Axillary Tail Research Articles

Pseudoaneurysm in the Axillary Tail of the Breast After A Core Needle Biopsy.

We present the case of a forty-year-old asymptomatic female with no personal or family history of breast cancer, who underwent a core needle biopsy (CNB) following the identification of a focal asymmetry in the right breast on screening mammography. Eight months later, a prominent adjacent vascular structure with a round outpouching was detected on breast ultrasound, confirmed as a post-biopsy pseudoaneurysm. Breast pseudoaneurysms, although exceedingly rare, result from inadvertent vessel puncture during core needle biopsies, particularly when larger gauge needles are used. They present as palpable, throbbing lumps in the breast and are well-defined heterogeneous structures that exhibit turbulent flow with a feeding artery on color Doppler imaging. This swirling sign showing a to-and-fro waveform is also known as the "yin-yang" sign on Doppler ultrasound. Post-CNB pseudoaneurysms in the breast, while rare, should be considered as potential complications following core need biopsy. Understanding their characteristic imaging features, risk factors, and available management options is essential for early diagnosis and appropriate treatment. This case underscores the importance of vigilance in biopsy procedures and the need for prompt recognition and intervention in case of such complications.

EP484 - Triple negative male breast cancer: a case report

Abstract Background Male breast cancer (MBC) is a rare malignancy, may present at advanced disease stage. Triple negative breast cancer (TNBC) known to have the poorest prognosis of all other histological types of breast cancer. This paper presents a case of 71 years old gentleman diagnosed with TNBC. Materials and Methods A 71 years old male patient, presented with a right breast lump. Clinically he had a skin dent and a palpable 3cm lump underneath in the right breast axillary tail. Mammogram and breast US showed suspicious lesion in right breast axillary tail in addition to a suspicious lymph node in right axilla. Imaging guided core biopsies were taken from the breast and axillary abnormalities. The histology revealed grade1 invasive ductal carcinoma NST, ER 0, PR 0 and HER 2 negative. The Breast-Multidisciplinary Team meeting advised for mastectomy and axillary clearance, this has been performed. Result The postoperative Pathomorphology report revealed 23 mm triple negative invasive ductal carcinoma NST, grade 1with Ki67 10%, T2N1M0. The postoperative MDT recommended annual surveillance with mammogram for 5 years. Conclusions MBC is uncommon entity, accounting for < 1% of all breast cancer diagnosed in both genders and the MTNBC still is rarer, and mastectomy is the mainstay of surgical treatment in addition to chemotherapy and radiotherapy , however the later doesn’t affect the cause-specific survival rate.

Establishment of a logistic regression model nomogram for clinicopathological characteristics and risk factors with axillary lymph node metastasis in T1 locally advanced breast cancer: a retrospective study.

Although the research reports on locally advanced breast cancer (LABC) are increasing year by year, there are few reports on T1 LABC axillary lymph node metastasis (ALNM). By establishing a prediction model for T1 LABC ALNM, this study provides a reference value for the probability of ALNM of related patients, which helps clinicians to develop a more effective and individualized treatment plan for LABC. Cases with pathologically confirmed T1 breast cancer (BC) between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were identified. Logistic regression was used to analyze the correlation between LABC lymph node metastasis and every factor, and the odds ratio (OR) and 95% confidence interval (CI) were used to identify any influencing factors. A nomogram was drawn after incorporating meaningful factors identified in multivariate logistic regression into the model. The receiver operating characteristic (ROC) curve of the model was drawn, and the area under the curve (AUC) and its 95% CI were calculated. Hosmer-Lemeshow goodness-of-fit test and clinical decision curve analysis (DCA) were performed. The results were validated in the validation group. A total of 200,933 female T1 BC patients were included in this study. Univariate and multivariate logistic regression analysis of T1 BC showed that progesterone receptor (PR)-negative, race, age, lobular carcinoma, micropapillary ductal carcinoma, axillary tail tumor, poor differentiation, and larger tumor diameter increased the probability of ALNM in T1 LABC. A predictive nomogram was established using the above predictors, the AUC of the modeling group was 0.739 (95% CI: 0.732-0.747), and when the AUC cut-off value was 0.026, the specificity and sensitivity of the model were 65.78% and 69.99%, respectively. Validation of the model showed that the AUC of the validation group (n=60,280) was 0.741. When all the risk factors were met, the predicted probability of N2-N3 was 50.40%. In this study, it was found that PR-negative, Black race, age, lobular carcinoma, micropapillary ductal carcinoma, axillary tail tumor, poor differentiation, and tumor diameter increased the probability of large lymph node metastasis in T1 LABC small tumors.

