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1

Axillary Lymph Nodes and Breast Cancer  

MedlinePLUS

Axillary Lymph Nodes FACTS FOR LIFE For more information, call Susan G. Komen for the Cure ® at 1-877 ... www.komen.org. Lymphatic system and axillary nodes Lymph nodes are small clumps of immune cells that ...

2

Sentinel lymph node biopsy alone without axillary lymph node dissection – follow up of sentinel lymph node negative breast cancer patients  

Microsoft Academic Search

Aims: To evaluate the rate of axillary recurrences in sentinel lymph node (SLN) negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND).Methods: Between May 1999 and February 2001 all patients who had primary invasive breast cancer and were SLN negative were eligible for this prospective study. SLNB was performed by using

R Reitsamer; F Peintinger; E Prokop; C Menzel; W Cimpoca; L Rettenbacher

2003-01-01

3

Factors Predicting the Axillary Lymph Node Metastasis in Breast Cancer: Is Axillary Node Clearance Indicated in Every Breast Cancer Patient?  

Microsoft Academic Search

The study was carried out to find out predictors of axillary lymph node metastasis in breast cancer and to evaluate its significance\\u000a in selecting the group of patients in whom axillary dissection could be avoided. Ninety-five breast cancer patients who underwent\\u000a mastectomy and axillary dissection were included in the study. Factors like patient’s age, tumor size, histopathological type,\\u000a histological grade

Amrut V. Ashturkar; Gayatri S. Pathak; Sanjay D. Deshmukh; Harshal T. Pandave

4

Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol  

PubMed Central

Background For patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients. With improvements in adjuvant therapy, routine axillary treatment may no longer offer any overall advantage. Objectives To assess the short and long term benefits and adverse effects of routine axillary treatment (axillary lymph node clearance or axillary radiotherapy) for patients with lymph node positive early-stage breast cancer. Methods/Design Criteria for potentially eligibility for the study will be that the participants are men and women with early breast cancer and lymph nodes with metastasis. The study compares either axillary treatment with no axillary treatment, or axillary node clearance with axillary radiotherapy, and the study is a randomized trial. Primary outcomes are axillary recurrence, disease-free and overall survival. Secondary outcomes include breast or chest wall recurrence, distant metastasis, time to axillary recurrence, axillary recurrence-free survival, arm morbidity, quality of life and health economic costs. The search strategy will include the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform (ICTRP) search portal. Two independent reviewers will assess studies for inclusion in the review, assess study quality and extract data. Characteristics of included studies will be described. Meta-analysis will be conducted using ReVman software. Comment This review addresses an important clinical question, and results will inform clinical practice and health care policy.

2013-01-01

5

Axillary lymph node metastasis from serous ovarian cancer: a case report and review of the literature  

Microsoft Academic Search

Introduction  The symptoms and findings of ovarian cancer are parallel with the degree of intra-abdominal expansion of the tumor. Metastases\\u000a in the early stage occur by peritoneal fluid’s tracking via the circulatory system. Renal and cerebral metastases of ovarian\\u000a cancer have been previously reported, but axillary lymph node metastasis is quite rare. Axillary lymph node metastasis usually\\u000a occurs in the advanced

Çetin Aydin; Haluk R. Ünalp; Ali Balo?lu; Ay?e Gül ?nci; Seyran Yi?it; Ali Yavuzcan

2009-01-01

6

Feasibility of sentinel lymph node biopsy in breast cancer patients clinically suspected of axillary lymph node metastasis on preoperative imaging  

PubMed Central

Background Generally, sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI). Methods A prospectively maintained database of 767 breast cancer patients enrolled between January 2006 and December 2009 was reviewed. All patients were offered preoperative breast ultrasound, magnetic resonance imaging, and positron emission tomography scanning. SI patients were regarded as those for whom preoperative imaging was “suspicious for axillary LN metastasis” and NSI as “non-suspicious for axillary LN metastasis” on preoperative imaging techniques. Patients were subgrouped by presence of SI and types of axillary operation, and analyzed. Results For 323 patients who received SLNB, there was no statistically significant difference in axillary recurrence (P=0.119) between SI and NSI groups. There also was no significant difference in axillary recurrence between SLNB and axillary lymph node dissection (ALND) groups in 356 SI patients (P=0.420). The presence of axillary LN metastasis on preoperative imaging carried 82.1% sensitivity and 45.9% specificity for determining axillary LN metastasis on the final pathology. Conclusions SLNB in SI patents is safe and feasible. Complications might be avoided by not performing ALND. Therefore, we recommend SLNB, instead of a direct ALND, even in SI patients, for interpreting the exact nodal status and avoiding unnecessary morbidity by performing ALND.

2013-01-01

7

The Prognostic Significance of the Lymph Node Ratio in Axillary Lymph Node Positive Breast Cancer  

PubMed Central

Purpose This study evaluated the prognostic impact of the lymph node ratio (LNR; i.e., the ratio of positive to dissected lymph nodes) on recurrence and survival in breast cancer patients with positive axillary lymph nodes (LNs). Methods The study cohort was comprised of 330 breast cancer patients with positive axillary nodes who received postoperative radiotherapy between 1987 and 2004. Ten-year Kaplan-Meier locoregional failure, distant metastasis, disease-free survival (DFS) and disease-specific survival (DSS) rates were compared using Kaplan-Meier curves. The prognostic significance of the LNR was evaluated by multivariate analysis. Results Median follow-up was 7.5 years. By minimum p-value approach, 0.25 and 0.55 were the cutoff values of LNR at which most significant difference in DFS and DSS was observed. The DFS and DSS rates correlated significantly with tumor size, pN classification, LNR, histologic grade, lymphovascular invasion, the status of estrogen receptor and progesterone receptor. The LNR based classification yielded a statistically larger separation of the DFS curves than pN classification. In multivariate analysis, histologic grade and pN classification were significant prognostic factors for DFS and DSS. However, when the LNR was included as a covariate in the model, the LNR was highly significant (p<0.0001), and pN classification was not statistically significant (p>0.05). Conclusion The LNR predicts recurrence and survival more accurately than pN classification in our study. The pN classification and LNR should be considered together in risk estimates for axillary LNs positive breast cancer patients.

Kim, Ji-Yoon; Ryu, Mi-Ryeong; Choi, Byung-Ock; Park, Woo-Chan; Oh, Se Jeong; Won, Jong-Man

2011-01-01

8

In vitro diagnosis of axillary lymph node metastases in breast cancer by spectrum analysis of radio frequency echo signals  

Microsoft Academic Search

Axillary lymph node status is of particular importance for staging and managing breast cancer. Currently, axillary lymph node dissection is performed routinely in cases of invasive breast cancer because of the lack of accurate noninvasive methods for diagnosing lymph node metastasis. We investigated the diagnostic ability of ultrasonic tissue characterization based on spectrum analysis of backscattered echo signals to detect

Tsutomu Tateishi; Junji Machi; Ernest J. Feleppa; Robert Oishi; Jerry Jucha; Eugene Yanagihara; Laurence J. McCarthy; Tomoaki Noritomi; Kazuo Shirouzu

1998-01-01

9

FDG-PET for axillary lymph node staging in primary breast cancer  

Microsoft Academic Search

Management of the axilla in patients with operable breast cancer is still one of the most controversial areas in clinical oncology. The best procedure to examine the lymph nodes is still standard axillary lymph node dissection; nevertheless, the morbidity associated with this procedure is well known. Based on these considerations, it is important for progress in the treatment of operable

Flavio Crippa; Alberto Gerali; Alessandra Alessi; Roberto Agresti; Emilio Bombardieri

2004-01-01

10

[A case report of surgical treatment for axillary lymph node metastasis from descending colon cancer].  

PubMed

We report a rare case of a 78-year-old woman with metachronous axillary lymph node metastasis originating from descending colon cancer. Her past medical history included right mastectomy for breast cancer at age 53 and distal gastrectomy for gastric cancer at age 70. She underwent a left hemicolectomy for descending colon adenocarcinoma in April 2011. Four months after that operation, 3 enlarging nodules in the left lung and a swollen left axillary lymph node were detected by computed tomography. No tumor was detected in the left breast by ultrasonography and mammography. The lung tumors were resected thoracoscopically, and the left axillary lymph node was excised. These specimens were histologically diagnosed as moderately differentiated adenocarcinoma, which had metastasized from colon cancer, not from the previous breast or gastric cancer. She received adjuvant chemotherapy with uracil and tegafur (UFT) plus Leucovorin for 6 months and is still alive after 12 months without recurrence. PMID:23268040

Kikuchi, Isao; Nishimura, Yoji; Nishida, Kazunori; Nishimura, Yu; Ujiie, Hideki; Akiyama, Hirohiko; Hanawa, Hidetsugu; Yatsuoka, Toshimasa; Amikura, Katsumi; Kawashima, Yoshiyuki; Sakamoto, Hirohiko; Kurosumi, Masafumi; Tanaka, Yoichi

2012-11-01

11

Avoiding Axillary Treatment in Sentinel Lymph Node Micrometastases of Breast Cancer: A Prospective Analysis of Axillary or Distant Recurrence  

Microsoft Academic Search

Background  The need for axillary lymph node dissection (ALND) in breast cancer patients with sentinel lymph node (SLN) micrometastases\\u000a remains controversial. The aims of the study were to evaluate the locoregional failure and outcome of breast cancer patients\\u000a with sentinel node micrometastases who did not undergo completion ALND.\\u000a \\u000a \\u000a \\u000a Methods  Between November 2000 and December 2006, SLN biopsy was successfully performed in 1178

Sonia Pernas; Marta Gil; Ana Benítez; Maria Teresa Bajen; Fina Climent; Maria Jesús Pla; Enrique Benito; Anna Gumà; Cristina Gutierrez; Aleydis Pisa; Ander Urruticoechea; Javier Pérez; Miguel Gil Gil

2010-01-01

12

[A successful treatment by surgery for axillary lymph node recurrence of lung cancer].  

PubMed

This case concerns a 78-year-old man, who was diagnosed with lung cancer at the age of 73. He underwent right lobectomy and lymph node dissection, and pathological analysis revealed a poorly differentiated adenocarcinoma, pT1N0M0 pStage IA. 15 months after surgery, computed tomography showed recurrence of lung cancer at the apex of thoracic cavity. He underwent radiation to the recurrence site, and 33 months after surgery, fluorodeoxyglucose uptake was observed at the axillary and infraclavicular lymph nodes in positron emission tomography examination. Treatment with pemetrexed was started because carcinomatous pericarditis was also found. Although pericardial effusion disappeared, the patient complained of the enlarged size of the axillary and infraclavicular lymph nodes and severe numbness in an arm. Beyond lymph node involvement, no other metastatic sites were found. An operation was performed to relieve the pain and the pathological analysis of lymph nodes showed metastases of lung cancer. The operation successfully reduced the pain experienced by the patient. There has been no further recurrence in the 9 months following surgery. Axillary lymph node metastasis is thought to be a distant metastasis; however, this is a case where local control was needed and was effective. PMID:23268091

Oda, Goshi; Kobayashi, Toshiko; Yokosuka, Tetsuya; Yasuno, Masamichi

2012-11-01

13

The role of preoperative axillary lymph node fine needle aspiration in locoregional staging of breast cancer.  

PubMed

Preoperative ultrasound-guided fine needle aspiration cytology (UG-FNAC) of axillary lymph nodes in breast cancer emerged after the onset of the surgical sentinel node (SN) procedure. Today it is established as one of the preoperative routine procedures in patients with a cytological or histological confirmation or strong suspicion of breast carcinoma, the interest being that a positive UG-FNAC allows to avoid SLN biopsy or two-stage surgical procedure. Our article reviews the recent data in the literature regarding the diagnostic accuracy of lymph node FNAC in breast cancer staging, and presents the experience of the Breast Diagnostic Centre of Oslo University Hospital Ullevaal, Norway, in this context. Nowadays, UG-FNAC is indicated whenever the breast radiologist finds a suspicious or otherwise abnormal axillary lymph node, regardless of the size of the primary tumour. UG-FNAC is a cost effective and safe method. A diagnosis of metastatic malignancy has a very high accuracy and false-positives are virtually non-existent. False-negatives do occur, especially in lymph nodes with partial involvement as micrometastases and isolated tumor cells (ITC), and recent recommendations advocate that in these particular situations the axillary dissection is not necessary. PMID:23244481

Sauer, Torill; Suciu, Voichita

2012-11-22

14

The Role of Axillary Lymph Node Fine Needle Aspiration in Breast Cancer Staging prior to Chemotherapy with Histological Correlation  

Microsoft Academic Search

Objective: Axillary lymph node (LN) sampling is important for breast cancer staging and can be performed using fine needle aspiration (FNA). The aim of this study is to review the axillary LN FNAs performed at our institution prior to treatment, and to correlate their results with the available LN histology in order to evaluate the diagnostic utility of FNA. Study

Sara E. Monaco; Amy Colaizzi; Anisa Kanbour; Ahmed S. Ibrahim; Amal Kanbour-Shakir

2012-01-01

15

Axillary lymph node analysis using Raman spectroscopy  

NASA Astrophysics Data System (ADS)

Raman Spectroscopy is an optical diagnostic technique applied in this study to classify axillary lymph nodes from breast cancer patients as positive or negative for metastases. The mapping technique in this study is 81% sensitive and 97% specific for the correct classification of positive lymph nodes. Raman spectral images of lymph node sections are constructed to facilitate interpretation of tissue features.

Smith, Jenny; Christie-Brown, Jonathan; Sammon, Alastair; Stone, Nicholas

2004-07-01

16

Relationship of CD44+CD24-/low breast cancer stem cells and axillary lymph node metastasis  

PubMed Central

Background Axillary node staging plays an important role in the prognostic evaluation and planning of adjuvant treatment. Breast cancer stem cells, identified on the basis of CD44+CD24-/low expression, are associated with metastases and drug resistance. It is therefore important to investigate the proportion of CD44+CD24-/low breast cancer stem cells for the diagnosis of metastases in axillary nodes. Methods Thirty-two ipsilateral axillary lymph nodes were collected from patients diagnosed with invasive breast cancer. Each lymph node (LN) was divided into two equals – one was examined by H&E staining, while the other was made into a single cell suspension to study the content of CD44+CD24-/low cells by flow cytometry (FCM). The relationship was investigated between the content of CD44+CD24-/low cells and metastases in axillary nodes which were confirmed by histology. Associations were tested using the chi-square test (linear-by-linear association), and the significance level was set at a value of p < 0.05. Results In the 32 axillary nodes, the level of CD44+CD24-/low cells was determined to be between 0 and 18.4%: there was no presence of CD44+CD24-/low cells in 9 LNs, of which 2 had confirmed metastasis; there were less than 10% CD44+CD24-/low cells in 12 LNs, of which 6 had confirmed metastasis; and there were more than 10% CD44+CD24-/low cells in 11 LNs, of which 9 had confirmed metastasis. A higher percentage of detected CD44+CD24-/low cells was significantly associated with more confirmed LN metastases (p = 0.009). Conclusions CD44+CD24-/low breast cancer stem cells might help clinicians to determine the presence of LN metastases. However, its prognostic value remains unclear, while histological diagnosis is still the gold standard.

2012-01-01

17

Learning curve for the detection of axillary sentinel lymph node in breast cancer  

Microsoft Academic Search

Aim: Sentinel axillary lymph node (SALN) detection is a new technique. Surgeons must progress up a learning curve in order to guarantee quality and safety equivalent to axillary lymphadenectomy. To ensure accurate staging of patients this learning curve must include SALN detection and an axillary lymphadenectomy. The aim of our work was to validate the principles and evaluate the consequences

J. M. Classe; C. Curtet; L. Campion; C. Rousseau; M. Fiche; C. Sagan; I. Resche; R. Pioud; N. Andrieux; F. Dravet

2003-01-01

18

Axillary Irradiation as an Imperative Alternative to Axillary Dissection in Clinically Lymph Node-Negative but Sentinel Node-Positive Breast Cancer Patients?  

PubMed Central

At the moment, positive sentinel lymph node dissection (SLND) of the axilla is followed by axillary lymph node dissection (ALND) as standard of care. Recent data proves that omitting ALND after positive SLND in clinically lymph node-negative early stage breast cancer patients is feasible with low recurrence rates. The well known effect of radiotherapy to destroy occult tumor cells highly contributes to these results as a large extent of level I and II lymph nodes are unavoidably included in standard tangential radiation treatment fields. Reviewing the up to date published data on axillary lymph node treatment with radiotherapy, we hypothesize that full dosage coverage of level I and II of the axilla in early stage breast cancer will improve outcome and should be further evaluated.

Nitsche, Mirko; Hermann, Robert

2011-01-01

19

Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment  

PubMed Central

The aim of this study was to confirm the effectiveness of early physiotherapeutic stimulation for lymphatic flow progression in patients with breast cancer undergoing axillary dissection. This was a randomized experimental study on 22 patients who underwent lymphoscintigraphy in their arms on two different occasions, firstly without stimulation and secondly after randomization into two groups: without physiotherapeutic stimulation (WOPS; n=10) and with physiotherapeutic stimulation (WPS; n=12). The lymphoscintigraphy scan was performed with 99mTc-phytate administered into the second interdigital space of the hand, ipsilaterally to the dissected axilla, in three phases: dynamic, static, and delayed whole body imaging. Physiotherapeutic stimulation was carried out using Földi's technique. In both groups, images from the two examinations of each patient were compared. Flow progression was considered positive when, on the second examination, the radiopharmaceutical reached areas more distant from the injection site. Statistical analysis was used to evaluate frequencies, percentages and central trend measurements, and non-parametric tests were conducted. Descriptive analysis showed that the WPS and WOPS groups were similar in terms of mean age, weight, height, body mass index and number of lymph nodes removed. There were statistically significant associations between physiotherapeutic stimulation and radiopharmaceutical progression at all three phases of the study (p<0.0001). Early physiotherapeutic stimulation in breast cancer patients undergoing radical axillary dissection is effective, and can therefore be indicated as a preventive measure against lymphedema.

SARRI, ALMIR JOSE; MORIGUCHI, SONIA MARTA; DIAS, ROGERIO; PERES, STELA VERZINHASSE; DA SILVA, EDUARDO TINOIS; KOGA, KATIA HIROMOTO; ZUCCA MATTHES, ANGELO GUSTAVO; DOS SANTOS, MARCELO JOSE; DA ROCHA, EUCLIDES TIMOTEO; HAIKEL, RAPHAEL LUIZ

2010-01-01

20

A 10-year follow-up of treatment outcomes in patients with early stage breast cancer and clinically negative axillary nodes treated with tangential breast irradiation following sentinel lymph node dissection or axillary clearance  

Microsoft Academic Search

We compare long-term outcomes in patients with node negative early stage breast cancer treated with breast radiotherapy (RT)\\u000a without the axillary RT field after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND). We hypothesize\\u000a that though tangential RT was delivered to the breast tissue, it at least partially sterilized occult axillary nodal metastases\\u000a thus providing low nodal

A. Gabriella Wernicke; Robert L. Goodman; Bruce C. Turner; Lydia T. Komarnicky; Walter J. Curran; Paul J. Christos; Imraan Khan; Katherine Vandris; Bhupesh Parashar; Dattatreyudu Nori; K. S. Clifford Chao

2011-01-01

21

Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: A study from the Danish Breast Cancer Cooperative Group  

Microsoft Academic Search

BackgroundSentinel lymph node biopsy was implemented in the treatment of early breast cancer with the aim of reducing shoulder and arm morbidity. Relatively few prospective studies have been published where the morbidity was assessed by clinical examination. Very few studies have examined the impact on shoulder mobility of node positive patients having a secondary axillary dissection because of the findings

Anders Husted Madsen; Karen Haugaard; Jan Soerensen; Susanne Bokmand; Esbern Friis; Helle Holtveg; Jens Peter Garne; John Horby; Peer Christiansen

2008-01-01

22

Axillary recurrence after negative sentinel lymph node biopsy  

Microsoft Academic Search

Background Sentinel lymph node biopsy (SLNB) has almost totally replaced axillary lymph node dissection as the first-line axillary procedure\\u000a for node-negative breast cancer. SLNB has a false-negative rate of 0–22%, and regional nodal recurrence is a major concern\\u000a after SLNB. In this study, we assessed axillary recurrence and risk factors in breast cancer patients 40 months after negative\\u000a SLNB. Methods Of

Hee Jeong Kim; Byung Ho Son; Eun Wha Park; Woo Sung Lim; Jin Young Seo; Mi Ae Jang; Bo Kyong Ku; Sei Hyun Ahn

2009-01-01

23

Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer  

Microsoft Academic Search

The aim of this study was to investigate the nature and severity of the arm complaints among breast cancer patients after axillary lymph node dissection (ALND) and to study the effects of this treatment-related morbidity on daily life and well-being. 400 women, who underwent ALND as part of breast cancer surgery, filled out a treatment-specific quality of life questionnaire. The

J. M. M. A Ververs; R. M. H. Roumen; A. J. J. M. Vingerhoets; G. Vreugdenhil; J. W. W. Coebergh; M. A. Crommelin; E. J. Th. Luiten; O. J. Repelaer van Driel; M. Schijven; J. C. Wissing; A. C. Voogd

2001-01-01

24

Whole sentinel lymph node analysis by a molecular assay predicts axillary node status in breast cancer  

PubMed Central

Background: The one-step nucleic acid amplification (OSNA) assay is a rapid procedure for the detection of lymph node (LN) metastases using molecular biological techniques. The aim of this study was to assess the reliability of the whole sentinel lymph node (SLN) analysis by the OSNA assay as a predictor of non-SLN metastases. Methods: Consecutive 742 patients with breast cancer were enroled in the study. The association of non-SLN or ?4 LN metastases with clinicopathological variables was investigated using multivariate logistic analysis. Results: In total, 130 patients with a positive SLN who underwent complete axillary LN dissection were investigated. The frequency of non-SLN metastases in patients who were OSNA+ and ++ was 19.3% and 53.4%, respectively, and that in patients with ?4 LN metastases who were OSNA+ and ++ was 7.0% and 27.4%, respectively. The cytokeratin 19 (CK19) mRNA copy number (?5.0 × 103; OSNA++) in the SLN was the most significant predictors of non-SLN metastases (P=0.003). The CK19 mRNA copy number (?1.0 × 105) in the SLN was the only independent predictor of ?4 LN metastases (P=0.014). Conclusion: Whole SLN analysis using the OSNA assay could become a valuable method for predicting non-SLN and ?4 LN metastases.

Ohi, Y; Umekita, Y; Sagara, Y; Rai, Y; Yotsumoto, D; Matsukata, A; Baba, S; Tamada, S; Matsuyama, Y; Ando, M; Sagara, Y; Sasaki, M; Tsuchimochi, S; Tanimoto, A; Sagara, Y

2012-01-01

25

Accurate staging of axillary lymph nodes from breast cancer patients using a novel molecular method  

PubMed Central

Background: The one-step nucleic acid amplification (OSNA) assay is a molecular-based lymph-node metastasis detection procedure that can assess a whole node and yields semi-quantitative results for the detection of clinically relevant nodal metastases. We aimed to determine the performance of the OSNA assay as an accurate nodal staging tool in comparison with routine histological examination. Methods: Subjects comprised 183 consecutive patients with pT1-2 breast cancer who underwent axillary dissection after positive sentinel-node (SN) biopsy with the OSNA assay. Of these, for non-SN evaluation, 119 patients underwent OSNA assay evaluation, whereas 64 had single-section histology. We compared the detection rates of non-SN metastasis and upstaging rates from the SN stage according to the American Joint Committee on Cancer staging between the OSNA and histology cohorts. Results: OSNA detected more cases of non-SN metastases than histology (OSNA 66/119, 55.5% vs histology 13/64, 20.3% P<0.001), particularly micrometastases (36/119, 30.3% vs 1/64, 1.6% P<0.001). Total upstaging rates were similar in both cohorts (20/119, 16.8% vs 9/64, 14.1%, P=0.79). Conclusion: OSNA detects a far greater proportion of non-SN micrometastases than routine histological examination. However, upstaging rates after axillary dissection were not significantly different between both cohorts. Follow-up of the OSNA cohort is required to determine its clinical relevance.

Osako, T; Iwase, T; Kimura, K; Yamashita, K; Horii, R; Akiyama, F

2011-01-01

26

Raman spectroscopy in the assessment of breast cancer and axillary lymph node metastases  

NASA Astrophysics Data System (ADS)

Raman Spectroscopy is an optical diagnostic technique applied in this study to characterise breast tissue by biochemical signature spectra. In cross-validated results, Raman Spectroscopy identifies invasive breast carcinoma with 75 - 97% agreement with Histology opinion. Axillary lymph nodes from patients with breast carcinoma were mapped with confocal Raman Spectroscopy and colour-weighted principal component analysis (PCA) images were used to identify local biochemical features and correlate these with parallel section slides analysed with routine histology.

Smith, Jenny; Kendall, Catherine; Christie-Brown, Jay; Sammon, Alastair; Stone, Nicholas

2003-10-01

27

Tattoo pigment in axillary lymph node mimicking calcification of breast cancer.  

PubMed

A tattoo is defined as the intentional or accidental deposit of pigment into the skin. The phenomenon of skin tattooing is on the rise worldwide and complications of tattooing are increasingly being recognised in diagnostic and clinical medicine. We describe a case of calcification-like changes on mammography resembling that of breast malignancy as a result of tattoo pigment deposition in an axillary lymph node. Recognition of such changes in routine breast screening is crucial to avoid further unnecessary invasive investigations and surgery in such patients. PMID:23929611

Matsika, Admire; Srinivasan, Bhuvana; Gray, Janet Meryl; Galbraith, Christine Ruth

2013-08-08

28

Induction of lymphangiogenesis in and around axillary lymph node metastases of patients with breast cancer  

PubMed Central

We studied the presence of lymphangiogenesis in lymph node (LN) metastases of breast cancer. Lymph vessels were present in 52 of 61 (85.2%) metastatically involved LNs vs 26 of 104 (25.0%) uninvolved LNs (P<0.001). Furthermore, median intra- and perinodal lymphatic endothelial cell proliferation fractions were higher in metastatically involved LNs (P<0.001). This is the first report demonstrating lymphangiogenesis in LN metastases of cancer in general and breast cancer in particular.

Van den Eynden, G G; Van der Auwera, I; Van Laere, S J; Huygelen, V; Colpaert, C G; van Dam, P; Dirix, L Y; Vermeulen, P B; Van Marck, E A

2006-01-01

29

Ratio between positive lymph nodes and total excised axillary lymph nodes as an independent prognostic factor for overall survival in patients with nonmetastatic lymph node-positive breast cancer.  

PubMed

BACKGROUND.: The status of the axillary lymph nodes in nonmetastatic lymph node-positive breast cancer (BC) patients remains the single most important determinant of overall survival (OS). Although the absolute number of nodes involved with cancer is important for prognosis, the role of the total number of excised nodes has received less emphasis. Thus, several studies have focused on the utility of the axillary lymph node ratio (ALNR) as an independent prognostic indicator of OS. However, most studies suffered from shortcomings, such as including patients who received neoadjuvant therapy or failing to consider the use of adjuvant therapy and tumor receptor status in their analysis. METHODS.: We conducted a single-center retrospective review of 669 patients with nonmetastatic lymph nodepositive BC. Data collected included patient demographics; breast cancer risk factors; tumor size, histopathological, receptor, and lymph node status; and treatment modalities used. Patients were subdivided into four groups according to ALNR value (<.25, .25-.49, .50-.74, .75-1.00). Study parameters were compared at the univariate and multivariate levels for their effect on OS. RESULTS.: On univariate analysis, both the absolute number of positive lymph nodes and the ALNR were significant predictors of OS. On multivariate analysis, only the ALNR remained an independent predictor of OS, with a 2.5-fold increased risk of dying at an ALNR of ?.25. CONCLUSIONS.: Our study demonstrates that ALNR is a stronger factor in predicting OS than the absolute number of positive axillary lymph nodes. PMID:22695879

Hatoum, Hassan A; Jamali, Faek R; El-Saghir, Nagi S; Musallam, Khaled M; Seoud, Muhieddine; Dimassi, Hani; Abbas, Jaber; Khalife, Mohamad; Boulos, Fouad I; Tawil, Ayman N; Geara, Fadi B; Salem, Ziad; Shamseddine, Achraf A; Al-Feghali, Karine; Shamseddine, Ali I

2011-03-29

30

Lymphatic Invasion, Tumor Size, and Age Are Independent Predictors of Axillary Lymph Node Metastases in Women With T1 Breast Cancers  

PubMed Central

Objective To identify characteristics of the primary tumor highly associated with lymph node metastases. Summary Background Data Recent enthusiasm for limiting axillary lymph node dissection (ALND) in women with breast cancer may increase the likelihood that nodal metastases will be missed. Identification of characteristics of primary tumors predictive of lymph node metastases may prompt a more extensive surgical and pathologic search for metastases in patients with negative sentinel lymph nodes or limited ALND. Methods The authors studied 850 consecutive patients who underwent ALND for T1 breast cancer. Age, tumor size, histopathologic diagnosis, tumor differentiation, presence of lymphatic invasion, and estrogen and progesterone receptor results were studied prospectively. Stepwise logistic regression was used to identify variables independently associated with axillary lymph node metastases. Results Lymphatic invasion, tumor size, and age were independently associated with lymph node metastases. Fifty-one percent of the 181 patients with lymphatic invasion had axillary lymph node metastases, compared with 19% of the 669 patients without lymphatic invasion. Thirty-five percent of the 470 patients with tumors >1 cm had nodal involvement compared with 13% of the 380 patients with smaller cancers. Thirty-seven percent of the 63 women younger than age 40 had lymph node involvement compared with 25% of the 787 women older than age 40. Significant correlations were noted between lymphatic invasion and patient age and between lymphatic invasion and tumor size. The proportion of tumors with lymphatic invasion decreased progressively with increasing age and increased with increasing tumor size. Conclusions Axillary lymph node metastases are most significantly related to lymphatic invasion in the primary tumor, followed, in order of significance, by tumor size and patient age. Axillary nodal metastases should be suspected in the presence of lymphatic invasion of large tumors in young patients.

Gajdos, Csaba; Tartter, Paul Ian; Bleiweiss, Ira J.

1999-01-01

31

Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer  

Microsoft Academic Search

Background  A regional nodal recurrence is a major concern after a sentinel lymph node biopsy (SLNB) alone in patients with breast cancer.\\u000a In this study we investigated patterns and risk factors of regional nodal recurrence after SLNB alone.\\u000a \\u000a \\u000a \\u000a Patients and Methods  Between January 1999 and March 2005, a series of 1,704 consecutive breast cancer cases in 1,670 patients (34 bilateral breast\\u000a cancer

Hiroyuki Takei; Kimito Suemasu; Masafumi Kurosumi; Yoshio Horii; Takashi Yoshida; Jun Ninomiya; Miho Yoshida; Yasutaka Hagiwara; Mari Kamimura; Yuji Hayashi; Kenichi Inoue; Toshio Tabei

2007-01-01

32

Prediction of axillary lymph node metastasis in primary breast cancer patients using a decision tree-based model  

PubMed Central

Background The aim of this study was to develop a new data-mining model to predict axillary lymph node (AxLN) metastasis in primary breast cancer. To achieve this, we used a decision tree-based prediction method—the alternating decision tree (ADTree). Methods Clinical datasets for primary breast cancer patients who underwent sentinel lymph node biopsy or AxLN dissection without prior treatment were collected from three institutes (institute A, n?=?148; institute B, n?=?143; institute C, n?=?174) and were used for variable selection, model training and external validation, respectively. The models were evaluated using area under the receiver operating characteristics (ROC) curve analysis to discriminate node-positive patients from node-negative patients. Results The ADTree model selected 15 of 24 clinicopathological variables in the variable selection dataset. The resulting area under the ROC curve values were 0.770 [95% confidence interval (CI), 0.689–0.850] for the model training dataset and 0.772 (95% CI: 0.689–0.856) for the validation dataset, demonstrating high accuracy and generalization ability of the model. The bootstrap value of the validation dataset was 0.768 (95% CI: 0.763–0.774). Conclusions Our prediction model showed high accuracy for predicting nodal metastasis in patients with breast cancer using commonly recorded clinical variables. Therefore, our model might help oncologists in the decision-making process for primary breast cancer patients before starting treatment.

2012-01-01

33

Results of Preoperative Lymphoscintigraphy for Breast Cancer Are Predictive of Identification of Axillary Sentinel Lymph Nodes  

Microsoft Academic Search

The aim of this study was to identify the variables associated with successful peroperative sentinel lymph node (SLN) localization.\\u000a We studied 201 patients with T1, T2, N0 invasive breast cancer who underwent a SLN procedure from 1999 to 2003. Of these 201\\u000a patients, 55 underwent peritumoral and 146 underwent periareolar radioisotope injection before the blue dye injection. All\\u000a patients were

Frédéric Marchal; Philippe Rauch; Olivier Morel; Jean Claude Mayer; Pierre Olivier; Agnès Leroux; Jean Luc Verhaeghe; François Guillemin

2006-01-01

34

[Axillary reverse mapping. preserving nodes during an axillary lymph node dissection].  

PubMed

A considerable percentage of breast cancer patients who have undergone an axillary lymph node dissection (ALND) experience postoperative complications, with lymphoedema occurring most frequently. Axillary Reverse Mapping (ARM) is a new technique in which the lymphatic drainage system of the upper extremity can be visualized during an ALND. If lymphoedema is caused by severing of the lymphatic drainage system or removal of its associated lymph nodes, the preservation of these structures should reduce the incidence of lymphoedema. Patients who might benefit from ARM are patients for whom a subsequent ALND is indicated following a positive sentinel lymph node diagnostic procedure, and perhaps also patients who have an indication for a primary ALND following neo-adjuvant chemotherapy. A multicenter RCT is to start in the near future, during which we will investigate whether the preservation of axillary lymph nodes results in reduced morbidity. PMID:23714290

Gobardhan, Paul D; Klompenhouwer, Elisabeth G; Beek, Martinus A; Voogd, Adri C; Luiten, Ernest J T

2013-01-01

35

Correlation of breast cancer axillary lymph node metastases with stem cell mutations.  

PubMed

IMPORTANCE Mutations in oncogenes AKT1, HRAS, and PIK3CA in breast cancers result in abnormal PI3K/Akt signaling and tumor proliferation. They occur in ductal carcinoma in situ, in breast cancers, and in breast cancer stem and progenitor cells (BCSCs). OBJECTIVES To determine if variability in clinical presentation at diagnosis correlates with PI3K/Akt mutations in BCSCs and provides an early prognostic indicator of increased progression and metastatic potential. DESIGN, SETTING, AND PARTICIPANTS Malignant (BCSCs) and benign stem cells were collected from fresh surgical specimens via cell sorting and tested for oncogene mutations in a university hospital surgical oncology research laboratory from 30 invasive ductal breast cancers (stages IA through IIIB). MAIN OUTCOMES AND MEASURES Presence of AKT1, HRAS, and PIK3CA mutations in BCSCs and their correlation with tumor mutations, pathologic tumor stage, tumor histologic grade, tumor hormone receptor status, lymph node metastases, and patient age and condition at the last follow-up contact. RESULTS Ten tumors had mutations in their BCSCs. In total, 9 tumors with BCSC mutations and 4 tumors with BCSCs without mutations had associated tumor present in the lymph nodes (P?=?.001). CONCLUSIONS AND RELEVANCE Tumors in which BCSCs have defects in PI3K/Akt signaling are significantly more likely to manifest nodal metastases. These oncogenic defects may be missed by gross molecular testing of the tumor and are markers of more aggressive breast cancer. Molecular profiling of BCSCs may identify patients who would likely benefit from PI3K/Akt inhibitors, which are being tested in clinical trials. PMID:23884447

Donovan, Cory A; Pommier, Rodney F; Schillace, Robynn; O'Neill, Steven; Muller, Patrick; Alabran, Jennifer L; Hansen, Juliana E; Murphy, Jennifer A; Naik, Arpana M; Vetto, John T; Pommier, Suellen J

2013-09-01

36

Outcomes of locally advanced breast cancer patients with ? 10 positive axillary lymph nodes.  

PubMed

Breast cancers with 10 or more positive lymph nodes at the time of diagnosis are staged as pathological N3a (pN3a) and they have poor prognosis. Recent studies showed five-year disease-free survival (DFS) and overall survival (OS) rates of N3a disease as 43-66 and 58-81 %, respectively. We herein present outcomes of our patients with stage pN3a breast cancer. Among 2,578 patients diagnosed with invasive breast carcinoma at Hacettepe University Hospital between 2002 and 2012, 218 patients (8.4 %) had pN3a disease and were included and analyzed retrospectively in this study. Patients with internal mammary, infraclavicular, and supraclavicular node metastasis or distant metastasis at initial diagnosis were excluded. Demographic features, tumor characteristics, treatment regimens, and patient outcomes in terms of DFS and OS were analyzed. Lymph node ratio was defined as the ratio of positive to total removed lymph nodes. The median age was 49. Most common histological subtype was ductal carcinoma (82.1 %). About 82.6 % of patients had stage T2/T3 cancers and 47.7 % (104) had grade III cancers. Estrogen and progesterone receptors were positive in 133 (61 %) and 121 (55.5 %) patients, respectively. HER2 status was known for 213 patients and was positive in 87 (39.9 %) patients. A total of 27 (12.6 %) patients had triple-negative tumors. Lymphovascular invasion, extracapsular extension, and perineural invasion were present in 106 (48.6 %), 105 (48.2 %), 20 (9.2 %) cases, respectively. A total of 18 patients (8.3 %) received neoadjuvant and 200 patients (91.7 %) received adjuvant chemotherapy, mostly with anthracycline- (95 %) and taxane (60 %)-containing regimens. A total of 210 patients (96.3 %) received radiotherapy. Median follow-up was 39.5 months. A total of 96 patients relapsed on follow-up and 64 patients died. Nineteen of the relapses were locoregional and 77 were distant relapses. The 5-year DFS rate was 46.2 % and the OS rate was 69.8 %. In multivariate Cox regression analysis, grade III disease (HR 1.899, 95 % CI 1.196-3.017, P = 0.007), perineural invasion (HR 2.519, 95 % CI 1.341-4.731, P = 0.004), and lymph node ratio (? 0.9 vs. <0.9) (HR 2.290, 95 % CI 1.368-3.835, P = 0.002) were significantly associated with DFS, and grade III disease (HR 2.679, 95 % CI 1.500-4.782, P = 0.001) and lymph node ratio (? 0.9 vs. <0.9) (HR 2.182, 95 % CI 1.211-3.932, P = 0.009) were significantly associated with OS. Patients with pN3a disease in our cohort have comparable survival rates with other reports in the literature. Within this high risk group of patients, those with grade III disease, perineural invasion, and lymph node ratio ? 0.9 seem to confer poorer prognosis. PMID:23729267

Koca, Emre; Kuzan, Taha Y; Dizdar, Omer; Babacan, Taner; Sahin, Ilyas; Ararat, Erhan; Altundag, Kadri

2013-06-01

37

Prognostic Value of Metastatic Axillary Lymph Node Ratio for Chinese Breast Cancer Patients  

PubMed Central

Objective The prevalence of breast cancer varies among countries and regions. This retrospective study investigated the prognostic value of the lymph node ratio (LNR) compared with the number of positive lymph nodes (pN) in Chinese breast cancer patients. Methods The medical records of female breast cancer patients (N?=?2591) were retrospectively evaluated. The association of LNR and TMN staging system were compared with respect to overall, disease-free, and distant metastasis-free survival. Results Out of 2591 patients, 2495 underwent modified radical surgery and 96 received breast conserving surgery. All patients had adjuvant chemotherapy following surgery. The median follow up period 66.9 months (range 5–168 months). The 5-year and 10-year overall survival rates were 89.3% and 78.8%, respectively, and 5-year disease-free survival and distant metastasis-free survival rates were 81.6% and 83.5%, respectively. Univariate analysis indicated that in general T, pN, LNR, as well as tumor expression of the estrogen receptor, progesterone receptor, and HER2 were associated with overall, disease-free, and distant metastasis-free survival (all P-values <0.05). Mutlivariate analysis found pN stage and LNR were independent predictors of overall, disease-free, and distant metastasis-free survival (all P-values <0.001). If pN stage and LNR were both included in a multivariate analysis, LNR was still an independent prognostic factor for overall, disease-free, and distant metastasis-free survival (all P-values <0.001). Conclusion Our findings support the use of LNR as a predictor of survival in Chinese patients with breast cancer, and that LNR is superior to pN stage in determining disease prognosis.

Li, Qun; Sun, Jia-Yuan; Li, Feng-Yan; Lin, Qin; Lin, Huan-Xin; Guan, Xun-Xing

2013-01-01

38

Detection of lymphovascular invasion in early breast cancer by D2-40 (podoplanin): a clinically useful predictor for axillary lymph node metastases  

Microsoft Academic Search

Purpose The aim of this study was to investigate the use of D2-40 for the detection of lymphovascular invasion (LVI) in node positive\\u000a and negative early breast cancer. LVI is associated with axillary lymph node metastases (ALNM) and a long-term prognostic\\u000a factor. A precise identification of LVI would have a strong clinical impact for breast cancer patients. Methods Immunohistochemical staining

Michael Braun; Uta Flucke; Manuel Debald; Gisela Walgenbach-Bruenagel; Klaus-Jürgen Walgenbach; Tobias Höller; Martin Pölcher; Matthias Wolfgarten; Axel Sauerwald; Mignon Keyver-Paik; Marietta Kühr; Reinhard Büttner; Walther Kuhn

2008-01-01

39

Percutaneous tattoo pigment simulating calcific deposits in axillary lymph nodes  

PubMed Central

The isolated finding of calcific deposits within axillary lymph nodes on mammography suggests a broad range of differential diagnoses, from benign causes such as granulomatous reaction secondary to previous histoplasmosis infection to malignancies such as breast cancer and metastatic disease from extramammary primary malignancies. Therefore, the isolated finding of intranodal calcium may warrant biopsy for a definitive diagnosis when a benign etiology is not apparent. We present a patient with isolated axillary lymph node densities on mammography and chest computed tomography, which were subsequently proven to represent deposition of tattoo pigment.

Yactor, Amy R.; Michell, Michael N.; Koch, Meghan S.; Leete, Tyler G.; Shah, Zeeshan A.; Carter, Brett W.

2013-01-01

40

Contralateral Axillary Lymph Node Metastases at the Time of Primary Breast Cancer Diagnosis: Curative or Palliative Intent?  

PubMed Central

Contralateral axillary lymph node metastases (CAMs) in breast cancer patients are uncommon. CAM can be found at the time of primary breast cancer diagnosis or following prior treatment of breast cancer as a recurrence. This distinction may have important implications for disease staging and treatment selection. We report the case of a premenopausal woman with synchronous CAM. Despite extensive multimodality treatment, a recurrence was found 27 months after primary surgery. We reviewed the literature on histopathological tumor characteristics associated with CAM, lymphatic drainage of the breast to other sites than the ipsilateral axilla, and outcome of cases with CAM. This case contradicts current conceptions that CAM only develops from tumors with poor histopathological features. Emerging evidence shows that altered lymphatics play a central role in development of synchronous CAM. It is precisely this etiology that supports the concept that synchronous CAM occurs by lymphatic spread and not by hematogenous spread. Although controversial, treatment of synchronous CAM (without evidence of distant metastases) should therefore be of curative intent.

Zhou, C.; Richir, M. C.; Leenders, M. W. H.; Langenhorst, B. L. A. M.; Knol, H. P.; Schreurs, W. H.

2013-01-01

41

The Prognostic Effect of the Number of Histologically Examined Axillary Lymph Nodes in Breast Cancer: Stage Migration or Age Association?  

Microsoft Academic Search

Background  The number of pathologically examined axillary nodes has been associated with breast cancer survival, and examination of ?10\\u000a nodes has been advocated for reliable axillary staging. The considerable variation observed in axillary staging prompted this\\u000a population-based study, which evaluated the prognostic effect of a variable number of pathologically examined nodes.\\u000a \\u000a \\u000a \\u000a Methods  In total, 5314 consecutive breast cancer patients who underwent mastectomy

Michael Schaapveld; Elisabeth G. E. de Vries; Renée Otter; Jakob de Vries; Pax H. B. Willemse

2006-01-01

42

Feasibility of FDG PET/CT to monitor the response of axillary lymph node metastases to neoadjuvant chemotherapy in breast cancer patients  

PubMed Central

Purpose The aim of this study was to assess the accuracy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT to visualize lymph node metastases before the start of neoadjuvant chemotherapy and to determine how often the visualization is sufficiently prominent to allow monitoring of the axillary response. Methods Thirty-eight patients with invasive breast cancer of >3 cm and/or lymph node metastasis underwent FDG PET/CT before neoadjuvant chemotherapy. The results of the FDG PET/CT were compared with those from ultrasonography with fine-needle aspiration (FNA) cytology or sentinel node biopsy. Patients suitable for response monitoring of the axilla were defined as having either a maximum standardized uptake value (SUVmax)???2.5 or a tumour to background ratio ?5 in the most intense lymph node. Results The sensitivity and specificity of FDG PET/CT in detecting axillary involvement were 97 and 100%, respectively. No difference existed between the SUVmax of the primary tumour and that from the related most intense lymph node metastasis. Moreover, the mean tumour to background ratio was 90% higher in the lymph nodes compared to the primary tumour (p?=?0.006). Ninety-three per cent of the patients had sufficient uptake in the lymph nodes to qualify for subsequent response monitoring of the axilla. A considerable distinction in metabolic activity was observed between the different subtypes of breast cancer. The mean SUVmax in lymph node metastases of oestrogen receptor (ER)-positive, triple-negative and human epidermal growth factor receptor 2 (HER2)-positive tumours was 6.6, 11.6 and 6.6, respectively. Conclusion The high accuracy in visualizing lymph node metastases and the sufficiently high SUVmax and tumour to background ratio at baseline suggest that it is feasible to monitor the axillary response with FDG PET/CT, especially in triple-negative tumours.

Straver, Marieke E.; Aukema, Tjeerd S.; Olmos, Renato A. Valdes; Rutgers, Emiel J. T.; Gilhuijs, Kenneth G. A.; Schot, Margaret E.; Vogel, Wouter V.

2010-01-01

43

Real-Time Intraoperative Detection of Breast Cancer Axillary Lymph Node Metastases Using a Green Fluorescent Protein-Expressing Herpes Virus  

PubMed Central

Objective: To investigate the use of a green fluorescent protein (GFP)-expressing oncolytic herpes virus to enable real-time intraoperative detection of breast cancer lymph node metastases. Summary Background Data: Axillary lymph node status is the most important factor determining treatment, recurrence, and overall survival for women with breast cancer. The current methods of determining nodal status, however, have limitations. NV1066 is a novel oncolytic herpes viral strain that specifically infects cancer cells and expresses GFP. Methods: Seven human breast cancer cell lines were infected in vitro with NV1066 and assessed for GFP expression, viral replication, and cytotoxicity. An in vivo model of breast cancer lymphatic metastasis was established in mice. Tumor-bearing mice were treated with NV1066 via injection into the primary tumor. Axillary lymph nodes were analyzed using an in vivo fluorescent imaging system. Histologic and molecular assessment of lymph nodes were performed using immunohistochemistry and reverse transcriptase PCR and operating characteristics were determined. Results: NV1066 infected, expressed GFP, replicated within, and killed all human breast cancer cell lines in vitro. Injection of NV1066 into primary breast tumors resulted in viral transit to axillary lymph nodes, infection of lymphatic metastases, and GFP expression that was visualized with in vivo fluorescent imaging. Histologic and molecular confirmation demonstrated favorable operating characteristics of this method (sensitivity 80%; specificity 96%). Conclusions: We introduce a novel, sensitive, and specific method of lymphatic mapping that utilizes NV1066-guided cancer cell-specific viral production of GFP to enable real-time intraoperative detection of lymphatic metastases.

Eisenberg, David P.; Adusumilli, Prasad S.; Hendershott, Karen J.; Chung, Sun; Yu, Zhenkun; Chan, Mei-Ki; Hezel, Michael; Wong, Richard J.; Fong, Yuman

2006-01-01

44

Prognosis of breast cancer: evidence for interaction between c-erbB-2 overexpression and number of involved axillary lymph nodes.  

PubMed

The prognostic significance of c-erbB-2 oncogene amplification or overexpression in relation to axillary lymph node metastasis is controversial. We investigated this question in 159 cases of operable breast cancer: 56 patients with node negative disease and 103 patients with pathological involvement of axillary lymph nodes. c-erbB-2 overexpression was assessed by immunohistochemistry using a polyclonal antibody raised against a synthetic peptide fragment of the oncoprotein. The overall incidence of c-erbB-2 overexpression was 35%. c-erbB-2 overexpression was significantly related to survival when all patients were considered (P = 0.0124), and also for patients with positive axillary lymph nodes (P = 0.0026). c-erbB-2 overexpression had no influence on survival of node negative patients (P = 0.7972). A multivariate survival analysis using the Cox proportional hazard model revealed that number of involved lymph nodes, c-erbB-2 overexpression, ER status, and tumour size were independently related to prognosis (P = 0.0000, 0.0012, 0.0112, and 0.0204, respectively). When an interaction term was introduced in the Cox model between c-erbB-2 overexpression and number of involved axillary lymph nodes, a statistically highly significant interaction between these two factors was observed (P = 0.0002), suggesting that the expression of prognostic power of c-erbB-2 overactivity is related to the number of involved axillary lymph nodes. The 159 patients were then subdivided into three groups: node negative (-ve) (56); 1-6 node positive (+ve) (55); and > or = 7 node +ve (48). This cutoff criterion gave the most numerically equitable distribution of the 159 patients into three groups. The relative risk of death increased stepwise from 0.86 (95% CI 0.26-2.78) for node negative patients, to 1.95 (95% CI 0.82-4.63) for 1-6 node positive patients, to 2.23 (95% CI 1.15-4.35) for > 7 node positive patients. Our results suggest that the prognostic influence of c-erbB-2 overexpression increases arithmatically with increasing number of involved axillary lymph nodes. PMID:7564375

Mittra, I; Redkar, A A; Badwe, R A

1995-10-01

45

The Comparative Study of Ultrasonography, Contrast-Enhanced MRI, and 18F-FDG PET/CT for Detecting Axillary Lymph Node Metastasis in T1 Breast Cancer  

PubMed Central

Purpose A more noninvasive evaluation of axillary lymph node in breast cancer is one of the principal challenges of breast cancer treatment. To detect axillary lymph node metastasis (ALNM) in T1 breast cancer, we have compared the axillary ultrasonography (AUS), contrast-enhanced magnetic resonance imaging (cMRI), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) to determine the most adequate test or a combination of tests. Methods Retrospectively, 349 T1 breast cancer patients who were preoperatively examined using AUS, cMRI, and PET/CT between 2008 and 2011 and whom underwent pathological evaluations of axillary lymph nodes were reviewed and analyzed. Results In total, 26.4% (92/349) of patients exhibited ALNM. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of AUS for determining ALNM were 44.6%, 88.7%, 58.6%, 81.7%, and 77.1%, respectively. cMRI was similar to AUS. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 44.5%, 94.2%, 73.2%, 82.6%, and 81.1%, respectively. The combination including cMRI and PET/CT was the most accurate with sensitivity, specificity, PPV, NPV, and accuracy values of 39.1%, 98.8%, 92.3%, 81.9%, and 83.1%, respectively. The mean number (3.5±4.2) of ALNMs in the patients who were positive based on cMRI and PET/CT and also pathologically proven to exhibit ALNM was significantly larger than the number (2.16±2.26) in other patients who exhibited ALNM (p=0.035). Conclusion There are no definitive modalities for detecting ALNM in T1 breast cancers to replace sentinel lymph node biopsy (SLNB). If ALNM is suspected based on cMRI and PET/CT, the axillary dissection without SLNB might be a better option because it is related to high possibilities of ALNM and large axillary metastatic volumes.

