Evaluation Of Axilla Research Articles

Exploring methylene blue as an effective alternative to radiotracer for sentinel lymph node biopsy in early breast cancer in resource-limited settings

Background: Sentinel lymph node biopsy is the recommended approach in the evaluation of axilla during breast cancer surgery. This study evaluated the results of patients who underwent methylene blue sentinel lymph node biopsy. Methods: The study included 35 female patients with T1, T2 and T3 tumours. 5 ml of 1% methylene blue was injected into the periareolar region. The axillary sentinel lymph node was found and removed, and axillary dissection was performed. The sentinel lymph node and axillary dissection specimen were histopathologically examined, and the results were compared. Results: The sentinel lymph node was found in 33 (90%) patients. There were no complications associated with the use of methylene blue dye. Methylene blue-stained sentinel nodes were histologically negative for malignancy in 42% and positive in 58% of patients. Corresponding to sentinel nodes, the final axillary staging was negative in 60% and positive in 40% of patients. On diagnostic accuracy parameters, the sensitivity of the methylene blue method in early breast cancer (cT1-3N0M0) patients was 90.47%, and the specificity was 100%. The PPV of the technique under study was found to be 100% and NPV was 85.71%. The accuracy rate was 93%, and the false negative rate was identified as 9.5%. Conclusions: Sentinel lymph node biopsy by methylene blue is a method that can be applied with high accuracy. Methylene blue can be considered as an alternative to radio colloid dye in sentinel lymph node biopsy in a limited resource setting.

Evaluation of Axilla With Sentinel Lymph Node Biopsy (Using Methylene-Blue) and Reverse Axillary Mapping (Using Fluorescein) to Validate Optimum and Safe Axillary Dissection in Breast Cancer.

Introduction Sentinel lymph node biopsy (SLNB) has replaced routine axillary lymph node dissection (ALND) in node-negative axillae. In cases where the axilla needs to be dissected, one must dissect below the uppermost intercostobrachial nerve (ICBN) to avoid damaging arm lymphatics. Methods One milliliter of methylene blue dye was injected around the areola. Fluorescein dye (1 ml) was injected into the upper arm. After SLNB and ALND, the axilla was visualized under blue light. The location of fluorescent lymphatics was mapped with respect to the uppermost ICBN. Results The identification rate of sentinel lymph nodes and arm lymphatics was 100%. Arm lymphatics were above ICBN in 86.7%. The false negative rate of SLNB was 13%, with sensitivity and specificity of 87% and 100%, respectively. Conclusions SLNB using the single-dye technique has results comparable to dual agent studies that utilizeblue dye and radioactive colloid. The uppermost ICBN could define the superior limit of axillary dissection.

Abstract PS1-38: Role of MR spectroscopy in evaluation of axilla in breast cancer

