Combining bi-modal imaging and immunohistochemical indicators to predict axillary lymph nodes status in cN 1 breast cancer patients receiving neoadjuvant chemotherapy / 中华超声影像学杂志

Objective:To investigate whether ultrasound features, mammographic features and immunohistochemical indicators show any association with rates of axillary pathologic complete response(pCR) in cN 1 breast cancer patients receiving neoadjuvant chemotherapy(NAC), and to construct prediction models of axillary pCR to predict axillary lymph nodes (ALN) status, so as to select suitable patients for less invasive axillary surgery after NAC. Methods:This retrospective study evaluated 134 consecutive cN 1 breast cancer patients with ALN metastasis who underwent NAC in the Second Affiliated Hospital and Tumor Hospital of Harbin Medical University from July 2020 to July 2022. According to the pathological results of ALN surgery after NAC, the cases were divided into pCR and non pathologic complete respose(npCR) groups. The ultrasound images, mammographic images and immunohistochemical indicators of the two groups were compared. In terms of logistic regression algorithm, the model A(the ultrasound model), the model B(the ultrasound combined with mammography model), the model C(the ultrasound combined with immunohistochemistry model) and the model D(the ultrasound combined with mammography and immunohistochemistry model) were respectively established for predicting the pathological state of axillary lymph nodes in breast cancer patients, ROC curves were plotted to evaluate the performance of the models, and the diagnostic efficiency of different models was compared by Delong′s test. The model with the best predictive performance was shown in a nomogram. Results:①The P values between two groups of the short diameter of ALN, the ratio of long/short diameter of ALN, fatty hilum and central hilar vascularity, mammographic spiculation, estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor receptor 2(HER2) were <0.05 by the t test and χ 2 test analysis. ②The ratio of long/short diameter and fatty hilum in the model A were independent factors for predicting the pathological status of ALN after NAC. The independent predictors of model B and Model C were respectively added with mammographic spiculation and immunohistochemical indicators (ER, PR) on the basis of model A. In the model D, the ratio of long/short diameter, short diameter, fatty hilum, mammographic spiculation, and immunohistochemical indicators (ER, PR) remained significant independent predictors associated with axillary pCR. ③The area under ROC curve (AUC) of the model A, B, C, D was 0.78, 0.84, 0.84 and 0.89, respectively. The sensitivity was 0.71, 0.80, 0.78 and 0.86, the specificity was 0.76, 0.74, 0.76 and 0.80, and the accuracy was 0.73, 0.76, 0.77 and 0.83, respectively. ④Delong′s test showed the model D had an improved AUC of 0.89(0.89 vs 0.78, 0.84, 0.84, all P<0.05). Conclusions:The prediction models combining bi-modal imaging and immunohistochemical indicators show good prediction ability and can provide reference for selecting suitable patients for less invasive axillary surgery after NAC.

The effectiveness of ultrasound-guided core needle biopsy in detecting lymph node metastases in the axilla in patients with breast cancer: systematic review and meta-analysis

Abstract Objective: This study aimed to perform a meta-analysis to investigate the diagnostic safety and accuracy of Ultrasound-Guided Core Needle Biopsy (US-CNB) Axillary Lymph Nodes (ALNs) region in patients with Breast Cancer (BC). Methods: The authors searched the electronic databases PubMed, Scopus, Embase, and Web of Science for clinical trials about US-CNB for the detection of ALNs in breast cancer patients. The authors extracted and pooled raw data from the included studies and performed statistical analyses using Meta-DiSc 1.4 and Review Manager 5.3 software. A random effects model was used to calculate the data. At the same time, data from the Ultrasound-guided Fine-Needle Aspiration (US-FNA) were introduced for comparison with the US-CNB. In addition, the subgroup was performed to explore the causes of heterogeneity. (PROSPERO ID: CRD42022369491). Results: In total, 18 articles with 2521 patients were assessed as meeting the study criteria. The overall sensitivity was 0.90 (95% CI [Confidence Interval], 0.87‒0.91; p = 0.00), the overall specificity was 0.99 (95% CI 0.98‒ 1.00; p = 0.62), the overall area under the curve (AUC) was 0.98. Next, in the comparison of US-CNB and US-FNA, US-CNB is better than US-FNA in the diagnosis of ALNs metastases. The sensitivity was 0.88 (95% CI 0.84‒ 0.91; p = 0.12) vs. 0.73 (95% CI 0.69‒0.76; p = 0.91), the specificity was 1.00 (95% CI 0.99‒1.00; p = 1.00) vs. 0.99 (95% CI 0.67‒0.74; p = 0.92), and the AUC was 0.99 vs. 0.98. Subgroup analysis showed that heterogeneity may be related to preoperative Neoadjuvant Chemotherapy (NAC) treatment, region, size of tumor diameter, and the number of punctures. Conclusion: US-CNB has a satisfactory diagnostic performance with good specificity and sensitivity in the preoperative diagnosis of ALNs in BC patients.

