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1

[Intramammary lymph node sentinel metastasis without metastasis in axilla. Axillary lymph node dissection or conservative surgery?].  

PubMed

The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM) sentinel lymph node (SLN) occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation. PMID:23288226

Vieira, René Aloisio da Costa; Viviani, Dionísio Nepomuceno; Ferreira, Suellen Strada; Bailão, Antônio; Kerr, Ligia Maria; Matthes, Angelo Gustavo Zucca; Moriguchi, Sonia Marta

2012-10-01

2

An optimized posterior axillary boost technique in radiation therapy to supraclavicular and axillary lymph nodes: A comparative study  

SciTech Connect

To assess the advantages of an optimized posterior axillary (AX) boost technique for the irradiation of supraclavicular (SC) and AX lymph nodes. Five techniques for the treatment of SC and levels I, II, and III AX lymph nodes were evaluated for 10 patients selected at random: a direct anterior field (AP); an anterior to posterior parallel pair (AP-PA); an anterior field with a posterior axillary boost (PAB); an anterior field with an anterior axillary boost (AAB); and an optimized PAB technique (OptPAB). The target coverage, hot spots, irradiated volume, and dose to organs at risk were evaluated and a statistical analysis comparison was performed. The AP technique delivered insufficient dose to the deeper AX nodes. The AP-PA technique produced larger irradiated volumes and higher mean lung doses than the other techniques. The PAB and AAB techniques originated excessive hot spots in most of the cases. The OptPAB technique produced moderate hot spots while maintaining a similar planning target volume (PTV) coverage, irradiated volume, and dose to organs at risk. This optimized technique combines the advantages of the PAB and AP-PA techniques, with moderate hot spots, sufficient target coverage, and adequate sparing of normal tissues. The presented technique is simple, fast, and easy to implement in routine clinical practice and is superior to the techniques historically used for the treatment of SC and AX lymph nodes.

Hernandez, Victor, E-mail: vhernandezmasgrau@gmail.com [Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Arenas, Meritxell [Department of Radiation therapy, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Müller, Katrin [Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Gomez, David; Bonet, Marta [Department of Radiation therapy, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain)

2013-01-01

3

Endocervicosis involving axillary lymph nodes: first case report.  

PubMed

The occurence of Mullerian epithelial inclusions, especially endosalpingiosis, in pelvic and other subdiaphragmatic lymph nodes is well known. In contrast, Mullerian inclusions involving lymph nodes above the diaphragm is uncommon, although occasional cases of endosalpingiosis have been reported. We report a case of benign Mullerian inclusions of mucinous endocervical type (endocervicosis) coexistent with metastatic breast-infiltrating ductal carcinoma in 2 axillary lymph nodes. The inclusions exhibited diffuse positive staining with CK7, PAX8, CA125, and estrogen receptor and were WT1 negative. To our knowledge, this is the first report of endocervicosis involving supradiaphragmatic lymph nodes. Close morphologic examination and immunohistochemistry assists in distinguishing Mullerian inclusions from metastatic adenocarcinoma. PMID:25272302

Mukonoweshuro, Pinias; McCluggage, W Glenn

2014-11-01

4

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

5

Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy  

PubMed Central

Purpose The axillary arch is an anomalous muscle that is not infrequently encountered during axillary sentinel lymph node biopsy (SLNB) of breast cancer patients. In this study, we aimed to investigate how often the axillary arch is found during SLNB and whether it affects the intraoperative sentinel lymph node (SLN) identification rate. Methods We retrospectively analyzed the correlation between the presence of the axillary arch and the SLN sampling failure rate during SLNB in 1,069 patients who underwent axillary SLNB for invasive breast cancer. Results Of 1,069 patients who underwent SLNB, 79 patients (7.4%) had the axillary arch present. The SLNB failure rate was high when the patient's body mass index was ?25 (p=0.026), when a single SLN mapping technique was used (p=0.012), and when the axillary arch was present (p<0.001). These three factors were also found to be statistically significant by multivariate analysis, and of these three factors, presence of the axillary arch most significantly increased the SLNB failure rate (hazard ratio, 10.96; 95% confidence interval, 4.42-27.21; p<0.001). Additionally, if the axillary arch was present, the mean operative time of SLNB was 20.8 minutes, compared to 12.5 minutes when the axillary arch was not present (p<0.001). If the axillary arch was present, the SLN was often located in a high axillary region (67%) rather than in a general low axillary location. Conclusion The axillary arch was found to be a significant factor affecting intraoperative SLN failure rate. It is necessary to keep in mind that carefully checking the high axillar region during SLNB in breast cancer patients with the axillary arch is important for reducing SLN sampling failure. PMID:25320622

Lee, Jeong Eon; Nam, Seok Jin

2014-01-01

6

Toward nodal staging of axillary lymph node basins through intradermal administration of fluorescent imaging agents  

PubMed Central

As part of a proof-of-concept study for future delivery of targeted near-infrared fluorescent (NIRF) tracers, we sought to assess the delivery of micrograms of indocyanine green to all the axillary lymph nodes following intraparenchymal breast injections and intradermal arm injections in 20 subjects with advanced breast carcinoma and undergoing complete axillary lymph node dissection. Lymphatic vessels and nodes were assessed in vivo. Ex vivo images demonstrated that 87% of excised lymph nodes, including 81% of tumor-positive lymph nodes, were fluorescent. Future clinical studies using microdose amounts of tumor-targeting NIRF contrast agents may demonstrate improved surgical intervention with reduced morbidity. PMID:24466486

Meric-Bernstam, Funda; Rasmussen, John C.; Krishnamurthy, Savitri; Tan, I-Chih; Zhu, Banghe; Wagner, Jamie L.; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Sevick-Muraca, Eva M.

2013-01-01

7

Patients with Recurrent Breast Cancer: Does the Primary Axillary Lymph node Status Predict more Aggressive Tumor Progression?  

Microsoft Academic Search

Background. The extent of axillary lymph node involvement represents the foremost important prognostic parameter in primary breast cancer, and, thus, is one of the main determinants for subsequent systemic treatment. Nevertheless, the relevance of the initial axillary lymph node status on survival after disease recurrence is discussed controversially. Persisting prognostic impact after relapse would identify lymph node status as a

Brigitte Rack; Wolfgang Janni; Bernd Gerber; Barbara Strobl; Christian Schindlbeck; Elisabeth Klanner; Gerhard Rammel; Harald Sommer; Thomas Dimpfl; Klaus Friese

2003-01-01

8

Axillary Dissection in the Case of Positive Sentinel Lymph Nodes: Results of the Innsbruck Consensus Conference  

PubMed Central

The prognosis of breast cancer is most heavily influenced by the status of the axillary nodes. Until a few years ago, this knowledge was gained through radical axillary lymph node clearance. In the meantime, sentinel lymph node clearance has become an established part of the surgical treatment of breast cancer. With the development of this procedure, the morbidity caused by axillary dissection has been reduced significantly. Although comprehensive prospective, randomised data regarding the safe use of the sentinel concept are only now available, the focus currently, however, is on the question of whether in the case of positive sentinel lymph nodes, an axillary dissection can be done away with altogether without having any negative impact on the risk of loco-regional recurrence or on progression-free survival and overall survival. The results of the American ACOSOG-Z001 study have changed the fundamental perspective of this. In this study on the advantages of axillary dissection following the confirmation of tumour tissue in the sentinel lymph nodes, there were no statistically significant advantages from axillary dissection for women with a favourable overall risk profile who had received radiotherapy and systemic therapy. If this concept takes hold, the surgical treatment of node-positive breast cancer, at least in the axilla, would be reduced to a minimum, and the focus of treatment would in future lie more on the systemic treatment of this condition. As part of an interdisciplinary consensus meeting, a standardised approach for Austria with regard to this question was decided upon.

Hubalek, M.; Bartsch, R.; Gnant, M.; Kapp, K. S.; Lang, A.; Lax, S.; Lukas, P.; Neunteufel, W.; Pristauz, G.; Reitsamer, R.; Sandbichler, P.; Schrenk, P.; Singer, C.; Tamussino, K.; Tschmelitsch, J.; Zeimet, A. G.; Marth, C.

2012-01-01

9

Intradermal administration of fluorescent contrast agents for delivery to axillary lymph nodes  

NASA Astrophysics Data System (ADS)

In this proof-of-concept study we seek to demonstrate the delivery of fluorescent contrast agent to the tumor-draining lymph node basin following intraparenchymal breast injections and intradermal arm injection of micrograms of indocyanine green in 20 breast cancer patients undergoing complete axillary lymph node dissection. Individual lymph nodes were assessed ex vivo for presence of fluorescent signal. In all, 88% of tumor-negative lymph nodes and 81% of tumor-positive lymph nodes were fluorescent. These results indicate that future studies utilizing targeted fluorescent contrast agents may demonstrate improved surgical and therapeutic intervention.

Rasmussen, John C.; Meric-Berstam, Funda; Krishnamurthy, Savitri; Tan, I.-Chih; Zhu, Banghe; Wagner, Jamie L.; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Sevick-Muraca, Eva M.

2014-05-01

10

Role of axillary lymph node dissection after tumor downstaging with induction chemotherapy for locally advanced breast cancer  

Microsoft Academic Search

Background: Induction chemotherapy has become the standard of care for patients with locally advanced breast cancer (LABC) and currently is being evaluated in prospective clinical trials in patients with earlier-stage disease. To better gauge the role of axillary lymph node dissection in patients with LABC this study was performed to assess initial axillary status on physical and ultrasound examination, axillary

Henry M. Kuerer; Lisa A. Newman; Bruno D. Fornage; Kapil Dhingra; Kelly K. Hunt; Aman U. Buzdar; Fred C. Ames; Merrick I. Ross; Barry W. Feig; Gabriel N. Hortobagyi; S. Eva Singletary

1998-01-01

11

Efficiency of a Preoperative Axillary Ultrasound and Fine-Needle Aspiration Cytology to Detect Patients with Extensive Axillary Lymph Node Involvement  

PubMed Central

Background Recent studies have demonstrated that axillary lymph node dissection (ALND) does not affect patient survival, even in those with one or two positive sentinel lymph nodes (SLNs). On the other hand, patients with 3 or more metastatic lymph nodes are eligible for chemotherapy. Therefore, it is crucial to identify a priori patients at risk of having a high number of metastatic axillary lymph nodes for their surgical and/or clinical management. Ultrasound (US) guided Fine-Needle Aspiration (FNA) has been proven to be a useful and highly specific method for detecting metastatic axillary lymph nodes. However, only one recent study has evaluated the efficiency of this method in identifying patients with high metastatic nodal involvement. Our aim was to validate US-guided FNA as a reliable method to discriminate a priori patients with >3 metastatic lymph nodes. Methods A retrospective series of 1287 breast cancer patients who underwent a simultaneous preoperative breast and axillary US to stage their axilla was collected. A total of 365 patients, with either positive SLNs (278) or positive axillary lymph nodes detected via US-guided FNA (87), underwent ALND. In these two subgroups, we compared the number of metastatic lymph nodes in the axilla. Results The number of metastatic axillary lymph nodes in patients who underwent US-guided FNA was significantly higher (63% had >3 metastatic lymph nodes) than that in patients with SLNs positive for micro- or macrometastases (3% and 27%, respectively) (P<0.001, ?2?=?117.897). Conclusions Preoperative axillary US-guided FNA could act as a reliable tool in identifying breast cancer patients with extensive nodal involvement. PMID:25207643

Castellano, Isabella; Deambrogio, Cristina; Muscara, Francesca; Chiusa, Luigi; Mariscotti, Giovanna; Bussone, Riccardo; Gazzetta, Guglielmo; Macri, Luigia; Cassoni, Paola; Sapino, Anna

2014-01-01

12

How Many Sentinel Lymph Nodes Are Enough for Accurate Axillary Staging in T1-2 Breast Cancer?  

PubMed Central

Purpose During a sentinel lymph node biopsy (SLNB) for breast cancer, the appropriate number of sentinel lymph nodes (SLNs) to be removed for accurate axillary staging is still controversial. We hypothesized that there might be an optimal threshold number of SLNs. We investigated how many SLNs should be removed to achieve an acceptable accuracy and ensure minimal morbidity. Methods We reviewed data of 328 patients with invasive breast cancer who underwent SLNB followed by complete level I and II axillary dissection between January 2004 and December 2005. The false negative rate (FNR) and accuracy of SLNB according to the number of removed SLNs were evaluated. Results The mean number of SLNs removed was 3.0 (range, 1-14), and that of total retrieved axillary lymph nodes was 17.5 (range, 10-40). In total, 111 (33.8%) patients had positive nodes on the permanent pathological report. Among them, 12 patients had negative SLNs; thus, the overall FNR of SLNB was 10.8% (12/111) and the accuracy was 96.3% (316/328). The FNR was 26.6% for a single SLN, 8.0% for two, and 11.1% for three. In cases where four or more SLNs were removed, the FNR decreased to 0% and accuracy reached 100%. Conclusion Our data suggest that a SLNB should not only remove one or two of the hottest node(s) when other hot nodes exist. We also suggest that four might be an optimal threshold number of SLNs to be removed and that removal of more than four SLNs does not improve axillary staging accuracy. PMID:22323916

Ban, Eun Jeong; Lee, Jun Sang; Koo, Ja Seung; Park, Seho; Kim, Seung Il

2011-01-01

13

In breast cancer patients sentinel lymph node metastasis characteristics predict further axillary involvement.  

PubMed

The aim of the study was to correlate various primary tumor characteristics with lymph node status, to examine sentinel lymph node (SLN) metastasis size and non-SLN axillary involvement, to look for a cut-off size/number value possibly predicting additional axillary involvement with more accuracy and to examine the relationship of SLN metastasis size to overall survival. Of 301 patients who underwent SLN biopsy, 75 had positive SLNs. The size of the metastases was measured. For different size categories, association with the prevalence of non-SLN metastases was assessed. Associations between metastasis size and tumor characteristics and overall survival (OS) were studied. The prevalence of axillary lymph node (ALN) involvement was not significantly different between cases with micrometastasis or macrometastasis in SLNs (p = 0.124). However, for metastases larger than 6, 7, and 8 mm, the prevalence of ALN involvement was significantly higher (p = 0.046, 0.022, and 0.025). OS was significantly lower in SLN-positive than in SLN-negative cases (p = 0.0375). Primary tumor size larger than 20 mm was associated with a significantly higher incidence of SLN metastasis (p < 0.001), and primary tumor size over 26 mm was associated with additional positive non-SLN (p < 0.001). Higher mitotic index (? 7) in primary tumors was significantly (p < 0.001) associated with ALN involvement in SLN-positive cases, whereas higher Ki67 labeling index was not significantly correlated with SLN or ALN involvement. Lymphovascular invasion (LVI) in primary tumors was significantly correlated with SLN positivity (p < 0.001) but not with further ALN involvement or OS. Tumor size and LVI are predictive for SLN metastasis. Mitotic index, primary tumor size, and larger volume SLN involvement are determinants of further ALN involvement. SLN metastasis size over 6 mm is a strong predictor of further axillary involvement. OS is shorter in the presence of positive SLN. PMID:24809673

Illyes, Ildiko; Tokes, Anna-Maria; Kovacs, Attila; Szasz, A Marcell; Molnar, Bela A; Molnar, Istvan A; Kaszas, Ilona; Baranyak, Zsuzsanna; Laszlo, Zsolt; Kenessey, Istvan; Kulka, Janina

2014-07-01

14

Relevance and methods of interventional breast sonography in preoperative axillary lymph node staging.  

PubMed

Reduction of therapy-induced morbidity is an important goal for the improvement of the quality of breast cancer treatment. The introduction of sentinel lymph node biopsy (SLNB) significantly contributed to the reduction of surgery-induced morbidity in the shoulder-arm region. However, a clinically positive nodal status is still considered a contra-indication for SLNB. The current data constellation clearly shows that the clinical and also the sonographic malignancy assessment is insufficient for the accurate identification of the nodal status. A merely clinical and/or image-based appraisal of the axillary lymph node status would lead to overtreatment due to unnecessary axillary dissection in approximately 40 % of patients. In order to reduce the rate of unnecessary axillary dissection (AD), pretreatment interventional clarification is necessary to provide more detailed information about the histological condition of the lymph node. Comparing the currently available methods, fine needle aspiration (FNA) is the best in terms of cost and time requirement, practicability and complication rate. However, considering the sensitivity, it is inferior to ultrasound-guided core needle biopsy (CNB). Thus, a negative FNA outcome requires further clarification, which possibly can be performed with CNB. With a specificity of nearly 100 % and therefore a low rate of false positive cases for FNA, complete AD can be indicated by a positive FNA result. In the context of the interventional procedure, it must be stressed that FNA requires a high level of expertise on the part of both the examiner and the cytologist. The prerequisite for optimal interventional diagnostics of lymph nodes is an adequate sonographic assessment on the basis of standardized sonomorphological criteria. PMID:21618166

Gruber, I; Hahn, M; Fehm, T; Hann von Weyhern, C; Stäbler, A; Winckelmann, A; Wallwiener, D; Kühn, T

2012-08-01

15

Chalkley microvessel but not lymphatic vessel density correlates with axillary lymph node metastasis in primary breast cancers.  

PubMed

This study aimed to investigate tumor microvessel density (MVD) and lymphatic vessel density (LVD) using the Chalkley method as predictive markers for the risk of axillary lymph node metastasis and their relationship to other clinicopathological parameters in primary breast cancer cases. Forty two node-positive and eighty node-negative breast cancers were immunostained for CD34 and D2-40. MVD and LVD were counted by the Chalkley method at x400 magnification. There was a positive significant correlation of the MVD with the tumor size, coexisting ductal carcinoma in situ (DCIS) and lymph node metastases (P<0.05). In multivariate analysis, the MVD (2.86-4: OR 5.87 95%CI 1.05-32; >4: OR 20.03 95%CI 3.47-115.6), lymphovascular invasion (OR 3.46, 95% CI 1.13-10.6), and associated DCIS (OR 3.1, 95%CI 1.04-9.23) independently predicted axillary lymph node metastasis. There was no significant relationship between LVD and axillary lymph node metastasis. However, D2-40 was a good lymphatic vessel marker to enhance the detection of lymphatic invasion compared to H and E staining. In conclusion, MVD by the Chalkley method, lymphovascular invasion and associated DCIS can be additional predictive factors for axillary lymph node metastases in breast cancer. No relationship was identified between LVD and clinicopathological variables, including axillary lymph node metastasis. PMID:23534799

Kanngurn, Samornmas; Thongsuksai, Paramee; Chewatanakornkul, Siripong

2013-01-01

16

A Rapidly Enlarging Squamous Inclusion Cyst in an Axillary Lymph Node following Core Needle Biopsy  

PubMed Central

A 73-year-old woman was found to have a 1.7?cm axillary mass, for which a core needle biopsy was performed. The specimen revealed fragmented squamous epithelium surrounded by lymphoid tissue consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. Within one month, the lesion enlarged to 5?cm and was excised. Touch preparation cytology during intraoperative consultation displayed numerous single and sheets of atypical epithelioid cells with enlarged nuclei and occasional mitoses, suggesting a carcinoma. However, multinucleated giant cells and neutrophils in the background indicated reactive changes. We interpreted the touch preparation as atypical and recommended conservative surgical management. Permanent sections revealed a ruptured squamous inclusion cyst in a lymph node with extensive reactive changes. Retrospectively, the atypical epithelioid cells on touch preparation corresponded to reactive histiocytes. This is the first case report of a rapidly enlarging ruptured squamous inclusion cyst in an axillary lymph node following core needle biopsy. Our case demonstrates the diagnostic challenges related to a ruptured squamous inclusion cyst and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations. PMID:22953131

Zhang, Cunxian; Xiong, Jinjun; Quddus, M. Ruhul; Ou, Joyce J.; Hansen, Katrine; Sung, C. James

2012-01-01

17

Infiltrating ductal carcinoma breast, metastatic to ipsilateral axillary lymph nodes harbouring primary tuberculous lymphadenitis: a case report  

PubMed Central

The coexistence of breast cancer and tuberculosis has been described in over 100 cases; however its coexistence in the axillary lymph node is rare with only a handful cases have been reported in the literature. We report a case of infiltrating ductal carcinoma of the left breast, metastatic to ipsilateral axillary lymph nodes harbouring tuberculous lymphadenitis without primary mammary or pulmonary tuberculosis. The case is presented for its rarity and illustrates that the simultaneous occurrence of tuberculosis and carcinoma can create a dilemma in the diagnosis and treatment, so surgeons and pathologists should keep such a combination on the back of their mind, especially in endemic areas.

Pandey, Pinki; Dixit, Alok; Tanwar, Aparna; Mahajan, NC

2014-01-01

18

Toxoplasmosis presenting as a swelling in the axillary tail of the breast and a palpable axillary lymph node mimicking malignancy: a case report  

PubMed Central

Introduction Lymphadenopathy is a common finding in toxoplasmosis. A breast mass due to toxoplasmosis is very rare, and only a few cases have been reported. We present a case of toxoplasmosis that presented as a swelling in the axillary tail of the breast with a palpable axillary lymph node which mimicked breast cancer. Case presentation A 45-year-old otherwise healthy Caucasian woman presented with a lump on the lateral aspect of her left breast. Her mother had breast cancer that was diagnosed at the age of 66 years. During an examination, we discovered that our patient had a discrete, firm lump in the axillary tail of her left breast and an enlarged, palpable lymph node in her left axilla. Her right breast and axilla were normal. The clinical diagnosis was malignancy in the left breast. Ultrasound and mammographic examinations of her breast suggested a pathological process but were not conclusive. She had targeted fine-needle aspiration cytology (FNAC) and core biopsy of the lesions. FNAC was indeterminate (C3) but suggested a possibility of toxoplasmosis. The core biopsy was not suggestive of malignancy but showed granulomatous inflammation. She had a wide local excision of the breast lump and an axillary lymph node biopsy. Histopathology and immunohistochemical studies excluded carcinoma or lymphoma but suggested the possibility of intramammary and axillary toxoplasmic lymphadenopathy. The results of Toxoplasma gondii IgM and IgG serology tests were positive, supporting a diagnosis of toxoplasmosis. Conclusions Toxoplasmosis rarely presents as a pseudotumor of the breast. FNAC and histology are valuable tools for a diagnosis of toxoplasmosis, and serology is an important adjunct for confirmation. PMID:21816047

2011-01-01

19

Quality of Life After Axillary or Groin Sentinel Lymph Node Biopsy, With or Without Completion Lymph Node Dissection, in Patients With Cutaneous Melanoma  

Microsoft Academic Search

Background  The aim of this study was to asses quality of life (QoL) after axillary or inguinal sentinel lymph node biopsy (SLNB) with\\u000a or without completion lymph node dissection (CLND) in patients with cutaneous melanoma by comparing patients to a norm group\\u000a of the general population and by comparing QoL between four patient groups depending on surgical procedure and location, i.e.,

Mattijs de Vries; Harald J. Hoekstra; Josette E. H. M. Hoekstra-Weebers

2009-01-01

20

Lymph-node staining with activated carbon CH40: a new method for axillary lymph-node dissection in breast cancer  

PubMed Central

Objective To demonstrate the usefulness of activated carbon particles (CH40) as a vital staining dye for visualizing lymphatic vessels and lymph nodes in breast cancer. Design A retrospective evaluation. Setting Department of Surgery in Sendai National Hospital, Japan, a 716-bed teaching hospital. Methods To identify as many lymph nodes as possible in the axillary fat, by which we might decrease the possibility of the presence of undetected metastatic nodes, an emulsion of activated carbon particles (CH40) was injected into the centre of the mammary gland, close to the tumour site, 3 days before radical surgery. Main outcome measure The number of lymph nodes found by the traditional method and by the CH40-injection method were recorded. Results After injection, the CH40 was readily adsorbed into regional lymphatics and streamed along with the lymph flow to blacken regional lymph nodes. The CH40-guided method increased the mean number of nodes per case found in the axilla from 8.4, by the traditional method, to 14.0 nodes per case. Conclusions The use of the CH40 technique has two technical advantages; one is that it allows surgeons to locate the blackened lymph nodes at the time of surgery and the other is that it allows pathologists to look for the nodes in fatty tissue. Lymph-node dissection with the aid of activated carbon particles is inexpensive, easy to perform and enables the smallest lymph nodes to be easily recognized. CH40 is the technique of choice for the detection of axillary lymph nodes in cases where the number of lymph nodes detected by the traditional method is too small for accurate surgery. In conclusion, the present study demonstrates that CH40 could be an appropriate tool for more accurate staging of breast cancer axillary specimens. PMID:10851412

Yokota, Takashi; Saito, Toshihiro; Narushima, Yoichi; Iwamoto, Kazutsugu; Iizuka, Masashi; Hagiwara, Akeo; Sawai, Kiyoshi; Kikuchi, Shu; Kunii, Yasuo; Yamauchi, Hidemi

2000-01-01

21

A moat around castle walls. The role of axillary and facial hair in lymph node protection from mutagenic factors.  

PubMed

Axillary hair is a highly conserved phenotypical feature in humans, and as such deserves at least consideration of its functional significance. Protection from environmental factors is one of the main functions attributed to hair in furred vertebrates, but is believed to be inapplicable to humans. I considered the hypothesis that the phenotypic preservation of axillary hair is due to its unrecognized role in the organism protection. Two immediate questions arise--what exactly is being protected and what it is protected from. A large group of axillary lymph nodes represents a major difference between underarms and the adjacent areas of the trunk. The consideration of potential factors from which hair can offer protection identifies sunlight as the most likely candidate. Intense sweat production underarms may represent an independent defense mechanism, specifically protecting lymph nodes from overheating. Moreover, the pattern of facial hair growth in males strikingly overlaps with the distribution of superficial lymph nodes, suggesting potential role for facial hair in protection of lymph nodes, and possibly thymus and thyroid. The idea of lymph node protection from environmental mutagenic factors, such as UV radiation and heat, appears particularly important in light of wide association of lymph nodes with cancers. The position of contemporary fashion towards body hair is aggressively negative, including the social pressure for removal of axillary and bikini line hair for women, facial hair for men in many professional occupations, and even body hair for men. If this hypothesis is proven to be true, the implications will be significant for immunology (by providing new insights in lymph node physiology), health sciences (depilation is painful and therefore easily modifiable habit if proven to increase disease risk), as well as art, social fashion and economy. PMID:16690220

Komarova, Svetlana V

2006-01-01

22

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. PMID:23136607

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

23

Use of the dye-guided sentinel lymph node biopsy method alone for breast cancer metastasis to avoid unnecessary axillary lymph node dissection  

PubMed Central

For sentinel lymph node biopsy (SLNB), a combination of dye-guided and ?-probe-guided methods is the most commonly used technique. However, the number of institutes in which the ?-probe-guided method is able to be performed is limited, since special equipment is required for the method. In this study, SLNB with the dye-guided method alone was evaluated, and the clinicopathological characteristics were analyzed to identify any factors that were predictive of whether the follow-up axillary lymph node dissection (ALND) was able to be omitted. A total of 374 patients who underwent SLNB between 1999 and 2009 were studied. The SLN identification rate was analyzed, in addition to the false-positive and false-negative rates and the correlation between the clinicopathological characteristics and axillary lymph node metastases. The SLN was identified in 96.8% of cases, and, out of the patients who had SLN metastasis, 63.0% did not exhibit metastasis elsewhere. The sensitivity was 96.4% and the specificity was 100%. The false-negative rate was 3.6%. Univariate analyses revealed significant differences in the lymph vessel invasion (ly) status, nuclear grade (NG), maximum tumor size and the percentage of the area occupied by the tumor cells in the SLN (SLN occupation ratio) between the patients with and without non-SLN metastasis, indicating that these factors may be predictive of axillary lymph node metastasis. Multivariate analysis revealed that ly status was an independent risk factor for non-SLN metastasis. In conclusion, SLN with the dye-guided method alone provided a high detection rate. The study identified a predictive factor for axillary lymph node metastasis that may improve the patients’ quality of life. PMID:24396425

TAKAMARU, TOMOKO; KUTOMI, GORO; SATOMI, FUKINO; SHIMA, HIROAKI; OHNO, KEISUKE; KAMESHIMA, HIDEKAZU; SUZUKI, YASUYO; OHMURA, TOUSEI; TAKAMARU, HIROYUKI; NOJIMA, MASANORI; MORI, MITSURU; HIRATA, KOICHI

2014-01-01

24

Axillary lymph node metastasis as first presentation of peritoneal carcinomatosis from serous papillary ovarian cancer: case report and review of the literature.  

PubMed

Ovarian cancer usually spreads into abdominal cavity and to the loco-regional lymph nodes. Extra-abdominal metastases are less frequent and isolated axillary metastases are very rare. The authors describe the case of a 49-year-old woman who was diagnosed with a peritoneal carcinomatosis from ovarian cancer by mean of an enlarged axillary lymph node biopsy, whose histological examination identified as a ovarian cancer metastasis. Patient was treated by peritonectomy and intraperitoneal chemohyperthermic perfusion (HIPEC). Although patients with axillary lymph node metastasis from ovarian cancer are though to be metastatic (FIGO Stage IV), surgical radical treatment and adjuvant systemic chemotherapy can achieve the same prognosis of Stage IIIb-c patients, suggesting they could be a particularly good prognosis subset of patients. Early differential diagnosis between ovarian or breast cancer in axillary lymph node metastasis is crucial but not always very simple, because of the very different course and treatment of these tumours. PMID:24772922

Sibio, S; Sammartino, P; Accarpio, F; Framarino dei Malatesta, M L; Biacchi, D; Sollazzo, B M; Di Giorgio, A

2014-01-01

25

High-dose chemotherapy with autologous peripheral blood progenitor cell support for primary breast cancer in patients with 4–9 involved axillary lymph nodes  

Microsoft Academic Search

Breast cancer patients with more than three involved axillary lymph have a high likelihood of relapse after adjuvant therapy. Early results of administration of high-dose chemotherapy (HDCT) and autologous peripheral blood progenitor cells (PBPC) to patients with primary breast cancer and ?10 involved axillary nodes have been encouraging. We performed a multicenter trial to determine whether HDCT could be safely

SI Bearman; BA Overmoyer; BJ Bolwell; CW Taylor; EJ Shpall; PJ Cagnoni; BE Mechling; B Ronk; AE Barón; MH Purdy; M Ross; RB Jones

1997-01-01

26

Optical characterization of ex-vivo axillary lymph nodes of breast-cancer patients using a custom-built spectrophotometer  

NASA Astrophysics Data System (ADS)

Quantitative photoacoustics is emerging as a new hybrid modality to investigate diseases and cells in human pathology and cytology studies. Optical absorption of light is the predominant mechanism behind the photoacoustic effect. Therefore, a need exits to characterize the optical properties of specimens and to identify the relevant operating wavelengths for photoacoustic imaging. We have developed a custom low-cost spectrophotometer to measure the optical properties of human axillary lymph nodes dissected for breast-cancer staging. Optical extinction curves of positive and negative nodes were determined in the spectral range of 400 to 1000 nm. We have developed a model to estimate tissue optical properties, taking into account the role of fat and saline. Our results enabled us to select the optimal optical wavelengths for maximizing the imaging contrast between metastatic and noncancerous tissue in axillary lymph nodes.

Sampathkumar, Ashwin; Saegusa-Beecroft, Emi; Mamou, Jonathan; Chitnis, Parag V.; Machi, Junji; Feleppa, Ernest J.

2014-03-01

27

Spontaneous regression of breast cancer with axillary lymph node metastasis: a case report and review of literature  

PubMed Central

Spontaneous regression (SR) of cancer is a rare but well-documented biological phenomenon. However, the mechanism remains to be elucidated. We herein report a case of the SR of breast cancer at both the primary site and metastatic axillary lymph node with spontaneously-induced T cell-mediated immunological responses. A 52-year-old female with a lump in the left axilla was diagnosed to have a small breast carcinoma with a distinct axillary lymph node metastasis. During the preoperative systemic examination, she was diagnosed to have severe type 2 diabetes mellitus, was treated with insulin, and the hyperglycemia was normalized after one month. Surgery for left breast cancer was then performed. The postoperative histopathological examination revealed the SR of breast cancer at both the primary site and metastatic axillary lymph node. Immunohistochemical studies revealed that estrogen receptor positive, AE1/AE3-positive ductal carcinoma completely underwent necrosis associated with extensive infiltration of CD3-positive T cells in the tumor nodule in the lymph node. In addition, primary ductal carcinoma cells also underwent single cell necrosis with infiltration of T cells with lymph follicle-like organization of B cells in the mammary gland. The features were suggestive that the tumor eradication in the metastatic lymph node and regression of the primary ductal carcinoma could be due to host T cell response to the ductal carcinoma. As far as we know it is the first report that shows the spontaneous regression of breast cancer, probably due to the spontaneously-induced T cell response. PMID:25120822

Tokunaga, Eriko; Okano, Shinji; Nakashima, Yuichiro; Yamashita, Nami; Tanaka, Kimihiro; Akiyoshi, Sauri; Taketani, Kenji; Shirouzu, Mitsunori; Yamamoto, Hidetaka; Morita, Masaru; Maehara, Yoshihiko

2014-01-01

28

The number of tumor-free axillary lymph nodes removed as a prognostic parameter for node-negative breast cancer.  

PubMed

Recently, there has been controversy about the relationship between the number of lymph nodes removed and survival of patients diagnosed with lymph node-negative breast cancer. To assess this relationship, 603 cases of lymph node-negative breast cancer with a median of 126 months of follow-up data were studied. Patients were stratified into two groups (Group A, 10 or fewer tumor-free lymph nodes removed; Group B, more than 10 tumor-free lymph nodes removed). The number of tumor-free lymph nodes in ipsilateral axillary resections as well as 5 other disease parameters were analyzed for prognostic value. Our results revealed that the risk of death from breast cancer was significantly associated with patient age, marital status, histologic grade, tumor size, and adjuvant therapy. The 5- and 10-year survival rates for patients with 10 or fewer tumor-free lymph nodes removed was 88.0% and 66.4%, respectively, compared with 69.2% and 51.1%, respectively, for patients with more than 10 tumor-free lymph nodes removed. For patients with 10 or fewer tumor-free lymph nodes removed, the adjusted hazard ratio (HR) for risk of death from breast cancer was 0.579 (95% confidence interval, 0.492-0.687, P < 0.001), independent of patient age, marital status, histologic grade, tumor size, and adjuvant therapy. Our study suggests that the number of tumor-free lymph nodes removed is an independent predictor in cases of lymph node-negative breast cancer. PMID:25322865

Gao, Fei; He, Ni; Wu, Pei-Hong

2014-11-01

29

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

30

The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature  

Microsoft Academic Search

Axillary lymph node status is the most powerful prognostic indicator in patients with breast cancer. FDG-PET has been suggested\\u000a as a non-invasive method of staging the axilla. The aim of this study was to review and aggregate all studies that measured\\u000a the performance of FDG-PET in patients with breast cancer, using surgically obtained axillary histology as a reference, in\\u000a a

Rebecca PeareR; S. D. Heys

2010-01-01

31

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

32

Reactivity of axillary lymph-nodes draining invasive breast carcinomas - immunohistochemical evidence of tumor-associated reactions of B-region and T-region.  

PubMed

The B and T regions in 495 axillary lymph nodes (TU-LN) draining 104 invasive breast carcinomas and 34 non-tumor-draining axillary/cervical lymph nodes (R-LN) were investigated immunohistochernically in frozen sections. The extents of the B regions and T regions were evaluated by staining with TO15 (CD22) and Leu-1 (CD5), respectively. Staining with Ki-M4, which specifically recognizes follicular dendritic cells, enabled determination of the number of lymphatic follicles. The germinal-center index (GCI), the numerical ratio of primary to secondary follicles, was determined to quantify the reactivity of the B regions. The number of Ki-67+ proliferating lymphoid cells per 0.5 mm(2) T region (PCT) was assessed as an index of the reactivity of the T regions. (i) In the TU-LN, the median GCI and PCT (0.1 and 18, respectively) were significantly lower than in the R-LN (0.6 and 26, respectively; both p<0.01). (ii) Greater TU-LN volumes were found to be associated with predominance of the T regions, high GCIs, and high PCTs. (iii) Higher GCIs and PCTs were associated with predominance of the T regions in TU-LN in general, but TU-LN partially destroyed by tumor metastases exhibited higher GCIs and PCTs when there was predominance of the B regions. The findings of the study show that LN draining breast carcinomas and reactive LN with signs of chronic nonspecific lymphadenitis exhibit significant immunohistochemical differences but it remains open to speculation whether the malignant tumor exerts suppressive effects on the lymphoreticular tissue or whether its antigenicity is low, particularly when compared with common, mostly infectious stimuli leading to chronic lymphadenitis. PMID:21607369

Horny, H; Horst, H

1994-03-01

33

Large Axillary Defect after Lymph Node Dissection Directly Closed by Suturing the Pectoralis Major to the Latissimus Dorsi  

PubMed Central

Summary: In 2009, the Union for International Cancer Control defined lymph node (LN) metastasis ?6 cm in diameter as stage 4 in squamous cell carcinoma of the skin. Lesions from such LNs become ulcerated and infected and bleed without treatment. A 67-year-old man suffered from skin cancer on his right back and a 7-cm-diameter LN metastasis. After axillary LN dissection, a large skin and soft tissue defect was apparent. To rectify the defect, we simply sutured the pectoralis major muscle to the latissimus dorsi muscle and covered the suture with a split-skin mesh graft. After the surgery, the range of motion of the upper limb on the side where surgery was performed remained in good condition. PMID:25289196

Konno, Takayuki; Suzuki, Tamio

2013-01-01

34

Sentinel lymph node biopsy examination for breast cancer patients with clinically negative axillary lymph nodes after neoadjuvant chemotherapy  

Microsoft Academic Search

BackgroundThe feasibility and accuracy of sentinel lymph node (SLN) biopsy examination for breast cancer patients with clinically node-negative breast cancer after neoadjuvant chemotherapy (NAC) have been investigated under the administration of a radiocolloid imaging agent injected intradermally over a tumor. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical

Takayuki Kinoshita; Miyuki Takasugi; Eriko Iwamoto; Sadako Akashi-Tanaka; Takashi Fukutomi; Shoji Terui

2006-01-01

35

Women with Breast Cancer Micrometastases in Their Sentinel Lymph Nodes May Not Need Axillary Dissection  

MedlinePLUS

... Program Coordinating Center for Clinical Trials Women with Breast Cancer Micrometastases in Their Sentinel Lymph Nodes May Not ... Summary In a randomized clinical trial , women with breast cancer and only small numbers of cancer cells ( micrometastases ) ...

36

Evaluation of the metastatic status of lymph nodes identified using axillary reverse mapping in breast cancer patients  

PubMed Central

Background Axillary reverse mapping (ARM) is a new technique to preserve upper extremity lymphatic pathways during axillary lymph node dissection (ALND), thereby preventing lymphedema patients with breast cancer. However, the oncologic safety of sparing the nodes identified by ARM (ARM nodes), some of which are positive, has not been verified. We evaluated the metastatic status of ARM nodes and the efficacy of fine needle aspiration cytology (FNAC) in assessing ARM node metastasis. Methods Sixty patients with breast cancer who underwent ARM during ALND between January 2010 and July 2012 were included in this study. Twenty-five patients were clinically node-positive and underwent ALND without sentinel lymph node biopsy (SLNB). Thirty-five patients were clinically node-negative but sentinel node-positive on the SLND. The lymphatic pathway was visualized using fluorescence imaging with indocyanine green. ARM nodes in ALND field, whose status was diagnosed using FNAC, were removed and processed for histology. We evaluated the correlation between the cytological findings of FNAC and the histological analysis of excised ARM nodes. Results The mean number of ARM nodes identified per patient was 1.6 ±0.9 in both groups. In most patients without (88%) and with (79%) SLNB, the ARM nodes were located between the axillary vein and the second intercostobrachial nerve. FNAC was performed for 45 ARM nodes, 10 of which could not be diagnosed. Six of the patients without SLNB (24%) and onewith SLNB (3%) had positive ARM nodes. Of these sevenpatients, four had >3 positive ARM nodes. There was no discordance between the cytological and histological diagnosis of ARM nodes status. Conclusions Positive ARM nodes were observed in the patients not only with extensive nodal metastasis but also in those with a few positive nodes. FNAC for ARM nodes was helpful in assessing ARM nodes metastasis, which can be beneficial in sparing nodes essential for lymphatic drainage, thereby potentially reducing the incidence of lymphedema. However, the success of sampling rates needs to be improved. PMID:23116152

2012-01-01

37

INTRODUCTION Assessment of axillary lymph node status is important in breast cancer staging. UK guidance  

E-print Network

images of the body in any plane and is a non-invasive technique with few adverse events. An MRI scan may, are associated with adverse effects such as arm lymphoedema. Magnetic resonance imaging (MRI) provides detailed provide information on whether a lymph node is suspicious for metastasis, avoiding the need for surgery

Oakley, Jeremy

38

Is Axillary Lymph Node Dissection Indicated for Early Stage Breast Cancer---A Decision Analysis  

E-print Network

tumors who might not be candidates for adjuvant chemotherapy if lymph nodes are negative. Virtually no benefit results in ER negative women, almost all of whom would receive adjuvant chemotherapy. Adjusting in the management of breast cancer. In a patient with a clinically negative axilla, ALND is performed primarily

West, Mike

39

Risk factors for locoregional recurrence after postmastectomy radiotherapy in breast cancer patients with four or more positive axillary lymph nodes  

PubMed Central

Background We investigated risk factors for locoregional recurrence (lrr) in breast cancer patients with 4 or more positive axillary lymph nodes receiving postmastectomy radiotherapy (pmrt). Methods Medical records (1998–2007) were retrospectively reviewed for the population of interest. The Kaplan–Meier method was used to calculate the survival rate; Cox regression models were used for univariate and multivariate analysis of predictors of breast cancer lrr. Results The study enrolled 439 patients. Median duration of follow-up was 54 months. The 5-year rates of locoregional recurrence-free survival (lrrfs), distant metastasis–free survival (dmfs), and breast cancer–specific survival (bcss) were 87.8%, 59.5%, and 70.7% respectively. In patients with lrr and no concomitant metastasis, and in those without lrr, the 5-year rates of dmfs were 21.1% and 65.7% respectively (p < 0.001), and the 5-year rates of bcss were 34.5% and 76.4% respectively (p < 0.001). Univariate analysis showed that menopausal status (p = 0.041), pN stage (p = 0.006), and positivity for her2 [human epidermal growth factor receptor 2 (p = 0.003)] or the triple-negative disease subtype (p < 0.001) were determinants of lrrfs. Multivariate analysis showed that pN3 stage [hazard ratio (hr): 2.241; 95% confidence interval (ci): 1.270 to 3.957; p = 0.005], her2 positivity (hr: 2.705; 95% ci: 1.371 to 5.335; p = 0.004), and triple-negative disease subtype (hr: 4.617; 95% ci: 2.192 to 9.723; p < 0.001) were independent prognostic factors of lrrfs. Conclusions In breast cancer patients with 4 or more positive axillary lymph nodes who undergo pmrt for breast cancer, lrr significantly influences survival. Patients who developed lrr carried a high risk for distant metastasis and death. Pathologic stage (pN3), her2 positivity, and the triple-negative disease subtype are risk factors that significantly influence lrrfs. PMID:25302039

Li, Q.; Wu, S.; Zhou, J.; Sun, J.; Li, F.; Lin, Q.; Guan, X.; Lin, H.; He, Z.

2014-01-01

40

The value of preoperative ultrasound guided fine-needle aspiration cytology of radiologically suspicious axillary lymph nodes in breast cancer  

PubMed Central

Background: Preoperative ultrasound (US) and eventually US-guided fine-needle aspiration cytology (FNAC) of suspicious axillary lymph nodes (ALN) is a standard procedure in the work-up of suspicious breast lesions. Preoperative US FNAC may prevent sentinel node biopsy (SNB) procedure in 24-30% of patients with early stage breast carcinoma. The aim of this study was to evaluate the institutional results of this preoperative diagnostic procedure. Materials and Methods: A total of 182 cases of preoperative FNAC of suspicious ALN where retrieved from the pathology files. The results were compared with the final histology and staging. False negative (FN) FNAC cases were reviewed and possibly missed metastatic cases (2) were immunostained with the epithelial marker AE1/AE3. Results: There were no false positives, whereas 16 cases were FN. In all but one case the FN's represented sampling error. Half of the 16 FN cases in this series were macrometastases. Discussion: About 83% of the preoperatively aspirated cases were N+, indicating that a radiologically suspicious ALN has a very high risk of being metastatic. Preoperative US guided FNAC from radiologically suspicious ALN is highly efficient in detecting metastases. Depending on national guidelines, a preoperative, positive ALN FNAC might help to stratify the patients as to SNB and/or ALN dissection. PMID:25317197

Sauer, Torill; Karesen, Rolf

2014-01-01

41

Postoperative radiation for women with cancer of the breast and positive axillary lymph nodes  

SciTech Connect

The author states his belief that further studies of routine radiation therapy of women with Stage II breast cancer are not waranted and further use of this treatment is not justified. He has not been able to find any systematic discussion within the medical community about what criteria will be used to reach some conclusion about the efficacy of radiation therapy in the large group of women with Stage II disease. (DAD)

Lipsett, M.B.

1981-01-08

42

Cytological and Pathological Correlation of FNAC in Assessing Breast Lumps and Axillary Lymph Node Swellings in a Public Sector Hospital in India  

PubMed Central

Background. Breast lumps have varied pathology, and there are different techniques to prove the diagnosis. The aim of the present study is to analyze the role of fine needle aspiration cytology (FNAC) of the breast lesions at our center. Methods. We had retrospectively analysed 854 patients who underwent FNAC for primary breast lumps and 190 patients who underwent FNAC for an axillary lymph node in the year 2010. Results. Of 854 patients, histological correlation was available in 723 patients. The analysis was done for 812 patients as medical records were not available for 42 patients. FNAC was false negative in seven cases; 2 cases of phyllodes were reported as fibroadenoma, and 5 cases of carcinoma were diagnosed as atypical hyperplasia. The sensitivity, specificity, and false negative value of FNAC in diagnosing breast lumps were 99% (715/723), 100%, and 1%, respectively. Of 190 patients for whom FNAC was performed for axilla, 170 had proven to have axillary lymph node metastases, and the rest had reactive hyperplasia or inflammatory cells. Conclusions. FNAC is rapid, accurate, outpatient based, and less complicated procedure and helps in diagnosis of breast cancer, benign diseases, and axillary involvement in experienced hands with less chance of false results. PMID:24455419

Challa, Vasu Reddy; Yale Guru, Basavanna Goud; Rangappa, Poornima; Deshmane, Vijayalakshmi; Gayathri, devi. M.

2013-01-01

43

A prediction model for the presence of axillary lymph node involvement in women with invasive breast cancer: a focus on older women.  

PubMed

Axillary lymph node (ALN) status at diagnosis is the most powerful prognostic indicator for patients with breast cancer. Our aim is to examine the contribution of variables that lead to ALN metastases in a large dataset with a high proportion of patients greater than 70 years old. Using the data from two multicenter prospective studies, a retrospective review was performed on 2,812 patients diagnosed with clinically node-negative invasive breast cancer from 1996 to 2005 and who underwent ALN sampling. Univariate and multivariate logistic regression were used to identify variables that were strongly associated with axillary metastases, and an equation was developed to estimate risk of ALN metastases. Of the 2,812 patients with invasive breast cancer, 18% had ALN metastases at diagnosis. Based on univariate analysis, tumor size, lymphovascular invasion (LVI), tumor grade, age at diagnosis, menopausal status, race, tumor location, tumor type, and estrogen and progesterone receptor status were statistically significant. The relationship between age and involvement of axillary metastases was nonlinear. In multivariate analysis, LVI, tumor size and menopausal status were the most significant factors associated with ALN metastases. Age, however, was not a significant contributing factor for axillary metastases. Tumor size, LVI, and menopausal status are strongly associated with ALN metastases. We believe that age may have been a strong factor in previous analyses because there was not an adequate representation of women in older age groups and because of the violation of the assumption of linearity in their multivariate analyses. PMID:24475876

Greer, Lauren T; Rosman, Martin; Charles Mylander, W; Liang, Wen; Buras, Robert R; Chagpar, Anees B; Edwards, Michael J; Tafra, Lorraine

2014-01-01

44

Survival in 12,653 breast cancer patients with extensive axillary lymph node metastasis in the anthracycline era  

PubMed Central

Institutional data are conflicting regarding the prognosis of breast cancer patients with extensive (?10) axillary lymph node (ALN) metastases. We hypothesized that overall survival (OS) and disease specific survival (DSS) improved after the introduction of anthracycline-based therapy in 1997. We used the Surveillance, Epidemiology, and End results (SEER) database to identify breast cancer patients with ?10 ALN metastases diagnosed between 1988 and 2004. Patients were categorized according to whether they were diagnosed prior to the FDA approval of anthracyclines (pre-anthracycline era, pre-AE) or after approval (post-anthracycline era, post-AE). Univariate analyses of OS and DSS were performed using the Kaplan–Meier method and differences assessed via the log rank test. Anthracycline era as an independent predictor of OS and DSS was evaluated using Cox proportional hazards models with patient age, hormone receptor status, tumor size, use of radiation therapy, and number of metastatic ALNs as covariates. Entry criteria were met by 12,653 patients. Of these, 5,655 (44.7%) and 6,998 (55.3%) were treated in the pre-AE and post-AE, respectively. On univariate analysis, post-AE patients experienced significantly improved rates of OS (P<0.001) and DSS (P<0.001) relative to pre-AE patients. On multivariate analysis, treatment in the post-AE favorably influenced both OS (Hazard Ratio [HR] 0.90, 95% Confidence Interval [CI] 0.84–0.96) and DSS (HR 0.84, CI 0.79–0.91). Both OS and DSS are poor in patients with extensive ALN metastases. Patients with advanced breast cancer treated in the post-AE demonstrated superior OS and DSS. PMID:20049562

Beal, Shannon H.; Canter, Robert J.; Chen, Steven L.; Khatri, Vijay P.; Bold, Richard J.

2010-01-01

45

HER2 Expression in Fine Needle Aspirates of Lymph Nodes Detected by Preoperative Axillary Ultrasound in Breast Cancer Patients  

PubMed Central

The purpose of this study was to assess the usefulness of HER2 levels in ultrasonographically guided fine-needle aspiration biopsy (US-FNA) aspirates of axillary lymph nodes (ALNs) in the determination of lymph node metastasis or the characterization of primary breast cancer, and to correlate the HER2 levels in US-FNA aspirates (FNA-HER2s) of metastatic ALNs with the HER2 statuses of corresponding primary breast cancers. An institutional review board approved the study. Between January and October 2010, 164 patients with 167 ALNs examined by US-FNA were included. FNA-HER2s of ALNs were measured by chemiluminescence immunoassay, and they were correlated with cytologic/final diagnoses. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic ability to differentiate benign and metastatic ALNs. Additionally, FNA-HER2s of metastatic ALNs were correlated with HER2 status and other clinicopathologic variables of the primary breast cancers. Among the 167 ALNs, 138 were metastatic and 29 were benign. The mean FNA-HER2 (6.3 ng/ml) of metastatic ALNs was higher than that of benign ALNs. All 29 benign ALNs showed no measurable value of FNA-HER2 (0.0 ng/ml). The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis. The FNA-HER2 statuses of 108 metastatic ALNs (79.4%) were concordant with the HER2 statuses of the corresponding primary breast cancers. In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P?=?0.04). Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers. Additionally, FNA-HER2 analysis of ALN may help to develop more personalized treatment protocol for breast cancer patients by determining the concordance or discordance of HER2 status between primary cancers and metastatic ALNs. PMID:25393693

Choi, Ji Soo; Kim, Hyun Ok; Kim, Eun-Kyung; Suh, Young Joo; Yoon, Jung Hyun; Moon, Hee Jung; Kim, Min Jung

2014-01-01

46

Pathologic diagnosis of large cell neuroendocrine carcinoma of the lung in an axillary lymph node: a case report with immunohistochemical and molecular genetic studies.  

PubMed

The author herein reports a large cell neuroendocrine carcinoma (LCNEC) of the lung diagnosed in an axillary lymph node without clinical data, with an emphasis of KIT and PDGFRA. A 64-year-old woman presented with axillary and cervical lymph nodes swelling. An excisional biopsy of an axillary lymph node was performed under the clinical diagnosis of malignant lymphoma. The HE section showed a presence of large malignant cells arranged in a medullary pattern. The tumor cells had nucleoli. The HE diagnosis was large cell lymphoma or metastatic undifferentiated carcinoma, in particular large cell carcinoma of the lung. The tumor cells were positive for cytokeratins, p53 protein, thyroid transcriptional factor-1, neuron-specific enolase, synaptophysin, CD56, KIT, and PDGFRA. In contrast, they were negative for CD3, CD15, CD30, CD45, CD20, CD45RO, CEA, CA19-9, and chromogranin (Dako). Ki-67 labeling (Dako) was 100%. Therefore, a diagnosis of LCNEC of the lung was made. A molecular genetic analysis for KIT (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) identified no mutations. Later, a lung tumor and pleural effusion were detected, and the cytology of the effusion and sputum revealed carcinoma cells compatible with LCNEC. The patient was diagnosed as lung LCNEC, and treated by chemotherapy (cisplatin) and radiation (45 Gray). The present report is the first one with an examination of protein expression and gene mutations of KIT and PDGFRA in a metastatic focus of LCNEC of the lung. PMID:23696939

Terada, Tadashi

2013-01-01

47

Supraclavicular failure after breast-conserving therapy in patients with four or more positive axillary lymph nodes when prophylactic supraclavicular irradiation is omitted  

Microsoft Academic Search

Purpose  The incidence of supraclavicular metastasis as the initial failure and the failure patterns in patients with four or more\\u000a positive axillary lymph nodes (PALNs) after breast-conserving therapy (BCT) without prophylactic supraclavicular irradiation\\u000a were investigated.\\u000a \\u000a \\u000a \\u000a Materials and methods  Between 1991 and 2002, a total of 48 women with four or more PALNs underwent BCT without prophylactic supraclavicular irradiation\\u000a (33 patients with 4–9

Yasushi Hamamoto; Masaaki Kataoka; Takatoshi Semba; Kotaro Uwatsu; Yoshifumi Sugawara; Takeshi Inoue; Shinya Sakai; Shoji Aono; Tadaaki Takahashi; Shogo Oda

2009-01-01

48

Detection of sentinel lymph node in breast cancer recurrence may change adjuvant treatment decision in patients with breast cancer recurrence and previous axillary surgery.  

