Lymph Nodes In Breast Cancer Patients Research Articles

685: Incidental dose distribution to contralateral internal mammary nodes in breast cancer patients

685: Incidental dose distribution to contralateral internal mammary nodes in breast cancer patients

Viability of Whole-Slide Imaging for Intraoperative Touch Imprint Cytological Diagnosis of Axillary Sentinel Lymph Nodes in Breast Cancer Patients.

Whole-slide imaging (WSI) is a promising tool in pathology. However, the use of WSI in cytopathology has lagged behind that in histology. We aimed to evaluate the utility of WSI for the intraoperative touch imprint cytological diagnosis of axillary sentinel lymph nodes (SLNs) in breast cancer patients. Glass slides from touch imprint cytology of 480 axillary SLNs were scanned using two different WSI scanners. The intra- and interobserver concordance, accuracy, possible reasons for misdiagnosis, scanning time, and review time for three cytopathologists were compared between WSI and light microscopy (LM). A total of 4320 diagnoses were obtained. There was substantial to strong intraobserver concordance when comparing reads among paired LM slides and WSI digital slides (κ coefficient ranged from 0.63 to 0.88, and concordance rates ranged from 94.58% to 98.33%). Substantial to strong interobserver agreement was also observed among the three cytopathologists (κ coefficient ranged from 0.67 to 0.85, and concordance rates ranged from 95.42% to 97.92%). The accuracy of LM was slightly higher (average of 98.06%) than that of WSI (averages of 96.81% and 97.78%). The majority of misdiagnoses were false negative diagnoses due to the following top three causes: few cancer cells, confusing cancer cells with histiocytes, and confusing cancer cells with lymphocytes. This study is the first to address the feasibility of WSI in touch imprint cytology. The use of WSI for intraoperative touch imprint cytological diagnosis of SLNs is a practical option when experienced staff are not available on-site.

Evaluation of axillary lymph nodes in breast cancer patients with clinically negative axilla using contrast enhanced ultrasonography

Contrast enhanced ultrasonography enables dynamic evaluation of the microvasculature down to the capillaries when using high resolution ultrasound probes. It’s application in the evaluation of axillary lymph nodes in breast cancer patients with clinically negative axilla has been studied in 42 patients. The results of pre operative CEUS evaluation was correlated with histopathology status of axillary nodes after the harvesting of nodes during modified radical mastectomy or sentinel node biopsy. Heterogeneous enhancement with micro bubbles of the axillary nodes was found to be the most distinguishing criteria for malignant nodes.

Incidental dose distribution to contralateral internal mammary nodes in breast cancer patients undergoing adjuvant radiotherapy

Background and purposeIn a relevant number of primary breast cancer patients, lymphatic drainage to the contralateral internal mammary nodes (cIMN) is being observed. Nevertheless, so far lymphatic drainage pathway to the cIMN is largely neglected during adjuvant radiotherapy. Materials and methodsThis study evaluated the incidental dose to the cIMN for 120 volumetric modulated arc therapy (VMAT) treatment plans for node positive breast in dependence of internal mammary node irradiation (IMNI) and deep inspiration breath hold (DIBH). Additionally, incidental dose distribution to the cIMN based on the field design in the MA20, EORTC22922/10925 and AMAROS trials was assessed. ResultsThe incidental dose (Dmean ± SD) to the cIMN-CTV was 13.0 (±4.7) Gy with a maximum dose of < 30 Gy in 113/120 cases. If IMNI was included (n = 80), the Dmean to the cIMN-CTV was significantly higher compared to no IMNI, but still comparably low (n = 40; 14.3 Gy vs. 9.6 Gy; p = 0.0001). Furthermore, the dose in the cIMN during free breathing (n = 80) was higher compared to DIBH (n = 40; 13.9 Gy vs. 11.2 Gy; p = 0.002).Simulated treatment plans based on the randomized RNI trials revealed neglectable dose coverage of the cIMN (Dmean 1.0–1.8 Gy) for all protocols. ConclusionNeither in the randomized RNI trials nor during contemporary treatment techniques clinically relevant dose distribution to the cIMN was observed. Further studies are warranted to assess the potential impact of intended irradiation of cIMN in high-risk patients.

