Axillary Lymphadenectomy Research Articles

A Case of 10-Year Survival after Adrenalectomy for Isolated Adrenal Metastasis of Breast Cancer

Isolated adrenal metastasis of breast cancer is very rare, so adrenalectomy for breast cancer metastasis is rarely performed. The case of a breast cancer patient with five-year survival after resection of a left isolated adrenal metastasis is presented. A 70-year-old woman underwent left modified radical mastectomy and axillary lymphadenectomy for invasive ductal carcinoma (T2N1M0) 9 years earlier. At regular follow-up, a left adrenal mass, 4 cm in diameter, was seen on ultrasound examination and computed tomography (CT). Endoscopic adrenalectomy was performed. Pathological examination confirmed isolated adrenal metastasis of breast cancer. After surgery, hormone therapy was given for 5 years. Ten years after adrenalectomy, no metastatic lesions in other organs have been found on CT. Adrenalectomy for a metastatic adrenal tumor of breast cancer may provide survival benefits when combined with systemic hormone therapy and chemotherapy, particularly in patients with disease confined to the adrenal glands.

A method for reducing lymphorrhea in the postoperative period after axillary lymphadenectomy for metastatic lesion in patients with skin melanoma

Objective. Prevention of prolonged lymphorrhea, postoperative lymphocysts in patients with melanoma metastases after axillary lymph node dissection.
 Material and methods. Patients with metastases of melanoma in axillary lymph nodes (n = 67) who underwent axillary lymph node dissection were studied. Patients were divided into two groups comparisons (n = 35), which, after surgical intervention in the armpit, installed an active aspiration system according to Redon and the main (n = 32), patients of which, in addition to the draining system, installed an elastic rubber ball with water, which provided additional pressure on the skin. A significant difference (p0.001) was established between the main and comparison groups in the number of hospital days spent by patients in the hospital. For a statistical comparison, the Mann-Whitney test was used, the distribution form was checked using the Kolmogorov-Smirnov test. The median and interquartile range (Me [Q25%Q75%]) were determined as measures of the average tendency and spread.
 Results. In the main group, patients with lymphorrhea stopped faster, drainage was removed earlier and the average hospital stay was 3 days shorter than in patients in the comparison group, and lymphocyst formation was not observed in comparison with the comparison group in which this complication was observed 11.4%.
 Discussion. The duration of patients stay in the hospital directly depended on the date of drainage removal, the time of tissue adhesion and the end of lymphorrhea, the formation of a lymphocyst in the postoperative period, which directly depended on the application of a new technique of additional pressure on the tissues besides vacuum drainage.
 Conclusion. the installation of hydraulics immediately after the operation leads to a faster gluing of the separated tissues, a reduction in lymphorrhea, and, accordingly, a shorter use of drainage, early removal and discharge of the patient from the hospital, and prevention of the formation of lymphocytes with the corresponding medical and economic effect. Priority certificate No. 2019109858 dated 04/03/2019 was received for the method used.

Chronic adverse effects after an axillary lymphadenectomy in breast cancer patients after administering weaker and stronger postoperative analgesia: results of a prospective double-blind randomized study.

The aim of this study was to compare the rate of chronic adverse effects after a weaker and stronger postoperative analgesia. A prospective double-blind randomized study included 117 breast cancer patients receiving tramadol for pain relief for 4weeks after an axillary lymphadenectomy from 2015 to 2018. Patients with a larger dose received 75/650mg of tramadol with paracetamol every 8h and a group with a lower dose received 37.5/325mg of tramadol with paracetamol every 8h from the 2nd to the 29th postoperative day. 1year after surgery, patients were evaluated for the presence of neuropathic pain, chronic pain, arm symptoms and lymphedema. There was a trend for a lower rate of neuropathic pain after stronger analgesia in comparison to weaker analgesia (p = 0.059). Chronic pain was present in 18% of patients 1year after the lymphadenectomy. There was no difference in the rate of chronic pain after stronger and weaker postoperative analgesia. Patients had less arm symptoms after a stronger analgesia than after a weaker analgesia (p = 0.02). Furthermore, there was a trend for a lower rate of lymphedema of the forearm after a stronger analgesia than after a lower analgesia (p = 0.078). The patients who received a stronger postoperative analgesia had less arm symptoms and a better quality of life in comparison to patients who received a weaker analgesia. The patients who received a stronger postoperative analgesia had a statistical trend for less neuropathic pain in comparison to patients who received a weaker analgesia.