Hwang, Seung Ook; Lee, Sang-Woo; Kim, Hye Jung; Kim, Wan Wook; Park, Ho Yong

2013-01-01

46

Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging  

Microsoft Academic Search

Introduction  Axillary node fine needle aspiration cytology (FNAC) has the potential to triage women with operable breast cancer to initial\\u000a nodal surgical procedure. Because of variability in the reported accuracy of this test its role and clinical utility in pre-operative\\u000a staging remains controversial.\\u000a \\u000a \\u000a \\u000a Methods  We retrospectively evaluated the accuracy of ultrasound-guided axillary FNAC in all consecutive clinically T1–2 N0–1 breast\\u000a cancers that

Stefano Ciatto; Beniamino Brancato; Gabriella Risso; Daniela Ambrogetti; Paolo Bulgaresi; Cristina Maddau; Patricia Turco; Nehmat Houssami

2007-01-01

47

Axillary recurrence after sentinel lymph node biopsy  

Microsoft Academic Search

Sentinel lymph node biopsy (SLNB) without further axillary dissection in patients with sentinel node-negative breast carcinoma appears to be a safe procedure to ensure locoregional control. During a median follow-up of 35 months the false-negative rate was 1% in our study population of 185 patients.Background. The objective of this prospective study is to provide data on follow-up of patients with

B van der Vegt; M. H. E Doting; P. L Jager; J Wesseling; J de Vries

2004-01-01

48

Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients: long-term outcomes of a prospective study  

Microsoft Academic Search

Objectives  To evaluate the long-term disease-free and overall survival of patients with sentinel lymph node (SLN) micrometastases, in\\u000a whom a completion axillary lymph node dissection (ALND) was systematically omitted.\\u000a \\u000a \\u000a \\u000a \\u000a Background  The use of step sectioning and immunohistochemistry for SLN analysis results in a more accurate histopathologic examination\\u000a and a higher detection rate of micrometastases. However, the clinical relevance and therapeutic implications of

Igor Langer; Ulrich Guller; Carsten T. Viehl; Holger Moch; Edward Wight; Felix Harder; Daniel Oertli; Markus Zuber

2010-01-01

49

Axillary Lymph Node Dissection for Sentinel Lymph Node Micrometastases May Be Safely Omitted in Early-Stage Breast Cancer Patients: Long-Term Outcomes of a Prospective Study  

Microsoft Academic Search

Objectives  To evaluate the long-term disease-free and overall survival of patients with sentinel lymph node (SLN) micrometastases, in\\u000a whom a completion axillary lymph node dissection (ALND) was systematically omitted.\\u000a \\u000a \\u000a \\u000a \\u000a Background  The use of step sectioning and immunohistochemistry for SLN analysis results in a more accurate histopathologic examination\\u000a and a higher detection rate of micrometastases. However, the clinical relevance and therapeutic implications of

Igor Langer; Ulrich Guller; Carsten T. Viehl; Holger Moch; Edward Wight; Felix Harder; Daniel Oertli; Markus Zuber

2009-01-01

50

Molecular Detection of Micrometastatic Breast Cancer in Histopathology—Negative Axillary Lymph Nodes Fails to Predict Breast Cancer Recurrence: A Final Analysis of a Prospective Multi-Institutional Cohort Study  

Microsoft Academic Search

Background  To address the clinical relevance of molecular detection of occult breast cancer in sentinel lymph nodes and nonsentinel axillary\\u000a lymph nodes (ALN), we initiated the Minimally Invasive Molecular Staging of Breast Cancer (MIMS) trial, a multi-institutional\\u000a prospective cohort study. This trial represents the first prospective cohort study in which a multimarker, real-time reverse\\u000a transcription polymerase chain reaction (RT-PCR) analysis was

Carla Suzanne Fisher; David J. Cole; Michael Mitas; Elizabeth Garrett-Meyer; John S. Metcalf; William E. Gillanders; Kaidi Mikhitarian; Marshall M. Urist; G. Bruce Mann; Gerard Doherty; Virginia M. Herrmann; Arnold D. Hill; Oleg Eremin; Mohamed El-Sheemy; Richard K. Orr; Alvaro A. Valle; Michael A. Henderson; Robert L. Dewitty; Sonia L. Sugg; Eric Frykberg; Karen Yeh; Richard M. Bell; Megan K. Baker

2010-01-01

51

Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: A review  

Microsoft Academic Search

The purpose of this article is to provide a systematic review of Combined Physical Therapy, Intermittent Pneumatic Compression and arm elevation for the treatment of lymphoedema secondary to an axillary dissection for breast cancer. Combined Physical Therapy starts with an intensive phase consisting of skin care, Manual Lymphatic Drainage, exercises and bandaging and continues with a maintenance phase consisting of

Nele Devoogdt; Marijke Van Kampen; Inge Geraerts; Tina Coremans; Marie-Rose Christiaens

2010-01-01

52

Comparison of Mastoscopic and Conventional Axillary Lymph Node Dissection in Breast Cancer: Long-term Results From a Randomized, Multicenter Trial  

PubMed Central

Objective To compare the long-term results of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND). Patients and Methods From January 1, 2003, through December 31, 2005, a group of 1027 consecutive patients with operable breast cancer were randomly assigned to 1 of 2 study groups: MALND and CALND. The median follow-up was 63 months. The primary end points of the study were operative outcomes, complication reduction, function conservation, and cosmetics. The secondary end points were disease-free and overall survival. Results The mean operative blood loss in the MALND group was less than in the CALND group (P<.001). The patients who underwent MALND had less axillary pain, numbness or paresthesias, and arm swelling (P<.001). The aesthetic appearance of the axilla in the MALND group was much better than that in the CALND group (P=.001 at 6 months and P=.002 at 24 months). A significant difference was found between the 2 groups in distant metastasis (P=.04). The disease-free survival rate was 64.5% in the MALND group and 60.8% in the CALND group (P=.88). The overall survival rate was 81.7% in the MALND group and 78.6% in the CALND group (P=.95). Conclusion Compared with CALND, MALND has advantages in operative outcomes, complication reduction, function conservation, and cosmetics.

Luo, Chengyu; Guo, Wenbin; Yang, Jie; Sun, Qiuru; Wei, Wei; Wu, Suhua; Fang, Shubing; Zeng, Qingliang; Zhao, Zhensheng; Meng, Fanjie; Huang, Xuandong; Zhang, Xianlan; Li, Ruihua; Ma, Xiufeng; Luo, Chaoying; Yang, Yun

2012-01-01

53

International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases.  

PubMed

Recently, many centers have omitted routine axillary lymph node dissection (ALND) after metastatic sentinel node biopsy in breast cancer due to a growing body of literature. However, existing guidelines of adjuvant treatment planning are strongly based on axillary nodal stage. In this study, we aim to develop a novel international multicenter predictive tool to estimate a patient-specific risk of having four or more tumor-positive axillary lymph nodes (ALN) in patients with macrometastatic sentinel node(s) (SN). A series of 675 patients with macrometastatic SN and completion ALND from five European centers were analyzed by logistic regression analysis. A multivariate predictive model was created and validated internally by 367 additional patients and then externally by 760 additional patients from eight different centers. All statistical tests were two-sided. Prevalence of four or more tumor-positive ALN in each center's series (P = 0.010), number of metastatic SNs (P < 0.0001), number of negative SNs (P = 0.003), histological size of the primary tumor (P = 0.020), and extra-capsular extension of SN metastasis (P < 0.0001) were included in the predictive model. The model's area under the receiver operating characteristics curve was 0.766 in the internal validation and 0.774 in external validation. Our novel international multicenter-based predictive tool reliably estimates the risk of four or more axillary metastases after identifying macrometastatic SN(s) in breast cancer. Our tool performs well in internal and external validation, but needs to be further validated in each center before application to clinical use. PMID:23558360

Meretoja, Tuomo J; Audisio, R A; Heikkilä, P S; Bori, R; Sejben, I; Regitnig, P; Luschin-Ebengreuth, G; Zgajnar, J; Perhavec, A; Gazic, B; Lázár, G; Takács, T; K?vári, B; Saidan, Z A; Nadeem, R M; Castellano, I; Sapino, A; Bianchi, S; Vezzosi, V; Barranger, E; Lousquy, R; Arisio, R; Foschini, M P; Imoto, S; Kamma, H; Tvedskov, T F; Jensen, M-B; Cserni, G; Leidenius, M H K

2013-04-05

54

Outcome of small invasive breast cancer with no axillary lymph node involvement.  

PubMed

The prognosis and need or not for adjuvant therapy in patients with small breast tumors (?1cm N0) is the subject of controversy as regards the clinical benefit obtained, toxicity, and the economical costs generated. A retrospective analysis was made of 238 patients with early-stage breast cancer (pT1?1?cm N0M0) diagnosed between January 1993 and May 2008. As regards the systemic adjuvant treatments provided, (a) 122 (51%) received no treatment, (b) 102 (43%) received hormone therapy, (c) 9 (4%) chemotherapy, and (d) 5 (2%) received both hormone therapy and chemotherapy. An analysis was made of disease-free survival (DFS) and breast cancer-specific survival in our series of patients, and of their correlation to clinicopathological factors (age, tumor size, histological grade, estrogen receptor (ER) expression, HER-2 overexpression, and systemic adjuvant therapy). The median follow-up of this cohort was 63months (range 5-145). Some type of relapse was recorded in 4.2% of the patients (six patients presented local recurrence in all cases subjected to rescue treatment with surgery and/or radiotherapy, three patients developed distant metastases, and one patient presented a resected local recurrence followed by systemic relapse). The 5year DFS was 96%, and the 5year breast cancer-specific survival was 99.6%. A univariate analysis was made of the clinicopathological variables and their association to DFS. None of the variables was seen to be significantly correlated to shorter DSF except for an association between HER-2 overexpression and poor outcome borderline significance (p=0.07). The prognosis of our pT1?1cm N0M0 tumors was excellent, although the absence of systemic adjuvant therapy in one-half of the patients. PMID:21129091

Sánchez-Muñoz, Alfonso; Pérez-Ruiz, Elisabeth; Jurado, Jose Manuel; Ribelles, Nuria; Márquez, Antonia; Miramón, Jose; Maíz, Maria; Pajares, Bella; Gallego, Elena; Scholtz, Victoria; Jiménez, Begona; Soler, Concepcion; Molina, Manuel; García-Ríos, Isabel; Alba, Emilio

2010-12-06

55

Prognostic significance of axillary node and infraclavicular lymph node status after mastectomy  

Microsoft Academic Search

Aims: The American Joint Committee on Cancer staging system for breast carcinomas has been revised. According to this revised staging system, metastasis to infraclavicular lymph nodes and number of positive axillary nodes have prognostic significance and a new stage, stage IIIC, has been introduced. The aim of this study is to investigate the association of positive axillary nodes by level

B Kuru; M Camlibel; S Dinc; M. A Gulcelik; H Alagol

2003-01-01

56

Can clinically relevant prognostic subsets of breast cancer patients with four or more involved axillary lymph nodes be identified through immunohistochemical biomarkers? A tissue microarray feasibility study  

PubMed Central

Introduction Primary breast cancer involving four or more axillary lymph nodes carries a poor prognosis. We hypothesized that use of an immunohistochemical biomarker scoring system could allow for identification of variable risk subgroups. Methods Patients with four or more positive axillary nodes were identified from a clinically annotated tissue microarray of formalin-fixed paraffin-embedded primary breast cancers and randomized into a 'test set' and a 'validation set'. A prospectively defined prognostic scoring model was developed in the test set and was further assessed in the validation set combining expression for eight biomarkers by immunohistochemistry, including estrogen receptor, human epidermal growth factor receptors 1 and 2, carbonic anhydrase IX, cytokeratin 5/6, progesterone receptor, p53 and Ki-67. Survival outcomes were analyzed by the Kaplan–Meier method, log rank tests and Cox proportional-hazards models. Results A total of 313 eligible patients were identified in the test set for whom 10-year relapse-free survival was 38.3% (SEM 2.9%), with complete immunohistochemical data available for 227. Tumor size, percentage of positive axillary nodes and expression status for the progesterone receptor, Ki-67 and carbonic anhydrase IX demonstrated independent prognostic significance with respect to relapse-free survival. Our combined biomarker scoring system defined three subgroups in the test set with mean 10-year relapse-free survivals of 75.4% (SEM 7.0%), 35.3% (SEM 4.1%) and 19.3% (SEM 7.0%). In the validation set, differences in relapse-free survival for these subgroups remained statistically significant but less marked. Conclusion Biomarkers assessed here carry independent prognostic value for breast cancer with four or more positive axillary nodes and identified clinically relevant prognostic subgroups. This approach requires refinement and validation of methodology.

Crabb, Simon J; Bajdik, Chris D; Leung, Samuel; Speers, Caroline H; Kennecke, Hagen; Huntsman, David G; Gelmon, Karen A

2008-01-01

57

The usefulness of Tc-99m-tetrofosmin SPECT/CT in the detection of residual tumors and axillary lymph node metastases in breast cancer patients following neoadjuvant therapy.  

PubMed

Single photon emission computed tomography (SPECT)/CT is emerging as a useful diagnostic tool in several oncological fields. In this prospective study, we assessed the usefulness of Tc-99m-tetrofosmin SPECT/CT in the detection of both residual breast tumors and axillary lymph node metastases following neoadjuvant therapy. Thirty-seven consecutive breast cancer patients scheduled to surgery following neoadjuvant therapy preoperatively underwent a Tc-99m-tetrofosmin SPECT/CT study, using a dual head gamma camera integrated with a x-ray tube for low-dose CT, including both breasts and axillary regions in the field of view. Within 1 week of SPECT/CT, all 37 patients had breast surgery with associated axillary lymph node dissection in 33/37 cases. At surgery, 31/37 patients had breast residues (microscopic in 4/31 cases and macroscopic in 27/31 cases). Axillary lymph node metastases were ascertained in 19/33 cases (N1mi: 2 cases, N1a: 8 cases, N2a: 6 cases, N2b: 3 cases). SPECT/CT sensitivity, specificity, and accuracy in detecting residual tumors were 87%, 100%, and 89.2%, respectively; the corresponding values in detecting axillary lymph node metastases were 36.8%, 92.8%, and 60.6%. SPECT/CT missed breast cancer residues in 4/31 patients, including 2 cases with microscopic residual disease. Moreover, lymph node metastases were missed in 12/19 patients (10/12 with pN1mi or pN1a metastases), all with lymph nodes with post-therapy fibrotic changes and small deposits of metastases. Tc-99m-tetrofosmin SPECT/CT proved a useful diagnostic tool in the detection and in the localization of residual breast tumors following neoadjuvant therapy. The procedure lacked in sensitivity in identifying axillary lymph node metastases, especially in patients with a limited lymph node involvement. According to our data, SPECT/CT may guide the surgeon to the most appropriate breast surgical treatment and to eventually select the most suitable axillary lymph node sampling (axillary lymph node dissection or sentinel node biopsy). PMID:21975387

Spanu, Angela; Sanna, Daniela; Chessa, Francesca; Farris, Antonio; Nuvoli, Susanna; Madeddu, Giuseppe

2011-11-01

58

Effectiveness and cost-effectiveness of sentinel lymph node biopsy compared with axillary node dissection in patients with early-stage breast cancer: a decision model analysis  

PubMed Central

Background: Sentinel lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection (ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema and similar rates of locoregional recurrence up to 8 years. This study estimates the longer-term effectiveness and cost-effectiveness of SLNB. Methods: A Markov decision model was developed to estimate the incremental quality-adjusted life years (QALYs) and costs of an SLNB-based staging and management strategy compared with ALND over 20 years' follow-up. The probability and quality-of-life weighting (utility) of outcomes were estimated from published data and population statistics. Costs were estimated from the perspective of the Australian health care system. The model was used to identify key factors affecting treatment decisions. Results: The SLNB was more effective and less costly than the ALND over 20 years, with 8 QALYs gained and $883?000 saved per 1000 patients. The SLNB was less effective when: SLNB false negative (FN) rate >13% 5-year incidence of axillary recurrence after an SLNB FN>19% risk of an SLNB-positive result >48% lymphoedema prevalence after ALND <14% or lymphoedema utility decrement <0.012. Conclusion: The long-term advantage of SLNB over ALND was modest and sensitive to variations in key assumptions, indicating a need for reliable information on lymphoedema incidence and disutility following SLNB. In addition to awaiting longer-term trial data, risk models to better identify patients at high risk of axillary metastasis will be valuable to inform decision-making.

Verry, H; Lord, S J; Martin, A; Gill, G; Lee, C K; Howard, K; Wetzig, N; Simes, J

2012-01-01

59

A false positive for metastatic lymph nodes in the axillary region of a breast cancer patient following mastectomy.  

PubMed

Recent advanced imaging modalities such as positron emission tomography (PET) detect malignancies using 2-[18F]-fluoro-2-deoxy-D: -glucose (18-FDG) with high accuracy, and they contribute to decisions regarding diagnosis, staging, recurrence, and treatment response. Here, we report a case of false-positive metastatic lymph nodes that were diagnosed by PET/CT and ultrasonography in a 48-year-old breast cancer patient who had undergone mastectomy. The tumors, which were oval shaped and resembled lymph nodes, were detected by ultrasonography. PET/CT revealed high uptake of 18-FDG in the tumors. To investigate the proposed recurrence and to re-evaluate the biology of the recurrent tumors, a tumor was removed from the brachial plexus of the patient. Histological findings revealed it to be a schwannoma. All imaging modalities including PET/CT failed to distinguish benign tumors from metastatic lymph nodes in the brachial plexus. After resection of the schwannomas, the patient complained of a slight motor disorder of the second finger on the right hand. Hence, it is important to consider a false-positive case of lymph node metastasis in a breast cancer patient following mastectomy. PMID:19554397

Fujiuchi, Nobuko; Saeki, Toshiaki; Takeuchi, Hideki; Sano, Hiroshi; Takahashi, Takao; Matsuura, Kazuo; Shigekawa, Takashi; Misumi, Misono; Nakamiya, Noriko; Okubo, Katsuhiko; Osaki, Akihiko; Sakurai, Takaki; Matsuda, Hiroshi

2009-06-24

60

Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: a review.  

PubMed

The purpose of this article is to provide a systematic review of Combined Physical Therapy, Intermittent Pneumatic Compression and arm elevation for the treatment of lymphoedema secondary to an axillary dissection for breast cancer. Combined Physical Therapy starts with an intensive phase consisting of skin care, Manual Lymphatic Drainage, exercises and bandaging and continues with a maintenance phase consisting of skin care, exercises, wearing a compression sleeve and Manual Lymphatic Drainage if needed. We have searched the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and Cochrane. Only (pseudo-) randomised controlled trials and non-randomised experimental trials investigating the effectiveness of Combined Physical Therapy and its different parts, of Intermittent Pneumatic Compression and of arm elevation were included. These physical treatments had to be applied to patients with arm lymphoedema which developed after axillary dissection for breast cancer. Ten randomised controlled trials, one pseudo-randomised controlled trial and four non-randomised experimental trials were found and analysed. Combined Physical Therapy can be considered as an effective treatment modality for lymphoedema. Bandaging the arm is effective, whether its effectiveness is investigated on a heterogeneous group consisting of patients with upper and lower limb lymphoedema from different causes. There is no consensus on the effectiveness of Manual Lymphatic Drainage. The effectiveness of skin care, exercises, wearing a compression sleeve and arm elevation is not investigated by a controlled trial. Intermittent Pneumatic Compression is effective, but once the treatment is interrupted, the lymphoedema volume increases. In conclusion, Combined Physical Therapy is an effective therapy for lymphoedema. However, the effectiveness of its different components remains uncertain. Furthermore, high-quality studies are warranted. The long-term effect of Intermittent Pneumatic Compression and the effect of elevation on lymphoedema are not yet proven. PMID:20018422

Devoogdt, Nele; Van Kampen, Marijke; Geraerts, Inge; Coremans, Tina; Christiaens, Marie-Rose

2009-12-16

61

Breast Cancer Patients With 10 or More Involved Axillary Lymph Nodes Treated by Multimodality Therapy: Influence of Clinical Presentation on Outcome  

SciTech Connect

Purpose: To analyze tumor control and survival for breast cancer patients with 10 or more positive lymph nodes without systemic disease, treated by adjuvant radiation alone or combined-modality therapy. Methods and Materials: We reviewed the records of 309 consecutive patients with these characteristics who received locoregional radiotherapy (RT) at our institution. The majority of patients had clinical Stage II or IIIA-B disease (43% and 48%, respectively). The median number of positive axillary lymph nodes was 15 (range, 10-78). Adjuvant therapy consisted of RT alone, with or without chemotherapy, tamoxifen, and/or ovarian castration. Results: The overall 5-year and 10-year disease-free survival (DFS) rates were 20% and 7%, respectively. Median DFS was higher for patients with Stage I-II compared with those with Stage IIIABC (28 vs. 19 months; p = 0.006). Median DFS for patients aged {<=}35 years was lower than that of older patients (12 vs. 24 months; p < 0.0001). Patients treated with a combination therapy had a higher 5-year DFS rate compared with those treated by RT alone (26% vs. 11%; p 0.03). In multivariate analysis, clinical stage (III vs. I, II; relative risk = 1.8, p = 0.002) and age ({<=}35 vs. others; relative risk = 2.6, p <0.001) were found to be independent variables for DFS. Conclusion: This retrospective data analysis identified young age and advanced clinical stage as pertinent and independent clinical prognostic factors for breast cancer patients with advanced axillary disease (10 or more involved nodes). These factors can be used for further prognostic classification.

Geara, Fady B. [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon)]. E-mail: fg00@aub.edu.lb; Nasr, Elie [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Tucker, Susan L. [Department of Biomathematics, University of Texas, M. D. Anderson Cancer Center, Houston, TX (United States); Charafeddine, Maya [Department of Epidemiology and Biostatistics, American University of Beirut Medical Center, Beirut (Lebanon); Dabaja, Bouthaina [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Eid, Toufic [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Abbas, Jaber [Department of General Surgery, American University of Beirut Medical Center, Beirut (Lebanon); Salem, Ziad [Department of Medical Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Shamseddine, Ali [Department of Medical Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Issa, Philip [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); El Saghir, Nagi [Department of Medical Oncology, American University of Beirut Medical Center, Beirut (Lebanon)

2007-06-01

62

Intercostobrachial Nerves as a Novel Anatomic Landmark for Dividing the Axillary Space in Lymph Node Dissection  

PubMed Central

Purpose. Our aim was to assess the feasibility of using the intercostobrachial nerves (ICBNs) as a possible new anatomic landmark for axillaries lymph node dissection in breast cancer patients. Background Data Summary. The preservation of ICBN is now an accepted procedure in this type of dissection; however, it could be improved further to reduce the number of postoperative complications. The axillary space is divided into lower and upper parts by the ICBN—a thorough investigation of the metastasis patterns in lymph nodes found in this area could supply new information leading to such improvements. Methods. Seventy-two breast cancer patients, all about to undergo lymph node dissection and with sentinel lymph nodes identified, were included in this trial. The lymph nodes were collected in two groups, from lower and upper axillary spaces, relative to the intercostobrachial nerves. The first group was further subdivided into sentinel (SLN) and nonsentinel (non-SLN) nodes. All lymph nodes were tested to detect macro- and micrometastasis. Results. All the sentinel lymph nodes were found under the intercostobrachial nerves; more than 10 lymph nodes were located in that space. Moreover, when lymph nodes macrometastasize or micrometastasize above the intercostobrachial nerves, we also observe metastasis-positive nodes under the nerves; when the lower group nodes show no metastasis, the upper group is also metastasis free. Conclusions. Our results show that the intercostobrachial nerves are good candidates for a new anatomic landmark to be used in lymph node dissection procedure.

Li, Jianyi; Zhang, Yang; Zhang, Wenhai; Jia, Shi; Gu, Xi; Ma, Yan; Li, Dan

2013-01-01

63

Predictors of nonsentinel lymph node metastasis in breast cancer patients  

Microsoft Academic Search

Background: In order to define a future subset of breast cancer patients in whom the axilla may be staged by sentinel lymph node biopsy alone, the conditions under which nonsentinel axillary lymph node metastases occur must be delineated.Methods: A prospective database including 212 breast cancer patients who underwent sentinel lymph node biopsy followed by completion axillary dissection at our institution

Ulka Sachdev; Kara Murphy; Alain Derzie; Shabnam Jaffer; Ira J Bleiweiss; Steven Brower

2002-01-01

64

Factors associated with involvement of four or more axillary nodes for sentinel lymph node-positive patients  

Microsoft Academic Search

Purpose: Sentinel lymph node-positive (SLN+) patients who are unlikely to have 4 or more involved axillary nodes might be treated with less extensive regional nodal radiation. The purpose of this study was to define possible predictors of having 4 or more involved axillary nodes. Methods and Materials: The records of 224 patients with breast cancer and 1 to 3 involved

Angela. Katz; Andrzej Niemierko; Irene Gage; Sheila Evans; Margaret Shaffer; Frederick P. Smith; Alphonse Taghian; Colette Magnant

2006-01-01

65

Dose Distribution Analysis of Axillary Lymph Nodes for Three-Dimensional Conformal Radiotherapy With a Field-in-Field Technique for Breast Cancer  

Microsoft Academic Search

Purpose: We previously reported that most of axillary regions could be irradiated by the modified tangential irradiation technique (MTIT). The purpose of this study was to determine whether the three-dimensional conformal radiotherapy (3D-CRT) with a field-in-field technique improves dosimetry for the breast and axillary nodes. Methods and Materials: Fifty patients with left-sided breast cancer were enrolled. With MTIT, we planned

Toshio Ohashi; Atsuya Takeda; Naoyuki Shigematsu; Junichi Fukada; Naoko Sanuki; Atsushi Amemiya; Atsushi Kubo

2009-01-01

66

Does Fibrin Glue Improve Drainage after Axillary Lymph Node Dissection? Prospective and Randomized Study in Humans  

Microsoft Academic Search

The aim of this prospective and randomized study was to establish whether the use of fibrin glue was beneficial after axillary lymph node dissection. From January 1990 to January 1991, 40 women were randomized before surgery for breast cancer: 20 patients (group A) underwent vaporization of fibrin glue (Tissucol®, 5 ml of 500 IU thrombin) only in the area of

F. Vaxman; A. Kolbe; F. Stricher; D. Zund; P. Volkmar; D. Gros; J. F. Grenier

1995-01-01

67

Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial  

PubMed Central

Summary Background Sentinel node surgery was designed to minimize side effects of lymph node surgery but still offer outcomes equivalent to axillary dissection. The aims of NSABP Protocol B-32 were to determine whether sentinel node resection in breast cancer patients achieves the same survival and regional control as axillary dissection but with fewer side effects. Methods 5611 women with invasive breast cancer were randomly assigned to sentinel node resection plus axillary dissection (Group 1) or to sentinel node resection alone with axillary dissection only if sentinel nodes were positive (Group 2). Random assignment was done at the NSABP Biostatistical Center and accomplished via using a biased coin minimization approach. Stratification variables were age at entry (? 49,? 50), clinical tumor size (? 2.0 cm, 2.1 – 4 cm, ? 4.1 cm), and surgical plan (lumpectomy, mastectomy). Sentinel node resection was done using blue dye and radioactive tracer. As pre-specified in the protocol, analyses of endpoint data were performed according to the randomized group assignments on patients who were assessed at the time of randomization as having pathologically negative sentinel nodes (3989 patients). The endpoint analyses were performed on all such patients who had follow-up information regardless of their eligibility status (3986 patients). The primary endpoint for the study was overall survival. All deaths regardless of cause were included. The mean time on study for the 3986 sentinel node-negative patients with follow-up information was 95.6 months (range: 70.1 – 126.7 months). Findings A total of 309 deaths were reported in the 3986 sentinel node-negative patients with follow-up information. Log-rank comparison of overall survival in Groups 1 and 2 yielded an unadjusted hazard ratio of 1.20 (95% confidence interval [CI]; 0.96 –1.50, P = 0.12). Eight-year Kaplan-Meier estimates for overall survival are 91.8% in Group 1 and 90.3% in Group 2. Treatment comparisons for disease-free survival yielded an unadjusted hazard ratio of 1.05 (95% CI: 0.90 – 1.22, P=0.54). Eight-year Kaplan-Meier estimates for disease-free survival are 82.4% in Group 1 and 81.5% in Group 2. There were 8 regional node recurrences as first events in Group 1 and 14 in Group 2 (P=0.22). Patients are continuing follow up for longer term evaluation of survival and regional control. Interpretation Overall survival, disease-free survival, and regional control were statistically equivalent between groups. When the sentinel node is negative, sentinel node surgery alone with no further axillary dissection is an appropriate, safe, and effective therapy for breast cancer patients with clinically negative lymph nodes.

Krag, David N.; Anderson, Stewart J.; Julian, Thomas B.; Brown, Ann M.; Harlow, Seth P.; Costantino, Joseph P.; Ashikaga, Takamaru; Weaver, Donald L.; Mamounas, Eleftherios P.; Jalovec, Lynne M.; Frazier, Thomas G.; Noyes, R. Dirk; Robidoux, Andre; Scarth, Hugh M.C.; Wolmark, Norman

2010-01-01

68

GSTPi-positive tumour microenvironment-associated fibroblasts are significantly associated with GSTPi-negative cancer cells in paired cases of primary invasive breast cancer and axillary lymph node metastases  

PubMed Central

Background: Glutathione S-transferase Pi (GSTPi) expression is one of the factors, which is known to be associated with development of resistance to chemotherapeutics in cancer patients, including those with breast cancer. Yet, its expression has been reported to be undetectable in cancer cells in high percent of patients with primary breast cancer. However, GSTPi expression in stromal cells in breast tumour microenvironment, namely cancer-associated fibroblast (CAF), which is recognised to have major roles in cancer progression, remains poorly reported. Methods: The aim of the study was to determine the expression of GSTPi; vimetin, a fibroblast-associated cytoskeleton protein; and ?-smooth muscle actin (?-SMA), a known marker of CAF in breast cancer tissue, by immunohistochemical staining method in consecutive histologic sections of formalin-fixed and paraffin-embedded tissue biopsy specimens from a cohort of 39 paired cases of patients with invasive breast cancer and the corresponding axillary lymph nodes metastases. Results: Ductal and acinar luminal epithelial cells, myoepithelial cells and surrounding fibroblasts exhibited a homogeneous cytoplasmic reactivity with anti-GSTPi antibody in 11 of 11 cases of benign breast tissue biopsies. The vimentin-positive fibroblasts were unreactive with anti-?-SMA antibody. Loss of GSTPi expression was observed in breast cancer cells, at both the primary and metastatic sites, in 31 of 39 paired cases, as compared with benign breast epithelial cells (Fisher's exact test P<0.001). A significant association was observed between GSTPi-positive, vimentin-positive and ?-SMA-positive fibroblast in tumour microenvironment at both sites. Conclusion: This is an original report of demonstration of a significance association between tumour microenvironment-associated GSTPi-positive CAF (vimentin/?-SMA-positive) and the GSTPi-negative cancer cells in paired cases of primary invasive breast cancer and the corresponding axillary lymph nodes metastases.

Chaiwun, B; Sukhamwang, N; Trakultivakorn, H; Saha, B; Young, L; Tsao-Wei, D; Naritoku, W Y; Groshen, S; Taylor, C R; Imam, S A

2011-01-01

69

Age and Axillary Lymph Node Ratio in Postmenopausal Women with T1-T2 Node Positive Breast Cancer  

PubMed Central

Purpose. The purpose of this article was to examine the relationship between age and lymph node ratio (LNR, number of positive nodes divided by number of examined nodes), and to determine their effects on breast cancer (BC) and overall mortality. Methods. Women aged ?50 years, diagnosed in 1988–1997 with a unilateral histologically confirmed T1-T2 node positive surgically treated primary nonmetastatic BC, were selected from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER). Generalized Additive Models for Location Scale and Shape (GAMLSS) were used to evaluate the age-LNR relationship. Cumulative incidence functions and multivariate competing risks analysis based on model selection by the Bayesian Information Criterion (BIC) were used to examine the effect of age and LNR on mortality. Low LNR was defined as ?0.20, mid-LNR 0.21–0.65, and high LNR >0.65. Results. GAMLSS showed a nonlinear LNR-age relationship, increasing from mean LNR 0.26–0.28 at age 50–70 years to 0.30 at 80 years and 0.40 at 90 years. Compared with a 9.8% [95% confidence interval (CI) 8.8%–10.8%] risk of BC death at 5 years in women aged 50–59 years with low LNR, the risk in women ?80 years with low LNR was 12.6% [95% CI 10.1%–15.0%], mid-LNR 18.1% [13.9%–22.1%], high LNR 29.8% [22.7%–36.1%]. Five-years overall risk of death increased from 40.8% [37.5%–43.9%] by low LNR to 67.4% [61.4%–72.4%] by high LNR. The overall mortality hazard ratio for age ?80 years with high LNR was 7.49 [6.54–8.59], as compared with women aged 50–59 years with low LNR. Conclusion. High LNR combined with older age was associated with a threefold increased risk of BC death and a sevenfold increased hazard ratio of overall mortality.

Joseph, Sue A.; Coutty, Nadege; Ly, Bevan Hong; Vlastos, Georges; Nguyen, Nam Phong

2010-01-01

70

Can sentinel node biopsy avoid axillary dissection in clinically node-negative breast cancer patients?  

Microsoft Academic Search

In a consecutive series of 241 women with operable breast cancer and clinically negative axillary lymph nodes, 99mTc was injected on the day before surgery, and scintigraphic images were taken. During breast surgery a handheld gamma ray detector was used to locate the sentinel node and facilitate its removal separately via a small axillary incision. Complete axillary lymphadenectomy was then

V. Galimberti; S. Zurrida; P. Zucali; A. Luini

1998-01-01

71

Axillary staging of breast cancer and the sentinel node  

PubMed Central

Pathological aspects of axillary nodal staging of breast cancer and in particular sentinel lymph node (SLN) biopsy are reviewed. SLN biopsy seems an almost ideal staging procedure because it has both high accuracy and a low false negative rate. It may also allow a cost effective use of more sensitive methods of metastasis detection. However, the biological relevance of metastases detected only by modern tools remains to be elucidated. This review focuses on standard axillary staging and the histopathological investigation of SLNs, with emphasis on the intraoperative setting. Future trends including ancillary studies, quality control issues, prediction of non-SLN involvement, and suggestions concerning the minimum requirements for the histology of axillary SLNs are also discussed. Key Words: axillary staging • breast cancer • sentinel lymph node

Cserni, G

2000-01-01

72

A Logistic Regression Model for Predicting Axillary Lymph Node Metastases in Early Breast Carcinoma Patients  

PubMed Central

Nodal staging in breast cancer is a key predictor of prognosis. This paper presents the results of potential clinicopathological predictors of axillary lymph node involvement and develops an efficient prediction model to assist in predicting axillary lymph node metastases. Seventy patients with primary early breast cancer who underwent axillary dissection were evaluated. Univariate and multivariate logistic regression were performed to evaluate the association between clinicopathological factors and lymph node metastatic status. A logistic regression predictive model was built from 50 randomly selected patients; the model was also applied to the remaining 20 patients to assess its validity. Univariate analysis showed a significant relationship between lymph node involvement and absence of nm-23 (p = 0.010) and Kiss-1 (p = 0.001) expression. Absence of Kiss-1 remained significantly associated with positive axillary node status in the multivariate analysis (p = 0.018). Seven clinicopathological factors were involved in the multivariate logistic regression model: menopausal status, tumor size, ER, PR, HER2, nm-23 and Kiss-1. The model was accurate and discriminating, with an area under the receiver operating characteristic curve of 0.702 when applied to the validation group. Moreover, there is a need discover more specific candidate proteins and molecular biology tools to select more variables which should improve predictive accuracy.

Xie, Fei; Yang, Houpu; Wang, Shu; Zhou, Bo; Tong, Fuzhong; Yang, Deqi; Zhang, Jiaqing

2012-01-01

73

Detection of breast cancer micrometastases in axillary lymph nodes by means of reverse transcriptase-polymerase chain reaction. Comparison between MUC1 mRNA and keratin 19 mRNA amplification.  

PubMed Central

Usefulness of MUC1 mRNA and keratin 19 mRNA as a target of reverse-transcriptase polymerase chain reaction (RT-PCR) was compared in the detection of breast cancer micrometastases in axillary lymph nodes. RT-PCR amplification of MUC1 mRNA and keratin 19 mRNA was conducted using total RNA samples. RT-PCR products were stained with ethidium bromide and analyzed by agarose gel electrophoresis. Expression of both MUC1 mRNA and keratin 19 mRNA was detected by RT-PCR in a breast cancer cell line (MRK) and in all the 23 primary breast cancers but not in the control lymph nodes obtained from patients with benign diseases. A serial dilution study of MRK cells against normal lymph node cells has shown that detection sensitivity of MUC1 RT-PCR and keratin 19 RT-PCR were 1/10(5) and 1/10(6) (cancer/lymph node cells), respectively. Sixty-three axillary lymph nodes were obtained from 23 patients with primary breast cancer, and metastases in each lymph node were investigated by histological examination (hematoxylin and eosin sections) and RT-PCR method. In all 10 lymph nodes, which were histologically metastasis-positive, both MUC1 mRNA and keratin mRNA were detected by RT-PCR. Of the 53 histologically negative lymph nodes, 3 (6%) and 5 (9%) lymph nodes were found to express MUC1 mRNA and keratin 19 mRNA, respectively, indicating the presence of micrometastases which could be detected by RT-PCR but not by histological examination. These results demonstrate the usefulness of both MUC1 RT-PCR and keratin 19 RT-PCR in the detection of breast cancer micrometastases in lymph nodes, and also indicate the superiority of keratin 19 RT-PCR over MUC1 RT-PCR because of its higher detection sensitivity. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5

Noguchi, S.; Aihara, T.; Motomura, K.; Inaji, H.; Imaoka, S.; Koyama, H.

1996-01-01

74

Minimal and small size invasive breast cancer with no axillary lymph node involvement: the need for tailored adjuvant therapies  

Microsoft Academic Search

Background: Prognosis of patients with node-negative disease and tumor size <1 cm is a matter of controversy. While data exist to clearly correlate small tumor size to better prognosis, the fact that very small breast cancers may express biological markers of dire prognosis leads many to ignore small tumor size during treatment decision-making. Patients and methods: Data from 425 patients

M. Colleoni; N. Rotmensz; G. Peruzzotti; P. Maisonneuve; G. Viale; G. Renne; C. Casadio; P. Veronesi; M. Intra; R. Torrisi; A. Goldhirsch

2004-01-01

75

Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'  

PubMed Central

Background: Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. Patients and methods: We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. Results: Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€2947 (? = 580) versus €3331 (? = 902); P = 0.0001]. Conclusion: ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

Classe, J. M.; Baffert, S.; Sigal-Zafrani, B.; Fall, M.; Rousseau, C.; Alran, S.; Rouanet, P.; Belichard, C.; Mignotte, H.; Ferron, G.; Marchal, F.; Giard, S.; Tunon de Lara, C.; Le Bouedec, G.; Cuisenier, J.; Werner, R.; Raoust, I.; Rodier, J.-F.; Laki, F.; Colombo, P.-E.; Lasry, S.; Faure, C.; Charitansky, H.; Olivier, J.-B.; Chauvet, M.-P.; Bussieres, E.; Gimbergues, P.; Flipo, B.; Houvenaeghel, G.; Dravet, F.; Livartowski, A.

2012-01-01

76

High-resolution fiber optic microscopy with fluorescent contrast enhancement for the identification of axillary lymph node metastases in breast cancer: a pilot study  

PubMed Central

This prospective pilot study evaluates the potential of high-resolution fiber optic microscopy (HRFM) to identify lymph node metastases in breast cancer patients. 43 lymph nodes were collected from 14 consenting breast cancer patients. Proflavine dye was topically applied to lymph nodes ex vivo to allow visualization of nuclei. 242 images were collected at 105 sites with confirmed histopathologic diagnosis. Quantitative statistical features were calculated from images, assessed with one-way ANOVA, and were used to develop a classification algorithm with the goal of objectively discriminating between normal and metastatic tissue. A classification algorithm using mean image intensity and skewness achieved sensitivity of 79% (27/34) and specificity of 77% (55/71). This study demonstrates the technical feasibility and diagnostic potential of HRFM with fluorescent contrast in the ex vivo evaluation of lymph nodes from breast cancer patients.

Rosbach, Kelsey J.; Shin, Dongsuk; Muldoon, Timothy J.; Quraishi, Mohammad A.; Middleton, Lavinia P.; Hunt, Kelly K.; Meric-Bernstam, Funda; Yu, Tse-Kuan; Richards-Kortum, Rebecca R.; Yang, Wei

2010-01-01

77

Predictors of Axillary Lymph Node Metastases (ALNM) in a Korean Population with T1-2 Breast Carcinoma: Triple Negative Breast Cancer has a High Incidence of ALNM Irrespective of the Tumor Size  

PubMed Central

Purpose We estimated the likelihood of breast cancer patients having axillary lymph node metastases (ALNM) based on a variety of clinical and pathologic factors. Materials and Methods Three hundred sixty-one breast cancer patients without distant metastases and who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy (MRM) were identified, and we retrospectively reviewed their pathology records and treatment charts. Results Positive axillary lymph nodes were detected in 104 patients for an overall incidence of 28.8%: 2 patients (5%) with T1a tumor, 5 (9.2%) with T1b tumor, 24 (21.8%) with T1c tumor and 73 (44.2%) with T2 tumor. On the multivariate analysis, an increased tumor size (adjusted OR=11.87, p=0.02), the presence of lymphovascular invasion (adjusted OR=7.41, p<0.01), a triple negative profile (ER/PR-, Her2-) (adjusted OR=2.09, p=0.04) and a palpable mass at the time of diagnosis (adjusted OR=2.31, p=0.03) were all significant independent factors for positive ALNM. Conclusion In our study, the tumor size, the presence of lymphovascular invasion, a triple negative profile and a palpable mass were the independent predictive factors for ALNM. The tumor size was the strongest predictor of ALNM. Thus, the exact estimation of the extent of tumor is necessary for clinicians to optimize the patients' care. Patients with a triple negative profile have a high incidence of ALNM irrespective of the tumor size.

Lee, Jong Hoon; Suh, Young Jin; Shim, Byoung Yong; Kim, Hoon Kyo

2010-01-01

78

Detection of breast micro-metastases in axillary lymph nodes by infrared micro-spectral imaging†  

PubMed Central

We report the ability of infrared micro-spectral imaging, coupled with completely unsupervised methods of multivariate statistical analysis, to accurately reproduce the histological architecture of axillary lymph nodes and detect metastatic breast cancer cells. The acquisition of spectral data from tissue embedded in paraffin provided spectra free of dispersive artefacts that may be observed for infrared microscopic measurements using a ‘reflection/absorption’ methodology. As a consequence, superior tissue classification and identification of cellular abnormality unattainable for deparaffinised tissue was achieved.

Bedrossian, Kristi; Laver, Nora; Miljkovic, Milos; Romeo, Melissa J.; Diem, Max

2009-01-01

79

Variations in breast conservation surgery for women with axillary lymph node negative breast cancer in British Columbia.  

PubMed

A population-based study was conducted including all women diagnosed in British Columbia in 1991 with invasive node negative breast cancer (n = 942) in order to identify factors associated with variation in use of breast conserving surgery (BCS) and to determine if provincial practice guidelines were followed. Patient, disease, treatment and physician-specific information was abstracted from medical records and original source documents. 413 (44%) patients received BCS (51% and 23% in surgical candidates and non-candidates, respectively). Significant independent factors associated with BCS included patients' age, residence, family income, tumour size, tumour location, and extent of ductal carcinoma in-situ. Age and income had a significant interaction with stronger income effects in older women. A strong surgeon effect was observed which was not explained by measured surgeon attributes. Expansion of radiation treatment facilities may help address access issues. Further examination of the patient-physician relationship and of ways to assist patients in decision making is needed. PMID:9009395

Hislop, T G; Olivotto, I A; Coldman, A J; Trevisan, C H; Kula, J; McGregor, G I; Phillips, N

80

Predicting axillary lymph node metastasis from kinetic statistics of DCE-MRI breast images  

NASA Astrophysics Data System (ADS)

The presence of axillary lymph node metastases is the most important prognostic factor in breast cancer and can influence the selection of adjuvant therapy, both chemotherapy and radiotherapy. In this work we present a set of kinetic statistics derived from DCE-MRI for predicting axillary node status. Breast DCE-MRI images from 69 women with known nodal status were analyzed retrospectively under HIPAA and IRB approval. Axillary lymph nodes were positive in 12 patients while 57 patients had no axillary lymph node involvement. Kinetic curves for each pixel were computed and a pixel-wise map of time-to-peak (TTP) was obtained. Pixels were first partitioned according to the similarity of their kinetic behavior, based on TTP values. For every kinetic curve, the following pixel-wise features were computed: peak enhancement (PE), wash-in-slope (WIS), wash-out-slope (WOS). Partition-wise statistics for every feature map were calculated, resulting in a total of 21 kinetic statistic features. ANOVA analysis was done to select features that differ significantly between node positive and node negative women. Using the computed kinetic statistic features a leave-one-out SVM classifier was learned that performs with AUC=0.77 under the ROC curve, outperforming the conventional kinetic measures, including maximum peak enhancement (MPE) and signal enhancement ratio (SER), (AUCs of 0.61 and 0.57 respectively). These findings suggest that our DCE-MRI kinetic statistic features can be used to improve the prediction of axillary node status in breast cancer patients. Such features could ultimately be used as imaging biomarkers to guide personalized treatment choices for women diagnosed with breast cancer.

Ashraf, Ahmed B.; Lin, Lilie; Gavenonis, Sara C.; Mies, Carolyn; Xanthopoulos, Eric; Kontos, Despina

2012-02-01

81

The need for lymph node dissection in nonmetastatic breast cancer.  

PubMed

Determining whether cancer has spread to locoregional lymph nodes is a critical step in the initial staging of breast cancer patients. Although axillary dissection reliably identifies nodal metastases and prevents the recurrence of cancer in the axilla, there is a significant incidence of long-term side effects, notably lymphedema, and the procedure is of no therapeutic benefit in women without axillary metastases. With the advent of sentinel lymph node biopsy, the axilla can be accurately staged in patients with T1-T3, clinically node-negative breast cancers while avoiding the morbidity of axillary lymph node dissection if the nodes do not contain cancer. Recent clinical trials suggest that for women with metastases to 1 or 2 sentinel nodes, the radiation and systemic therapy that are part of modern multimodality breast cancer treatment can replace axillary dissection when breast-conserving therapy is undertaken. For those with greater disease burden or those undergoing mastectomy, axillary dissection remains standard management. PMID:23020881

Pesce, Catherine; Morrow, Monica

2012-09-27

82

Pathology Case Study: Enlarged Right Axillary Lymph Node  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 40-year-old man was found to have an enlarged right axillary lymph node. Visitors are given the patient history, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in pathology and clinical immunology.

Fung, Mark

2009-02-18

83

Dedicated PET Scanner for Axillary Node Imaging.  

National Technical Information Service (NTIS)

A key prognostic factor in breast cancer is the involvement of the axillary lymph nodes. This is currently determined by axillary lymph node dissection (ALND), a low yield surgical procedure associated with significant cost and morbidity. Positron Emissio...

S. Cherry

1998-01-01

84

Automatic detection and segmentation of axillary lymph nodes.  

PubMed

Lymph node detection and measurement is a difficult and important part of cancer treatment. In this paper we present a robust and effective learning-based method for the automatic detection of solid lymph nodes from Computed Tomography data. The contributions of the paper are the following. First, it presents a learning based approach to lymph node detection based on Marginal Space Learning. Second, it presents an efficient MRF-based segmentation method for solid lymph nodes. Third, it presents two new sets of features, one set self-aligning to the local gradients and another set based on the segmentation result. An extensive evaluation on 101 volumes containing 362 lymph nodes shows that this method obtains a 82.3% detection rate at 1 false positive per volume, with an average running time of 5-20 seconds per volume. PMID:20879211

Barbu, Adrian; Suehling, Michael; Xu, Xun; Liu, David; Zhou, S Kevin; Comaniciu, Dorin

2010-01-01

85

Blue Dye Injection in the Arm in Order to Conserve the Lymphatic Drainage of the Arm in Breast Cancer Patients Requiring an Axillary Dissection  

Microsoft Academic Search

Background  Despite the widespread use of the sentinel lymph node biopsy technique, many patients with invasive breast cancer still undergo\\u000a an axillary lymph node dissection and are at risk of arm lymphedema. With the new awareness of lymphatic spread in the axillary\\u000a nodes, it should be possible to define a new surgical approach between sentinel lymph node biopsy and complete axillary

Claude Nos; Benedicte Lesieur; Krishna B. Clough; Fabrice Lecuru

2007-01-01

86

Sentinel Lymph Node Biopsy for Breast Cancer: Our Technique and Future Directions in Lymph Node Staging  

PubMed Central

Breast cancer remains a major cause of cancer death for women in the United States. Accurate cancer staging, especially of the axillary lymph nodes, is essential for predicting the prognosis of patients and for determining the appropriate multimodality treatment strategy. Historically, the traditional approach for staging the lymphatic metastasis in breast cancer has been Axillary lymph node dissection (ALND). However, as the understanding of the lymphatic drainage of the breast has improved, the Sentinel lymph node (SLN) biopsy has replaced ALND as the gold standard for lymph node staging in breast cancer. Multiple studies have demonstrated the benefits of SLN biopsy compared to ALND in terms of morbidity, while maintaining the clinical ability to appropriately stage patients, but without any loss in therapeutic impact. In this review, we discuss the historical development of SLN biopsy, describe our technique in detail, and discuss the possible future directions of the lymphatic staging of breast cancer.

Rashid, Omar M.; Takabe, Kazuaki

2012-01-01

87

Combined ipsilateral neck and axillary lymphadenectomy for metastatic skin cancers: a case series and surgical tips.  

PubMed

In the absence of distant disease simultaneous skin cancer metastasis to neck and axillary lymph nodes necessitates both an axillary and neck en block lymphadenectomy. A combined ipsilateral neck and axillary lymph node dissection should involve an in-continuity dissection through the cervicoaxillary canal for optimal lymphatic and oncological clearance. Review of the literature reveals little published instruction on the procedure since the radical surgery performed by Bowden over 50 years ago. We present 4 cases where ipsilateral axillary and neck lymph node dissections were performed for metastatic melanoma and a case of apical axillary node dissection via a neck incision approach. Our surgical tips include performing apical axillary node dissection via the neck incision and consideration of clavicular osteotomy or clavicular excision. A transclavicular approach was taken in one patient who had an excellent functional outcome after a plate and screw fixation. One elderly patient required a middle third claviculectomy which reduced shoulder elevation but was not associated with functional impairment. We conclude the surgery is safe and associated with the usual morbidity ascribed with either an axillary or neck dissection undertaken in isolation. However, patients have a significant risk of disease relapse as would be expected due to the duel metastatic sites, multiple lymph node and neck involvement which are known to be independent poor prognostic factors on melanoma survival and relapse. PMID:23664381

Goodenough, J; Martin, H; Shaaban, H

2013-05-07

88

Axillary lymph node dose with tangential whole breast radiation in the prone versus supine position: a dosimetric study  

PubMed Central

Background Prone breast positioning reduces skin reaction and heart and lung dose, but may also reduce radiation dose to axillary lymph nodes (ALNs). Methods Women with early stage breast cancer treated with whole breast irradiation (WBI) in the prone position were identified. Patients treated in the supine position were matched for treating physician, laterality, and fractionation. Ipsilateral breast, tumor bed, and Level I, II, and III ALNs were contoured according to the RTOG breast atlas. Clips marking surgically removed sentinel lymph nodes (SLN)s were contoured. Treatment plans developed for each patient were retrospectively analyzed. V90% and V95% was calculated for each axillary level. When present, dose to axillary surgical clips was calculated. Results Treatment plans for 46 women (23 prone and 23 supine) were reviewed. The mean V90% and V95% of ALN Level I was significantly lower for patients treated in the prone position (21% and 14%, respectively) than in the supine position (50% and 37%, respectively) (p?axillary Level I. The mean V95% of SLN clips was 47% for patients treated in the supine position and 0% for patients treated in the prone position (p?axillary coverage is indicated such as those with positive sentinel lymph node biopsy who do not undergo completion axillary dissection, treatment in the prone position may be inappropriate.

2012-01-01

89

Lymphangiogenesis and Axillary Lymph Node Metastases Correlated with VEGF-C Expression in Two Immunocompetent Mouse Mammary Carcinoma Models  

PubMed Central

Lymphangiogenesis and the expression of vascular endothelial cell growth factor C (VEGF-C) in tumors have been considered to be causally promoting lymphatic metastasis. There are only a few studies on lymphatic metastasis in immunocompetent allograft mouse models. To study the relationship between VEGF-C-mediated lymphangiogenesis and axillary lymph node metastasis, we used two mouse mammary carcinoma cell lines; the BJMC338 has a low metastatic propensity, whereas the BJMC3879 has a high metastatic propensity although it originated from the former cell line. Each cell line was injected separately into two groups of female BALB/c mice creating in vivo mammary cancer models. The expression level of VEGF-C in BJMC3879 was higher than BJMC338. As the parent cell line, BJMC3879-derived tumors showed higher expression of VEGF-C compared to BJMC338-derived tumors. This higher expression of VEGF-C in BJMC3879-derived tumors was associated with marked increase in infiltrating macrophages and enhanced expression of lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1) reflecting increased tumoral lymphatic density and subsequent induction of axillary lymph node metastasis. Our mouse mammary carcinoma models are allotransplanted tumors showing the same axillary lymph node metastatic spectrum as human breast cancers. Therefore, our mouse models are ideal for exploring the various molecular mechanisms of cancer metastasis.

Ito, Yuko; Shibata, Masa-Aki; Eid, Nabil; Morimoto, Junji; Otsuki, Yoshinori

2011-01-01

90

Evaluating the efficacy of current clinical practice of adjuvant chemotherapy in postmenopausal women with early-stage, estrogen or progesterone receptor-positive, one-to-three positive axillary lymph node, breast cancer  

PubMed Central

Purpose We evaluated the benefit of the current clinical practice of adjuvant chemotherapy for postmenopausal women with early-stage, estrogen- or progesterone-receptor-positive (er/pr+), one-to-three positive axillary lymph node (1–3 ln+), breast cancer (esbc). Methods Using the Manitoba Cancer Registry, we identified all postmenopausal women diagnosed with er/pr+ 1–3 ln+ esbc during the periods 1995–1997, 2000–2002, and 2003–2005 (n = 156, 161, and 171 respectively). Treatment data were obtained from the Manitoba Cancer Registry and by linkage with Manitoba administrative databases. Seven-year survival data were available for the 1995–1997 and 2000–2002 populations. Using Cox regression, we assessed the independent effect of the clinical practice of adjuvant chemotherapy on disease-free (dfs) and overall survival (os). Results Clinical breast cancer treatments did not differ significantly between the 2000–2002 and 2003–2005 populations. Adjuvant chemotherapy was administered in 103 patients in the 2000–2002 population (64%) and in 44 patients in the 1995–1997 population [28.2%; mean difference: 36%; 95% confidence interval (ci): 31% to 40%; p < 0.0001]. Compared with 1995–1997, 2000–2002 was not significantly associated with an incremental dfs benefit for patients over a period of 7 years (2000–2002 vs. 1995–1997; adjusted hazard ratio: 0.98; 95% ci: 0.64 to 1.4). Conclusions The treatment standard of adjuvant chemotherapy in addition to endocrine therapy may not be effective for all women with er/pr+ 1–3 ln+ esbc. There could be a subgroup of those women who do not benefit from adjuvant chemotherapy as expected and who are therefore being overtreated. Further studies with a larger sample size are warranted to confirm our results.

Hannouf, M.B.; Brackstone, M.; Xie, B.; Zaric, G.S.