Evaluation of the pathological status of axillary lymph nodes after neoadjuvant chemotherapy based on multimodal ultrasound characteristics for breast cancer / 中华超声影像学杂志

Objective:To construct a diagnostic model based on the multimodal ultrasound imaging, and to predict the axillary lymph node (ALN) status of breast cancer patients after neoadjuvant chemotherapy (NAC).Methods:A total of 204 female breast cancer patients with ALN metastasis who had undergone puncture biopsy of aspiration in the Second Affiliated Hospital and Harbin Medical University Cancer Hospital between July 2017 to May 2021 were included. According to the pathological results of ALN surgery after NAC, the cases were divided into pathologically complete response (pCR) group and non-pCR group. The ultrasound images, immunohistochemistry and blood routine index were collected and compared between the two groups, the indexes whose P<0.02 were selected. In terms of logistic regression algorithm, a predictive model for the pathological state of axillary lymph nodes in breast cancer patients was established after NAC, and ROC curve was plotted to evaluate the performance of the model. Results:The P values for comparison between the two groups of the breast tumor size, blood flow resistance index (RI), elasticity score, lymph hilum structure, maximum cortical thickness, blood flow distribution, blood flow RI, and immunohistochemical detection indicators including estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor 2(HER-2), Ki67 molecular expressions were <0.20 by t test, Mann-Whitney U test, and χ 2 test analysis; in the multiple logistic regression analysis, tumor size, lymphatic hilum structure, maximum cortical thickness, lymph node blood flow distribution and blood flow resistance index, PR and HER-2 molecular expressions were the independent factors predicting the pathological status of axillary lymph nodes in breast cancer patients after NAC ( P<0.05). The performance of the predictive model was 0.870 (95% confidence interval: 0.819-0.922, P<0.05), with sensitivity of 86.82% and specificity of 70.67%. Conclusions:The model for predicting the pathological state of ALN in breast cancer patients after NAC using multi-modal ultrasound characteristic and immunohistochemical indexes achieves good diagnostic performance providing more objective evidence for the formulation of clinical treatment plans and prognostic evaluation.

Expresión morfológica del músculo axilopectoral: un estudio anatómico directo en una muestra de población colombiana / Morphological expression of the axillary pectoral muscle: a direct anatomical study in a sample of Colombian population

El músculo axilopectoral (MAP) es una estructura fibromuscular accesoria de la región axilar, que se relaciona con el plexo braquial, vasos y linfonodos axilares, y es reportado en los diferentes grupos poblacionales con incidencia variable. Se evaluaron un total de 106 axilas correspondientes a 53 cadáveres frescos que fueron sometidos a autopsia. El MAP se presentó en 5 regiones axilares (4,7 %), con tres casos unilaterales (2,8 %) y uno bilateral (0,9 %). La longitud total del MAP estuvo en un rango de 81,6-119,7 mm, mientras que su segmento tendinoso midió 13,3-28,1 mm. El espesor de su vientre muscular fue de 7,1-52 mm y del tendinoso 6,920,1 mm. En todos los casos, el MAP se originó del músculo latísimo del dorso y se insertó en el labio lateral del surco intertubercular del húmero, adyacente a la inserción del músculo pectoral mayor. Los MAP evaluados fueron inervados por el nervio toracodorsal. En dos casos, el vientre muscular del MAP cursó con trayectoria antero medial a las fibras infraclaviculares del plexo braquial, mientras que en los tres restantes, los segmentos fibrosos de inserción del MAP estuvieron relacionados con el plexo. La incidencia del MAP encontrada en el presente estudio es similar a los reportes previos realizados en cadáveres y considerablemente mayor a los reportes anatomoquirúrgicos. La importancia del MAP radica en su implicación con el síndrome de salida torácica, trombosis profunda del miembro superior y en las complicaciones en la linfadenectomía axilar.