Gauging the efficacy of neoadjuvant endocrine therapy in breast cancer patients with known axillary disease.

Neoadjuvant endocrine therapy (NET) for ER+ breast cancer can downstage primary tumors. We evaluated NET efficacy in node-positive patients. Node-positive patients undergoing NET for ER+ breast cancer from 2012 to 2019 were reviewed. Primary endpoints included rates of axillary lymphadenectomy (ALND), pathologic complete response (pCR), and final nodal staging. Thirty-nine patients were included. Before NET, all were clinically node-positive (cN1 = 36, 94%; cN2 = 2, 5%; cN3 = 1, 3%; Stage II = 23, 59%, Stage III = 16, 41%). After NET, nine (23%) had clinically persistent axillary disease necessitating ALND. The remaining 30 (77%) underwent sentinel lymph node biopsy (SLNB). Of these, 25 (83%) were SLNB+ on frozen section, undergoing immediate ALND. Five patients were negative on frozen section: one had a confirmed axillary pCR, and four had residual nodal disease on permanent pathology. One underwent delayed ALND, and for the remaining three patients, decision was made to forgo ALND. Final overall axillary staging was: N0 (pCR) = 1, 3%, pN1mic = 1, 3%, pN1 = 20, 51%, pN2 = 12, 30%, pN3 = 5, 13%; Stage II = 16, 41%, Stage III = 23, 59%. While NET is reported to downstage primary tumors, downstaging of the axilla was unsuccessful in the majority of patients.

Prospective Comparison of Intraoperative Touch Imprint Cytology and Frozen Section Histology on Axillary Sentinel Lymph Nodes in Early Breast Cancer Patients

Introduction: Since the late 1970s, sentinel lymph node biopsy (SLNB) has been used for several solid malignancies to identify lymph node metastases. This procedure is associated with less surgical morbidity than complete lymphadenectomy. Recent evidence suggests that axillary lymphadenectomy is not required for breast sentinel nodes with micrometastases (≤2 mm). Current clinical management of sentinel nodes indicates that only macrometastases (>2 mm) should be detected intraoperatively. In Japan, an intraoperative histopathological frozen section (FS) method is used to identify lymph node metastases, but this method takes more than 30 min and requires complex techniques and expensive equipment. Touch imprint cytology (TIC) is an easier, less expensive, and faster method, but its sensitivity has been shown to be low. Objective: The purpose of this study was to determine if TIC is more useful than FS in identifying macrometastases in sentinel lymph nodes in preoperative node-negative breast cancer operations. Methods: A prospective review of 49 consecutive patients with node-negative breast cancer treated with SLNB and intraoperative TIC and FS between November 2017 and June 2019 was performed. TIC samples were stained using Papanicolaou and Diff-Quick stains. Results were compared with routine postoperative paraffin sections. Results: With TIC, the Papanicolaou stain took a mean of 12 min, and the Diff-Quick stain took a mean of 10 min. Results of both TIC stain methods were the same. In contrast, the FS method took a mean of 80 min (including the transfer of specimens to a different hospital with the necessary equipment). TIC confirmed macrometastases in 5 cases. All macrometastases were diagnosed equally by the 2 techniques. Both the sensitivity and specificity of TIC were 100% for detection of macrometastases. Conclusion: TIC of SLNB for breast cancer is an easy and useful method for the detection of macrometastases of breast sentinel nodes.

Is SNOLL a good localization technique in early breast cancer treatment? A single center's experience.

