Identification Of Nodal Disease Research Articles

Abstract ES7-1: Challenges in the management of locoregional recurrence

Abstract The increasing trend toward tailoring treatment of the primary breast cancer with limited surgery of both the breast and axilla has increased the challenge of managing locoregional recurrence (LRR). In the era when patients uniformly had axillary dissection, the appropriateness of repeat sentinel node biopsy was not a question. Similarly, the dogma that all ipsilateral breast tumor recurrences must be treated with mastectomy if the breast has been previously irradiated is also being challenged. LRR events are infrequent with modern multi-modality therapy, and there are no randomized trials to address these questions. Re-operative sentinel node (SN) biopsy after breast conserving surgery therapy (BCT) has been shown to be feasible, with the likelihood of identifying additional SNs related to the number of nodes excised at the time of initial SN biopsy. The accuracy of SN biopsy after mastectomy is less clear. However, the impact of identification of nodal disease on management of LRR is controversial. In a study of 12 patients with isolated chest wall recurrence post mastectomy, 10/12 had successful mapping and 7/10 had an axillary SN. The absence of nodal metastases was an indication to avoid supraclavicular RT (Johnson J. Ann Surg Oncol 2016;23:715). In a study of 83 patients with in breast (n=79) or chest wall recurrence who were clinically node negative, 47 had axillary surgery and 36 did not. At a median of 4.2 years after LR, rates of axillary and non-axillary local recurrence, distant metastases, and death did not differ significantly between groups (Ugras S. Ann Surg Oncol 2016). With the findings of the CALOR trial that systemic chemotherapy is beneficial in the management of LRR, the finding of axillary metastases is less likely to influence systemic therapy than in the past and repeat axillary staging could potentially be avoided. In the untreated breast, drainage to the contralateral axilla is very rare and contralateral axillary metastases classify a patient as Stage IV. After initial axillary dissection, between 4% and 33% of patients with local recurrence will have contralateral axillary drainage. In a systemic review of 48 cases of contralateral nodal recurrence without other distant metastatic disease, at a mean follow-up of 50.3 months disease free survival was 65% and overall survival 83% after treatment that included both local and systemic therapy (Moossdorff M. Eur J Surg Oncol 2015;41:1128). These findings raise the possibility that in the setting of LR, contralateral axillary metastases should be treated aggressively for cure after excluding distant metastases. Citation Format: Morrow M. Challenges in the management of locoregional recurrence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES7-1.

Axillary nodal burden in primary breast cancer patients with positive pre-operative ultrasound guided fine needle aspiration cytology: Management in the era of ACOSOG Z011

IntroductionRecent years have seen a dramatic shift to more conservative management of the axilla in patients with a positive sentinel lymph node biopsy (SLNB). Identification of nodal disease with positive pre-operative ultrasound guided axillary fine needle aspiration cytology (AUS/FNAC) may represent a higher axillary disease burden mandating an axillary clearance and thus an upfront SLNB may be avoided. The aims of this study were to quantify nodal burden in patients with positive pre-operative AUS/FNAC and identify patients who may have been able to avoid an axillary clearance (ALND) based on ACOSOG Z011 criteria. MethodsA retrospective review of a prospectively maintained database identified patients with positive pre-operative AUS/FNAC between 2007 and 2012. Core biopsies were excluded. Demographic and tumour characteristics were analysed. Eligibility for ACOSOG Z011 criteria was assessed and patients who may have avoided ALND were identified. Results432 patients were identified with positive AUS/FNAC. 85 patients were excluded leaving 347 for analysis. Median age was 56 years (22–87), median tumour size was 25 mm (1.5 mm–150 mm) and median tumour pathology was grade 3 (50%) and invasive ductal carcinoma (82%). Median number of nodes removed at ALND was 23 (1–55) with a median number of positive nodes being 4 (1–47). 134 (39%) patients had ≤2 positive nodes identified on ALND making them eligible for the ACOSOG Z011 study. When other ACOSOG Z011 exclusion factors were applied only 27 (7.8%) patients may have avoided ALND. ConclusionsNodal positivity on AUS/FNAC is associated with higher axillary disease burden. Few patients would satisfy ACOSOG/Z011 criteria and avoid ALND making an upfront SLNB unnecessary.

Estadificación prequirúrgica del cáncer de recto mediante RM y correlación radiopatológica

Our aim is to asses the accuracy of MRI for preoperative rectal cancer staging and to establish a histopathologic correlation. A retrospective analysis was performed on 120 patients aged between 43 and 87 with histologically proven rectal cancer who underwent MRI for preoperative staging in our hospital between 2005 and 2010. Patients were categorized according to the TNM classification. Eighty of 120 patients underwent adjuvant chemoradiotheraphy because they had advanced disease (T3-T4), lymph node involvement (N1-N2) or resectable metastases. With 40 patients who didn't undergo neoadjuvant therapy we performed a correlation between MRI and histopathological findings with a diagnostic accuracy in predicting T stage of 72%, N stage of 60% and distance to the mesorectal fascia of 87,5%. Pelvic MRI is a useful technique for locoregional staging of rectal cancer with a good radiopathologic correlation although the identification of nodal disease is still a diagnostic problem.

Patterns of Regional Spread for Esthesioneuroblastoma

ENB is a rare malignant neoplasm that affects the anterior skull base. Disease stage is a significant predictor of survival, in particular the presence or absence of lymph node metastases. Multiple studies have identified the cervical lymph nodes as the most frequent site of spread; however, no studies have attempted to characterize the radiographic appearance of metastatic lymph nodes or identify the primary nodal drainage for these tumors. We retrospectively reviewed the medical records and imaging examinations of patients with a pathologically proved diagnosis of ENB from a single tertiary care institution from 2004 to 2010. A head and neck radiologist with 9 years of experience in evaluating ENB reviewed the imaging of all patients with lymph node metastases to confirm the lymph node findings. Spread of ENB to cervical lymph nodes was discovered in 14/48 patients (29%). Of the 14 patients, 5 (36%) were discovered to have lymph node involvement at initial staging, while 9 (64%) showed development of disease in the cervical nodes on surveillance examinations. Level II lymph nodes were the most frequently involved (13/14 cases). Levels I (57%) and III (50%) nodes and RPNs (43%) were also frequently involved. Metastatic lymph nodes were predominantly solid and demonstrated marked contrast enhancement, often approaching the degree of enhancement of nearby blood vessels. Metastatic nodes were moderately or highly FDG-avid. ENB exhibits a predictable pattern of metastasis to cervical lymph nodes, typically spreading first to level II nodes, with frequent involvement of level I and III nodes and RPNs. Metastatic lymph nodes have characteristic imaging features that can assist radiologists in the identification of nodal disease.