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Mutsaers A, Li G, Fernandes J, Ali S, Barnes E, Chen H, Czarnota G, Karam I, Moore-Palhares D, Poon I, Soliman H, Vesprini D, Cheung P, Louie A. Uncovering the armpit of SBRT: An institutional experience with stereotactic radiation of axillary metastases. Clin Transl Radiat Oncol 2024; 45:100730. [PMID: 38317679 PMCID: PMC10839264 DOI: 10.1016/j.ctro.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose/objectives The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to its use in varying anatomic locations. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes and process. Materials/methods Patients treated with SBRT to AM from 2014 to 2022 were reviewed. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). Univariate regression analysis examined predictors of LF. Results We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60 %) and elderly (median age: 72). Median follow-up was 14.6 months. Common primary cancers included breast (43 %), skin (19 %), and lung (14 %). Treatment indication included oligoprogression (46 %), oligometastases (35 %) and symptomatic progression (19 %). A minority had prior overlapping radiation (18 %) or surgery (11 %). Most had prior systemic therapy (70 %).Significant heterogeneity in planning technique was identified; a minority of patient received 4-D CT scans (46 %), MR-simulation (21 %), or contrast (10 %). Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy). Seventeen cases (44 %) utilized a low-dose elective volume to cover remaining axilla.At first assessment, 87 % had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57 % had complete resolution and 21 % had improvement. One and 2-year LF rate were 16 % and 20 %, respectively. Univariable analysis showed increasing BED reduced risk of LF. Median OS was 21.0 months (95 % [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95 % [CI] 4.3-11.3). Two grade 3 events were identified, and no grade 4/5. Conclusion Using SBRT for AM demonstrated low rates of toxicity and LF, and respectable symptom improvement. Variation in treatment delivery has prompted development of an institutional protocol to standardize technique and increase efficiency. Limited followup may limit detection of local failure and late toxicity.
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Affiliation(s)
- A. Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Li
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - J.S. Fernandes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - S. Ali
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - E.A. Barnes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Czarnota
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Moore-Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - P. Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - A.V. Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
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Riis ML, Augestad L, Flote VG, Tangerud A, Frich L. Simultaneous cutaneous melanoma and ipsilateral breast cancer with metastasis to the same axilla. A case report with a focus on a multidisciplinary approach. Int J Surg Case Rep 2024; 114:109119. [PMID: 38061088 PMCID: PMC10755039 DOI: 10.1016/j.ijscr.2023.109119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 01/01/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Treatment of simultaneously occurring primary malignancies with separate lymphatic drainage is a surgical and medical challenge. We present a patient in which multidisciplinary management of coexisting melanoma and breast cancer was mandatory for optimal results. CASE PRESENTATION A 67-year-old female had a primary surgical resection for a skin lesion on the back. Histology revealed melanoma with a Breslow thickness of 4.8 mm. According to guidelines, a wide local excision was scheduled. Prior to the surgery, routine mammography revealed simultaneous ipsilateral breast cancer. A preoperative work-up revealed a pathological lymph node in the left axilla. Biopsies found metastasis from malignant melanoma. She had combined surgery with breast-conserving therapy, wide local excision of the skin on the back, and extended axillary clearance of levels I-III. Final histology revealed axillary metastases both from melanoma and breast cancer. Adjuvant therapy was decided based on a multidisciplinary approach. CLINICAL DISCUSSION To our knowledge, cases of synchronous primary cutaneous melanoma with biopsy-verified axillary metastases and independent, ipsilateral primary breast carcinoma have not been described. The surgical approach was done according to guidelines. The breast cancer was re-staged based on the histology of the surgical specimen. Adjuvant treatment was a combination of treatment strategies for the two primary malignancies. CONCLUSION This case highlights the need for a multidisciplinary approach in treating simultaneous breast cancer and melanoma both with axillary metastasis. The optimal treatment approach was based on close collaboration between surgeons, oncologists, radiologists, and pathologists. Multidisciplinary meetings are mandatory for optimal results.