The aim of this study was to evaluate the method and present one center's experience in applying the SNOLL technique to patients with non-palpable suspicious breast lesions. 371 patients with suspected malignant lesions or diagnosed non-palpable breast cancer were subjected to a preoperative SNOLL procedure. The day before the surgery, they were administered two radiotracers to localize the tumor in the breast and the sentinel node. The following day, with the help of a handheld gamma probe the breast conserving surgery was performed. All 371 patients (100%) had their suspected occult breast lesions resected. Histo-pathological examination revealed cancer in 339 patients all these patients had their sentinel nodes examined. The intraoperative tests showed the sentinel node to be metastatic in 35 patients, who were then given a simultaneous axillary lymphadenectomy. Another 7 patients were diagnosed with positive lymph nodes in the final pathology and had to undergo a second operation. Reoperations compelled by positive surgical margins were performed in 26 cases. SNOLL as a good technique of intraoperative localization, enables to remove a nonpalpable breast cancer together with sentinel lymph node in a single surgical procedure. It seems to be a optional method to be used in patients treated with breast conserving therapy.

Characteristics of breast cancer in Slovenian patients with germline CHEK2 c.444+1G>A mutation.

e13536 Background: Different CHEK2 germline pathogenic variants/likely pathogenic variants (PV/LPV) are associated with distinct immunophenotypic molecular subtypes of breast cancer (BC). The aim of our study was to explore the characteristics of Slovenian BC patients with CHEK2 c.444+1G > A variant. Methods: Germline CHEK2 pathogenic PV/LPV were identified in 76 individuals from 50 families who underwent genetic counseling and testing using a multigene panel at our institution from year 2014 to 2019. The data on 41 Slovenian BC patients with CHEK2 PV/LPV were retrospectively collected and analyzed, with an emphasis on c.444+1G > A variant carriers. Results: BC in our CHEK2 positive patients was diagnosed in 40 females and one male. Mean age at BC diagnosis was 42.8 years (range 21-63). Four recurrent CHEK2 PV/LPV were found in 80% (33/41) of our BC patients: c.444+1G > A (12/41; 29%; 11 females, one male), c.349A > G (9/41; 22%). deletion of exons 9-10 (7/41; 17%) and c.1100delC (5/41; 12%). There was a trend for c.444+1G > A carriers to develop BC at younger age in comparison to patients with other CHEK2 PV/LPV (mean age 39.3 vs. 44.2 years; p = 0.089). None of the patients with the c.444+1G > A variant had invasive lobular carcinoma. Median tumor size in patients with c.444+1G > A variant was 34 mm and median number of positive lymph nodes was 2.67 (range 1-8). Patients with c.444+1G > A variant had a luminal A subtype in 2 cases, luminal B in 7 cases, HER2+ subtype in 3 cases, while none of patients had a triple negative BC. Mastectomy, tumorectomy and axillary lymphadenectomy was performed in 8, 4 and 12 patients, respectively. All c.444+1G > A carriers had to be treated with chemotherapy and external beam irradiation. Patients with the c.444+1G > A variant were more often treated with chemotherapy (p = 0.038) and/or external beam irradiation (p = 0.014) in comparison to patients with other PV/LPV. Distant metastases were diagnosed in two patients at age 45 and 47. Conclusions: Mutation c.444+1G > A was detected in 29% of Slovenian patients with CHEK2 PV/LPV. Distant dissemination was diagnosed despite aggressive treatment at a young age in 16% of these patients.

Ganglio centinela en el cáncer de mama masculino: reporte de caso y revisión de la literatura

IntroductionMale breast cancer accounts for <1% of all malignancies in men, and although it shares many similarities with breast cancer in women, it has important differences. Case reportA 68-year-old male patient presented with a 5-month history of a nodular lesion in the areolar region of the left breast accompanied by occasional pain and progressive growth. An ultrasound scan showed a heterogeneous lesion with irregular edges and calcifications, BIRADSV. It was decided to perform a mastectomy and sentinel lymph node biopsy, with positivity in the transoperative period, and axillary lymphadenectomy was completed. The histopathology report confirmed infiltrating ductal carcinoma, sentinel lymph node- and satellite-positive for metastatic carcinoma. ConclusionSeveral questions remain unanswered about breast cancer in men. It is important to enhance understanding of the biology of the disease to identify the differences between the two sexes and thus determine if they have therapeutic implications.

