Axillary Soft Tissue Research Articles

Breast Cancer Presenting With Intravascular Tumor Emboli in Axillary Soft Tissue: Recurrence Risk and Radiation Therapy Outcomes

Intravascular tumor emboli in axillary soft tissue (ITE) is a rare pathologic finding in breast cancer and is associated with higher axillary nodal disease burden. The independent prognostic and predictive value of this entity is unknown, as is the role of radiation therapy for ITE. We analyzed a prospectively maintained database of breast cancer patients treated from 1992 to 2020. Patients with ITE were matched to those without (1:2) based on propensity scores to control for potential confounding factors. Locoregional (LRR) and distant recurrence (DR) were evaluated using competing risks methods accounting for death as a competing event. Overall survival (OS) and disease-free survival (DFS) were evaluated by Cox regression models. Among patients with ITE, we also evaluated whether RT improved outcomes. Among 2377 total patients, 129 had ITE, of whom 126 were propensity score matched to 252 without ITE. Median follow-up from time of surgery was 5.5 years (IQR 2.3, 9.7). There were no statistically significant differences in the 5-year incidence of LRR between groups (5.4% [95% CI, 1.6%-13%] with ITE vs 10% [95% CI, 6.7%-15%] without, P = .53) or DR (24% [95% CI, 15% 35%] with ITE vs 21% [95% CI, 16%-27%] without, P = .51). Five-year OS and DFS did not differ between groups (P > .9 for both comparisons, patients with ITE vs without ITE). In analyzing the effect of RT among patients with ITE, receipt of RT was associated with significantly improved DFS (HR, 0.34, 95% CI, 0.12-0.93, P = .04). Patients with ITE do not exhibit significantly worse LRR, DR, DFS, or OS compared with a propensity-score-matched cohort without ITE. However, among patients with ITE, those who received RT demonstrated significantly improved DFS. Larger studies with longer follow-up are needed to evaluate the prognostic and predictive implications of ITE.

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.

EWSR1::WT1 Fusions in Neoplasms Other Than Conventional Desmoplastic Small Round Cell Tumor: Three Tumors Occurring Outside the Female Genital Tract

Desmoplastic small round cell tumor (DSRCT) is a high-grade, primitive round cell sarcoma classically associated with prominent desmoplastic stroma, coexpression of keratin and desmin, and a characteristic EWSR1::WT1 gene fusion. DSRCT typically arises in the abdominopelvic cavity of young males with diffuse peritoneal spread and poor overall survival. Although originally considered to be pathognomonic for DSRCT, EWSR1::WT1 gene fusions have recently been detected in rare tumors lacking the characteristic morphologic and immunohistochemical features of DSRCT. Here, we report 3 additional cases of neoplasms other than conventional DSCRCT with EWSR1::WT1 gene fusions that occurred outside the female genital tract. Two occurred in the abdominopelvic cavities of a 27-year-old man and a 12-year-old girl, whereas the third arose in the axillary soft tissue of an 85-year-old man. All cases lacked prominent desmoplastic stroma and were instead solid and cystic with peripheral fibrous pseudocapsules and occasional intervening fibrous septa. Necrosis was either absent (1/3) or rare (2/3), and mitotic activity was low (<1 to 3 per 10 hpf). In immunohistochemical studies, there was expression of smooth muscle actin (3/3) and desmin (3/3), rare to focal reactivity for EMA (2/3), and variable expression of CK AE1/AE3 (1/3). Myogenin and MyoD1 were negative, and C-terminus-specific WT1 was positive in both cases tested (2/2). All 3 tumors followed a more indolent clinical course with 2 cases demonstrating no evidence of disease at 20 and 44 months after resection. The patient from case 3 died of other causes at 14 months with no evidence of recurrence. DNA methylation profiling showed that the 3 cases clustered with DSRCT; however, they demonstrated fewer copy number variations with 2 cases having a flat profile (0% copy number variation). Differential methylation analysis with hierarchical clustering further showed variation between the 3 cases and conventional DSRCT. Although further study is needed, our results, in addition to previous reports, suggest that EWSR1::WT1 gene fusions occur in rare and seemingly distinctive tumors other than conventional DSRCT with indolent behavior. Proper classification of these unusual soft tissue tumors with EWSR1::WT1 gene fusions requires direct correlation with tumor morphology and clinical behavior, which is essential to avoid overtreatment with aggressive chemotherapy.