2012-01-01

91

An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement  

Microsoft Academic Search

Background. Axillary lymph node dissection (ALND) is the current standard of care for breast cancer patients with sentinel lymph node (SN) involvement. However, the SN is the only involved axillary node in a significant proportion of these patients. Here we examined factors predictive of non-SN involvement in patients with a metastatic SN, in order to develop a scoring system for

Emmanuel Barranger; Charles Coutant; Antoine Flahault; Yann Delpech; Emile Darai; Serge Uzan

2005-01-01

92

Quantum dots in axillary lymph node mapping: Biodistribution study in healthy mice  

PubMed Central

Background Breast cancer is the first cause of cancer death among women and its incidence doubled in the last two decades. Several approaches for the treatment of these cancers have been developed. The axillary lymph node dissection (ALND) leads to numerous morbidity complications and is now advantageously replaced by the dissection and the biopsy of the sentinel lymph node. Although this approach has strong advantages, it has its own limitations which are manipulation of radioactive products and possible anaphylactic reactions to the dye. As recently proposed, these limitations could in principle be by-passed if semiconductor nanoparticles (quantum dots or QDs) were used as fluorescent contrast agents for the in vivo imaging of SLN. QDs are fluorescent nanoparticles with unique optical properties like strong resistance to photobleaching, size dependent emission wavelength, large molar extinction coefficient, and good quantum yield. Methods CdSe/ZnS core/shell QDs emitting around 655 nm were used in our studies. 20 ?L of 1 ?M (20 pmol) QDs solution were injected subcutaneously in the anterior paw of healthy nude mice and the axillary lymph node (ALN) was identified visually after injection of a blue dye. In vivo fluorescence spectroscopy was performed on ALN before the mice were sacrificed at 5, 15, 30, 60 min and 24 h after QDs injection. ALN and all other organs were removed, cryosectioned and observed in fluorescence microscopy. The organs were then chemically made soluble to extract QDs. Plasmatic, urinary and fecal fluorescence levels were measured. Results QDs were detected in ALN as soon as 5 min and up to 24 h after the injection. The maximum amount of QDs in the ALN was detected 60 min after the injection and corresponds to 2.42% of the injected dose. Most of the injected QDs remained at the injection site. No QDs were detected in other tissues, plasma, urine and feces. Conclusion Effective and rapid (few minutes) detection of sentinel lymph node using fluorescent imaging of quantum dots was demonstrated. This work was done using very low doses of injected QDs and the detection was done using a minimally invasive method.

Robe, Anne; Pic, Emilie; Lassalle, Henri-Pierre; Bezdetnaya, Lina; Guillemin, Francois; Marchal, Frederic

2008-01-01

93

The impact of axillary lymphadenopathy on further treatment in breast cancer? A model for clinical staging.  

PubMed

Clinical assessment is an important part of the breast cancer patients' work-up, but it has low sensitivity and specificity. In a retrospective study, histological slides of axillary clearance specimens were used to model palpability of the axillary lymph nodes. Obvious nodes (enlarged and involving considerable amount of lymphatic and/or metastatic tissue) and nodes equal to or larger than 1 cm or 1.5 cm were counted and the slides were subsequently reviewed. The false positive and negative rates expected on the basis of the model ranged from 24 to 72 % and from 10 to 38 %, respectively. This model (also valid for intraoperative assessment of nodal status by palpation) documents the lack of specificity of clinical staging of the axilla. These results question the practice of excluding patients with palpable axillary lymph node enlargement from less radical staging procedures such as axillary sampling or sentinel node biopsy. PMID:9887361

Cserni, G

1998-01-01

94

Characteristics of axillary lymph nodes apparent on dynamic contrast-enhanced breast MRI in healthy women.  

PubMed

The study was initiated to characterize and better understand the natural characteristics of axillary lymph nodes (LNs) apparent on dynamic breast magnetic resonance imaging (MRI). The most important finding in 71 subjects that included healthy women was that 41% showed strong enhanced axillary LNs. The dynamic curves of these LNs revealed an initial mean signal increase of 197% (±58%), all of them with a following plateau (34%) or washout (66%). Our study points out that the previous understanding of contrast enhancement in breast lesions should be taken with care when assessing axillary LNs. This has to be considered especially in preoperative breast MRI. PMID:22726960

Krammer, Julia; Engel, Dorothee; Nissen, Johanna; Schnitzer, Andreas; Suetterlin, Marc; Schoenberg, Stefan O; Wasser, Klaus

2012-06-08

95

Sentinel lymph node biopsy for breast cancer using methylene blue dye manifests a short learning curve among experienced surgeons: a prospective tabular cumulative sum (CUSUM) analysis  

Microsoft Academic Search

BACKGROUND: The benefits of sentinel lymph node biopsy (SLNB) for breast cancer patients with histologically negative axillary nodes, in whom axillary lymph node dissection (ALND) is thereby avoided, are now established. Low false negative rate, certainly with blue dye technique, mostly reflects the established high inherent accuracy of SLNB and low axillary nodal metastatic load (subject to patient selection). SLN

Jeffrey M East; Christopher SP Valentine; Emil Kanchev; Garfield O Blake

2009-01-01

96

Axillary web syndrome after axillary dissection in breast cancer: a prospective study  

Microsoft Academic Search

The axillary web syndrome is a self-limiting and frequently overlooked cause of significant morbidity in the early post-operative\\u000a period after breast cancer axillary surgery, which is characterized by axillary pain that runs down the medial arm, limited\\u000a shoulder range of motion affecting mainly shoulder abduction, and cords of subcutaneous tissue extending from axilla into\\u000a the medial arm, made visible or

María Torres Lacomba; Orlando Mayoral del Moral; José Luís Coperias Zazo; María José Yuste Sánchez; Jean-Claude Ferrandez; Álvaro Zapico Goñi

2009-01-01

97

What is the burden of axillary disease after neoadjuvant therapy in women with locally advanced breast cancer?  

PubMed Central

Background The burden of axillary disease in patients with locally advanced breast cancer (labc) after neoadjuvant therapy (nat) has not been extensively described in a large modern cohort. Here, we describe the extent of nodal metastases after nat in patients with labc. Methods All patients with labc treated at a single institution during 2002–2007 were identified. Demographic, radiologic, and pathologic variables were extracted. To assess the extent of lymph node metastases after nat, patients were separated into two groups: those with and without clinical or radiologic evidence of lymph node metastases before nat. Axillary lymph nodes retrieved at surgery that had no evidence of metastases after hematoxylin and eosin (h&e) staining underwent further pathology evaluation. Results Of the 116 patients identified, 115 were female (median age: 48.5). Before nat, 26 patients were clinically and radiologically node-negative; of those 26, 14 were histologically negative on final pathology. After serial sectioning and immunohistochemistry, 9 of 26 (35%) were node-negative. Of the 90 patients who had clinical or radiologic evidence of lymph node metastases before nat, 23 (26%) had no evidence of lymph node metastases on h&e staining. After serial sectioning and immunohistochemistry, 19 (21%) had no further axillary lymph node metastases. Overall, 76% of patients had pathology evidence of lymph node metastases after nat. Conclusions Most patients with labc have axillary metastases after nat. Our findings support axillary lymph node dissection and locoregional radiation in most patients with labc after nat.

Cox, C.; Holloway, C.M.; Shaheta, A.; Nofech-Mozes, S.; Wright, F.C.

2013-01-01

98

Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for Stage I or II breast carcinoma  

Microsoft Academic Search

BACKGROUND. The goals of sentinel lymph node biopsy (SLNB) are to improve axillary staging and reduce unnecessary axillary lymph node dissections (ALND), thereby reducing treatment-related upper-limb morbidity. In the current prospec- tive study, short-term upper-limb morbidity was assessed after SLNB and\\/or ALND. METHODS. The study comprised 204 patients with Stage I\\/II breast carcinoma. Mean patient age was 55.6 years (standard

Johan S. Rietman; Pieter U. Dijkstra; Jan H. B. Geertzen; Peter Baas; Jaap de Vries; Wil Dolsma; Johan W. Groothoff; Willem H. Eisma; Harald J. Hoekstra

2003-01-01

99

Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage i. results from a randomised trial  

Microsoft Academic Search

The incidence and time course of arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy to the breast was assessed in a prospective randomised trial among 381 patients with stage I breast cancer. At 3–12 months, arm symptoms were reported by 59 110 of the patients who had ? 10 lymph nodes found in the axillary

G. Liljegren; L. Holmberg

1997-01-01

100

Primo Vascular System in the Lymph Vessel from the Inguinal to the Axillary Nodes  

PubMed Central

The primo vascular system (PVS) in a lymph system was observed mostly in large caliber ducts around the caudal vena cava of rabbits, rats, and mice. This required a severe surgery with laparectomy and massive removal of fat tissues in the abdomen to expose the lymph vessel. In the current brief report, we presented a new method to evade these shortcomings by observing the PVS in a less large caliber duct in the skin, that is, the lymph vessel from the inguinal to the axillary nodes. The Alcian blue injection into the inguinal node revealed the desired primo vessel in the target lymph vessel. This opened a new perspective for the investigation of the lymphatic PVS without severe damage to subject animals and for monitoring of the PVS in a long period of time.

Lee, Seung Hwan; Bae, Kyoung-Hee; Kim, Geum Ock; Nam, Min Ho; Kwon, Hee-Min; Ryu, Yeonhee; Soh, Kwang-Sup

2013-01-01

101

Non-Sentinel Lymph Node Metastases Associated With Isolated Breast Cancer Cells in the Sentinel Node  

PubMed Central

There are many reports on the frequency of non–sentinel lymph node involvement when isolated tumor cells are found in the sentinel node, but results and recommendations for the use of an axillary lymph node dissection differ among studies. This systematic review was conducted to give an overview of this issue and to provide recommendations for the use of an axillary lymph node dissection in these patients. We searched Medline, Embase, and Cochrane databases from January 1, 2002, through November 27, 2007, for articles on patients with invasive breast cancer who had isolated tumor cells in the sentinel lymph node (according to the sixth edition of the Cancer Staging Manual of the American Joint Committee on Cancer) and who also underwent axillary lymph node dissection. Of 411 selected articles, 29 (including 836 patients) were included in this review. These 29 studies were heterogeneous, reporting a wide range of non–sentinel lymph node involvement (defined as the presence of isolated tumor cells or micro- or macrometastases) associated with isolated tumor cells in the sentinel lymph node, with an overall pooled risk for such involvement of 12.3% (95% confidence interval = 9.5% to 15.7%). This pooled risk estimate was marginally higher than the risk of a false-negative sentinel lymph node biopsy examination (ie, 7%–8%) but marginally lower than the risk of non–sentinel lymph node metastases in patients with micrometastases (ie, approximately 20%) who are currently eligible for an axillary lymph node dissection. Because 36 (64%) of the 56 patients with isolated tumor cells in their sentinel lymph node also had non–sentinel lymph node macrometastases, those patients with isolated tumor cells in the sentinel lymph node without other indications for adjuvant systemic therapy might be candidates for axillary lymph node dissection.

de Boer, Maaike; Monninkhof, Evelyn M.; Bult, Peter; van der Wall, Elsken; Tjan-Heijnen, Vivianne C. G.; van Diest, Paul J.

2008-01-01

102

Axillary Ultrasound for Breast Cancer Staging: an Attempt to Identify Clinical/Histopathological Factors Impacting Diagnostic Performance  

PubMed Central

Aim: To assess the diagnostic value of pre-surgery axillary ultrasound for nodal staging in patients with primary breast cancer and to identify clinical/histopathological factors impacting diagnostic performance. Study design: Single-center, retrospective chart analysis. We assessed sensitivity, specificity, and positive and negative predictive value of clinical examination as well as axillary ultrasound vs. clinical examination alone. The histopathological results were the standard of truth. In addition, we analyzed clinical and histopathological factors regarding their potential to impact sensitivity and specificity. Results: We enrolled a total of 172 women in the study. Sensitivity of clinical examination plus ultrasound was significantly higher than for clinical examination alone (58% vs. 31.6%). Specificity and positive predictive value were similar while the negative predictive value increased from 63.4% to 73% when additionally applying ultrasound. Sensitivity and specificity of axillary ultrasound were impacted by tumor size (P = 0.2/0.04), suspicious axillary palpation (P < 0.01/<0.01), number of affected lymph nodes (P < 0.01/?) and distant metastases (P = 0.04/<0.01). All other factors had no impact. Conclusion: Since pre-surgery axillary nodal staging is currently used to determine disease management, axillary ultrasound is a useful add-on tool in the diagnostic armamentarium for breast cancer patients. Tumor size, suspicious axillary palpation, number of affected lymph nodes and distant metastases increase diagnostic performance of this diagnostic modality.

Ertan, Kubilay; Linsler, Christina; di Liberto, Alexander; Ong, Mei Fang; Solomayer, Erich; Endrikat, Jan

2013-01-01

103

Prognostic factors and natural history in lymph node-negative breast cancer patients  

Microsoft Academic Search

Summary The prognostic significance of clinical and histological factors as well as hormone receptors was analyzed in a population of 3,064 lymph node-negative breast cancer patients operated in the Stockholm region between 1976 and 1988. None of these patients received systemic adjuvant treatment. Multivariate analysis showed that only histological tumor size, number of examined axillary lymph nodes, and progesterone receptors

Rodrigo Arriagada; Lars Erik Rutqvist; Lambert Skoog; Hemming Johansson; Andrew Kramar

1992-01-01

104

Does the Metastatic Lymph Node Ratio Influence the Disease-Free Survival of Patients with Breast Cancer: Single-Center Experiences  

Microsoft Academic Search

Background: Axillary lymph nodes (ALNs) are the most important prognostic factor for survival in breast cancer. Pathological evaluation can affect the number of involved lymph nodes. In the current study, we evaluated whether the metastatic lymph node ratio (n ratio) is important in predicting disease-free survival (DFS) for breast cancer patients. Material and Methods: From 802 breast cancer cases, 427

Bala Basak Oven Ustaalioglu; Ahmet Bilici; Umut Kefeli; Emre Yildirim; Taflan Salepci; Mustafa Oncel; Metin Kement; Mahmut Gumus

2010-01-01

105

Multiple axillary-infraclavicular lymph node metastasis from malignant rhabdoid tumor of unknown primary site.  

PubMed

Malignant rhabdoid tumors (MRT) mostly originate from the kidney and central nervous system. However, they may also originate from retroperitoneal and paravertebral regions, mediastinum, liver, chest wall, extremity, and neck, as well as from the soft tissues. The most important method in the differential diagnosis is the analysis of cytogenetic alterations in the INI1 gene. A six-month-old girl presented with multiple conglomerated lymphadenopathies located in the anterior axillary line. MRT diagnosis was confirmed by loss of INI1 expression in the tumor tissue. This is the first case in the literature with unknown primary focus diagnosed from lymph node metastasis. PMID:23094545

Demir, Haci Ahmet; Kaçar, Ayper; Emir, Suna; Cihan, Birsen Songül; Tunç, Bahattin

106

Planar Tc99m – sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: Results of an international multicenter trial  

Microsoft Academic Search

BACKGROUND: Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion. As a part of an interregional protocol using scintimammography with Tc99m compounds, the value of planar Tc99m sestamibi scanning for axillary lymph node evaluation is presented. Since there is a wide range of reported values, a standardized protocol of planar imaging was

Teresa Massardo; Omar Alonso; Augusto Llamas-Ollier; Levin Kabasakal; Uma Ravishankar; Rossana Morales; Lucía Delgado; Ajit K Padhy

2005-01-01

107

Contraindications of sentinel lymph node biopsy: Áre there any really?  

Microsoft Academic Search

BACKGROUND: One of the most exciting and talked about new surgical techniques in breast cancer surgery is the sentinel lymph node biopsy. It is an alternative procedure to standard axillary lymph node dissection, which makes possible less invasive surgery and side effects for patients with early breast cancer that wouldn't benefit further from axillary lymph node clearance. Sentinel lymph node

George M Filippakis; George Zografos

2007-01-01

108

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sj?gren's Syndrome: A Case Report  

PubMed Central

Sjögren's syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.

Genc, Volkan; Genc, Aysun; Ozben, Volkan; Basceken, Salim; Dusunceli, Ebru Bilge

2011-01-01

109

The Axillary Nodal Harvest in Breast Cancer Surgery Is Unchanged by Sentinel Node Biopsy or the Timing of Surgery  

PubMed Central

Introduction. Patients with a positive sentinel lymph node biopsy may undergo delayed completion axillary dissection. Where intraoperative analysis is available, immediate completion axillary dissection can be performed. Alternatively, patients may undergo primary axillary dissection for breast cancer, historically or when preoperative assessment suggests axillary metastases. This study aims to determine if there is a difference in the total number of lymph nodes or the number of metastatic nodes harvested between the 3 possible approaches. Methods. Three consecutive comparable groups of 50 consecutive patients who underwent axillary dissection in each of the above contexts were identified from the Portsmouth Breast Unit Database. Patient demographics, clinicopathological variables, and surgical treatment were recorded. The total pathological nodal count and the number of metastatic nodes were compared between the groups. Results. There were no differences in clinico-pathological features between the three groups for all features studied with the exception of breast surgical procedure (P < 0.001). There were no differences in total nodal harvest (P = 0.822) or in the number of positive nodes harvested (P = 0.157) between the three groups. Conclusion. The three approaches to axillary clearance yield equivalent nodal harvests, suggesting oncological equivalence and robustness of surgical technique.

Byrne, B. E.; Cutress, R. I.; Gill, J.; Wise, M. H.; Yiangou, C.; Agrawal, A.

2012-01-01

110

Axillary Metastasis as the First Manifestation of Occult Breast Cancer in a Male Patient  

PubMed Central

Summary Background The aim of this study was to investigate the clinicopathologic features of male breast cancer. Case Report We present the clinicopathologic data of a 72-year-old male patient with occult breast cancer, who was diagnosed and underwent surgery in our hospital. The diagnosis was confirmed by histological examination, and the patient underwent modified radical mastectomy and axillary dissection. The histological examination showed no tumor foci in the resected breast tissue, but 2 of 15 dissected axillary lymph nodes were invaded by infiltrating ductal carcinoma. Immunohistochemistry staining was negative for both estrogen and progesterone receptors, but showed expression of p53 protein (+++), proliferating cell nuclear antigen (PCNA) (+++), Bcl-2 on-coprotein (+++), nm23 protein (++), multidrug resistance protein (MRP) (++), and human epidermal receptor (HER-2) oncoprotein (+++). 24 months after being diagnosed, the patient is alive without any residual or metastatic disease. Conclusions Breast cancer is very rare in men, and the occurrence of occult breast cancer is even less common. Axillary metastases can present as the first manifestation of breast cancer in a male.

Gu, Guo-Li; Wang, Shi-Lin; Wei, Xue-Ming; Ren, Li; Zou, Fu-Xian

2009-01-01

111

Solitary bulky mediastinal lymph node metastasis from colon cancer.  

PubMed

A 75 year-old man underwent right hemicolectomy for colon cancer 3 yrs and 6 months ago, followed by chemotherapy with capecitabine. One year and 10 months later, solitary liver metastasis was resected. Five months later, a bulky mediastinal mass of 6 cm in diameter was detected by chest computed tomography and he was referred to our department. The tumor was successfully extirpated by videothoracoscopy-assisted right axillary approach. Histopathology disclosed poorly-differentiated tubular adenocarcinoma and diagnosed as metastatic mediastinal lymph node from the colon cancer. He was discharged on the day 5 and alive without disease 13 months after the mediastinal surgery. PMID:23232303

Iwata, Takashi; Chung, Kyukwang; Hanada, Shoji; Toda, Michihito; Nakata, Ken; Kato, Takeshi; Miura, Takuya

2012-11-15

112

Sentinel Lymph Node Biopsy in Breast Cancer: Guidelines and Pitfalls of Lymphoscintigraphy and Gamma Probe Detection  

Microsoft Academic Search

Background: Sentinel node (SN) biopsy appears to offer an alternative to routine axillary lymph node dissection (ALND) for staging patients with breast cancer. Various techniques have been studied for identifying the SN, using vital blue dye or radioactive colloid, and initial reports are promising. The inherent limitations and pitfalls must be clearly understood before SN biopsy can be implemented in

Paul J Borgstein; Rik Pijpers; Emile F Comans; Paul J van Diest; Rob P Boom; Sybren Meijer

1998-01-01

113

Tamoxifen and Chemotherapy for Lymph Node-Negative, Estrogen Receptor-Positive Breast Cancer  

Microsoft Academic Search

Background: The B-20 study of the National Surgical Adju- vant Breast and Bowel Project (NSABP) was conducted to determine whether chemotherapy plus tamoxifen would be of greater benefit than tamoxifen alone in the treatment of patients with axillary lymph node-negative, estrogen recep- tor-positive breast cancer. Methods: Eligible patients (n = 2306) were randomly assigned to one of three treatment groups

Bernard Fisher; James Dignam; Norman Wolmark; Arthur DeCillis; Birol Emir; D. Lawrence Wickerham; John Bryant; Nikolay V. Dimitrov; Neil Abramson; James N. Atkins; Henry Shibata; Luc Deschenes; Richard G. Margolese

1997-01-01

114

Cost-effectiveness of a 21-gene recurrence score assay versus Canadian clinical practice in women with early-stage estrogen- or progesterone-receptor-positive, axillary lymph-node negative breast cancer  

PubMed Central

Background A 21-gene recurrence score (RS) assay may inform adjuvant systematic treatment decisions in women with early stage breast cancer. We sought to investigate the cost effectiveness of using the RS-assay versus current clinical practice (CCP) in women with early-stage estrogen- or progesterone-receptor-positive, axilliary lymph-node negative breast cancer (ER+/ PR?+?LN- ESBC) from the perspective of the Canadian public healthcare system. Methods We developed a Markov model to project the lifetime clinical and economic consequences of ESBC. We evaluated adjuvant therapy separately in post- and pre-menopausal women with ER+/ PR?+?LN- ESBC. We assumed that the RS-assay would reclassify pre- and post-menopausal women among risk levels (low, intermediate and high) and guide adjuvant systematic treatment decisions. The model was parameterized using 7 year follow up data from the Manitoba Cancer Registry, cost data from Manitoba administrative databases, and secondary sources. Costs are presented in 2010 CAD. Future costs and benefits were discounted at 5%. Results The RS-assay compared to CCP generated cost-savings in pre-menopausal women and had an ICER of $60,000 per QALY gained in post-menopausal women. The cost effectiveness was most sensitive to the proportion of women classified as intermediate risk by the RS-assay who receive adjuvant chemotherapy and the risk of relapse in the RS-assay model. Conclusions The RS-assay is likely to be cost effective in the Canadian healthcare system and should be considered for adoption in women with ER+/ PR?+?LN- ESBC. However, ongoing assessment and validation of the assay in real-world clinical practice is warranted.

2012-01-01

115

Consensus on the regional lymph nodes irradiation in breast cancer.  

PubMed

Standard locoregional treatment of early-stage breast cancer currently consists of the conservative surgery and sentinel lymph node biopsy. In the event of positive sentinel node biopsy, an axillary level I-II lymphadenectomy should be carried out. However, recent publications have increasingly supported a tendency not to apply the surgical lymphadenectomy, but simultaneously, it has been developed a new role of regional radiotherapy, even if there is only 1-3 axillary lymph nodes involved. Given these new trends, radiation oncologists are facing the dilemma with regard to deciding about regional irradiation of breast cancer. For such purpose, The Spanish Group of Breast Cancer Radiation Oncology (GEORM as per its Spanish acronym) decided to reach a consensus to issue the respective guidelines for such types of cases. GEORM Managing Commission, gathering 13 members of different Spanish regional communities, issued a questionnaire including different clinical situations. These questions were set as key questions seeking responses, which were answered by 66 % out of the 75 members of the group. Following the response, the guidelines were drafted based on the replies to the mentioned questionnaire. All the respective issues were discussed by means of a virtual platform. In this article, we show the levels of consensus for different clinical situations, depending on the number of nodes involved and the type of surgical procedure performed on the axillary lymph nodes. The ongoing evolution of the oncological treatments obliges the radiation oncologists to take decisions without any existing clarifying evidence, and therefore, the consensus is necessary, which can assist in the decision-making process by the practitioners in such kinds of clinical situations. PMID:23519538

Bayo, E; Herruzo, I; Arenas, M; Algara, M

2013-03-22

116

Parametric imaging of the local attenuation coefficient in human axillary lymph nodes assessed using optical coherence tomography  

PubMed Central

We report the use of optical coherence tomography (OCT) to determine spatially localized optical attenuation coefficients of human axillary lymph nodes and their use to generate parametric images of lymphoid tissue. 3D-OCT images were obtained from excised lymph nodes and optical attenuation coefficients were extracted assuming a single scattering model of OCT. We present the measured attenuation coefficients for several tissue regions in benign and reactive lymph nodes, as identified by histopathology. We show parametric images of the measured attenuation coefficients as well as segmented images of tissue type based on thresholding of the attenuation coefficient values. Comparison to histology demonstrates the enhancement of contrast in parametric images relative to OCT images. This enhancement is a step towards the use of OCT for in situ assessment of lymph nodes.

Scolaro, Loretta; McLaughlin, Robert A.; Klyen, Blake R.; Wood, Benjamin A.; Robbins, Peter D.; Saunders, Christobel M.; Jacques, Steven L.; Sampson, David D.

2012-01-01

117

New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients  

Microsoft Academic Search

BACKGROUND: Current practice is to perform a completion axillary lymph node dissection (ALND) for breast cancer patients with tumor-involved sentinel lymph nodes (SLNs), although fewer than half will have non-sentinel node (NSLN) metastasis. Our goal was to develop new models to quantify the risk of NSLN metastasis in SLN-positive patients and to compare predictive capabilities to another widely used model.

Holbrook E Kohrt; Richard A Olshen; Honnie R Bermas; William H Goodson; Douglas J Wood; Solomon Henry; Robert V Rouse; Lisa Bailey; Vicki J Philben; Frederick M Dirbas; Jocelyn J Dunn; Denise L Johnson; Irene L Wapnir; Robert W Carlson; Frank E Stockdale; Nora M Hansen; Stefanie S Jeffrey

2008-01-01

118

Angiogenesis and hypoxia in lymph node metastases is predicted by the angiogenesis and hypoxia in the primary tumour in patients with breast cancer  

Microsoft Academic Search

Hypoxia and angiogenesis are important factors in breast cancer progression. Little is known of hypoxia and angiogenesis in lymph node metastases of breast cancer. The aim of this study was to quantify hypoxia, by hypoxia-induced marker expression levels, and angiogenesis, by endothelial cell proliferation, comparing primary breast tumours and axillary lymph node metastases. Tissue sections of the primary tumour and

G G Van den Eynden; I Van der Auwera; S J Van Laere; C G Colpaert; H Turley; A L Harris; P van Dam; L Y Dirix; P B Vermeulen; E A Van Marck

2005-01-01

119

The Microanatomic Location of Metastatic Breast Cancer in Sentinel Lymph Nodes Predicts Nonsentinel Lymph Node Involvement  

PubMed Central

Background The majority of sentinel node (SN) positive breast cancer patients do not have additional non-SN involvement and may not benefit from axillary lymph node dissection (ALND). Previous studies in melanoma have suggested that microanatomic localization of SN metastases may predict non-SN involvement. The present study was designed to assess whether these criteria might also be used to be more restrictive in selecting breast cancer patients who would benefit from an ALND. Methods A consecutive series of 357 patients with invasive breast cancer and a tumor-positive axillary SN, followed by an ALND, was reviewed. Microanatomic SN tumor features (subcapsular, combined subcapsular and parenchymal, parenchymal, extensive localization, multifocality, and the penetrative depth from the SN capsule) were evaluated for their predictive value for non-SN involvement. Results Non-SN metastases were found in 136/357 cases (38%). Microanatomic location and penetrative depth of SN metastases were significant predictors for non-SN involvement (<0.001); limited penetrative depth was associated with a low frequency of non-SN involvement with a minimal of 10%. Conclusions Microanatomic location and penetrative depth of breast cancer SN metastases predict non-SN involvement. However, based on these features no subgroup of patients could be selected with less than 10% non-SN involvement.

van Deurzen, Carolien H. M.; Seldenrijk, Cees A.; Koelemij, Ron; van Hillegersberg, Richard; Hobbelink, Monique G. G.

2008-01-01

120

Predicting recurrence in axillary-node negative breast cancer patients  

Microsoft Academic Search

This study attempted to identify the risk groups in axillary node negative breast cancer patients using validated first-generation prognostic clinical and pathologic factors. An updated 10-year follow-up in 407 such patients treated by surgery alone at Roswell Park between 1976–1987 showed a 10-year recurrence rate (RR) of 19% (95% confidence interval ±5%). Predictors of outcome were, in order of strength:

Dutzu Rosner I

1993-01-01

121

The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study  

PubMed Central

Background Many patients suffer from severe shoulder complaints after breast cancer surgery and axillary lymph node dissection. Physiotherapy has been clinically observed to improve treatment of these patients. However, it is not a standard treatment regime. The purpose of this study is to investigate the efficacy of physiotherapy treatment of shoulder function, pain and quality of life in patients who have undergone breast cancer surgery and axillary lymph node dissection. Methods Thirty patients following breast cancer surgery and axillary lymph node dissection were included in a randomised controlled study. Assessments were made at baseline and after three and six months. The treatment group received standardised physiotherapy treatment of advice and exercises for the arm and shoulder for three months; the control group received a leaflet containing advice and exercises. If necessary soft tissue massage to the surgical scar was applied. Primary outcome variables were amount of pain in the shoulder/arm recorded on the Visual Analogue Scale, and shoulder mobility (flexion, abduction) measured using a digital inclinometer under standardized conditions. Secondary outcome measures were shoulder disabilities during daily activities, edema, grip strength of both hands and quality of life. The researcher was blinded to treatment allocation. Results All thirty patients completed the trial. After three and six months the treatment group showed a significant improvement in shoulder mobility and had significantly less pain than the control group. Quality of life improved significantly, however, handgrip strength and arm volume did not alter significantly. Conclusion Physiotherapy reduces pain and improves shoulder function and quality of life following axillary dissection after breast cancer. Trial registration ISRCTN31186536

Beurskens, Carien HG; van Uden, Caro JT; Strobbe, Luc JA; Oostendorp, Rob AB; Wobbes, Theo

2007-01-01

122

Predictors of Lymphedema Following Breast Cancer Surgery.  

National Technical Information Service (NTIS)

Surgery for breast cancer includes removal of the breast tumor along with axillary lymph nodes. Unfortunately, a relatively common side effect following axillary lymph node dissection (ALND) is upper-extremity lymphedema. The purpose of this study is to i...

K. K. Swenson

2007-01-01

123

Immunolymphoscintigraphy for the detection of lymph node metastases from breast cancer  

SciTech Connect

The presence of metastases in the regional lymph nodes is the major prognostic factor in breast cancer in the absence of overt distant metastases and is also an important indicator of the need for adjuvant therapy in ''early'' breast cancer. Currently, the accurate assessment of axillary lymph node status requires axillary dissection which has an associated morbidity. An alternative method of identifying patients who are ''node positive'' has been developed by means of immunolymphoscintigraphy with s.c. administered radioiodinated monoclonal antibody. The /sup 131/I-labeled anti-breast cancer antibody (RCC-1; 400 micrograms) and cold iodine-labeled blocking antibody (Ly-2.1; 2 mg which is nonreactive with breast cancer) were injected s.c. into both arms and scintigraphy images were obtained 16-18 h after the injection, using the axilla contralateral to the side of the breast cancer as the control. Studies were reported as positive if the amount of background-subtracted radioactive count in the axilla of interest exceeded the normal side by a radio equal to or greater than 1.5:1.0 as assessed by computer analysis. In 38 of 40 patients the findings on scintigraphy were correlated with operative and histopathological findings on the axillary dissection specimen or cytological findings of fine needle aspiration of axillary lymph nodes. In a prospective study of 26 patients, the method is more sensitive (86%) and specific (92%) than preoperative clinical assessment (57% sensitivity, 58% specificity) in the detection of axillary lymph node metastases; and by combining both modalities of assessment, there was an improvement in the sensitivity (100%) but a deterioration in the specificity (50%).

Tjandra, J.J.; Russell, I.S.; Collins, J.P.; Andrews, J.T.; Lichtenstein, M.; Binns, D.; McKenzie, I.F.

1989-03-15

124

Evaluation of a Single-Isocenter Technique for Axillary Radiotherapy in Breast Cancer  

SciTech Connect

The aim of this study was to develop a technique for axillary radiotherapy that minimizes the risk of radiation-induced damage to the surrounding normal tissue (i.e., arm, shoulder, lung, esophagus, and spinal cord) while keeping the risk of a nodal recurrence to a minimum. A planning study was performed in 20 breast cancer patients. The target volume of the axillary treatment encompassed the periclavicular and axillary lymph node areas. The 3-dimensional (3D) computed tomography (CT) information in this study was used to outline the lymph node areas and the organs at risk (i.e., the esophagus, spinal cord, brachial plexus, and lung). A conventional AP-PA technique (with a transmission plate placed in the AP beam) was evaluated. In addition, a new single-isocenter technique consisting of AP/PA fields using a gantry rotation of {+-}20 deg. and a medial AP segment was developed. Both techniques were compared by evaluation of the calculated dose distributions and the dose-volume histograms of the target volume and surrounding organs at risk. The field borders and humeral shielding were redefined based on the 3D anatomical references. Adapting the humeral shielding reduced the irradiated volume by 19% and might contribute to a reduction of the incidence of arm edema and impairment of shoulder function. The maximum radiation dose in the esophagus and spinal cord was reduced by more than 50% using the single-isocenter technique. The difference between both techniques with respect to the mean doses in the target volume and lung, and the maximum dose in brachial plexus, was not statistically significant. Moreover, the single-isocenter technique allowed a fast and easy treatment preparation and reduced the execution time considerably (with approximately 10 minutes per fraction)

Beek, Suzanne van [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands)], E-mail: s.v.beek@nki.nl; Jaeger, Katrien de [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands); Mijnheer, Ben [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands)]|[INHOLLAND University of Professional Training, Haarlem (Netherlands); Vliet-Vroegindeweij, Corine van [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands)

2008-10-01

125

The risk of nodal metastases in breast cancer patients with clinically negative lymph nodes: a population-based analysis  

Microsoft Academic Search

A population-based study was performed to assess the likelihood of axillary lymph node metastases in patients with clinically negative lymph nodes, according to patient age, tumor size and site, estrogen receptor status, histologic type and mode of detection. Data were obtained from the population-based Eindhoven Cancer Registry. During the period 1984–1997, 7680 patients with invasive breast cancer were documented, 6663

Adri C. Voogd; Jan-Willem W. Coebergh; Ocker J. Repelaer van Driel; Rudi M. H. Roumen; Mike W. P. M. van Beek; Art Vreugdenhil; Mariad A. Crommelin

2000-01-01

126

Helical Tomotherapy Planning for Left-Sided Breast Cancer Patients With Positive Lymph Nodes: Comparison to Conventional Multiport Breast Technique  

Microsoft Academic Search

Purpose: To evaluate the feasibility of using helical tomotherapy for locally advanced left-sided breast cancer. Methods and Materials: Treatment plans were generated for 10 left-sided breast cancer patients with positive lymph nodes comparing a multiport breast (three-dimensional) technique with the tomotherapy treatment planning system. The planning target volumes, including the chest wall\\/breast, supraclavicular, axillary, and internal mammary lymph nodes, were

S. Murty Goddu; Summer Chaudhari; Maria Mamalui-Hunter; Olga L. Pechenaya; David Pratt; Sasa Mutic; Imran Zoberi; Sam Jeswani; Simon N. Powell; Daniel A. Low

2009-01-01

127

Axillary Recurrence Following Conservative Surgery and Radiotherapy in Early Breast Cancer  

Microsoft Academic Search

At the institute, since the late 1980s, there has been a uniform treatment protocol for the management of the regional lymph nodes in patients referred for radiotherapy following breast-conserving surgery. An analysis of 2277 consecutive patients referred for radiotherapy between 1989 and 1992, with particular reference to regional lymph node management, has been undertaken. Axillary surgery alone was used in

J. E. Livsey; B. Magee; A. L. Stewart; R. Swindell

2000-01-01

128

Keratin 19 mRNA measurement to detect micrometastases in lymph nodes in breast cancer patients.  

PubMed Central

We have used polymerase chain reaction (PCR) to measure keratin 19 mRNA in order to detect breast cancer cells invading axillary lymph nodes. In a consecutive series of 125 patients with primary breast cancer, 75 patients had no evidence of lymph node involvement by conventional histology. A total of 530 lymph nodes from these patients were examined and 106 (20%) gave a keratin 19 product detectable by Southern hybridisation. This correlated with primary tumour size (P<0.001). These 106 nodes came from 23 patients. Thus, using this technique, 23/75 (30.6%) patients were found to have evidence of lymph node involvement who would otherwise have been designated lymph node negative.

Schoenfeld, A.; Luqmani, Y.; Sinnett, H. D.; Shousha, S.; Coombes, R. C.

1996-01-01

129

Sentinel lymph node biopsy versus axillary clearance in operable breast cancer: The RACS SNAC trial, a multicenter randomized trial of the royal Australian college of surgeons (RACS) section of breast surgery, in collaboration with the national health and medical research council clinical trials center  

Microsoft Academic Search

The aim of the SNAC trial is to determine if sentinel node biopsy (SNB) produces less morbidity and equivalent cancer-related\\u000a outcomes in comparison with immediate axillary clearance (AC) in women with early breast cancer. The intervention is SNB followed\\u000a by immediate AC, or SNB followed by AC only if the SNB specimen is positive. This is a multicenter, centrally randomized

P. Grantley Gill

2004-01-01

130

Sentinel lymph node mapping with GI cancer  

Microsoft Academic Search

Precise evaluation of lymph node status is one of the most important factors in determining clinical outcome in treating gastro-intestinal\\u000a (GI) cancer. Sentinel lymph node (SLN) mapping clearly has become highly feasible and accurate in staging GI cancer. The lunchtime\\u000a symposium focused on the present status of SLN mapping for GI cancer. Dr. Kitigawa proposed a new strategy using sentinel

Takashi Aikou; Yuko Kitagawa; Masaki Kitajima; Yoshikazu Uenosono; Anton J. Bilchik; Steve R. Martinez; Sukamal Saha

2006-01-01

131

Optimization of a gamma imaging probe for axillary sentinel lymph mapping  

NASA Astrophysics Data System (ADS)

Sentinel lymph node (SLN) mapping is a technique for assessing whether early-stage invasive breast cancer has metastasized, thus determining prognosis and treatment options. SLN identification is achieved using the blue-dye and radioactive colloids techniques, which are sometimes combined with lymphoscintigraphy. Furthermore, intra-operative gamma acoustic probes, as well as gamma imaging probes are used during surgery. The purpose of this study is the construction of a gamma probe for sentinel lymph node imaging and its optimization in terms of sensitivity with respect to spatial resolution. The reference probe has small field of view (2.5 × 2.5 cm2) and is based on a position sensitive photomultiplier tube (PSPMT) coupled to a pixellated CsI(Tl) scintillator. Following experimental validation, we simulated the system using the GATE Monte Carlo toolkit (GATE v6.1) and modeled various collimator geometries, in order to evaluate their performance and propose the optimal configuration. The constraints of the proposed gamma imaging probe are i) sensitivity close to 2 cps/kBq and ii) spatial resolution equal to 6 mm at 2 cm source-to-collimator distance and ~ 10 mm at 5 cm. An integrated structure that achieves those requirements is a tungsten collimator with 2 × 2 mm2square holes, 16 mm thickness, 0.15 mm septa, where each CsI(Tl) 2 × 2 × 5 mm3 crystal pixel is placed inside the collimator.

Georgiou, M.; Loudos, G.; Stratos, D.; Papadimitroulas, P.; Liakou, P.; Georgoulias, P.

2012-09-01

132

Ultrastaging of lymph node in uterine cancers  

Microsoft Academic Search

BACKGROUND: Lymph node status is an important prognostic factor and a criterion for adjuvant therapy in uterine cancers. While detection of micrometastases by ultrastaging techniques is correlated to prognosis in several other cancers, this remains a matter of debate for uterine cancers. The objective of this review on sentinel nodes (SN) in uterine cancers was to determine the contribution of

Corinne Bézu; Charles Coutant; Marcos Ballester; Jean-Guillaume Feron; Roman Rouzier; Serge Uzan; Emile Daraï

2010-01-01

133

Impairment of Lymph Drainage in Subfascial Compartment of Forearm in Breast Cancer-Related Lymphedema  

PubMed Central

Background: In arm lymphedema secondary to axillary surgery and radiotherapy (breast cancer-related lymphedema), the swelling is largely epifascial and lymph flow per unit epifascial volume is impaired. The subfascial muscle compartment is not measurably swollen despite the iatrogenic damage to its axillary drainage pathway, but this could be due to its low compliance. Our aim was to test the hypothesis that subfascial lymph drainage too is impaired. Methods and Results: Quantitative lymphoscintigraphy was used to measure the removal rate constant (local lymph flow per unit distribution volume) for technetium-99m-human immunoglobulin G injected intramuscularly in the forearms of nine women with unilateral lymphedema. The removal rate constant was on average 31% lower in the ipsilateral swollen forearm than in the contralateral forearm (swollen arm: ?0.096 ± 0.041% min?1, contralateralarm: ?0.138 ± 0.037% min?1; mean ± SD, p = 0.037). The decrease in subfascial rate constant correlated strongly with increase in arm volume (r 0.88, p = 0.002), even though the swelling is mainly epifascial. There was no convincing evidence of dermal backflow. Conclusions: Lymph flow in the subfascial muscle compartment is decreased in breast cancer-related lymphedema. The correlation between impairment of subfascial drainage and epifascial arm swelling could be because both depend on the severity of axillary damage, or because loss of function in subfascial lymphatics impairs drainage from the epifascial to the subfascial system.

MELLOR, R.H.; COOK, G.J.; SVENSSON, W.E.; PETERS, A.M.; LEVICK, J.R.; MORTIMER, P.S.

2005-01-01

134

Axillary recurrence following conservative surgery and radiotherapy in early breast cancer.  

PubMed

At the institute, since the late 1980s, there has been a uniform treatment protocol for the management of the regional lymph nodes in patients referred for radiotherapy following breast-conserving surgery. An analysis of 2,277 consecutive patients referred for radiotherapy between 1989 and 1992, with particular reference to regional lymph node management, has been undertaken. Axillary surgery alone was used in 517 patients (23%); 1,191 (52%) patients had no axillary surgery but had radiotherapy to the axilla, and infraclavicular and supraclavicular fossae by a single anterior field, delivering 40 Gy in 15 daily fractions over 3 weeks; and 474 patients (21%) had axillary surgery followed by radiotherapy. Ninety-five patients (4%) underwent no axillary treatment. There was a total of 155 axillary recurrences with a median follow-up of 5.9 years, giving an actuarial nodal control rate of 94% at 5 years (95% confidence interval (CI) 93.1-95.1). The overall survival at 5 years was 86% (95% CI 84.6-87.5). There was a trend towards improved axillary control with surgery alone compared with radiotherapy alone (4.5% versus 5.9% actuarial axillary failure rate at 5 years). An extremely low incidence of brachial plexus neuropathy secondary to radiotherapy was reported. The multidisciplinary treatment protocol used gave a high rate of regional node control, with minimal recorded morbidity. PMID:11315717

Livsey, J E; Magee, B; Stewart, A L; Swindell, R

2000-01-01

135

Detection efficiency for measuring 241Am in axillary lymph nodes using different types and sizes of detectors.  

PubMed

The detection efficiency and interference susceptibility of four different types of low energy photon detectors, each with a unique geometric arrangement, were compared for direct measurement of Am deposited in the axillary lymph nodes. Although the most efficient detector was a single large 23,226 mm square phoswich detector, it was also the most susceptible to confounding depositions from activity deposited in adjacent organs. The array of two 2,800 mm high purity germanium detectors exhibited the highest efficiency per unit detector area with some resistance to confounding from activity deposited in the lungs. The array of two 4,560 mm NaI(Tl) detectors was the least susceptible to confounding and nearly as efficient per square millimeter as the high purity germanium detector array. Thus, selection of a detector system for in vivo measurement of activity deposited in the axillary lymph nodes should consider whether there is a likelihood for activity deposited in other organs, such as the lungs, skeleton, or liver, to create an interference that will confound the measurement result. PMID:22850233

Lobaugh, Megan L; Spitz, Henry B; Glover, Samuel E

2012-09-01

136

Integration of risk factors to allow patient selection for adjuvant systemic therapy in lymph node-negative breast cancer patients  

Microsoft Academic Search

The selection of patients with axillary lymph node-negative breast cancer who should receive adjuvant therapy today is confused by an expanding arsenal of putative prognostic factors. The size of the primary tumor remains the dominant factor in sorting among this group of patients, with general agreement that tumors 1 cm or less should be spared adjuvant systemic therapy outside of

William C. Wood

1994-01-01

137

Efficacy and Significance of Sentinel Lymph Node Identification with Technetium99m-labeled Tin Colloids for Breast Cancer  

Microsoft Academic Search

Purpose  The sentinel lymph node (SLN) is thought to reflect the metastatic status of the remaining axillary lymph nodes in patients\\u000a with breast cancer. We used technetium-99m-labeled tin colloids to identify SLN. The efficacy and significance of SLN identification\\u000a using this method were investigated in terms of number, size, location, and tumor metastasis. The efficacy of the emulsion\\u000a charcoal injection method

Kazuhiko Sato; Hoshio Hiraide; Minoru Uematsu; Kuniyoshi Tamaki; Hirofumi Ishikawa; Tamio Yamasaki; Seiichi Tamai; Shoichi Kusano; Hidetaka Mochizuki

1998-01-01

138

Sentinel lymph node biopsy in male breast cancer patients.  

PubMed

The concept of sentinel node biopsy has been validated for female breast cancer patients whereas, ALND remains the standard of care for male breast cancer patients with similar tumours. We evaluated the results of SLN biopsy in male breast cancer patients with clinically negative axillae. This study included all male breast cancer patients who underwent SLN biopsy between February 1998 and October 2003. All patients had negative axillae on clinical examination. All patients underwent pre-operative lymphoscintigraphy. SLN biopsy was performed using a combination of Patent blue V and 99mTc-radiolabelled colloidal albumin injected peritumourally. Nine patients, 26-79 years of age, were included in the study. Pre-operative lymphoscinitgraphy identified SLNs in all patients. Intraoperatively, SLNs were successfully localised in all patients. The mean number of SLNs encountered was 2.4. Five patients had a positive SLN, four a negative SLN. Five patients (one with a negative SLN, four with a positive SLN) had been elected pre-operatively to undergo ALND regardless of findings on SLN biopsy. ALND confirmed the SLN to be negative in one patient (false-negative rate: 0%) and three of the four patients with positive SLN(s) had additional positive nodes in the axilla. SLN biopsy accurately predicted axillary lymph node status in these five patients. These findings compare favourably with findings reported in the literature regarding SLN biopsy in female breast cancer patients. SLN biopsy accurately staged the axilla in male breast cancer patients and should be considered for axillary staging in male breast cancer patients with clinically negative axillae. PMID:15135473

Goyal, A; Horgan, K; Kissin, M; Yiangou, C; Sibbering, M; Lansdown, M; Newcombe, R G; Mansel, R E; Chetty, U; Ell, P; Fallowfield, L; Kissin, M

2004-06-01

139

[Sentinel lymph-node biopsy in breast cancer: five years' experience].  

PubMed

The authors report on their experience with sentinel lymph-node biopsy in breast cancer. Sentinel lymph-node biopsy was performed in 91 patients with T1-T2 N0 M0 breast cancer using radiocolloid (99mTC radiolabelled colloidal human albumin microaggregate) injected perilesionally in 56 cases and by Blu Patent V alone in 35 cases. The sentinel lymph nodes identified were located in the axilla in 88 cases, in the internal mammary nodes in 2 cases and in a subclavicular site in 1 case. The histological examination was negative in 62 cases and positive in 29; Axillary lymph-node dissection was carried out in node-positive cases. No recurrences were observed in any of the cases treated. Lymphatic mapping and sentinel lymphadenectomy in primary breast cancer is now a feasible and useful method of avoiding routine axillary lymphadenectomy. However, the role of micro- or macrometastases in sentinel lymph nodes and the significance of identification of tumour mRNA have yet to be defined. PMID:15038655

Gioffrè Florio, Maria Antonietta; Famà, Fausto; Gullo, Grazia; Pollicino, Andrea; Scarfò, Paola

140

The expression of aldehyde dehydrogenase 1 in invasive primary breast tumors and axillary lymph node metastases is associated with poor clinical prognosis.  

PubMed

The enzyme aldehyde dehydrogenase 1 (ALDH1) has been reported as a biomarker for identifying cancer stem cells. Previous studies have shown that ALDH1 expression in primary breast cancers was associated with poor clinical prognosis. In this study, we aimed to determine whether ALDH1 expression in axillary lymph node metastases (ALNM) of breast cancer patients was also associated with poor prognosis. Expression of ALDH1, ER, PgR, HER2 and KI-67 was examined in primary tumors and ALNM of 161 patients with invasive breast cancer. Survival analysis and multivariate analysis were used to determine the relationship between ALDH1 expression and clinical prognosis. Patients with positive ALDH1 expression in primary tumors and in ALNM had significantly shorter relapse-free survival (RFS) times and overall survival (OS) times compared to those whose tissues were ALDH1 negative. ALDH1-positivity in primary tumors was significant both in univariate and multivariate analyses of RFS and OS. ALDH1 expression in ALNM was significant in a univariate analysis of RFS and OS but not in a multivariate analysis of RFS and OS. We conclude that the expression of ALDH1 in primary breast tumors or ALNM may be one potential risk factor for poor, long-term outcomes. PMID:23916993

Dong, Yi; Bi, Li-Rong; Xu, Ning; Yang, Hong-Mei; Zhang, Hai-Tao; Ding, Ying; Shi, Ai-Ping; Fan, Zhi-Min

2013-06-14

141

Axillary Dissection in Breast Cancer Patients with Metastatic Sentinel Node: To Do or Not to Do? Suggestions from Our Series  

PubMed Central

Several studies have put to question and evaluated the indication and prognosis of sentinel lymph node biopsy (SNLB) as sole treatment in human breast cancer. We reviewed 1588 patients who underwent axillary surgery. In 239 patients, axillary lymph node dissection (ALND) was performed following positive fine needle aspiration cytology (FNAC), and, in 299 cases, ALND was executed after positive SNLB. The most dramatic result from our data is that patients with either micrometastasis of the sentinel lymph node (SLN) or only metastatic SLN have, respectively, an 84.5% and a 75.0% chance of having no other nodal involvement. We believe a more refined patient selection is neccessary when considering ALND. Where the primary tumor is larger than 5?cm, where radio or adjuvant therapies are not indicated, in cases of FNAC+ nodes, and in cases presenting more than one metastatic sentinel node, we prefer to carry out ALND. Having thus said, however, our data suggests that it is wise not to perform ALND in almost all cases presenting positive SLNs.

Bortolini, M.; Genta, F.; Biacchiardi, Chiara Perono; Zanon, E.; Camanni, M.; Deltetto, F.

2011-01-01

142

Differentially expressed genes between primary cancer and paired lymph node metastases predict clinical outcome of node-positive breast cancer patients  

Microsoft Academic Search

The axillary lymph node status remains the most valuable prognostic factor for breast cancer patients. However, approximately\\u000a 20–30% of node-positive patients remain free of distant metastases within 15–30 years. It is important to develop molecular\\u000a markers that are able to predict for the risk of distant metastasis and to develop patient-tailored therapy strategies. We\\u000a hypothesize that the lymph node metastases may

Yumei Feng; Baocun Sun; Xiaoqing Li; Liang Zhang; Yun Niu; Chunhua Xiao; Liansheng Ning; Zhiyi Fang; Yuli Wang; Lina Zhang; Jing Cheng; Wei Zhang; Xishan Hao

2007-01-01

143

Male breast cancer arising in ectopic axillary breast tissue: A diagnostic dilemma  

PubMed Central

Male breast cancer arising in ectopic axillary breast tissue is a rare occurrence and few cases have been reported in the literature. Due to its rarity, male axillary breast cancer is easy to misdiagnose. As for adenocarcinoma in the axilla, it is difficult to identify whether the origin is the mammary tissue or the skin appendages, particularly in cases where there is a poor differentiation. The present study reports the case of a male patient with a right axillary lesion that had been present for 6 months. A histological evaluation revealed the features of a poorly-differentiated adenocarcinoma with regards to the pathological report. The patient was diagnosed with a metastatic adenocarcinoma with unknown primary origin. However, following 4 cycles of intensive chemotherapy, the patient experienced bone metastasis while the local lesion was in partial remission. Further immunohistochemistry confirmed its mammary origin. There is limited literature relating to male ectopic axillary breast cancer, and a high probability of misdiagnosis of this disease.

XIE, YANGCHUN; HUANG, JIN; XIAO, DESHENG; ZHONG, MEIZUO

2013-01-01

144

Safety of avoiding routine use of axillary dissection in early stage breast cancer: a systematic review.  