Abstract 65: Immediate Lymphatic Reconstruction After Axillary Lymphadenectomy Makes A Difference: A Two Year Comparative Analysis

Purpose: Axillary lymph node dissection (ALND) in the treatment of breast cancer increases the risk of iatrogenic lymphedema. Current rates after ALND range from 11-30%. We hypothesize that our lymphedema prevention surgical (LPS) paradigm, ALND with axillary reverse mapping (ARM) and lymphatico-venous bypass (LVB), lowers the risk of lymphedema. Here, we present findings from a case control study from patients undergoing this procedure. Methods: A review of our prospectively maintained lymphedema surgical registry was performed. Ninety-six consecutive patients with complete ALND underwent LPS at our institution from 9/2016-10/2019. A control group was selected consisting of 92 patients who underwent ALND without LPS in a concurrent time interval from 9/2016-11/2017 to prevent surgical technique or learning curve bias. Patients were followed for both signs and symptoms of lymphedema throughout the post treatment interval and underwent serial assessments for lymphedema via standardized arm circumference measurements by a certified lymphedema therapist. Lymphedema was defined as more than a 10% difference in volume between upper limbs in conjunction with characteristic symptoms and signs. Demographic, procedural and oncologic data was compared between groups. Results: Lymphedema occurrence rates were significantly different between control and treatment groups during the followup period (16.3% non-LPS vs. 5.3% LPS, p=0.006). Of the 15 non-LPS patients who developed lymphedema, 14 received PMRT and 5 had neoadjuvant chemotherapy. Five LPS patients acquired lymphedema, two had PMRT and all five underwent neoadjuvant chemotherapy. Clinical staging differed with a higher proportion of advanced nodal stage in LPS patient group. The mean lymph nodes removed per case was slightly higher in the LPS group (14.4 vs. 11.2). Rates of post mastectomy radiation therapy (PMRT) were similar (77% to 89%, respectively), but neoadjuvant chemotherapy rates were lower in non-LPS patients (43% vs 74%). The follow-up time was 15.3 months for the LPS group and 31.3 months for the non-LPS group. Following reverse mapping in LPS, an average of 2.1 blue transected lymphatics were identified per case. An average of 0.1 blue lymphatic vessels was left in continuity per case and 1.6 vessel anastomoses performed per case with intussusception being performed more frequently than end to end technique (55% vs 44%). Conclusion: In one of the largest controlled studies in this topic to date, our findings support that optimizing lymphatic preservation and restoring antegrade lymphatic flow with LPS significantly decreases short term lymphedema rates in patients undergoing axillary lymphadenectomy for breast cancer.

Primary neuroendocrine tumors of the breast: two case reports\xa0and review of the literature

BackgroundNeuroendocrine carcinomas mainly affect the bronchopulmonary and the gastrointestinal systems. Breast localizations are very rare. They represent less than 0.1% of all breast cancers. A definitive diagnosis relies on histological and immunohistochemical examinations.Case presentationCase 1We report a case of primary neuroendocrine carcinoma of the breast in a 71-year-old Arabic woman who presented with a 3 cm palpable and mobile tumor of the right breast. Clinical and radiological assessment excluded any other primary tumor. Radical mastectomy and axillary lymph node resection were performed. A histopathological examination disclosed the diagnosis of primary breast neuroendocrine tumors, with negative surgical margins and lymph nodes (18 N-/18 N). The tumor cells were positive for neuroendocrine markers, a weak Ki-67 proliferation index and negative Her2/neu. Our patient received adjuvant hormonal treatment with anti-aromatase for 21 months. She is on regular follow-up, and she remains free of disease to date.Case 2A 48-year-old Arabic woman consulted for a right breast nodule. She underwent lumpectomy with right axillary lymphadenectomy. The diagnosis was breast neuroendocrine tumor. Systemic treatment was proposed, but she was lost to follow-up. She consulted 1 year later for a mass in the same breast. A histological and immunohistochemical examination of a mammary biopsy was consistent with a recurrence of the previous neuroendocrine tumor. A radiological assessment showed a large mass in her right breast, ipsilateral axillary lymphadenopathies, and hepatic and pulmonary metastases. She received first-line metastatic chemotherapy, with good clinical and radiological improvement. She refused the mastectomy and was given hormone therapy. One year later, the tumor expanded clinically and radiologically, and she underwent second-line metastatic chemotherapy, with good clinical progress and radiological stability, and she then underwent maintenance hormonal therapy.ConclusionDue to the rarity of primary breast neuroendocrine tumors, no standard therapy exists and the prognosis remains difficult to determine. Studies, including larger series, are needed in order to understand the biological behavior of these tumors.