The axillary pectoral muscle (APM) is an accessory fibromuscular structure of the axillary region. It is related to the brachial plexus, axillary vessels and lymph nodes, and is reported with variable incidence in different population groups. A total of 106 axilla were evaluated corresponding to 53 fresh cadavers. The APM was presented in 5 axillary regions (4.7 %), with three unilateral cases (2.8 %) and one bilateral (0.9 %). The total length of the APM ranged from 81.6-119.7 mm, while its tendinous segment measured 13.3-28.1 mm. Muscular belly thickness was 7.1-52 mm and the tendinous segment measured 6.9-20.1 mm. In all cases, the APM originated from the latissimus dorsi muscle and inserted into the lateral lip of humerus intertubercular sulcus, adjacent to the pectoralis major muscle insertion. The evaluated APMs were innervated by the thoracodorsal nerve. In two cases, the APM muscular belly had an anterior medial trajectory to brachial plexus fibers, while in the remaining samples, long fibrous segments of APM insertion were related to the plexus. The incidence of the APM found in the present study is similar to previous reports carried out in cadavers; it was considerably higher than previous anatomy-surgical reports. The importance of APM relies on its involvement with thoracic outlet syndrome, deep thrombosis of the upper limb and complications in axillary lymphadenectomy.

Carcinoma buccal mucosa with left axillary lymph node metastasis: First reported case and review of the literature

Head-and-neck squamous cell carcinomas are tumors with propensity mostly for locoregional spread. The most frequent sites of metastasis include lung, bone, liver, adrenal, heart, and kidney. Distant metastasis to axillary lymph nodes from buccal mucosa cancer is extremely rare. To the authors' knowledge, this is the first case reported where a gentleman who was treated for carcinoma right buccal mucosa developed left axillary lymph node metastasis at 6th year of follow-up.

Dynamic contrast?enhanced MRI radiomic features predict axillary lymph node metastasis of breast cancer / 中华放射学杂志

Objective To investigate the prognostic value of radiomics analysis in predicting axillary lymph nodes (ALN) metastasis of breast cancer based on dynamic contrast-enhanced MR imaging (DCE-MRI). Methods One hundred and ninety-six patients with suspected breast cancer were prospectively collected for dynamic breast DCE-MRI. Enhanced MR imaging data of 72 axillary lymph nodes were evaluated separately by a chief radiologist and a resident, and the consistency analysis was performed. Lymph nodes were dichotomized according to the pathology results derived from operation or biopsy under real-time virtual sonography based on MRI data. Clinical and imaging data were also divided into corresponding groups. (Imaging) Data from both groups were respectively classified as training set and testing set by stratified sampling in proportion with 3∶1. AK software was applied to extract 6 major categories of 385 features (including histogram, morphology, texture parameters, gray level co-occurrence matrix, run-length matrix and grey level zone size matrix from imaging), and a set of statistically significant features were subsequently obtained by dimension reduction. The prediction model was established through binary classification logistic regression and employed to externally test the validation set by the method of confusion matrix. Meanwhile, ROC analysis was applied to assess the diagnostic performance of the model. Results Of the 72 axillary lymph nodes, 35 were metastatic negative and 37 were positive. The consistency of enhanced MRI radiomics features was good, between 0.841 and 0.980. Uniformity, ClusterProminence_AllDirection_offset1_SD, Correlation_AllDirection_offset1, LongRunEmphasis_angle90_offset7 and SurfaceVolumeRatio were statistically significant differences (P<0.01), the area under the ROC between 0.747 and 0.931. In the training and testing group, the areas under the ROC, sensitivity, specificity and accuracy of the model were 0.953, 0.893, 0.926, 92.6% (50/54) and 0.944, 0.900, 1.000, 88.9% (16/18) respectively. Conclusion The prediction model based on radiomic features may provide a non-invasive and effective approach to the assessment of the risk of ALN metastasis of breast cancer.