PubMed

Use of sentinel lymph node dissection in patients with ipsilateral breast cancer recurrence is still controversial. The objective of this study is to evaluate the feasibility of the sentinel lymph node in breast cancer recurrence (SLNBR) and whether the positivity had impact in the adjuvant treatment. Between 2008 and 2012 we performed SLNBR in patients with ipsilateral breast tumor recurrence. We included 53 patients in a prospective study. Forty-three patients (81%) had a previous axillary lymph node dissection (ALND) and ten (19%) had a previous sentinel lymph node biopsy (SLNB). Identification rate after SLNB was 50% and after ALND was 60.5% (p = 0.4). Nine patients (26%) had a positive SLNBR. Adjuvant systemic treatment was given to all the patients with a positive SLNBR and to 23 (85%) with a negative SLNBR (p = 0.29). Six patients (66%) with positive SLNBR and 4 patients (14%) with negative SLNBR underwent radiation therapy (p < 0.01). As conclusions of our study we conclude that sentinel lymph node biopsy in breast tumor recurrence is feasible and significant differences were found in the use of radiation therapy in patients with a positive SLNBR. PMID:24726837

Cordoba, Octavi; Perez-Ceresuela, Francesc; Espinosa-Bravo, Martin; Cortadellas, Tomas; Esgueva, Antonio; Rodriguez-Revuelto, Robert; Peg, Vicente; Reyes, Victoria; Xercavins, Jordi; Rubio, Isabel T

2014-08-01

49

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

50

99mTc-Tetrofosmin pinhole-SPECT (P-SPECT) and radioguided sentinel node (SN) biopsy and in breast cancer axillary lymph node staging.  

PubMed

We compared 99mTc-Tetrofosmin P-SPECT with radioguided SN biopsy in 101 T1/T2 BC pts to predict axillary lymph node status. The day before surgery all pts underwent lymphoscintigraphy (LS) to mark the SN, following subdermal injection of 99mTc-colloidal sulphur surrounding the breast lesion. LS was combined with pre and intraoperative gamma probe. Previously, all pts had also undergone P-SPECT. ALND was performed in all cases. The SN(s) was detected in 97/101 cases (96%) by LS and gamma probe; in the 4 missed cases P-SPECT predicted lymph node status. In the 97 comparable cases, radioguided SN biopsy showed a slightly higher accuracy than P-SPECT (94.8% vs 93.8%), but a higher false-negative rate (14.3% vs 8.6%); P-SPECT had a higher NPV (95.2% vs 92.5%). The two procedures when combined achieved 100% accuracy. Radioguided SN biopsy alone had 100% accuracy only in pts with BC < 15 mm. P-SPECT had 3 false negative cases, 2 of which were micrometastatic SNs, and 3 false positives. P-SPECT identified 81.2% of cases with a single node, determined the exact number of nodes in 82.6% of cases with 1 to 3 node and correctly classified 93.7% of pts as having < or = 3 or > 3 metastatic nodes. Radioguided SN biopsy seems indicated in selected, early stage, small BC pts, while P-SPECT shows a high sensitivity independent of primary tumor size, giving additional important preoperative prognostic information. The two procedures combined provided a better axillary lymph node status prediction in T1/T2 carcinomas, and could thus improve ALND pt selection. PMID:11789027

Spanu, A; Dettori, G; Chessa, F; Porcu, A; Cottu, P; Solinas, P; Falchi, A; Solinas, M E; Scanu, A M; Nuvoli, S; Madeddu, G

2001-12-01

51

Histologic evaluation of sentinel and non-sentinel axillary lymph nodes in breast cancer by multilevel sectioning and predictors of non-sentinel metastasis  

PubMed Central

Sentinel lymph node (SLN) provides accurate nodal staging for breast cancer. This technique has been introduced in Siriraj Hospital since 1998. The goal of this study is to assess its accuracy in predicting the state of the axilla, and compare the results of standard examination and multilevel sectioning. A retrospective analysis of 195 breast cancer patients who underwent both SLN biopsy (using dye alone as the lymphatic mapping) and axillary node dissection during 1998-2002 were analyzed. All slides including SLNs and the non-SLNs (NSLNs) were reviewed and multilevel study was performed on all SLNs and NSLNs [four levels of hematoxylin-eosin (HE) at 200 µm interval and keratin stains on the first and fourth levels]. Of 195 patients, 30% of cases were SLN-positive (32 NSLN-positive and 27 NSLN-negative). Additional study could detect positive axillary nodes 10.8% (4 SLN-positive and 5 NSLN-positive) more than standard HE stain. The false negative rate increased from 20.3% to 24.1%. The concordance between SLN and NSLN statuses was 89.7%. The sensitivity was 75.9%. By multivariate analysis, the significant predictors for axillary node metastasis were tumor size of more than 2.2 cm, histologic type of invasive ductal carcinoma (IDC), not otherwise specified (NOS) and lymphovascular invasion (LVI). By univariable analysis, the significant predictors of NSLN metastasis after positive-SLN were outer location of the tumor, LVI and perinodal extension. In conclusion, use of multilevel and immunohistochemistry increased detection of positive-SLNs. Caution should be kept in accepting SLN biopsy using peritumoral dye technique alone as the procedure for staging due to a high false-negative rate. The concordance rate of 89.7% confirmed the reliability of SLN. Outer location of tumor, LVI and perinodal extension is significant predictors of positive-NSLN after positive-SLN. PMID:25083488

Jeeravongpanich, Piyarat; Komoltri, Chulaluk; Ratanawichitrasin, Adune

2014-01-01

52

Risk of node metastasis of sentinel lymph nodes detected in level II/III of the axilla by single-photon emission computed tomography/computed tomography  

PubMed Central

In breast cancer, single-photon emission computed tomography/computed tomography (SPECT/CT) shows the exact anatomical location of sentinel nodes (SN). SPECT/CT mainly exposes axilla and partly exposes atypical sites of extra-axillary lymphatic drainage. The mechanism of how the atypical hot nodes are involved in lymphatic metastasis was retrospectively investigated in the present study, particularly at the level II/III region. SPECT/CT was performed in 92 clinical stage 0-IIA breast cancer patients. Sentinel lymph nodes are depicted as hot nodes in SPECT/CT. Patients were divided into two groups: With or without hot node in level II/III on SPECT/CT. The existence of metastasis in level II/III was investigated and the risk factors were identified. A total of 12 patients were sentinel lymph node biopsy metastasis positive and axillary lymph node dissection (ALND) was performed. These patients were divided into two groups: With and without SN in level II/III, and nodes in level II/III were pathologically proven. In 11 of the 92 patients, hot nodes were detected in level II/III. There was a significant difference in node metastasis depending on whether there were hot nodes in level II/III (P=0.0319). Multivariate analysis indicated that the hot nodes in level II/III and lymphatic invasion were independent factors associated with node metastasis. There were 12 SN-positive patients followed by ALND. In four of the 12 patients, hot nodes were observed in level II/III. Two of the four patients with hot nodes depicted by SPECT/CT and metastatic nodes were pathologically evident in the same lesion. Therefore, the present study indicated that the hot node in level II/III as depicted by SPECT/CT may be a risk of SN metastasis, including deeper nodes. PMID:25289038

SHIMA, HIROAKI; KUTOMI, GORO; SATOMI, FUKINO; MAEDA, HIDEKI; TAKAMARU, TOMOKO; KAMESHIMA, HIDEKAZU; OMURA, TOSEI; MORI, MITSURU; HATAKENAKA, MASAMITSU; HASEGAWA, TADASHI; HIRATA, KOICHI

2014-01-01

53

Discordance rate of HER2 status in primary breast carcinomas versus synchronous axillary lymph node metastases: a multicenter retrospective investigation  

PubMed Central

Background Human epidermal growth factor receptor 2 (HER2) is considered to be a therapeutic and prognostic marker in the management of breast carcinoma (BC), although discordance rates between primary and metastatic or locally recurrent lesions have been reported. Methods One hundred and forty-eight paraffin-embedded BC tissues from patients of mean age 59.27 (33–96) years and corresponding synchronous lymph node metastases were collected and retrospectively studied using immunohistochemistry and fluorescence in situ hybridization to evaluate HER2 status. Fleiss-Cohen weighted k statistics were used to assess the concordance rate between HER2 status of the primary BC and the synchronous metastatic lesions. Results The overall concordance rate for HER2 was 95.28%. Eighty-nine cases were concordantly HER2-negative in primary BC and nodal metastases, and 52 cases were HER2-positive in both primary and metastatic tumors. Changes in HER2 status between primary BC and corresponding synchronous metastases were observed in seven (4.72%) cases. Three of the discordant cases were HER2-negative in the primary tumor and HER2-positive in the metastases, while four cases were HER2-positive in the primary BC and HER2-negative in the metastases. No significant correlations were identified between HER2 status and expression of hormone receptors, growth fraction (Ki-67), or other histopathological parameters (pT, pN, grade). Conclusion Simultaneous determination of HER2 in BC and corresponding metastatic lymph nodes is not mandatory, but may strongly influence the therapeutic management. It was demonstrated that loss of HER2 amplification results in worse post-relapse survival and overall survival in BC patients and, on the other hand, a gain in HER2 expression in metastatic lymph nodes of BC may allow the possibility of a targeted treatment. Thus, our opinion is that significant prognostic information may be obtained by simultaneous assessment of HER2 status in both primary and synchronous metastatic BC. PMID:25050068

Ieni, Antonio; Barresi, Valeria; Caltabiano, Rosario; Cascone, Anna Maria; Del Sordo, Rachele; Cabibi, Daniela; Zeppa, Pio; Lanzafame, Salvatore; Sidoni, Angelo; Franco, Vito; Tuccari, Giovanni

2014-01-01

54

Uracil-tegafur and tamoxifen vs cyclophosphamide, methotrexate, fluorouracil, and tamoxifen in post-operative adjuvant therapy for stage I, II, or IIIA lymph node-positive breast cancer: a comparative study  

Microsoft Academic Search

Background:It has been reported that treatment with uracil-tegafur (UFT) has shown significantly better survival and relapse-free survival (RFS) than surgery alone. Therefore, we compared UFT with a combination therapy of cyclophosphamide, methotrexate, and fluorouracil (CMF) in patients who had undergone curative surgery for axillary lymph node-positive breast cancer.Methods:A total of 377 node-positive patients with stage I, II, or IIIA disease

K Okamura; S Mitsuyama; T Saito; J Koh; S Kyono; K Higaki; M Ogita; T Asaga; H Inaji; H Komichi; N Kohno; K Yamazaki; F Tanaka; T Ito; H Nishikawa; A Osaki; H Koyama; T Suzuki

2009-01-01

55

Pleomorphic lobular carcinoma of the male breast with axillary lymph node involvement: a case report and review of literature  

PubMed Central

Background Carcinoma of the male breast is responsible for less than 1% of all malignancies in men but the incidence is rising. Invasive ductal carcinoma is the most common histological subtype while invasive lobular carcinoma is responsible for only 1.5% of the total cases of which pleomorpic lobular carcinoma is an extremely rare variant. We report the case of a gentleman with node positive, pleomorphic lobular carcinoma of the breast. Case presentation An elderly gentleman with a past history of type 2 diabetes and long term ethanol use presented to us with a self-discovered palpable lump in the left breast. Physical examination revealed bilateral gynaecomastia along with a well circumscribed subareolar mass and palpable lymphadenopathy in the ipsilateral axilla. The breast nodule revealed atypical cells on fine needle aspiration biopsy and the patient underwent a modified radical mastectomy after systemic surveillance was negative for metastatic disease. The lesion was reported as grade III pleomorphic lobular carcinoma with a lack of E-cadherin expression on immunohistochemistry and the neoplastic cells exhibited strong positivity for estrogen receptor in the absence of Her2 gene amplification. Six out of the eleven dissected regional lymph nodes showed evidence of disease. The patient completed 4 cycles of adjuvant chemotherapy without evidence of recurrent disease and was subsequently lost to follow up. Conclusions Although invasive lobular carcinomas comprise 12% of all female breast cancers, they are very rare in males due to lack of acini and lobules in the normal male breast. Pleomorphic lobular carcinoma, an aggressive variant of ILC is even rarer in males. Chronic consumption of ethanol by our patient may have resulted in some degree of hepatic impairment with resultant hyperestrogenism. This in theory may have been the cause of his gynaecomastia, resultant breast cancer and is a plausible explanation for development of the invasive lobular subtype in a male. The prognosis and clinicopatholocial features of pleomorphic lobular carcinoma in men are less clearly defined due to its rarity. Additional studies are hence necessary to improve our understanding of this disease in males. PMID:24795533

2014-01-01

56

99mTc-labelled SM3 in the preoperative evaluation of axillary lymph nodes and primary breast cancer with change detection statistical processing as an aid to tumour detection.  

PubMed Central

The extent of primary surgery for breast cancer could be tailored to the patient if previous information on the presence or absence of lymph node involvement could be reliably determined. Prospective radioimmunoscintigraphy in 29 patients with primary breast cancer that was found on screening has been undertaken with 555 MBq (15 mCi) 99mTc SM3, an Imperial Cancer Research Fund (ICRF) murine monoclonal antibody, 0.5 mg with images at 10 min and 22 h, and analysis using a change detection algorithm. Sites of significant change between the early and later images were displayed as a map of probabilities. Image-positive and -negative axillary lymph nodes were compared by histology in the 28 evaluable patients. The correct identification of the presence or absence of node involvement, even if impalpable, has been shown in 24 out of 28 patients (29 lymph node groups). Sensitivity was 90% (nine out of ten), specificity 84% (16 out of 19) and accuracy 86%. These results encourage further assessment of this technique. Images Figure 1 Figure 2 PMID:9459158

Biassoni, L.; Granowska, M.; Carroll, M. J.; Mather, S. J.; Howell, R.; Ellison, D.; MacNeill, F. A.; Wells, C. A.; Carpenter, R.; Britton, K. E.

1998-01-01

57

Axillary Reverse Mapping Using 99mTc-SC: A Case Illustration.  

PubMed

Lymphedema is a common complication in breast carcinoma patients undergoing axillary lymph node dissection. Although there is a significant reduction in the lymphedema rate with sentinel lymph node biopsy compared to axillary lymph node dissection, there is some risk after sentinel lymph node biopsy. Axillary reverse mapping, an emerging concept aims at identifying and preserving the draining lymph node of the arm that is invariably devoid of malignancy. This concept if validated may prevent lymphedema in breast carcinoma patients. Axillary reverse mapping node can be identified using a radiotracer or blue dye. We describe the procedure using filtered Tc-SC. PMID:24152646

Gandhi, Sunny J; Satish, C; Sundaram, P Shanmuga; Subramanyam, Padma; Vijaykumar, D K

2014-10-01

58

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

59

Pitt study finds breast cancer patients with positive ultrasound guided axillary node biopsy need dissection  

Cancer.gov

Contrary to a trend in treatment, breast cancer patients with suspicious lymph nodes should have an ultrasound-guided axillary node biopsy, and if that biopsy is positive these patients should undergo an axillary dissection, a new study shows. The study, conducted at the University of Pittsburgh Medical Center, compared 199 patients with a positive ultrasound-guided axillary node biopsy to 434 patients with a positive sentinel lymph node biopsy.

60

Can mammographic and sonographic imaging features predict the Oncotype DX™ recurrence score in T1 and T2, hormone receptor positive, HER2 negative and axillary lymph node negative breast cancers?  

PubMed

To determine whether mammographic or sonographic features can predict the Oncotype DX™ recurrence scores (RS) in patients with TI-II, hormone receptor (HR) positive, HER2/neu negative and node negative breast cancers. Institutional board review was obtained and informed consent was waived for this retrospective study. Seventy-eight patients with stage I-II invasive breast cancer that was HR positive, HER2 negative, and lymph node negative for whom mammographic and or sonographic imaging and Oncotype DX™ assay scores were available were included in the study Four breast dedicated radiologists blinded to the RS retrospectively described the lesions according to BI-RADS lexicon descriptors. Multivariable logistic regression was used to test for significant independent predictors of low (<18) versus intermediate to high range (?18). Two imaging features reached statistical significance in predicting low from intermediate or high risk RS: pleomorphic microcalcifications within a mass (P = 0.017); OR 8.37, 95 % CI (1.47-47.79) on mammography and posterior acoustic enhancement in a mass on ultrasound (P = 0.048); OR 4.35, 95 % CI (1.01-18.73) on multivariable logistic regression. A mass with pleomorphic microcalcifications on mammography or the presence of posterior acoustic enhancement on ultrasound may predict an intermediate to high RS as determined by the Oncotype DX(TM) assay in patients with stage I-II HR positive, HER2 negative, and lymph node negative invasive breast cancer. PMID:25262341

Yepes, Monica Maria; Romilly, Ada Pat; Collado-Mesa, Fernando; Net, Jose Miguel; Kiszonas, Richard; Arheart, Kristopher L; Young, Daniel; Glück, Stefan

2014-11-01

61

Axillary surgery in breast cancer patients  

Microsoft Academic Search

Surgeons have routinely removed ipsilateral axillary lymph nodes from women with breast cancer for over 100 years. The procedure\\u000a provides important staging information, enhances regional control of the malignancy and may improve survival. As screening\\u000a of breast cancer has increased, the mean size of newly diagnosed primary invasive breast cancers has steadily decreased and\\u000a so has the number of women

A. Millet; C. A. Fuster; A. Lluch; F. Dirbas

2007-01-01

62

Prognostic value of axillary lymphoscintigraphy in breast carcinoma patients  

SciTech Connect

Axillary lymphoscintigraphy (AxLS) with bilateral interdigital injection of (99mTc)antimony sulfide colloid carried out concurrently with internal mammary lymphoscintigraphy in 488 patients with breast carcinoma was evaluated. Patterns of radiocolloid distribution within the ipsilateral axilla and supraclavicular fossa were compared with similar features on the contralateral side to determine whether image characteristics are significantly disrupted by prior surgery, reflect the presence of metastases, and can predict treatment failure. Interpretive criteria for AxLS were refined after correlation of the identified image components with clinical parameters including axillary surgery, lymph node histology and relapse within a follow-up period of 2 years from the study. Results indicate that AxLS is at least as accurate as clinical assessment and provides data predictive of relapse to complement axillary lymph node status although the technique cannot presently replace lymph node sampling for patient staging.

McLean, R.G.; Ege, G.N.

1986-07-01

63

The lateral thoracic fasciocutaneous island flap for treatment of recurrent hidradenitis axillaris suppurativa and other axillary skin defects.  

PubMed

A series of eight axillary skin defect reconstructions in seven patients using the lateral thoracic island fasciocutaneous flap is presented. The defects originated from wide excision of recurrent hidradenitis axillaris suppurativa and in one case from radical melanoma resection with axillary lymph node clearance. The technique used to cover the resulting large defects is advancement or transposition of an island flap from the lateral thoracic wall, pedicled on two or three nourishing vessels arising from the lateral thoracic or thoracodorsal vessels. No flap complications occurred and the results with respect to donor site morbidity, functional and aesthetic outcome were very satisfactory. PMID:11090324

Schwabegger, A H; Herczeg, E; Piza, H

2000-12-01

64

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

65

Epitrochlear Sentinel Lymph Nodes in Melanoma: Interval or Independent?  

PubMed Central

Most primary melanomas on the distal upper extremity metastasize to a sentinel lymph node (SLN) in the axillary basin, but occasionally a primary melanoma will drain to the epitrochlear basin. The relationship between tumor-draining axillary and epitrochlear SLNs is unclear. We hypothesize that the epitrochlear SLN functions in an interval manner with the axillary lymph node basin. We queried our melanoma database to identify patients who underwent SLN biopsy for a distal upper-extremity melanoma. Patient demographics, tumor characteristics, patterns of nodal drainage and incidence of SLN metastasis were analyzed. Of 255 patients identified, 38 (14.9%) had an epitrochlear SLN. Mean Breslow thickness was 2.26 mm. All patients with epitrochlear drainage had concurrent axillary drainage and underwent axillary and epitrochlear SLN biopsies. Of these 38 patients, two (5.2%) had epitrochlear and axillary SLN metastasis, four (10.5%) had epitrochlear metastasis only, four (10.5%) had axillary metastasis only, and the remaining 28 (73.7%) had tumor-free SLNs. The invariable association of epitrochlear and axillary drainage in this study suggests that epitrochlear nodes function in an interval role with the axillary lymph node basin. Therefore we recommend that all patients with a positive epitrochlear SLN undergo completion axillary dissection. PMID:22643268

Kidner, Travis; Yoon, Jeong; Faries, Mark; Morton, Donald

2012-01-01

66

Equivalent cross relaxation rate image for decreasing a false negative case of sentinel lymph node biopsy  

Microsoft Academic Search

In the breast carcinamas, sentinel lymph node biopsy (SLNB) attracts attention as technique to be settled by axillary lymph node metastasis, but existence of a false negative case is a problem. Equivalent cross relaxation rate image (ECRI) is the measurement method that we can evaluate a change of organization structure quantitatively by magnetic resonance imaging. We executed axillary ECRI as

Shigeru Matsushima; Fumio Sasaki; Shuhei Sarumaru; Daisuke Ohta; Seiichi Era; Masaru Sogami; Tadashi Inaba; Yasutomi Kinosada

2003-01-01

67

Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology  

Microsoft Academic Search

Background: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both

Andrew J. Creager; Kim R. Geisinger; Stephen A. Shiver; Nancy D. Perrier; Perry Shen; Jo Ann Shaw; Peter R. Young; Edward A. Levine

2002-01-01

68

Tattoo Pigment Mimics Positive Sentinel Lymph Node in Melanoma  

Microsoft Academic Search

A 42-year-old man with metastasizing melanoma from an unknown primary is presented. Initially a subcutaneous metastasis in the scapular region and a single lung metastasis were resected. Thorough examinations did not show any evidence of a primary tumour. From the site of the metastasis on the right scapular region, lymphoscintigraphy with axillary sentinel lymph node biopsy was performed. One axillary

M. Moehrle; H. J. Blaheta; P. Ruck

2001-01-01

69

Primary axillary hydatid cyst.  

PubMed

Echinococcosis (hydatid disease) is a zoonosis caused by the larval stage of Echinococcus granulosus (or Taenia echinococcus). The adult form of the parasite lives in the gut of the dog, while the intermediate hosts, where the tapeworm develops to larval stage are cats, cattle, pigs and humans(considered to be accidental intermediate hosts). The parasite has a worldwide distribution, but the endemic areas are Canada and Alaska, Australia, New Zealand, South America and the Mediterranean region. Hydatid cyst can grow many years before the symptoms and clinical signs appear. The liver and the lungs are the most affected organs, but primary location of the hydatid disease in the axilla is extremely rare. In our country we did not find any records of axillary hydatid disease, while the literature contains only 12 cases of axillary location. We present the case of a woman, 60 years old, with a primary axillary location of hydatid cyst, who underwent a total cystectomy. PMID:25149625

Mercu?, D; Andri?oiu, A; Tra?c?, Et; Silo?i, C; Resceanu, A; Mercu?, R

2014-01-01

70

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. PMID:23559874

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

2013-01-01

71

Volume-Based Parameters of {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Improve Disease Recurrence Prediction in Postmastectomy Breast Cancer Patients With 1 to 3 Positive Axillary Lymph Nodes  

SciTech Connect

Purpose: To determine whether volume-based parameters on pretreatment {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer patients treated with mastectomy without adjuvant radiation therapy are predictive of recurrence. Methods and Materials: We retrospectively analyzed 93 patients with 1 to 3 positive axillary nodes after surgery, who were studied with {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography for initial staging. We evaluated the relationship between positron emission tomography parameters, including the maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinical outcomes. Results: The median follow-up duration was 45 months. Recurrence was observed in 11 patients. Metabolic tumor volume and TLG were significantly related to tumor size, number of involved nodes, nodal ratio, nuclear grade, estrogen receptor (ER) status, and triple negativity (TN) (all P values were <.05). In receiver operating characteristic curve analysis, MTV and TLG showed better predictive performance than tumor size, ER status, or TN (area under the curve: 0.85, 0.86, 0.79, 0.74, and 0.74, respectively). On multivariate analysis, MTV was an independent prognostic factor of locoregional recurrence-free survival (hazard ratio 34.42, 95% confidence interval 3.94-882.71, P=.0008) and disease-free survival (DFS) (hazard ratio 13.92, 95% confidence interval 2.65-103.78, P=.0018). The 3-year DFS rate was 93.8% for the lower MTV group (<53.1; n=85) and 25.0% for the higher MTV group (?53.1; n=8; P<.0001, log–rank test). The 3-year DFS rate for patients with both ER-positive status and MTV <53.1 was 98.2%; and for those with ER-negative status and MTV ?53.1 it was 25.0% (P<.0001). Conclusions: Volume-based parameters improve recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive nodes. The addition of MTV to ER status or TN has potential benefits to identify a subgroup at higher risk for recurrence.

Nakajima, Naomi, E-mail: haruhi0321@gmail.com [Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Department of Radiology, Ehime University, Ehime (Japan); Kataoka, Masaaki [Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Sugawara, Yoshifumi [Department of Diagnostic Radiology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Ochi, Takashi [Department of Radiology, Ehime University, Ehime (Japan); Kiyoto, Sachiko; Ohsumi, Shozo [Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Mochizuki, Teruhito [Department of Radiology, Ehime University, Ehime (Japan)

2013-11-15

72

Some Women May Not Need More Extensive Lymph Node Surgery for Breast Cancer  

Cancer.gov

Results from a randomized clinical trial published February 9, 2011, in the Journal of the American Medical Association demonstrate that axillary lymph node dissection provided no additional survival benefit when compared with sentinel lymph node biopsy in women with small breast tumors and minimal lymph node metastasis who were treated with lumpectomy, whole-breast radiotherapy, and adjuvant systemic therapy.

73

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. PMID:23513181

Rashid, Omar M.; Takabe, Kazuaki

2012-01-01

74

Automatic detection of axillary lymphadenopathy on CT scans of untreated chronic lymphocytic leukemia patients  

NASA Astrophysics Data System (ADS)

Patients with chronic lymphocytic leukemia (CLL) have an increased frequency of axillary lymphadenopathy. Pretreatment CT scans can be used to upstage patients at the time of presentation and post-treatment CT scans can reduce the number of complete responses. In the current clinical workflow, the detection and diagnosis of lymph nodes is usually performed manually by examining all slices of CT images, which can be time consuming and highly dependent on the observer's experience. A system for automatic lymph node detection and measurement is desired. We propose a computer aided detection (CAD) system for axillary lymph nodes on CT scans in CLL patients. The lung is first automatically segmented and the patient's body in lung region is extracted to set the search region for lymph nodes. Multi-scale Hessian based blob detection is then applied to detect potential lymph nodes within the search region. Next, the detected potential candidates are segmented by fast level set method. Finally, features are calculated from the segmented candidates and support vector machine (SVM) classification is utilized for false positive reduction. Two blobness features, Frangi's and Li's, are tested and their free-response receiver operating characteristic (FROC) curves are generated to assess system performance. We applied our detection system to 12 patients with 168 axillary lymph nodes measuring greater than 10 mm. All lymph nodes are manually labeled as ground truth. The system achieved sensitivities of 81% and 85% at 2 false positives per patient for Frangi's and Li's blobness, respectively.

Liu, Jiamin; Hua, Jeremy; Chellappa, Vivek; Petrick, Nicholas; Sahiner, Berkman; Farooqui, Mohammed; Marti, Gerald; Wiestner, Adrian; Summers, Ronald M.

2012-03-01

75

Intramammary lymph node metastasis predicts poorer survival in breast cancer patients.  

PubMed

Involvement of an intramammary lymph node with metastatic breast cancer is an uncommon clinical or radiological presentation. Previously reported series of patients are small in number and the clinical advice is unclear. We identified 100 patients on our pathology database with intramammary lymph nodes in association with a primary breast cancer. Ten were identified pre-operatively on breast imaging and 90 were first discovered on pathological assessment of excised breast tissue. Twenty one contained metastasis. Factors that predicted for intramammary node metastasis were increasing age (p=0.017), lymphovascular invasion (p=0.002) and grade of tumour (p=0.012). The presence of metastasis within the intramammary lymph node was associated with a poorer disease free survival (p=0.007) and reduced overall survival (p=0.035). Sixty seven percent of patients with intramammary node metastasis had further axillary metastases. One patient had an intramammary node metastasis but uninvolved axillary sentinel node. She presented 19 months later with an axillary nodal recurrence. The presence of intramammary lymph node metastasis is associated with poorer outcome in breast cancer patients. Pre-operative detection of intramammary lymph node metastasis is helpful to guide breast and axillary surgeries. Intramammary lymph node metastasis predicts strongly for axillary metastatic disease and axillary node clearance is recommended. PMID:19171479

Hogan, Brian V; Peter, Mark B; Shenoy, Hrishikesh; Horgan, Kieran; Shaaban, Abeer

2010-03-01

76

Radiotherapy for Stage II and Stage III Breast Cancer Patients With Negative Lymph Nodes After Preoperative Chemotherapy and Mastectomy  

SciTech Connect

Purpose: To evaluate the effect of postmastectomy radiotherapy (PMRT) in Stage II-III breast cancer patients with negative lymph nodes (pN0) after neoadjuvant chemotherapy (NAC). Patients and Materials: Of 1,054 breast cancer patients treated with NAC at our institution between 1990 and 2004, 134 had pN0 status after NAC and mastectomy. The demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The effect of PMRT on locoregional recurrence-free survival and overall survival (OS) was evaluated by multivariate analysis, including known prognostic factors. Results: Of the 134 eligible patients, 78 (58.2%) received PMRT and 56 (41.8%) did not. At a median follow-up time of 91.4 months, the 5-year locoregional recurrence-free survival and OS rate was 96.2% and 88.3% with PMRT and 92.5% and 94.3% without PMRT, respectively (p = NS). The corresponding values at 10 years were 96.2% and 77.2% with PMRT and 86.8% and 87.7% without PMRT (p = NS). On multivariate analysis, PMRT had no effect on either locoregional recurrence-free survival (hazard ratio, 0.37; 95% confidence interval, 0.09-1.61; p = .18) or OS (hazard ratio, 2.06; 95% confidence interval, 0.71-6; p = .18). This remained true in the subgroups of patients with clinical Stage II or Stage III disease at diagnosis. A trend was seen toward poorer OS among patients who had not had a pathologic complete in-breast tumor response after NAC (hazard ratio, 6.65; 95% confidence interval, 0.82-54.12; p = .076). Conclusions: The results from the present retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence, or death when PMRT was omitted in breast cancer patients with pN0 status after NAC and mastectomy. Whether the omission of PMRT is acceptable for these patients should be addressed prospectively.

Le Scodan, Romuald, E-mail: lescodan@crh1.org [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Selz, Jessica [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Stevens, Denise [Department of Biostatistics, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Bollet, Marc A.; Lande, Brigitte de la; Daveau, Caroline [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Lerebours, Florence [Department of Medical Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Labib, Alain [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Bruant, Sarah [Department of Biostatistics, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France)

2012-01-01

77

Botulinum toxin for axillary hyperhidrosis.  

PubMed

Botulinum toxin is a safe and effective treatment option for axillary hyperhidrosis. Although its pathophysiology is not clear and somewhat controversial, the beneficial effect of neuromodulators in inhibiting localized sweating temporarily is well known. Before the procedure, correct identification of the affected area is mandatory to avoid wastage of drug and neglect of target areas, and to enhance efficacy, as the hyperhidrotic location may not match the hairy axillary region. Utilization of this medication, such as dilution and injection techniques, depends on medical experience and may have some variations, including methods to make the procedure as painless as possible. PMID:25152343

de Almeida, Ada Regina Trindade; Montagner, Suelen

2014-10-01

78

Sentinel Lymph Node Biopsy in Early Breast Cancer  

PubMed Central

Summary The role of axillary surgery for the treatment of primary breast cancer is in a process of constant change. During the last decade, axillary dissection with removal of at least 10 lymph nodes (ALD) was replaced by sentinel lymph node biopsy (SLNB) as a staging procedure. Since then, the indication for SLNB rapidly expanded. Today's surgical strategies aim to minimize the rate of patients with a negative axillary status who undergo ALD. For some subgroups of patients, the indication for SLNB (e.g. multicentric disease, large tumors) or its implication for treatment planning (micrometastatic involvement, neoadjuvant chemotherapy) is being discussed. Although the indication for ALD is almost entirely restricted to patients with positive axillary lymph nodes today, the therapeutic effect of completion ALD is more and more questioned. On the other hand, the diagnostic value of ALD in node-positive patients is discussed. This article reflects today's standards in axillary surgery and discusses open issues on the diagnostic and therapeutic role of SLNB and ALD in the treatment of early breast cancer. PMID:21779223

Kuhn, Thorsten

2011-01-01

79

Axillary and intramammary lymphadenopathy caused by Kikuchi-Fujimoto disease mimicking malignant lymphoma.  

PubMed

We describe a rare case of intramammary and axillary lymphadenopathy caused by Kikuchi-Fujimoto disease (KFD). A 30-year-old woman presented with enlarged axillary lymph nodes and a right breast mass with tenderness. Computed tomography, ultrasonography, F-2-deoxy-fluoro-D-glucose positron emission tomography and fine-needle aspiration cytology were performed, and malignant lymphoma (ML) was suspected. Histological diagnosis of a needle biopsy and surgical specimen showed histiocytic necrotizing lymphadenitis. It is important to differentiate KFD from ML because of differences in treatment choice and clinical outcome. PMID:19943128

Ohta, Kouji; Endo, Naoki; Kaizaki, Yasuharu

2013-01-01

80

Less-Invasive Lymph Node Surgery Safe for Women with Breast Cancer  

Cancer.gov

Breast cancer patients who had sentinel lymph node biopsy followed by axillary lymph node dissection (ALND) only if cancer cells were detected in the sentinel nodes had the same overall survival as those  who underwent ALND regardless of sentinel node status, according to a randomized trial published online September 20, 2010, in Lancet Oncology.

81

Omics-based profiling of carcinoma of the breast and matched regional lymph node metastasis  

Microsoft Academic Search

Axillary lymph node (ALN) status is currently used as an important clinical indicator of breast cancer prognosis. However, the molecular mechanisms underlying lymph node metastasis are poorly understood and the relationship between ALN metastasis and the primary tumor remains unclear. In an effort to reveal structural changes in the genome and related protein responses that may drive regional metastatic progression

Jian Li; Pavel Gromov; Irina Gromova; José M. Moreira; Vera Timmermans-Wielenga; Fritz Rank; Kai Wang; Shengting Li; Heng Li; Carsten Wiuf; Huanming Yang; Xiuqing Zhang; Lars Bolund; Julio E. Celis

2008-01-01

82

Lymph Nodes  

MedlinePLUS

... Citation Help Home » Cancer Registration & Surveillance Modules » Anatomy & Physiology » Lymphatic System » Components of the Lymphatic System » Lymph Nodes Cancer Registration & Surveillance Modules Anatomy & Physiology Intro to the Human Body Body Functions & Life ...

83

Handheld array-based photoacoustic probe for guiding needle biopsy of sentinel lymph nodes  

NASA Astrophysics Data System (ADS)

By modifying a clinical ultrasound array system, we develop a novel handheld photoacoustic probe for image-guided needle biopsy. The integration of optical fiber bundles for pulsed laser light delivery enables photoacoustic image-guided insertion of a needle into rat axillary lymph nodes with accumulated indocyanine green (ICG). Strong photoacoustic contrast of the needle is achieved. After subcutaneous injection of the dye in the left forepaw, sentinel lymph nodes are easily detected, in vivo and in real time, beneath 2-cm-thick chicken breast overlaying the axillary region. ICG uptake in axillary lymph nodes is confirmed with fluorescence imaging both in vivo and ex vivo. These results demonstrate the clinical potential of this handheld photoacoustic system for facile identification and needle biopsy of sentinel lymph nodes for cancer staging and metastasis detection in humans.

Kim, Chulhong; Erpelding, Todd N.; Maslov, Konstantin; Jankovic, Ladislav; Akers, Walter J.; Song, Liang; Achilefu, Samuel; Margenthaler, Julie A.; Pashley, Michael D.; Wang, Lihong V.

2010-07-01

84

Current trends of sentinel lymph node biopsy for breast cancer —A surgeon’s perspective  

Microsoft Academic Search

Sentinel lymph node biopsy (SLNB) is standard care for patients with early-stage breast cancer, and axillary lymph node dissection\\u000a (ALND) is considered unnecessary when sentinel lymph nodes (SLNs) are tumor-free. Additional non-SLN metastasis in patients\\u000a with positive SLNs can be estimated using several risk factors such as primary tumor size, metastatic tumor size in SLNs,\\u000a lymphatic vessel invasion, and so

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

2007-01-01

85

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 PMID:23782712

2013-01-01

86

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

Microsoft Academic Search

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

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

2007-01-01

87

Lymph node biopsy  

MedlinePLUS

Biopsy - lymph nodes; Open lymph node biopsy; Fine needle aspiration biopsy; Sentinel lymph node biopsy ... A lymph node biopsy is done in an operating room in a hospital. Or, it is done at an outpatient surgical center. The ...

88

Low-affinity antibodies against collagen type II produced by lymph node cells are associated with pathology in collagen-induced arthritis in rats.  

PubMed Central

The relationship between the affinity of antibodies against type II collagen (CII) and arthritis was studied in rats immunized intradermally with bovine CII. Disease was associated with a higher mean titre of serum antibody and a lower mean functional antibody affinity (determined in a chaotropic dissociation assay) against both the immunizing bovine CII and homologous autoantigenic rat CII in comparison with the response in immunized rats that did not develop disease. The functional affinity of the antibodies present in the serum was found to correlate with that of antibodies produced in culture by cells from the lymph nodes draining the site of immunization with collagen. The reduction in mean functional affinity in the anti-collagen response may be the result of the increased production of antibodies of the lowest affinity and a consequent broadening of the affinity heterogeneity. It is proposed that production of low-affinity antibodies in the lymph nodes draining the site of immunization with collagen is important in the pathogenesis of collagen-induced arthritis in rats. PMID:1606731

Rahman, J; Loh, J; Staines, N A

1992-01-01

89

Determination of Indication for Sentinel Lymph Node Biopsy in Clinical Node-negative Breast Cancer Using Preoperative 18 F-fluorodeoxyglucose Positron Emission Tomography\\/ Computed Tomography Fusion Imaging  

Microsoft Academic Search

Objective: Sentinel node biopsy (SNB) is indicated for axillary lymph node metastasis- negative cases (N0), but clarification of the indication may increase treatment efficiency. Fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) may have a high positive predictive value in diagnosis of axillary lymph node metastasis. Methods: Ninety-two breasts\\/axillae were analyzed retrospectively in 90 patients (median age 54.6-year old, median primary tumor

Naruto Taira; Shozo Ohsumi; Daisuke Takabatake; Fumikata Hara; Seiki Takashima; Kenjiro Aogi; Shigemitsu Takashima; Takeshi Inoue; Shigenori Sugata; Rieko Nishimura

90

Sentinel Node Biopsy Alone versus Completion Axillary Node Dissection in Node Positive Breast Cancer: Systematic Review and Meta-Analysis  

PubMed Central

Introduction. There has been recent interest in validity of completion axillary node dissection after a positive sentinel node. This systematic review aims to ascertain if sentinel lymph node dissection alone was noninferior to axillary lymph node dissection for breast cancer patients who have a positive sentinel node. Method. A systematic review of the electronic databases Embase, MEDLINE, and Cochrane Register of Controlled Trials was carried out. Only randomised trials that had patients with positive sentinel node as the study sample were included in the meta-analysis using the reported hazard ratios with a fixed effect model. Results. Three randomised controlled trials and five retrospective studies were identified. The pooled effect for overall survival was HR 0.94, 95% CI [0.79, 1.19], and for disease free survival was HR 0.83, 95% CI [0.60, 1.14]. The reported rates for locoregional recurrence were similar in both groups. The surgical morbidity was found to be significantly more in patients who had underwent axillary dissection. Conclusion. Amongst patients with micrometastasis in the sentinel node, no further axillary dissection is necessary. For patients with macrometastasis in the sentinel node, it is reasonable to consider omitting axillary dissection to avoid the morbidity of the procedure. PMID:25383226

Singh, Jasprit; McCaig, Eddie

2014-01-01

91

Altered lymphatic drainage after breast-conserving surgery and axillary node dissection: local recurrence with contralateral intramammary nodal metastases.  

PubMed

A review of the literature shows that lymphoscintigraphy and sentinel node biopsy are feasible in patients with previous breast and axillary surgery and could be especially warranted because in these patients, lymphatic drainage might not include the axillary basin. We report a case of a woman with recurrent breast cancer after breast-conserving surgery. The patient was found to have metastases in the contralateral intramammary lymph nodes. Demonstrating that such patterns do occur after previous treatment for breast cancer carries implications for the staging and management of these patients. PMID:17386126

Wellner, Rachel; Dave, Jasmine; Kim, Unsup; Menes, Tehillah S

2007-02-01

92

To Do or Not to Do: Axillary Nodal Evaluation after ACOSOG Z0011 Trial.  

PubMed

Methods of axillary evaluation in invasive breast cancer continue to evolve. The recent American College of Surgeons Oncology Group Z0011 Trial is a prospective, randomized, multicenter trial that compared the survival and locoregional recurrence rates after complete axillary lymph node dissection (ALND) versus sentinel node biopsy (SNB) alone in women with a positive sentinel node in an effort to avoid the complications associated with ALND. As the results of this trial are implemented clinically, affecting surgical management of axillary metastatic disease, radiologists may need to redefine their role in the preoperative assessment of the axilla. Before the Z0011 trial, breast imagers worked to identify axillary metastases preoperatively, allowing appropriate patients to proceed directly to ALND and avoiding the need for SNB. However, the Z0011 trial concluded that ALND may not be necessary in women with metastatic axillary disease who meet the trial criteria. In the Z0011 trial, after 6 years of median follow-up there was no difference in either locoregional recurrence or survival among the women who underwent SNB alone compared with those who underwent ALND, suggesting that ALND is unnecessary in a subset of women with a positive node at SNB. These results raise questions about how aggressively radiologists should pursue percutaneous sampling of axillary nodes, as some practitioners conclude that, in an otherwise eligible woman, positive results from imaging-guided percutaneous biopsy preclude a Z0011 trial-directed pathway. Debate about the best way to implement the results of the Z0011 trial into daily clinical practice exists. It is important for breast imagers to work closely with breast surgeons to provide the most appropriate treatment course for each patient. ©RSNA, 2014. PMID:25384280

Humphrey, Kathryn L; Saksena, Mansi A; Freer, Phoebe E; Smith, Barbara L; Rafferty, Elizabeth A

2014-01-01

93

Axillary intranodal palisaded myofibroblastoma: report of a case associated with chronic mastitis.  

PubMed

Intranodal palisaded myofibroblastoma is a rare tumour of the lymph node that may be derived from myofibroblasts. The most usual area of presentation is the inguinal lymph nodes, but occurrence within other areas has also been reported. It is characterised by spindle cells, amianthoid-like fibres, and by the proliferation of hemosiderin-containing histiocytes in the lymph node. Although intranodal palisaded myofibroblastoma is benign, it is frequently confused with metastatic lesions, especially when it occurs in atypical sites. We herein report the second case of axillary intranodal palisaded myofibroblastoma occurring in a woman with a granulomatous chronic mastitis. The salient clinicopathological features of this unusual tumour are presented with emphasis to the pathogenesis of the tumour as well as to its histological and immunohistochemical characteristics. Clinicians and pathologists must be aware of this rare tumour to avoid a misdiagnosis of malignancy and assure patient a correct therapeutic management. PMID:25323283

D'Antonio, Antonio; Addesso, Maria; Amico, Paolo; Fragetta, Filippo

2014-01-01

94

Measuring intranodal pressure and lymph viscosity to elucidate mechanisms of arthritic flare and therapeutic outcomes  

PubMed Central

Rheumatoid arthritis (RA) is a chronic autoimmune disease with episodic flares in affected joints, whose etiology is largely unknown. Recent studies in mice demonstrated alterations in lymphatics from affected joints precede flares. Thus, we aimed to develop novel methods for measuring lymph node pressure and lymph viscosity in limbs of mice. Pressure measurements were performed by inserting a glass micropipette connected to a pressure transducer into popliteal lymph nodes (PLN) or axillary lymph nodes (ALN) of mice and determined that the lymphatic pressures were 9 and 12 cm of water, respectively. We are also developing methods for measuring lymph viscosity in lymphatic vessels afferent to PLN, which can be measured by multi-photon fluorescence recovery after photobleaching (MP-FRAP) of FITC-BSA injected into the hind footpad. These results demonstrate the potential of lymph node pressure and lymph viscosity measurements, and warrant future studies to test these outcomes as biomarkers of arthritic flare. PMID:22172039

Bouta, Echoe M.; Wood, Ronald W.; Perry, Seth W.; Brown, Edward; Ritchlin, Christopher T.; Xing, Lianping; Schwarz, Edward M.

2012-01-01

95

Reversibility of hyperhidrosis post axillary depilatory laser.  

PubMed

Hyperhidrosis and bromhidrosis were lately reported as novel side effects of laser-assisted removal of axillary hair. The goal of our study was to evaluate the reversibility of these two side effects. An observational, single-center cohort study included over a 30-month screening period 30 patients with newly reported hyperhidrosis and/or bromhidrosis related to axillary depilatory laser. After 26 weeks of follow-up, each patient was assessed for spontaneous reversibility. A 12-week duration treatment with topical aluminum chloride was evaluated in patients with persisting hyperhidrosis. Hyperhidrosis was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Spontaneous reversibility was observed in 20% of patients. In total, 23 out of 30 patients recovered normal axillary transpiration either spontaneously or after treatment. Mean HDSS score was significantly lower in the treated group. It appears that axillary hyperhidrosis and bromhidrosis, secondary to laser depilation, reverse either spontaneously or after using topical antiperspirant. PMID:23887660

Helou, Josiane; Habre, Maya; Soutou, Boutros; Maatouk, Ismael; Ibrahim, Tony; Tomb, Roland

2014-03-01

96

Multidisciplinary approach to selective sentinel lymph node mapping in breast cancer  

Microsoft Academic Search

Although the role of axillary lymph node dissection is controversial with respect to survival benefits, its role as a staging\\u000a procedure has been well established since nodal involvement is the most reliable prognostic indicator for patients with breast\\u000a cancer. Selective sentinel lymph node (SLN) dissection is gaining acceptance as a useful staging procedure because it is minimally\\u000a invasive and spares

Stanley P. L. Leong; Engene T. Morita; Patrick A. Treseler; Jan H. Wong

2000-01-01

97

Axillary shoot proliferation of blue honeysuckle  

Microsoft Academic Search

Factors affecting axillary shoot development of blue honeysuckle in vitro were studied with two genotypes, Lonicera caerulea\\u000a f. caerulea and L. caerulea f. edulis. There was a linear relationship between the concentration of N6-benzyladenine (1.1 to 17.8 ?mol l?1) and the number of axillary branches produced (3 to 13 new shoots), biomass production and callus formation of the form caerulea

Saila T. Karhu

1997-01-01

98

Lipoxygenase mediates invasion of intrametastatic lymphatic vessels and propagates lymph node metastasis of human mammary carcinoma xenografts in mouse  

PubMed Central

In individuals with mammary carcinoma, the most relevant prognostic predictor of distant organ metastasis and clinical outcome is the status of axillary lymph node metastasis. Metastases form initially in axillary sentinel lymph nodes and progress via connecting lymphatic vessels into postsentinel lymph nodes. However, the mechanisms of consecutive lymph node colonization are unknown. Through the analysis of human mammary carcinomas and their matching axillary lymph nodes, we show here that intrametastatic lymphatic vessels and bulk tumor cell invasion into these vessels highly correlate with formation of postsentinel metastasis. In an in vitro model of tumor bulk invasion, human mammary carcinoma cells caused circular defects in lymphatic endothelial monolayers. These circular defects were highly reminiscent of defects of the lymphovascular walls at sites of tumor invasion in vivo and were primarily generated by the tumor-derived arachidonic acid metabolite 12S-HETE following 15-lipoxygenase-1 (ALOX15) catalysis. Accordingly, pharmacological inhibition and shRNA knockdown of ALOX15 each repressed formation of circular defects in vitro. Importantly, ALOX15 knockdown antagonized formation of lymph node metastasis in xenografted tumors. Furthermore, expression of lipoxygenase in human sentinel lymph node metastases correlated inversely with metastasis-free survival. These results provide evidence that lipoxygenase serves as a mediator of tumor cell invasion into lymphatic vessels and formation of lymph node metastasis in ductal mammary carcinomas. PMID:21540548

Kerjaschki, Dontscho; Bago-Horvath, Zsuzsanna; Rudas, Margaretha; Sexl, Veronika; Schneckenleithner, Christine; Wolbank, Susanne; Bartel, Gregor; Krieger, Sigurd; Kalt, Romana; Hantusch, Brigitte; Keller, Thomas; Nagy-Bojarszky, Katalin; Huttary, Nicole; Raab, Ingrid; Lackner, Karin; Krautgasser, Katharina; Schachner, Helga; Kaserer, Klaus; Rezar, Sandra; Madlener, Sybille; Vonach, Caroline; Davidovits, Agnes; Nosaka, Hitonari; Hammerle, Monika; Viola, Katharina; Dolznig, Helmut; Schreiber, Martin; Nader, Alexander; Mikulits, Wolfgang; Gnant, Michael; Hirakawa, Satoshi; Detmar, Michael; Alitalo, Kari; Nijman, Sebastian; Offner, Felix; Maier, Thorsten J.; Steinhilber, Dieter; Krupitza, Georg

2011-01-01

99

Prognostic Factors and Availability of D2 Lymph Node Dissection for the Patients with Stage II Gastric Cancer: Comparative Analysis of Subgroups in Stage II  

Microsoft Academic Search

Background  According to the fifth edition of the UICC TNM classification, stage II gastric cancer has three subgroups: T1N2M0, T2N1M0,\\u000a and T3N0M0. This study was designed to investigate the prognosis of stage II gastric cancer according to the T and N category\\u000a to verify the accuracy of TNM staging for stage II and to determine the prognostic factors for patients with

Joong-Min Park; Jong-Han Kim; Sung-Soo Park; Seung-Joo Kim; Young-Jae Mok; Chong-Suk Kim

2008-01-01

100

The Value of Ultrasound in Detecting Extra-Axillary Regional Node Involvement in Patients With Advanced Breast Cancer  

PubMed Central

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

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

2012-01-01

101

Re-sentinel node biopsy after previous breast and axillary surgery.  

PubMed

There is no consensus regarding the strategy for managing the regional lymph nodes in patients with local breast cancer recurrence. This paper reviews the updated data on re-sentinel lymph node biopsy (re-SLNB) after previous surgery. The identification rate of re-SLNB varied from 29 to 100 % (mean 67 %). The success rate of re-SLNB depends on the method used for the previous axillary surgery and the number of lymph nodes harvested. Re-SLNB may be feasible even after mastectomy. A relationship between post-operative radiotherapy and identification of re-SLNB was not seen. A longer disease-free interval may correlate with a lower identification rate, but this finding is not definitive. Based on data regarding back-up dissection after re-SLNB, the accuracy of re-SLNB may be as good as SLNB in primary cases. Altered lymphatic drainage was reported in 2-89 % (mean 32 %) of cases. Because the altered lymphatic drainage can be detected only by lymphoscintigraphy, the radioisotope method, followed by lymphoscintigraphy, should be used. There are not many reported cases of axillary recurrence after re-SLNB, and the follow-up periods have been short. Because re-SLNB cases have a wide variety of backgrounds, it is necessary to accumulate a larger number of cases and to obtain data from longer follow-up period in order to make clear recommendations. PMID:24254062

Ikeda, Tadashi

2014-11-01

102

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

103

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

104

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

105

Management of sentinel node re-mapping in patients who have second or recurrent breast cancer and had previous axillary procedures  

PubMed Central

Background In patients with recurrent or second primary ipsilateral breast cancer, axillary staging is the key factor in locoregional control and a strong prognostic characteristic. The efficient evaluation of lymphatic drainage of re-sentinel lymph node biopsies (re-SLNBs) has remained a challenge in the management of ipsilateral primary or recurrent breast cancer patients who are clinically lymph node negative. This study explores whether a SLNB for patients with primary or recurrent breast cancer is possible after previous axillary surgery. It evaluates potential reasons for mapping failure that might be associated with patients in this group. Methods Between March 2006 and November 2013, 458 patients were subjected to a breast SLNB. A lymphoscintigraphy procedure was performed on 330 patients for sentinel lymph node (SLN) mapping on the day of surgery. Seven patients with either a second primary cancer in the same breast or recurrent breast cancer were described. Two of these seven patients had axillary lymph node dissection (ALND) during previous treatments and five had SLNB. A dual mapping method was used for all patients. Preoperative lymphoscintigraphy was performed four hours before surgery. Results SLNs were successfully remapped in six of seven (85.7%) patients, of whom five (71.43%) had previously undergone SLNB and two (28.57%) previous ALND. Localizations of SLNs were ipsilateral axillary in three patients, ipsilateral internal mammary in one patient, and contralateral axillary in two patients. An altered distribution of lymph nodes was discovered in both patients with previous ALND. In one of the two patients, metastases were found in an aberrant lymph drainage basin at the location of a non-ipsilateral axillary node (contralateral axillary SLN). The second previously ALND patient had an internal mammary SLN. In one patient, mapping was unsuccessful and the SLN was not identified. Conclusions Altered lymphatic drainage incidence increases following breast-conserving surgery for an initial breast cancer, and the location of SLNs becomes unpredictable at the time of a second primary or recurrent ipsilateral breast cancer. This leads to the necessity of using a radionuclide (lymphoscintigraphy) for a successful re-mapping procedure. A re-SLNB is precise and beneficial even though there are few patients. A lymphoscintigraphy can identify SLNs at their new unpredicted location. PMID:25016393

2014-01-01

106

Improvement in intramammary sentinel lymph node removal using a novel prototype hand held probe during breast conservative surgery.  