Pathologic Exploration of the Axillary Soft Tissue Microenvironment and Its Impact on Axillary Management and Breast Cancer Outcomes.

Axillary soft tissue (AXT) involvement with tumor cells extending beyond the positive lymph node (LN+) and extracapsular extension (ECE) has been overlooked in breast pathology specimen analysis. We analyzed 2,162 LN+ patients, dividing them into four groups on the basis of axillary pathology: (1) LN+ only, (2) LN+ and ECE only, (3) LN+ and AXT without ECE, and (4) LN+ with both AXT and ECE. The primary end points were 10-year locoregional failure (LRF), the 10-year axillary failure, and 10-year distant metastasis rates. Multivariable Cox models, accounting for clinical factors, were fitted using the entire cohort, and subgroups analyses were conducted. The median follow-up was 9.4 years. The 10-year distant metastasis incidence was 42% for LN + AXT + ECE, 23% for both LN + AXT and LN + ECE only, and 13% for LN+ only. The 10-year axillary failure rates were 4.5% for LN + AXT + ECE, 4.6% for LN + AXT, 0.8% for LN + ECE only, and 1.6% for LN+ only. The 10-year LRF rates were 14% for LN + AXT + ECE, 10% for LN + AXT, 5.7% for LN + ECE only, and 6.2% for LN+ only. Multivariable analysis revealed that AXT was significantly associated with distant metastasis (hazard ratio [HR], 1.6; P < .001), locoregional failure (HR, 2.3; P < .001), and axillary failure (HR, 3.3; P = .003). Subgroup analyses showed that regional LN radiation (RLNR) improved locoregional tumor outcomes with AXT, ECE, or both (HR, 0.5; P = .03). Delivering ≤50 Gy to the axilla in the presence of AXT/ECE increased axillary failure (HR, 3.0; P = .04). Moreover, when delivering RLNR, axillary LN dissection could be de-escalated to sentinel node biopsy even in the presence of features such as AXT or ECE without significantly increasing any failure outcome: (HR, 1.0; P = .92) for LRF, (HR, 1.1; P = .94) axillary failure, and (HR, 0.4; P = .01) distant metastasis. Routine reporting of axillary tissue involvement, beyond LNs and ECE, is crucial in predicting breast cancer outcomes. Ruling out the presence of AXT is imperative before any form of axillary de-escalation, especially RLNR omission.

Limb-sparing resection of axillary soft tissue sarcomas

For patients with soft tissue sarcoma, surgical resection is akey element of curative therapy. Surgery is performed as awide resection with microscopically negative margins (R0resection) and as limb-sparing procedure whenever possible to preserve maximum function. Soft tissue sarcoma, metastases. Extensive disease with major neurovascular involvement, placement of biopsy tract necessitates extensive resection, palliative care. Extended deltopectoral approach. Release of pectoralis major and minor tendons. Vascular and neurologic exploration, identification of the axillary vessels and brachial plexus, placing of loops around major structures. Mobilization of these structures to achieve adequate exposure. Clipping of vessels entering the tumor. Tumor resection, suture marking for histological analysis. Soft tissue reconstruction by transosseous reinsertion of the pectoralis minor to the coracoid process. Drill channel placement, transosseous refixation of the pectoralis major to the humerus. Shoulder abduction brace for 6weeks, passive mobilization for 6-12weeks followed by active mobilization. Compression sleeve. Oncological follow-up. Between 2017 and 2022, wide resection was performed in 6consecutive cases including 4 primary soft tissue sarcomas and 2metastases. Primary R0 resection was achieved in 100%. Mean follow-up was 22.5months (3-60months). There were no local recurrences. Mean active shoulder abduction was 135.0 ± 41.4° (90-180°). Neurological deficits were not observed. Mean subjective shoulder function was 80.0 ± 21.0% (50-100%). The mean Musculoskeletal Tumor Society (MSTS) score was 89.5% (32-100%), indicating good functional outcome in the study cohort.