Abstract P1-20-18: Second axillary lymphadenectomy in case of ipsilateral breast cancer recurrence

Abstract Background: In case of ipsilateral recurrence, the interest of a new surgery is sure but the interest of a new axillary surgery is not established. A second axillary lymphadenectomy (SAL) was proposed to patients with ipsilateral recurrence in order to check in a surgical way the absence of axillary involvement. The principal objective is to examine the current state of this practice. The secondary objective is to define the rate of nodal involvement concomitant of ipsilateral recurrence. Methods : It is a mono centric retrospective study realized at theToulouse University Cancer Institute-Oncopole (IUCT - Oncopole) included patients with ipsilateral infiltrative breast cancer recurrence with past history of axillary lymphadenectomy from January 2015 to December 2017. Results: 74 patients got an indication of SAL. The mean period between the 1st cancer and recurrence was 19,2 years [2,6-35,2]. At the time of 1st cancer, the mean number of removed nodes was 13 [6-27]. For the pre-operative check-up, 79,7% of the patients had a axillary ultrasound, 75,7% a thoraco-abdomino-pelvic CTscan, and 6,8% a PET-CT. A pre-operative axillary sampling had been performed for 5 patients (6,8%) and 2 patients had a pathologic result. About the surgery, in the operative report, it was noted in 94,6% of the patients an opening of the axillary space, in 54,4% the identification of the anatomic marks. A surgical sample was realized in 64,9% (n=48) of cases. Histologic mean tumoral size was 15mm [0.0: 75.0] with 67,5% of tumors classed as a pT1. For 82,4% (n= 42), it was a no special type carcinoma and 81,7% (n= 58) of tumors was histologic -type luminal (RH+/HER2-). In 47,9% (n= 23) of sampling of SAL, there was no lymph node. The mean number of harvested node was 1 [0-12]. Among the harvested nodes, none was involved. The 2 pre-operative axillary involvements were involvement of lateral upper part of breast. Post-operative complications occurred for 50% (n= 37) of patients : 29,7% (n= 22) had seroma, 10,8%(n= 8) infection, 9,5%(n= 7) delayed wound healing, 4,2%(n= 3) lymphoedema, 4,1%(n= 3) chronic pains. Mean follow-up was 21,1 months (95%CI[14,95;25,20]). Two patients had a nodal recurrence: one axillary, one supraclavicular but both had a synchronous metastatic disease. Conclusion : This cohort confirms the low rate of axillary recurrence after axillary lymphadenectomy. SAL does not show axillary recurrence concomitant to breast recurrence. And it does not provide us information to adapt adjuvant treatment. An optimal pre-operative assessment of axilla should be done to avoid complications of this diagnostic surgery. Citation Format: Gabrielle Selmes, Marine Bachelier, Miassa Hessas, Charlotte Vaysse, Eleonora De Maio, Jean-Louis Lacaze, Mony Ung, Eva Jouve, Florence Dalenc. Second axillary lymphadenectomy in case of ipsilateral breast cancer recurrence [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-18.

Combined positive axillary lymph node marking with iodine-125 seeds and sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy

ObjectiveTo present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with 125I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients. Material and methodsProspective study, January 2017 – March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1.The ML was marked 227±36 days before NACT (n: 10), or 1–6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy (AD) was undertaken in 10 patients. ResultsML and SLN were identified in the surgery in 93.7 % (15/16) of the cases, in 33.3 % (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2±0.9 (range 1–3) and AD: 13.5±5.2 (range 7–23). In all cases, histopathological analysis of ML, 125I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the 125I radioactive seed was recovered. ConclusionsPlacing of 125I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy.

Predictive factors for omitting lymphadenectomy in patients with node-positive breast cancer treated with neo-adjuvant systemic therapy.

