Contralateral Axillary Lymph Node Research Articles

Survival After Contralateral Axillary Metastasis in Breast Cancer.

Despite stage IV categorization, survival outcomes for breast cancer patients who experience contralateral axillary lymph node metastasis (CAM) remain uncertain. This study aimed to investigate the clinical outcomes for patients with metachronous CAM to provide insights into its prognosis and treatment recommendations. This study retrospectively reviewed medical records of patients who underwent curative surgery for breast cancer and experienced CAM as the first site of distant metastasis (DM) during the follow-up period between January 2001 and April 2023. Survival outcomes of the CAM patients were compared with those of breast cancer patients with other DM via propensity score-matching (PSM). The study identified 40 breast cancer patients with metachronous CAM. The estimated 5-year overall survival (OS) was 39.6%, and the progression-free survival was 39.4%. The patients with CAM exhibited marginally better OS than the patients with DM (p = 0.071), but survival similar to that of the patients with isolated supraclavicular node recurrence (SCN) (p = 0.509). Moreover, matching of CAM with DM using two PSM models showed a consistently insignificant survival difference (hazard ratio [HR], 1.47; p = 0.124 vs. HR, 1.19; p = 0.542). Ipsilateral breast tumor recurrences (IBTRs) were experienced by 12 patients before or concurrently with the CAM. These patients exhibited significantly better survival than the remaining patients (HR, 0.28; p = 0.024). The breast cancer patients with CAM showed survival similar to that for the patients with DM, supporting the current stage IV classification of the CAM. However, CAM associated with IBTR exhibited superior survival outcomes, suggesting that this subset of CAM may benefit from treatments with curative intent.

Contralateral axillary lymph node metastasis of breast cancer: UK single-centre 10-year experience

Contralateral axillary lymph node metastasis of breast cancer: UK single-centre 10-year experience

Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy.

Anatomic and functional descriptions of trunk and breast lymphedema following breast cancer treatment are emerging as indicators of lymphatic dysfunction. Indocyanine green-lymphangiography has been instrumental in characterizing this dysfunction in the extremity and can be applied to other regions. Previous work has established a validated Pittsburgh Trunk Lymphedema Staging System to characterize such affected areas. This study aims to identify risk and protective factors for the development of truncal and upper extremity lymphedema using alternative lymphatic drainage, providing implications for medical and surgical treatment. Patients undergoing revisional breast surgery with suspicion of upper extremity lymphedema between 12/2014 and 3/2020 were offered lymphangiography. The breast and lateral/anterior trunks were visualized and blindly evaluated for axillary and inguinal lymphatic flow. A linear-weighted Cohen's kappa statistic was calculated comparing alternative drainage evaluation. Binomial regression was used to compute relative risks (RRs). Significance was assessed at alpha = 0.05. Eighty-six sides (46 patients) were included. Twelve sides underwent no treatment and were considered controls. Eighty-eight percent of the noncontrols had alternative lymphatic flow to the ipsilateral axillae (64%), ipsilateral groins (57%), contralateral axillae (20.3%), and contralateral groins (9.3%). Cohen's kappa for alternative drainage was 0.631 ± 0.043. Ipsilateral axillary and contralateral inguinal drainage were associated with reduced risk of developing truncal lymphedema [RR 0.78, confidence interval (CI) 0.63-0.97, P = 0.04; RR 0.32, CI 0.13-0.79, P = 0.01, respectively]. Radiation therapy increased risk of truncal and upper extremity lymphedema (RR 3.69, CI 0.96-14.15, P = 0.02; RR 1.92, CI 1.09-3.39, P = 0.03, respectively). Contralateral axillary drainage and axillary lymph node dissection were associated with increased risk of upper extremity lymphedema (RR 4.25, CI 1.09-16.61, P = 0.01; RR 2.83, CI 1.23-6.52, P = 0.01, respectively). Building upon previous work, this study shows risk and protective factors for the development of truncal and upper extremity lymphedema. Most prevalent alternative channels drain to the ipsilateral axilla and groin. Ipsilateral axillary and contralateral inguinal drainage were associated with reduced risk of truncal lymphedema. Patients with radiation, axillary dissection, and contralateral axillary drainage were associated with increased risk of upper extremity lymphedema. These findings have important clinical implications for postoperative manual lymphatic drainage and for determining eligibility for lymphovenous bypass surgery.