PubMed

Physicians are moving away from routine axillary lymph node dissection (ALND) in clinically node-negative breast cancer. We conducted a systemic review on the safety of this policy. Pubmed and Cochrane library were searched for. Sixty-eight studies were included: studies of clinically node-negative patients in the pre-sentinel node (SN) era; observational studies of SN-negative patients, without ALND; comparative studies of SN-negative patients, with a non-ALND and an ALND group; SN-positive studies, of patients without ALND. Primary endpoint was the pooled axillary recurrence rate (ARR) of each category; secondary endpoint was overall survival (OS) rate. In pre-SN studies, with larger tumors and less systemic therapy, ARR without ALND after 5-10 years follow-up was 12-18%, with 5% reduced OS. In the observational SN-negative studies, with median follow-up of 36 months, the pooled ARR was 0.6% (95% CI 0.6-0.8). In the comparative SN-negative studies, pooled ARR was 0.4% (95% CI 0.2-0.6) without ALND versus 0.3% (95% CI 0.1-0.6) with ALND at 31 and 47 months, respectively, and no survival disadvantage. In SN-positive studies, ARR was up to 1.7% (95% CI 1.0-2.7) at 30 months. For patients with an H&E positive SN the ARR without ALND was 5% after 23 months, which may imply rates as high as 13 and 18% after 5 and 8 years. In conclusion, this systematic review confirms the safety of omitting ALND in SN-negative patients. There is a potential role for avoiding ALND in selected SN-positive patients, but eligibility criteria and the role of systemic therapy need further to be elucidated. PMID:20972825

Pepels, Manon J; Vestjens, Johanna H M J; de Boer, Maaike; Smidt, Marjolein; van Diest, Paul J; Borm, George F; Tjan-Heijnen, Vivianne C G

2010-10-24

145

Effocacu and Significance of Sentinel Lymph Node Identification with Technetium-99m-labeled Tin Colloids for Breast Cancer.  

PubMed

PURPOSE: The sentinel lymph node (SLN) is thought to reflect the metastatic status of the remaining axillary lymph nodes in patients with breast cancer. We used technetium-99m-labeled tin colloids to identify SLN. The efficacy and significance of SLN identification using this method were investigated in terms of number, size, location, and tumor metastasis. The efficacy of the emulsion charcoalinjection method for the intraoperative visible identification of SLN was also evaluated. METHODS: Twenty-five patients with invasive breast cancer were studied. Underultrasonographic guidance, technetium-99m-labeled tin colloid particles (3 ml) were injected into 3 sites around the tumor within 3 mm of the margin or into the wall of the excisional biopsy cavity 2 hours before surgery. At surgery, just before the incision, an emulsion of charcoal particles (2.5 ml) was injected into 3 sites of the breast parenchyma surrounding the tumor. All patients underwent mastectomy with axillary dissection to the infraclavicular region. The radioactivity of each dissected lymph node was measured. All axillary specimens were processed in individual blocks for permanent section histopathologic evaluation with H & E. RESULTS: SLN were defined as lymph nodes with 100, 000 or more counts per minute (cpm) in radioactivity after injection of labeled tin colloids. In all 25 patients, SLN were identified (mean, 1.9 SLN/patient; range,1-4). Since the mean uptake in SLN was 383 124 cpm, but only 884 cpm in non-SLN nodes, discrimination between SLN and non-SLN nodes was easy. Clearly visible lymph nodes with charcoalstaining accounted for 83.3% of all SLN, although 21.3% of non-SLN also stained. SLN were located only in the axillary region, but there were no other specific features in the location or size of SLN. The SLN were metastatic in 10 of the 25 patients: in 4, the SLN were the only metastatic nodes whereas in the remaining 6 patients, other axillary nodes were also positive. Fifteen patients with no metastasis in SLN had no tumor involvement in any other lymph nodes. There were no skip metastases. CONCLUSION: SLN identified with labeled tin colloids have clinical value in predicting the metastatic status of the remaining axillary lymph nodes in breast cancer. PMID:11091680

Sato; Hiraide; Uematsu; Tamaki; Ishikawa; Yamasaki; Tamai; Kusano; Mochizuki

1998-10-25

146

Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial  

Microsoft Academic Search

Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were {>=}55 years

Julia S. Wong; Alphonse G. Taghian; Jennifer R. Bellon; Aparna Keshaviah; Barbara L. Smith; Eric P. Winer; Barbara Silver; Jay R. Harris

2008-01-01

147

Sentinel lymph node mapping with GI cancer.  

PubMed

Precise evaluation of lymph node status is one of the most important factors in determining clinical outcome in treating gastro-intestinal (GI) cancer. Sentinel lymph node (SLN) mapping clearly has become highly feasible and accurate in staging GI cancer. The lunchtime symposium focused on the present status of SLN mapping for GI cancer. Dr. Kitigawa proposed a new strategy using sentinel node biopsy for esophageal cancer patients with clinically early stage disease. Dr. Uenosono reported on whether the SLN concept is applicable for gastric cancer through his analysis of more than 180 patients with cT1-2, N0 tumors. The detection rate was 95%, the false negative rate of lymph node metastasis including micro-metastasis was 4%, and accuracy was 99% in gastric cancer patients with cT1N0. Dr. Bilchik recommended the best technique for identifying SLNs in colorectal cancer: a combination of radiotracer and blue dye method, emphasizing that this technique will become increasingly popular because of the SLN concept, with improvement in staging accuracy. He stressed that this novel procedure offers the potential for significant upstaging of GI cancer. Dr. Saha emphasized that SLN mapping for colorectal cancer is highly successful and accurate in predicting the presence or absence of nodal disease with a relatively low incidence of skip metastases. It provided the "right nodes" to the pathologists for detailed analysis for appropriate staging and treatment with adjuvant chemotherapy. Although more evidence from large-scale multicenter clinical trials is required, SLN mapping may be very useful for individualizing multi-modal treatment for esophageal cancer and might be widely acceptable even for GI cancer. PMID:16770539

Aikou, Takashi; Kitagawa, Yuko; Kitajima, Masaki; Uenosono, Yoshikazu; Bilchik, Anton J; Martinez, Steve R; Saha, Sukamal

2006-06-01

148

Number of Metastatic Sentinel Nodes As Predictor of Axillary Involvement in Patients with Breast Cancer  

Microsoft Academic Search

Background and objectives. More than half of patients with positive sentinel node (SN) have no metastases in non-sentinel nodes (NSNs) on axillary lymph node dissection (ALND).The aim of this study was to investigate factors predictive of NSNs involvement, in order to identify patients with metastatic disease confined to the SN which might avoid ALND.\\u000aMethods. ALND was performed in 167

Giorgio Zavagno; Gian Luca De Salvo; Fernando Bozza; Giuliano Scalco; Renato Marconato; Stefano Valletta; Carlo Racano; Paolo Burelli; Donato Nitti; Mario Lise

2004-01-01

149

Sentinel Lymph Node Biopsy for Breast Cancer: Impact of the Number of Sentinel Nodes Removed on the False-Negative Rate  

Microsoft Academic Search

BACKGROUND: Numerous studies have demonstrated that sentinel lymph node (SLN) biopsy can accurately determine axillary nodal status for breast cancer, but unacceptably high false negative rates have also been reported. Attention has been focused on factors associated with improved accuracy. We have previously shown that injection of blue dye in combination with radioactive colloid reduces the false negative rate compared

Sandra L Wong; Michael J Edwards; Celia Chao; Todd M Tuttle; R Dirk Noyes; David J Carlson; Patricia B Cerrito; Kelly M McMasters

150

Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate 1 1 No competing interests declared  

Microsoft Academic Search

BACKGROUND:Numerous studies have demonstrated that sentinel lymph node (SLN) biopsy can accurately determine axillary nodal status for breast cancer, but unacceptably high false negative rates have also been reported. Attention has been focused on factors associated with improved accuracy. We have previously shown that injection of blue dye in combination with radioactive colloid reduces the false negative rate compared with

Sandra L Wong; Michael J Edwards; Celia Chao; Todd M Tuttle; R. Dirk Noyes; David J Carlson; Patricia B Cerrito; Kelly M McMasters

2001-01-01

151

Mechanism of lymph node metastasis in prostate cancer  

PubMed Central

Detection of lymph node metastases indicates poor prognosis for prostate cancer patients. Therefore, elucidation of the mechanism(s) of lymph node metastasis is important to understand the progression of prostate cancer and also to develop therapeutic interventions. In this article, the known mechanisms for lymph node metastasis are discussed and the involvement of lymphatic vessels in prostate cancer lymph node metastasis is comprehensively summarized. In addition, contradictory findings regarding the importance of lymphangiogenesis in facilitating lymph node metastasis in prostate cancer are pointed out and reconcilation is attempted.

Datta, Kaustubh; Muders, Michael; Zhang, Heyu; Tindall, Donald J

2010-01-01

152

Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial  

SciTech Connect

Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were {>=}55 years of age with Stage I-II clinically node-negative, hormone-receptor-positive breast cancer underwent tumor excision to negative margins without axillary surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy. Results: For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0-4%). Eight patients died, one of metastatic disease and seven of other causes. Conclusion: In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without axillary surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive axillary treatment (axillary surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity.

Wong, Julia S. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States)], E-mail: jwong@lroc.harvard.edu; Taghian, Alphonse G. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bellon, Jennifer R. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Keshaviah, Aparna [Department of Biostatistics and Computational Biology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Smith, Barbara L. [Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Winer, Eric P. [Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Silver, Barbara; Harris, Jay R. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States)

2008-11-01

153

Cell proliferation of the primary tumor predicts ipsilateral axillary node disease in elderly breast cancer patients.  

PubMed

The present study investigated whether tumor markers such as cell proliferation and steroid receptor status, which have been shown to have relevance for important endpoints (relapse-free and overall survival), can also predict axillary disease in elderly patients with breast cancer. We evaluated 351 consecutive elderly women with breast cancer ?70 years of age with estrogen receptor (ER)?positive tumors with no palpable axillary nodes, for whom information on cell proliferation determined by the 3H-thymidine labeling index (TLI) and progesterone receptor (PgR) was available. Patients underwent quadrantectomy (70.1%) or quadrantectomy plus radiotherapy (29.9%) without axillary node dissection, followed by adjuvant tamoxifen for at least 2 years. Univariable (cumulative incidence curves) and multivariable analyses (Fine and Gray models) were carried out. After a median follow-up of 16 years, ipsilateral axillary relapse was not related to PgR status but was strongly associated with tumor cell proliferation in both small (pT1) and large (pT2-4b) tumors. Axillary relapse cumulative incidence increased from 1% in patients with low-TLI (?3%), PgR-positive and pT1 tumors to a maximum of 20% in patients with high-TLI, PgR-negative and pT2-4b tumors. Tumor cell proliferation, determined by TLI at primary surgery, is an important predictor of axillary relapse in elderly ER-positive breast cancer patients and could help to identify patients who should undergo axillary surgery. PMID:23558937

Silvestrini, Rosella; Martelli, Gabriele; Miceli, Rosalba; Agresti, Roberto; Veneroni, Silvia; Daidone, Maria Grazia

2013-04-23

154

Sentinel Lymph Node Biopsy in Colon Cancer  

PubMed Central

Introduction: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results. Methods: Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination. Results: At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI ?24) were investigated in experienced centers (>22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MM/ITC) in the SLN. Conclusions: The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy.

Bembenek, Andreas E.; Rosenberg, Robert; Wagler, Elke; Gretschel, Stephan; Sendler, Andreas; Siewert, Joerg-Ruediger; Nahrig, Jorg; Witzigmann, Helmut; Hauss, Johann; Knorr, Christian; Dimmler, Arno; Grone, Jorn; Buhr, Heinz-Johannes; Haier, Jorg; Herbst, Hermann; Tepel, Juergen; Siphos, Bence; Kleespies, Axel; Koenigsrainer, Alfred; Stoecklein, Nikolas H.; Horstmann, Olaf; Grutzmann, Robert; Imdahl, Andreas; Svoboda, Daniel; Wittekind, Christian; Schneider, Wolfgang; Wernecke, Klaus-Dieter; Schlag, Peter M.

2007-01-01

155

Lymph Node Metastases and Prognosis in Penile Cancer  

PubMed Central

Lymph node status is a key prognostic factor in penile squamous cell carcinoma. Recently, growing evidence indicates a multimodality approach consisting of neoadjuvant chemotherapy followed by consolidation surgery improves the outcome of locally advanced penile cancer. Thus, accurate estimation of survival probability in node-positive penile cancer is critical for treatment decision making, counseling of patients and follow-up scheduling. This article reviewed evolving developments in assessing the risk for cancer progression based on lymph node related variables, such as the number of metastatic lymph nodes, bilateral lymph node metastases, the ratio of positive lymph nodes, extracapsular extension of metastatic lymph nodes, pelvic lymph node metastases, metastatic deposit in sentinel lymph nodes and N stage in TNM classification. Controversial issues surrounding the prognostic value of these nodal related predictors were also discussed.

Zhu, Yao; Ye, Ding-wei

2012-01-01

156

Current applications and future prospects of fine-needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer.  

PubMed

Staging of disease is routine in the evaluation of patients newly diagnosed with breast cancer. Assessment of palpable and/or nonpalpable locoregional lymph nodes is an important component of the initial staging. Ultrasound (US) is the favored imaging modality for the initial investigation of lymph nodes and results in a significant increase in the specificity of the overall evaluation when used in conjunction with fine-needle aspiration (FNA). This review provides a concise summary, based on published literature, of the current applications and future prospects of FNA biopsy of locoregional lymph nodes in the initial staging and subsequent surgical management of patients with breast cancer. Patients undergo either sentinel lymph node (SLN) biopsy or complete axillary lymph node dissection, based on whether the axillary lymph node status is determined to be negative or positive in the initial staging process. The status of lymph nodes in the supraclavicular, infraclavicular, and internal mammary regions provides more accurate staging information and also impacts subsequent surgical management. The identification and evaluation of intramammary lymph nodes can add value in the overall assessment of patients with breast cancer. The feasibility of noninvasive imaging modalities for SLN mapping in animal models has indicated a good potential for FNA biopsy in the subsequent investigation of SLNs identified noninvasively in humans. PMID:19813277

Krishnamurthy, Savitri

2009-12-25

157

Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer  

Microsoft Academic Search

Summary  This study is the first large prospective RCT of sentinel node biopsy (SNB) compared with standard axillary treatment (level\\u000a I-III axillary lymph node dissection or four node sampling), which includes comprehensive and repeated quality of life (QOL)\\u000a assessments over 18 months. Patients (n=829) completed the Functional Assessment of Cancer Therapy?–?Breast (FACT-B+4) and the Spielberger State\\/Trait Anxiety Inventory\\u000a (STAI) at baseline (pre-surgery)

Anne Fleissig; Lesley J. Fallowfield; Carolyn I. Langridge; Leigh Johnson; Robert G. Newcombe; J. Michael Dixon; Mark Kissin; Robert E. Mansel

2006-01-01

158

Micrometastatic Breast Cancer Cells in Bone Marrow at Primary Surgery: Prognostic Value in Comparison With Nodal Status  

Microsoft Academic Search

Background: Approximately 30% of the patients with primary breast cancer who have no axillary lymph node in- volvement (i.e., lymph node negative) at the time of surgery will relapse within 10 years; 10% -20% of the patients with distant metastases will be lymph node negative at surgery. Axillary lymph node dissection, as a surgical procedure, is associated with frequent complications.

Ingo J. Diel; Manfred Kaufmann; Serban D. Costa; Erich F. Solomayer; Sepp Kaul; Gunther Bastert

159

The Prognostic Value of Lymph Node Cross-Sectional Cancer Area in Node-Positive Breast Cancer: A Comparison with N Stage and Lymph Node Ratio  

PubMed Central

The number of positive axillary lymph nodes (LNs) is the only node-related factor for prognostic evaluation of breast cancer recognized by AJCC (TNM staging). However, N staging may not completely reflect LN tumor involvement due to the erroneous count of LNs in the presence of matted LNs and different tumor volume in LNs. Additionally, the positive/total LN ratio (LNR) has been shown to outperform N staging in survival prediction. In our study, to better quantify the tumor involvement of axillary LNs, we measured the cross-sectional cancer area (CSCA) of the positive LNs in 292 breast cancer patients diagnosed between 1998 and 2000 in our institution and compared its prognostic value to that of number of positive LNs (metLN)/N stage and LNR. Statistical analyses of these three LN-related factors were performed by Kaplan-Meier method and multivariate Cox's regression model. Patients were divided into three groups based on the different LN CSCA (<50, 50–500, and >500?mm2), or LNR (<0.1, 0.1–0.65, and >0.65), or N stage (N1–N3). Multivariate analysis demonstrated LNR was the most significant LN-related survival predictor with hazard ratio (HR) 25.0 (P = 0.001), compared to the metLN (HR 0.09, P = 0.052) and CSCA (HR 2.24, P = 0.323).

Li, Yanxia; Holmes, Earle; Shah, Karan; Albuquerque, Kevin; Szpaderska, Anna; Ersahin, Cagatay

2012-01-01

160

A prospective comparative study to assess the contribution of radioisotope tracer method to dye-only method in the detection of sentinel lymph node in breast cancer  

PubMed Central

Background Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session. Methods Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, the total numbers of lymph nodes removed and their metastatic states were determined separately. Results At least one blue-stained sentinel lymph node was identified in all patients during the blue-stained lymph node detection stage. The average number of sentinel nodes removed at this stage was 2.1?±?1.1. In the second surgical stage (the stage in which nodes with axillary counts were investigated with the gamma probe) in these 41 patients, at least one additional hot node was removed, or at least one of the nodes that was removed because it was blue was also hot. In addition to the lymph nodes removed in the dye stage, 34 hot lymph nodes were excised from 21 patients. Overall, the average number of hot lymph nodes removed was 2.9?±?1.5. In all patients, subsequent frozen sections and histopathological examinations were 100% concordant with the sentinel lymph nodes that were removed; the stained sentinel lymph nodes that were removed first did not affect the decision to perform axillary dissection. Conclusion The results of our study indicate that performing sentinel lymph node biopsy with dye only is sufficient and as effective as the combined method.

2013-01-01

161

Impact of Axillary Dissection on Clinical Outcomes of Breast Cancer Surgery.  

National Technical Information Service (NTIS)

To determine whether failure to perform axillary dissection or irradiation is associated with decreased survival in women with early-stage breast cancer, we studied 26,290 women aged >/-25 in 1988-93 from the Surveillance, Epidemiology and End Results (SE...

X. Du

2001-01-01

162

Mediastinal lymph node size in lung cancer  

SciTech Connect

Using a size criterion of 1 cm or greater as evidence for abnormality, the size of mediastinal lymph nodes identified by computed tomography (CT) was a poor predictor of mediastinal lymph node metastases in a series of 86 patients who had surgery for bronchogenic carcinoma. The surgery included full nodal sampling in all patients. Of the 86 patients, 36 had nodes greater than or equal to 1 cm identified by CT. Of the 21 patients with mediastinal metastases proven at surgery, 14 had nodes greater than or equal to 1 cm (sensitivity = 67%). Of the 65 patients without mediastinal metastases, 22 had nodes greater than or equal to 1 cm. Obstructive pneumonia and/or pulmonary collapse distal to the cancer was present in 39 patients (45%). Obstructive pneumonia and/or pulmonary collapse is a common occurrence in bronchogenic carcinoma, but mediastinal nodes greater than or equal to 1 cm in this circumstance cannot be presumed to represent metastatic disease. Metastatic mediastinal lymph node involvement was related to nodal size also in patients with evidence of prior granulomatous disease and in patients with no putative benign cause for nodes greater than or equal to 1 cm.

Libshitz, H.I.; McKenna, R.J. Jr.

1984-10-01

163

A prognostic biomarker for gastric cancer with lymph node metastases.  

PubMed

Gastric cancer is one of the leading causes of tumor-related deaths in China. The tumor, node, metastasis (TNM) classification system is useful for predicting clinical prognosis of patients with gastric cancer. However, determining the presence of lymph node involvement in the early stages of gastric cancer is difficult without biopsy. Therefore, it is necessary to identify novel serum biomarkers for TNM cancer staging and prognostic follow-up. In this study, we have reported fibrinopeptide-A (FPA) with alanine truncation at the N-terminal as a novel biomarker to differentiate gastric cancer with and without lymph node metastases. We analyzed 369 individual serum samples including gastric cancer patients without lymph node metastases (n = 33), gastric cancer patients with lymph node metastases (n = 157; confirmed by pathology), and age- and sex-matched healthy individuals (n = 179). The data showed that 85.4% of patients with lymph node metastases were positive for FPA with alanine truncation at the N-terminal (degAla-FPA, 1,465.63 Da), as determined by tandem mass spectrometry (MS). Using degAla-FPA as the biomarker, the sensitivity was 85.4% for gastric cancer patients with lymph node metastases, and the specificity was 100% for gastric cancer patients without lymph node metastases. The high sensitivity and specificity achieved with serum degAla-FPA levels indicated that MS technology could facilitate the discovery of a novel and quantitative prognostic biomarker for gastric cancer with lymph node involvement. PMID:23382154

Zhang, Mei-Hua; Xu, Xiao-Hong; Wang, Yue; Linq, Qi-Xin; Bi, Yun-Tao; Miao, Xiao-Jie; Ye, Chao-Fu; Gao, Shang-Xian; Gong, Cheng-Yu; Xiang, Hang; Dong, Mao-Sheng

2013-02-04

164

The value of ultrasound in detecting extra-axillary regional node involvement in patients with advanced breast cancer.  

PubMed

Assessment of the regional lymphatics is important for accurate staging and treatment of breast cancer patients. We sought to determine the role of regional ultrasound in providing clinically relevant information. We retrospectively analyzed data from patients who were treated curatively in 1996-2006 at The University of Texas MD Anderson Cancer Center for clinical stage III breast cancer. We compared differences in regional lymph node staging based on ultrasound versus mammography and physical examination in the 865 of 1,200 patients who had external-beam radiation as part of their treatment and regional ultrasound studies as part of their initial evaluation. Ultrasound uniquely identified additional lymph node involvement beyond the level I or II axilla in 37% of the patients (325 of 865), leading to a change in clinical nodal stage. Ninety-one percent of these abnormalities that could be biopsied (266 or 293) were confirmed to contain disease. The sites of additional regional nodal disease were: infraclavicular disease, 32% (275 of 865); supraclavicular disease, 16% (140 of 865); and internal mammary disease, 11% (98 of 865). All patients with involvement in the extra-axillary regional nodal basins received a radiation boost to the involved areas ? 10 Gy. Thus, over one third of patients with advanced breast cancer had their radiation plan altered by the ultrasound findings. Regional ultrasound evaluation in patients with advanced breast cancer commonly revealed abnormalities within and beyond the axilla, which changed the clinical stage of disease and the radiation treatment strategy. Therefore, regional ultrasound is beneficial in the initial staging evaluation for such patients. PMID:22982581

Iyengar, Puneeth; Strom, Eric A; Zhang, Yu-Jing; Whitman, Gary J; Smith, Benjamin D; Woodward, Wendy A; Yu, Tse-Kuan; Buchholz, Thomas A

2012-09-14

165

Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer  

Microsoft Academic Search

Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases\\u000a the risk of infection and is psychologically distressing, serving as a constant reminder of cancer. 1. To ascertain the incidence\\u000a of lymphedema in a hospital based population (in patients undergoing axillary dissection for breast cancer. 2. To determine\\u000a the clinico-epidemilogical factors

Pramod R. Pillai; Shekhar Sharma; Sheikh Zahoor Ahmed; D. K. Vijaykumar

2010-01-01

166

Axillary Metastasis as the First Manifestation of Occult Breast Cancer in a Male Patient  

Microsoft Academic Search

SummaryBackground: The aim of this study was to investigate the clinicopathologic features of male breast cancer. Case Report: We present the clinicopathologic data of a 72year-old male patient with occult breast cancer, who was diagnosed and underwent surgery in our hospital. The diagnosis was confirmed by histological examination, and the patient underwent modified radical mastectomy and axillary dissection. The histological

Guo-Li Gu; Shi-Lin Wang; Xue-Ming Wei; Li Ren; Fu-Xian Zou

2009-01-01

167

Rare axillary metastasis from squamous cell carcinoma of the tonsil.  

PubMed

Tonsillar squamous cell carcinoma (SCC) is rarely involved in axillary lymph nodes. We describe herein a rare case of tonsillar SCC involved in axillary lymph nodes. A 55-year-old man with a history of a wide excision of the left tonsil and concurrent chemoradiotherpy for the tonsillar SCC 1 year ago was presented to us with dysphagia. Except for the confirmed tumor over the retropharyngeal space, whole-body FDG PET/CT demonstrated a hypermetabolic lesion about 1 cm in size in the right axilla. Histopathology proved as a metastatic tonsillar SCC. The cancer staging and therapeutic regimens were thus altered. PMID:23478853

Cheng, Cheng-Yi; Su, Ting-Fu; Lin, Yau-Hsan; Ho, Ching-Liang; Huang, Wen-Sheng

2013-07-01

168

Using the lymph nodal ratio to predict the risk of locoregional recurrence in lymph node-positive breast cancer patients treated with mastectomy without radiation therapy  

PubMed Central

Background To evaluate the prognostic value of axillary lymph node ratio (LNR) as compared to the number of involved nodes (pN stage) in patients with axillary lymph node-positive breast cancer treated with mastectomy without radiation. Methods We performed a retrospective analysis of the clinical data of patients with stage II-III node-positive breast cancer (N=1068) between 1998 and 2007. Locoregional recurrence-free survival (LRFS) and overall survival (OS) were compared based on the LNR and pN staging. Results A total of 780 cases were classified as pN1, 183 as pN2, and 105 as pN3. With respect to LNR, 690 cases had a LNR from 0.01-0.20, 269 cases a LNR from 0.21-0.65, and 109 cases a LNR > 0.65. The median follow-up time was 62 months. Univariate analysis showed that both LNR and pN stage were prognostic factors of LRFS and OS (p<0.05). Multivariate analysis indicated that LNR was an independent prognostic factor of LRFS and OS (p<0.05). pN stage had no significant effect on LRFS or OS (p>0.05). In subgroup analysis, the LNR identified groups of patients with different survival rates based on pN stage. Conclusions LNR is superior to pN staging as a prognostic factor in lymph node-positive breast cancer after mastectomy, and should be used as one of the indications for adjuvant radiation therapy.

2013-01-01

169

Nuclear pleomorphism, a strong prognostic factor in axillary node-negative small invasive breast cancer  

Microsoft Academic Search

Summary We have evaluated established risk factors (tumor size, menopausal status, receptor status, tumor histology, and grading according to Bloom & Richardson including subfactor analysis) as well as local therapeutic procedures in a series of 121 patients with axillary node-negative (ANN) breast cancer stage T1a and T1b. The patients were operated on at a single institution (Department of Surgery, Hanuschkrankenhaus,

Michael Stierer; Harald Rosen; Renate Weber

1991-01-01

170

Minimally Invasive Approaches for Diagnosis and Treatment of Early-Stage Breast Cancer  

Microsoft Academic Search

Breastcancermanagementhasbeenevolvingtowardmin- imally invasive approaches. Image-guided percutaneous biopsy techniques provide accurate histologic diagnosis without the need for surgical biopsy. Breast conservation therapy has become the treatment standard for early- stage breast cancer. Sentinel lymph node biopsy is a new procedure that can predict axillary lymph node status without the need of axillary lymph node dissection. The next challenge is to treat

ELENA M. VERKOOIJENb

171

A mammaglobin-A targeting agent for noninvasive detection of breast cancer metastasis in lymph nodes.  

PubMed

Pathologic axillary lymph node (ALN) status is an important prognostic factor for staging breast cancer. Currently, status is determined by histopathology following surgical excision of sentinel lymph node(s), which is an invasive, time consuming, and costly procedure with potential morbidity to the patient. Here, we describe an imaging platform for noninvasive assessment of ALN status, eliminating the need for surgical examination of patients to rule out nodal involvement. A targeted imaging probe (MamAb-680) was developed by conjugation of a mammaglobin-A-specific monoclonal antibody to a near-infrared fluorescent dye. Using DNA and tissue microarray, mammaglobin-A was validated as a cell-surface target that is expressed in ALN-positive patient samples but is not expressed in normal lymph nodes. In vivo selectivity was determined by i.v. injection of MamAb-680 into mice with mammaglobin-A-positive and -negative mammary fat pad (MFP) tumors; and by peritumoral MFP injection of the targeted imaging probe in mice with spontaneous ALN metastases. Fluorescence imaging showed that probe was only retained in positive tumors and metastases. As few as 1,000 cells that endogenously express mammaglobin-A were detected in ALN, indicating high sensitivity of this method. Translation of this approach offers considerable potential as a noninvasive clinical strategy to stage breast cancer. PMID:21169406

Tafreshi, Narges K; Enkemann, Steven A; Bui, Marilyn M; Lloyd, Mark C; Abrahams, Dominique; Huynh, Amanda S; Kim, Jongphil; Grobmyer, Stephen R; Carter, W Bradford; Vagner, Josef; Gillies, Robert J; Morse, David L

2010-12-17

172

Radioguided Sentinel Lymph Node Biopsy in Breast Cancer Surgery  

Microsoft Academic Search

The concept of sentinel lymph node biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way through the lymphatic system, from the first to upper levels. Therefore, the first lymph node met (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it

Giuliano Mariani; Luciano Moresco; Giuseppe Viale; Giuseppe Villa; Marcello Bagnasco; Giuseppe Canavese; John Buscombe; H. William Strauss; Giovanni Paganelli

173

Genetic diagnosis of lymph-node metastasis in colorectal cancer  

Microsoft Academic Search

If a regional lymph node taken during surgery for colorectal cancer is found to be free of tumour on histological examination this is taken to be a good sign. However, conventional staining may not be sensitive enough. Mutant-allele-specific amplification (MASA) is a technique that can detect, at the level of an individual cell, micrometastases to lymph nodes that are histologically

N. Hayashi; I. Ito; Y. Nakamura; A. Yanagisawa; Y. Kato; S. Nakamori; S. Imaoka; H. Watanabe; M. Ogawa

1995-01-01

174

[Analysis of sentinel lymph node in early breast cancer patient - Clinical Hospital Center Rijeka].  

PubMed

Sentinel lymph node (SLN) biopsy is an accurate method for the detection of axillary metastases in early breast cancer patients and is of value as a replacement for axillary dissection. However, variations in the methods and protocols used for the pathological evaluation of SLN exist in everyday practice. Therefore, standardization how to detect, dissect, process, stain, assess and report SNL is required in order to stratify patients into adequate prognostic groups. The aim of this study was to present our experience in SLN analysis in patients with early breast cancer and clinical stage T1-2 and N0. In the period between 2003 and 2011, 1071 consecutive patients or 1915 SLN were analyzed. The protocol included intraoperative analysis of histological frozen sections and cytological imprint, followed by analysis of paraffin sections according to the protocol that included sections of whole SLN with the interval of 250 prm. According to the accepted protocol 75% of SLN were negative. The obtained results were correlated with literature data. PMID:23991488

Jonji?, Nives; Musta?, Elvira; Bekafigo, Irena Seili; Molek, Koraljka Rajkovi?; Lovasi?, Franjo; Lukanovi?, Miljenko; Ivankovi?, Svjetlana Grbac; Girotto, Neva; Lovasi?, Ingrid Belac; Petkovi?, Marija

175

Fine needle aspiration cytology is a valuable adjunct to axillary ultrasound in the preoperative staging of breast cancer  

Microsoft Academic Search

AimsTo compare the predictive values of axillary ultrasound (US) combined with fine needle aspiration (FNA) cytology with tumour size (T stage) and grade in the preoperative staging of breast cancer. More precise definition of axillary FNA reporting nomenclature is also presented.Patients and Methods314 patients: 119 patients had suspicious US investigated by FNA, 195 patients had normal US not investigated further

Morna MacNeill; Isobel Arnott; Jeremy Thomas

2010-01-01

176

Feasibility of telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine needle aspiration of axillary lymph nodes in a remote breast care center  

PubMed Central

Background: In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA) specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA) of axillary lymph nodes in a remote breast care center. Materials and Methods: Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of the preliminary diagnosis was compared with the final diagnosis, retrospectively. Results: A total of 39 female patients (mean age: 50.5 years) seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases. Conclusions: This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate compared with the final cytologic evaluation. It allows pathologists to use their time more efficiently and makes on-site evaluation at a remote site possible.

Khurana, Kamal K.; Kovalovsky, Andra; Masrani, Deepa

2012-01-01

177

Conservative treatment of early breast cancer. Long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy.  

PubMed Central

One thousand two hundred and thirty-two women with invasive breast cancer lesions measuring less than 2 cm in diameter, clinically assessed as T1N0-1M0, were treated from 1970 to 1983 at the National Cancer Institute of Milan with quadrantectomy, axillary dissection, and radiotherapy (QUART). Pathologic evidence of lymph-nodes metastases was found in 32% of the patients. Overall survival at 5 and 10 years from surgery was 91% and 78%, respectively. The cumulative probability of survival tends to decrease with increasing tumor size: the 7-year survival rate was 84% in cases in which lesions measured from 1.6 to 2.0 cm, and 94% in cases in which the lesions were less than 0.5 cm. Tumor site in the treated breast did not affect distant outcome. No difference was found between the patients without node metastases and patients with one node involved, whereas the patients with more than one node showed a lower probability of survival. The survival curves of 352 cases treated inside a randomized trial and that of 880 cases routinely treated appear to be superimposable. Local recurrences and new primary ipsilateral tumors were, respectively, 35 (2.8%) and 19 (1.6%); 56 women with local recurrences or second tumors underwent second surgery (total mastectomy, 43; wide resection, 11). Five of them died from distant spread of breast cancer, while 49 are alive and well. In the contralateral breasts 45 carcinomas were recorded during the follow-up time. The results of the present analysis of a large number of T1 cases reconfirm the safety of integrated radiosurgical conservative treatments.

Veronesi, U; Salvadori, B; Luini, A; Banfi, A; Zucali, R; Del Vecchio, M; Saccozzi, R; Beretta, E; Boracchi, P; Farante, G

1990-01-01

178

Larger axillary metastases in obese women and smokers with breast cancer- an influence by host factors on early tumor behavior  

Microsoft Academic Search

To better define the influence by host factors on very early breast cancer behavior, we retrospectively analyzed nodal status, diameter of the largest axillary metastasis (M), diameter of the primary tumor (P), the M\\/P ratio, tumor estrogen receptor status, age, obesity, and smoking habits in 176 women with node-positive breast cancer.

Harry W. Daniell; Edward Tam; Albert Filice

1993-01-01

179

The Applications of Sentinel Lymph Node to Cancer  

Microsoft Academic Search

\\u000a It is likely that every solid neoplasm drains to an initial lymph node (sentinel lymph node – SLN) before spreading to regional\\u000a nodes or systemically. Focused evaluation of the SLN as originally described by Morton et al. in 1990 [1] has improved staging\\u000a accuracy in melanoma and breast cancer and has been applied to other solid neoplasms with the purpose

Anton J. Bilchik; Maria M. Gonzalez; Alexander Stojadinovic

180

Sentinel Lymph Node Detection in Patients with Cervical Cancer  

Microsoft Academic Search

Purpose. We investigated the validity of sentinel lymph node (SLN) detection after radioactive isotope and\\/or blue dye injection in patients with cervical cancer.Patients and methods. Between December 1998 and May 2000, 50 patients (mean age 44 years) with cervical cancer FIGO stage I (n = 32), stage II (n = 16), or stage IV (n = 2) underwent SLN detection

Sabine Malur; Norman Krause; Christhardt Köhler; Achim Schneider

2001-01-01

181

[Complete response of advanced breast cancer with lymph node metastases to nab-paclitaxel therapy-report of a case].  

PubMed

We report a case of breast cancer with lymph node metastases. A complete response was recognized in response to nab-paclitaxel as a first-line therapy after recurrence. The patient was a 50-year-old woman who had a tumor in her right breast. We palpated a mass with clear boundaries in her right breast. The tumor was 2 cm in diameter. Core-needle biopsy of the breast tumor led to a diagnosis of invasive ductal carcinoma (estrogen receptor-, progesterone receptor-, and human epidermal growth factor receptor 2-negative). She received 4 cycles of EC (E: 90 mg/m2/tri-weekly; C: 600 mg/m2 /tri-weekly) plus 4 cycles of TC(T: 75 mg/m2/tri-weekly; C: 600 mg/m2/tri-weekly)as preoperative adjuvant chemotherapy. After chemotherapy, she underwent quadrantectomy plus axillary lymph node dissection. Six months after the operation, lymph node metastases were observed in her right supraclavicular lymph nodes. She received 8 cycles of nab-paclitaxel(260 mg/m2/tri-weekly) therapy. After 8 cycles of treatment, ultrasonography and computed tomography revealed the disappearance of the metastatic lymph nodes. Therefore, a clinical complete response was observed. PMID:23267983

Hara, Yukiko; Sakurai, Kenichi; Enomoto, Katsuhisa; Matsumoto, Kyoko; Ueda, Yuichi; Hagiwara, Mio; Waga, Eiko; Nagashima, Saki; Tani, Mayumi; Amano, Sadao

2012-11-01

182

Efficacy of intraoperative GeneSearch Breast Lymph Node (BLN) Assay for breast cancer metastasis detection in sentinel lymph node in Chinese patients.  

PubMed

Although intraoperative assessment of the sentinel lymph node (SLN) is useful, it has not gained popularity in China as it involves a heavy workload for pathologists. We conducted a prospective clinical feasibility study of the GeneSearch Breast Lymph Node (BLN) Assay performed in 158 SLNs from 97 patients by comparison with postoperative permanent section histopathology, to validate its potential usefulness in China. Every SLN was cut into alternating 1.5 to 3.0 mm slabs. The BLN assay processed 50% of the fresh alternating slabs to detect the presence of cytokeratin 19 and mammaglobin mRNA. Assay results were compared with those for permanent section histopathology and intraoperative imprint cytology. Slides for imprint cytology were prepared from the BLN assay node tissue before it was processed. Full axillary lymph node (ALN) dissections were performed on some patients after a SLN biopsy. The BLN assay was successfully performed on 158 SLNs from 97 patients. Overall performance of the BLN assay compared with permanent section histopathology was sensitivity 83.9% (26/31), specificity 95.5% (63/66), positive predictive value 89.7% (26/29), negative predictive value 92.6% (63/68), and overall agreement 91.8% (89/97). The BLN assay detected about 25% more metastases than imprint cytology. Moreover, the BLN assay correctly identified most of the additional non-sentinel ALNs metastases (P = 0.005). Our results from a large series of Chinese patients with breast cancer indicate that the BLN assay may be a viable alternative for the standard intraoperative procedures used for metastases detection, especially in early stage breast cancer patients. Name of the trial register: GeneSearch Breast Lymph Node (BLN) Assay China Registration Study. Clinical trial registration number: NCT00869674. PMID:20557308

Liu, Yan-Hui; Xu, Fang-Ping; Liao, Ning; Li, Li; Zhang, Guo-Chun; Zhuang, Heng-Guo; Mei, Ping; Xu, Jie; Zhu, Xiao-Lan; Luo, Xin-Lan; Kuang, Li-Juan

2010-01-17

183

Detection of parasternal metastatic lymph nodes by sentinel lymph node methods in a patient with recurrence in the conserved breast  

Microsoft Academic Search

We herein report a case of second sentinel lymph node biopsy (SLNB). A 57-year-old woman underwent breast-conserving surgery\\u000a including axillary clearance at Aichi Cancer Center on October 20, 2003. Recurrent tumor in the conserved breast was diagnosed\\u000a in March 2006. She received SLNB using radioactive tracer. Preoperative lymphoscintigraphy detected 2 parasternal lymph nodes\\u000a as hot spots. No abnormal lymph nodes

Toshinari Yamashita; Takashi Fujita; Hironori Hayashi; Yoshiaki Ando; Yukari Hato; Akiyo Horio; Chieko Toyoshima; Mai Yamada; Hiroji Iwata

184

[Microscopic thyroid papillary cancers presenting as cervical lymph node metastases].  

PubMed

Microscopic papillary thyroid cancer (< 1 cm in diameter) is reputed to have an excellent prognosis. In 10 to 20% of cases, it presents in the form of lymph ode metastases. Immediately metastatic forms can be associated with unfavourable prognostic factors, such as multifocal tumours, extension to adjacent tissues, capsular effraction and development of distant metastases. We report 4 cases of microscopic papillary thyroid cancer presenting in the form of lymph node metastases. No primary thyroid lesion was palpable in any of these patients, but the subsequent course was complicated by ling metastases in one case. All patients underwent total thyroidectomy with lymph node dissection followed by adjuvant therapy with radioactive iodine and thyroxin inhibitory treatment. Lung metastases were observed in one case. The authors propose a therapeutic approach based on analysis of severity factors, which determine the recurrence rate. PMID:9752488

Emy, P; Michenet, P; Saint-Marc, O

1998-01-01

185

Morbidity of Breast Cancer Patients Following Complete Axillary Dissection or Sentinel Node Biopsy Only: A Comparative Evaluation  

Microsoft Academic Search

Introduction The usefulness of routine axillary dissection (AD) at levels I–II in breast cancer patients has been questioned for years because of the high postoperative morbidity in the shoulder and arm region, and the increasing number of patients with negative nodes. Sentinel node biopsy (SNB) was hoped both to reduce morbidity and to improve the reliability of staging. This study

Anton Haid; Roswitha Köberle-Wührer; Michael Knauer; Judit Burtscher; Heinz Fritzsche; William Peschina; Zerina Jasarevic; Maria Ammann; Klaus Hergan; Heinz Sturn; Gerhard Zimmermann

2002-01-01

186

Evaluation of the Benefit of Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes in Breast Cancer  

PubMed Central

Aims. Intraoperative analysis of the sentinel lymph node (SLN) by frozen section (FS) allows for immediate axillary lymph node dissection (ALND) in case of metastatic disease in patients with breast cancer. The aim of this study is to evaluate the benefit of intraoperative FS, with regard to false negative rate (FNR) and influence on operation time. Materials and Methods. Intraoperative analysis of the SLN by FS was performed on 628 patients between January 2005 and October 2009. Patients were retrospectively studied. Results. FS accurately predicted axillary status in 525 patients (83.6%). There were 78 true positive findings (12.4%), of which there are 66 macrometastases (84.6%), 2 false positive findings (0.3%), and 101 false negative findings (16.1%), of which there are 65 micrometastases and isolated tumour cells (64.4%) resulting in an FNR of 56.4%. Additional operation time of a secondary ALND after wide local excision and SLNB is 17 minutes, in case of ablative surgery 35 minutes. The SLN was negative in 449 patients (71.5%), making their scheduled operation time unnecessary. Conclusions. FS was associated with a high false negative rate (FNR) in our population, and the use of telepathology caused an increase in this rate. Only 12.4% of the patients benefited from intraoperative FS, as secondary ALND could be avoided, so FS may be indicated for a selected group of patients.

Francissen, C. M. T. P.; van la Parra, R. F. D.; Mulder, A. H.; Bosch, A. M.; de Roos, W. K.

2013-01-01

187

Lymph Node Metastases of Prostatic Adenocarcinoma in the Mesorectum in Patients with Rectal Cancer  

PubMed Central

Lymph node involvement is the most important prognostic factor of rectal cancer. Cancer originating from sites other than the rectum rarely metastasizes to the mesorectal lymph node. We report a rectal cancer patient with a synchronous metastatic prostatic carcinoma to the mesorectal lymph node.

Park, In Ja; Kim, Hee Cheol; Yu, Chang Sik; Kim, Choung Soo; Kim, Jung Sun

2005-01-01

188

Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors.  

National Technical Information Service (NTIS)

Lymphedema of the arm is a consequence of breast cancer treatment that can result in substantial functional impairment and distress. In this study, women diagnosed with a first primary invasive breast cancer and treated with axillary lymph node dissection...

K. E. Malone M. A. Rossing

2006-01-01

189

The “Sentinel Chain”: a new concept for prediction of axillary node status in breast cancer patients  

Microsoft Academic Search

SummaryBackground and objectives  More than half the breast cancer patients with positive sentinel lymph nodes (SLN) do not harbor additional metastases in non-sentinel nodes (NSN). The aim of this study was to identify a subgroup of patients with positive SLNs and negative NSNs, on the basis of tumor involvement patterns in multiple radioactive nodes.Methods  Between 2000 and 2004, 290 patients with primary

Moshe Carmon; Oded Olsha; William P. Schecter; David Raveh; Constantin Reinus; Dan D. Hershko; Uziel Beller; Eliahu Golomb

2006-01-01

190

Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.  

PubMed

Aim: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. Methods: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. Results: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. Conclusion: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS. PMID:24045625

Martínez-Rodríguez, I; De Arcocha Torres, M; Banzo, I; Quirce, R; Jiménez-Bonilla, J; Medina-Quiroz, P; Rubio-Vassallo, A; Del Castillo, R; Carril, J M

2013-09-01

191

Predictors of non-sentinel lymph node metastasis in breast cancer patients.  

PubMed

In many patients, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients would not be expected to benefit from completion axillary lymph node dissection (CALND). This study evaluated the factors that may determine the likelihood of additional positive nodes in the axilla in the presence of sentinel node metastasis. A total of 618 breast cancer patients underwent SLN biopsy based on lymphoscintigraphy, intraoperative gamma probe detection, and blue dye mapping using 99mTc-nanocolloid and Patent Blue V injected peritumourally. This was followed by standard axillary node clearance at the same operation. Of the 201 patients with a positive SLN, 105 (52%) patients had no further positive nodes in the axilla, 96 (48%) patients had additional metastasis in non-sentinel lymph nodes (NSLN) upon CALND. In patients with a positive SLN, increasing tumour size and tumour grade significantly increased the frequency of additional positive nodes on univariate analysis. The number of SLNs removed and the number of negative SLNs were significant negative predictors. Increasing tumour burden in the sentinel nodes (determined by the number of positive SLNs) was significantly associated with increasing likelihood of positive NSLNs. Multivariate analysis revealed that the rest of the axilla is more likely to be positive if there are more positive than negative SLNs removed and more likely to be negative otherwise. A group of cases from one centre (Cardiff) were subjected to further detailed analysis. Tumour burden in the positive SLN was assessed by measuring the size of metastasis, percentage replacement of the SLN by tumour and by documenting extracapsular extension (ECE) around the SLN. Of the 64 patients with a positive SLN, 34 (53%) patients had no further positive nodes in the axilla, 30 patients (47%) had additional metastasis in NSLNs upon CALND. Increasing tumour burden in the SLN was associated with additional positive nodes in the axilla. Multivariate analysis revealed that size of the SLN metastasis is the most important predictor of involvement of only the SLN. Overall, in patients with a positive SLN, the difference in the number of positive and negative SLNs removed and size of the metastasis in the SLN, all predicted the frequency of additional positive nodes. PMID:15251163

Goyal, A; Douglas-Jones, A; Newcombe, R G; Mansel, R E

2004-07-01

192

Angiogenesis and hypoxia in lymph node metastases is predicted by the angiogenesis and hypoxia in the primary tumour in patients with breast cancer  

PubMed Central

Hypoxia and angiogenesis are important factors in breast cancer progression. Little is known of hypoxia and angiogenesis in lymph node metastases of breast cancer. The aim of this study was to quantify hypoxia, by hypoxia-induced marker expression levels, and angiogenesis, by endothelial cell proliferation, comparing primary breast tumours and axillary lymph node metastases. Tissue sections of the primary tumour and a lymph node metastasis of 60 patients with breast cancer were immunohistochemically stained for the hypoxia-markers carbonic anhydrase 9 (CA9), hypoxia-inducible factor-1? (Hif-1?) and DEC-1 and for CD34/Ki-67. Endothelial cell proliferation fraction (ECP%) and tumour cell proliferation fraction (TCP%) were assessed. On haematoxylin–eosin stain, the growth pattern and the presence of a fibrotic focus were assessed. Hypoxia-marker expression, ECP% and TCP% in primary tumours and in lymph node metastases were correlated to each other and to clinico-pathological variables. Median ECP% and TCP% in primary tumours and lymph node metastases were comparable (primary tumours: ECP%=4.02, TCP%=19.54; lymph node metastases: ECP%=5.47, TCP%=21.26). ECP% correlated with TCP% (primary tumours: r=0.63, P<0.001; lymph node metastases: r=0.76, P<0.001). CA9 and Hif-1? expression were correlated (primary tumours P=0.005; lymph node metastases P<0.001). In primary tumours, CA9 and Hif-1? expression were correlated with DEC-1 expression (P=0.05), presence of a fibrotic focus (P<0.007) and mixed/expansive growth pattern (P<0.001). Primary tumours and lymph node metastases with CA9 or Hif-1? expression had a higher ECP% and TCP% (P<0.003); in primary tumours, mixed/expansive growth pattern and fibrotic focus were characterised by higher ECP% (P=0.03). Furthermore, between primary tumours and lymph node metastases a correlation was found for ECP%, TCP%, CA9 and Hif-1? expression (ECP% r=0.51, P<0.001; TCP r=0.77, P<0.001; CA9 and Hif-1? P<0.001). Our data demonstrate that the growth of breast cancer lymph node metastases is angiogenesis dependent and that angiogenesis and hypoxia in the primary tumour predict angiogenesis and hypoxia in the lymph node metastases. Together with previous findings in breast cancer liver metastases, which grow in 96% of cases angiogenesis independently, these data suggest that both the intrinsic growth characteristics and angiogenic potential of breast cancer cells and the site-specific tumour microenvironment determine angiogenesis and hypoxia in breast cancer.

Van den Eynden, G G; Van der Auwera, I; Van Laere, S J; Colpaert, C G; Turley, H; Harris, A L; van Dam, P; Dirix, L Y; Vermeulen, P B; Van Marck, E A

2005-01-01

193

Will early detection of non-axillary sentinel nodes affect treatment decisions?  

PubMed

Axillary lymph node involvement is the best prognostic factor for breast cancer survival. Staging breast cancers by axillary dissection remains standard management and is part of the UK national guidelines for breast cancer treatment. In the presence of involved axillary lymph nodes best treatment has been shown to be axillary clearance (Fentiman and Mansell, 1991), but clearly for women whose nodes are uninvolved avoidance of morbidity is optimal and this will be achieved by minimal dissection of the axilla. Thus, for node-negative women the introduction of the sentinel node biopsy technique may revolutionise the approach to the axilla. These will be women with mammographic screen detected small well and moderately differentiated tumours (Hadjiloucas and Bundred, 2000). The impact of sentinel node biopsy in women who have symptomatic large tumours is unproven, and around half of these women will require a second procedure to clear their axilla or radiotherapy as treatment. Even for those women found to have involved sentinel lymph nodes the ability to use early systemic chemotherapy followed by axillary clearance or radiotherapy may provide long-term survival gains. Sentinel node biopsy should not, however, become routine practice until randomised controlled trials have proven its benefit and safety in reducing morbidity. Several randomised controlled trials (including ALMANAC) are currently underway. PMID:12232747

Wärnberg, F; Bundred, N

2002-09-23

194

False Positive 18F-FDG Uptake in Mediastinal Lymph Nodes Detected with Positron Emission Tomography in Breast Cancer: A Case Report  

PubMed Central

Breast cancer is the most frequently diagnosed cancer among females. It is accepted that lymph node involvement with metastatic tumor and the presence of distant metastasis are the most important prognostic factors. Accurate staging is important in determining prognosis and appropriate treatment. Positron emission tomography with computed tomography detects malignancies using 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG PET CT) with high accuracy and they contribute to decisions regarding diagnosis, staging, recurrence, and treatment response. Here, we report a case of false positive metastatic mediastinal lymph nodes that were diagnosed by 18F-FDG PET CT in a 40-year-old breast cancer patient who had undergone preoperative evaluation. Right paratracheal, prevascular, aorticopulmonary, precarinal, subcarinal, hilar, and subhilar multiple conglomerated mediastinal lymph nodes were revealed in addition to left breast mass and axillary lymph nodes. Mediastinoscopy was performed with biopsy and pathology was reported as granulomatous lymphadenitis. In conclusion, any abnormal FDG accumulation in unusual lymph nodes must be evaluated carefully and confirmed histopathologically.

Ugurluer, Gamze; Kibar, Mustafa; Yavuz, Sinan; Kuzucu, Akin; Serin, Meltem

2013-01-01

195

Detection of parasternal metastatic lymph nodes by sentinel lymph node methods in a patient with recurrence in the conserved breast.  

PubMed

We herein report a case of second sentinel lymph node biopsy (SLNB). A 57-year-old woman underwent breast-conserving surgery including axillary clearance at Aichi Cancer Center on October 20, 2003. Recurrent tumor in the conserved breast was diagnosed in March 2006. She received SLNB using radioactive tracer. Preoperative lymphoscintigraphy detected 2 parasternal lymph nodes as hot spots. No abnormal lymph nodes were revealed on preoperative computed tomography. Salvage mastectomy was performed along with dissection of the Rotter and infraclavicular lymph nodes and biopsy of the detected parasternal lymph nodes. Micrometastases were discovered in both parasternal lymph nodes detected as sentinel lymph nodes. No more metastases were seen in the other lymph nodes. Reoperative SLNB offers the possibility of detecting metastasis in residual lymph nodes and determining whether chemotherapy should be used. PMID:21213080

Yamashita, Toshinari; Fujita, Takashi; Hayashi, Hironori; Ando, Yoshiaki; Hato, Yukari; Horio, Akiyo; Toyoshima, Chieko; Yamada, Mai; Iwata, Hiroji

2011-01-01

196

Relative microvessel area of the primary tumour, and not lymph node status, predicts the presence of bone marrow micrometastases detected by reverse transcriptase polymerase chain reaction in patients with clinically non-metastatic breast cancer  

Microsoft Academic Search

About 50% of patients with breast cancer have no involvement of axillary lymph nodes at diagnosis and can be considered cured\\u000a after primary locoregional treatment. However, about 20–30% will experience distant relapse. The group of patients at risk\\u000a is not well characterised: recurrence is probably due to the establishment of micrometastases before treatment. Given the\\u000a early steps of metastasis in

Ina H Benoy; Roberto Salgado; Hilde Elst; Peter Van Dam; Joost Weyler; Eric Van Marck; Simon Scharpé; Peter B Vermeulen; Luc Y Dirix

2004-01-01

197

Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: a randomised clinical trial in a population with access to public mammography screening  

Microsoft Academic Search

The effect of postoperative radiotherapy after sector resection for stage I-II lymph node-negative breast cancer was evaluated in a patient population with access to public mammographical screening. 1187 women were randomised to no further treatment or postoperative radiotherapy following a standardised sector resection and axillary dissection. Radiation was administered to a dose of 48-54 Gy. Median age was 60 years,

P Malmström; L Holmberg; H Anderson; J Mattsson; P-E Jönsson; L Tennvall-Nittby; G Balldin; L Lovén; J-H Svensson; C Ingvar; T Möller; E Holmberg; A Wallgren

2003-01-01

198

Systemic mediastinal lymph node dissection of right lung cancer: surgical quality control and analysis of mediastinal lymph node metastatic patterns.  

