ABSTRACT
BACKGROUND: The aim of the study was to assess positivity nonsentinel lymph nodes in patients with macro, micro and submicrometastases in sentinel lymph nodes and find predictive factors of positivity nonsentinel lymph nodes. Study was conducted at the Department of Surgery in Pardubice, Pilsen, Ostrava and Zlín. MATERIAL AND METHODS: Sentinel lymph nodes were assessed based on standards of Czech Pathological Society. Detection of sentinel lymph nodes was performed based on radionavigation or combination of radionavigation and blue dye method. RESULTS: In group N1 (macrometastases) there was found positivity of nonsentinel lymph nodes in 50% (45 from 90 patients). In group N1 Mi (micrometastases) there was found positivity of nonsentinel lymph nodes in 26.7% (16 from 60 patients). In group NO I+ (sub-micrometastases) there was found positivity of nonsentinel lymph nodes in 6.7% (1 from 15 patients). Predictive factors were size of metastasis, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor of positivity nonsentinel lymph nodes. DISCUSSION: High positivity of nonsentinel lymph nodes in pacients with macro and micrometastases in sentinel lymph nodes advocates to perform axillary lymph nodes dissection. Due to small number of patients with submicrometastases it is not possible to assess if axillary dissection is necessary or not. Predictive factors of positivity of nonsentinel lymph nodes are size of metastasis in sentinel lymph nodes, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor due to small tumors in the study. In spite of this it is necessary to consider it like a predictive factor of positivity nonsentinel lymph nodes. CONCLUSION: In patients with macro and micrometastases it is necessary to perform axillary dissection. In patients with submicrometastases in sentinel lymph nodes it is necessary to consider predictive factors.
Subject(s)
Breast Neoplasms/pathology , Lymph Node Excision , Lymph Nodes/pathology , Axilla , Female , Humans , Lymphatic Metastasis , Prognosis , Sentinel Lymph Node BiopsyABSTRACT
BACKGROUND: The breast carcinoma is the most frequent malignancy in the women in the Czech Republic. The incidence of the breast carcinoma is still increasing. But the diagnostics and treatment of this disease was also changed. MATERIAL AND A METHODS: Retrospective study on the Department of Surgery Pardubice General Hospital. There are compared two periods--the years 1991 and 2006. Particularly there are followed numbers of procedures, diagnostics methods, types of procedures, size of the tumor, lymph node and systemic metastases, preoperative time and age of the patients. RESULTS AND CONCLUSION: The number of procedures doubled, the size of the tumor decreased from 3.05 to 2.01 cm, detection of lymph node metastases and lung metastases improved, there is trend to breast conservative treatment, preoperative time shortened.
Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Czech Republic , Female , HumansABSTRACT
BACKGROUND: Carcinoma of the breast is the most commonly diagnosed women cancer. Less than 1% of the patients diagnosed with breast cancer initially present with axillary metastases as their only clinical manifestation. CASUISTIC: We report case of 58 years old woman with occult breast carcinoma in which extensive axillary node metastasis was the first manifestation. DISCUSSION: Breast cancer presenting with axillary metastases and no clinical apparent primary tumour in the breast is an uncommon form of stage II or IV of this disease. Ultrasonography, mammography, MRI and excisional biopsy are indicated for detecting occult primary tumours. The appropriate treatment of the breast after an axillary presentation of occult breast carcinoma continues to be a controversial issue. Complete axillary lymph node dissection is indicated in all patients. As a local treatment of the breast is indicated irradiation of the breast or total mastectomy or subcutaneus mastectomy with application of the breast prothesis. CONCLUSION: Axillary metastasis is rare first sign of breast cancer. Diagnostics of the occult breast carcinoma is difficult. The treatment of occult breast carcinoma is still controversial.
Subject(s)
Breast Neoplasms/diagnosis , Carcinoma, Ductal, Breast/diagnosis , Axilla , Breast Neoplasms/secondary , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/secondary , Carcinoma, Ductal, Breast/surgery , Female , Humans , Lymph Node Excision , Lymphatic Metastasis , Mastectomy, Segmental , Middle AgedABSTRACT
BACKGROUND: Axillary lymph node staging is the most powerful predictor of survival in breast cancer women. Sentinel lymph node biopsy (SLNB) is more accurate method in evaluation of axillary lymph node staging than complete axillary lymph node dissection (CALND) because of more precious histological and imunohistochemical assessment of the first draining lymph nodes. Furthermore, SLNB eliminates complications resulting from CALND. MATERIAL AND METHODS: SLNB is either performed using blue dye technique or using of combination of blue dye and radioguided technique. We prefer two days protocol in application of Tc 99 radiocolloid. There were used both techniques for detection sentinel lymph nodes and results were compared. RESULTS: There were performed 21 SLNBs using blue dye technique, Group A, and 20 SLNBs using combination of blue dye and radioguided technique, Group B, from October 2001 to November 2003. Sentinel lymph nodes were not detected in Group A in two cases, false negativity occurred two times in this group. Sentinel lymph nodes were detected in all cases in Group B and there was no false negativity present in this group. CONCLUSION: Combination of blue dye and radioguided technique is more precious in detection of sentinel lymph node than blue dye technique itself. Two days protocol of application of Tc 99 radiocolloid enables performing this method even in hospitals, where the Department of Nuclear Medicine is not available.