Hypermetabolic Axillary Lymphadenopathy After Shingrix Vaccination for Varicella Zoster Virus.

A 67-year-old woman underwent staging 18 F-FDG PET/CT scan for recently diagnosed breast cancer. Her scan showed a highly hypermetabolic right breast mass, with ipsilateral hypermetabolic axillary lymph nodes. The contralateral axillary lymph nodes were also enlarged with avid FDG uptake, alongside focal increased uptake in the left deltoid muscle. Upon investigation, the patient reported receiving the new zoster recombinant adjuvanted varicella zoster vaccine (Shingrix, GlaxoSmithKline) 4 days before the scan. The lymph node uptake could be potential pitfall for cancer staging.

Surgery on Metastatic Foci is a Better Strategy for Stage IV Breast Cancer Patients with only Nonregional Lymph Node Metastasis.

Our study aims to explore whether breast cancer patients with non-regional lymph node (NRLN) metastasis benefit from surgery on distant nodes, and to determine the influencing factors affecting the prognosis of this type of patient. Information of invasive ductal carcinoma (IDC) patients from 2004 to 2016 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed by statistical methods, including multivariate Cox regression model, chi-squared test, propensity score matching (PSM), Kaplan-Meier plot, and log-rank test. A total of 4236 M1 patients met the designated criteria. Among 847 patients with only NRLN metastasis who have detailed information, only 114 patients received surgery on metastatic distant lymph nodes. The Kaplan-Meier plot for overall survival (OS) showed that the prognosis of NRLN metastatic patients was superior to visceral metastasis (P<0.0001) but similar to supraclavicular metastasis (P=0.33). In addition, NRLN metastatic patients who underwent surgery on the NRLNs were found to have superior prognoses in terms of both OS (P=0.041) and cancer-specific survival (P=0.034) compared with those who did not undergo NRLN surgery. We have also demonstrated that NRLN metastatic patients who have received radiotherapy plus chemotherapy for primary tumors gain superior survival compared with those who only received chemotherapy apart from NRLN surgery. Surgery on NRLN and radiotherapy for the primary tumor improved the prognosis of NRLN metastatic patients. Thus, the classification of NRLN, especially contralateral axillary lymph node metastasis (CAM), into the M1 breast cancer stage should be reconsidered. Different locoregional treatment strategies for metastatic foci should be recommended for patients with only NRLN and patients with visceral metastasis.

D25. Alternative Patterns of Superficial Lymphatic Drainage in the Breast and Trunk after Breast Cancer Surgery

PURPOSE: Changes in superficial lymphatic drainage from the chest wall/trunk after breast cancer treatment are not well described. This study examines alternative lymphatic flow in the post-mastectomy lymphedema population to identify risks associated with truncal and upper extremity lymphedema. METHODS: Patients undergoing revision breast surgery with suspicion of lymphedema from 2014-2020 were offered lymphangiography. Breasts and trunks were visualized and blindly evaluated for alternative drainage. Summary statistics were computed, and linear Cohen’s Kappa statistic was used to compare rater agreement. Binomial regression was used to compute relative risks (RR). RESULTS: 86 sides (46 patients) were included. 12 sides underwent no treatment and were considered controls. 88% of the non-controls had alternative lymphatic flow. This was seen in ipsilateral axillae (64%), ipsilateral groins (57%), contralateral axillae (20.3%), and contralateral groins (9.3%). Cohen’s Kappa for alternative drainage was 0.631 ± 0.043. Ipsilateral axillary and contralateral inguinal drainage reduced risk of truncal lymphedema (RR 0.78, CI 0.63-0.97, p=0.04; RR 0.32, CI 0.13-0.79, p=0.01, respectively). Radiation therapy increased risk of truncal and upper extremity lymphedema (RR 3.69, CI 0.96-14.15, p=0.02; RR 1.92, CI 1.09-3.39, p=0.03, respectively). Contralateral axillary drainage and axillary lymph node dissection increased risk of upper extremity lymphedema (RR 4.25, CI 1.09-16.61, p=0.01; RR 2.83, CI 1.23-6.52, p=0.01, respectively). CONCLUSION: This study highlights several risk/protective factors for truncal and upper extremity lymphedema. Ipsilateral axillary and contralateral inguinal drainage are protective against truncal lymphedema. Patients with radiation, axillary lymph node dissection and contralateral axillary drainage are at highest risk of upper extremity lymphedema.