Abstract The role of surgery for women with breast cancer presenting with clinically negative axilla is being questioned. Trials are underway to evaluate axillary ultrasound (AUS) for non-invasive evaluation of axilla instead of sentinel node biopsy. However, AUS has a sensitivity of 50-59%. Thus, there is a need for non-invasive test to complement AUS. MR Spectoroscopy (MRS) identifies metabolites, viz. glycerophosphocholine (GPC), phosphocholine (PC), threonine (Thr), lactate (Lac), Choline (Cho) etc that are associated with presence of metastasis in axillary lymph nodes (LN) . Biochemical changes in tumor infiltrated LNs occur earlier than morphological changes and MRS can detect these chemical changes, it can be a useful investigation in evaluation of axilla. Aim: To evaluate the role of MR Spectroscopy (MRS) in identifying biochemical changes in axillary lymph nodes in breast cancer and correlate the findings with Histopathology (HP) to predict presence of metastasis.Methods: Axillary lymph nodes were obtained from 59 patients with early breast cancer with clinically negative axilla who underwent surgery. Each LN was bisected into two equal halves. One half of LN was snap frozen in liquid nitrogen (-196°C) and then stored at −80°C until perchloric acid extraction was carried out. Other half of LN was subjected to HP evaluation with standard Eosin and Hematoxylin staining . METHOD OF MR Spectroscopy: Water-soluble metabolites from the tissue samples were extracted using PCA extraction procedure (Seenu et al Magn Reson Imaging 2005 doi: 10.1016/j.mri.2005.10.004). Proton (1H) NMR spectroscopy of specimen was performed. Concentrations of GPC, PC, Thr, Lac, Cho and other metabolites were determined by comparing the integrated intensity of isolated resonances of the compounds of interest with that of the TSP signal, correcting for the number of contributing protons and with the tissue weight . Intensity ratio for metabolites, GPC, PC and Thr (GPC+PC/Thr) was also determined.Statistical Analyses: Levels of concentrations of various metabolites were compared between involved and non-involved lymph nodes using Wilcoxon rank sum test. Diagnostic indices of MRS were assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and overall accuracy taking final histopathology as ‘gold standard’ with 95% confidence intervals.Results: Mean concentrations of GPC, PC and Thr were significantly increased in involved as compared to non-involved node (table 1). Cho and Lac were not significantly increased. A cut-off value of 0.80 for the GPC-PC/Thr ratio was chosen to obtain a maximum accuracy of 89% based on previous study. MRS accurately predicted metastasis in 21 of the 24 patients who had LN metastasis on HP. Out of 35 patients with no LN metastasis, MRS correlated accurately with HP in 30 of them. Sensitivity, specificity, PPV, NPV and overall accuracy for MRS in detecting LN metastasis were 87.5%; 88%; 80.7%; 90.9%; and 86.4% respectively. Likelihood ratio for positive test and negative test for MRS to detect LN metastasis were 6.1 and 0.14 respectively.Conclusion: MRS can accurately predict presence of metastasis in axillary lymph nodes in vitro. In vivo studies are essential to corroborate these findings. Mean concentrations of metabolites in axillary lymph nodesInvolvedNon involvedP valueGPC0.5923(SD=0.5726)0.3648(SD=0.6774)0.02PC0.7347(SD=0.9466)0.5286(SD=1.1111)0.03Cho0.6930(SD=0.6756)0.8435(SD=0.5030)0.21Thr2.9656(SD=2.2397)1.1674(SD=1.2274)0.02Lac4.5515(SD=2.3271)3.2907(SD=1.3296)0.31 Citation Format: Srineil Vuthaluru, Anurag Srivastava. Role of MR spectroscopy in evaluation of axilla in breast cancer [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 PS1-38.

Is there a role of frozen section of sentinel lymph node in patients with early breast cancer for the management of axilla in India: a prospective study

Background: Evaluation of axilla using sentinel lymph node biopsy (SLNB) is the standard of care in node negative early breast cancer. Intra operative assessment of SLNB with frozen section (FS) often guides the surgeon regarding decision for level of axillary dissection. The aim of this study was to evaluate accuracy of FS of SLNB in these patients with histopathology examination (HPE) as the gold standard.Methods: This study was performed between July 2017 and November 2018. After gross evaluation of SLNB, nodes were cut in half and frozen; the other half was preserved for HPE. For FS, nodes were sectioned to 4 mm width and examined.Results: A total of 61 patients underwent SLNB, 55 patients undergoing intra-operative FS. The mean age was 53 years (range 30-84, ± 15.09 SD), primary tumor was clinically T1 in 23.6%, T2 in 76.4% patients. A median of four sentinel nodes were identified, mean size 13.84 mm. On FS SLNB was positive for metastasis in 14 (25.5%), on HPE in 16 (29.1%) patients. There were 13 true positive, 38 true negative, 3 false negative and 1 false positive result for FS. The sensitivity, specificity, positive and negative predictive value, false negative and false positive rates were 81.25%, 97.44%, 92.86%, 92.73%, 18.75% and 2.56% respectively in this study. The overall accuracy of FS of SLNB in early carcinoma breast was found to be 92.73%.Conclusions: An intra-operative FS of the SLN in node negative early breast cancer is a highly sensitive tool in axilla management.

Efficacy of Methylene Blue in Sentinel Lymph Node Biopsy for Early Breast Cancer.

Sentinel lymph node biopsy is the recommended approach in the evaluation of axilla during breast cancer surgery. In this study, results of patients who underwent methylene blue sentinel lymph node biopsy were evaluated. The study included 32 female patients with T1 and T2 tumors. 5 ml of 1% methylene blue was injected into the peritumoral area or around the cavity. The axillary sentinel lymph node was found and removed, and then axillary dissection was performed. The sentinel lymph node and axillary dissection specimen were histopathologically examined and the results were compared. The sentinel lymph node was found in 30 (94%) patients. Lymph node metastasis was not observed in 17 patients in both the sentinel lymph node and axilla. Two patients had metastasis in the axilla although this was not detected in sentinel lymph node. Eleven patients had metastasis both in the sentinel lymph node and in the axilla. The accuracy rate was 93%, and the false negativity rate was identified as 15%. Sentinel lymph node biopsy by methylene blue is a method that can be applied with high accuracy. Methylene blue can be considered as an alternative to isosulphane blue in sentinel lymph node biopsy.