Unraveling the Influence of Social, Economic, and Demographic Factors in Texas on Breast Cancer Survival.

According to the Centers for Disease Control (CDC), breast cancer is the second most common cancer among women in the United States. Affected people are financially challenged due to the high out-of-pocket cost of breast cancer treatment, as it is the most expensive treatment. Using a 16-year cohort study of breast cancer survival data in Texas, we investigate the factors that might explain why some breast cancer patients live longer than others. Performing a survival analysis consisting of the log-rank test, a survival time regression, and Cox proportional hazards regression, we explore the breast cancer survivors' specific attributes to identify the main determinants of survival time. Analyses show that the factors: stage, grade, primary site of the cancer, number of cancers each patient has, histology of the cancer, age, race, and income are among the main variables that enlighten why some breast cancer survivors live much longer than others. For instance, compared to White non-Hispanics, Black non-Hispanics have a shorter length of survival with a hazard ratio of (1.282). The best prognostic for White non-Hispanics, Hispanics (all races), and Black non-Hispanics is a woman aged between 40 to 49 years old, diagnosed with localized stage and grade one with Axillary tail of breast as a primary site with only one cancer and with a household income of 75,000.00 and over. Policymakers should promote early diagnosis and screening and better assist the older and the poor to improve the survival time for breast cancer patients.

Intramammary Tumor Location and Ipsilateral Lymphatic Spread in Early Breast Cancer Patients Using One‐Step Nucleic Acid Amplification (OSNA) Assay

Establishing an accurate prognosis for women diagnosed with breast cancer (BC) is extremely challenging. Axillary lymph node (ALN) evaluation is considered of major prognostic value. The one‐step nucleic acid amplification (OSNA) assay is currently used for assessing axillary sentinel lymph node (SLN) status in BC. Additionally, total tumor load (TTL) may help predict further metastatic axillary involvement beyond the SLN. The prognostic value of primary BC location remains controversial due to lack of consensus on the biological differences among tumors at various sites. Evidence suggests that tumors in the internal quadrants (INLs) have worse prognosis compared to those in the external quadrants. Furthermore, ALN involvement is believed to be mainly associated with external quadrant tumors, mainly due to the lymphatic drainage system of the breast. This pilot observational study, despite lacking a control group and having a relatively small sample size, is the first to evaluate the potential relationship between primary BC location and ALN metastasis using the OSNA assay. A sample of consecutive BC patients undergoing axillary staging with the OSNA assay were included. Tumors were categorized into three groups based on primary location: external quadrants and axillary tail (EXL), INLs, and nipple and areola location (NAL). Although not statistically significant, the INL group exhibited a higher mean TTL. Additionally, no significant differences were observed between groups concerning SLN detection techniques, SLN status, number of metastatic SLN, or mean TTL. These findings support the use of the innovative tracer superparamagnetic iron oxide regardless of tumor site. This study underscores the importance of understanding the relationship between BC location and ALN status, which may improve prognostic stratification and targeted therapies based on tumor site. If these observations are confirmed in larger, multicentric studies, the potential conclusions may shift the paradigm of INL tumor treatment, significantly impacting clinical practice and research.

Fibroadenoma of the Axillary Tail: A Common Lesion in an Uncommon Location

Fibroadenoma of the Axillary Tail: A Common Lesion in an Uncommon Location

Clear Cell Hidradenoma with Extensive Mucinous Change in the Axillary Tail of Breast as Mimicker: A Rare Case Report

Introduction: Clear cell hidradenoma (CCH) is a rare benign tumor of sweat gland. It can mimic other diseases clinically, radiologically and histologically when found in axilla. Methods: A 62-year-old female presented with a solitary lump in the axillary tail of her breast. Differentials in clinical examination and imaging were breast neoplasm and lymph nodal mass. Results: The patient underwent preoperative diagnostic workup, and the lesion was suspicious of hidradenoma. She underwent wide excision of the lesion. The final histopathological examination was suggestive of CCH with extensive mucinous change. Conclusion: Even though rare, hidradenoma should always be kept as a differential when presented as a solitary painless swelling. The present case represents diagnostic challenges involved during the course of her management and accurate use of preoperative tools, which helped in the diagnosis of the case before the definitive treatment.