PubMed

Standardization of systemic mediastinal lymph node dissection (SMLD) of lung cancer requires further investigation. A consecutive 124 right lung cancer patients were recruited for pulmonary resection plus SMLD. Three mediastinal lymph node compartments, (i) the upper compartment (station 1-4), (ii) the middle compartment (station 7-8) and (iii) the lower compartment (station 9), were en bloc collected to achieve surgical quality control and to analyze mediastinal lymph node metastatic patterns. The number of total harvested lymph nodes, N1 nodes and N2 nodes were 21.9+/-8.7, 9.2+/-4.7 and 12.8+/-6.7, respectively. Tumor location (peripheral or central) (P=0.023) and status of blood vessel invasion (P=0.002) were identified as risk factors for nodal involvement. Right upper lobe (RUL) cancer with N2 disease primarily metastasized to the upper compartment (27.3%) (P=0.001). For right lower lobe (RLL) cancer, lymph node metastasis most commonly detected in the middle compartment (48.8%) (P=0.001). Single mediastinal compartment metastasis occurred in 64.7% (11/17) of adenocarcinomas from RUL and RML, whereas multiple compartments metastasis occurred in all adenocarcinoma cases (12/12) from RLL (P=0.001). SMLD needs to standardize the extent of lymphadenectomy and number of removed lymph nodes for surgical quality control. Simplifying mediastinal lymph node stations to three compartments may benefit surgical excision. PMID:18077504

Wu, Nan; Lv, Chao; Yan, Shi; Duan, Hongwei; Zheng, Qingfeng; Wang, Jia; Xiong, Hongchao; Yang, Yue

2007-12-12

199

Multicentre review of lymph node harvest in colorectal cancer  

Microsoft Academic Search

Background  Lymph node examination in colorectal cancer is of vital importance for accurate staging. Patients who have fewer nodes examined\\u000a may be understaged and not offered adjuvant chemotherapy. The national institute of clinical excellence and the association\\u000a of coloproctology of Great Britain and Ireland both recommend that 12 nodes should be examined for accurate staging. The aim\\u000a of this study was

P. J. Mitchell; S. Ravi; B. Grifftiths; F. Reid; D. Speake; C. Midgley; N. Mapstone

2009-01-01

200

Complications of Pelvic Lymph Node Dissection for Prostate Cancer  

Microsoft Academic Search

Pelvic lymph node dissection (PLND) represents the standard for detection of occult pelvic nodal metastases from prostate\\u000a cancer, and may be performed separately from or at the time of radical prostatectomy. In addition to its potential for diagnostic\\u000a staging, a PLND may be therapeutic in some patients. However, considerable debate centers on the appropriate candidates for\\u000a the procedure, the extent

K. A. Keegan; M. S. Cookson

2011-01-01

201

Current controversies in sentinel lymph node biopsy for breast cancer  

Microsoft Academic Search

Despite the widespread use of sentinel lymph node biopsy (SLNBx) in the surgical management of breast cancer patients, several areas remain controversial. The following controversies are reviewed:Learning curves and validation studies. There clearly is a learning curve, and a completion ALND should be done until adequate proficiency is exhibited, both in terms of identification and false-negative rates.Location of injection. Intradermal

T. M Allweis; M Badriyyah; V Bar Ad; T Cohen; H. R Freund

2003-01-01

202

Lymphedema of the Arm and Breast in Irradiated Breast Cancer Patients: Risks in an Era of Dramatically Changing Axillary Surgery  

Microsoft Academic Search

? Abstract: The purpose of this study was to assess risk for lymphedema of the breast and arm in radiotherapy patients in an era of less extensive axillary surgery. Breast cancer patients treated for cure were reviewed, with a minimum follow-up of 1.5 years from the end of treatment. Clinical, surgical, and radiation-related variables were tested for statistical association with

Thomas E. Goffman; Christine Laronga; Lori Wilson; David Elkins

2004-01-01

203

Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomised controlled trial  

PubMed Central

Objective To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to breast cancer. Design Randomised single blinded controlled trial. Setting University Hospitals Leuven, Leuven, Belgium. Participants 160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed. Randomisation was done independently from recruitment and treatment. Baseline characteristics were comparable between the groups. Intervention For six months the intervention group (n=79) performed a treatment programme consisting of guidelines about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group (n=81) performed the same programme without manual lymph drainage. Main outcome measures Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in arm volume of 200 mL or more in the value before surgery. Results Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The time to develop arm lymphoedema was comparable between the two group during the first year after surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as (presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30). Conclusion Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in the short term. Trial registration Netherlands Trial Register No NTR 1055.

2011-01-01

204

Predicting Likelihood of Having Four or More Positive Nodes in Patient With Sentinel Lymph Node-Positive Breast Cancer: A Nomogram Validation Study  

SciTech Connect

Purpose: Katz suggested a nomogram for predicting having four or more positive nodes in sentinel lymph node (SLN)-positive breast cancer patients. The findings from this formula might influence adjuvant radiotherapy decisions. Our goal was to validate the accuracy of the Katz nomogram. Methods and Materials: We reviewed the records of 309 patients with breast cancer who had undergone completion axillary lymph node dissection. The factors associated with the likelihood of having four or more positive axillary nodes were evaluated in patients with one to three positive SLNs. The nomogram developed by Katz was applied to our data set. The area under the curve of the corresponding receiver operating characteristics curve was calculated for the nomogram. Results: Of the 309 patients, 80 (25.9%) had four or more positive axillary lymph nodes. On multivariate analysis, the number of positive SLNs (p < .0001), overall metastasis size (p = .019), primary tumor size (p = .0001), and extracapsular extension (p = .01) were significant factors predicting for four or more positive nodes. For patients with <5% probability, 90.3% had fewer than four positive nodes and 9.7% had four or more positive nodes. The negative predictive value was 91.7%, and sensitivity was 80%. The nomogram was accurate and discriminating (area under the curve, .801). Conclusion: The probability of four or more involved nodes is significantly greater in patients who have an increased number of positive SLNs, increased overall metastasis size, increased tumor size, and extracapsular extension. The Katz nomogram was validated in our patients. This nomogram will be helpful to clinicians making adjuvant treatment recommendations to their patients.

Unal, Bulent; Gur, Akif Serhat [Department of Surgical Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Beriwal, Sushil [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Tang Gong [Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (United States); Johnson, Ronald; Ahrendt, Gretchen; Bonaventura, Marguerite [Department of Surgical Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Soran, Atilla, E-mail: asoran@magee.ed [Department of Surgical Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States)

2009-11-15

205

Detection of isolated ipsilateral regional lymph node recurrences by F18-fluorodeoxyglucose positron emission tomography-CT in follow-up of postoperative breast cancer patients.  

PubMed

Imaging diagnostic methods except for mammograms are not recommended for follow-up of postoperative breast cancer patients in order to detect small recurrences because of the poor survival improvement in earlier randomized trials. However, the use of new imaging modalities may improve survival by detection of small isolated regional lymph node recurrences which are potentially curable. Between April 2006 and December 2008, we used PET-CT to find small recurrences in follow-up of 1,907 postoperative breast cancer patients. A total of 3,280 PET-CT imagings were performed. The median age at PET-CT imaging was 58 years, with a median 48-month interval from definitive surgery to the PET-CT imaging. Twenty-two patients were found to have isolated ipsilateral regional recurrences only by PET-CT (axillary node recurrences in 6, infraclavicular node recurrences in 5, supraclavicular node recurrences in 6, and parasternal node recurrences in 5). All of those recurrences were missed by palpation or were nonpalpable. The pathological lymph node status at the definitive surgery for the primary breast cancer of 22 patients with the isolated ipsilateral regional lymph node recurrences was positive in 17 patients. If patients are limited to those who had pathologically positive node(s) at definitive surgery, the incidence of patients with isolated regional lymph node recurrences found only by PET-CT would be 2.6% (17/663 patients). Seventeen other asymptomatic cancers including contralateral breast cancers were found only by PET-CT. Early detection of isolated loco-regional recurrences of breast cancer is suggested to result in improved survival. Therefore, the use of PET-CT in follow-up of postoperative node-positive breast cancer patients may improve their survival because of early detection of isolated regional lymph node recurrences which are still potentially curable, and screening of other asymptomatic cancers. PMID:21590272

Ohsumi, Shozo; Inoue, Takeshi; Kiyoto, Sachiko; Hara, Fumikata; Takahashi, Mina; Takabatake, Daisuke; Takashima, Seiki; Aogi, Kenjiro; Takashima, Shigemitsu

2011-05-13

206

Role of Axillary Clearance After a Tumor-Positive Sentinel Node in the Administration of Adjuvant Therapy in Early Breast Cancer  

PubMed Central

Purpose The After Mapping of the Axilla: Radiotherapy or Surgery? (AMAROS) phase III study compares axillary lymph node dissection (ALND) and axillary radiation therapy (ART) in early breast cancer patients with tumor-positive sentinel nodes. In the ART arm, the extent of nodal involvement remains unknown, which could have implications on the administration of adjuvant therapy. In this preliminary analysis, we studied the influence of random assignment to ALND or ART on the choice for adjuvant treatment. Patients and Methods In the first 2,000 patients enrolled in the AMAROS trial, we analyzed the administration of adjuvant systemic therapy. Multivariate analysis was used to assess variables affecting the administration of adjuvant chemotherapy. Adjuvant therapy was applied according to institutional guidelines. Results Of 2,000 patients, 566 patients had a positive sentinel node and were treated per random assignment. There was no significant difference in the administration of adjuvant systemic therapy. In the ALND and ART arms, 58% (175 of 300) and 61% (162 of 266) of the patients, respectively, received chemotherapy. Endocrine therapy was administered in 78% (235 of 300) of the patients in the ALND arm and in 76% (203 of 266) of the patients in the ART arm. Treatment arm was not a significant factor in the decision, and no interactions between treatment arm and other factors were observed. Multivariate analysis showed that age, tumor grade, multifocality, and size of the sentinel node metastasis significantly affected the administration of chemotherapy. Within the ALND arm, the extent of nodal involvement remained not significant in a sensitivity multivariate analysis. Conclusion Absence of knowledge regarding the extent of nodal involvement in the ART arm appears to have no major impact on the administration of adjuvant therapy.

Straver, Marieke E.; Meijnen, Philip; van Tienhoven, Geertjan; van de Velde, Cornelis J.H.; Mansel, Robert E.; Bogaerts, Jan; Demonty, Gaston; Duez, Nicole; Cataliotti, Luigi; Klinkenbijl, Jean; Westenberg, Helen A.; van der Mijle, Huub; Hurkmans, Coen; Rutgers, Emiel J.T.

2010-01-01

207

Mayo Clinic study finds less invasive surgery detects residual breast cancer in lymph nodes after chemotherapy  

Cancer.gov

Most patients whose breast cancer has spread to their lymph nodes have most of the lymph nodes in their armpit area removed after chemotherapy to see if any cancer remains. A study conducted through the American College of Surgeons Oncology Group and led by the Mayo Clinic shows that a less invasive procedure known as sentinel lymph node surgery successfully identified whether cancer remained in lymph nodes in 91 percent of patients with node-positive breast cancer who received chemotherapy before their surgery. In sentinel lymph node surgery, only a few lymph nodes, the ones most likely to contain cancer, are removed. The findings are being presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.

208

Dose to level I and II axillary lymph nodes and lung by tangential field radiation in patients undergoing postmastectomy radiation with tissue expander reconstruction  

PubMed Central

Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Methods and Materials Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. Results The mean coverage of the level I/II axillary volume by the 95% isodose line (VD95%) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung VD50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary VD95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung VD50% correlated with angle of the expander from midline (p = 0.05). Conclusions In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated.

2011-01-01

209

Lymph node harvest in colon and rectal cancer: Current considerations  

PubMed Central

The prognostic significance of identifying lymph node (LN) metastases following surgical resection for colon and rectal cancer is well recognized and is reflected in accurate staging of the disease. An established body of evidence exists, demonstrating an association between a higher total LN count and improved survival, particularly for node negative colon cancer. In node positive disease, however, the lymph node ratios may represent a better prognostic indicator, although the impact of this on clinical treatment has yet to be universally established. By extension, strategies to increase surgical node harvest and/or laboratory methods to increase LN yield seem logical and might improve cancer staging. However, debate prevails as to whether or not these extrapolations are clinically relevant, particularly when very high LN counts are sought. Current guidelines recommend a minimum of 12 nodes harvested as the standard of care, yet the evidence for such is questionable as it is unclear whether an increasing the LN count results in improved survival. Findings from modern treatments, including down-staging in rectal cancer using pre-operative chemoradiotherapy, paradoxically suggest that lower LN count, or indeed complete absence of LNs, are associated with improved survival; implying that using a specific number of LNs harvested as a measure of surgical quality is not always appropriate. The pursuit of a sufficient LN harvest represents good clinical practice; however, recent evidence shows that the exhaustive searching for very high LN yields may be unnecessary and has little influence on modern approaches to treatment.

McDonald, James R; Renehan, Andrew G; O'Dwyer, Sarah T; Haboubi, Najib Y

2012-01-01

210

Enhancement of pleural dissemination and lymph node metastasis of intrathoracic lung cancer cells by vascular endothelial growth factors (VEGFs).  

PubMed

The expression of vascular endothelial growth factors (VEGFs) in tumors including lung cancer is considered to be associated with tumor development via capillary and lymph vessel neogenesis. Dissemination of the tumor cells to the pleura or regional lymph nodes is a critical poor prognostic factor for lung cancer patients. To investigate how VEGFs expressed in the intrathoracic infiltrating lung cancer cells participate in disease progression, we established stably VEGF-A-, VEGF-C-, VEGF-D-, VEGF-A and VEGF-C-, and VEGF-A and VEGF-D-expressing large cell lung cancer clones (TKB5/VEGF-A, TKB5/VEGF-C, TKB5/VEGF-D, TKB5/VEGF-A/C, and TKB5/VEGF-A/D), orthotopically inoculated these into the right thoracic cavity (i.t.) of nude mice, and evaluated the subsequent development of lung lesion, pleural effusion, pleural dissemination, and lymph node metastasis. While there were no significant differences either in culture or in subcutaneous tumor cell growth between the empty vector-transfected group (TKB5/empty) and each transfectant, the i.t. model demonstrated significantly different biological properties between the transfectants. TKB5/empty-inoculated mice frequently developed a large tumor on the pleura without pleural effusion, dissemination, or lymph node (LN) metastasis. In contrast, VEGF-A promoted a bloody pleural effusion (6/14), and VEGF-A and VEGF-D frequently generated pleural dissemination (11/14 and 9/11, respectively). Although both VEGF-C and VEGF-D generated LN metastasis (6/10 and 8/11, respectively), the locations of the metastasized LNs were quite different. TKB5/VEGF-C metastasized on the same side of axillary LNs as i.t. (right axillary LNs), whereas TKB5/VEGF-D metastasized to the mediastinal and left axillary and/or cervical LNs. Since the TKB5/VEGF-A/C or TKB5/VEGF-A/D co-transfectants revealed overlapping tumor progression patterns of VEGF-A and VEGF-C or VEGF-D, the metastatic LNs had abundant new capillaries and were larger than those of TKB5/VEGF-C or TKB5/VEGF-D-inoculated mice. Our results clearly demonstrate that VEGF-A secreted from intrathoracic lung cancer cells plays important roles in producing pleural effusion, dissemination, and capillary neogenesis, that VEGF-C is involved in LN metastasis, and VEGF-D in pleural dissemination and LN metastasis. It is most likely, however, that the mechanisms by which VEGF-C promotes LN metastasis are different from those of VEGF-D. The regulation of the expression of VEGFs in intrathoracic lung cancer cells might be a useful therapeutic approach to inhibiting tumor development and improving patient prognosis. PMID:15301873

Ishii, Haruhiko; Yazawa, Takuya; Sato, Hanako; Suzuki, Takehisa; Ikeda, Masaichi; Hayashi, Yasufumi; Takanashi, Yoshinori; Kitamura, Hitoshi

2004-09-01

211

Completion of axillary dissection for a positive sentinel node: necessary or not?  

PubMed

Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports of outcomes when axillary node dissection was not performed in the setting of positive sentinel nodes, models for predicting the status of nonsentinel nodes, and the morbidity associated with axillary operations. Despite an approximate 10% false-negative rate, early results indicate that there is a much lower local recurrence rate after sentinel node excision alone and that systemic therapy may sterilize the axilla. In selected patients, it may be appropriate to forgo an axillary node dissection, although there are no randomized clinical trial data to support or refute this suggestion. PMID:19080737

Erb, Kathleen M; Julian, Thomas B

2009-01-01

212

Completion of Axillary Dissection for a Positive Sentinel Node: Necessary or Not?  

PubMed Central

Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports of outcomes when axillary node dissection was not performed in the setting of positive sentinel nodes, models for predicting the status of nonsentinel nodes, and the morbidity associated with axillary operations. Despite an approximate 10% false-negative rate, early results indicate that there is a much lower local recurrence rate after sentinel node excision alone and that systemic therapy may sterilize the axilla. In selected patients, it may be appropriate to forgo an axillary node dissection, although there are no randomized clinical trial data to support or refute this suggestion.

Julian, Thomas B.

2008-01-01

213

Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy  

SciTech Connect

Between January, 1967 and July, 1980, 176 women who were referred to the Joint Center for Radiation Therapy (JCRT) for definitive breast irradiation underwent low axillary dissection. A typical operative technique is described. The dissection stops short of the axillary vein although the vein is usually visualized. One hundred thirty-two axillae were thought to be N/sub 0/ or N/sub 1a/. Forty-six axillae were felt to be N/sub 1b/. Seventeen percent of the T/sub 1/ N/sub 0/ patients had pathologically positive nodes. Twenty-seven percent of the T/sub 2/ N/sub 0/ patients had positive nodes. When 5 or less nodes were removed at axillary sampling the incidence of nodal involvement was very low. There were no differences in nodal positivity when comparing under quadrant to lower or central lesions. Ninety-four percent of axillae with N/sub 1b/ lesions were pathologically confirmed. The complication rate for this procedure was low. There was 5 transient non-surgical complications and 1 cellulitis resulting in a frozen shoulder, which required corrective surgery. There were no cases of moderate or severe arm edema. Axillary sampling is compared to axillary dissection as a diagnostic procedure. Axillary sampling may underestimate the true pathologic positive rate, but diagnostic accuracy appears excellent if level 1 and 2 nodes are sampled.

Rose, C.M.; Botnick, L.E.; Weinstein, M.; Harris, J.R.; Koufman, C.; Silen, W.; Hellman, S.

1983-03-01

214

Risk Factors of Lymph Edema in Breast Cancer Patients  

PubMed Central

Background. Lymphedema secondary to breast cancer treatment is a common and serious problem for disease survivors. The objective of the current study was to identify the risk factors of secondary lymphedema after breast carcinoma treatment. Materials & Methods. The breast cancer patients who were followed up in three centers in Tehran and Mashhad in 2010 were recruited in the study. The circumference measurement was used for defining lymphedema. Results. Among 410 breast cancer patients, 123 cases (30%) developed lymphedema. Variables such as low educational level, body mass index (BMI), higher stage of disease, number of involved lymph nodes, comorbid diseases, trauma, infection, and the time after surgery showed significant correlation with the development of lymphedema. In logistic regression analysis, increase of 1?kg/m2 in BMI (OR?=?1.09; 95%??CI 1.05–1.15), each number increase in lymph node involvement (OR?=?1.15; 95%??CI 1.08–1.21) and the increase of every 1 month after surgery (OR?=?1.01; 95%??CI 1.01–1.02) significantly increased the risk of lymphedema. Conclusion. The results of this study demonstrated that preserving a fitted BMI, emphasis on self-care, and educating preventive activities may have important roles in decreasing the lymphedema incidence and improving the patients' quality of life.

Shahpar, Haghighat; Atieh, Akbari; Maryam, Ansari; Fatemeh, Homaei Shandiz; Massoome, Najafi; Mandana, Ebrahimi; Masud, Yunesian; Hamid Reza, Mirzaei; Mohammad Esmaeil, Akbari

2013-01-01

215

Regional Distribution of Epifascial Swelling and Epifascial Lymph Drainage Rate Constants in Breast Cancer-Related Lymphedema  

PubMed Central

Background: The view that breast cancer-related lymphedema (BCRL) is a simple, direct mechanical result of axillary lymphatic obstruction (‘stopcock’ mechanism) appears incomplete, because parts of the swollen limb (e.g., hand) can remain nonswollen. The lymph drainage rate constant (k) falls in the swollen forearm but not in the spared hand, indicating regional differences in lymphatic function. Here the generality of the hypothesis that regional epifascial lymphatic failure underlies regional swelling was tested. To do so, the regional distribution of epifascial swelling along the forearm was compared with that of epifascial (subcutis) k. Methods and Results: Epifascial k (local lymph flow per unit distribution volume) was measured by quantitative lymphoscintigraphy of subcutaneous radiolabeled human immunoglobulin IgG in regions of maximal and minimal % swelling in the ipsilateral swollen forearm, and at matching sites in the contralateral nonswollen arm, in 11 women with BCRL. Swelling was maximal distally in 5 patients and proximally in 6. Proximal k, ?0.085 ± 0.025% min?1 (mean ± SD), was 27% bigger than distal k, ?0.067 ± 0.021% min?1, irrespective of swelling (p = 0.02, two-way repeated measures ANOVA). k fell by 11% from ?0.080 ± 0.028% min?1 in the nonswollen arm to ?0.072 ± 0.021% min?1 in the swollen arm (p = 0.17, t test). Local epifascial k was not significantly lower, however, at sites of maximal swelling than minimal swelling, and k correlated positively with arm circumference. Conclusions: A systematic difference in lymph drainage along the axis of the forearm was demonstrated for the first time. Local differences in epifascial k did not, however, explain the regionality of swelling, in keeping with previous evidence that epifascial k does not correlate with differences in swelling between arms, whereas subfascial k does. The results lead to the rejection of the hypothesis that epifascial (cf. subfascial) lymph drainage rate constants govern epifascial swelling in human forearm.

STANTON, ANTHONY W. B.; MELLOR, RUSSELL H.; MICHAEL PETERS, A.; RODNEY LEVICK, J.; MORTIMER, PETER S.

2005-01-01

216

Exploring molecular links between lymph node invasion and cancer prognosis in human breast cancer  

PubMed Central

Background Lymph node invasion is one of the most powerful clinical factors in cancer prognosis. However, molecular level signatures of their correlation are remaining poorly understood. Here, we propose a new approach, monotonically expressed gene analysis (MEGA), to correlate transcriptional patterns of lymph node invasion related genes with clinical outcome of breast cancer patients. Results Using MEGA, we scored all genes with their transcriptional patterns over progression levels of lymph node invasion from 278 non-metastatic breast cancer samples. Applied on 65 independent test data, our gene sets of top 20 scores (positive and negative correlations) showed significant associations with prognostic measures such as cancer metastasis, relapse and survival. Our method showed better accuracy than conventional two class comparison methods. We could also find that expression patterns of some genes are strongly associated with stage transition of pathological T and N at specific time. Additionally, some pathways including T-cell immune response and wound healing serum response are expected to be related with cancer progression from pathway enrichment and common motif binding site analyses of the inferred gene sets. Conclusions By applying MEGA, we can find possible molecular links between lymph node invasion and cancer prognosis in human breast cancer, supported by evidences of feasible gene expression patterns and significant results of meta-analysis tests.

2011-01-01

217

The role of lymph node dissection in the management of prostate cancer  

Microsoft Academic Search

Lymph node dissection is a standard procedure for treatment of several cancers, but its role in prostate cancer (PCa) as an\\u000a adjunct of radical prostatectomy is still debated and controversial. Pelvic lymph node dissection (PLND) is currently the\\u000a most reliable means of diagnosis of lymph node metastases. A uniform PLND surgical template cannot be determined, but recent\\u000a evidence shows that

Jun Miki; Shin Egawa

2011-01-01

218

Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer  

Microsoft Academic Search

Objective: The purpose of this study was to identify the prognostic impact of unexpected lymph node metastases in patients undergoing resection of pulmonary metastases from colorectal cancer and specify the influence of pulmonary and mediastinal nodal involvement according to the modified Narukes lymph node mapping [Mountain CF, Dresler CM. Regional lymph node classification for lung cancer. Chest 1997;111(6):1718–23.]. Methods: From

Stefan Welter; Jan Jacobs; Thomas Krbek; Christoph Poettgen; Georgios Stamatis

2007-01-01

219

Sentinel lymph node biopsy for breast cancer using methylene blue dye manifests a short learning curve among experienced surgeons: a prospective tabular cumulative sum (CUSUM) analysis  

PubMed Central

Background The benefits of sentinel lymph node biopsy (SLNB) for breast cancer patients with histologically negative axillary nodes, in whom axillary lymph node dissection (ALND) is thereby avoided, are now established. Low false negative rate, certainly with blue dye technique, mostly reflects the established high inherent accuracy of SLNB and low axillary nodal metastatic load (subject to patient selection). SLN identification rate is influenced by volume, injection site and choice of mapping agent, axillary nodal metastatic load, SLN location and skill at axillary dissection. Being more subject to technical failure, SLN identification seems to be a more reasonable variable for learning curve assessment than false negative rate. Methylene blue is as good an SLN mapping agent as Isosulfan blue and is much cheaper. Addition of radio-colloid mapping to blue dye does not achieve a sufficiently higher identification rate to justify the cost. Methylene blue is therefore the agent of choice for SLN mapping in developing countries. The American Society of Breast Surgeons recommends that, for competence, surgeons should perform 20 SLNB but admits that the learning curve with a standardized technique may be "much shorter". One appropriate remedy for this dilemma is to plot individual learning curves. Methods Using methylene blue dye, experienced breast surgeons performed SLNB in selected patients with breast cancer (primary tumor < 5 cm and clinically negative ipsilateral axilla). Intraoperative assessment and completion ALND were performed for standardization on the first 13 of 24 cases. SLN identification was plotted for each surgeon on a tabular cumulative sum (CUSUM) chart with sequential probability ratio test (SPRT) limits based on a target identification rate of 85%. Results The CUSUM plot crossed the SPRT limit line after 8 consecutive, positively identified SLN, signaling achievement of an acceptable level of competence. Conclusion Tabular CUSUM charting, based on a justified choice of parameters, indicates that the learning curve for SLNB using methylene blue dye is completed after 8 consecutive, positively identified SLN. CUSUM charting may be used to plot individual learning curves for trainee surgeons by applying a proxy parameter for failure in the presence of a mentor (such as failed SLN identification within 15 minutes).

East, Jeffrey M; Valentine, Christopher SP; Kanchev, Emil; Blake, Garfield O

2009-01-01

220

Lymphangiogenesis and lymph node metastasis in breast cancer  

PubMed Central

Introduction There have been few studies on lymphangiogenesis in the past due to the lack of specific lymphatic endothelial markers, and lymphatic-specific growth factors. Recently, these limitations have been relieved by the discovery of a small number of potential lymphatic-specific markers. The relationship between lymphangiogenesis and regional or distant metastasis has not previously been investigated in humans. Using these lymphatic markers, it is possible to explore the relationship between lymphangiogenesis and tumour metastasis. This study indirectly quantified lymphangiogenesis by measuring mRNA expression of all seven lymphatic markers described above in breast cancers and correlated these markers with lymphatic involvement and survival. The cDNA from 153 frozen archived breast samples were analysed with Q-PCR for all seven lymphangiogenic markers. This was correlated with various prognostic factors as well as patient survival. Results There was significantly greater expression of all 7 markers in malignant compared to benign breast tissue. In addition, there was greater expression in lymph node positive/grade 3 tumours when compared to lymph node negative/grade 1 tumours. In 5 of the markers, there was a greater expression in poor NPI prognostic tumours when compared to favourable prognostic tumours which was not statistically significant. There was no association between recurrence risk and lymphangiogenic marker expression. Conclusion In summary, the findings from this study show that lymphangiogenesis, measured by specific lymphatic marker expression, is higher in breast cancers than in normal breast tissue. Secondly, breast cancers which have metastasised to the regional lymphatics show higher expression compared to those which have not, although the individual differences for all five markers were not statistically significant.

Cunnick, Giles H; Jiang, Wen G; Douglas-Jones, Tony; Watkins, Gareth; Gomez, Kelvin F; Morgan, Mike J; Subramanian, Ashok; Mokbel, Kefah; Mansel, Robert E

2008-01-01

221

Comparative Analysis of Nodal Upstaging Between Colon and Rectal Cancers by Sentinel Lymph Node Mapping: A Prospective Trial  

Microsoft Academic Search

PURPOSE Sentinel lymph node mapping accurately predicts nodal status in >90 percent of melanoma and breast and colorectal cancers. However, because of anatomic differences, sentinel lymph node mapping of rectal cancers has been considered inaccurate and difficult relative to colon. A prospective study was undertaken to identify differences in sentinel lymph node mapping between patients with colon cancer and those

Sukamal Saha; Keith M. Monson; Anton Bilchik; Thomas Beutler; Adrian G. Dan; Ellie Schochet; David Wiese; Sunil Kaushal; Balvant Ganatra; Dilip Desai

2004-01-01

222

Molecular and functional imaging for detection of lymph node metastases in prostate cancer.  

PubMed

Knowledge on lymph node metastases is crucial for the prognosis and treatment of prostate cancer patients. Conventional anatomic imaging often fails to differentiate benign from metastatic lymph nodes. Pelvic lymph node dissection is an invasive technique and underestimates the extent of lymph node metastases. Therefore, there is a need for more accurate non-invasive diagnostic techniques. Molecular and functional imaging has been subject of research for the last decades, in this respect. Therefore, in this article the value of imaging techniques to detect lymph node metastases is reviewed. These techniques include scintigraphy, sentinel node imaging, positron emission tomography/computed tomography (PET/CT), diffusion weighted magnetic resonance imaging (DWI MRI) and magnetic resonance lymphography (MRL). Knowledge on pathway and size of lymph node metastases has increased with molecular and functional imaging. Furthermore, improved detection and localization of lymph node metastases will enable (focal) treatment of the positive nodes only. PMID:23823804

Fortuin, Ansje; Rooij, Maarten de; Zamecnik, Patrik; Haberkorn, Uwe; Barentsz, Jelle

2013-07-03

223

New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients  

PubMed Central

Background Current practice is to perform a completion axillary lymph node dissection (ALND) for breast cancer patients with tumor-involved sentinel lymph nodes (SLNs), although fewer than half will have non-sentinel node (NSLN) metastasis. Our goal was to develop new models to quantify the risk of NSLN metastasis in SLN-positive patients and to compare predictive capabilities to another widely used model. Methods We constructed three models to predict NSLN status: recursive partitioning with receiver operating characteristic curves (RP-ROC), boosted Classification and Regression Trees (CART), and multivariate logistic regression (MLR) informed by CART. Data were compiled from a multicenter Northern California and Oregon database of 784 patients who prospectively underwent SLN biopsy and completion ALND. We compared the predictive abilities of our best model and the Memorial Sloan-Kettering Breast Cancer Nomogram (Nomogram) in our dataset and an independent dataset from Northwestern University. Results 285 patients had positive SLNs, of which 213 had known angiolymphatic invasion status and 171 had complete pathologic data including hormone receptor status. 264 (93%) patients had limited SLN disease (micrometastasis, 70%, or isolated tumor cells, 23%). 101 (35%) of all SLN-positive patients had tumor-involved NSLNs. Three variables (tumor size, angiolymphatic invasion, and SLN metastasis size) predicted risk in all our models. RP-ROC and boosted CART stratified patients into four risk levels. MLR informed by CART was most accurate. Using two composite predictors calculated from three variables, MLR informed by CART was more accurate than the Nomogram computed using eight predictors. In our dataset, area under ROC curve (AUC) was 0.83/0.85 for MLR (n = 213/n = 171) and 0.77 for Nomogram (n = 171). When applied to an independent dataset (n = 77), AUC was 0.74 for our model and 0.62 for Nomogram. The composite predictors in our model were the product of angiolymphatic invasion and size of SLN metastasis, and the product of tumor size and square of SLN metastasis size. Conclusion We present a new model developed from a community-based SLN database that uses only three rather than eight variables to achieve higher accuracy than the Nomogram for predicting NSLN status in two different datasets.

Kohrt, Holbrook E; Olshen, Richard A; Bermas, Honnie R; Goodson, William H; Wood, Douglas J; Henry, Solomon; Rouse, Robert V; Bailey, Lisa; Philben, Vicki J; Dirbas, Frederick M; Dunn, Jocelyn J; Johnson, Denise L; Wapnir, Irene L; Carlson, Robert W; Stockdale, Frank E; Hansen, Nora M; Jeffrey, Stefanie S

2008-01-01

224

Head-to-head comparison of lymph node density and number of positive lymph nodes in stratifying the outcome of patients with lymph node-positive prostate cancer submitted to radical prostatectomy and extended lymph node dissection.  

PubMed

OBJECTIVE: The aim of this study was to compare the predictive ability of lymph node density (LND) and number of positive lymph nodes in patients with prostate cancer and lymph node invasion. MATERIALS AND METHODS: We included 568 patients with lymph node invasion treated with radical prostatectomy and extended pelvic lymph node dissection between January 1990 and July 2011 at a single center. The Kaplan-Meier method and multivariable Cox regression models tested the association between the number of positive lymph nodes or LND and cancer-specific survival (CSS). The predictive accuracy of a baseline model was assessed using Harrell's concordance index and then compared with that of a model including either the number of positive nodes or LND. RESULTS: The median number of positive lymph nodes was 2, whereas the median LND was 11.1%. At 5, 8, and 10 years, CSS rates were 92.5%, 83.9%, and 82.8%, respectively. At multivariable analyses, number of positive lymph nodes and LND, considered as continuous variables, were independent predictors of CSS (all P?0.01). A 30% LND cutoff was found to be highly predictive of CSS (P = 0.004), and a cutoff of 2 positive nodes was confirmed to be a strong predictor of CSS (P = 0.02). The number of positive nodes and LND similarly, continuous or dichotomized, increased the accuracy for CSS predictions (0.68-0.69 vs. 0.61 of baseline model). LND cutoff of 30% increased the discrimination the most (0.69; +0.083). CONCLUSIONS: The number of positive lymph nodes and LND showed comparable discriminative power for long-term CSS predictions. A cutoff of 30% LND might be suggested for the selection of patients candidate for adjuvant systemic therapy, because it increased the model's discrimination the most. PMID:23490908

Passoni, Niccolò Maria; Abdollah, Firas; Suardi, Nazareno; Gallina, Andrea; Bianchi, Marco; Tutolo, Manuela; Fossati, Nicola; Gandaglia, Giorgio; Salonia, Andrea; Freschi, Massimo; Rigatti, Patrizio; Montorsi, Francesco; Briganti, Alberto

2013-03-12

225

Is the presence of small volume disease in the sentinel node an indication for axillary clearance?  

PubMed

The finding of micrometastases (M(i)) and isolated tumour cells (ITC) within the axillary lymph nodes of patients with breast cancer has raised the question whether either/both have some prognostic significance. Several studies have shown that compared to node-negative patients, prognosis is significantly poorer in patients with M(i) and ITC. The fact that patients with M(i)/ITC in their sentinel lymph nodes have a systemic relapse risk that is higher than that of node-negative patients may be considered as an indication for systemic treatment. Most studies in the literature suggest that in patients with M(i) or ITC in their sentinel nodes who receive systemic therapy and whole breast radiotherapy, the risk of axillary relapse without axillary lymphadenectomy is under 2%. Given the fact that axillary lymphadenectomy is associated with a 5-25% risk of lymphoedema, we propose that a policy of close follow up should be adopted in these patients rather than axillary lymphadenectomy. PMID:22721758

Patten, Darren K; Leff, Daniel R; Wani, Zubair; Cleator, Susan J; Palmieri, Carlo; Coombes, R Charles; Hadjiminas, Dimitri J

2012-06-19

226

Virchow lymph node metastatic recurrence of sigmoid colon cancer with severe lymph node metastases successfully treated using systemic chemotherapy combined with radiotherapy.  

PubMed

Metastatic recurrence of colon cancer in the left supraclavicular lymph node (Virchow lymph node) is rare, and to date there are no reports on radiotherapy as treatment. We report on a case of metastatic recurrence of sigmoid colon cancer in the Virchow lymph node with severe lymph node metastases successfully treated with a combined modality therapy of systemic chemotherapy and radiotherapy. The case is of a 58-year-old man, who underwent sigmoid excision and lymph node excision, and subsequently received systemic chemotherapy. After left supraclavicular lymph node recurrence appeared he later received radiotherapy. Complete response was achieved, and there has been no further recurrence, to date, 10 months after the radiotherapy. Radiotherapy was effective as a local treatment, and local control of distant metastasis of colonic cancer may lead to a good prognosis. PMID:23780983

Ohchi, Takafumi; Akagi, Yoshito; Kinugasa, Tetsushi; Ishibashi, Yoshiaki; Tanaka, Natsuki; Fujino, Shinya; Kibe, Shiro; Yuge, Kotaro; Sasatomi, Teruo; Mizobe, Tomoaki; Oka, Yosuke; Hong, Kawang Dae; Shirouzu, Kazuo

2013-07-01

227

Differential lymph node retrieval in rectal cancer: associated factors and effect on survival  

PubMed Central

Background Recent publications have identified positive associations between numbers of lymph nodes pathologically examined and five-year overall survival (5-yr OS) in colon cancer. However, focused examinations of relationships between survival of rectal cancer and lymph node counts are less common. We conducted a single institution, retrospective review of rectal cancer resections to determine whether lymph node counts correlated with 5-yr OS and to explore the relationship between lymph node counts and various clinical and pathologic factors. Methods A retrospective review of our institutional tumor registry identified 159 patients with AJCC Stage 1, 2, or 3 rectal cancers that underwent surgical resection at our institution over eleven years. Univariate analysis was used to explore the relationship between lymph node counts and age, AJCC Stage, time period of diagnosis, preoperative radiotherapy, and performance of TME. Survival analysis was performed by the Kaplan-Meier method and the Cox proportional hazards model. Results In univariate analysis, there was an association between increased lymph node counts and age <70, higher stage, and diagnosis during the later portion of the study period [all P-values <0.05]. Lymph node counts were not associated with survival in Kaplan-Meier analysis or in multivariate Cox proportional hazards analysis. Conclusions Increasing lymph node counts improve survival and the accuracy of colorectal cancer staging. The body of literature recommends identical minimum lymph node counts in both colon and rectal cancer. In our study, which exclusively examined rectal cancer, we could not demonstrate that increased lymph node counts were associated with improved survival.

McFadden, Cedrek; McKinley, Brian; Greenwell, Brian; Knuckolls, Kaylee; Culumovic, Patrick; Schammel, David; Schammel, Christine

2013-01-01

228

Axillary Staging by Ultrasound-guided Fine-Needle Aspiration Cytology in Breast Cancer Patients. Still Up to Date?  

PubMed

To investigate whether clinicopathological features of breast cancer patients could predict the likelihood of lymph node metastases and the likelihood of false-negative results of ultrasound-guided fine-needle aspiration cytology of suspicious lymph nodes (US+FNAC). Between 2004 and 2009, US+FNAC was performed in 1,150 axillae (18 bilateral breast carcinomas). Based on final histologic diagnosis, the true- and false-negative group of US+FNAC were defined. Subsequently, 11 clinicopathological factors were compared between these two groups. These factors were also compared between patients with and patients without lymph node metastases. Of 1,150 axillae, 429 had lymph node metastases at final histology. US+FNAC indicated metastases in 107 axillae. 1,043 axillae were negative by US+FNAC. Final histology showed metastases in 323 of these 1,043 axillae, resulting in a false-negative group of US+FNAC of 31%. Both age <60 years and a cT2/cT3 breast carcinoma were significantly associated with lymph node metastases and with false-negative results of US+FNAC. Lymph node metastases were found in 59.6% of patients <60 years with a cT2/cT3 breast carcinoma. In these patients, 52.3% of the negative US+FNAC results were falsely negative. In patients <60 years with a cT2/cT3 breast carcinoma, we recommend to omit US+FNAC preoperatively and perform a SNB directly, because lymph node metastases were found in 59.6% of these patients and 52.3% of negative US+FNAC results were falsely negative. PMID:24011125

Leenders, Martijn; Richir, Milan; Broeders, Maud; Moormann, Gisela; Mollema, Robbert; Lopes Cardozo, Alexander; Meijer, Sybren; Schreurs, Hermien

2013-09-09

229

Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery.  

PubMed

The purpose of this study was to assess risk for lymphedema of the breast and arm in radiotherapy patients in an era of less extensive axillary surgery. Breast cancer patients treated for cure were reviewed, with a minimum follow-up of 1.5 years from the end of treatment. Clinical, surgical, and radiation-related variables were tested for statistical association with arm and breast lymphedema using regression analyses, t-tests, and chi-squared analyses. Between January 1998 and June 2001, 240 women received radiation for localized breast cancer in our center. The incidence of lymphedema of the ipsilateral breast, arm, and combined (breast and arm) was 9.6%, 7.6%, and 1.8%, respectively, with a median follow-up of 27 months. For breast edema, t-test and multivariate analysis showed body mass index (BMI) to be significant (p = 0.043, p = 0.0038), as was chi-squared and multivariate testing for site of tumor in the breast (p = 0.0043, p = 0.0035). For arm edema, t-test and multivariate analyses showed the number of nodes removed to be significant (p = 0.0040, p = 0.0458); the size of the tumor was also significant by multivariate analyses (p = 0.0027). Tumor size appeared significant because a number of very large cancers failed locally and caused cancer-related obstructive lymphedema. In our center, even modern, limited level 1-2 axillary dissection and tangential irradiation carries the risk of arm lymphedema that would argue in favor of sentinel node biopsy. For breast edema, disruption of draining lymphatics by surgery and radiation with boost to the upper outer quadrant increased risk, especially for the obese. Fortunately both breast and arm edema benefited from manual lymphatic drainage. PMID:15327493

Goffman, Thomas E; Laronga, Christine; Wilson, Lori; Elkins, David

230

Evaluation of the histological size of the sentinel lymph node metastases using RT-PCR assay: a rapid tool to estimate the risk of non-sentinel lymph node invasion in patients with breast cancer.  

PubMed

A RT-PCR assay (GeneSearch™, Veridex, LLC), FDA approved and CE marked to detect metastases > 0.2 mm in sentinel lymph nodes (SLNs) is used intra-operatively for the management of patients with breast cancer. The assay provides qualitative results by applying cut-off values to cycle times (Ct) for mammaglobin (MG) and cytokeratin-19 (CK19) genes. Aims of this study were to evaluate the performance of the quantitative Ct values to estimate the size of nodal metastases and the risk of additional disease in non-SLNs. SLNs from 367 patients were clinically processed using both BLN assay and post-operative histology. Complementary axillary lymph node dissection (ALND) was performed concurrently in case of BLN assay positivity or tumour size > 2 cm. BLN positivity was reported in 19.6% of the patients for a sensitivity of 89%. BLN specificity (94.5%) and negative predictive value (97.5%) clearly demonstrated its reliability to guide ALND decision. All, except one, residual axillary metastases were found in BLN-positive patients. Considering the 78 patients with SLN positivity or discordant status according to both criteria, the metastases histological size was significantly correlated to the expression level of MG (? = 0.62) and CK19 (? = 0.64) genes (P < 10E-6). Moreover, ALND status positivity was significantly associated to Ct value of MG (z = 2.4; P = 0.018) and CK19 (z = 3.2; P = 0.001). The high intra-operative quality performance of the BLN assay minimizes the need for second surgeries for ALND. Results from this investigational study suggest that markers Ct value may provide, intra-operatively, valuable metastases size data and a risk prediction of additional disease in non-SLNs. PMID:19779817

Veys, I; Majjaj, S; Salgado, R; Noterman, D; Schobbens, J C; Manouach, F; Bourgeois, P; Nogaret, J M; Larsimont, D; Durbecq, V

2009-09-25

231

Occult Lymph Node Metastases Detected by Cytokeratin Immunohistochemistry Predict Recurrence in Node-Negative Endometrial Cancer  

Microsoft Academic Search

Objective. Even after curative resection of early endometrial cancer, some patients die as a result of recurrence. We believe that these patients likely had occult lymph node metastases at the time of diagnosis. In an attempt to identify the responsible occult metastases, the clinicopathological significance of cytokeratin expression in lymph nodes with unconfirmed metastasis was evaluated retrospectively in patients with

Hiromitsu Yabushita; Mitsuma Shimazu; Hidefumi Yamada; Keizo Sawaguchi; Masayoshi Noguchi; Masami Nakanishi; Michiyasu Kawai

2001-01-01

232

Internal Mammary Lymph Node Drainage Patterns in Patients With Breast Cancer Documented by Breast Lymphoscintigraphy  

Microsoft Academic Search

Background: Metastases to internal mammary lymph nodes (IMN) may occur in patients with breast cancer and may alter treatment recommendations. The purpose of this study was to identify the frequency of IMN drainage in patients undergoing breast lymphoscintigraphy and sentinel lymph node dissection (SLND).Methods: The combined technique of peritumoral injection of radiocolloid and Lymphazurin blue for SLND was performed on

David R. Byrd; Lisa K. Dunnwald; David A. Mankoff; Benjamin O. Anderson; Roger E. Moe; Raymond S. Yeung; Erin E. Schubert; Janet F. Eary

2001-01-01

233

Intramammary lymph node metastases — a rare presenting sign of breast cancer  

Microsoft Academic Search

Lymph nodes are commonly seen in the breast tissue on mammographic examination but reports of findings suspicious of metastatic change are few. Two patients with intramammary lymph node metastasis detected by mammography are presented; in both of these a change in the intramammary node over time was the major reason for mammographic suspicion of breast cancer.

J. Cawson; A. K. Rose

1995-01-01

234

Laparoscopic Assessment of the Sentinel Lymph Node in Early Stage Cervical Cancer  

Microsoft Academic Search

Objective. The aim of this study was to describe a minimally invasive technique enabling us to identify the sentinel lymph node in patients affected by early stage cervical cancer and to report the preliminary data.Method. Patent Blue Violet was injected around the tumor. Laparoscopy was undertaken and the blue-dyed lymph nodes (BDLN) were sought. The evidenced BDLN were removed, and

D. Dargent; X. Martin; P. Mathevet

2000-01-01

235

Axillary Padding as an Alternative to Closed Suction Drain for Ambulatory Axillary Lymphadenectomy: A Prospective Cohort of 207 Patients With Early Breast Cancer  

Microsoft Academic Search

Results: Eighty-seven (42.0%) of the 207 patients un- derwent a 1-day procedure. In the 1-day surgery group, 87 (84.5%) of the 103 patients benefited from a true 1-day surgery procedure. The main reasons for conversion were nausea and anxiety rather than surgical complications. Hospital stay never exceeded 3 days. The most common postoperative complication was axillary seroma, with an average

Jean-Marc Classe; Pierre Francois Dupre; Thierry Francois; Serge Robard; Jean Loup Theard; Francois Dravet

2002-01-01

236

Completion of axillary dissection for a positive sentinel node: Necessary or not?  

Microsoft Academic Search

Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast\\u000a cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure\\u000a that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports\\u000a of

Kathleen M. Erb; Thomas B. Julian

2009-01-01

237

Factors associated with regional nodal failure in patients with early stage breast cancer with 0–3 positive axillary nodes following tangential irradiation alone  

Microsoft Academic Search

Purpose: Recent randomized trials have suggested that improved local-regional control after radiation therapy significantly increases survival for breast cancer patients with positive axillary nodes treated with adjuvant systemic therapy (1, 2). It has been our policy to use a third radiation field only in patients with 4 or more positive nodes. The purpose of this study was to assess whether

Sharon Galper; Abram Recht; Barbara Silver; Judy Manola; Rebecca Gelman; Stuart J. Schnitt; James L. Connolly; Jay R. Harris

1999-01-01

238

Intramammary lymph node metastasis in a patient with ovarian carcinoma and a brief review of the literature  

PubMed Central

Metastasis from serous carcinoma of the ovary usually occurs in the subdiaphragmatic region. Metastasis to the breast and/or axillary-intramammary lymph node is very rare. It usually occurs in advanced disease, and it is important to distinguish a primary breast cancer from an ovarian cancer metastasis since the management of these two entities is totally different. Here we present a patient with metastasis to the breast and intramammary lymph nodes from ovarian serous carcinoma 25 months after diagnosis.

Erten, Cigdem; Yigit, Seyran Ceri; Can, Alper; Dirican, Ahmet; Bayoglu, Vedat; Kucukzeybek, Yuksel; Somali, Isil; Tarhan, M Oktay

2012-01-01

239

Physiotherapy After Breast Cancer Surgery: Results of a Randomised Controlled Study to Minimise Lymphoedema  

Microsoft Academic Search

The development of secondary arm lymphoedema after the removal of axillary lymph nodes remains a potential problem for women with breast cancer. This study investigated the incidence of arm lymphoedema following axillary dissection to determine the effect of prospective monitoring and early physiotherapy intervention. Sixty-five women were randomly assigned to either the treatment (TG) or control group (CG) and assessments

Robyn C. Box; Hildegard M. Reul-Hirche; Joanne E. Bullock-Saxton; Colin M. Furnival

2002-01-01

240

The association of cytokeratin-only-positive sentinel lymph nodes and subsequent metastases in breast cancer  

Microsoft Academic Search

IntroductionThe purpose of this study was to better characterize the clinical significance of cytokeratin immunohistochemistry (IHC)-only-positive lymph node metastases among patients with breast cancer.

Philip S. Mullenix; Tommy A. Brown; Micheal O. Meyers; Lydia R. Giles; Elin R. Sigurdson; Marcia C. Boraas; John P. Hoffman; Burton L. Eisenberg; Michael H. Torosian

2005-01-01

241

Raman spectroscopy is sensitive and specific in the detection of lymph node metastases in breast cancer  

NASA Astrophysics Data System (ADS)

: laboratory Raman spectroscopy was performed on 59 lymph node sections from breast cancer patients, demonstrating 91% sensitivity and 93% specificity for the correct classification of positive node spectra in a model.

Smith, Jenny; Kendall, Catherine; Sammon, Alastair M.; Christie-Brown, Jonathan; Mandalia, Trupti; Stone, Nicholas

2005-08-01

242

LAPAROSCOPIC PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER: COMPARISON OF THE EXTENDED AND MODIFIED TECHNIQUES  

Microsoft Academic Search

PurposeWe compared the results of extended (obturator, hypogastric, common and external iliac nodes) to modified (obturator and hypogastric nodes only) laparoscopic pelvic lymph node dissection in patients with clinically localized prostate cancer.

Nelson N. Stone; Richard G. Stock; Pamela Unger

1997-01-01

243

Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer  

Microsoft Academic Search

PurposeThe purpose of this study was to determine the rates of sentinel lymph node (SLN) positivity in patients with a final diagnosis of ductal carcinoma in situ (DCIS) or microinvasive breast cancer (MIC).

Angela Katz; Irene Gage; Sheila Evans; Margaret Shaffer; Thomas Fleury; Frederick P. Smith; Richard Flax; Cynthia Drogula; Peter Petrucci; Colette Magnant

2006-01-01

244

Outcomes by Ethnicity: Sentinel Lymph Node Status in Women With Breast Cancer.  

National Technical Information Service (NTIS)

Breast cancer incidence and outcomes vary in women of different racial/ethnic backgrounds. Race/ethnicity and tumor biology may affect outcomes. Since regional lymph node status and tumor markers are strong prognostic indicators, this study examines the r...

M. Hassett K. K. Hunt K. Keyomarsi

2005-01-01

245

Biological and molecular aspects of lymph node metastasis in gastro-intestinal cancer.  

PubMed

Recently, the existence of lymph node micrometastasis, including isolated tumor cells, has been the focus of the development of molecular diagnostic tools for lymph node metastasis in various malignant neoplasms, including those of the GI tract. In this review, we summarize recent molecular biological studies that might provide two reasons to explain the survival of single isolated cancer cells in lymph nodes. One is the specific characteristics of cancer cells, which can exist under severe circumstances, along with recent technological innovations to obtain expression profiles and sequencing from a single cell. The other is microenvironmental factors that support the formation of micrometastasis even in small numbers of cancer cells. The expression profile of whole transcriptome sequencing, genomic sequencing and epigenetic sequencing of a single cancer cell with tumorigenic properties in lymph node metastases should be disclosed in the near future. PMID:23828632

Mimori, Koshi; Shinden, Yoshiharu; Eguchi, Hidetoshi; Sudo, Tomoya; Sugimachi, Keishi

2013-07-05

246

Technique of sentinel lymph node biopsy and lymphatic mapping during laparoscopic colon resection for cancer  

PubMed Central

Background: The utility of lymph node mapping to improve staging in colon cancer is still under evaluation. Laparoscopic colectomy for colon cancer has been validated in multi-centric trials. This study assessed the feasibility and technical aspects of lymph node mapping in laparoscopic colectomy for colon cancer. Methods: A total of 42 patients with histologically proven colon cancer were studied from January 2006 to September 2007. Exclusion criteria were: advanced disease (clinical stage III), rectal cancer, previous colon resection and contraindication to laparoscopy. Lymph-nodal status was assessed preoperatively by computed tomography (CT) scan and intra-operatively with the aid of laparoscopic ultrasound. Before resection, 2–3 ml of Patent Blue V dye was injected sub-serosally around the tumour. Coloured lymph nodes were marked as sentinel (SN) with metal clips or suture and laparoscopic colectomy with lymphadenectomy completed as normal. In case of failure of the intra-operative procedure, an ex vivo SN biopsy was performed on the colectomy specimen after resection. Results: A total number of 904 lymph nodes were examined, with a median number of 22 lymph nodes harvested per patient. The SN detection rate was 100%, an ex vivo lymph node mapping was necessary in four patients. Eleven (26.2%) patients had lymph-nodal metastases and in five (45.5%) of these patients, SN was the only positive lymph node. There were two (18.2%) false-negative SN. In three cases (7.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The accuracy of SN mapping was 95.2% and negative predictive value was 93.9%. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. The ex vivo technique is useful as a salvage technique in case of failure of the intra-operative procedure. Prospective studies are justified to determine the real accuracy and false-negative rate of the technique.

