Axillary Lymph Node Metastasis Research Articles

Dedifferentiated endometrial carcinoma metastasis to axillary lymph node: a case report

BackgroundWe present an unusual case of a left axillary lymph node metastasis from a primary dedifferentiated endometrial carcinoma. This pattern of metastasis is likely the result of circulating tumor cells reaching the node through its arterial blood supply.Case presentationIn this report, a 68-year-old white woman with a dedifferentiated endometrial carcinoma underwent a hysterectomy. She later developed an enlarged axillary lymph node due to metastatic dedifferentiated endometrial carcinoma, treated with chemotherapy and anti-programmed cell death protein 1 immunotherapy resulting in a complete clinical and radiological response.ConclusionA review of the literature reveals the rarity of blood-borne lymph node metastasis, especially with uterine carcinoma. Immunotherapy has shown promising results in the treatment of some subtypes of metastatic uterine carcinoma.

Concordance between Axillary Ultrasound and Sentinel Biopsy in Clinically Node-Negative Early Breast Cancer

Objective: To determine the sensitivity of axillary ultrasound in detecting axillary nodal metastasis in clinically and radiologically uninvolved axillary nodes in early carcinoma breast by comparing with sentinel node biopsy histopathology on frozen section. Study Design: Comparative cross-sectional study Place and Duration of Study: Breast Clinic, CMH, Rawalpindi Pakistan, from Aug 2020 to May 2021. Methodology: Patients included in the study presented with breast cancer lesions with clinically impalpable axillary lymph nodes aged 18-75. Patients with clinically impalpable nodes underwent an ultrasound of the axilla; if suspicious nodes were found, the patient had subsequent axillary node dissection. Sentinel node biopsy (SLNB) was performed on axillary ultrasound in all patients with no suspicious or benign-looking nodes. Histopathological reporting was taken as standard. Lymph nodal status on axillary ultrasound, SLN biopsy and axillary lymph node clearance were documented and analyzed. Results: Twenty-nine patients were included who had benign-looking lymph nodes on axillary ultrasound and underwent sentinel lymph node biopsy. The mean age of the patients was 54.03 ± 7.94. Out of 29 patients, 24(82.8%) patients had negative Sentinel lymph node biopsy, and 5(17.2%) had positive Sentinel lymph node biopsy, who then underwent axillary lymph node dissection. Conclusion: Sentinel lymph node biopsy is the gold standard to determine axillary lymph nodes involved in early carcinoma breast, which seem benign on pre-operative axillary ultrasound.

Cervix uterine Cancer with Axillary and Neck Lymph Node Metastasis: An Unusual Finding

Background: Cervix uterii cancer is the fourth most common female malignancy. It commonly spreads by direct extension or lymphatic dissemination within the pelvis into the regional lymph nodes. Distant lymph node metastasis remains exeptionnal. To our knowledge, synchronous cervical and axillary lymph node metastasis from cervix cancer have never been reported. Here we report a case of cervical and axillary lymph node metastasis from cervix uterii cancer. Case presentation: A 51-year-old woman diagnosed with cervix uterii cancer and treated with cocomitant chemoradiotherapy, presented 8 months after the initial diagnosis multiple round masses located at the left side of her neck. F-18 FDG PET/CT revealed pathological axillary and neck lymph nodes. Histopathology and immunohistochemistry confirmed the metastatic nature of the lymph nodes. the patient underwent lymph node dissection before undergoing chemotherapy, followed by radiotherapy to the affected cervical and axillary lymph nodes. Conclusions: Metastases from the uterine cervix to the neck lymph nodes are extremely uncommon. Lymphatic drainage and the lymph node jump phenomenon can explain the possible mode of cervical cancer tumor cell spread to the neck area. The mechanism of axillary lymph node metastasis from cervix uterii cancer can be explained by the communication between neck lymph nodes and axillary lymph nodes due to the alteration of the centripetal flow causing a retrograd spread. Distant lymph node metastasis in cervix uterii cancer are associated with a poor prognosis.

Axillary Lymph Node Metastasis from Ovarian Carcinoma: A Systematic Review of the Literature.

