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

Microsoft Academic Search

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

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



Axillary Lymph Nodes and Breast Cancer  


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


Axillary lymph node analysis using Raman spectroscopy  

NASA Astrophysics Data System (ADS)

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

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



Axillary recurrence after sentinel lymph node biopsy  

Microsoft Academic Search

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

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



Axillary recurrence after negative sentinel lymph node biopsy  

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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



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


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

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



Percutaneous tattoo pigment simulating calcific deposits in axillary lymph nodes  

PubMed Central

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

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



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

PubMed Central

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

Nitsche, Mirko; Hermann, Robert



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

Microsoft Academic Search

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

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


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



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

Microsoft Academic Search

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

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



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

PubMed Central

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



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

PubMed Central

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



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


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

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



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


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

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



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


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

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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



Automatic detection and segmentation of axillary lymph nodes.  


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

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



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


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

Sauer, Torill; Suciu, Voichita



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



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

NASA Astrophysics Data System (ADS)

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

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



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

PubMed Central

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

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



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

NASA Astrophysics Data System (ADS)

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

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



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

PubMed Central

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

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



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

PubMed Central

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



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

Microsoft Academic Search

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

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



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


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

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


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


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

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



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

Microsoft Academic Search

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

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



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.




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

PubMed Central

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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



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


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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



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:; 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)



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

PubMed Central

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

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



Optimization of a gamma imaging probe for axillary sentinel lymph mapping  

NASA Astrophysics Data System (ADS)

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

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



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


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



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

PubMed Central

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

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



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


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

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



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

PubMed Central

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

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



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

PubMed Central

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



Dedicated PET Scanner for Axillary Node Imaging.  

National Technical Information Service (NTIS)

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

S. Cherry



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

Microsoft Academic Search

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

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



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


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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



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


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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



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


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

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



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


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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



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



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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


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

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



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

PubMed Central

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

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



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


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

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



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


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

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



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

PubMed Central

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

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



Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer  

Microsoft Academic Search

The diagnosis of a lymph node-negative colorectal carcinoma should imply a good prognosis; however, the outcomes for TNM stage II patients remain variable. Few studies have examined the relationship of the number of lymph nodes examined to the prognosis of this stage. The aim of this study was to determine whether the number of lymph nodes examined has an effect

Leopoldo Sarli; Giovanni Bader; Domenico Iusco; Carlo Salvemini; Davide Di Mauro; Antonio Mazzeo; Gabriele Regina; Luigi Roncoroni



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

PubMed Central

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

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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



Predictors of nonsentinel lymph node metastasis in breast cancer patients  

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



Axillary Web Syndrome after Sentinel Node Biopsy  

PubMed Central

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

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



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

PubMed Central

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

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



Axillary staging of breast cancer and the sentinel node  

PubMed Central

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

Cserni, G



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

Microsoft Academic Search

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

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



Pathology Case Study: Enlarged Axillary Lymph Node  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 73 year old female who had a history of thyroidectomy for benign nodules who presented with a lump in her thyroidectomy scar. Visitors are given a patient history, microscopic description, and immunohistochemistry, including images. They are also given an opportunity to diagnose the patient before clicking on the "Final Diagnosis" section, which provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopatholgy.

Contis, Lydia C.; Peng, Yan



Near-infrared fluorescent type II quantum dots for sentinel lymph node mapping  

PubMed Central

The use of near-infrared or infrared photons is a promising approach for biomedical imaging in living tissue1. This technology often requires exogenous contrast agents with combinations of hydrodynamic diameter, absorption, quantum yield and stability that are not possible with conventional organic fluorophores. Here we show that the fluorescence emission of type II2,3 quantum dots can be tuned into the near infrared while preserving absorption cross-section, and that a polydentate phosphine coating renders them soluble, disperse and stable in serum. We then demonstrate that these quantum dots allow a major cancer surgery, sentinel lymph node mapping4–6, to be performed in large animals under complete image guidance. Injection of only 400 pmol of near-infrared quantum dots permits sentinel lymph nodes 1 cm deep to be imaged easily in real time using excitation fluence rates of only 5 mW/cm2. Taken together, the chemical, optical and in vivo data presented in this study demonstrate the potential of near-infrared quantum dots for biomedical imaging.

Kim, Sungjee; Lim, Yong Taik; Soltesz, Edward G; De Grand, Alec M; Lee, Jaihyoung; Nakayama, Akira; Parker, J Anthony; Mihaljevic, Tomislav; Laurence, Rita G; Dor, Delphine M; Cohn, Lawrence H; Bawendi, Moungi G; Frangioni, John V



Impact on Prognosis of Lymph Node Micrometastasis and Isolated Tumor Cells in Stage II Colorectal Cancer  

PubMed Central

Purpose Even though the importance of micrometastases (MMS) and isolated tumor cells (ITC) has been brought up by many physicians, its impact on the prognosis in stage II colorectal cancer is uncertain. In this research, we tried to investigate the clinical features of MMS and ITC and to prove any correlation with prognosis. Methods The research pool was 124 colorectal cancer patients who underwent a curative resection from April 2005 to November 2009. A total of 2,379 lymph nodes (LNs) were examined, and all retrieved LNs were evaluated by immunohistochemical staining with anti-cytokeratin antibody panel. Clinicopathologic parameters and survival rates were compared based on the presence of MMS or ITC and on the micrometastatic lymph node ratio (mmLNR), which is defined as the number of micrometastatic LNs divided by the number of retrieved LNs. Results Out of 124 patients (26.6%) 33 were found to have MMS or ITC. There were no significant differences in clinicopathologic features, such as gender, tumor location and size, depth of invasion, histologic grade, except for age (P = 0.04). The three-year disease-free survival rate for the MMS or ITC positive group was 85.7%, and that for MMS and ITC negative group was 92.8% (P = 0.209). The three-year disease-free survival rate for the mmLNR > 0.25 group was 73.3%, and that for the mmLNR ? 0.25 group was 92.9% (P = 0.03). Conclusion The presence of MMS or ITC was not closely correlated to the prognosis. However, mmLNR is thought to be a valuable marker of prognosis in cases of stage II colorectal cancer.

Oh, Tai Young; Shin, Ui Sup; Lee, Hyang Ran; Park, Sun Hoo



Rare axillary metastasis from squamous cell carcinoma of the tonsil.  


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

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



Axillary skin: biology and care.  


In skin care, the axilla is a biologically unique site requiring specialized attention and care. This area of skin is often subject to hair removal techniques, such as shaving and plucking. These procedures damage the skin leading to erythema and dryness in the short term, and in some cases, post-inflammatory hyperpigmentation (PIHP) in the long term. This study will (i) briefly review the biology and unique properties of axillary skin, and (ii) describe the characteristics of the irritation and damage induced by contemporary skin care habits and resolution of these responses by the use of efficacious skin moisturizing technology. With respect to the latter, we propose that there are five groups of compounds, defined according to their mechanism of action, which are particularly relevant to the care of damaged axillary skin. PMID:22612735

Evans, R L; Marriott, R E; Harker, M



18 F-FDG PET in A Clinical Unsuspected Axillary Tuberculous Lymphadenitis Mimicking Malignancy  

Microsoft Academic Search

Isolated axillary tuberculous lymphadenitis is rare. We present a 33-year-old female who had palpable right axillary masses without remarkable clinical symptom. Ultrasound examination of breast and abdomen, mam- mography, and chest radiography were negative. 18 F- Fluorodeoxyglucose positron emission tomography (FDG-PET) study was misinterpreted as malignant dis- ease extensively involving right axillary and the sur- rounding lymph nodes, possibly metastatic

Che-Ming Yang; Chung-Huei Hsu; Chia-Ming Hsieh; Mao-Yuan Chen


Topography of the major superficial lymph nodes and their efferent lymph pathways in the koala (Phascolarctos cinereus).  

PubMed Central

The koala has an inguinoaxillary lymph trunk on either side of the ventral midline, and this carries efferent lymph from the superficial inguinal lymph node directly to the deep axillary lymph node. The superficial lymph nodes are large and soft compared with those of the domestic species, and each lymph centre usually contains only one or two large lymph nodes. Koalas have a rostral mandibular lymph node which has not been described in other species, but lack popliteal and subiliac lymph nodes. The superficial lymph nodes which are readily palpable in the live koala are the facial, rostral mandibular, mandibular, superficial axillary and superficial inguinal. All superficial lymph pathways terminate at the confluence of the common jugular and subclavian veins.

Hanger, J J; Heath, T J



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



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

Microsoft Academic Search

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

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



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


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

Goodenough, J; Martin, H; Shaaban, H



The need for lymph node dissection in nonmetastatic breast cancer.  


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

Pesce, Catherine; Morrow, Monica



Which Patients Need an Axillary Clearance after Sentinel Node Biopsy?  

PubMed Central

Sentinel lymph node biopsy (SLNB) is a safe and accurate minimally invasive method for detecting axillary lymph node (ALN) involvement in the clinically negative axilla thereby reducing morbidity in patients who avoid unnecessary axillary lymph node dissection (ALND). Although current guidelines recommend completion ALND when macro- and micrometastatic diseases are identified by SLNB, the benefit of this surgical intervention is under debate. Additionally, the management of the axilla in the presence of isolated tumour cells (ITCs) in SLNB is questioned. Particularly controversial is the prognostic significance of minimal SLNB metastasis in relation to local recurrence and overall survival. Preliminary results of the recently published Z0011 trial suggest similar outcomes after SNB or ALND when the SN is positive, but this finding has to be interpreted with caution.

Pazaiti, Anastasia; Fentiman, Ian S.



Axillary Recurrence Following Conservative Surgery and Radiotherapy in Early Breast Cancer  

Microsoft Academic Search

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

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



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



Consensus on the regional lymph nodes irradiation in breast cancer.  


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

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



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



Radioguided lymph node biopsy of a chemoresistant lymph node detected on interim FDG PET-CT in Hodgkin lymphoma  

Microsoft Academic Search

A 32-year-old male patient was diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma. Staging FDG PET-CT detected\\u000a a large right axillary lymph node conglomerate and splenic manifestation. Interim PET-CT following two cycles of ABVD chemotherapy\\u000a revealed good metabolic response with the exception of a single axillary lymph node. A second “interim” PET-CT after two further\\u000a cycles showed a similar result. A biopsy

Tamás Györke; Attila Kollár; Gyula Bottlik; Ágota Szepesi; Imre Bodó; Tamás Masszi; Viktor Bérczi; Ildikó Garai



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

PubMed Central

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

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



Computer-aided lymph node segmentation in volumetric CT data  

PubMed Central

Purpose: The purpose of this work was to develop and validate a computer-aided method for the 3D segmentation of lymph nodes in CT images. The proposed method can be utilized to facilitate applications like biopsy planning, image guided radiation treatment, or assessment of response to therapy. Methods: An optimal surface finding based lymph node segmentation method was developed. Based on the approximate center point of a lymph node of interest, a graph is generated, which represents the local neighborhood around the lymph node at discrete locations (graph nodes). A cost function is calculated based on a weighted edge and region homogeneity term. By means of optimization, a surface-based segmentation of the lymph node is derived. In addition, an interactive segmentation refinement algorithm was developed, which allows the user to quickly correct segmentation errors, if needed. For assessment of segmentation accuracy, 111 lymph nodes of mediastinum, abdomen, head/neck, and axillary regions from 35 volumetric CT scans were utilized. For accuracy analysis, lymph nodes were divided into three test sets based on lymph node size and spatial resolution of the CT scan. The average lymph node size for test set I, II, and III was 1056, 1621, and 501 mm3, respectively. Spatial resolution of test set II was lower than for test sets I and III. To generate an independent reference standard for comparison, all 111 lymph nodes were segmented by an expert with a live wire approach. Results: All test sets were segmented with the proposed approach. Out of the 111 lymph nodes, 40 cases (36%) required computer-aided refinement of initial segmentation results. The refinement typically required 10 s per lymph node. The mean and standard deviation of the Dice coefficient for final segmentations was 0.847 ± 0.061, 0.836 ± 0.058, and 0.809 ± 0.070 for test sets I, II, and II, respectively. The average signed surface distance error was 0.023 ± 0.171, 0.394 ± 0.189, and 0.001 ± 0.146 mm for test sets I, II, and II, respectively. The time required for locating the approximate center point of a target lymph node in a scan, generating an initial OSF segmentation, and refining the segmentation, if needed, is typically less than one minute. Conclusions: Segmentation of lymph nodes in volumetric CT images is a challenging task due to partial volume effects, nearby strong edges, neighboring structures with similar intensity profiles and potentially inhomogeneous density of lymph nodes. The presented approach addresses many of these obstacles. In the majority of cases investigated, the initial segmentation method delivered results that did not require further processing. In addition, the computer-aided segmentation refinement framework was found to be effective in dealing with potentially occurring segmentation errors.

Beichel, Reinhard R.; Wang, Yao



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


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

Cserni, G



Anatomy and nomenclature of murine lymph nodes: Descriptive study and nomenclatory standardization in BALB\\/cAnNCrl mice  

Microsoft Academic Search

Murine lymph nodes are intensively studied but often assigned incorrectly in scientific papers. In BALB\\/cAnNCrl mice, we characterized a total of 22 different lymph nodes. Peripheral nodes were situated in the head and neck region (mandibular, accessory mandibular, superficial parotid, cranial deep cervical nodes), and at the forelimb (proper axillary, accessory axillary nodes) and hindlimb (subiliac, sciatic, popliteal nodes). Intrathoracic

Wim Van den Broeck; Annie Derore; Paul Simoens



Axillary swelling and a reduced general condition in a middle-aged man  

Microsoft Academic Search

Background A 48-year-old man presented to his GP with an indolent swelling in his left axillary region. He also complained of a cough, a feeling of pressure in his chest, general poor health, and had increasingly suffered from night-time sweating and fever. Physical examination and an ultrasound revealed an enlarged lymph node of almost 4 cm in the left axillary

Andreas Engert; Volker Diehl; Beate Klimm



Malignant Adenomyoepithelioma of the Breast with Lymph Node Metastasis: A Detailed Immunohistochemical Study  

PubMed Central

Malignant adenomyoepithelioma of the breast is a rare tumour with around 30 cases reported in the literature. Metastases associated with these tumours are usually haematogenous. Axillary lymph node metastases are thought to be unusual, and it has been recently suggested that axillary node dissection is not indicated unless clinically palpable. We here present a case of a 63-year-old woman, who developed a malignant adenomyoepithelioma with axillary lymph node metastasis, that included epithelial and myoepithelial elements, in spite of the absence of clinically enlarged nodes. We suggest that histological examination of axillary sentinel node(s) or node sampling may be worthwhile in this condition.

Awamleh, Ahlam A.; Gudi, Mihir; Shousha, Sami



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


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

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



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

Microsoft Academic Search

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

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



Lymph Node Metastasis in Patients with Frozen Section Analyses That Are Negative for Tumors  

Microsoft Academic Search

Objectives: This study was designed to assess the necessity of delayed complete axillary lymph node dissection (cALND) for patients whose sentinel lymph nodes (SLNs) were negative for tumors on intraoperative frozen section analysis, but later proven positive on hematoxylin and eosin staining or immunohistochemistry. Methods: We identified 341 patients who underwent sentinel lymph node biopsy (SLNB) with cALND at the

Se Kyung Lee; Kyo Won Lee; Sangmin Kim; Min-Young Choi; Jiyoung Kim; Jeonghui Lee; Seung Pil Jung; Jun-Ho Choe; Jung-Han Kim; Jee Soo Kim; Jeong Eon Lee; Jung-Hyun Yang; Seok Jin Nam



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

Microsoft Academic Search

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

G. Liljegren; L. Holmberg



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

PubMed Central

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

Rashid, Omar M.; Takabe, Kazuaki



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

PubMed Central

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



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

Microsoft Academic Search

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

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


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


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

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



Radiation Therapy Field Extent for Adjuvant Treatment of Axillary Metastases From Malignant Melanoma  

SciTech Connect

Purpose: To compare treatment-related outcomes and toxicity for patients with axillary lymph node metastases from malignant melanoma treated with postoperative radiation therapy (RT) to either the axilla only or both the axilla and supraclavicular fossa (extended field [EF]). Methods and Materials: The medical records of 200 consecutive patients treated with postoperative RT for axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients received postoperative hypofractionated RT for high-risk features; 95 patients (48%) received RT to the axilla only and 105 patients (52%) to the EF. Results: At a median follow-up of 59 months, 111 patients (56%) had sustained relapse, and 99 patients (50%) had died. The 5-year overall survival, disease-free survival, and distant metastasis-free survival rates were 51%, 43%, and 46%, respectively. The 5-year axillary control rate was 88%. There was no difference in axillary control rates on the basis of the treated field (89% for axilla only vs. 86% for EF; p = 0.4). Forty-seven patients (24%) developed treatment-related complications. On both univariate and multivariate analyses, only treatment with EF irradiation was significantly associated with increased treatment-related complications. Conclusions: Adjuvant hypofractionated RT to the axilla only for metastatic malignant melanoma with high-risk features is an effective method to control axillary disease. Limiting the radiation field to the axilla only produced equivalent axillary control rates to EF and resulted in lower treatment-related complication rates.

Beadle, Beth M. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail:; Ballo, Matthew T. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Lee, Jeffrey E.; Gershenwald, Jeffrey E.; Cormier, Janice N.; Mansfield, Paul F.; Ross, Merrick I. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Zagars, Gunar K. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)



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


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

Wärnberg, F; Bundred, N



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


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

Erb, Kathleen M; Julian, Thomas B



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

PubMed Central

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

Julian, Thomas B.



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

PubMed Central

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

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



Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection?  

PubMed Central

OBJECTIVE: To determine the likelihood of nonsentinel axillary metastasis in the presence of sentinel node metastasis from a primary breast carcinoma. SUMMARY BACKGROUND DATA: Sentinel lymphadenectomy is a highly accurate technique for identifying axillary metastasis from a primary breast carcinoma. Our group has shown that nonsentinel axillary lymph nodes are unlikely to contain tumor cells if the axillary sentinel node is tumor-free, but as yet no study has examined the risk of nonsentinel nodal involvement when the sentinel node contains tumor cells. METHODS: Between 1991 and 1997, axillary lymphadenectomy was performed in 157 women with a tumor-involved sentinel node. Fifty-three axillae (33.5%) had at least one tumor-involved nonsentinel node. The authors analyzed the incidence of nonsentinel node involvement according to clinical and tumor characteristics. RESULTS: Only two variables had a significant impact on the likelihood of nonsentinel node metastasis: the size of the sentinel node metastasis and the size of the primary tumor. The rate of nonsentinel node involvement was 7% when the sentinel node had a micrometastasis (< or =2 mm), compared with 55% when the sentinel node had a macrometastasis (>2 mm). In addition, the rate of nonsentinel node tumor involvement increased with the size of the primary tumor. CONCLUSIONS: If a primary breast tumor is small and if sentinel node involvement is micrometastatic, then tumor cells are unlikely to be found in other axillary lymph nodes. This suggests that axillary lymph node dissection may not be necessary in patients with sentinel node micrometastases from T1/T2 lesions, or in patients with sentinel node metastases from T1a lesions.

Chu, K U; Turner, R R; Hansen, N M; Brennan, M B; Bilchik, A; Giuliano, A E



Axillary lymphadenopathy 17 years after digital silicone implants: study with x-ray microanalysis  

SciTech Connect

Axillary lymphadenopathy developed in a patient with rheumatoid arthritis 17 years after the placing of Swanson implants in the hand. Foreign material in the lymph nodes was identified as silicone by energy-dispersive x-ray microanalysis. This emphasizes the long latent period that may be associated with this clinical phenomenon which may mimic other, more serious, diseases.

Paplanus, S.H.; Payne, C.M.



Axillary Shoot Branching in Plants  

Microsoft Academic Search

\\u000a The yield of many crop plants is influenced by the number of axillary shoot branches they produce. Plants possess several\\u000a mechanisms to control axillary branch growth and development. Recently, tremendous progress has been achieved towards gaining\\u000a a better understanding of these mechanisms, and several novel genes have been identified which are implicated in shoot branching.\\u000a This chapter highlights recent progress

M. W. F. Yaish; D. R. Guevara; A. El-Kereamy; S. J. Rothstein


Phase II study of high-dose cyclophosphamide, etoposide, and carboplatin (CEC) followed by autologous hematopoietic stem cell rescue in women with metastatic or high-risk non-metastatic breast cancer: multivariate analysis of factors affecting survival and engraftment  

Microsoft Academic Search

Seventy women with high-risk stage II (n = 10), IIIA (n = 12), IIIB (n = 11), or IV (n = 37) breast cancer received cyclophosphamide 6000 mg\\/m2, etoposide 2400 mg\\/m2, and carboplatin 1200 mg\\/m2 followed by infusion of autologous hematopoietic stem cells (AHSC). Women with high-risk stage II disease had eight or more involved axillary lymph nodes (n =

TR Klumpp; SL Goldberg; AJ Magdalinski; KF Mangan



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

PubMed Central

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

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



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


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

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



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

Microsoft Academic Search

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

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



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: [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)



Prediction of nonsentinel lymph node metastasis in sentinel node–positive breast carcinoma  

Microsoft Academic Search

The incidence of nonsentinel (NSN) lymph node metastases in patients with a tumor-positive sentinel (SN) lymph node varies greatly from 20% to 70% in the published literature. Current practice is that most patients with a positive SN (micro- and macrometastases) undergo a complete axillary dissection. However, it has been shown by other investigators that a large number of patients with

Umesh Kapur; Tara Rubinas; Ritu Ghai; James Sinacore; Katherine Yao; Prabha B. Rajan



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

Microsoft Academic Search

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

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



Detection of Genetic Alterations in Breast Sentinel Lymph Node by Array- CGH.  