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Affiliation(s)
- Margit Leonie Riis
- Section of Breast and Endocrine Surgery, Department of Cancer Treatment, Oslo University Hospital, Oslo, Norway.
| | - Linnea Augestad
- Locum Consultant for Melanoma, Department of Oncology, Oslo University Hospital, Norway.
| | | | - Aase Tangerud
- Department of Radiology, Oslo University Hospital, Oslo, Norway.
| | - Lars Frich
- Section of Oncologic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Oslo University Hospital Radiumhospitalet, Oslo, Norway
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Younes B, Amal C, Soukaina S, Mustapha B, Simohamed E, Mohamed EK. Occult primary breast cancer: Two cases report and literature review. Int J Surg Case Rep 2023; 112:108937. [PMID: 37852094 PMCID: PMC10667777 DOI: 10.1016/j.ijscr.2023.108937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Occult breast cancer (OBC) is defined as a clinically recognizable metastatic carcinoma arising from an undetectable primary breast tumor. PRESENTATION OF CASE We report in this work 2 cases of occult breast cancer treated at the Mohammed VI center of onco-gynecology of the CHU of Casablanca. CLINICAL DISCUSSION Significant advances in breast imaging have occurred since its description, decreasing its incidence. However current management is based upon old studies, with variable clinical, radiological and pathological definitions of OBC. CONCLUSION The introduction of better diagnostic techniques and more detailed pathology continue to impact the true incidence of OBC. SUMMARY Carcinoma of unknown primary is an intriguing clinical phenomenon that is defined as biopsy-proven metastasis of a malignant tumor in the absence of an identifiable primary site after a complete clinical workup. Carcinoma of unknown primary accounts for approximately 3 to 5% of all cancer diagnoses, and consists of a heterogeneous group of tumors that have acquired the ability to metastasize before the development of a clinically evident primary lesion. Clinical and radiological examinations represent the first steps in the diagnostic algorithm for Carcinoma of unknown primary syndrome. However, histological and immunohistochemical analyses, together with evaluation by a multidisciplinary team and adequate therapy are essential for the diagnosis and treatment of Carcinoma of unknown primary syndrome of OBC. We report in this work 2 cases of occult breast cancer treated at the Mohammed VI center of onco-gynecology of the CHU of Casablanca; A multidisciplinary approach including surgery, radiotherapy, hormonal and biological therapy was implemented. Currently, 10 month after the first presentation, the two patient received ipsilateral breast radiotherapy and sequential adjuvant chemotherapy followed by hormone therapy. Evolution was marked by good control.
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Affiliation(s)
- Bencherifi Younes
- Au centre Mohammed VI pour le traitement des cancers, pole d'oncologie gynécologique; Centre Hospitalier Universitaire IBN ROCHD, faculté de médecine et de pharmacie, Université Hassan 2, Casablanca, Morocco
| | - Cherkaoui Amal
- Résident au centre Mohammed VI pour le traitement des cancers, pole d'oncologie gynécologique; Centre Hospitalier Universitaire IBN ROCHD, faculté de médecine et de pharmacie, Université Hassan 2, Casablanca, Morocco.