Axillary lymph node metastasis is a rare stage IV ovarian carcinoma manifestation. This manuscript aims to systematically review the literature regarding axillary lymph node metastasis from ovarian carcinoma. We searched three medical internet databases (PubMed, Scopus, and Web of Science) for relevant articles published until 22 July 2023. Cases describing supraclavicular or intramammary lymph node metastases and concurrent metastasis to the breast were excluded. After applying eligibility/inclusion and exclusion criteria, twenty-one manuscripts describing twenty-five cases were included from the English literature. Data were collected and analyzed regarding demographic, clinical, laboratory, radiological, histopathological, and oncological characteristics. We analyzed the clinical and oncological characteristics of patients with axillary lymph node metastasis from ovarian carcinoma, presented either as an initial diagnosis of the disease or as a recurrent disease. The analysis we performed showed a significant difference only in the serum CA-125 level (p = 0.004) between the two groups. There was no observed difference in womens' survival.

Association of a complete breast cancer pathologic response with axillary lymph node metastasis via neoadjuvant chemotherapy: Results from the CSBrS-012 study.

Association of a complete breast cancer pathologic response with axillary lymph node metastasis via neoadjuvant chemotherapy: Results from the CSBrS-012 study.

Construction of a comprehensive predictive model for axillary lymph node metastasis in breast cancer: a retrospective study

PurposeThe accurate assessment of axillary lymph node metastasis (LNM) in early-stage breast cancer (BC) is of great importance. This study aimed to construct an integrated model based on clinicopathology, ultrasound, PET/CT, and PET radiomics for predicting axillary LNM in early stage of BC.Materials and methods124 BC patients who underwent 18 F-fluorodeoxyglucose (18 F-FDG) PET/CT and whose diagnosis were confirmed by surgical pathology were retrospectively analyzed and included in this study. Ultrasound, PET and clinicopathological features of all patients were analyzed, and PET radiomics features were extracted to establish an ultrasound model (clinicopathology and ultrasound; model 1), a PET model (clinicopathology, ultrasound, and PET; model 2), and a comprehensive model (clinicopathology, ultrasound, PET, and radiomics; model 3), and the diagnostic efficacy of each model was evaluated and compared.ResultsThe T stage, US_BIRADS, US_LNM, and PET_LNM in the positive axillary LNM group was significantly higher than that of in the negative LNM group (P = 0.013, P = 0.049, P < 0.001, P < 0.001, respectively). Radiomics score for predicting LNM (RS_LNM) for the negative LNM and positive LNM were statistically significant difference (-1.090 ± 0.448 vs. -0.693 ± 0.344, t = -4.720, P < 0.001), and the AUC was 0.767 (95% CI: 0.674–0.861). The ROC curves showed that model 3 outperformed model 1 for the sensitivity (model 3 vs. model 1, 82.86% vs. 48.57%), and outperformed model 2 for the specificity (model 3 vs. model 2, 82.02% vs. 68.54%) in the prediction of LNM. The AUC of mode 1, model 2 and model 3 was 0.687, 0.826 and 0.874, and the Delong test showed the AUC of model 3 was significantly higher than that of model 1 and model 2 (P < 0.05). Decision curve analysis showed that model 3 resulted in a higher degree of net benefit for all the patients than model 1 and model 2.ConclusionThe use of a comprehensive model based on clinicopathology, ultrasound, PET/CT, and PET radiomics can effectively improve the diagnostic efficacy of axillary LNM in BC. Trial registration: This study was registered at ClinicalTrials Gov (number NCT05826197) on 7th, May 2023.

Trends in the pre-operative diagnosis and surgical management of axillary lymph node metastases in women with screen-detected breast cancer