Bianchi, PP; Andreoni, B; Rottoli, M; Celotti, S; Chiappa, A; Montorsi, M

2007-01-01

247

Endoscopic thyroidectomy and sentinel lymph node biopsy via an anterior chest approach for papillary thyroid cancer  

Microsoft Academic Search

The clinical role of endoscopic thyroidectomy and sentinel lymph node biopsy (SLNB) for differentiated thyroid cancer remains\\u000a open to debate. Conventional thyroidectomy requires a cervical incision and often leaves an unsightly scar on the anterior\\u000a neck. Endoscopic thyroidectomy is technically feasible and safe, with much better cosmetic results. The prognostic importance\\u000a of lymph node metastasis in thyroid cancer makes central

Ja Seong Bae; Woo Chan Park; Byung Joo Song; Sang Seol Jung; Jeong Soo Kim

2009-01-01

248

The clinical relevance of axillary reverse mapping (ARM): study protocol for a randomized controlled trial  

PubMed Central

Background Axillary lymph node dissection (ALND) in patients with breast cancer has the potential to induce side-effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the breast from that of the upper limb in the axillary lymph node (LN) basin. If lymphedema is caused by removing these lymphatics and nodes in the upper limb, the possibility of identifying these lymphatics would enable surgeons to preserve them. The aim of this study is to determine the clinical relevance of selective axillary LN and lymphatic preservation by means of ARM. To minimize the risk of overlooking tumor-positive ARM nodes and the associated risk of undertreatment, we will only include patients with a tumor-positive sentinel lymph node (SLN). Patients who are candidates for ALND because of a proven positive axillary LN at clinical examination can be included in a registration study. Methods/design The study will enroll 280 patients diagnosed with SLN biopsy-proven metastasis of invasive breast cancer with an indication for a completion ALND. Patients will be randomized to undergo standard ALND or an ALND in which the ARM nodes and their corresponding lymphatics will be left in situ. Primary outcome is the presence of axillary surgery-related lymphedema at 6, 12, and 24 months post-operatively, measured by the water-displacement method. Secondary outcome measures include pain, paresthesia, numbness, and loss of shoulder mobility, quality of life, and axillary recurrence risk. Discussion The benefit of ALND in patients with a positive SLN is a subject of debate. For many patients, an ALND will remain the treatment of choice. This multicenter randomized trial will provide evidence of whether or not axillary LN preservation by means of ARM decreases the side-effects of an ALND. Enrolment of patients will start in April 2013 in five breast-cancer centers in the Netherlands, and is expected to conclude by April 2016. Trial registration TC3698

2013-01-01

249

Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer.  

PubMed

Lymph node staging is of paramount importance for prognosis estimation and therapy stratification in colorectal cancer. A high number of harvested lymph nodes is associated with an improved outcome. Methylene blue-assisted lymph node dissection effectively improves the lymph node harvest and ensures sufficient staging. Now, the effect on node positivity rate and stage-related outcome was investigated. The study cohort with advanced lymph node dissection consisted of 669 colorectal cancer cases of all stages, which were collected between 2007 and 2012. A historical collection of 663 cases investigated with conventional techniques between 2002 and 2004 served as control. Lymph node harvest was dramatically improved in the study group with mean lymph node numbers of 34 ± 17 vs 13 ± 5 (P<0.001) and sufficient staging rates of 98% vs 62% (P<0.001). However, neither the rate of nodal positive cases (37% vs 37%; P = 0.98) nor the rate of N2 cases differed between the two groups (14% vs 13%; P = 0.80). Furthermore, no differences were found concerning the outcome in both groups. The advanced lymph node dissection technique guarantees adequate histopathological lymph node staging in virtually all cases of colorectal cancer and is therefore extremely helpful. The hypothesis that it also provides a higher sensitivity in detecting metastases, however, could be not proved. PMID:23599158

Märkl, Bruno; Schaller, Tina; Krammer, Ines; Cacchi, Claudio; Arnholdt, Hans M; Schenkirsch, Gerhard; Kretsinger, Hallie; Anthuber, Matthias; Spatz, Hanno

2013-04-19

250

Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer.  

PubMed

This study is the first large prospective RCT of sentinel node biopsy (SNB) compared with standard axillary treatment (level I-III axillary lymph node dissection or four node sampling), which includes comprehensive and repeated quality of life (QOL) assessments over 18 months. Patients (n = 829) completed the Functional Assessment of Cancer Therapy - Breast (FACT-B+4) and the Spielberger State/Trait Anxiety Inventory (STAI) at baseline (pre-surgery) and at 1, 3, 6, 12, and 18 months post-surgery. There were significant differences between treatment groups favouring the SNB group throughout the 18 months assessment. Patients in the standard treatment group showed a greater decline in Trial Outcome Index (TOI) scores (physical well-being, functional well-being and breast cancer concerns subscales in FACT-B+4) and recovered more slowly than patients in the SNB group (p < 0.01). The change in total FACT-B+4 scores (measuring global QOL) closely resembled the TOI results. 18 months post-surgery approximately twice as many patients in the standard group compared with the SNB group reported substantial arm swelling (14% versus 7%) (p = 0.002) or numbness (19% versus 8.7%) (p < 0.001). Despite the uncertainty about undergoing a relatively new procedure and the possible need for further surgery, there was no evidence of increased anxiety amongst patients randomised to SNB (p > 0.05). For 6 months post-surgery younger patients reported less favourable QOL scores (p < 0.001) and greater levels of anxiety (p < 0.01). In view of the benefits regarding arm functioning and quality of life, the data from this randomised study support the use of SNB in patients with clinically node negative breast cancer. PMID:16163445

Fleissig, Anne; Fallowfield, Lesley J; Langridge, Carolyn I; Johnson, Leigh; Newcombe, Robert G; Dixon, J Michael; Kissin, Mark; Mansel, Robert E

2005-09-15

251

Is PCR testing of sentinel lymph nodes ready for clinical application in breast cancer ?  

Microsoft Academic Search

While the majority of breast cancer patients with histologically lymph node-negative cancers are cured by local therapy alone, approximately 25% will develop recurrent breast cancer and die of their disease in the absence of systemic adjuvant chemotherapy [1]. Cytotoxic chemotherapy markedly improves outcome for some of these patients. Assays that could better distinguish those nodenegative patients who are more likely

Benjamin O. Anderson; Ira J. Bleiweiss

2011-01-01

252

PROSTATE CANCER TOPOGRAPHY AND PATTERNS OF LYMPH NODE METASTASIS  

PubMed Central

Pelvic lymph node (LN) metastasis is a well-recognized route of prostate cancer spread. However, the relationship between topography and pathologic features of primary prostatic cancers and patterns of pelvic LN metastasis has not been well studied. We reviewed original slides of radical prostatectomies and pelvic LN dissections from 125 patients with LN metastasis and recorded total # of LN excised / laterality of positive LN, as well as localization, staging parameters, lymphovascular invasion and tumor volume of primary tumors. LN Quantity and Distribution 14.6 (mean) and 13 (median) LN were resected. 76 (61%), 33 (26%) and 16 (13%) cases had 1, 2 and > 2 positive LN, while 58, 44 and 20 cases had LN metastasis on the right (R), left (L), and bilaterally. Pathologic Features 86% (108/125) and 37% (46/125) demonstrated extraprostatic extension and seminal vesicle invasion, while 64% showed lymphovascular invasion. Mean and median total tumor volume was 6.39 and 3.92 cc, with ? 50% and ? 90% Gleason patterns 4/5 in 105 (84%) and 73 (58%) cases, respectively. Correlation with Dominant Tumor Location Dominant lesions on RP: 50 R lobe, 44 L lobe, 31 bilateral. 15/50 (30%) R lobe and 18/44 (41%) L lobe dominant tumors had LN metastasis on the contralateral side. Only 4% (5/125) of cases were associated with anterior dominant tumors. 30–40% of LN metastases occur contralateral to the dominant tumor. LN metastasis is overwhelmingly associated with high grade, high stage and large volume disease. LN positivity is rarely associated with anterior dominant tumors.

Tokuda, Yuji; Carlino, Lauren J.; Gopalan, Anuradha; Tickoo, Satish K.; Kaag, Matthew G.; Guillonneau, Bertrand; Eastham, James A.; Scher, Howard I.; Scardino, Peter T.; Reuter, Victor E.; Fine, Samson W.

2012-01-01

253

A New Formula for Prostate Cancer Lymph Node Risk  

SciTech Connect

Introduction: The successful treatment of prostate cancer depends on the accurate estimation of the risk of regional lymph node (LN) involvement. The Roach formula (RF) has been criticized as overestimating LN risk. A modification of the RF has been attempted by other investigators using simplified adjustment ratios: the Nguyen formula (NF). Methods and Materials: The National Cancer Institute Surveillance, Epidemiology, and End Results database was investigated for patients treated in 2004 through 2006 for whom at least 10 LN were examined at radical prostatectomy, cT1c or cT2 disease, and prostate-specific antigen (PSA) <26 ng/ml (N = 2,930). The Yale formula (YF) was derived from half of the sample (n = 1,460), and validated in the other half (n = 1,470). Results: We identified 2,930 patients. Only 4.6% of patients had LN+, and 72.6% had cT1c disease. Gleason (GS) 8-10 histology was found in 14.4% of patients. The YF for prediction of %LN+ risk is [GS - 5]x [PSA/3 + 1.5 x T], where T = 0, 1, and 2 for cT1c, cT2a, and cT2b/cT2c. Within each strata of predicted %LN+ risk, the actual %LN+ was closest to the YF. Using a >15% risk as an indicator of high-risk disease, the YF had increased sensitivity (39.0% vs. 13.6%) compared with the NF, without a significant reduction in specificity (94.9% vs. 98.8%). The NF was overly restrictive of the high-risk group, with only 2% of patients having a >15% risk of LN+ by that formula. Conclusion: The YF performed better than the RF and NF and was best at differentiating patients at high risk for LN+ disease.

Yu, James B., E-mail: james.b.yu@yale.ed [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT (United States); Yale Cancer Center, New Haven, CT (United States); Makarov, Danil V. [Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT (United States); Section of Urology, Yale School of Medicine, New Haven, CT (United States); Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT (United States); Gross, Cary [Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT (United States); Department of Internal Medicine, Yale School of Medicine, New Haven, CT (United States)

2011-05-01

254

Sonographic Assessment of Axillary Lymph Nodes After a Mammographically Recommended Breast Sonogram for Women 55 Years and Older: A Feasibility Study  

Microsoft Academic Search

Sonographic guidelines have been provided for assessing lymph nodes both in the axilla and other areas of the body. The objective of this study was to determine the feasibility of using sonography and Doppler to provide diagnostic nodal information for women 55 years and older. The authors conducted a retrospective longitudinal study of a group of women 55 years and

Kevin D. Evans; Xiaobai Li; Suzanne R. Robertson; Ashley M. Boyd; Michael Knopp

2007-01-01

255

Toxoplasma lymphadenitis mimicking malign axillary lymphadenopathy of a left breast mass.  

PubMed

Toxoplasmosis is an infection caused by the intracellular parasite, Toxoplasma gondii. Immunocompetent persons with primary infection are usually asymptomatic, but latent infection can persist for the life of the host. There is a risk of reactivating infection at a later time should the individual become immunocompromised, even if infection was asymptomatic or only mildly symptomatic initially. Axillary lymph nodes receive 85% of the lymphatic drainage from the breast. Lymph node metastases are relatively common even with invasive breast cancers ?1 cm in size. Here, we report a case of toxoplasma lymphadenitis in a female adult patient mimicking a malign breast lymphadenopathy of a left breast mass. PMID:22383305

Yildirim, Ali Cihat; Bostanci, Hasan; Yilmaz, Engin Deniz; Kutluer, Nizamettin; Kargici, Hulagu

2012-03-01

256

Magnetic Resonance Lymphography-Guided Selective High-Dose Lymph Node Irradiation in Prostate Cancer  

SciTech Connect

Purpose: To demonstrate the feasibility of magnetic resonance lymphography (MRL) -guided delineation of a boost volume and an elective target volume for pelvic lymph node irradiation in patients with prostate cancer. The feasibility of irradiating these volumes with a high-dose boost to the MRL-positive lymph nodes in conjunction with irradiation of the prostate using intensity-modulated radiotherapy (IMRT) was also investigated. Methods and Materials: In 4 prostate cancer patients with a high risk of lymph node involvement but no enlarged lymph nodes on CT and/or MRI, MRL detected pathological lymph nodes in the pelvis. These lymph nodes were identified and delineated on a radiotherapy planning CT to create a boost volume. Based on the location of the MRL-positive lymph nodes, the standard elective pelvic target volume was individualized. An IMRT plan with a simultaneous integrated boost (SIB) was created with dose prescriptions of 42 Gy to the pelvic target volume, a boost to 60 Gy to the MRL-positive lymph nodes, and 72 Gy to the prostate. Results: All MRL-positive lymph nodes could be identified on the planning CT. This information could be used to delineate a boost volume and to individualize the pelvic target volume for elective irradiation. IMRT planning delivered highly acceptable radiotherapy plans with regard to the prescribed dose levels and the dose to the organs at risk (OARs). Conclusion: MRL can be used to select patients with limited lymph node involvement for pelvic radiotherapy. MRL-guided delineation of a boost volume and an elective pelvic target volume for selective high-dose lymph node irradiation with IMRT is feasible. Whether this approach will result in improved outcome for these patients needs to be investigated in further clinical studies.

Meijer, Hanneke J.M., E-mail: H.Meijer@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Debats, Oscar A. [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kunze-Busch, Martina; Kollenburg, Peter van; Leer, Jan Willem [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Witjes, J. Alfred [Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Barentsz, Jelle O. [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Lin, Emile N.J.Th. van [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

2012-01-01

257

[Comparative studies of K1-67 expression between the primary tumor and breast cancer metastases to regional lymph nodes].  

PubMed

Breast cancer is often relatively slow growing, but at diagnosis about 40% of patients have regional spread to at least one axillary node. It has been shown that unrelated clones are in primary breast carcinomas. There is possibility that only a small subpopulation of the cells of the primary tumour (PT) metastasis. It has been shown that Ki-67 protein is a useful marker in histopathology, which is present during all active phases of the cell cycle and making possibility to assess growth fraction of tumour cells. The purpose of the study was to evaluate the expression of Ki-67 and comparison between the PTs and MRLNs as well as to estimate the relationships between Ki-67 and the chosen anatomoclinical features of the breast cancer. Immunohistochemical analyses for Ki-67 were performed on the PTs (69 cases without primary chemotherapy) and MRLNs (33 cases) of breast cancer. Increased expression of Ki-67 in PTs significantly correlated with pT2 stage of tumours (p < 0.05) and grade G3 (p < 0.04), but there was not relationship with lymph node status. Expression of Ki-67 positively correlated between PTs and MRLNs (p < 0.001). Comparison between PTs and matching MRLNs revealed that 23 (69.7%) cases showed a convergence between PTs and matching MRLNs with regard to negative or positive staining. We would like to emphasize the importance of studies concerning the proteins involved in proliferation in MRLNs, because knowledge about heterogeneity between PTs and MRLNs could shed light on tumour biology and may lead to development of more effective anti-cancer therapies. PMID:14674120

Koda, Mariusz; Jarzabek, Katarzyna; Ka?czugakoda, Luiza; Przystupa, Wojciech; Tomaszewski, Jakub; Sulkowska, Mariola; Wo?czy?ski, S?awomir; Sulkowski, Stanis?aw

2003-09-01

258

Salvage radiotherapy for lymph node recurrence after radical surgery in cervical cancer  

PubMed Central

Objective This study was to evaluate the treatment outcomes and prognostic factors of patients treated with salvage radiotherapy for the treatment of isolated lymph node recurrence of cervical cancer. Methods Between 1990 and 2009, 22 cervical cancer patients with lymph node recurrence who had previously undergone radical hysterectomy and pelvic lymph node dissection were treated with salvage radiotherapy with (n=18) or without (n=4) chemotherapy. Of the 22 patients, 10 had supraclavicular lymph node recurrence, 9 had para-aortic lymph node, and 3 had inguinal lymph node. The median total radiotherapy dose was 60 Gy (range, 40 to 70 Gy). Initial pathologic findings, latent period to lymph node recurrence and other clinical parameters such as squamous cell carcinoma antigen (SCC-Ag) level and concurrent chemotherapy were identified as prognostic factors for survival. Results The median follow-up period after salvage radiotherapy was 31.2 months (range, 12.1 to 148.9 months). The 5-year progression-free and overall survival rates of all patients were 32.7% and 30.7%, respectively. Concurrent chemoradiotherapy (p=0.009) and longer latent period to lymph node recurrence (>18 months vs. ?18 months, p=0.019) were significant predictors of progression-free survival and SCC-Ag level at the time of recurrence (>8 ng/dL vs. ?8 ng/dL, p=0.008) and longer latent period to lymph node recurrence (p=0.040) for overall survival. Treatment failure after salvage radiotherapy occurred in 14 (63.6%) for the 22 patients (in field, 2; out of field, 10; both in and out field, 2). Grade 3 acute skin (n=2) and hematologic toxicity (n=1) developed in 3 patients. Conclusion For isolated lymph node recurrence of cervical cancer, salvage radiotherapy with concurrent chemotherapy should be considered, especially in patients with a long-term progression-free period.

Jeon, Wan; Koh, Hyeon Kang; Wu, Hong-Gyun; Kim, Jin Ho; Chung, Hyun Hoon

2012-01-01

259

Hypermetabolic Axillary Mass on 18 F FDG PET\\/CT: Breast Cancer Arising from Accessory Breast Tissue  

Microsoft Academic Search

Differential diagnosis among several causes of axillary malignant mass is important. The most common cause of palpable malignant\\u000a axillary mass is metastatic lymphadenopathy. Although carcinoma arising from ectopic breast tissue is rare, the diagnosis\\u000a should be kept in mind when evaluating malignant axillary mass. In this report we present a case with carcinoma arising from\\u000a ectopic breast tissue. 18F FDG

Ji Sun Park; Ah Young Lee; Sang Gyun Bae; Seok Mo Lee

2010-01-01

260

Additional value of combined evaluation of tumor size with lymph node size in the detection of lymph node metastases in early-stage cervical cancer patients.  

PubMed

Although tumor size is a prognostic factor in cervical cancer patients, its role in the diagnosis of lymph node metastasis is unclear. We therefore evaluated the diagnostic value of tumor and lymph node size compared with lymph node size alone in the detection of metastatic lymph nodes in patients with early-stage cervical cancer.We retrospectively evaluated 699 patients with International Federation of Obstetrics and Gynecology stage IB1-IIA cervical carcinoma who underwent magnetic resonance imaging before lymphadenectomy involving all visible lymph nodes in the surgical fields. Seven nodal groups were evaluated: para-aortic, both common iliac, both external iliac, and both internal/obturator areas. Pathologic evaluation was the diagnostic standard. The largest short-axis diameter of lymph nodes in each region and the largest tumor diameters were measured in magnetic resonance images. The value of additional information from magnetic resonance images was evaluated by receiver operating characteristic curve analysis.Of the 699 patients, 108 (15.8%) had lymph node metastases. The areas under the curve for measurements of lymph node size, tumor size, and both were (A) 0.635, (B) 0.706, and (C) 0.742, respectively (A vs B, P = 0.006; A vs C P < 0.001; B vs C, P = 0.002).This study illustrates that magnetic resonance imaging measurements of tumor size and tumor size plus lymph node size showed a higher diagnostic performance than lymph node size alone in predicting lymph node metastasis in patients with early-stage cervical cancer. PMID:23863534

Kang, Sunji; Kim, Young Seok; Choi, Hyuck Jae; Kim, Mi-Hyun; Cho, Kyung-Sik

261

Use of Axillary Deodorant and Effect on Acute Skin Toxicity During Radiotherapy for Breast Cancer: A Prospective Randomized Noninferiority Trial  

SciTech Connect

Purpose: To prospectively determine the effect of deodorant use on acute skin toxicity and quality of life during breast radiotherapy (RT). Methods and Materials: Before breast RT, 84 patients were randomly assigned to the deodorant group (n = 40) or the no-deodorant group (n = 44). The patients were stratified by axillary RT and previous chemotherapy. Toxicity evaluations were always performed by the principal investigator, who was unaware of the group assignment, at the end of RT and 2 weeks after completion using the Radiation Therapy Oncology Group acute skin toxicity criteria. Symptoms of acute skin toxicity (i.e., discomfort, pain, pruritus, sweating) and quality of life were self-evaluated. For each criterion, the point estimate of rate difference with the 95% one-sided upper confidence limit was computed. To claim noninferiority owing to deodorant use, the 95% one-sided upper confidence limit had to be lower than the noninferiority margin, fixed to 12.8%. Results: In the deodorant vs. no-deodorant groups, Grade 2 axillary radiodermatitis occurred in 23% vs. 30%, respectively, satisfying the statistical criteria for noninferiority (p = .019). Grade 2 breast radiodermatitis occurred in 30% vs. 34% of the deodorant vs. no-deodorant groups, respectively, also satisfying the statistical criteria for noninferiority (p = .049). Similar results were observed for the self-reported evaluations. The deodorant group reported less sweating (18% vs. 39%, p = .032). No Grade 3 or 4 radiodermatitis was observed. Conclusion: According to our noninferiority margin definition, the occurrence of skin toxicity and its related symptoms were statistically equivalent in both groups. No evidence was found to prohibit deodorant use (notwithstanding the use of an antiperspirant with aluminum) during RT for breast cancer.

Theberge, Valerie, E-mail: valerie.theberge.1@ulaval.c [Departement de Radio-Oncologie, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Quebec, QB (Canada); Harel, Francois [Centre de Recherche de L'Hotel-Dieu de Quebec, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Centre de Recherche en Cancerologie de l'Universite Laval, Quebec, QB (Canada); Dagnault, Anne [Departement de Radio-Oncologie, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Quebec, QB (Canada); Centre de Recherche de L'Hotel-Dieu de Quebec, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Centre de Recherche en Cancerologie de l'Universite Laval, Quebec, QB (Canada)

2009-11-15

262

Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection  

Microsoft Academic Search

Lateral lymph node metastases occur in 9% of rectal cancer patients. For cancers localized in the lower rectum below peritoneal\\u000a reflection, the frequency increases to 13% of all cases and to 25.5% in those of Dukes' stage C. The most important technique\\u000a in colorectal surgery for decreasing local failure in the pelvis is lateral lymph node dissection. Today, however, it

T. Mori; K. Takahashi; M. Yasuno

1998-01-01

263

[Lymphoscintigraphy of separate lymph nodes for radiotherapy planning in breast cancer].  

PubMed

Determination of lymph flow from breast cancer can be used as effective tool for individualization of radiation portals for regional radiotherapy. We evaluated this technique in 86 patients with lymph nodes (LN) scintigraphy which was performed 20-240 min after intratumoural injection of 50-100 MBq of 99mTc-nanocolloids. After visualisation of lymph flow patterns standard radiation portals were modified in 75% of patients with external and 85%--with internal localisation of primary tumours, In addition we recognised that extent and wideness of radiation portals for internal mammary lymph LN must be arranged in accordance with individual lymph flow pattern. In particularly irradiation of LN on both sides of the sternum was performed only in 3 of 27 (11%) evaluated cases. PMID:22238932

Kanaev, S V; Novikov, S N; Zhukova, L A; Zotova, O V; Semiglazov, V F; Krivorot'ko, P V

2011-01-01

264

Gene expression pattern in oral cancer cervical lymph node metastasis.  

PubMed

Treatment protocols for malignant tumors in the oral cavity differ greatly based on the presence of cervical lymph node metastasis. We applied gene expression profiling to the pathological lymph node status and used a training-test approach to evaluate the reliability of cDNA microarray-based classifications of 15 matched resected primary oral squamous cell carcinomas (OSCCs) and corresponding normal oral tissues. The clustering of all the microarray data was separated into two groups based on metastatic node positivity and node negativity. Furthermore, a 20-gene signature was identified that differentiated the testing set (n=8) with high classification accuracy (88%). Our findings support the hypothesis that the lymph node metastasis status can be predicted using the gene expression patterns of the primary OSCC, and may be a powerful tool in identifying patients at high risk of lymph node metastasis. PMID:17016585

Kato, Yoshikuni; Uzawa, Katsuhiro; Saito, Kengo; Nakashima, Dai; Kato, Masaki; Nimura, Yoshinori; Seki, Naohiko; Tanzawa, Hideki

2006-11-01

265

Alternative paratracheal lymph node dissection in left-sided hilar lung cancer patients: comparing the number of lymph nodes dissected to the number of lymph nodes dissected in right-sided mediastinal dissections  

Microsoft Academic Search

Objective: Removing or sampling lymph nodes from the bilateral paratracheal area through a left thoracotomy is not a standard procedure in patients with lung cancer. The aim of this study was to evaluate the feasibility of a technique without ductus arteriosus division and mobilization of the aortic arch and to compare the number of lymph nodes resected in left-sided dissections

Alper Toker; Serhan Tanju; Sedat Ziyade; Serkan Kaya; Suat Erus; Berker Ozkan; Dilek Yilmazbayhan

2011-01-01

266

Quality of life of breast cancer patients with lymphedema  

Microsoft Academic Search

Background: Quality of life has increasingly become an important issue in breast cancer treatment. One of the impetuses for sentinel lymph node biopsy or selective axillary lymph node dissection (ALND) is the assumed decreased incidence of lymphedema compared with standard ALND. This is based on the assumption that ALND is associated with a clinically significant incidence of lymphedema and that

Vic Velanovich; Wanda Szymanski

1999-01-01

267

HPV and histological status of pelvic lymph node metastases in cervical cancer: a prospective study  

PubMed Central

Aims: The purpose of this prospective study was to describe the incidence and distribution pattern of human papillomavirus (HPV) DNA in intraoperative dissected lymph nodes and to relate this to the pathological confirmation of metastasis. Methods: Samples of primary cervical cancer lesions and dissected lymph nodes were obtained from women undergoing surgical treatment. The presence of HPV DNA was detected by the polymerase chain reaction. Results: Tissue from 79 tumours and 365 lymph nodes was analysed. Metastasis to the lymph nodes was found in 19 cases. Metastasis correlated with the volume of the primary lesion, the depth of cervical and vaginal invasion, and with invasion of the corpus. HPV DNA was found in 60 of the primary lesions and 31 of the lymph nodes. The presence of HPV DNA in the lymph nodes correlated with the volume of the primary lesion and vaginal invasion. Conclusions: The incidence of HPV DNA in lymph nodes is twice as high as that of histopathologically confirmed metastases. The risk of the presence of HPV DNA and histopathologically confirmed metastases in lymph nodes is related to certain features of the primary tumour.

Lukaszuk, K; Liss, J; Wozniak, I; Sliwinski, W; Emerich, J; Wojcikowski, C

2004-01-01

268

Androgen and androgen-metabolizing enzymes in metastasized lymph nodes of breast cancer.  

PubMed

Androgen receptor and androgen metabolizing enzymes, 17?-hydroxysteroid dehydrogenase type 5 (17?HSD5) and 5?-reductase1 (5?1), are frequently detected in primary tumor of breast cancer, but their status in metastatic lymph nodes has not been examined. The biological role of androgen in breast cancer and its metastatic process also remain unknown. In this study, we used immunohistochemistry to localize the expression of androgen receptor, 17?HSD5, and 5?1 in primary tumors and paired metastatic lymph nodes and correlated the findings with clinicopathologic factors of individual patients. Approximately 70% of primary tumors and paired metastatic lymph nodes expressed androgen receptor, with significant correlation between both lesions. However, 17?HSD5 and 5?1 immunoreactivity was decreased in metastatic lymph nodes. Alone or in tandem with androgen receptor, 5?1 was associated with significantly lower Ki-67 index, lower pathologic grade, and higher estrogen receptor positivity, but androgen receptor/5?1 double positivity in lymph nodes was associated with larger lymph node metastasis and higher TNM stage. In conclusion, androgen receptor immunoreactivity remained stable during the process of metastasis, whereas androgen-metabolizing enzymes decreased. Although results of our study and previous reports imply additional roles of androgen metabolism in the metastasis process, especially conversion by 5?1, there may be divergence between its effects on primary tumor and those in metastatic lymph nodes. PMID:23953348

Shibahara, Yukiko; Miki, Yasuhiro; Sakurada, Chikako; Uchida, Keiko; Hata, Shuko; McNamara, Keely; Yoda, Tomomi; Takagi, Kiyoshi; Nakamura, Yasuhiro; Suzuki, Takashi; Ishida, Takanori; Ohuchi, Noriaki; Sasano, Hironobu

2013-08-13

269

Video-assisted thoracoscopic surgery (VATS) right upper lobectomy and systematic lymph node dissection for lung cancer.  

PubMed

Video-assisted thoracoscopic surgery (VATS) represents a new trend in the development of minimally invasive thoracic surgery. When applied in lung cancer surgeries, VATS can be used for both pulmonary lobectomy and regional lymph node dissection. Currently the main concerns are focused on the completeness of lymph node dissection for lung cancer and the safety of surgery. The lymph node dissection includes two parts: (I) dissection of interlobar and hilar lymph nodes; and (II) dissection of mediastinal lymph nodes. The demonstrated surgical procedures are featured by: (I) the interlobar and hilar lymph nodes are not removed separately; rathr, they are taken out en bloc with the pulmonary lobes during the surgery; and (II) systematic lymph node dissection, instead of systematic sampling, is applied for the removal of mediastinal lymph nodes. Also, during the fully anatomical resection, each blood vessel and bronchus underwent anatomical dissociation, indicating that this surgery is safe. PMID:24040542

Li, Xiao-Dong; Yang, Hong; Zheng, Ying-Bin; Huang, Qing-Yuan

2013-08-01

270

Video-assisted thoracoscopic surgery (VATS) right upper lobectomy and systematic lymph node dissection for lung cancer  

PubMed Central

Video-assisted thoracoscopic surgery (VATS) represents a new trend in the development of minimally invasive thoracic surgery. When applied in lung cancer surgeries, VATS can be used for both pulmonary lobectomy and regional lymph node dissection. Currently the main concerns are focused on the completeness of lymph node dissection for lung cancer and the safety of surgery. The lymph node dissection includes two parts: (I) dissection of interlobar and hilar lymph nodes; and (II) dissection of mediastinal lymph nodes. The demonstrated surgical procedures are featured by: (I) the interlobar and hilar lymph nodes are not removed separately; rathr, they are taken out en bloc with the pulmonary lobes during the surgery; and (II) systematic lymph node dissection, instead of systematic sampling, is applied for the removal of mediastinal lymph nodes. Also, during the fully anatomical resection, each blood vessel and bronchus underwent anatomical dissociation, indicating that this surgery is safe.

Yang, Hong; Zheng, Ying-Bin; Huang, Qing-Yuan

2013-01-01

271

Patterns of lymphatic drainage and lymph node involvement in esophageal cancer.  

PubMed

The esophagus has a complex pattern of lymphatic drainage. Lymph node involvement and number of lymph node metastases are very important prognostic factors, and the newly revised TNM staging system for esophageal cancer reflects this. Knowledge of the location and nomenclature of the common nodal stations in the thorax and upper abdomen is essential for the accurate staging of these patients. PET-CT and EUS are essential in the routine staging of esophageal cancer patients. The aim of this pictorial review is to present the nodal stations, nomenclature and location of regional lymph nodes in esophageal cancer using PET-CT and EUS images from selected patient cases. We will review the EUS and PET-CT imaging for a number of patients with esophageal cancer, using cases which highlight the advantages and diagnostic pitfalls for these imaging modalities. PMID:22711183

Howard, J M; Johnston, C

2013-04-01

272

Lymphangiogenesis in Regional Lymph Nodes Is an Independent Prognostic Marker in Rectal Cancer Patients after Neoadjuvant Treatment  

PubMed Central

One of the major prognostic factors in rectal cancer is lymph node metastasis. The formation of lymph node metastases is dependent on the existence of a premetastatic niche. An important factor preceding metastasis are lymph vessels which are located in the lymph node. Accordingly, the occurrence of intranodal lymphangiogenesis is thought to indicate distant metastasis and worse prognosis. To evaluate the significance of lymph node lymphangiogenesis, we studied formalin fixed, paraffin embedded adenocarcinomas and regional lymph nodes of 203 rectal cancer patients who were treated with neoadjuvant radiochemotherapy and consecutive curative surgery with cancer free surgical margins (R0). Regional lymph node lymph vessels were detected by immunohistochemistry for podoplanin (D2-40). Our results show that the presence of lymphatic vessels in regional lymph nodes significantly affects the disease-free survival in univariate and multivariate analyses. In contrast, there was no correlation between peritumoral or intratumoral lymph vessel density and prognosis. Indeed, our study demonstrates the importance of lymphangiogenesis in regional lymph nodes after neoadjuvant radiochemotherapy and consecutive surgery as an independent prognostic marker. Staining for intranodal lymphangiogenesis and methods of intravital imaging of lymphangiogenesis and lymphatic flow may be a useful strategy to predict long-term outcome in rectal cancer patients. Furthermore, addition of VEGF-blocking agents to standardized neoadjuvant treatment schemes might be indicated in advanced rectal cancer.

Jakob, Christiane; Aust, Daniela E.; Liebscher, Birgit; Baretton, Gustavo B.; Datta, Kaustubh; Muders, Michael H.

2011-01-01

273

Adjacent thoracic lymph node metastases originating from two separate primary cancers: case report  

PubMed Central

Reported is an unusual case of adjacent thoracic lymph nodes demonstrating metastases from two different primary malignancies. A 51 year-old woman with a previous history of bilateral breast cancer underwent a radical gastro-oesophagectomy for adenocarcinoma of the lower third of the oesophagus. The resection specimen demonstrated breast and oesophageal metastases in adjacent thoracic lymph nodes. Mechanisms for this phenomenon, including the known local immune suppression on lymphoid cells by oesophageal carcinoma cells, are discussed.

El-Gendy, Khalid A; Atkin, Gary K; Brightwell, Robert E; Richman, Paul; Livingstone, Jeremy I

2008-01-01

274

Intraoperative radioisotope sentinel lymph node mapping in non–small cell lung cancer  

Microsoft Academic Search

Background. Lymph node metastases are the most significant prognostic factor in localized non–small cell lung cancer (NSCLC). Nodal micrometastases may not be detected. Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. We performed intraoperative Technetium 99m sentinel lymph node (SN) mapping in patients with resectable NSCLC.Methods. Fifty-two patients (31 men, 21 women) with

Michael J Liptay; Gregory A Masters; David J Winchester; Brian L Edelman; Ben J Garrido; Todd R Hirschtritt; Reid M Perlman; Willard A Fry

2000-01-01

275

Noninvasive Detection of Clinically Occult LymphNode Metastases in Prostate Cancer  

Microsoft Academic Search

background Accurate detection of lymph-node metastases in prostate cancer is an essential com- ponent of the approach to treatment. We investigated whether highly lymphotropic superparamagnetic nanoparticles, which gain access to lymph nodes by means of in- terstitial-lymphatic fluid transport, could be used in conjunction with high-resolution magnetic resonance imaging (MRI) to reveal small nodal metastases. methods Eighty patients with presurgical

Mukesh G. Harisinghani; Jelle Barentsz; Peter F. Hahn; Willem M. Deserno; Shahin Tabatabaei; Christine Hulsbergen van de Kaa; Jean de la Rosette; Ralph Weissleder

2003-01-01

276

Imaging of Ep-CAM Positive Metastatic Cancer in the Lymph System.  

National Technical Information Service (NTIS)

The majority of cancer mortalities occur not from the primary tumor but rather from distant metastases. Since the lymphatic system provides a route for the metastatic spread of cancer, it is not surprising that lymph node status serves as the primary prog...

K. Adams

2011-01-01

277

Prediction of risk factors for lymph node metastasis in early gastric cancer  

PubMed Central

AIM: To explore risk factors for lymph node metastases in early gastric cancer (EGC) and to confirm the appropriate range of lymph node dissection. METHODS: A total of 202 patients with EGC who underwent curative gastrectomy with lymphadenectomy in the Department of Surgery, Xinhua Hospital and Ruijin Hospital of Shanghai Jiaotong University Medical School between November 2003 and July 2009, were retrospectively reviewed. Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines. The macroscopic type was classified as elevated (type?I?or IIa), flat (IIb), or depressed (IIc or III). Histopathologically, papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas, and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas. Univariate and multivariate analyses of lymph node metastases and patient and tumor characteristics were undertaken. RESULTS: The lymph node metastases rate in patients with EGC was 14.4%. Among these, the rate for mucosal cancer was 5.4%, and 8.9% for submucosal cancer. Univariate analysis showed an obvious correlation between lymph node metastases and tumor location, depth of invasion, morphological classification and venous invasion (?2 = 122.901, P = 0.001; ?2 = 7.14, P = 0.008; ?2 = 79.523, P = 0.001; ?2 = 8.687, P = 0.003, respectively). In patients with submucosal cancers, the lymph node metastases rate in patients with venous invasion (60%, 3/5) was higher than in those without invasion (20%, 15/75) (?2 = 4.301, P = 0.038). Multivariate logistic regression analysis revealed that the depth of invasion was the only independent risk factor for lymph node metastases in EGC [P = 0.018, Exp (B) = 2.744]. Among the patients with lymph node metastases, 29 cases (14.4%) were at N1, seven cases were at N2 (3.5%), and two cases were at N3 (1.0%). Univariate analysis of variance revealed a close relationship between the depth of invasion and lymph node metastases at pN1 (P = 0.008). CONCLUSION: The depth of invasion was the only independent risk factor for lymph node metastases. Risk factors for metastases should be considered when choosing surgery for EGC.

Ren, Gang; Cai, Rong; Zhang, Wen-Jie; Ou, Jin-Ming; Jin, Ye-Ning; Li, Wen-Hua

2013-01-01

278

Laparoscopy-assisted lateral pelvic lymph node dissection for advanced rectal cancer.  

PubMed

In Japan, there has been no indication of laparoscopic surgery for advanced lower rectal cancer because of the problem about the treatment of lateral pelvic lymph node metastasis. We report a new technique which allows lateral pelvic lymph node dissection like in open surgery for advanced rectal cancer. After laparoscopic total mesorectal excision for rectal cancer, a surgical incision of approximately 8 cm is placed in the supra-pubic area. Then, the latero-vesical area of the retroperitoneum, latero-vesical space is dissected bluntly with forceps. The external iliac artery and vein are taped and lymph node dissection is performed. As the external iliac vein is pulled internally, fatty tissue including lymph nodes in the obturator space is separated from the psoas major muscle. After completing of such a procedure, the obturator nerve is indentified in the fatty tissue with surrounding lymph nodes. As the external iliac vein is pulled laterally, fatty tissue including lymph nodes in the oburator space is dissected by fat aspiration procedure (FAP) using a suction tip. FAP is helpful to confirm the vascular system, by which the obturator space is skeletonized and anatomical structures are identified clearly. PMID:21410045

Kawahara, Hidejiro; Watanabe, Kazuhiro; Ushigome, Takuro; Noaki, Rohta; Kobayashi, Susumu; Yanaga, Katsuhiko

279

Intra-operative rapid diagnostic method based on CK19 mRNA expression for the detection of lymph node metastases in breast cancer  

PubMed Central

Staging by sentinel node (SN) biopsy is the standard procedure for clinically node-negative breast cancer patients. Intra-operative analysis of the SN allows immediate axillary lymph node (ALN) dissection in SN positive patients, but a quick, reliable and reproducible method is lacking. We tested the suitability of a quantitative cytokeratin 19 (CK19) mRNA one step nucleic acid amplification (OSNA#) technique (OSNA-CK19) for intra-operative SN analysis. OSNA-CK19 involves a short manual sample preparation step and subsequent fully automated amplification of CK19 mRNA based on reverse transcription loop-mediated isothermal amplification, with results available within 30–40 min. OSNA-CK19 was compared to histological staining (Hematoxylin&Eosin and CAM5.2 and CK19 immunostaining) of 346 frozen ALNs from 32 breast cancer patients, using half of the lymph node for each method. 267 samples were negative and 61 positive by both methods. Three samples were histology positive and OSNA-CK19 negative. Fifteen samples were histology negative and OSNA-CK19 positive, 11 of which had copy numbers close to the cut-off level of OSNA-CK19. Seven of these 15 samples were RT-PCR positive for epithelial markers and/or showed CK19 protein expression by Western blot suggesting the presence of tumor deposits in the lymph node part investigated by OSNA-CK19. Concordance with histology was 94.8%, and 96.8% after exclusion of the latter 7 discordant cases. Sensitivity was 95.3% and specificity was 94.7% before and 97.1% after discordant case investigation. Our results indicate that OSNA-CK19 can potentially be useful in an intra-operative clinical setting to detect SN tumor involvement in breast cancer patients.

Visser, Mike; Jiwa, Mehdi; Horstman, Anja; Brink, Antoinette ATP; Pol, Rene P; van Diest, Paul; Snijders, Peter JF; Meijer, Chris JLM

2008-01-01

280

Prognostic assessment of different metastatic lymph node staging methods for gastric cancer after D2 resection  

PubMed Central

AIM: To compare the prognostic assessment of lymph node ratio and absolute number based staging system for gastric cancer after D2 resection. METHODS: The clinical, pathologic, and long-term follow-up data of 427 patients with gastric cancer that underwent D2 curative gastrectomy were retrospectively analyzed. The relationships between the metastatic lymph node ratio (MLR), log odds of positive lymph nodes (LODDS), and positive lymph nodes (pN) staging methods and the long-term prognoses of the patients were compared. In addition, the survival curves, accuracy, and homogeneity were compared with stratification to evaluate the prognostic assessment of the 3 methods when the number of tested lymph nodes was insufficient (< 10 and 10-15). RESULTS: MLR [hazard ratio (HR) = 1.401, P = 0.012], LODDS (HR = 1.012, P = 0.034), and pN (HR = 1.376, P = 0.005) were independent risk factors for gastric cancer patients. The receiver operating characteristic (ROC) curves showed that the prognostic accuracy of the 3 methods was comparable (P > 0.05). Spearman correlation analysis confirmed that MLR, LODDS, and pN were all positively correlated with the total number of tested lymph nodes. When the number of tested lymph node was < 10, the value of survival curves staged by MLR and LODDS was superior to those of pN staging. However, the difference in survival curves between adjacent stages was not significant. In addition, the survival rate of stage 4 patients using the MLR and LODDS staging methods was 26.7% and 27.3% with < 10 lymph node, respectively which were significantly higher than the survival rate of patients with > 15 tested lymph nodes (< 4%). The ROC curve showed that the accuracy of the prognostic assessment of MLR, LODDS, and pN staging methods was comparable (P > 0.05), and the area under the ROC curve of all 3 methods were increased progressively with the enhanced levels of examined lymph nodes. In addition, the homogeneity of the 3 methods in patients with ? 15 tested lymph nodes also showed no significant difference. CONCLUSION: Neither MLR or LODDS could reduce the staging bias. A sufficient number of tested lymph nodes is key to ensure an accurate prognosis for patients underwent D2 radical gastrectomy.

Xu, Jia; Bian, Yu-Hai; Jin, Xin; Cao, Hui

2013-01-01

281

Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green  

PubMed Central

Background There are various methods for detecting sentinel lymph nodes in breast cancer. Sentinel lymph node biopsy (SLNB) using a vital dye is a convenient and safe, intraoperatively preparative method to assess lymph node status. However, the disadvantage of the dye method is that the success rate of sentinel lymph node detection depend on the surgeon's skills and preoperative mapping of the sentinel lymph node is not feasible. Currently, a vital dye, radioisotope, or a combination of both is used to detect sentinel nodes. Many surgeons have reported successful results using either method. In this study we have analyzed breast lymphatic drainage pathways using indocyanine green (ICG) fluorescence imaging. Methods We examined the lymphatic courses, or lymphatic vessels, in the breast using ICG fluorescence imaging, and applied this method to SLNB in patients who underwent their first operative treatment for breast cancer between May 2006 and April 2008. Fluorescence images were obtained using a charge coupled device camera with a cut filter used as a detector, and light emitting diodes at 760 nm as a light source. When ICG was injected into the subareola and periareola, subcutaneous lymphatic vessels from the areola to the axilla became visible by fluorescence within a few minutes. The sentinel lymph node was then dissected with the help of fluorescence imaging navigation. Results The detection rate of sentinel nodes was 100%. 0 to 4 states of lymphatic drainage pathways from the areola were observed. The number of sentinel nodes was 3.41 on average. Conclusions This method using indocyanine green (ICG) fluorescence imaging may possibly improve the detection rate of sentinel lymph nodes with high sensitivity and compensates for the deficiencies of other methods. The ICG fluorescence imaging technique enables observation of breast lymph vessels running in multiple directions and easily and accurately identification of sentinel lymph nodes. Thus, this technique can be considered useful.

2011-01-01

282

Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer  

PubMed Central

Purpose Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer. Methods A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. Results According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ? 0.15 (P = 0.02). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was independently associated with worse DFS. Conclusion This study showed the prognostic significance of ratio-based staging for rectal cancer and may help in developing better staging systems. LNR 0.15 (15%) was shown to be a cutoff point for determining survival and prognosis in rectal cancer cases.

Gunal, Omer; Manukyan, Manuk; Ozden, Gulden; Yegen, Cumhur

2013-01-01

283

Increased expression of galectin-3 in primary gastric cancer and the metastatic lymph nodes.  

PubMed

Galectin-3, a multifunctional beta-galactocide binding lectin possibly participates in a variety of biological events including cell proliferation, differentiation, and apoptosis. The implication of galectin-3 during malignancy progression has been suggested in several cancers, including colon, prostate, thyroid, and breast cancer, however, scarce data are available in gastric cancer. We examined the expression of galectin-3 in 86 primary gastric cancers and the 40 metastatic lymph nodes by immunohistochemistry to explore whether it is related to the malignant progression. Positive galectin-3 expression was observed in 84% of the gastric cancer cases. In enhanced cells of cancerous lesions, 48% showed stronger nuclear immunoreactivity than cytoplasmic one, whereas adjacent epithelial cells showed little or weak nuclear immunoreactivity. When galectin-3 expression in gastric carcinoma was compared with that in gastric tissues adjacent to the cancers, there was a significant difference. The degree of enhancement of immunoreactivity was different corresponding to various histopathological subtypes in cancer tissues. A significantly stronger expression of galectin-3 in cancer tissues was only observed in papillary and poorly differentiated adenocarcinoma. When galectin-3 expression and tumor progression (TNM staging) was compared, a significant correlation was observed in overall cases, and only in poorly differentiated adenocarcinoma the galectin-3 expression correlated with tumor progression among various subtypes. Galectin-3 expression was observed significantly stronger in metastatic lymph nodes than in the primary gastric cancers, and also in these cases among histological subtypes, only in poorly differentiated adenocarcinoma, the expression of galectin-3 in metastatic lymph nodes was stronger than the primary cancer. In conclusion galectin-3 might be a useful tumor marker for gastric cancers with respects to tumor progression and potentiality of lymph node metastasis especially in certain histological types of gastric cancer. PMID:12375039

Miyazaki, Junichi; Hokari, Ryota; Kato, Shingo; Tsuzuki, Yoshikazu; Kawaguchi, Atushi; Nagao, Shigeaki; Itoh, Kazuro; Miura, Soichiro

284

Distribution of Mast Cells in Mediastinal Lymph Nodes from Lung Cancer Patients  

PubMed Central

Background Mast cells have been documented to have several key functions with regards to malignant neoplasms. However, the functional significance of their accumulation is largely unknown. An analysis of the mast cell profile in mediastinal lymph nodes from lung cancer patients is reported here. Methods One hundred thirty-four, randomly selected lymph nodes (63 with positive pathological lymph node status) from 39 surgically treated lung cancer patients were examined. All cancer negative nodes were obtained from stage I patients. Mast cells were stained with Alcian blue and safranin O. Metastatic cancer cells were stained using anti-cytokeratin antibody. Results Immunohistochemical studies with cytokeratin revealed micro metastasis in 9/71 (12.68%) nodes previously diagnosed as histological negative. In tumor-free mediastinal lymph nodes, the mast cell count was significantly higher than in metastatic nodes. In all cases, mast cells were observed primarily in the T-cell area. Conclusions An inverse relationship was observed between the number of mast cells and the amount of tumor tissue. The presence of mast cells primarily in the T-cell area implies a relationship between mast cells and the T-cell system. From the present study it is not possible to conclude whether mast cells in lymph nodes are for or against tumor spread.

Tomita, Masaki; Matsuzaki, Yasunori; Edagawa, Masao; Shimizu, Tetsuya; Hara, Masaki; Onitsuka, Toshio

2003-01-01

285

Prediction of lymph node metastases in vulvar cancer: a review  

Microsoft Academic Search

The aim of this study was to review the literature on currently available non- and minimally-invasive diagnostic methods and analysis of primary tumor characteristics for prediction of inguinofemoral lymph node metastases in patients with primary squamous cell carcinoma of the vulva. We used the English language literature in PubMed and reference lists from selected articles. Search terms included vulvar carcinoma,

M. H. M. OONK; H. Hollema; J. A. de Hullu

2006-01-01

286

Sentinel lymph node dissection in more than 1200 prostate cancer cases: Rate and prediction of lymph node involvement depending on preoperative tumor characteristics.  

PubMed

OBJECTIVES: To stratify the rate and prediction of lymph node involvement in prostate cancer patients undergoing sentinel-lymphadenectomy depending on preoperative tumor characteristics, and to compare the outcome with the European Association of Urology Guideline indication for lymphadenectomy. METHODS: A total of 1229 patients (median age 66 years) were treated with open sentinel-lymphadenectomy and prostatectomy between 2005 and 2009. Median preoperative prostate-specific antigen was 7.4?ng/mL. The rate of lymph node involvement was analyzed for D'Amico risk groups. Multivariable logistic regression was used to estimate the probability of lymph node involvement. Predictor variables included preoperative prostate-specific antigen, clinical T-category and biopsy Gleason sum. Predictive accuracy has been quantified (area under the curve) and lymph node positive patients were verified under consideration of the recommended European threshold for lymphadenectomy (nomogram-predicted lymph node invasion risk of >7%). RESULTS: The median number of lymph nodes removed was 10 (interquartile range 7-13). Overall, 17.1% of patients had lymph node involvement; 3.2% in low-, 14.8% in intermediate- and 37.4% in high-risk disease. The predicted risk for lymph node involvement ranged from 2% (prostate-specific antigen ?4?ng/mL, T1, Gleason sum ?6) to 87% (prostate-specific antigen >20?ng/mL, T3, Gleason sum ?8). The predictive accuracy was 82.1%. According to the European guidelines, 15.9% of all lymph node involved cases would not have been detected. CONCLUSIONS: The rate of lymph node involvement seems to be higher in the examined sentinel collective than expected according to the European Guideline nomogram. The first sentinel-based lymph node involvement prediction model can assist in deciding on the indication for sentinel-lymphadenectomy. The validation of a corresponding sentinel-based nomogram is still missing. PMID:23659488

Winter, Alexander; Kneib, Thomas; Henke, Rolf-Peter; Wawroschek, Friedhelm

2013-05-01

287

Axillary Web Syndrome after Sentinel Node Biopsy  

PubMed Central

Summary Background Axillary web syndrome (AWS) is a self-limiting cause of morbidity in the early postoperative period after axillary surgery, but it is encountered also after sentinel lymph node biopsy. The syndrome is characterized by cords of subcutaneous tissue extending from the axilla into the medial arm. Case Report Here, we report a patient presenting with AWS several weeks after sentinel lymph node biopsy. Conclusion AWS has been reported to be resolved spontaneously in all patients 8–16 weeks after axillary surgery, and shoulder movements improve in this period. There is no definitive treatment modality for AWS. Patients should be reassured and informed that this condition will improve even without treatment.

Aydogan, Fatih; Belli, Ahmet Korkut; Baghaki, Semih; Karabulut, Kagan; Tahan, Gulgun; Uras, Cihan

2008-01-01

288

Lymphnode dissection in breast cancer  

Microsoft Academic Search

Background: Along with the ongoing modifications in treatment of primary breast cancer, the purpose and extent of lymph-node dissection\\u000a has changed. The following is an overview of the current knowledge and practice of lymph-node dissection in breast cancer,\\u000a with special regard to expected developments in the near future. Axillary dissection is described as a ten-step procedure,\\u000a including dissection of level-I

A. Bembenek; P. M. Schlag

2000-01-01

289

Genomic Profiling of Hormone-Na?ve Lymph Node Metastases in Patients with Prostate Cancer1*  

PubMed Central

Abstract The progression of organ-confined prostate cancer to metastatic cancer is inevitably fatal. Consequently, identification of structural changes in the genome and associated transcriptional responses that drive this progression is critical to understanding the disease process and the development of biomarkers and therapeutic targets. In this study, whole genome copy number changes in genomes of hormone-naïve lymph node metastases were profiled using array comparative genomic hybridization, and matched primaries were included for a subset. Matched primaries and lymph node metastases showed very similar copy number profiles that are distinct from primary tumors that fail to metastasize.

Paris, Pamela L; Hofer, Matthias D; Albo, Giancarlo; Kuefer, Rainer; Gschwend, Juergen E; Hautmann, Richard E; Fridyland, Jane; Simko, Jeffrey; Carroll, Peter R; Rubin, Mark A; Collins, Colin

2006-01-01

290

Lymph node evaluation in stage IIA colorectal cancer and its impact on patient prognosis: A population-based study.  