One-stop CT gemstone spectral and perfusion imaging for prediction in rabbit axillary lymph nodes / 中国医学影像技术

Objective: To explore the application value of one-stop CT gemstone spectral and perfusion imaging quantitative parameters in predicting the properties of axillary lymph nodes. Methods Totally 60 purebred female New Zealand white rabbits were randomly divided into two groups, and rabbit models of axillary metastatic lymph nodes with VX2 implanted breast cancer (metastasis group) and inflammatory lymph nodes (inflammation group) were established, respectively. One-stop CT gemstone spectral and perfusion imaging scan was performed at the end of the fourth week after modeling. Then the axillary lymph nodes were taken for pathological examination and compared with CT images. Two independent samples t-test were used to compare the energy parameters and perfusion parameters between metastatic and inflammatory lymph nodes. Logistic regression and ROC curves were used to analyze the efficacy of single parameters and combined parameters in diagnosis of rabbit axillary lymph nodes. Results The blood flow (BF), blood volume (BV), arteriovenous iodine concentration (IC), standardized iodine value (NIC) and the slope (λ) of the energy spectrum curve from 40 keV to 70 keV in the metastasis group were higher than those in inflammation group (all P0.05). Taken 0.65 as the threshold, AUC of combined parameters (BF+arterial phase λ+venous phase λ) was 0.942, the sensitivity, specificity, positive predictive value and negative predictive value in diagnosis of axillary lympy nodes were 79.68%, 95.92%, 92.91% and 82.70%, respectively. Conclusion: The quantitative parameters of one-stop CT gemstone spectral and perfusion imaging show good diagnostic efficacy in identifying rabbit axillary breast cancer metastatic lymph nodes and inflammatory lymph nodes, while combined parameters (BF+arterial phase λ+venous phase λ) have higher diagnostic value.

Dynamic contrast-enhanced MRI radiomic features predict axillary lymph node metastasis of breast cancer / 中华放射学杂志

Objective@#To investigate the prognostic value of radiomics analysis in predicting axillary lymph nodes (ALN) metastasis of breast cancer based on dynamic contrast-enhanced MR imaging (DCE-MRI).@*Methods@#One hundred and ninety-six patients with suspected breast cancer were prospectively collected for dynamic breast DCE-MRI. Enhanced MR imaging data of 72 axillary lymph nodes were evaluated separately by a chief radiologist and a resident, and the consistency analysis was performed. Lymph nodes were dichotomized according to the pathology results derived from operation or biopsy under real-time virtual sonography based on MRI data. Clinical and imaging data were also divided into corresponding groups. (Imaging) Data from both groups were respectively classified as training set and testing set by stratified sampling in proportion with 3∶1. AK software was applied to extract 6 major categories of 385 features (including histogram, morphology, texture parameters, gray level co-occurrence matrix, run-length matrix and grey level zone size matrix from imaging), and a set of statistically significant features were subsequently obtained by dimension reduction. The prediction model was established through binary classification logistic regression and employed to externally test the validation set by the method of confusion matrix. Meanwhile, ROC analysis was applied to assess the diagnostic performance of the model.@*Results@#Of the 72 axillary lymph nodes, 35 were metastatic negative and 37 were positive. The consistency of enhanced MRI radiomics features was good, between 0.841 and 0.980. Uniformity, ClusterProminence_AllDirection_offset1_SD, Correlation_AllDirection_offset1, LongRunEmphasis_angle90_offset7 and SurfaceVolumeRatio were statistically significant differences (P<0.01), the area under the ROC between 0.747 and 0.931. In the training and testing group, the areas under the ROC, sensitivity, specificity and accuracy of the model were 0.953, 0.893, 0.926, 92.6% (50/54) and 0.944, 0.900, 1.000, 88.9% (16/18) respectively.@*Conclusion@#The prediction model based on radiomic features may provide a non-invasive and effective approach to the assessment of the risk of ALN metastasis of breast cancer.

Tumor-infiltrating Lymphocytes are Independent Favorable Prognostic Indicator in 17-year Disease-Free Survival in Lymph Node-Negative Triple-Negative Breast Cancer Patient.

