Axillary Lymph Node Metastasis Research Articles

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.

Automated Versus Handheld Breast Ultrasound for Evaluating Axillary Lymph Nodes in Patients With Breast Cancer.

Automated breast ultrasound (ABUS) is a relevant imaging technique for early breast cancer diagnosis and is increasingly being used as a supplementary tool for mammography. This study compared the performance of ABUS and handheld ultrasound (HHUS) in detecting and characterizing the axillary lymph nodes (LNs) in patients with breast cancer. We retrospectively reviewed the medical records of women with recently diagnosed early breast cancer (≤ T2) who underwent both ABUS and HHUS examinations for axilla (September 2017-May 2018). ABUS and HHUS findings were compared using pathological outcomes as reference standards. Diagnostic performance in predicting any axillary LN metastasis and heavy nodal-burden metastases (i.e., ≥ 3 LNs) was evaluated. The ABUS-HHUS agreement for visibility and US findings was calculated. The study included 377 women (53.1 ± 11.1 years). Among 385 breast cancers in 377 patients, 101 had axillary LN metastases and 30 had heavy nodal burden metastases. ABUS identified benign-looking or suspicious axillary LNs (average, 1.4 ± 0.8) in 246 axillae (63.9%, 246/385). According to the per-breast analysis, the sensitivity, specificity, positive and negative predictive values, and accuracy of ABUS in predicting axillary LN metastases were 43.6% (44/101), 95.1% (270/284), 75.9% (44/58), 82.6% (270/327), and 81.6% (314/385), respectively. The corresponding results for HHUS were 41.6% (42/101), 95.1% (270/284), 75.0% (42/56), 82.1% (270/329), and 81.0% (312/385), respectively, which were not significantly different from those of ABUS (P ≥ 0.53). The performance results for heavy nodal-burden metastases were 70.0% (21/30), 89.6% (318/355), 36.2% (21/58), 97.3% (318/327), and 88.1% (339/385), respectively, for ABUS and 66.7% (20/30), 89.9% (319/355), 35.7% (20/56), 97.0% (319/329), and 88.1% (339/385), respectively, for HHUS, also not showing significant difference (P ≥ 0.57). The ABUS-HHUS agreement was 95.9% (236/246; Cohen's kappa = 0.883). Although ABUS showed limited sensitivity in diagnosing axillary LN metastasis in early breast cancer, it was still useful as the performance was comparable to that of HHUS.

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

To develop a nomogram for predicting axillary lymph node metastasis (ALNM) in patients with invasive breast cancer. We included 307 patients with clinicopathologically confirmed invasive breast cancer. The cohort was divided into a training group (n=215) and a validation group (n=92). Ultrasound images were used to extract radiomics features. The least absolute shrinkage and selection operator (LASSO) algorithm helped select pertinent features, from which Radiomics Scores (Radscores) were calculated using the LASSO regression equation. We developed three logistic regression models based on Radscores and 2D image features, and assessed the models' performance in the validation group. A nomogram was created from the best-performing model. In the training set, the area under the curve (AUC) for the Radscore model, 2D feature model, and combined model were 0.76, 0.85, and 0.88, respectively. In the validation set, the AUCs were 0.71, 0.78, and 0.83, respectively. The combined model demonstrated good calibration and promising clinical utility. Our ultrasound-based radiomics nomogram can accurately and non-invasively predict ALNM in breast cancer, suggesting potential clinical applications to optimize surgical and medical strategies.

Does F-18 FDG-PET/CT Have an Additional Impact on Axillary Approach in Early-Stage Breast Cancer?