| | - Sabir Soukaina
- Résident au centre Mohammed VI pour le traitement des cancers, pole d'oncologie gynécologique; Centre Hospitalier Universitaire IBN ROCHD, faculté de médecine et de pharmacie, Université Hassan 2, Casablanca, Morocco
| | - Benhessou Mustapha
- Au centre Mohammed VI pour le traitement des cancers, pole d'oncologie gynécologique; Centre Hospitalier Universitaire IBN ROCHD, faculté de médecine et de pharmacie, Université Hassan 2, Casablanca, Morocco
| | - Ennachit Simohamed
- Au centre Mohammed VI pour le traitement des cancers, pole d'oncologie gynécologique; Centre Hospitalier Universitaire IBN ROCHD, faculté de médecine et de pharmacie, Université Hassan 2, Casablanca, Morocco
| | - El Karroumi Mohamed
- Chef de service du centre Mohammed VI pour le traitement des cancers, pole d'oncologie gynécologique; Centre Hospitalier Universitaire IBN ROCHD, faculté de médecine et de pharmacie, Université Hassan 2, Casablanca, Morocco
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Cserni G, Ambrózay É, Serényi P, Bori R, Sejben I, Csörgő E, Serfőző O, Lóránd K, Venczel L, Maráz R, Sinkó M, Szeleczki N, Nyári T, Zombori T. Preoperative axillary nodal staging of invasive lobular breast cancer with ultrasound guided fine needle aspiration in patients with suspicious ultrasound findings versus aspiration in all patients - A retrospective single institutional analysis. Eur J Surg Oncol 2021:S0748-7983(21)00939-2. [PMID: 34872778 DOI: 10.1016/j.ejso.2021.11.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION - At present, surgical strategies for breast cancer patients with >2 lymph nodes (LN) involved differ from those with no or lower degree of nodal involvement. Preoperative assessment of the axilla is less sensitive in patients with lobular carcinoma (ILC) than patients with other histological tumour types. MATERIALS AND METHODS - A retrospective analysis of axillary staging by palpation, axillary ultrasound (AXUS) and AXUS-guided fine-needle aspiration cytology (FNAC) of 153 patients with ILC diagnosed and operated on between January 2013 and December 2020 was performed. Patients had either sentinel node biopsy or axillary lymph node dissection according to current practice. In period 1, patients had FNAC only when AXUS suggested nodal involvement (n = 106), and in period 2, all ILC patients had axillary FNAC (n = 47). RESULTS - Of the factors associated with >2LNs involvement, logistic regression suggested only AXUS/FNAC based staging as independent variable for all patients. Patients with AXUS-guided FNAC had a significantly higher proportion of true negative and lower proportion of true positive cases in the P2 period (0 vs 55% and 72% vs 11% for >2 LNs involvement, respectively; both p < 0.0001). CONCLUSIONS - AXUS-guided FNAC of all ILC patients did not result in improved preoperative identification of patients with >2 metastatic LNs but increased the false-negative rate of the assessment by producing false-negative results in patients who would not have undergone a biopsy due to negative AXUS findings.
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Suehiro A, Nagahara K, Moritani S, Omori K. Axillary lymph node metastases from thyroid carcinoma: Report of seven cases. Auris Nasus Larynx 2021; 48:718-22. [PMID: 33172762 DOI: 10.1016/j.anl.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 01/04/2023]
Abstract
Axillary lymph node metastasis (ALNM) of well- or poorly-differentiated thyroid cancer is rare. Notably, there are only 14 single case reports available; therefore, the mechanism of metastasis is unclear at this point. Because we encountered seven cases at a single institution, we were able to infer the mechanism of ALNM of thyroid cancer. The seven cases treated at our institution were analyzed retrospectively. In addition, 14 cases reported from other institutions were reviewed. All seven patients we treated and the 10 patients, among the 14, from other institutions were postoperative recurrences. All seven patients we treated had lymph node metastases near the venous angle, and invasive manipulation had been performed during the previous surgery. Therefore, we can presume that fibrosis at the venous angle caused by ablative surgery or tumor invasion could have resulted in anomalous lymphatic flow from the neck to the axilla. Hence, the subclavian region would probably need to be dissected besides axillary dissection. All 21 cases underwent surgical treatment for ALNM. Metastatic lymph nodes in the venous angle, subclavian or axilla, occasionally invade or adhere to the vessels. Hence, a surgical strategy is required in those cases rather than molecular targeted therapy or radioactive iodine irradiation.