National Technical Information Service (NTIS)

The sentinel lymph node (SLN) is the first node in the mammary gland to harbor malignant cells in breast tumors with metastasis, and SLN positivity is an indication for axillary lymph node dissection. The purpose of our study is to identify specific genet...

L. R. Cavalli



Detection of Genetic Alterations in Breast Sentinel Lymph Node by Array- CGH.  

National Technical Information Service (NTIS)

The sentinel lymph node (SLN) is the first node in the mammary gland to harbor malignant cells in breast tumors with metastasis, and SLN positivity is an indication for axillary lymph node dissection. The purpose of our study is to identify specific genet...

L. R. Cavalli



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

PubMed Central

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



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

PubMed Central

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

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



Effect of {sup 18}F-FDG PET/CT Imaging in Patients With Clinical Stage II and III Breast Cancer  

SciTech Connect

Purpose: To investigate the potential effect of using {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in the initial assessment of patients with clinical Stage II or III breast cancer. Methods and Materials: During 14 consecutive months, 39 patients (40 tumors) who presented with Stage II or III breast cancer on the basis of a routine extension assessment were prospectively included in this study. PET/CT was performed in addition to the initial assessment. Results: In 3 cases, PET/CT showed extra-axillary lymph node involvement that had not been demonstrated with conventional techniques. Two of these patients had hypermetabolic lymph nodes in the subpectoral and infraclavicular regions, and the third had a hypermetabolic internal mammary node. PET/CT showed distant uptake in 4 women. Of these 4 women, 1 had pleural involvement and 3 had bone metastasis. Overall, of the 39 women, the PET/CT results modified the initial stage in 7 (18%). The modified staging altered the treatment plan for 5 patients (13%). It led to radiotherapy in 4 patients (bone metastasis, pleural lesion, subpectoral lymph nodes, and internal mammary nodes) and excision of, and radiotherapy to, the infraclavicular lymph nodes in 1 patient. Conclusions: PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in a significant percentage of patients. Therefore, initial PET/CT could enable better treatment planning for patients with Stage II and III breast cancer.

Groheux, David [Department of Nuclear Medicine, Breast Diseases Unit, Saint Louis Hospital, Paris (France)], E-mail:; Moretti, Jean-Luc [Department of Nuclear Medicine, Breast Diseases Unit, Saint Louis Hospital, Paris (France); EAD Imagerie Moleculaire Diagnostique et Ciblage Therapeutique, IUH, University of Paris VII, Paris (France); Baillet, Georges [Department of Nuclear Medicine, Breast Diseases Unit, Saint Louis Hospital, Paris (France); Espie, Marc; Giacchetti, Sylvie [Department of Medical Oncology, Breast Diseases Unit, Saint Louis Hospital, Paris (France); Hindie, Elif [Department of Nuclear Medicine, Breast Diseases Unit, Saint Louis Hospital, Paris (France); EAD Imagerie Moleculaire Diagnostique et Ciblage Therapeutique, IUH, University of Paris VII, Paris (France); Hennequin, Christophe [EAD Imagerie Moleculaire Diagnostique et Ciblage Therapeutique, IUH, University of Paris VII, Paris (France); Department of Radiation Oncology, Breast Diseases Unit, Saint Louis Hospital, Paris (France); Vilcoq, Jacques-Robert [Department of Radiation Oncology, Hartmann Hospital, Neuilly sur Seine (France); Cuvier, Caroline [Department of Medical Oncology, Breast Diseases Unit, Saint Louis Hospital, Paris (France); Toubert, Marie-Elisabeth [Department of Nuclear Medicine, Breast Diseases Unit, Saint Louis Hospital, Paris (France); Filmont, Jean-Emmanuel [Department of Nuclear Medicine, Breast Diseases Unit, Saint Louis Hospital, Paris (France); EAD Imagerie Moleculaire Diagnostique et Ciblage Therapeutique, IUH, University of Paris VII, Paris (France); Sarandi, Farid [Department of Nuclear Medicine, Breast Diseases Unit, Saint Louis Hospital, Paris (France); Misset, Jean-Louis [Department of Medical Oncology, Breast Diseases Unit, Saint Louis Hospital, Paris (France)



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

Microsoft Academic Search

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

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



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



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

PubMed Central

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

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



Axillary artery transection after shoulder dislocation.  


Axillary artery transection after shoulder dislocation without bone fracture is extremely rare. Early diagnosis, use of the occlusion balloon for proximal control of axillary artery bleeding, and surgical treatment are important to avoid morbidity and mortality. A 74-year old man presented with a complete transection of axillary artery associated with anterior dislocation of the shoulder without bone fracture. Left axillary artery transection was seen on angiography. An angioplasty balloon was used to prevent bleeding from the subclavian artery. The brachial plexus was compressed by a hematoma. Axillary artery repair was performed with an autologous reversed saphenous vein graft interposition. The patient had palpable distal pulses postoperatively. Motor function was significantly improved but still impaired in the postoperative period. Follow-up at 3 months showed good function of the left arm.Successful management of axillary artery injuries requires prompt diagnosis and surgical treatment. Neurologic injury may affect the functional outcome of the limb. PMID:23849653

Ergüne?, Kazim; Yazman, Serkan; Yetkin, Ufuk; Cak?r, Volkan; Gurbuz, Ali



Elective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin-based chemotherapy for esophageal squamous cell carcinoma: a phase II study  

PubMed Central

Background In this phase II study, we evaluated the efficacy, toxicity, and patterns of failure of elective lymph node irradiation (ENI) late course accelerated hyper-fractionated radiotherapy (LCAHRT) concurrently with cisplatin-based chemotherapy (CHT) for esophageal squamous cell carcinoma (ESCC). Methods Patients with clinical stage II-IVa (T1-4N0-1M0 or M1a) ESCC were enrolled between 2004 and 2011. Radiation therapy (RT) comprised two courses: The first course of radiation covered the primary and metastatic regional tumors and high risk lymph nodal regions, given at 2 Gy per fraction for a dose of 40 Gy. In the second course, LCAHRT was delivered to the boost volume twice a day for an additional 19.6 Gy in 7 treatment days, using 1.4 Gy per fraction. Two cycles of CHT were given at the beginning of RT. Results The median age and Karnofsky performance status were 63 years and 80, respectively. The American Joint Committee on Cancer stage was II in 14 (20.6%) patients, III in 32 (47.1%), and IVa in 22 (32.3%). With a median follow-up of 18.5 months, the overall survival at 1-, 3-, 5-year were 75.5%, 46.5%, 22.7% for whole group patients, versus 78.6%, 49.4%, 39.9% for patients with stage II–III. The patterns of first failure from local recurrence, regional failure, and distant metastasis were seen in 20.6%, 17.6%, and 19.1%, respectively. The most frequent acute high-grade (? 3) toxicities were esophagitis and leucopenia, occurred in 26.4% and 32.4%. Conclusions ENI LCAHRT concurrently with CHT was appeared to be an effective regimen for ESCC patient with a favorable and tolerated profile. Further observation with longer time and randomized phase III trial is currently underway. Trial registration ChiCTR-TRC-09000568



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

Kathleen M. Erb; Thomas B. Julian



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


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

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



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

Microsoft Academic Search

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

P. Grantley Gill



Radiotherapy-related axillary arteriopathy  

PubMed Central

Treatment of breast cancer involves surgery, then perhaps radiation, hormonal or chemotherapy. Radiation-induced arterial injury is a well-known entity that represents a rare cause of arterial occlusion. We present the case of a 76-year old woman who complained of a severe intermittent claudication of the right upper limb. Twenty years before, she underwent a right-sided radical mastectomy followed by intense radiation therapy for several weeks. The patient was found to suffer of a radiotherapy-related axillary artery thrombosis and was successfully treated by angioplasty and stenting.

Bucci, Federico; Robert, Frederic; Fiengo, Leslie; Plagnol, Philippe



Polymeric micelles incorporating (1,2-diaminocyclohexane)platinum (II) suppress the growth of orthotopic scirrhous gastric tumors and their lymph node metastasis.  


Nano-scaled drug carriers have great potential for the treatment of solid tumors. Nevertheless, hypovascularity and fibrosis in some types of solid tumors have been demonstrated to reduce the penetration and accumulation of nano-scaled drug carriers. Diffuse-type scirrhous gastric cancers present such characteristics as well as frequent metastasis to the lymph nodes; therefore, it remains a great challenge to eradicate scirrhous gastric cancers based on the drug targeting using nanocarriers. Herein, we demonstrated that polymeric micelles with 30-nm diameter incorporating (1,2-diaminocyclohexane)platinum(II) (DACHPt), the parent complex of the anticancer drug oxaliplatin, efficiently penetrated and accumulated in an orthotopic scirrhous gastric cancer model, leading to the inhibition of the tumor growth. Moreover, the elevated localization of systemically injected DACHPt-loaded micelles in metastastic lymph nodes reduced the metastatic tumor growth. These results suggest DACHPt-loaded micelles as a promising nanocarrier for the treatment of scirrhous gastric cancers and their lymphatic metastases. PMID:22326402

Rafi, Md; Cabral, H; Kano, M R; Mi, P; Iwata, C; Yashiro, M; Hirakawa, K; Miyazono, K; Nishiyama, N; Kataoka, K



Contemporary management of lymph node metastases from an unknown primary to the neck: II. a review of therapeutic options.  


Although uncommon, cancer of an unknown primary (CUP) metastatic to cervical lymph nodes poses a range of dilemmas relating to optimal treatment. The ideal resolution would be a properly designed prospective randomized trial, but it is unlikely that this will ever be conducted in this group of patients. Accordingly, knowledge gained from retrospective studies and experience from treating patients with known head and neck primary tumors form the basis of therapeutic strategies in CUP. This review provides a critical appraisal of various treatment approaches described in the literature. Emerging treatment options for CUP with metastases to cervical lymph nodes are discussed in view of recent innovations in the field of head and neck oncology and suitable therapeutic strategies for particular clinical scenarios are presented. For pN1 or cN1 disease without extracapsular extension (ECE), selective neck dissection or radiotherapy offer high rates of regional control. For more advanced neck disease, intensive combined treatment is required, either a combination of neck dissection and radiotherapy, or initial (chemo)radiotherapy followed by neck dissection if a complete response is not recorded on imaging. Each of these approaches seems to be equally effective. Use of extensive bilateral neck/mucosal irradiation must be weighed against toxicity, availability of close follow-up with elective neck imaging and guided fine-needle aspiration biopsy (FNAB) when appropriate, the human papillomavirus (HPV) status of the tumor, and particularly against the distribution pattern (oropharynx in the majority of cases) and the emergence rate of hidden primary lesions (<10% after comprehensive workup). The addition of systemic agents is expected to yield similar improvement in outcome as has been observed for known head and neck primary tumors. PMID:22034062

Strojan, Primož; Ferlito, Alfio; Langendijk, Johannes A; Corry, June; Woolgar, Julia A; Rinaldo, Alessandra; Silver, Carl E; Paleri, Vinidh; Fagan, Johannes J; Pellitteri, Phillip K; Haigentz, Missak; Suárez, Carlos; Robbins, K Thomas; Rodrigo, Juan P; Olsen, Kerry D; Hinni, Michael L; Werner, Jochen A; Mondin, Vanni; Kowalski, Luiz P; Devaney, Kenneth O; de Bree, Remco; Takes, Robert P; Wolf, Gregory T; Shaha, Ashok R; Genden, Eric M; Barnes, Leon



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



Axillary iodine-131 accumulation due to perspiration  

Microsoft Academic Search

A case of spurious axillary uptake of I-131 proven to be caused by perspiration is presented. False-positive localizations of radioiodine, both pathologic and physiologic, are reviewed to avoid confusion of these entities with functioning thyroid carcinoma metastases.

E. J. Camponovo; P. F. Goyer; E. D. Silverman; A. M. Kistler; W. M. Yudt



Axillary iodine-131 accumulation due to perspiration  

SciTech Connect

A case of spurious axillary uptake of I-131 proven to be caused by perspiration is presented. False-positive localizations of radioiodine, both pathologic and physiologic, are reviewed to avoid confusion of these entities with functioning thyroid carcinoma metastases.

Camponovo, E.J.; Goyer, P.F.; Silverman, E.D.; Kistler, A.M.; Yudt, W.M. (Naval Hospital, Bethesda, MD (USA))



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.

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



Circulation of lymph (image)  


... the bloodstream during normal circulation is filtered through lymph nodes to remove bacteria, abnormal cells and other ... then transported back into the bloodstream via the lymph vessels. Lymph only moves in one direction, toward ...


Swollen lymph nodes  


Swollen glands; Glands - swollen; Lymph nodes - swollen; Lymphadenopathy ... Common areas where the lymph nodes can be felt (with the fingers) include: Groin Armpit Neck (there is a chain of lymph nodes on either ...


Axillary lipogranuloma mimicking carcinoma metastasis after silicone breast implant rupture: a case report.  


Silicone-gel-filled breast implants have been widely used for breast augmentation and reconstruction after mastectomy. However, silicone implants have some well-known complications, such as implant rupture, which requires surgical intervention. Dissemination of silicone particles out of the implant causes a granulomatous reaction, a phenomenon known as silicone granuloma, in breast parenchyma as well as axillary, breast and chest wall lymph nodes, which mimics breast cancer metastasis. However, lipogranuloma after silicone breast implant rupture has not been reported in the literature, although it is a common complication after mineral oil or liquid silicone injection. We present a case report of an axillary lymphadenopathy resulting from lipogranuloma after silicone-gel-filled implant rupture. Review of the literature suggests that this is the first report of a lipogranuloma resulting from implant rupture. PMID:23245917

Gundeslioglu, A Ozlem; Hakverdi, Sibel; Erdem, Ozlem; Ozen, E Cigdem; Inan, Irfan; Emlik, Dilek



Automatic detection and segmentation of lymph nodes from CT data.  


Lymph nodes are assessed routinely in clinical practice and their size is followed throughout radiation or chemotherapy to monitor the effectiveness of cancer treatment. This paper presents a robust learning-based method for automatic detection and segmentation of solid lymph nodes from CT data, with the following contributions. First, it presents a learning based approach to solid lymph node detection that relies on marginal space learning to achieve great speedup with virtually no loss in accuracy. Second, it presents a computationally efficient segmentation method for solid lymph nodes (LN). Third, it introduces two new sets of features that are effective for LN detection, one that self-aligns to high gradients and another set obtained from the segmentation result. The method is evaluated for axillary LN detection on 131 volumes containing 371 LN, yielding a 83.0% detection rate with 1.0 false positive per volume. It is further evaluated for pelvic and abdominal LN detection on 54 volumes containing 569 LN, yielding a 80.0% detection rate with 3.2 false positives per volume. The running time is 5-20 s per volume for axillary areas and 15-40 s for pelvic. An added benefit of the method is the capability to detect and segment conglomerated lymph nodes. PMID:21968722

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



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

Microsoft Academic Search

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

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



Use of USPIO-induced magnetic susceptibility artifacts to identify sentinel lymph nodes and lymphatic drainage patterns. I. Dependence of artifact size with subcutaneous Combidex dose in rats.  


Subcutaneously administered Combidex contrast agent produced characteristic magnetic susceptibility artifacts in gradient-echo (GE) images of rat brachial and axillary lymph nodes. These artifacts were useful in the rapid location and identification of normal sentinel lymph nodes. A linear dose response was observed with maximum artifact size in transverse images and was used noninvasively to study lymphatic drainage patterns. PMID:9814774

Rogers, J M; Jung, C W; Lewis, J; Groman, E V



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:; 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)



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


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

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



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.

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



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



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



High Levels of a Major Histocompatibility Complex II-Self Peptide Complex on Dendritic Cells from the T Cell Areas of Lymph Nodes  

Microsoft Academic Search

Summary T lymphocytes recirculate continually through the T cell areas of peripheral lymph nodes. During each passage, the T cells survey the surface of large dendritic cells (DCs), also known as interdigitating cells. However, these DCs have been difficult to release from the lymph node. By emphasizing the use of calcium-free media, as shown by Vremec et al. (Vremec, D.,

Kayo Inaba; Maggie Pack; Muneo Inaba; Hiraki Sakuta; Frank Isdell; Ralph M. Steinman



Enhanced sonographic imaging to diagnose lymph node metastasis: importance of blood vessel volume and density.  


Lymph node size is an important variable in ultrasound diagnosis of lymph node metastasis. However, the size criterion often leads to oversight of tumor-positive lymph nodes within the range of "normal" size, such that more accurate diagnostic criteria for lymph node metastasis are required. In this study, we show how diagnosis of lymph node metastasis can be improved by evaluating changes in blood vessel volume and density using a novel contrast-enhanced high-frequency ultrasound (CE-HFUS) system with Sonazoid. An MRL/MpJ-lpr/lpr (MRL/lpr) mouse model of lymph node metastasis was used in which lymph nodes are similar in size to humans. Metastasis via lymphatic vessels to proper axillary lymph nodes (proper ALN) was induced by injection of tumor cells into the subiliac lymph nodes. Within 21 days of injection, significant increases in blood vessel volume and density, but no increases in the size of the proper ALNs, were observed. The increase in blood vessel density was confirmed with immunohistochemical analysis and was positively related to tumor cell proliferation as measured using bioluminescence imaging. Together, our results showed that alterations in blood vessel volume and density precede alterations in lymph node size in the early stages of lymph node metastasis. Detection of these changes by ultrasonography may offer new criteria for early diagnosis of lymph node metastasis. PMID:23333937

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



Intermittent axillary vein obstruction in a competitive canoeist.  

PubMed Central

The case is reported of a competitive canoeist with intermittent axillary vein obstruction secondary to shoulder girdle muscle hypertrophy. The anatomy of the axilla, pathology of the axillary vein, and reported cases of sports injuries involving the axillary vein are discussed. This would appear to be the first report of such an occurrence in a canoeist. Images Figure 1 Figure 2

Livesey, J R



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

PubMed Central

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

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



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

PubMed Central

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

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



Influence of insulin-like growth factor-binding protein-2 on plasma clearance and transfer of insulin-like growth factors-I and -II from plasma into mammary-derived lymph and milk of goats.  


Plasma clearance of insulin-like growth factors-I and -II (IGF-I and -II) and insulin-like growth factor-binding protein-2 (IGFBP-2) from lactating goats (n = 4) was determined following a single intravenous injection of the corresponding 125I-labelled human protein. Transfer of these proteins out of the vascular space was monitored by their subsequent appearance in mammary-derived lymph and milk. Clearance of 125I-IGFBP-2 from circulation was 0.37 +/- 0.06 ml/min/kg, which is markedly greater than that of 125I-IGF-I or -II (0.11 +/- 0.01 and 0.12 +/- 0.01 ml/min/kg respectively). This was also reflected in longer elimination half-lives for IGF-I (353 +/- 6 min) and -II (254 +/- 8 min) compared with IGFBP-2 (110 +/- 9 min). Three hours after injection of the 125I-labelled protein, the plasma:lymph ratio of trichloroacetic acid-precipitable radioactivity was 1.54 +/- 0.04, 3.3 +/- 0.6 and 4.1 +/- 0.4 for IGFBP-2, IGF-I and -II respectively. The form of 125I-IGFBP-2 in lymph was not different from that of plasma. Elevation of plasma concentrations of IGFBP-2 by its intravenous infusion significantly decreased plasma half-life of both IGF-I and -II (251 +/- 8 and 198 +/- 7 min respectively). Although the amount and rate of transfer of IGF into mammary-derived lymph was decreased slightly by IGFBP-2, concentrations eventually obtained were not different from control. However, secretion of IGFs into milk was significantly reduced by IGFBP-2, particularly in the case of IGF-I. These results are consistent with the ability of all three compounds to cross the vascular endothelium intact and of IGFBP-2 to decrease the uptake of IGF by mammary epithelium and subsequent secretion into milk. IGFBP-2 may well have acted to target plasma IGF towards non-mammary tissues, thus explaining the more rapid plasma clearance of IGFs in the presence of elevated IGFBP-2. PMID:8708553

Prosser, C G; Schwander, J



Duplicated axillary arch muscles arising from the latissimus dorsi  

PubMed Central

Many origins and insertions of an axillary muscular slip (also known as Langer's or axillary arch muscles) have been documented previously. In this report, we found duplicated axillary arch muscles (two variant muscular slips) originating from the inferolateral border of the right side latissimus dorsi muscle. Obviously, these axillary arch muscles can be distinguished as short and long muscular strips. While the origin was the same, the short muscular slip inserts into the fascia covering on the pectoralis minor, whereas the longer one inserts on/into the aponeurosis of pectoralis major. For the surgery in the axillary region, this rare variation should be considered a cause of surgical interventions.

Uabundit, Nongnut; Khamanarong, Kimaporn; Sripanidkulchai, Kittisak; Chaiciwamongkol, Kowit; Namking, Malivalaya; Ratanasuwan, Somsiri; Boonruangsri, Porntip; Hipkaeo, Wiphawi



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



Swollen lymph node (image)  


Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if ... infection is trivial or not apparent. Swelling of lymph nodes generally results from localized or systemic infection, ...


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:; 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)



Immunolymphoscintigraphy for the detection of lymph node metastases from breast cancer  

SciTech Connect

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

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



Can axillary node dissection be omitted in a subset of patients with low local and regional failure rates?  