AimThe aim of the current study was to investigate time-trends in pre-operative diagnosis and surgical treatment of axillary lymph node metastases in breast cancers detected at screening mammography. MethodsWe included all women who underwent screening mammography in the South of the Netherlands between 2005 and 2020. During a follow-up period of at least two years, data on clinical radiological examinations, biopsy procedures and surgical interventions were obtained. The 15 years of inclusion were divided into five cohorts of three years each. ResultsOf the 4049 women with invasive breast cancer, 22.1 % (896/4049) had axillary lymph node metastasis at pathology (ALN+). Percutaneous axillary biopsy was performed in 39.6 % (355/896) of these women, with the proportions of fine needle aspiration biopsy (FNAB) decreasing from 97.6 % (40/41) in 2005–2007 to 41.6 % (37/89) in 2017–2019 and core needle biopsy (CNB) rising from 2.4 % (1/41) in 2005–2007 to 58.4 % (52/89) in 2017–2019 (P < 0.001). Sensitivity of FNAB and CNB was comparable (77.4 % (188/243, 95%CI = 71%–82 %) versus 82.4 % (103/125), 95%CI = 74%–88 %) (P = 0.26). Pre-operative confirmation of ALN + by percutaneous biopsy ranged from 27.3 % (56/205) in 2011–2013 to 39.0 % (80/205) in 2017–2019, with no significant trend changes over time (P = 0.103). The proportion of ALN + women who underwent axillary lymph node dissection (ALND) decreased from 96.0 % (97/101) in 2005–2007 to 16.6 % (34/205) in 2017–2019 (P < 0.001). ConclusionPre-operative confirmation of axillary lymph node metastasis by ultrasound-guided biopsy did not rise despite the increased use of CNB at the expense of less invasive FNAB. A significant reduction in ALND was observed through the years.

Simultaneous 18F-FDG PET/MRI Radiomics and Machine Learning Analysis of the Primary Breast Tumor for the Preoperative Prediction of Axillary Lymph Node Status in Breast Cancer.

In this prospective study, 117 female patients (mean age = 53 years) with 127 histologically proven breast cancer lesions (lymph node (LN) positive = 85, LN negative = 42) underwent simultaneous 18F-FDG PET/MRI of the breast. Quantitative parameters were calculated from dynamic contrast-enhanced (DCE) imaging (tumor Mean Transit Time, Volume Distribution, Plasma Flow), diffusion-weighted imaging (DWI) (tumor ADCmean), and PET (tumor SUVmax, mean and minimum, SUVmean of ipsilateral breast parenchyma). Manual whole-lesion segmentation was also performed on DCE, T2-weighted, DWI, and PET images, and radiomic features were extracted. The dataset was divided into a training (70%) and a test set (30%). Multi-step feature selection was performed, and a support vector machine classifier was trained and tested for predicting axillary LN status. 13 radiomic features from DCE, DWI, T2-weighted, and PET images were selected for model building. The classifier obtained an accuracy of 79.8 (AUC = 0.798) in the training set and 78.6% (AUC = 0.839), with sensitivity and specificity of 67.9% and 100%, respectively, in the test set. A machine learning-based radiomics model comprising 18F-FDG PET/MRI radiomic features extracted from the primary breast cancer lesions allows high accuracy in non-invasive identification of axillary LN metastasis.

Molybdenum target mammography-based prediction model for metastasis of axillary sentinel lymph node in early-stage breast cancer.

Sentinel lymph node (SLN) status is closely related to axillary lymph node metastasis in breast cancer. However, SLN biopsy has certain limitations due to invasiveness and diagnostic efficiency. This study aimed to develop a model to predict the risk of axillary SLN metastasis in early-stage breast cancer based on mammography, a noninvasive, cost-effective, and potential complementary way. Herein, 649 patients with early-stage breast cancer (cT1-T2) who received SLN biopsy were assigned to the training cohort (n = 487) and the validation cohort (n = 162). A prediction model based on specific characteristics of tumor mass in mammography was developed and validated with R software. The performance of model was evaluated by receiver operating characteristic curve, calibration plot, and decision curve analysis. Tumor margins, spicular structures, calcification, and tumor size were independent predictors of SLN metastasis (all P < .05). A nomogram showed a satisfactory performance with an AUC of 0.829 (95% CI = 0.792-0.865) in the training cohort and an AUC of 0.825 (95% CI = 0.763-0.888) in validation cohort. The consistency between model-predicted results and actual observations showed great Hosmer-Lemeshow goodness-of-fit (P = .104). Patients could benefit from clinical decisions guided by the present model within the threshold probabilities of 6% to 84%. The prediction model for axillary SLN metastasis showed satisfactory discrimination, calibration abilities, and wide clinical practicability. These findings suggest that our prediction model based on mammography characteristics is a reliable tool for predicting SLN metastasis in patients with early-stage breast cancer.

Radiomics nomogram for predicting axillary lymph node metastasis-a potential method to address the limitation of axilla coverage in cone-beam breast CT: a bi-center retrospective study.