PubMed

Intramammary sentinel lymph node excision during breast conservative surgery was performed, in this case report, using a prototype intraoperative gamma probe. In contrast to the four axillary sentinel lymph nodes that were subnormal, the excised intramammary sentinel lymph node was massively invaded by cancer cells. Therefore this finding had profound implication for the staging of the tumor and for treatment selection. This case report illustrates that an efficient intraoperative gamma probe is useful to locate and remove intramammary sentinel lymph node in breast cancer patients treated with breast conservation. PMID:15754130

Mathelin, Carole; Tomasetto, Catherine; Rio, Marie-Christine; Chenard, Marie-Pierre; Brettes, Jean-Philippe; Guyonnet, Jean-Louis

2005-02-01

107

Midterm Experience of Ipsilateral Axillary-Axillary Arteriovenous Loop Graft as Tertiary Access for Haemodialysis  

PubMed Central

Objectives. To present a series of ipsilateral axillary artery to axillary vein loop arm grafts as an alternative vascular access procedure for haemodialysis in patients with difficult access. Design. Retrospective case series. Methods. Patients who underwent an axillary loop arteriovenous graft from September 2009 to September 2012 were included. Preoperative venous imaging to exclude central venous stenosis and to image arm/axillary veins was performed. A cuffed PTFE graft was anastomosed to the distal axillary artery and axillary vein and looped on the arm. Results. 25 procedures were performed on 22 patients. Median age was 51 years, with 9 males and 13 females. Median number of previous access procedures was 3 (range 0–7). Median followup was 16.4 months (range 1–35). At 3 months and 1 year, the primary and secondary patency rates were 70% and 72% and 36% and 37%, respectively. There were 11 radiological interventions in 6 grafts including 5 angioplasties and 6 thrombectomies. There were 19 surgical procedures in 10 grafts, including thrombectomy, revision, repair for bleeding, and excision. Conclusions. Our series demonstrates that the axillary loop arm graft yields acceptable early patency rates in a complex group of patients but to maintain graft patency required high rates of surgical and radiological intervention, in particular graft thrombectomy. PMID:24778864

Hunter, J. P.; Nicholson, M. L.

2014-01-01

108

A case of invasive micropapillary carcinoma of the breast involving extensive lymph node metastasis.  

PubMed

We herein report a case of invasive micropapillary carcinoma (IMPC) involving extensive lymph node metastasis with no recurrence for over 7 years. A 41-year-old female presented with pain and a swelling mass in the left axillary region, which had been present for several months. The tumor measured 1.6 cm in diameter in the middle of upper area of the left breast. Based on the findings of a core needle biopsy the pathological diagnosis was IMPC or mucinous carcinoma. The cytology of the left axillary lymph node was positive for metastatic carcinoma. The patient underwent a left mastectomy and a left axillary dissection (level I to III). The postoperative pathological diagnosis was IMPC with mucin production, and the number of metastatic lymph nodes was 59. The patient was given adjuvant chemotherapy (four courses of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and four courses of docetaxel), radiation for the left chest wall, supraclavicular and internal thoracic area, and then received tamoxifen for 5 years. The patient has remained recurrence-free for over 7 years. IMPC is known to be an aggressive histological type associated with a high incidence of lymph node metastasis and a poor prognosis. It seems that long-term survival was obtained by performing sufficient medical treatment. Prognostic factors other than the number of lymph node metastases may also exist. PMID:24708742

Taketani, Kenji; Tokunaga, Eriko; Yamashita, Nami; Tanaka, Kimihiro; Zaitsu, Yoko; Akiyoshi, Sayuri; Okada, Satoko; Aishima, Shinichi; Morita, Masaru; Maehara, Yoshihiko

2014-01-01

109

S-1 combined with docetaxel following doxorubicin plus cyclophosphamide as neoadjuvant therapy in breast cancer: phase II trial  

PubMed Central

Background This study evaluated the efficacy and safety of S-1 combined with docetaxel (SD) following doxorubicin plus cyclophosphamide (AC) as neoadjuvant therapy in patients with HER2-negative, stage II-III breast cancer. Methods Patients received AC every 3 weeks for four cycles followed by S-1 (30 mg/m2 orally b.i.d. on days 1–14) and docetaxel (75 mg/m2 i.v. on day 1) every 3 weeks for four cycles. The primary endpoint was the pathological complete response (pCR) rate in breast and axillary lymph nodes. Results The study included 49 patients with a median age of 43 years. The median breast tumor size was 4.0 cm by palpation. All patients were positive for involvement of axillary lymph node and five patients also had supraclavicular lymph node metastasis, which was confirmed by histological examination. In total, 85.4% of patients (41/49) completed eight cycles of therapy and 95.9% of patients (47/49) received curative surgery. The pCR rate was 22.5% (n = 11). The clinical response rate was 67.4%. During SD chemotherapy, the most frequent grade 3–4 toxicity was neutropenia (8.5% by cycle). There was a single treatment-related mortality from severe neutropenia. Grade 3 S-1 specific toxicities such as epigastric pain (12.2% by person), stomatitis (4.1% by person), and diarrhea (2.0% by person) were also observed. In particular, gastrointestinal discomfort led to dose reduction of S-1 in 45.8% of patients. Conclusions Given all axillary lymph node positive diseases, neoadjuvant S-1 combined with docetaxel following AC showed a favorable anti-tumor activity but gastrointestinal discomfort should be carefully considered for future studies. Trial registration NCT00994968 PMID:24314307

2013-01-01

110

Lymphatic Vessel Function and Lymphatic Growth Factor Secretion after Microvascular Lymph Node Transfer in Lymphedema Patients  

PubMed Central

Background: Recent reports have shown that microvascular lymph node transfer may improve lymphatic drainage in lymphedema patients. Lymphatic anastomoses are expected to form spontaneously in response to lymphatic growth factor [vascular endothelial growth factor C (VEGF-C)] secreted by the transferred lymph nodes. Methods: We have analyzed the results of 19 lymph node transfer patients operated on 2007–2012. Postoperat ive lymphatic function of the affected arm was evaluated using semiquantitative lymphoscintigraphy (transport index) and limb circumference measurements. To investigate the postoperative VEGF-C secretion, we examined axillary seroma fluid samples after different surgical operations, including lymph node transfer. Results: The transport index was improved postoperatively in 7 of 19 patients. Ten of the 19 patients were able to reduce or even discontinue using compression garments. Arm circumferences were reduced in 12 of 19 patients. Six of the 7 patients with preoperative erysipelas infections have not had infectious episodes postoperatively during 15–67 months follow-up. Neuropathic pain was relieved in 5 of 5 patients. VEGF-C protein was detected in the axillary seroma fluid both after lymph node transfer and normal breast reconstruction. Conclusions: Reconstructing the lymphatic anatomy of the axilla with a lymph node flap may offer possibilities that other reconstructive options are lacking. However, we will need further reports and comparative studies about the clinical efficacy of this new promising technique. In addition to the transferred lymph nodes, lymphatic growth factor production may also be induced by other factors related to microvascular breast reconstruction. PMID:25289206

Viitanen, Tiina P.; Visuri, Mikko T.; Hartiala, Pauliina; Maki, Maija T.; Seppanen, Marko P.; Suominen, Erkki A.

2013-01-01

111

The lymph drainage pattern of the mammary glands in the cat: a lymphographic and computerized tomography lymphographic study.  

PubMed

Seventy-three clinically normal, lactating cats were used to investigate the lymph drainage of 73 mammary glands. In 50 cats of the first group, the number of lymphatic vessels emerging from the examined mammary gland, their course and the lymph nodes into which they are drained were studied by indirect lymphography (IL) after intramammary injection of an oily contrast medium. In 23 cats of the second group, the lymph drainage of the mammary glands was studied by computerized tomography indirect lymphography (CT-IL) after intramammary injection of a water soluble contrast medium. The following day, the lymph drainage of the mammary gland examined by CT-IL was studied by IL, as it was described in the first group, for comparison purposes. The main conclusions drawn after this study were as follows: lymph drains from the first and second mammary glands with one or rarely two or three lymphatic vessels to the accessory axillary lymph nodes. Lymph drains from the third mammary gland with one or two and rarely three lymphatic vessels usually to the accessory inguinal lymph nodes or to the accessory axillary lymph nodes. In some cases, it drains to both lymph nodes simultaneously or it may rarely drain only to the medial iliac lymph nodes. The fourth mammary gland with one or two and rarely three lymphatic vessels usually drains to the accessory inguinal lymph nodes. It may rarely drain only to the medial iliac lymph nodes. Mammary lymphatic vessels that cross the midline and lymphatic connection between the mammary glands were not demonstrated. No differences in the mammary lymph drainage pattern between IL and CT-IL were found. PMID:19614630

Papadopoulou, P L; Patsikas, M N; Charitanti, A; Kazakos, G M; Papazoglou, L G; Karayannopoulou, M; Chrisogonidis, I; Tziris, N; Dimitriadis, A

2009-08-01

112

Axillary Cavernous Lymphangioma in Pregnancy and Puerperium  

Microsoft Academic Search

Background: Cavernous lymphangioma is a form of benign congenital abnormality grouped under lymphatic malformations, which can clinically manifest as a cystic tumor. Common areas are the neck and axillary region. Most cases are diagnosed in children under the age of 2, and occasionally the diagnosis is made in utero. Case: We present the case of a 29-year-old primigravid woman with

Katharina C. Quack Loetscher; Abdul-Raham Jandali; Elisabeth Garzoli; Judit Pok; Ernst Beinder

2005-01-01

113

Local procedural approaches for axillary hyperhidrosis.  

PubMed

When medical options for axillary hyperhidrosis have failed, botulinum toxin is an effective, safe, and well-tolerated, although temporary, treatment option. For long-lasting or permanent efficacy, some patients turn to local procedures, such as superficial liposuction or manual curettage, or more invasive local surgery. Newer, minimally invasive treatments have become available, such as microwave energy thermolysis. PMID:25152347

Glaser, Dee Anna; Galperin, Timur A

2014-10-01

114

Methylene blue dye--a safe and effective alternative for sentinel lymph node localization.  

PubMed

Sentinel lymph node (SLN) biopsy has emerged as an effective diagnostic tool in axillary staging in breast cancer. The commonly used technique employs isosulfan blue/patent blue V combined with radioactive colloid tracer. Methylene blue (MB) is a less expensive and readily available alternative dye. The study evaluated the safety and efficacy of MB in SLN localization. A retrospective study of 329 patients with early breast cancer who had SLN localization as part of an ethically approved prospective evaluation study of SLN localization technique was carried out. Lymph node positive, tumors >2 cm on clinical and radiological evaluation, those with previous breast and axillary surgery, neo-adjuvant chemotherapy were excluded from the study. One hundred seventy three patients underwent SLN localization using 1 mL of 1% MB, and a combined MB-radio colloid tracer technique was used in the other 156 patients. Allocation to the groups was by simple randomization. Injection of the dye and radioisotope was into the subdermal plane in the sub-areolar region. Patients underwent breast conservation surgery or mastectomy with SLN directed four node axillary sampling +/- axillary clearance. The lymph node was examined by standard microscopy. There were no reported complications with the use of MB aside from temporary tattooing. The technique failed in eight patients giving an identification rate of 97.6%. Ten of the 258 (3.9%) patients had false-negative SLN, with negative predictive value of 96.1%, sensitivity of predicting further axillary disease of 73%, specificity of 87.3%, and overall accuracy of 85.7%. Reported adverse reaction to isosulfan blue/patent blue V varied from minor to severe anaphylactic reactions (1-3%) requiring vigorous resuscitation. Subdermal sub-areolar injection of MB is safe and effective readily available dye for SLN localization in axillary staging of breast cancer with no major adverse reaction. PMID:18186867

Varghese, Philip; Abdel-Rahman, Alaa Talaat; Akberali, Samira; Mostafa, Azad; Gattuso, Jennifer May; Carpenter, Robert

2008-01-01

115

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. PMID:23788864

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

2012-01-01

116

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

PubMed

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. PMID:23788864

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

2012-01-01

117

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

118

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

2010-01-01

119

The significance of intramammary lymph nodes in breast cancer: a systematic review and meta-analysis.  

PubMed

Intramammary lymph nodes (IntraMLNs) are frequent mostly benign incidental findings. However, they are clinically important because they can be the primary sites of metastasis and sentinel lymph nodes. Literature data regarding the clinical significance of IntraMLNs metastasis, however, remains controversial. This study aimed to perform a systematic review and meta-analysis to better define the prognostic value of positive IntraMLNs in patients with breast cancer. A systematic review of the literature without date restrictions was conducted. Five electronic medical databases were searched, and a hand-search of the reference lists of the collected articles was also performed. Studies with sufficient and relevant pathologic and clinical survival data were included. Other studies with insufficient data or normal findings were excluded. This study found 18 studies eligible for systematic review, 3 of which were eligible for outcome meta-analysis. IntraMLNs metastases were strongly correlated with axillary lymph nodes involvement. Positive IntraMLNs are reliable predictors of axillary lymph node involvement and therefore a guide for further surgical management of the axillary nodes. Even though it could be concluded that IntraMLNs metastasis is an independent predictor of outcome, this meta-analysis was limited because of the scarcity of data and the inconsistencies and heterogeneity of the outcome studies. PMID:22649167

Abdullgaffar, Badr; Gopal, Parthasarathi; Abdulrahim, Manal; Ghazi, Esaaf; Mohamed, Eliza

2012-12-01

120

Total and differential leucocyte counts and lymphocyte subpopulations in lymph, afferent and efferent to the supramammary lymph node, during endotoxin-induced bovine mastitis.  

PubMed

Leucocyte trafficking in afferent and efferent mammary lymph and the supramammary lymph node in cows was examined during 4 h after intramammary infusion of endotoxin from Escherichia coli. Total and differential leucocyte counts were measured in milk, blood and lymph. The proportions of CD4(+), CD8(+), major histocompatibility complex (MHC) class II(+) and IgM(+) lymphocytes were examined in the lymph and lymph node. At post-infusion hour (PIH) 4, the flow rates of both lymph fluids had increased approximately eightfold. Total leucocyte concentration increased in afferent lymph, but decreased in efferent lymph. Neutrophils increased in afferent lymph at PIH 2 and in efferent lymph and milk at PIH 4. The predominant cell type in afferent lymph shifted from lymphocyte to neutrophil while lymphocyte was still at PIH 4 the predominant type in efferent lymph. Among the lymphocytes, B cells were predominant in afferent lymph and lymph node at PIH 4 while T cells, mainly CD4(+) cells, were predominant in efferent lymph both at PIH 0 and PIH 4. The CD4 : CD8 ratio was higher in efferent lymph and the challenged lymph node than in afferent lymph and the control node, respectively. There was a significant difference in proportions of each lymphocyte subpopulation except for IgM(+) cells, between afferent and efferent lymph after infusion. According to the results, there was already during the first hours of the immune response, a non-random trafficking of neutrophils and lymphocyte subpopulations resulting in a changed distribution of cells in afferent and efferent lymph and a difference in lymphocyte reactivity between the two lymph fluids. PMID:17348968

Lun, S; Aström, G; Magnusson, U; Ostensson, K

2007-04-01

121

The human axillary organ: An evolutionary puzzle  

Microsoft Academic Search

In the cavum axillae of humans lies a glandular organ composed of tightly packed apocrine glands with secrete a colourless,\\u000a or slightly pigmented fluid — the so-called axillary organ. It develops during childhood but remains inactive until the onset\\u000a of sexual maturity when it grows hairs and embarks on a lifetime of secretion. A similar structure occurs in African apes

D. M. Stoddart

1998-01-01

122

Positive sentinel lymph node metastasis from a metastasis in Melanoma.  

PubMed

The rationale for certain patterns of metastatic spread seen in melanoma is not well understood. Currently, there is no clear experimental evidence to support the potential for metastases to form metastases in this disease. We report a case of a 31-year-old woman, with metastatic melanoma, who developed axillary lymph node metastases hypothesized to originate from a breast metastasis rather than the primary disease. Improved understanding of the underlying molecular processes involved in systemic spread would facilitate development of improved adjuvant therapies and prognostic markers. PMID:24456240

Bowyer, Samantha; Feeney, Kynan; Millward, Michael

2014-12-01

123

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

2013-01-01

124

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. PMID:23617459

2013-01-01

125

Cost Modeling of Preoperative Axillary Ultrasound and Fine-Needle Aspiration to Guide Surgery for Invasive Breast Cancer  

PubMed Central

Purpose Preoperative axillary lymph node ultrasound (US) and fine-needle aspiration (FNA) biopsy can identify a proportion of node-positive patients and avoid sentinel lymph node (SLN) surgery and direct surgical treatment. We compared the costs with preoperative US/FNA to without US/FNA (standard of care) for invasive breast cancer. Methods Using decision-analytic software we constructed a model to assess the costs associated with the two preoperative strategies. Diagnostic test sensitivities and specificities were obtained from literature review. Costs were derived from Medicare payment rates and actual resource utilization. Base-case results were fully probabilistic to capture parameter uncertainty in economic results. Results Base-case results estimate total mean costs per patient of $10,947 (“$” indicates US dollars throughout) with the US/FNA strategy and $10,983 with standard of care, an incremental cost savings of $36, on average, per patient [95% confidence interval (CI) of cost difference: ?$248 to $179]. Most (63%) of the simulations resulted in cost saving with axillary US/FNA. One-way sensitivity analyses suggest that results are sensitive to assumed diagnostic and surgical costs and selected diagnostic test parameters. US/FNA approach was similar in costs or cost saving relative to the standard of care for all tumor stages. Conclusions The additional cost of performing axillary US with possible FNA in every patient is balanced, on average, by the savings from avoiding SLN in cases where metastasis can be documented preoperatively. Routine use of preoperative axillary US with FNA to guide surgical planning can decrease the overall cost of patient care for invasive breast cancer. PMID:20127185

Boughey, Judy C.; Moriarty, James P.; Degnim, Amy C.; Gregg, Melissa S.; Egginton, Jason S.; Long, Kirsten Hall

2010-01-01

126

Is Regional Lymph Node Irradiation Necessary in Stage II to III Breast Cancer Patients With Negative Pathologic Node Status After Neoadjuvant Chemotherapy?  

Microsoft Academic Search

Purpose: Neoadjuvant chemotherapy (NAC) generally induces significant changes in the pathologic extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation (LNI) in breast cancer (BC) patients with pathologic N0 status (pN0) after NAC and breast-conserving surgery (BCS). Methods and Materials: Among 1,054 BC patients treated with NAC

Caroline Daveau; Denise Stevens; Etienne Brain; Oscar Berges; Sylviane Villette; Patricia Moisson; Miriam Gardner; Brigitte De la Lande; Serge Lasry; Alain Labib; Romuald Le Scodan

2010-01-01

127

[Intramammary sentinel lymph node preoperative identification with SPECT/CT in a patient with breast cancer. Clinical meaning and relevance].  

PubMed

We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy. PMID:21334108

Andrés, A; Prats, E; Santapau, A; Tardín, L; Razola, P; Parra, A; Rambalde, E F; Banzo, J

2011-01-01

128

Use of Fluorescence Imaging in Combination with Patent Blue Dye versus Patent Blue Dye Alone in Sentinel Lymph Node Biopsy in Breast Cancer  

PubMed Central

Purpose Near-infrared fluorescence imaging with indocyanine green (ICG) has the potential to improve sentinel lymph node (SLN) mapping in breast cancer. In this clinical trial, we compared the potential value of ICG combined with blue dye with that of blue dye alone for detecting SLNs. Methods Patients undergoing SLN biopsy (SLNB) between November 2010 and November 2013 were included. Up to December 2011, SLNs were detected by using patent blue (PB) alone, and since January 2012, by using PB in combination with ICG. The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups. All patients underwent level I and II axillary dissections after SLNB. Results In group A, the SLN detection rate was 96.9% (93/96), the accuracy of detection was 98.9% (92/93), and the false-negative rate (FNR) was 3.4% (1/29). In group B, the SLN detection rate was 84.9% (62/73), the accuracy of detection was 96.8% (60/62), and the FNR was 11.1% (2/18). The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR. Conclusion The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results. PMID:25320623

Tong, Meng; Gao, Wei

2014-01-01

129

Photoacoustic image-guided needle biopsy of sentinel lymph nodes  

NASA Astrophysics Data System (ADS)

We have implemented a hand-held photoacoustic and ultrasound probe for image-guided needle biopsy using a modified clinical ultrasound array system. Pulsed laser light was delivered via bifurcated optical fiber bundles integrated with the hand-held ultrasound probe. We photoacoustically guided needle insertion into rat sentinel lymph nodes (SLNs) following accumulation of indocyanine green (ICG). Strong photoacoustic image contrast of the needle was achieved. After intradermal injection of ICG in the left forepaw, deeply positioned SLNs (beneath 2-cm thick chicken breast) were easily indentified in vivo and in real time. Further, we confirmed ICG uptake in axillary lymph nodes with in vivo and ex vivo fluorescence imaging. These results demonstrate the clinical potential of this hand-held photoacoustic system for facile identification and needle biopsy of SLNs for cancer staging and metastasis detection in humans.

Kim, Chulhong; Erpelding, Todd N.; Akers, Walter J.; Maslov, Konstantin; Song, Liang; Jankovic, Ladislav; Margenthaler, Julie A.; Achilefu, Samuel; Wang, Lihong V.

2011-03-01

130

Hazard of recurrence and adjuvant treatment effects over time in lymph node-negative breast cancer  

Microsoft Academic Search

Background For patients with axillary lymph node-negative breast cancer, benefits from adjuvant therapy are smaller than in node-positive\\u000a disease and thus more selective use is warranted, prompting development of risk profiling to identify those most likely to\\u000a benefit. Examination of the magnitude and changes in the hazard of failure over time in node-negative breast cancer may also\\u000a be informative in

James J. Dignam; Vanja Dukic; Stewart J. Anderson; Eleftherios P. Mamounas; D. Lawrence Wickerham; Norman Wolmark

2009-01-01

131

Axillary lymphoscintigraphy in the management of patients with breast cancer: A study of 341 patients  

SciTech Connect

Axillary lymphoscintigraph (AxLS) has been proposed preoperatively to diagnose breast cancer and postoperatively to predict recurrence; its role in routine management of carcinoma of the breast has not yet been determined. In a population with predominantly Stage I or II disease AxLS was performed in 140 patients who underwent surgery without axillary dissection (GpI), and in 201 whose surgery included axillary dissection (GpII), 49 of whom were studied prior to surgery; 84% of all patients were studied within 2 months of operation. Bilateral interdigital injections of Tc-99mSb/sub 2/S/sub 3/ (20MBq) were given and anterior images obtained 2 hours later. Internal mammary lymphoscintigraphy (IMLS) was performed concurrently. Scans were classed as normal (NOR) or abnormal (ABN) by adapting criteria used in interpretation of IMLS. For analysis of prognostic value, only patients with a minimum follow-up of 2 years were assessed. In patients scanned prior to surgery, AxLS sensitivity and specificity in predicting nodal involvement were 74% and 77% respectively. Clinical correlation suggests that features in the AxLS can be recognized which may be predictive of disease outcome despite the lack of direct correlation between the image and histopathological findings.

McLean, R.G.; Ege, G.N.

1985-05-01

132

Follicular lymphoma mimicking marginal zone lymphoma in lymph node: a case report  

PubMed Central

Nodal follicular lymphoma (FL) is typically composed of follicular or nodular proliferation of small cleaved lymphoid cells, presumably derived from germinal center (GC) B cells. The hallmark of FL is t(14;18)(q32;q21) chromosomal translocation, which juxtaposes anti-apoptotic gene BCL2 to immunoglobulin heavy chain (IGH) promoter. Reflecting this background, FL cells are immunohistochemically positive for BCL2 as well as GC B cell markers CD10 and BCL6. It is known that low grade B-cell lymphomas, including FL, chronic lymphocytic leukemia/small lymphocytic lymphoma, and marginal zone lymphoma, are sometimes associated with marginal zone differentiation or plasmacytic differentiation. The marginal zone differentiation obscures the morphological differences among these, providing diagnostic challenges for histopathologists. In this paper, we present a case of FL, originally mimicking marginal zone lymphoma in the axillary lymph node. Subsequent bone marrow biopsy showed paratrabecular infiltration of small to medium-sized lymphoid cells. Immunohistochemical analysis of the bone marrow biopsy together with histopathology and flow cytometry of the axillary lymph node led to a final diagnosis of FL with marginal zone differentiation in the axillary lymph node and its bone marrow infiltration. Our case illustrates and reconfirms the importance of clinicopathological correlation which leads to a correct diagnosis.

Matsuda, Ikuo; Shimizu, Yoshifumi; Okamoto, Takahiro; Hirota, Seiichi

2014-01-01

133

Neurologic Complications of 405 Consecutive Continuous Axillary Catheters  

Microsoft Academic Search

Continuous axillary brachial plexus block may theoret- ically increase the risk of neurologic complications be- cause of catheter-induced mechanical trauma or local anesthetic toxicity. In this study, we retrospectively re- viewed the frequency of complications using current techniques and applications. There were 405 continu- ous axillary catheters in 368 patients. A preexisting neurologic condition was present in 41 (10.1%) patients,

Bradley D. Bergman; James R. Hebl; Jay Kent; Terese T. Horlocker

2003-01-01

134

Reoperative sentinel lymph node biopsy in ipsilateral breast cancer relapse.  

PubMed

Sentinel lymph node biopsy (SLNB) is controversial following ipsilateral breast tumour relapse (IBTR) and previous axillary surgery. We retrospectively assessed the feasibility, outcomes and utility of this procedure. Eighteen patients with IBTR who underwent reoperative SLNB were identified. Fifteen women had previously undergone axillary lymph node dissection and three SLNB for breast cancer. Twelve of 16 patients underwent successful lymphoscintigraphy (LSG). Lymphatic drainage patterns varied widely - ipsilateral axilla (5), contralateral axilla (5), and ipsilateral internal mammary (5). Two patients had drainage to more than one nodal basin. Nine of 12 patients demonstrated drainage outside of the ipsilateral axilla. Reoperative SLNB was successful in 12/18 of patients - 4 ipsilateral axilla, 1 ipsilateral internal mammary, 1 ipsilateral intramammary, 4 contralateral axilla. Two patients had sentinel nodes in multiple nodal basins. Positive sentinel node was found in one successful case (contralateral axilla) and isolated tumour cells in two (1 contralateral axilla, 1 ipsilateral internal mammary). In conclusion, reoperative SLNB is feasible. Lymphatic drainage patterns vary widely and preoperative LSG is vital to facilitate identification of sentinel nodes in unusual sites. Its prognostic and therapeutic significance warrants further study. PMID:19819141

Tasevski, R; Gogos, A J; Mann, G B

2009-10-01

135

A newly discovered Anaerococcus strain responsible for axillary odor and a new axillary odor inhibitor, pentagalloyl glucose.  

PubMed

Skin surface bacteria contribute to body odor, especially axillary odor. We aimed to investigate anaerobic bacteria that had not been previously studied for axillary odor formation. A new anaerobic Anaerococcus sp. A20, that releases 3-hydroxy-3-metyl-hexanoic acid (HMHA, main component of axillary odor) from its glutamyl conjugate, was discovered from axillary isolates. This strain showed strong resistance to the antimicrobial agents, triclosan and 4-isopropyl-3-methylphenol; therefore, we screened plant extracts that inhibit the A20 strain. We discovered that pentagalloyl glucose (PGG) extracted from the Chinese Gall plant exhibited both antibacterial and inhibitory activities against HMHA release by the A20 strain. As the excellent antibacterial activity and inhibitory effect of PGG against HMHA release were seen in vitro, we conducted an open study to evaluate the deodorant effects of PGG on axillary odor. The sensory tests on odor strength showed that application of the PGG solution could reduce axillary odors in vivo. Although there was a small change in axillary microbiota, the microbial count of A20 significantly reduced. These results strongly indicate PGG as a new innovative deodorant material that only affects odor-releasing bacteria in the axillary microbiota. PMID:24784923

Fujii, Takayoshi; Shinozaki, Junko; Kajiura, Takayuki; Iwasaki, Keiji; Fudou, Ryosuke

2014-07-01

136

Sentinel Lymph Node Biopsy  

Cancer.gov

A fact sheet that describes the sentinel lymph node biopsy (SLNB) procedure, its use in determining the extent, or stage, of cancer in the body, and the results of research on the use of SLNB in breast cancer and melanoma.

137

Axillary Metastasis from an Occult Tubal Serous Carcinoma in a Patient with Ipsilateral Breast Carcinoma: A Potential Diagnostic Pitfall  

PubMed Central

Axillary nodal metastasis from a nonmammary neoplasia is much rarer than diseases associated with a primary breast carcinoma. However, this has to be considered in the differential diagnosis of nodal disease in patients with a history of breast cancer. Here, we report the case of a 73-year-old female with a past medical history of breast cancer, presenting with an ipsilateral axillary metastatic carcinoma. The immunohistochemical profile of the metastatic lesion was consistent with a high grade serous carcinoma. After undergoing a total abdominal hysterectomy and salpingo-oophorectomy, thorough pathological examination revealed two microscopic foci of serous carcinoma in the right fallopian tube, not detectable by preoperative magnetic resonance imaging. In this context, the poorly differentiated appearance of the metastatic tumor and positive staining for estrogen receptor, might lead to a misdiagnosis of metastatic breast carcinoma. As the therapeutic implications differ, it is important for the pathologist to critically assess axillary lymph node metastases, even in patients with a past history of ipsilateral breast carcinoma and no other known primary tumors. PMID:25110596

Altinel, Gulbeyaz; Arseneau, Jocelyne; Omeroglu, Atilla

2014-01-01

138

Value of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Previous Excisional Biopsy  

PubMed Central

Purpose Sentinel lymph node biopsy (SLNB) in breast cancer patients with clinically negative axilla will ensure axillary dissection only for cases with lymph node metastasis and provide information about pathologic staging as accurate as the axillary dissection. It was shown that SLNB could be successfully performed regardless of the type of biopsy. The aim of this study was to investigate the feasibility of SLNB after excisional biopsy. Methods One hundred patients diagnosed with excisional biopsy or guide wire-localization and operated on with SLNB between February 2007 and March 2009 were retrospectively analyzed. SLNB was performed with 10 cc of 1% methylene blue alone or both methylene blue and 1 mCi of Tc-99m nanocolloid combination. Age, tumor localization and size, length of the biopsy incision, size of the biopsy specimen, multifocality, lymphovascular invasion, tumor grade, staining with methylene blue, localization, number and metastatic status of the lymph nodes stained, and success rate with a gamma probe were evaluated. Results Sentinel lymph node (SLN) could not be identified in 9 (16.9%) of patients in the methylene blue group (n=53). In the combination group (n=47), SLN could not be identified in one patient. Of 32 patients with negative SLNB, metastatic involvement was found to be present in 5 patients after axillary lymph node dissection (false negatives). The average numbers of SLNs found in the methylene blue group and combination group were 1.4 and 1.6, respectively. SLN detection and false negative rates in the methylene blue group were 83% and 15.7%, respectively. The rates for the combination group were 98% and 6.4%, respectively. None of the parameters related to patient, tumor or process were found to affect detection rates of SLN. Conclusion Only SLNB using a combination method is a safe and reliable technique for breast cancer patients diagnosed with excisional biopsy. PMID:22493633

Coskun, Gokhan; Dogan, Lutfi; Ozaslan, Cihangir; Atalay, Can

2012-01-01

139

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

140

Reoperative Selective Sentinel Lymphadenectomy Combined With Lymphoscintigraphy Is Technically Feasible for Cutaneous Tumors of the Upper Extremity After Radical Dissection of Regional Lymph Node Basins for Breast Cancer  

PubMed Central

Objective: The rising incidence of melanoma and the high prevalence of breast cancer have generated a new scientific problem—how do the regional lymph node basins function after radical lymphadenectomy and are lymphatic drainage patterns altered after radical lymphadenectomy? Furthermore, after radical lymphadenectomy, selective sentinel lymphadenectomy is still a technically feasible and valid staging tool in the upper extremity? Thus, our study asks if selective sentinel lymph node dissection is technically feasible after radical lymph node dissection of the regional draining basin of the upper extremity (axilla). Methods: Retrospective review of a prospectively maintained database of patients was reviewed to identify patients who had lymphoscintigraphy and sentinel lymph node biopsy of the upper extremity after a radical axillary node dissection procedure. Imaging and pathology results were analyzed. Results: Seven patients fulfilling the inclusion criteria were identified. The patients all had either melanoma or invasive squamous cell carcinoma, and sentinel lymph nodes were identified in 6 out of 7 patients. One patient had metastases to 2 sentinel lymph nodes. Alternative drainage pathways were identified in 29% of patients, and 14% of patients had no identifiable drainage basin on lymphoscintigraphy. Conclusions: Sentinel lymph node dissection is technically feasible after previous axillary dissection. Lymphoscintigraphy is an important perioperative tool as lymphatic drainage may be altered or not observed as evidenced in 43% of the studied patients. However, when lymphatic drainage is detected by lymphoscintigraphy, pathologically significant sentinel lymph nodes are surgically identifiable.

Bellevue, Oliver C.; Leong, Stanley P.L.

2014-01-01

141

The levels of Ki-67 positive are positively associated with lymph node metastasis in invasive ductal breast cancer.  

PubMed

Breast cancer is the most common cancer in women worldwide. In this study, we evaluate the potential risk factors for lymph node metastasis in invasive breast cancer patients with axillary dissection. 147 patients were included into this prospective study. The prognostic biomarkers including Ki-67, human epidermal growth factor receptor 2 (HER-2), hormone receptor status, p53, and lymph node involvement were determined by immunohistochemistry. The association between lymph node metastasis and these biomarkers was analyzed. Lymph node metastasis was found in 62 patients out of 147 patients. The high levels of Ki-67 positive (greater than 20 %) were positively correlated with a higher incidence of lymph node metastasis, including the numbers of lymph nodes that contain tumor cells and the lymph node metastatic rate. The high rate of positive lymphovascular invasion (LVI) is associated with lymph node metastasis. However, the levels of Ki-67 positive were not correlated with the positive rate of LVI. There was also no association between lymph node metastasis and other prognostic biomarkers, such as HER-2, estrogen receptor, progesterone receptor, and p53. In addition, apart from p53, the levels of Ki-67 positive were correlated with other prognostic biomarkers. Our data suggest that Ki-67 positivity has value as a prognostic and predictive biomarker in breast cancer and may be a valuable proliferation marker in routine diagnosis of breast cancer. PMID:24879617

Yin, Yongxiang; Zeng, Ke; Wu, Man; Ding, Yun; Zhao, Min; Chen, Qi

2014-11-01

142

Ultrasound diagnosis of an atypical axillary lesion.  

PubMed

We report on the case of a 41-year-old man with a recently diagnosed amelanotic ulcerated melanoma, with a Breslow thickness of 3.5?mm and Clark level IV. He had a pre-existing mass in the axilla, which had grown in parallel to the developing tumor. A large regional lymph node was clinically suspected. Ultrasound (US) examination of the axilla showed a large benign lipoma but also a very atypical peripheral perfusion. At the same time, a sentinel node showed a peripheral perfusion on US. Fine-needle aspiration cytology was performed of the different lesions and showed a melanoma metastasis in the sentinel node. Thereafter, a lymph node dissection was performed. The lipoma was seen in histopathology and even the peripheral perfusion was confirmed. US and US-guided fine-needle aspiration cytology can be easily applied in the diagnosis of lymph node metastases in melanoma patients and can help determine a benign or a malignant involvement. PMID:25003535

Voit, Christiane A; van Akkooi, Alexander C J; Eggermont, Alexander M M; Tüttenberg, Andrea

2014-10-01

143

Lymphocytopoietic factor in lymph.  

PubMed

The evidences which suggest the presence of a lymphocytopietic factor in rat thoracic duct lymph are summarized briefly. The intravenous injections of the extracted materials from lymph plamsa into syngeneic recipient rats resulted in the massive proliferation of lymphoid cells predominantly in the thymus dependent areas and thymic cortex, suggesting that the target cells for the factor are not marrow-derived (B) cells, but thymus derived (T) cells. The existence of a thymus is not necessarily required for the production or secretion of the factor. The augmenting effect of the factor on T cell functions, eg. local graft-versus-host rection and helper activity of plaque forming response to sheep erythrocytes, is mentioned. The physicochemical characteristics of the factor are nondialysable and heat-stable glyco-protein molecules. The roles of lymph humoral factor in T cell-differentiation or proliferation are discussed. PMID:312981

Yamashita, A; Fukumoto, T; Miyamoto, M

1979-03-01

144

Significance of intramammary lymph nodes in the staging of breast cancer: correlation with tumor characteristics and outcome.  

PubMed

Intramammary lymph nodes (intraMLNs) have received little attention as potential prognostic indicators for patients with breast carcinoma. Patients with stage I breast carcinoma and positive intraMLN metastases have been reported to have a poorer prognosis compared to patients with similar stage and negative intraMLN metastases. However, the presence of intraMLN metastases does not appear to influence the survival of patients with stage II breast carcinoma. In the current retrospective analysis, we assessed the clinical significance of intraMLNs and evaluated their role in predicting outcome in patients with breast carcinoma. Between 1995 and 2005, 116 intraMLN specimens were identified. In all, 59 patients (50.8%) were found in association with benign breast conditions and the remaining 57 (49.2%) with primary breast carcinoma. Primary tumor characteristics and axillary lymph node (AxLN) status were recorded. Outcome data were documented. Statistical analysis was performed to detect correlation between intraMLN and tumor characteristics as well as outcome. IntraMLN metastases were found in 26% of all in-situ and invasive cancer cases (15/57), and 32% (15/47) of invasive cancer cases only. Most patients (80%) who had intraMLN metastases also had axillary metastases; however, an isolated intraMLN metastasis was documented in one patient (7%). Univariate analysis revealed that predictors of intraMLN metastases include: tumor size (p = 0.04), tumor grade (p = 0.04), tumor stage (p < 0.001), and AxLN status (p < 0.001). Furthermore patients with intraMLN positive for metastases have a poorer 4-year overall (40% versus 88%; p < 0.001) and disease-free survival (37% versus 83%; p < 0.001) than patients with negative intraMLN. On multivariate analysis, intraMLN metastasis is not an independent predictor of outcome (disease-free survival: p = 0.350; and overall survival p = 0.138). IntraMLN metastasis is a poor prognostic marker but not an independent predictor of poor outcome in patients with breast carcinoma. PMID:18248563

Nassar, Aziza; Cohen, Cynthia; Cotsonis, George; Carlson, Grant

2008-01-01

145

Infraclavicular brachial plexus injury following axillary regional block.  

PubMed

Infraclavicular brachial plexopathy is a potential complication of axillary regional block. We retrospectively reviewed 13 such injuries and found the median nerve most often affected, followed by combined median and ulnar neuropathies, and then by various combinations involving the median, ulnar, radial, and musculocutaneous nerves. All were axon-loss in type and most were severe in degree electrophysiologically. The clinical and electrodiagnostic features of these injuries are strikingly similar to those sustained after axillary arteriography, which has been associated with the medial brachial fascial compartment (MBFC) syndrome. This syndrome is characterized by the evolution of neurologic deficits and pain following hematoma formation within a compartment of the upper arm. Thus, we believe that this mechanism underlies most nerve injuries that result from axillary angiography or axillary regional block. This has important treatment implications, as timely surgical intervention may lead to improved outcome. PMID:15221877

Tsao, Bryan E; Wilbourn, Asa J

2004-07-01

146

Statistical relationship between human axillary and forehead temperatures  

NASA Astrophysics Data System (ADS)

Forehead or face infrared thermometric screening for febrile people in public places, i.e., entry and exit ports of a country, is one of the important measures for the prevention and control of infectious diseases. The statistical relationship between body and skin temperatures are the key factors that affect the accuracy of estimating axillary temperature from forehead temperature. The axillary and forehead temperatures of more than 1000 individuals were acquired. A two-regressand linear model was used to estimate the difference between the axillary and forehead temperatures of the subjects, with corrections for ambient temperature. At an ambient temperature of 23.6 °C, the statistical temperature difference between axillary and forehead temperatures was 3.70±0.12 °C at 36.5 °C and 3.14±012 °C at 38.0 °C in axillary temperature. Statistical distributions of the individual residual deviations from the regressed estimates were obtained. The uncertainty of the regression equation and its applications were analyzed in detail. The individual differences in forehead and axillary temperatures, with standard deviations of 0.88 °C and 0.66 °C, respectively, were the main factors that contributed to the uncertainty in the screening and confirmation measurements. This study provides important information for verifying or improving the body-site correction model for forehead thermometers and screening thermal imagers, and necessary for estimating rational alarm setting and the probabilities of erroneous and missing alarms in preliminary screenings.

Yuan, Z.; Hao, X.; Wang, F.; Tu, X.; Bai, C.; Ran, L.

2013-09-01

147

MRI of axillary brachial plexus blocks  

PubMed Central

BACKGROUND Axillary plexus blocks are usually guided by ultrasound, but alternative methods may be used when ultrasound equipment is lacking. For a nonultrasound-guided axillary block, the need for three injections has been questioned. OBJECTIVES Could differences in block success between single, double and triple deposits methods be explained by differences in local anaesthetic distribution as observed by MRI? DESIGN A blinded and randomised controlled study. SETTING Conducted at Oslo University Hospital, Rikshospitalet, Norway from 2009 to 2011. PATIENTS Forty-five ASA 1 to 2 patients scheduled for surgery were randomised to three equally sized groups. All patients completed the study. INTERVENTIONS Patients in the single-deposit group had an injection through a catheter parallel to the median nerve. In the double-deposit group the patients received a transarterial block. In the triple-deposit group the injections of the two other groups were combined. Upon completion of local anaesthetic injection the patients were scanned by MRI, before clinical block assessment. The distribution of local anaesthetic was scored by its closeness to terminal nerves and cords of the brachial plexus, as seen by MRI. The clinical effect was scored by the degree of sensory block in terminal nerve innervation areas. MAIN OUTCOME MEASURES Sensory block effect and MRI distribution pattern. RESULTS The triple-deposit method had a higher success rate (100%) than the single-deposit method (67%) and the double-deposit method (67%) in blocking all cutaneous nerves distal to the elbow (P?=?0.04). The patients in the triple-deposit group most often had the best MRI scores. For any nerve or cord, at least one of the single-deposit or double-deposit groups had a similarly high MRI score as the triple-deposit group. CONCLUSION Distal to the elbow, the triple-deposit method had the highest sensory block success rate. This could be explained to some extent by analysis of the magnetic resonance images. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01033006. PMID:25051144

Kjelstrup, Trygve; Hol, Per K.; Courivaud, Frederic; Smith, Hans-J?rgen; R?kkum, Magne; Klaastad, ?ivind

2014-01-01

148

Sentinel Lymph Node (SLN) Biopsy  

MedlinePLUS

... 1 BREAST CANCER LUMPECTOMY AND SENTINEL LYMPH NODE BIOPSY GENESIS MEDICAL CENTER DAVENPORT, IOWA October 10. 2007 ... breast cancer lumpectomy and subsequent sentinel lymph node biopsy. The procedure will be performed by Dr. David ...

149

Evaluation of Breast Sentinel Lymph Node Coverage by Standard Radiation Therapy Fields  

SciTech Connect

Background: Biopsy of the breast sentinel lymph node (SLN) is now a standard staging procedure for early-stage invasive breast cancer. The anatomic location of the breast SLN and its relationship to standard radiation fields has not been described. Methods and Materials: A retrospective review of radiotherapy treatment planning data sets was performed in patients with breast cancer who had undergone SLN biopsy, and those with a surgical clip at the SLN biopsy site were identified. The location of the clip was evaluated relative to vertebral body level on an anterior-posterior digitally reconstructed radiograph, treated whole-breast tangential radiation fields, and standard axillary fields in 106 data sets meeting these criteria. Results: The breast SLN varied in vertebral body level position, ranging from T2 to T7 but most commonly opposite T4. The SLN clip was located below the base of the clavicle in 90%, and hence would be excluded from standard axillary radiotherapy fields where the inferior border is placed at this level. The clip was within the irradiated whole-breast tangent fields in 78%, beneath the superior-posterior corner multileaf collimators in 12%, and outside the tangent field borders in 10%. Conclusions: Standard axillary fields do not encompass the lymph nodes at highest risk of containing tumor in breast cancer patients. Elimination of the superior-posterior corner MLCs from the tangent field design would result in inclusion of the breast SLN in 90% of patients treated with standard whole-breast irradiation.

Rabinovitch, Rachel [Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO (United States)], E-mail: Rachel.rabinovitch@uchsc.edu; Ballonoff, Ari; Newman, Francis M.S. [Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO (United States); Finlayson, Christina [Department of GI, Tumor, and Endocrine Surgery, University of Colorado Cancer Center, Aurora, CO (United States)

2008-04-01

150

Recent development of sentinel lymph node biopsy for breast cancer in Japan.  

PubMed

The number of breast cancer cases undergoing sentinel lymph node biopsy (SLNB) has been increasing with the number of articles published in Japan. SLNB using the dye method alone is performed in about one-third of patients. Analysis of questionnaire responses from 40 institutions in Japan revealed an identification rate by the dye method alone of 87%, compared with 96% using the combined method; the combined method is now recognized in Japan as superior to the dye method alone. No dyes have been specifically approved by the government for use in SLNB, and physicians have been using several inappropriate dyes as tracers for SLNB, such as indocyanine green, patent blue, indigo carmine, and isosulfan blue. The colloidal radiotracers used in Japan include tin colloid, stannous phytate, rhenium sulfate and human serum albumin. Albumin colloid and sulfur colloid are not commercially available in Japan. Small-size tin colloids, stannous phytate and rhenium sulfate all yield good results in terms of detection and false-negative rates. Provided that the surgeon has adequate experience in SLNB, a negative sentinel node can serve as a substitute for negative results from axillary lymph node dissection. Although many institutions have introduced SLNB, few reports have focused on the results of SLNB without axillary dissection because of short follow-up times and small number of patients. The final decision as to whether SLNB is an adequate substitute for axillary dissection awaits the results of prospective randomized trials. PMID:15564178

Ikeda, Tadashi; Jinno, Hiromitsu; Fujii, Hirofumi; Kitajima, Masaki

2004-10-01

151

Lymph Nodes Surgery Codes  

Cancer.gov

Lymph Nodes C770–C779 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 19 Local tumor destruction or excision, NOS Unknown whether a specimen

152

InterLymph Supplementals  

Cancer.gov

Morton LM, Turner JJ, Cerhan JR, Linet MS, Treseler PA, Clarke CA, Jack A, Cozen W, Maynadié M, Spinelli JJ, Seniori Costantini A, Rüdiger T, Scarpa A, Zheng T, Weisenburger DD. Proposed classification of lymphoid neoplasms for epidemiologic research from the International Lymphoma Epidemiology Consortium (InterLymph). Blood.

153

Postoperative morbidity of lymph node excision for cutaneous melanoma-sentinel lymphonodectomy versus complete regional lymph node dissection.  

PubMed

For patients with melanoma metastasis to a sentinel lymph node, subsequent complete regional lymph node dissection (CLND) is currently regarded to be the surgical standard. This approach, however, has not been confirmed by controlled studies, so that surgical morbidity is of primary importance. Using clinical examination and a questionnaire, we determined morbidity in 315 patients with axillary or inguinal lymph node excision on whom 275 sentinel lymphonodectomies (SLNEs) and 90 CLNDs were performed. The overall incidence of at least one complication following SLNE was 13.8%. The short-term complication rate was 11.3% (allergic reaction to blue dye 0%, wound breakdown 0%, haematoma 2.5%, wound infection 3.6%, seroma 6.9%). The incidence of long-term complications was 4.1% (persistent tattoo 0.4%, functional deficit 0.4%, nerve dysfunction/pain 0.7% or swelling 2.5%). All complications were mild. Significantly, the complication rate was not higher for patients aged 70 years or older. After CLND, the overall complication rate was significantly higher (65.5%, P<0.000001). The incidence of short-term complications was 50% (haematoma 0%, wound breakdown 6.7%, wound infection 24.7% or seroma 34.8%). The incidence of long-term complications was also 50% (nerve dysfunction/pain 8.9%, functional deficit 16.8%, swelling 37.1%). Overall, inguinal lymph node excision was burdened by a higher complication rate (P=0.015). Age and sex did not influence postoperative morbidity. No deaths linked to either procedure were noted. Complication rates after SLNE are low and most complications are minor and short-lasting. In contrast, CLND has been demonstrated to be a major and potentially morbid surgical procedure. This highlights the importance of testing the therapeutic value that CLND adds to the sentinel lymph node procedure. PMID:18227703

Kretschmer, Lutz; Thoms, Kai-Martin; Peeters, Sabine; Haenssle, Holger; Bertsch, Hans-Peter; Emmert, Steffen

2008-02-01

154

In vivo photoacoustic and ultrasonic mapping of rat sentinel lymph nodes with a modified commercial ultrasound imaging system  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB) has become the standard method for axillary staging in breast cancer patients, relying on invasive identification of sentinel lymph nodes (SLNs) following injection of blue dye and radioactive tracers. While SLNB achieves a low false negative rate (5-10%), it is an invasive procedure requiring ionizing radiation. As an alternative to SLNB, ultrasound-guided fine needle aspiration biopsy has been tested clinically. However, ultrasound alone is unable to accurately identify which lymph nodes are sentinel. Therefore, a non-ionizing and noninvasive detection method for accurate SLN mapping is needed. In this study, we successfully imaged methylene blue dye accumulation in vivo in rat axillary lymph nodes using a Phillips iU22 ultrasound imaging system adapted for photoacoustic imaging with an Nd:YAG pumped, tunable dye laser. Photoacoustic images of rat SLNs clearly identify methylene blue dye accumulation within minutes following intradermal dye injection and co-registered photoacoustic/ultrasound images illustrate lymph node position relative to surrounding anatomy. To investigate clinical translation, the imaging depth was extended up to 2.5 cm by adding chicken breast tissue on top of the rat skin surface. These results raise confidence that photoacoustic imaging can be used clinically for accurate, noninvasive SLN mapping.

Erpelding, Todd N.; Kim, Chulhong; Pramanik, Manojit; Guo, Zijian; Dean, John; Jankovic, Ladislav; Maslov, Konstantin; Wang, Lihong V.

2010-02-01

155

Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance  

PubMed Central

Aim: Breast cancer-related lymphoedema (BCRL) is a disabling complication developing after breast cancer treatment in a proportion of patients. Its impact on quality of life becomes more substantial as survival after breast cancer diagnosis increases. The incidence of BCRL following breast cancer treatment varies due to a lack of ­uniform definition and measurement criteria. This review aims to determine the prevalence of BCRL following axillary lymph node dissection (ALND) as a benchmark to be used in a risk-benefit medical decision whether to proceed with ALND or not. The risk of leaving unresected non-sentinel metastatic lymph nodes with a presumed inherent risk of local recurrence will be balanced against the risk of BCRL following a potentially unnecessary ALND. Methods: Pubmed and Embase databases were searched for all publications on BCRL in order to estimate its ­incidence and to decide on the most appropriate measurement method to use in clinical practice. Results: 51 articles were identified on BCRL incidence and measurement technique. Most studies measured BCRL based on differences in arm circumference (n?=?18) or by self-reported symptoms (n?=?18). The weighted average of BCRL incidence following ALND measured by self-report and circumference method was 28% and 16%, respectively. Conclusion: The importance of ALND and irradiation as part of the treatment of operable breast carcinoma is well established, but its morbidity is less well documented. We argue self-report as the most appropriate method to ­establish a diagnosis of BCRL. Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND. PMID:24753936

Goker, M.; Devoogdt, N.; Van de Putte, G.; Schobbens, J.C.; Vlasselaer, J.; Van den Broecke, R.; de Jonge, E.T.M.

2013-01-01

156

Lymph node involvement by Langerhans cell histiocytosis: a clinicopathologic and immunohistochemical study of 20 cases.  