PubMed

Abstract Background. The analysis of regional lymph nodes is particularly relevant in patients with stage II colorectal cancer, in whom the role of adjuvant chemotherapy remains unclear. The aim of this study was to assess the relationship between number of examined lymph nodes and survival in patients with stage IIA (pT3N0M0) colorectal cancer, and to determine the optimal number of lymph nodes that should be examined. Methods. The study group included all the surgically-treated colorectal cancer patients in stage IIA (n = 657) who were identified through the population-based Cancer Registry of the Province of Modena (Northern Italy), during the period 2002-2006. Results. The median number of harvested lymph nodes was 19 (range 1-68). Considering, as a reference point, patients with 12 or less lymph nodes, subjects with n ? 20 lymph nodes examined showed, in univariate analysis, a significantly higher cancer specific (p = 0.01) and relapse-free survival (p = 0.003). The results were confirmed by multivariate analysis (Cox model). Conclusion. The result suggests that colorectal cancer patients in stage IIA with n ? 20 lymph nodes examined exhibit better survival when compared with subjects in whom fewer lymph nodes were examined. The number of 20 lymph nodes is the essential requirement for an oncologic resection of the large bowel. PMID:23786176

Iachetta, Francesco; Reggiani Bonetti, Luca; Marcheselli, Luigi; Di Gregorio, Carmela; Cirilli, Claudia; Messinese, Simona; Cervo, Gian L; Postiglione, Raffaella; Di Emidio, Katia; Pedroni, Monica; Longinotti, Ernesto; Federico, Massimo; Ponz de Leon, Maurizio

2013-06-20

291

Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes  

PubMed Central

Background: To test the hypotheses that breast cancer patients with one to three positive lymph nodes (pN1) consist of heterogeneous prognostic subsets and that the ratio of positive nodes to total nodes dissected (lymph node ratio, LNR) might discriminate patients with a higher risk as candidates for post-mastectomy radiation therapy (PMRT). Methods: Using information from 7741 node-positive patients, we first identified cutoff values of the LNR using the nonparametric bootstrap method. Focusing on 3477 patients with pN1 disease, we then evaluated the clinical relevance of the LNR categorised by the estimated cutoff values (categorised LNR, cLNR). Results: Among 3477 patients with pN1 disease, 3059 and 418 patients were assigned into the low and intermediate cLNR groups, respectively, based on a cutoff value of 0.18. The prognostic factors associated with poor overall survival (OS) included younger age, T2 stage, negative oestrogen/progesterone receptors, high histologic grade, and intermediate cLNR. Post-mastectomy radiation therapy significantly increased OS in patients assigned to the intermediate cLNR (hazard ratio, 0.39; 95% confidence interval, 0.17–0.89; P=0.0248), whereas patients in the low cLNR group derived no additional survival benefit from PMRT. Conclusion: This study suggests that PMRT should be recommended for patients with pN1 disease and an intermediate cLNR.

Kim, S I; Cho, S-H; Lee, J S; Moon, H-G; Noh, W C; Youn, H J; Ko, B K; Park, B-W

2013-01-01

292

[Current status of sentinel lymph node-based nodal ultrastaging in colorectal cancer].  

PubMed

Metastasis to the regional lymph nodes is an important prognostic factor in colorectal cancer, and nodal evaluation is essential for accurate staging. In colorectal cancer, the aim of evaluating sentinel lymph nodes (SLNs) is the selection of patients for adjuvant therapy and the detection of aberrant lymphatic drainage patterns, leading to modification of the initial therapeutic plan. In a review of the literature, tracer, technique, tumor-related factors (location and size of tumor, T stage, status of lymph node metastasis), neoadjuvant chemoradiation therapy, and body mass index were important factors in the accurate diagnosis of SLNs in colorectal cancer. In recent multicenter SLN trials, ultrastaging has been possible in 10-38% of NO colon cancer patients. Most recently, the trial conducted by Bilchik et al., which investigated the prognostic significance of micrometastases in SLNs in colon cancer patients, found that all NO colon cancer patients with recurrence had positive SLN findings after reverse transcriptase-polymerase chain reaction (RT-PCR)-ultrastaging, whereas none of those with negative SLN findings in immunohistologic staining had recurrence, and there was only a significant correlation between recurrence and molecular markers in RT-PCR. However, further prospective multicenter trials are warranted to evaluate the ultimate clinical relevance of SLN diagnosis in colorectal cancer including anal cancer. PMID:19348197

Funahashi, Kimihiko

2009-03-01

293

Optimized Dose Coverage of Regional Lymph Nodes in Breast Cancer: The Role of Intensity-Modulated Radiotherapy  

Microsoft Academic Search

Purpose: To determine whether the use of intensity-modulated radiotherapy (IMRT) would lead to improved dosimetry for the breast and regional nodes. Methods and Materials: Ten patients with left-sided breast cancer were selected. The clinical target volume included left breast and internal mammillary (IM), supraclavicular (SC), and axillary (AX) nodes. The critical structures included heart, right and left lungs, contralateral breast,

Nesrin. Dogan; Laurie Cuttino; Rick C Lloyd; Edward A. C Bump; Douglas W. Arthur

2007-01-01

294

Electrothermal bipolar vessel sealing system in axillary dissection: A prospective randomized clinical study  

Microsoft Academic Search

We assessed whether axillary dissection using the electrothermal bipolar vessel sealing system (LigaSure™) improved perioperative outcome when compared with conventional axillary dissection, in a prospective randomized study of 100 women with breast cancer. Those needing axillary dissection were randomized to the use of LigaSure™ or to conventional axillary dissection (with 50 patients in each group, all of whom had a

Tomás Cortadellas; Octavi Córdoba; Martín Espinosa-Bravo; César Mendoza-Santin; Julia Rodríguez-Fernández; Antonio Esgueva; María Álvarez-Vinuesa; Isabel T. Rubio; Jordi Xercavins

295

ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer  

Microsoft Academic Search

Summary Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC) is of paramount importance. It will guide choices of treatment and determine prognosis and outcome. Over the last years, different techniques have become available. They vary in accuracy and procedure-related morbidity. The Council of the ESTS initiated a workshop on preoperative mediastinal

Paul De Leyn; Didier Lardinois; Paul E. Van Schil; Ramon Rami-Porta; Bernward Passlick; Marcin Zielinski; David A. Waller; Tony Lerut; Walter Weder

2010-01-01

296

THE IMPACT OF PRIMARY STAGE ON SURVIVAL IN PATIENTS WITH LYMPH NODE POSITIVE BLADDER CANCER  

Microsoft Academic Search

PurposeContemporary series indicate that survival of cystectomy candidates with node positive bladder cancer is favorable when the primary tumor is confined to the bladder wall and lymph node involvement is minimal. However, these series lack node negative controls with a similar tumor stage to determine accurately the true impact of pelvic lymphadenectomy and radical cystectomy on survival.

JOHANNES VIEWEG; JURGEN E. GSCHWEND; HARRY W. HERR; WILLIAM R. FAIR

1999-01-01

297

OUR EXPERIENCE WITH SENTINEL LYMPH NODE DETECTION AND BIOPSY IN BREAST CANCER AND MALIGNANT MELANOMA  

Microsoft Academic Search

A b s t r a c t The aim of this study was to establish whether it is necessary to employ three methods or whether it is sufficient to use one or two methods for sentinel lymph node detection in breast cancer and malignant melanoma patients. There are described methods of scintigraphic detection, utilisation of surgical gamma probe and

298

Residual pelvic lymph node involvement after concomitant chemoradiation for locally advanced cervical cancer  

Microsoft Academic Search

Objective.Concomitant chemoradiation (and brachytherapy) has become the standard treatment for locally advanced cervical cancers (FIGO stage IB2 to IVA). Adjuvant surgery is optional. The aim of this study was to evaluate the rate of residual positive pelvic lymph nodes after chemoradiation.

Gilles Houvenaeghel; Loic Lelievre; Anne-Laure Rigouard; Max Buttarelli; Jocelyne Jacquemier; Patrice Viens; Laurence Gonzague-Casabianca

2006-01-01

299

Open cervical lymph node biopsy for head and neck cancers: any benefit?  

Microsoft Academic Search

BACKGROUND: Most patients with head and neck cancers in our environment present late and usually first to the general surgeons whose practice is to subject these patients to open cervical lymph node biopsy without a prior examination under anesthesia and endoscopic biopsy from the primary tumor site in order to obtain a histological diagnosis. This paper presents the influence of

Adeyi A Adoga; Olugbenga A Silas; Tonga L Nimkur

2009-01-01

300

Epithelial ovarian cancer relapsing as isolated lymph node disease: natural history and clinical outcome  

Microsoft Academic Search

BACKGROUND: Several evidences suggested that ovarian cancer (OC) patients showing isolated lymph node recurrence (ILNR) have an indolent evolution. The aim of the study was to retrospectively review ILNR observed in our Institution over the past 11 years in order to investigate: the pattern of disease progression after the first diagnosis of ILNR, and their clinical outcome. METHODS: Between September

Francesco Legge; Marco Petrillo; Vincenzo Adamo; Salvatore Pisconti; Giovanni Scambia; Gabriella Ferrandina

2008-01-01

301

Three-dimensional High-frequency Characterization of Cancerous Lymph Nodes  

PubMed Central

High-frequency ultrasound (HFU) offers a means of investigating biological tissue at the microscopic level. High-frequency, three-dimensional (3D) quantitative-ultrasound (QUS) methods were developed to characterize freshly-dissected lymph nodes of cancer patients. 3D ultrasound data were acquired from lymph nodes using a 25.6-MHz center-frequency transducer. Each node was inked prior to tissue fixation to recover orientation after sectioning for 3D histological evaluation. Backscattered echo signals were processed using 3D cylindrical regions-of-interest to yield four QUS estimates associated with tissue microstructure (i.e., effective scatterer size, acoustic concentration, intercept, and slope). QUS estimates were computed following established methods using two scattering models. In this study, 46 lymph nodes acquired from 27 patients diagnosed with colon cancer were processed. Results revealed that fully-metastatic nodes could be perfectly differentiated from cancer-free nodes using slope or scatterer-size estimates. Specifically, results indicated that metastatic nodes had an average effective scatterer size (i.e., 37.1 ± 1.7 um) significantly larger (p <0.05) than that in cancer-free nodes (i.e., 26 ± 3.3 um). Therefore, the 3D QUS methods could provide a useful means of identifying small metastatic foci in dissected lymph nodes that might not be detectable using current standard pathology procedures.

Mamou, Jonathan; Coron, Alain; Hata, Masaki; Machi, Junji; Yanagihara, Eugene; Laugier, Pascal; Feleppa, Ernest J.

2009-01-01

302

CT-Based Study on Potential Mediastinal Lymph Node Spread of Patients with Lung Cancer  

Microsoft Academic Search

Aims: To provide a schematized and graduated CT reference series of the mediastinum showing CT-detectable lymph node areas of lung cancer patients to support 3-D treatment planning and documentation for adjuvant irradiation of the mediastinum. Patients and Methods: Cross sections of mediastinal structures from one male individual were schematized and overlaid with a 1 cm2 reference grid. Mediastinal CT scans

Joachim Slanina; Jörg Laubenberger

2002-01-01

303

[Extended salvage pelvic and retroperitoneal lymph node dissection due to prostate cancer relapse].  

PubMed

Treatment of a biochemical prostate cancer relapse represents a difficult clinical dilemma, which has remained without a definitive solution so far. Based on clinical studies, we combine radical prostatectomy with extended pelvic lymph node dissection in intermediate and high risk patients as a routine procedure at our clinic. In this paper, we report on a case of extended salvage lymphadenectomy performed due to biochemical prostate cancer recurrence. The 56-year-old patient came to our clinic in April 2012 with a finding of lymph node metastasis according to PET-CT imaging. Laparoscopic radical retropubic prostatectomy with lymphadenectomy had been performed in 2008 [pT3a, N0 (0/4), M0, R0, GS 5+4=9, iPSA 26.67 ng/mL], and followed by radiotherapy as of September 2009. The extended salvage lymphadenectomy was performed in April 2012 due to a PSA-level rise up to 24 ng/mL and the aforementioned PET-CT findings. A total of 22 lymph nodes were removed, among them 3 lymph nodes with metastases. In the fossa obturatoria on the right we identified a walnut-size lymph node relapse with tumour necrosis, which fully corresponded to the PET-CT scan. The PSA level subsequently dropped to 0.4 ng/mL postoperatively, and further to the current value of 0.02 ng/mL (August 2012). PMID:23325670

Osmonov, D K; Aksenov, A V; Jünemann, K-P

2013-01-16

304

Chromosomal Copy Number Alterations are Associated with Persistent Lymph Node Metastasis after Chemoradiation in Locally Advanced Rectal Cancer  

PubMed Central

Background Lymph node metastasis is an important indicator of oncologic outcome for patients with rectal cancer. Identifying predictive biomarkers of lymph node metastasis could therefore be clinically useful. Objective To assess whether chromosomal copy number alterations can assist in predicting lymph node metastasis in patients with locally advanced rectal cancer treated with pre-operative chemoradiation therapy. Design Non-randomized, prospective Phase II study. Setting Multi-institutional. Patients 95 patients with stage II (cT3-4, cN0) or stage III (any cT, cN1-2) rectal cancer. Intervention Patients were treated with pre-operative chemoradiation therapy (CRT) followed by total mesorectal excision. Pretreatment biopsy tumor DNA and surgical margin control DNA was extracted and analyzed by oligonucleotide array-based comparative genomic hybridization. Chromosomal copy number alterations were correlated with lymph node metastasis. Finally, a model for predicting lymph node metastasis was built. Main outcome measures To determine if chromosomal copy number alterations are associated with lymph node metastasis in patients with rectal cancer, and to assess the accuracy of oligonucleotide array-based comparative genomic hybridization for predicting lymph node metastasis. Results Twenty-five of 95 (26%) patients had lymph node metastasis after chemoradiation. Losses of 28 chromosomal regions, most notably in chromosome 4, were significantly associated with lymph node metastasis. Our predictive model contained 65 probes and predicted lymph node metastasis with 68% sensitivity, 93% specificity, and positive and negative predictive values of 77% and 89%. Using this model lymph node status (positive or negative) after CRT was predicted accurately in 82 out of 95 patients (86%). Limitations The patient cohort was not completely homogeneous which may have influenced their clinical outcome. Additionally, while we performed rigorous statistically sound internal validation, external validation will be important to further corroborate our findings. Conclusions Copy number alterations can help identify rectal cancer patients at risk of lymph node metastasis after chemoradiation.

Chen, Zhenbin; Liu, Zheng; Deng, Xutao; Warden, Charles; Li, Wenyan; Garcia-Aguilar, Julio

2012-01-01

305

The effects of ECE on the benefits of PMRT for breast cancer patients with positive axillary nodes  

PubMed Central

Background The purpose of the present study was to retrospectively evaluate the effects of extracapsular extension (ECE) on the benefits of post-mastectomy radiation therapy (PMRT) for groups of patients with varying numbers of positive axillary nodes (1–3, 4–9 and ?10 positive axillary nodes). Methods: A total of 1220 axillary node-positive patients who had received mastectomy were involved in this study. Patients were grouped as ‘Radio + /ECE + ’, ‘Radio–/ECE + ’, ‘Radio + /ECE–’ or ‘Radio–/ECE–’ according to status of ECE and whether receiving PMRT or not, and were evaluated in terms of local region relapse (LRR) rate. The 5-year and 10-year Kaplan-Meier disease-free survival and overall survival (OS) rates were analyzed. Results: ECE-positive differed from ECE-negative groups with statistical significance for all comparisons in favor of the ECE-negative group: 5-year locoregional failure-free survival (LRFFS) (82.69% vs 91.83%, P < 0.001), 10-year LRFFS (75.39% vs 90.02%, P < 0.001); 5-year OS (52.12% vs 74.46%, P < 0.001), 10-year OS (35.17% vs 67.63%, P < 0.001). There were no significant effects of ECE on the benefits of PMRT for patients with 1–3 (P = 0.5720), ?10(P = 0.0614) positive axillary nodes. However, for the group of patients with 4–9 positive axillary nodes, ECE status had a significant effect on the benefits of PMRT with respect to 5-year and 10-year LRFFS (P < 0.05). Conclusion: In our study, regardless of the ECE status, PMRT didn't significantly improve the LRFFS for patients with 1–3 or ?10 positive axillary nodes. However, for patients with 4–9 positive axillary nodes, ECE could be an important criterion to consider when deciding whether to receive PMRT.

Geng, Wenwen; Zhang, Bin; Li, Danhua; Liang, Xinrui; Cao, Xunchen

2013-01-01

306

Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer  

PubMed Central

Background Lymph node metastasis is one of the most important prognostic factors for extra-hepatic bile duct carcinoma (ExHBDC). Extra capsular lymph node involvement (ExCLNI) is the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The prognostic impact of ExCLNI has been shown to be significant mainly in head and neck malignancies. Recently, the prognostic impacts of ExCLNI have evaluated in gastrointestinal malignancies. However no data is available regarding the incidence and prognostic significance of extra-capsular lymph node involvement (ExCLNI) in resectable ExHBDCs. The aim of the present study is first to evaluate the incidence of ExCLNI in surgically-treated ExHBDCs and second, to determine the prognostic impact of ExCLNI in patients with surgically-treated ExHBDCs. Methods A total of 228 patients (110 cases of hilar cholangiocarcinoma and 118 cases of distal cholangiocarcinoma) with surgically-treated ExHBDCs were included in this retrospective study. ExCLNI was defined as the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The existence of ExCLNI and its prognostic value were analyzed as a subgroup of lymph node metastasis. Results ExCLNI was detected in only 22% of patients with lymph node metastasis of surgically-treated ExHBDC. The presence of ExCLNI correlated with distal cholangiocarcinoma (p?=?0.002). On univariate analysis for survival, perineural invasion, vascular invasion, histological grade, and lymph node metastasis were statistically significant factors. On multivariate analysis, only lymph node metastasis was identified as a significant independent prognostic factor in patients with resectable ExHBDC. Subgroups of lymph node metastasis including the presence of ExCLNI, location of lymph node metastasis, and the number of lymph node metastasis had no statistically significant impact on survival. Conclusion ExCLNI was present in only 22% of the LNM (7% of overall patients) in patients with surgical treated ExHBDCs. And ExCLNI would have no impact on the survival of patients with surgically-treated ExHBDCs.

2012-01-01

307

Prognostic significance of occult lymph node metastases in node-negative breast cancer  

Microsoft Academic Search

Background: Lymph node status, established by a single hematoxylin and eosin (H&E) section from each node, remains an important prognostic\\u000a indicator in patients with breast cancer, but used alone it is insufficient to identify patients who will develop metastatic\\u000a disease. This study was conducted to assess the significance of detecting occult metastases in 86 patients with breast cancer\\u000a originally reported

Susan E. Clare; Stephen F. Sener; William Wilkens; Robert Goldschmidt; Douglas Merkel; David J. Winchester

1997-01-01

308

The Prognostic Value of Harvested Lymph Nodes and the Metastatic Lymph Node Ratio for Gastric Cancer Patients: Results of a Study of 1,101 Patients  

PubMed Central

Aim To investigate whether the recommendation to remove 15 lymph nodes that is used in the staging system is necessary to assess gastric cancer progression and to evaluate whether our metastatic lymph node ratio dividing method, adapted from the AJCC’s (American Joint Committee on Cancer) 7th TNM staging system, is helpful for the patients with fewer than 15 harvested lymph nodes. Methods We performed a retrospective study of 1101 patients with histologically diagnosed gastric cancer who underwent a D2 gastrectomy at the Sun Yat-sen University Cancer Center between January 2001 and December 2010. The Kappa and Chi-squared tests were employed to compare the clinicopathological variables. The Kaplan-Meier method and Cox regression were employed for the univariate and multivariate survival analyses. Results In the trial, 346, 601 and 154 patients had 0–14, 15–30 and more than 30 lymph nodes harvested, respectively. The median survival times of patients with different lymph nodes harvested in N0, N1, N2 and N3a groups were 45.43, 54.28 and 66.95 months (p?=?0.068); 49.22, 44.25 and 56.72 months (p<0.001), 43.94, 47.97 and 35.19 months (p?=?0.042); 32.88, 42.76 and 23.50 months (p?=?0.016). Dividing the patients who had fewer than 15 lymph nodes harvested by the metastatic lymph node ratio at 0, 0.13 and 0.40, the median survival times of these 4 groups were 70.6, 50.5, 53.5 and 30.7 months (p<0.001). After re-categorising these 4 groups into the N0, N1, N2, N3a groups, the histological grade, T staging, premier N staging, and restaged N staging were the independent prognostic factors. Conclusions Large numbers of lymph nodes harvested in radical gastrectomy do not cause stage migration. For those patients with a small number of harvested lymph nodes, their stage should be divided by the metastatic lymph node ratio, referred to in the TNM staging system, to assign them an accurate stage.

Li, Yuan-Fang; Feng, Xing-Yu; Sun, Xiao-Wei; Li, Wei; Zhou, Zhi-Wei; Zhan, You-Qing; Qian, Chao-Nan; Chen, Ying-Bo

2012-01-01

309

Genetic polymorphisms in DPF3 associated with risk of breast cancer and lymph node metastases  

PubMed Central

Background Several studies have identified rare genetic variations responsible for many cases of familial breast cancer but their contribution to total breast cancer incidence is relatively small. More common genetic variations with low penetrance have been postulated to account for a higher proportion of the population risk of breast cancer. Methods and Results In an effort to identify genes that influence non-familial breast cancer risk, we tested over 25,000 single nucleotide polymorphisms (SNPs) located within approximately 14,000 genes in a large-scale case-control study in 254 German women with breast cancer and 268 age-matched women without malignant disease. We identified a marker on chromosome 14q24.3-q31.1 that was marginally associated with breast cancer status (OR = 1.5, P = 0.07). Genotypes for this SNP were also significantly associated with indicators of breast cancer severity, including presence of lymph node metastases (P = 0.006) and earlier age of onset (P = 0.01). The association with breast cancer status was replicated in two independent samples (OR = 1.35, P = 0.05). High-density association fine mapping showed that the association spanned about 80 kb of the zinc-finger gene DPF3 (also known as CERD4). One SNP in intron 1 was found to be more strongly associated with breast cancer status in all three sample collections (OR = 1.6, P = 0.003) as well as with increased lymph node metastases (P = 0.01) and tumor size (P = 0.01). Conclusion Polymorphisms in the 5' region of DPF3 were associated with increased risk of breast cancer development, lymph node metastases, age of onset, and tumor size in women of European ancestry. This large-scale association study suggests that genetic variation in DPF3 contributes to breast cancer susceptibility and severity.

Hoyal, Carolyn R; Kammerer, Stefan; Roth, Richard B; Reneland, Richard; Marnellos, George; Kiechle, Marion; Schwarz-Boeger, Ulrike; Griffiths, Lyn R; Ebner, Florian; Rehbock, Joachim; Nelson, Matthew R; Braun, Andreas

2005-01-01

310

The impact of complete lymph node dissection for lung cancer on the postoperative course.  

PubMed

The role of lymph node dissection (LND) for non-small cell lung cancers (NSCLCs) remains controversial. LND adds little morbidity to a pulmonary resection for NSCLC, although it requires an additional 15 to 20 minutes of operative time. Four prospective randomized trials have been performed to compare lymph node sampling and LND; 3 trials showed no difference in survival and 1 showed survival benefit of LND. It is recommended that all patients with resectable NSCLC undergo LND because the procedure provides patients with the most accurate staging and the opportunity for effective adjuvant therapy. PMID:22520291

Date, Hiroshi

2011-12-16

311

Metasin-An Intra-Operative RT-qPCR Assay to Detect Metastatic Breast Cancer in Sentinel Lymph Nodes.  

PubMed

Nodal status is one of the most important prognostic factors in breast cancer. Established tests such as touch imprint cytology and frozen sections currently used in the intra-operative setting show variations in sensitivity and specificity. This limitation has led to the development of molecular alternatives, such as GeneSearch, a commercial intra-operative real-time quantitative Polymerase Chain Reaction (RT-qPCR) assay that allows the surgeon to carry out axillary clearance as a one-step process. Since GeneSearch has been discontinued, we have developed the replacement Metasin assay, which targets the breast epithelial cell markers CK19 and mammaglobin mRNA and identifies metastatic disease in sentinel lymph nodes. The optimised assay can be completed within 32 min (6 min for RNA preparation and 26 min instrument run time), making its use feasible in the intraoperative setting. An analysis by Metasin of 154 archived lymph node homogenates previously analysed by both parallel histology and GeneSearch showed concordance for 148 cases. The sensitivity and specificity of Metasin compared with GeneSearch were 95% (CI 83%-99%) and 97% (CI 91%-99%) respectively; compared with histology they were 95% (CI 83%-99%) and 97% (CI 91%-99%), respectively. The sensitivity and specificity of GeneSearch compared with histology were 90% (CI 77%-96%) and 97% (CI 93%-99%) respectively. The positive predictive value of Metasin was 90% and negative predictive value was 98% for both histology and GeneSearch. The positive predictive value of GeneSearch was 92% and the negative predictive value was 97% compared to histology. The discordance rates of Metasin with both GeneSearch and histology were 3.89%. In comparison, the discordance rate of GeneSearch with histology was 4.5%. Metasin's robustness was independently evaluated on 193 samples previously analysed by GeneSearch from the Jules Bordet Institute, where Metasin yielded comparable results. PMID:23797656

Al-Ramadhani, Salma; Sai-Giridhar, Priya; George, Dilushana; Gopinath, Preethi; Arkoumani, Evdokia; Jader, Samar; Sundaresan, Maryse; Salgado, Roberto; Larsimont, Dennis; Bustin, Stephen A; Sundaresan, Vasi

2013-06-24

312

RTOG GU Radiation Oncology Specialists Reach Consensus on Pelvic Lymph Node Volumes for High-Risk Prostate Cancer  

SciTech Connect

Purpose: Radiation therapy to the pelvic lymph nodes in high-risk prostate cancer is required on several Radiation Therapy Oncology Group (RTOG) clinical trials. Based on a prior lymph node contouring project, we have shown significant disagreement in the definition of pelvic lymph node volumes among genitourinary radiation oncology specialists involved in developing and executing current RTOG trials. Materials and Methods: A consensus meeting was held on October 3, 2007, to reach agreement on pelvic lymph node volumes. Data were presented to address the lymph node drainage of the prostate. Extensive discussion ensued to develop clinical target volume (CTV) pelvic lymph node consensus. Results: Consensus was obtained resulting in computed tomography image-based pelvic lymph node CTVs. Based on this consensus, the pelvic lymph node volumes to be irradiated include: distal common iliac, presacral lymph nodes (S{sub 1}-S{sub 3}), external iliac lymph nodes, internal iliac lymph nodes, and obturator lymph nodes. Lymph node CTVs include the vessels (artery and vein) and a 7-mm radial margin being careful to 'carve out' bowel, bladder, bone, and muscle. Volumes begin at the L5/S1 interspace and end at the superior aspect of the pubic bone. Consensus on dose-volume histogram constraints for OARs was also attained. Conclusions: Consensus on pelvic lymph node CTVs for radiation therapy to address high-risk prostate cancer was attained and is available as web-based computed tomography images as well as a descriptive format through the RTOG. This will allow for uniformity in evaluating the benefit and risk of such treatment.

Lawton, Colleen A.F. [Medical College of Wisconsin, Milwaukee WI (United States)], E-mail: clawton@mcw.edu; Michalski, Jeff [Washington University, St. Louis, MO (United States); El-Naqa, Issam [Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Buyyounouski, Mark K. [Fox Chase Cancer Center, Philadelphia, PA (United States); Lee, W. Robert [Wake Forest University School of Medicine, Winston-Salem, NC (United States); Menard, Cynthia [PMH-UHN University of Toronto, Toronto, Ontario (Canada); O'Meara, Elizabeth [American College of Radiology, Philadelphia, PA (United States); Rosenthal, Seth A. [Radiation Oncology Center, Radiological Associates of Sacramento, Sacramento, CA (United States); Ritter, Mark [University of Wisconsin School of Medicine and Public Health, Madison, WI (United States); Seider, Michael [Akron City Hospital, Akron, OH (United States)

2009-06-01

313

T cell subpopulations in lymph nodes may not be predictive of patient outcome in colorectal cancer  

PubMed Central

Background The immune response has been proposed to be an important factor in determining patient outcome in colorectal cancer (CRC). Previous studies have concentrated on characterizing T cell populations in the primary tumour where T cells with regulatory effect (Foxp3+ Tregs) have been identified as both enhancing and diminishing anti-tumour immune responses. No previous studies have characterized the T cell response in the regional lymph nodes in CRC. Methods Immunohistochemistry was used to analyse CD4, CD8 or Foxp3+ T cell populations in the regional lymph nodes of patients with stage II CRC (n = 31), with (n = 13) or without (n = 18) cancer recurrence after 5 years of follow up, to determine if the priming environment for anti-tumour immunity was associated with clinical outcome. Results The proportions of CD4, CD8 or Foxp3+ cells in the lymph nodes varied widely between and within patients, and there was no association between T cell populations and cancer recurrence or other clinicopathological characteristics. Conclusions These data indicate that frequency of these T cell subsets in lymph nodes may not be a useful tool for predicting patient outcome.

2011-01-01

314

Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer  

PubMed Central

Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role.

Teymoortash, A.; Werner, J. A.

2012-01-01

315

The Prognosis of T3N0 Colon Cancer Is Dependent on the Number of Lymph Nodes Examined  

Microsoft Academic Search

Background: T3N0 colon cancer is the target of many adjuvant studies. Very few studies have examined the relationship of the number of lymph nodes examined to the prognosis of this stage. We examined data from the National Cancer Data Base (NCDB) to determine whether the number of examined lymph nodes is prognostic for T3N0 colon cancer.Methods: A total of 35,787

Richard S. Swanson; Carolyn C. Compton; Andrew K. Stewart; Kirby I. Bland

2003-01-01

316

Association of CXCR4 and CCR7 chemokine receptor expression and lymph node metastasis in human cervical cancer  

Microsoft Academic Search

space involvement (P = 0.0002), or lymph node metastasis (P < 0.0001). CCR7 expression was significantly higher in cases of squamous cell carcinomas (P = 0.010) and in patients with cancers showing large tumor size (P < 0.0001), deep stromal invasion (P < 0.0001), vaginal invasion (P = 0.047), lymph-vascular space involvement (P = 0.012), or lymph node metastasis (P

J. Kodama; Hasengaowa; T Kusumoto; N Seki; T Matsuo; Y Ojima; K Nakamura; A Hongo; Y Hiramatsu

2006-01-01

317

Comparison of Protein Expression Profiles of Different Stages of Lymph Nodes Metastasis in Breast Cancer  

PubMed Central

Breast cancer is the most common cancer among women worldwide. Breast cancer metastasis primarily happens through lymphatic system, where the extent of lymph node metastasis is the major factor influencing staging, prognosis and therapeutic decision of the disease. We aimed to study the protein expression changes in different N (regional lymph nodes) stages of breast cancer. Protein expression profiles of breast cancerous and adjacent normal tissues were mapped by proteomics approach that comprises of two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and tandem mass spectrometry (LC-MS/MS) analysis. Calreticulin and tropomyosin alpha 3 chains were the common up-regulated proteins in N0, N1 and N2 stages of breast cancer. Potential biomarker for each N stage was HSP 70 for N0, 80 k protein H precursor and PDI for N1 stage while 78 kDa glucose-regulated protein was found useful for N2 stage. In addition, significant up-regulation of PDI A3 was detected only in the metastasized breast cancer. The up-regulation expression of these proteins in cancerous tissues can potentially use as indicators for diagnosis, treatment and prognosis of different N stages of breast cancer.

Lee, Hui-Hua; Lim, Chu-Ai; Cheong, Yew-Teik; Singh, Manjit; Gam, Lay-Harn

2012-01-01

318

[Supra- and infraclavicular lymph node irradiation in breast cancer patients: state of the art].  

PubMed

Radiation therapy plays an essential role in the treatment of invasive breast cancer. However, prophylactic treatment of supra- and infraclavicular lymph nodes is not consensual, with different treatment depending on the centres and practitioners. Clinical indications for radiotherapy of the supra- and infraclavicular lymph nodes are often the subject of a consensus. Nevertheless, radiotherapy induces some toxicity. Various techniques have been developed. To date, conformal radiotherapy allows an accurate assessment of doses to target volumes and organs at risk, but at the cost of a sometime complex delineation. This article reviews the literature on radiation of supra- and infraclavicular lymph nodes, with a special focus on technical aspects in delineation and its potential toxicity. PMID:22551779

Auberdiac, P; Cartier, L; Chargari, C; Zioueche, A; Mélis, A; de Laroche, G; Castro Pena, P; Kirova, Y M; Magné, N

2012-04-30

319

Tumor Lymphangiogenesis and Metastasis to Lymph Nodes Induced by Cancer Cell Expression of Podoplanin  

PubMed Central

The membrane glycoprotein podoplanin is expressed by several types of human cancers and might be associated with their malignant progression. Its exact biological function and molecular targets are unclear, however. Here, we assessed the relevance of tumor cell expression of podoplanin in cancer metastasis to lymph nodes, using a human MCF7 breast carcinoma xenograft model. We found that podoplanin expression promoted tumor cell motility in vitro and, unexpectedly, increased tumor lymphangiogenesis and metastasis to regional lymph nodes in vivo, without promoting primary tumor growth. Importantly, high cancer cell expression levels of podoplanin correlated with lymph node metastasis and reduced survival times in a large cohort of 252 oral squamous cell carcinoma patients. Based on comparative transcriptional profiling of tumor xenografts, we identified endothelin-1, villin-1, and tenascin-C as potential mediators of podoplanin-induced tumor lymphangiogenesis and metastasis. These unexpected findings identify a novel mechanism of tumor lymphangiogenesis and metastasis induced by cancer cell expression of podoplanin, suggesting that reagents designed to interfere with podoplanin function might be developed as therapeutics for patients with advanced cancer.

Cueni, Leah N.; Hegyi, Ivan; Shin, Jay W.; Albinger-Hegyi, Andrea; Gruber, Silke; Kunstfeld, Rainer; Moch, Holger; Detmar, Michael

2010-01-01

320

Collagen I fiber density increases in lymph node positive breast cancers: pilot study  

PubMed Central

Abstract. Collagen I (Col1) fibers are a major structural component in the extracellular matrix of human breast cancers. In a preliminary pilot study, we explored the link between Col1 fiber density in primary human breast cancers and the occurrence of lymph node metastasis. Col1 fibers were detected by second harmonic generation (SHG) microscopy in primary human breast cancers from patients presenting with lymph node metastasis (LN+) versus those without lymph node metastasis (LN?). Col1 fiber density, which was quantified using our in-house SHG image analysis software, was significantly higher in the primary human breast cancers of LN+ (fiber volume=29.22%±4.72%, inter-fiber distance=2.25±0.45???m) versus LN? (fiber volume=20.33%±5.56%, inter-fiber distance=2.88±1.07???m) patients. Texture analysis by evaluating the co-occurrence matrix and the Fourier transform of the Col1 fibers proved to be significantly different for the parameters of co-relation and energy, as well as aspect ratio and eccentricity, for LN+ versus LN? cases. We also demonstrated that tissue fixation and paraffin embedding had negligible effect on SHG Col1 fiber detection and quantification. High Col1 fiber density in primary breast tumors is associated with breast cancer metastasis and may serve as an imaging biomarker of metastasis.

Kakkad, Samata M.; Solaiyappan, Meiyappan; Argani, Pedram; Sukumar, Saraswati; Jacobs, Lisa K.; Leibfritz, Dieter; Bhujwalla, Zaver M.; Glunde, Kristine

2012-01-01

321

Near infrared imaging to identify sentinel lymph nodes in invasive urinary bladder cancer  

NASA Astrophysics Data System (ADS)

Approximately 12,000 people are diagnosed with invasive transitional cell carcinoma of the urinary bladder (InvTCC) each year in the United States. Surgical removal of the bladder (cystectomy) and regional lymph node dissection are considered frontline therapy. Cystectomy causes extensive acute morbidity, and 50% of patients with InvTCC have occult metastases at the time of diagnosis. Better staging procedures for InvTCC are greatly needed. This study was performed to evaluate an intra-operative near infrared fluorescence imaging (NIRF) system (Frangioni laboratory) for identifying sentinel lymph nodes draining InvTCC. NIRF imaging was used to map lymph node drainage from specific quadrants of the urinary bladder in normal dogs and pigs, and to map lymph node drainage from naturally-occurring InvTCC in pet dogs where the disease closely mimics the human condition. Briefly, during surgery NIR fluorophores (human serum albumen-fluorophore complex, or quantum dots) were injected directly into the bladder wall, and fluorescence observed in lymphatics and regional nodes. Conditions studied to optimize the procedure including: type of fluorophore, depth of injection, volume of fluorophore injected, and degree of bladder distention at the time of injection. Optimal imaging occurred with very superficial injection of the fluorophore in the serosal surface of the moderately distended bladder. Considerable variability was noted from dog to dog in the pattern of lymph node drainage. NIR fluorescence was noted in lymph nodes with metastases in dogs with InvTCC. In conclusion, intra-operative NIRF imaging is a promising approach to improve sentinel lymph node mapping in invasive urinary bladder cancer.

Knapp, Deborah W.; Adams, Larry G.; Niles, Jacqueline D.; Lucroy, Michael D.; Ramos-Vara, Jose; Bonney, Patty L.; deGortari, Amalia E.; Frangioni, John V.

2006-03-01

322

Automatic detection and segmentation of lymph nodes from CT data.  

PubMed

Lymph nodes are assessed routinely in clinical practice and their size is followed throughout radiation or chemotherapy to monitor the effectiveness of cancer treatment. This paper presents a robust learning-based method for automatic detection and segmentation of solid lymph nodes from CT data, with the following contributions. First, it presents a learning based approach to solid lymph node detection that relies on marginal space learning to achieve great speedup with virtually no loss in accuracy. Second, it presents a computationally efficient segmentation method for solid lymph nodes (LN). Third, it introduces two new sets of features that are effective for LN detection, one that self-aligns to high gradients and another set obtained from the segmentation result. The method is evaluated for axillary LN detection on 131 volumes containing 371 LN, yielding a 83.0% detection rate with 1.0 false positive per volume. It is further evaluated for pelvic and abdominal LN detection on 54 volumes containing 569 LN, yielding a 80.0% detection rate with 3.2 false positives per volume. The running time is 5-20 s per volume for axillary areas and 15-40 s for pelvic. An added benefit of the method is the capability to detect and segment conglomerated lymph nodes. PMID:21968722

Barbu, Adrian; Suehling, Michael; Xu, Xun; Liu, David; Zhou, S Kevin; Comaniciu, Dorin

2011-10-03

323

DNA ploidy and helix pomatia lectin binding as predictors of regional lymph node metastases and prognostic factors in breast cancer  

Microsoft Academic Search

This study was designed to evaluate whether DNA ploidy and\\/orHelix pomatia lectin (HPA) staining would be useful for predicting regional lymph node metastases and patients' prognosis in 106 patients with invasive breast cancer. The combination of DNA ploidy and HPA staining correlated better with regional lymph node metastases than DNA aneuploidy or HPA staining alone. DNA ploidy and HPA staining

Masakuni Noguchi; Michael Thomas; Hirohisa Kitagawa; Kazuo Kinishita; Shinich Kinami; Hirohisa Takamura; Itsuo Miyazaki; Yuji Mizukami

1993-01-01

324

The effect of excisional biopsy on the accuracy of sentinel lymph node mapping in early stage breast cancer: comparison with core needle biopsy.  

PubMed

Despite the successful application of sentinel node mapping in breast cancer patients, its use in patients with a history of previous excisional biopsy of the breast tumors is a matter of controversy. In the present study we evaluated the accuracy of sentinel node biopsy in this group of patients and compared the results with those in whom the diagnosis of breast cancer was established by core needle biopsy. Eighty patients with early stage breast carcinoma were included into our study. Forty patients had a history of previous excisional biopsy and the remainder 40 had undergone core needle biopsy. Intradermal injections of 99mTc-antimony sulfide colloid as well as patent blue were both used for sentinel node mapping. Sentinel nodes were harvested during surgery with the aid of surgical gamma probe. All patients underwent standard axillary lymph node dissection subsequently. Detection rate was 97.5 per cent for both groups of the study. Number of detected sentinel node during surgery was not significantly different between groups. False negative rate was 0 per cent for both groups of the study. In conclusion sentinel node biopsy is reliable in patients with previous history of excisional biopsy of the breast tumors and has a low false negative rate. PMID:21140690

Forghani, Mohammad Naser; Memar, Bahram; Jangjoo, Ali; Zakavi, Rasoul; Mehrabibahar, Mostafa; Kakhki, Vahid Reza Dabbagh; Kashani, Ida; Hashemian, Farnaz; Sadeghi, Ramin

2010-11-01

325

Predictors of Nonsentinel Nodal Involvement to Aid Intraoperative Decision Making in Breast Cancer Patients with Positive Sentinel Lymph Nodes  

PubMed Central

Background. Up to 60% of patients with a positive sentinel lymph node (SLN) have no additional nodal involvement and do not benefit from completion axillary lymph node dissection (ALND). We aim to identify factors predicting for non-SLN involvement and to validate the MSKCC nomogram and Tenon score in our population. Methods. Retrospective review was performed of 110 consecutive patients with positive SLNs who underwent ALND over an 8-year period. Results. Fifty patients (45%) had non-SLN involvement. Non-SLN involvement correlated positively with the number of positive SLNs (P = 0.04), macrometastasis (P = 0.01), and inversely with the total number of SLNs harvested (P = 0.03). The MSKCC nomogram and Tenon score both failed to perform as previously reported. Conclusions. The MSKCC nomogram and Tenon score have limited value in our practice. Instead, we identified three independent predictors, which are more relevant in guiding the intraoperative decision for ALND.

Tan, Ern Yu; Ho, Bernard; Chen, Juliana J. C.; Ho, Pey Woei; Teo, Christine; Earnest, Arul; Chan, Patrick M. Y.

2011-01-01

326

Molecular Mechanism of Lymph Node Metastasis in Breast Cancer.  

National Technical Information Service (NTIS)

Many challenges exist in the current management of metastatic breast cancer as there are fewer recognized therapeutic strategies. Therefore, a better understanding of the molecular events in the metastatic process is critical. Several reports have describ...

R. K. Singh

2010-01-01

327

Axillary lipogranuloma mimicking carcinoma metastasis after silicone breast implant rupture: a case report.  

PubMed

Silicone-gel-filled breast implants have been widely used for breast augmentation and reconstruction after mastectomy. However, silicone implants have some well-known complications, such as implant rupture, which requires surgical intervention. Dissemination of silicone particles out of the implant causes a granulomatous reaction, a phenomenon known as silicone granuloma, in breast parenchyma as well as axillary, breast and chest wall lymph nodes, which mimics breast cancer metastasis. However, lipogranuloma after silicone breast implant rupture has not been reported in the literature, although it is a common complication after mineral oil or liquid silicone injection. We present a case report of an axillary lymphadenopathy resulting from lipogranuloma after silicone-gel-filled implant rupture. Review of the literature suggests that this is the first report of a lipogranuloma resulting from implant rupture. PMID:23245917

Gundeslioglu, A Ozlem; Hakverdi, Sibel; Erdem, Ozlem; Ozen, E Cigdem; Inan, Irfan; Emlik, Dilek

2012-12-12

328

Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma  

PubMed Central

Background Sentinel lymph node (SLN) biopsy is the standard of care for the surgical assessment of the axilla during breast cancer surgery. However, the diagnostic accuracy of intraoperative frozen section analysis for confirming metastatic involvement of SLNs in cases of invasive lobular carcinoma (ILC) versus that of invasive ductal carcinoma (IDC) has generated controversy secondary to a frequently low-grade cytologic appearance and an often discohesive pattern displayed by metastatic lymph nodes in ILC. In the current report, we present a comparison of intraoperative frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. Methods We evaluated the results of 131 consecutive cases of ILC from 1997 to 2008 and 133 cases of IDC (selected by a random sequence generator program) from amongst 1163 consecutive cases of IDC from the same time period. All cases had at least one SLN that had both intraoperative frozen section analysis and confirmatory permanent section analysis performed. Results No statistically significant difference was found in the sensitivity (67% vs. 75%, P = 0.385), specificity (100% vs. 100%), accuracy (86% vs. 92%, P = 0.172), false negative rate (33% vs. 25%, P = 0.385), negative predictive value (81% vs. 89%, P = 0.158), and positive predictive value (100% vs. 100%) for frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. Conclusion Since there was no statistically significant difference in sensitivity, specificity, accuracy, false negative rate, negative predictive value, and positive predictive value between frozen section analysis of SLNs for patients with ILC and IDC, the clinical accuracy of confirming metastatic involvement of SLNs on frozen section analysis for ILC should not be considered inferior to the clinical accuracy for IDC. Therefore, frozen section analysis of all SLNs during breast cancer surgery in patients with ILC should remain the standard of care in order to reduce the risk of the need of a later, separate axillary lymph node dissection.

Horvath, James W; Barnett, Gary E; Jimenez, Rafael E; Young, Donn C; Povoski, Stephen P

2009-01-01

329

Overexpression of CD73 in Prostate Cancer is Associated with Lymph Node Metastasis.  

PubMed

Prostate cancer is the most common malignancy in men in Europe and North America. At present, it is becoming an increasingly common cancer in China. CD73 (ecto-5'-nucleotidase) is a glycosylphosphatidylinositol (GPI)-linked 70-kDa cell surface enzyme. It is also broadly expressed in many types of tissues. Recent studies have showed that CD73 is widely expressed on malignancies and is up-regulated in cancerous tissues. Consequently, we analyzed the expression of CD73 in prostate cancer tissue. The expression of the CD73 protein was evaluated by Immunohistochemistry staining in 116 tissue specimens. The expression was further examined by quantitative real-time PCR (qRT-PCR) and Western blot in the same set of patients. The intense cell membrane staining for the CD73 protein was observed. The expression of CD73 in lymph node non-metastasizing prostate cancer tissues can be seen at low levels, and is generally undetectable. RT-PCR and Western blot showed that the expression of CD73 in lymph node metastasizing prostate cancer was higher compared with non-metastasizing ones. These results suggest that CD73 could be considered as a relevant-specific target for molecular therapy of prostate cancer metastasis. PMID:23653114

Yang, Qing; Du, Jun; Zu, Lingling

2013-05-08

330

The pattern of lymphatic metastasis of breast cancer and its influence on the delineation of radiation fields  

SciTech Connect

Purpose: The delineation of radiation fields should cover the clinical target volume (CTV) and minimally irradiate the surrounding normal tissues and organs. This study was designed to explore the pattern of lymphatic metastasis of breast cancer and indications for radiotherapy after radical or modified radical mastectomy and to discuss the rational delineation of radiation fields. Methods and materials: Between September 1980 and December 2003, 78 breast cancer patients receiving extended radical mastectomy in the Margottini model and 61 cases with complete data were analyzed to investigate the internal mammary lymphatic metastatic status. Between March 1988 and December 1988, 46 patients with clinical negative supraclavicular nodes received radical mastectomy plus supraclavicular lymph node dissection. The supraclavicular lymph nodes and axillary lymph nodes were labeled as S and levels I, II, or III, respectively, and examined pathologically. Between January 1996 and April 1999, 412 patients who had radical or modified radical mastectomy underwent the pathologic examination of axillary or levels I, II, or III nodes. Results: The incidence of internal mammary lymph node metastasis was 24.6%. It was 36.7% for the patients with positive axillary lymph nodes and 12.9% for the patients with negative axillary lymph nodes. All the metastatic internal mammary lymph nodes were located at the first, second, and third intercostal spaces. Skipping metastasis of the supraclavicular and axillary lymph nodes was observed in 3.8% and 8.1% of patients, respectively. Conclusions: According to our data, we suggest that the radiation field for internal mammary lymph nodes should exclude the fourth and fifth intercostal spaces, which may help to reduce the radiation damage to heart. It is unnecessary to irradiate the supraclavicular lymph nodes for the patients with negative axillary level III nodes, even with positive level I and level II nodes.

Yu Jinming [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Province (China)]. E-mail: jn7984729@public.jn.sd.cn; Li Gong [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Province (China); Li Jianbin [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Province (China); Wang Yongsheng [Department of Breast Oncology, Shandong Cancer Hospital and Institute, Shandong Province (China)

2005-03-01

331

A multicenter trial of sentinel lymph node mapping in colorectal cancer: prognostic implications for nodal staging and recurrence  

Microsoft Academic Search

BackgroundSentinel lymph node (SLN) mapping (M) for staging in colorectal cancer (CRCa) remains controversial and needs to be validated. This study analyzes results of SLNM at a multi-institutional level for CRCa.

Sukamal Saha; Rajesh Seghal; Mehul Patel; Kiet Doan; Adrian Dan; Anton Bilchik; Thomas Beutler; David Wiese; Nader Bassily; Charles Yee

2006-01-01

332

Comparison of nodal positivity between SLNM vs conventional surgery in colon cancer patients with <12 and ?12 lymph nodes harvested  

Microsoft Academic Search

Background:Examination of ?12 lymph nodes (LNs) ensures accurate staging in colon cancer. The aim of this study was to compare nodal positivity between sentinel LN mapping (SLNM) and conventional surgery in patients with

Mehul Soni; David Wiese; Alpesh Korant; Saad Sirop; Bishan Chakravarty; Adam Gayar; Anton Bilchik; Thomas Beutler; David Ratz; Sukamal Saha

333

Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer  

Microsoft Academic Search

Endorectal ultrasonography (ERUS) with a flexible-type radial scanner (Aloka Co. Ltd., Tokyo, Japan; 7.5 MHz) was applied to 120 patients with rectal cancer for the assessment of wall invasion and pararectal lymph node metastasis. Normal rectal wall was described as a five- or seven-layer structure excluding the lowest part within 3 cm from the anal verge. Loss of normal layers

Yoshinori Katsura; Kazutaka Yamada; Takashi Ishizawa; Heiji Yoshinaka; Hisaaki Shimazu

1992-01-01

334

Boron neutron capture therapy for recurrent oral cancer and metastasis of cervical lymph node.  

PubMed

We treated 6 patients with recurrent oral cancer and metastasis to the cervical lymph nodes after conventional treatments in 5 and non-conventional in 1 using BNCT, and herein report our results. The clinical response in our patients ranged from CR to PD. In 5 cases, spontaneous pain decreased immediately after BNCT. Three of the 6 are alive at the time of writing and we found that BNCT contributed to QOL improvement in all. PMID:19395269

Kimura, Y; Ariyoshi, Y; Shimahara, M; Miyatake, S; Kawabata, S; Ono, K; Suzuki, M; Maruhashi, A

2009-03-26

335

Radiation safety of the sentinel lymph node technique in breast cancer  

Microsoft Academic Search

.   Many publications attest to the potential of the sentinel lymph node technique in advancing the clinical management of melanoma\\u000a and, more recently, breast cancer. Whilst not yet universally regarded as the standard of care, the technique is gaining wide\\u000a acceptance. Use of a radiolabelled colloidal tracer is central to optimising sensitivity, and this brings with it the need\\u000a to

W. A. Waddington; M. R. S. Keshtgar; I. Taylor; S. R. Lakhani; M. D. Short; P. J. Eli

2000-01-01

336

Overexpression of Bcl-x L in Human Breast Cancer Cells Enhances Organ-Selective Lymph Node Metastasis  

Microsoft Academic Search

Lymph node metastasis are the first prognostic factor in breast cancer diagnosis and an early event in metastatic spread. To assess the role of anti-apoptotic proteins in lymph node metastatic progression of human breast cancer cells we analyzed the metastatic activity of MDA-MB-435 cells transfected with the Bcl-xL gene, after orthotopic inoculation in Nude Balb\\/c and in SCID mice. The

Laura España; Yolanda Fernández; Nuria Rubio; Angels Torregrosa; Jeronimo Blanco; Angels Sierra

2004-01-01

337

FDG-PET staging and importance of lymph node SUV in head and neck cancer  

PubMed Central

Objectives The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC. Methods Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on to receive radiotherapy. Results The median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p < 0.0007). Maximum SUV for the primary tumor > 8.0 was predictive of worse overall survival (p < 0.045), while the SUV of the lymph nodes was predictive for distant recurrence at one year--with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p < 0.05). Conclusions FDG-PET staging in head and neck cancer has good positive and negative predictive values in determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the first report to find that the SUV of a lymph node is predictive for ECE and also for distant recurrence.

2010-01-01

338

Pathology Case Study: Enlarged Axillary Lymph Node  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 73 year old female who had a history of thyroidectomy for benign nodules who presented with a lump in her thyroidectomy scar. Visitors are given a patient history, microscopic description, and immunohistochemistry, including images. They are also given an opportunity to diagnose the patient before clicking on the "Final Diagnosis" section, which provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopatholgy.

Contis, Lydia C.; Peng, Yan

2009-03-23

339

Noninvasive photoacoustic sentinel lymph node mapping using Au nanocages as a lymph node tracer in a rat model  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB) has been widely performed and become the standard procedure for axillary staging in breast cancer patients. In current SLNB, identification of SLNs is prerequisite, and blue dye and/or radioactive colloids are clinically used for mapping. However, these methods are still intraoperative, and especially radioactive colloids based method is ionizing. As a result, SLNB is generally associated with ill side effects. In this study, we have proposed near-infrared Au nanocages as a new tracer for noninvasive and nonionizing photoacoustic (PA) SLN mapping in a rat model as a step toward clinical applications. Au nanocages have great features: biocompatibility, easy surface modification for biomarker, a tunable surface plasmon resonance (SPR) which allows for peak absorption to be optimized for the laser being used, and capsule-type drug delivery. Au nanocage-enhanced photoacoustic imaging has the potential to be adjunctive to current invasive SLNB for preoperative axillary staging in breast cancer patients.

Song, Kwang Hyun; Kim, Chulhong; Cobley, Claire M.; Xia, Younan; Wang, Lihong V.