Cone-beam breast CT (CBBCT) has an inherent limitation that the axilla cannot be imaged in its entirety. We aimed to develop and validate a nomogram based on clinical factors and contrast-enhanced (CE) CBBCT radiomics features to predict axillary lymph node (ALN) metastasis and complement limited axilla coverage. This retrospective study included 312 patients with breast cancer from two hospitals who underwent CE-CBBCT examination in a clinical trial (NCT01792999) during 2012-2020. Patients from TCIH comprised training set (n = 176) and validation set (n = 43), and patients from SYSUCC comprised external test set (n = 93). 3D ROIs were delineated manually and radiomics features were extracted by 3D Slicer software. RadScore was calculated and radiomics model was constructed after feature selection. Clinical model was built on independent predictors. Nomogram was developed with independent clinical predictors and RadScore. Diagnostic performance was compared among three models by ROC curve, and decision curve analysis (DCA) was used to evaluate the clinical utility of nomogram. A total of 139 patients were ALN positive and 173 patients were negative. Twelve radiomics features remained after feature selection. Location and focality were selected as independent predictors for ALN status. The AUC of nomogram in external test set was higher than that of clinical model (0.80 vs. 0.66, p = 0.012). DCA demonstrated that the nomogram had higher overall net benefit than that of clinical model. The nomogram combined CE-CBBCT-based radiomics features and clinical factors could have potential in distinguishing ALN positive from negative and addressing the limitation of axilla coverage in CBBCT.

Axillary Lymph Node Metastasis as the First Symptom of Colon Cancer.

Axillary lymph node metastasis in colon cancer is extremely rare. We describe the FDG PET/CT findings in a 61-year-old woman who presented with a mass in the right axilla, which revealed irregular thickening of the ascending colon wall, as well as multiple enlarged lymph nodes in the ileocecal mesentery, para-aortic region, and right axilla with higher uptake of FDG. Ascending colon carcinoma with lymph node metastasis in the right axilla was confirmed by pathological examination.

Assessment of breast cytoarchitecture and its associated axillary lymph node status under normal and pathological conditions in Egyptian women

ObjectiveHerein, we compare the features of neoplastic cancer cells in invasive ductal carcinoma (IDC) grade II and III patients to their corresponding normal cells both in breast and axillary lymph node (ALN) tissues. MethodsA retrospective cohort of 70 female breast cancer patients enrolled between 2018 and 2020 at Medical Research Institute, Alexandria University, Egypt, was analyzed for clinicopathological features presentation. Fresh tiny pieces of breast tissue and its associated ALN tissues were then processed to investigate the morphological appearance by scanning electron microscopy. Moreover, the histological architecture of tissue sections stained with hematoxylin and eosin was studied by light microscope, while the characterization of the ultrastructure features of breast and ALN tissues was analyzed by transmission electron microscopy. ResultsClinicopathological presentation of patients revealed that the Egyptian female breast cancer population adhered to the global trends of breast cancer disease with elevated incidence rate among postmenopausal women (61.3%), high frequency of IDC (95.7%), and increased ALN metastasis (65.7%). The percentage of estrogen receptor alpha (ERα) and human epidermal growth factor receptor 2 (HER2) expression, as key indicators for carcinogenesis and disease progression was 87.1% and 55.8%, respectively. The present study points to the observed discrepancies among the investigated variables in the diagnostic separation between IDC grade II and grade III. Ductal epithelial cells organization, nuclei size and irregularity, chromatin amount and uniformity, mitochondrial abundance and dysfunction were differentially manifested in IDC grades. Moreover, aberrations in the cellular organelles like lysosomes, endoplasmic reticulum, and lipid droplets vary according to the grade of IDC and the aggressiveness of the invasive breast cancer. ConclusionsTo sum up, this study emphasizes the importance of accurate specimen evaluation for treatment choice and decision.

Top 100 cited classical articles in sentinel lymph nodes biopsy for breast cancer.

