ABSTRACT
PURPOSE: Factors affecting local outcome were evaluated in patients with clinically node-positive (cN+) breast cancer at diagnosis, who underwent sentinel lymph node biopsy (SLNB) alone after neoadjuvant chemotherapy (NAC). METHODS: Between 2004 and 2018, 303 cytopathology-proven cN (+) patients in a multicentric registry, who received NAC and underwent SLNB alone were analysed. All patients had regional nodal irradiation. RESULTS: Median age was 46 (23-70). Of those, 211 patients had ypN0 disease (69.6%), whereas 92 patients had ypN (+) disease including 19 (20.6%) isolated tumor cells (ITC), 33 micrometastases (35.9%) and 40 macrometastases (43.5%). At a median follow-up of 36 months (24-172), one patient (0.3%) with macrometastatic SLN was found to have locoregional recurrence as chest wall and supraclavicular LN metastases at the 60th month. Five-year disease-free survival (DFS) and disease specific survival (DSS) rates were 87% and 95%, respectively. Patients with cT3/4 (HR = 2.41, 95% CI; 1.14-5.07), non-luminal molecular pathology (HR = 2.60, 95% CI, 1.16-5.82), and non-pCR in the breast (HR = 2.11, 95% CI, 0.89-5.01) were found to have an increased HR compared to others in 5-year DFS. However, no difference could be found between ypN0 and ypN ITC and micrometastasis (HR = 1.23, 95% CI, 0.44-3.47), whereas there was a slight increase in HR of patients with ypN macrometastasis versus ypN0 (HR = 1.91, 95% CI, 0.63-5.79). CONCLUSION: ALND could be avoided in meticulously selected cN (+) patients who underwent SLNB after NAC having breast and/or nodal pCR, cT1-2, or low volume residual nodal disease with luminal pathology, as long as axillary radiotherapy is provided.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/therapy , Neoplasm Recurrence, Local/pathology , Sentinel Lymph Node Biopsy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Axilla , Breast Neoplasms/diagnosis , Breast Neoplasms/metabolism , Disease-Free Survival , Female , Humans , Lymph Node Excision , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis/radiotherapy , Mastectomy, Segmental , Middle Aged , Neoadjuvant Therapy , Neoplasm Micrometastasis , Radiotherapy, Adjuvant , Retrospective Studies , Survival Rate , Turkey , Young AdultABSTRACT
BACKGROUND: The purpose of this study was to determine the relationship between calcifications in the thyroid gland and malignant thyroid lesions. METHODS: From June 2005 - May 2010, 169 patients, who had been operated on for thyroidectomy, were evaluated. The demographic findings were analyzed with regard to ultrasonographic and histopathologic calcifications. The relationship between calcifications and malignant and benign thyroid lesions was statistically determined by SPSS 10.01 version of Z-test and Chi-square test. RESULTS: Microcalcifications were found in 54 patients (31.95 %). Macrocalcification was found in one patient (0.59 %).Malignancy was determined in 29 patients (17.16 %). The rate of malignancy in patients with calcifications was 17/55 (30.9 1%). The diagnosis was nodular colloidal goiter in 38 patients (38/55, 69.09 %) with calcifications. The rate of calcification in malignant patients was 17/29 (58.62 %). The rate of malignancy in patients without calcification was 12/114 (10.52 %). The difference between the rate of malignancy in patients with calcification and the rate of malignancy in patients without calcification was statistically significant (Z-test, p < 0.001). CONCLUSION: Microcalcifications of the thyroid gland could predict malignant thyroid disease. They should be strictly evaluated by all thyroid cancer diagnostic modalities and surgical treatment should also be considered (Tab. 4, Ref. 29).