Aims: To estimate the prognostic value of tumor-infiltrating lymphocytes, among other variables, in triple-negative breast cancer patients with a 17-year disease-free survival. Study Design: A retrospective study of 79 patients was conducted to investigate treatment, and clinical, microscopic and immunohistochemical tumor characteristics. Place and Duration of Study: Pathology Division, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil, between January 1992 and December 1996. Methodology: Histologically diagnosed 79 node-negative triple-negative breast cancer patients underwent partial or total mastectomy with axillary lymphadenectomy, with or without radiotherapy, chemotherapy and/or hormone therapy. Disease-free survival was estimate by the Kaplan-Meier method and log-rank test. Prognostic variables were obtained by Cox regression models. Results: The 17-year disease-free survival was 50.6%. Disease-free survival was worse in patients aged 51-82 years, who underwent neoadjuvant chemotherapy and had skin compromise, geographic necrosis, grade 3 tumors, had no tumor-infiltrating lymphocytes, had vascular/lymphatic invasion, CD44+/CD24-/low and elevated Ki-67. The risk of recurrence and/or metastasis, adjusted for the remaining variables of the final Cox model was 2.44 times higher for patients aged 51-82 years, 2.60 times higher for patients undergoing neoadjuvant chemotherapy, 3.97 times higher for grade 3 tumors and 0.34 times for patients with tumor-infiltrating lymphocytes. Conclusion: The risk of recurrence and/or metastasis, adjusted for the remaining variables of the model, was about 2.5 times higher for older patients undergoing neoadjuvant chemotherapy. In grade 3 tumor patients, the risk increased almost fourfold. Patients with tumor-infiltrating lymphocytes had a 66% lower risk, i.e, tumor-infiltrating lymphocytes were shown to be a protective factor.

Evaluation of axillary lymph node metastasis of breast cancer via an ultrasonic multi parameter regression model / 军事医学

Objective To evaluate conventional ultrasound combined with real-time elastography in differential diagnosis of metastatic axillary lymph nodes of breast cancer with a logistic regression model.Methods Conventional ultrasound and real-time elastography were performed in 112 breast cancer patients with 113 axillary lymph nodes.All the cases were confirmed with pathological examinations after surgery. A binary logistic regression model based on ultrasonographic features was developed.A receiver operator characteristic ( ROC) curve was constructed to assess the performance of the model.Results There were 28 nodes with no metastasis and 85 with metastasis in a total of 113 axillary lymph nodes.Three ultrasonographic features including the elastic strain ratio(SR), elastic score and shape were finally selected into the logistic regression model .The correct rate of the logistic regression model for predicting axillary lymph node metastasis was 93.8%, and the area under ROC curve was 0.962.Conclusion The binary classification logistic regression model has a good diagnostic efficacy in the diagnosis of benign and malignant axillary lymph nodes,while real-time elastography can improve the accuracy of conventional ultrasound in the diagnosis of axillary lymph nodes.

Intervention in vitro of miR30a on tumor stem cell related gene expression and invasiveness of breast cancer swollen axillary lymph nodes / 重庆医学

Objective To investigate the micrometastatic lesion of tumor stem cells in the axillary swollen lymph nodes of breast cancer patients and the influence of miR30a on its invasive ability ,and to explore the feasibility of miRNAs anti‐breast cancer treatment .Methods The tumor stem cell‐like breast cancer cells were separated from the axillary swollen lymph nodes in breast cancer patients and cultured .miR30a oligonucleotide fragment was synthesized and transfected into human primary generation breast cancer cells by using adenovirus ,meanwhile the breast cancer cell line MDA‐MB‐231 was taken as the experimental control and the transfection efficiency was assessed by the fluorescence microscopy .The changes of tumor cell proliferation and invasiveness before and after transfection were detected by the Transwell chamber in vitro invasion assay .Western blot was used to detect the ALDH1 ,Vimentin and N‐Cadherin protein expression .Results The Transwell chamber in vitro invasion assay showed that the pri‐mary generation breast cancer cell had more strong invasive ability than MDA‐MB‐231 cell line ,their invasion indexes were (75 .3 ± 3 .2)% and (58 .4 ± 2 .8)% respectively ,the difference was statistically significant (P<0 .05) ,and after transfecting miR30a ,the in vitro invasiveness ability in these two kinds of cells were significantly weakened and their invasion indexes were (21 .4 ± 1 .9)% and (28 .2 ± 2 .3)% respectively ,the difference compared with the control group showed the statistical significance (P<0 .05) .Conclu‐sion The ALDH expression in partial axillary hyperplasia and swollen lymph nodes in the patients with breast cancer is increased , and the tumor micrometastasis may exist ,which should be completely cleaned in operation .miR30a inhibits the expression and inva‐sive ability of tumor stem gene .