PubMed

Twenty cases of Langerhans cell histiocytosis (LCH) involving lymph nodes with no other sites of disease are presented. The patients were 12 men and 8 women between 3 months and 68 years of age. Seven patients were younger than 11 years; the other 13 patients were older than 16 years. Clinically, all patients presented with lymphadenopathy and underwent excisional biopsy; clinical and imaging studies did not reveal abnormalities in other organs. Cervical lymph nodes were most commonly involved; other lymph nodes involved included axillary, inguinal, and supraclavicular. Histologically, LCH in lymph nodes had 3 main architectural patterns: (1) preserved nodal architecture with subtle involvement, (2) subtotal effacement of nodal architecture, and (3) total effacement of nodal architecture. There was a gradient of involvement by LCH from focal sinus involvement to diffuse sinus involvement and from focal paracortical involvement to diffuse paracortical involvement. In some cases, focal involvement was initially unrecognized because of the subtle nature of the changes in the lymph node, posing difficulties for diagnosis. Langerhans cells in the involved areas showed strong positivity by immunohistochemical studies for S100 protein and CD1a in all 11 cases assessed. In conclusion, LCH can initially manifest clinically with involvement limited to lymph nodes. Recognition of the different patterns of LCH, particularly cases with subtle involvement, is important for recognizing this disease and separating LCH from other more common causes of lymphadenopathy. PMID:17669469

Edelweiss, Marcia; Medeiros, L Jeffrey; Suster, Saul; Moran, Cesar A

2007-10-01

157

Effect of lymph node micrometastases on prognosis of gastric carcinoma  

PubMed Central

AIM: To evaluate the relationship between lymph node micrometastases and prognosis of patients with gastric carcinoma and to evaluate the significance of the new assessment of nodal status in determining the pN categories in the 5th edition of the UICC TNM classification. METHODS: A total of 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy were assessed by reverse transcription polymerase chain reaction assay in addition to histologic examination. Cytokeratin-20 gene marker was used in this assay. RESULTS: Routine examination by HE staining confirmed metastasis in 233 lymph nodes from 20 patients. All these 233 lymph nodes were cytokeratin-20 positive. Moreover, lymph node micrometastases were detected in an additional 67 lymph nodes in 12 of these 20 patients. Lymph node micrometastases were also detected in 10 lymph nodes from 2 of 10 patients who had no obvious metastases identified by HE staining. Totally, lymph node micrometastases were identified by the reverse transcription polymerase chain reaction assay in 77 (12.5%) lymph nodes from 14 (46.7%) patients with gastric carcinoma. Of 27 patients who underwent curative resection, 7 (25.9%) were up-staged (fromIB stage to II stage in 1 patient, from IB stage to IIIA stage in 1 patient, from II stage to IIIA stage in 1 patient, from IIIA stage to IIIB stage in 1 patient, from IIIA stage to IV stage in 1 patient, from IIIB stage to IV stage in 2 patients). In a median follow-up of 32 (range 8-36) mo, Kaplan-Meier survival analysis showed significant improvements in median survival (22.86 ± 3.17 mo, 95% CI: 16.64-29.08 mo vs 18.00 ± 7.4 mo, 95% CI: 3.33-32.67 mo) of patients with negative lymph node micrometastases over patients with positive lymph node micrometastases (log-rank, P < 0.05). CONCLUSION: Lymph node micrometastases have a significant impact on the current staging system of gastric carcinoma, and are significant risk factors for prognosis of patients with gastric carcinoma. PMID:17696234

Wu, Ze-Yu; Li, Jing-Hua; Zhan, Wen-Hua; He, Yu-Long; Wan, Jin

2007-01-01

158

Risk Factors for Regional Nodal Relapse in Breast Cancer Patients With One to Three Positive Axillary Nodes  

SciTech Connect

Purpose: In many centers, supraclavicular fossa radiotherapy (SCF RT) is not routinely offered to breast cancer patients with one to three positive lymph nodes. We aimed to identify a subgroup of these patients who are at high risk of supra or infraclavicular fossa relapse (SCFR) such that they can be offered SCFRT at the time of diagnosis to improve long term locoregional control. Methods and Materials: We performed a retrospective analysis of the pathological features of 1,065 cases of invasive breast cancer with one to three positive axillary lymph nodes. Patients underwent radical breast conserving surgery or mastectomy. A total of 45% of patients received adjuvant chest wall/breast RT. No patients received adjuvant SCFRT. The primary outcome was SCFR. Secondary outcomes were chest wall/breast recurrence, distant metastasis, all death, and breast-cancer specific death. Kaplan-Meier estimates were used to calculate actuarial event rates and survival functions compared using log-rank tests. Multivariate analyses (MVA) of factors associated with outcome were conducted using Cox proportional hazards models. Results: Median follow-up was 9.7 years. SCFR rate was 9.2%. Median time from primary diagnosis to SCFR was 3.4 years (range, 0.7-14.4 years). SCFR was associated with significantly lower 10-year survival (18% vs. 65%; p < 0.001). Higher grade and number of positive lymph nodes were the most significant predictors of SCFR on MVA (p < 0.001). 10 year SCFR rates were less than 1% in all patients with Grade 1 cancers compared with 30% in those having Grade 3 cancers with three positive lymph nodes. Additional factors associated with SCFR on univariate analysis but not on MVA included larger nodal deposits (p = 0.002) and proportion of positive nodes (p = 0.003). Conclusions: Breast cancer patients with one to three positive lymph nodes have a heterogenous risk of SCFR. Patients with two to three positive axillary nodes and/or high-grade disease may warrant consideration of SCFRT.

Yates, Lucy, E-mail: lucy.yates@gstt.nhs.uk [Guy's, King's, St Thomas' Cancer Centre, Guy's Hospital, London (United Kingdom); Kirby, Anna [Guy's, King's, St Thomas' Cancer Centre, Guy's Hospital, London (United Kingdom); Department of Clinical Oncology, Royal Marsden Hospital, Sutton (United Kingdom); Crichton, Siobhan [Department of Statistics, Kings College London (United Kingdom); Gillett, Cheryl [Breast Pathology, Kings College London (United Kingdom); Cane, Paul [Department of Histopathology, Guy's and St Thomas' Foundation Trust, London (United Kingdom); Fentiman, Ian; Sawyer, Elinor [Guy's, King's, St Thomas' Cancer Centre, Guy's Hospital, London (United Kingdom)

2012-04-01

159

Lymph node macrophages  

PubMed Central

Summary Lymph node (LN) macrophages have long been known for their efficient uptake of lymph-borne antigens. A convergence of studies on innate and adaptive immune responses has led to exciting recent advances in understanding their more specialized properties: presenting antigens to B cells, dendritic cells and T cells, producing trophic factors and cytokines, and, remarkably, being permissive for viral infection, a property critical for mounting anti-viral responses. LN macrophages have been traditionally divided into subsets based on their subcapsular sinus and medullary locations. Here we classify LN macrophages into three subsets: subcapsular sinus macrophages (SSMs), medullary sinus macrophages (MSMs) and medullary cord macrophages (MCMs). We review the literature regarding the roles of these cells in innate and adaptive immune responses and requirements for their development. We also discuss challenges associated with their purification as well as the existence of additional heterogeneity among LN macrophages. PMID:22488251

Gray, Elizabeth E.; Cyster, Jason G.

2013-01-01

160

Potential axillary nerve stretching during RSA implantation: an anatomical study.  

PubMed

Clinical and subclinical neurological injury after reverse shoulder arthroplasty (RSA) may jeopardize functional outcomes due to the risk of irreversible damage to the axillary nerve. We proposed a simple anatomical study in order to assess the macroscopic effects on the axillary nerve when lowering the humerus as performed during RSA implantation. We also measured the effect on the axillary nerve of a lateralization of the humerus. Between 2011 and 2012, cadaveric dissections of 16 shoulder specimens from nine fresh human cadavers were performed in order to assess the effects on the axillary nerve after the lowering and lateralization of the humerus. We assessed the extent of stretching of the axillary nerve in four positions in the sagittal plane [lowering of the humerus: great tuberosity in contact with the acromion (position 1), in contact with the upper (position 2), middle (position 3) and lower rim of the glenoid (position 4)] and three positions in the frontal plane [lateralization of the humerus: humerus in contact with the glenoid (position 1), humerus lateralized 1 cm (position 2) and 2 cm (position 3)]. When the humerus was lowered, clear macroscopical changes appeared below the middle of the glenoid (the highest level of tension). As regards the lateralization of the humerus, macroscopic study and measurements confirm the absence of stretching of the nerve in those positions. Lowering of the humerus below the equator of the glenoid changes the course and tension of the axillary nerve and may lead to stretching and irreversible damage, compromising the function of the deltoid. Improvements in the design of the implants and modification of the positioning of the glenosphere to avoid notching and to increase mobility must take into account the anatomical changes induced by the prosthesis and its impact on the brachial plexus. Level of Evidence and study type Level IV. PMID:24497198

Marion, Blandine; Leclère, Franck Marie; Casoli, Vincent; Paganini, Federico; Unglaub, Frank; Spies, Christian; Valenti, Philippe

2014-09-01

161

Clinicopathologic subtypes and compromise of lymph nodes in patients with breast cancer  

PubMed Central

Breast cancer (BC) is currently a heterogeneous disease with variations in clinical behaviour. Classification according to subtypes has allowed progress in the individualisation of treatment. The objective of this study is to evaluate the risk of axillary node compromise in patients with BC, according to clinicopathologic subtypes. Materials and methods are a retrospective, descriptive-analytical study. All patients that had undergone surgery for invasive BC were included, with the study of sentinel lymph nodes (SLNs) at Hospital Clínico de la Pontificia Universidad Católica, between May 1999 and December 2012. The results showed 632 patients fulfilled the inclusion criteria, with the median age being 55 years (range: 28–95), and 559 (88.4%) patients presented with estrogen receptor and/or progesterone receptor positive tumours. Luminal A: 246 patients (38.9%), luminal B: 243 (38.4%), luminal not otherwise specified: 70 (11.1%) triple negative (TN): 60 (9.5%) and over expression of epidermal growth factor type 2 receptor (HER2 positive): 13 (2.1%). Luminal tumours displayed a greater risk of metastasis in the SLNs, but this difference was not statistically significant (p = 0.67). TN and HER2 positive tumours presented the greatest proportion of metastatic compromise in non-sentinel lymph nodes (non-SLNs) (57.1% and 50%, respectively). The presence of macrometastasis (MAM) in the SLN was associated with a greater risk of compromise of the non-SLN. Conclusions: Luminal tumours are the most frequent and present a greater proportion of axillary lymph node compromise, without being statistically significant. TN and HER2 positive tumours tend to have a higher axillary compromise; however, this was not statistically significant in either. Only the presence of MAM in SLNs displayed a statistically significantly association in the compromise of non-SLNs. PMID:25114720

Jaime Jans, B; Nicolas Escudero, M; Dahiana Pulgar, B; Francisco Acevedo, C; Cesar Sanchez, R; Camus, A Mauricio

2014-01-01

162

Mouse Model of Lymph Node Metastasis via Afferent Lymphatic Vessels for Development of Imaging Modalities  

PubMed Central

Animal studies of lymph node metastasis are constrained by limitations in the techniques available for noninvasive monitoring of the progression of lymph node metastasis, as well as difficulties in the establishment of appropriate animal models. To overcome these challenges, this study has developed a mouse model of inter-lymph-node metastasis via afferent lymphatic vessels for use in the development of imaging modalities. We used 14- to 18-week-old MRL/MpJ?/lpr/lpr (MRL/lpr) mice exhibiting remarkable systemic lymphadenopathy, with proper axillary lymph nodes (proper-ALNs) and subiliac lymph nodes (SiLNs) that are 6 to 12 mm in diameter (similar in size to human lymph nodes). When KM-Luc/GFP malignant fibrous histiocytoma-like cells stably expressing the firefly luciferase gene were injected into the SiLN, metastasis could be detected in the proper-ALN within 3 to 9 days, using in vivo bioluminescence imaging. The metastasis route was found to be via the efferent lymphatic vessels of the SiLN, and metastasis incidence depended on the number of cells injected, the injection duration and the SiLN volume. Three-dimensional contrast-enhanced high-frequency ultrasound imaging showed that the blood vessel volume and density in the metastasized proper-ALN significantly increased at 14 days after tumor cell inoculation into the SiLN. The present metastasis model, with lymph nodes similar in size to those of humans, has potential use in the development of ultrasound imaging with high-precision and high-sensitivity as well as other imaging modalities for the detection of blood vessels in lymph nodes during the progression of metastasis. PMID:23405215

Li, Li; Mori, Shiro; Sakamoto, Maya; Takahashi, Shoki; Kodama, Tetsuya

2013-01-01

163

Clinical behavior of untreated axillary nodes after local treatment for primary breast cancer  

Microsoft Academic Search

Background: The purpose of this study was to examine the rate of axillary failure in patients with primary breast cancer treated without\\u000a axillary dissection or radiation and to determine what factors may be associated with axillary failure.\\u000a \\u000a \\u000a Methods: We studied 112 patients with invasive breast cancer treated for primary disease with breast-conserving surgery without axillary\\u000a dissection or radiation to the

Nancy Baxter; David McCready; Judy-Anne Chapman; Edward Fish; Harriette Kahn; Wedad Hanna; Maureen Trudeau; H. Lavina Lickley

1996-01-01

164

Tuberculous dactylitis (spina ventosa) with concomitant ipsilateral axillary scrofuloderma in an immunocompetent child: A rare presentation of skeletal tuberculosis  

PubMed Central

Tuberculous dactylitis is a distinctly uncommon, yet well recognized form of tuberculosis involving the small bones of the hand or foot. It occurs in young children in endemic areas under 5 years of age. Tuberculosis of the short tubular bones like phalanges, metacarpals or metatarsals is quite uncommon beyond 6 years of age, once the epiphyseal centers are well established. The radiographic features of cystic expansion have led to the name “Spina Ventosa” for tuberculous dactylitis of the short bones. Scrofuloderma is a mycobacterial infection affecting children and young adults, representing direct extension of tuberculosis into the skin from underlying structures e.g. lymph nodes. An 8-year-old malnourished girl had multiple axillary ulcers with lymphadenopathy. Tuberculous dactylitis with ipsilateral axillary scrofuloderma was suspected on clinical and radiological grounds. The suspicion was confirmed by histology and bacteriology. The patient responded to antitubercular drugs with progressive healing of the lesions without surgery. Concomitant presence of these dual lesions suggesting active disseminated tuberculosis in immune-competent child over 6 years is very rare and hardly reported. PMID:23977657

Bhaskar; Khonglah, Tashi; Bareh, Jerryson

2013-01-01

165

A dual-modality photoacoustic and ultrasound imaging system for noninvasive sentinel lymph node detection: preliminary clinical results  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB) has emerged as an accurate, less invasive alternative to axillary lymph node dissection, and it has rapidly become the standard of care for patients with clinically node-negative breast cancer. The sentinel lymph node (SLN) hypothesis states that the pathological status of the axilla can be accurately predicted by determining the status of the first (i.e., sentinel) lymph nodes that drain from the primary tumor. Physicians use radio-labeled sulfur colloid and/or methylene blue dye to identify the SLN, which is most likely to contain metastatic cancer cells. However, the surgical procedure causes morbidity and associated expenses. To overcome these limitations, we developed a dual-modality photoacoustic and ultrasound imaging system to noninvasively detect SLNs based on the accumulation of methylene blue dye. Ultimately, we aim to guide percutaneous needle biopsies and provide a minimally invasive method for axillary staging of breast cancer. The system consists of a tunable dye laser pumped by a Nd:YAG laser, a commercial ultrasound imaging system (Philips iU22), and a multichannel data acquisition system which displays co-registered photoacoustic and ultrasound images in real-time. Our clinical results demonstrate that real-time photoacoustic imaging can provide sensitive and specific detection of methylene blue dye in vivo. While preliminary studies have shown that in vivo detection of SLNs by using co-registered photoacoustic and ultrasound imaging is feasible, further investigation is needed to demonstrate robust SLN detection.

Erpelding, Todd N.; Garcia-Uribe, Alejandro; Krumholz, Arie; Ke, Haixin; Maslov, Konstantin; Appleton, Catherine; Margenthaler, Julie; Wang, Lihong V.

2014-03-01

166

Epithelial inclusion cyst arising in an intramammary lymph node: case report with cytologic findings.  

PubMed

The occurrence of epithelial inclusion cysts (EIC) in axillary lymph nodes is a rare but well recognized entity, arising either from direct implantation or from embryonal rests. Theoretically, EIC can occur in intramammary lymph nodes, but there has been only one prior report of such a lesion. Here, we describe a case of an EIC arising in an intramammary lymph node of a 37-year-old woman. This report focuses on the FNA cytologic features of this lesion and its differential diagnoses. On FNA, the EIC arising in an intramammary lymph node was characterized by mature lymphocytes, squamous epithelial cells, and keratinizing material. The presence of squamous cells can lead to the erroneous diagnosis of more common breast lesions, such as squamous cell carcinoma or metaplastic carcinoma. Contrary to these more sinister diagnoses, EIC arising in an intramammary lymph node is a benign condition. As this rare lesion sometimes mimics a neoplasm both clinically and radiographically, awareness of this entity is important to prevent over treatment. PMID:19177497

Nakaguro, Masato; Suzuki, Yasuhiko; Ichihara, Shu; Kobayashi, Tadao K; Ono, Kenzo

2009-03-01

167

Does the Addition of Tramadol and Ketamine to Ropivacaine Prolong the Axillary Brachial Plexus Block?  

PubMed Central

Background and Objectives. A prospective, randomized, controlled, double-blind clinical trial to assess the effect of tramadol and ketamine, 50?mg, added to ropivacaine in brachial plexus anesthesia. Methods. Thirty-six ASA physical statuses I and II patients, between 18 and 60 years of age, scheduled for forearm and hand surgery under axillary brachial plexus block, were allocated to 3 groups. Group R received 0.375% ropivacaine in 40?mL, group RT received 0.375% ropivacaine in 40?mL with 50?mg tramadol, and group RK received 0.375% ropivacaine in 40?mL with 50?mg ketamine for axillary brachial plexus block. The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events (nausea, vomiting, and feeling uncomfortable) were recorded. Results. The onset time of sensorial block was the fastest in ropivacaine + tramadol group. Duration of sensorial and motor block was the shortest in the ropivacaine + tramadol group. Duration of analgesia was significantly longer in ropivacaine + tramadol group. Conclusion. We conclude that when added to brachial plexus analgesia at a dose of 50?mg, tramadol extends the onset and duration time of the block and improves the quality of postoperative analgesia without any side effects. PMID:24883319

Senel, Ahmet Can; Ukinc, Ozlem; Timurkaynak, Alper

2014-01-01

168

Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block  

PubMed Central

To evaluate the hypothesis that adding dexmedetomidine to ropivacaine prolongs axillary brachial plexus block. Forty-five patients of ASA I~II and aged 25-60 yr who were scheduled for elective forearm and hand surgery were randomly divided into 3 equal groups and received 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (50 ?g) (Group DR1), 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (100 ?g) (group DR2) or 40 ml of 0.33% ropivacaine + 1 ml saline (group R) in a double-blind fashion. The onset and duration of sensory and motor blocks and side effects were recorded. The demographic data and surgical characteristics were similar in each group. Sensory and motor block onset times were the same in the three groups. Sensory and motor blockade durations were longer in group DR2 than in group R (P < 0.05). There was no significant difference in the sensory blockade duration between group DR1 and group R. Bradycardia, hypertension and hypotension were not observed in group R and occurred more often in group DR2 than in group DR1. Dexmedetomidine added to ropivacaine for an axillary brachial plexus block prolongs the duration of the block. However, dexmedetomidine may also lead to side effects such as bradycardia, hypertension, and hypotension. PMID:24753763

Zhang, Yu; Wang, Chang-Song; Shi, Jing-Hui; Sun, Bo; Liu, Shu-Jie; Li, Peng; Li, En-You

2014-01-01

169

Axillary Artery Injury Caused by Fracture of Humerus Neck and Its Repair Using Basilic Vein Graft  

PubMed Central

Proximal humerus fractures are rarely associated with axillary artery injury. We present a case of a 59-year-old female who had fracture neck humerus along with absent pulsations in the left upper limb after blunt trauma. Computed tomographic angiogram revealed complete occlusion of the left axillary artery. Urgent surgical intervention was done in the form of fixation of fracture followed by exploration and repair of axillary artery. Axillary artery was contused and totally occluded by fractured edge of humerus. Repair of the axillary artery was done using basilic vein graft harvested through the same incision. Postprocedure pulsations were present in the upper limb. PMID:25061530

Kalia, Sandeep; Sehgal, Manik

2014-01-01

170

Lymph Drainage in Pregnant Women  

PubMed Central

Aim. The aim of this study was to evaluate the efficacy of lymph drainage to reduce edema of pregnant women. Method. Pregnant women (30 limbs) from the Obstetrics Outpatient Clinic of the Medical School of Santa Casa in São Paulo in the period December 2009 to May 2010 were enrolled in this quantitative, prospective study. The patients, in the 5th to 8th months of gestation, were submitted to one hour of manual lymph drainage of the legs. The volume of the legs was measured by water displacement volumetry before and after one hour of drainage using the Godoy & Godoy manual lymph drainage technique. The paired t-test was used for statistical analysis with an alpha error of 5% being considered significant. Results. Manual lymph drainage significantly reduced swelling of the legs of pregnant women during the day (P = 0.04). Conclusion. Manual lymph drainage helps to reduce limb size during the day of pregnant women. PMID:24251034

Cataldo Oportus, Sylvia; de Paiva Rodrigues, Lilian; Pereira de Godoy, José Maria; Guerreiro Godoy, Maria de Fátima

2013-01-01

171

Comparison of different predictive tools of axillary status in breast cancer with micrometastatic sentinel node.  

PubMed

Aim. To compare the performance of six different nomograms and one score in the prediction of non-sentinel lymph node status in a subset of women with breast cancer and micrometastatic sentinel nodes (SN). Material and methods. Twenty-five patients were included in the study. Five different nomograms not specifically designed for micrometastatic SN, one recently published nomogram specially developed for this type of patients and one score were analyzed, and the corresponding receiver operating characteristic curves were obtained. The area under the curve (AUC) was calculated, as well as the false negative and false positive results and their corresponding rates (FNR and FPR) for a cutoff of ?10% or ?4 points. Results. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram showed the best performance in this low-risk group of patients (AUC 0.900, FPR 64%, FNR 0%), followed by the French nomogram. Conclusions. The MSKCC nomogram seems to have the highest accuracy in the identification of patients with low risk of further axillary disease in the subgroup of women with micrometastatic SN. PMID:25296590

Cordero García, José Manuel; Palomar Muñoz, Azahara; García Vicente, Ana María; Jiménez Londoño, Germán Andrés; León Martín, Antonio Alberto; Pardo García, Ricardo; Soriano Castrejón, Angel

2014-01-01

172

The Efficacy of Arm Node Preserving Surgery Using Axillary Reverse Mapping for Preventing Lymphedema in Patients with Breast Cancer  

PubMed Central

Purpose The axillary reverse mapping (ARM) technique to identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) was developed to prevent lymphedema. The purpose of this study was to investigate the location and metastatic rate of the arm node, and to evaluate the short term incidence of lymphedema after arm node preserving surgery. Methods From January 2009 to October 2010, 97 breast cancer patients who underwent ARM were included. Blue-dye (2.5 mL) was injected into the ipsilateral upper-inner arm. At least 20 minutes after injection, SLNB or ALND was performed and blue-stained arm nodes and/or lymphatics were identified. Patients were divided into two groups, an arm node preserved group (70 patients had ALND, 10 patients had SLNB) and an unpreserved group (13 patients had ALND, 4 patients had SLNB). The difference in arm circumference between preoperative and postoperative time points was checked in both groups. Results The mean number of identified blue stained arm nodes was 1.4±0.6. In the majority of patients (92%), arm nodes were located between the lower level of the axillary vein and just below the second intercostobrachial nerve. In the arm node unpreserved group, 2 patients had metastasis in their arm node. Among ALND patients, in the arm node preserved group, the difference in arm circumference between preoperative and postoperative time points in ipsilateral and contralateral arms was 0.27 cm and 0.07 cm, respectively, whereas it was 0.47 cm and -0.03 cm in the unpreserved group; one case of lymphedema was found after 6 months. No difference was found between arm node preserved and unpreserved group among SLNB patients. Conclusion Arm node preserving was possible in all breast cancer patients with identifiable arm nodes, during ALND or SLNB, except for those with high surgical N stage, and lymphedema did not develop in patients with arm node preserving surgery. PMID:22493634

Han, Jung Woo; Seo, Yu Jeong; Choi, Jung Eun; Kang, Su Hwan; Bae, Young Kyung

2012-01-01

173

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

174

Methylation signature of lymph node metastases in breast cancer patients  

PubMed Central

Background Invasion and metastasis are two important hallmarks of malignant tumors caused by complex genetic and epigenetic alterations. The present study investigated the contribution of aberrant methylation profiles of cancer related genes, APC, BIN1, BMP6, BRCA1, CST6, ESR-b, GSTP1, P14 (ARF), P16 (CDKN2A), P21 (CDKN1A), PTEN, and TIMP3, in the matched axillary lymph node metastasis in comparison to the primary tumor tissue and the adjacent normal tissue from the same breast cancer patients to identify the potential of candidate genes methylation as metastatic markers. Methods The quantitative methylation analysis was performed using the SEQUENOM’s EpiTYPER™ assay which relies on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Results The quantitative DNA methylation analysis of the candidate genes showed higher methylation proportion in the primary tumor tissue than that of the matched normal tissue and the differences were significant for the APC, BIN1, BMP6, BRCA1, CST6, ESR-b, P16, PTEN and TIMP3 promoter regions (P<0.05). Among those candidate methylated genes, APC, BMP6, BRCA1 and P16 displayed higher methylation proportion in the matched lymph node metastasis than that found in the normal tissue (P<0.05). The pathway analysis revealed that BMP6, BRCA1 and P16 have a role in prevention of neoplasm metastasis. Conclusions The results of the present study showed methylation heterogeneity between primary tumors and metastatic lesion. The contribution of aberrant methylation alterations of BMP6, BRCA1 and P16 genes in lymph node metastasis might provide a further clue to establish useful biomarkers for screening metastasis. PMID:22695536

2012-01-01

175

Treatment of axillary osmidrosis with the use of Versajet.  

PubMed

Axillary osmidrosis is a distressing problem. Since the secretion from apocrine glands is believed to be responsible for malodour, many treatment modalities have been developed to remove the glands. Local surgery with the excision of the apocrine glands has been proved to be most effective. We introduce the treatment of axillary osmidrosis, using Versajet (Versajet hydrosurgery system, Smith & Nephew, Memphis, TN, USA). From October 2010 to February 2012, 31 patients (21 females and 10 males) whose age ranged from 12 to 63 years were treated. All patients were followed up for 13.1 months on average. Thirty patients were very satisfied and recommended this procedure and one patient was satisfied with the result. We experienced one haematoma and one wound dehiscence. Excision of glands, using Versajet, makes the operation a simple and efficient procedure. Moreover, precise and even debridement reduces complications by preserving the skin flap and subdermal plexus. PMID:23466344

Kim, Sang Wha; Choi, Ik Kyun; Lee, Jung Ho; Rhie, Jong Won; Ahn, Sang Tae; Oh, Deuk Young

2013-05-01

176

Axillary accessory breast associated with galactorrhea in an adolescent girl  

PubMed Central

We present herein a case of right axillary accessory breast associated with galactorrhea in an adolescent girl. A 14-year-old Japanese girl presented with an 11-month history of a tender, subcutaneous lesion in the right axillary fossa. Seven months later, she experienced menarche. Subsequently, the patient noticed pressure-induced galactorrhea from both nipples. Physical examination revealed an elastic, firm and well-demarcated subcutaneous tumor 3 × 2 cm in size. A biopsy specimen showed proliferation of mammary gland tissue in the stroma located below the subcutaneous fat tissue. On the basis of these findings the patient was diagnosed with an accessory breast. Interestingly, the galactorrhea ceased after surgical removal of the accessory breast. PMID:21547148

Kyo, Akemi; Sasaki, Yoshihito; Fukunaga, Atsushi; Nagano, Tohru; Funasaka, Yoko; Nishigori, Chikako

2010-01-01

177

Ein Fall von Aneurysma der Arteria axillaris nach Luxatio humeri  

Microsoft Academic Search

Die grol~e Seltenheit der F~tlle yon Zerroi~ung tier Arteria axillaris uncl der Umstand, dab ich eine derartige Verletzung gleichzeitig mit Herrn Geheimrat Bardenheuer beobachten und behandeln durfte, geben mir Anlal~, dieselben an dieser Stelle zu verSffentlichen. Am 20. Oktober 1908 morgens 3 Uhr fiel Herr H. F., ein krifftiger junger Mann yon 29 Jahren beim Verlassen einer Droschke auf das

Ernst Hoffmann; Krankenhaus Rotes Kreuz

1909-01-01

178

Five-Year Update of an Expanded Phase II Study of Dose-Dense and Intense Doxorubicin, Paclitaxel and Cyclophosphamide (ATC) in High-Risk Breast Cancer  

Microsoft Academic Search

Objectives: This study evaluated the safety and efficacy of dose-dense and -intense sequential doxorubicin (A), paclitaxel (T) and cyclophosphamide (C) as adjuvant therapy for breast cancer (BC) with ?4 ipsilateral axillary lymph nodes.Methods: Patients were recruited after BC surgery if ?4 axillary nodes were involved by metastatic cancer. Planned treatment was A 90 mg\\/m2 three times every 14 days (q14d×3),

Maysa M. Abu-Khalaf; Stephen Windsor; Keita Ebisu; Saritha Salikooti; Gowri Ananthanarayanan; Gina G. Chung; Michael P. DiGiovanna; Bruce G. Haffty; Martin Abrams; Leonard R. Farber; Arlene D. Hsu; Michael Reiss; Daniel Zelterman; Barbara A. Burtness

2005-01-01

179

Spectral imaging as a potential tool for optical sentinel lymph node biopsies  

NASA Astrophysics Data System (ADS)

Sentinel Lymph Node Biopsy (SLNB) is an increasingly standard procedure to help oncologists accurately stage cancers. It is performed as an alternative to full axillary lymph node dissection in breast cancer patients, reducing the risk of longterm health problems associated with lymph node removal. Intraoperative analysis is currently performed using touchprint cytology, which can introduce significant delay into the procedure. Spectral imaging is forming a multi-plane image where reflected intensities from a number of spectral bands are recorded at each pixel in the spatial plane. We investigate the possibility of using spectral imaging to assess sentinel lymph nodes of breast cancer patients with a view to eventually developing an optical technique that could significantly reduce the time required to perform this procedure. We investigate previously reported spectra of normal and metastatic tissue in the visible and near infrared region, using them as the basis of dummy spectral images. We analyse these images using the spectral angle map (SAM), a tool routinely used in other fields where spectral imaging is prevalent. We simulate random noise in these images in order to determine whether the SAM can discriminate between normal and metastatic pixels as the quality of the images deteriorates. We show that even in cases where noise levels are up to 20% of the maximum signal, the spectral angle map can distinguish healthy pixels from metastatic. We believe that this makes spectral imaging a good candidate for further study in the development of an optical SLNB.

O'Sullivan, Jack D.; Hoy, Paul R.; Rutt, Harvey N.

2011-07-01

180

Management of accidentally found pathological lymph nodes on routine screening mammography.  

PubMed

Normal lymph nodes in the anterior part of the axilla are readily seen on routine mammography. It is important, however, to recognize pathological lymph nodes, characterized by increased attenuation, high density, a round or irregular shape and lack of fat in the hilus, as they often indicate significant diseases. We examined the final diagnosis in 22 patients referred for clinical examination from a mammographic screening programme because of pathological lymph nodes without concomitant breast malignancy. Ten of them were found to have a malignant lesion, and one had sarcoidosis. None of the malignancies had been diagnosed before screening. Among women with abnormal but impalpable nodes, only one malignancy was found (in a woman with previous breast cancer), whereas nine of 13 women with palpable nodes had malignancies. Seven malignant lymphomas were discovered, but among all 60 women of the age group in question with newly diagnosed lymphomas in the region, only 13 had pathological axillary nodes. Mammography cannot therefore be used as a screening method for lymphoma. We conclude that mammographically pathological lymph nodes in the axilla should be examined clinically and propose a simple programme for patient management. PMID:8654606

Bergkvist, L; Frodis, E; Hedborg-Mellander, C; Hansen, J

1996-06-01

181

Lymph nodes in gastric cancer.  

PubMed

Surgery is the only curative therapy for gastric cancer and controversy still exist on the extend of surgery. As the lymphatic distribution of stomach is very complex, the determination of the actual lymph node involvement is important for making the decision in order to avoid complications. Sentinel node navigation surgery has recently been introduced in gastrointestinal tract cancer. Present article reviews the detection techniques of lymph nodes and significance of lymphadenectomies in gastric cancer. PMID:18720367

Ozmen, M Mahir; Ozmen, Fusun; Zulfikaroglu, Bari?

2008-11-01

182

Metabolome profiling of floral scent production in Petunia axillaris.  

PubMed

Emission of floral scent benzenoid/phenylpropanoid compounds in Petunia axillaris increases significantly at night, a change that is primarily determined by the endogenous concentration of these compounds in the corolla. Among wild type P. axillaris plants, there are lines that emit different amounts of scent. To understand how the nocturnal rhythm of floral scent concentrations is controlled, the concentration profiles of metabolites in the scent biosynthetic pathway in two lines of P. axillaris, a strongly scented line and a weakly scented line, are reported. In the strongly scented line, the concentration of a series of compounds from glucose-6-phosphate (G6P) to the scent compounds changed synchronously. In the weakly scented lines, the concentrations of some metabolites including 6-phosphogluconate (6PG) and downstream metabolites of shikimic acid were remarkably lower, suggesting a reduction in metabolism of G6P to 6PG and the metabolism of shikimic acid in the weakly scented line. Nocturnal increases in the concentrations of sucrose, fructose, and glucose were not found in strongly scented line. Nocturnal increases in concentrations of S-adenosylhomocysteine (SAH) and methionine and reductions in the concentrations of S-adenosylmethionine (SAM), a methylation donor to benzenoid-skeletons, were observed only in strongly scented line. It is concluded that the biosynthetic regulation of each step from G6P to the volatile scent benzenoids is performed by, at least in part, concentrations of substrates, and the regulation also affects concentrations of SAM cycle compounds. PMID:23562394

Oyama-Okubo, Naomi; Sakai, Tomoyuki; Ando, Toshio; Nakayama, Masayoshi; Soga, Tomoyoshi

2013-06-01

183

Intraoperative Subareolar Radioisotope Injection for Immediate Sentinel Lymph Node Biopsy  

PubMed Central

Objective: To determine the identification of sentinel lymph node biopsy (SLNB) in breast cancer patients after intraoperative injection of unfiltered technetium-99m sulfur colloid (Tc-99) and blue dye. Background: SLNB guided by a combination of radioisotope and blue dye injection yields the best identification rates in breast cancer patients. Radioisotope is given preoperatively, without local anesthesia, whereas blue dye is given intraoperatively. We hypothesized that, because of the rapid drainage noted with the subareolar injection technique of radioisotope, intraoperative injection would be feasible and less painful for SLN localization in breast cancer patients. Methods: Intraoperative injection of Tc-99 and confirmation blue dye was performed using the subareolar technique for SLNB in patients with operable breast cancer. The time lapse between injection and axillary incision, the background count, the preincision and ex vivo counts of the hot nodes, and the axillary bed counts were documented. The identification rate was recorded. Results: Ninety-six SLNB procedures were done in 88 patients with breast cancer employing intraoperative subareolar injection technique for both radioisotope (all 96 procedures) and blue dye (93 procedures) injections. Ninety-three (97%) procedures had successful identification; all SLNs were hot; 91 (of 93 procedures with blue dye) were blue and hot. The mean time from radioisotope injection to incision was 19.9 minutes (SD 8.5 minutes). The mean highest 10 second count was 88,544 (SD 55,954). Three of 96 (3%) patients with failure of localization had previous excisional biopsies: 1 circumareolar and 2 upper outer quadrant incisions that may have disrupted the lymphatic flow. Conclusion: Intraoperative subareolar injection of radioisotope rapidly drains to the SLNs and allows immediate staging of the axilla, avoiding the need to coordinate diagnostic services and a painful preoperative procedure. PMID:15166963

Layeeque, Rakhshanda; Kepple, Julie; Henry-Tillman, Ronda S.; Adkins, Laura; Kass, Rena; Colvert, Maureen; Gibson, Regina; Mancino, Anne; Korourian, Soheila; Klimberg, V Suzanne

2004-01-01

184

Implication of an Intramammary Sentinel Lymph Node in Breast Cancer: Is This a True Sentinel Node? A Case Report.  

PubMed

BACKGROUND: Intramammary lymph nodes (ILN) are often diagnosed by final histological examination. Recently, sentinel lymph node biopsy (SLNB) has been developed as a new standard in the treatment of breast cancer. However, reports describing intramammary sentinel nodes (ISLNs) are relatively rare, and the clinical significance of metastases in ISLNs is still unclear. CASE REPORT: We herein report a patient with breast cancer with an ISLN that was detected prior to surgery. In the current case, the ISLN contained foci of carcinoma, but the axillary SLNs (aSLN) did not contain such foci. Previous reports related to ISLNs and aSLNs, including our case, are reviewed. Interestingly, there was no case with negative ISLNs and positive aSLNs. CONCLUSIONS: The current and previous cases have shown that axillary lymph node dissection (ALDN) might rely on the aSLN status but not on the ISLN status. The effect on the prognosis or clinical significance in cases with positive ISLNs has not been fully elucidated. Cases of ISLNs found by SLN navigation are discussed in relation to their clinical significance. PMID:20847822

Fujii, Takaaki; Yajima, Reina; Matsumoto, Asuka; Yamaki, Sayaka; Uchida, Nobuyuki; Tsutsumi, Soichi; Asao, Takayuki; Kuwano, Hiroyuki

2010-01-01

185

The sonographic "coffee bean" sign helps distinguish an axillary neurofibroma from a lymphadenopathy.  

PubMed

Axillary masses may represent various soft tissue tumors or lymphadenopathy. Neurofibromas are benign peripheral nerve sheath tumors and, while they are very uncommon, it is important to remember that neurogenic tumors arising from brachial plexus can develop in the axilla. We describe an axillary neurofibroma arising from the brachial plexus that presented with a "coffee bean sign" on sonography that distinguished it from axillary lymphadenopathy. PMID:23606585

Song, Sung Eun; Seo, Bo Kyoung; Choi, Jung-Woo; Son, Gil-Soo; Cho, Kyu Ran; Kim, Baek Hyun

2014-01-01

186

Surgical Repair of Axillary Graft Stump Syndrome: Report of Two Cases  

PubMed Central

Late upper extremity embolic complications of occluded axillofemoral bypass graft (AxFG) or occluded axillo- axillary bypass graft (AxAG) are not frequently noted. A patient presented with acute right upper extremity thromboembolism 2 years after an AxFG occlusion. Computed tomography (CT) findings revealed kinking and occlusion of the axillary artery at the anastomosis. Another patient presented with acute left upper extremity thromboembolism 2 years and 6 years after an AxAG occlusion. CT indicated a thrombus progressing from the occluded graft to the axillary artery. Surgical repair of the axillary artery was performed in both patients without any complications. PMID:24995062

2014-01-01

187

How I do it: Simple and effortless approach to identify thoracodorsal nerve on axillary clearance procedure  

PubMed Central

Breast cancer surgery frequently involves an axillary clearance procedure for nodal metastases. Injury to the thoracodorsal nerve is one of the complications related to the axillary dissection. The thoracodorsal nerve innervates the latissimus dorsi muscle which facilitates in certain movements of the arm. Moreover, it can be used as a nerve graft in long thoracic nerve injury whether in trauma or surgery. Understanding the anatomy structures and good surgical technique in the axillary clearance procedure can identify and prevent such an injury to the thoracodorsal nerve. Here, we demonstrate a simple and effortless technique for identification of the thoracodorsal nerve during axillary surgery. PMID:22675404

Zin, T; Maw, M; Oo, SM; Pai, DR; Paijan, RB; Kyi, M

2012-01-01

188

Trafficking of a Dual-Modality Magnetic Resonance and Fluorescence Imaging Superparamagnetic Iron Oxide-Based Nanoprobe to Lymph Nodes  

Microsoft Academic Search

Purpose  This study aims to develop and characterize the trafficking of a dual-modal agent that identifies primary draining or sentinel\\u000a lymph node (LN).\\u000a \\u000a \\u000a \\u000a \\u000a Procedure  Herein, a dual-reporting silica-coated iron oxide nanoparticle (SCION) is developed. Nude mice were imaged by magnetic resonance\\u000a (MR) and optical imaging and axillary LNs were harvested for histological analysis. Trafficking through lymphatics was observed\\u000a with intravital and ex

Ambika Bumb; Celeste A. S. Regino; Jackson G. Egen; Marcelino Bernardo; Peter J. Dobson; Ronald N. Germain; Peter L. Choyke; Martin W. Brechbiel

189

Postauricular and Axillary Approach Endoscopic Neck Surgery: A New Technique  

Microsoft Academic Search

Background  While the bilateral axillo-breast approach (BABA) to endoscopic neck surgery resolves various benign and malignant thyroid\\u000a and parathyroid diseases with minimal adverse effects and excellent cosmetic outcomes, it involves circumareolar incisions.\\u000a Many patients, especially young female patients, are reluctant to have their breast involved. Consequently, we developed the\\u000a postauricular and axillary approach (PAA) that uses postauricular incisions.\\u000a \\u000a \\u000a \\u000a Methods  From June 2006

Kyu Eun Lee; Hoon Yub Kim; Won Seo Park; Jun-Ho Choe; Mi Ra Kwon; Seung Keun Oh; Yeo-Kyu Youn

2009-01-01

190

[Axillo-axillary bypass for coronary-subclavian steal syndrome].  

PubMed

We describe a case of coronary-subclavian steal syndrome in a 77-year-old man who presented with progressive coronary ischemia 8 years after coronary artery bypass grafting with an in-situ left internal thoracic artery graft. Coronary and left subclavian artery angiogram revealed completely patent internal thoracic artery graft and 90% stenosis in the proximal left subclavian artery. We performed axilloaxillary artery bypass using expanded polytetrafluoroethylene (ePTFE)[8 mm] graft. No coronary ischemia was noted postoperatively. Axillo-axillary artery bypass grafting was effective for coronary subclavian steal syndrome. PMID:23674033

Sasaki, Yasuyuki; Hirai, Hidekazu; Hosono, Mitsuharu; Bito, Yasuyuki; Nakahira, Atsushi; Suehiro, Yasuo; Kaku, Daisuke; Okada, Yuko; Suehiro, Shigefumi; Harada, Shigeru

2013-05-01

191

Nodular Fasciitis in the Axillary Tail of the Breast  

PubMed Central

Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast carcinoma when located within breast tissue. This presents a problem for appropriate treatment planning as the natural history of nodular fasciitis is spontaneous regression. We present the mammographic, sonographic, computed tomography, and histopathologic characteristics of nodular fasciitis in a 68 year female initially presenting with a rapidly enlarging right axillary mass.

Samardzic, Dejan; Chetlen, Alison; Malysz, Jozef

2014-01-01

192

A Functional ABCC11 Allele Is Essential in the Biochemical Formation of Human Axillary Odor  

Microsoft Academic Search

The characteristic human axillary odor is formed by bacterial action on odor precursors that originate from apocrine sweat glands. Caucasians and Africans possess a strong axillary odor ,whereas many Asians have only a faint acidic odor. In this study, we provide evidence that the gene ABCC11 (MRP8), which encodes an apical efflux pump, is crucial for the formation of the

Annette Martin; Matthias Saathoff; Fabian Kuhn; Heiner Max; Lara Terstegen; Andreas Natsch

2010-01-01

193

The clinical and hemodynamic results after axillary – to – popliteal vein valve transplantation  

Microsoft Academic Search

Purpose: To evaluate the results of axillary vein to popliteal vein valve transplantation (VVTX), we reviewed the clinical, phlebographic, and noninvasive hemodynamic results in 15 patients.Methods: All patients had postthrombotic destruction of deep venous valves as determined by ascending phlebography, whereas descending phlebography demonstrated grade III or IV reflux in all patients. A segment of valve-bearing axillary vein was transplanted

John D. L. Bry; Paula A. Muto; Thomas F. O'Donnell; Lois A. Isaacson

1995-01-01

194

Deodorants and antiperspirants affect the axillary bacterial community.  

PubMed

The use of underarm cosmetics is common practice in the Western society to obtain better body odor and/or to prevent excessive sweating. A survey indicated that 95 % of the young adult Belgians generally use an underarm deodorant or antiperspirant. The effect of deodorants and antiperspirants on the axillary bacterial community was examined on nine healthy subjects, who were restrained from using deodorant/antiperspirant for 1 month. Denaturing gradient gel electrophoresis was used to investigate the individual microbial dynamics. The microbial profiles were unique for every person. A stable bacterial community was seen when underarm cosmetics were applied on a daily basis and when no underarm cosmetics were applied. A distinct community difference was seen when the habits were changed from daily use to no use of deodorant/antiperspirant and vice versa. The richness was higher when deodorants and antiperspirants were applied. Especially when antiperspirants were applied, the microbiome showed an increase in diversity. Antiperspirant usage led toward an increase of Actinobacteria, which is an unfavorable situation with respect to body odor development. These initial results show that axillary cosmetics modify the microbial community and can stimulate odor-producing bacteria. PMID:25077920

Callewaert, Chris; Hutapea, Prawira; Van de Wiele, Tom; Boon, Nico

2014-10-01

195

Management of subclavian-axillary vein thrombosis: a review  

PubMed Central

Objective To study, by literature review, the management of subclavian-axillary vein thrombosis (SAVT) and to make recommendations. Data sources The MEDLINE database and cross-referenced articles. Study selection Key words subclavian-axillary vein thrombosis, venous thrombosis, Paget–Schroetter syndrome, anticoagulation, and thrombolysis were used to extract articles related to SAVT. Data extraction Independent extraction of articles by 2 observers. Data synthesis Although numerous studies are available in the literature, they vary widely in their patient selection, treatment methods, follow-up and conclusions. As such, the management of patients with SAVT remains controversial. Conclusions Anticoagulation remains the initial treatment of choice for acute SAVT although there is definitely a role for thrombolysis and surgery in selected cases. Surgical intervention should be reserved for patients in whom there is a specific indication. Since chronic symptoms depend largely on the etiology of the disease, treatment should be tailored to address the causative factors. A multicentre, prospective study is necessary to evaluate the optimum management strategies for patients with SAVT. PMID:9492744

Hicken, Gary J.; Ameli, F. Michael

1998-01-01

196

Traumatic Pseudoaneurysm of Axillary Artery Combined with Brachial Plexus Injury  

PubMed Central

Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years). After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus. PMID:25412426

Chen, Lin; Peng, Feng; Wang, Tao; Chen, Desong; Yang, Jianyun

2014-01-01

197

Axillary metastases from occult breast cancer. Our experience.  

PubMed

We report the case of a 63-year-old woman with occult breast cancer who presented with a hard metastatic nodule in the left axilla. Although histology identified a metastatic carcinoma in the lymph nodes, numerous tests failed to detect the primary tumor. Resected lymph node was positive for both estrogen and progesterone receptors, suggesting the breast as the site of the primary tumor. Left modified radical mastectomy was performed. Pathology revealed an invasive lobular carcinoma (2.5 x 2 mm in size) with extensive lymphatic involvement, which strongly expressed both vascular endothelial growth factor-C (VEGF-C) and VEGF-D. PMID:24576904

Sanguinetti, Alessandro; Polistena, Andrea; D'Ermo, Giuseppe; Lucchini, Roberta; Triola, Roberta; Conti, Claudia; Avenia, Stefano; Cavallaro, Giuseppe; De Toma, Giorgio; Avenia, Nicola

2014-02-01

198

Extracapsular tumor spread and the risk of local, axillary and supraclavicular recurrence in node-positive, premenopausal patients with breast cancer  

PubMed Central

Background: Extracapsular tumor spread (ECS) has been identified as a possible risk factor for breast cancer recurrence, but controversy exists regarding its role in decision making for regional radiotherapy. This study evaluates ECS as a predictor of local, axillary, and supraclavicular recurrence. Patients and methods: International Breast Cancer Study Group Trial VI accrued 1475 eligible pre- and perimenopausal women with node-positive breast cancer who were randomly assigned to receive three to nine courses of classical combination chemotherapy with cyclophosphamide, methotrexate, and fluorouracil. ECS status was determined retrospectively in 933 patients based on review of pathology reports. Cumulative incidence and hazard ratios (HRs) were estimated using methods for competing risks analysis. Adjustment factors included treatment group and baseline patient and tumor characteristics. The median follow-up was 14 years. Results: In univariable analysis, ECS was significantly associated with supraclavicular recurrence (HR?=?1.96; 95% confidence interval 1.23–3.13; P = 0.005). HRs for local and axillary recurrence were 1.38 (P = 0.06) and 1.81 (P = 0.11), respectively. Following adjustment for number of lymph node metastases and other baseline prognostic factors, ECS was not significantly associated with any of the three recurrence types studied. Conclusions: Our results indicate that the decision for additional regional radiotherapy should not be based solely on the presence of ECS. PMID:18385202

Gruber, G.; Cole, B. F.; Castiglione-Gertsch, M.; Holmberg, S. B.; Lindtner, J.; Golouh, R.; Collins, J.; Crivellari, D.; Thürlimann, B.; Simoncini, E.; Fey, M. F.; Gelber, R. D.; Coates, A. S.; Price, K. N.; Goldhirsch, A.; Viale, G.; Gusterson, B. A.

2008-01-01

199

In vivo carbon nanotube-enhanced non-invasive photoacoustic mapping of the sentinel lymph node  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB), a less invasive alternative to axillary lymph node dissection (ALND), has become the standard of care for patients with clinically node-negative breast cancer. In SLNB, lymphatic mapping with radio-labeled sulfur colloid and/or blue dye helps identify the sentinel lymph node (SLN), which is most likely to contain metastatic breast cancer. Even though SLNB, using both methylene blue and radioactive tracers, has a high identification rate, it still relies on an invasive surgical procedure, with associated morbidity. In this study, we have demonstrated a non-invasive single-walled carbon nanotube (SWNT)-enhanced photoacoustic (PA) identification of SLN in a rat model. We have successfully imaged the SLN in vivo by PA imaging (793 nm laser source, 5 MHz ultrasonic detector) with high contrast-to-noise ratio (=89) and good resolution (~500 µm). The SWNTs also show a wideband optical absorption, generating PA signals over an excitation wavelength range of 740-820 nm. Thus, by varying the incident light wavelength to the near infrared region, where biological tissues (hemoglobin, tissue pigments, lipids and water) show low light absorption, the imaging depth is maximized. In the future, functionalization of the SWNTs with targeting groups should allow the molecular imaging of breast cancer.

Pramanik, Manojit; Song, Kwang Hyun; Swierczewska, Magdalena; Green, Danielle; Sitharaman, Balaji; Wang, Lihong V.

2009-06-01

200

Clinical outcomes after sentinel lymph node biopsy in clinically node-negative breast cancer patients  

PubMed Central

Purpose To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. Materials and Methods From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. Results The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. Conclusion In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

Han, Hee Ji; Kim, Ju Ree; Nam, Hee Rim; Keum, Ki Chang; Suh, Chang Ok

2014-01-01

201

99mTc-dextran lymphoscintigraphy can detect sentinel lymph node in breast cancer patients  

PubMed Central

The aim of this study was to retrospectively determine the accuracy and feasibility of using 99mTc-dextran (DX) lymphoscintigraphy for the localization of sentinel lymph nodes (SLNs) in breast cancer patients. The relevant factors affecting lymphoscintigraphy were also investigated. In this study, 235 breast cancer patients underwent 99mTc-DX lymphoscintigraphic imaging and examination by a ?-probe method in combination with blue dye staining to detect SLNs. The detection results were considered in combination with rapid frozen pathology results to determine whether SLN metastasis was positive or negative. SLNs were identified in 191 patients by ?-probe detection among the 202 patients that tested positive by lymphoscintigraphic imaging, a coincidence rate of 94.6%. This suggested that lymph node metastasis had occurred and could be detected using lymphoscintigraphy. The axillary status of the breast cancer patients was also predicted using lymphoscintigraphy and the false-negative rate, sensitivity, specificity and positive predictive value were 13.3% (4/30), 90.7% (39/43), 23.4% (45/192) and 13.5% (21/155), respectively. The age of the patient, menstrual status, tumor location, tumor size, pathological type, preoperative biopsy and neoadjuvant chemotherapy were unrelated to the success of lymphoscintigraphy (P>0.05). 99mTc-DX lymphoscintigraphy is able to exactly determine the location of SLN in breast cancer patients, and can be used for guiding ?-probe methods and sentinel lymph node biopsy.

WEI, LINLIN; CHEN, FANGNI; ZHANG, XUEHUI; LI, DANGSHENG; YAO, ZHONGQIANG; DENG, LIYAN; XIAO, GUOYOU

2015-01-01

202

Visualising lymph movement in anuran amphibians with computed tomography.  

PubMed

Lymph flux rates in anuran amphibians are high relative to those of other vertebrates owing to 'leaky' capillaries and a high interstitial compliance. Lymph movement is accomplished primarily by specialised lymph muscles and lung ventilation that move lymph through highly compartmentalised lymph sacs to the dorsally located lymph hearts, which are responsible for pumping lymph into the circulatory system; however, it is unclear how lymph reaches the lymph hearts. We used computed tomography (CT) to visualise an iodinated contrast agent, injected into various lymph sacs, through the lymph system in cane toads (Rhinella marina). We observed vertical movement of contrast agent from lymph sacs as predicted, but the precise pathways were sometimes unexpected. These visual results confirm predictions regarding lymph movement, but also provide some novel findings regarding the pathways for lymph movement and establish CT as a useful technique for visualising lymph movement in amphibians. PMID:25165132

Hedrick, Michael S; Hansen, Kasper; Wang, Tobias; Lauridsen, Henrik; Thygesen, Jesper; Pedersen, Michael

2014-09-01

203

Characterization of Staphylococcus and Corynebacterium Clusters in the Human Axillary Region  

PubMed Central

The skin microbial community is regarded as essential for human health and well-being, but likewise plays an important role in the formation of body odor in, for instance, the axillae. Few molecular-based research was done on the axillary microbiome. This study typified the axillary microbiome of a group of 53 healthy subjects. A profound view was obtained of the interpersonal, intrapersonal and temporal diversity of the human axillary microbiota. Denaturing gradient gel electrophoresis (DGGE) and next generation sequencing on 16S rRNA gene region were combined and used as extent to each other. Two important clusters were characterized, where Staphylococcus and Corynebacterium species were the abundant species. Females predominantly clustered within the Staphylococcus cluster (87%, n?=?17), whereas males clustered more in the Corynebacterium cluster (39%, n?=?36). The axillary microbiota was unique to each individual. Left-right asymmetry occurred in about half of the human population. For the first time, an elaborate study was performed on the dynamics of the axillary microbiome. A relatively stable axillary microbiome was noticed, although a few subjects evolved towards another stable community. The deodorant usage had a proportional linear influence on the species diversity of the axillary microbiome. PMID:23950955

Callewaert, Chris; Kerckhof, Frederiek-Maarten; Granitsiotis, Michael S.; Van Gele, Mireille; Van de Wiele, Tom; Boon, Nico

2013-01-01

204

Characterization of Staphylococcus and Corynebacterium clusters in the human axillary region.  