Abstract PO2-07-12: Analysis Of Malignity Rates Of Percutaneous Biopsy In Lymph Nodes Of Breast Cancer Patients

Abstract BACKGROUND: The evaluation of regional lymph nodes in patients with breast cancer is one of the main predictive and prognostic factors for treatment. The methods of percutaneous biopsies of suspicious lymph nodes frequently used are fine-needle aspiration cytology (FNA) and core needle biopsy (CORE). According to the international literature, CORE and FNA are considered diagnostic methods with high specificity (98% vs. 99%), however, the FNA may present up to 21% of inconclusive results by insufficient material. Although CORE is well established as a percutaneous method for diagnostic evaluation of suspected breast lesions, the literature is scarce on the use of this technique for the evaluation of suspicious lymph nodes in breast cancer patients. OBJECTIVE: Analyze the positivity of FNA and CORE performed in suspicious lymph nodes for breast cancer metastasis according to the anatomical location of biopsies and the type of needle used, verifying which technique was preferred. METHODS: A retrospective study was conducted by evaluating the database of patients treated in a public hospital in São Paulo, Brazil. Women submitted to ultrasound-guided percutaneous biopsy of lymph nodes from May 2015 to November 2019 were included in the study. The data were analyzed using IBM-SPSS version 27 and Microsoft EXCEL version 2010. RESULTS: A total of 499 biopsies were performed and the mean age of the women was 54.2 years (SD± 11.9) in the CORE group and 53.4 years (SD± 11.8) in the FNA group (p=0.619). According to the anatomical location, 385 were axillary (77.2%), 62 supraclavicular (12.4%), 48 cervical (9.6%) and 4 infraclavicular (0.8%). Regarding the type of needle, 393 were CORE (78.8%) and 106 were FNA (21.2%). When analyzing the results of the FNA, 38 (35.8%) did not present enough material, 31 (29.2%) were positive, 32 (30.2%) were negative and 5 (4.8%) showed atypical cells. Among the 393 CORE performed, 255 (64.9%) were positive, 132 (33.6%) were negative, 1 (0.3%) showed atypical cells and 5 (1.3%) had no representative material. No complications were reported after the procedures. CONCLUSION: CORE was the preferred diagnostic technique in our center, being considered a feasible procedure to evaluate lymph nodes in different sites and with low rates of inconclusive results by insufficient material. In the future, studies evaluating indirect costs may confirm the feasibility of CORE in patients with suspicious lymph nodes in terms of obtaining greater agility and resolutive conducts in the public healthcare system. Citation Format: Marina Diogenes, Andressa Amorim, ANDRE MATTAR, MARCELO ANTONINI, Luiz Henrique Gebrim, REGINALDO COELHO LOPES, Luciana Damous. Analysis Of Malignity Rates Of Percutaneous Biopsy In Lymph Nodes Of Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-07-12.

Accuracy of positron emission tomography-computed tomography in the assessment of metabolically negative axillary lymph nodes in breast cancer

Background Breast cancer is a significant public health concern, and early detection of breast lesions is crucial for improved patient outcomes. Accurate assessment of axillary lymph node involvement in breast cancer is vital for staging and treatment decisions. The purpose of this study was to assess to what extent positron emission tomography (PET)-computed tomography (CT) can be used in the assessment of negative axillary lymph nodes in breast cancer and to determine if pathological variability can affect the result of the PET-CT. Patients and methods This prospective study was carried out on 50 female patients with locally advanced breast cancer and with negative PET-CT scans for active axillary lymph nodes. All studied cases underwent postoperative pathological examination to be compared with preoperative PET-CT results. Results Of the studied cases, 84% showed negative axillary lymph node involvement. PET/CT exhibited high sensitivity (95.24%) and specificity (87.5%) in predicting positive nodes, with an axillary maximum standardized uptake value cutoff value of 4.22 (area under the curve=0.923). Logistic regression revealed a significant association between higher T stage and positive lymph nodes (P&lt;0.05). Conclusion PET/CT demonstrates strong predictive accuracy in detecting metabolically negative axillary lymph nodes in breast cancer patients.

200 (PB-107) Poster - The INFLUENCE II study: identification of sentinel lymph nodes in breast cancer patients through non-invasively fluorescent imaging using indocyanine green: an international multicentre implementation study protocol

200 (PB-107) Poster - The INFLUENCE II study: identification of sentinel lymph nodes in breast cancer patients through non-invasively fluorescent imaging using indocyanine green: an international multicentre implementation study protocol

Evaluation of HER2/neu Expression in Metastatic Axillary Lymph Node Tissue of Breast Cancer Patients Using [99mTc]Tc-(HE)3-G3.

Anatomic visualization and molecular typing of metastatic regional lymph nodes in breast cancer patients are a serious clinical challenge in modern oncology. According to the results of previous studies, [99mTc]Tc-(HE)3-G3 has proven to be a promising diagnostic agent in differentiating the HER2/neu receptor status in primary breast tumors (p < 0.05, Mann-Whitney test). In this regard, the purpose of this study is to explore the possibilities of using [99mTc]Tc-(HE)3-G3 to determine the HER2/neu receptor status in the metastatic axillary lymph nodes (mALNs) of breast cancer patients. The study was conducted using clinical material from 20 breast cancer patients (T2-4N1-3M0-1) before systemic therapy (10 patients with positive and 10 patients with negative HER2/neu expression in mALNs) who underwent SPECT/CT scan 4 h after the administration of [99mTc]Tc-(HE)3-G3. Morphological and immunohistochemical studies of mALNs with assessment of the HER2/neu status were performed on all patients. We found that mALN-to-background and mALN-to-latissimus dorsi muscle ratios for [99mTc]Tc-(HE)3-G3 uptake 4 h after its administration may be used for typing of the HER2/neu status in mALNs of breast cancer patients (p < 0.05, Mann-Whitney test). In that case, sensitivity and specificity for the mALN-to-background ratio were identical at 80%, with the threshold value being > 12.25.

