Mapping of the functional anatomy of lymphatic drainage to the axilla in early breast cancer: A cohort study of 933 cases.

INTRODUCTION: The aims of this study were to investigate the correlation between lymphatic drainage and the sentinel lymph node (SLN) status of the subregions in the context of the clinic-pathological parameters of the tumour and the coverage of the axillary volumes by standard and high tangential fields (STgF and HTgF) for whole breast radiotherapy and axillary reverse mapping (ARM). PATIENTS AND METHODS: 933 women with early breast cancer and clinically negative axillary status underwent breast surgery and SLN biopsy followed by axillary lymph node dissection in SLN-positive cases. The subregional localisation of the SLN(s) was registered and statistically analysed with the clinic-pathological characteristics of the breast tumour. In node-positive patients treated with breast-conserving therapy in whom the SLNs were found in the anterior or posterior axillary subregions, the axillary volumes were contoured using the Radiation Therapy Oncology Group contouring atlas (n = 61). RESULTS: In 91.1% (n = 797) of the cases, the SLN appeared in the anterior, posterior or central subregions. Using HTgF, Level I or II were completely covered in 65.6% (40/61) and 6.6% (4/61) of the cases, respectively. With STgF, the complete coverage was 0% for both levels. 6.8% (n = 63) of all cases had one positive lymph node in the expected ARM lymph node regions. DISCUSSION: A SLN is more than likely to be present in the anterior, posterior and central axillary subregions. Tangential fields allow only limited coverage of the axillary volumes. Preserving the lateral subregion during ARM may increase the possibility of understaging.

[Combined presentation of autoimmune thyroiditis, bilateral papillary thyroid carcinoma, cervical thyrolipoma and diabetes mellitus]. / Az autoimmun thyreoiditis, a kétoldali papillaris pajzsmirigy-carcinoma, a nyaki thyreolipoma és a diabetes mellitus együttes elofordulása.

Thyrolipoma or thyroid adenolipoma is an extremely rare form of thyroid adenoma, which also contains mature adipose tissue and follicles covered with fibrous capsule. We present the case of the growing cervical lesion of a 52-year-old female with diabetes, which was removed during total thyreoidectomy. Autoimmune thyroiditis, bilateral papillary carcinoma and cervical thyrolipoma have been identified by the histopathological examination of the thyroid gland. Orv Hetil. 2018; 159(25): 1024-1032.

[Sentinel lymph node biopsy in pregnancy-associated breast cancer]. / Orszemnyirokcsomó-biopszia terhességi emlorákban.

The incidence of pregnancy-associated breast cancer is rising. Sentinel lymph node biopsy is the method of choice in clinically node negative cases as the indicated minimally invasive regional staging procedure. Some reports have linked radioisotope and blue dye required for lymphatic mapping to teratogenic effects, the idea of which has become a generalized statement and, until recently, contraindication for these agents was considered during pregnancy. Today, there are many published reports of successful interventions with low-dose 99mTc-labeled human albumin nanocolloid, based on dosimetric modeling demonstrating a negligible radiation exposure of the fetus. These results contributed to the seemingly safe and successful use of sentinel lymph node biopsy during pregnancy, though generally it can not replace axillary lymphadenectomy in the absence of high-quality evidence. The possibility of sentinel lymph node biopsy should be offered to pregnancy-associated early breast cancer patients with clinically negative axilla, and patients should be involved in the decision making following extensive counselling. This paper presents the successful use of sentinel lymph node biopsy with low-dose tracer during two pregnancies (in the first and third trimesters) and, for the first time in Hungarian language, it offers a comprehensive literature review on this topic. Orv. Hetil., 154(50), 1991-1997.