A pathologic complete response (pCR) in the axilla occurs in 30%-40% of patients with initially node-positive breast cancer after neo-adjuvant chemotherapy (NACT). Debate persists about whether to perform systematic axillary lymphadenectomy (ALND) in patients with initial node-positive disease and clinical complete response after NACT. We aimed to identify predictive factors of axillary pCR (ypN0) after NACT. This retrospective study analyzed data for all patients with initial biopsy-proven node-positive disease who underwent ALND after NACT between June 2008 and December 2016 at our institution. Clinical and pathologic features, recurrence and specific mortality rates were compared between patients who achieved an axillary pCR and those who did not (ypN0 vs ypN+, respectively). A total of 331 patients were included, of whom 128 (38.7%) became ypN0 after NACT. Among patients with >2 suspicious axillary lymph nodes before treatment, 54 (38%) achieved ypN0 status. The independent predictors of ypN0 were Ki-67>30 (OR 1.98; 95% CI, 1.146-3.381), HER2 positivity (OR 2.6; 95% CI, 1.354-5.108), nonluminal molecular-like subtype (OR 4.15; 95% CI, 2.068-5.108), and clinical complete response, defined as negative clinical and ultrasonographic findings (OR 2.8; 95% CI, 1.110-7.081). After a mean follow-up of 61months, distant disease-free and overall survival rates were higher in patients with ypN0 disease (HR 4.14; 95% CI, 2.03-8.43) than ypN+ patients. Complete clinical response and the presence of nonluminal molecular-like subtypes independently predicted ypN0. Patients meeting these criteria might be suitable form omitting ALND and just performing targeted axillary procedures to patients meeting these criteria.

The Axillary Lymph Node Dissection in Patients with Breast Cancer-How Do We Treat - An Insight into Own Practice.

Background: Ongoing debate in the literature and new clinical data presented at the conference in St. Gallen bring a new insight into the role of axillary clearance in patient with positive sentinel lymph node in the course of invasive breast cancer. Data pointing to no difference in disease-free survival and overall survival of patient undergoing axillary lymphadenectomy and without axillary clearance undergoing other oncologic treatment inspired us to analyze the patient data from our Breast Surgery Department where we operate about 850 breast cancer patients annually.

Surgical Management of the Axilla in Patients with Occult Breast Cancer (cT0 N+) After Neoadjuvant Chemotherapy.

Occult breast cancer (OBC) is a rare clinical entity. Current surgical management includes axillary lymphadenectomy (ALND) with or without mastectomy. We sought to investigate the role of sentinel lymph node biopsy (SLNB) in patients with OBC treated with neoadjuvant chemotherapy (NAC). Patients with clinical T0N+ breast cancer were selected from the National Cancer Data Base (NCDB, 2004-2014) and compared according to axillary surgical approach, SLNB (≤ 4 LNs) or ALND (> 4 LNs). Primary outcome was overall survival (OS), calculated using Kaplan-Meier methods. Secondary outcome was complete pathological response (pCR). A total of 684 patients with OBC were identified: 470 (68.7%) underwent surgery upfront and 214 (31.3%) received NAC. Of the NAC patients, 34 (15.9%) underwent SLNB and 180 (84.1%) ALND. One hundred and fifty-three (72%) patients received radiotherapy (RT). There was no difference in pCR rates between the ALND and SLNB (34.3% vs 24.5%, respectively p = 0.245). In patients undergoing surgery first, improved OS was observed with ALND compared to SLNB (106.9 vs 85.5months, p = 0.013); however, no difference in OS was found in patients who received NAC (105.6 vs 111.3months, p = 0.640). RT improved OS in patients who underwent NAC followed by SLNB (RT, 123months vs no RT, 64months, p = 0.034). Of NAC patients who did not undergo RT, ALND had superior survival compared to SLNB (113 vs 64months, p = 0.013). This is the first comparative analysis assessing the surgical management of the axilla in patients with OBC who underwent NAC. In this population, there was a decrease in survival in patients who underwent SLNB alone; however, with the addition of RT, there was no difference in OS between SLNB and ALND. SLNB plus RT may be considered as an alternative to ALND in patients with OBC who have a good response to NAC.

