ABSTRACT
The most common primary malignant disease in the world amongst women is carcinoma breast. Metabolic activity of a lesion (SUVmax) has strong clinical correlation with various prognostic factors according to numerous literature reviews. The main aim of this study is to assess the correlation between maximum Standardized Uptake Value [SUVmax] and initial disease staging (as per AJCC TNM-8th edition). We wanted to study the correlation between metabolic activity [SUVmax] of the primary tumour in breast carcinoma, and size of the primary, nodal and distant metastatic status.METHODSThis is an observational study conducted over a period of two years in breast cancer patients [n=139] undergoing PET-CT as a part of initial staging. PET-CT was done using Siemens Horizon True-V PET according to institutional protocols.RESULTSSignificantly higher SUVmax values were observed in tumours with larger size [>2 cms]. However, there was no significant correlation between SUVmax of primary tumours and the status of axillary nodal involvement and distant metastases [p = 0.125 and 0.847 respectively].CONCLUSIONSMetabolic activity of primary breast cancer has strong clinical correlation with size; however, there is no such correlation found in nodal and metastatic spread of the disease.
ABSTRACT
Background: Surgical dissection is the accepted mode of staging the axilla in breast cancer. Proper prediction of axillary node positivity can help towards stratifying patients. The primary objective of the study was to assess the clinical factors influencing pathological axillary lymph node positivity in early carcinoma breast.Methods: This was a retrospective study, conducted at a tertiary cancer centre. Case records of all the patients with invasive breast cancer which are clinical T1 and T2 and either N0 or NI, from January 2011 to October 2014 were analysed. Clinical profile of the patient including age, BMI, comorbid, menstrual history, family history, symptoms, site of the lesion, size, single or multi centric origin were analysed.Results: Total of 608 patients of early breast cancer analysed of which 248 had pathological nodal positivity. The age group of 51 to 75 years, BMI ≥30, pre-menopausal patients had significant positive predictive value when compared to post-menopausal. Tumours in lower outer quadrant, central sector and multiple tumours also had positive predictive value. Clinical T2 when compared to clinical T1 stage and MRM when compared to BCS had significant positive predictive value.Conclusions: To conclude in present study age of the patient and clinical location of the tumour and surgery performed emerged as significant independent predictive factors of positive lymph node. Prospective studies are required to further prove the significance of these factors.
ABSTRACT
Introduction Axillary lymph node dissection (ALND) is a standard procedure in the management of breast cancer for diagnosis of axillary node metastasis and for local control. The aim of this study was to investigate the ease and the effectiveness of using methylene blue dye in the localisation of sentinel lymph node (SLN) and biopsy (SLNB) in patients undergoing surgery for breast cancer at RIPAS Hospital. Materials and Methods Twenty-five patients with confirmed fine needle aspiration cytological diagnosis of breast cancer, who were undergoing planned mastectomy and axillary node clearance, were included in the study. Four to five milliliters of methylene blue dye was injected into the peri-tumour area 20 to 30 minutes preoperatively before surgical incision was made. All SLNs were submitted for intra-operative frozen section analysis. All patients underwent mastectomy and Level II axillary clearance. Results Methylene blue dye staining and localisation of SLNs were positive in 22 (88%) patients, out of which 10 (45.45%) patients had SLN which were positive for metastasis. In three patients (12%), the dye failed to reach the axilla with one patient having micro-metastasis in the axillary lymph nodes. The mean duration to SLN harvesting was 20 min (range 15 to 25 min) after injection of the methylene blue. Complications included blue discolouration of urine (28%), post-operative fever (4%), tattooing near the scar (4%) and a small area of skin necrosis near the scar (4%). Conclusions In our setting, SLNB using methylene blue dye is also an effective method for accurately identifying SLNs in breast cancer patients and provide an accurate pathological staging without having to do a formal axillary clearance.