Breast Cancer Presenting with Intravascular Tumor Emboli in Axillary Soft Tissue: Recurrence Risk and Radiotherapy Outcomes

<h3>Purpose/Objective(s)</h3> Intravascular tumor emboli in axillary soft tissue (ITE) is a rare pathologic finding in breast cancer and is associated with higher axillary nodal disease burden. The independent prognostic and predictive value of this biomarker is unknown, as is the role of radiotherapy for ITE. <h3>Materials/Methods</h3> We analyzed breast cancer patients treated at our institution from 1992-2020, excluding those over 90 years of age at diagnosis, primary tumors >5cm in size, receipt of neoadjuvant chemotherapy, or those with synchronous bilateral breast cancers. A 1:3 propensity score match was performed between patients with ITE and those without. Matching was based on age, pathologic T stage, number of positive nodes removed, receipt of radiotherapy or chemotherapy, and biologic subtype. Disease free survival (DFS) was evaluated using a Cox regression analysis. Locoregional recurrence (LRR) and distant recurrence were evaluated using competing risks methods. These endpoints were compared between patients with versus without ITE. Among those with ITE, we evaluated whether radiotherapy (RT) improved outcomes using the same methods with a six-month landmark. <h3>Results</h3> We identified 127 patients with ITE, of whom, 103 (81%) were propensity score matched to 309 without ITE. Median follow up from surgery was 6.9 years (IQR 2.5, 10). 5-year DFS for those with ITE was 68% (95% CI 57%-82%) versus 78% (95% CI 73%-84%) for those without ITE (HR 1.37, 95% CI 0.82-2.30, p = 0.2). ITE was associated with increased likelihood of distant recurrence (p=0.02; 5-year cumulative incidence 26%, 95% CI 16%-38% and 14%, 95% CI 10%, 19%, respectively), but was not associated with LRR (p=0.97; 5-year cumulative incidence 5.4%, 95% CI 1.3%-14% and 8.7%, 95% CI 5.6%-12%, respectively). Among those with ITE, 5-year DFS was 74% (95% CI 63%-87%) for those receiving RT versus 32% (95% CI 10%-98%) among those not receiving RT (HR 0.33, 95% CI 0.12-0.91, p=0.03). <h3>Conclusion</h3> Patients with intravascular tumor emboli in axillary soft tissue exhibited higher rates of distant recurrence compared to a propensity score matched control group. Among patients with ITE, those who received RT demonstrated improved DFS.

Preoperative Planning Using Three-Dimensional Multimodality Imaging for Soft Tissue Sarcoma of the Axilla: A Pilot Study.

