.858 for the clinicopathologic, radiomics, and combined models, respectively. In the validation cohort, the AUCs were 0.708, 0.831, and 0.810, respectively. The combined model showed significantly better diagnostic performance than the clinicopathologic model. CONCLUSION A radiomics model based on the US features of primary breast cancers showed additional value when combined with a clinicopathologic model to predict axillary lymph node metastasis.
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Affiliation(s)
- Si Eun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yongsik Sim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
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Nowikiewicz T, Głowacka‐Mrotek I, Tarkowska M, Nowikiewicz M, Zegarski W. Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis. Breast J 2020; 26:873-881. [DOI: 10.1111/tbj.13769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Tomasz Nowikiewicz
- Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
- Department of Clinical Breast Cancer and Reconstructive Surgery Oncology Centre Bydgoszcz Poland
| | - Iwona Głowacka‐Mrotek
- Department of Rehabilitation Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Magdalena Tarkowska
- Department of Physiotherapy Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Magdalena Nowikiewicz
- Student Scientific Society – Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Wojciech Zegarski
- Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
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Chai R, Ma H, Xu M, Arefan D, Cui X, Liu Y, Zhang L, Wu S, Xu K. Differentiating axillary lymph node metastasis in invasive breast cancer patients: A comparison of radiomic signatures from multiparametric breast MR sequences. J Magn Reson Imaging 2019; 50:1125-1132. [PMID: 30848041 DOI: 10.1002/jmri.26701] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/20/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ruimei Chai
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
| | - He Ma
- Sino‐Dutch Biomedical and Infornation Engineering SchoolNortheastern University Shenyang Liaoning Province China
| | - Mingjie Xu
- Sino‐Dutch Biomedical and Infornation Engineering SchoolNortheastern University Shenyang Liaoning Province China
| | - Dooman Arefan
- Imaging Research Division, Department of RadiologyUniversity of Pittsburgh Pittsburgh Pennsylvania USA
| | - Xiaoyu Cui
- Sino‐Dutch Biomedical and Infornation Engineering SchoolNortheastern University Shenyang Liaoning Province China
| | - Yi Liu
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
| | - Lina Zhang
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
| | - Shandong Wu
- Imaging Research Division, Department of RadiologyUniversity of Pittsburgh Pittsburgh Pennsylvania USA
| | - Ke Xu
- Department of RadiologyFirst Hospital of China Medical University Shenyang Liaoning Province China
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Nowikiewicz T, Nowak A, Wiśniewska M, Wiśniewski M, Nowikiewicz M, Zegarski W. Analysis of the causes of false negative and false positive results of preoperative axillary ultrasound in patients with early breast cancer - a single-centre study. Contemp Oncol (Pozn) 2018; 22:247-251. [PMID: 30783389 PMCID: PMC6377422 DOI: 10.5114/wo.2018.82644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/30/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Properly planned and performed diagnostic tests allow the optimal treatment option to be chosen for the patient. They also allow qualification for the correct surgical procedure. AIM OF THE STUDY In this study we evaluated the clinical value of preoperative ultrasound scan (USS) testing performed during primary disease staging in patients with early breast cancer qualified to sentinel lymph node biopsy (SLNB). MATERIAL AND METHODS The group of breast cancer patients who underwent SLNB from March 2012 to May 2013. As well as the standard procedure of the preoperative diagnostics model, in each patient the USS of axillary lymph nodes was performed additionally. The results were compared with the data from postoperative pathological reports. We attempted to define the factors influencing the possibility of obtaining false positive and false negative USS results. RESULTS The analysis comprised 172 patients. In 14.4% of cases with normal USS result the pathological result was different from the expected one (pN1). In 42.3% of patients with suspicious axillary lymph nodes the result of the pathological report was positive. The sensitivity of the USS testing was 89.3%, and the specificity was 34.4%, PPV - 85.6%, NPV - 42.3%. CONCLUSIONS Ultrasonographic assessment of axillary lymph nodes in breast cancer patients qualified for SLNB is a test with high sensitivity and high predictive value of the positive test result. The possibility of a result contrary to the actual nodal status may result primarily from the technical limitations of USS testing.
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Affiliation(s)
- Tomasz Nowikiewicz
- Chair and Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Department of Breast Cancer and Reconstructive Surgery, Prof. Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Adam Nowak
- Diagnostic Imaging and Interventional Radiology Unit, Prof. Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Magdalena Wiśniewska
- Department of Oncology and Brachytherapy, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Chemotherapy Department, Prof. Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Michał Wiśniewski
- Outpatient Chemotherapy Department, Prof. Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Magdalena Nowikiewicz
- Student Scientific Society, Chair and Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Chair and Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Department of Breast Cancer and Reconstructive Surgery, Prof. Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland
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Assing MA, Patel BK, Karamsadkar N, Weinfurtner J, Usmani O, Kiluk JV, Drukteinis JS. A comparison of the diagnostic accuracy of magnetic resonance imaging to axillary ultrasound in the detection of axillary nodal metastases in newly diagnosed breast cancer. Breast J 2017; 23:647-655. [PMID: 28397344 DOI: 10.1111/tbj.12812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
Abstract
Patients with a diagnosis of invasive breast cancer are increasingly undergoing breast magnetic resonance imaging (MRI) for preoperative staging including evaluation of axillary lymph node metastases (ALNM). This retrospective study aims to evaluate the utility of adding axillary ultrasound (AUS) in the preoperative setting when an MRI is planned or has already been performed. This IRB approved, HIPAA compliant study reviewed a total of 271 patients with a new diagnosis of invasive breast cancer at a single institution, between June 1, 2010 and June 30, 2013. The study included patients who received both AUS and MRI for preoperative staging. Data were divided into two cohorts, patients who underwent MRI prior to AUS and those who underwent AUS prior to MRI. AUS and MRI reports were categorized according to BI-RADS criteria as "suspicious" or "not suspicious" for ALNM. In the setting of a negative MRI and subsequent positive AUS, only one out of 25 cases (4%) were positive for metastases after correlating with histologic pathology. MRI detected metastatic disease in four out of 27 (15%) patients who had false-negative AUS performed prior to MRI. Our results indicate the addition of AUS after preoperative MRI does not contribute significantly to increased detection of missed disease. MRI could serve as the initial staging imaging method of the axilla in the setting that AUS is not initially performed and may be valuable in identification of lymph nodes not identified on AUS.
