Axillary Lymph Node Metastasis Research Articles

Primary fallopian tube cancer followed by primary breast cancer in RAD51C mutation carrier treated with niraparib as first line maintenance therapy: a case report

Given the rarity of RAD51C mutations, the risk and treatment of metachronous breast cancer after the diagnosis of ovarian cancer in RAD51C mutation carriers is not clear, especially for those who have received PARPi treatment. We report the case of a 65-year-old woman diagnosed with stage IIIC high-grade serous primary fallopian tube cancer. The patient had no family history of breast or ovarian cancer. The patient received three cycles of neoadjuvant chemotherapy with paclitaxel and carboplatin and achieved a complete response. After interval debulking surgery, the patient received three cycles of adjuvant chemotherapy. Collection and extraction of saliva DNA for next-generation sequencing identified a RAD51C mutation c.838-2 A > G. The patient received niraparib as front-line maintenance treatment. After 36 months of niraparib treatment, the patient had grade II invasive ductal carcinoma of the left breast that was positive for estrogen receptor (90%) and Ki-67 (30%) and negative for progesterone receptor and human epidermal growth factor receptor 2. Computed tomography revealed the absence of distant metastases. Modified radical mastectomy and axillary lymph node dissection were then performed. The final pathological report of the breast showed a 1.8 cm Bloom-Richardson grade II invasive ductal carcinoma in the left breast with axillary lymph node metastasis (1/21). Finally, the breast cancer was stage IIA, pT1cN1M0. The metachronous breast cancer in this case may be the first report of second primary cancer in fallopian tube cancer patient harboring a RAD51C mutation during niraparib treatment. Further studies are required to determine optimal treatment.

Artificial Intelligence for Breast Ultrasound: AJR Expert Panel Narrative Review.

Breast ultrasound is used in a wide variety of clinical scenarios, including both diagnostic and screening applications. Limitations of ultrasound, however, include its low specificity and, for automated breast ultrasound screening, the time necessary to review whole-breast ultrasound images. As of this writing, four AI tools that are approved or cleared by the FDA address these limitations. Current tools, which are intended to provide decision support for lesion classification and/or detection, have been shown to increase specificity among non-specialists and to decrease interpretation times. Potential future applications include triage of patients with palpable masses in low-resource settings, preoperative prediction of axillary lymph node metastasis, and preoperative prediction of neoadjuvant chemotherapy response. Challenges in the development and clinical deployment of AI for ultrasound include: the limited availability of curated training datasets compared to mammography; the high variability in ultrasound image acquisition due to equipment- and operator-related factors (which may limit algorithm generalizability); and the lack of post-implementation evaluation studies. Furthermore, current AI tools for lesion classification were developed based on 2D data, but diagnostic accuracy could potentially be improved if multimodal ultrasound data were used, such as color Doppler, elastography, cine clips, and 3D imaging.

Multi-modality radiomics model predicts axillary lymph node metastasis of breast cancer using MRI and mammography

Multi-modality radiomics model predicts axillary lymph node metastasis of breast cancer using MRI and mammography

Prediction of ≥ 4 axillary lymph node metastasis in cN0 T1-2 breast cancer: A comparative analysis of the per-protocol population of the SINODAR-ONE multicenter randomized clinical trial.

Prediction of ≥ 4 axillary lymph node metastasis in cN0 T1-2 breast cancer: A comparative analysis of the per-protocol population of the SINODAR-ONE multicenter randomized clinical trial.

Ultrasonic features of automated breast volume scanner (ABVS) and handheld ultrasound (HHUS) combined with molecular biomarkers in predicting axillary lymph node metastasis of clinical T1-T2 breast cancer.