Comparison of standard tangential field and multiple fileld radiotherapy in axillary lymph node after conserving surgery / 中国基层医药

Objective To investigate the difference of standard tangential field and multiple fileld radiotherapy in axillary lymph node after conserving surgery,to provide a reference for clinical treatment.Methods 20 cases of left breast cancer patients were selected,all patients underwent breast -conserving surgery,postoperative radiothera-py.All patients used standard radiotherapy wild tangent based and reverse -intensity modulated radiation therapy optimization.Armpit I,Ⅱ lymph nodes were used to calculate the extent of coverage of the original plan,target dose uniformity HI,dose conformal CI,dosimetric parameters were calculated.Results Under standard tangential field irradiation,I stand mean dose was (33.95 ±8.24)Gy,which was significantly higher than Ⅱ station (22.13 ± 6.67)Gy,and V50,V45,V40 were (22.45 ±6.32)%,(39.83 ±7.54)%,(49.65 ±8.31)%,which were higher than Ⅱ stand,I stand irradiation was significantly more,the differences were statistically significant (t =5.632,P =0.009;t =7.214,P =0.000;t =8.954,P =0.000;t =6.121,P =0.002).The whole breast irradiation armpit IMRT plan,19 patients (95.00%)reached 95% by volume APTV≥50Gy,coverage was better;but HI,CI were (1.11 ± 0.03),(1.36 ±0.07)respectively,which were significantly worse than the standard wild tangent,the differences were statistically significant (t =6.584,P =0.001;t =9.144,P =0.000).Under Hatano IMRT irradiation ipsilateral lung,heart suffered an average dose of (1 694.58 ±102.31)cGy,(645.54 ±74.44)cGy,which were significantly more than the standard tangential field irradiation,the differences were statistically significant (t =7.654,P =0.000;t =6.654,P =0.001).Conclusion Standard tangential field irradiation has poor coverage in Ⅱ axillary lymph node station,irradiation intensity modulated radiation has better coverage,but significantly increased the dose to normal tissues.

Sentinel lymph node biopsy replaces axillary lymph node dissection for patients with early breast cancer / 中华内分泌外科杂志

Objective To study the application value and safety of sentinel lymph node biopsy ( SLNB) replacing axillary lymph node dissection ( ALND) for patients with early breast cancer .Methods Data was col-lected for patients undergoing SLNB or ALND in the Second Hospital of Dalian Medical University from June 2011 to June 2014.The complication of upper extremity , axillary local recurrence and distant metastasis were retro-spectively analyzed.The patients were followed up to Nov .2014, with the median follow-up of 41 ( 18-52 ) months.Results Patients undergoing SLNB had less postoperative complications of upper extremity ( numb and painχ2 =18.174, P =0.000;Restricted movement χ2 =20.413, P =0.000; Strength loss χ2 =23.785, P =0.000;P0.05).Conclusion In early breast cancer without SLN, SLNB can achieve the equivalent effect to ALND with less damage and complications .

Evaluation of axillary lymph nodes response after neoadjuvant chemotherapy in locally advanced breast cancer / 中国癌症杂志

Neoadjuvant chemotherapy or neoadjuvant chemotherapy in combination with targeted therapy has been widely accepted as the standard treatment for locally advanced breast cancer (Ⅱb-Ⅲ). Nearly forty percent of the patients who accepted neoadjuvant chemotherapy achieved pathological complete response of axillary lymph nodes in addition to downstage the primary lesions. However, for patients with clinical complete response of lymph nodes after pre-operative systemic therapy, there are constant controversies regarding the prediction of axillary lymph nodes response and sentinel lymph nodes biopsy after the treatment. Here we design to review the latest studies about how to evaluate the axillary lymph nodes response after neoadjuvant chemotherapy and try to enlighten the treatment choices in clinical practice.