Breast cancer (BC) is a significant health concern and one of the most diagnosed cancers in women, both in Turkey and globally. Despite advances in the management of BC, axillary lymph node involvement remains a significant consideration for treatment planning, local recurrence, and prognosis. We aimed to evaluate the contribution of F-18 fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG-PET/CT) in detecting axillary lymph node metastasis compared to ultrasound (US). Eighty patients who were diagnosed with stage I and II BC and underwent US and F-18 FDG-PET/CT scans before surgery were enrolled in this study. Those who did not undergo F-18 FDG-PET/CT imaging, patients with distant metastases at the time of diagnosis and patients with micrometastases in the axilla were excluded from the analysis. Imaging results of the status of axillary lymph nodes were verified with the final pathology report of axillary lymph nodes. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-18 FDG-PET/CT for the detection of ipsilateral axillary lymph node metastases were 75%, 77.27%, 72.97%, 79.07%, and 76.25%. The corresponding values for US were 72.22%, 81.82%, 76.47%, 78.26%, and 77.50%, respectively. When US finding is negative or suspicious in axillary lymph node evaluation, the accuracy of F-18 FDG-PET/CT for the detection of ipsilateral axillary lymph node metastases were 65.38%, 83.33%, 70.83%, and 79.55%, respectively. This study found that F-18 FDG-PET/CT does not provide an additional advantage over US in assessing the axilla in early-stage disease.

Development and Validation of a Nomogram for Axillary Lymph Node Metastasis Risk in Breast Cancer.

Purpose: Preoperative assessment of axillary lymph node (ALN) status is essential for breast cancer treatment planning. This study prospectively analyzed risk factors for ALN metastasis by comparing high-resolution computed tomography (HRCT) imaging with pathology and developed a nomogram to aid in diagnosis. Methods: From April 2023 to May 2024, breast cancer patients confirmed by pathology participated in the study. All had chest HRCT before surgery, and ALN samples were anatomically matched to HRCT imaging and pathology. The least absolute shrinkage and selection operator (LASSO) regression helped refine metastasis features, and a nomogram was constructed using the final selected features determined by multivariate logistic regression. The nomogram's performance was evaluated with concordance index (C-index), calibration plot, and decision curve analysis, with internal validation through bootstrapping. Results: A total of 302 ALN from 98 patients were included in this study. The predictors included in the nomogram encompassed the mean CT value, short diameter, border, and shape of ALN, as well as the Ki-67 status and histological grade of the primary tumor. The model exhibited satisfactory discrimination, with a C-index of 0.869 (95% CI: 0.826-0.912) and an AUC of 0.862 (95% CI, 0.815-0.909). The calibration curve demonstrated a high degree of concordance between the predicted and actual probabilities. The decision curve analysis demonstrated that the nomogram was clinically useful when the threshold for intervention was set at the metastasis possibility range of 1% to 86%. Conclusion: The nomogram combined with preoperative pathology and HRCT imaging have the potential to improve the evaluation of ALN status.

Comparison of diagnostic accuracy of conventional ultrasonography for characterization of axillary lymph nodes with histological findings.

Objective: To determine the diagnostic accuracy of conventional ultrasonography for characterization of axillary lymph nodes. Study Design: Cross-sectional study. Setting: Department of Radiology, Aziz Fatima Medical and Dental Hospital, Faisalabad. Period: 1st of October 2022 to 31st of March 2023. Material &amp; Methods: A total number of 145 female patients above the age of 18 years who reported with mastalgia and diagnosed clinically with the presence of suspicious axillary lymph nodes were included in the study. The conventional ultrasonic evaluation index was used for characterization. The ultrasonological results of characterization of axillary lymph nodes were compared with histopathological results where results of histopathology were taken as gold standard. Results: The Mean±SD of age in this study was 44.15±8.42 years with an age range of 29-62 years. The Mean±SD of duration of complaints was 10.17±5.60 months. USG diagnosed 89 (61.37%) patients while histopathology diagnosed 92 (63.44%) patients with metastasis of ALN. USG showed sensitivity of 86.957%, specificity 83.019%, diagnostic accuracy 86%, PPV 89.888% and NPV 78.571% in diagnosis of metastasis of axillary lymph nodes (p &lt; 0.000). Conclusion: Conventional USG is a commonly available and affordable diagnostic tool which is useful with a good accuracy for characterization of axillary lymph nodes and detecting the metastasis.

Correlation between conventional ultrasound features combined with contrast-enhanced ultrasound patterns and pathological prognostic factors in malignant non-mass breast lesions.