Sonographic Characteristics of Enlarged Axillary Lymph Node in Breast Cancer

Background: Breast cancer, the most prevalent cancer in women globally, presents unique challenges in Pakistan, particularly due to the younger average age of diagnosis compared to Western countries. Accurate assessment of axillary lymph nodes using ultrasound (US) is essential for effective breast cancer staging and prognosis. Objective: This study aimed to evaluate the sonographic characteristics of axillary lymph nodes in breast cancer patients in Pakistan and to assess the diagnostic efficacy of ultrasound in differentiating between benign and malignant lymph nodes. Methods: Conducted at Shalamar Hospital, Lahore, this cross-sectional study spanned four months and included 150 breast cancer patients aged 45-70 years, selected through convenient sampling. Ultrasound examinations were performed using a GE Ultrasound Machine Evolsion E7 with a linear probe (7.5-12Hz). Key sonographic parameters, including the shape, size (length and width), and echogenicity of lymph nodes, were meticulously recorded and analyzed by using SPSS 24.0. Results: The average length and width of lymph nodes were 5.86 mm (SD = 1.35) and 3.90 mm (SD = 0.77), respectively. A significant proportion of lymph nodes (74.2%) presented with a round shape in patients experiencing pain, and a predominance of hyperechoic nodes was noted, diverging from established literature that often associates hypoechoic nodes with malignancy. Additionally, an irregular shape was identified as a potential predictive marker for axillary lymph node metastasis. Conclusion: This study highlights the efficacy of axillary sonography in diagnosing axillary metastasis in breast cancer, showing moderate sensitivity and substantial specificity. It also identifies a notable association between older age and the likelihood of axillary lymph node metastasis, especially in women in their forties.

Immune checkpoint status and exhaustion-related phenotypes of CD8+ T cells from the tumor-draining regional lymph nodes in breast cancer.

Functional status of T cells determines the responsiveness of cancer patients to immunotherapeutic interventions. Even though T cell-mediated immunity is inaugurated in the tumor-adjacent lymph nodes, peripheral blood has been routinely sampled for testing the immunological assays. The purpose of this study is to determine the immune checkpoint molecule expression and the exhaustion-related phenotype of cytotoxic T cells in the regional lymph nodes from breast cancer patients. Multicolor immunophenotyping was used to determine the expression of PD-1, TIM-3, LAG3, CTLA-4, CCR7, CD45RO, CD127, CD25, CXCR5, and ICOS molecules on CD3+ CD4- CD56- CD8+ cytotoxic T cells freshly obtained from the lymph nodes and the peripheral blood samples of the breast cancer patients. The results were assessed together with the clinical data. A population of cytotoxic T cells was noted with high PD-1 and CXCR5 expression in the lymph nodes of the breast cancer patients. Co-expression of PD-1, CXCR5, TIM-3, and ICOS indicated a follicular helper T cell (Tfh)-like, exhaustion-related immunophenotype in these cytotoxic T cells. Only a minor population with CTLA-4 and LAG3 expression was noted. The PD-1+ CXCR5+ cytotoxic T cells largely displayed CD45RO+ CCR7+ central memory markers. The amount of CXCR5-expressing PD-1- cytotoxic T cells was elevated in the lymph nodes of the patients. The regional lymph nodes of breast cancer patients harbor Tfh-like exhausted cytotoxic T lymphocytes with high PD-1 and TIM-3 checkpoint molecule expression. The immunological conditions in the regional lymph nodes should be implicated for immune checkpoint immunotherapy (ICI) of cancer.