Linfonodos axilares em pacientes com câncer de mama: avaliação ultrassonográfica / Axillary lymph nodes in breast cancer patients: sonographic evaluation

O estadiamento axilar nas pacientes portadoras de câncer de mama inicial é fator essencial no planejamento terapêutico. Atualmente este é realizado durante o tratamento cirúrgico, mas há uma tendência em buscar técnicas pré-operatórias e de menor morbidade para avaliação dos linfonodos axilares. A ultrassonografia é um exame amplamente usado para esta finalidade e muitas vezes associado a punção aspirativa por agulha fina ou por agulha grossa. Entretanto, os critérios ultrassonográficos de suspeição para linfonodos axilares não apresentam valores preditivos significativos, gerando resultados discrepantes em estudos sobre sensibilidade e especificidade do método. O objetivo deste trabalho é realizar uma revisão na literatura médica sobre a ultrassonografia no estadiamento axilar e as principais alterações morfológicas do linfonodo metastático.

Axillary staging of patients with early-stage breast cancer is essential in the treatment planning. Currently such staging is intraoperatively performed, but there is a tendency to seek a preoperative and less invasive technique to detect lymph node metastasis. Ultrasonography is widely utilized for this purpose, many times in association with fine-needle aspiration biopsy or core needle biopsy. However, the sonographic criteria for determining malignancy in axillary lymph nodes do not present significant predictive values, producing discrepant results in studies evaluating the sensitivity and specificity of this method. The present study was aimed at reviewing the literature approaching the utilization of ultrasonography in the axillary staging as well as the main morphological features of metastatic lymph nodes.

Axillary Lymph Node Metastasis of Papillary Thyroid Carcinoma: A Case Report / 대한갑상선학회지

We report a case of axillary lymph node metastasis (LNM) as a recurrence of papillary thyroid carcinoma (PTC) in a 68-year-old male. The patient initially presented in 2009 with a 3.4x5.4 cm sized neck swelling and left cervical lymphadenopathy. He underwent total thyroidectomy and central compartment neck dissection (CCND) with left modified radical neck dissection (MRND). The pathological report confirmed PTC with metastasis of neck lymph node. On a regular follow up of positron emission tomography (PET), LNM was found on the right supraclavicular area and on the left axillary area. It was 17 months after the initial thyroid cancer had been diagnosed. The right MRND and left axillary lymph node dissections were performed in April of 2012. Pathological result confirmed metastatic PTC of left axillary lymph nodes. After recovery from the surgery, the patient got radioactive iodine therapy with I-131 180 mCi.

Value of doppler ultrasound hook-wire-guided suspicious node biopsy in early breast cancer / 中华内分泌外科杂志

Objective To explore ideal surgical axillary management of early breast cancer,and to determine the feasibility of reducing false negative rate of sentinel lymph node biopsy(SLNB)by combination of axillary suspicious lymph node biopsy and SLNB.Methods From Jan.2008 to Oct.2009,42 consecutive cases with early breast cancer were enrolled.All patients underwent suspicious node hook-wire location by doppler ultrasonography before operation.SLNB and suspicious lymph node biopsy were performed during operation.Complete axillary nodes dissection(ALND)or level II dissection would be conducted according to the biopsy result.The difference of node status prediction between SLNB and SLNB with axillary suspicious lymph node biopsy and was compared.Results All the 42 cases successfully underwent SLNB (100%).There were 2 false negatives occurred in SLNB,resulting in false negative rate of 11%,sensitivity of 88.9%and accuracy of 95.2%in predicting axillary nodes status.By contrast,SLNB with axillary suspicious node biopsy showed a false-negative rate of 0%,sensitivity of 100%,and accuracy of 100%.Conclusions Compared to SLNB in early breast cancer,combination of suspicious node biopsy and SLAB has a tendency of reducing false negative rate.However,Because of the limited samples,the difference has no statistical significance(P=0.2500).