Axillary node dissection (ALND) is the standard of care for patients who have a positive sentinel lymph node (SLN) on sentinel lymph node biopsy (SLNB). We sought to identify a low-risk patient population with positive SLN that may not need cALND. We analyzed SLNB for breast cancer at our institutions between 1999 and 2007. We identified 130 patients who had a positive SLN but did not undergo completion ALND. We evaluated clinical data, adjuvant treatment patterns and intermediate locoregional and distant events. The median patient age was 50; 19% had N0(i+) disease, 53% had micrometastatic (N1mi) disease, and 28% had macrometastasis. Eighty-eight percent of patients underwent radiation therapy; 66 patients (51%) had documented nodal radiation (of these 50 were treated with three fields and 14 with high tangents. Local recurrence in the breast occurred in two patients (2%) and nine patients (7%) developed distant metastases; there were no axillary/nodal recurrences. In this highly selected group of patients who had a positive SLNB but did not undergo cALND, we observed no axillary recurrences. PMID:22017599

Barkley, Christina; Burstein, Harold; Smith, Barbara; Bellon, Jennifer; Wong, Julia; Gadd, Michele; Taghian, Alphonse; Winer, Eric; Iglehart, James Dirk; Harris, Jay; Golshan, Mehra



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

PubMed Central

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

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



In-situ and invasive carcinoma within a phyllodes tumor associated with lymph node metastases  

PubMed Central

Background Phyllodes tumors (cystosarcoma phyllodes) are uncommon lesions in the female breast. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in the literature, but has never been associated with lymph node metastases. Case presentation A 26-year-old woman presented with a firm, mobile, non-tender mass in the left breast and palpable lymph nodes in the left axilla. The excised lesion appeared well circumscribed and lobulated, with variable fleshy and firm areas. Microscopic examination showed a circumscribed fibroepithelial lesion with a well developed leaf-like architecture, in keeping with a benign phyllodes tumor. The epithelial component showed extensive high grade ductal carcinoma in-situ (DCIS) and invasive carcinoma of no special type, located entirely within the phyllodes tumor. Subsequent axillary lymph node dissection revealed metastatic carcinoma in four lymph nodes. Conclusions Although rare, phyllodes tumors may harbor DCIS and invasive carcinoma, with potential for lymph node metastasis.

Parfitt, Jeremy R; Armstrong, Chris; O'Malley, Frances; Ross, Joan; Tuck, Alan B



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

Microsoft Academic Search

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

William C. Wood



Feasibility of contrast-enhanced ultrasound-guided biopsy of sentinel lymph nodes in dogs.  


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


Noninvasive photoacoustic sentinel lymph node mapping using Au nanocages as a lymph node tracer in a rat model  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB) has been widely performed and become the standard procedure for axillary staging in breast cancer patients. In current SLNB, identification of SLNs is prerequisite, and blue dye and/or radioactive colloids are clinically used for mapping. However, these methods are still intraoperative, and especially radioactive colloids based method is ionizing. As a result, SLNB is generally associated with ill side effects. In this study, we have proposed near-infrared Au nanocages as a new tracer for noninvasive and nonionizing photoacoustic (PA) SLN mapping in a rat model as a step toward clinical applications. Au nanocages have great features: biocompatibility, easy surface modification for biomarker, a tunable surface plasmon resonance (SPR) which allows for peak absorption to be optimized for the laser being used, and capsule-type drug delivery. Au nanocage-enhanced photoacoustic imaging has the potential to be adjunctive to current invasive SLNB for preoperative axillary staging in breast cancer patients.

Song, Kwang Hyun; Kim, Chulhong; Cobley, Claire M.; Xia, Younan; Wang, Lihong V.



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

PubMed Central

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




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



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



Variant Branching Pattern of Axillary Artery: A Case Report  

PubMed Central

During routine dissection of an approximately 50-year-old male cadaver for the undergraduate medical students at Melaka Manipal Medical College, Manipal University, Manipal, we came across a variation in branching pattern of right axillary artery. The second part of axillary artery gave rise to a common trunk which divided into the subscapular and lateral thoracic arteries. The third part of right axillary artery gave rise to anterior and posterior circumflex humeral arteries. Variations in the branching pattern of axillary artery are important for the surgeons performing interventional or diagnostic procedures in cardiovascular diseases.

Shantakumar, Swamy Ravindra; Mohandas Rao, K. G.



Solitary bulky mediastinal lymph node metastasis from colon cancer.  


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



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.



Thymic mucosa-associated lymphoid tissue lymphoma involving lymph nodes  

PubMed Central

INTRODUCTION Thymic mucosa-associated lymphoid tissue (MALT) lymphoma involving lymph nodes is quite rare with only 13 previous cases reported in the literature. PRESENTATION OF CASE The 33-years-old female was referred to our department for the investigation of abnormalities on computed tomographic (CT) scans. CT scans showed a 9-cm × 3-cm mass composed of a mixture of soft tissue and fat at the anterior mediastinum with lymphadenopathy in the neck, axillary and mediastinal regions. She was underwent complete surgical resection of the mass with regional lymph node dissection through a median sternotomy. Histological examination of the surgical specimens confirmed the diagnosis of MALT lymphoma arising in the thymus with nodal metastasis. She achieved complete remission after postoperative rituximab combined chemotherapy. DISCUSSION Thymic MALT lymphoma occurs most frequently in Asian female aged 40–60 years and commonly appears anterior mediastinal masses on CT scans. The excised tissue is necessary to confirm the accurate histological diagnosis. The disease usually remains localized for a long time, making local surgical resection highly effective. However, when the lymph nodes are involved, effective treatment approaches of the disease is still undefined. CONCLUSION We report a case of thymic MALT lymphoma involving lymph nodes, in which the patient was successfully treated with primary site resection with regional lymph node dissection followed by rituximab combined chemotherapy. Surgery provided not only a useful approach for collecting tissue for an accurate histological diagnosis, but also an effective local treatment, even in the case of advanced-stage thymic MALT lymphoma.

Ota, Hideki; Kawai, Hideki; Tsubasa, Matsuo



Axillary-axillary interarterial chest loop graft for successful early hemodialysis access.  


Purpose: Obtaining adequate vascular access in patients undergoing chronic hemodialysis therapy can be demanding, particularly for those in whom all peripheral venous options have been exhausted. Case: We present a case of a 46-year-old woman with a history of complex vascular access for end-stage renal failure for whom there was no remaining possibility of venous access and had reached a palliative stage. We implanted an emergency loop axillary-axillary interarterial early needling graft. Post-operatively, the patient made a quick and uneventful recovery, resuming hemodialysis after only six days with no interventions necessary up to four months follow-up. To the best of our knowledge, this is the first dedicated case report describing the successful implantation of an axillary-axillary interarterial chest loop graft to re-establish access in a patient with exhausted options. Conclusion: We recommend the use of this technique to surgeons who find themselves in comparable situations in the future. PMID:23172167

Stephenson, Matthew A; Norris, Joseph M; Mistry, Hiren; Valenti, Domenico



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.



Excision of subcutaneous tissue for the treatment of axillary osmidrosis  

Microsoft Academic Search

Axillary osmidrosis is a distressing problem. Medical treatment is often inadequate. Local excision of the apocrine and eccrine glands is the most effective method available but is often accompanied by significant morbidity. We report a modified surgical technique for the treatment of this condition. From January 1994 to December 1995, 46 patients (38 females, 8 males) with axillary osmidrosis have

T.-C. Tung; F.-C. Wei



Traumatic Axillary Artery Dissection with Radial Artery Embolism  

SciTech Connect

This report describes a case of pathologically proven traumatic arterial dissection, presenting as complete occlusion of the axillary artery with radial artery embolism. Occlusion of the axillary artery by traumatic dissection mimicked transection and radial artery embolism mimicked congenital absence of the radial artery on the initial angiogram, but these were correctly diagnosed with the following sonogram.

Chung, Hwan-Hoon; Cha, Sang Hoon, E-mail:; Cho, Sung Bum; Kim, Jung Hyuck; Lee, Seung Hwa [Ansan Hospital, Korea University College of Medicine, Department of Radiology (Korea, Republic of); Shin, Jae Seung [Ansan Hospital, Korea University College of Medicine, Department of Thoracic and Cardiovascular Surgery (Korea, Republic of); Park, Sang Woo [KonKuk University Hospital, Department of Radiology (Korea, Republic of)



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


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

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



Sentinel lymph node biopsy following prior augmentation mammaplasty and implant rupture.  


We report the case of a 44 year old lady with bilateral cosmetic silicone breast implants who had previously undergone a change of her right implant following extracapsular rupture. She presented 4 years later with a new lump in her right breast and underwent subcutaneous mastectomy for a grade 3 invasive ductal carcinoma. Sentinel lymph node biopsy demonstrated axillary silicone lymphadenopathy but nil evidence of metastatic disease. We present this as the first described case of successful sentinel lymph node biopsy in the context of prior augmentation mammaplasty and ipsilateral implant rupture with silicone lymphadenopathy. PMID:23047180

Warbrick-Smith, J; Cawthorn, S J



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

PubMed Central

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

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



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

SciTech Connect

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 in our institution between 1990 and 2004, 248 patients with clinical N0 or N1 to N2 lymph node status at diagnosis had pN0 status after NAC and BCS. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival (LRR-FS), disease-free survival (DFS), and overall survival (OS). Results: All 248 patients underwent breast irradiation, and 158 patients (63.7%) also received LNI. With a median follow-up of 88 months, the 5-year LRR-FS and OS rates were respectively 89.4% and 88.7% with LNI and 86.2% and 92% without LNI (no significant difference). Survival was poorer among patients who did not have a pathologic complete primary tumor response (hazard ratio, 3.05; 95% confidence interval, 1.17-7.99) and in patients with N1 to N2 clinical status at diagnosis (hazard ratio = 2.24; 95% confidence interval, 1.15-4.36). LNI did not significantly affect survival. Conclusions: Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among cN0 to cN2 breast cancer patients with pN0 status after NAC. These results need to be confirmed in a prospective study.

Daveau, Caroline [Department of Radiation Oncology, Centre Rene Huguenin, Saint-Cloud (France); Stevens, Denise [Department of Biostatistics, Centre Rene Huguenin, Saint-Cloud (France); Brain, Etienne [Department of Medical Oncology, Centre Rene Huguenin, Saint-Cloud (France)



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

Microsoft Academic Search

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

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



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


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

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


Variations of scalp, pubic and axillary hair.  


Hair examinations and comparisons conducted by forensic scientists often provide investigative and associative information. Apart from its length and its natural color, hair displays a morphologic diversity both macroscopically and microscopically. Pseudogenization of axillary and pubic hair) of 18 adult Bengalee Hindu caste females. Apart from variation in histomorphological variables, quantitative variables regarding shaft and medulla diameter demonstrated variation in terms of being significantly higher (p < 0.05) in pubic hair compared to that of axillary and scalp hair. Therefore, the present study envisaged that variability in histomorphological and quantitative traits in different areas of human could be one of the important criteria for personal identification in forensic research. PMID:22338799

Mistry, Sanchita; Chatterjee, Madhumati; Ghosh, Jyoti Ratan; Chakrabarti, Nirmal Kanti; Bandyopadhyay, Arup Ratan



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

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

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


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

Microsoft Academic Search

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

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



Sentinel lymph node biopsy for risk-reducing mastectomy.  


Risk-reducing mastectomy (RRM) confers 90-95% decreased risk of breast cancer, and may reduce mortality, especially in high-risk groups such as BRCA carriers. Risk of occult disease in RRM specimen is ~5%. This demands axillary staging: sentinel lymph node (SLN) biopsy is no longer possible, axillary clearance confers significant risks and may prove negative. Contemporaneous SLN biopsy allows axillary staging with minimal further dissection. Women undergoing RRM and SLN biopsy between June 2005 and July 2010 were reviewed retrospectively from our prospectively maintained database of 1,522 SLN procedures in 1,498 patients. SLN(s) localized using routine tracer methods. SLNs and mastectomy specimens underwent routine histologic examination. Eighty-three RRMs with SLN biopsy were performed in 71 patients (12 bilateral). Indications for RRM: contralateral invasive (55), in situ (5) disease, BRCA 1/2 mutation (12), and strong family history (10). Mean number of SLNs: 1.35. Occult disease was detected in four cases (4.8%), with one case of occult invasive lobular carcinoma (1.2%). Remaining occult disease was lobular in situ neoplasia (LISN). SLNs were negative in all cases. Our findings are comparable to those in the literature: 4.8% rate of occult disease overall, 1.2% invasive. The significant risk with SLN biopsy is lymphoedema, quoted around 7%. We have had no reports of symptomatic lymphoedema in patients undergoing RRM and SLN biopsy. We propose that SLN at the time of mastectomy requires only limited further dissection, and confers minimal risk compared with secondary axillary surgery. PMID:23865803

Burger, Amy; Thurtle, David; Owen, Sally; Mannu, Gurdeep; Pilgrim, Simon; Vinayagam, Raman; Pain, Simon



Recannulation of the Right Axillary Artery for Complex Aortic Surgeries  

PubMed Central

Owing to the increased use of the axillary artery for arterial inflow during cardiopulmonary bypass, patients with previous cannulation at this site who require reoperation will be encountered more and more frequently. We describe the cases of 2 patients who required recannulation of the axillary artery for complex reoperations of the thoracic aorta. The technique and pitfalls are described. The decision was made to reuse the previous cannulation site at the right axillary artery due to the presence of large pseudoaneurysms in proximity to the sternum. The old 8-mm Dacron stump was found and excised, and a new 8-mm Dacron graft was sutured to the right axillary artery for arterial inflow. In the 1st patient, the Dacron side-graft enabled insertion and subsequent inflation of an EndoClamp® within the Dacron graft of the ascending aorta, which obviated profound hypothermia. In the 2nd patient, recannulation of the right axillary artery enabled us to open the sternum at low flow using moderate hypothermia, given that antegrade cerebral perfusion was easily accessible in the event of a more prolonged arrest time. Both patients recovered fully, without neurovascular complications secondary to the recannulation of the right axillary. Recannulation of the right axillary artery is safe during complex reoperation of the thoracic aorta. It avoids retrograde perfusion in the often-diseased descending thoracic aorta. Furthermore, sternal reentry may be performed under moderate hypothermia, because antegrade cerebral perfusion can be initiated with ease.

Shetty, Rahul; Voisine, Pierre; Mathieu, Patrick; Dagenais, Francois



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

Microsoft Academic Search

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

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


Design and development of a dedicated mammary and axillary region positron emission tomography system  

NASA Astrophysics Data System (ADS)

Breast cancer is the second leading cause of cancer death in women. Currently, mammography and physical breast examination, both non-invasive techniques, provide the two most effective methods available for screening potential breast cancer patients. During the management of patients, however, several invasive techniques such as axillary lymph node dissection, core biopsies and lumpectomies, are utilized to determine the stage or malignancy of the disease with significant cost and morbidity associated with them. Positron Emission Tomography (PET), using [F-18] fluorodeoxyglucose (FDG) tracer is a sensitive and non-invasive imaging modality that may be a cost-effective alternative to certain invasive procedures. In this project we have developed a low cost, high performance, dedicated PET camera (maxPET) for mammary and axillary region imaging. The system consists of two 15x15 cm2 planar scintillation detector arrays composed of modular detectors operating in coincidence. The modular detectors are comprised of a 9x9 array of 3x3x20 mm3 lutetiurn oxyorthosilicate (LSO) detector elements, read out by a 5x5 array of position- sensitive photomultiplier tubes. The average measured intrinsic spatial resolution of a detector module is 2.26 mm with a sensitivity of up to 40% for a central point source. The measured coincidence timing resolution for two modules is 2.4 ns. The average energy resolution measured across the entire two detector plates is 21.6%. The coincidence timing resolution for the entire system is 8.1 ns. A line bar phantom was imaged and images were reconstructed using the focal plane tomography algorithm. A 4 mm projection image resolution was measured based on profiles taken through the line bar phantom images. The goal of the maxPET system will be to aid in breast cancer patient management by assisting in imaging women with dense, fibro-glandular breasts, detecting axillary lymph node metastases without surgery, monitoring chemotherapy effectiveness and assisting in visualization of recurrence and tumoral boundaries.

Doshi, Niraj Kumar


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


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



Intramammary lymph nodes.  

PubMed Central

AIMS: To determine the prevalence and pathology of intramammary lymph nodes in breast specimens. METHODS: All breast specimens examined by a single pathologist over 70 months in a large teaching hospital were studied retrospectively. All the surgical pathology reports were reviewed. Relevant glass slides from cases in which intramammary lymph nodes were identified were also reexamined. RESULTS: Breast specimens (n = 682) were examined. Seven lymph nodes were found in five patients. The specimens comprised 533 biopsy specimens, 29 segmental resections, 22 reduction mammoplasties, 77 modified radical mastectomies and 20 gynecomastia mastectomies. No clinically relevant microscopical abnormalities were found in four lymph nodes and slight sinus histiocytosis was seen in two nodes. One node contained metastatic adenocarcinoma and benign glandular epithelial inclusions. CONCLUSION: Although rare, intramammary lymph nodes may be detected by careful gross examination of breast specimens even in the absence of clinical identification. They can occur in any quadrant of the breast and can display a variety of pathological conditions. Pathologists should be alert to the existence and potential importance of these lymph nodes. Images

Jadusingh, I. H.



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


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

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



Generalized lymphadenopathy mimicking malignant lymph node metastases after interferon-?2b therapy for melanoma.  


A patient, who complained of axillary swelling, was diagnosed with malignant melanoma of stage IIb and received adjuvant high-dose interferon-?2b (HDI) therapy for 3 months. Computed tomography demonstrated multiple, generalized lymph node enlargement with high fluorine-18-fluorodeoxyglucose uptake (6.6 of the standardized uptake value) on PET. Histological examination of the axillary lymph node revealed reactive hyperplasia, without evidence of malignant cells. Discontinuation of interferon therapy for 6 weeks resulted in near-complete resolution of the lymphadenopathies. HDI therapy was therefore resumed at a reduced dose and was continued for 25 weeks without recurrence of the lymphadenopathies. HDI therapy is the only adjuvant therapy proven to be effective in malignant melanoma. The release of various additional cytokines is stimulated by interferon, which is responsible for the more common side effects of this therapy. The cytokines are also likely to stimulate helper T cells and induce T-cell sequestration within lymph nodes. These actions are possibly associated with generalized lymph node enlargement in some patients undergoing HDI therapy. The results from the present case indicate that HDI therapy can be safely maintained after confirming the benign nature of the lymphadenopathies that occur during the treatment. PMID:23777872

Yune, Sehyo; Jang, Kee-Taek; Jung, Seung Min; Kim, Jung Han; Lee, Jeeyun



Myofascial pain from pectoralis major following trans-axillary surgery  

Microsoft Academic Search

SummaryThis is the first reported description, to the author’s knowledge, of myofascial pain occurring at a surgical drain site. The patient consulted a medical acupuncturist after suffering five months of continuous chest and arm pain associated with ‘tingling’ in the forearm and hand. She had undergone trans-axillary resection of the first left rib following a left axillary vein thrombosis 18

Mike Cummings



Axillary artery injury as a complication of proximal humerus fractures  

Microsoft Academic Search

Proximal humerus fractures are common injuries and represent approximately 5% of all fractures.10, 14, 21 These fractures are infrequently associated with neurovascular injuries. Brachial plexus injuries are uncommon,18 whereas axillary artery injuries are rare.5–9, 11, 12, 16–20, 22–24 A review of 19 previously reported cases of axillary artery injury after proximal humerus fracture revealed that 84% occurred in patients older

John A McLaughlin; Ronald Light; Irving Lustrin



Sentinel lymph node biopsy at the time of mastectomy does not increase the risk of lymphedema: implications for prophylactic surgery  

PubMed Central

Women diagnosed with or at high risk for breast cancer increasingly choose prophylactic mastectomy. It is unknown if adding sentinel lymph node biopsy (SLNB) to prophylactic mastectomy increases the risk of lymphedema. We sought to determine the risk of lymphedema after mastectomy with and without nodal evaluation. 117 patients who underwent bilateral mastectomy were prospectively screened for lymphedema. Perometer arm measurements were used to calculate weight-adjusted arm volume change at each follow-up. Of 234 mastectomies performed, 15.8 % (37/234) had no axillary surgery, 63.7 % (149/234) had SLNB, and 20.5 % (48/234) had axillary lymph node dissection (ALND). 88.0 % (103/117) of patients completed the LEFT-BC questionnaire evaluating symptoms associated with lymphedema. Multivariate analysis was used to assess clinical characteristics associated with increased weight-adjusted arm volume and patient-reported lymphedema symptoms. SLNB at the time of mastectomy did not result in an increased mean weight-adjusted arm volume compared to mastectomy without axillary surgery (p = 0.76). Mastectomy with ALND was associated with a significantly greater mean weight-adjusted arm volume change compared to mastectomy with SLNB (p < 0.0001) and without axillary surgery (p = 0.0028). Patients who underwent mastectomy with ALND more commonly reported symptoms associated with lymphedema compared to those with SLNB or no axillary surgery (p < 0.0001). Patients who underwent mastectomy with SLNB or no axillary surgery reported similar lymphedema symptoms. Addition of SLNB to mastectomy is not associated with a significant increase in measured or self-reported lymphedema rates. Therefore, SLNB may be performed at the time of prophylactic mastectomy without an increased risk of lymphedema.

Miller, Cynthia L.; Skolny, Melissa N.; Jammallo, Lauren S.; Horick, Nora; O'Toole, Jean; Coopey, Suzanne B.; Hughes, Kevin; Gadd, Michele; Smith, Barbara L.; Taghian, Alphonse G.



Sentinel lymph node biopsy at the time of mastectomy does not increase the risk of lymphedema: implications for prophylactic surgery.  