Abstract OT1-20-01: SentiNot 2.0: Avoid unnecessary Sentinel Lymph Node Biopsies in women with DCIS

Abstract Background Approximately 15-30% of women with a preoperative diagnosis of ductal carcinoma in situ (DCIS) will be diagnosed with invasive cancer (IBC) on specimen pathology. Risk of upgrade, and impairment of lymphatic outflow after breast surgery, mainly mastectomy, are drivers for upfront sentinel lymph node dissection (SLND). In the SentiNot feasibility study, marking the SLN by superparamagnetic iron oxide nanoparticles (SPIO) injection during primary surgery minimized unnecessary SLNDs, allowing for delayed SLND (d-SLND) only in those with IBC up to 50 days after primary surgery. This policy resulted in that 78.3% study participants avoided upfront SLND. In the d-SLND setting, SPIO detection outperformed the isotope (98.5 vs 60.6%), regardless of type of breast procedure. Incremental healthcare costs were reduced by 8.5% (485 USD per patient) for the entire trial population (ref 1). Prospective Clinical Trial Design SentiNot 2.0 (ClinicalTrials.gov Identifier: NCT04722692), is currently accruing data, powered to examine the detection rate of SPIO over isotope±blue dye during d-SLND. Trial candidates are: patients with a diagnosis of high-risk DCIS/pLCIS (mass-lesions, microinvasion, grade 3, grade 2 >20mm) regardless of type of breast surgery, and patients with planned breast surgery that precludes safe and accurate axillary mapping at a d-SLND (extensive oncoplastic breast conservation, tumors of the axillary tail and mastectomy). In d-SLND, study patients receive isotope±blue dye and within-patient-randomization is performed for which detection method to start with (SPIO-first vs. isotope-first). The trial is stratified for mastectomy and breast conservation. Secondary outcomes are nodal concordance (SPIO vs. isotope) at d-SLND, quality-of-life and health-economy outcomes. Present and Planned Accrual Total target accrual is 500 d-SLNDs. Insofar, 360 women have been included at six different sites in Sweden, Hong Kong, and the USA. Currently, data accrual and institution recruitment is active and expanding. For more information about the trial please refer to ClinicalTrials.gov Identifier: NCT04722692. For discussion regarding potential participation contact dr Andreas Karakatsanis (andreas.karakatsanis@surgsci.uu.se). Citation Format: Eirini Pantiora, Staffan Eriksson, Lida Pistiolis, Roger Olofsson Bagge, Gyula Nagy, Alastair M. Thompson, Vivian Man, Ava Kwong, Andreas Karakatsanis, Fredrik Wärnberg. SentiNot 2.0: Avoid unnecessary Sentinel Lymph Node Biopsies in women with DCIS [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-20-01.

A Diagnostic Revelation: Case of a Mucinous Carcinoma of the Breast.

Mucinous or colloid cancers are a rare subtype of invasive ductal carcinoma, making up only 2-3% of infiltrating carcinomas. Prevalence of pure mucinous breast cancer(PMBC) among infiltrating duct carcinomas in less than 60year olds is 2-7%, and in less than 35year olds, it is 1%. Mucinous carcinoma of the breast is divided into 2 subtypes, the pure type and mixed type. PMBC is characterized by a lower incidence of nodal involvement, favourable histological grade, and higher ER/PR expression. Axillary metastases are rare, though found in 12-14%. It has a better prognosis than infiltrative ductal cancer with 10-year survival being more than 90%. Here is the case of a 70-year-old female who presented with lump in the left breast since 3years. On examination, we detected a left breast lump occupying the whole breast except lower outer quadrant, measuring 10 × 8cm with overlying skin stretched with puckering and engorged veins seen, nipple displaced laterally and higher by 1cm, firm to hard in consistency, and mobile with breast tissue. Sonomammography, mammography, FNAC and biopsy were suggestive of benign phyllodes tumour. Patient was hence posted for simple mastectomy on the left side with removal of attached lymph nodes (near axillary tail). Histopathological examination revealed pure mucinous breast carcinoma with nine lymph nodes, free from tumour and showing reactive hyperplasia. Immunohistochemistry studies demonstrated ER + , PR + , HER-2-NEU-. The patient was started on hormonal therapy. Therefore, mucinous carcinoma of the breast is a rare entity with imaging features sometimes mimicking a benign tumour such as Phyllodes tumour, hence making it important to include it as a differential diagnosis in our daily practice. It is especially important in the subtyping of carcinoma of the breast since it carries a favourable risk profile with less chances of lymph node involvement, higher hormone receptor positivity and good response to endocrine treatment.