In the post-American College of Surgeons Oncology Group Z0011 trial era, clinicians are attempting to preoperatively evaluate axillary lymph node (ALN) status using ultrasound. However, the value of preoperative ultrasound examination remains uncertain. The study aimed to investigate the ultrasonic features of automated breast volume scanner (ABVS) and handheld ultrasound (HHUS), in combination with molecular biomarkers, to predict the risk of ALN metastasis (ALNM) in clinical T1-T2 breast cancer. A retrospective case-control analysis was conducted on 168 patients with clinical T1-T2 breast cancer at Peking University First Hospital between January 2013 and August 2021. Preoperative ABVS and HHUS examinations were performed. According to the pathology results of the ALN, patients were divided into metastatic and nonmetastatic groups. Logistic regression analyses were used to analyze the ultrasonic characteristics of ABVS and HHUS on clinical T1-T2 breast cancer, and molecular biomarkers were incorporated to predict the risk of ALNM. Of the 168 patients, 88 (52.4%) had ipsilateral ALNM while 80 (47.6%) had no ipsilateral ALNM. The univariate analysis showed that shorter tumor-skin distance (P=0.011), the Adler blood flow grade of II-III (P=0.014), and larger tumor size on ABVS (P<0.001) were associated with ALNM. The multivariate logistic analysis showed that these three risk factors, including the tumor-skin distance [odds ratio (OR) =0.279; P=0.024], the Adler blood flow grade (OR =2.164; P=0.046), and the tumor size on ABVS (OR =1.033; P=0.002), were independent predictive parameters. The tumor-skin distance, tumor size on ABVS, and Adler blood flow grade have diagnostic value for ALNM in clinical T1-T2 breast cancer.

Elucidating Axillary Soft Tissue Involvement in Breast Cancer: Unveiling Metastatic Mechanisms and Therapeutic Perspectives

This perspective focuses on axillary soft tissue (AXT) involvement in breast cancer, revealing diverse pathological entities beyond traditional axillary lymph node metastasis. AXT involvement is linked to increased risks of distant metastasis and locoregional failure, emphasizing its significance in predicting breast cancer outcomes. We posit that AXT involvement could signify a retrograde metastatic event stemming from reactivated circulating tumor cells navigating towards the axillary soft tissue guided by chemokines. Therefore, AXT disease warrants aggressive systemic therapy. Axillary radiation therapy could be a potentially preferable alternative to axillary lymph node dissection. Routine reporting of axillary soft tissue involvement is crucial for accurate treatment planning.

Ultrasound-based radiomics nomogram for predicting axillary lymph node metastasis in early-stage breast cancer.

We aimed at assessing the predictive ability of ultrasound-based radiomics combined with clinical characteristics for axillary lymph node (ALN) status in early-stage breast cancer patients and to compare performance in different peritumoral regions. A total of 755 patients (527 in the primary cohort and 228 in the external validation cohort) were enrolled in this study. Ultrasound images for all patients were acquired and radiomics analysis performed for intratumoral and different peritumoral regions. The MRMR and LASSO regression analyses were performed on extracted features from the primary cohort to construct a radiomics signature formula combined with clinical characteristics. Pearson's coefficient and the variance inflation factor (VIF) were performed to check the correlation and the multicollinearity among the final predictors. The best performing model was selected to develop a nomogram, which was established by performing binary logistic regression and acquiring cut-off values based on the corresponding nomogram scores of the masses. Among all the radiomics models, the "Mass + Margin3mm" model exhibited the best performance. The areas under the curves (AUC) of the nomogram in the primary and external validation cohorts were 0.906 (95% confidence intervals [CI] 0.882-0.930) and 0.922 (95% CI 0.894-0.960), respectively. They both showed good calibrations. The nomogram exhibited a good ability to discriminate between positive and negative lymph nodes (AUC: 0.853 (95% CI 0.816-0.889) in primary cohort, 0.870 (95% CI 0.818-0.922) in validation cohort), and between low-volume and high-volume lymph nodes (AUC: 0.832 (95% CI 0.781-0.884) in primary cohort, 0.911 (95% CI 0.858-0.964) in validation cohort). The established nomogram is a prospective clinical prediction tool for non-invasive assessment of ALN status. It has the ability to enhance the accuracy of early-stage breast cancer treatment.