Women diagnosed with or at high risk for breast cancer increasingly choose prophylactic mastectomy. It is unknown if adding sentinel lymph node biopsy (SLNB) to prophylactic mastectomy increases the risk of lymphedema. We sought to determine the risk of lymphedema after mastectomy with and without nodal evaluation. 117 patients who underwent bilateral mastectomy were prospectively screened for lymphedema. Perometer arm measurements were used to calculate weight-adjusted arm volume change at each follow-up. Of 234 mastectomies performed, 15.8 % (37/234) had no axillary surgery, 63.7 % (149/234) had SLNB, and 20.5 % (48/234) had axillary lymph node dissection (ALND). 88.0 % (103/117) of patients completed the LEFT-BC questionnaire evaluating symptoms associated with lymphedema. Multivariate analysis was used to assess clinical characteristics associated with increased weight-adjusted arm volume and patient-reported lymphedema symptoms. SLNB at the time of mastectomy did not result in an increased mean weight-adjusted arm volume compared to mastectomy without axillary surgery (p = 0.76). Mastectomy with ALND was associated with a significantly greater mean weight-adjusted arm volume change compared to mastectomy with SLNB (p < 0.0001) and without axillary surgery (p = 0.0028). Patients who underwent mastectomy with ALND more commonly reported symptoms associated with lymphedema compared to those with SLNB or no axillary surgery (p < 0.0001). Patients who underwent mastectomy with SLNB or no axillary surgery reported similar lymphedema symptoms. Addition of SLNB to mastectomy is not associated with a significant increase in measured or self-reported lymphedema rates. Therefore, SLNB may be performed at the time of prophylactic mastectomy without an increased risk of lymphedema. PMID:22941538

Miller, Cynthia L; Specht, Michelle C; Skolny, Melissa N; Jammallo, Lauren S; Horick, Nora; O'Toole, Jean; Coopey, Suzanne B; Hughes, Kevin; Gadd, Michele; Smith, Barbara L; Taghian, Alphonse G



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.



Agrobacterium -mediated genetic transformation and development of herbicide-resistant sugarcane ( Saccharum species hybrids) using axillary buds  

Microsoft Academic Search

Direct regeneration from explants without an intervening callus phase has several advantages, including production of true type progenies. Axillary bud explants from 6-month-old sugarcane cultivars Co92061 and Co671 were co-cultivated with Agrobacterium strains LBA4404 and EHA105 that harboured a binary vector pGA492 carrying neomycin phosphotransferase II, phosphinothricin acetyltransferase ( bar) and an intron containing ?-glucuronidase ( gus-intron) genes in the

M. Manickavasagam; A. Ganapathi; V. R. Anbazhagan; B. Sudhakar; N. Selvaraj; A. Vasudevan; S. Kasthurirengan



Sealing of Postoperative Axillary Leakage After Axillary Lymphadenectomy Using a Fibrin Glue Coated Collagen Patch: a Prospective Randomised Study  

Microsoft Academic Search

Seroma formation after axillary lymphadenectomy in women with breast cancer remains a problem despite many efforts to reduce surgery-related morbidity. In a prospective, randomised, open, parallel-group, controlled clinical trial we evaluated the effect of a fibrin-glue coated collagen patch (TachoComb H®, Nycomed Pharma AS, Denmark) on volume and duration of postoperative axillary drainage, duration of hospital stay, and procedural safety.

A. Berger; C. Tempfer; B. Hartmann; P. Kornprat; A. Rossmann; G. Neuwirth; A. Tulusan; E. Kubista




PubMed Central

Three intracellular compartments for potassium exchange have been observed in intact cells of the giant-celled alga, Nitella axillaris. These compartments have been compared with the exchange properties of isolated subcellular structures. The smallest and fastest compartment (apparent half-time, 23 seconds) appears to involve passive absorption on the cell wall. The next largest (apparent half-time, 5 hours) may represent exchange with the cytoplasmic layer through the plasma membrane, the chloroplasts being in rapid equilibrium with the surrounding cytoplasm. The largest and slowest compartment (apparent half-time, 40 days) has been identified with the central vacuole. The vacuolar membrane and the plasma membrane have similar properties with respect to K permeability. Thus, the experimental data from the whole cell can be accounted for by a structural model of the compartments. Cyanide in concentrations up to 10-3 M causes no net loss of K. The fastest compartment in Nitella and in higher plants is compared, and the ecological significance of the slow rate of potassium transport in Nitella is discussed.

Diamond, Jared M.; Solomon, A. K.



Micropropagation of Helleborus through axillary budding.  


Helleborus genus, belonging to the Ranunculaceae family, has 20 species of herbaceous perennial flowering plants. The commercial exploitation of this plant is dependent on the selection and propagation of appropriate lines. High propagation rate could be accomplished by using a suitable tissue culture method enabling the rapid introduction of valuable selections in the market. However, in vitro cultivation of Helleborus is still very difficult. Thereby the development of reliable in vitro propagation procedures is crucial for future production systems. Axillary buds cultured on agar-solidified Murashige and Skoog medium supplemented with 1 mg/L benzyladenine, 0.1 mg/L ?-naphthoxyacetic acid, and 2 mg/L isopentenyl adenine develop shoots after 16 weeks of culture under 16 h light regime, 50-60 ?mol/s/m(2), and 19 ± 1°C. The multiplication rate ranges from 1.4 to 2.1. However, the genotype and the number of subcultures affect the efficiency of the micropropagation process. The rooting of shoots is about 80% in solidified MS medium containing 1 mg/L 1-naphthaleneacetic acid and 3 mg/L indole-3-butyric acid. The described protocol provides information which can contribute to the commercial production of Helleborus plants. PMID:23179705

Beruto, Margherita; Viglione, Serena; Bisignano, Alessandro



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:; 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)



The effect of vitamin A depletion on antigen-stimulated trapping of peripheral lymphocytes in local lymph nodes of rats.  

PubMed Central

The effect of vitamin A depletion on antigen-stimulated trapping of peripheral lymphocytes in lymphatic organs was studied in rats. Distribution of [3H]-uridine-labelled syngenic peripheral lymphocytes was quantified by assaying radioactive content of brachial and axillary lymph nodes, spleen and liver of normal and vitamin A-depleted F344/Ducrj rats immunized with sheep red blood cells. Localization of labelled cells in the ipsilateral brachial lymph nodes of the normal rats was stimulated by three times upon immunization with sheep erythrocytes as compared with the contralateral nodes. Recruitment of cells in axillary lymph nodes, spleen and liver was not significantly different from non-immunized values. The vitamin A-depleted rats exhibited marked deterioration in antigen-stimulated trapping of labelled cells in the draining brachial lymph nodes. These results suggest that this effect of vitamin A depletion is due to derangement of integrity of lymphocyte-trapping mechanism in the draining lymph nodes and not to any change in nature of lymphocytes per se.

Takagi, H; Nakano, K



Primary Plasmacytoma of Lymph Nodes  

Microsoft Academic Search

Most plasmacytomas of lymph nodes are secondary metastases from myeloma or from primary plasmacytoma of the upper air passages. Primary plasmacytomas of lymph nodes are very rare. A case of primary plasmacytoma of mediastinal, cervical and para-aortic lymph nodes is reported. Bence Jones proteinuria of 8 g\\/24 h was present. Repeated bone marrow examinations were normal. When the patient died,

J. Jansen; P. Blok



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


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



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


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

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



Experimental characterization of axillary/underarm interface pressure in swing-through crutch walking.  


Supporting weight on the upper support of crutches is not recommended because it can lead to axillary nerve damage. Despite this warning, improper axillary loadings may still occur because of a lack of arm strength or fatigue. It is generally accepted that improper use of conventional axillary crutches contributes to axillary nerve damage, but surprisingly there are no studies characterizing axillary support/underarm configurations. In this study, we compared traditional and horizontal axillary support designs by measuring various biomechanical parameters on the axillary support during a swing-through gait while supporting weight on the axillary support. Subjects found the axillary support that remains horizontal to be more comfortable than the axillary support of axillary crutches. The higher perceived comfort may be attributed to the lower force and contact area, both average and maximum, developed on the horizontal axillary support and/or shorter excursion of the position of the center of force during a stride. These findings suggest that avoiding all weight bearing on the axillary support may be an overly conservative recommendation for supports that remain horizontal. Individuals with insufficient arm strength may benefit by considering this type of support, but because further study is needed, a physical therapist should be consulted. PMID:23881767

Borrelli, James; Haslach, Henry W



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


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

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



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

PubMed Central

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

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



Axillary web syndrome following secondary breast-conserving surgery: a case report  

PubMed Central

Background Axillary web syndrome is a cause of significant morbidity in the early postoperative period after axillary surgery. Case presentation A patient developed axillary web syndrome after secondary breast surgery and recovered in 3 weeks through physical therapy and using Aescuven Forte. Discussion The pathogenesis of axillary web syndrome is not clear. It is reported that axillary surgery is the main cause. The presented case indicates that tissue injury might be an important cause of axillary web syndrome. Though axillary web syndrome is self-limiting, special physical therapy and Aescuven Forte can shorten the natural duration. Conclusion Secondary breast surgery could cause axillary web syndrome. Physical therapy and Aescuven Forte could shorten the duration of the self-limited morbidity.



[Axillary wound with complete vasculo-nervous section. Functional outcomes].  


Axillary wound with complete vasculonervous section are rare in adults, males between 20 and 30 years being more affected. In children these lesions are even more rarely encountered. Immediate surgical repair of vascular and nervous sections is recommended. Neurological impalement may be severe when all nervous trunks in the axilla are affected. Recovery of the motor and sensitive deficit is a long process and is often partial, good functional outcome being rare. Recovery in children is supposed to be better due to a more rapid regenerative capacity of the nerves. We present the case of a 9-year-old boy with axillary wound and complete section of axillary artery, median, ulnar, radial and musculocutaneous nerves and medial cutaneous nerve of arm. Vascular reconstruction with venous graft and epiperineural nerve reconstruction was done. Kinetotherapy and physiotherapy was part of recovery treatment. Follow up at 15 months confirmed very good functional outcomes with almost complete motor and sensitive function of the limb. PMID:20209776

Per?ea, Mihaela; Lunc?, S; Moro?anu, C


Progressive fetal axillary cystic lymphangioma with coexistent naevus flammeus.  


We report the rare occurrence of a progressive fetal axillary cystic lymphangioma coexistent with an overlying naevus flammeus. The fetus at 22 weeks' gestation was found to have a 37 x 35 mm left axillary multiloculated mass without colour-flow imaging. Amniocentesis showed a normal 46,XX karyotype. Multiple fine-needle aspirations of the mass in the second and third trimesters obtained blood-stained chocolate-coloured fluid containing numerous erythrocytes and lymphocytes but proved ineffective in lessening the progressive growth of the mass. The mother underwent caesarean delivery and a healthy neonate was born with a 141 x 81 mm left axillary cystic lymphangioma and a 50 x 35 mm coexistent naevus flammeus. The neonate was well after simple excision of the lesions. Although cystic lymphangiomas arising in the axilla enlarge progressively during fetal life, our case suggests a good prognosis and except for genetic evaluation, no prenatal intervention is required. PMID:9039304

Chen, C P; Chen, H C; Liu, F F; Jan, S W; Lin, S P; Sheu, J C; Chen, B F



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.

Gray, Elizabeth E.; Cyster, Jason G.



Axillary sheath hematomas causing neurologic complications following arterial access.  


Iatrogenic brachial plexus injuries secondary to expanding hematomas and pseudoaneurysms have been described in limited nature in previously published data. We present the case of a 55-year-old woman who developed neurologic deficits because of a compressive hematoma after axillary arteriography. She underwent emergent exploration of her left arm with decompression of the axillary sheath and brachial artery repair with complete recovery. We describe the presentation, relevant anatomy, and importance of this condition and stress the need for early recognition and surgical intervention to prevent permanent neurologic deficits. PMID:21514101

Tran, Daniel D; Andersen, Charles A



Mouse model of lymph node metastasis via afferent lymphatic vessels for development of imaging modalities.  


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



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


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

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



Active specific chemoimmunotherapy of lymph-node metastasis from a poorly immunogenic murine fibrosarcoma.  


The fibrosarcoma MCA-SP, which was recently induced with methylcholanthrene (MCA) in C3H/HeJ mice, displays poor immunogenicity in in vivo prophylaxis. A cell variant MCA-SPN1, which bears a tumor-specific transplantation antigen (TSTA) cross-reactive with the parental line MCA-SP, was selected because of its proclivity for axillary lymph-node metastases. Although these lymph-node metastases were resistant to sinecomitant (post-excisional) immunity, they were susceptible to combined active and passive specific chemoimmunotherapy, using tumor-specific, 1-butanol-extracted, preparative isoelectric focusing-purified, TSTA (1 microgram weekly sc injections), cyclophosphamide (CY, a single intraperitoneal 20 mg/kg dose), and adoptive transfer of immune splenic T lymphocytes, which had been re-stimulated in vitro with extracted TSTA and interleukin-2. This triple regimen both reduced the incidence of spontaneous lymph-node metastases, and prolonged the survival of tumor-bearing, as well as tumor-resected hosts. The results from local adoptive transfer assay using T-lymphocyte subpopulations of spleen and lymph nodes in these treated hosts suggested that Lyt 2+ cytotoxic T-lymphocytes (CTL) mediated in vivo tumor-neutralization. Thus TSTA/CY/CTL therapy activates tumoricidal host responses effective against the poorly immunogenic MCA-SP tumor and its lymph-node metastases. PMID:2514172

Naito, K; Oka, T; Nomi, S; Yamagishi, H; Kahan, B D



Predictive Factors of Non-sentinel Lymph Node Involvement in Patients with Invasive Breast Cancer and Sentinel Node Micrometastases.  


Patient-related, tumor-related, and sentinel node (SN)-related factors have been identified with the aim of predicting non-SN status in patients with SN micrometastases. According to our previous experience, primary tumor size (p=0.005) and the presence of lymphovascular invasion (LVI) (p=0.000) significantly predicted non-SN status in patients with SN micrometastasis; moreover, non-SN metastases were never detected in patients with pT1a-1b, G1, and no LVI. A prospective assessment was undertaken in a validation set of 126 patients to confirm these findings. Univariate analysis indicated that primary tumor size (p=0.05), Scarff-Bloom-Richardson (SBR) grade (p=0.008), LVI (p=0.001), and the number of mitoses/mm(2) (p=0.01) were significant predictors of non-SN status. By logistic regression analysis, tumor size (p=0.03), LVI (p=0.001), grade (p=0.003) and the number of mitoses/mm(2) (p=0.01) were the only variables remaining in the model. Three subsets of patients were identified: i) 18.3% of patients (pT1, G1, and no LVI) had tumor-negative non-SN (no risk group); ii) 37.3% of patients (number of mitoses/mm(2) <10, SBR grade II-III) had a rate of tumor-positive non-SN <15% (intermediate risk); iii) 44.4% of patients had a mean rate of non-SN involvement of 46% (high risk). By these parameters, more than 50% of patients could be selectively spared unnecessary axillary lymph node dissection without staging or therapeutic benefit, especially in patients with well-differentiated pT1 tumors without LVI. PMID:24123023

Friedman, Daniele; Gipponi, Marco; Murelli, Federica; Meszaros, Paolo; Solari, Nicola; Massa, Michela; Depaoli, Francesca; Baccini, Paola; Carli, Franca; Gallo, Maurizio; Cafiero, Ferdinando



Caught in the middle: case study of a brachial (sentry) lymph node recurrence after resection and locoregional breast radiotherapy  

PubMed Central

To reduce local recurrence, adjuvant locoregional radiotherapy is given routinely for post-mastectomy breast patients with 4 or more positive lymph nodes. Most institutions adopt a 3- or 4-field radiotherapy technique, in which the field and shielding placements are informed by bony anatomic landmarks viewed on digitally reconstructed radiographs. Here, we report on a 40-year-old woman who underwent a lumpectomy with axillary node dissection, followed by chemotherapy, completion mastectomy, and adjuvant locoregional radiotherapy (50 Gy in 25 fractions) for a multicentric pT1cN2aM0 invasive ductal carcinoma of the right breast. At 9 months after radiotherapy, she presented with a palpable brachial lymph node, a major draining node of the upper extremity, in the axilla, abutting the previous anterior supraclavicular and axillary radiation fields. This occurrence highlights the potential superolateral border of the level i axillary nodal chain and its relationship to the upper extremity lymphatics via the brachial (“sentry”) node. Adapting the delineated nodal target volume in locoregional radiotherapy of the breast for disease with extensive nodal involvement or other high-risk pathologic indications may be warranted in certain situations. Careful imaging and an informed discussion with the patient is needed before deciding to treat the sentry node and including the acromial–clavicular joints, balanced with the potential increased risk of lymphedema.

Lee, G.; Clemons, M.; Cho, J.; Czarnota, G.J.; Dinniwell, R.



Elastic scattering spectroscopy for detection of sentinel lymph node metastases in breast carcinoma  

NASA Astrophysics Data System (ADS)

Sentinel node biopsy is the new standard for lymphatic staging of breast carcinoma. Intraoperative detection of sentinel node metastases avoids a second operation for those patients with metastatic lymph nodes. Elastic scattering spectroscopy is an optical technique which is sensitive to cellular and subcellular changes occurring in malignancy. We analyzed 2078 ESS spectra from 324 axillary sentinel nodes from patients with breast carcinoma. ESS was able to detect metastatic lymph nodes with an overall sensitivity of 60% and specificity of 94%, which is comparable to existing pathological techniques. Nodes completely replaced with metastatic tumour were detected with 100% sensitivity, suggesting that further improvement in sensitivity is likely with more intensive optical sampling of the nodes.

Chicken, D. W.; Lee, A. C.; Johnson, K. S.; Clarke, B.; Falzon, M.; Bigio, I. J.; Bown, S. G.; Keshtgar, M. R. S.



Morphometric analysis of CD4 +, CD8 +, and ? ? + T-lymphocytes in lymph nodes of cattle vaccinated with Brucella abortus strains RB51 and 19  

Microsoft Academic Search

T-lymphocyte subpopulations were examined in vivo by computer-assisted morphometry of superficial cervical lymph nodes of cattle vaccinated with Brucella abortus. Twenty-four 8-month-old Hereford heifers were injected subcutaneously in the axillary area with 1×1010 live B. abortus strain RB51 (SRB51, n = 12) or strain 19 (S19, n = 6) suspended in 2 ml of saline. Six control heifers were injected

R. A. Kunkle; E. M. Steadham; N. F. Cheville



Sentinel Lymph Node Biopsy in Colon Cancer  

PubMed Central

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

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



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



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.

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



Treatment of axillary osmidrosis with the use of Versajet.  


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



Predicting recurrence in axillary-node negative breast cancer patients  

Microsoft Academic Search

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

Dutzu Rosner I



Oestrogen receptor-? variant mRNA expression in primary human breast tumours and matched lymph node metastases  

PubMed Central

We have shown previously that the relative expression of a truncated oestrogen receptor-? variant mRNA (ER clone 4) is significantly increased in axillary node-positive primary breast tumours compared with node-negative tumours. In this study, we have examined the relative expression of clone 4-truncated, exon 5-deleted and exon 7-deleted oestrogen receptor-? variant mRNAs in 15 primary breast tumour samples and in synchronous axillary lymph node metastases. Overall, there were no significant differences between the primary tumours and the matched metastases in the relative expression of these three specific variant mRNAs. Furthermore, the pattern of all deleted oestrogen receptor-? variant mRNAs appeared conserved between any primary and its matched secondary tumour. © 1999 Cancer Research Campaign

Leygue, E; Hall, R E; Dotzlaw, H; Watson, P H; Murphy, L C



Microbiological and biochemical origins of human axillary odour.  


The generation of malodour on various sites of the human body is caused by the microbial biotransformation of odourless natural secretions into volatile odorous molecules. On the skin surface, distinctive odours emanate, in particular, from the underarm (axilla), where a large and permanent population of microorganisms thrives on secretions from the eccrine, apocrine and sebaceous glands. Traditional culture-based microbiological studies inform us that this resident microbiota consists mainly of Gram-positive bacteria of the genera Staphylococcus, Micrococcus, Corynebacterium and Propionibacterium. Among the molecular classes that have been implicated in axillary malodour are short- and medium-chain volatile fatty acids, 16-androstene steroids and, most recently, thioalcohols. Most of the available evidence suggests that members of the Corynebacterium genus are the primary causal agents of axillary odour, with the key malodour substrates believed to originate from the apocrine gland. In this article, we examine, in detail, the microbiology and biochemistry of malodour formation on axillary skin, focussing on precursor-product relationships, odour-forming enzymes and metabolic pathways and causal organisms. As well as reviewing the literature, some relevant new data are presented and considered alongside that already available in the public domain to reach an informed view on the current state-of-the-art, as well as future perspectives. PMID:23278215

James, A Gordon; Austin, Corrine J; Cox, Diana S; Taylor, David; Calvert, Ralph



Erythropoietin induces lymph node lymphangiogenesis and lymph node tumor metastasis.  