2009-02-01

340

Molecular Investigation of Lymph Nodes in Colon Cancer Patients Using One-Step Nucleic Acid Amplification (OSNA)  

PubMed Central

BACKGROUND A new diagnostic system, called one-step nucleic acid amplification (OSNA), has recently been designed to detect cytokeratin 19 mRNA as a surrogate for lymph node metastases. The objective of this prospective investigation was to compare the performance of OSNA with both standard hematoxylin and eosin (H&E) analysis and intensive histopathology in the detection of colon cancer lymph node metastases. METHODS In total, 313 lymph nodes from 22 consecutive patients with stage I, II, and III colon cancer were assessed. Half of each lymph node was analyzed initially by H&E followed by an intensive histologic workup (5 levels of H&E and immunohistochemistry analyses, the gold standard for the assessment of sensitivity/specificity of OSNA), and the other half was analyzed using OSNA. RESULTS OSNA was more sensitive in detecting small lymph node tumor infiltrates compared with H&E (11 results were OSNA positive/H&E negative). Compared with intensive histopathology, OSNA had 94.5% sensitivity, 97.6% specificity, and a concordance rate of 97.1%. OSNA resulted in an upstaging of 2 of 13 patients (15.3%) with lymph node-negative colon cancer after standard H&E examination. CONCLUSIONS OSNA appeared to be a powerful and promising molecular tool for the detection of lymph node metastases in patients with colon cancer. OSNA had similar performance in the detection of lymph node metastases compared with intensive histopathologic investigations and appeared to be superior to standard histology with H&E. Most important, the authors concluded that OSNA may lead to a potential upstaging of >15% of patients with colon cancer. Cancer 2012. © 2012 American Cancer Society.

Guller, Ulrich; Zettl, Andreas; Worni, Mathias; Langer, Igor; Cabalzar-Wondberg, Daniela; Viehl, Carsten T; Demartines, Nicolas; Zuber, Markus

2012-01-01

341

Contrast-Enhanced MR Imaging of Lymph Nodes in Cancer Patients  

PubMed Central

The accurate identification and characterization of lymph nodes by modern imaging modalities has important therapeutic and prognostic significance for patients with newly diagnosed cancers. The presence of nodal metastases limits the therapeutic options, and it generally indicates a worse prognosis for the patients with nodal metastases. Yet anatomic imaging (CT and MR imaging) is of limited value for depicting small metastatic deposits in normal-sized nodes, and nodal size is a poor criterion when there is no extracapsular extension or focal nodal necrosis to rely on for diagnosing nodal metastases. Thus, there is a need for functional methods that can be reliably used to identify small metastases. Contrast-enhanced MR imaging of lymph nodes is a non-invasive method for the analysis of the lymphatic system after the interstitial or intravenous administration of contrast media. Moreover, some lymphotrophic contrast media have been developed and used for detecting lymph node metastases, and this detection is independent of the nodal size. This article will review the basic principles, the imaging protocols, the interpretation and the accuracies of contrast-enhanced MR imaging of lymph nodes in patients with malignancies, and we also focus on the recent issues cited in the literature. In addition, we discuss the results of several pre-clinical studies and animal studies that were conducted in our institution.

Choi, Seung Hong

2010-01-01

342

Lymph node ratio and pN staging in patients with node-positive breast cancer: a report from the Korean breast cancer society  

Microsoft Academic Search

Patients with node-positive breast cancer are currently classified according to pN stage. Lymph node ratio (LNR), the ratio\\u000a of positive to total removed lymph nodes, maybe a more useful prognostic factor in these patients. We therefore compared LNR\\u000a and pN staging as prognostic factors in patients with node-positive breast cancer. Using two large prospective databases of\\u000a the Korean Breast Cancer

Sei Hyun Ahn; Hee Jeong Kim; Jong Won Lee; Gyung-Yub Gong; Dong-Yong Noh; Jung Hyun Yang; Sang Seol Jung; Ho Yong Park

343

Depth of Tumor Invasion Independently Predicts Lymph Node Metastasis in T2 Rectal Cancer  

Microsoft Academic Search

Objective  The aim of this study was to identify risk factors of lymph node metastasis (LNM) for T2 rectal cancer.\\u000a \\u000a \\u000a \\u000a Methods  From a prospectively maintained single-institution database, we identified 346 consecutive pT2 rectal cancers treated with\\u000a total mesorectal excision from 1998 to 2009. Univariate and multivariate analyses were performed to identify risk factors\\u000a associated with overall and intermediate\\/apical LNM. The incidence of

Pei-Rong Ding; Xin An; Yun Cao; Xiao-Jun Wu; Li-Ren Li; Gong Chen; Zhen-Hai Lu; Yu-Jing Fang; De-Sen Wan; Zhi-Zhong Pan

2011-01-01

344

Feasibility of laparoscopic D3 lymphadenectomy for male rectosigmoid cancer with clinically positive lymph nodes  

Microsoft Academic Search

Background  Laparoscopic D3 lymphadenectomy is a challenging surgical procedure and has not been reported before. The present study aimed\\u000a to test the technical feasibility of this procedure.\\u000a \\u000a \\u000a \\u000a Methods  Fifty-four consecutive male patients with clinically staged III rectosigmoid cancer were recruited to undergo laparoscopic\\u000a D3 lymph node dissection. The extent of the D3 lymphadenectomy of rectosigmoid cancer included skeletonization of bilateral\\u000a common iliac

Jin-Tung Liang; Kuo-Chin Huang; Hong-Shiee Lai; Po-Huang Lee; Chia-Tung Sun

2008-01-01

345

The lymph node ratio as a prognostic factor for gastric cancer.  

PubMed

Abstract To predict prognosis of gastric cancer, an adequate assessment of the stage of gastric cancer is important. The UICC/AJCC TNM classification is the most commonly used classification system. For adequate N staging at least 15 lymph nodes should be retrieved. In some countries, this amount of lymph nodes is not met, which can lead to understaging. Therefore, the lymph node ratio (LNR) is proposed as an alternative N staging modality. The purpose of this study was to compare the different staging modalities. Patients and methods. We included all patients who underwent surgery for gastric cancer, newly diagnosed between 2000 and 2009 and staged patient by UICC/AJCC TNM 5th/6th or 7th and by LNR. We conducted crude survival analysis, univariate and multivariate analyses according to the different staging systems. Results. The five-year overall survival rates ranged from 58% for N0 disease to 18% in case of more than 15 metastatic lymph nodes. The distribution of overall five-year survival according to LNR was 58% for LNR0 and 10% for LNR3. Univariate analysis showed that all the UICC/AJCC TNM classification systems as well as the LNR were strong prognostic factors for overall survival. The LNR correlated less with the number of nodes examined. Conclusion. LNR is a good prognostic tool for overall survival, it is an independent prognostic factor with a more homogenous spread of hazard ratios and five-year survival rates than UICC/AJCC systems. Furthermore, the LNR has a lower correlation with the number of nodes examined, making it less vulnerable for stage migration. PMID:23317142

Nelen, Stijn D; van Steenbergen, Liza N; Dassen, Anneriet E; van der Wurff, Anneke A M; Lemmens, Valery E P P; Bosscha, Koop

2013-01-15

346

A case of lymph node metastasis following a curative endoscopic submucosal dissection of an early gastric cancer.  

PubMed

Currently in Japan, differentiated gastric submucosal invasive cancers <500 ?m (SM1) with negative lymphovascular involvement are included in expanded pathological criteria for curative endoscopic treatment. This is based on a retrospective examination of surgical resection cases in which patients suitable for such expanded criteria were determined to have a negligible risk of lymph node metastasis. We performed endoscopic submucosal dissection on a 65-year-old male with early gastric cancer in April 2005, and pathology revealed a well-differentiated adenocarcinoma, 21 × 10 mm in size, SM1 invasion depth and negative lymphovascular invasion as well as tumor-free margins, so the case was diagnosed as a curative resection. This case, however, resulted in lymph node metastasis that was diagnosed by endoscopic ultrasonography with fine-needle aspiration biopsy in May 2009. Distal gastrectomy with D2 lymph node dissection was then performed, confirming lymph node metastasis from the original gastric cancer. PMID:22083418

Oya, Hisaharu; Gotoda, Takuji; Kinjo, Tetsu; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Taniguchi, Hirokazu; Kushima, Ryoji; Saka, Makoto; Katai, Hitoshi; Oda, Ichiro

2011-11-15

347

The current status of lymph node dissection in the treatment of papillary thyroid cancer. A literature review.  

PubMed

Aim. Cervical lymph node micrometastases are observed in up to 90% of papillary thyroid cancers (PTC), showing that lymph nodal involvement is very common. Nevertheless, during the last years, the role of lymph node dissection in the treatment of PTC has been controversial and, at present, the best indications to the routine or therapeutic neck dissection remain subject of research. In order to better analyze the current role of lymph node dissection in the surgical treatment of PTC, an analysis of the most recent literature data was performed. Study Design. By using as keywords lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, prophylactic or therapeutic lymph node dissection, papillary thyroid cancer, a Pub Med data base research was carried out. The most recent guidelines of different referral endocrine societies, inhering neck dissection for PTC, were also evaluated. Results. The role of neck dissection in PTC management remains controversial regarding routine or therapeutic indications, surgical extension, and its impact on local recurrence and long term survival. Due to inhomogeneous literature data, the current status of node dissection is still subject of research. Conclusions. There is agreement between endocrine and neck surgeons about the extension of therapeutic lymph node dissection in N+ PTC patients , and also in the prophylactic treatment of N0 "high risk" patients. Considering a recent trend toward routine central lymphadenectomy avoiding radioactive treatment, prospective randomized trials are needed to evaluate the benefits of different approaches. PMID:24045534

Conzo, G; Docimo, G; Mauriello, C; Gambardella, C; Esposito, D; Cavallo, F; Tartaglia, E; Napolitano, S; Santini, L

348

Prediction of Non-Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastases: Evaluation of the Tenon Score  

PubMed Central

Introduction Current guidelines recommend completion axillary lymph node dissection (cALND) in case of a sentinel lymph node (SLN) metastasis larger than 0.2 mm. However, in 50%–65% of these patients, the non-SLNs contain no further metastases and cALND provides no benefit. Several nomograms and scoring systems have been suggested to predict the risk of metastases in non-SLNs. We have evaluated the Tenon score. Patients and Methods In a retrospective review of the Swedish Sentinel Node Multicentre Cohort Study, risk factors for additional metastases were analysed in 869 SLN-positive patients who underwent cALND, using uni- and multivariate logistic regression models. A receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity of the Tenon score, and the area under the curve (AUC) was calculated. Results Non-SLN metastases were identified in 270/869 (31.1%) patients. Tumour size and grade, SLN status and ratio between number of positive SLNs and total number of SLNs were significantly associated with non-SLN status in multivariate analyses. The area under the curve for the Tenon score was 0.65 (95% CI 0.61–0.69). In 102 patients with a primary tumour <2 cm, Elston grade 1–2 and SLN metastases ?2 mm, the risk of non SLN metastasis was less than 10%. Conclusion The Tenon score performed inadequately in our material and we could, based on tumour and SLN characteristics, only define a very small group of patients in which negative non-sentinel nodes could be predicted.

Andersson, Y; Frisell, J; de Boniface, J; Bergkvist, L

2012-01-01

349

Feasibility of contrast-enhanced ultrasound-guided biopsy of sentinel lymph nodes in dogs.  

PubMed

Our goal was to develop and validate a technique to identify the sentinel lymph nodes of the mammary glands of healthy dogs with contrast-enhanced ultrasound, and evaluate the feasibility of obtaining representative samples of a sentinel lymph node under ultrasound guidance using a new biopsy device. Three healthy intact female adult hounds were anesthetized and each received an injection of octafluoropropane-filled lipid microspheres and a separate subcutaneous injection of methylene blue dye around a mammary gland. Ultrasound was then used to follow the contrast agent through the lymphatic channel to the sentinel lymph node. Lymph node biopsy was performed under ultrasound guidance, followed by an excisional biopsy of the lymph nodes and a regional mastectomy procedure. Excised tissues were submitted for histopathologic examination and evaluated as to whether they were representative of the node. The ultrasound contrast agent was easily visualized with ultrasound leading up to the sentinel lymph nodes. Eight normal lymph nodes (two inguinal, one axillary in two dogs; two inguinal in one dog) were identified and biopsied. Lymphoid tissue was obtained from all biopsy specimens. Samples from four of eight lymph nodes contained both cortical and medullary lymphoid tissue. Contrast-enhanced ultrasound can be successfully used to image and guide minimally invasive biopsy of the normal sentinel lymph nodes draining the mammary glands in healthy dogs. Further work is needed to evaluate whether this technique may be applicable in patients with breast cancer or other conditions warranting evaluation of sentinel lymph nodes in animals. PMID:21158235

Gelb, Hylton R; Freeman, Lynetta J; Rohleder, Jacob J; Snyder, Paul W

350

Landmark trials affecting the surgical management of invasive breast cancer.  

PubMed

Significant progress has been made in the surgical management of breast cancer. Most women diagnosed with early stage invasive breast cancer can now be managed with breast-conserving therapy to include a segmental mastectomy followed by radiation. Axillary lymph nodes are routinely assessed by sentinel lymph node biopsy. Axillary lymph node dissection is reserved for patients with documented nodal metastasis; however, here too progress has been made because a population of low-risk patients has been identified in whom a complete dissection is not required even in the setting of a positive sentinel lymph node. This article details the landmark clinical trials that have guided the surgical management of breast cancer. PMID:23464699

Black, Dalliah M; Mittendorf, Elizabeth A

2013-01-29

351

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery  

PubMed Central

Background Mediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery. Methods Sixty-two samples obtained from cadavers who did not die from chest malignancies, extrathoracic malignancies, any kind of infections or previous hospitalization before the death were included to the study. The locations of the nodes were recorded according to the American Thoracic Society Mediastinal Lymph Node Map. The number, size and weight of the nodes were determined at each station. Results Median age of the cadavers was 39 years. Primary causes of death were asphyxia in 10 (16.1%) subjects, trauma in 29 (46.8%) subjects, cardiovascular problems in 10 (16.1%) subjects, and undetermined in 13 (21%) subjects. The median number of lymph nodes resected from each patient was 23 (range: 11–54). The right sided paratracheal lymph nodes (Station 2R and 4R) were more frequent, heavier and longer than left sided lymph nodes (Station 2L and 4L) at the paratrecheal region. Right sided inferior mediastinal lymph nodes were heavier and longer than the left ones; however, their availability was more often on the left. Conclusions The properties of mediastinal lymph nodes at particular stations are different for number, size and weight. Station 4R and 7 have the highest number of nodes followed by stations 5 and 6. We recommend removing the lymph nodes of these stations completely in lung cancer patients to rule out the possibility of micrometastatic disease. Diameter of normal lymph node may be 1 cm for the stations other than 4R and 7, but the definition of normal diameter of a lymph node at the stations 4R and 7 may be changed as 1,5 cm and 2,0 cm, respectively. Weight of the nodes may be a new subject to study and may be defined as a new modality to define a staging to be more accurate and the issue needs further investigations.

2013-01-01

352

Expression of insulin receptor substrate 1 in primary breast cancer and lymph node metastases  

PubMed Central

Background: Insulin receptor substrate 1 (IRS-1) transmits signals from the insulin-like growth factor I receptor (IGF-IR) and insulin receptor (IR) and has been associated with the pathogenesis of cancer. IRS-1 downregulation has been suggested to play a role in breast cancer progression, but no simultaneous assessments of IRS-1 expression in primary breast cancer and metastases have been performed. Aims: To assess IRS-1 expression in primary and metastatic breast cancer. Methods: IRS-1 expression was analysed by means of immunohistochemistry in 109 samples of primary breast cancer and in 42 matched primary and metastatic tumours. In addition, IRS-1 expression was correlated with selected clinicopathological features, including oestrogen receptor ? (ER?) and proliferation marker Ki-67 status. Results: Positive cytoplasmic IRS-1 immunostaining was found in 69.7% (76 of 109) and 76.2% (32 of 42) of the primary and metastatic tumours, respectively. Both IRS-1 positive and IRS-1 negative primary tumours produced IRS-1 positive and IRS-1 negative metastases. IRS-1 expression in primary tumours correlated with poorly differentiated (G3) breast cancer (p<0.005) and with lymph node involvement (p<0.05). In the subgroup of ER? positive primary tumours, IRS-1 expression positively correlated with Ki-67 (p<0.02, r?=?0.351), but in the subgroup of ER? negative primary tumours there was a negative correlation (p<0.03, r?=??0.509). IRS-1 expression in lymph node metastases correlated with neither ER? nor Ki-67. Conclusions: IRS-1 might be involved in breast cancer progression. Knowledge about differences between primary and metastatic tumours might help to understand mechanisms of breast cancer progression and lead to the development of more effective anticancer drugs.

Koda, M; Sulkowska, M; Kanczuga-Koda, L; Sulkowski, S

2005-01-01

353

Interleukin-24 is correlated with differentiation and lymph node numbers in rectal cancer  

PubMed Central

AIM: To assess the significance of interleukin (IL)-24 and vascular endothelial growth factor (VEGF) expression in lymph-node-positive rectal cancer. METHODS: Between 1998 and 2005, 90 rectal adenocarcinoma patients with lymph node involvement were enrolled. All patients received radical surgery and postoperative pelvic chemoradiotherapy of 50.4-54.0 Gy. Chemotherapy of 5-fluorouracil and leucovorin or levamisole was given intravenously during the first and last week of radiotherapy, and then monthly for about 6 mo. Expression of IL-24 and VEGF was evaluated by immunohistochemical staining of surgical specimens, and their relations with patient characteristics and survival were analyzed. The median follow-up of surviving patients was 73 mo (range: 52-122 mo). RESULTS: IL-24 expression was found in 81 out of 90 patients; 31 showed weak intensity and 50 showed strong intensity. VEGF expression was found in 64 out of 90 patients. Negative and weak intensities of IL-24 expression were classified as negative expression for analysis. IL-24 expression was significantly reduced in poorly differentiated tumors in comparison with well or moderately differentiated tumors (P = 0.004), N2b to earlier N stages (P = 0.016), and stage IIIc to stage IIIa or IIIb (P = 0.028). The number of involved lymph nodes was also significantly reduced in IL-24-positive patients in comparison with IL-24-negative ones.There was no correlation between VEGF expression and patient characteristics. Expression of IL-24 and VEGF was not correlated with survival, but N stage and stages were significantly correlated with survival. CONCLUSION: IL-24 expression was significantly correlated with histological differentiation, and inversely correlated with the degree of lymph node involvement in stage III rectal cancer.

Choi, Youngmin; Roh, Mee-Sook; Hong, Young-Seoub; Lee, Hyung-Sik; Hur, Won-Joo

2011-01-01

354

Increased expression of connexins 26 and 43 in lymph node metastases of breast cancer  

PubMed Central

Background Gap junctions are intercellular channels composed of connexins, which mediate the direct passage of small molecules between neighbouring cells. They are involved in regulation of cell cycle, cell signalling, and differentiation, and probably invasion and metastasis. The role of connexins in the metastatic process is controversial, because some studies indicate that connexin expression is inversely correlated with metastatic capacity. In contrast, others demonstrate that connexins may be involved in metastasis. In addition, connexin status in breast cancer metastasis has not been widely studied. Methods We evaluated by immunohistochemistry the expression of connexin 26 (Cx26) and connexin 43 (Cx43) in primary breast tumours (PTs) and matched paired metastases to lymph nodes (MLNs). Results In PTs, we observed predominantly cytoplasmic localisation of evaluated connexins, indicating alterations in connexin expression in breast cancer cells. We demonstrated that expression of Cx26 and Cx43 was increased in MLNs compared with PTs (p<0.00001 and p<0.001, for CX26 and Cx43, respectively). In addition, Cx26 and Cx43 negative PTs developed Cx26 and Cx43 positive MLNs. Furthermore, besides increased cytoplasmic staining, enhanced membranous localisation of Cx43, typical of normal cells, was found in MLNs. Additionally, membranous Cx26 expression appeared only in metastatic breast cancer cells. Conclusions These findings suggest that connexins may contribute to the efficient metastasising of breast cancer to the lymph nodes.

Kanczuga-Koda, L; Sulkowski, S; Lenczewski, A; Koda, M; Wincewicz, A; Baltaziak, M; Sulkowska, M

2006-01-01

355

Ultrasonic Detection of Metastases in Dissected Lymph Nodes of Cancer Patients  

NASA Astrophysics Data System (ADS)

Current histological methods can miss micrometastases (< 2.0 mm) in dissected lymph nodes because nodes are cut into sections that are at least 2-mm thick for examination, and the entire node volume cannot be evaluated microscopically. In this study, high-frequency, quantitative ultrasound (HFU, QUS) methods were applied to freshly dissected lymph nodes to detect micrometastases based on their microstructural properties. 3-D ultrasound data were acquired from 40 nodes from 22, colorectal-cancer patients using a single-element, 25 MHz transducer. Significant cancer was detected subsequently in 7 of the 40 nodes. Node images were segmented semi-automatically in 3-D, and echo signals were processed to yield basic spectral parameters (slope, intercept, and midband) values plus QUS estimates associated with tissue microstructural properties (scatterer size and acoustic concentration). Images were formed by expressing local QUS estimates as color-encoded pixels and overlaying the color on conventional, gray-scale ultrasound images. Linear discriminant analysis classified nodes based on intercept, midband, size, and acoustic concentration. ROC methods assessed classification performance. 3-D QUS images interactively displayed spectral-parameter and QUS values. Linear-discriminant methods produced an area under the ROC curve of 1.000 based on size and intercept; interestingly, the areas for size alone and for intercept alone were 0.986. These initial results appear to validate spectrum-analysis-based QUS methods for distinguishing cancerous from non-cancerous tissue in lymph nodes. The Areas under the ROC curves suggest that this approach can be valuable clinically to identify nodal micrometastases that current histologic methods can miss.

Feleppa, E. J.; Mamou, J.; Machi, J.; Hata, M.; Coron, A.; Yanagihara, E.; Laugier, P.

356

18 F-FDG PET in A Clinical Unsuspected Axillary Tuberculous Lymphadenitis Mimicking Malignancy  

Microsoft Academic Search

Isolated axillary tuberculous lymphadenitis is rare. We present a 33-year-old female who had palpable right axillary masses without remarkable clinical symptom. Ultrasound examination of breast and abdomen, mam- mography, and chest radiography were negative. 18 F- Fluorodeoxyglucose positron emission tomography (FDG-PET) study was misinterpreted as malignant dis- ease extensively involving right axillary and the sur- rounding lymph nodes, possibly metastatic

Che-Ming Yang; Chung-Huei Hsu; Chia-Ming Hsieh; Mao-Yuan Chen

357

miRNA expression profile in primary gastric cancers and paired lymph node metastases indicates that miR-10a plays a role in metastasis from primary gastric cancer to lymph nodes  

PubMed Central

The aim of this study was to identify and evaluate microRNAs (miRNAs) in gastric cancer lymph node metastasis. A miRNA array was used to compare the expression of miRNAs in primary gastric cancer and paired lymph node metastases. miRNAs found to be differentially expressed were validated in a cohort of primary gastric cancer tissues, and the relationship between expression and the clinicopathological characteristics of the specimens was analyzed. The expression level of miR-10a in a gastric mucosal cell line and three gastric cancer cell lines was also detected using qPCR. Moreover, the target genes for miR-10a were predicted using bioinformatic methods. Based on the results, four differentially expressed miRNAs were detected by the miRNA array. Compared with primary gastric cancer, lymph node metastases displayed downregulated expression of miR-24-1*, miR-510 and miR-1284, while the expression of miR-10a was upregulated. Consequently, analysis found that the expression of miR-10a was associated with lymph node metastasis (P=0.047), but was independent of the state of lymphatic invasion (P=0.169) in the cohort of primary gastric carcinoma. The expression of miR-10a was at least 10-fold higher in the three gastric cancer cell lines than in the gastric mucosal cell line. Two gastric cancer cell lines, which were established from lymph node metastasis, expressed higher miR-10a compared to the primary tumor origin cell line. Bioinformatic analysis demonstrated that the target genes of miR-10a are involved in multiple related pathways of tumorigenesis and metastasis. In conclusion, our study suggests that miR-10a is involved in the development of gastric cancer and lymph node metastasis, particularly in the latter process.

CHEN, WEIDONG; TANG, ZHAOQING; SUN, YIHONG; ZHANG, YOUYOU; WANG, XUEFEI; SHEN, ZHENBIN; LIU, FENGLIN; QIN, XINYU

2012-01-01

358

Topography of the major superficial lymph nodes and their efferent lymph pathways in the koala (Phascolarctos cinereus).  

PubMed Central

The koala has an inguinoaxillary lymph trunk on either side of the ventral midline, and this carries efferent lymph from the superficial inguinal lymph node directly to the deep axillary lymph node. The superficial lymph nodes are large and soft compared with those of the domestic species, and each lymph centre usually contains only one or two large lymph nodes. Koalas have a rostral mandibular lymph node which has not been described in other species, but lack popliteal and subiliac lymph nodes. The superficial lymph nodes which are readily palpable in the live koala are the facial, rostral mandibular, mandibular, superficial axillary and superficial inguinal. All superficial lymph pathways terminate at the confluence of the common jugular and subclavian veins.

Hanger, J J; Heath, T J

1991-01-01

359

Differential expression of hypoxia and (lymph)angiogenesis-related genes at different metastatic sites in breast cancer  

Microsoft Academic Search

Introduction  Breast cancer can metastasize via lymphatic and hematogenous pathways. Hypoxia and (lymph)angiogenesis are closely related\\u000a processes that play a pivotal role in the tumor progression and metastasis. The aim of this study was to compare expression\\u000a of hypoxia and (lymph)angiogenesis-related genes between primary breast tumors and metastases in different tissues.\\u000a \\u000a \\u000a \\u000a Materials and methods  A gene list of 269 hypoxia and (lymph)angiogenesis-related

Gert G. Van den Eynden; Steven J. Van Laere; Ilse Van der Auwera; Leen Gilles; J. Lance Burn; Cecile Colpaert; Peter van Dam; Eric A. Van Marck; Luc Y. Dirix; Peter B. Vermeulen

2007-01-01

360

Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer  

Microsoft Academic Search

Monoclonal antibody D2-40, a marker of lymphatic endothelium, identifies tumor emboli in lymph vessels. The aim of the study was to assess whether D2-40+ lymph vessel invasion (LVI) correlates with clinicopathologic factors including lymphovascular invasion (LVI) as assessed by haematoxylin and eosin-stained sections (H&E+ or H&E?) and to assess the prognostic significance in node-negative breast cancer. The study group consisted

Angel Arnaout-Alkarain; Harriette J Kahn; Steven A Narod; Ping A Sun; Alexander N Marks

2007-01-01

361

Comparison between periareolar and peritumoral injection of radiotracer for sentinel lymph node biopsy in patients with breast cancer  

Microsoft Academic Search

Background. The technique of sentinel lymph node (SLN) biopsy in patients with breast cancer varies among reports, and the optimal method remains to be established, particularly with regard to the site of radiotracer injection. The aim of this study was to compare periareolar and peritumoral injection of radiotracer in detecting SLN in patients with breast cancer. Methods. Patients with T1-2

Kenzo Shimazu; Yasuhiro Tamaki; Tetsuya Taguchi; Yuuki Takamura; Shinzaburo Noguchi

2002-01-01

362

Staging of regional lymph nodes in melanoma: a case for including nonsentinel lymph node positivity in the american joint committee on cancer staging system.  

PubMed

IMPORTANCE Survival varies widely in patients with stage III melanoma. The existence of clinical significance for positive nonsentinel lymph node (NSLN) status would warrant consideration for incorporation into the American Joint Committee on Cancer staging system and better prediction of survival. OBJECTIVE To evaluate whether disease limited to sentinel lymph nodes (SLNs) represents different clinical significance than disease spread into NSLNs. DESIGN, SETTING, AND PARTICIPANTS The database of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, was queried for all patients with SLNs positive for cutaneous melanoma who subsequently underwent completion lymph node dissection. MAIN OUTCOMES AND MEASURES Disease-free survival, melanoma-specific survival (MSS), and overall survival. RESULTS A total of 4223 patients underwent SLN biopsy from 1986 to 2012. Of these patients, 329 had a tumor-positive SLN. Of the 329, 250 patients (76.0%) had no additional positive nodes and 79 (24.0%) had a tumor-positive NSLN. Factors predictive of NSLN positivity included older age (P?=?.04), greater Breslow thickness (P?lymph nodes, comparison was done for patients with only N2 disease (2-3 total positive lymph nodes); the results of this comparison confirmed the independent effect of NSLN status (MSS; P?=?.04). CONCLUSIONS AND RELEVANCE Nonsentinel lymph node positivity is one of the most significant prognostic factors in patients with stage III melanoma. Subclassification of melanoma by NSLN tumor status should be considered for the American Joint Committee on Cancer staging system. PMID:23903435

Leung, Anna M; Morton, Donald L; Ozao-Choy, Junko; Hari, Danielle M; Shin-Sim, Myung; Difronzo, Andrew L; Faries, Mark B

2013-09-01

363

Linac-based Stereotactic Body Radiotherapy for Oligometastatic Patients With Single Abdominal Lymph Node Recurrent Cancer.  

PubMed

OBJECTIVES:: To evaluate stereotactic body radiotherapy (SBRT) for single abdominal lymph node cancer recurrence. METHODS:: Inclusion criteria for this retrospective study were as follows: adult oligometastatic cancer patients with single abdominal lymph node recurrence that underwent SBRT but not other local therapy, written informed consent for treatment. Previous radiotherapy or concomitant systemic therapy were allowed. Toxicity and tumor response were evaluated using Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Scale and Response Evaluation Criteria in Solid Tumors. RESULTS:: Sixty-nine patients (94 lesions) underwent SBRT (median 24 Gy/3 fractions). Primary diagnosis included urological, gastrointestinal, gynecologic, and other malignancies. Concomitant systemic therapy was performed in 35 cases. Median follow-up was 20 months. Two grade 3 acute and 1 grade 4 late toxicity events were registered. Complete radiologic response, partial response, stabilization, and progressive disease were observed in 36 (44%), 21 (26%), 20 (25%), and 4 (5%) lesions, respectively, out of 81 evaluable lesions. Response rates were similar when analysis was restricted to lesions treated with exclusive SBRT (no concomitant therapy). Actuarial 3-year in-field progression-free interval, progression-free survival and overall-survival rates were 64.3%, 11.7%, and 49.9%, respectively. Overall-survival rates were significantly higher in favorable histology cases (prostate and kidney tumors). Pattern of failure was predominantly out-field. CONCLUSIONS:: SBRT is a feasible approach for single abdominal lymph node recurrence, offering excellent in-field tumor control with low-toxicity profile. Future studies are warranted to identify the patients that benefit most from this treatment. The optimal combination with systemic treatment should also be defined. PMID:22992626

Jereczek-Fossa, Barbara A; Piperno, Gaia; Ronchi, Sara; Catalano, Gianpiero; Fodor, Cristiana; Cambria, Raffaella; Fossati Ing, Piero; Gherardi, Federica; Alterio, Daniela; Zerini, Dario; Garibaldi, Cristina; Baroni, Guido; De Cobelli, Ottavio; Orecchia, Roberto

2012-09-18

364

Simultaneous Foxp3 and IDO expression is associated with sentinel lymph node metastases in breast cancer  

PubMed Central

Background There is evidence that the immune systems of patients with breast cancer are dysfunctional. Regulatory T cells (Tregs), and IDO, an immunosuppressive enzyme, are associated with more advanced disease in some cancers and may promote immunologic tolerance to tumors. Our aim was to assess whether expression of Foxp3, a marker of Tregs, and IDO were linked with nodal metastasis in breast cancer patients. Inhibitors of IDO are available and could potentially demonstrate utility in breast cancer if IDO drives progression of disease. Methods Sentinel lymph nodes (SLN) of 47 breast cancer patients with varying degrees of nodal disease and 10 controls were evaluated for expression of Foxp3 and IDO using immunohistochemistry. Positively stained cells were quantified and their distribution within the SLN noted. Results The proportion of Foxp3+ cells was higher in SLN of cancer patients than controls (19% v. 10%, p < 0.001). Specifically, there were more Foxp3+ cells in SLN with metastasis than tumor-free SLN (20% v. 14%, p = 0.02). The proportion IDO+ cell in SLN of cancer patients was not statistically different than controls (4.0% v. 1.6%, p = 0.08). In order to demonstrate the combined immunosuppressive effect of Foxp3 and IDO, we categorized each SLN as positive or negative for Foxp3 and IDO. The Foxp3+/IDO+ group almost exclusively consisted of cancer patients with node positive disease. Conclusion In conclusion, our study shows that Foxp3+ cells are associated with more advanced disease in breast cancer, a finding that is proving to be true in many other cancers. As IDO has been found to promote differentiation of Tregs, IDO may become a suitable target to abrogate the development of T-cell tolerance and to promote an effective immune response to breast cancer. Our results about the combined expression of IDO and Foxp3 in metastastic SLN support this assumption.

2009-01-01

365

Prognostic Value of P53 Gene Mutations in a Large Series of Node-negative Breast Cancer Patients  

Microsoft Academic Search

The most important subgroup ol breast cancer patients for which reliable prognostic factors are needed are women without axillary lymph node involvement. Although overall, these patients have a good prognosis, it is known that 20-30% will experience a recurrence of the disease. To determine the prognostic significance of P53 tumor suppressor gene mu tation, specimens from 113 primary breast cancers

Nicole Palette; Marie-Pierre Paperin; Isabelle Treilleux; Anne-Christelle Gratadour; Nadine Peloux; Nigel Tooke; Alain Bremond; Mehmet Ozturk; Alain Puisieux

1998-01-01

366

An animal model of buccal mucosa cancer and cervical lymph node metastasis induced by U14 squamous cell carcinoma cells  

PubMed Central

The buccal mucosa is the site with the highest risk of contracting a malignancy in habitual betel quid chewers who expose the buccal mucosa to high doses of carcinogens. Of all oral cancers, those of the buccal mucosa are associated with the poorest prognoses. Therefore, it would be helpful to have an animal model to evaluate new treatment modalities for buccal mucosa cancer. In the present study, we evaluated whether the imprinting control region (ICR) mouse animal model could be employed as a cancer model for buccal mucosa cancer. Sixty male ICR mice were randomly divided into two groups, a normal group (n=10) and a cancer-induced group (n=50). Each mouse in the cancer group was inoculated with 0.05 ml U14 cancer cell suspension (1×107/ml) on the buccal mucosa. Histological staining and gene expression assays revealed that neck lymph node metastasis animal models were established. After 20 days, the cheek tumor formation rate of the ICR mice reached 100%. Furthermore, the neck lymph node metastasis rate was 53%. We identified that U14 cells produce strong metastasis in ICR mice. Metastasis of the tumor to the lymph node began with carcinoma metastasis encroaching on the marginal sinus. Then it infiltrated to the cortex and medulla and the infiltration continued until the normal lymph node structure was completely damaged. This animal model may be employed in medical research on buccal mucosa cancer and cervical lymph node metastasis. In conclusion, our findings indicate that U14 cell-induced mouse buccal mucosa cancer may be a potential cancer model for human buccal mucosa squamous cell carcinoma.

ZHAO, XIN; PANG, LIANG; QIAN, YU; WANG, QIANG; LI, YONG; WU, MINGYI; OUYANG, ZILAN; GAO, ZHI; QIU, LIHUA

2013-01-01

367

Can axillary node dissection be omitted in a subset of patients with low local and regional failure rates?  

PubMed

Axillary node dissection (ALND) is the standard of care for patients who have a positive sentinel lymph node (SLN) on sentinel lymph node biopsy (SLNB). We sought to identify a low-risk patient population with positive SLN that may not need cALND. We analyzed SLNB for breast cancer at our institutions between 1999 and 2007. We identified 130 patients who had a positive SLN but did not undergo completion ALND. We evaluated clinical data, adjuvant treatment patterns and intermediate locoregional and distant events. The median patient age was 50; 19% had N0(i+) disease, 53% had micrometastatic (N1mi) disease, and 28% had macrometastasis. Eighty-eight percent of patients underwent radiation therapy; 66 patients (51%) had documented nodal radiation (of these 50 were treated with three fields and 14 with high tangents. Local recurrence in the breast occurred in two patients (2%) and nine patients (7%) developed distant metastases; there were no axillary/nodal recurrences. In this highly selected group of patients who had a positive SLNB but did not undergo cALND, we observed no axillary recurrences. PMID:22017599

Barkley, Christina; Burstein, Harold; Smith, Barbara; Bellon, Jennifer; Wong, Julia; Gadd, Michele; Taghian, Alphonse; Winer, Eric; Iglehart, James Dirk; Harris, Jay; Golshan, Mehra

2011-10-21

368

Analytic Lymph Node Number Establishes Staging Accuracy by Occult Tumor Burden in Colorectal Cancer  

PubMed Central

Background and Objectives Recurrence in lymph node-negative (pN0) colorectal cancer suggests the presence of undetected occult metastases. Occult tumor burden in nodes estimated by GUCY2C RT-qPCR predicts risk of disease recurrence. This study explored the impact of the number of nodes analyzed by RT-qPCR (analytic) on the prognostic utility of occult tumor burden. Methods Lymph nodes (range: 2–159) from 282 prospectively enrolled pN0 colorectal cancer patients, followed for a median of 24 months (range: 2–63), were analyzed by GUCY2C RT-qPCR. Prognostic risk categorization defined using occult tumor burden was the primary outcome measure. Association of prognostic variables and risk category were defined by multivariable polytomous and semi-parametric polytomous logistic regression. Results Occult tumor burden stratified this pN0 cohort into categories of low (60%; recurrence rate (RR)=2.3% [95% CI 0.1–4.5%]), intermediate (31%; RR=33.3% [23.7%–44.1%]), and high (9%; RR=68.0% [46.5%–85.1%], p<0.001) risk of recurrence. Beyond race and T stage, the number of analytic nodes was an independent marker of risk category (p<0.001). When >12 nodes were analyzed, occult tumor burden almost completely resolved prognostic risk classification of pN0 patients. Conclusions The prognostic utility of occult tumor burden assessed by GUCY2C RT-qPCR is dependent on the number of analytic lymph nodes.

Hyslop, Terry; Weinberg, David S.; Schulz, Stephanie; Barkun, Alan; Waldman, Scott A.

2012-01-01

369

A computer-aided algorithm to quantitatively predict lymph node status on MRI in rectal cancer  

PubMed Central

Objective The aim of this study was to demonstrate the principle of supporting radiologists by using a computer algorithm to quantitatively analyse MRI morphological features used by radiologists to predict the presence or absence of metastatic disease in local lymph nodes in rectal cancer. Methods A computer algorithm was developed to extract and quantify the following morphological features from MR images: chemical shift artefact; relative mean signal intensity; signal heterogeneity; and nodal size (volume or maximum diameter). Computed predictions on nodal involvement were generated using quantified features in isolation or in combinations. Accuracies of the predictions were assessed against a set of 43 lymph nodes, determined by radiologists as benign (20 nodes) or malignant (23 nodes). Results Predictions using combinations of quantified features were more accurate than predictions using individual features (0.67–0.86 vs 0.58–0.77, respectively). The algorithm was more accurate when three-dimensional images were used (0.58–0.86) than when only middle image slices (two-dimensional) were used (0.47–0.72). Maximum node diameter was more accurate than node volume in representing the nodal size feature; combinations including maximum node diameter gave accuracies up to 0.91. Conclusion We have developed a computer algorithm that can support radiologists by quantitatively analysing morphological features of lymph nodes on MRI in the context of rectal cancer nodal staging. We have shown that this algorithm can combine these quantitative indices to generate computed predictions of nodal status which closely match radiological assessment. This study provides support for the feasibility of computer-assisted reading in nodal staging, but requires further refinement and validation with larger data sets.

Tse, D M L; Joshi, N; Anderson, E M; Brady, M; Gleeson, F V

2012-01-01

370

Comparative study of the expression of metalloproteases and their inhibitors in different localizations within primary tumours and in metastatic lymph nodes of breast cancer  

PubMed Central

Studies on metastasic lesions from human carcinomas are scarce. Therefore there is a need for such studies to identify the expression of the biological factors that will help in the assessment of the natural history of breast cancer. Here an immunohistochemical study was performed using tissue arrays and specific antibodies against matrix metalloproteinases (MMPs)-1, 2, 7, 9, 11, 13, 14 and tissue inhibitors of metalloproteases (TIMPs)-1, 2 and 3 in 39 patients with breast cancer. Specimens from 39 patients with node-positive carcinomas were examined and the analysis was performed at the central core of the tumour, at the invasive front, and in the metastasic axillary lymph nodes (MALNs). Global expression of MMP-1, 7 and 14, TIMP-1, and 3, were significantly higher at the centre of the tumour compared with the invasive front or the MALNs. Significantly higher expression of MMP-7 and 14, and TIMP-3, by fibroblast-like cells and mononuclear inflammatory cells (MICs) was seen in MALNs. In addition, in the tumour centre, the expression of MMP-11 and TIMP-1 and 2 by MICs, as well as TIMP-2 expression by fibroblast-like cells, were associated significantly with the occurrence of distant metastasis. In contrast, TIMP-3 expression by tumour cells or by fibroblast-like cells in this same tumour locations, as well as TIMP-1 expression by fibroblast-like cells at the invasive front, were associated significantly with poor prognosis. However, the expression of all of these biological factors in MALNs was not associated with the development of distant metastasis. Our data suggest that there is prognostic relevance to the expression of MMPs and TIMPs in the stromal cells of primary tumours, rather than to the expression of these enzymes in MALNs.

Garcia, Maria Fernanda; Gonzalez-Reyes, Salome; Gonzalez, Luis Ovidio; Junquera, Sara; Berdize, Nana; Del Casar, Jose Manuel; Medina, Maria; Vizoso, Francisco Jose

2010-01-01

371

Should a Sentinel Node Biopsy Be Performed in Patients with High-Risk Breast Cancer?  

PubMed Central

A negative sentinel lymph node (SLN) biopsy spares many breast cancer patients the complications associated with lymph node irradiation or additional surgery. However, patients at high risk for nodal involvement based on clinical characteristics may remain at unacceptably high risk of axillary disease even after a negative SLN biopsy result. A Bayesian nomogram was designed to combine the probability of axillary disease prior to nodal biopsy with customized test characteristics for an SLN biopsy and provides the probability of axillary disease despite a negative SLN biopsy. Users may individualize the sensitivity of an SLN biopsy based on factors known to modify the sensitivity of the procedure. This tool may be useful in identifying patients who should have expanded upfront exploration of the axilla or comprehensive axillary irradiation.

Westover, Kenneth D.; Westover, M. Brandon; Winer, Eric P.; Richardson, Andrea L.; Iglehart, J. Dirk; Punglia, Rinaa S.

2011-01-01

372

[A case of rectal cancer which showed complete response to chemotherapy for para-aortic lymph node metastases remaining after surgery, for which resection of Virchow's lymph node recurrence led to long-term survival].  

PubMed

A 55-year-old man with a positive fecal occult blood test visited our department, and after a thorough medical evaluation, was diagnosed with Stage IV Rs rectal cancer with marked para-aortic lymph node metastasis. In December 2007, the patient underwent low anterior rectal resection with D3 lymph node dissection, but the para-aortic lymph nodes were left. The metastatic lymph nodes showed a complete response(CR)to post-operative chemotherapy with FOLFOX, FOLFIRI, IRIS, and irinotecan+cetuximab, and the complete response was sustained for 18 months after surgery. Later, he developed Virchow's lymph node metastasis, which was also resected. At present, 5 years after the first surgery, the patient, whose chemotherapy has been discontinued, is alive without recurrence. It appears that using key drugs, such as 5-fluorouracil, leukovorin, oxaliplatin, irinotecan, and cetuximab, and performing aggressive salvage surgery for Virchow's lymph node recurrence, led to long-term recurrence-free survival. PMID:24047787

Imamura, Hiroshi; Iino, Satoshi; Sakamoto, Akihiko; Kuwahata, Taisaku; Yonemori, Keiichi; Onishi, Shun; Higashi, Hiroshi; Sakita, Hironori; Tanabe, Gen; Natsugoe, Shouji

2013-09-01

373

Occult tumor burden predicts disease recurrence in lymph node-negative colorectal cancer  

PubMed Central

Purpose While lymph node involvement by histopathology informs colorectal cancer prognosis, recurrence in 25% of node-negative patients suggests the presence of occult metastasis. GUCY2C is a marker of colorectal cancer cells that identifies occult nodal metastases associated with recurrence risk. Here, we defined the association of occult tumor burden, quantified by GUCY2C RT-PCR, with outcomes in colorectal cancer. Experimental Design Lymph nodes (range: 2–159) from 291 prospectively enrolled node-negative colorectal cancer patients were analyzed by histopathology and GUCY2C quantitative (q)RT-PCR. Participants were followed for a median of 24 months (range: 2–63). Time to recurrence and disease-free survival served as primary and secondary outcomes, respectively. Association of outcomes with prognostic markers, including molecular tumor burden, was estimated by recursive partitioning and Cox models. Results In this cohort,176 (60%) patients exhibited low tumor burden (MolLow), and all but 4 remained free of disease (recurrence rate 2.3% [95%CI 0.1–4.5%]). Also, 90 (31%) patients exhibited intermediate tumor burden (MolInt) and 30 (33.3% [23.7%–44.1%]) developed recurrent disease. Further, 25 (9%) patients exhibited high tumor burden (MolHigh), and 17 (68.0% [46.5%–85.1%]) developed recurrent disease (p<0.001). Occult tumor burden was an independent marker of prognosis. MolInt and MolHigh patients exhibited a graded risk of earlier time to recurrence (MolInt, adjusted hazard ratio 25.52 [11.08–143.18]; p<0.001; MolHigh, 65.38 [39.01–676.94]; p<0.001) and reduced disease-free survival (MolInt, 9.77 [6.26–87.26]; p<0.001; MolHigh, 22.97 [21.59–316.16]; p<0.001). Conclusions Molecular tumor burden in lymph nodes is independently associated with time to recurrence and disease-free survival in patients with node-negative colorectal cancer.

Hyslop, Terry; Weinberg, David S.; Schulz, Stephanie; Barkun, Alan; Waldman, Scott A.

2011-01-01

374

Sentinel lymph node mapping in patients with operable non-small cell lung cancer  

PubMed Central

Background The aim of this study was to determine the accuracy and the role of the sentinel lymph node (SLN) in patients with non-small cell lung cancer. Material and method This study was carried out on 25 consecutive patients [M/F=23:2, mean age 62.84 (47-81) years] with operable non-small cell lung cancer (NSCLC). At thoracotomy, 0.25 mCi of Technecium99m (99mTc) nanocolloid was injected into each quadrant of lung tissue surrounding the tumor. Before resection scintigraphic measurements of lymph nodes were obtained in vivo and ex vivo using a hand-held gamma probe counter and the findings were compared with histological examination. SLN was defined as the node with the highest count rate. Results SLNs were identified in 23 of 25 patients (92%) with a total number of 52 SLNs. Seven of 52 (13%) of these SLNs were positive for metastatic involvement after histological and immunohistochemical examination. In two patients (8%), SLNs could not be found. The sensitivity and specificity were 55% and 86% respectively. Conclusions This technic is a good method for identifying the first site of potential nodal metastases of NSCLC. These preliminary results demonstrate this procedure is feasible, but the detection rate has to be improved.

Yoruk, Yener; Yanik, Fazli; Sarikaya, Ali

2013-01-01

375

Association between the HLA-G molecule and lymph node metastasis in papillary thyroid cancer.  

PubMed

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer and can present as lymph node metastasis in 30 to 65% of cases when initially diagnosed. High frequency recurrence, distant metastasis and treatment resistance can be found in cases of PTC so early diagnosis and treatment are critical for improved prognosis and better survival rates. The characterization of new biomarkers has proved useful for the diagnosis and follow-up of these patients. HLA-G is a non-classical HLA class I molecule whose expression in cancer cells has been associated with tumor evasion of immune response. Therefore, the aim of this study was to investigate the HLA-G expression and its clinical significance in PTC. Paraffin-embedded thyroid biopsies of 70 PTC patients (40 of whom had presented with metastasis) were evaluated. HLA-G-staining was observed in tumor cells in PTC, and the HLA-G expression was significantly associated with an increased occurrence of lymph node metastasis (p=0.0006) and capsular invasion (p=0.02). This preliminary data shows the HLA-G expression in thyroid carcinoma specimens for the first time and suggests that this expression could impair efficient anti-tumor immunity in PTC. This would indicate that HLA-G could have an independent prognostic value in PTC, principally for tumor recurrence. PMID:23261411

Nunes, Larissa Mesquita; Ayres, Flávio Monteiro; Francescantonio, Isadora Carvalho Medeiros; Saddi, Vera Aparecida; Avelino, Melissa Ameloti Gomes; Alencar, Rita de Cássia Gonçalves; Silva, Rosana Correa da; Meneghini, Alexandre J; Wastowski, Isabela Jubé

2012-12-20

376

Cardiac Arrest after Patent Blue V Injection for Sentinel Lymph Node Biopsy in Breast Cancer  

PubMed Central

Summary Background Sentinel lymph node biopsy (SLNB) is a widely accepted method to determine lymph node status in for instance breast cancer, cervical cancer, or cutaneous melanomas. Although injection of blue dyes facilitates successful detection of sentinel nodes, they have also been shown to cause adverse reactions. Case Report A 62-year-old female patient was referred to the surgical department of the Atrium Medical Centre with a suspicious lesion located in the right breast, detected during population-based screening. Immediately after injection of patent blue V, the patient developed tachycardia on top of preexisting supraventricular tachycardia and showed an instant drop in blood pressure, after which cardiac arrest occurred. These clear symptoms of anaphylactic shock required prompt treatment, and the patient was treated accordingly. Conclusions Anaphylactic shock after injection of patent blue V remains a serious adverse event and warrants awareness. Immediate action with ephedrine, antihistamines, and subsequently corticosteroids can stabilize the patient. Tc-99m, isosulphan blue, and methylene blue can alternatively be used for SLNB, although also not without side effects.

Telgenkamp, Bjorn; Japink, Dennis; van Haaren, Els

2010-01-01

377

Genetic diagnosis of micrometastasis based on SCC antigen mRNA in cervical lymph nodes of head and neck cancer  

Microsoft Academic Search

This study is designed to assess gene expression of squamous cell carcinoma antigen (SCCA) mRNA to detect micrometastases\\u000a in cervical lymph nodes (LNs) of head and neck cancer. We examined the expression of SCCA mRNA in 12 primary tumors and 212\\u000a cervical LNs (101 LNs taken from 8 patients with tongue cancer, 71 from 7 patients with gingival cancer, 19

Hiroyuki Hamakawa; Masakuni Fukizumi; Yang Bao; Tomoki Sumida; Akiko Onishi; Hiroaki Tanioka; Hidemitsu Sato; Eiji Yumoto

1999-01-01

378

Elevated expression of L-selectin ligand in lymph node-derived human prostate cancer cells correlates with increased tumorigenicity  

Microsoft Academic Search

Human prostate cancer LNCaP cells including C-33 and C-81 cells were originally derived from the lymph nodes of a patient\\u000a with metastatic prostate cancer. These two cells were employed for characterization of L-selectin ligand and in vitro tumorigenicity, because they mimic the clinical conditions of early and late-stage human prostate cancer. C-81 cells exhibit\\u000a higher in vitro migratory and invasive

Prakash Radhakrishnan; Ming-Fong Lin; Pi-Wan Cheng

2009-01-01

379

A prognostic score in histological node negative breast cancer  

Microsoft Academic Search

Between October 1977 and December 1983, 379 consecutive patients have been treated for unilateral, non-metastatic breast cancer, either with conservative (n = 205) or radical surgery (n = 174), with axillary dissection in all the cases. None of them had histologically proved lymph node involvement. Oestrogen receptor (ER) and progesterone receptor (PR) levels were measured on each tumour. Levels greater

B Chevallier; V Mosseri; JP Dauce; P Bastit; JP Julien; B Asselain

1990-01-01

380

Non-invasive molecular imaging of prostate cancer lymph node metastasis  

PubMed Central

Imaging in medicine has been classically based on the anatomical description of organs. In the past 15 years, new imaging techniques based on gene expression that characterize a pathological process have been developed. Molecular imaging is the use of such molecules to image cell-specific characteristics. Here, we review recent advances in molecular imaging, taking as our prime example lymph node (LN) metastasis in prostate cancer. We describe the new techniques and compare their accuracy in detecting LN metastasis in prostate cancer. We also present new molecular strategies for improving tumor detection using adenoviruses, molecular promoters and amplification systems. Finally, we present the concept of ‘in vivo pathology’, which envisages using molecular imaging to accurately localize metastatic lesions based on the molecular signature of the disease.

Pouliot, Frederic; Johnson, Mai; Wu, Lily

2009-01-01

381

Preoperative Lymphoscintigraphy Predicts the Successful Identification but Is Not Necessary in Sentinel Lymph Nodes Biopsy in Breast Cancer  

Microsoft Academic Search

Background  Although preoperative lymphoscintigraphy in sentinel lymph node biopsy (SLNB) for breast cancer patients is undergone commonly,\\u000a its clinical significance remains controversial.\\u000a \\u000a \\u000a \\u000a Methods  We retrospectively analyzed our database that contained 636 consecutive breast cancer patients who received preoperative lymphoscintigraphy\\u000a before SLNB.\\u000a \\u000a \\u000a \\u000a Results  The sentinel lymph nodes (SLNs) of 86.5% of patients were well imaged by lymphoscintigraphy, and SLN were located extra-axilla\\u000a in 5.3%

Lei Wang; Jin-ming Yu; Yong-sheng Wang; Wen-shu Zuo; Yan Gao; Jiang Fan; Ji-yu Li; Xu-dong Hu; Ming-lu Chen; Guo-ren Yang; Zheng-bo Zhou; Yan-song Liu; Yong-qing Li; Yan-bing Liu; Tong Zhao; Peng Chen

2007-01-01