PubMed

The skin microbial community is regarded as essential for human health and well-being, but likewise plays an important role in the formation of body odor in, for instance, the axillae. Few molecular-based research was done on the axillary microbiome. This study typified the axillary microbiome of a group of 53 healthy subjects. A profound view was obtained of the interpersonal, intrapersonal and temporal diversity of the human axillary microbiota. Denaturing gradient gel electrophoresis (DGGE) and next generation sequencing on 16S rRNA gene region were combined and used as extent to each other. Two important clusters were characterized, where Staphylococcus and Corynebacterium species were the abundant species. Females predominantly clustered within the Staphylococcus cluster (87%, n?=?17), whereas males clustered more in the Corynebacterium cluster (39%, n?=?36). The axillary microbiota was unique to each individual. Left-right asymmetry occurred in about half of the human population. For the first time, an elaborate study was performed on the dynamics of the axillary microbiome. A relatively stable axillary microbiome was noticed, although a few subjects evolved towards another stable community. The deodorant usage had a proportional linear influence on the species diversity of the axillary microbiome. PMID:23950955

Callewaert, Chris; Kerckhof, Frederiek-Maarten; Granitsiotis, Michael S; Van Gele, Mireille; Van de Wiele, Tom; Boon, Nico

2013-01-01

205

Concomitant axillary mycobacteriosis and neuro-sarcoidosis: diagnostic pitfalls  

PubMed Central

There are many similarities between mycobacteriosis, in particular, tuberculosis, and sarcoidosis such as predominant intrathoracic localisation (even if all organs and tissues may be concerned), great variability of phenotypic expression, and granulomatous inflammatory reaction, caseous necrosis not being an absolute criterion of tuberculosis. Moreover, microbial (or mycobacterial?) agents may play a role in the pathogenesis of sarcoidosis which remains a diagnosis of exclusion particularly in atypical cases. The authors report a case of a non-immunocompromised female patient who presented, simultaneously, isolated axillary tubercular adenitis and neuro-sarcoidosis without any other localisation. This case illustrates the difficulty to distinguish between both of these two diseases and thus to choose an adequate treatment when diagnosis is not proven. Moreover, our patient (human leucocyte antigen B27 positive) presented symptoms of spondylarthritis which also may have a nosological link with tuberculosis or sarcoidosis. PMID:22679226

Meckenstock, Roderich; Therby, Audrey; Chapelon-Abric, Catherine; Nifle, Chantal; Beressi, Jean Paul; Lebas, Constance; Greder-Belan, Alix

2011-01-01

206

In vivo photoacoustic (PA) mapping of sentinel lymph nodes (SLNs) using carbon nanotubes (CNTs) as a contrast agent  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB), a less invasive alternative to axillary lymph node dissection (ALND), is routinely used in clinic for staging breast cancer. In SLNB, lymphatic mapping with radio-labeled sulfur colloid and/or blue dye helps identify the sentinel lymph node (SLN), which is most likely to contain metastatic breast cancer. Even though SLNB, using both methylene blue and radioactive tracers, has a high identification rate, it still relies on an invasive surgical procedure, with associated morbidity. In this study, we have demonstrated a non-invasive single-walled carbon nanotube (SWNT)-enhanced photoacoustic (PA) identification of SLN in a rat model. We have used single-walled carbon nanotubes (SWNTs) as a photoacoustic contrast agent to map non-invasively the sentinel lymph nodes (SLNs) in a rat model in vivo. We were able to identify the SLN non-invasively with high contrast to noise ratio (~90) and high resolution (~500 ?m). Due to the broad photoacoustic spectrum of these nanotubes in the near infrared wavelength window we could easily choose a suitable light wavelength to maximize the imaging depth. Our results suggest that this technology could be a useful clinical tool, allowing clinicians to identify SLNs non-invasively in vivo. In the future, these contrast agents could be functionalized to do molecular photoacoustic imaging.

Pramanik, Manojit; Song, Kwang Hyun; Swierczewska, Magdalena; Green, Danielle; Sitharaman, Balaji; Wang, Lihong V.

2009-02-01

207

Collagen sealant patch to reduce lymphatic drainage after lymph node dissection  

PubMed Central

Background Seroma formation is a frequent complication following radical lymph node dissection (RLND) in patients with metastatic melanoma. Several strategies have been used to prevent fluid accumulation and thereby reduce the duration of postoperative drainage, including fibrin sealants. Methods This was a prospective, single-center study in which consecutive patients undergoing surgical treatment of stage III metastatic melanoma by axillary or ilio-inguinal RLND were randomized to receive standard treatment plus fibrinogen/thrombin-coated collagen sealant patch (CSP) or standard treatment alone. The primary endpoint of the study was postoperative duration of drainage. Results A total of 70 patients underwent axillary (n = 47) or ilio-inguinal (n = 23) RLND and received CSP plus standard treatment (n = 37) or standard treatment alone (n = 33). Mean duration of drainage was significantly reduced in the CSP group compared with standard treatment (ITT analysis: 20.1 ± 5.1 versus 23.3 ± 5.1 days; p = 0.010). The percentage of patients drainage-free on day 21 was significantly higher in the CSP group compared with the standard treatment group (86% versus 67%; p = 0.049). Conclusions Use of the tissue sealant resulted in a significant reduction in duration of drainage. Further studies are warranted to confirm these results in different and selected types of lymphadenectomy. PMID:23253298

2012-01-01

208

Near infrared fluorescent chlorophyll nanoscale liposomes for sentinel lymph node mapping  

PubMed Central

Background Sentinel lymph node (SLN) mapping using in vivo near infrared fluorescence imaging has attracted great attention during the past few years. Here we report on the early use of poorly water-soluble chlorophyll with near infrared fluorescence extracted from the leaf of Chimonanthus salicifolius, for mouse axillary SLN mapping. Methods and results To improve the water solubility and SLN targeting of the chlorophyll, we encapsulated the chlorophyll in nanoscale liposomes. The liposome-coated chlorophyll nanocomposites obtained were spherical in shape and had an average diameter of 21.7 ± 6.0 nm. The nanocomposites dispersed well in water, and in aqueous suspension they exhibited brighter near infrared fluorescence than chlorophyll alone. After incubation of the nanocomposites with normal liver cells (QSG-7701) and macrophage cells (Ana-1) for no more than 48 hours, there was no obvious reduction in cell viability. When the nanocomposites were injected intradermally into the paw of a mouse, the axillary SLN was found to be strongly fluorescent and was easily visualized in real time without a requirement for surgery. The intensity of the near infrared fluorescence emitted by the SLN was obviously brighter than that emitted by the SLN of another mouse that had been intradermally injected with chlorophyll alone. Conclusion Our data show that the liposome-coated chlorophyll nanocomposites could have great potential for clinical SLN mapping due to their lack of toxicity, bright near infrared fluorescence, and small diameter. PMID:22787402

Fan, Lina; Wu, Qiang; Chu, Maoquan

2012-01-01

209

[Prolonged blocking of the brachial plexus by axillary approach in children].  

PubMed

Surgical interventions were carried out under combined total anesthesia with prolonged blocking of the brachial plexus via axillary approach in 40 children aged 4-14 years with surgical diseases of the arms. Prolonged axillary blockade maintained adequate analgesia in the lower third of the brachial bone, ulnar joint, forearm, and hand for 24-48 h. The proposed protocols of lidocaine and bupivacaine infusion into the axillary space of the brachial plexus caused no toxic reactions in children of this age group. The method can be used in children during and after surgery. PMID:10584368

Leshkevich, A I; Razhev, S V; Lukin, G I; Sidorov, V A

1999-01-01

210

Bilateral trans-radial approach in stenting of occluded right axillary artery.  

PubMed

With recent advancement in percutaneous endovascular interventions, angioplasty and stenting of axillary artery lesions could become the treatment of choice vs. surgical intervention owing to its lower complication and mortality rates and shorter hospital stay.We report a Caucasian female case with axillary artery chronic total occlusion (CTO) with dual etiology (atherosclerotic and radiation induced), which was successfully managed with stent angioplasty. The strategy used was right radial retrograde approach with contralateral injections from left radial catheter. Two year follow-up revealed widely patent axillary stents. PMID:25149874

Kedev, Sasko; Jovkovski, Aleksandar; Zafirovska, Biljana

2014-01-01

211

One-step nucleic acid amplification assay for intraoperative prediction of non-sentinel lymph node metastasis in breast cancer patients with sentinel lymph node metastasis.  

PubMed

The aim of the present study was to construct the intra-operative prediction model of non-sentinel lymph node (non-SLN) metastasis in breast cancer patients with SLN metastasis using one-step nucleic acid amplification (OSNA). Of 833 breast cancer patients (T1-T2, N0) who underwent SLN biopsy and had their SLNs examined intra-operatively with the OSNA assay, 161 with SLN metastasis and treated with completion axillary lymph node dissection (cALND) were randomly divided into a training (n = 81) and a validation (n = 80) cohort. Non-SLN metastasis of the training cohort was associated with the number of positive SLNs (P = 0.001), CK19 mRNA copy number (P = 0.001), and clinical tumor size (P = 0.055). These parameters were used to construct the intra-operative prediction model of non-SLN metastasis. Its diagnostic accuracy (AUC of ROC curve) was 0.809 and 0.704 for the training and validation cohorts, respectively. The intra-operative prediction model using OSNA may have a diagnostic accuracy of non-SLN metastasis comparable to that of the conventional, post-operative prediction model, indicating that it might help decide the indication for cALND. PMID:24973902

Teramoto, Atsuko; Shimazu, Kenzo; Naoi, Yasuto; Shimomura, Atsushi; Shimoda, Masafumi; Kagara, Naofumi; Maruyama, Naomi; Kim, Seung Jin; Yoshidome, Katsuhide; Tsujimoto, Masahiko; Tamaki, Yasuhiro; Noguchi, Shinzaburo

2014-10-01

212

Proteomic Analysis of Human Mesenteric Lymph  

PubMed Central

Extensive animal work has established mesenteric lymph as the mechanistic link between gut ischemia/reperfusion (I/R) and distant organ injury. Our trauma and transplant services provide a unique opportunity to assess the relevance of our animal data to human mesenteric lymph under conditions that simulate those used in the laboratory. Mesenteric lymph was collected from eleven patients; with lymphatic injuries, during semi-elective spine reconstruction, or immediately before organ donation. The lymph was tested for its ability to activate human neutrophils in vitro, and was analyzed by label-free proteomic analysis. Human mesenteric lymph primed human PMNs in a pattern similar to that observed in previous rodent, swine, and primate studies. A total of 477 proteins were identified from the 11 subject’s lymph samples with greater than 99% confidence. In addition to classical serum proteins, markers of hemolysis, extracellular matrix components, and general tissue damage were identified. Both tissue injury and shock correlate strongly with production of bioactive lymph. Products of red blood cell hemolysis correlate strongly with human lymph bioactivity and immunoglobulins have a negative correlation with the pro-inflammatory lymph. These human data corroborate the current body of research implicating post shock mesenteric lymph in the development of systemic inflammation and multiple organ failure. Further studies will be required to determine if the proteins identified participate in the pathogenesis of multiple organ failure and if they can be used as diagnostic markers. PMID:21192285

Dzieciatkowska, Monika; Wohlauer, Max V.; Moore, Ernest E.; Damle, Sagar; Peltz, Erik; Campsen, Jeffrey; Kelher, Marguerite; Silliman, Christopher; Banerjee, Anirban; Hansen, Kirk C.

2011-01-01

213

Nasal, axillary, and perineal carriage of Staphylococcus aureus among women: identification of strains producing epidermolytic toxin.  

PubMed Central

Following two outbreaks of staphylococcal scalded skin syndrome in a maternity unit, 500 pregnant women attending an antenatal clinic were screened for carriage of epidermolytic toxin producing Staphylococcus aureus. Nasal, axillary, and perineal swabs were collected from women whose gestational ages ranged from 12-40 weeks. Isolates of S aureus were purified, phage typed, and tested for methicillin sensitivity and production of epidermolytic toxin. The results showed that 164 (33%) women carried S aureus; of these, 100 (61%) were from the nose and three (2%) from axillae, but 41 (25%) strains were isolated from the perineum alone. Screening for nasal carriage alone will therefore miss 25% of carriers. More than one strain of S aureus was identified in seven of 20 women with multiple site carriage. Three (2%) methicillin resistant strains were isolated during the survey, and five (3%) isolates produced epidermolytic toxin. Phage typing identified 63 (34%) strains as non-typable, but 50% of isolates typed either groups I, II or III, and a further 10% represented varying combinations of these and other phage groups. These results provide baseline information on S aureus in the community, and identification of methicillin resistant and toxin producing strains shows a reservoir of outbreak potential which could become relevant on hospital admission of such a carrier. PMID:1890203

Dancer, S J; Noble, W C

1991-01-01

214

Near Infrared Photoacoustic Detection of Sentinel Lymph Nodes with Gold Nanobeacons  

PubMed Central

Detection of sentinel lymph node (SLN) using photoacoustic imaging is an emerging technique for noninvasive axillary staging of breast cancer. Due to the absence of intrinsic contrast inside the lymph nodes, exogenous contrast agents are used for photoacoustic detection. In this work, we have demonstrated near infrared detection of SLN with gold nanobeacons (GNB) providing the photoacoustic contrast in a rodent model. We found that size dictates the in vivo characteristics of these nanoparticles in SLN imaging. Larger nanobeacons with high pay loads of gold were not as efficient as smaller size nanobeacons with lower pay loads for this purpose. Colloidal GNBs were designed as a nanomedicine platform with “soft” nature that is amenable to bio-elimination, an essential feature for in vivo efficacy and safety. The GNBs were synthesized as lipid- or polymer-encapsulated colloidal particles incorporating tiny gold nanoparticles (2–4 nm) in three tunable sizes (90 nm, 150 nm and 290 nm). Smaller GNBs were noted trafficking through the lymphatic system and accumulating more efficiently in the lymph nodes in comparison to the bigger nanoagents. At 20 min, the GNBs reached the SLN and were no longer observed within the draining lymphatic vessel. Within one hour post injection, the contrast ratio of the lymphnodes with the surrounding blood vessels was 9:1. These findings were also supported by analytical measurements of the ex vivo tissue samples. Results indicate that cumulative nanoparticle deposition in lymph nodes is size dependent and that high payloads of gold, although offering greater contrast in vitro, may yield nanoagents with poor intradermal migration and lymphatic transport characteristics. PMID:20172607

Pan, Dipanjan; Pramanik, Manojit; Senpan, Angana; Ghosh, Soumojit; Wickline, Samuel A.; Wang, Lihong V.; Lanza, Gregory M.

2010-01-01

215

Lymph drainage from the ovine tonsils: an anatomical study of the tonsillar lymph vessels.  

PubMed

Although the tonsils of sheep have gained much attention during the last decade, only few data are available on their lymph vessel architecture. Tonsillar lymph vessels are immunologically important as they form the efferent routes for locally activated immune cells to reach the draining lymph nodes. To gain insight into the tonsillar lymph drainage in the sheep, Indian ink and a casting polymer were injected into the interstitium of the five tonsils present in the heads of slaughtered sheep. This enabled us to determine the draining lymph node and to examine the microscopic organization of lymph vessels using light and scanning electron microscopy. No lymph vessels were observed within the tonsillar lymphoid follicles. The corrosion casts demonstrated that the lymphoid follicles are surrounded by numerous sacculated lymph sinuses that drain into a dense interfollicular lymph vessel network. From here, the lymph flows into single small lymph vessels that in turn drain into larger lymph vessels extending towards the medial retropharyngeal lymph node. The presented results can be valuable for immunological studies, for example during oral or intranasal vaccine development. PMID:24597835

Casteleyn, C; Cornillie, P; Van Ginneken, C; Simoens, P; Van Cruchten, S; Vandevelde, K; Van den Broeck, W

2014-12-01

216

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

217

Daily battle against body odor: towards the activity of the axillary microbiota.  

PubMed

The microbial community of the human axilla plays a key role in the formation of axillary odor by biotransformation of odorless natural secretions into volatile odorous molecules. Culture-based microbiological and biochemical studies have allowed the characterization of the axillary microbiota, but the advent of next-generation culture-independent DNA sequencing approaches has provided an unprecedented depth of data regarding the taxonomic composition of the axillary microbiota and intra- and interindividual variation. However, the physiological activity of the microbiota of an individual and its variation under different environmental conditions remains largely unknown. Thus, metatranscriptomics represents a promising technique to identify specific metabolic activities in the axillary microbiota linked to individual differences in body odor. PMID:23566668

Fredrich, Eugenie; Barzantny, Helena; Brune, Iris; Tauch, Andreas

2013-06-01

218

Long-term results with axillo-axillary bypass grafts for symptomatic subclavian artery insufficiency  

Microsoft Academic Search

Purpose: The surgical treatment for patients with a subclavian steal is controversial, especially for patients with coexisting severe carotid stenosis. This study determines the long-term efficacy of axillo-axillary bypass grafts in patients with and without a simultaneous carotid endarterectomy.Methods: The axillo-axillary bypass was done in 39 patients who were monitored for 5.8 ± 3.9 years. Fifteen of these patients with

John B. Chang; Theodore A. Stein; Julie P. Liu; Mary Ellen Dunn

1997-01-01

219

Cryopreservation of dried axillary buds from plantlets of Asparagus officinalis L. grown in vitro  

Microsoft Academic Search

Dried axillary buds from plantlets of Asparagus lofficinalis L. grown in vitro were successfully cryopreserved. Single node segments (5mm in length) with axillary bud were taken from mature in vitro plantlets. The segments were precultured on solidfied Murashige-Skoog medium (1962) containing 0.7M sucrose at 25 °C in light for 2 days. Thereafter, these precultured segments were subjected to dehydration with

A. Uragami; A. Sakai; M. Nagai

1990-01-01

220

Dermal Injection of Radioactive Colloid Is Superior to Peritumoral Injection for Breast Cancer Sentinel Lymph Node Biopsy: Results of a Multiinstitutional Study  

PubMed Central

Objective To determine the optimal radioactive colloid injection technique for sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data The optimal radioactive colloid injection technique for breast cancer SLN biopsy has not yet been defined. Peritumoral injection of radioactive colloid has been used in most studies. Although dermal injection of radioactive colloid has been proposed, no published data exist to establish the false-negative rate associated with this technique. Methods The University of Louisville Breast Cancer Sentinel Lymph Node Study is a multiinstitutional study involving 229 surgeons. Patients with clinical stage T1–2, N0 breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed at the discretion of the operating surgeon. Peritumoral injection of isosulfan blue dye was performed concomitantly in most patients. The SLN identification rates and false-negative rates were compared. The ratios of the transcutaneous and ex vivo radioactive SLN count to the final background count were calculated as a measure of the relative degree of radioactivity of the nodes. One-way analysis of variance and chi-square tests were used for statistical analysis. Results A total of 2,206 patients were enrolled. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed in 1,074, 297, and 511 patients, respectively. Most of the patients (94%) who underwent radioactive colloid injection also received peritumoral blue dye injection. The SLN identification rate was improved by the use of dermal injection compared with subdermal or peritumoral injection of radioactive colloid. The false-negative rates were 9.5%, 7.8%, and 6.5% (not significant) for peritumoral, subdermal, and dermal injection techniques, respectively. The relative degree of radioactivity of the SLN was five- to sevenfold higher with the dermal injection technique compared with peritumoral injection. Conclusions Dermal injection of radioactive colloid significantly improves the SLN identification rate compared with peritumoral or subdermal injection. The false-negative rate is also minimized by the use of dermal injection. Dermal injection also is associated with SLNs that are five- to sevenfold more radioactive than with peritumoral injection, which simplifies SLN localization and may shorten the learning curve. PMID:11360892

McMasters, Kelly M.; Wong, Sandra L.; Martin, Robert C. G.; Chao, Celia; Tuttle, Todd M.; Noyes, R. Dirk; Carlson, David J.; Laidley, Alison L.; McGlothin, Terre Q.; Ley, Philip B.; Brown, C. Matthew; Glaser, Rebecca L.; Pennington, Robert E.; Turk, Peter S.; Simpson, Diana; Cerrito, Patricia B.; Edwards, Michael J.

2001-01-01

221

Stimulation of axillary shoot development and concentration of fruit set in cucumber, Cucumis sativus L., as a result of chemical inactivation of the apical meristem  

E-print Network

Appearance of Experiment II treatments at harvest with leaves removed. Treat- ments are: (a) control, untreated; b) hand-topped at third leaf stage; c-e) . 02 to . 04 M decyl alcohol appli- ed at third leaf stage; (f) hand-topped at fourth leaf stage; (g... for number of axillary shoots pez plant. Source of Variation dF MS Total Treatments Control vs. rest Hand-topped vs. chemical Methyl decanoate vs. decyl alcohol Within methyl decanoate O. OOM vs. zest Linear Quadratic Cubic Deviations 158 1 6...

Campbell, Gary Davis

2012-06-07

222

Endovascular management of spontaneous axillary artery aneurysm: a case report and review of the literature  

PubMed Central

Introduction Spontaneous atraumatic true axillary artery aneurysm is a relatively unusual disorder. Although most cases are asymptomatic, complications of axillary artery aneurysms may result in acute vascular insufficiency and neurological deficits. Prompt treatment, therefore, should be employed in the management of this condition. To date, the standard treatment for peripheral aneurysms is still surgical resection with end-to-end anastomosis. However, aneurysmectomy and interposition grafting with autologous or artificial vessels are more invasive and time-consuming. The ideal treatment for axillary artery aneurysm should be relatively noninvasive, safe and free of significant complications, cost-effective, cosmetically acceptable, and incur less absence from usual daily activities. Endovascular stent grafts have also been successfully used to treat these aneurysms. Management of select aneurysms using stent grafts has become more prevalent with the developing endoluminal technology. Case presentation We report a case of a spontaneous atraumatic axillary artery aneurysm where the patient was a 48-year-old ethnic Han Chinese woman with a gradually enlarging left axillary pulsatile mass. She was treated with endovascular stent grafts. The postoperative course of the patient was uneventful during the six-month follow-up. Conclusions We show that there are significant early advantages with the endovascular management technique versus the conventional operation in the management of axillary artery aneurysm. PMID:23714201

2013-01-01

223

Micropropagation of Melissa officinalis L. through proliferation of axillary shoots.  

PubMed

Multiple shoots were differentiated in cotyledonary nodes of 10 d old seedlings of Melissa officinalis, cultured on MS medium supplemented with BAP (0-4 mg/l). The production of shoots was further induced in subcultures of the original expiant, after the first harvest of shoots (stump), using similar conditions. The highest average number of shoots in the two inoculations was obtained with 2 mg/l of BAP: 24 axillary shoots per explant, 7 in the first inoculation and 17 in the second one. The maximum elongation of shoots was achieved with BAP at 0.2 mg/l, and higher concentrations of the hormone induced a decrease in their size. A range of BAP concentrations between 0.2-0.5 mg/l allowed the production of more shoots with a size suitable for rooting. Roots were induced in 30 d old shoots, transferred to MS medium individually supplemented with IBA or NAA (0-4 mg/l). Micropropagated plants were successfully transferred to soil. PMID:24178426

Tavares, A C; Pimenta, M C; Gonçalves, M T

1996-02-01

224

The first and second echelon sentinel lymph node evaluation in oral cancer.  

PubMed

Sentinel lymph node biopsy shows promise as a minimally invasive technique that samples the first echelon (station) of nodes to predict the need for more extensive neck dissection. This paper discusses the accuracy and feasibility of sentinel node and "station II node" biopsy for predicting the status of neck in 20 patients of oral cancer. We identified sentinel node in these patients. The next higher-order nodes, that is, second echelon of nodes known as "station II nodes" were delineated by further injecting 0.1 ml of isosulfan blue dye in sentinel lymph node. Identification rate for station I nodes was 95 %. Station II nodes were identified in 84 % of patients. One patient had false negative station I node. Station II node status was false negative in two patients. "Station I and station II concept" is feasible in early-stage tumors of oral cavity. PMID:24426480

Bassi, Kuldeep Kumar; Srivastava, Anurag; Seenu, Vuthaluru; Kumar, Rakesh; Parshad, Rajinder; Chumber, Sunil; Gupta, Siddarth Datta; Bahadur, Sudhir

2013-10-01

225

Pulmonary hilar lymph node metastasis of breast cancer induced bronchopleural fistula and superior vena cava syndrome.  

PubMed

Background It is extremely rare for pulmonary hilar lymph node metastasis (PHLNM) of a cancer to be independently lethal. Here, we report an exceedingly rare case of cavitation in PHLNM from breast cancer triggering broncho-pleural fistula and empyema (BPFE), complicated with superior vena cava syndrome (SVCS). Case Report A 56-year-old woman who had undergone left segmental mastectomy and axillary lymph node dissection due to left breast cancer was then treated for 1 year with postoperative adjuvant chemotherapy. Recurrence of right PHLNM was observed 2 years after the operation, for which 3 courses of bevacizumab (BEV) and paclitaxel combination chemotherapy were administered. The woman had dyspnea and fever during the washout period, and CT examination revealed fistula formation between the right PHLNM cavitation and right main bronchus, so she was admitted for further treatment. This fistula rapidly progressed to BPFE, and contralateral aspiration was observed to cause pneumonia of the left lung. In addition, edema of both upper limbs and head and neck were observed, and CT examination revealed SVCS caused by re-enlargement of PHLNM. Active treatment was performed, but the recommencement of chemotherapy was not possible, and she died on Day 150 of admission. Conclusions We think that PHLNM deteriorated to central necrosis due to chemotherapy with BEV taking effect, leading to formation of BPFE. The case was also made more difficult due to the complication of SVCS caused by the re-enlarged PHLNM. PMID:25399335

Nishinari, Yutaka; Kashiwaba, Masahiro; Umemura, Akira; Komatsu, Hideaki; Sasaki, Akira; Wakabayashi, Go

2014-01-01

226

The optimal number of lymph nodes removed in maximizing the survival of breast cancer patients  

NASA Astrophysics Data System (ADS)

The number of lymph nodes removed is one of the important predictors for survival in breast cancer study. Our aim is to determine the optimal number of lymph nodes to be removed for maximizing the survival of breast cancer patients. The study population consists of 873 patients with at least one of axillary nodes involved among 1890 patients from the University of Malaya Medical Center (UMMC) breast cancer registry. For this study, the Chi-square test of independence is performed to determine the significant association between prognostic factors and survival status, while Wilcoxon test is used to compare the estimates of the hazard functions of the two or more groups at each observed event time. Logistic regression analysis is then conducted to identify important predictors of survival. In particular, Akaike's Information Criterion (AIC) are calculated from the logistic regression model for all thresholds of node involved, as an alternative measure for the Wald statistic (?2), in order to determine the optimal number of nodes that need to be removed to obtain the maximum differential in survival. The results from both measurements are compared. It is recommended that, for this particular group, the minimum of 10 nodes should be removed to maximize survival of breast cancer patients.

Peng, Lim Fong; Taib, Nur Aishah; Mohamed, Ibrahim; Daud, Noorizam

2014-07-01

227

Recent Advance in Lymph Dynamic Analysis in Lymphatics and Lymph Nodes  

PubMed Central

Lymphatics are a unidirectional transport system that carries fluid from the interstitial space and back into the blood stream. Initial lymphatics take up not only fluid but also high-molecular-weight substances, such as plasma proteins and hyaluronan; immune cells, such as lymphocytes, macrophages, and dendritic cells; and colloidal particles, such as carbon particles, bacteria, and tattoo dye. Interstitially injected colloidal particles are known to accumulate in the regional lymph nodes. This phenomenon is applied to find sentinel lymph nodes in cancer patients. Lymph flow rate and composition are influenced by interstitial fluid, lymphatic pump activity, and intra-lymphatic pressure. Lymph composition is changed during its flow downstream. In this review, the main focus is on the mechanisms of lymph formation at the initial lymphatics and lymph transport through the collecting lymphatics and lymph nodes. (*English Translation of J Jpn Coll Angiol, 2008, 48: 113-123.) PMID:23555523

2012-01-01

228

Treatment of Axillary Osmidrosis Using a Subcutaneous Pulsed Nd-YAG Laser  

PubMed Central

Background Axillary osmidrosis is characterized by an unpleasant odor, profuse sweating, and in some instances, staining of clothes that may socially and psychologically impair affected individuals. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. This study was undertaken to evaluate the effectiveness of subcutaneous pulsed neodymium: yttrium-aluminum-garnet (Nd-YAG) laser treatment for the treatment of axillary osmidrosis. Methods Twenty-nine patients with axillary osmidrosis were included in this study. Patients were categorized according to the results of an axillary malodor grading system, and a subcutaneous pulsed Nd-YAG laser was applied to all patients. The treatment area for the appropriate distribution of laser energy was determined using the iodine starch test (Minor's test) against a grid pattern composed of 2×2 cm squares. The endpoint of exposure was 300 to 500 J for each grid, depending on the preoperative evaluation results. The results were evaluated by measurement of axillary malodor both pre- and postoperatively using the grading system and iodine starch test. Results The average follow-up period was 12.8 months. Nineteen patients had a fair-to-good result and ten patients had poor results. The postoperative Minor's test demonstrated that there were remarkable improvements for patients with mild to moderate symptoms. Complications including superficial second degree burns (n=3) were treated in a conservative manner. A deep second degree burn (n=1) was treated by a surgical procedure. Conclusions Subcutaneous pulsed Nd-YAG laser has many advantages and is an effective noninvasive treatment for mild to moderate axillary osmidrosis. PMID:22783514

Kim, Daejin; Yeo, Hyeonjung; Kwon, Hyukjun; Son, Daegu; Han, Kihwan

2012-01-01

229

A comparison between double-injection axillary brachial plexus block and midhumeral block for emergency upper limb surgery.  

PubMed

In this prospective and randomized study, we compared a double-injection axillary (median and radial nerves) block with a midhumeral block in 90 patients undergoing emergency upper limb surgery. Time to perform the block, success rate, and patient tolerance were evaluated. The time to perform the block was 5 min longer in the midhumeral group. The success rate was similar in both groups (80% and 91% in groups axillary and midhumeral respectively), except for the musculocutaneous nerve. Patient tolerance was better in the axillary group. Double-injection axillary brachial plexus block is superior to midhumeral block for emergency hand surgery. PMID:16717337

Fuzier, Régis; Fourcade, Olivier; Pianezza, Antoine; Gilbert, Marie-Luce; Bounes, Vincent; Olivier, Michel

2006-06-01

230

Upper Extremity Axillary Loop Grafts: An Opportunity in Hemodialysis Access  

PubMed Central

Background Dialysis vascular access complications are considered as significant causes of morbidity in chronic hemodialysis patients. Objectives The aim of the present study was a comparison of axillary loop and straight grafts patency and its complications in hemodialysis access. Patients and Methods In this cohort study conducted at Shahid Beheshti Medical University, 77 patients who underwent placement of loop or straight access grafts were included. Demographics, primary and secondary patency rates and complications like thrombosis, infection, bleeding, steal syndrome and other complications were compared in these two groups. The collected data was analyzed by chi-square test, t-test, and logistic regression. Results Primary patency rate in straight and loop groups after 1 month were 88.9% and 92.3% respectively (P = 0.721), and after 24 months were 31% and 55.5% respectively (P = 0.058). Secondary patency rate in straight and loop groups after 3 months were 75.6% and 92.3% respectively (P = 0.189), and after 24 months were 37.9% and 66.7% respectively (P = 0.044). The frequency of complications were the same among two methods of graft replacement and mal incidence of thrombosis, infection, delayed infection, pseudoaneurysm formation and steal syndrome occurrence ultimate graft failure and venous hypertension were not significantly different (P > 0.05). Conclusions Polytetrafluorethylene (PTFE) vascular graft seems to be an appropriate vascular access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, there was no significant difference between the two groups for complications and early patency, but late patency was improved in loop group. More study is necessary for a conclusive assessment. PMID:23577334

Khoshnevis, Jalaladin; Sobhiyeh, Mohammad Reza; Lotfolahzadah, Saran; Hoseinzadegan Shirazi, Fatemah; Jalali, Amir Hosein

2012-01-01

231

Axillary node dissection in patients with breast cancer diagnosed through the Ontario Breast Screening Program: a need for minimally invasive techniques  

PubMed Central

Objective To determine the role of axillary node dissection by studying patient and tumour characteristics of invasive breast cancer through the Ontario Breast Screening Program (OBSP). Design A retrospective evaluation. Setting The London, Ont., branch of the OBSP. Patients Three groups of women seen were studied: 50 women with screen-detected breast cancers, which were palpable and detected by the nurse-examiner, 62 women with occult screen-detected breast cancers and 353 age-matched women with invasive breast cancer from the LRCC prospective database, who served as controls. Main outcome measure The proportion of involved axillary nodes within the 3 groups based on patient and tumour characteristics. Results Twenty-five (22.3%) of the 112 women had screen-detected tumours less than 1 cm in dimension, but only 1 had an involved axillary node. Twelve (19%) of the 62 women with occult screen-detected tumours had involved lymph nodes compared with 17 (34%) of the 50 women with palpable screen-detected cancers (NS). In the control group tumour dimension less than 1 cm versus 1 cm or larger had a marked effect on the probability of axillary node involvement (12.5% v. 40.7%, p = 0.001). In the palpable screen-detected group 3 times as many women with outer quadrant or central lesions had involved nodes as those with inner quadrant lesions (38% v. 12%) and for those with a family history of breast cancer almost twice as many had involved axillary nodes. In occult screen-detected patients there was more nodal involvement in patients aged 60 years or less than in those older than 60 years (35% v. 10%, p = 0.042); only 4 of 41 patients older than 60 years had involved nodes at surgery. A significant difference in nodal involvement was found with respect to high or intermediate grade versus low grade lesions in the occult group (44% v. 12%, p = 0.033). In the control group, tumour grade (intermediate and high [45.3%] v. low [20.0%]) and hormone replacement therapy (HRT) (current or recent use [56.5%] v. no use [34.5%]) were significant findings (p < 0.001 and p = 0.005 respectively). Conclusions Women older than 60 years with tumours smaller than 1 cm had a low probability of nodal positivity (0% to 8.7%), but there is insufficient information in this group to give a 95% or better prediction of nodal status at the time of surgery. Studies of minimally invasive techniques such as sentinel node biopsy are needed in this group to minimize surgical morbidity in these women who, as a result of early diagnosis, have an excellent long-term outlook. PMID:9336528

Singhal, Hemant; O'Malley, Frances P.; Tweedie, Edward; Stitt, Lawrence; Tonkin, Katia S.

1997-01-01

232

Potential Bud Bank Responses to Apical Meristem Damage and Environmental Variables: Matching or Complementing Axillary Meristems?  

PubMed Central

Soil nutrients, dormant axillary meristem availability, and competition can influence plant tolerance to damage. However, the role of potential bud banks (adventitious meristems initiated only after injury) is not known. Examining Central European field populations of 22 species of short-lived monocarpic herbs exposed to various sources of damage, we hypothesized that: (1) with increasing injury severity, the number of axillary branches would decrease, due to axillary meristem limitation, whereas the number of adventitious shoots (typically induced by severe injury) would increase; (2) favorable environmental conditions would allow intact plants to branch more, resulting in stronger axillary meristem limitation than in unfavorable conditions; and (3) consequently, adventitious sprouting would be better enabled in favorable than unfavorable conditions. We found strong support for the first hypothesis, only limited support for the second, and none for the third. Our results imply that whereas soil nutrients and competition marginally influence plant tolerance to damage, potential bud banks enable plants to overcome meristem limitation from severe damage, and therefore better tolerate it. All the significant effects were found in intraspecific comparisons, whereas interspecific differences were not found. Monocarpic plants with potential bud banks therefore represent a distinct strategy occupying a narrow environmental niche. The disturbance regime typical for this niche remains to be examined, as do the costs associated with the banks of adventitious and axillary reserve meristems. PMID:24516587

Klimesova, Jitka; Malikova, Lenka; Rosenthal, Jonathan; Smilauer, Petr

2014-01-01

233

Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories  

PubMed Central

Objective To determine the clinicopathological characteristics, and evaluate the appropriate extent of lymph node dissection in distal gastric cancer patients with comparable T category. Methods A retrospective study was conducted on 570 distal gastric cancer patients, who underwent gastric resection with D2 nodal dissection, which was performed by the same surgical team from January 1997 to January 2011. We compared the differences in lymph node metastasis rates and metastatic lymph node ratios between different T categories. Additionally, we investigated the impact of lymph node metastasis in the 7th station on survival rate of distal gastric cancer patients with the same TNM staging. Results Among the 570 patients, the overall lymph node metastasis rate of advanced distal gastric cancer was 78.1%, and the metastatic lymph node ratio was 27%. The lymph node metastasis rate in the 7th station was similar to that of perigastric lymph nodes. There was no statistical significance in patients with the same TNM stage (stage II and III), irrespective of the metastatic status in the 7th station. Conclusions Our results suggest that to a certain extent, it is reasonable to include lymph nodes in the 7th station in the D1 lymph node dissection. PMID:25232215

Song, Wu; Wang, Shaochuan; He, Weiling; Xu, Jianbo

2014-01-01

234

Evolution of sentinel lymph node biopsy in breast cancer, in and out of vogue?  

PubMed

Sentinel lymph node biopsy (SLNB) was introduced 2 decades ago and thereafter validated for routine surgical management of breast cancer, including cases treated with neoadjuvant chemotherapy. As the number of lymph nodes for staging has decreased, pathologists have scrutinized SLN with a combination of standard hematoxylin and eosin, levels, immunohistochemistry (IHC), and molecular methods. An epidemic of small-volume metastases thereby arose, leading to modifications in the American Joint Committee on Cancer staging to accommodate findings such as isolated tumor cells (ITC) and micrometastases. With the goal of determining the significance of these findings, retrospective followed by prospective trials were performed, showing mixed results. The ACOSOG Z10 and NSABP B-32 trials both independently showed that ITC and micrometastases were not significant and thus discouraged the use of levels and IHC for detecting them. However, the Surveillance Epidemiology and End Results database showed that patients with micrometastases had an overall decreased survival. In addition, the MIRROR (Micrometastases and ITC: Relevant and Robust or Rubbish?) trial, showed that patients with ITC and micrometastases treated with adjuvant therapy had lower hazard ratios compared with untreated patients. Subsequently, the ACOSOG Z0011 trial randomized patients with up to 2 positive SLN to axillary lymph node dissection (ALND) or not, all treated with radiation and chemotherapy, showing no difference in survival or recurrence rates between the 2 groups and causing a shift from ALND. As the rate of ALND has declined, the necessity of performing levels, IHC, frozen section, and molecular studies on SLN needs to be revisited. PMID:25299312

Jaffer, Shabnam; Bleiweiss, Ira J

2014-11-01

235

Surgical sentinel lymph node biopsy in early breast cancer. Could it be avoided by performing a preoperative staging procedure? A pilot study  

PubMed Central

Summary Background The aim of this pilot trial was to study the feasibility of sentinel node percutaneous preoperative gamma probe-guided biopsy as a valid preoperative method of assessment of nodal status compared to surgical sentinel lymph node biopsy. Material/Methods This prospective study enrolled 10 consecutive patients without evidence of axillary lymph node metastases at preoperative imaging. All patients underwent sentinel node occult lesion localization (SNOLL) using radiotracer intradermic injection that detected a “hot spot” corresponding to the sentinel node in all cases. Gamma probe over the skin detection with subsequent ultrasonographically guided needle biopsy of the sentinel node were performed. The percutaneous needle core histopathological diagnosis was compared to the results of the surgical biopsy. Results Preoperative sentinel node identification was successful in all patients. Conclusions The combination of preoperative gamma probe sentinel node detection and ultrasound-guided biopsy could represent a valid alternative to intraoperative sentinel node biopsy in clinically and ultrasonographically negative axillary nodes, resulting in shorter duration of surgery and lower intraoperative risks. PMID:22936189

Testori, Alberto; Meroni, Stefano; Moscovici, Oana Codrina; Magnoni, Paola; Malerba, Paolo; Chiti, Arturo; Rahal, Daoud; Travaglini, Roberto; Cariboni, Umberto; Alloisio, Marco; Orefice, Sergio

2012-01-01

236

Molecular analysis of sarcoidosis lymph nodes for microorganisms: a case-control study with clinical correlates  

PubMed Central

Introduction Sarcoidosis is an incurable, chronic granulomatous disease primarily involving the lungs and lymph nodes of unknown aetiology, treated with non-specific anti-inflammatory/immunosuppressive drugs. Persistently symptomatic patients worsen with a disabling, potentially fatal clinical course. To determine a possible infectious cause, we correlated in a case-control study the clinical information with the presence of bacterial DNA in sarcoidosis mediastinal lymph nodes compared with control lymph nodes resected during cancer surgery. Methods We retrospectively studied formalin-fixed, paraffin-embedded, mediastinal lymph nodes from 30 patients with sarcoidosis and 30 control patients with lung cancer. Nucleic acids were extracted from nodes, evaluated by ribosomal RNA PCR for bacterial 16S ribosomal DNA and the results were sequenced and compared with a bacterial sequence library. Clinical information was correlated. Results 11/30 (36.7%) of lymph nodes from patients with sarcoidosis had detectable bacterial DNA, significantly more than control patient lymph nodes (2/30, 6.7%), p=0.00516. At presentation, 19/30 (63.3%) patients with sarcoidosis were symptomatic including all patients with detectable bacterial DNA. Radiographically, there were 18 stage I and 12 stage II patients. All stage II patients were symptomatic and 75% had PCR-detectable bacteria. After a mean follow-up of 52.8±32.8?months, all patients with PCR-detectable bacteria in this series were persistently symptomatic requiring treatment. Discussion 36.6% of patients with sarcoidosis had detectable bacterial DNA on presentation, all of these patients were quite symptomatic and most were radiographically advanced stage II. These findings suggest that bacterial DNA-positive, symptomatic patients have more aggressive sarcoidosis that persists long term and might benefit from antimicrobial treatment directed against this presumed chronic granulomatous infection. PMID:24366580

Robinson, Lary A; Smith, Prudence; SenGupta, Dhruba J; Prentice, Jennifer L; Sandin, Ramon L

2013-01-01

237

Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation.  

PubMed

Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial plexus block. Ten residents with no previous experience with using ultrasound received ultrasound training and another ten residents with no previous experience with using nerve stimulation received nerve stimulation training. The novices' learning curves were generated by retrospective data analysis out of our electronic anaesthesia database. Individual success rates were pooled, and the institutional learning curve was calculated using a bootstrapping technique in combination with a Monte Carlo simulation procedure. The skills required to perform successful ultrasound-guided axillary brachial plexus block can be learnt faster and lead to a higher final success rate compared to nerve stimulator-guided axillary brachial plexus block. PMID:21318138

Luyet, C; Schüpfer, G; Wipfli, M; Greif, R; Luginbühl, M; Eichenberger, U

2010-01-01

238

Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation  

PubMed Central

Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial plexus block. Ten residents with no previous experience with using ultrasound received ultrasound training and another ten residents with no previous experience with using nerve stimulation received nerve stimulation training. The novices' learning curves were generated by retrospective data analysis out of our electronic anaesthesia database. Individual success rates were pooled, and the institutional learning curve was calculated using a bootstrapping technique in combination with a Monte Carlo simulation procedure. The skills required to perform successful ultrasound-guided axillary brachial plexus block can be learnt faster and lead to a higher final success rate compared to nerve stimulator-guided axillary brachial plexus block. PMID:21318138

Luyet, C.; Schupfer, G.; Wipfli, M.; Greif, R.; Luginbuhl, M.; Eichenberger, U.

2010-01-01

239

An extraordinary case of axillary contracture: trapped healthy skin and its adnexes under contracted scar.  

PubMed

Abstract Although striking improvements have been achieved in overall management of burn injury, postburn contractures are still an ongoing challenge to burn surgeons. Axillary adduction contracture is one of the most common types of these disabling postburn complications that usually result from suboptimal treatment after acute burns. An unusual and complicated case of axillary contracture in which the unburned, healthy axillary dome skin was trapped as a cystic mass under the scarred area was reconstructed by transfer of a big (17 × 13-cm) thoracodorsal artery perforator flap after contracture release. The result was satisfactory in terms of function and acceptable cosmetically. The underlying reasons for the inadequate treatment the patient received after surviving a severe electrical injury were discussed. PMID:25058781

Nisanci, Mustafa; Sahin, Ismail; Guzey, Serbulent

2014-01-01

240

Does intensive histopathological workup by serial sectioning increase the detection of lymph node micrometastasis in patients with primary cutaneous melanoma?  

PubMed

Various histopathological techniques have been developed in order to improve the detection of micrometastasis in the regional lymph nodes of patients with malignant melanoma. Our standard histopathological examination of lymph nodes included haematoxylin and eosin (H & E) staining and immunohistochemistry (IH) using antibodies to HMB-45 and S-100 proteins of three paraffin sections at one level. In addition, lymph nodes were examined by molecular biological methods using tyrosinase reverse transcription-polymerase chain reaction (RT-PCR). In this study, we investigated the use of step sections and IH in lymph nodes regarded as negative by standard histopathology but positive by tyrosinase RT-PCR, suggesting the presence of tumour cells. In a series of 76 consecutive patients with stage I and II cutaneous melanoma, a total of 156 regional lymph nodes were examined by H & E staining, IH and tyrosinase RT-PCR. All lymph nodes were bisected along their long axis for separate evaluation. In 21 patients, at least one lymph node in the regional nodal basin reported as tumour-negative by standard histopathology was demonstrated to express tyrosinase (total number of nodes = 33). These 33 lymph nodes were re-examined by H & E and IH at 10 additional levels of the paraffin block. Only one lymph node from one patient had occult melanoma cells in deeper levels detected exclusively by IH. Six out of 20 patients with positive findings exclusively on tyrosinase RT-PCR developed tumour recurrences during a median follow-up of 34 months. We therefore conclude that additional step sectioning with IH does not significantly increase the detection of tumour-positive lymph nodes. Patients with melanoma cells detected exclusively by RT-PCR, however, were shown to be at increased risk for tumour recurrence. PMID:11254116

Blaheta, H J; Sotlar, K; Breuninger, H; Bueltmann, B; Rassner, G; Garbe, C; Horny, H P

2001-02-01

241

Mesenteric lymph node cavitation in coeliac disease.  

PubMed Central

A patient with coeliac disease and mesenteric lymph node cavitation is reported. This is a rare occurrence and has received very little attention in the English literature. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:3721297

Holmes, G K

1986-01-01

242

Familial Blood and Lymph Node Cancers Study  

Cancer.gov

A study of a group of familial blood and lymph node cancers (also called "lymphoproliferative disorders"), including: chronic lymphocytic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, Waldenström's macroglobulinemia, and multiple myeloma

243

Plant growth regulator and graft control of axillary bud formation and development in the TO2 mutant tomato  

Microsoft Academic Search

The torosa-2 tomato mutant is characterized by a strong inhibition of release of axillary shoots, that is not under the control of the main apex and IAA. Microscopic examination indicated that about 70% of leaf axils do not have axillary buds. Of the growth regulators tested, gibberellic acid and cytokinins were able to modify the to-2 phenotype: increasing bud number

S. Mapelli; J. M. Kinet

1992-01-01

244

Effect of plant growth substances on the growth of axillary buds in cultured stem segments of Phaseolus vulgaris L  

Microsoft Academic Search

The hormonal control of axillary bud growth was investigated in cultured stem segments of Phaseolus vulgaris L. When the stem explants were excised and implanted with their apical end in a solid nutrient medium, outgrowth of the axillary buds-located at the midline of the segment-was induced. However, if indoleacetic acid (IAA) or naphthaleneacetic acid (NAA) was included in the medium,

Imre A. Tamas; Janet L. Schlossberg-Jacobs; Robert Lim; Leslie B. Friedman; Charles C. Barone

1989-01-01

245

Surgical treatment of axillary hyperhidrosis by suction-curettage of sweat glands*  

PubMed Central

Suction curettage is a dermatologic surgery technique for the treatment of axillary hyperhidrosis, which is becoming more popular. Objective: The purpose of this study is to describe the current technique of removal of axillary sweat glands, and evaluate its efficacy and safety. Conclusion: Suction-curettage of sweat glands is a minimally invasive surgical technique that is easy to perform, safe, has high rates of success and relatively few side-effects. It is generally well tolerated by patients and requires shorter time away from daily activities, when compared with other surgical modalities. PMID:25387499

de Rezende, Rebeca Maffra; Luz, Flavio Barbosa

2014-01-01

246

Rupture of the axillary (circumflex) nerve and artery in a champion jockey  

PubMed Central

Rupture of the circumflex artery and nerve, without fracture or dislocation, is a rare traumatic event. Such a case is reported in a champion flat jockey who sustained blunt trauma to the shoulder after a fall during a race; the literature is also reviewed. At urgent surgical exploration, the axillary artery and nerve were repaired. The patient subsequently successfully returned to professional riding. This case highlights the difficulties in diagnosis and management. Key Words: axillary/circumflex nerve; infraclavicular brachial plexus; horse racing; jockey PMID:11579075

Patel, J; Turner, M; Birch, R; McCrory, P

2001-01-01

247

Postmastectomy/Axillary Node Dissection Chyloma: The Additional Value of SPECT/CT Lymphoscintigraphy  

PubMed Central

After mastectomy and axillary node dissection, chylous leakage is rare. However, considerable anatomical variation in the termination of the thoracic duct has been reported. Hence, during breast surgery, injury to the lateral terminating branch is not unlikely and might lead to retrograde chyle leak. Herein, we describe a patient who had a chylous leakage at her wound site after a left simple mastectomy and axillary node dissection and for whom lymphoscintigraphy with Tc-99m albumin nanocolloid was performed. In this case, additional hybrid single-photon emission computed tomography/computed tomography study was done, and has helped with the accurate identification of the chyle leakage site, thus aiding in surgical management.

Thang, Sue Ping; Ng, David Chee Eng

2014-01-01

248

CT angiogram and endovascular stent graft for an axillary artery gunshot wound.  

PubMed

A patient with an axillary artery gunshot wound pseudoaneurysm was evaluated and managed with computed tomographic angiogram and endovascular stent graft. Vascular injuries resulting from penetrating trauma or interventional vascular procedures are relatively uncommon. Subclavian and axillary arterial injuries may be associated with substantial morbidity and mortality if not managed expeditiously. The inaccessibility of these arteries makes stent graft treatment particularly attractive. The stable patient with a pseudoaneurysm or an arteriovenous fistula seems to be the ideal candidate to treat in this way. As computed tomography (CT) technology has evolved, CT angiography has become an integral part of the initial assessment of proximal extremity vascular injuries. PMID:18622336

Testerman, George M; Gonzalez, G Daniel; Dale, Elizabeth

2008-08-01

249

Lymph Node Ratio Predicts Disease-Specific Survival in Melanoma Patients  

PubMed Central

Background The objectives of this analysis were to compare various measures associated with lymph node (LN) dissection and to identify threshold values associated with disease-specific survival (DSS) outcomes in patients with melanoma. Methods Patients with node positive melanoma who underwent therapeutic LN dissection of the neck, axilla, and inguinal region were identified from the SEER database (1988–2005). We performed Cox multivariate analyses to determine the impact of the total number of LNs removed, number of negative LNs removed, and LN ratio on DSS. Multivariate cut-point analyses were conducted for each anatomic region to identify the threshold values associated with the largest improvement in DSS. Results The LN ratio was significantly associated with DSS for all LN regions. The LN ratio thresholds resulting in the greatest difference in 5-year DSS were 0.07, 0.13, and 0.18 for neck, axillary, and inguinal regions, respectively, corresponding to 15, 8, and 6 LNs removed per positive node. After adjustment for other clinicopathologic factors, the hazard ratios (HRs) were 0.53 (95% confidence intervals (CIs), 0.40 to 0.71) in the neck, 0.52 (95% CI, 0.42 to 0.65) in the axillary, and 0.47 (95% CI, 0.36 to 0.61) in the inguinal regions for patients in whom the LN ratio threshold was met. Conclusions Among the prognostic factors examined, LN ratio was the best indicator of the extent of LN dissection, regardless of anatomic nodal region. These data provide evidence-based guidelines for defining adequate LN dissections in melanoma patients. PMID:19309746

Xing, Yan; Badgwell, Brian D.; Ross, Merrick I.; Gershenwald, Jeffrey E.; Lee, Jeffrey E.; Mansfield, Paul F.; Lucci, Anthony; Cormier, Janice N.

2009-01-01

250

Quality indicators for sentinel lymph node biopsy: Is there room for improvement?  

PubMed Central

Background Eleven quality indicators (QIs) for sentinel lymph node biopsy (SLNB) were previously developed through a consensus-based approach, yet still need to be incorporated into clinical practice. We sought to evaluate the applicability and clinical relevance for surgeons. Methods Breast cancer patients undergoing SLNB between 2004 and 2008 at Mount Sinai Hospital, Toronto, were evaluated. Clinical and pathological data were obtained from an institutional database. Information on axillary recurrences was obtained through a retrospective chart review. Adherence to standardized protocols was evaluated in each case. Results All 11 QIs were measurable in 300 patients. The identification rate was 100%. More than 1 SLN was identified in 78.6% of patients. The SLNB was performed simultaneously with primary surgery in 96.7% of patients; 61 SLNs harboured metastasis. Of these patients, 80.3% underwent completion lymphadenectomy. Cases complied with protocols for radiocolloid injection and pathologic SLN evaluation/reporting. No ineligible patients underwent SLNB. Of patients with a complete 5-year follow-up (n = 42), only 1 had axillary recurrence. Conclusion Applying QIs for SLNB was feasible, but modifications were necessary to develop a more practical approach to quality assessment. Of the 11 suggested QIs, those that encompass protocols (nuclear medicine and pathology) should be reclassified as prerequisites, as they are independent of the technical aspect of SLNB performance. The remaining 8 QIs encompass surgery per se and should be measured routinely by surgeons. Furthermore, concise and clinically relevant target rates are necessary for these QIs to be established as widely recognized control standards. PMID:23351501

Acuna, Sergio A.; Angarita, Fernando A.; McCready, David R.; Escallon, Jaime

2013-01-01

251

Interspecific comparisons of lymph volume and lymphatic fluxes: do lymph reserves and lymph mobilization capacities vary in anurans from different environments?  