A Model Incorporating Axillary Tail Position on Mammography for Preoperative Prediction of Non-sentinel Lymph Node Metastasis in Patients with Initial cN+ Breast Cancer after Neoadjuvant Chemotherapy

This study aimed to develop a model incorporating axillary tail position on mammography (AT) for the prediction of non-sentinel Lymph Node (NSLN) metastasis in patients with initial clinical node positivity (cN+). The study reviewed a total of 257 patients with cN+ breast cancer who underwent both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) following neoadjuvant chemotherapy (NAC). A logistic regression model was developed based on these factors and the results of post-NAC AT and axillary ultrasound (AUS). Four clinical factors with p<0.1 in the univariate analysis, including ycT0(odds ratio [OR]: 4.84, 95% confidence interval [CI]: 2.13-11.91, p<0.001), clinical stage before NAC (OR: 2.68, 95%CI: 1.15-6.58, p=0.025), estrogen receptor (ER) expression (OR: 3.29, 95%CI: 1.39-8.39, p=0.009), and HER2 status (OR: 0.21, 95%CI: 0.08-0.50, p=0.001), were independent predictors of NSLN metastases. The clinical model based on the above four factors resulted in the area under the curve (AUC) of 0.82(95%CI: 0.76-0.88) in the training set and 0.83(95% CI: 0.74-0.92) in the validation set. The results of post-NAC AUS and AT were added to the clinical model to construct a clinical imaging model for the prediction of NSLN metastasis with AUC of 0.87(95%CI: 0.81-0.93) in the training set and 0.89(95%CI: 0.82-0.96) in the validation set. The study incorporated the results of post-NAC AT and AUS with other clinal factors to develop a model to predict NSLN metastasis in patients with initial cN+ before surgery. This model performed excellently, allowing physicians to select patients for whom unnecessary ALND could be avoided after NAC.

Abstract P3-01-14: A model incorporating axillary tail position on mammography for preoperative prediction of non-sentinel lymph node metastasis in patients with initial cN+ breast cancer after neoadjuvant chemotherapy

Abstract Background and Objectives: Few models with good discriminative power have been constructed to predict the risk of non-sentinel lymph node (NSLN) metastasis in breast cancer prior to breast surgery after neoadjuvant chemotherapy (NAC). This study aimed to develop a new model for the prediction of NSLN metastasis in patients with initial clinical node positivity (cN+).Methods: The present study reviewed a total of 257 patients (179 in the training set and 78 in the testing set) with cN+ breast cancer who underwent both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) following NAC. Univariate and multivariate analyses were used to select clinical factors affecting NSLN metastasis prior to breast surgery. A logistic regression model was developed based on these factors and the results of post-NAC axillary tail position on mammography (AT) and ultrasound (AUS).Results: Four factors with p&amp;lt;0.05 in the univariate analysis, including ycT0 (odds ratio [OR]: 4.84, 95% confidence interval [CI]: 2.13-11.91, p&amp;lt;0.001), clinical stage before NAC (OR: 2.68, 95% CI: 1.15-6.58, p=0.025), estrogen receptor (ER) expression (OR: 3.29, 95% CI: 1.39-8.39, p=0.009), and Her2 status (OR: 0.21, 95% CI: 0.08-0.50, p=0.001), were independent predictors of NSLN metastases. The clinical model based on the above data resulted in an AUC of 0.82 (95% confidence interval [CI]: 0.76-0.88) in the training set and 0.83 (95% CI: 0.74-0.92) in the validation set. The results of the post-NAC AUS and. AT were added to the clinical model to construct a clinical imaging model for the prediction of NSLN metastasis with an area under the curve of 0.87 (95% confidence interval [CI]: 0.81-0.93) in the training set and 0.89 (95% CI: 0.82-0.96) in the validation set.Conclusions: The present study incorporated the results of post-NAC AT and AUS with other clinal factors to develop a new model for the prediction of NSLN metastasis in patients with initial cN+ prior to breast surgery. This model performed excellently, allowing physicians to select patients for whom unnecessary ALND could be omitted after NAC. Citation Format: Kun Wang, Teng Zhu, Tingfeng Zhang. A model incorporating axillary tail position on mammography for preoperative prediction of non-sentinel lymph node metastasis in patients with initial cN+ breast cancer after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-01-14.