Cancer therapy often produces anemia, which is treated with erthropoietin (EPO) to stimulate erythrocyte production. However, concerns have recently arisen that EPO treatment may promote later tumor metastasis and mortality. The mechanisms underlying such effects are unknown, but it is clear that EPO has pleiotropic effects in cell types other than hematopoietic cells. In this study, we investigated how EPO affects lymphangiogenesis and lymph node tumor metastasis in mouse models of breast cancer and melanoma. In these models, EPO increased lymph node lymphangiogenesis and lymph node tumor metastasis in a manner associated with increased migration, capillary-like tube formation, and dose- and time-dependent proliferation of human lymphatic endothelial cells. EPO increased sprouting of these cells in a thoracic duct lymphatic ring assay. These effects were abrogated by cotreatment with specific inhibitors of phosphoinositide 3-kinase or mitogen-activated protein kinase, under conditions in which EPO increased Akt and extracellular signal-regulated kinase 1/2 phosphorylation. Intraperitoneal administration of EPO stimulated peritoneal lymphangiogenesis, and systemic treatment of EPO increased infiltration of CD11b(+) macrophages in tumor-draining lymph nodes. Finally, EPO increased VEGF-C expression in lymph node-derived CD11b(+) macrophages as well as in bone marrow-derived macrophages in a dose- and time-dependent manner. Our results establish that EPO exerts a powerful lymphangiogenic function and can drive both lymph node lymphangiogenesis and nodal metastasis in tumor-bearing animals. PMID:21586615

Lee, Ae Sin; Kim, Duk Hoon; Lee, Jung Eun; Jung, Yu Jin; Kang, Kyung Pyo; Lee, Sik; Park, Sung Kwang; Kwak, Jae Yong; Lee, Sang Yong; Lim, Suk Tae; Sung, Mi Jung; Yoon, Suk Ran; Kim, Won



Sentinel lymph nodes detection with an imaging system using Patent Blue V dye as fluorescent tracer  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy is the gold standard to detect metastatic invasion from primary breast cancer. This method can help patients avoid full axillary chain dissection, thereby decreasing the risk of morbidity. We propose an alternative to the traditional isotopic method, to detect and map the sentinel lymph nodes. Indeed, Patent Blue V is the most widely used dye in clinical routine for the visual detection of sentinel lymph nodes. A Recent study has shown the possibility of increasing the fluorescence quantum yield of Patent Blue V, when it is bound to human serum albumin. In this study we present a preclinical fluorescence imaging system to detect sentinel lymph nodes labeled with this fluorescent tracer. The setup is composed of a black and white CCD camera and two laser sources. One excitation source with a laser emitting at 635 nm and a second laser at 785 nm to illuminate the region of interest. The prototype is operated via a laptop. Preliminary experiments permitted to determine the device sensitivity in the ?mol.L-1 range as regards the detection of PBV fluorescence signals. We also present a preclinical evaluation performed on Lewis rats, during which the fluorescence imaging setup detected the accumulation and fixation of the fluorescent dye on different nodes through the skin.

Tellier, F.; Steibel, J.; Chabrier, R.; Rodier, J. F.; Pourroy, G.; Poulet, P.



Partial shoot reiteration in Wollemia nobilis (Araucariaceae) does not arise from 'axillary meristems'  

PubMed Central

Background and Aims Conifers are characterized by the paucity of axillary buds which in dicotyledonous trees usually occur at every node. To compensate, conifers also produce ‘axillary meristems’, which may be stimulated to late development. In juvenile material of Wollemia nobilis (Araucariaceae: Massart's model) first-order (plagiotropic) branches lack both axillary buds and, seemingly, axillary meristems. This contrasts with orthotropic (trunk) axes, which produce branches, either within the terminal bud or as reiterated orthotropic axes originating from axillary meristems. However, plagiotropic axes do produce branches if they are decapitated. This study investigated how this can occur if axillary meristems are not the source. Methods The terminal buds of a series of plagiotropic branches on juvenile trees were decapitated in order to generate axillary shoots. Shoots were culled at about weekly intervals to obtain stages in lateral shoot development. Serial sections were cut with a sliding microtome from the distal end of each sample and scanned sequentially for evidence of axillary meristems and early bud development. Key Results Anatomical search produced no clear evidence of pre-existing axillary meristems but did reveal stages of bud initiation. Buds were initiated in a group of small starch-rich cortical cells. Further development involved de-differentiation of these small cells and the development of contrasting outer and inner regions. The outer part becomes meristematic and organizes the apex of the new branch. The inner part develops a callus-like tissue of vacuolated cells within which vascular cambia are developed. This kind of insertion of a branch on the parent axis seems not to have been described before. Conclusions Axillary meristems in Wollemia characterize the leaf axils of trunk axes so that the origin of reiterated shoots is clear. Plagiotropic axes seemingly lack axillary meristems but still produce axillary branches by distinctive developmental processes. These observations demonstrate limited understanding of branch initiation in trees generally.

Tomlinson, P. B.; Huggett, Brett A.



Axillary artery entrapment following proximal humeral fracture: a case report and review of literature  

Microsoft Academic Search

Injury to the axillary artery following proximal humerus fracture is a very rare occurrence. The most common mechanism of\\u000a axillary artery injury is fracture dislocation, resulting with intimal tears, arterial lacerations or avulsions. The most\\u000a common lesion is the subtotal transaction of the vessel. In this report, we aim to define entrapment of axillary artery by\\u000a tethering of anterior circumflex

Selçuk Keser; Ahmet Ege; Egemen Turhan; Murat Songür; Ahmet Bayar; Mustafa Kemal Akça



Sentinel lymph node biopsy in male breast cancer patients.  


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

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



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


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



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


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

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



Tramadol Added to Mepivacaine Prolongs the Duration of an Axillary Brachial Plexus Blockade  

Microsoft Academic Search

Tramadol is an analgesic drug that is antagonized by a2-adrenoceptor antagonists, as well as opioid antago- nists. We hypothesized that tramadol might produce effects on an axillary brachial plexus blockade similar to those of clonidine. We designed a prospective, con- trolled, double-blinded study to assess the impact of tramadol added to mepivacaine on the duration of an axillary brachial plexus

Stephan Kapral; Gabriele Gollmann; Barbara Waltl; Rudolf Likar; Robert N. Sladen; Christian Weinstabl; Franz Lehofer



Shoot Bud Proliferation from Axillary Nodes and Leaf Sections of Non-toxic Jatropha curcas L  

Microsoft Academic Search

Protocols for in vitro propagation of non-toxic variety of J. curcas through axillary bud proliferation and direct adventitious shoot bud regeneration from leaf segments have been established. Shoot bud proliferation from axillaries was assessed on an initial basal Murashige and Skoog (MS) salt medium supplemented with different concentrations of benzyladenine (BA), kinetin and thidiazuron (TDZ) followed by subculture to medium

M. Sujatha; H. P. S. Makkar; K. Becker



Axillary hyperidrosis - surgical treatment using vacuum curettage Hiperidrose axilar - tratamento cirúrgico através da curetagem aspirativa  

Microsoft Academic Search

Objective: To evaluate the results of treating axillary hyperhidrosis by vacuum curettage. Methods: Vacuum curettage was performed in 37 patients to treat axillary hyperidrosis, from May 1999 to December 2005. Based on the reason for patients looking for treatment (interference in their quality of life), the evaluation criterion was a validated self- applicable questionnaire called \\

Ronaldo Golcman; Benjamin Golcman; Murilo Francisco Pires Fraga


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



Staged axillary thoracotomy for bilateral lung metastases: an effective and minimally invasive approach  

Microsoft Academic Search

Objective: We describe our experience with the staged axillary thoracotomy (SAT), for the treatment of bilateral lung metastases. Materials and Methods: Between January 1995 and June 1998, 75 lung metastasectomies were carried out in our institution, 49 (65%) monolateral, and 26 (35%) bilateral. In the latter group of patients we adopted a staged axillary thoracotomy. Results: All wedge resections and

Stefano Margaritora; Alfredo Cesario; Domenico Galetta; Kenji Kawamukai; Elisa Meacci; Pierluigi Granone



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



Axillary Artery and Brachial Plexus Injuries due to Anterior Shoulder Dislocation  

Microsoft Academic Search

Axillary artery injury after shoulder dislocation, without an associated bone fracture is very rare. Vascular injuries associated with brachial plexus lesions range in incidence from 27% to 44%. Management of axillary artery injury is mainly surgical and depends on the extent and the site of injury. The treatment of associated nerve injuries is more controversial. There is a scarcity of

Bibombe Patrice Mwipatayi; Andrew Finlayson; Christopher John Welman; Mark John Hamilton; Manzoor Abbas; Kishore Sieunarine



Axillary artery transection following anterior shoulder dislocation: classical presentation and current concepts  

Microsoft Academic Search

Injury to the axillary artery following anterior shoulder dislocation is a very rare occurrence. This review serves to illustrate the now classical case of an elderly gentleman with a recurrent dislocation, transection of the axillary artery and its invariable association with a severe brachial plexus lesion, which is the most important determinant of long-term disability. It also highlights the pathognomic

S. P. Kelley; A. F. Hinsche; J. F. M. Hossain



Arthroscopic Trans-capsular Axillary Nerve Decompression: Indication and Surgical Technique  

Microsoft Academic Search

Symptomatic axillary nerve compression is rare yet results in debilitating pain, weakness, and decreased athletic performance in some patients. If nonoperative modalities fail, surgical intervention is necessary to reduce symptoms and avoid functional decline. Traditionally, open techniques have been described to decompress the axillary nerve and are reported to provide satisfactory results. Similar to suprascapular nerve decompression, recent advances have

Peter J. Millett; Trevor R. Gaskill



Femoral\\/Axillary Volume Flow Ratio as a New Index for the Assessment of Iliac Atherosclerosis  

Microsoft Academic Search

Objective: To measure the arterial volume flow (VF) with duplex scan, calculate femoral\\/axillary VF ratio, and discuss its applicability as a new index for the hemodynamic significance of an aorto-iliac occlusive lesion. Methods: Several measures of VF were obtained consecutively with duplex scan in both common femoral and axillary arteries of healthy volunteers with no signs of atherosclerosis and patients

Charles Angotti Furtado de Medeiros; Sandra Aparecida Ferreira Silveira; Fábio Hüsemann Menezes



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

PubMed Central

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

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



Agreement between temporal artery, oral, and axillary temperature measurements in the perioperative period.  


This study examined agreement in temperature readings preoperatively and postoperatively between temporal artery and electronic oral/axillary thermometers as well as the seconds required to obtain temperature readings across the three measuring modes. Using a repeated measures design, 86 adult subjects had temporal artery, oral, and axillary temperatures taken upon admission to the surgical area and upon admission to the PACU. Findings indicated best agreement both preoperatively and postoperatively between the oral mode of the electronic thermometer and the temporal artery thermometer, followed by agreement between oral and axillary modes of the electronic thermometer, and the least agreement between the temporal artery and axillary readings. Seconds to temperature measurement was significantly different both preoperatively and postoperatively, with temporal artery measurement the fastest, followed by oral and then axillary. Results support the use of the temporal artery thermometers as an alternative for perioperative noninvasive temperature monitoring. PMID:21641529

Barringer, Lynn B; Evans, Cheryl W; Ingram, Lori L; Tisdale, Patrice P; Watson, Susan P; Janken, Janice K



Fetal axillary hemangiolymphangioma with secondary intralesional bleeding: serial ultrasound findings.  


A case of fetal axillary hemangiolymphangioma coexisting with intralesional hemorrhage is presented. At 27 weeks' gestation, the fetus was found to have a 52 x 43-mm left axillary multilocular cystic mass which showed no signals on color Doppler. The mass was composed mostly of sonolucent spaces. At 29 weeks' gestation, an arterial flow signal (15 cm/s) was detected within the mass. In addition, two low-density echogenic cystic spaces with bidirectional flow waveforms were found, which raised the suspicion of intratumoral bleeding. Two weeks later, a fine-needle aspiration of the mass revealed both straw-colored and chocolate-colored fluid. The tumor size increased from 52 x 43 mm at 27 weeks to 100 x 79 mm at 37 weeks. Blood clots developed gradually in the hemorrhagic spaces. The pregnancy proceeded smoothly to term and at 38 weeks an elective Cesarean section was performed. After a surgical excision of the mass at the age of 4 days, a mixed cavernous hemangioma and cystic lymphangioma with secondary intralesional hemorrhage was confirmed histopathologically. PMID:11952973

Tseng, J J; Chou, M M; Ho, E S C



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


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

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


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

Microsoft Academic Search

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

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



Sentinel Lymph Node Detection and Evidence of Axillary Lymphatic Integrity After Transaxillary Breast Augmentation: A Prospective Study Using Lymphoscintography  

Microsoft Academic Search

Background  The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact\\u000a of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this\\u000a study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG).\\u000a \\u000a \\u000a \\u000a Methods  Twenty patients (40 breasts) who underwent TBA were evaluated

Heitor Naoki Sado; Ruth M. Graf; Lady W. Canan; Giovana G. Romano; Jorge R. Timi; Jorge E. Matias; Airton S. Yamada; Luiz C. Woellner; Gilvani A. Oliveira Cruz



Predictors of Nonsentinel Nodal Involvement to Aid Intraoperative Decision Making in Breast Cancer Patients with Positive Sentinel Lymph Nodes  

PubMed Central

Background. Up to 60% of patients with a positive sentinel lymph node (SLN) have no additional nodal involvement and do not benefit from completion axillary lymph node dissection (ALND). We aim to identify factors predicting for non-SLN involvement and to validate the MSKCC nomogram and Tenon score in our population. Methods. Retrospective review was performed of 110 consecutive patients with positive SLNs who underwent ALND over an 8-year period. Results. Fifty patients (45%) had non-SLN involvement. Non-SLN involvement correlated positively with the number of positive SLNs (P = 0.04), macrometastasis (P = 0.01), and inversely with the total number of SLNs harvested (P = 0.03). The MSKCC nomogram and Tenon score both failed to perform as previously reported. Conclusions. The MSKCC nomogram and Tenon score have limited value in our practice. Instead, we identified three independent predictors, which are more relevant in guiding the intraoperative decision for ALND.

Tan, Ern Yu; Ho, Bernard; Chen, Juliana J. C.; Ho, Pey Woei; Teo, Christine; Earnest, Arul; Chan, Patrick M. Y.



Ring-shaped light illumination ultrasound-modulated optical tomography and its application for sentinel lymph node mapping ex vivo  

NASA Astrophysics Data System (ADS)

We have succeeded in implementing ring-shaped light illumination ultrasound-modulated optical tomography (UOT) in both transmission and reflection modes. These systems used intense acoustic bursts and a charge-coupled device camera-based speckle contrast detection method. By mounting an ultrasound transducer into an optical condenser, we can combine the illuminating light component with the ultrasound transducer. Thus, the UOT system is more clinically applicable than previous orthogonal mode systems. Furthermore, we have successfully imaged an ex vivo methyleneblue-dyed sentinel lymph node (SLN) embedded deeper than 12 mm, the mean depth of human sentinel lymph nodes, in chicken breast tissue. These UOT systems offer several advantages: noninvasiveness, nonionizing radiation, portability, cost-effectiveness, and possibility of combination with ultrasound pulse-echo imaging and photoacoustic imaging. One potential application of the UOT systems is mapping SLNs in axillary staging for breast cancer patients.

Kim, Chulhong; Song, Kwang Hyun; Maslov, Konstantin; Wang, Lihong V.



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

Microsoft Academic Search

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

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



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


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

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



Swollen lymph nodes in the groin (image)  


Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if ... infection is trivial or not apparent. Swelling of lymph nodes generally results from localized or systemic infection, ...


Surface chemistry architecture of silica nanoparticles determine the efficiency of in vivo fluorescence lymph node mapping.  


Near-infrared (NIR) imaging of the lymphatic system offers a sensitive, versatile, and accurate lymph node mapping to locate the first, potentially metastatic, draining nodes in the operating room. Many luminescent nanoprobes have received great attention in this field, and the design of nontoxic and bright nanosystems is of crucial importance. Fluorescent NIR-emitting dye doped silica nanoparticles represent valuable platforms to fulfill these scopes, providing sufficient brightness, resistance to photobleaching, and hydrophilic nontoxic materials. Here, we synthesized these highly stable core-shell nanoparticles with a programmable surface charge positioning and determined the effect of these physicochemical properties on their in vivo behavior. In addition, we characterized their fluorescence kinetic profile in the right axillary lymph node (RALN) mapping. We found that nanoparticles with negative charges hidden by a PEG shell are more appropriate than those with external negative charges in the mapping of lymph nodes. We also demonstrated the efficient excretion of these nanostructures by the hepatobiliary route and their nontoxicity in mice up to 3 months postinjection. These results indicate the potential future development of these fluorescent nanosystems for LN mapping. PMID:24070236

Helle, Marion; Rampazzo, Enrico; Monchanin, Morgane; Marchal, Frédéric; Guillemin, François; Bonacchi, Sara; Salis, Francesca; Prodi, Luca; Bezdetnaya, Lina



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


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

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



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.



Comparison of 2- and 4-wavelength methods for the optical detection of sentinel lymph node  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy is the gold standard method to detect a metastatic invasion from the primary breast cancer. This method can avoid patients to be submitted to full axillary chain dissection. In this study we present and compare two near-infrared optical probes for the sentinel lymph node detection, based on the recording of scattered photons. The two setups were developed to improve the detection of the dye injected in clinical routine: the Patent Blue V dye. Herein, we present results regarding clinical ex-vivo detection of sentinel lymph node after different volume injections. We have previously published results obtained with a two-wavelength probe on phantom and animal models. However this first generation device did not completely account for the optical absorption variations from biological tissue. Thus, a second generation probe has been equipped with four wavelengths. The dye concentration computation is then more robust to measurement and tissue property fluctuations. The detection threshold of the second setup was estimated at 8.10-3?mol/L, which is about 37 times lower than the eye visibility threshold. We present here the preliminary results and demonstrate the advantages of using four wavelengths compared to two on phantom suspensions simulating the optical properties of breast tissues.

Tellier, F.; Simon, H.; Blé, F. X.; Ravelo, R.; Chabrier, R.; Steibel, J.; Rodier, J. F.; Poulet, P.



Primary lymph node invasive aspergillosis  

Microsoft Academic Search

Summary A case of apparently primary lymph node granulomatous aspergillosis is described. A review of the so-called primary aspergillosis cases since 1977 shows that granulomatous instead of exudative inflammation patterns have been observed in histological sections only when neither major nor minor predisposing factors have been detected in the clinical history of the patients. A possible pathogenetic role of selectively

A. Mazzoni; Anna Nanetti; R. Manfredi; A. Facchini; M. Ferrarese; C. Sturani



Functional Anatomy of Lymph Nodes  

Microsoft Academic Search

Histological alterations in the paracortical zones of rabbit lymph nodes were produced by the intravenous injection of the acridine dye euchrysin. The paracortical parenchyma was reduced to narrow bands of lymphoid tissue which cuffed and outlined the venules against a distended and cell-filled sinus system. These perivenous lymphocyte cuffs, termed the paracortical cords, represented the basic anatomical unit of the

R. H. Kelly



Distribution of ricin within the mammalian para-aortic lymph node. II. Comparison of the localization, after intramuscular dosage of colloidal gold-labelled ricin in vivo, with in vitro binding characteristics of the native toxin.  


Previous work has shown that, following an intramuscular injection of ricin, the toxin becomes localized within histiocytes in the sinuses of lymph nodes draining the 'wound' site. When ricin labelled with colloidal gold was similarly injected, it was found within the same lymphoid cells as seen with native ricin. Biologically inert Indian ink apparently follows a similar fate, as demonstrated by the appearance of carbon particles within sinus histiocytes, as soon as 1 h after intramuscular injection. When the binding in vitro of Indian ink or ricin toxin to sections of lymph node was examined, ricin was seen to bind to the surfaces of the same sinusoidal cells and also, with a much lower frequency, to follicular lymphocytes, whereas Indian ink failed to bind. This indicated an interaction between ricin and cell membrane components. Moreover, this binding was inhibited markedly by the galactose-containing disaccharide, lactose, a target sugar specified by the lectin binding site of ricin and to a much lesser extent by the monosaccharide mannose. PMID:2793525

Griffiths, G D; Leith, A G; Leek, M D; Green, M A



Atrial Septal Defect Closure: Comparison of Vertical Axillary Minithoracotomy and Median Sternotomy  

PubMed Central

Background This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of 16.5±9.7. Group II comprised 14 female and 3 male patients with an average age of 18.5±9.8 showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was 1.8±0.2. The average pulmonary artery pressure was 35±10 mmHg. Following the diagnosis, performing elective surgery was planned. Results No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

Poyrazoglu, Huseyin Hakan; Avsar, Mustafa Kemal; Karakaya, Zeynep; Guler, Tayfun; Tor, Funda



Unilateral high origin of radial artery from axillary artery.  


Variations in the vascular system of upper limbs are relatively common, with considerable significance towards the clinical and surgical point of view. The major arterial variations reported are of high origins of radial and ulnar arteries. During routine dissection of an upper extremity in the Department of Anatomy, Medical University of the Americas, Nevis, West Indies, a variation in the origin of the radial artery from the axillary artery was observed in the right upper limb of a 55-year-old female cadaver. The normal and variant origin of the radial artery has pragmatic importance for surgeons and radiologists. Also, the superficial position of an artery makes it vulnerable to injury during cannulation, which may lead to pseudoaneurysm. PMID:22648593

Yagain, V K; Dave, M R; Anadkat, S



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

PubMed Central

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

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



Human axillary odor: are there side-related perceptual differences?  