PubMed

The femoral lymph sac volumes and lymph mobilization capacity were compared in three anuran species that span a range of environments, dehydration tolerance, ability to maintain blood volume with dehydration, and degrees of development of skeletal muscles putatively involved in moving lymph vertically to the posterior lymph hearts. The femoral lymph sac volume determined by Evans blue injection and dilution in the femoral lymph sac varied interspecifically. The semiaquatic species, Lithobates catesbeianus, had the greatest apparent lymph volume expressed either as 18.7 mL kg body mass?¹ or 94 mL kg thigh mass?¹, compared with both the terrestrial and aquatic species, Rhinella marina (7.3 mL kg body mass?¹ and 57 mL kg thigh mass?¹) and Xenopus laevis (6.5 mL kg body mass?¹ and 40 mL kg thigh mass?¹, respectively. Injections of Evans blue into the subvertebral lymph sac, which communicates with both pairs of lymph hearts, yielded the highest rates of lymph return to the circulation in all three species. The most terrestrial species had a greater rate of lymphatic return from the subvertebral lymph sac, compared with the other two species. The rate of lymph flux from the femoral sac varied interspecifically and was correlated with the number and development of skeletal muscles involved in lymph movement. The results indicated that the three species differ in both the volume of lymph present and the capacity to return lymph. Lymph flux was correlated with habitat and the ability to maintain blood volume when challenged by dehydration or hemorrhage, whereas femoral lymph volume was not correlated with these factors. PMID:21527817

Hillman, Stanley S; Drewes, Robert C; Hedrick, Michael S; Withers, Philip C

2011-01-01

252

A Model to Estimate the Risk of Breast Cancer-Related Lymphedema: Combinations of Treatment-Related Factors of the Number of Dissected Axillary Nodes, Adjuvant Chemotherapy, and Radiation Therapy  

SciTech Connect

Purpose: The development of breast cancer-related lymphedema (LE) is closely related to the number of dissected axillary lymph nodes (N-ALNs), chemotherapy, and radiation therapy. In this study, we attempted to estimate the risk of LE based on combinations of these treatment-related factors. Methods and Materials: A total of 772 patients with breast cancer, who underwent primary surgery with axillary lymph node dissection from 2004 to 2009, were retrospectively analyzed. Adjuvant chemotherapy (ACT) was performed in 677 patients (88%). Among patients who received radiation therapy (n=675), 274 (35%) received supraclavicular radiation therapy (SCRT). Results: At a median follow-up of 5.1 years (range, 3.0-8.3 years), 127 patients had developed LE. The overall 5-year cumulative incidence of LE was 17%. Among the 127 affected patients, LE occurred within 2 years after surgery in 97 (76%) and within 3 years in 115 (91%) patients. Multivariate analysis showed that N-ALN (hazard ratio [HR], 2.81; P<.001), ACT (HR, 4.14; P=.048), and SCRT (HR, 3.24; P<.001) were independent risk factors for LE. The total number of risk factors correlated well with the incidence of LE. Patients with no risk or 1 risk factor showed a significantly lower 5-year probability of LE (3%) than patients with 2 (19%) or 3 risk factors (38%) (P<.001). Conclusions: The risk factors associated with LE were N-ALN, ACT, and SCRT. A simple model using combinations of these factors may help clinicians predict the risk of LE.

Kim, Myungsoo; Kim, Seok Won; Lee, Sung Uk; Lee, Nam Kwon; Jung, So-Youn; Kim, Tae Hyun; Lee, Eun Sook; Kang, Han-Sung [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)] [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Shin, Kyung Hwan, E-mail: shin.kyunghwan@gmail.com [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

2013-07-01

253

Axillary artery pseudoaneurysm after plate osteosynthesis for a clavicle nonunion: A case report and literature review  

PubMed Central

Neurovascular complications have been reported from both plate osteosynthesis and intramedullary fixation of midshaft clavicle fractures. We wish to report a case of limb threatening ischemia from screw penetration of the axillary artery after plate osteosynthesis for a clavicle nonunion. A literature review of vascular trauma from midshaft clavicle fractures is presented. PMID:21472068

Bain, Gregory I.; Galley, Ian J.; Keogh, Angus R. E.; Durrant, Adam W.

2010-01-01

254

Clinical features of axillary osmidrosis: a retrospective chart review of 723 Japanese patients.  

PubMed

Axillary osmidrosis often disturbs a person's social life, particularly in Asian countries. However, the clinical aspects of this condition have not been well documented in the English-language published work. This study aimed to provide information on the features of axillary osmidrosis, with a particular focus on sex differences. A retrospective review was made of the charts for 723 Japanese patients (492 female, 231 male). The mean age at initial presentation (29.1 years) was nearly the same for males and females. Almost all patients (96.1%) had wet earwax, which was extremely high compared to its frequency in the general Japanese population. An association with hyperhidrosis was seen in 61.8% of these patients. Subjective odor levels in female patients were significantly lower than those in males (P < 0.001). A positive family history was more frequent for females than for males (P < 0.001), and prior treatment history was also more frequent for females than for males (P < 0.015). Most patients (86.6%) had received some treatments in our clinic. There were significantly fewer females who underwent surgical treatments compared to males (P = 0.026), as females preferred less invasive techniques (P < 0.001). Several features, including male/female ratios, and associations of wet earwax and hyperhidrosis, corresponded to previously reported data on axillary osmidrosis. Female patients were more concerned with axillary odor than males, and females had a tendency for polysurgery. PMID:23451913

Morioka, Daichi; Ohkubo, Fumio; Amikura, Yoshiyasu

2013-05-01

255

[Ventricular fibrillation with tolonium chloride: axillary brachial plexus anesthesia led to cessation of circulation].  

PubMed

A 22-year-old patient underwent surgery for a glass wound incision of the hand and anesthesia was carried out using an axillary brachial plexus block with prilocaine. Following surgery the patient developed methemoglobinemia which was treated with tolonium chloride. After administration of the drug the sinus rhythm changed into ventricular fibrillation. The current treatment options of methemoglobinemia will be discussed. PMID:21491141

Radke, O C; Hoffmann, C; Klut, I; Koch, T

2011-05-01

256

Histologic Study of the Regeneration of Axillary Hair after Removal with Subcutaneous Tissue Shaver  

Microsoft Academic Search

It was observed that after subcutaneous tissue shaving for the radical therapy of hircismus and hyperhidrosis axillary hair often regrew. Histologic study of this phenomenon showed that hair bulb and most of the follicle up to a level near the sebaceous duct opening had been removed. Hair regrows from remnant outer root sheath, but only when sebaceous glands are preserved,

Masumi Inaba; Joseph Anthony; Chieko McKinstry

1979-01-01

257

Application of the inner arm perforator flap in the management of axillary hidradenitis suppurativa.  

PubMed

Axillary hidradenitis suppurativa is a chronic and debilitating disease that primarily affects the axillae, perineum, and inframammary areas. Surgical removal of all the diseased skin constitutes the only efficient treatment. Covering an axillary fossa defect is challenging, due to the range of shoulder movement required. Indeed, shoulder movement may be compromised by scar contraction after inadequate surgery. The present study is the first to apply an inner arm perforator flap to the treatment of twelve axillary skin defects in 10 patients. The defect originated from extensive excision of recurrent hidradenitis suppurativa in the axilla. The technique used to cover the defect is a V-Y advancement flap or a propeller flap from the inner arm based on one to three perforators arising from the brachial artery or the superior ulnar collateral artery. The flap provides a tensionless wound closure and a generally unremarkable postoperative course in a short hospital stay. No major complications occurred. Two patients had minor delayed wound healing. Outcomes (including donor site morbidity, function and the cosmetic outcome) were very satisfactory in all cases. We consider that the inner arm perforator flap is a valuable new option for the reconstruction of axillary defects. PMID:24290491

Alharbi, M; Perignon, D; Assaf, N; Qassemyar, Q; Elsamad, Y; Sinna, R

2014-02-01

258

The Effects of Arm Position on Onset and Duration of Axillary Brachial Plexus Block  

Microsoft Academic Search

BACKGROUND: We assessed the effects of arm position after block performance on success rate, onset time, and duration of axillary block (AXB). METHODS: After performing AXB, patients were randomized into two groups: group adduction in which the arm was immediately placed in adduction along the body and group abduction in which the arm remained in abduction. These positions were maintained

Adil Ababou; Nizar Marzouk; Ahlam Mosadiq; Ahmed Sbihi

2007-01-01

259

Do medical procedures in the arm increase the risk of lymphoedema after axillary surgery? A review.  

PubMed

Lymphoedema of the arm is a potentially serious consequence of any axillary procedure performed during the management of breast cancer. In an attempt to reduce its incidence and severity, patients are instructed to avoid venepunctures and blood pressure measurements on the treated arm. These precautions are not possible in some patients and attempts to adhere to them can cause discomfort, anxiety and stress for both patients and their health-care workers. The strength with which these recommendations are made is in contrast to the level of evidence underpinning them. This paper reviews this evidence regarding the safety, or lack thereof, of blood pressure monitoring and intravenous puncture in women who have had axillary surgery. With this evidence generally being anecdotal in nature, there appears to be no rigorous evidence-based support for the risk-reduction behaviours of avoiding blood pressure monitoring and venepuncture in the affected arm in the prevention of lymphoedema after axillary procedure. A clinical trial was proposed to investigate whether such avoidance measures were valuable, but failed during its inception. There remains a need for research from prospective trials on this controversial topic to determine the most appropriate patient recommendations that should be provided after axillary procedure regarding the risks for development of lymphoedema. PMID:24274353

Cheng, Chris-Tin; Deitch, Jessica M; Haines, Ian E; Porter, David J; Kilbreath, Sharon L

2014-01-01

260

Axillary Metastases With DCIS: Is the Glass Half Empty or Half Full?  

Microsoft Academic Search

Traditionally, ductal carcinoma-in-situ (DCIS) has been thought to be an indolent localized disease lacking metastatic potential by itself. Axillary dissection for DCIS was abandoned because the rate of nodal metastases with this noninvasive disease was believed to be a trivial 1% to 2%, based on data from the era prior to sentinel node mapping. However, the article in this issue

Benjamin O. Anderson

2000-01-01

261

Axillary giant lipoma: a report of two cases and published work review.  

PubMed

Lipomas are common, benign, small-sized, soft-tissue tumors. However, giant lipomas are uncommon and the tumor size can cause pain and nerve compression syndrome. The axilla is an extremely rare location for development of giant lipomas. We report two cases of axillary giant lipoma. A 47-year-old man (case 1) and a 42-year-old woman (case 2) presented with a large mass in the axillary region. Case 2 had tenderness in the shoulder and numbness in the upper arm. Magnetic resonance imaging of each tumor showed a homogenous soft-tissue mass in the axillary region, suggestive of lipoma. In case 2, the tumor extended from the axilla to the supraclavicular region and split and compressed the neurovascular bundle. Each lesion was successfully excised surgically without serious complications and recurrence. In case 2, the tenderness and numbness disappeared. Histologically, each lesion was composed of multilobulated, mature adipose cells, which led to a diagnosis of benign lipoma. Axillary giant lipoma is preferably excised surgically to avoid damage caused by tumor compression to the major vessels or nerves, to offer better local control and to establish a correct final diagnosis. PMID:25156953

Nakamura, Yasuhiro; Teramoto, Yukiko; Sato, Sayuri; Yamada, Katsuhiro; Nakamura, Yoshiyuki; Fujisawa, Yasuhiro; Fujimoto, Manabu; Otsuka, Fujio; Yamamoto, Akifumi

2014-09-01

262

Draining lymph node cell activation in guinea pigs: comparisons with the murine local lymph node assay.  

PubMed

The local lymph node assay in the mouse is a novel predictive test for the identification of contact sensitizing chemicals. The purpose of the studies described was to determine whether a similar local lymph node assay could be performed successfully in guinea pigs; currently the species of choice for assessment of sensitizing potential for regulatory purposes. Ten sensitizing chemicals (oxazolone, picryl chloride, 2,4-dinitrofluorobenzene, benzocaine, cinnamic aldehyde, 2,4,-dinitrothiocyanobenzene, p-nitrosodimethylaniline, formaldehyde, p-phenylenediamine and cyanuric chloride) and equal concentrations of sodium lauryl sulphate were examined in a guinea pig local lymph node assay. Animals received three consecutive daily applications of various concentrations of the test chemical on the dorsum of both ears. Control animals were untreated. Five days following the initiation of exposure, draining auricular lymph nodes were excised and weighed. Suspensions of lymph node cells (LNC) were prepared and cultured for 24 or 48 h and proliferation measured by incorporation of [3H]thymidine. Exposure to at least one concentration of all sensitizing chemicals, other than benzocaine, induced proliferation by draining LNC. Responses were higher at 24 h rather than 48 h. Evidence is presented that guinea pig LNC proliferation may be enhanced or maintained by addition to culture of an exogenous source of the T cell growth factor interleukin 2 (IL-2). Draining lymph node weight was increased following exposure to some sensitizing chemicals but, compared with LNC proliferation, provided a less sensitive correlate of lymph node activation. Exposure to sodium lauryl sulphate failed to induce changes in either lymph node weight of LNC proliferation. Data are compared with three-day murine local lymph node assays performed concurrently. The available information indicates that the local lymph node assay may be performed in guinea pigs. PMID:1949049

Maurer, T; Kimber, I

1991-01-01

263

Anthracotic intrapulmonal lymph nodes mimicking lung metastases.  

PubMed

Intrapulmonal round lesions show characteristic radiologic features that distinguish them from other lung pathologies. Typically, they display a sharp margin with a homogenous inner pattern. Differential diagnosis includes metastases, particularly if the patient has a history of malignancy. However, benign lesions, although less common, should also be considered. We here present the case of a 58-year-old man with a history of bladder and prostate carcinoma, showing multiple typical round lesions on chest computed tomography, mimicking metastatic disease to the lung. Subsequently, wedge-resected specimens revealed anthracotic lymph nodes, so that intrapulmonal lymph nodes should be anticipated even in patients with preceding malignant disease. PMID:25087795

Jungraithmayr, Wolfgang; Delaloye-Frischknecht, Barbara; Weder, Walter

2014-08-01

264

[Mullerian "inclusions" within an intramammary lymph node].  

PubMed

We report a case of mullerian "inclusions" within an intra-mammary lymph node. Discovered on a routine mammography, the inclusions appeared in the right breast as a focus of microcalcifications. The 63-year-old patient was asymptomatic. Microcalcifications were associated with benign appearing epithelial formations which were positive for estrogen receptor antibodies and negative for thyroglobulin, calretinin and smooth muscle actin antibodies. Three years later, the patient developed a peritoneal low-grade serous carcinoma. Mullerian inclusions within lymph nodes are rather frequent below the diaphragm but exceptional above. Even in a supra-diaphragmatic localization, they can be associated with a pelvic serous tumor. PMID:17127851

Rousselot, Cécilia; Chapiron, Céline; Blechet, Claire; Arbion, Flavie; Fetissof, Franck

2006-06-01

265

Sentinel lymph node detection ex vivo using  

E-print Network

-vivo methylene-blue-dyed sen- tinel lymph nodes embedded in 3.2-cm-thick chicken breast tissues. The UOT system, as is photoacoustic imaging,6 nonionizing UOT has the potential to detect methylene-blue-dyed SLNs noninva- sively to our knowledge, we report the use of UOT to detect ex-vivo methylene-blue-dyed SLNs buried in chicken

Wang, Lihong

266

Lymph node metastases arising from uveal melanoma  

Microsoft Academic Search

Summary Since the eye lacks lymphatic vessels, uveal melanomas primarily metastasize hematogenously. Here we report the case of a patient with ciliary body ring melanoma who developed lymph node metastases after a fistulating glaucoma operation. A 40-year-old female Caucasian patient presented with unilateral pigment dispersion. Pigment dispersion glaucoma was diagnosed and since the intraocular pressure could not be managed with

Navid Ardjomand; Peter Komericki; Gerald Langmann; Dietmar Mattes; Murat Moray; Michael Scarpatetti; Yosuf El-Shabrawi

2005-01-01

267

Lymph node findings in generalized mastocytosis.  

PubMed

Lymph nodes from 21 cases of generalized mastocytosis were studied histologically to confirm or exclude mast cell infiltration, and to investigate their micro-architecture. Mast cell infiltrates were detected in 17 (80%) of the lymph nodes and were found mainly in the medullary cords and sinuses. Diffuse infiltration was seen in 14 cases and focal infiltration in three cases. The following pathological findings were frequently observed: germinal centre hyperplasia (n = 14), which is probably a nonspecific finding; and hyperplasia of small blood vessels, which sometimes resembled high endothelial venules (14), eosinophilia (8), plasmacytosis (7) and collagen fibrosis (6), all of which may well be related to the effects of mediators released by mast cells. Infiltrates of acute or chronic myeloid leukaemia were seen in six lymph nodes. Division of the cases into two prognostically different groups, i.e. systemic mastocytosis, in which the skin lesions of urticaria pigmentosa are present and the prognosis is favourable, and malignant mastocytosis, in which there is no cutaneous involvement and the prognosis is poor, revealed that all six lymph nodes exhibiting leukaemic infiltrates came from the malignant mastocytosis group; eosinophilia, plasmacytosis and fibrosis were seen significantly more often in malignant than in systemic mastocytosis, but blood vessel hyperplasia and germinal centre hyperplasia were encountered with the same high frequency in both groups; and mast cell atypia tended to be more pronounced in malignant mastocytosis; this diagnosis could therefore easily be missed without naphthol AS-D chloroacetate esterase staining.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1452127

Horny, H P; Kaiserling, E; Parwaresch, M R; Lennert, K

1992-11-01

268

Rapid propagation of Holostemma ada-kodien Schult., a rare medicinal plant, through axillary bud multiplication and indirect organogenesis  

Microsoft Academic Search

Efficient protocols of axillary bud multiplication and indirect organogenesis were established for Holostemma ada-kodien Schult. (Asclepiadaceae). Murashige and Skoog (MS) medium supplemented with 2.0 mg l-1 N6-benzylaminopurine (BAP) and 0.5 mg l-1 indole-3-butyric acid (IBA) induced an average of eight shoots per node and was the best for axillary bud proliferation. Subsequent cultures enhanced the number of shoots. The explant

K. P. Martin

2002-01-01

269

Introduction About 6070% of patients with lymph-node-negative  

E-print Network

Articles Introduction About 60­70% of patients with lymph-node-negative breast cancer are cured predictions on disease outcome for patients with lymph-node-negative breast cancer. Methods Patients' samples samples from patients with lymph-node- negative breast cancer who were treated during 1980­95, but who did

Tian, Qi

270

Protein predictive signatures for lymph node metastasis of gastric cancer.  

PubMed

Lymph node status remains one of most crucial indicators of gastric cancer prognosis and treatment planning. Current imaging methods have limited accuracy in predicting lymph node metastasis. We sought to identify protein markers in primary gastric cancer and to define a risk model to predict lymph node metastasis. The Protein Pathway Array (PPA) (initial selection) and Western blot (confirmation) were used to assess the protein expression in a total of 190 freshly frozen gastric cancer samples. The protein expression levels were compared between samples with lymph node metastasis (n = 73) and those without lymph node metastasis (n = 57) using PPA. There were 27 proteins differentially expressed between lymph node positive samples and lymph node negative samples. Five proteins (Factor XIII B, TFIIH p89, ADAM8, COX-2 and CUL-1) were identified as independent predictors of lymph node metastasis. Together with vascular/lymphatic invasion status, a risk score model was established to determine the risk of lymph node metastasis for each individual gastric cancer patient. The ability of this model to predict lymph node metastasis was further confirmed in a second cohort of gastric cancer patients (33 with and 27 without lymph node metastasis) using Western blot. This study indicated that some proteins differentially expressed in gastric cancer can be selected as clinically useful biomarkers. The risk score model is useful for determining patients' risk of lymph node metastasis and prognosis. PMID:23011604

Li, Wei; Ye, Fei; Wang, Daguang; Sun, Xuan; Tong, Weihua; Lian, Guodong; Jiang, Jing; Suo, Jian; Zhang, David Y

2013-04-15

271

PRECLINICAL STUDY Prediction of lymph node involvement in breast cancer  

E-print Network

PRECLINICAL STUDY Prediction of lymph node involvement in breast cancer from primary tumor tissue- ther lymph node involvement in breast cancer is influenced by gene or miRNA expression of the primary tissue from a group of 96 breast cancer patients balanced for lymph node involvement using Affymetrix

272

Extraction and Analysis of Carcinoembryonic Antigen in Lymph Nodes  

Microsoft Academic Search

PURPOSE: To detect lymph node metastasis of colorectal cancer, we extracted protein from lymph nodes and determined the concentration of carcinoembryonic antigen. METHODS: In Experiment 1, a total of 237 lymph nodes from 23 colorectal cancer patients were examined histologically after immersion in 200 µl of saline for 2 hours. Concentrations of protein and carcinoembryonic antigen in each saline sample

Toshiyuki Kanoh; Takushi Monden; Yasuhiro Tamaki; Tadashi Ohnishi; Kimimasa Ikeda; Hikaru Izawa; Mitsugu Sekimoto; Naohiro Tomita; Morito Monden

2002-01-01

273

Magnetic resonance imaging of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma: Patterns of spread  

SciTech Connect

Purpose: To investigate the incidence, distribution, and spread pattern of retropharyngeal lymph node (RLN) involvement in patients with nasopharyngeal carcinoma (NPC) by using magnetic resonance imaging (MRI). Methods and Materials: The MR images of 275 patients with newly diagnosed NPC were reviewed retrospectively. Nodes were classified as metastatic based on size criteria, the presence of nodal necrosis, and extracapsular spread. Results: Retropharyngeal lymph node involvement was detected in 175 (63.6%) patients. Metastatic RLNs were seen at the following levels: occipital bone, 24 (9.6%) nodes; C1, 157 (62.5%) nodes; C1/2, 40 (15.9%) nodes; C2, 27 (10.8%) nodes; C2/3, 1 (0.4%) node; and C3, 2 (0.8%) nodes. The incidence of RLN involvement was equal to the incidence of cervical lymph node involvement (81.4% vs. 81.4%) in 215 patients with nodal metastases. A significantly higher incidence of metastatic RLNs was observed in the presence of oropharynx, prestyloid parapharyngeal space, post-styloid parapharyngeal space, longus colli muscle, medial pterygoid muscle, levator muscle of velum palatini, tensor muscle of velum palatini, Level II node, Level III node, and Level V node involvement. A significantly lower incidence of metastatic RLNs was found in T1, N0, and Stage I disease. Conversely, no significant difference in the incidence of metastatic RLNs was observed between T1, 2, and, 3; N2 and N3; or Stage II, III, and IV disease. Conclusions: There is an orderly decrease in the incidence of metastatic lateral RLNs from the C1 to C3 level. Metastatic RLNs associate well with involvement of certain structures in early stage primary tumors and lymph node metastases of the upper jugular chain (Level II, Level III nodes) and the posterior triangle (Level V nodes). Both RLNs and cervical Level II nodes appear to be the first-echelon nodes in NPC.

Liu Lizhi [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou (China); Zhang Guoyi [Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou (China); Xie Chuangmiao [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou (China); Liu Xuewen [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou (China); Cui Chunyan [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou (China); Li Li [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou (China)]. E-mail: lililixj@hotmail.com

2006-11-01

274

Endovascular treatment of iatrogenic axillary artery pseudoaneurysm under echographic control: A case report  

PubMed Central

Aim Brief case report of the treatment of a large axillary artery pseudoaneurysm after a pacemaker using a left brachial cutdown and a retrograde delivery of a covered stent using ultrasound and fluoroscopic guidance. The patient's renal function precluded the use of contrast materials. Case Report A 77 years old man presenting with acute renal failure and haemoglobin decrease arrived with an expanding pseudoaneurysm of the left axillary artery from a pacemaker placement. Considering the site of the lesion and patient's comorbidities, under echographic control, a Hemobahn® stent-graft was placed; fluoroscopy assisted manipulation of guidewires and sheaths into the aortic arch. The procedure was successfully ended without any complications. At 8 months the stent graft was still patent. Conclusion Ultrasound guidance may represent an alternative for pseudo-aneurysm exclusion without any use of contrast medium, especially in those patient where lesions are easily detectable using ultrasonography and when comorbidities contraindicate aggressive surgical or angiographic approach. PMID:21619625

2011-01-01

275

Clinical Significance of Axillary Microresiduals After Neoadjuvant Chemotherapy in Breast Cancer Patients with Cytologically Proven Metastases  

Microsoft Academic Search

Background  Neoadjuvant chemotherapy (NAC) has been widely accepted for advanced breast cancer patients, and pathological complete remission\\u000a (pCR) was revealed to be an important prognostic factor. The pCR status of cytologically proven axillary metastases (ALN-pCR)\\u000a offers a more powerful prognostic predictor than pCR of the main tumor. This study evaluated the clinical significance of\\u000a residual micrometastases and discusses screening methods after

Masahiro Sakakibara; Takeshi Nagashima; Masami Kadowaki; Yasuhide Onai; Toshihiko Fujimori; Jissei Yokomizo; Hiroshi Suzuki; Koya Fushimi; Yukio Nakatani; Masaru Miyazaki

2009-01-01

276

Rupture of the axillary (circumflex) nerve and artery in a champion jockey.  

PubMed

Rupture of the circumflex artery and nerve, without fracture or dislocation, is a rare traumatic event. Such a case is reported in a champion flat jockey who sustained blunt trauma to the shoulder after a fall during a race; the literature is also reviewed. At urgent surgical exploration, the axillary artery and nerve were repaired. The patient subsequently successfully returned to professional riding. This case highlights the difficulties in diagnosis and management. PMID:11579075

Patel, J; Turner, M; Birch, R; McCrory, P

2001-10-01

277

Two cases of neoplasia of basal cell origin affecting the axillary region in anseriform species.  

PubMed

Neoplasms of the skin are occasionally seen in domestic birds but are uncommon in nondomestic birds. An 8-year-old male hooded merganser (Lophodytes cucullatus) was presented with bilateral axillary ulcerative lesions that improved but did not resolve with empiric antibiotic and antifungal therapy. Skin biopsies were taken, and bilateral feather folliculomas were diagnosed on histopathologic examination. The duck was euthanatized because of the poor prognosis. A 9-year-old Indian runner duck (Anas platyrhynchos) was presented with an ulcerative lesion, with pseudomembrane and serocellular crust affecting the axillary region. This mass was diagnosed as a basosquamous carcinoma. The mass was surgically excised, and no recurrence was observed. Feather folliculomas are usually considered benign neoplasms in domestic birds and may be primarily ulcerative, exudative, bilateral, and symmetric in location. Basosquamous carcinoma may have a similar gross appearance. It is unknown if the axillary region may be an area with increased incidence of neoplasia in birds. This appears to be the first report of feather folliculoma and basosquamous carcinoma in Anseriforme species. Feather folliculomas and other neoplasms, such as basosquamous carcinoma, should be considered as a differential diagnosis in ulcerative or proliferative skin lesions in birds. PMID:19999766

Bradford, Carol; Wack, Allison; Trembley, Sarah; Southard, Teresa; Bronson, Ellen

2009-09-01

278

Lymph flow and contractile activity of mesenteric lymph nodes in rats with toxic hepatitis effects of antioxidants.  

PubMed

We studied contractile function of isolated mesenteric lymph nodes in rats with toxic hepatitis. We observed suppression of spontaneous and stimulated contractile activity of mesenteric lymph nodes and changes in biochemical composition of the lymph. We propose a method of correction of these dysfunctions with antioxidant ?-tocopherol and Selen-Active. PMID:23667863

Abdreshov, S N; Bulekbayeva, L E; Demshenko, G A

2013-05-01

279

Pattern, predictors, and recurrence of cervical lymph node metastases in papillary thyroid cancer  

PubMed Central

Aim of the study This study investigated the pattern, predictors, and recurrence of node metastasis in papillary thyroid cancer patients. Material and methods One hundred and 65 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy and cervical lymph node (LN) dissection (LND), in which more than 12 lymph nodes were dissected, were examined. The nodes were classified from levels I to VI. Final pathologic diagnosis of positive lymph node metastases in the differential node levels was determined. Results Cervical metastases of PTC were most commonly encountered in level VI, followed by levels III and IV, and then levels II and V. Metastases in level I seldom occurred. Skip metastases occurred in nine patients. Univariate analysis suggested that multifocality and extracapsular invasion were associated with LN metastases. The metastatic ratio for micro PTC and local canceration derived from benign lesions and encapsulation was low. Multivariate analysis showed that LN metastases were closely related to invasion of the thyroid capsule and primary PTC. Standardized estimation showed that the encapsulating pattern had the greatest impact on developing cervical LN metastases. Lymph node recurrence was observed in 11 patients. Conclusions The metastatic pattern of PTC assists in delineating the extent of selective LND. Routine bilateral central node dissection at the time of thyroidectomy is recommended. Comprehensive selective LND is recommended in multifocal PTC and with capsular invasion. PMID:24592137

Song, Haiping; Zhu, Huiping; Li, Dapeng; Zhang, Ning

2013-01-01

280

Solitary Lymph Node Metastasis in Gastric Cancer  

Microsoft Academic Search

The feasibility and diagnostic reliability of sentinel node (SN) biopsy for gastric cancer are still controversial. We studied\\u000a the clinicopathological features and localization of solitary lymph node metastasis (SLM) in gastric cancer to provide useful\\u000a information for use of the SN concept in gastric cancer. From 2000 to 2004, 3,267 patients with gastric cancer underwent D2\\u000a radical gastrectomy. The clinicopathological

Chen Li; Sungsoo Kim; Ji Fu Lai; Sung Jin Oh; Woo Jin Hyung; Won Hyuk Choi; Seung Ho Choi; Sung Hoon Noh

2008-01-01

281

Clonidine as an adjuvant in axillary brachial plexus block for below elbow orthopedic surgeries: A comparison between local and systemic administration  

PubMed Central

Background: Axillary brachial plexus block for below elbow orthopedic surgery provides a safe and low-cost technique with the advantage of prolonged postoperative analgesia. Clonidine, with selective partial agonist activity on ?2 adrenergic receptors, has significantly demonstrated its role in this regard as an adjuvant to local anesthetics. The current study compares the locally administered clonidine with systemically administered control group in terms of onset and duration of sensory block, motor block, and analgesia; hemodynamic variability; sedation; and other side effect profile. Materials and Methods: Seventy patients (ASA I or II) scheduled for below elbow orthopedic surgeries were randomly allocated in equal numbers to receive either 30 ml of 0.5% plain bupivacaine with 150 ?g (1 ml) of inj. clonidine locally in the axillary sheath and 1 ml of normal saline (NS) subcutaneously (Group L) or 30 ml of 0.5% plain bupivacaine with 1 ml of NS locally and 150 ?g (1 ml) of inj. clonidine subcutaneously (Group S). Standard monitoring of vital parameters was done. Duration of sensory and motor block, analgesia, hemodynamic changes, and any adverse effects were observed and recorded for different duration up to 24 h. Results: Duration of sensory block (625 ± 35 min), motor block (690 ± 38 min), and analgesia (930 ± 45 min) was significantly longer in Group L than in Group S [sensory block (480 ± 30 min), motor block (535 ± 25 min), and analgesia (720 ± 30 min)] (P < 0.05). Significant alteration of heart rate, systolic blood pressure and diastolic blood pressure, and mean arterial pressure in Group S was observed compared to Group L (P < 0.05). Side effects like nausea and vomiting were comparable, but highly significant sedation score (?2 = 47.75 and 49.51 at 120 and 240 min, respectively; P < 0.01) was observed between the two groups. Conclusion: Compared to systemic administration, local clonidine as an adjuvant in axillary block resulted in significant prolongation of duration of sensory and motor blockade, and analgesia without any hemodynamic alteration, probably by locally mediated mechanism of action.

Ghoshmaulik, Sumanta; Bisui, Bikash; Saha, Debasish; Swaika, Sarbari; Ghosh, Arun K.

2012-01-01

282

Chemoendocrine Therapy for Premenopausal Women With Axillary Lymph Node-Positive, Steroid Hormone Receptor-Positive Breast Cancer: Results From INT 0101 (E5188)  

Microsoft Academic Search

Purpose Chemotherapy, tamoxifen, and ovarian ablation\\/suppression (OA\\/OS) are effective adjuvant approaches for premenopausal, steroid hormone receptor-positive breast cancer. The value of combined therapy has not been clearly established.

Nancy E. Davidson; Anne M. O'Neill; Allen M. Vukov; C. Kent Osborne; Silvana Martino; Douglas R. White; Martin D. Abeloff

283

Self-illuminating quantum dots for highly sensitive in vivo real-time luminescent mapping of sentinel lymph nodes.  

PubMed

Quantum dots (QDs) show promise as novel nanomaterials for sentinel lymph node (SLN) mapping through their use in noninvasive in vivo fluorescence imaging, and they have provided remarkable results. However, in vivo fluorescence imaging has limitations mainly reflected in the strong autofluorescence and low deepness of tissue penetration associated with this technique. Here, we report on the use of self-illuminating 3-mercaptopropionic acid-capped CdTe/CdS QDs for mouse axillary SLN mapping by bioluminescence resonance energy transfer, which was found to overcome these limitations [corrected]. We used CdTe/CdS QDs synthesized in aqueous solution to conjugate a mutant of the bioluminescent protein, Renilla reniformis luciferase. The nanobioconjugates obtained had an average hydrodynamic diameter of 19 nm, and their luminescence catalyzed by the substrate (coelenterazine) could penetrate into at least 20 mm of hairless pigskin, which could be observed using an in vivo imaging system equipped with a 700 nm emission filter. Conversely, the fluorescence of the nanobioconjugates penetrated no more than 10 mm of pigskin and was observed with a strong background. When 80 ?L of the nanobioconjugates (containing about 0.5 ?mol/L of QDs) and 5 ?L of coelenterazine (1 ?g/?L) were intradermally injected into a mouse paw, the axillary SLN could be imaged in real time without external excitation, and little background interference was detected. Furthermore, the decayed luminescence of QD-Luc8 in SLNs could be recovered after being intradermally reinjected with the coelenterazine. Our data showed that using self-illuminating QDs, as opposed to fluorescence QDs, has greatly enhanced sensitivity in SLN mapping, and that the SLN could be identified synchronously by the luminescence and fluorescence of the self-illuminating QDs. PMID:22848169

Wu, Qiang; Chu, Maoquan

2012-01-01

284

Eight-year experience with the intraoperative frozen section examination of sentinel lymph node biopsy for breast cancer in a North-Italian university center  

PubMed Central

Sentinel lymph node biopsy (SLNB) completely changed the impact of breast surgery on patients psycho-physical wellness, reducing morbidity associated with complete axillary lymph node dissection (CALND) while granting an adequate breast cancer staging. We reviewed our experience with the SLNB in a University Clinic. We collected data about all breast cancer patients submitted to SLNB from 2002 to 2010, and analyzed them with R (version 2.15.2), considering significant p<0.05. We performed 615 SLNBs on 607 patients, with a mean age of 59.86 (±10.76). Sentinel node detection rate resulted 99,7%, with a mean number of biopsied nodes of 1.64 (±0.67), axillary localization in 98% of cases, and negative intraoperative histological finding in the 86.2% of cases. Prevalence of ITCs, micrometastasis, macrometastasis and pericapsular metastasis resulted respectively 0.6%, 4.9%, 7.5% and 8.8%. Among women who received CALND, mean number of examined nodes was 16.36 (±6.19) and mean number of metastatic non-sentinel nodes was 0.97 in case of micrometastasis, 2.65 in case of macrometastasis, and up to 9.88 when pericapsular invasion was described. To conclude, our data confirm the role of nodal metastasis size in the prediction of non-sentinel node involvement, but further studies are required in order to better assess the role of ITCs and micrometastasis in the diagnostic and therapeutic management of breast cancer, with the final aim to reduce the surgical complications of axilla demolition when unnecessary. PMID:24427358

Cedolini, Carla; Bertozzi, Serena; Seriau, Luca; Londero, Ambrogio P; Concina, Serena; Cattin, Federico; Geatti, Onelio; Loreto, Carla Di; Risaliti, Andrea

2014-01-01

285

Near-Infrared Fluorescence Sentinel Lymph Node Mapping of the Oral Cavity in Head and Neck Cancer Patients  

PubMed Central

Objectives Elective neck dissection is frequently performed during surgery in head and neck cancer patients. The sentinel lymph node (SLN) procedure can prevent the morbidity of a neck dissection and improve lymph node staging by fine pathology. Near-infrared (NIR) fluorescence imaging is a promising technique to identify the sentinel lymph node (SLN) intraoperatively. This feasibility study explored the use of indocyanine green adsorbed to human serum albumin (ICG:HSA) for SLN mapping in head and neck cancer patients. Materials and Methods A total of 10 consecutive patients with oral cavity or oropharyngeal cancer and a clinical N0 neck were included. After exposure of the neck, 1.6 mL of ICG:HSA (500 ?M) was injected at 4 quadrants around the tumor. During the neck dissection, levels I, II, III and IV were measured for fluorescence using the Mini-FLARE imaging system. Results In all 10 patients, NIR fluorescence imaging enabled visualization of one or more SLNs. A total of 17 SLNs were identified. The mean contrast between the fluorescent signal of the lymph nodes and of the surrounding tissue was 8.7 ± 6.4. In 3 patients, of which 1 was false-negative, lymph node metastases were found. After administration of ICG:HSA, the average number of fluorescent lymph nodes significantly increased over time (P < 0.001). Conclusion This study demonstrated feasibility to detect draining lymph nodes in head and neck cancer patients using NIR fluorescence imaging. However, the fluorescent tracer quickly migrated beyond the SLN to higher tier nodes. PMID:22939692

van der Vorst, Joost R.; Schaafsma, Boudewijn E.; Verbeek, Floris P.R.; Keereweer, Stijn; Jansen, Jeroen C.; van der Velden, Lilly-Ann; Langeveld, Antonius; Hutteman, Merlijn; Lowik, Clemens; van de Velde, Cornelis J.H.; Frangioni, John V.; Vahrmeijer, Alexander L.

2013-01-01

286

Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging  

PubMed Central

Background It is not clear if sentinel lymph node (SLN) mapping can improve outcomes in patients with colorectal cancers. The purpose of this study was to determine the prognostic values of ex vivo sentinel lymph node (SLN) mapping and immunohistochemical (IHC) detection of SLN micrometastasis in colorectal cancers. Methods Colorectal cancer specimens were obtained during radical resections and the SLN was identified by injecting a 1% isosulfan blue solution submucosally and circumferentially around the tumor within 30?min after surgery. The first node to stain blue was defined as the SLN. SLNs negative by hematoxylin and eosin (HE) staining were further examined for micrometastasis using cytokeratin IHC. Results A total of 54 patients between 25 and 82?years of age were enrolled, including 32 males and 22 females. More than 70% of patients were T3 or above, about 86% of patients were stage II or III, and approximately 90% of patients had lesions grade II or above. Sentinel lymph nodes were detected in all 54 patients. There were 32 patients in whom no lymph node micrometastasis were detected by HE staining and 22 patients with positive lymph nodes micrometastasis detected by HE staining in non-SLNs. In contrast only 7 SLNs stained positive with HE. Using HE examination as the standard, the sensitivity, non-detection rate, and accuracy rate of SLN micrometastasis detection were 31.8% (7/22), 68.2% (15/22), and 72.2%, respectively. Micrometastasis were identified by ICH in 4 of the 32 patients with HE-negative stained lymph nodes, resulting in an upstaging rate 12.5% (4/32). The 4 patients who were upstaged consisted of 2 stage I patients and 2 stage II patients who were upstaged to stage III. Those without lymph node metastasis by HE staining who were upstaged by IHC detection of micrometastasis had a significantly poorer disease-free survival (p?=?0.001) and overall survival (p?=?0.004). Conclusion Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging, and may become a factor affecting prognosis and guiding treatment. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1350200526694475. PMID:22726450

2012-01-01

287

Accumulation of functionally immature myeloid dendritic cells in lymph nodes of rhesus macaques with acute pathogenic simian immunodeficiency virus infection.  

PubMed

Myeloid dendritic cells (mDC) are key mediators of innate and adaptive immunity to virus infection, but the impact of HIV infection on the mDC response, particularly early in acute infection, is ill-defined. We studied acute pathogenic simian immunodeficiency virus (SIV) infection of rhesus macaques to address this question. The mDC in blood and bone marrow were depleted within 12 days of intravenous infection with SIVmac251, associated with a marked proliferative response. In lymph nodes, mDC were apoptotic, activated and proliferating, despite normal mDC numbers, reflecting a regenerative response that compensated for mDC loss. Blood mDC had increased expression of MHC class II, CCR7 and CD40, whereas in lymph nodes these markers were significantly decreased, indicating that acute infection induced maturation of mDC in blood but resulted in accumulation of immature mDC in lymph nodes. Following SIV infection, lymph node mDC had an increased capacity to secrete tumour necrosis factor-? upon engagement with a Toll-like receptor 7/8 ligand that mimics exposure to viral RNA, and this was inversely correlated with MHC class II and CCR7 expression. Lymph node mDC had an increased ability to capture and cleave soluble antigen, confirming their functionally immature state. These data indicate that acute SIV infection results in increased mDC turnover, leading to accumulation in lymph nodes of immature mDC with an increased responsiveness to virus stimulation. PMID:24684292

Wijewardana, Viskam; Bouwer, Anthea L; Brown, Kevin N; Liu, Xiangdong; Barratt-Boyes, Simon M

2014-10-01

288

Advances in thoracic aortic surgery: Arch replacement with axillary cannulation and thoracic stent grafts  

PubMed Central

During the past decade, significant advances in thoracic surgery have contributed to a decrease in the morbidity and mortality linked to surgery of the thoracic aorta. Drawing from the experiences at the Quebec Heart Institute, the present article focuses on the improvements in surgery of the aortic arch, mainly the use of the ‘arch-first technique’ and arterial cannulation through the right axillary artery. Furthermore, advances in the treatment of diseases of the descending aorta using thoracic stent grafts are delineated. The importance of establishing dedicated multi-disciplinary teams and follow-up clinics to ensure good outcomes in the treatment of these complex diseases is stressed. PMID:17932592

Dagenais, Francois; Dumont, Eric; Mathieu, Patrick; Voisine, Pierre

2007-01-01

289

Advances in thoracic aortic surgery: arch replacement with axillary cannulation and thoracic stent grafts.  

PubMed

During the past decade, significant advances in thoracic surgery have contributed to a decrease in the morbidity and mortality linked to surgery of the thoracic aorta. Drawing from the experiences at the Quebec Heart Institute, the present article focuses on the improvements in surgery of the aortic arch, mainly the use of the 'arch-first technique' and arterial cannulation through the right axillary artery. Furthermore, advances in the treatment of diseases of the descending aorta using thoracic stent grafts are delineated. The importance of establishing dedicated multidisciplinary teams and follow-up clinics to ensure good outcomes in the treatment of these complex diseases is stressed. PMID:17932592

Dagenais, François; Dumont, Eric; Mathieu, Patrick; Voisine, Pierre

2007-10-01

290

Spontaneous rupture of a posttraumatic aneurysm of the axillary artery-a rare cause of hemorrhagic shock in children.  

PubMed

Posttraumatic aneurysms of the axillary artery are extremely scarce. In pediatrics, no similar case has been described. Injuries of axillary artery are often associated with ischemic complications, whereas the bleeding risks are not well documented. We report the case of a 5-year-old boy who was admitted with a scapular pulsatile lump 2 weeks after a domestic accident. During his stay, he suddenly presented a hemorrhagic shock. The patient was immediately admitted to the operating room to undergo surgical hemostasis and was then transferred to intensive care unit to stabilize his vital functions. This case shows the possibility of spontaneous and life-threatening acute bleeding of posttraumatic aneurysms of the axillary artery. PMID:24704582

Saad, Nabil; Bentalha, Aziza; Thar, Abdellatif; Benjelloun, Mohammed Younes; Oulahyane, Rachid; Mossadik, Ahlam; El Koraichi, Alae; El Kettani, Salma

2014-10-01

291

Black sentinel lymph node and 'scary stickers'.  

PubMed

An unusual case is presented of a young adult patient with two black-stained, radio-nucleotide tracer-active sentinel lymph nodes biopsied following her primary cutaneous melanoma treatment. This was subsequently confirmed to be secondary to cutaneous tattoos, averting the need of an elective regional node dissection. History of tattooing and tattoo removal should therefore be obtained as a routine in all melanoma patients considered for sentinel node biopsy (SLN). SLN biopsy and any subsequent completion node dissection should be strictly staged so that proper histologic diagnosis of the sentinel node is available for correct decision making and treatment. PMID:23010587

Yang, Arthur S; Creagh, Terrence A

2013-04-01

292

Lymph node metastasis in gastric cardiac adenocarcinoma in male patients  

PubMed Central

AIM: To reveal the clinicopathological features and risk factors for lymph node metastases in gastric cardiac adenocarcinoma of male patients. METHODS: We retrospective reviewed a total of 146 male and female patients with gastric cardiac adenocarcinoma who had undergone curative gastrectomy with lymphadenectomy in the Department of Surgery, Xin Hua Hospital and Rui Jin Hospital of Shanghai Jiaotong University Medical School between November 2001 and May 2012. Both the surgical procedure and extent of lymph node dissection were based on the recommendations of Japanese gastric cancer treatment guidelines. Univariate and multivariate analyses of lymph node metastases and the clinicopathological features were undertaken. RESULTS: The rate of lymph node metastases in male patients with gastric cardiac adenocarcinoma was 72.1%. Univariate analysis showed an obvious correlation between lymph node metastases and tumor size, gross appearance, differentiation, pathological tumor depth, and lymphatic invasion in male patients. Multivariate logistic regression analysis revealed that tumor differentiation and pathological tumor depth were the independent risk factors for lymph node metastases in male patients. There was an obvious relationship between lymph node metastases and tumor size, gross appearance, differentiation, pathological tumor depth, lymphatic invasion at pN1 and pN2, and nerve invasion at pN3 in male patients. There were no significant differences in clinicopathological features or lymph node metastases between female and male patients. CONCLUSION: Tumor differentiation and tumor depth were risk factors for lymph node metastases in male patients with gastric cardiac adenocarcinoma and should be considered when choosing surgery. PMID:24115823

Ren, Gang; Chen, Ying-Wei; Cai, Rong; Zhang, Wen-Jie; Wu, Xiang-Ru; Jin, Ye-Ning

2013-01-01

293

EVALUATION OF LYMPH NODE COUNTS IN PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION  

PubMed Central

Background Lymph node counts are a measure of quality assurance and are associated with prognosis for numerous malignancies. To date, investigations of lymph node counts in testis cancer are lacking. Methods Using the Memorial Sloan-Kettering Testis Cancer Database, we identified 255 patients treated with primary retroperitoneal lymph node dissection (RPLND) for nonseminomatous germ cell tumors (NSGCT) between 1999 and 2008. Features associated with node counts, positive nodes, number of positive nodes, and risk of positive contralateral nodes were evaluated with regression models. Results Median (IQR) total node count was 38 (27–53) and was 48 (34 – 61) during the most recent 5 years. Features associated with higher node count on multivariate analysis included high volume surgeon (p=0.034), clinical stage (p=0.036), and more recent year of surgery (p<0.001) while pathologist was not significantly associated with node count (p=0.3). Clinical stage (p<0.001) and total node count (p=0.045) were significantly associated with finding positive nodes on multivariate analysis. The probability of finding positive nodes were 23%, 23%, 31%, and 48% if the total node count was <21, 21 – 40, 41 – 60, and >60, respectively. With a median follow-up of 3.0 years all patients were still alive and 16 patients relapsed while no patient relapsed in the paracaval, interaortocaval, paraaortic, or iliac regions. Conclusion Our results suggest that >40 lymph nodes removed at RPLND improves the diagnostic efficacy of the operation. These results will be useful for future trials comparing RPLND, especially when assessing the adequacy of lymph node dissection. PMID:20665486

Thompson, R. Houston; Carver, Brett S.; Bosl, George J.; Bajorin, Dean; Motzer, Robert; Feldman, Darren; Reuter, Victor E.; Sheinfeld, Joel

2014-01-01

294

The neuromuscular basis of courtship song in Drosophila : The role of the direct and axillary wing muscles  

Microsoft Academic Search

Summary  \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a Power for both flight and for courtship song inDrosophila is provided by the indirect, myogenic, flight muscles (Fig. 7). The axillary and direct wing muscles (Fig. 1) control wing\\u000a extension, most of the parameters of wing movement and the timing of song pulses. The role of these muscles during song was\\u000a investigated electrophysiologically.\\u000a \\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a Most of the axillary

Arthur W. Ewing

1979-01-01

295

Tumor cell entry into the lymph node is controlled by CCL1 chemokine expressed by lymph node lymphatic sinuses  

PubMed Central

Lymphatic vessels are thought to contribute to metastasis primarily by serving as a transportation system. It is widely believed that tumor cells enter lymph nodes passively by the flow of lymph. We demonstrate that lymph node lymphatic sinuses control tumor cell entry into the lymph node, which requires active tumor cell migration. In human and mouse tissues, CCL1 protein is detected in lymph node lymphatic sinuses but not in the peripheral lymphatics. CCR8, the receptor for CCL1, is strongly expressed by human malignant melanoma. Tumor cell migration to lymphatic endothelial cells (LECs) in vitro is inhibited by blocking CCR8 or CCL1, and recombinant CCL1 promotes migration of CCR8+ tumor cells. The proinflammatory mediators TNF, IL-1?, and LPS increase CCL1 production by LECs and tumor cell migration to LECs. In a mouse model, blocking CCR8 with the soluble antagonist or knockdown with shRNA significantly decreased lymph node metastasis. Notably, inhibition of CCR8 led to the arrest of tumor cells in the collecting lymphatic vessels at the junction with the lymph node subcapsular sinus. These data identify a novel function for CCL1–CCR8 in metastasis and lymph node LECs as a critical checkpoint for the entry of metastases into the lymph nodes. PMID:23878309

Das, Suvendu; Sarrou, Eliana; Podgrabinska, Simona; Cassella, Melanie; Mungamuri, Sathish Kumar; Feirt, Nikki; Gordon, Ronald; Nagi, Chandandeep S.; Wang, Yarong; Entenberg, David; Condeelis, John

2013-01-01

296

Micropropagation of paradise tree (Melia azedarach) by in vitro culture of axillary buds.  

PubMed

Paradise tree (Melia azedarach L.) is a multipurpose ornamental and timber tree, and its extracts are used to make insecticides and fungicides. Conventional propagation is done by seeds; however, sexual reproduction results in wide genetic variability. Therefore, clonal propagation is desirable to reduce genetic variation. This chapter describes a protocol for in vitro propagation of paradise tree by axillary buds. There are major steps for this protocol. Firstly, shoot induction by in vitro culture of axillary buds, excised from potted plants obtained by rooting of cuttings of 10-15-year-old adult trees. The initiation medium was composed of Murashige and Skoog medium (MS) supplemented with 0.5 mg/L BAP (benzylaminopurine), 0.1 mg/L IBA (indolebutyric acid), and 0.1 mg/L GA(3) (gibberellic acid). Secondly, multiplication of the regenerated shoots on MS medium amended with 0.5 mg/L BAP and 0.1 mg/L GA(3). Thirdly, rooting of the regenerated shoots on MS medium containing 0.1 mg/L IBA. Fully well-developed plants were transferred to pots containing sand, peat moss, and perlite (1:1:1), and maintained initially in the greenhouse or plastic tunnels. PMID:23179702

Mroginski, Luis A; Rey, Hebe Y

2013-01-01

297

Control of axillary bud initiation and shoot architecture in Arabidopsis through the SUPERSHOOT gene  

PubMed Central

The aerial architecture of flowering plants is determined to a large extent by shoot growth and shoot branching arising from the initiation and growth of axillary meristems. We have identified an Arabidopsis mutant, supershoot (sps), which is characterized by a massive overproliferation of shoots, such that a single plant can generate 500 or more inflorescences. Analysis of the mutant plants shows that the primary defect is because of an increase in the number of meristems formed in leaf axils, together with release of bud arrest, resulting in reiterative branch formation from rosette and cauline leaves. The SPS gene is shown here to encode a cytochrome P450, and together with a 3- to 9-fold increase in levels of Z-type cytokinins in sps mutant plants, indicate a role for SPS in modulating hormone levels. The expression pattern of SPS, with strong expression at the leaf axils, correlates well with the phenotypic defects. Our results indicate that control of shoot branching in Arabidopsis may be accomplished in part by suppression of axillary meristem initiation and growth through the localized attenuation of cytokinin levels at sites of bud initiation. PMID:11410537

Tantikanjana, Titima; Yong, Jean W.H.; Letham, D. Stuart; Griffith, Megan; Hussain, Mumtaz; Ljung, Karin; Sandberg, Goran; Sundaresan, Venkatesan

2001-01-01

298

BRANCHED1 Promotes Axillary Bud Dormancy in Response to Shade in Arabidopsis[C][W  

PubMed Central

Plants interpret a decrease in the red to far-red light ratio (R:FR) as a sign of impending shading by neighboring vegetation. This triggers a set of developmental responses known as shade avoidance syndrome. One of these responses is reduced branching through suppression of axillary bud outgrowth. The Arabidopsis thaliana gene BRANCHED1 (BRC1), expressed in axillary buds, is required for branch suppression in response to shade. Unlike wild-type plants, brc1 mutants develop several branches after a shade treatment. BRC1 transcription is positively regulated 4 h after exposure to low R:FR. Consistently, BRC1 is negatively regulated by phytochrome B. Transcriptional profiling of wild-type and brc1 buds of plants treated with simulated shade has revealed groups of genes whose mRNA levels are dependent on BRC1, among them a set of upregulated abscisic acid response genes and two networks of cell cycle– and ribosome-related downregulated genes. The downregulated genes have promoters enriched in TEOSINTE BRANCHED1, CYCLOIDEA, and PCF (TCP) binding sites, suggesting that they could be transcriptionally regulated by TCP factors. Some of these genes respond to BRC1 in seedlings and buds, supporting their close relationship with BRC1 activity. This response may allow the rapid adaptation of plants to fluctuations in the ratio of R:FR light. PMID:23524661

Gonzalez-Grandio, Eduardo; Poza-Carrion, Cesar; Sorzano, Carlos Oscar S.; Cubas, Pilar

2013-01-01

299

Primary lymph node plasmacytomas (plasmacytic lymphomas).  