Abstract P4-07-59: Management of Isolated Contralateral Axillary Lymph Node Metastasis in Breast Cancer: A Single Institution Experience

Abstract Background: Contralateral axillary lymph node metastasis (CAM) in breast cancer (BC) is uncommon with an incidence of 1.9-6%. It is considered as stage IV disease based on the TNM classification in the 8th edition of the American Joint Committee on Cancer (AJCC) staging manual. However, in the absence of other distant metastases, patients with CAM have been found to have better outcomes compared to those with stage IV disease. Recent studies suggest that CAM may represent locoregional spread of tumor through lymphatics rather than hematogenous spread and patients should be classified as N3 rather than M1. There are no clear guidelines on the optimal management of these patients and it is unclear if patients with isolated CAM should be treated as curative intent or as metastatic disease with palliative treatment. The goal of this study was to describe the management and outcomes of patients with BC and isolated CAM seen at our institution. Methods: We performed a retrospective chart review on all patients with BC and isolated CAM but no other distant metastases who were seen at our institution between 2000-2021. We collected information on demographics, tumor characteristics, intent of therapy (curative versus palliative), types of treatment (systemic treatments including chemotherapy (CT), hormone therapy, targeted therapy; radiation therapy; surgery), and response to frontline treatment. Results: We identified a total of ten eligible patients who were diagnosed between 2011-2020. The median age of diagnosis was 57 years and 70% had de novo cancers while the remainder had recurrent disease. The table below describes each patient’s cancer, treatment, and response. Patients are listed in chronological order, with those at the top diagnosed in 2011 and bottom in 2020. Four patients had hormone receptor (HR)-positive and HER2-negative BC, 3 patients had triple negative BC, 2 had HER2-positive BC and 1 had HR-positive and HER2-positive BC. Regarding treatment, 50% of patients were treated with curative intent, of whom 3 have no evidence of recurrence at a follow up of 23-137 months. Of the other two patients, one had response to systemic treatment but remains surgically unresectable and the other patient developed recurrent disease. In the 5 patients treated with palliative systemic therapy as Stage IV disease, 3 patients had clinical response to first line treatment with control of disease. One patient who passed away had triple negative disease. The last patient developed progression of disease and is on second line systemic treatment. Conclusions: At our institution, among patients treated with palliative intent systemic therapy, most (60%) had a response to first line treatment. In the 5 patients treated with curative intent, 3 patients remain without evidence of recurrence of whom 2 have had 9 years of follow up. The current study illustrates the heterogeneity in management for patients with CAM. Our findings highlight the need for larger studies focusing on BC patients with CAM to optimize their treatment and outcomes. Limitations of our study include its retrospective nature and small sample size given rarity of CAM. Table 1. Treatment and Outcomes of Patients with CAM Citation Format: Rima Patel, Shana Berwick, Cao Jin, Paula Klein. Management of Isolated Contralateral Axillary Lymph Node Metastasis in Breast Cancer: A Single Institution Experience [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 P4-07-59.

Abstract P5-01-04: Contralateral Axillary Lymph Node Metastasis after Ipsilateral Breast Tumor Recurrence: Is it distant metastasis or locoregional progression?