Appropriateness of a physiotherapic treatment protocol for the axillary web syndrome, applied in a territorial rehabilitation service

The “Axillary web syndrome” (AWS) is an early complication following breast cancer surgery with axillary lymph nodes dissection. To apply an appropriated physiotherapic protocol to deal with patients having AWS who show up in territorial rehabilitation service. The enrolled patient underwent quadrantectomy and right axillary lymphadenectomy surgery resulting in painful shoulder, functional limitation and a clinical picture that gave evidence for AWS, and for this she was addressed to the territorial rehabilitation service. The rehabilitation treatment carried out was composed of active and passive mobilization of the upper-right limb of the cervico-dorsal segment together with self-mobilization exercises (MAPEA), that lasted two months with a three-month follow-up. The outcomes of reference were the numerical rating scale (N.R.S), the Constant-Murley Scale (C.M.S.) and the EuroQoL questionnaire (EQ-5D). After two months of treatment, the results show an improvement in both functionality and pain in the upper limb and in the patient’s quality of life, in particular: 43% on the N.R.S scale, 59% on the C.M.S. scale and 81% on the EQ-5D questionnaire. After three-month follow-up, the improvement was 75% in the N.R.S, 27% in the C.M.S. and 23% in the EQ-5D. The description of the clinical case afflicted with AWS and the treatment protocol applied, highlighted the good performance of the results, notably as concerns patient’s quality of life. This result could represent a starting point for creating clinical trials aimed at building appropriate rehabilitation courses in territorial rehabilitation services.

Appropriateness of a physiotherapic treatment protocol for the axillary web syndrome, applied in a territorial rehabilitation service

The “Axillary web syndrome” (AWS) is an early complication following breast cancer surgery with axillary lymphnodes dissection.To apply an appropriated physiotherapic protocol to deal with patients having AWS who show up in territorial rehabilitation service.The enrolled patient underwent quadrantectomy and right axillary lymphadenectomy surgery resulting in painfulshoulder, functional limitation and a clinical picture that gave evidence for AWS, and for this she was addressed tothe territorial rehabilitation service.The rehabilitation treatment carried out was composed of active and passive mobilization of the upper-right limb ofthe cervico-dorsal segment together with self-mobilization exercises (MAPEA), that lasted two months with a threemonth follow-up.The outcomes of reference were the numerical rating scale (N.R.S), the Constant-Murley Scale (C.M.S.) and the EuroQoL questionnaire (EQ-5D).After two months of treatment, the results show an improvement in both functionality and pain in the upper limb andin the patient’s quality of life, in particular: 43% on the N.R.S scale, 59% on the C.M.S. scale and 81% on the EQ-5Dquestionnaire.After three-month follow-up, the improvement was 75% in the N.R.S, 27% in the C.M.S. and 23% in the EQ-5D.The description of the clinical case afflicted with AWS and the treatment protocol applied, highlighted the goodperformance of the results, notably as concerns patient’s quality of life. This result could represent a starting pointfor creating clinical trials aimed at building appropriate rehabilitation courses in territorial rehabilitation services

Assessment of prognosis in patients with invasive breast cancer and metastatic sentinel lymph node treated with or without axillary lymphadenectomy

Introduction: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial was a landmark in axillary surgical treatment. Its results brought significant contributions to the reduction of the extension of breast cancer surgery. However, this approach was questioned at first. Objectives: To assess the global survival and the locoregional recurrence in patients with metastatic sentinel lymph node biopsy treated with or without axillary lymphadenectomy (AL). Method: A historical cohort study was carried out with patients with primary invasive breast carcinoma and clinically negative axilla who underwent breast-conserving surgery and SLNB between February 2008 and December 2018. Results: We included 415 patients who were submitted to conserving surgery. In 23.3% (97 patients), SLNB was positive, 56 patients were submitted only to SLNB, and 41 patients were treated with AL. The groups were homogeneous regarding the variables: age group (p=0.279), anatomopathological diagnosis (p=0.210), histological grade (p=0.983), hormone receptor expression (p=0.708), HER 2 expression (p=0.695) and pT (p=0.334). Global survival, in the mean period of 5 years, was 80.1% in the SLNB group, and 87.5% in the AL group (p=0.376). The locoregional recurrence was a rare event; in the mean period of 5 years, there was 1.8% in the SLNB group, and 7.7% in the AL group (p=0.196). Only 4 locoregional recurrences were described, and all took place in up to 18 months of follow-up. Conclusions: Global survival and locoregional recurrence in patients with metastatic axillary sentinel lymph node treated only with sentinel lymph node biopsy did not present differences in relation to patients who underwent axillary lymphadenectomy, which corroborates the data from ACOSOG Z0011. The omission of axillary lymphadenectomy and the implantation of such a practice in our service benefitted the patients treated with less aggressive surgery, and, potentially, with lower morbidity.