Expression of Hypoxia-inducible factor 1-α and Vascular endothelial growth factor-C in locally advanced breast cancer patients

BACKGROUND: Locally advanced breast cancers are more prevalent in underdeveloped countries. Targeted therapy has been improved to identify hallmarks that are specific to these subtypes of tumors. OBJECTIVES: We aimed to prospectively assess the expression of Hypoxia inducible factor-1 α and vascular endothelial growth factor-C in locally advanced breast cancer patients. METHODS: Thirty women underwent incisional biopsies for the histopathological diagnosis of breast carcinoma and participated in neoadjuvant chemotherapy. The association of Hypoxia inducible factor-1 α and vascular endothelial growth factor-C with age, tumor size, histological grade, clinical staging, hormonal and axillary status, clinical and pathological response after neoadjuvant chemotherapy, expression of estrogen and progesterone receptors, and the presence of c-erbB-2 antigen was studied. RESULTS: Hypoxia inducible factor-1 α expression and Vascular endothelial growth factor-C expression were observed in 66.7 percent and 63.3 percent of all patients, respectively, and were marginally associated with each other (p = 0.06). Among the studied variables, only positive axillary status was associated with the presence of HIF-1α (p = 0.02). Complete pathological response was significantly associated (p = 0.04) with the expression of vascular endothelial growth factor-C prior to neoadjuvant chemotherapy. CONCLUSION: We concluded that Hypoxia inducible factor-1 α was associated with a poor prognosis and that vascular endothelial growth factor-C could be used as a predictive factor in locally advanced breast cancer patients with complete pathological response after neoadjuvant chemotherapy.

A Comparative Study on Sensitivity of HE,IHC and RT-PCR in Detection of Breast Cancer Metastases in Axillary Lymph Nodes / 中国普外基础与临床杂志

Objective To compare the sensitivity of HE,immunohistochemistry (IHC) and RT-PCR in detection of breast cancer metastases in axillary lymph nodes.Methods Twenty female patients with newly diagnosed and clinically node-negative breast cancers underwent modified radical mastectomy, including a complete axillary lymph node dissection. The ages of the patients ranged from 31 years to 65 years, and the diagnosis of breast cancer was approved by pathological finding. Two hundred and thirty-nine axillary lymph nodes were found in these 20 patients. Metastases in axillary lymph nodes were explored by HE, cytokeratin 19 IHC and RT-PCR for cytokeratin 19 respectively. Results Seven(2.9%) lymph nodes were found to have metastatic cancers by HE in 3 patients,all nodes were found in level Ⅰ. Metastatic cancers were found in 13 (5.4%) nodes by IHC in 7 patients,11 nodes in level Ⅰ and 2 nodes in level Ⅱ; and 52(21.8%) nodes were found to contain tumor cells by RT-PCR in 14 patients,30 nodes in level Ⅰ and 22 nodes in level Ⅱ. All of 7 histologically(HE) positive nodes were found to contain tumor cells by IHC and RT-PCR. Among 232 histologically(HE) negative nodes,6(2.6%) nodes were found to contain tumor cells by IHC,and 45(19.4%) nodes were found to contain tumor cells by RT-PCR, all 6 IHC positive nodes showed the expected 460-base pair products on gel electrophoresis ( P

Qualitative Value of Enlarged Axillary Lymph Nodes by Breast Molybdenum Target Radiography / 实用放射学杂志

Objective To evaluate the value of breast molybdenum target radiography in evaluating the enlarged axillary lymph nodes in breast diseases.Methods 79 patients underwent breast molybdenum target radiography,including conventional laxial and oblique projection. Some of them were examine furtheremore in compress projection in axillary fossa. The X-ray findings were analysis. And radiologic-pathologic correlation were carried out.Results There were 46 cases of brease carcinoma, 20 cases of hyperplasia,7cases of fibroadenoma,2 cases of plasmacytic mammitis,2cases of lipoma and 2 cases of papilloma in 79 patients. In the 33 cases of breast benign lesion , the enlarged axillary lymph nodes were seen bilaterally in 12 cases, sum was 1 to 5 in each case, smaller than 2 cm in diameter in 31 cases and uneven density in 13 cases were showed. In the 46 cases of brease carcinoma, the enlarged lymph nodes were seen laterally in 43cases, sum was 1 to 4 in each cases, larger than 2 cm in diameter was showed in 17 cases, and all were even density. There were statistical differences in number, diameter and density of enlarged lymph nodes between two groups. Conclusion The enlarged axillary lymph nodes are of different X-ray features in breast benign lesion and malignant lesion,it is helpful in differential diagnosis of breast diseases.