The sentinel lymph node biopsy (SLNB) takes on a critical significance in breast cancer surgery since it is the gold standard for assessing axillary lymph node (ALN) metastasis and determining whether to perform axillary lymph node dissection (ALND). A bibliometric analysis is beneficial to visualize characteristics and hotspots in the field of sentinel lymph nodes (SLNs), and it is conducive to summarizing the important themes in the field to provide more insights into SLNs and facilitate the management of SLNs. Search terms relating to SLNs were aggregated and searched in the Web of Science core collection database to identify the top 100 most cited articles. Bibliometric tools were employed to identify and analyze publications for annual article volume, authors, countries, institutions, keywords, as well as hotspot topics. The period was from 1998 to 2018. The total number of citations ranged from 160 to 1925. LANCET ONCOLOGY and JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION were the top two journals in which the above articles were published. Giuliano, AE was the author with the highest number of articles in this field with 15. EUROPEAN INST ONCOL is the institution with the highest number of publications, with 35 articles. Hotspots include the following 4 topics, false-negative SLNs after neoadjuvant chemotherapy; prediction of metastatic SLNs; quality of life and postoperative complications; and lymphography of SLNs. This study applies bibliometric tools to analyze the most influential literature, the top 100 cited articles in the field of SLNB, to provide researchers and physicians with research priorities and hotspots.

Contralateral axillary lymph node metastasis in breast cancer: An oligometastatic-like disease

BackgroundContralateral axillary lymph node metastasis (CAM) is rare. It remains controversial whether CAM should be regarded as a regional or distant metastatic disease. Our study aims to investigate the accurate clinical orientation and management of CAM. MethodsTwo hundred and ninety-nine female patients diagnosed with breast cancer from 2000 to 2014 and confirmed to develop CAM, oligometastasis (OM) or locoregional recurrence (LRR) at Fudan University Shanghai Cancer Center (FUSCC) were included in this study. Baseline information and survival outcomes were analyzed and compared among the three groups. ResultsPatients with CAM exhibited similar overall survival (OS) and progression-free survival (PFS) to those with OM, but worse than those with LRR (HR: 0.47 [95 % CI: 0.27–0.85], p = 0.0097; HR:0.39 [95 % CI: 0.24–0.63], p < 0.0001, respectively). Considering the patients presented with CAM or OM as a whole, we found that local treatment combined with systemic treatment did not provide a superior survival benefit over systemic treatment alone. ConclusionCAM was similar to an oligometastatic-like disease, and patients with these diseases may benefit from systemic treatment. Adding local treatment failed to significantly improve OS.

Analysis of Prognoses according to Breast MRI Results in Patients with Axillary Lymph Node Metastases from an Unknown Primary Origin.

To compare the prognosis of patients with axillary adenocarcinoma from an unknown primary (ACUPax) origin with negative MRI results and those with MRI-detected primary breast cancers. The breast MRI images of 32 patients with ACUPax without signs of primary breast cancer on mammography and ultrasound (US) were analyzed. Spot compression-magnification mammography and second-look US were performed for the area of MRI abnormality in patients with positive results; any positive findings corresponding to the MRI abnormality were confirmed by biopsy. If suspicious MRI lesions could not be localized on mammography or US, MR-guided biopsy or excision biopsy after MR-guided localization was performed. We compared the prognosis of patients with negative breast MRI with that for patients with MRI-detected primary breast cancers. Primary breast cancers were confirmed in 8 (25%) patients after breast MRI. Primary breast cancers were not detected on MRI in 24 (75%) patients, including five cases of false-positive MRI results. Twenty-three patients underwent axillary lymph node dissection (ALND) followed by whole breast radiation therapy (WBRT) and chemotherapy (n=17) or subsequent chemotherapy only (n=2). Recurrence or distant metastasis did not occur during follow up in 7/8 patients with MRI-detected primary breast cancers and 22/24 patients with negative MRI results. Regional recurrence or distant metastasis did not occur in any MR-negative patient who received adjuvant chemotherapy after ALND and WBRT. The prognoses of MR-negative patients with ACUPax who received ALND and WBRT followed by chemotherapy were as good as those of patients with MRI-detected primary breast cancers.

Application of ultrasound-based radiomics models of breast masses to predict invasive components of encapsulated papillary carcinoma.