Simple SummarySoft tissue sarcoma (STS) of the axilla, with its proximity to vital neurovascular bundles and occasional involvement, is a challenge for surgeons. Conventionally, surgeons need to build the whole tumour model with its adjacent anatomical structures by absorbing necessary information from each separate preoperative 2D and 3D image, which is very experience-demanding and potentially inaccurate. Therefore, a computer-generated 3D tumour model revealing tumour and adjacent key anatomical structures from multimodal images was developed, and we attempted to explore whether this digital model could facilitate surgical planning and outcomes for axillary STS. This study suggested significantly better performance in reducing surgical blood loss, operative time, and length of hospital stay. Considering that the surgeries were performed by two specialists with 15 years of experience, the real-world benefit might be even greater, especially for less-experienced STS surgeons. Therefore, this technology might change how preoperative planning is performed for complex STS in the future.Axillary soft tissue sarcoma (STS) is challenging due to its proximity to vital neurovascular bundles. We conducted a prospective observational pilot study to explore whether 3D multimodality imaging (3DMMI) can improve preoperative planning for and surgical outcomes of patients with axillary STS. Twenty-one patients with STS (diameter > 5 cm) of the axilla were allocated, at their discretion, to either a control group undergoing traditional preoperative planning with separate computed tomography angiography, magnetic resonance imaging, and magnetic resonance neurography, or an intervention group where 3DMMI, digitally created based on these images, revealed the tumour and adjacent skeletomuscular and neurovascular structures in three dimensions. Primary outcome measures were surgical margins and surgical complications. Secondary outcomes included operative time, blood loss, serum C-reactive protein and interleukin-6, length of hospital stay, and limb function. The 3DMMI group had a lower, although not significantly different, inadvertent positive margin rate (1/12 vs. 3/9, p = 0.272), a significantly shorter operative time (p = 0.048), reduced blood loss (p = 0.038), and reduced length of hospital stay (p = 0.046). This endorses larger trials to improve complex surgical procedures and study how preoperative planning could be performed in the future.

Leczenie operacyjne rozległego ubytku tkanek miękkich dołu pachowego – opis przypadku

ABSTRAKTPourazowe ubytki tkanek miękkich dołu pachowego są bardzo rzadkie. W pracy przedstawiono przypadek 41-letniego mężczyzny, u którego taki ubytek powstał w następstwie wypadku komunikacyjnego. Do pokrycia ubytku zastosowano skórno-powięziowy płat zrotowany z bocznej strony klatki piersiowej i przeszczepy skóry pośredniej grubości w miejscach, których płat nie obejmował. Uzyskano całkowite zamknięcie ubytku, z niewielkim ograniczeniem odwiedzenia w stawie ramiennym. Pacjent odzyskał pełną sprawność uszkodzonej kończyny górnej.

Peripheral nerve sheath tumors of the breast

Benign and malignant peripheral nerve sheath tumors can involve the breast, presenting as masses in the dermis, deep breast parenchyma or axillary soft tissue. Although the histologic features are frequently characteristic, diagnosis can be challenging on core needle biopsy, and the differential diagnosis includes a variety of other benign and malignant spindle cell lesions of the breast. Here, we review the key clinical and pathological features of breast schwannoma, neurofibroma, granular cell tumor, and malignant peripheral nerve sheath tumor.

Techniques to refine the upper outer breast aesthetic subunit in alloplastic breast reconstruction: The lateral capsular flap

Background Lateral displacement of breast implants and axillary fullness are common causes of patient dissatisfaction and reoperation following prosthetic breast reconstruction. Suture plication of the capsule and acellular dermal matrix slings have been described to address lateral implant malposition, but with unacceptably high rates of recurrence and additional cost, respectively. Objective To describe a novel technique using a lateral capsular flap to provide durable correction of implant malposition and, at the same time, redefinition of the lateral breast border, thereby restoring balance to the breast aesthetic subunits. Methods Sixteen patients presented with lateral malposition of tissue expanders or breast implants during staged implant-based breast reconstruction, four of whom had additional unwanted axillary soft tissue fullness. An anteriorly based lateral capsular flap was performed for each breast to reconstruct the lateral border of the breast, return the implant to its appropriate position and address axillary fullness when indicated. Results Lateral capsular flaps were performed for 16 patients (20 breasts) resulting in durable medial repositioning of the implant for a minimum of six months follow-up (range six to 60 months). Eight patients presented after implant placement with subsequent malposition while the remainder presented after tissue expander placement alone. For the eight patients with axillary fullness, elevation of the capsular flap allowed access to axillary contents for excision (four cases) or incorporation of axillary fat into the flap to prevent lateral implant palpability. No major complications, infectious complications or wound healing complications were reported. All patients showed satisfactory results, and reported high cosmetic and functional satisfaction with the appearance of their reconstructed breasts and axillary comfort. Conclusions In the authors' experience, the lateral capsular flap represents a simple, safe and reliable technique to correct breast implant lateral malposition, reconstruct the lateral breast border, and address unwanted axillary fullness in primary or revision implant-based breast reconstruction with improved cosmetic appearance and balance of the breast.