Discordance of Biomarker Expression Profile between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis in Preoperative Core Needle Biopsy

Background: Breast cancer (BC) is a heterogeneous disease made up of clones with different metastatic potential. Intratumoral heterogeneity may cause metastases to show divergent biomarker expression, potentially affecting chemotherapy response. Methods: We investigated the immunohistochemical (IHC) and FISH profile of estrogen receptors (ER), progesterone (PR) receptors, Ki67, and HER2 in a series of BC-matched primary tumors (PTs) and axillary lymph node (ALN) metastases in pre-operative core needle biopsies (CNBs). Phenotypical findings were correlated to morphological features and their clinical implications. Results: Divergent expression between PTs and ALNs was found in 10% of the tumors, often involving multiple biomarkers (12/31, 39%). Most (52%) displayed significant differences in ER and PR staining. HER2 divergences were observed in almost three-quarters of the cases (23/31, 74%), with five (16%) switching from negativity to overexpression/amplification in ALNs. Roughly 90% of disparities reflected significant morphological differences between PTs and ALN metastases. Less than half of the discrepancies (12/31, 39%) modified pre/post-operative treatment options. Conclusions: We observed relevant discrepancies in biomarker expression between PTs and metastatic ALNs in a noteworthy proportion (10%) of preoperative BC CNBs, which were often able to influence therapies. Hence, our data suggest routine preoperative assessment of biomarkers in both PTs and ALNs in cases showing significant morphological differences.

Elasticity Values as a Predictive Modality for Response to Neoadjuvant Chemotherapy in Breast Cancer.

Shear-wave elastography (SWE) is an effective tool in discriminating malignant lesions of breast and axillary lymph node metastasis in patients with breast cancer. However, the association between the baseline elasticity value of breast cancer and the treatment response of neoadjuvant chemotherapy is yet to be elucidated. Baseline SWE measured mean stiffness (E-mean) and maximum stiffness (E-max) in 830 patients who underwent neoadjuvant chemotherapy and surgery from January 2012 to December 2022. Association of elasticity values with breast pCR (defined as ypTis/T0), pCR (defined as ypTis/T0, N0), and tumor-infiltrating lymphocytes (TILs) was analyzed. Of 830 patients, 356 (42.9%) achieved breast pCR, and 324 (39.0%) achieved pCR. The patients with low elasticity values had higher breast pCR and pCR rates than those with high elasticity values. A low E-mean (adjusted odds ratio (OR): 0.620; 95% confidence interval (CI): 0.437 to 0.878; p = 0.007) and low E-max (adjusted OR: 0.701; 95% CI: 0.494 to 0.996; p = 0.047) were independent predictive factors for breast pCR. Low elasticity values were significantly correlated with high TILs. Pretreatment elasticity values measured using SWE were significantly associated with treatment response and inversely correlated with TILs, particularly in HR+HER2- breast cancer and TNBC.

Association and predictive value of contrast‑enhanced ultrasound features with axillary lymph node metastasis in primary breast cancer.

Primary breast cancer is the most common malignant tumor in women worldwide, and axillary lymph node metastasis (ALNM) is an important marker of disease progression in patients with breast cancer. The objective of the present study was to analyze the association between contrast-enhanced ultrasound (CEUS) features and ALNM in primary breast cancer and its predictive value. A total of 120 patients with breast cancer were assigned to the non-metastatic group (n=70) and metastatic group (n=50). The factors influencing ALNM were explored by multivariate logistic regression analysis. The consistency of CEUS, ordinary ultrasonography and pathological examination in the diagnosis of the ALNM of breast cancer was evaluated by consistency testing. The sensitivity, specificity and consistency rate of CEUS features and ordinary ultrasonography were analyzed by receiver operating characteristic curve and four-fold table analyses. High enhancement amplitude, centripetal enhancement sequence, increased maximum cortical thickness, high peak intensity and a larger area under the curve of lymph nodes were more commonly found in the metastatic group than in the non-metastatic group. The lymph node aspect ratio and time to peak were lower in the metastatic group than the non-metastatic group. The time to peak was a protective factor for ALNM in patients with breast cancer. The sensitivity, specificity and coincidence rate with pathological examination of CEUS in the diagnosis of ALNM were 92.00, 90.00 and 90.83%, while these of ordinary ultrasonography were 76.00, 80.00 and 78.33%, respectively. The consistency test indicated that CEUS and pathological examination were consistent in the diagnosis of ALNM in patients with breast cancer, with a κ value of 0.816, indicating a good consistency. The κ value of ordinary ultrasonography and pathological examination was 0.763, also indicating a good consistency. However, these results indicate that CEUS is more valuable than ordinary ultrasonography in the diagnosis of ALNM in cases of breast cancer. In conclusion, the present study indicates that CEUS features were influencing factors associated with ALNM in patients with breast cancer and may serve as an important reference for the preoperative prediction of ALNM in breast cancer.