There is No "Axillary Tail": Rethinking the Assumption of James Spence.

Summary:Widely quoted, “the axillary tail of Spence” refers to a contiguous extension of adipose angling superolaterally from the primary breast into the axilla. Described anecdotally in 1871, the “tail of Spence” has been considered important to the fields of general surgery, oncology, plastic surgery, and anatomy ever since. Despite the ubiquitous presence of the concept in literature, clinical discussions, and educational settings, we argue against the very existence of Spence’s “tail.” While pinch-testing and topographically mapping 316 consecutive patients in preparation for breast and gynecomastia surgery, we found a consistent pattern of focal fat mounds without continuity between breast and axilla. The absence of an uninterrupted superolateral tail was reaffirmed while analyzing 20 research participants who were pinch-tested with calipers and topographically mapped, specifically to define fat pad anatomy. We documented that the axillary breast mound was always distinct from the primary breast and that all women and many men had an additional “lateral chest wall tail” that never angled toward the axilla. In most, rolling the shoulder girdle anteriorly created a visible groove between the axillary mound and the primary breast, with little or no pinchable fat beneath that crease. With all deference to Spence, we have established that the outer half of the chest is consistently defined by three focal adipose structures—an axillary mound, the primary breast mound, and a previously unnamed “lateral chest wall tail”—with no anatomic evidence of an “axillary tail” of fat extending superolaterally from breast to axilla.

English

BACKGROUND The axilla is a triangular space between the lateral wall of thorax and the upper part of arm. The component of axilla can give rise to different diseases ranging from developmental and reactive to neoplastic. Various mesenchymal tissues present in the axilla can give rise to different lesions. Fine needle aspiration cytology (FNAC) is a safe, quick, easy, and a cheap diagnostic tool to decipher the benign or the malignant nature of the swelling. Imaging techniques and FNAC, both used individually or coupled, improve the accuracy of diagnosis and help in avoiding unnecessary invasive procedures. The most common lymph node lesion in axilla is benign reactive lymph node hyperplasia. It is caused by inflammation of the lymph nodes or the adjacent organs, such as the breast or lung. METHODS The present study is a retrospective review of swellings aspirated from axillary region. FNAC was performed following strict aseptic precautions. Inadequate aspirates were excluded from the study. The aspirated sample was blown on clean glass slides and smears were made using squash preparation. Smears were fixed using air dried and alcohol fixation method. Smears were stained with Giemsa stain, and the alcohol - fixed smears were stained with haematoxylin and eosin and Papanicolaou stains. Cytological smears were evaluated for adequacy, cellularity, type of cells, arrangement of cells and nuclear as well as cytoplasmic features. RESULTS A total of 191 axillary swelling were aspirated during the study period. Out of which 148 (77.5 %) cases were females and 43 (22.5 %) cases were males. Most common lesion was lipoma followed by axillary tail of breast. CONCLUSIONS Various pathological processes may affect the axilla. There is overlap in the imaging findings of these diseases. FNAC is a diagnostic tool which is required for conformation of diagnosis of axillary lesions. KEYWORDS Axillary Swelling, Fine Needle Aspiration, Lipoma

Accuracy of individualized 3D modeling of ossicles using high-resolution computed tomography imaging data.