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Mathias BJ, Sun J, Sun W, Zhou JM, Fulp WJ, Laronga C, Lee MC, Kiluk JV. Surgeon Bias in the Management of Positive Sentinel Lymph Nodes. Clin Breast Cancer 2020; 21:74-79. [PMID: 32917535 DOI: 10.1016/j.clbc.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The standard of care for clinically node-negative (cN0) patients following positive sentinel lymph node biopsy (SLNB) was completion axillary lymph node dissection (CALND). Publication of ACOSOG Z0011 in 2010 changed this standard for patients undergoing lumpectomy. Clinicians have since expanded this practice to mastectomy patients, and ongoing prospective studies are seeking to validate this practice. Here, we evaluate patient and tumor characteristics that led surgeons to forego a second surgery for CALND in cN0 mastectomy patients with positive SLNB. PATIENTS AND METHODS A single institution, retrospective review of cN0 patients with invasive primary breast cancer and positive SLNB from 2010 to 2016 was performed. Patients with T4 disease, positive preoperative axillary biopsy, prior neoadjuvant therapy or axillary surgery were excluded. Patients with positive SLNB undergoing CALND were compared with patients for whom CALND was omitted. Statistical analysis was performed using Kruskal-Wallis tests for continuous variables and χ2 tests or Fischer exact tests for categorical variables. RESULTS Of 259 patients with positive SLNB, 180 (69.4%) patients underwent mastectomy. CALND was performed at the time of mastectomy in 54 (30%) patients, at time of second operation in 22 (12.2%) patients, and not performed in 104 (57%) patients. Delayed CALND was significantly associated with younger age, larger tumors, increased number of positive sentinel nodes, invasive lobular carcinoma, extranodal extension, and lymphovascular invasion. CONCLUSIONS The management of cN0 patients with positive SLNB that do not meet ACOSOG Z0011 criteria is evolving and is influenced by tumor and patient characteristics in an attempt to balance the morbidity of CALND with the low rate of local regional recurrence.
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Affiliation(s)
| | - James Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Weihong Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Christine Laronga
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - M Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - John V Kiluk
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Zuhdy M, Alghandour R, Abdelazeem G, Saleh GA, Saleh MM, Hamdy M, Hamdy O. Axillary nodal metastasis in ovarian cancer: a report of three cases and review of literature. J Egypt Natl Canc Inst 2019; 31:9. [PMID: 32372131 DOI: 10.1186/s43046-019-0008-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ovarian cancer represents a major global health burden that is rarely associated with distant metastasis. Axillary lymph node metastasis from ovarian cancer is rare and is reported only in few case reports in literature. CASE PRESENTATION We report three cases of ovarian carcinoma associated with axillary lymph node metastasis as well as a brief literature review. The pathologic subtype in one case was malignant mixed Mullerian tumor, while the other two cases were high-grade serous ovarian carcinoma. Axillary nodal metastasis was reported as a synchronous event in one case, while it was reported as recurrence events in the other two cases. CONCLUSION Physicians should be aware of this uncommon mode of metastasis in ovarian cancer cases. Multi-disciplinary discussion is crucial in the management of these cases to offer them the best suitable treatment.
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Affiliation(s)
- Mohammad Zuhdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, 35516, Egypt.
| | - Reham Alghandour
- Medical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Gena Abdelazeem
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud M Saleh
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed Hamdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, 35516, Egypt
| | - Omar Hamdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, 35516, Egypt
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Horváth Z, Paszt A, Simonka Z, Látos M, Kaizer L, Hamar S, Vörös A, Ormándi K, Fejes Z, Lázár G. Is axillary lymph node dissection necessary for positive preoperative aspiration cytology lymph node results? Eur J Surg Oncol 2019; 46:504-510. [PMID: 31708307 DOI: 10.1016/j.ejso.2019.10.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/17/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Based on international guidelines, axillary lymph node dissection (ALND) is recommended in cases of breast cancer if preoperative examinations confirm axillary metastasis. We examined which set of preoperative parameters might render ALND unnecessary. PATIENTS AND METHODS Preoperative examinations (axillary ultrasound and aspiration cytology) confirmed axillary metastasis in 190 cases out of 2671 patients with breast cancer; primary ALN dissection was performed on these patients with or without prior neoadjuvant therapy. The clinicopathological results were analysed to determine which parameter might predict the presence of no more than 2 or 3 metastatic ALNs. RESULTS The final histological examination confirmed 1-3 metastatic lymph nodes in ALND samples in 116 cases and over 3 metastatic lymph nodes in 74 cases. For patients receiving neoadjuvant therapy (59 out of the 190 cases), if the size of the primary tumour was 2 cm or smaller and/or the metastatic ALN was 15 mm or smaller, then the patient was likely to have no more than 3 positive ALNs (stage N0-1 disease) (p < 0.001). If the patient did not receive neoadjuvant therapy, stage N2 or N3 disease was very likely. No correlation was found between other clinicopathological characteristics of the tumour and involvement of the ALNs. CONCLUSION Axillary lymph node dissection is not necessary for selected breast cancer patients with axillary metastasis receiving neoadjuvant therapy. In these cases, sentinel lymph node biopsy with or without radiation therapy and close follow-up may serve as adequate therapy.