PubMed

To determine whether primary lymph node plasmacytoma (PLNP) is a distinct entity among other types of plasma cell neoplasia, we analyzed a large series of PLNPs from 2 large lymphoma registries to compare histologic, immunophenotypic, and clinical features of PLNPs, nonnodal extramedullary plasmacytomas, and multiple myeloma. Twenty-five PLNPs (clinical data on 15 cases) were compared with 10 non-lymph node plasmacytomas and 51 cases of multiple myeloma; 36 cases of reactive plasmacytoses were used as controls. The histologic features of PLNP and other extramedullary plasmacytomas were similar. The histologic features of PLNPs were more immature than those of reactive plasmacytoses and less immature than in multiple myeloma. The immunophenotype of PLNPs significantly differed from that of reactive plasmacytoses, other extramedullary plasmacytomas, and multiple myeloma. PLNPs did not progress to multiple myeloma, unlike other extramedullary plasmacytomas, even though survival in PLNPs and other extramedullary plasmacytomas was similar. Our findings suggest that PLNPs may be distinct from other plasma cell dyscrasias. PMID:11190797

Menke, D M; Horny, H P; Griesser, H; Tiemann, M; Katzmann, J A; Kaiserling, E; Parwaresch, R; Kyle, R A

2001-01-01

300

Sensitive, Noninvasive Detection of Lymph Node Metastases  

PubMed Central

Background Many primary malignancies spread via lymphatic dissemination, and accurate staging therefore still relies on surgical exploration. The purpose of this study was to explore the possibility of semiautomated noninvasive nodal cancer staging using a nanoparticle-enhanced lymphotropic magnetic resonance imaging (LMRI) technique. Methods and Findings We measured magnetic tissue parameters of cancer metastases and normal unmatched lymph nodes by noninvasive LMRI using a learning dataset consisting of 97 histologically proven nodes. We then prospectively tested the accuracy of these parameters against 216 histologically validated lymph nodes from 34 patients with primary cancers, in semiautomated fashion. We found unique magnetic tissue parameters that accurately distinguished metastatic from normal nodes with an overall sensitivity of 98% and specificity of 92%. The parameters could be applied to datasets in a semiautomated fashion and be used for three-dimensional reconstruction of complete nodal anatomy for different primary cancers. Conclusion These results suggest for the first time the feasibility of semiautomated nodal cancer staging by noninvasive imaging. PMID:15630471

2004-01-01

301

Predictors of recurrence in breast cancer subtypes with negative lymph node in a Chinese population  

PubMed Central

To establish a series of objective parameters to predict the risk of relapse from axillary lymph node-negative (ANN) breast cancer, and evaluate the patterns of recurrence according to molecular subtypes, we collected information on 2126 consecutive breast cancer patients operated between 2002 and 2006. In this case-control study, 212 patients experiencing recurrence or breast cancer related death were defined as ‘poor group’. Another 212 patients were selected from the remaining cases with stratified sampling method to comprise the ‘good group’. Significant differences were found in vascular invasion, grade and molecular subtype between the two groups. Expression of ER and PR in the ‘poor group’ was lower (P < 0.05). However, positive rates of Ki67, p53 and VEGF in the ‘poor group’ were higher (P < 0.05). Multivariate analysis revealed that molecular subtype, expression of VEGF, tumor grade, and vascular invasion were closely correlated with bad outcome. Analysis of the ‘poor group’ demonstrated that ‘HER2 positive’ and ‘triple negative’ subtypes more commonly suffered from distant metastases and death. No metastasis was found in patients with pure invasive papillary carcinoma, invasive cribriform carcinoma or adenoid cystic carcinoma, whereas the diagnoses of invasive micropapillary carcinoma, invasive apocrine carcinoma, invasive papillary carcinoma mixed with invasive ductal carcinoma, or metaplastic carcinoma were correlated with distant metastasis and death. In conclusion, molecular subtype and expression of VEGF are useful markers for predicting prognosis of ANN breast cancer patients. ‘Luminal A-like’ subtype has better outcome than others. Moreover, molecular subtypes have different recurrence patterns. PMID:25031741

Liu, Xia; Guan, Yong; Zhang, Wei; Liu, Shan; Liu, Junjun; Wang, Li; Niu, Yun

2014-01-01

302

Hazard of recurrence and adjuvant treatment effects over time in lymph node-negative breast cancer  

PubMed Central

Background For patients with axillary lymph node-negative breast cancer, benefits from adjuvant therapy are smaller than in node-positive disease and thus more selective use is warranted, prompting development of risk profiling to identify those most likely to benefit. Examination of the magnitude and changes in the hazard of failure over time in node-negative breast cancer may also be informative in this regard. Methods Among 9,444 participants from five randomized trials (accrual 1982–1998) investigating chemotherapy and tamoxifen for node-negative breast cancer, we estimated recurrence hazards over time by tumor estrogen receptor (ER) status and adjuvant treatment. Results In patients treated by surgery only, we observed the previously noted larger hazard peak followed by a rapid decrease in ER-negative patients and smaller but more persistent hazard in ER-positive patients. After approximately 48 months, the ER-positive hazard is greater. For adjuvant treatment, while tamoxifen decreases the early hazard in ER-positive patients to that of the chemotherapy-treated ER-negative group, in later follow-up (beyond 5 years) the hazard for ER-positive patients again exceeds that of ER-negative patients. Adding chemotherapy to tamoxifen in ER-positive patients results in large early hazard reduction, but in later follow-up the hazard converges with those of patients treated by surgery only or tamoxifen. Conclusions Recurrence hazards over time reveal changes in risk that may have biologic and therapeutic strategy relevance. In ER-negative tumors, a large early chemotherapy benefit is followed by a consistently low recurrence hazard over time. In ER-positive patients, the chemotherapy benefit appears concentrated mostly in earlier follow-up, and a greater recurrence risk remains. PMID:18830816

Dukic, Vanja M.; Anderson, Stewart J.; Mamounas, Eleftherios P.; Wickerham, D. Lawrence; Wolmark, Norman

2008-01-01

303

Dynamics of Neutrophil Migration in Lymph Nodes during Infection  

E-print Network

Immunity Article Dynamics of Neutrophil Migration in Lymph Nodes during Infection Tatyana Chtanova that control neutrophil migration from the blood to sites of infection have been well characterized, little is known about their migration patterns within lymph nodes or the strategies that neutrophils use to find

Nollmann, Marcelo

304

Novel method and applications for labeling and identifying lymph nodes  

NASA Astrophysics Data System (ADS)

The lymphatic system comprises a series of interconnected lymph nodes that are commonly distributed along branching or linearly oriented anatomic structures. Physicians must evaluate lymph nodes when staging cancer and planning optimal paths for nodal biopsy. This process requires accurately determining the lymph node's position with respect to major anatomical landmarks. In an effort to standardize lung cancer staging, The American Joint Committee on Cancer (AJCC) has classified lymph nodes within the chest into 4 groups and 14 sub groups. We present a method for automatically labeling lymph nodes according to this classification scheme, in order to improve the speed and accuracy of staging and biopsy planning. Lymph nodes within the chest are clustered around the major blood vessels and the airways. Our fully automatic labeling method determines the nodal group and sub-group in chest CT data by use of computed airway and aorta centerlines to produce features relative to a given node location. A classifier then determines the label based upon these features. We evaluate the efficacy of the method on 10 chest CT datasets containing 86 labeled lymph nodes. The results are promising with 100% of the nodes assigned to the correct group and 76% to the correct sub-group. We anticipate that additional features and training data will further improve the results. In addition to labeling, other applications include automated lymph node localization and visualization. Although we focus on chest CT data, the method can be generalized to other regions of the body as well as to different imaging modalities.

Kiraly, Atilla P.; Naidich, David P.; Guendel, Lutz; Zhang, Li; Novak, Carol L.

2007-03-01

305

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

306

RESEARCH Open Access Proteomic biomarkers predicting lymph node  

E-print Network

of lymph node involvement. Other outcomes were histological type, lymphvascular space involvement (LVSI differentiation between various subtypes of cervical cancer. However, identification of the potential biomarkers, Lymph node, SELDI-TOF MS Background Cervical cancer is the seventh most common cancer in both sexes

307

Lymph flow pattern in the intact thoracic duct in sheep.  

PubMed Central

1. To study the lymph flow dynamics in the intact thoracic duct, we applied an ultrasound transit-time flow probe in seven anaesthetized and four unanaesthetized adult sheep (approximately 60 kg). In unanaesthetized non-fasting animals we found that lymph flow in the thoracic duct was always regular pulsatile (pulsation frequency, 5.2 +/- 0.8 min-1) with no relation to heart or respiratory activity. At baseline the peak level of the thoracic duct pulse flow was 11.6-20.7 ml min-1 with a nadir of 0-3.6 ml min-1. Mean lymph flow was 5.4 +/- 3.1 ml min-1. The flow pattern of lymph in the thoracic duct was essentially the same in the anaesthetized animals. 2. In both the anaesthetized and unanaesthetized animals, the lymph flow response to a stepwise increase in the outflow venous pressure showed interindividual variation. Some were sensitive to any increase in outflow venous pressure, but others were resistant in that lymph flow did not decrease until outflow venous pressure was increased to higher levels. This resistance was also observed in the high lymph flow condition produced by fluid infusion in the anaesthetized animal and mechanical constriction of the caudal vena cava in the unaesthetized animals. Pulsation frequency of the thoracic duct flow initially increased and then decreased with a stepwise increase in the outflow venous pressure. This initial increase might be a compensatory response to maintain lymph flow against elevated outflow venous pressure. 3. To test the effect of long-term outflow venous pressure elevation in unanaesthetized sheep, outflow venous pressure was increased by inflation of a cuff around the cranial vena cava for 1, 5 or 25 h. The cuff was inflated to a level where lymph flow was reduced. Lymph flow remained low or decreased further during the entire cuff-inflation period. We calculated the lymph debt caused by the outflow venous pressure elevation and the amount 'repaid' when venous pressure returned to normal. Lymph debt for 25 h was 6400 ml but only 200 ml was repaid. Since we observed no visible oedema formation in the lower body of the sheep, the non-colloidal components of the lymph must have been reabsorbed into the bloodstream, most likely in the lymph nodes. PMID:9288690

Onizuka, M; Flateb?, T; Nicolaysen, G

1997-01-01

308

Characterization of sheep lung lymph lipoproteins: chemical and physical properties  

SciTech Connect

The authors have determined the composition and distribution of plasma and lung lymph lipoproteins from unanesthetized ewes. Cholesterol, triglyceride, and phospholipid levels in lung lymph were 45%, 50%, and 50%, respectively, of those in plasma. Lipoproteins from both lymph and plasma were separated into two major fractions: d < 1.063 g/ml or LDL, and d 1.063-1.21 g/ml or HDL. HDL was the major lipoprotein species in the plasma and lymph. Gradients gel electrophoresis of HDL on 4-30% gels showed that, in lymph, HDL particles were shifted to larger sizes; in addition to a peak at 8.5 nm, which was similar to plasma HDL, there were two additional components of larger size, one at 9.2 nm and the other at 12 nm. Electron microscopy revealed that lymph HDL contained two new particles not seen in plasma: large, round particles, 13.6 nm diameter, and discoidal particles, 18.7 by 4.9 nm, long and short axis, respectively. Compositional analysis of lymph HDL revealed a relative enrichment in free cholesterol as well as an enrichment in apolipoprotein E. Lymph LDL on gradient gel electrophoresis was extremely heterogeneous. Several peaks were evident in the 23-30 nm size range (similar to plasma LDL), but a supplementary component at approximately 15-16 nm was also present. Whereas plasma LDL on electron microscopy contained only round particles 26 nm in diameter, lymph contained an additional, unusual particle which was close-packed, with square geometry, and was 15 nm in diameter. Changes in the physical and chemical properties of lung lymph lipoproteins suggest that these particles are metabolically modified.

Forte, T.M.; Cross, C.E.; Gunther, R.A.; Kramer, G.C.

1983-01-01

309

Clonidine Administered as an Axillary Block Does Not Affect Postoperative Pain When Given as the Sole Analgesic  

Microsoft Academic Search

Used as the sole analgesic, clonidine produces analge- sia after epidural, intrathecal, and intraarticular admin- istration. We conducted this double-blinded study to determine whether clonidine has analgesic effects when administered into the brachial plexus sheath. At the conclusion of hand or forearm surgery, performed under axillary brachial plexus block, 45 patients were randomly divided into three groups of 15 each

Salvatore Sia; Antonella Lepri

1999-01-01

310

A strong association of axillary osmidrosis with the wet earwax type determined by genotyping of the ABCC11 gene  

Microsoft Academic Search

BACKGROUND: Two types of cerumen occur in humans: the wet type with brownish, sticky earwax, and the dry type with a lack of or reduced ceruminous secretion. The wet type is common in populations of European and African origin, while the dry type is frequently seen in Eastern Asian populations. An association between axillary odor and the wet-type earwax was

Motoi Nakano; Nobutomo Miwa; Akiyoshi Hirano; Koh-ichiro Yoshiura; Norio Niikawa

2009-01-01

311

Prevention of Lymphorrhea by Means of Fibrin Glue after Axillary Lymphadenectomy in Breast Cancer: Prospective Randomized Trial  

Microsoft Academic Search

A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin

F. N. Gilly; Y. François; A. C. Sayag-Beaujard; O. Glehen; A. Brachet; J. Vignal

1998-01-01

312

Sentinel lymph node mapping technique in colon cancer.  

PubMed

Current conventional surgical and pathological techniques substantially understage colon cancer. This is evidenced by the fact that a significant subset of patients who are stage I and II at the time of colectomy return with distant metastases and ultimately succumb to the disease within the next 5 years. The identification of more nodes within a specimen and the detailed analysis of lymph nodes with advanced pathological techniques such as immunohistochemistry and reverse-transcriptase polymerase chain reaction (RT-PCR) can improve the staging of colon cancer, but are also associated with tremendous financial, time, and labor constraints. Sentinel lymph node (SLN) mapping has provided an avenue of staging colon cancer with high success rates and accuracy rates, while maintaining cost- and time-effectiveness. The ability to reproduce these results is dependent on adherence to the technical details of the procedure, and thereby providing the pathologist with the true SLNs, upon which the advanced pathological studies can be applied. We report our experience of SLN mapping for colon tumors in 209 patients, elaborating on the materials used, technical details, pitfalls, and results of the procedure. Our results show a success rate of 100% (209/209) and an overall accuracy rate for predicting positive or negative metastatic disease of 96.2% (201/209). Nodal metastases were identified in 46.2% (85/184) of patients with invasive disease (stage T1 to T4). The SLN was the exclusive site of metastases in 38.8% (33/85) of these patients, and the nodal disease was detected only as micrometastases in 22.4% (19/85). The skip metastases rate (false negatives) was 9.4% (8/85). SLN mapping is a powerful tool for accurate staging of colon cancer with a high success rate. The upstaging associated with this procedure may reveal disease that might otherwise go undetected by conventional surgical and pathological methods. Those patients who are upstaged can then benefit from adjuvant chemotherapy, which has been shown to improve survival of colon cancer patients with nodal disease by at least 33%. PMID:15190495

Saha, Sukamal; Dan, Adrian G; Beutler, Thomas; Wiese, David; Schochet, Elie; Badin, Julio; Branigan, Timothy; Ng, Peter; Bassily, Nader; David, Doina

2004-06-01

313

Deodorant effects of a sage extract stick: Antibacterial activity and sensory evaluation of axillary deodorancy  

PubMed Central

Background: Deodorant products prevent the growth and activity of the degrading apocrine gland bacteria living in the armpit. Common antibacterial agents in the market like triclosan and aluminum salts, in spite of their suitable antibacterial effects, increase the risk of Alzheimer's disease, breast and prostate cancers or induce contact dermatitis. Therefore, plant extracts possessing antibacterial effects are of interest. The aim of the present study was to verify the in vitro antimicrobial effects of different sage extracts against two major bacteria responsible for axillary odor, and to evaluate the deodorant effect of a silicon-based stick containing sage extracts in different densities in humans. Materials and Methods: Different fractions of methanolic extract of Salvia officinalis (sage) were evaluated on a culture of armpit skin surface of volunteers through agar microdilution antimicrobial assay. Then, randomized, double-blind placebo-controlled clinical trial with the best antibacterial fraction was conducted on 45 female healthy volunteers. Participants were treated with a single dose in four groups, each containing 15 individuals: Group 1 (200 ?g/mL), 2 (400 ?g/mL), 3 (600 ?g/mL) of dichloromethane sage extract, and placebo (without extract). A standard sensory evaluation method for the evaluation of deodorant efficacy was used before, and two hours, four hours, and eight hours after single application of a deodorant or placebo (ASTM method E 1207-87 Standard Practice for the Sensory Evaluation of Axillary Deodorancy). Results: The data were analyzed with two factors relating to densities and time. In 45 participants with a mean [± standard deviation (SD)] age of 61.5±11.8 years, statistically significant within-group differences were observed before and two, four, and eight hours after deodorant treatment for groups 1, 2, and 3. Groups 1, 2, and 3 had a significantly smaller odor score than placebo after two, four, and eight hours (P < 0.001). In a comparison of different deodorant densities, the interaction effect was not significant between deodorant 200 and 400 ?g/mL, but was significant between 200 and 600 and between 400 and 600 ?g/mL sage extract sticks (P < 0.001). Before running the sensory evaluation of the deodorant sticks on the subjects, a rabbit skin patch test was used to demonstrate that the formulation had no irritants. Conclusion: A single treatment with a stick deodorant containing dichloromethane sage extract of 200, 400, or 600 ?g/mL concentrations was effective in reducing the axillary malodor level compared with the control, in healthy subjects. PMID:24497852

Shahtalebi, Mohammad Ali; Ghanadian, Mustafa; Farzan, Ali; Shiri, Niloufar; Shokri, Dariush; Fatemi, Syed Ali

2013-01-01

314

Non-invasive mapping of deep-tissue lymph nodes in live animals using a multimodal PET/MRI nanoparticle  

NASA Astrophysics Data System (ADS)

The invasion status of tumour-draining lymph nodes (LNs) is a critical indicator of cancer stage and is important for treatment planning. Clinicians currently use planar scintigraphy and single-photon emission computed tomography (SPECT) with 99mTc-radiocolloid to guide biopsy and resection of LNs. However, emerging multimodality approaches such as positron emission tomography combined with magnetic resonance imaging (PET/MRI) detect sites of disease with higher sensitivity and accuracy. Here we present a multimodal nanoparticle, 89Zr-ferumoxytol, for the enhanced detection of LNs with PET/MRI. For genuine translational potential, we leverage a clinical iron oxide formulation, altered with minimal modification for radiolabelling. Axillary drainage in naive mice and from healthy and tumour-bearing prostates was investigated. We demonstrate that 89Zr-ferumoxytol can be used for high-resolution tomographic studies of lymphatic drainage in preclinical disease models. This nanoparticle platform has significant translational potential to improve preoperative planning for nodal resection and tumour staging.

Thorek, Daniel L. J.; Ulmert, David; Diop, Ndeye-Fatou M.; Lupu, Mihaela E.; Doran, Michael G.; Huang, Ruimin; Abou, Diane S.; Larson, Steven M.; Grimm, Jan

2014-01-01

315

Trafficking of a Dual-Modality Magnetic Resonance and Fluorescence Imaging Superparamagnetic Iron Oxide-Based Nanoprobe to Lymph Nodes  

PubMed Central

Purpose To develop and characterize the trafficking of a dual-modal agent that identifies primary draining or sentinel lymph node (LN). Procedure Herein, a dual-reporting silica-coated iron oxide nanoparticle (SCION) is developed. Nude mice were imaged by magnetic resonance (MR) and optical imaging and axillary LNs were harvested for histological analysis. Trafficking through lymphatics was observed with intravital and ex vivo confocal microscopy of popliteal LNs in B6-albino, CD11c-EYFP, and lys-EGFP transgenic mice. Results In vivo, SCION allows visualization of LNs. The particle’s size and surface functionality play a role in its passive migration from the intradermal injection site and its minimal uptake by CD11c+ dendritic cells and CD169+ and lys+ macrophages. Conclusions After injection, SCION passively migrates to LNs without macrophage uptake and then can be used to image LN(s) by MRI and fluorescence. Thus, SCION can potentially be developed for use in sentinel node resections or for intralymphatic drug delivery. PMID:21080233

Bumb, Ambika; Regino, Celeste A. S.; Egen, Jackson G.; Bernardo, Marcelino; Dobson, Peter J.; Germain, Ronald N.; Choyke, Peter L.; Brechbiel, Martin W.

2010-01-01

316

Lymph node flap based on the right transverse cervical artery as a donor site for lymph node transfer.  

PubMed

Lymph node transfer is a novel technique in lymphedema surgery. In this study, we present our experience in harvesting lymph nodes flap based on the right transverse cervical artery. In a period of 7 months, we harvested 11 cervical lymph node flaps based on the right transverse cervical artery (TCA). The reliable anatomy of the TCA and the low complication rate of the donor site make this lymph node flap ideal for transfer in the treatment of lymphedema. Knowledge of the regional anatomy and the anatomic variations of the TCA are mandatory for safe dissection of this flap. We also present the preliminary results of our first 2 cases in which we performed cervical lymph node transfer for secondary lower extremity lymphedema. PMID:23759964

Sapountzis, Stamatis; Singhal, Dhruv; Rashid, Abid; Ciudad, Pedro; Meo, Domenico; Chen, Hung-Chi

2014-10-01

317

Mastectomy With Immediate Expander-Implant Reconstruction, Adjuvant Chemotherapy, and Radiation for Stage II-III Breast Cancer: Treatment Intervals and Clinical Outcomes  

SciTech Connect

Purpose: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients. Methods and Materials: Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated. Results: Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%. Conclusions: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.

Wright, Jean L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Cordeiro, Peter G. [Department of Surgery, Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Ben-Porat, Leah [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Van Zee, Kimberly J. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hudis, Clifford [Department of Medicine, Solid Tumor Division, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Beal, Kathryn [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); McCormick, Beryl [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: mccormib@mskcc.org

2008-01-01

318

Axillary Metaplastic Breast Carcinoma with Ipsilateral Pectoral Invasive Ductal Carcinoma: An Unusual Presentation  

PubMed Central

We report a case of axillary metaplastic breast carcinoma (MBC) with triple negative (ER?/PR?/Her2?) phenotype, concurrent with multifocal invasive ductal carcinoma (IDC) of ipsilateral pectoral breast (ER+/PR+/Her2?) in a 60-year-old woman. The two tumors demonstrate different morphology, immunophenotype, and opposite response to neoadjuvant chemotherapy of paclitaxol, adriamycin, and cyclophosphamide. Methylation analysis of human androgen receptor (HUMARA) on X-chromosome identified monoclonal pattern of X-chromosome inactivation in MBC and mosaic pattern in the IDC. Stem cell origin of MBC is suggested in this case. Clinicopathological features, imaging findings, biological markers, chemoradiation management, and prognosis of MBC are reviewed in comparison to invasive ductal carcinoma. Our case and literature review suggest that traditional chemotherapy applicable to IDC is less effective towards MBC. However, new chemotherapy protocols targeting stem cell and multimodality management of MBC are promising. Recognition of unusual presentation of MBC will help tailor therapy towards tumor with worse prognosis.

Zhang, Lei; Comertpay, Sabahattin; Shimizu, David; DeMay, Richard M.; Carbone, Michele; Honda, Stacey A.; Eaves, Jodi M. Matsuura

2014-01-01

319

[Does the use of TachoSil allow to reduce the morbidity of axillary dissection?].  

PubMed

The lymphocele is the most frequently encountered complication after axillary dissection performed for breast cancer (15-81%). This study compares the efficacy of a lympho-hemostatic combipatch TachoSil(®) versus conventional implementation of a suction drain on the incidence and severity of lymphoceles. This is a case (group TachoSil(®)n=20) control (drainage group) n=40 study. In our study, we demonstrated an increased rate of postoperative complications (<3weeks) in the group TachoSil(®) (P=0.0265) explained by a lymphocele rate significantly higher (P=0.0194). However, no significant difference was demonstrated on the severity of these lymphoceles. Beyond 3weeks postoperatively, the two groups were comparable in terms of postoperative complications. The TachoSil(®) does not prevent the formation of seroma but their severity is not increased. In addition, it reduces of more than 48hours the duration of hospitalization stay (P=0.002). PMID:23375637

Lacoste, C; Ouldamer, L; Body, G; Marret, H

2013-02-01

320

Case Report and Dosimetric Analysis of an Axillary Recurrence After Partial Breast Irradiation with Mammosite Catheter  

SciTech Connect

Partial breast irradiation (PBI) was designed in part to decrease overall treatment times associated with whole breast radiation therapy (WBRT). WBRT treats the entire breast and usually portions of the axilla. The goal of PBI is to treat a smaller volume of breast tissue in less time, focusing the dose around the lumpectomy cavity. The following is a case of a 64-year-old woman with early-stage breast cancer treated with PBI who failed regionally in the ipsilateral axilla. With our dosimetric analysis, we found that the entire area of this axillary failure would have likely received at least 45 Gy if WBRT had been used, enough to sterilize microscopic disease. With PBI, this area received a mean dose of only 2.8 Gy, which raises the possibility that this regional failure may have been prevented had WBRT been used instead of PBI.

Shah, Anand P. [Department of Radiation Oncology, Department of Pathology, and Department of General Surgery, Rush University Medical Center, Chicago, IL (United States)], E-mail: anand_shah@rush.edu; Dickler, Adam; Kirk, Michael C.; Chen, Sea S.; Strauss, Jonathan B.; Coon, Alan B.; Turian, Julius V.; Siziopikou, Kalliopi; Dowlat, Kambiz; Griem, Katherine L. [Department of Radiation Oncology, Department of Pathology, and Department of General Surgery, Rush University Medical Center, Chicago, IL (United States)

2008-10-01

321

An organ boundary-enriched gene regulatory network uncovers regulatory hierarchies underlying axillary meristem initiation.  

PubMed

Gene regulatory networks (GRNs) control development via cell type-specific gene expression and interactions between transcription factors (TFs) and regulatory promoter regions. Plant organ boundaries separate lateral organs from the apical meristem and harbor axillary meristems (AMs). AMs, as stem cell niches, make the shoot a ramifying system. Although AMs have important functions in plant development, our knowledge of organ boundary and AM formation remains rudimentary. Here, we generated a cellular-resolution genomewide gene expression map for low-abundance Arabidopsis thaliana organ boundary cells and constructed a genomewide protein-DNA interaction map focusing on genes affecting boundary and AM formation. The resulting GRN uncovers transcriptional signatures, predicts cellular functions, and identifies promoter hub regions that are bound by many TFs. Importantly, further experimental studies determined the regulatory effects of many TFs on their targets, identifying regulators and regulatory relationships in AM initiation. This systems biology approach thus enhances our understanding of a key developmental process. PMID:25358340

Tian, Caihuan; Zhang, Xiaoni; He, Jun; Yu, Haopeng; Wang, Ying; Shi, Bihai; Han, Yingying; Wang, Guoxun; Feng, Xiaoming; Zhang, Cui; Wang, Jin; Qi, Jiyan; Yu, Rong; Jiao, Yuling

2014-01-01

322

Regional block anesthesia in a patient with factor V Leiden mutation and axillary artery occlusion  

PubMed Central

Anesthetic management of patients with coagulation disorders presents safety and technical challenges. This case describes a 58-year-old woman with factor V Leiden mutation who required distal saphenous vein harvest and axillo-brachial bypass to treat axillary artery occlusion. The patient underwent surgery with satisfactory anesthesia using infraclavicular brachial plexus block, thoracic paravertebral block, and unilateral subarachnoid block. These three regional anesthetic interventions were performed in lieu of general anesthesia to minimize risks of thrombotic events, pain, and to decrease recovery time. Despite higher failure rates of regional anesthesia, longer time required for procedures, and added discomforts during surgery, the benefits may outweigh risks for selected high-risk patients, including those with factor V Leiden mutations. PMID:22915885

Erkalp, Kerem; Comlekci, Mevlut; Inan, Bekir; Basaranoglu, Gokcen; Ozdemir, Haluk; Saidoglu, Leyla

2011-01-01

323

Serious axillary nerve injury caused by subscapular artery compression resulting from use of backpacks.  

PubMed

A palsy of the brachial plexus elements caused by carrying a heavy backpack is a very rare injury usually occurring in soldiers or hikers, and recovery is usually spontaneous. We describe here the case of male civilian presenting with an isolated serious axillary nerve palsy associated with chronic backpack use. During the surgery, a dumbbell-shaped neuroma-in-continuity was found which was caused by direct pressure from the subscapular artery. After resection of the neuroma, a nerve graft from the sural nerve was used to reconstruct the nerve. Reinnervation was successful and the patient was able to abduct his arm to its full range, with full muscle strength, within 24 months. PMID:23696291

Haninec, Pavel; Mencl, Libor; Ba?inský, Peter; Kaiser, Radek

2013-12-01

324

Clinical stage B non-seminomatous germ cell testis cancer: The Indiana University experience (1965–1989) using routine primary retroperitoneal lymph node dissection  

Microsoft Academic Search

Between 1965 and 1989, 1180 patients at Indiana University, U.S.A., underwent retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ cell (NSGC) testis cancer of whom 638 cases had primary RPLND. A subset of 174 cases were considered clinical stage B (or II) before surgery (retroperitoneal nodal metastases by clinical staging). Surgery revealed that 23% (n = 41) had pathological stage

J. P. Donohue; J. A. Thornhill; R. S. Foster; R. G. Rowland; R. Bihrle

1995-01-01

325

Multiple shoot induction from axillary bud cultures of the medicinal orchid, Dendrobium longicornu  

PubMed Central

Background and aims Dendrobium longicornu, commonly known as the ‘Long-horned Dendrobium’, is an endangered and medicinally important epiphytic orchid. Over-exploitation and habitat destruction seriously threaten this orchid in Northeast India. Our objective was to develop an efficient protocol for the mass propagation of D. longicornu using axillary bud segments. Methodology and principal results Axillary buds cultured in Murashige and Skoog semi-solid medium supplemented with ?-naphthalene acetic acid (NAA), 2,4-dichlorophenoxy acetic acid (2,4-D) and 6-benzylaminopurine (BAP) readily developed into plantlets. These formed either directly from shoot buds or from intermediary protocorm-like bodies (PLBs). The maximum explant response (86.6 %) was obtained in medium supplemented with NAA at 30 µM, while the maximum number of shoots (4.42) and maximum bud-forming capacity (3.51) were observed in medium containing 15 µM BAP and 5 µM NAA in combination. Protocorm-like bodies were obtained when the medium contained 2,4-D. The maximum number of explants forming PLBs (41.48 %) was obtained in medium containing 15 µM BAP and 15 µM 2,4-D. Well-developed plantlets obtained after 20–25 weeks of culture were acclimatized and eventually transferred to the greenhouse. Over 60 % of these survived to form plants ?3–4 cm tall after 90 days in glasshouse conditions using a substrate of crushed brick and charcoal, shredded bark and moss. Conclusions The method described can readily be used for the rapid and large-scale regeneration of D. longicornu. Its commercial adoption would reduce the collection of this medicinally important and increasingly rare orchid from the wild. PMID:23136638

Dohling, Stadwelson; Kumaria, Suman; Tandon, Pramod

2012-01-01

326

Whole Proteome Analysis of Mouse Lymph Nodes in Cutaneous Anthrax  

PubMed Central

This study aimed to characterize a soluble proteome of popliteal lymph nodes during lymphadenitis induced by intradermal injection of Bacillus anthracis Sterne spores in mice using tandem LC-MS/MS and reverse-phase protein microarray with antibodies specific to epitopes of phosphorylated proteins. More than 380 proteins were detected in the normal intra-nodal lymph, while the infectious process resulted in the profound changes in the protein abundances and appearance of 297 unique proteins. These proteins belong to an array of processes reflecting response to wounding, inflammation and perturbations of hemostasis, innate immune response, coagulation and fibrinolysis, regulation of body fluid levels and vascular disturbance among others. Comparison of lymph and serum revealed 83 common proteins. Also, using 71 antibodies specific to total and phosphorylated forms of proteins we carried initial characterization of circulating lymph phosphoproteome which brought additional information regarding signaling pathways operating in the lymphatics. The results demonstrate that the proteome of intra-nodal lymph serves as a sensitive sentinel of the processes occurring within the lymph nodes during infection. The acute innate response of the lymph nodes to anthrax is accompanied by cellular damage and inflammation with a large number of up- and down-regulated proteins many of which are distinct from those detected in serum. MS data are available via ProteomeXchange with identifier PXD001342. PMID:25329596

Zhou, Weidong; Mueller, Claudius; Liotta, Lance; Popov, Serguei G.

2014-01-01

327

Prospective study of sentinel lymph node biopsy for conjunctival melanoma  

PubMed Central

Background To report our experience with sentinel lymph node biopsy for staging patients with conjunctival melanoma. Methods A prospective review of patients with conjunctival melanoma who underwent sentinel lymph node biopsy at St Bartholomew's Hospital from May 2008 to May 2012. The selection criterion for sentinel node biopsy depended on the tumour thickness (?2?mm) and location of the conjunctival melanoma. The main outcome measures were the incidence of sentinel lymph node positivity and the procedure-related complications. Results In 4?years, 26 out of 70 patients met the selection criteria for sentinel lymph node biopsy. 4 patients declined and 22 patients consented for the procedure. Technetium-99m failed to identify a sentinel lymph node in four of the 22 patients (18%). Of the remaining 18 patients, two were found to have subclinical micrometastasis in regional lymph nodes. Median follow-up was 20?months (range 6–36?months). No false-negative events were observed. Complications of the procedure included transient blue staining of the epibulbar surface in five patients and transient facial nerve palsy in one patient. Conclusions Sentinel lymph node biopsy is a safe procedure with minimal complications. It should be considered for the staging of conjunctival melanomas, especially melanomas in non-limbal location or conjunctival melanomas ?2?mm thick. PMID:24064944

Cohen, Victoria M L; Tsimpida, Maria; Hungerford, John L; Jan, Hikmat; Cerio, Rino; Moir, Graeme

2013-01-01

328

Downregulation of miR-193a-5p correlates with lymph node metastasis and poor prognosis in colorectal cancer  

PubMed Central

AIM: To investigate the correlation of miR-193a-5p with lymph node metastasis and postoperative survival of colorectal cancer (CRC) patients. METHODS: A total of 304 formalin-fixed, paraffin-embedded specimens (69 paired cancer and normal tissues, 55 primary tumors of stage III CRC and matched lymph nodes, and 56 primary tumors of stage II CRC) were included in this study. The relative expression levels of miR-193a-5p in the normal mucosa, primary cancer, and metastatic lymph node lesions were measured by quantitative real-time reverse transcriptase polymerase chain reaction. We evaluated the association of its expression with colorectal cancer lymph node metastasis, clinicopathological factors, and patient survival. RESULTS: The relative expression level of miR-193a-5p was significantly lower in CRC tissues than in the normal mucosa (P = 0.0060). The expression levels of miR-193a-5p were lower in primary CRC tissues with lymph node metastases than in those without metastases (P = 0.0006), and decreased expression of miR-193a-5p correlated with advanced lymph node metastatic stage (P = 0.0007). Kaplan-Meier analysis showed that patients with low miR-193a-5p expression had decreased disease-free survival (DFS) (P = 0.0026) and poor overall survival (OS) (P = 0.0003). Interestingly, for the group of patients with lymph node metastases, miR-193a-5p expression was also related to survival. Patients with low miR-193a-5p expression had decreased DFS (P = 0.0262) and poor OS (P = 0.0230). Moreover, multivariate analysis indicated that downregulation of miR-193a-5p was an independent predictor of poor OS. CONCLUSION: Downregulation of miR-193a-5p correlates with lymph node metastasis and poor survival of CRC. miR-193a-5p may be a useful biomarker for CRC diagnosis, metastasis and prognosis prediction.

Zhang, Peng; Ji, Deng-Bo; Han, Hai-Bo; Shi, Yun-Fei; Du, Chang-Zheng; Gu, Jin

2014-01-01

329

Synergistic Effect of Adjustments of Elastic Stockings to Maintain Reduction in Leg Volume after Mechanical Lymph Drainage  

PubMed Central

The objective of the present study was to evaluate the effect of elastic compression stockings on volumetric variations of lymphedematous limbs between mechanical lymph drainage sessions. Eleven patients with Grade II leg lymphedema, regardless of etiology, were evaluated in a randomized clinical trial. The ages ranged from 47 to 83 years old with a mean of 62.4 years. Participants were submitted to mechanical lymph drainage (RAGodoy) associated with adjusted and unadjusted knee-high elastic compression stockings (20/30 Venosan). The effect of these stockings on the maintenance of volumetric reductions between sessions of lymph drainage was assessed. In all, 33 evaluations were carried out, 18 of patients using well-adjusted stockings and 15 with badly-adjusted stockings. The differences in volumes were significant (unpaired t-test; P-value?lymph drainage. PMID:25328707

de Godoy, Jose Maria Pereira; Lopes Pinto, Renata; Pereira de Godoy, Ana Carolina; de Fatima Guerreiro Godoy, Maria

2014-01-01

330

Does medical treatment of lymphedema act by increasing lymph flow?  

PubMed

The lymphatic origin of chronic edema of the lower limbs was identified by lymphoscintigraphic exploration. Patients underwent therapy involving 8 days of manual lymph drainage combined with elevation of the limbs during rest periods and double compression bandaging. Manual drainage increased lymph flow in 16 limbs, implying that the edema resulted from a functional lymphatic anomaly. In contrast, manual drainage did not increase lymph flow in 9 limbs, suggesting a structural anomaly of the lymphatics. Hence, the same clinical picture corresponded to two different lymphatic anomalies, distinguished by lymphoscintigraphy. However, the therapeutic results were independent of the lymphoscintigraphic results. Increased lymph flow is therefore not the only explanation for the decrease in edema during therapy. PMID:2609733

François, A; Richaud, C; Bouchet, J Y; Franco, A; Comet, M

1989-01-01

331

Nanoparticle Transport from Mouse Vagina to Adjacent Lymph Nodes  

PubMed Central

To test the feasibility of localized intravaginal therapy directed to neighboring lymph nodes, the transport of quantum dots across the vaginal wall was investigated. Quantum dots instilled into the mouse vagina were transported across the vaginal mucosa into draining lymph nodes, but not into distant nodes. Most of the particles were transported to the lumbar nodes; far fewer were transported to the inguinal nodes. A low level of transport was evident at 4 hr after intravaginal instillation, and transport peaked at about 36 hr after instillation. Transport was greatly enhanced by prior vaginal instillation of Nonoxynol-9. Hundreds of micrograms of nanoparticles/kg tissue (ppb) were found in the lumbar lymph nodes at 36 hr post-instillation. Our results imply that targeted transport of microbicides or immunogens from the vagina to local lymph organs is feasible. They also offer an in vivo model for assessing the toxicity of compounds intended for intravaginal use. PMID:23284844

Ballou, Byron; Andreko, Susan K.; Osuna-Highley, Elvira; McRaven, Michael; Catalone, Tina; Bruchez, Marcel P.; Hope, Thomas J.; Labib, Mohamed E.

2012-01-01

332

A gangliocytic patially glandular paraganglioma with lymph node metastasis  

PubMed Central

Gangliocytic paraganglioma (GP) is an infrequent neuroendocrine tumor usually with three elements as epithelioid cells, spindle-shaped cells and ganglion-like cells, which is generally regarded as a benign tumor. Only a few cases with lymph node metastasis have been reported. Herein, we reported a 47-year-old man of GP with distinct glandular component embedded in the spindle tumor cells in the primary tumor and the metastatic lymph nodes. The immunohistochemical profile was helpful to give the final diagnosis as gangliocytic paraganglioma. Here, we added one more GP case with regional lymph nodes metastasis. And particularly, there were small amount of distinct glandular component both in the primary tumor and the metastatic lymph nodes, which indicated that adenocarcinoma might coexist with GP. And GP should also be distinguished from carcinoid tumor, paraganglioma, ganglioneuroma, or GIST. PMID:24649939

2014-01-01

333

The endolymphatic perfusion of lymph nodes with toxic materials.  

PubMed Central

Individual lymph nodes of sheep were perfused, via a cannula in one of their afferent lymphatics, with a variety of toxic materials. This procedure was designed to ablate the parenchyma of the nodes so that the macrophage-rich afferent lymph would pass unaltered into the efferent duct, which also had been cannulated. Although many materials caused transient inflammation and/or immunoblastic responses, few caused lasting alterations in the cellular composition of the efferent lymph. Only melphalan, an alkylating agent, succeeded in damaging the internal structure of the nodes so that true afferent lymph appeared in the efferent duct and abundant dendritic macrophages could be collected. In the doses necessary to achieve this enough of the melphalan became systematized to produce a transient alopecia. PMID:2765388

Hall, J. G.; Sinnett, H. D.

1989-01-01

334

Recurrent ovarian cancer presenting in the right supraclavicular lymph node with isolated metastasis: a case report  

PubMed Central

Introduction The majority of ovarian cancer recurrences are in the abdomen. However, some cases relapse as isolated lymph node metastases, mostly in pelvic or para-aortic nodes. Peripheral isolated lymph node metastasis is rare. Case presentation A 69-year-old Japanese woman had recurrent ovarian cancer presenting with isolated right supraclavicular lymph node metastasis. After surgical resection and combination chemotherapy with carboplatin and paclitaxel, her right supraclavicular lymph node completely regressed. Conclusions Peripheral isolated lymph nodes, including right supraclavicular lymph node, can recur without a macroscopic abdominal lesion. Clinicians should carefully examine peripheral lymph nodes for recurrence. PMID:22747642

2012-01-01

335

Effect of light quality (red: far-red ratio) and defoliation treatments applied at a single phytomer on axillary bud outgrowth in Trifolium repens L  

Microsoft Academic Search

We studied the effects of light quality and defoliation on the rate of phytomer appearance and axillary bud outgrowth in white clover. The treatments were applied to one phytomer, a phytomer being defined as the structural unit comprising a node, internode, axillary bud, subtending leaf and two nodal root primordia. Light of a low red:far-red (R:FR) ratio (0.27) was applied

Ch. Robin; M. J. M. Hay; P. C. D. Newton

1994-01-01

336

Chest Wall Radiotherapy: Middle Ground for Treatment of Patients With One to Three Positive Lymph Nodes After Mastectomy  

SciTech Connect

Purpose: To evaluate the outcomes for patients with Stage II breast cancer and one to three positive lymph nodes after mastectomy who were treated with observation or adjuvant radiotherapy to the chest wall (CW) with or without the regional lymphatics. Methods and Materials: We retrospectively analyzed 238 patients with Stage II breast cancer (one to three positive lymph nodes) treated with mastectomy at the Massachusetts General Hospital between 1990 and 2004. The estimates of locoregional recurrence (LRR), disease-free survival (DFS), and overall survival were analyzed according to the delivery of radiotherapy and multiple prognostic factors. Results: LRR and DFS were significantly improved by postmastectomy radiotherapy (PMRT), with a 5- and 10-year LRR rate without PMRT of 6% and 11%, respectively and, with PMRT, of 0% at both 5 and 10 years (p = .02). The 5- and 10-year DFS rate without PMRT was 85% and 75%, respectively, and, with PMRT, was 93% at both 5 and 10 years (p = .03). A similar benefit was found for patients treated with RT to the CW alone. The LRR, DFS, and overall survival rate for patients treated to the CW only was 0%, 96%, and 95% at 10 years, respectively. Conclusion: Our data suggest that adjuvant PMRT to the CW alone provides excellent disease control for patients with breast cancer <5 cm with one to three positive lymph nodes.

MacDonald, Shannon M.; Abi-Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Alm El-Din, Mohamed A. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Tanta University Hospitals, Tanta Faculty of Medicine (Egypt); Niemierko, Andrzej; Kobayashi, Wendy; McGrath, John J.; Goldberg, Saveli I.; Powell, Simon [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Smith, Barbara [Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Taghian, Alphonse G., E-mail: ataghian@partners.or [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)

2009-12-01

337

Axillary Block as the Sole Anesthetic for Peripherally Inserted Central Catheter Placement in an Infant with Goldenhar Syndrome  

PubMed Central

The use of peripheral nerve block as the sole anesthetic in infants is not very common. Studies have demonstrated that ultrasound guided (USG) peripheral nerve block is associated with higher overall success rate when compared with nerve stimulation (Rubin et al., 2009, and Gelfand et al., 2011). Described below is a medically complex infant who had an USG axillary brachial plexus block for peripherally inserted central catheter (PICC) placement. PMID:24371529

Bernardo-Ocampo, Ma. Carmen

2013-01-01

338

A comparison of energy consumption in upper limb during swing through gait with axillary and elbow crutches in normal subjects  

Microsoft Academic Search

The swing-through gait using Functional Electrical Stimulation (FES) with crutches has a problem that patientsupper limbs have to support their body against gravity during the body-swing phase. So we compared the energy consumption in upper limb muscles during the swing-through gait using axillary and elbow crutches to consider the selection of a suitable crutch for the swing-through gait by FES.

Chida S; Shimada Y; Matsunaga T; Sato M; Hatakeyama K; Misawa A; Sakuraba T; Aizawa T; Iwami T; Miyawaki K; Iizuka K

339

Comparison of Postoperative Analgesic Effect of Dexamethasone and Fentanyl Added to Lidocaine through Axillary Block in Forearm Fracture  

PubMed Central

Aim. Regional analgesia has been introduced as better analgesic technique compared to using systemic analgesic agents, and it may decrease the adverse effects of them and increase the degree of satisfaction. Several additives have been suggested to enhance analgesic effect of local anesthetic agents such as opioids and steroids. We designed this randomized double-blind controlled study to compare the analgesic efficacy of the dexamethasone and fentanyl added to lidocaine using axillary block in patients undergoing operation of forearm fracture. Materials and Methods. Seventy-eight patients 20–60 years old were recruited in a prospective, double-blinded, randomized way. Axillary block was performed in the three groups by using 40?mL lidocaine and 2?mL distilled water (L group), 40?mL lidocaine and 2?mL dexamethasone (LD group), and 40?mL lidocaine and 2?mL fentanyl (LF group). The onset time of sensory and motor block, duration of sensory and motor block, the total analgesic dose administered during 6 hours after the surgery, and hemodynamic variables were recorded. Results. The duration of sensory and motor block was significantly longer in LD group compared to other groups (P < 0.001). Similarly, the total analgesic consumption in LD group was smaller compared to other groups (P < 0.001). Comparison of hemodynamic consequences of axillary block and surgery failed to reveal any statistically significant differences between all groups. Conclusion. Addition of dexamethasone to lidocaine significantly prolonged the duration of analgesia compared with fentanyl/lidocaine mixture or lidocaine alone using axillary block in patients undergoing forearm fracture surgery. This trial is registered with IRCT2012120711687N1. PMID:24490067

Yaghoobi, Siamak; Seddighi, Mahyar; Yazdi, Zohreh; Ghafouri, Razieh; Khezri, Marzieh Beigom

2013-01-01

340

Effects of thidiazuron and benzyladenine on axillary shoot proliferation of three green ash (Fraxinus pennsylvanica Marsh.) clones  

Microsoft Academic Search

Mature seeds of three green ash (Fraxinus pennsylvanica Marsh.) clones, SD1009 (South Dakota origin), SD2002 (South Dakota origin), and KA2018 (Kansas origin) were cut to remove the apical portion and germinated on Murashige and Skoog (1962) salts with B5 vitamins (Gamborg et al., 1968) (MSB5) medium without plant growth regulators. Stable axillary shoot establishment was achieved for all three clones

Mee-Sook Kim; Carol M. Schumann; Ned B. Klopfenstein

1997-01-01

341

Pattern of lymph node involvement and prognosis in pancreatic adenocarcinoma: direct lymph node invasion has similar survival to node-negative disease.  

PubMed

Lymph node status is one of the most important predictors of survival in pancreatic ductal adenocarcinoma. Surgically resected pancreatic adenocarcinoma is often locally invasive and may invade directly into peripancreatic lymph nodes. The significance of direct invasion into lymph nodes in the absence of true lymphatic metastases is unclear. The purpose of this study was to retrospectively compare clinical outcome in patients with pancreatic ductal adenocarcinoma with direct invasion into peripancreatic lymph nodes with patients with node-negative adenocarcinomas and patients with true lymphatic lymph node metastasis. A total of 380 patients with invasive pancreatic ductal adenocarcinoma classified as pT3, were evaluated: ductal adenocarcinoma with true lymphatic metastasis to regional lymph nodes (248 cases), ductal adenocarcinoma without lymph node involvement (97 cases), and ductal adenocarcinoma with regional lymph nodes involved only by direct invasion from the main tumor mass (35 cases). Isolated lymph node involvement by direct invasion occurred in 35 of 380 (9%) patients. Overall survival for patients with direct invasion of lymph nodes (median survival, 21 mo; 5-year overall survival, 36%) was not statistically different from patients with node-negative adenocarcinomas (median survival, 30 mo; 5-year overall survival, 31%) (P=0.609). Patients with node-negative adenocarcinomas had an improved survival compared with patients with lymph node involvement by true lymphatic metastasis (median survival, 15 mo; 5-year overall survival, 8%) (P<0.001) regardless of the number of lymph nodes involved by adenocarcinoma. There was a trend toward decreased overall survival for patients with 1 or 2 lymph nodes involved by true lymphatic metastasis compared with patients with direct invasion of tumor into lymph nodes (P=0.056). However, this did not reach statistical significance. Our results indicate that patients with isolated direct lymph node invasion have a comparable overall survival with patients with node-negative adenocarcinomas as opposed to true lymphatic lymph node metastasis. PMID:21263243

Pai, Rish K; Beck, Andrew H; Mitchem, Jonathan; Linehan, David C; Chang, Daniel T; Norton, Jeffrey A; Pai, Reetesh K

2011-02-01

342

Hawkmoth pollinators decrease seed set of a low-nectar Petunia axillaris line through reduced probing time.  

PubMed

Although deception of floral pollinators is well known among orchids, the majority of animal-pollinated plants secure pollination by nectar rewards. The costs and benefits of nectar production remain poorly understood. Here, we developed a crossing design to introgress a low-nectar-volume locus of Petunia integrifolia into the genetic background of P. axillaris. The resulting introgression line resembled P. axillaris but produced only one-third of the nectar volume. When exposed simultaneously to low-nectar and wild-type P. axillaris plants, hawkmoth pollinators reduced their probing duration on low-nectar plants but otherwise did not show any signs of discrimination against these plants. However, reduced probing duration resulted in reduced seed production in the low-nectar plants despite their higher reproductive potential as evidenced by hand pollination. In line with this interpretation, we found a positive correlation between probing duration and seed set, and hawkmoth pollination of low-nectar plants that were manually supplemented with nectar to parental levels yielded seed sets similar to hand pollination. Thus, a simple self-serving pollinator behavior--the adjustment of probing time in response to nectar volume--may select against reducing nectar and protect many plant-pollinator mutualisms against a drift toward parasitism. PMID:22840518

Brandenburg, Anna; Kuhlemeier, Cris; Bshary, Redouan

2012-09-11

343

The Role of Lymphovascular Invasion as a Prognostic Factor in Patients with Lymph Node-Positive Operable Invasive Breast Cancer  

PubMed Central

Purpose Lymphovascular invasion (LVI) is an important prognostic factor in patients with lymph node-negative patients with invasive breast cancer. However, the prognostic value of LVI it is unclear and controversial about its prognostic value in patients with lymph node-positive breast cancer patients. So, we report the an analysis of the prognostic significance of LVI in a large cohort study of patients with lymph node-positive patients with invasive breast cancer. Methods We retrospectively reviewed 967 patients with invasive breast cancer that had undergone surgical treatment at our hospital, from January 2004 to December 2007. Among these thempatients, 349 patients with lymph node-positive breast cancer patients are were included in this study. We evaluated clinical and pathological data in these patients, we compared with 5-year overall survival and disease-free survival between an LVI-present group and an LVI-absent group. Results The median follow-up was 48 months (range, 12-78 months), and the mean age of the patients was 48 years (range, 23-78 years). LVI was present in 192 patients (55%) of with tumors and was associated with age ?40 years (p=0.009), high histologichistological grade (p=0.007), estrogen receptor status (p=0.001), tumor size ?2 cm (p<0.001), and number of involved lymph nodes (p<0.001), but not with progesterone receptor status, HER2 status, p53 status, or tumor multiplicity. LVI was a significant independent prognostic factor for disease-free survival (p<0.001) and overall survival (p=0.006). By multivariate analysis revealed that LVI (p=0.003), number of involved lymph nodes (?4; p=0.005), and high histological grade (II and III; p=0.02) was were an independent significant predictors of disease-free survival and overall survival in the whole group of patients. Conclusion In this case, we demonstrated that LVI is a significant predictor of poor prognosis in patients with lymph node-positive patients with primary invasive breast cancer, LVI is a significant predictive predictor value of poor prognosis. So, LVI should be considered in the therapeutic strategy as a decision making tool in the adjuvant chemotherapy setting. PMID:22031801

Song, Young Ju; Shin, Sun Hyoung; Cho, Jin Seong; Yoon, Jung Han; Jegal, Young Jong

2011-01-01

344

[Gastrectomy with radical D2 lymph node excision--effective and economically standardized therapy of adenocarcinoma of the stomach].  