MRI-Based Kinetic Heterogeneity Evaluation in the Accurate Access of Axillary Lymph Node Status in Breast Cancer Using a Hybrid CNN-RNN Model.

Accurate evaluation of the axillary lymph node (ALN) status is needed for determining the treatment protocol for breast cancer (BC). The value of magnetic resonance imaging (MRI)-based tumor heterogeneity in assessing ALN metastasis in BC is unclear. To assess the value of deep learning (DL)-derived kinetic heterogeneity parameters based on BC dynamic contrast-enhanced (DCE)-MRI to infer the ALN status. Retrospective. 1256/539/153/115 patients in the training cohort, internal validation cohort, and external validation cohorts I and II, respectively. 1.5 T/3.0 T, non-contrast T1-weighted spin-echo sequence imaging (T1WI), DCE-T1WI, and diffusion-weighted imaging. Clinical pathological and MRI semantic features were obtained by reviewing histopathology and MRI reports. The segmentation of the tumor lesion on the first phase of T1WI DCE-MRI images was applied to other phases after registration. A DL architecture termed convolutional recurrent neural network (ConvRNN) was developed to generate the KHimage (kinetic heterogeneity of DCE-MRI image) score that indicated the ALN status in patients with BC. The model was trained and optimized on training and internal validation cohorts, tested on two external validation cohorts. We compared ConvRNN model with other 10 models and the subgroup analyses of tumor size, magnetic field strength, and molecular subtype were also evaluated. Chi-squared, Fisher's exact, Student's t, Mann-Whitney U tests, and receiver operating characteristics (ROC) analysis were performed. P < 0.05 was considered significant. The ConvRNN model achieved area under the curve (AUC) of 0.802 in the internal validation cohort and 0.785-0.806 in the external validation cohorts. The ConvRNN model could well evaluate the ALN status of the four molecular subtypes (AUC = 0.685-0.868). The patients with larger tumor sizes (>5 cm) were more susceptible to ALN metastasis with KHimage scores of 0.527-0.827. A ConvRNN model outperformed traditional models for determining the ALN status in patients with BC. 3 TECHNICAL EFFICACY: Stage 2.

Feasibility and accuracy of targeted axillary dissection in breast cancer patients; single center experience.

Axillary complete response (pCR) was observed in approximately half of breast cancer patients who received neoadjuvant chemotherapy (NAC) due to axillary positivity. Preventing axillary morbidity due to unnecessary axillary lymph node dissection (ALND) is extremely important for patients' quality of life. Targeted axillary dissection (TAD) is a technique developed to improve axillary staging and reduce the false negative rate in sentinel lymph node biopsy. Patients with cN1-N2 (clinically node) breast cancer whose axillary lymph node metastasis was confirmed by biopsy and who received NAC marked with a clip were included in the study. Patients who achieved clinical response after systemic treatment underwent sentinel lymph node biopsy (SLNB) with additional methods such as methylene blue guided dissection, skin marking for clip on lymph node (CLN) localization, and wire guided with imaging excision of the CLN. TAD and ALND pathology results were evaluated and analyzed with patient and tumor characteristics. 83 patients who met the eligibility criterias for the study were examined retrospectively. 21 of the patients underwent TAD alone, and 62 patients underwent ALND after TAD. CLN rate was 98.8% in patients underwent only TAD and this rate was increased to 100% in patients underwent ALND after TAD. FNR in SLN, CLN, and TAD were 28.6%, 10.7%, and 3.6%, respectively. TAD is a feasible and reliable surgical approach to detect axillary residual disease with a high success rate.