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Affiliation(s)
- Z Horváth
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - A Paszt
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - Z Simonka
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - M Látos
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - L Kaizer
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - S Hamar
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - A Vörös
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - K Ormándi
- Affidea Hungary - Szeged, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 6/A, Hungary.
| | - Z Fejes
- Affidea Hungary - Szeged, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 6/A, Hungary.
| | - G Lázár
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
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Ha R, Chang P, Karcich J, Mutasa S, Fardanesh R, Wynn RT, Liu MZ, Jambawalikar S. Axillary Lymph Node Evaluation Utilizing Convolutional Neural Networks Using MRI Dataset. J Digit Imaging 2019; 31:851-856. [PMID: 29696472 DOI: 10.1007/s10278-018-0086-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to evaluate the role of convolutional neural network (CNN) in predicting axillary lymph node metastasis, using a breast MRI dataset. An institutional review board (IRB)-approved retrospective review of our database from 1/2013 to 6/2016 identified 275 axillary lymph nodes for this study. Biopsy-proven 133 metastatic axillary lymph nodes and 142 negative control lymph nodes were identified based on benign biopsies (100) and from healthy MRI screening patients (42) with at least 3 years of negative follow-up. For each breast MRI, axillary lymph node was identified on first T1 post contrast dynamic images and underwent 3D segmentation using an open source software platform 3D Slicer. A 32 × 32 patch was then extracted from the center slice of the segmented tumor data. A CNN was designed for lymph node prediction based on each of these cropped images. The CNN consisted of seven convolutional layers and max-pooling layers with 50% dropout applied in the linear layer. In addition, data augmentation and L2 regularization were performed to limit overfitting. Training was implemented using the Adam optimizer, an algorithm for first-order gradient-based optimization of stochastic objective functions, based on adaptive estimates of lower-order moments. Code for this study was written in Python using the TensorFlow module (1.0.0). Experiments and CNN training were done on a Linux workstation with NVIDIA GTX 1070 Pascal GPU. Two class axillary lymph node metastasis prediction models were evaluated. For each lymph node, a final softmax score threshold of 0.5 was used for classification. Based on this, CNN achieved a mean five-fold cross-validation accuracy of 84.3%. It is feasible for current deep CNN architectures to be trained to predict likelihood of axillary lymph node metastasis. Larger dataset will likely improve our prediction model and can potentially be a non-invasive alternative to core needle biopsy and even sentinel lymph node evaluation.
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Affiliation(s)
- Richard Ha
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA.