Most studies on perception of human social odors in axillary sweat do not distinguish between samples from the right and left axillae. However, each axilla might not produce identical odor samples due, for instance, to the increased use of one arm as a result of lateralization. The aim of the present study was to test whether odor samples from the right and left axillae provided by right- and left-handed men were perceived differently by female raters. Participants were 38 males and 49 females, aged 19-35 years. Fresh odor samples (cotton pads worn underarm for 24 h) were evaluated for attractiveness, intensity, and masculinity, with left and right samples being presented as independent stimuli. A side-related difference emerged in left-handers only (no difference in right-handers): The odor from the axilla corresponding to the dominant side (left) was rated more masculine and more intense than the other side (right). This effect was limited to the ratings of a restricted group of females, that is, those who did not take hormone-based contraception and were estimated to be in the fertile phase of their menstrual cycle. In conclusion, future studies using axillary odor samples can consider left and right samples as perceptually equivalent stimuli when the participant samples are representative of the general population, which comprises relatively low proportions of left-handed men and spontaneously ovulating fertile women. The results also provide new evidence of the variation of female sensitivity to biologically relevant stimuli across the menstrual cycle. PMID:19556335

Ferdenzi, Camille; Schaal, Benoist; Roberts, S Craig



Chromosomal Copy Number Alterations are Associated with Persistent Lymph Node Metastasis after Chemoradiation in Locally Advanced Rectal Cancer  

PubMed Central

Background Lymph node metastasis is an important indicator of oncologic outcome for patients with rectal cancer. Identifying predictive biomarkers of lymph node metastasis could therefore be clinically useful. Objective To assess whether chromosomal copy number alterations can assist in predicting lymph node metastasis in patients with locally advanced rectal cancer treated with pre-operative chemoradiation therapy. Design Non-randomized, prospective Phase II study. Setting Multi-institutional. Patients 95 patients with stage II (cT3-4, cN0) or stage III (any cT, cN1-2) rectal cancer. Intervention Patients were treated with pre-operative chemoradiation therapy (CRT) followed by total mesorectal excision. Pretreatment biopsy tumor DNA and surgical margin control DNA was extracted and analyzed by oligonucleotide array-based comparative genomic hybridization. Chromosomal copy number alterations were correlated with lymph node metastasis. Finally, a model for predicting lymph node metastasis was built. Main outcome measures To determine if chromosomal copy number alterations are associated with lymph node metastasis in patients with rectal cancer, and to assess the accuracy of oligonucleotide array-based comparative genomic hybridization for predicting lymph node metastasis. Results Twenty-five of 95 (26%) patients had lymph node metastasis after chemoradiation. Losses of 28 chromosomal regions, most notably in chromosome 4, were significantly associated with lymph node metastasis. Our predictive model contained 65 probes and predicted lymph node metastasis with 68% sensitivity, 93% specificity, and positive and negative predictive values of 77% and 89%. Using this model lymph node status (positive or negative) after CRT was predicted accurately in 82 out of 95 patients (86%). Limitations The patient cohort was not completely homogeneous which may have influenced their clinical outcome. Additionally, while we performed rigorous statistically sound internal validation, external validation will be important to further corroborate our findings. Conclusions Copy number alterations can help identify rectal cancer patients at risk of lymph node metastasis after chemoradiation.

Chen, Zhenbin; Liu, Zheng; Deng, Xutao; Warden, Charles; Li, Wenyan; Garcia-Aguilar, Julio



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.

Dancer, S J; Noble, W C



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


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

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


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


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

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



?????????? ??? ?????? ?????????? ????????????: ????????? II ??????? ??????? ?? ????  

Microsoft Academic Search

The article discusses the image of Catherine II in the context of the French anti-monarchist pamphlets that abounded after the French revolution and were often directed at the Russian empress as well, representing her as the “Semiramis of the North”. A special case is Marquis de Sade?s Histoire de Juliette, ou les Prospérités du vice, which unmistakably refers to Catherine

Alexandre Stroev




Microsoft Academic Search

Axillary lymph node dissection (ALND) is a standard staging procedure in patients with invasive carcinoma of the breast. The presence of axillary nodal metastasis establishes the presence of stage II disease and identifies a group of patients at high risk for eventual widespread relapse. The importance of ALND stems from the increased cure rate obtained when patients with axillary nodal



[Outcomes after Total Arch Replacement using Antegrade Selective Cerebral Perfusion under Right Axillary Artery Perfusion].  


Although the outcomes of total arch replacement have been improving, the prevention of cerebral infarction is still an important consideration in aortic arch surgery. Herein, we reviewed our experience with total arch replacement using antegrade selective cerebral perfusion under right axillary artery perfusion. Between January 2002 and March 2013, total arch replacement was performed for 125 patients including 31 patients with acute aortic dissection. An 8 mm polyester grafts was sutured to the axillary artery through the right subclavicular incision and was connected to cardiopulmonary bypass circuit. Antegrade selective cerebral perfusion under hypothermic circulatory arrest was initiated using right axillary artery perfusion. Postoperative cerebral infarction occurred in 5.6% of patients. Hospital mortality rate was 3.2%. The 5-year rate of freedom from aortic event was 83%. The 5-year survival rate was 75%. We consider that right axillary artery perfusion is advantageous for preventing cerebral infarction in total arch replacement. PMID:24105111

Nishimura, Yoshiharu; Honda, Kentaro; Yuzaki, Mitsuru; Nakai, Takeo; Uchita, Shunji; Okamura, Yoshitaka



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

PubMed Central

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




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

Microsoft Academic Search

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

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



Very Superficial Ultrasound-Assisted Lipoplasty for the Treatment of Axillary Osmidrosis  

Microsoft Academic Search

.   Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major\\u000a surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis\\u000a resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was\\u000a that liposuction could not effectively

Sanghoon Park



Hemodialysis catheter implantation in the axillary vein by ultrasound guidance versus palpation or anatomical reference  

PubMed Central

Background We compared the results of four different methods of hemodialysis catheter insertion in the medial segment of the axillary vein: ultrasound guidance, palpation, anatomical reference, and prior transient catheter. Methods All patients that required acute or chronic hemodialysis and for whom it was determined impossible or not recommended either to place a catheter in the internal jugular vein (for instance, those patients with a tracheostomy), or to practice arteriovenous fistula or graft; it was then essential to obtain an alternative vascular access. When the procedure of axillary vein catheter insertion was performed in the Renal Care Facility (RCF), ultrasound guidance was used, but in the intensive care unit (ICU), this resource was unavailable, so the palpation or anatomical reference technique was used. Results Two nephrologists with experience in the technique performed 83 procedures during a period lasting 15 years and 8 months (from January 1997–August 2012): 41 by ultrasound guidance; 19 by anatomical references; 15 by palpation of the contiguous axillary artery; and 8 through a temporary axillary catheter previously placed. The ultrasound-guided patients had fewer punctures than other groups, but the value was not statistically significant. Arterial punctures were infrequent in all techniques. Analyzing all the procedure-related complications, such as hematoma, pneumothorax, brachial-plexus injury, as well as the reasons for catheter removal, no differences were observed among the groups. The functioning time was longer in the ultrasound-guided and previous catheter groups. In 15 years and 8 months of surveillance, no clinical or image evidence for axillary vein stenosis was found. Conclusion The ultrasound guide makes the procedure of inserting catheters in the axillary veins easier, but knowledge of the anatomy of the midaxillary region and the ability to feel the axillary artery pulse (for the palpation method) also allow relatively easy successful implant of catheters in the axillary veins.

Valencia, Cesar A Restrepo; Villa, Carlos A Buitrago; Cardona, Jose A Chacon



Cryopreservation of encapsulated gentian axillary buds following 2 step-preculture with sucrose and desiccation  

Microsoft Academic Search

Alginate beads containing axillary buds of in vitro-grown gentian (Gentiana scabra Bunge var. buergeri Maxim.), were successfully cryopreserved following 2 step-preculture with sucrose and desiccation. The optimal preculture conditions were as follows: axillary buds were excised from in vitro-grown gentian plants and precultured on semi-solid Murashige and Skoog (MS) medium containing 0.1 M sucrose for 10 days (25 °C, 16-h photoperiod) (first step).

Mitsuteru Suzuki; Tomoya Akihama; Masaya Ishikawa



A novel preculture method for the induction of desiccation tolerance in gentian axillary buds for cryopreservation  

Microsoft Academic Search

Axillary buds of in vitro-grown gentian (Gentiana scabra Bunge var. buergeri Maxim.) were successfully desiccated and cryopreserved using a novel two-step preculture method: preculturing axillary buds excised from in vitro-grown gentian plants on Murashige and Skoog (MS) semi-solid medium containing 0.1 M sucrose for 8–13 days at 25°C under a 16 h-photoperiod (first step) and the subsequent short period incubations

Mitsuteru Suzuki; Masaya Ishikawa; Tomoya Akihama



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)



Axillary nerve neurotization with the anterior deltopectoral approach in brachial plexus injuries.  


Combined neurotization of both axillary and suprascapular nerves in shoulder reanimation has been widely accepted in brachial plexus injuries, and the functional outcome is much superior to single nerve transfer. This study describes the surgical anatomy for axillary nerve relative to the available donor nerves and emphasize the salient technical aspects of anterior deltopectoral approach in brachial plexus injuries. Fifteen patients with brachial plexus injury who had axillary nerve neurotizations were evaluated. Five patients had complete avulsion, 9 patients had C5, six patients had brachial plexus injury pattern, and one patient had combined axillary and suprascapular nerve injury. The long head of triceps branch was the donor in C5,6 injuries; nerve to brachialis in combined nerve injury and intercostals for C5-T1 avulsion injuries. All these donors were identified through the anterior approach, and the nerve transfer was done. The recovery of deltoid was found excellent (M5) in C5,6 brachial plexus injuries with an average of 134.4° abduction at follow up of average 34.6 months. The shoulder recovery was good with 130° abduction in a case of combined axillary and suprascapular nerve injury. The deltoid recovery was good (M3) in C5-T1 avulsion injuries patients with an average of 64° shoulder abduction at follow up of 35 months. We believe that anterior approach is simple and easy for all axillary nerve transfers in brachial plexus injuries. PMID:22434572

Jerome, J Terrence Jose; Rajmohan, Bennet



Suppression of a Vegetative MADS Box Gene of Potato Activates Axillary Meristem Development1  

PubMed Central

Potato MADS box 1 (POTM1) is a member of the SQUAMOSA-like family of plant MADS box genes isolated from an early stage tuber cDNA library. The RNA of POTM1 is most abundant in vegetative meristems of potato (Solanum tuberosum), accumulating specifically in the tunica and corpus layers of the meristem, the procambium, the lamina of new leaves, and newly formed axillary meristems. Transgenic lines with reduced levels of POTM1 mRNA exhibited decreased apical dominance accompanied by a compact growth habit and a reduction in leaf size. Suppression lines produced truncated shoot clusters from stem buds and, in a model system, exhibited enhanced axillary bud growth instead of producing a tuber. This enhanced axillary bud growth was not the result of increased axillary bud formation. Tuber yields were reduced and rooting of cuttings was strongly inhibited in POTM1 suppression lines. Both starch accumulation and the activation of cell division occurred in specific regions of the vegetative meristems of the POTM1 transgenic lines. Cytokinin levels in axillary buds of a transgenic suppression line increased 2- to 3-fold. These results imply that POTM1 mediates the control of axillary bud development by regulating cell growth in vegetative meristems.

Rosin, Faye M.; Hart, Jennifer K.; Van Onckelen, Harry; Hannapel, David J.



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

SciTech Connect

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

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



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

PubMed Central

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



USTUR whole body case 0262: 33-y follow-up of PuO2 in a skin wound and associated axillary node.  


This whole body donation case (USTUR Registrant) involved two suspected PuO2 inhalation intakes, each indicated by a measurable Pu alpha activity in a single urine sample, followed about 1(1/2) y later by a puncture wound to the thumb while working in a Pu glovebox. The study is concerned with modelling simultaneously the biokinetics of deposition and retention in the respiratory tract and at the wound site; and the biokinetics of Pu subsequently transferred to other body organs, until the donor's death. Urine samples taken after the wound incident had readily measurable Pu alpha activity over the next 14 y, before dropping below the minimum detectable excretion rate (<0.4 mBq d(-1)). The Registrant died about 33 y after the wound intake, at the age of 71, from hepatocellular carcinoma with extensive metastases. At autopsy, all major soft tissue organs were harvested for analysis of their 238Pu, 239+240Pu and 241Am content. The amount of 239+240Pu retained at the wound site was 68 +/- 7 Bq (1 SD), measured by low-energy planar Ge spectrometry. A further 56.0 +/- 1.2 Bq was retained in an associated axillary lymph node, measured by radiochemistry. Simultaneous mathematical analysis (modelling) of all in vivo urinary excretion data, together with the measured lung, thoracic lymph node, wound, axillary lymph node and systemic tissue contents at death, yielded estimated intake amounts of 757 and 1504 Bq, respectively, for the first and second inhalation incidents, and 204 Bq for the total wound intake. The inhaled Pu material was highly insoluble, with an estimated long-term absorption rate from the lungs of 2 x 10(-5) d(-1). The Pu material deposited at the wound site was mixed: approximately 14% was rapidly absorbed, approximately 49% was absorbed at the rate of about 6 x 10(-5) d(-1), and the remainder ( approximately 37%) was absorbed extremely slowly (at the rate of about 5 x 10(-6) d(-1)). Thus, it was estimated that only approximately 40% of the Pu initially deposited in the wound had been absorbed systemically over the 33-y period until the donor's death. The biokinetic modelling also indicated that, in this individual case, some of the parameter values (rate constants) incorporated in the ICRP Publication 67 Pu model were up to a factor of 2 different from ICRP's recommended values (for reference man). PMID:18227076

James, A C; Sasser, L B; Stuit, D B; Wood, T G; Glover, S E; Lynch, T P; Dagle, G E



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


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

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



Capabilities of two- and three-dimensional FDG-PET for detecting small lesions and lymph nodes in the upper torso: a dynamic phantom study  

Microsoft Academic Search

.   The capabilities and limitations of two-(2D) and three-dimensional (3D) fluorine-18 fluorodeoxyglucose positron emission\\u000a tomography (FDG-PET) in detecting small tumors and lymph nodes were studied in a phantom modeling the human chest and axilla.\\u000a Multiple dual-radionuclide phantom studies were performed. Five hollow spheres ranging in diameter from 3 mm to 15 mm were\\u000a filled with carbon-11 and placed in the axillary and

Raymond R. Raylman; Paul V. Kison; Richard L. Wahl



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

PubMed Central

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

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



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

Microsoft Academic Search

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

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



Double-injection method using peripheral nerve stimulator is superior to single injection in axillary plexus block  

Microsoft Academic Search

Background and Objectives. Axillary block using a single-injection method does not always provide effective analgesia. This study examined whether a double axillary block injection technique is superior to a single injection axillary block. Methods. Fifty patients were randomly allocated to two groups. In group 1 (single injection), the whole volume of local anesthetic (0.7 mL\\/kg) was injected after locating only

Per Inberg; Ilkka Annila; Päivi Annila



Smallpox Vaccine, Dried, Calf Lymph Type  

Center for Biologics Evaluation and Research (CBER)

... Smallpox Vaccine, Dried, Calf Lymph Type. -. Product. Dryvax Wyeth Pharmaceuticals, Inc. -. Contact FDA. (800) 835-4709. ... More results from


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

PubMed Central

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

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



Armpit lump  


... lymphadenopathy - armpit; Axillary lymphadenopathy; Axillary lymph enlargement; Lymph nodes enlargement - axillary; Axillary abscess ... in the armpit may have many causes. Lymph nodes are filters that can catch germs or cancerous ...


[Pathways of regional lymph node metastases originating from soft tissue sarcomas].  


Lymph node metastases originating from soft tissue sarcomas are very rare and the reason for this is unclear. While this observation was less important in former times when ultraradical excision and amputation were the norm, modern reconstructive surgical treatment options have to take the possibility of lymphatic metastases into account.We attempted to identify parameters that may be predictive of lymphatic metastases in a cohort of 1,597 patients with soft tissue sarcomas of whom 26 patients (1.6? %) had regional lymph node (RLN) metastases. We studied these RLN metastases with recently described techniques that enabled us to histologically visualize lymphatic vessels.We conclude that sarcomas should not be evaluated from a histogenetic perspective but more on the basis of regional topography of the lymphatic vasculature. As we described previously, two different lymphatic systems should be differentiated: lymphatic vessel system I (LGS I) contains RLN and lymph vessels are mostly superficial; however, there are also vessels near large blood vessels of the extremities. System LGS II is more delicate and its vessels run into the musculature, a metastatic homing area of many sarcomas. Lymph vessels of system LGS II drain directly into veins without intervening lymph nodes. Sarcomas with LGS I drainage will form RLN metastases. In contrast, sarcomas with LGS II drainage will do so only after surgical resection if system LGS I has been opened. PMID:23591905

Stelzner, F; Steinau, H U; Friedrichs, N; von Mallek, D



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.

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



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


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

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



Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma  

Microsoft Academic Search

Background: Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics. Methods: Review of a consecutive series

Jeffrey D. Wagner; Darrell Davidson; John J. Coleman III; Gary Hutchins; Donald Schauwecker; Hee-Myung Park; Robert J. Havlik



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


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

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



'Revertant' DCIS in human axillary breast carcinoma metastases.  


Recent experimental evidence obtained in Scid mice has suggested that the metastatic process is in large part epigenetically regulated and undergoes partial reversion once the metastatic process is completed: the metastatic colonies become more engaged in the process of growing in situ than actively metastasizing. Based on this experimental evidence, examples were sought of metastatic human cancers where similar reversion to an in situ growth state was occurring. Review of 200 cases of metastatic human breast cancer revealed a 21 per cent incidence of reversion to a ductal carcinoma in situ (DCIS) growth pattern within axillary nodal metastases. The revertant DCIS areas were characterized by an intact and circumferential basement membrane, as demonstrated by extracellular laminin and type IV collagen immunoreactivity. These revertant DCIS areas could be distinguished from primary DCIS, however, by the absence of surrounding myoepithelial cells in the former, identified in the latter by their positive maspin, S-100, and smooth muscle actin immunoreactivity. The pattern of revertant DCIS, poorly differentiated (comedo) (13 per cent), intermediate (non-comedo) (6 per cent), or well-differentiated (non-comedo) (2%), exhibited complete 100 per cent concordance with the primary DCIS pattern. The concordance of histological patterns held true for even the subtypes of DCIS determined by architectural pattern, such as the micropapillary or cribriform subtypes. Nuclear size by digital image analysis and Her-2/neu, p53, and Ki-67 status in the revertant DCIS also exhibited complete concordance with the primary DCIS counterparts. Cases exhibiting a revertant DCIS pattern tended to be ER-negative/EGFR-positive and exhibited significant nodal involvement (mean number, 9; mean area, 90 per cent) compared with cases lacking a revertant pattern (mean number, 4; mean area, 15 per cent) (P < 0.01) These findings suggest that reversion of the metastatic phenotype may also be occurring within autochthonous human metastasis. PMID:9390032

Barsky, S H; Doberneck, S A; Sternlicht, M D; Grossman, D A; Love, S M



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

PubMed Central

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

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



The sonographic evaluation of lymph nodes.  


Ultrasound can be used to detect and evaluate both normal and abnormal lymph nodes, as well as aid in biopsy sampling procedures, an important part of staging procedures in cancer patients. Several parameters can be evaluated using ultrasound; lymph node size, margins, echogenicity, echopattern (echotexture), acoustic transmission, presence and distribution of vascular flow, and vascular flow indices. The most diagnostically helpful include the short/long axis ratio of the lymph node, the pattern of distribution of the blood vessels within the lymph node, and to some extent the resistive and pulsatility indices. This review discusses the use of ultrasound for detecting, evaluating, and sampling peripheral, abdominal and thoracic lymph nodes in small animals. PMID:17844819

Nyman, Helena T; O'Brien, Robert T



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.)



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

PubMed Central

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

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



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

PubMed Central

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

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



Inguinal or inguino-iliac/obturator lymph node dissection after positive inguinal sentinel lymph node in patients with cutaneous melanoma  

PubMed Central

Background The aim of the study was to determine whether the presence of inguinal sentinel lymph node (SLN) metastases smaller than 2 mm (micrometastases) subdivided according to the number of micrometastases predicts additional, non-sentinel inguinal, iliac or obturator lymph node involvement in completion lymph node dissection (CLND). Patients and methods. Positive inguinal SLN was detected in 58 patients (32 female, 26 male, median age 55 years) from 743 consecutive and prospectively enrolled patients with primary cutaneous melanoma stage I and II who were treated with SLN biopsy between 2001 and 2007. Results Micrometastases in inguinal SLN were detected in 32 patients, 14 were single, 2 were double, and 16 were multiple. Twenty-six patients had macrometastases. Conclusions No patient with any micrometastases or a single SLN macrometastasis in the inguinal region had any iliac/obturator non-sentinel metastases after CLND in our series. Furthermore, no patient with single SLN micrometastasis in the inguinal region had any non-sentinel metastases at all after CLND in our series. In these cases respective CLND might be omitted.

Glumac, Nebojsa; Hocevar, Marko; Zadnik, Vesna; Snoj, Marko



Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid  

Microsoft Academic Search

Background: The purpose of this study was to determine whether the sentinel lymph node (SLN) localization technique, which uses blue dye and 99mTc-labeled sulfur colloid, provides advantages over blue dye alone in the management of patients with stages I and II cutaneous melanoma. Methods: The records of 626 consecutive patients with melanoma who underwent lymphatic mapping and SLN biopsy between

Jeffrey E. Gershenwald; Chi-hong Tseng; William Thompson; Paul F. Mansfield; Jeffrey E. Lee; Michael Bouvet; J. Jack Lee; Merrick I. Ross



A comparison of the use of tympanic, axillary, and rectal thermometers in infants.  