Could breast multiparametric MRI discriminate between pure ductal carcinoma in situ and microinvasive carcinoma?

Ductal carcinoma in situ (DCIS) is often reclassified as invasive cancer in the final pathology report of the surgical specimen. It is of significant clinical relevance to acknowledge the possibility of underestimating invasive disease when utilizing preoperative biopsies for a DCIS diagnosis. In cases where such histologic upgrades occur, it is imperative to consider them in the preoperative planning process, including the potential inclusion of sentinel lymph node biopsy due to the risk of axillary lymph node metastasis. To assess the capability of breast multiparametric magnetic resonance imaging (MP-MRI) in differentiating between pure DCIS and microinvasive carcinoma (MIC). Between January 2018 and November 2022, this retrospective study enrolled patients with biopsy-proven DCIS who had undergone preoperative breast MP-MRI. We assessed various MP-MRI features, including size, morphology, margins, internal enhancement pattern, extent of disease, presence of peritumoral edema, time-intensity curve value, diffusion restriction, and ADC value. Subsequently, a logistic regression analysis was conducted to explore the association of these features with the pathological outcome. Of 129 patients with biopsy-proven DCIS, 36 had foci of micro-infiltration on surgical specimens and eight were diagnosed with invasive ductal carcinoma (IDC). The presence of micro-infiltration foci was significantly associated with several MP-MRI features, including tumor size (P <0.001), clustered ring enhancement (P <0.001), segmental distribution (P <0.001), diffusion restriction (P = 0.005), and ADC values <1.3 × 10-3 mm2/s (P = 0.004). Breast MP-MRI has the potential to predict the presence of micro-infiltration foci in biopsy-proven DCIS and may serve as a valuable tool for guiding therapeutic planning.

Reliability of predicting low-burden (≤ 2) positive axillary lymph nodes indicating sentinel lymph node biopsy in primary operable breast cancer — a retrospective comparative study with PET/CT and breast MRI

BackgroundSentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in early breast cancer patients with low-burden axillary metastasis (≤ 2 positive nodes). This study aimed to determine the diagnostic performances of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and breast magnetic resonance imaging in detecting axillary lymph node (ALN) metastases and the reliability to predict ALN burden.MethodsA total of 275 patients with primary operable breast cancer receiving preoperative PET/CT and upfront surgery from January 2001 to December 2022 in a single institution were enrolled. A total of 244 (88.7%) of them also received breast MRI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT and breast MRI were assessed. The predictive values to determine ALN burden were evaluated using radio-histopathological concordance.ResultsPET/CT demonstrated a sensitivity of 53.4%, specificity of 82.1%, PPV of 65.5%, NPV of 73.5%, and accuracy of 70.9% for detecting ALN metastasis, and the corresponding values for MRI were 71.8%, 67.8%, 56%, 80.8%, and 69.2%, respectively. Combining PET/CT and MRI showed a significantly higher PPV than MRI (72.7% vs 56% for MRI alone, p = 0.037) and a significantly higher NPV than PET/CT (84% vs 73.5% for PET/CT alone, p = 0.041). For predicting low-burden axillary metastasis (1–2 positive nodes), the PPVs were 35.9% for PET/CT, 36.7% for MRI, and 55% for combined PET/CT and MRI. Regarding patients with 0–2 positive ALNs in imaging, who were indicated for SLNB, the predictive correctness was 96.1% for combined PET/CT and MRI, 95.7% for MRI alone, and 88.6% for PET/CT alone.ConclusionsPET/CT and breast MRI exhibit high predictive values for identifying low-burden axillary metastasis in patients with operable breast cancer with ≦ 2 positive ALNs on imaging.

2020 Annual Report of National Clinical Database-Breast Cancer Registry: 10-year mortality of elderly breast cancer patients in Japan.