Abstract Background: Contralateral axillary lymph node metastasis (CAM) in breast cancer is currently classified as a stage IV disease but its prognosis is still controversial. Purpose: To determine outcomes in overall survival (OS) and disease-free survival (DFS) in patients with and without locoregional tumor recurrence who present with contralateral axillary lymph node metastasis (CAM). Methods: Patients with pathologically confirmed invasive breast cancer with metachronous CAM who received treatment between 1988 and 2017 were retrospectively reviewed. Patients with other distant metastases at the time of CAM diagnosis were excluded. The outcome of CAM in cases of IBTR and regional recurrence (RR) were compared to CAM not accompanied by locoregional tumor recurrence. Results: Thirty-eight patients with metachronous CAM were included in the study. Metachronous CAM occurred 55 months (interquartile range, 17-77 months) after surgical treatment of the primary tumor and median follow-up was 95 months (interquartile range, 49-117 months) from the initial operation date and 40 months (interquartile range, 15-54 months) from the diagnosis of CAM. At the time of initial CAM diagnosis, 11 patients had IBTR, 12 patients had RR, and 15 patients had no locoregional recurrence. The estimated 5-year OS was 49.1% and 5-year DFS was 45.3%. Although statistically insignificant due to small sample size, when stratified by loco regional recurrence, the prognosis of CAM patients with IBTR appeared to be better than those without locoregional recurrence (5-year OS: 88.9% vs. 41.4%, HR 5.88, p = 0.09) whereas the prognosis of CAM patients with RR was worse than those without locoregional recurrence (5-year OS: 35.4% vs. 41.4%, HR 0.44, p = 0.20). Axillary lymph node dissection (ALND) improved median OS (83 vs. 36 months, p = 0.069) in all patients. When stratified, improvement in median OS was 13 vs 27 months (p = 0.094) in patients with RR, and 36 vs. 65 months (p = 0.061) in patients without locoregional recurrence. For patients accompanied by IBTR, ALND was performed in 8 out of 11 and only one patient died during the follow-up period. Conclusion: Our study indicates that the patients with CAM have superior survival outcome when compared to other stage IV patients, especially when CAM was accompanied by other loco regional recurrences. These data suggest that the CAM patients may benefit from active loco regional treatment. Citation Format: Ji-Jung Jung, Hyeong-Gon Moon, Wonshik Han, Han-Byoel Lee, Hong-Kyu Kim, Jung Whan Chun, Eunhye Kang, Changjin Lim, Jang-il Kim, Hyunsu Yeoh. Contralateral Axillary Lymph Node Metastasis after Ipsilateral Breast Tumor Recurrence: Is it distant metastasis or locoregional progression? [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 P5-01-04.

Abstract OT1-21-01: Preoperative radiotherapy and systemic therapy following surgery in ‘de novo’ metastatic breast cancer (Protocol MF22-01; Intervention Systemic Treatment METastasis-ISTMET)

Abstract Background Five to eight percent of breast cancer (BC) patients present with distant metastasis at diagnosis, known as ‘de Novo’ metastatic breast cancer (dnMBC). Recent data showed that approximately 40% of dnMBC patients undergo locoregional treatment (LRT). LRT treatment modalities for metastasis and primary tumor benefit a subset of patients with oligometastatic disease. Our study group has recently demonstrated two prospective studies regarding this topic with favorable outcomes. MF07-01 IMET study, one of the first clinical randomized trials, showed that the patients with the diagnosis of dnMBC undergoing LRT followed by systemic therapy had an additional 14% OS benefit by the end of the 10-year follow-up when compared with others who received only systemic therapy. A prospective multicenter registry study MF14-01 BOMET also presented LRT prolonged survival and decreased locoregional recurrence in a prospective registry study with a median follow-up of 3 years. Timing of primary breast surgery either at diagnosis or after systemic treatment provided a survival benefit similar to systemic therapy alone in bone-only dnMBC patients. Although, the optimal timing of concurrent endocrine therapy, radiotherapy, and/or sequential surgery remains unclear. Hypothesis We hypothesize that in the era of modern radiotherapy and endocrine therapy, concurrent radiation and endocrine therapy will be non-inferior to sequential treatment modalities in terms of locoregional and systemic disease control in dnMBC. ER/PR (+), Her2 neu (-) oligometastatic dnMBC patients are potentially curable with multimodality treatments. Objectives The primary objective is to perform a Phase I study to evaluate the feasibility of this curative intent treatment approach for patients with oligometastatic disease. Secondary objectives are to present the treatment response evaluating with CTC and/or ctDNA, and IHC and marker changes with multimodality treatments Methods Postmenopausal ER/PR (+) and Her2 neu (-), oligometastatic dnMBC patients will be enrolled in the study. Inclusion criteria: Primary breast tumor amenable for complete surgical resection, patients in good physical condition for receiving protocol-driven locoregional and systemic treatments and radiotherapy; Bone-only oligometastatic disease (5 or less metastasis); Primary tumor biopsy, metastatic site biopsy (ER/PR, Her2, Ki67). Exclusion criteria: Primary tumor not amenable for complete resection; primary tumor with extended infection, bleeding, or necrosis; patients with poor physical condition which prevents the patient from receiving protocol-driven locoregional and systemic treatment; synchronous primary cancer at the contralateral breast; clinically involved contralateral axillary nodes; patients not suitable for adequate follow-up, and failure to give informed consent. Study Design: • RT to the primary tumor (Hypo fractionated) + AI concurrent, Collect CTC and/or ctDNA • Add CDK4/6i to AI 2-4 weeks after RT + (6 months) • RT to bone metastasis (if still visible), Collect CTC and/or ctDNA + (12 months) • Primary Breast Surgery, Collect CTC and/orctDNA, ER/PR/Her 2 in the final specimen + • CDK4/6i +AI until progression and/or unmanageable toxicity Conclusion We hypothesize that in the era of modern radiotherapy and endocrine therapy, concurrent radiation and endocrine therapy will be non-inferior to sequential treatment modalities in terms of locoregional and systemic disease control in dnMBC. ER/PR (+), Her2 neu (-) oligometastatic dnMBC patients are potentially curable with multimodality treatments. Citation Format: Atilla Soran, Serdar Ozbas, Lutfi Dogan, Kamuran İbis, Mutlu Dogan, M Selam, Kazim Senol, Secil Ak Aksoy, Mine Ozsen, Sibel Cetintas, Turkkan Evrensel, Efe Sezgin. Preoperative radiotherapy and systemic therapy following surgery in ‘de novo’ metastatic breast cancer (Protocol MF22-01; Intervention Systemic Treatment METastasis-ISTMET) [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 OT1-21-01.