This study examined the relationship between three instruments used in measuring tympanic, axillary, and rectal temperatures in infants less than 1 year of age. Temperatures were measured by Oto-temp Pedi Q tympanic thermometers, Becton Dickinson axillary thermometer, and rectal thermometers. A convenience sample of 5 infants less than 90 day and 54 greater than 90 days with fever, as well as 34 infants less than 90 days and 27 infants greater than 90 days without fever were studied. Correlations of infants less than 90 days and greater 90 days of age, as well as differences between infant temperature with and without fevers as variables, were examined. Results indicated a strong statistical relationship between Oto-Temp Pedi Q, Becton Dickinson axillary temperatures, and rectal temperatures, but not strong enough to base critical clinical decisions. Age and presence or absence of fever significantly affected the relationships between thermometers. PMID:10337119

Wilshaw, R; Beckstrand, R; Waid, D; Schaalje, G B



Axillary neuropathy mimicking quadrilateral space syndrome and its follow up for one year.  


Axillary neuropathy due to entrapment of the nerve in the quadrilateral space is seen rarely. Here, we describe a 24-year-old patient diagnosed with isolated axillary neuropathy that mimicked quadrilateral space syndrome. Quadrilateral or quadrangular space syndrome (QSS), first described by Cahill and Palmer in 1983, was defined as the entrapment of the distal branch of the axillary nerve and the posterior humeral circumflex artery (PHCA) in the quadrangular shaped anatomic space. We tracked the follow up of the patient for one year both clinically and electrophysiologically. Our aim in reporting this case is to stress the point that cases of such a nature usually represent situations of diagnostic and treatment challenges, where multidisciplinary approaches are required. PMID:21063294

Turker, Hande; Sarica, Murat; Bilgici, Ayhan; Cengiz, Nilgun; Onar, Musa K; Us, Onder



In-vitro and in-vivo studies of human axillary odour and the cutaneous microflora.  


The axillary microflora of 34 male subjects were studied in relation to their underarm odour intensity. The predominant groups of micro-organisms were aerobic coryneforms, Micrococcaceae and propionibacteria. There was no competition for habitat between these groups (Fisher's exact test P greater than 0.05). There was an association between the population density of aerobic coryneforms and the intensity of odour (Spearman, P = 0.001). Dominance of aerobic coryneforms within the axillary microflora was associated with high odour intensity (chi 2, P = 0.005). An in-vitro odour model was developed using a diethyl ether extract of axillary skin incubated with test bacteria. Underarm odour was produced exclusively by aerobic coryneform bacteria. Of aerobic coryneforms, 71.4% were odour producers and these were identified as Corynebacterium xerosis. PMID:2064946

Rennie, P J; Gower, D B; Holland, K T



A Discrete Subpopulation of Dendritic Cells Transports Apoptotic Intestinal Epithelial Cells to T Cell Areas of Mesenteric Lymph Nodes  

Microsoft Academic Search

This study identifies a dendritic cell (DC) subset that constitutively transports apoptotic intesti- nal epithelial cell remnants to T cell areas of mesenteric lymph nodes in vivo. Rat intestinal lymph contains two DC populations. Both populations have typical DC morphology, are ma- jor histocompatibility complex class II hi , and express OX62, CD11c, and B7. CD4 1 \\/OX41 1 DCs

Fang-Ping Huang; Nicholas Platt; Michelle Wykes; James R. Major; Timothy J. Powell; Christopher D. Jenkins; G. Gordon MacPherson


Cathepsin S in tumours, regional lymph nodes and sera of patients with lung cancer: relation to prognosis  

Microsoft Academic Search

Cysteine proteinase cathepsin S (Cat S) is expressed mainly in lymphatic tissues and has been characterised as a key enzyme in major histocompatibility complex class II (MHC-II) mediated antigen presentation. Cat S has been measured in tissue cytosols of lung parenchyma, lung tumours and lymph nodes and in sera of patients with lung tumours and of healthy controls, by specific

J Kos; A Sekirnik; G Kopitar; N Cimerman; K Kayser; A Stremmer; W Fiehn; B Werle



Aneurysms of the mid axillary artery in major league baseball pitchers—A report of two cases  

Microsoft Academic Search

True aneurysms of the axillary artery and its branches are rarely identified. Our recent experience with successful repairs of symptomatic aneurysms of the axillary arteries at the origin of the circumflex humeral arteries in 2 major league baseball pitchers suggests a condition that may be more common than recognized previously. We report this unique experience with baseball pitchers to focus

George J. Todd; Alan I. Benvenisty; Stuart Hershon; Louis U. Bigliani



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



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



Characteristics of Refractory Sweating Areas Following Minimally Invasive Surgery for Axillary Hyperhidrosis  

Microsoft Academic Search

Background  Several surgical strategies have evolved for the treatment of focal axillary hyperhidrosis (FAH). However, nonresponders are\\u000a found in every procedure. Until now no characterization of the recurrent sweating areas has been reported. The aim of this\\u000a study was to characterize the axillary sweat area by using the iodine starch test in nonresponders prior to surgery.\\u000a \\u000a \\u000a \\u000a Methods  Prior to minimally invasive surgery,

Falk Georges Bechara; Michael Sand; Peter Altmeyer



Axillary nerve palsy after retrograde humeral nailing: clinical confirmation of an anatomical fear  

Microsoft Academic Search

Introduction  Locked antegrade or retrograde nailing of humeral shaft and proximal humerus fractures is a well etablished treatment option.\\u000a Anatomic-morphological studies revealed a potential high risk of axillary nerve injury within proximal interlocking screw\\u000a insertion. However, clinical experiences do not seem to confirm this, as there is a lack of interlocking screw insertion associated\\u000a axillary lesions in literature.\\u000a \\u000a \\u000a \\u000a Case report  We report

Tim Tobias Lögters; Michael Wild; Joachim Windolf; Wolfgang Linhart



Evaluation of preoperative C-reactive protein aids in predicting poor survival in patients with curative colorectal cancer with poor lymph node assessment  

PubMed Central

Lymph node status is the most significant prognostic factor of colorectal cancer. However, there is a risk of disease understaging if the extent of lymph node assessment is sub-optimal. Preoperative C-reactive protein (CRP) is known to be a useful tool in predicting postoperative outcomes in patients with colorectal cancer. We retrospectively evaluated whether CRP adds to prognosis information in stage I–III colorectal cancer patients with poor lymph node assessment. In stages I–III, multivariate analysis revealed that CRP-positive status and advanced T-stage were factors that independently affected survival. In stage III, univariate analysis revealed that lymph node number retrieval and lymph node ratio were factors that affected survival. However, CRP positivity was the only independent factor for survival. CRP positivity did not predict poor prognosis in stage II or III patients with adequate lymph node retrieval. By contrast, the prognosis of CRP-positive patients was poorer than that of CRP-negative patients in stage II and III, with inadequate lymph node retrieval. CRP is an independent prognostic marker in patients with stage I–III, II or III colorectal cancer. The evaluation of CRP may provide useful information on prognosis in curative patients with an inadequate examination of lymph nodes.




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

Microsoft Academic Search

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

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



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


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

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



Extracapsular Extension of the Sentinel Lymph Node Metastasis: A Predictor of Nonsentinel Node Tumor Burden  

PubMed Central

Objective To identify predictors of nonsentinel node (NSN) tumor involvement in patients with a tumor-involved sentinel node (SN). Summary Background Data For many breast cancer patients who undergo intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL), the SN is the only tumor-involved axillary node. Associations between NSN tumor involvement and several clinical and histopathologic factors have been identified. The authors hypothesize that extracapsular extension (ECE) of the SN metastasis is highly predictive of NSN tumor involvement. Methods Between May 1998 and December 2001, 260 patients (263 cases) with clinical T1 or T2 (<5.0 cm) breast cancer underwent LM/SL at the University of North Carolina, using a combined blue dye and technetium sulfur colloid technique. In all cases with a tumor-involved SN, axillary lymph node dissection (ALND) was recommended. Statistical analysis, with Pearson chi-square tests, Fisher exact test, and multiple logistic regression, was performed. Results The SN contained tumor in 74 (28.1%) cases. ALND was performed in 70 of the 74 cases. ECE of the SN metastasis was present in 18 (25.7%) of the 70 cases. Patients with ECE of the SN metastasis were more likely to have NSN tumor involvement and had a greater total number of tumor-involved nodes than patients without ECE of the SN metastasis. Increasing size of the SN metastasis and increasing size of the primary tumor, examined as continuous variables, were associated with an increased likelihood of NSN tumor involvement on univariate analysis. However, only ECE of the SN metastasis was associated with NSN tumor involvement on multivariate analysis. Conclusions ECE of the SN metastasis is a strong predictor of NSN tumor involvement. All patients with ECE of the SN metastasis should undergo mandatory completion ALND.

Stitzenberg, Karyn B.; Meyer, Anthony A.; Stern, Stacey L.; Cance, William G.; Calvo, Benjamin F.; Klauber-DeMore, Nancy; Kim, Hong Jin; Sansbury, Leah; Ollila, David W.



Internal mammary node drainage and its role in sentinel lymph node biopsy: the initial ALMANAC experience.  


This study was designed to identify the frequency of internal mammary drainage in patients undergoing sentinel lymph node (SLN) lymphoscintigraphy in a controlled clinical trial. The practicability and relevance of internal mammary SLN biopsy as a method to improve nodal staging and treatment in breast cancer were investigated. A total of 707 evaluable patients with invasive breast cancer underwent SLN biopsy based on lymphoscintigraphy, intraoperative g probe detection, and blue dye mapping using technetium Tc 99m albumin colloid and Patent Blue V injected peritumorally. This was followed by standard axillary treatment in the same operation in all patients. Lymphoscintigraphy showed internal mammary sentinel nodes in 62 patients (9%), and internal mammary drainage was identified perioperatively in an additional 7 patients (1%) using g probe detection. Sampling of the internal mammary basin, based on the results of lymphoscintigraphy and g probe detection, was done in 31 of 69 patients (45%). One patient had a pneumothorax and 2 experienced bleeding during internal mammary sampling. Internal mammary metastases were detected in 4 of 31 patients (13%). In 2 of the patients (6%), internal mammary nodes (IMNs) showed metastatic involvement without accompanying axillary metastases. One of these 2 patients would have received adjuvant endocrine systemic therapy because of the characteristics of the tumor, but may not have been recommended to receive adjuvant chemotherapy. Sampling of the internal mammary basin led to a change of management in these 2 patients, ie, institution of adjuvant chemotherapy. Therefore, a change in management occurred in only 2 of the 69 patients in our series, but 38 patients with unbiopsied "hot" IMNs remained with unknown internal mammary status. Biopsy of IMNs alters staging in few patients, and the impact on indication for adjuvant treatment was low. Internal mammary SLN biopsy may be associated with some additional morbidity. Current evidence suggests that internal mammary SLN biopsy is still a research tool. PMID:15507173

Mansel, Robert E; Goyal, Amit; Newcombe, Robert G



Prediction of Non-Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastases: Evaluation of the Tenon Score  

PubMed Central

Introduction Current guidelines recommend completion axillary lymph node dissection (cALND) in case of a sentinel lymph node (SLN) metastasis larger than 0.2 mm. However, in 50%–65% of these patients, the non-SLNs contain no further metastases and cALND provides no benefit. Several nomograms and scoring systems have been suggested to predict the risk of metastases in non-SLNs. We have evaluated the Tenon score. Patients and Methods In a retrospective review of the Swedish Sentinel Node Multicentre Cohort Study, risk factors for additional metastases were analysed in 869 SLN-positive patients who underwent cALND, using uni- and multivariate logistic regression models. A receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity of the Tenon score, and the area under the curve (AUC) was calculated. Results Non-SLN metastases were identified in 270/869 (31.1%) patients. Tumour size and grade, SLN status and ratio between number of positive SLNs and total number of SLNs were significantly associated with non-SLN status in multivariate analyses. The area under the curve for the Tenon score was 0.65 (95% CI 0.61–0.69). In 102 patients with a primary tumour <2 cm, Elston grade 1–2 and SLN metastases ?2 mm, the risk of non SLN metastasis was less than 10%. Conclusion The Tenon score performed inadequately in our material and we could, based on tumour and SLN characteristics, only define a very small group of patients in which negative non-sentinel nodes could be predicted.

Andersson, Y; Frisell, J; de Boniface, J; Bergkvist, L



Mechanoinduction of lymph vessel expansion  

PubMed Central

In the mammalian embryo, few mechanical signals have been identified to influence organ development and function. Here, we report that an increase in the volume of interstitial or extracellular fluid mechanically induces growth of an organ system, that is, the lymphatic vasculature. We first demonstrate that lymph vessel expansion in the developing mouse embryo correlates with a peak in interstitial fluid pressure and lymphatic endothelial cell (LEC) elongation. In ‘loss-of-fluid' experiments, we then show that aspiration of interstitial fluid reduces the length of LECs, decreases tyrosine phosphorylation of vascular endothelial growth factor receptor-3 (VEGFR3), and inhibits LEC proliferation. Conversely, in ‘gain-of-fluid' experiments, increasing the amount of interstitial fluid elongates the LECs, and increases both VEGFR3 phosphorylation and LEC proliferation. Finally, we provide genetic evidence that ?1 integrins are required for the proliferative response of LECs to both fluid accumulation and cell stretching and, therefore, are necessary for lymphatic vessel expansion and fluid drainage. Thus, we propose a new and physiologically relevant mode of VEGFR3 activation, which is based on mechanotransduction and is essential for normal development and fluid homeostasis in a mammalian embryo.

Planas-Paz, Lara; Strilic, Boris; Goedecke, Axel; Breier, Georg; Fassler, Reinhard; Lammert, Eckhard



Robotic-assisted inguinal lymph node dissection: A preliminary report  

PubMed Central

Penile cancer with inguinal lymph node metastasis is a common cancer in India. Open inguinal lymphadenectomy is the gold standard treatment of metastatic inguinal lymph nodes. We report our experience and technique of robotic assisted inguinal lymph node dissection in two patients presented with palpable inguinal lymph nodes, which to our knowledge is the first reported case series from India.

Dogra, P. N.; Saini, Ashish Kumar; Singh, Prabhjot



Laparoscopic Retroperitoneal Lymph Node Dissection: Extraperitoneal Approach  

Microsoft Academic Search

We review our early experience with laparoscopic retroperitoneal lymph node dissection (RPLND) via extraperitoneal approach\\u000a to assess the precise pathological status of retroperitoneal lymph nodes in early-stage testicular cancer. A total of 32 patients\\u000a (23 with stage I, 4 with stage IIa, and 5 with stage IIb) with testicular cancer underwent extraperitoneal laparoscopic RPLND\\u000a in the supine position. After developing

Makoto Satoh; Akihiro Ito; Yoichi Arai


Sentinel lymph node mapping with GI cancer  

Microsoft Academic Search

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

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



Morphological evaluation of olive plants propagated in vitro culture through axillary buds and somatic embryogenesis methods  

Microsoft Academic Search

The morphological fidelity of the olive plants propagated through axillary buds, microplants and somatic embryogenesis, somatic plants was evaluated. Thirty-two morphological traits were used to characterize the tissue culture propagated olive plants. The microplants showed very high phenotypic similarity compared to plants produced by conventional cutting propagation method. The somatic plants exhibited variant morphological stable phenotypes, among somaclonal population two

Leva Annarita


Virtual reality-based regional anaesthesia simulator for axillary nerve blocks.  


In this paper, we present a simulator for regional anaesthesia for nerve blocks in the axillary plexus region. We use a novel approach based on electric distance to simulate electronic impulse transmission through soft tissue. The traversal of electrons emitted from the needle tip is calculated by modified pathfinding algorithms. Kinematic algorithms visualize the motor response of the forearm by skeletal animation. PMID:19377191

Ullrich, Sebastian; Frommen, Thorsten; Rossaint, Rolf; Kuhlen, Torsten



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

National Technical Information Service (NTIS)

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

X. Du



A functional ABCC11 allele is essential in the biochemical formation of human axillary odor.  


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 characteristic axillary odor and that a single-nucleotide polymorphism (SNP) 538G --> A, which is prominent among Asian people, leads to a nearly complete loss of the typical odor components in axillary sweat. The secretion of amino-acid conjugates of human-specific odorants is abolished in homozygotic carriers of the SNP, and steroidal odorants and their putative precursors are significantly reduced. Moreover, we show that ABCC11 is expressed and localized in apocrine sweat glands. These data point to a key function of ABCC11 in the secretion of odorants and their precursors from apocrine sweat glands. SNP 538G --> A, which also determines human earwax type, is present on an extended haplotype, which has reached >95% frequency in certain populations in recent human evolution. A strong positive selection in mate choice for low-odorant partners with a dysfunctional ABCC11 gene seems a plausible explanation for this striking frequency of a loss-of-function allele. PMID:19710689

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



What is the relationship between paresthesia and nerve stimulation for axillary brachial plexus block?  

Microsoft Academic Search

Background and Objectives: To quantify the motor threshold current of a needle following elicitation of paresthesia during axillary brachial plexus block (ABPB). Methods: This is a prospective, observational study of ABPB in 72 patients. Having elicited paresthesia, the minimum current required to produce a motor response was noted. The development and success of the block were subsequently followed. Results: Nineteen

Andrew Choyce; Vincent W. S. Chan; William J. Middleton; Paul R. Knight; Philip Peng; Colin J. L. McCartney



The Risk of Persistent Paresthesia Is Not Increased with Repeated Axillary Block  

Microsoft Academic Search

Neurologic deficits are noted on physical examination in approximately 0.2%-19% of patients after regional anes- thetic techniques. Laboratory and clinical studies suggest that a subclinical neuropathy occurs much more often. Performing a regional anesthetic technique during this period may result in additional nerve trauma. We evalu- ated the frequency of neurologic complications in patients undergoing repeated axillary block. A total

Terese T. Horlocker; Ronald P. Kufner; Allen T. Bishop; Pamela M. Maxson; Darrell R. Schroeder



Clonal Propagation of an Important Medicinal Tree Crataeva nurvala Through Enhanced Axillary Branching  

Microsoft Academic Search

In vitro clonal propagation system for Crataeva nurvala, a valuable medicinal tree utilized in traditional systems of Indian medicine, has been developed. Multiple shoot induction was achieved through axillary branching, using stem node segments as explants collected from field grown plants. Cytokinins (6-benzyladenine and kinetin) were investigated for in vitro shoot multiplication and BA proved to be more effective. Formation

Fatima Shirin; Sushma Maravi



The impact of previous para-areolar incision in the upper outer quadrant of the breast on the localization of the sentinel lymph node in a canine model  

PubMed Central

OBJECTIVES: This paper discusses the influence of a para-areolar incision in the upper outer quadrant of the breast on the location of the sentinel lymph node in a canine model. METHODS: The sentinel lymph node was marked with technetium-99, which was injected into the subareolar skin of the cranial breast. After the marker had migrated to the axilla, an arcuate para-areolar incision was performed 2 cm from the nipple in the upper outer quadrant. Patent blue dye was then injected above the upper border of the incision. At the marked site, an axillary incision was made, and the sentinel lymph node was identified by gamma probe and/or by direct visualization of the dye. The agreement between the two injection sites and the two sentinel lymph node identification methods was determined. Our sample group consisted of 40 cranial breasts of 23 adult females of the species Canis familiaris. The data were analyzed by using the McNemar test and by determining the kappa agreement coefficient. RESULT: Our findings showed that in 95% of the breasts, the sentinel lymph node was identified by the injection of technetium-99 m into the subareolar region, and in 82% of the cases, the sentinel lymph node was identified by the injection of patent blue dye above the upper border of the incision. The methods agreed 82% of the time. CONCLUSIONS: Previous para-areolar incisions in the upper outer quadrant did not interfere significantly with the biopsy when the dye was injected above the upper border of the incision.

Vasques, Paulo Henrique Diogenes; Pinheiro, Luiz Gonzaga Porto; de Meneses e Silva, Joao Marcos; de Moura Torres-de-Melo, Jose Ricardo; Pinheiro, Karine Bessa Porto; Rocha, Joao Ivo Xavier



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

PubMed Central

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




New method to assess manual lymph drainage using lymphoscintigraphy.  


The aim of this study was to describe a new variation of the technique to evaluate lymph drainage utilizing lymphoscintigraphy. A LS scan marks the route of lymphatic vessels and may be used to assess both manual lymph drainage and lymph drainage after using some apparatuses. This evaluation may be dynamic, collecting images whilst performing lymph drainage or static, with scans before and after the lymph drainage procedure. PMID:22951956

de Godoy, José Maria Pereira; Iozzi, Adriana Joaquim; Azevedo, Walter Ferreira; Godoy, Maria de Fátima Guerreiro



Carotid axillary bypass in a patient with blocked subclavian stents: a case report  

PubMed Central

Introduction Surgical treatment of symptomatic occlusive lesions of the proximal subclavian artery is infrequently necessary. Carotid subclavian bypass has gained popularity and is now considered standard treatment when stenting is not possible. Exposure of the subclavian artery and bypass grafting onto it is difficult, as the vessel is delicate, thin-walled and located deep in the supraclavicular fossa. The thoracic duct and brachial plexus are in close proximity to the left subclavian artery and are therefore susceptible to damage. Distal grafting to the axillary artery instead of the subclavian artery has the potential of avoiding some of these risks. Infraclavicular exposure of the axillary artery is more straightforward. The vessel wall is thicker and is easier to handle. In this case report, we describe a patient with a left proximal subclavian occlusion which was stented twice and blocked on both occasions. The patient underwent a carotid axillary bypass, as grafting onto the subclavian artery was impossible because of the two occluded metal stents. Case presentation A 56-year-old Caucasian woman, a heavy smoker, presented acutely with left arm numbness and pain and blood pressure discrepancies in both arms. A diagnosis of subclavian stenosis was confirmed on the basis of a computed tomographic scan and a magnetic resonance angiogram. The patient had undergone subclavian artery stenting twice, and unfortunately the stents blocked on both occasions. The patient underwent carotid axillary bypass surgery. She had an uneventful recovery and was able to return to a full, normal life. Conclusion Carotid axillary bypass appears to be a good alternative to carotid subclavian bypass in the treatment of symptomatic proximal stenosis or occlusion of the subclavian artery.