The Japanese Breast Cancer Society initiated the breast cancer registry in 1975, which transitioned to the National Clinical Database-Breast Cancer Registry in 2012. This annual report presents data from 2020 and analyzes the ten-year mortality rates for those aged 65 and older. We analyzed data from 93,784 breast cancer (BC) cases registered in 2020 and assessed 10-year mortality rates for 36,279 elderly patients diagnosed between 2008 and 2012. In 2020, 99.4% of BC cases were females with a median age of 61. Most (65%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery rates varied with stages: 58.5% at cStage I, 30.8% at cStage II, and 13.1% at cStage III. Sentinel lymph node biopsy was done in 73.6% of cases, followed by radiotherapy in 70% of those post-conserving surgery and chemotherapy in 21.1% post-surgery. Pathology showed that 63.4% had tumors under 2.0cm, 11.7% had pTis tumors, and 77.3% had no axillary lymph node metastasis. ER positivity was seen in 75.1%, HER2 in 14.3%, and 30% had a Ki67 positivity rate above 30%. Across all stages and subtypes, there was a trend where the 10-year mortality rates increased for individuals older than 65years. In Stage I, many deaths were not directly linked to BC and, for those with HER2-type and triple-negative BC, breast cancer-related deaths increased with age. Within Stage II, patients older than 70years with luminal-type BC often experienced deaths not directly linked to BC, whereas patients below 80years with HER2-type and triple-negative BC, likely had breast cancer-related deaths. In Stage III, breast cancer-related deaths were more common, particularly in HER2 and triple-negative BC. Our prognostic analysis underscores distinct mortality patterns by stage, subtype, and age in elderly BC patients. It highlights the importance of personalized treatment strategies, considering subtype-specific aggressiveness, age-related factors, and comorbidities.

Sentinel Node Biopsy Positivity: Is Axillary Dissection Always Necessary? – A Retrospective Analysis

Breast cancer remains a significant health concern, with predictions indicating a rise in global incidence. While the primary focus is on oncological radicality, the aesthetic and psychological impacts of surgical interventions, such as radical mastectomy, cannot be ignored. This study, conducted over 8 years, aimed to identify factors that can prevent unnecessary lymphadenectomy. The research analyzed various parameters, including age, BMI, tumor size, and immunohistochemistry, to determine their correlation with axillary lymph node invasion. The results highlighted the importance of tumor size and estrogen receptor status in predicting axillary lymph node metastasis. The study underscores the value of sentinel lymph node biopsy in early breast cancer treatment, emphasizing its benefits over complete axillary lymph node dissection.

Axillary lymph node dissection in triple-negative or HER2-positive breast cancer patients with clinical N2 achieving pathological complete response after neoadjuvant therapy: Is it necessary?

Aim:This study aims to identify suitable candidates for axillary sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) among clinical N2 (cN2) triple-negative (TN) or HER2 positive (HER2+）breast cancer patients following neoadjuvant therapy（NAT）.Background: Despite the substantial axillary burden in cN2 breast cancer patients, high pathological response rates can be achieved with NAT in TN or HER2+ subtypes, thus enabling potential downstaging of axillary surgery.Methods: A retrospective analysis was conducted on data from the CSBrS-012 study, screening 709 patients with initial cN2, either HER2+ or TN subtype, from January 1, 2010 to December 31, 2020. The correlation between axillary pathologic complete response (pCR) (yPN0) and breast pCR was examined.Results: Among the 177 cN2 patients who achieved breast pCR through NAT, 138 (78.0 %) also achieved axillary pCR. However, in the 532 initial clinical N2 patients who did not achieve breast pCR, residual axillary lymph node metastasis persisted in 77.4 % (412/532) of cases. The relative risk of residual axillary lymph node metastasis in patients who did not achieve breast pCR was 12.4 (8.1–19.1), compared to those who did achieve breast pCR, P < 0.001.Conclusion: For cN2 TN or HER2+ breast cancer patients who achieve breast pCR following NAT, consideration could be given to downstaging and performing an axillary SLNB or TAD.