Techniques to refine the upper outer breast aesthetic subunit in alloplastic breast reconstruction: The lateral capsular flap.

Lateral displacement of breast implants and axillary fullness are common causes of patient dissatisfaction and reoperation following prosthetic breast reconstruction. Suture plication of the capsule and acellular dermal matrix slings have been described to address lateral implant malposition, but with unacceptably high rates of recurrence and additional cost, respectively. To describe a novel technique using a lateral capsular flap to provide durable correction of implant malposition and, at the same time, redefinition of the lateral breast border, thereby restoring balance to the breast aesthetic subunits. Sixteen patients presented with lateral malposition of tissue expanders or breast implants during staged implant-based breast reconstruction, four of whom had additional unwanted axillary soft tissue fullness. An anteriorly based lateral capsular flap was performed for each breast to reconstruct the lateral border of the breast, return the implant to its appropriate position and address axillary fullness when indicated. Lateral capsular flaps were performed for 16 patients (20 breasts) resulting in durable medial repositioning of the implant for a minimum of six months follow-up (range six to 60 months). Eight patients presented after implant placement with subsequent malposition while the remainder presented after tissue expander placement alone. For the eight patients with axillary fullness, elevation of the capsular flap allowed access to axillary contents for excision (four cases) or incorporation of axillary fat into the flap to prevent lateral implant palpability. No major complications, infectious complications or wound healing complications were reported. All patients showed satisfactory results, and reported high cosmetic and functional satisfaction with the appearance of their reconstructed breasts and axillary comfort. In the authors' experience, the lateral capsular flap represents a simple, safe and reliable technique to correct breast implant lateral malposition, reconstruct the lateral breast border, and address unwanted axillary fullness in primary or revision implant-based breast reconstruction with improved cosmetic appearance and balance of the breast.

Myofibroblastoma of Axillary Soft Tissue in a Child

Myofibroblastoma of Axillary Soft Tissue in a Child

Prosthetic metal implants and airport metal detectors

Metal detectors have been present in airports and points of departure for some time. With the introduction of heightened security measures in response to fears of an increased threat of terrorism, they may become more prevalent in other public locations. The aim of this study was to ascertain which prosthetic devices activated metal detector devices used for security purposes. A range of prosthetic devices used commonly in orthopaedic and plastic surgery procedures were passed through an arch metal detector at Birmingham Airport in the UK. Additionally, each item was passed under a wand detector. Items tested included expandable breast prostheses, plates used in wrist and hand surgery, screws, K-wires, Autosuture™ ligation clips and staples. No prostheses were detected by the arch detector. The expandable implants and wrist plates were the only devices detected by passing the wand directly over them. No device was detected by the wand when it was under cover of the axillary soft tissue. Screws, K-wires, Autosuture™ clips and staples were not detected under any of the study conditions. Although unlikely to trigger a detector, it is possible that an expandable breast prosthesis or larger plate may do so. It is therefore best to warn patients of this so they can anticipate detection and further examination.

Extraskeletal Chondroma: Another Diagnostic Possibility for a Soft Tissue Axillary Mass in an Adolescent

Extraskeletal chondroma is a benign cartilaginous tumor that occurs predominantly in the soft tissues near small joints of the hands and feet. There are rare reports of the lesion in other sites, such as the head, neck, trunk, oral cavity, larynx, and pharynx. We present a case of an axillary mass in a 15-year-old girl who underwent MRI examination and resection, with the ultimate diagnosis of an extraskeletal chondroma, in order to expand the differential diagnosis of an axillary soft tissue mass in an adolescent.