| | - Peter Chang
- Department of Radiology, T32 Training Grant (NIH T32EB001631), UC San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Jenika Karcich
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Simukayi Mutasa
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Reza Fardanesh
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Ralph T Wynn
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Michael Z Liu
- Department of Medical Physics, Columbia University Medical Center, 177 Ft. Washington Ave., Milstein Bldg Room 3-124B, New York, NY, 10032-3784, USA
| | - Sachin Jambawalikar
- Department of Medical Physics, Columbia University Medical Center, 177 Ft. Washington Ave., Milstein Bldg Room 3-124B, New York, NY, 10032-3784, USA
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Kutluturk K, Simsek A, Comak A, Gonultas F, Unal B, Kekilli E. Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer. Niger J Clin Pract 2019; 22:63-68. [PMID: 30666022 DOI: 10.4103/njcp.njcp_198_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aim There are conflicting results of studies on accuracy of positron emission tomography (PET)/computed tomography (CT) for axillary staging. The aim of this study is to determine the factors affecting the efficacy of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in detecting axillary metastases in invasive breast cancer. Materials and Methods Data of 232 patients with invasive breast cancer who underwent 18F-FDG PET/CT examination before surgery between January 2013 and September 2017 were reviewed retrospectively. Histopathological examination of axillary lymph nodes (ALNs) was used as a reference to assess the efficacy of 18F-FDG PET/CT in detecting axillary metastases. Results While 134 (57.8%) patients had axillary metastases as detected in 18F-FDG PET/CT scans, histopathologically axillary metastases were detected in 164 (70.7%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of 18F-FDG PET/CT in detection of axillary metastasis were 72.56%, 77.94%, 88.8%, 54%, and 74.1%, respectively. The false-negative and false-positive rates were 27.4% and 22%, respectively. In univariate analysis, patients' age, estrogen receptor positivity, higher ALN SUVmax, greater tumor size, and lymph node size determined by 18F-FDG PET/CT were all significantly associated with accuracy of 18F-FDG PET/CT for axillary metastasis. In multivariate analysis, tumor size determined by 18F-FDG PET/CT and ALN SUVmax were independent variables associated with axillary metastasis. The accuracy of 18F-FDG PET/CT for axillary metastasis was higher in patients with a larger tumor (≥19.5 mm) and a higher ALN SUVmax (≥3.2). Conclusion 18F-FDG PET/CT should not be routinely used for axillary staging, especially in patients with small tumors. It cannot eliminiate the necessity of sentinel lymph node biopsy. When it is used, both visual information and optimal cut-off value of axillary node SUVmax should be taken into consideration.
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Affiliation(s)
- K Kutluturk
- Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - A Simsek
- Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - A Comak
- Department of Nuclear Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - F Gonultas
- Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - B Unal
- Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - E Kekilli
- Department of Nuclear Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
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Bhayana A, Misra RN, Bajaj SK, Bankhar H. Clinicoradiologicial aspects of secretory carcinoma breast: A rare pediatric breast malignancy. Indian J Radiol Imaging 2019; 28:448-451. [PMID: 30662208 PMCID: PMC6319105 DOI: 10.4103/ijri.ijri_46_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group. We report imaging and clinicopathological features of secretory carcinoma breast with distant and axillary metastasis, in an 11-year-old girl, who presented with a painful lump in right breast. Ultrasound revealed a well-defined, partially microlobulated hypoechoic mass with skin and pectoralis muscle involvement and a suspicious morphology right axillary lymph node. Color Doppler revealed increased vascularity in both the breast mass and suspicious axillary node. Magnetic resonance imaging helped in better evaluation of pectoralis muscle involvement. Computed tomography (CT) neck, chest, and abdomen revealed multiple fibronodular opacities in bilateral lung fields. 18 Flouro-Deoxy-Glucose Positron Emission Tomography (FDG PET-CT) showed a hypermetabolic retroareolar breast mass with multiple hypermetabolic bilateral lung nodules suggesting lung metastasis. The histopathology confirmed the diagnosis of secretory carcinoma. The patient was offered chemotherapy for 2 years and put on follow-up since then.
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Affiliation(s)
- Aanchal Bhayana
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ritu N Misra
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunil K Bajaj
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Himani Bankhar
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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12
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Foschini MP, Miglio R, Quinn C, Belgio B, Regitnig P, Bianchi S, Nannini R, Buerger H, Kaya H, Illyés I, Kulka J, Wells CA, De Gaetano J, Lipeniece-Karele I, Cserni G. Prognostic impact of macrometastasis linear size in sentinel node biopsy for breast carcinoma. Eur J Surg Oncol 2017; 43:1421-7. [PMID: 28576464 DOI: 10.1016/j.ejso.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 11/21/2022] Open
Abstract
AIM The aim of the present study was to evaluate the risk of axillary non-sentinel lymph-node metastases (ALN) in breast cancer patients presenting macrometastasis (Mac-m) in the sentinel lymph node (SN). MATERIALS AND METHODS A retrospective series of 1464 breast cancers from patients who underwent ALN dissection following the diagnosis of Mac-m in the sentinel node (SN) was studied. In all the cases the MAC-m linear size was evaluated and correlated with presence or absence of non-SN ALN metastases. RESULTS Non-SN metastases were detected in 644∖1464 cases (43.98%). The risk of further axillary metastases ranged from 20.2% (37/183) in cases with Mac-m between 2 and 2.9 mm, to 65.3% (262/401) in cases with Mac-m measuring > 10 mm. The risk of non-SN ALN metastases showed a 3% increase, parallel to each mm increment in SN metastasis size. The data evaluated with the receiver operating characteristic (ROC) curve showed that the Mac-m could be subdivided according to a new cut-off of 7 mm. pT1 tumours, with Mac-m < 7 mm had a risk of non-SN ALN metastases of <30%. Furthermore 109/127 of these (85.8%) had 3 or less non-SN ALN -metastases. CONCLUSIONS The present data give a detailed description on the risk of non-SN ALN involvement, that may be useful in the evaluation of breast cancer patients. It is suggested that a Mac-m size of <7 mm is related to a low residual axillary disease burden in breast cancer patients with small (pT1) tumours.