The present study aimed to investigate the visibility of small ossicle parts/landmarks on high-resolution computed tomography (HRCT)/3D reconstruction (3D) to investigate what improvements in scanning resolution are needed before accurate 3D printing of patient-specific ossicles is possible. A total of 24 patients with sudden deafness sought consultation at the Department of Otorhinolaryngology Head and Neck Surgery at the Sixth Medical Center of People's Liberation Army General Hospital between October 2013 and June 2014 were enrolled in the study. All participants underwent a 256-slice spiral HRCT temporal bone axial scan, yielding a Digital Imaging and Communications in Medicine documents series. These documents were then inputted into Mimics 16.0 interactive medical image processing software for data conversion and the creation of 3D segmentation and visualizations of the ossicles. Finally, the 3D images were compared using multiplanar reformation (MPR) and 3D volume-rendering (VR) reconstructed images of ossicles to verify their consistency. These were then compared with the normal ossicle structure to evaluate the accuracy of the restoration. The findings indicated that the morphology of the ossicles from the converted Mimics 16.0 data achieved a display rate of ≥90% when used to display 7 landmarks (the caput mallei, collum mallei, processus lateralis mallei, manubrium mallei, corpus incudis, crus longum incudis, and crus breve incudis). This demonstrates excellent matching with the images of ossicles obtained from MPR and 3D VR reconstruction. Kappa consistency testing found that the κ-value was higher than 0.75. When displaying the lenticular process, caput stapedis, crus anterius stapedis, and crus posterius stapedis landmarks. The display rate was around 60%, which shows good matching with the ossicles' images obtained from MPR and 3D VR reconstruction, with a κ-value >0.4. However, the display rate of the stapes footplate was only 25%, showing greater differences with the images obtained from MPR (76.4%) and 3D VR reconstruction (52.8%), with a κ-value <0.4. The accuracy of the visualization of the malleus and incus after restoration via Mimics 16.0 software, based on temporal bone HRCT data, was high, and the degree of restoration was good. However, the accuracy and degree of restoration of the stapes footplate require further improvement.

Tips and Tricks in Gender-Affirming Mastectomy.

Gender-affirming mastectomy has become a highly sought-after procedure for the treatment of gender dysphoria and has been shown to improve quality of life in transgender and gender-nonbinary individuals. Aesthetic outcomes after double-incision mastectomy can be influenced by several factors; however, certain operative variables can be controlled to obtain aesthetic and reproducible results. Chest wall contour is arguably the most critical component of these procedures and requires highlighting the definition of the pectoralis muscle. Planning incisions within the inferior and lateral borders of the pectoralis major rather than the inframammary fold, and ensuring removal of all breast tissue in the lateral and medial chest and the axillary tail, will help obtain an aesthetically pleasing chest wall shape while concealing scars. Finally, attention to nipple resizing and repositioning inferiorly and laterally relative to the borders of the pectoralis muscle are critical to an aesthetic outcome. The authors have found that appropriate preoperative planning to control these three factors-(1) contour, (2) nipple position, and (3) scars-and critical analysis and adjustment of on-table results will help achieve the goals of creating an aesthetic and gender-congruent chest.

Nodular fasciitis of the breast: a clinicopathological and genetic analysis of seven cases

Objective: To investigate the clinicopathological and genetic features of nodular fasciitis of the breast (NFB). Methods: The clinical and histologic features of seven NFBs were retrospectively reviewed. Immunohistochemistry, fluorescence in situ hybridization (FISH) and reverse transcription-polymerase chain reaction (RT-PCR) were performed. Results: All the seven patients were female, with a mean age of 36 years (range from 15 to 51 years). The duration of the lesion ranged from 10 days to 2 years. There was no history of trauma for all patients. The lesions occurred in the upper quadrant (4 cases), the lower quadrant (2 cases) and the axillary tail region (1 case). The maximum diameter was 1.0-3.5 cm. All cases showed similar morphology as nodular fasciitis occurring elsewhere in the body. They were composed of plump spindle cells arranged in short bundles or fascicles within a loose collagenous/myxoid stroma. Erythrocyte extravasation, mixed chronic inflammatory cells infiltration and microcystic changes were typically seen. Mitoses were present, with no atypical mitoses observed. The spindle cells were positive for smooth muscleactin(SMA, 6/6), CD10(2/3), and negative for desmin, β-catenin, CD34, CKpan, EMA, S-100, p63 and ALK-1.The Ki-67 index were 5%-15%. USP6 gene rearrangement was found in six cases and MYH9-USP6 gene fusion in two cases. Local resection was performed in six cases. Spontaneous regression was observed in one case. Follow-up of all seven cases revealed no recurrence or metastasis. Conclusions: Although rare, NFB can mimic breast cancer clinically, radiologically and histologically. It should be always considered in the differential diagnosis for the spindle cell proliferations of the breast. A diagnosis of NFB can be achieved basing on the typical clinicopathological presentation. FISH detection of USP6 gene rearrangement in challenging cases is of great value.