A Prospective Multi-Institutional Observational Study on ER, PR, HER2/NEU, and Ki-67 Expression and Discordance Pattern in Primary and Metastatic and Recurrent Carcinoma Breast and Its Therapeutic Implications and Prognostic Outcome.

Only few studies reported in literature that has elucidated in detail the implications of molecular typing in metastatic and recurrent breast cancer. In this prospective study, we have analysed in depth the pattern of expression, discordances of molecular markers in various metastatic sites, and recurrent cases and their response to chemotherapy/targeted agents and the prognostic outcome. The primary aim of the study was to determine ER, PR, HER2/NEU, and Ki-67 from recurrent and metastatic carcinoma breast to study the expression pattern and discordance and also to study the degree of discordance in relation to the site of metastasis and pattern of metastasis (synchronous vs metachronous) and discordance pattern with the response to chemotherapy and median overall survival rates in months in available subset of patients. Prospective open-label study done at the Government Rajaji Hospital, Madurai Medical College, and Government Royapettah Hospital, Kilpauk Medical College, India, from November 2014 to August 2021. All breast carcinoma patients with recurrence or oligo metastasis (defined as one organ with less than 5 metastases in our study) with known receptor status were eligible and 110 patients were enrolled in the study. ER (ER + to ER -) discordance was seen in 19 (26.38%) cases. PR (PR + to PR -Ve) discordance was seen in 14 (19.17%) cases. HER2/NEU (HER2/NEU + Ve to -Ve) discordance was seen in 3 (16.6%) cases. Ki-67 discordance was seen in 54 (49.09%) cases. High Ki-67 as a proliferative marker has increased response to chemotherapy but earlier relapse and disease progression especially in Luminal B type. In further subset analysis, ER, PR, and HER2/NEU discordance is higher for lung metastasis (ER, PR 61.1%, p value .001, HER2/NEU 5.5%), followed by liver metastasis (ER, PR 50%, p value .0023, 1 case turning ER -ve to + ve, HER2/NEU 1 (10%)). In lung, discordance is more for metachronous metastasis. In liver, discordance is 100% for synchronous metastasis. Synchronous metastasis with discordance in ER and PR is associated with rapid disease progression. High Ki-67 subset of Luminal B-like tumors progressed rapidly than triple negative and HER2/NEU positive subset. Complete clinical response rate in contralateral axillary node metastasis group was 87.8%, followed by local only recurrence with high Ki-67 where chemotherapy had response rate of 81% and 2years DFS of 93.12% after excision. Certain subsets like contralateral axillary nodes and supraclavicular nodes which present as oligo metastatic disease with discordance and high Ki-67 respond well to chemotherapeutics and targeted agents improving the OS in this subset of patients. Molecular markers and their expression and discordance pattern determine the therapeutic outcome and prognosis of the disease. Early identification and targeting the discordance would go a long way in improving the outcome and DFS and OS of breast cancer patients.