To investigate the correlation between ultrasound performance and prognostic factors in malignant non-mass breast lesions (NMLs). This study included 106 malignant NMLs in 104 patients. Different US features and contrast enhancement patterns were evaluated. Prognostic factors, including histological types and grades, axillary lymph node and peritumoral lymphovascular status, estrogen and progesterone receptor status and the expression of HER-2 and Ki-67 were determined. A chi-square test and logistic regression analysis were used to analyse possible associations. Lesion size (OR: 3.08, p = 0.033) and posterior echo attenuation (OR: 8.38, p < 0.001) were useful in reflecting malignant NMLs containing an invasive carcinoma component. Posterior echo attenuation (OR: 7.51, p = 0.003) and unclear enhancement margin (OR: 6.50, p = 0.018) were often found in tumors with axillary lymph node metastases. Peritumoural lymphovascular invasion mostly exhibited posterior echo attenuation (OR: 3.84, p = 0.049) and unclear enhancement margin (OR: 8.68, p = 0.042) on ultrasound images. Perfusion defect was a comparatively accurate enhancement indicator for negative ER (OR: 2.57, p = 0.041) and PR (OR: 3.04, p = 0.008) expression. Calcifications (OR: 3.03, p = 0.025) and enlarged enhancement area (OR: 5.36, p = 0.033) imply an increased risk of positive HER-2 expression. Similarly, Calcifications (OR: 4.13, p = 0.003) and enlarged enhancement area (OR: 11.05, p < 0.001) were valid predictors of high Ki-67 proliferation index. Ultrasound performance is valuable for non-invasive prediction of prognostic factors in malignant NMLs.

Feasibility Study of Transarterial Chemotherapy Followed by Chemoembolization for Recurrent Breast Cancer

PurposeTo assess the treatment response to transarterial chemotherapy followed by chemoembolization for locally recurrent breast cancer. Materials and MethodsThirty-nine women with locally recurrent breast cancer after standard therapy underwent selective intra-arterial chemotherapy followed by embolization using drug-eluting microspheres for locally recurrent tumors and axillary lymph node metastases. Tumor response and toxicity were assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) and Common Terminology Criteria for Adverse Events (CTCAE), and survival was evaluated by the Kaplan‒Meier method. ResultsThe local responses of breast tumors at 3 and 6 months were as follows: complete response, 5.1% and 7.2%; partial response, 35.9% and 67.8%; stable disease, 59.0% and 21.4%; and progressive disease, 0.0% and 3.6%, respectively. All adverse events were mild and did not require treatment. The median overall survival (OS) was 46.5 months, and the OS rates for 1 and 2 years were 81.4% and 69.2%, respectively. The size of recurrent tumors and axillary lymph node metastases did not impact prognosis, but both liver and bone metastases adversely affected survival. ConclusionTransarterial chemotherapy followed by chemoembolization may provide a favorable tumor response in patients with locally recurrent breast cancer in whom conventional therapy has failed.

Sonographic Characteristics of Enlarged Axillary Lymph Node in Breast Cancer

Background: Breast cancer, the most prevalent cancer in women globally, presents unique challenges in Pakistan, particularly due to the younger average age of diagnosis compared to Western countries. Accurate assessment of axillary lymph nodes using ultrasound (US) is essential for effective breast cancer staging and prognosis. Objective: This study aimed to evaluate the sonographic characteristics of axillary lymph nodes in breast cancer patients in Pakistan and to assess the diagnostic efficacy of ultrasound in differentiating between benign and malignant lymph nodes. Methods: Conducted at Shalamar Hospital, Lahore, this cross-sectional study spanned four months and included 150 breast cancer patients aged 45-70 years, selected through convenient sampling. Ultrasound examinations were performed using a GE Ultrasound Machine Evolsion E7 with a linear probe (7.5-12Hz). Key sonographic parameters, including the shape, size (length and width), and echogenicity of lymph nodes, were meticulously recorded and analyzed by using SPSS 24.0. Results: The average length and width of lymph nodes were 5.86 mm (SD = 1.35) and 3.90 mm (SD = 0.77), respectively. A significant proportion of lymph nodes (74.2%) presented with a round shape in patients experiencing pain, and a predominance of hyperechoic nodes was noted, diverging from established literature that often associates hypoechoic nodes with malignancy. Additionally, an irregular shape was identified as a potential predictive marker for axillary lymph node metastasis. Conclusion: This study highlights the efficacy of axillary sonography in diagnosing axillary metastasis in breast cancer, showing moderate sensitivity and substantial specificity. It also identifies a notable association between older age and the likelihood of axillary lymph node metastasis, especially in women in their forties.