107 COVID 19 - Developing A Second Brain for Axillary Conservation During the Pandemic By Extrapolating Evidence On Technical Trends Of Sentinel Node Staging Of Axilla Into A Streamlined Recommendation

IntroductionAxillary conservation is the way forward after game changing trials like ACOSOG Z0011, surrogate trials like IBCSG,AMAROS, ALMANAC, on-going POSNOC, and newbie ATNEC have decreased the need to fiddle with the axilla. Current standard is the utilisation of double technique with radioisotope and blue dye to decrease false negative rates for true sentinel node retrieval.MethodLiterature search on the topic in the last two decades.ResultsThe search yielded 197 publications which were subjected to a meticulous review.ConclusionsSingle agent radioisotope is recommended in palpable and good biology breast tumours. Use of single agent blue dye can be standardised in axillary tail tumours. It is also recommended when isotope mapping is logistically not feasible or during pandemics like COVID 19 where looming infrastructure challenges are prevalent. Dual agent technique should be considered in previously treated breast and axilla, neoadjuvant chemotherapy cohort, bad tumour biology, high BMI and macromastia groups for true nodal retrieval. Optimal number of nodes taken out should not be more than three (n = 3). Lower axillary sampling of not more than 3 nodes is recommended for troubleshooting. Magnetic tracing can be used as an adjunct to either single agent (RI/BD) technique when there is failure to localise the sentinel node.

To study ductal carcinoma breast with histopathological grades of Nottingham score

Background & Methods : This case study was prospective and retrospective. Prospective cases were selected from the patients admitted for surgery of invasive ductal carcinoma breast in Medical College Hospital. As regards retrospective cases, they were obtained from the histopathological records obtained from Pathology department of SRMS-IMS, Bareilly. Result: Out of 56 cases, 52 cases (92.85%) had undergone modified radical mastectomy under which whole breast tissue including axillary tail, nipple, surrounding skin were excised. In 2 cases (3.57%) radical mastectomy was done under which besides pectoralis muscles was also excised. In 2 cases (3.57%) core biopsies from breast were taken. The quick scoring of ER & PR is combination of proportion and intensity scoring. Out of 56 cases, 24 cases (42.85%) were ER negative & 22 cases (39.28%) were PR negative while both were negative in 18 cases (32.14%). Study Designed: Observational Study Conclusion: For all invasive carcinomas, hormone receptor status is also studied using immunoperoxidase method and Quick scoring was done. The Quick score for ER was 0 in 42.85% (24/56) cases and for PR was0 in 39.28% (22/56) cases, indicating no hormone expression in majority. Keywords: Carcinoma Breast Histopathological & Nottingham score.

Abstract PS1-62: Two decades of experience with sentinel node staging of axilla - is false negative no longer a worry?