Supraclavicular and Contralateral Axillary Lymph Node Involvement in Breast Cancer Patients.

Ipsilateral supraclavicular disease was reclassified from Stage IV, distant metastatic disease, to Stage IIIC, locally advanced breast cancer 20 years ago. Treatment with curative intent with multimodality therapy has led to improved outcomes over time. In contrast, metastatic disease to contralateral axillary lymph nodes remains as Stage IV distant disease. Despite this, in the absence of other distant metastases, many patients with contralateral axillary disease are treated more aggressively than other Stage IV patients. Outcomes of patients with contralateral axillary disease treated with curative intent are more like patients with ipsilateral supraclavicular disease and other locally advanced breast cancers than patients with de novo distant metastases elsewhere. Therefore, some favor reclassification of contralateral axillary metastases without distant metastasis from Stage IV to Stage III breast cancer similar to ipsilateral supraclavicular metastases.

Contralateral Axillary Lymph Node Metastasis of Breast Cancer: Retrospective Analysis and Literature Review.

BackgroundContralateral axillary lymph node metastasis (CAM) is classified as distant metastasis in guidelines, but the prognosis is better than that of stage IV patients. It is controversial to classify CAM as a distant metastasis or a regional metastasis, and the optimal treatment strategy for CAM is unknown.Patients and MethodsBreast cancer patients who were confirmed by pathology and treated at Shandong Cancer Hospital between January 2012 and July 2021 were included in our study. We retrospectively reviewed the medical records of the patients for their clinical features, pathological diagnosis, treatment strategy, and follow-up data. Survival analysis was calculated by Kaplan–Meier analysis, and patient matching was performed by case–control matching.ResultsA total of 60 patients were included, and there were 49 metachronous CAM cases and 11 synchronous CAM cases. The prognosis of isolated CAM patients was better than that of patients with other distant metastases in terms of CAM-OS and PFS with significant differences (median CAM-OS 71.0 vs. 30.0 months, P=0.022; median PFS 42.0 vs. 11.0 months, P=0.009) and OS without significant differences (median OS 126.0 vs. 79.0 months, P=0.111). The five-year survival rate of isolated CAM patients was 67.4%, and the five-year disease-free survival (DFS) rate was 52.9%. The prognosis of CAM patients was similar to that of N3M0 patients in terms of OS (mean OS 82.4 vs. 65.6 months, P=0.537) and DFS (mean PFS 54.5 vs. 52.6 months, P=0.888). Axillary lymph node dissection (ALND) or low-middle level ALND significantly improved the OS (mean OS 237.4 vs. 111.0 months, P=0.011), CAM-OS (mean CAM-OS 105.2 vs. 46.6 months, P = 0.002), and PFS (mean PFS 92.3 vs. 26.9 months, P = 0.001) of isolated CAM patients. Axillary radiotherapy improved PFS, CAM-OS, and OS but without significant differences (mean PFS 80.0 vs. 46.6 months, P = 0.345; mean CAM-OS 86.8 vs. 72.1 months, P = 0.338; mean OS 147.6 vs. 133.0 months, P = 0.426).ConclusionCAM should be diagnosed as local recurrence and treated with aggressive and curative rather than palliative strategies. Contralateral axillary surgery and radiotherapy are recommended for isolated CAM patients.

Temporary Reactive Response of Axillary Lymph Nodes to COVID-19 Vaccination on 18F-rhPSMA-7.3 PET/CT in Patients with Prostate Cancer.