PubMed

In a retrospective single center study, the impact of radical D2-lymph adenectomy and splenectomy on operativ course, morbidity, mortality and long-term survival, in 243 patients who underwent radical surgical therapy for gastric cancer, was analyzed. D2-lymph node dissection during gastrectomy or gastric resection did not influence blood loss, artificial respiration time, ICU days or surgical morbidity, whereas splenectomy correlated with a higher hospital mortality, leakage and abscess rate. Due to routinely performed D2-lymphadenectomy long term survival rate (5 years) was 40.6% for all (in detail: 96% in stage IA; 68.5%/IB; 61.2%/II; 35.8%/IIIA; 17.3%IIIB; and 2.6% in stage IV and 58.1% for curative resected patients. PMID:9574334

Schmid, A; Thybusch, A; Henne-Bruns, D; Kremer, B

1997-01-01

345

[In vitro propagation of mahogany tree (Swietenia macrophylla King) from axillary buds].  

PubMed

The mahogany tree (Swietenia macrophylla King) is a forest tree with a great commercial value mainly due to its wood quality. Unfortunately, this species is being threatened by the effect of intensive timber exploitation, its low capacity to regenerate, and the attack of the Meliaceae shoot borer (Hypsipylla grandella Zeller) (Lepidoptera Pyralidae). To increase population, large-scale propagation of mahogany by in vitro culture was developed. To obtain plantlets, nodal segments were cultured in a half-strength MS medium supplemented with different combinations of naphthaleneacetic acid (NAA) and 6-benzyladenine (BA), specified by the Central Compositional Rotable Statistical Design Method, within a range of 0-3 mg/L for both hormones. Favourable incubation conditions were: 16 h light, and 40-45 micromol x m(-2) x s(-1) at 25 degrees C. The derived response surface showed an optimal axillary bud elongation on a medium containing 1.94 mg BA/L and 0.38 mg NAA/L. No significant differences were found neither applying Orellana Method nor modified Orellana method. Mahogany plantlets obtained were successfully acclimated. PMID:15916160

Tacoronte, Melángel; Vielma, María; Mora, Argenis; Valecillos, Carle

2004-01-01

346

Programmed cell death and necrosis during cryopreparative drying of in vitro Eucalyptus grandis axillary buds.  

PubMed

In preparation for cryopreservation, Eucalyptus grandis in vitro axillary buds were dried over silica gel. Pretreatment of the buds with 5 mg per L ABA resulted in partial resistance to water loss (0.76 to 0.45 g per g fresh mass basis) as compared with untreated buds (0.76 to 0.33 g per g) and was associated with the retention of viability (70 vs. 55%). The loss of viability of the dried buds was protracted over several days. Ultrastructural examination and vital staining demonstrated cellular and tissue responses to drying. The meristem appeared to withstand drying and 72 h of rehydration whilst the leaf primordia were destroyed immediately after drying. High reactive oxygen species (ROS) activity was associated with bud excision and drying. Caspase-3-like protease activity was detected after rehydration, thereby providing evidence that the dried buds, that had ultimately died, had undergone programmed cell death. ROS production is considered to be the trigger for programmed cell death. PMID:24441369

Risenga, I; Watt, P; Mycock, D

2013-01-01

347

The right vertical infra-axillary incision for mitral valve replacement  

PubMed Central

Background As the physiologic results of valve surgery have improved dramatically in recent years, the cosmetic effect of the procedure gains increased attention, and various alternatives to the standard median sternotomy have been developed for mitral valve surgery. We report a new minimally invasive and cosmetic approach for mitral valve replacement. Methods From December 2003 to December 2009, the right vertical infra-axillary incision (RVIAI) was employed to perform mitral valve replacement in 256 patients. 62.9% patients had replaced mechanical valve, others were bioprosthetic valve, at the same time 28.1% patients received tricuspid valvuloplasty. Results There were one hospital death in this series due to multiple organ failure, one reoperation for bleeding and one incision infection. Mean follow-up duration was 42.8 months (range, 3 to 72), and follow-up rate was 94%. There were no paravalvular leaks or late death during the follow up. Conclusions The RVIAI can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy for MVR in selected patients. PMID:21054893

2010-01-01

348

Radical Surgical Excision and Use of Lateral Thoracic Flap for Intractable Axillary Hidradenitis Suppurativa  

PubMed Central

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients. PMID:23233895

Teo, Wan-Lin; Ong, Yee-Siang

2012-01-01

349

Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients.  

PubMed

We evaluated whether the sequence or regimen of systemic chemotherapy could be a risk factor for breast cancer-related lymphedema (LE). We retrospectively analyzed 848 patients with stage II/III breast cancer who underwent curative surgery with adequate systemic therapy from 2004 to 2009. Adjuvant chemotherapy (ACT) was performed in 552 patients (65.1 %) and neoadjuvant chemotherapy (NAC) in 296 (34.9 %). We evaluated the incidence of LE based on clinicopathological factors and treatments. At a median follow-up of 5.1 years, 358 patients (42.2 %) had experienced LE and 243 (28.7 %) had retained (persistent LE) [120/552 (21.7 %) with ACT vs. 123/296 (41.6 %) with NAC; P < 0.001]. The incidence of LE in patients with taxane was greater than in those without taxane [233/704 (33.1 %) vs. 10/144 (6.9 %); P < 0.001]. Multivariate analysis showed that NAC [hazard ratio (HR), 1.63 in LE event; P < 0.001; HR, 1.39 in persistent LE; P = 0.02] and RT including supraclavicular area (SCRT) (HR 1.55; P = 0.02; HR 1.93; P = 0.006), number of dissected axillary lymph nodes (N-ALNs) >10 (HR, 1.37; P = 0.01; HR, 1.71; P = 0.001), advanced stage (HR, 1.31; P = 0.03; HR, 1.60; P = 0.002), and taxane (HR, 1.69; P = 0.03; HR, 2.07; P = 0.04) were independent risk factors for the LE occurrence. In addition to advanced stage, N-ALNs and SCRT, NAC, and taxane were shown to increase the risk of LE, which could help clinicians identify patients at risk for LE. PMID:25253173

Jung, So-Youn; Shin, Kyung Hwan; Kim, Myungsoo; Chung, Seung Hyun; Lee, Seeyoun; Kang, Han-Sung; Lee, Eun Sook; Kwon, Youngmee; Lee, Keun Seok; Park, In Hae; Ro, Jungsil

2014-11-01

350

[Tracers used for the detection of sentinel lymph nodes].  

PubMed

The dye or isotope technique is generally used for sentinel lymph node mapping. There are many types of tracers available for the two techniques, and it is important to understand their characteristics such as particle size for appropriate use in specific diseases or conditions. There is an increasing tendency to use indocyanine green or indigo carmine dye instead of isosulfan or sulfan blue dye to avoid potentially life-threatening allergic reactions. Sentinel lymph nodes can easily be detected with the dye method 5-20 min after peritumoral tracer injection. When using dye mapping alone, sentinel lymph node detection should be achieved before the dye reaches nonsentinel nodes. Technetium-99m-labeled tin-colloid or phytate is frequently used in the isotope technique. Isotope injection the day before surgery can reduce the effects of the shine-through phenomenon. Lymphoscintigraphy often permits preoperative sentinel lymph node detection as a guide to intraoperative survey. In current practice, the combination of a radioisotope and blue dye for lymphatic mapping is thought to improve the sentinel lymph node identification rate. New techniques such as fluorescence imaging are being investigated. PMID:19348200

Nakahara, Tadaki

2009-03-01

351

Proteome changes in mesenteric lymph induced by sepsis.  

PubMed

The present study aimed to examine the changes in mesenteric lymph during the development of sepsis and to identify the distinct proteins involved, as targets for further study. The sepsis animal model was constructed by cecal ligation and puncture (CLP). The mesenteric lymph was collected from 28 adult male Sprague?Dawley rats, which were randomly divided into the following four groups (n=7 per group): CLP?6 h, CLP?24 h, sham?6 h and sham?24 h groups. Capillary high performance liquid chromatography?tandem mass spectrometry was performed to analyze the proteome in mesenteric lymph. A comprehensive bioinformatic analysis was then conducted to investigate the distinct proteins. Compared with the sham group, 158 distinct proteins were identified in the lymph samples from the CLP group. Five of these proteins associated with the same lipid metabolism pathway were selected, apolipoprotein E (ApoE), annexin A1 (Anxa1), neutrophil gelatinase?associated lipocalin (NGAL), S100a8 and S100a9. The expression of ApoE, Anxa1, NGAL, S100a8 and S100a9 were all elevated in the progression of sepsis. The five proteins were reported to be closely associated with disease development and may be a potential target for the diagnosis and treatment of sepsis. In conclusion, identifying proteome changes in mesenteric lymph provides a novel perspective to understand the pathological mechanisms underlying sepsis. PMID:25242054

Zhang, Ping; Li, Yan; Zhang, Lian-Dong; Wang, Liang-Hua; Wang, Xi; He, Chao; Lin, Zhao-Fen

2014-12-01

352

Sentinel Lymph Node Biopsy in Nonmelanoma Skin Cancer Patients  

PubMed Central

The management of lymph nodes in nonmelanoma skin cancer patients is currently still debated. Merkel cell carcinoma (MCC), squamous cell carcinoma (SCC), pigmented epithelioid melanocytoma (PEM), and other rare skin neoplasms have a well-known risk to spread to regional lymph nodes. The use of sentinel lymph node biopsy (SLNB) could be a promising procedure to assess this risk in clinically N0 patients. Metastatic SNs have been observed in 4.5–28% SCC (according to risk factors), in 9–42% MCC, and in 14–57% PEM. We observed overall 30.8% positive SNs in 13 consecutive patients operated for high-risk nonmelanoma skin cancer between 2002 and 2011 in our institution. These high rates support recommendation to implement SLNB for nonmelanoma skin cancer especially for SCC patients. Completion lymph node dissection following positive SNs is also a matter of discussion especially in PEM. It must be remembered that a definitive survival benefit of SLNB in melanoma patients has not been proven yet. However, because of its low morbidity when compared to empiric elective lymph node dissection or radiation therapy of lymphatic basins, SLNB has allowed sparing a lot of morbidity and could therefore be used in nonmelanoma skin cancer patients, even though a significant impact on survival has not been demonstrated. PMID:23476781

Matthey-Gie, Marie-Laure; Boubaker, Ariane; Letovanec, Igor; Demartines, Nicolas; Matter, Maurice

2013-01-01

353

Proteome changes in mesenteric lymph induced by sepsis  

PubMed Central

The present study aimed to examine the changes in mesenteric lymph during the development of sepsis and to identify the distinct proteins involved, as targets for further study. The sepsis animal model was constructed by cecal ligation and puncture (CLP). The mesenteric lymph was collected from 28 adult male Sprague-Dawley rats, which were randomly divided into the following four groups (n=7 per group): CLP-6 h, CLP-24 h, sham-6 h and sham-24 h groups. Capillary high performance liquid chromatography-tandem mass spectrometry was performed to analyze the proteome in mesenteric lymph. A comprehensive bioinformatic analysis was then conducted to investigate the distinct proteins. Compared with the sham group, 158 distinct proteins were identified in the lymph samples from the CLP group. Five of these proteins associated with the same lipid metabolism pathway were selected, apolipoprotein E (ApoE), annexin A1 (Anxa1), neutrophil gelatinase-associated lipocalin (NGAL), S100a8 and S100a9. The expression of ApoE, Anxa1, NGAL, S100a8 and S100a9 were all elevated in the progression of sepsis. The five proteins were reported to be closely associated with disease development and may be a potential target for the diagnosis and treatment of sepsis. In conclusion, identifying proteome changes in mesenteric lymph provides a novel perspective to understand the pathological mechanisms underlying sepsis. PMID:25242054

ZHANG, PING; LI, YAN; ZHANG, LIAN-DONG; WANG, LIANG-HUA; WANG, XI; HE, CHAO; LIN, ZHAO-FEN

2014-01-01

354

Randomized Multicenter Trial of Sentinel Node Biopsy Versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC Trial  

Microsoft Academic Search

Background: Sentinel lymph node biopsy in women with operable breast cancer is routinely used in some countries for staging the axilla despite limited data from randomized trials on morbidity and mortality outcomes. We conducted a multi- center randomized trial to compare quality-of-life outcomes between patients with clinically node-negative invasive breast cancer who received sentinel lymph node biopsy and patients who

Robert E. Mansel; Amit Goyal; Robert G. Newcombe; J. Michael Dixon; Constantinos Yiangou; Kieran Horgan; Nigel Bundred; Ian Monypenny; David England; Mark Sibbering; Tholkifl I. Abdullah; Lester Barr; Dudley H. Sinnett; Anne Fleissig; Dayalan Clarke; Peter J. Ell

2006-01-01

355

Application of Sentinel Lymph Node Biopsy in Cutaneous Basosquamous Carcinoma  

PubMed Central

Basosquamous carcinoma of the skin is a relatively rare cutaneous neoplasm that has significant metastatic potential and a metastatic rate greater than that of basal cell and squamous cell carcinoma. We describe the use of lymphatic mapping and sentinel lymph node biopsy in a 63-year-old man after identification of basosquamous carcinoma. Sentinel lymph node biopsy, which is a standard tool to detect regional lymphatic metastasis in cutaneous melanoma, has been rarely employed to detect lymphatic metastasis of basosquamous carcinoma. The approach was successful in detecting a regional lymphatic metastasis of two nodal basins with minor morbidity. Sentinel lymph node biopsy may be useful for certain high-risk lesions of basosquamous carcinoma. PMID:22028558

Kovacevic, Predrag; Visnjic, Milan; Jankovic, Dimitrije; Binic, Ivana; Jankovic, Aleksandar; Ilic, Ivan

2011-01-01

356

Anaphylaxis to isosulfan blue dye during sentinel lymph node biopsy.  

PubMed

We describe a case of intraoperative anaphylaxis resulting from isosulfan blue (IB) dye, an agent being increasingly used for identification of sentinel lymph nodes. A 45-year-old woman undergoing a left mastectomy with sentinel lymph node biopsy under general endotracheal anesthesia developed severe intraoperative hypotension and tachycardia 10 minutes after subcutaneous injection of IB dye for lymphatic mapping. This was associated with a reduction in pulse oximeter reading to 89%. She was successfully resuscitated using 1 mg of epinephrine intravenously (IV). Invasive arterial and central venous pressures were initiated; her lymph node biopsy was concluded, but the rest of her procedure was canceled. Postoperative workup revealed a high tryptase level indicative of an intraoperative anaphylactic reaction most probably related to the IB dye. Isosulfan blue dye can act as an antigen, causing a full-blown intraoperative anaphylactic reaction. Early recognition and aggressive hemodynamic interventions can reduce morbidity and mortality. PMID:16427538

Sandhu, Sukhjit; Farag, Ehab; Argalious, Maged

2005-12-01

357

Radical lymph node dissection for gallbladder cancer: indications and limitations.  

PubMed

Radical lymph node dissection provides survival benefit for patients with pT2 or more advanced gallbladder carcinoma tumors only if potentially curative resection is feasible; it must always be considered when planning a resection or re-resection for robust patients with pT2 or more advanced gallbladder carcinoma tumors. The degree of radical lymphadenectomy depends on clinically assessed nodal status: portal lymph node dissection is limited to cN0 disease; extended portal nodal dissection is indicated for cN0 and a modest degree of cN1 disease; peripancreatic lymph node dissection with pancreaticoduodenectomy is indicated for selected cases of evident peripancreatic nodal disease and/or direct organ involvement. Extended resection with extensive lymphadenectomy should be limited to expert surgeons because it may cause serious morbidity and mortality. PMID:17336245

Shirai, Yoshio; Wakai, Toshifumi; Hatakeyama, Katsuyoshi

2007-01-01

358

Seven synchronous early gastric cancer with 28 lymph nodes metastasis  

PubMed Central

An 85 year male patient complaining epigastric discomfort was admitted. From the esophagogastroduodenoscopy, three early gastric cancer (EGCa) lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type. The patient underwent operation. From the post-operative mapping, however, additional 4 EGCa lesions were found, and the patient was diagnosed with 7 synchronous EGCa. Out of the 7 EGCa lesions, 6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3 layer of submucosa. In spite of such superficial invasions, 28 of 48 lymph nodes had been identified as metastases. The multiple lesions of EGCa do not increase the risk of lymph node metastasis, but if their differentiations are poor or if they have lympho-vascular invasion, multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer. PMID:24307810

Seong, Hyeonjin; Kim, Jin Il; Lee, Hyun Jeong; Kim, Hyun Jin; Cho, Hyung Joon; Kim, Hye Kang; Cheung, Dae Young; Kim, Dong Jin; Kim, Wook; Kim, Tae-Jung

2013-01-01

359

RANK is essential for osteoclast and lymph node development  

PubMed Central

The physiological role of the TNF receptor (TNFR) family member, RANK, was investigated by generating RANK-deficient mice. RANK?/? mice were characterized by profound osteopetrosis resulting from an apparent block in osteoclast differentiation. RANK expression was not required for the commitment, differentiation, and functional maturation of macrophages and dendritic cells from their myeloid precursors but provided a necessary and specific signal for the differentiation of myeloid-derived osteoclasts. RANK?/? mice also exhibited a marked deficiency of B cells in the spleen. RANK?/? mice retained mucosal-associated lymphoid tissues including Peyer’s patches but completely lacked all other peripheral lymph nodes, highlighting an additional major role for RANK in lymph node formation. These experiments reveal that RANK provides critical signals necessary for lymph node organogenesis and osteoclast differentiation. PMID:10500098

Dougall, William C.; Glaccum, Moira; Charrier, Keith; Rohrbach, Kathy; Brasel, Kenneth; De Smedt, Thibaut; Daro, Elizabeth; Smith, Jeffery; Tometsko, Mark E.; Maliszewski, Charles R.; Armstrong, Allison; Shen, Victor; Bain, Steven; Cosman, David; Anderson, Dirk; Morrissey, Philip J.; Peschon, Jacques J.; Schuh, JoAnn

1999-01-01

360

Mapping lymph nodes in cancer management - role of 99mTc-tilmanocept injection  

PubMed Central

Two decades ago, lymphatic mapping of sentinel lymph nodes (SLN) was introduced into surgical cancer management and was termed sentinel node navigated surgery. Although this technique is now routinely performed in the management of breast cancer and malignant melanoma, it is still under investigation for use in other cancers. The radioisotope technetium (99mTc) and vital blue dyes are among the most widely used enhancers for SLN mapping, although near-infrared fluorescence imaging of indocyanine green is also becoming more commonly used. 99mTc-tilmanocept is a new synthetic radioisotope with a relatively small molecular size that was specifically developed for lymphatic mapping. Because of its small size, 99mTc-tilmanocept quickly migrates from its site of injection and rapidly accumulates in the SLN. The mannose moieties of 99mTc-tilmanosept facilitate its binding to mannose receptors (CD206) expressed in reticuloendothelial cells of the SLN. This binding prevents transit to second-echelon lymph nodes. In Phase III trials of breast cancer and malignant melanoma, and Phase II trials of other malignancies, 99mTc-tilmanocept had superior identification rates and sensitivity compared with blue dye. Trials comparing 99mTc-tilmanocept with other 99mTc-based agents are required before it can be routinely used in clinical settings. PMID:25028560

Tausch, Christoph; Baege, Astrid; Rageth, Christoph

2014-01-01

361

Importance of Metastatic Lymph Node Ratio in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial  

PubMed Central

Background The aim of this study was to evaluate the prognostic importance of the metastatic lymph node ratio for stage III colon cancer patients and to find a cut-off value at which the overall survival and disease-free survival change. Material/Methods Patients with pathological stage III colon cancer were retrospectively evaluated for: age; preoperative values of Crp, Cea, Ca 19-9, and Afp; pathologic situation of vascular, perineural, lymphatic, and serosal involvement; and metastatic lymph node ratio values were calculated. Results The study included 58 stage III colon cancer patients: 20 (34.5%) females and 38 (65.5%) males were involved in the study. Multivariate analysis was applied to the following variables to evaluate significance for overall survival and disease-free survival: age, Crp, Cea, perineural invasion, and metastatic lymph node ratio. The metastatic lymph node ratio (<0.25 or ?0.25) is the only independent variable significant for overall and disease-free survival. Conclusions Metastatic lymph node ratio is an ideal prognostic marker for stage III colon cancer patients, and 0.25 is the cut-off value for prognosis. PMID:25087904

Isik, Arda; Peker, Kemal; Firat, Deniz; Yilmaz, Bahri; Sayar, Ilyas; Idiz, Oguz; Cakir, Coskun; Demiryilmaz, Ismail; Yilmaz, Ismayil

2014-01-01

362

Terminal endothelial cells of lymph capillaries as active transport structures involved in the formation of lymph in rat skin.  

PubMed

Electron microscopic examination of lymph capillaries of the dermal papillae of rat scalp skin revealed continuous extension of the lymph collection system into 4 to 10 micron diameter lumen capillaries with thin walls, scant basement lamellae (membranes), and blind-endings of 1 to 4 micron lumen diameter within endothelial-type cells. These terminal endothelial cells also displayed intracytoplasmic channels and pinocytotic vesicles, extensive cytoplasmic processes and a high cytoplasmic volume-percent of mitochondria suggesting active transport capabilities of lymphatic endothelia. The mitochondrial cytoplasmic volume-percent (mean 14.5%) exceeded that present in blood capillary endothelial cells of the rat brain (the anatomic substrate of the blood-brain barrier), that have a volume-percent of mitochondria of 10 to 12% (1). Active transport processes centered in such endothelial cells could account for a portion of lymph formation, and explain the continued accumulation of lymphedema distal to blocked lymphatic collection ducts when lymphatic intraluminal pressure is greatly increased. The small lumen diameter capillaries, which correspond spatially to the prelymphatics of other authors (2), typically converge in groups of three to form larger diameter lymph capillaries corresponding to the lymph "initials" previously described (2,3). PMID:8355520

Cornford, M E; Oldendorf, W H

1993-06-01

363

Robust automated lymph node segmentation with random forests  

NASA Astrophysics Data System (ADS)

Enlarged lymph nodes may indicate the presence of illness. Therefore, identification and measurement of lymph nodes provide essential biomarkers for diagnosing disease. Accurate automatic detection and measurement of lymph nodes can assist radiologists for better repeatability and quality assurance, but is challenging as well because lymph nodes are often very small and have a highly variable shape. In this paper, we propose to tackle this problem via supervised statistical learning-based robust voxel labeling, specifically the random forest algorithm. Random forest employs an ensemble of decision trees that are trained on labeled multi-class data to recognize the data features and is adopted to handle lowlevel image features sampled and extracted from 3D medical scans. Here we exploit three types of image features (intensity, order-1 contrast and order-2 contrast) and evaluate their effectiveness in random forest feature selection setting. The trained forest can then be applied to unseen data by voxel scanning via sliding windows (11×11×11), to assign the class label and class-conditional probability to each unlabeled voxel at the center of window. Voxels from the manually annotated lymph nodes in a CT volume are treated as positive class; background non-lymph node voxels as negatives. We show that the random forest algorithm can be adapted and perform the voxel labeling task accurately and efficiently. The experimental results are very promising, with AUCs (area under curve) of the training and validation ROC (receiver operating characteristic) of 0.972 and 0.959, respectively. The visualized voxel labeling results also confirm the validity.

Allen, David; Lu, Le; Yao, Jianhua; Liu, Jiamin; Turkbey, Evrim; Summers, Ronald M.

2014-03-01

364

Novel imaging modalities for lymph node imaging in urologic oncology.  

PubMed

Accurate lymph node staging in genitourinary (GU) malignancies is important for planning an appropriate treatment and establishing an accurate prognosis. This article discusses the novel imaging techniques for detection of metastases in various GU malignancies, including prostate, bladder, penile, and testicular cancers. Discussion includes nuclear medicine techniques of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), (11)C-choline and (18)F-choline PET/CT, and ProstaScint scanning, as well as sentinel lymph node mapping. Magnetic resonance (MR) techniques include lymphotropic nanoparticle-enhanced MR imaging and diffusion-weighted MR imaging. PMID:22045178

Chernyak, Victoria

2011-11-01

365

Imaging in assessing lymph node status in gastric cancer  

Microsoft Academic Search

Background  Accurate assessment of lymph node status is of crucial importance for appropriate treatment planning and determining prognosis\\u000a in patients with gastric cancer. The aim of this study was to systematically review the current role of imaging in assessing\\u000a lymph node (LN) status in gastric cancer.\\u000a \\u000a \\u000a \\u000a Methods  A systematic literature search was performed in the PubMed\\/MEDLINE and Embase databases. The methodological quality

Robert Michael Kwee; Thomas Christian Kwee

2009-01-01

366

Pathology Case Study: Enlarged Left Inguinal Lymph Node  

NSDL National Science Digital Library

The Department of Pathology at the University of Pittsburgh Medical Center has compiled a wide range of pathology case studies to aid students and instructors in the medical/health science field. This case involves the diagnosis of a fifty-nine year old female with an enlarged inguinal lymph node. Both gross and microscopic descriptions and images of the lymph node are provided to aid in the diagnosis of the patient. The final diagnosis is included, which allows students to check their own conclusions. This is an excellent resource for providing students experience with patient history, lab results and diagnostics.

Nine, Jeff S.

2007-11-26

367

Axillary Meristems and the Development of Epicormic Buds in Wollemi Pine (Wollemia nobilis)  

PubMed Central

Intact trees of Wollemia nobilis Jones, Hill and Allen (Araucariaceae) routinely develop multiple coppice shoots as well as orthotropic epicormic shoots that become replacement or additional leaders. As these are unusual architectural features for the Araucariaceae, an investigation was made of the axillary meristems of the main stem and their role in the production of epicormic and possibly coppice shoots. Leaf axils, excised from the apex to the base of 2?m?high W. nobilis plants (seedling origin, ex situ grown), were examined anatomically. Small, endogenous, undifferentiated (no leaf primordia, no vascular or provascular connections) meristems were found in the axils from near the shoot apex. In the more proximal positions about half the meristems sampled did not differentiate further, but became tangentially elongated to compensate for increases in stem diameter. In the remaining axils the meristems slowly developed into bud primordia, although these buds usually developed few leaf primordia and their apical ‘domes’ were wide and flat. Associated vascular development was generally restricted to provascular dedifferentiation of the cortical parenchyma, with the procambium usually forming a ‘closed loop’ that did not extend back to the secondary vascular tissues. Development of the meristems was very uneven with adjacent axils often at widely differing stages of development into buds. The study shows that, unlike most conifers, W. nobilis possesses long?lived meristematic potential in most, if not all, leaf axils. Unlike other araucarias that have been investigated, many of the meristems in the orthotropic main stem will slowly develop into bud primordia beneath the bark in intact plants. It appears likely that this slow but continued development provides a ready source of additional or replacement leaders and thus new branches and leaves. PMID:14612379

BURROWS, G. E.; OFFORD, C. A.; MEAGHER, P. F.; ASHTON, K.

2003-01-01

368

Intraoperative identification of esophageal sentinel lymph nodes with near-infrared fluorescence imaging  

PubMed Central

Objective In esophageal cancer, selective removal of involved lymph nodes could improve survival and limit complications from extended lymphadenectomy. Mapping with vital blue dyes or technetium Tc-99m often fails to identify intrathoracic sentinel lymph nodes. Our purpose was to develop an intraoperative method for identifying sentinel lymph nodes of the esophagus with high-sensitivity near-infrared fluorescence imaging. Methods Six Yorkshire pigs underwent thoracotomy and received submucosal, esophageal injection of quantum dots, a novel near-infrared fluorescent lymph tracer designed for retention in sentinel lymph nodes. Six additional pigs underwent thoracotomy and received submucosal esophageal injection of CW800 conjugated to human serum albumin, another novel lymph tracer designed for uptake into distant lymph nodes. Finally, 6 pigs received submucosal injection of the fluorophore-conjugated albumin with an endoscopic needle through an esophagascope. These lymph tracers fluoresce in the near-infrared, permitting visualization of migration to sentinel lymph nodes with a custom intraoperative imaging system. Results Injection of the near-infrared fluorescent lymph tracers into the esophagus revealed communicating lymph nodes within 5 minutes of injection. In all 6 pigs that received quantum dot injection, only a single sentinel lymph node was identified. Among pigs that received fluorophore-conjugated albumin injection, in 5 o f 12 a single sentinel lymph node was revealed, but in 7 o f 12 two sentinel lymph nodes were identified. There was no dominant pattern in the appearance of the sentinel lymph nodes either cranial or caudal to the injection site. Conclusion Near-infrared fluorescence imaging of sentinel lymph nodes is a novel and reliable intraoperative technique with the power to assist with identification and resection of esophageal sentinel lymph nodes. PMID:15821653

Parungo, Cherie P.; Ohnishi, Shunsuke; Kim, Sang-Wook; Kim, Sunjee; Laurence, Rita G.; Soltesz, Edward G.; Chen, Frederick Y.; Colson, Yolonda L.; Cohn, Lawrence H.; Bawendi, Moungi G.; Frangioni, John V.

2005-01-01

369

Feasibility of an endoscopic approach to the axillary nerve and the nerve to the long head of the triceps brachii with the help of the Da Vinci Robot.  

PubMed

Surgery to transfer the axillary nerve and the nerve of the long head of the triceps presents two obstacles: 1) the access portals are not standardized and 2) the nerves are for their larger part approached through large incisions. The goal of this study was to explore the feasibility of an endoscopic microsurgical approach. The posterior aspect of a cadaver shoulder was approached through three communicating mini-incisions. The Da Vinci robot camera was installed on a central trocart, and the instrument arms on the adjacent trocarts. A gas insufflation distended the soft tissues up to the lateral axillary space. The branches of the axillary nerve and the nerve to the long head of the triceps brachii muscle were identified. The dissection of the axillary nerve trunk and its branches was easy. The posterior humeral circumflex veins and artery were dissected as well without any difficulty. Finding the nerve to the long head of the triceps brachii was found to be more challenging because of its deeper location. Robots properties allow performing conventional microsurgery: elimination of the physiologic tremor and multiplication of the movements. They also facilitate the endoscopic approach of the peripheral nerves, as seen in our results on the terminal branches of the axillary nerve and the nerve to the long head of the triceps brachii. PMID:23867724

Porto de Melo, P M; Garcia, J C; Montero, E F de Souza; Atik, T; Robert, E-G; Facca, S; Liverneaux, P-A

2013-09-01

370

Proposed Lymph Node Staging System Using the International Consensus Guidelines for Lymph Node Levels Is Predictive for Nasopharyngeal Carcinoma Patients From Endemic Areas Treated With Intensity Modulated Radiation Therapy  

SciTech Connect

Purpose: To propose a lymph node (N) staging system for nasopharyngeal carcinoma (NPC) based on the International Consensus Guidelines for lymph node (LN) levels and MRI-determined nodal variables. Methods and Materials: The MRI scans and medical records of 749 NPC patients receiving intensity modulated radiation therapy with or without chemotherapy were retrospectively reviewed. The prognostic significance of nodal level, laterality, maximal axial diameter, extracapsular spread, necrosis, and Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) size criteria were analyzed. Results: Nodal level and laterality were the only independent prognostic factors for distant failure and disease failure in multivariate analysis. Compared with unilateral levels Ib, II, III, and/or Va involvement (hazard ratio [HR] 1), retropharyngeal lymph node involvement alone had a similar prognostic value (HR 0.71; 95% confidence interval [CI] 0.43-1.17; P=.17), whereas bilateral levels Ib, II, III, and/or Va involvement (HR 1.65; 95% CI 1.06-2.58; P=.03) and levels IV, Vb, and/or supraclavicular fossa involvement (HR 3.47; 95% CI 1.92-6.29; P<.01) both significantly increased the HR for distant failure. Thus we propose that the N category criteria could be revised as follows: N0, no regional LN metastasis; N1, retropharyngeal lymph node involvement, and/or unilateral levels Ib, II, III, and/or Va involvement; N2, bilateral levels Ib, II, III, and/or Va involvement; N3, levels IV, Vb, and/or supraclavicular fossa involvement. Compared with the 7th edition of the UICC/AJCC criteria, the proposed N staging system provides a more satisfactory distinction between the HRs for regional failure, distant failure, and disease failure in each N category. Conclusions: The proposed N staging system defined by the International Consensus Guidelines and laterality is predictive and practical. However, because of no measurements of the maximal nodal diameter on MRI slices, the prognostic significance of LN size needs further evaluation.

Li, Wen-Fei; Sun, Ying; Mao, Yan-Ping; Chen, Lei; Chen, Yuan-Yuan; Chen, Mo [Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China)] [Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China); Liu, Li-Zhi [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China)] [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China); Lin, Ai-Hua [Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou (China)] [Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou (China); Li, Li [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China)] [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China); Ma, Jun, E-mail: majun2@mail.sysu.edu.cn [Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China)] [Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China)

2013-06-01

371

Anatomical retroperitoneoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors: Initial operative experience  

PubMed Central

To introduce the technique of anatomical retroperitoneoscopic retroperitoneal lymph node dissection (ARRPLND) was performed in 12 consecutive patients with a clinical stage I nonseminomatous germ-cell tumor (NSGCT) between February 2008 and October 2010. All procedures were performed using a modified template nerve-sparing approach. The retroperitoneal space was adequately expanded using double gasbags. After the retroperitoneal fat was cleared, two relatively bloodless planes were entered consecutively to expose the lymph node and permit dissection. Dissection proceeded first in the plane between the anterior renal fascia and posterior peritoneum, and secondly in the avascular plane between the posterior renal fascia and transversalis fascia. The proximal spermatic vein was clipped at the initial stage. En bloc resection of the lymph tissue and fat between the anterior renal fascia and posterior renal fascia were performed. Three patients (25%) had pathologic stage IIA disease and received adjuvant chemotherapy. No recurrence was observed during follow-up ranging from 26 to 58 months. The median operative time was 205 min (range: 165–430 min) and median estimated blood loss was 320 ml (range: 100–1200 ml). There were two intraoperative complications (Clavien grade II) and one open conversion due to perforation of the peritoneum. Postoperative complications (Clavien I) developed in three patients. Normal antegrade ejaculation recovered by 1 month following the operation. Our preliminary results indicate that ARRPLND is technically feasible and associated with satisfactory clinical outcomes for clinical stage I NSGCT. Further studies are necessary to evaluate this technique. PMID:24369147

Yao, Kai; Li, Zai-Shang; Zhou, Fang-Jian; Qin, Zi-Ke; Liu, Zhuo-Wei; Li, Yong-Hong; Han, Hui

2014-01-01

372

Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis†  

PubMed Central

OBJECTIVES Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. METHODS From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). RESULTS The mean postoperative follow-up period was 12.5 (range: 1–24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. CONCLUSIONS Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis. PMID:23442937

Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Vanni, Camilla; Venuta, Federico; Rendina, Erino Angelo

2013-01-01

373

Effects of carbon ion beam irradiation on the shoot regeneration from in vitro axillary bud explants of the Impatiens hawkeri  

NASA Astrophysics Data System (ADS)

Accelerated ion beams is an excellent mutagen in plant breeding which can induce higher mutation frequencies and wider mutation spectrum than those of low linear energy transfer (LET) irradiations, such as X-rays (Okamura et al. 2003, Yamaguchi et al. 2003). Mutation breeding operation of two Saintpaulia ionahta cultivars using the method combining plant tissue culture technique and carbon ion beam irradiations were set out at Institute of Modern Physics from 2005 (Zhou et al. 2006). The effects of 960 MeV carbon ion beam and 8 MeV X-ray irradiations on regenerated shoots of Impatiens hawkeri from another kind of explants named in vitro axillary buds explants were studied recently. The biology endpoints in this study included relative number of roots (RNR), relative length of roots (RLR), relative height of shoots (RHS), relative number of nodes (RNN), survival fraction (SF) and morphology changes in the regenerated shoots. The experimental results showed that carbon ion beams inhibited the root and stem developments of axillary bud explants more severely than X-rays did. And the 50% lethal dose (LD50 ) is about 23.3 Gy for the carbon ion beam and 49.1 Gy for the X-rays, respectively. Relative biological effectiveness (RBE) of Impatiens hawkeri with respect to X-rays according to 50% SF was about two. Secondly, the percentage of shoots regenerated with malformed shoots including curliness, carnification, nicks in all Impatiens hawkeri axillary bud explants irradiated with carbon ion beam at 20 Gy accounted for 55.6%, while the highest number for the 40 Gy X-ray irradiation was 40%. Last, many regenerated shoots whose vascular bundle fused together were obtained only from explants irradiated with carbon ion beams. Based on the results above, it can be concluded that the effect of mutation induction by carbon ion beam irradiation on the axillary explants of Impatiens hawkeri is better than that by X-ray irradiation; and the optimal mutagenic dose varies from 20 Gy for carbon ion beam irradiation.

Zhou, Libin; Zhou, Libin; Li, Wenjian; Li, Ping; Dong, Xicun; Qu, Ying; Ma, Shuang; Li, Qiang

374

Aminobisphosphonates prevent the inhibitory effects exerted by lymph node stromal cells on anti-tumor V? 2 T lymphocytes in non-Hodgkin lymphomas  

PubMed Central

In this study, we analyzed the influence of mesenchymal stromal cells derived from lymph nodes of non-Hodgkin’s lymphomas, on effector functions and differentiation of Vdelta (?)2 T lymphocytes. We show that: i) lymph-node mesenchymal stromal cells of non-Hodgkin’s lymphoma inhibit NKG2D-mediated lymphoid cell killing, but not rituximab-induced antibody-dependent cell-mediated cytotoxicity, exerted by V?2 T lymphocytes; ii) pre-treatment of mesenchymal stromal cells with the aminobisphosphonates pamidronate or zoledronate can rescue lymphoma cell killing via NKG2D; iii) this is due to inhibition of transforming growth factor-? and increase in interleukin-15 production by mesenchymal stromal cells; iv) aminobisphosphonate-treated mesenchymal stromal cells drive V?2 T-lymphocyte differentiation into effector memory T cells, expressing the Thelper1 cytokines tumor necrosis factor-? and interferon-?. In non-Hodgkin’s lymphoma lymph nodes, V?2 T cells were mostly naïve; upon co-culture with autologous lymph-node mesenchymal stromal cells exposed to zoledronate, the percentage of terminal differentiated effector memory V?2 T lymphocytes increased. In all non-Hodgkin’s lymphomas, low or undetectable transcription of Thelper1 cytokines was found. In diffused large B-cell lymphomas and in a group of follicular lymphoma, transcription of transforming growth factor ? and interleukin-10 was enhanced compared to non-neoplastic lymph nodes. Thus, in non-Hodgkin lymphomas mesenchymal stromal cells interfere with V?2 T-lymphocyte cytolytic function and differentiation to Thelper1 and/or effector memory cells, depending on the prominent in situ cytokine milieu. Aminobisphosphonates, acting on lymph-node mesenchymal stromal cells, can push the balance towards Thelper1/effector memory and rescue the recognition and killing of lymphoma cells through NKG2D, sparing rituximab-induced antibody-dependent cell-mediated cytotoxicity. PMID:24162786

Musso, Alessandra; Catellani, Silvia; Canevali, Paolo; Tavella, Sara; Vene, Roberta; Boero, Silvia; Pierri, Ivana; Gobbi, Marco; Kunkl, Annalisa; Ravetti, Jean-Louis; Zocchi, Maria Raffaella; Poggi, Alessandro

2014-01-01

375

Aminobisphosphonates prevent the inhibitory effects exerted by lymph node stromal cells on anti-tumor V? 2 T lymphocytes in non-Hodgkin lymphomas.  

PubMed

In this study, we analyzed the influence of mesenchymal stromal cells derived from lymph nodes of non-Hodgkin's lymphomas, on effector functions and differentiation of Vdelta (?)2 T lymphocytes. We show that: i) lymph-node mesenchymal stromal cells of non-Hodgkin's lymphoma inhibit NKG2D-mediated lymphoid cell killing, but not rituximab-induced antibody-dependent cell-mediated cytotoxicity, exerted by V?2 T lymphocytes; ii) pre-treatment of mesenchymal stromal cells with the aminobisphosphonates pamidronate or zoledronate can rescue lymphoma cell killing via NKG2D; iii) this is due to inhibition of transforming growth factor-? and increase in interleukin-15 production by mesenchymal stromal cells; iv) aminobisphosphonate-treated mesenchymal stromal cells drive V?2 T-lymphocyte differentiation into effector memory T cells, expressing the Thelper1 cytokines tumor necrosis factor-? and interferon-?. In non-Hodgkin's lymphoma lymph nodes, V?2 T cells were mostly naïve; upon co-culture with autologous lymph-node mesenchymal stromal cells exposed to zoledronate, the percentage of terminal differentiated effector memory V?2 T lymphocytes increased. In all non-Hodgkin's lymphomas, low or undetectable transcription of Thelper1 cytokines was found. In diffused large B-cell lymphomas and in a group of follicular lymphoma, transcription of transforming growth factor ? and interleukin-10 was enhanced compared to non-neoplastic lymph nodes. Thus, in non-Hodgkin lymphomas mesenchymal stromal cells interfere with V?2 T-lymphocyte cytolytic function and differentiation to Thelper1 and/or effector memory cells, depending on the prominent in situ cytokine milieu. Aminobisphosphonates, acting on lymph-node mesenchymal stromal cells, can push the balance towards Thelper1/effector memory and rescue the recognition and killing of lymphoma cells through NKG2D, sparing rituximab-induced antibody-dependent cell-mediated cytotoxicity. PMID:24162786

Musso, Alessandra; Catellani, Silvia; Canevali, Paolo; Tavella, Sara; Venè, Roberta; Boero, Silvia; Pierri, Ivana; Gobbi, Marco; Kunkl, Annalisa; Ravetti, Jean-Louis; Zocchi, Maria Raffaella; Poggi, Alessandro

2014-01-01

376

Radiotherapy of Internal Mammary Lymph Nodes in Breast Cancer  

Microsoft Academic Search

Background: Radiotherapy of internal mammary lymph nodes (IMN) in breast cancer is discussed controversially due to its potential toxicity and debatable efficacy. Aim of the present study was to assess the cardiac and lung dose in 3-D planned radiotherapy and to discuss these results with regard to arguments pro and contra IMN irradiation. Patients and Methods: 32 patients underwent 3-D

Marie-Luise Sautter-Bihl; Beatrix Hültenschmidt; Ute Melcher; Hans Ulrich Ulmer

2002-01-01

377

Sentinel Lymph Node - Work Hypothesis in Sinonasal Carcinoma Treatment  

PubMed Central

ABSTRACT Although rare, sinonasal malignancies (SNM) can be lesions of immense importance. Approximately 60-70% of sinonasal malignancies (SNM) occur in the maxillary sinus and 20-30% occurs in the nasal cavity itself. The lymphatic drainage of the sinuses and nasal cavity include levels I-III as well as the parapharyngian nodes. Elective regional lymph node dissections became controversial because of overtreatment of the many patients without lymph node metastases. Lymphatic metastasis is the most important mechanism of spread in sinonasal squamous cell carcinoma considering the vast network of vessels in this area. The indications and type of neck dissection to be performed in the positive node neck and management of the N0 neck remain controversial. The sentinel lymph node concept is based on the Halsted theory that stressed the importance of locoregional cancer treatment because of the far site spread. Each patient with head and neck malignancies, including sinonasal carcinoma have about 2-3 sentinel lymph nodes of which up to 40% of them contain metastases. PMID:22879846

ENE, Patricia; POPESCU, Radu Cristian; VOICULESCU, Stefan; SCAUNASU, Razvan; POPESCU, Bogdan; GRIGORE, Raluca; ENE, Razvan; CARSTOIU, Catalin

2011-01-01

378

A Spatially-Organized Multicellular Innate Immune Response in Lymph  

E-print Network

inflammasome-generated IL-18 and addi- tional cytokine signals from the pathogen-sensing phagocytes. This leads spread of lymph- borne bacteria. These findings extend our under- standing of the functional significance the rapid acquisition of viruses and nano-particles by SCS macrophages and the transfer of some undegraded

379

Diagnostic Features and Subtyping of Thymoma Lymph Node Metastases  

PubMed Central

Aim. The purpose of the present study was to characterize the morphological features of thymoma metastases in lymph nodes and to evaluate the possibility of their subtyping according to the 2004 WHO classification of thymus tumors. Materials and Methods. We reviewed 210 thymoma cases in our series of thymic epithelial tumors (TET), including their recurrences and lymphogenous metastases. Three cases of lymph node metastases, one case occurring synchronously with the primary tumor and one synchronously with the first relapse (both in intrathoracic location) and one case of metastasis observed in a laterocervical lymph node subsequently to two thymoma relapses were found. Results. The metastatic nodes were variably but extensively involved in all cases. The histological features were similar in both primary tumors and metastases. Thymoma metastases were subtyped according to the WHO classification as B3 (one case) and B2 (two cases), and distinctive features in comparison to metastatic epithelial neoplasias from other sites were observed. Conclusion. Thymoma lymph node metastases, although rare, can be subtyped according to the WHO classification on the basis of their morphological and immunohistochemical features. Clinically, the presence of nodal metastases may herald subsequent relapses and further metastases even in extrathoracic sites. PMID:25105128

Sioletic, Stefano; Lauriola, Libero; Martucci, Robert; Evoli, Amelia; Palmieri, Giovannella; Melis, Enrico; Rinaldi, Massimo; Lalle, Maurizio; Pescarmona, Edoardo; Granone, Pierluigi; Facciolo, Francesco

2014-01-01

380

Principles of sentinel lymph node identification: background and clinical implications  

Microsoft Academic Search

The management of clinically negative regional lymph nodes in early-stage melanoma has been controversial for many years. While some advocate wide excision of the primary with elective node dissection (ELND), others recommend excision of the primary alone and therapeutic node dissection (TLND) for recurrences in the nodal basin. ELND is based on the concept that metastases occur by passage of

Alistair J. Cochran; Richard Essner; D. Michael Rose; Edwin C. Glass

2000-01-01

381

Prostanoid induces premetastatic niche in regional lymph nodes.  

PubMed

The lymphatic system is an important route for cancer dissemination, and lymph node metastasis (LNM) serves as a critical prognostic determinant in cancer patients. We investigated the contribution of COX-2-derived prostaglandin E2 (PGE2) in the formation of a premetastatic niche and LNM. A murine model of Lewis lung carcinoma (LLC) cell metastasis revealed that COX-2 is expressed in DCs from the early stage in the lymph node subcapsular regions, and COX-2 inhibition markedly suppressed mediastinal LNM. Stromal cell-derived factor-1 (SDF-1) was elevated in DCs before LLC cell infiltration to the lymph nodes, and a COX-2 inhibitor, an SDF-1 antagonist, and a CXCR4 neutralizing antibody all reduced LNM. Moreover, LNM was reduced in mice lacking the PGE2 receptor EP3, and stimulation of cultured DCs with an EP3 agonist increased SDF-1 production. Compared with WT CD11c+ DCs, injection of EP3-deficient CD11c+ DCs dramatically reduced accumulation of SDF-1+CD11c+ DCs in regional LNs and LNM in LLC-injected mice. Accumulation of Tregs and lymph node lymphangiogenesis, which may influence the fate of metastasized tumor cells, was also COX-2/EP3-dependent. These results indicate that DCs induce a premetastatic niche during LNM via COX-2/EP3-dependent induction of SDF-1 and suggest that inhibition of this signaling axis may be an effective strategy to suppress premetastatic niche formation and LNM. PMID:25271626

Ogawa, Fumihiro; Amano, Hideki; Eshima, Koji; Ito, Yoshiya; Matsui, Yoshio; Hosono, Kanako; Kitasato, Hidero; Iyoda, Akira; Iwabuchi, Kazuya; Kumagai, Yuji; Satoh, Yukitoshi; Narumiya, Shuh; Majima, Masataka

2014-11-01

382

Lymph node metastasis in nasal vestibule cancer: A review  

Microsoft Academic Search

BACKGROUND: Squamous cell carcinoma of the nasal vestibule (SCCNV) is an uncommon malignancy. Our purpose is to define the incidence of simultaneous and delayed regional metastasis in SCCNV according to the available literature. METHODS: Articles discussing SCCNV and addressing the issue of regional lymph node metastases were reviewed. CONCLUSION: SCCNV is an uncommon form of cancer, possibly originating in the

Y. P. Talmi; A. Ferlito; R. P. Takes; P. Strojan; J. A. Langendijk; A. R. Shaha; A. Rinaldo

2011-01-01

383

Staging lymph node metastases from lung cancer in the mediastinum  

PubMed Central

Background The presence of tumor metastases in the mediastinum is one of the most important elements in determining the optimal treatment strategy in patients with non-small cell lung cancer. This review is aimed at examining the current strategies for investigating lymph node metastases corresponding to an “N2” classification delineated by The International Staging Committee of the International Association for the Study of Lung Cancer (IASLC). Methods Extensive review of the existing scientific literature related to the investigation of mediastinal lymph node metastases was undertaken in order to summarize and report current best practices. Conclusions N2 disease is very heterogeneous requiring multiple modalities for thorough investigation. New research is now focusing on better identifying, defining, and classifying lymph node metastases in the mediastinum. Molecular staging and sub-classifying mediastinal lymph node metastases are being actively researched in order to provide better prognostic value and to optimize treatment strategies. Non-invasive imaging, such as PET/CT and minimally invasive techniques such as endobronchial and endoscopic ultrasound guided biopsy, are now the lead investigative methods in evaluating the mediastinum for metastatic presence. PMID:24624287

Teran, Mario D.

2014-01-01

384

False negative rate of sentinel lymph node biopsy in multicentric and multifocal breast cancers may be higher in cases with large additive tumor burden.  

PubMed

We aimed to evaluate the feasibility of sentinel lymph node biopsy (SLNB) in multicentric/ multifocal breast cancer. In this prospective study, 23 women with multicentric/multifocal breast cancer underwent SLNB at our institution from April 2002 to February 2006. Presence of preoperative axillary metastases was confirmed by FNA. Patients underwent sub-areolar radiopharmaceutical injection +/- isosulfan blue to perform SLNB, then completion ALND. The false-negative (FN) rate of SLNB was determined based upon final pathology. Twenty women with multicentric and three with multifocal invasive carcinoma were enrolled. The SLN identification rate was 100%. The overall FN rate of SLNB was 15% (95% CI 0.0466, 0.4281). Both cases with FN SLNB had multicentric disease, pathologic stage III breast cancer and a larger tumor burden compared with the study population. SLNB using sub-areolar injection is feasible for patients with multicentric/multifocal breast cancer yet may be associated with a higher FN rate in patients with large additive tumor burden. PMID:19735388

Fearmonti, Regina M; Batista, Larissa I; Meric-Bernstam, Funda; Bedrosian, Isabelle; Kuerer, Henry M; Hunt, Kelly K; Eva Singletary, S; Babiera, Gildy V

2009-01-01

385

Evaluation of metastatic celiac axis lymph nodes in patients with esophageal carcinoma: accuracy of EUS  

Microsoft Academic Search

Background: Endosonography (EUS) is the most accurate modality for assessing depth of tumor invasion and local lymph node metastasis. However, its accuracy in the identification of metastatic (celiac axis) lymph nodes is less well defined. Our Objective In This Study Was To Determine The Accuracy Of Eus In Detecting Celiac Axis Lymph Node Metastasis In Patients With Esophageal Carcinoma. Methods:

Marc F. Catalano; Eduardo Alcocer; Amitabh Chak; Cuong C. Nguyen; Isaac Raijman; Joseph E. Geenen; Sandeep Lahoti; Michael V. Sivak

1999-01-01

386

Changes after Decapitation in Concentrations of Indole-3-Acetic Acid and Abscisic Acid in the Larger Axillary Bud of Phaseolus vulgaris L. cv Tender Green 1  

PubMed Central

Early changes in the concentrations of indole-3-acetic acid (IAA) and abscisic acid (ABA) were investigated in the larger axillary bud of 2-week-old Phaseolus vulgaris L. cv Tender Green seedlings after removal of the dominant apical bud. Concentrations of these two hormones were measured at 4, 6, 8, 12 and 24 hours following decapitation of the apical bud and its subtending shoot. Quantitations were accomplished using either gas chromatography-mass spectrometry-selected ion monitoring (GS-MS-SIM) with [13C6]-IAA or [2H6]-ABA as quantitative internal standards, or by an indirect enzyme-linked immunosorbent assay, validated by GC-MS-SIM. Within 4 hours after decapitation the IAA concentration in the axillary bud had increased fivefold, remaining relatively constant thereafter. The concentration of ABA in axillary buds of decapitated plants was 30 to 70% lower than for buds of intact plants from 4 to 24 hours following decapitation. Fresh weight of buds on decapitated plants had increased by 8 hours after decapitation and this increase was even more prominent by 24 hours. Anatomical assessment of the larger axillary buds at 0, 8, and 24 hours following decapitation showed that most of the growth was due to cell expansion, especially in the intermodal region. Thus, IAA concentration in the axillary bud increases appreciably within a very few hours of decapitation. Coincidental with the rise in IAA concentration is a modest, but significant reduction in ABA concentration in these axillary buds after decapitation. Images Figure 4 Figure 6 PMID:16667989

Gocal, Greg F. W.; Pharis, Richard P.; Yeung, Edward C.; Pearce, David

1991-01-01

387

18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography-Positive Lymph Node Endometriosis Masquerading as Lymph Node Metastasis of a Malignant Tumor  

PubMed Central

Endometriosis is defined as the presence of endometrium-like tissues at extrauterine sites, most commonly in the abdominal cavity. Lymph node endometriosis is a rare but clinically important type of endometriosis that can mimic lymph node metastasis of a malignant tumor. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a useful tool for diagnosing malignant tumors, although it occasionally shows false positive results in tissues with high metabolic activity caused by severe inflammation. In the present report, we describe a case of lymph node endometriosis that mimicked lymph node metastasis of a malignant tumor and showed a positive result on 18F-FDG PET/CT. The findings of the present case suggest that lymph node endometriosis could present as swollen lymph nodes with 18F-FDG PET/CT-positive results and provide important information for determining an appropriate treatment strategy.

Mori, Taisuke; Matsushima, Hiroshi; Sawada, Morio

2014-01-01