Abstract Aim: To review current literature and standard practices in various techniques of sentinel node biopsy for staging the axilla for treating early breast cancer. The purpose is to provide evidence based recommendation as guidance platform for optimal true sentinel node retrieval irrespective of surgeon expertise. Background: Axillary conservation is the way forward after game changing trials like ACOSOG Z0011, surrogate trials like IBCSG,AMAROS, ALMANAC, ongoing POSNOC, and newbie ATNEC have progressively or plan to decrease the need to unnecessarily fiddle with the axilla thereby increasing the chances of arm related and other morbidities. Axillary sentinel node biopsy entails retrieval of first draining lymph node in the breast-axilla pathway to plan treatment in breast cancer by appropriate staging of axilla. Current standard is the utilisation of double agent technique with radioactive isotope and blue dye injection to decrease false negative rates for true sentinel node retrieval. Novel techniques like magnetic and infrared tracing are still being investigated for validation. Method: PMC, Medline, EMBASE, PubMed and Cochrane library searched for clinical trials, randomised trials, systematic reviews and meta-analysis on techniques of axillary sentinel node biopsy in early breast cancer. This covered the last 25 years literature on the topic. Results: The search yielded 197 publications which were subjected to a meticulous review and narrowed to a select pertinent body of evidence to extrapolate suggested guidance rationally, the bibliography of which is provided at the end. Conclusion: Single agent preferably radioisotope for lymphatic mapping is recommended in palpable and good biology tumours. Use of single agent blue dye can be standardised in axillary tail tumours. It is also recommended as being effective when isotope mapping is logistically not feasible or during pandemics like COVID 19 where looming infrastructure challenges are prevalent. Dual agent technique should be considered in previously treated breast and axilla, neoadjuvant chemotherapy cohort, bad tumour biology, high BMI and macromastia groups for true nodal retrieval. Optimal number of nodes taken out should not be more than three (n=3). Lower axillary sampling of not more than 3 nodes is recommended for troubleshooting with any localising agent technique. Triple site injection at peri-tumoural, subcutaneous and sub areolar regions and larger volume of blue dye agent injection of up to 8mls increases the localisation success in the dual technique group for lymphatic mapping. Magnetic tracing can be used as an adjunct to either single agent radioactive isotope or blue dye (RI/BD) technique when there is failure to localise the sentinel node. Citation Format: Tahera Arif, Mohammed Shamim Absar. Two decades of experience with sentinel node staging of axilla - is false negative no longer a worry? [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-62.

27P Breast cancer primary site and laterality as predictive factors of prognosis: SEER based analysis for survival

Breast cancer prognostic factors vary from pathological grades, hormonal sensitivity, stage and LN metastasis. Results from recent studies discuss primary location as survival indicator but its significance still unclear. With SEER database registry in place, a rich source for data collection with differentiating breast cancer sites and primary location. With analysis of these data, the effect of cancer's primary origin on breast cancer survivorship would be more comprehensive. Using SEER*stat 8.3.6 program, Based on Incidence - SEER Research Data, 9 Registries, Nov 2019 Sub (1975-2017), patients diagnosed with breast cancer (site recode ICD-O-3) between 1975-2017 are selected. Case listing session was done with extraction patients year of diagnosis, survival time in months, laterality, and primary site. Cox regression was done using IBM SPSS statistics 25. p-value <0.001 is considered significant. 720272 patients were involved in analysis (50.9% left:49.1% right origin of primary). Median survival time for the cohort was 185 months(95% CI:184.4:185.5). Left side malignancy showed a significantly less positive effect on survival than right originated ones (HR, 0.988; 95% CI, 0.982–0.995). The upper and lower inner quadrants show a significantly higher effect on survival (HR, 1.877; 95% CI, 1.797–1.960) and 1.761(1.685). (HR, 1.761; 95% CI, 1.685–:1.842) respectively P-value <0.001.Table: 27PP-valueHR95.0% CI for HRLowerUpperNippleReferenceCentral portion of breast<0.0011.4541.3911.521Upper-inner quadrant of breast<0.0011.8771.7971.960Lower-inner quadrant of breast<0.0011.7611.6851.842Upper-outer quadrant of breast<0.0011.5671.5011.635Lower-outer quadrant of breast<0.0011.7111.6371.788Axillary tail of breast<0.0011.1421.0781.211Overlapping lesion of breast<0.0011.6801.6101.754Breast, NOS<0.0011.3501.2931.410Hazard ratios for primary site of breast cancer: Cox regression analysis Optimal cut-offs were determined with a maximal chi-square method.HR: hazard ratio; CI: confidence interval; NOS: not otherwise specified Open table in a new tab Hazard ratios for primary site of breast cancer: Cox regression analysis Optimal cut-offs were determined with a maximal chi-square method. HR: hazard ratio; CI: confidence interval; NOS: not otherwise specified Upper and lower inner quadrants show the best survival for patients diagnosed with breast cancer. The primary site of malignancy in breast cancer appears to be a good predictive value of survival and can be used as a rough method to predict patients` prognosis. More Data extraction, analysis, and interpretation of overall and cause-specific survival are recommended for more knowledge about the primary site in depth.