Vaccine-associated lymphadenopathy (VAL) is a common finding on 18F-FDG PET/CT examinations after coronavirus disease 2019 (COVID-19) vaccination. However, data regarding VAL on 18F-rhPSMA-7.3-ligand PET are currently lacking. This study assesses the prevalence, temporal response to vaccination, and characteristics of VAL. Methods: Two hundred thirty-three consecutive vaccinated and 41 unvaccinated patients with confirmed prostate cancer who underwent 18F-rhPSMA-7.3 PET/CT were retrospectively analyzed. Size and uptake of the axillary lymph nodes were measured. Ratios of SUVmax of ipsilateral to contralateral axillary lymph node (SUVratio) were determined. The characteristics of SUVratio in respect to the duration of PSMA avidity in the axillary lymph node after COVID-19 vaccination was analyzed. Results: The prevalence of VAL on 18F-rhPSMA-7.3 PET was 45%. Up to a period of 8 wk after the last COVID-19 vaccination, SUVratio was positive (2.05 ± 0.17). Thereafter, SUVratio dropped significantly (1.35 ± 0.09) and approached the value of unvaccinated group (1.1 ± 0.2). SUVratio of metastatic axillary lymph nodes was very high (>11) and can be easily detected visually or semiquantitatively. In 3 patients, we observed suspected development and consecutively confirmed involving metastasis of axillary lymph node with SUVratio between 4.0 to 6.6. Correlation between SUVratio and lymph node size (r = 0.93, P < 0.0001) and lymph node size and duration after vaccine (r = -0.88, P < 0.0008) was found. Conclusion: Increased uptake of the PSMA ligand 18F-rhPSMA-7.3 by axillary lymph nodes is common after COVID-19 vaccination and can persist for 8 wk. This finding should be considered in the interpretation of 18F-rhPSMA-7.3 PET/CT examinations.

Contralateral axillary lymph node metastasis in primary breast cancer: A case report.

IntroductionContralateral axillary lymph node metastasis (CAM) is rare, especially in primary breast cancer.Presentation of caseA 71-year-old woman visited our hospital after noticing a mass in her right breast. A mass of 5 cm in diameter with skin infiltration was palpable on the medial side of the right breast. She underwent a needle biopsy and was diagnosed with invasive ductal carcinoma. On various imaging modalities, there were no distant metastases but bilateral axillary lymph node metastases were found. She underwent preoperative chemotherapy and showed a clinical partial response. After thorough discussion, she opted for surgery and underwent partial mastectomy of the right breast and bilateral axillary lymph node dissection. Histopathological examination revealed residual breast tumor and one metastatic axillary lymph node on each side. Postoperative radiotherapy and hormone therapy were performed. The patient is alive and recurrence-free as of 1 year after the start of treatment.ConclusionCAM is often regarded as distant metastasis, but can be considered curable if there is no distant metastasis to other organs. CAM without distant metastasis to other organs should be treated with curative intent in order to avoid a disadvantage to the patient.

Frequency and intensity of [18F]-PSMA-1007 uptake after COVID-19 vaccination in clinical PET.

Objectives:To assess the frequency and intensity of [18F]-prostate-specific membrane antigen (PSMA)-1007 axillary uptake in lymph nodes ipsilateral to COVID-19 vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) in patients with prostate cancer referred for oncological [18F]-PSMA positron emission tomography (PET)/CT or PET/MR imaging.Methods:126 patients undergoing [18F]-PSMA PET/CT or PET/MR imaging were retrospectively included. [18F]-PSMA activity (maximum standardized uptake value) of ipsilateral axillary lymph nodes was measured and compared with the non-vaccinated contralateral side and with a non-vaccinated negative control group. [18F]-PSMA active lymph node metastases were measured to serve as quantitative reference.Results:There was a significant difference in maximum standardized uptake value in ipsilateral and compared to contralateral axillary lymph nodes in the vaccination group (n = 63, p < 0.001) and no such difference in the non-vaccinated control group (n = 63, p = 0.379). Vaccinated patients showed mildly increased axillary lymph node [18F]-PSMA uptake as compared to non-vaccinated patients (p = 0.03). [18F]-PSMA activity of of lymph node metastases was significantly higher (p < 0.001) compared to axillary lymph nodes of vaccinated patients.Conclusion:Our data suggest mildly increased [18F]-PSMA uptake after COVID-19 vaccination in ipsilateral axillary lymph nodes. However, given the significantly higher [18F]-PSMA uptake of prostatic lymph node metastases compared to “reactive” nodes after COVID-19 vaccination, no therapeutic and diagnostic dilemma is to be expected.Advances in knowledge:No specific preparations or precautions (e.g. adaption of vaccination scheduling) need to be undertaken in patients undergoing [18F]-PSMA PET imaging after COVID-19 vaccination.