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13
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Badiu CD, Aungurenci A, Manea CA, Tomosoiu R, Chirca N, Rahnea-Nita G, Andronache L, Grigorean VT, Madan VL. Axillary skin metastasis of renal cell carcinoma-Case report. Int J Surg Case Rep 2017; 34:74-76. [PMID: 28371635 PMCID: PMC6319084 DOI: 10.1016/j.ijscr.2016.11.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Metastatic diseases are seen in approximately 25% of all cases with renal cell carcinoma and sometimes they can appear in unusual sites. CASE PRESENTATION We present a 35-year old patient with a painful left axillary mass which causes the functional impairment of the left arm. The axillary mass appeared 2 years after the nephrectomy performed for a left renal cell carcinoma. Numerous metastases have been identified through CT scans during the postoperative evolution of the disease for which the patient underwent adjuvant therapy with tyrosine-kinase inhibitors. DISCUSSIONS Particular to our case is not just the rare metastatic site but also the fact that the tumor appeared despite the adjuvant therapy with tyrosine-kinase inhibitors. Unfortunately, the prognosis of metastatic RCC with skin metastasis is in most cases unfavorable. CONCLUSIONS We believe that our case could add more information to subsequent measures, complete the frame of rare oncologic cases and consolidate the data published on the topic so far.
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Affiliation(s)
- Cristinel D Badiu
- Clinical Emergency Hospital "Bagdasar-Arseni", Bucharest, Romania; University of Medicine and Pharmacy "Dr. Carol Davila", Bucharest, Romania
| | | | - Cristina A Manea
- Clinical Emergency Hospital "Bagdasar-Arseni", Bucharest, Romania
| | - Radu Tomosoiu
- Clinical Hospital "Prof. Dr. Th. Burghele", Bucharest, Romania
| | - Narcis Chirca
- Clinical Hospital "Prof. Dr. Th. Burghele", Bucharest, Romania
| | | | - Liliana Andronache
- University of Medicine and Pharmacy "Dr. Carol Davila", Bucharest, Romania
| | - Valentin T Grigorean
- Clinical Emergency Hospital "Bagdasar-Arseni", Bucharest, Romania; University of Medicine and Pharmacy "Dr. Carol Davila", Bucharest, Romania
| | - Victor L Madan
- University of Medicine and Pharmacy "Dr. Carol Davila", Bucharest, Romania; University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania
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Abstract
Context: Assigning grade to breast cancer on FNAC provides prognostic information and guides optimal therapy. Aims: The present study was undertaken to grade breast carcinoma on cytology by Robinson's grading system and correlate it with Elstons modified Bloom Richardson histological grading system. Settings and Design: It is a prospective study done on fifty cases of breast cancer reported on cytology. Materials and Methods: Fifty patients who underwent FNAC and mastectomy for breast carcinoma were cytologically and histologically graded. Correlation between cytological and histological grading system was determined. Sensitivity and specificity of Robinson's cytological grading system was calculated in each grade. All cases evaluated for presence of metastasis to axillary lymph nodes. Statistical Analysis Used: Correlation between cytological and histological grading was established using the non parametric Spearman’ s correlation coefficient. Results: Concordance rate between cytological and histological grade was 78%. The coefficient of correlation between cytological grade and histological grade was 0.804 and P value was <0.001 which indicated a strong correlation and significant association between the cytological and histological grade. Sensitivity was maximum in cytological grade I tumors (100%) and least in cytological grade III tumors (45.45%). Specificity was maximum in cytological grade III tumors (94.87%) and least in cytological grade II tumors (72.72%). The incidence of axillary lymph node metastasis was maximum in cytological grade III tumors and grade I tumors. Conclusions: Cytological grade strongly predicts histological grade and is useful in selecting neoadjuvant chemotherapy.