Lymph node micrometastases of cutaneous melanoma: increased sensitivity of molecular diagnosis in comparison to immunohistochemistry.  


The presence of regional lymph node metastases is one of the most significant prognostic factors for predicting survival in patients with clinical stage I or II cutaneous melanoma. For accurate staging of the primary tumor a sensitive technique is required to detect occult nodal micrometastases. This prospective diagnostic study was designed to evaluate the incidence of nodal micrometastases using nested reverse transcription-polymerase chain reaction (RT-PCR) for tyrosinase in comparison to immunohistochemical examination. Furthermore, the incidence of melanoma micrometastases detected by RT-PCR was analysed in correlation to major prognostic factors. A total of 466 regional lymph nodes from 79 patients with primary cutaneous melanoma (tumor thickness > 0.75 mm) were investigated. In 49 lymph nodes from 31 patients immunohistochemistry demonstrated melanoma metastases. Using tyrosinase RT-PCR, nodal micrometastases were detected in 136 lymph nodes from 52 patients including all lymph nodes positive by immunohistochemical examination. Out of the 417 lymph nodes negative by immunohistochemistry, 87 nodes (21%) were identified to express tyrosinase by the RT-PCR technique. Among the 48 patients negative by immunohistochemical assessment, 21 (44%) had nodal micrometastases (n = 40) using RT-PCR. All 68 lymph nodes from 46 non-melanoma patients serving as negative controls for tyrosinase RT-PCR were negative. The detection of melanocytic nodal micrometastases by tyrosinase RT-PCR is a highly specific method with a sensitivity significantly higher than that achieved by immunohistochemistry (p < 0.0001). Patients with nodal micrometastases identified exclusively by RT-PCR had significantly higher tumor thickness as compared to patients with negative results by RT-PCR (p < 0.01). PMID:9699521

Blaheta, H J; Schittek, B; Breuninger, H; Maczey, E; Kroeber, S; Sotlar, K; Ellwanger, U; Thelen, M H; Rassner, G; Bültmann, B; Garbe, C



Identifying additional lymph nodes in radical cystectomy lymphadenectomy specimens.  


Lymph node count has prognostic implications in bladder cancer patients who are treated with radical cystectomy. Lymph nodes that are too small to identify grossly can easily be missed, potentially leading to missed nodal metastases and inaccurate nodal counts, resulting in inaccurate prognoses. We investigated whether there is a benefit to submitting the entire lymph node packet for histological examination to identify additional lymph nodes. We prospectively assessed 61 pelvic lymphadenectomy specimens in 14 consecutive patients undergoing radical cystectomy. The specimens were placed in Carnoy's solution overnight, then analyzed for lymph nodes. The residual tissue was entirely submitted to assess for additional lymph nodes. In 61 specimens, we identified 391 lymph nodes, ranging from 4-44 nodes per patient. We identified 238 (61%) lymph nodes with standard techniques and 153 (39%) lymph nodes in submitted residual tissue. The number of additional lymph nodes found in the residual tissue ranged from 0 to 26 (0-75%) per patient. These lymph nodes ranged in size from 0.05 to 1 cm. All additional lymph nodes were negative for metastatic disease. Submitting the entire specimen for histological examination allowed for identification of more lymph nodes in radical cystectomy pelvic lymphadenectomy specimens. However, as none of the additional lymph nodes contained metastatic disease, it is unclear if there is a clinical benefit in evaluating lymph nodes that are neither visible nor palpable in lymphadenectomy specimens. PMID:21909079

Gordetsky, Jennifer; Scosyrev, Emelian; Rashid, Hani; Wu, Guan; Silvers, Christopher; Golijanin, Dragan; Messing, Edward M; Yao, Jorge L



Collateral presentation of antigens as physiological prototype for lymph node metastases.  


The formation of lymphogenic metastases remains enigmatic. In particular, the much more pronounced predilection of carcinomas than of sarcomas to metastasizing into regional lymph nodes is an unsolved problem. We suggest that this difference could be due to the ability of epitheliocytes for a hypothetical process termed by us "collateral presentation of antigens". Under conditions of infection of epithelium with intracellular pathogens or during inflammation, epithelial cells acquire a special receptor phenotype, undergo the epithelial-mesenchymal transition, and migrate along lymphatic vessels into lymph nodes where they present antigen to immunocytes. The collateral presentation of antigens can be of significant biological importance in the case of insufficient classical pathway of antigen presentation (by dendritic cells) or on disturbance in the death mechanisms of the infected cells. Depending on conditions of induction of the epithelial-mesenchymal transition and on possible ability of epitheliocytes to express MHC II with co-stimulating molecules, two pathways,  "container-mediated" and "MHC II-dependent", of antigen presentation in lymph nodes resulting in development of immunogenesis or anergy of immunocytes are supposed to exist. All pathways of delivery of the epithelial cells into lymph nodes and of antigen presentation by epitheliocytes terminate by death of these cells. The lymphogenic metastasizing realizes the same mechanism under conditions of tumor disease; however, this is not associated with cell death, but they actively colonize the lymph node. The proposed hypothesis allows us to explain the metastasizing of sarcomas into lymph nodes. The main prerequisite for lymphogenic metastasizing seems to be related with the mesenchymal-epithelial transition of sarcoma cells promoting their involvement in the presentation of antigens. PMID:23586727

Manskikh, V N; Perelmuter, V M



Immunohistochemical consistency between primary tumors and lymph node metastases of gastric neuroendocrine carcinoma  

PubMed Central

Background Gastric neuroendocrine carcinoma (G-NEC) is a rare, highly malignant tumor that exhibits aggressive growth leading to vascular invasion, distant metastasis and extremely poor prognosis. We studied the clinicopathological findings of seven patients at our institute to better under this disease. Methods Seven cases of G-NEC were identified among 1,027 cases of gastric carcinoma that underwent gastrectomy at Kansai Rousai Hospital between 2002 and 2010. We studied the pathological and immunohistochemical features of gastric neuroendocrine carcinomas at both the primary site and metastatic lymph nodes. Results The mean patient age was 73 years (range 63 to 86 years). There were no females in this series. The final staging was Stage I in one case, Stage II in two, Stage III in two and Stage IV in two. A total of 31 metastatic lymph nodes were found in these patients. This study revealed that the ratio of neuroendocrine cells was similar between the primary and metastatic sites, which tended to show the same expression patterns of neuroendocrine markers. Conclusions Metastatic lymph nodes showed heterogeneous immunohistochemical expression patterns similar to the primary sites. G-NEC is far advanced at diagnosis and rapidly reaches the lymph nodes retaining its heterogeneity, carrying a worse prognosis than common gastric cancer. Mini abstract G-NEC grows rapidly and metastasizes to the lymph nodes, retaining its pathological and immunohistochemical heterogeneity even at the metastatic sites.



Predicting residual lymph node basin disease in melanoma patients with sentinel lymph node metastases  

Microsoft Academic Search

BackgroundThe incidence of residual occult disease in nonsentinel lymph nodes (NSLN) after a positive sentinel lymph node (SLN) biopsy in patients with melanoma is relatively low. The purpose of this study is to identify factors that may be predictive of occult NSLN metastases after positive SLN biopsy.

George I Salti; Tapas K Das Gupta



Agrobacterium-mediated genetic transformation and development of herbicide-resistant sugarcane (Saccharum species hybrids) using axillary buds.  


Direct regeneration from explants without an intervening callus phase has several advantages, including production of true type progenies. Axillary bud explants from 6-month-old sugarcane cultivars Co92061 and Co671 were co-cultivated with Agrobacterium strains LBA4404 and EHA105 that harboured a binary vector pGA492 carrying neomycin phosphotransferase II, phosphinothricin acetyltransferase (bar) and an intron containing beta-glucuronidase (gus-intron) genes in the T-DNA region. A comparison of kanamycin, geneticin and phosphinothricin (PPT) selection showed that PPT (5.0 mg l(-1)) was the most effective selection agent for axillary bud transformation. Repeated proliferation of shoots in the selection medium eliminated chimeric transformants. Transgenic plants were generated in three different steps: (1) production of putative primary transgenic shoots in Murashige-Skoog (MS) liquid medium with 3.0 mg l(-1) 6-benzyladenine (BA) and 5.0 mg l(-1) PPT, (2) production of secondary transgenic shoots from the primary transgenic shoots by growing them in MS liquid medium with 2.0 mg l(-1) BA, 1.0 mg l(-1) kinetin (Kin), 0.5 mg l(-1) alpha-napthaleneacetic acid (NAA) and 5.0 mg l(-1) PPT for 3 weeks, followed by five more cycles of shoot proliferation and selection under same conditions, and (3) rooting of transgenic shoots on half-strength MS liquid medium with 0.5 mg l(-1) NAA and 5.0 mg l(-1) PPT. About 90% of the regenerated shoots rooted and 80% of them survived during acclimatisation in greenhouse. Transformation was confirmed by a histochemical beta-glucuronidase (GUS) assay and PCR amplification of the bar gene. Southern blot analysis indicated integration of the bar gene in two genomic locations in the majority of transformants. Transformation efficiency was influenced by the co-cultivation period, addition of the phenolic compound acetosyringone and the Agrobacterium strain. A 3-day co-cultivation with 50 micro M acetosyringone considerably increased the transformation efficiency. Agrobacterium strain EHA105 was more effective, producing twice the number of transgenic shoots than strain LBA4404 in both Co92061 and Co671 cultivars. Depending on the variety, 50-60% of the transgenic plants sprayed with BASTA (60 g l(-1) glufosinate) grew without any herbicide damage under greenhouse conditions. These results show that, with this protocol, generation and multiplication of transgenic shoots can be achieved in about 5 months with transformation efficiencies as high as 50%. PMID:15133712

Manickavasagam, M; Ganapathi, A; Anbazhagan, V R; Sudhakar, B; Selvaraj, N; Vasudevan, A; Kasthurirengan, S



Venous thrombosis in subclavian, axillary, brachial veins with extension to internal jugular vein, right sigmoid sinus and simultaneous pulmonary embolism  

PubMed Central

We present a rare case of Venous Thrombosis in Subclavian, Axillary, Brachial Veins with extension to Internal Jugular vein, right sigmoid sinus and simultaneous Pulmonary embolism during the treatment with low molecular weight heparin.

Tamizifar, Babak; Beigi, Arash; Rismankarzadeh, Maryam



Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury  

Microsoft Academic Search

The axillary nerve is invariably reported to be one of the most commonly injured nerves during surgical procedures of the\\u000a shoulder, and the importance of protecting it cannot be overemphasized. Many researchers have tried to identify safe regions,\\u000a but the results vary among published studies. The axillary nerve may also be injured during acute trauma to the shoulder or\\u000a by

Nihal ApaydinR; R. Shane Tubbs; Marios Loukas; Fabrice Duparc



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



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

Microsoft Academic Search

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

Morna MacNeill; Isobel Arnott; Jeremy Thomas



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.



[Repeated local thrombolysis in a patient with axillary and subclavian vein injury and thrombosis].  


Deep vein thrombosis (DVT) is a disorder with blood clot (thrombus) formation in deep veins. DVT of upper extremities (UE) is rare but serious, bearing in mind its possible complications, disease. UE DVT treatment involves subcutaneous injections of low molecular weight heparins and subsequent switch to oral anticoagulation or thrombolysis; thrombolysis by intravenous administration of a thrombolytic agent is used only if indicated (subclavian vein thrombosis). A case of a professional sportswoman is presented, who was treated for venous thrombosis of subclavian and axillary veins using local thrombolysis. Thrombosis emerged suddenly after a basketball match, during which oedema of the right arm occurred subsequent to the patient being hit with the ball to the armpit area. Venipuncture as well as all catheter repositionings were performed under the duplex ultrasound (DUS) surveillance. Proximal brachial vein was punctured and four French catheters were used to enter subclavian vein. For thrombolysis, 0.2-0.6 mg/hour alteplase (rt-PA) was used. Injury to axillary vein tunica intima was evident the following day after the subclavian and axillary thrombosis was dissolved completely, and thrombosis in the same area recurred immediately after stopping the thrombolytic infusion. Therefore, administration of a thrombolytic agent into the same area was re-introduced and acetylsalicylic acid was added to the medication. This combined therapy resulted in recanalization of the arm as well as the axillary and subclavian areas. Thrombolysis was stopped on the 3rd day of treatment. The method can be used to manage deep vein thromboses of the upper arms even without X-ray control. Local thrombolysis of deep vein thrombosis with ultrasound surveillance is, in indicated patients, a safe method even if a vein injury occurs. PMID:20017444

Sárník, S; Hofírek, I



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

Microsoft Academic Search

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

Michael Stierer; Harald Rosen; Renate Weber



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

Microsoft Academic Search

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

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



Transpulmonary thermodilution cardiac output measurement using the axillary artery in critically ill patients  

Microsoft Academic Search

Study Objective: To compare cardiac output (CO) as measured by the arterial thermodilution technique using only a central venous catheter and an arterial catheter inserted into the axillary artery, with conventional CO measurement with thermodilution using a pulmonary artery (PA) catheter (PAC).Design: Prospective clinical study in which each patient served as his\\/her own control.Setting: General ICU of a large tertiary-care

Eran Segal; Rita Katzenelson; Haim Berkenstadt; Azriel Perel



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

Microsoft Academic Search

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

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



Axillary plexus block using a peripheral nerve stimulator: single or multiple injections  

Microsoft Academic Search

This prospective, randomized, double-blind study was undertaken to evaluate the success rates of axillary brachial plexus\\u000a block performed with the help of a peripheral nerve stimulator when either one, two or four of the major nerves of the brachial\\u000a plexus were located. Seventy-five patients undergoing upper limb surgery were randomly allocated to one of the following five\\u000a groups according to

J. Lavoie; R. Martin; J.-P. Tétrault; D. J. Côté; M. J. Colas



Low dose axillary block by targeted injections of the terminal nerves  

Microsoft Academic Search

Purpose  To compare anesthetic time, success rate and adverse effects of axillary block by single or multiple injections of local anesthetic.\\u000a \\u000a \\u000a \\u000a Methods  Two groups of patients were studied. In group T (targeted injections, n = 53) the four terminal nerves were located by electrical\\u000a stimulation, and anesthetized with 5 ml mepivacaine 1% with epinephrine 5 ?g·ml?1 (MEPE). In group S (single injection,

Zbigniew J. Koscielniak-Nielsen; Per Rotbøll Nielsen; Tommy Sørensen; Michael Stenør



Is daily shaving of axillary and pubic hair a feature of suicide in the Muslim community?  


In the Islamic context, "fitrah" refers to humanity's innate disposition toward virtue and the ability to differentiate between right and wrong. A common quote regarding fitrah, from the Prophet is "The fitrah consists of 5 things: circumcision, trimming the moustache, cutting the nails, plucking the armpit hairs, and shaving the pubic hairs."In this study, our aim was to determine the status of axillary and pubic shaving in medicolegal death cases that took place in the Konya Province of Turkey and to evaluate the relationship with the origin of suicide. Of 2850 medicolegal death cases, 206 (7.2%) were of suicidal origin. It was observed that the average age in the cases of suicidal origin was 36.76 +/- 17.72 years, and 146 of 206 cases (70.9%) were men. As a method of suicide, hanging was the chosen method in 100 cases (48.5%), whereas firearm injuries occurred in 54 cases (26.2%), and intoxication was involved in 37 cases (18.0%). Daily axillary and pubic shaving was observed in 26 of 2644 (1.0%) death cases that occurred with nonsuicidal reasons, but in 65 of 206 were (31.6%) suicidal cases. Because suicidal notes were present in 25 (12.1%) of all of the suicidal cases, the ratio of daily axillary and pubic shaving was significantly higher than that of the suicidal notes.In investigating the cases of suicidal origin for medicolegal purposes, evidence showing that this action was committed by the victim, the presence of a suicide note at the death scene and, a history of a previous suicidal attempt, it was thought that the presence of daily axillary and pubic shaving on external examination of the victim's body, when of Muslim faith, could also be considered a feature of suicide. PMID:19259019

Demirci, Serafettin; Dogan, Kamil Hakan; Erkol, Zerrin; Deniz, Idris



Bilateral Cerebral Perfusion via Right Axillary Artery Cannulation Alone in Aortic Arch Surgery.  


Several methods have been proposed to avoid cerebral damage during aortic arch surgery. Antegrade, bilateral, selective cerebral perfusion is probably the most efficient one, although it has some drawbacks, such as air or particulate embolism risk, limitation in operative field visibility, and interactions with surgical maneuvers. We describe a surgical technique that provides bilateral antegrade perfusion to the brain, via the right axillary artery, with no need of additional arterial lines or shunting devices. PMID:23344761

Bassano, Carlo; Mvondo, Charles Mve; Bovio, Emanuele; Chiariello, Luigi



In vitro plant regeneration of Aristolochia indica through axillary shoot multiplication and organogenesis  

Microsoft Academic Search

Protocols for in vitro plant regeneration via axillary and adventitious shoot regeneration were established in an important\\u000a medicinal plant, Aristolochia indica L. (Aristolochiaceae). Basal Murashige and Skoog's (MS) medium supplemented with 0.54\\u000a M ?-naphthaleneacetic acid (NAA) and 13.31 M benzyladenine (BA) induced the maximum number of shoots (45-50) from shoot\\u000a tip and nodal segment cultures. Phenolic accumulation in leaf and

S. Manjula; Anita Thomas; Benny Daniel; G. M. Nair



Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block  

Microsoft Academic Search

A 74-yr-old diabetic woman developed necrotizing fasciitis of the right upper limb after axillary brachial plexus block for carpal tunnel decompression. Clinical signs included oedema, diffuse swelling and bullae; rapidly followed by toxic shock syndrome and multiorgan failure. The patient died 48 h after hospital admission, despite broad-spectrum antibiotics, surgical treatment and supportive measures for the management of shock and

S. Nseir; P. Pronnier; S. Soubrier; T. Onimus; F. Saulnier; D. Mathieu; A. Durocher



Shoot apical organisation and development of leaf and axillary bud in Capparis decidua pax  

Microsoft Academic Search

The present study deals with the shoot apical organisation, leaf and axillary bud initiation and their development inCapparis decidua. The shoot apex exhibits four cyto-histological zones during most of its plastochronic cycle. The number of tunica layers\\u000a varies from 2–3 in different phases of plastochron. An additional zone of ‘cambium-like’ cells was observed during the mid-plastochron\\u000a phase. This zone is

M. L. Trivedi



Comparison of lidocaine hydrocarbonate, lidocaine hydrochloride and mepivacaine in the axillary block  

Microsoft Academic Search

Axillary block was performed on 60 patients undergoing various types of surgical procedures on the upper limb. The patients\\u000a were divided randomly into three equal groups of 20 and received lidocaine hydrocarbonate 1% or lidocaine hydrochloride 1%\\u000a or mepivacaine 1%, each solution containing epinephrine 11400,000. A double-blind design was used. Lidocaine hydrocarbonate\\u000a and lidocaine hydrochloride were both found to have

R. Martin; L. Beauregard; Y. Lamarche; J. P. Tétrault



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


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

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



Sentinel lymph node biopsy for melanoma: comparison of lymphocele rates by surgical technique.  


Lymphocele is a common wound complication of sentinel lymph node biopsy (SLNB). The surgical technique may play a key role in lymphocele formation. This study compared rates of postoperative lymphocele formation by different surgical techniques (Harmonic Scalpel [HS], LigaSure [LS], and traditional electrocautery with clips) after SLNB in the groin or axilla for the staging of clinically node-negative cutaneous melanoma. Patients were selected by convenience sample from a single-institution, single-surgeon, prospectively collected melanoma database over a 27-month period. One hundred fifty consecutive patients underwent SLNB, 70 with clips, 37 with HS, and 43 with LS. The median number of nodes removed was two and did not vary significantly between groups. Twenty-three lymphoceles occurred for an overall rate of 15 per cent; rates were 9.9 and 26.5 per cent for the axilla and groin, respectively. Sixteen (70%) were aspirated for size or symptoms; lymphoceles after groin SLNB were significantly (P = 0.03) more likely to require aspiration. Lymphocele rates for the clip, HS, and LS groups were 20.0, 18.9, and 4.7 per cent, respectively. The differences between the LS and other groups were statistically significant. Use of the LS may lead to lower lymphocele rates after groin and axillary SLNB compared with electrocautery and clips. PMID:23574849

White, Ian; Mills, Jane K; Diggs, Brian; Fortino Hima, Jeanine; Ellis, Michelle C; Vetto, John T



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


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

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



Treatment of acute embolic occlusions of the subclavian and axillary arteries using a rotational thrombectomy device.  


Acute embolic or local thrombotic ischaemia of the upper limbs can be treated by embolectomy or by endovascular techniques. We report here on the endovascular thrombectomy of acute embolic occlusions of subclavian and axillary arteries in two patients using a rotational thrombectomy device and give an overview about the actual literature. Two female patients, each with a history of multivessel coronary disease and intermittent atrial fibrillation, complained of sudden onset of pain at rest and paleness of the left and right arm, respectively. Duplex ultrasound showed a localized embolic occlusion of the left subclavian artery and the bifurcation of the brachial artery in the first patient and a localized embolic occlusion of the distal right subclavian and axillary artery in the second patient. In the first patient, the left subclavian artery was reopened using a 8F-Rotarex device via the femoral access, while the bifurcation of the brachial artery was reopened by local thrombolysis using 25 mg rt-PA because of the insufficient length of