Axillary lymph node (ALN) metastasis is seen in encapsulated papillary carcinoma (EPC), mostly with an invasive component (INV). Radiomics can offer more information beyond subjective grayscale and color Doppler ultrasound (US) image interpretation. This study aimed to develop radiomics models for predicting an INV of EPC in the breast based on US images. This study retrospectively enrolled 105 patients (107 masses) with a pathological diagnosis of EPC from January 2016 to April 2021, and all masses had preoperative US images. Of the 107 masses, 64 were randomized to a training set and 43 to a test set. US and clinical features were analyzed to identify features associated with INVs. Then, based on the manually segmented US images to obtain radiomics features, the models to predict INVs were built with 5 ensemble machine learning classifiers. We estimated the performance of the predictive models using accuracy, the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, and specificity. The mean age was 63.71 years (range, 31 to 85 years); the mean size of tumors was 23.40 mm (range, 9 to 120 mm). Among all clinical and US features, only shape was statistically different between EPC with INVs and those without (P<0.05). In this study, the models based on Random Under Sampling (RUS) Boost, Random Forest, XGBoost, AdaBoost, and Easy Ensemble methods had good performance, among which RUS Boost had the best performance with an AUC of 0.875 [95% confidence interval (CI): 0.750-0.974] in the test set. Radiomics prediction models were effective in predicting the INV of EPC, whereas clinical and US features demonstrated relatively decreased predictive utility.

The predictive value, sensitivity, specificity, and accuracy of PET CT in the evaluation of axillary metastases in breast cancer.

This study aims to evaluate the accuracy of preoperative 18F-FDG PET CT in detecting axillary lymph node (ALN) metastases in patients with breast cancer. A retrospective analysis was performed on the medical records of 114 patients who underwent PET CT for breast cancer between January 2017 and January 2020. Clinicopathological features and the relationship between lymph node metastasis were evaluated. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated based on the PET CT findings compared to histopathological results. Among the 67 patients included in this study, 29 were identified as having no axillary involvement, while 38 showed axillary involvement according to preoperative PET CT. Of the 34 patients with histopathologically confirmed metastatic lymph nodes, 28 had PET CT-detected axillary involvement, while 6 did not. Similarly, among the 33 patients without histopathological evidence of lymph node metastasis, 23 had no axillary involvement according to PET CT, while 10 showed axillary involvement. The calculated values were as follows: sensitivity = 82.4% (67-92%), specificity = 69.7% (53-83%), positive predictive value = 73.7% (62-83%), negative predictive value = 79.3% (64%-89%), and accuracy = 76.1% (64-86%). The results suggest that preoperative 18F-FDG PET CT, particularly p SUVmax, can serve as an independent prognostic factor for ALN metastasis in breast cancer patients. Therefore, it may be beneficial for preoperative risk stratification and personalized treatment planning.

Clinical Trials of Carbon Ion Radiotherapy for Early-Stage Breast Cancer

Our institute conducted a clinical trial of curative partial breast irradiation using carbon ion radiotherapy (CIRT) to patients with stage 0 and I breast cancer since 2013. The purpose of this report is to evaluate treatment outcomes up to now. To date, we have conducted three clinical trials and one advanced medical treatment (NIRS 9404 Comprehensive Research). The first study (UMIN000010848: commonly known as Breast I trial) was 4-split irradiation for stage I low-risk patients aged 60 years or older, and the next clinical study (UMIN000029478: commonly known as Breast II trial) was for Tis-1N0M0 cases of 2 cm or less. On the other hand, 4-split irradiation using standard adjuvant drug therapy according to risk combined with whole breast irradiation by X-ray, the latest clinical trial (UMIN000046859: commonly known as Breast III trial) is a single irradiation for Tis-1N0M0 patients aged 50 years or older. be. In each phase I, the dose increase test was performed, and in phase II, treatment was performed with the recommended dose determined in phase I. Advanced medical care was provided in parallel with breast I for stage I breast cancer that was difficult or rejected to participate in breast I trial. By January 2023, 60 cases were enrolled. A total of 19 were enrolled In Breast I, 7 in Phase I, 12 in Phase II of the recommended dose of 60.0 Gy (RBE). A total of 14 were enrolled in the 9404 Comprehensive Research. A total of 17 were enrolled In Breast II, 5 cases in Phase I, 12 cases in Phase II of recommended dose 60.0 Gy (RBE). A total of 10 were enrolled in Breast III, 6 cases in Phase I, and 4 in Phase II of recommended dose 50.0 Gy (RBE). As acute adverse events, grade 2 of acute radiation dermatitis were observed in 1 case, grade 1 of acute radiation dermatitis was observed in 31 cases, and grade 1 of mastitis was observed in 6 cases. As a late adverse event, grade 3 of pneumonia of unknown causality were observed in one case, but there were no other problematic adverse events, and breast cosmetic outcome was excellent in all cases. Tumor disappearance after CIRT took 3 to 24 months. Local recurrence and axillary lymph node metastasis were observed in one high-risk case of advanced medical treatment who refused any other therapy. Two cases had ipsilateral intramammary metachronous breast cancer with different subtypes. To date, no other recurrences or metastases have been observed. CIRT for early-stage breast cancer is expected to be effective with mild adverse events, and it is considered meaningful to continue research.