Ultrasound pathology of the axilla. Part II

In comparison with other diagnostic modalities axillary sonography undoubtedly is highly valuable examining unclear palpation findings, in the staging of tumours with lymphatic drainage to the axilla and in posttherapeutic screening of cancer patients. Usually pathologic changes of the axilla are due to diseases of the lymph nodes. Infrequently there are soft tissue tumours, inflammations, diffuse changes of the axillary soft tissue, vascular diseases and pathologic findings of the shoulder joint. Provided the most common sonographic features of morphologic changes of the axillary tissues are known, sonography of the axilla is a very important diagnostic tool and is extremely helpful in deciding on further diagnostic and therapeutic procedures. Part I deals with the pathology of the axillary lymph nodes, whereas in part II pathological changes of the other soft tissues are discussed in detail.

Sonographic pathology of the axilla. Part I

In comparison with other diagnostic modalities axillary sonography undoubtedly is highly valuable in when examining unclear palpation findings, in the staging of tumours with lymphatic drainage to the axilla and in post-therapeutic screening of cancer patients. Usually pathologic changes of the axilla are due to diseases of the lymph nodes. Infrequently there are soft tissue tumours, inflammations, diffuse changes of the axillary soft tissue, vascular diseases and pathologic findings of the shoulder joint. Provided the most common sonographic features of morphologic changes of the axillary tissues are known, sonography of the axilla is a very important diagnostic tool and is extremely helpful in deciding on further diagnostic and therapeutic procedures. Part I deals with the pathology of the axillary lymph nodes, whereas in part II pathological changes of the other soft tissues are discussed in detail.

Management of Axillary Burn Contractures

This article will review the basic principles and techniques of managing axillary burn contractures in both industrialized and developing nations. Surgeons specializing in hand and upper extremity surgery should be adept in treating axillary soft tissue deficits secondary to burn contractures. The focus of this article will be to provide suggestions for performing skin grafts and latissimus dorsi musculocutaneous flaps, as well as illustrate guidelines for postoperative rehabilitation.

Obesity and Hemodialysis Vascular Access Failure

A variety of factors have been proposed to explain arteriovenous fistula primary failures in patients undergoing hemodialysis, including obesity, diabetes mellitus, female sex, and the absence of preoperative vein mapping. In this report, we describe 2 women for whom premature upper-extremity arteriovenous fistula failures occurred in the setting of venographic evidence of soft-tissue compression of the venous outflow with the patient's arm in the adducted position. In each instance, preoperative noninvasive duplex vein mapping showed veins of adequate diameter (0.28 to 0.54 cm), and further evaluation showed no evidence of a hypercoagulable state. Upper-extremity venography was used to assess central venous patency and fully assess the venous vasculature. Unlike the widely patent venous systems seen in the abducted position, venography performed with the upper extremities in adduction showed marked narrowing of the brachial and/or axillary veins. The hemodynamic effects of this narrowing were readily apparent in patient 2 with the appearance of collateral filling of the cephalic vein in the adducted position. Patient 1 had a body mass index of 39 kg/m(2), and patient 2 had a body mass index of 34 kg/m(2). Each patient had excess axillary soft tissue that appeared to compress the venous outflow in adduction. To our knowledge, this is the first report to radiographically document soft-tissue compression of the venous outflow of the upper extremity in the adducted position, suggesting a mechanism whereby obesity, or at least excess axillary fat, can lead to premature hemodialysis vascular access failures.