Cytohistological Evaluation of Unusual Male Breast lesions: A Case Series from a Tertiary Care Centre

Introduction: Pathologic lesions of male breast are not as common as its female counterpart.In this study we have reported six cases of unusual pathological lesions of male breast presenting clinically asbreast lump studied by Fine Needle Aspiration Cytology (FNAC) with histologic correlation.Method: 6 male patients were studied who presented to us with breast lump and had FNAC done with subsequenthistopathological correlation.Result: Out of 6 cases, 3 were fibromatosis (desmoid-type), 2 cases of invasive carcinoma involving both breastswith axillary lymph node metastasis and 1 case of complex fibroadenoma were reported. In all of the above casesdefinitive diagnosis was given on FNAC with subsequent histopathological confirmation except for fibromatosisin which the diagnosis was benign breast lesion on FNAC.Conclusion: FNAC being a fast and cheap diagnostic tool proves to be a reliable diagnostic method for evaluationof breast lumps at an earliest with excellent histologic reproducibility.

Characteristics of multifocality/multicentricity in breast cancer and its effect on axillary lymph node metastasis

Multifocal (MF) and multicentric (MC) breast cancers are seen with increasing frequency with advances in imaging methods. However, there is no consensus on the behavior and management of these tumors. In this study, we aimed to investigate the characteristics of MF/MC breast cancers and their relationship with axillary lymph node metastasis (ALNM). Patients who underwent surgery for breast cancer between January 2015 and January 2023 were retrospectively scanned. Exclusion criteria were as follows; male breast cancer, second primary cancer diagnosis, previous breast cancer history, previous excisional/incisional breast biopsy, neoadjuvant chemotherapy, and occult breast cancer. Multiple tumors that were closer than 5 cm to each other were defined as MF, and the others were defined as MC. T stage was determined in two different ways, using the largest tumor diameter (Tmax) and the aggregate tumor diameter (Tsum), and two different multivariate analysis models were applied. A total of 156 patients were enrolled in the study, including 130 unifocal (UF), 17 MF and 9 MC. Lymphovascular invasion (LVI) (p=0.43), ALNM (p=0.23), younger age (&lt;50) (p=0.41) and invasive lobular carcinoma (ILC) (p&lt;0.001) were higher in MF/MC tumors than in UFs. When comparing MF and MC, no difference was seen except progesterone receptor positivity (p=0.017). In both multivariate analyses, LVI and ILC had an effect on ALNM, while no effect of MF/MC was seen. In addition, while T stage had a significant effect on ALNM in the model using Tsum, it did not have a significant effect in the Tmax model. Our retrospective data supports that MF/MC is not a direct risk factor for ALNM and that the main factor affecting ALNM is the total tumor burden.

Prediction of axillary lymph node metastasis using tumor volume to breast volume ratio: retrospective cohort study.

Tumour size appear to be a risk factor of axillary lymph node metastasis in breast cancer. Recent evidence shows that higher the T staging is associated with higher rate of axillary lymph node metastasis. However, no studies shows that in the same T staging or tumour size but different breast size or breast volume the incidence of axillary lymph node metastasis differ or not . This Study aimed to investigate the association between tumour to breast ratio in breast cancer as a predictive factor of axillary lymph node metastasis. This study included 200 consecutive patients diagnosed with breast cancer between January 2012 to march 2022. The authors retrospectively reviewed medical data pathologic report and Ultrasonography and mammography of breast. Tumour diameter reported in pathologic report was used to calculate tumour volume using formula for ellipse. Breast volume was calculate using formula referencing from study of Jack W. Rostas et all by formula Breast Volume=1/3׶×Radius2ccview×Heightccview by measuring from mammography of patient. Tumour volume to breast volume ratio was calculated and analyzed. Of 200 patient included in this study, 84 patient (42%) was in lymph node positive group and 116 patient (58%) was in lymph node-negative group. Median for tumour and breast volume ratio in node positive group was higher [median 0.0093 (interquartile range=0.0047-0.023)] than in node-negative group [median 0.0065 (interquartile range (0.0028-0.0199)]. P=0.0414 receiver operating characteristic curve for tumour to breast ratio showed AUC of 0.7389 (95% CI 0.67993-0.82335) Which seems to be a significance as predictive factors for Axillary lymph node metastasis. Higher tumour volume to breast volume ratio tends to be a significance predictive factors for axillary lymph node metastasis in breast cancer patients.