A rare case of unilateral breast filariasis mimicking chronic mastitis

Filariasis of the breast is a very rare condition. In India, largest number (around 600 million) of people live in endemic areas. Despite the huge number, it is quite rare to find microfilaria in routine smears and body fluids and it is even more rare to find it in breasts. A 40 years old female, presented with a history of lump in the right breast approximately 3x3 cm in size in the right lower quadrant. Findings were confirmed by clinical examination which did not reveal any palpable ipsilateral or contralateral axillary lymph nodes. FNAC showed it as a benign lesion. After local excision, histopathology revealed a filarial worm. Filariasis of the breast is a rare disease. The presence of microfilaria in breasts using FNAC has been reported at times but the presence of the filarial worms can only be confirmed on histopathology, hence a core biopsy or an excision biopsy is a must in all the cases. A presumptive diagnosis of filariasis can be made on sonography if the worms are alive and active, the typical presentation on USG is the filarial dance. Surgical excision of the lump followed by DEC therapy is the treatment of choice for filarial lump of the breast.

Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination.

Ipsilateral avid axillary lymph node uptake at FDG PET/CT persists in 29% (49 of 169) of patients between 7 to 10 weeks after the second dose of the mRNA-based BNT162b2 COVID-19 vaccination.

Breast cancer metastasizing to the contralateral axilla several years after treatment: A case report with literature review.

Introduction and importanceLymph node metastasis is the most prominent prognostic factor in breast cancer. The aim of this paper is to report a case of contralateral axillary lymph node metastasis (CAM) which look like metachronous initially, but histopathologicaly confirmed as synchronous CAM.Case presentationA-44-year old female was a known case of left breast cancer five years prior to this presentation (T2,N2,M0, grade III, Triple negative, multifocal invasive ductal carcinoma). On follow up, multiple contralateral axillary suspicious lymph nodes were discovered. Fine Needle Aspiration Cytology from the lesion revealed grade III, Triple negative, invasive ductal carcinoma consistent with metastasis from the left invasive ductal carcinoma. Bilateral mastectomy and right axillary dissection were performed. The histopathological examination and immunohistochemistry showed left breast recurrent 0.5 cm grade III, Triple negative invasive ductal carcinoma.DiscussionIf a cancer is found in the contralateral axilla, three main potential sources should be considered: contralateral spread from the original breast tumor, metastasis from an occult primary in the ipsilateral breast, and metastasis from an extramammary site.ConclusionAlthough CAM in patients with breast cancer is an uncommon condition, it is still possible to occur. There is a controversy regarding the appropriate management.

Contralateral axillary lymph node metastasis and molecular changes in second primary breast cancer: a case report

: Contralateral axillary metastasis (CAM) is rather rare in primary breast cancer. In this case, we present a 46-year-old female patient who underwent left breast-conserving surgery (BCS) and left axillary lymph node dissection (ALND). Two years later, an enlarged lymph node was found in her right axilla. Magnetic resonance imaging (MRI) of the breast displayed a left breast mass with multiple internal mammary lymph nodes and abnormal lymph nodes in the right axillary region. However, no abnormalities were found in the right breast. The left breast mass was diagnosed as invasive carcinoma by core needle biopsy. During the operation, we suggested that the contralateral lymph nodes were metastatic from the second primary breast cancer by preoperative 99mTc injection around the left breast. The patient underwent left mastectomy and right axillary lymph node dissection. The postoperative pathology was diagnosed as metachronous secondary primary left breast cancer, in which the initial presentation was lymph node metastasis to the contralateral axilla of the left breast. Therefore, we propose that CAM may be more common in second primary or recurrent breast cancer. It should be treated as locoregional extension. Preoperative lymph node markers are important to identify whether contralateral axillary lymph node metastasis occurs from a second primary breast cancer.

Progressive Transformation of Germinal Centers in Axillary Lymph Nodes Mimicking Metastatic Lymphadenopathy after Breast Cancer Surgery: A Case Report

Progressive transformation of germinal centers (PTGC) is a rarely diagnosed, benign disease of the lymph nodes that commonly manifests as chronic lymphadenopathy. PTGC may be characterized by single or multiple non-tender lymph nodes, and it commonly involves the cervical, axillary, and inguinal areas. Although PTGC is identified with concurrent lymphoma in some patients, it is not considered as a premalignant entity. Histopathologic diagnosis of PTGC is rarely made, and imaging findings have been reported in very few studies. We present a case of PTGC that occurred at the contralateral axillary lymph nodes and mimicked metastatic lymphadenopathy after breast cancer surgery. We also discuss its imaging findings.