Predictors for axillary lymph node metastasis in primary neuroendocrine carcinomas of the breast and neuroendocrine differentiated breast cancers

Aims: Primary neuroendocrine carcinomas of the breast (NEC) and neuroendocrine differentiated breast cancers are rare entities. The aim of this study was to investigate clinical and histopathological findings and predictors for axillary lymph node metastasis (ALNM) in primary neuroendocrine carcinomas of the breast (NEC) and neuroendocrine differentiated breast cancers (NEBC).&#x0D; Methods: Patients with a diagnosis of breast cancer with histopathological neuroendocrine features between the years 2015 and 2022 were retrospectively screened. The patients were divided into two main groups, the NEC and NEBC groups. The two groups were evaluated in terms of their clinical and histopathological characteristics and predictive factors for axillary lymph node.&#x0D; Results: A total of 35 patients [NEBC group: 24 patients, NEC group: 11 patients) were evaluated. At the time of diagnosis, the median age was 57 (NEC: 49 years, NEBC: 57.5). Of the 35 patients, 15 (57.1%) had ALNM, and lymphovascular invasion was detected in 16 (45.7%). When the whole patient population was evaluated for ALNM, it was found that lymphovascular invasion had an effect on ALNM (p=0.005). In the NEBC group, the rate of ALNM was associated with an increase in tumor diameter (p=0.035). Additionally, the tumor diameter was found to be predictive of ALNM in the ROC analysis (AUC: 0.753, 95% CI: 0.557-0.950, cut-off: 2.35 cm, p=0.035). Analyses of correlation revealed a low-level correlation between age and Ki-67 in the study cohort ( ρ= -0.341, p=0.45).&#x0D; Conclusion: NECs and NEBCs of the breast are uncommon tumors with a high ALNM potential. Patients with lymphovascular invasion and a large tumor diameter should be carefully evaluated for ALNM. Further research is required to determine the most appropriate treatment strategy for these rare subtypes of breast cancers.

18F-fluorodeoxyglucose positron emission tomography/computed tomography findings of breast cancer with signet ring cell differentiation: A single-center experience

Aim: Due to the low incidence of breast cancer with signet ring cell (SRC) differentiation, which constitutes less than 1% of all breast cancers, little is known about its imaging features. The aim of this study was to evaluate the utility of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in staging breast cancer with SRC differentiation.&#x0D; &#x0D; Methods: We conducted a retrospective analysis of 14 patients with histologically confirmed breast cancer with SRC differentiation who underwent 18F-FDG PET/CT at our institution between 2014 and 2023. The imaging findings were analyzed in terms of maximum standardized uptake value (SUVmax), lesion size, and the presence of regional or distant metastases were statistically evaluated.&#x0D; &#x0D; Results: The histological subtypes of SRC differentiated primary tumors were 9 invasive lobular, and 5 invasive ductal carcinoma. More intense 18F-FDG uptake was observed in primary tumoral lesions of the ductal subtype (mean SUVmax: 18.8±9.8; range: 2.6–28.9) compared to the lobular subtype (mean SUVmax: 2.6±1.3; range: 1.5–5.1) (p=0.007, Z=2.600). Among the patients included in the study, axillary lymph node metastasis was present in 64% (n=9) of the cases, with lymph node metastasis identified in five cases classified as ductal carcinoma. Additionally, distant organ metastasis was identified in 21% (n=3) of patients, comprising two patients with ductal carcinoma and one with lobular carcinoma.&#x0D; &#x0D; Conclusion: Despite the general consensus that signet-ring cell tumors have a low affinity for 18F-FDG, our study has observed the possibility of high 18F-FDG uptake in cases of ductal carcinoma. However, in cases of lobular carcinoma, where 18F-FDG uptake tends to be low, considering alternative PET radiopharmaceuticals for imaging could be a viable option.