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Affiliation(s)
- Shweta Pal
- Department of Pathology, Rabindra Nath Tagore (RNT) Medical College, Udaipur, Rajasthan, India
| | - Mohan Lal Gupta
- Department of Pathology, Geetanjali Medical College, Udaipur, Rajasthan, India
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Saxena AK, Goyal N, Singhal J, Kumar P. Primary ovarian serous adenocarcinoma with ipsilateral axillary lymph node metastasis: a case report. Indian J Surg Oncol 2014; 5:224-6. [PMID: 25419072 DOI: 10.1007/s13193-014-0323-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 06/06/2014] [Indexed: 01/03/2023] Open
Abstract
Axillary lymph node metastasis from primary ovarian cancer is rare. Here, we reporting a unique case of 45 years old who presented with axillary lymph node metastasis which was thought from breast carcinoma but it turned out to be due to ovarian serous adenocarcinoma confirmed by histopathology & immunohistochemistry. Staging laparotomy (IIIc) with hysterectomy with bilateral salpingo-oophorectomy was done. Post-operatively, the patient was given adjuvant chemotherapy. No local or systemic recurrence was noted during 1 year follow up period.
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Affiliation(s)
| | - Nitin Goyal
- Room-44, New PG Hostel, SN Medical College, Agra, India
| | | | - Parveen Kumar
- Room-41, New PG Hostel, SN Medical College, Agra, India
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16
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Abstract
BACKGROUND Evaluation of cytologic features is indispensable in the preoperative diagnosis and grading of infiltrating ductal breast carcinoma (CA) in fine-needle aspiration cytology (FNAC) material and this method can also provide additional information regarding intrinsic features of the tumor as well as its prognosis. AIM This study has been done to evaluate comparatively the cytologic and histomorphologic grading of infiltrating ductal carcinoma of breast with specific reference to lymph node metastasis and its role in prognostication. MATERIALS AND METHODS Forty three patients who underwent FNAC and mastectomy for infiltrating ductal carcinoma were cytologically and histologically graded (employing Robinson's cytologic grading system and Elston's modification of Bloom-Richardson system, respectively). Statistical analysis was done employing 'z' test and χ(2) test to compare the two grading system and to examine the degree of correlation between the cytologic and histologic grades. Multiple regression analysis was done to assess the significance of every cytologic and histologic parameter. All 43 cases, graded cyto-histologically were also evaluated for presence or absence of metastasis to the regional lymph nodes employing χ(2) test. RESULTS With histologic grade taken as the standard, cytology was found to be fairly comparable, for grading breast carcinoma (overall sensitivity 89.1%, specificity 100%). Further comparison of the two grading systems by Z-test showed that difference between the cytologic and histologic grading was insignificant in all the three grade (P > 0.05). Of the six parameters studied, cell dissociation, nucleoli and chromatin pattern were the most influential features (P < 0.001). The statistically significant difference (p < 0.001) was found in incidences of axillary lymph node metastatic rate in three cytologic grades (15.4% in grade I vs. 83.3% in grade III) as well. CONCLUSIONS Apart from being simple and noninvasive, cytologic grading is comparable to histologic grading and might provide relevant information on the aggressiveness of invasive ductal carcinoma of breast and could be a useful parameter to take into consideration when selecting mode of therapy and to predict tumor behavior.
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Affiliation(s)
- Nazoora Khan
- Department of Pathology, J.N. Medical College, A.M.U., Aligarh - 202 002, India
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