Pregnancy-associated breast cancer – Case report

Introduction: Mammographic screening is recommended yearly after the age of 40; however, many pregnant women are younger and should undergo the test. In these cases, anamnesis and clinical examination of the breasts are essential to detect any breast change. In case of clinical suspicion, it is recommended to undergo mammography with abdominal protection, and breast ultrasound is the examination of choice to assess the extension of the injury and guide the percutaneous biopsy. Breast surgery is safe, and can be performed in the three trimesters of pregnancy. It is important to emphasize the importance of the type of surgery according to gestational age. The reference axillary surgery during pregnancy is axillary lymphadenectomy. However, some articles present the safety of the sentinel lymph node biopsy. The use of technetium (Tc-99m) with lymphoscintigraphy is an acceptable technique, with fetal exposure to radiation inferior to the teratogenic limit of 50 mGv. Objective: To emphasize the importance of mammary propedeutics during pregnancy. Case report: 37 year-old patient, primiparous, of 34 weeks, referred a nodule in the right breast for 1 year. She denies having family history of carcinoma. At clinical examination, she presented with turgid breasts, absence of palpable nodules and negative axilla. Current mammography with presence of architectural distortion in the inferolateral quadrant of the right breast, and ultrasound with irregular and spiculated 2 cm nodule , both BIRADS category 5. Percutaneous biopsy showed invasive breast carcinoma of no special type, histological grade 2, and immunohistochemical with positive hormone receptors (estrogen and progesterone receptor with 90%), negative HER2 and Ki 67 of 20%&gt; The conduct was conserving surgery (excision of the breast injury and radio-guided sentinel lymph node biopsy) on the 36th week of pregnancy. The intraoperative assessment of the sentinel lymph node showed presence of macrometastasis and, as a consequence of the exclusion of pregnancy in the ACOSOG Z0011 study, the patient was submitted to axillary lymphadenectomy. The definitive anatomopathological result was invasive breast carcinoma of no special type, histological grade 3, measuring 2.1 cm, and 1 lymph node compromised by macrometastasis of 15 dissected nodes (pT2 pN1a). The multidisciplinary team chose to wait for delivery, from 2 to 4 weeks, and a Cesarean section was performed after 40 weeks of pregnancy. The chemotherapy was scheduled to begin 4 weeks after delivery. The patient was referred to genetic counselling. Conclusions: The treatment of breast cancer during pregnancy is challenging for the multidisciplinary team, which must focus on maternal and fetal well-being. Therapy should be carried out similarly to non-pregnant patients, respecting the procedures that are allowed in each gestational trimester. It is important to mention how essential it is to not delay the treatment, in order to not compromise the patient’s prognosis.

Appropriateness of a Physiotherapic Treatment Protocol for the Axillary Web Syndrome, Applied in a Territorial Rehabilitation Service: Description of a Clinical Case

The “Axillary web syndrome” (AWS) is an early complication following breast cancer surgery with axillary lymph nodes dissection. Case Report: The patient is a 69-year-old woman, retired ex-employee, with outcome surgery right axillary lymphadenectomy with shoulder pain and functional limitation with diagnosis AWS it where it was recommended the physiotherapy. The patient had improvement in terms of shoulder function and pain and quality of life. Conclusions: The description of the clinical case afflicted with AWS and the treatment protocol applied, highlighted the good performance of the results, notably as concerns patient’s quality of life. This result could represent a starting point for creating clinical trials aimed at building appropriate rehabilitation route in territorial rehabilitation services.