Axillary soft tissue metastases: A significant prognostic factor in breast carcinoma patients

808 Background: To clarify the prognostic factors in breast cancer patients with axillary soft tissue metastases. Methods: 620 connective breast carcinoma patients with modified redical mastectomy were involved in this study, axillary lymph nodes dissection including level I, level II and level III. At least 20 lymph nodes were found for pathology diagnosis in each case. The follow up rate was 99.7%(2/620). Results: 49.8% (309/620) of all the patients were local regional lymph nodes metastases, 29.8%(92/309) of them were axillary soft tissue metastases. The five year overall survival (OS) and disease free survival (DFS) of those with lymph nodes metastases were both 72.8% (158/217), respectively. OS and DFS of 10 years were 64.5% (140/217) and 62.2%, respectively. 5 and 10 years OS of the patients with both axillary lymph nodes and soft tissue metastases was 40.2% (37/92) and 27.1% (25/92) respectively,x2 was 29.5, 36.2, p=0.000. There were 84 cases with more than 10 lymph nodes metastases and level III lymph node metastases. Out of these 84 cases, there were 24 cases without soft tissue involved, 10 year OS was 20.8% (5/24); There were 35 cases with all three level axillary soft tissue metastases, the 10 year OS was 8.6% (3/35), x2 =0.93, p0.25. Statistical analysis showed that axillary soft tissue metastases correlated with survival negatively, r =-0.404, p=0.000. COX regression analysis showed that x2 =173.016, p=0.000, RR=2.055 (95%CI, 1.81∼2.321), demonstrating that cases with axillary soft tissue metastases have two time possibility of distant metastases and mortality comparing with the cases without axillary soft tissue metastases, x2 =104.638, p=0.000. The axillary soft tissue metastases is another independent prognostic factor comparing with the metastases level and number of the regional lymph nodes, x2 =185.169, p=0.000. Conclusions: Although the influence of axillary soft tissue metastases to the survival was weaker than that of level and number of local regional lymph nodes metastases, it still correlated with the survival period of breast carcinoma patients and was a significant prognostic and therapeutic index in breast cancer patients. No significant financial relationships to disclose.

Axillary soft tissue metastases: A significant prognostic factor in breast carcinoma patients

808 Background: To clarify the prognostic factors in breast cancer patients with axillary soft tissue metastases. Methods: 620 connective breast carcinoma patients with modified redical mastectomy were involved in this study, axillary lymph nodes dissection including level I, level II and level III. At least 20 lymph nodes were found for pathology diagnosis in each case. The follow up rate was 99.7%(2/620). Results: 49.8% (309/620) of all the patients were local regional lymph nodes metastases, 29.8%(92/309) of them were axillary soft tissue metastases. The five year overall survival (OS) and disease free survival (DFS) of those with lymph nodes metastases were both 72.8% (158/217), respectively. OS and DFS of 10 years were 64.5% (140/217) and 62.2%, respectively. 5 and 10 years OS of the patients with both axillary lymph nodes and soft tissue metastases was 40.2% (37/92) and 27.1% (25/92) respectively,x2 was 29.5, 36.2, p=0.000. There were 84 cases with more than 10 lymph nodes metastases and level III lymph node metastases. Out of these 84 cases, there were 24 cases without soft tissue involved, 10 year OS was 20.8% (5/24); There were 35 cases with all three level axillary soft tissue metastases, the 10 year OS was 8.6% (3/35), x2 =0.93, p0.25. Statistical analysis showed that axillary soft tissue metastases correlated with survival negatively, r =-0.404, p=0.000. COX regression analysis showed that x2 =173.016, p=0.000, RR=2.055 (95%CI, 1.81∼2.321), demonstrating that cases with axillary soft tissue metastases have two time possibility of distant metastases and mortality comparing with the cases without axillary soft tissue metastases, x2 =104.638, p=0.000. The axillary soft tissue metastases is another independent prognostic factor comparing with the metastases level and number of the regional lymph nodes, x2 =185.169, p=0.000. Conclusions: Although the influence of axillary soft tissue metastases to the survival was weaker than that of level and number of local regional lymph nodes metastases, it still correlated with the survival period of breast carcinoma patients and was a significant prognostic and therapeutic index in breast cancer patients. No significant financial relationships to disclose.