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Affiliation(s)
| | | | | | | | - Omar Usmani
- H. Lee Moffitt Cancer Center, Tampa, FL, USA
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Reyna C, Kiluk JV, Frelick A, Khakpour N, Laronga C, Lee MC. Impact of axillary ultrasound (AUS) on axillary dissection in breast conserving surgery (BCS). J Surg Oncol 2015; 111:813-8. [DOI: 10.1002/jso.23885] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/24/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Chantal Reyna
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - John V. Kiluk
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Anne Frelick
- University of South Florida; Morsani College of Medicine; Tampa Florida
| | - Nazanin Khakpour
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Christine Laronga
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Marie Catherine Lee
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
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Reyna C, Lee MC, Frelick A, Khakpour N, Laronga C, Kiluk JV. Axillary burden of disease following false-negative preoperative axillary evaluation. Am J Surg 2014; 208:577-81. [DOI: 10.1016/j.amjsurg.2014.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
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Reyna C, Lee MC. Breast cancer in young women: special considerations in multidisciplinary care. J Multidiscip Healthc 2014; 7:419-29. [PMID: 25300196 PMCID: PMC4189712 DOI: 10.2147/jmdh.s49994] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Breast cancer is one of the most prevalent cancers in females, and 5%-7% of breast cancer cases occur in women under 40 years of age. Breast cancer in the young has gained increased attention with an attempt to improve diagnosis and prognosis. Young patients tend to have different epidemiology, presenting with later stages and more aggressive phenotypes. Diagnostic imaging is also more difficult in this age group. Multidisciplinary care generally encompasses surgeons, medical oncologists, radiation oncologists, radiologists, and social workers. Other special considerations include reconstruction options, fertility, genetics, and psychosocial issues. These concerns enlarge the already diverse multidisciplinary team to incorporate new expertise, such as reproductive specialists and genetic counselors. This review encompasses an overview of the current multimodal treatment regimens and the unique challenges in treating this special population. Integration of diagnosis, treatment, and quality of life issues should be addressed and understood by each member in the interdisciplinary team in order to optimize outcomes.
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Affiliation(s)
- Chantal Reyna
- Comprehensive Breast Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Marie Catherine Lee
- Comprehensive Breast Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study. Cir Esp 2014; 93:23-9. [PMID: 24560631 DOI: 10.1016/j.ciresp.2014.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A controversial aspect of breast cancer management is the use of sentinel lymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P=0,002) in the negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients.
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Thakur C, Lu Y, Sun J, Yu M, Chen B, Chen F. Increased expression of mdig predicts poorer survival of the breast cancer patients. Gene 2013; 535:218-24. [PMID: 24309373 DOI: 10.1016/j.gene.2013.11.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/24/2013] [Accepted: 11/14/2013] [Indexed: 02/07/2023]
Abstract
Breast cancer is the most common cancer and the second leading cause of cancer death among women of all races and Hispanic origin populations in the United States. In the present study, we reported that the survival time of the breast cancer patients is influenced by the expression level of mdig, a previously identified lung cancer-associated oncogene encoding a JmjC-domain protein. By checking the expression levels of mRNA and protein of mdig through both RT-PCR and immunohistochemistry in samples from 204 patients, we noticed that about 30% of breast cancer samples showed increased expression of mdig. Correlation of the mdig expression levels with the survival time of the breast cancer patients indicated a clear inverse relationship between mdig expression and patient survival, including poorer overall survival, distant metastasis free survival, relapse free survival, and post-progression survival. Taken together, these data suggest that an increased expression of mdig is an important prognostic factor for poorer survival time of the breast cancer patients.
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Affiliation(s)
- Chitra Thakur
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA
| | - Yongju Lu
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA
| | - Jiaying Sun
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA; Institute of Respiratory Diseases, First Affiliated Hospital, China Medical University, Shenyang, China; Respiratory Medicine, The 4th Affiliated Hospital, China Medical University, Liaoning Province, China
| | - Miaomiao Yu
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA; Institute of Respiratory Diseases, First Affiliated Hospital, China Medical University, Shenyang, China; Liaoning Cancer Hospital and Institute, Shenyang, Liaoning Province, China
| | - Bailing Chen
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA
| | - Fei Chen
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA.
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Rebollo-Aguirre Á, Gallego-Peinado M, Sánchez-Sánchez R, Pastor-Pons E, García-García J, Chamorro-Santos C, Menjón-Beltrán S. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rebollo-Aguirre AC, Gallego-Peinado M, Sánchez-Sánchez R, Pastor-Pons E, García-García J, Chamorro-Santos CE, Menjón-Beltrán S. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis. Rev Esp Med Nucl Imagen Mol 2013; 32:240-5. [PMID: 23684711 DOI: 10.1016/j.remn.2013.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS A prospective study was performed from January 2008 to December 2012 in 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, and ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA). RESULTS Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without nanocolloid migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2. CONCLUSION SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy.
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Affiliation(s)
- A C Rebollo-Aguirre
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.
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