Nonmetastatic Axillary Lymph Nodes Have Distinct Morphology and Immunophenotype in Obese Patients with Breast Cancer at Risk for Metastasis

Obese breast cancer patients have worse outcomes than their normal weight counterparts, with a 50% to 80% increased rate of axillary nodal metastasis. Recent studies suggest a link between increased lymph node adipose tissue and breast cancer nodal metastasis. Further investigation into potential mechanisms underlying this link may reveal potential prognostic utility of fat-enlarged lymph nodes in breast cancer patients. This study uses a deep learning model to identify morphological differences in non-metastatic axillary nodes between obese, node-positive and node-negative breast cancer patients. The model was developed using nested cross-validation on 180 cases and achieved an AUC of 0.67 in differentiating patients using hematoxylin and eosin stained whole-slide images. The top predictive patches from the slides according to the model were reviewed by a pathologist and their morphological differences were quantified. This analysis showed an increased average adipocyte size (p-value=0.004), increased white space between lymphocytes (p-value<0.0001), and increased red blood cells (p-value<0.001) in non-metastatic lymph nodes of node-positive patients. Preliminary immunohistochemistry analysis on a subset of 30 patients showed a trend of decreased CD3 expression and increased leptin expression in fat-replaced axillary lymph nodes of obese, node-positive patients. These findings suggest a novel direction to further investigate the interaction between lymph node adiposity, lymphatic dysfunction, and breast cancer nodal metastases, highlighting a possible prognostic tool for obese breast cancer patients.

Multiparametric magnetic resonance imaging in the assessment of pathological axillary lymph nodes in cases of breast cancer

BackgroundBreast cancer is the most frequent cancer affecting females. It represents leading cause of death from all cancers in females. Traditionally, axillary staging was surgically assessed by axillary lymph node dissection (ALND), which is associated with complications. Sentinel lymph node biopsy (SLNB) is a minimally invasive surgical method for axillary staging in patients with primary breast cancer with lower morbidity and better quality of life. Clinical examination of the axilla is usually associated with a high false negative rate, so role of imaging is crucial to identify lymph nodes with or without suspicious features, to predict the pathological state of the lymph nodes and to direct the diagnostic and therapeutic process toward SLNB, ALND, or chemotherapy. Aim of this study was to assess axillary lymph nodes in breast cancer patients by magnetic resonance imaging and functional MRI preoperatively to determine its nature and eliminate invasive procedures as invasive dissection used in diagnosis.ResultsLymph node size cannot significantly predict malignant infiltration with p value 0.425, using cut-off value of 21.5 mm, with a sensitivity of 14.6% and specificity of 100%. Cortical thickness of lymph nodes can significantly predict malignant infiltration with p value 0.006, using cut-off value of 4.5 mm, with a sensitivity of 68.8%, specificity of 62.5%, and diagnostic accuracy of 64.1%. ADC can significantly predict lymph node infiltration with p value 0.011, using a cut-off value of 0.99, with sensitivity of 43.85, specificity of 100%, diagnostic accuracy of 57.8%, and AUC of 71.4%. There was a statistically significant correlation between pathological findings and DCE-MRI curve type III with p value 0.0001, showing a sensitivity of 37.5%, specificity of 100%, and diagnostic accuracy of 84.4% for detection of malignant lymph nodes.ConclusionsCortical thickness and effaced fatty hilum of lymph nodes can significantly predict malignant infiltration, while lymph node size cannot significantly predict malignant infiltration. Diffusion weighted images and ADC maps can be of significant value in predicting metastatic lymph nodes with approximate ADC cut-off value of 0.99. Kinetic MRI features of the axillary lymph nodes are not reliable enough to be used alone in the clinical management of breast cancer patients.

A Nomogram to Predict Pathological Axillary Status in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

This study aimed to identify factors influencing axillary pathological complete response (pCR) and to develop a predictive nomogram to evaluate axillary pCR rate in breast cancer patients treated with neoadjuvant chemotherapy (NAC). A total of 2368 patients who received NAC and mastectomy between 2000 and 2014 from 12 grade A tertiary hospitals in China were analyzed retrospectively. The patients treated in three cancer hospitals (training set, n = 1629) were used to construct the nomogram based on multivariate logistic regression analyses. The nomograph was validated by the area under the receiver operating characteristic curve (AUC) and calibration curve in patients from 9 other general hospitals (validation set, n = 739). The nomogram incorporated seven predicting factors including NACT cycles, response to NACT, clinical T stage, clinical N stage, grade, LVI, and molecular subtype. The AUC for the training set and validation set were 0.762 and 0.802, respectively. In addition, the calibration curve also showed good agreement between the nomogram-based predictions and the actual observations. A nomogram was established to predict the status of axillary lymph nodes in breast cancer patients after NAC. The predictive model performed well both in the training set and external validation set.

Role of Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) of Main Tumor in Breast Cancer in Prediction of Occult Axillary Lymph Node Metastasis

Background In breast cancer, the axillary lymph node (ALN) status has been well established to be a significant prognostic factor and essential for treatment decisions that consider systemic and locoregional approaches. Axillary lymph node dissection (ALND) was performed to examine pathologic information regarding axillary lymph node during breast surgery (e.g. breast conserving surgery or mastectomy), which may cause critical complications such as lymphedema, pain, and movement restriction. Aim of the Work To assess the clinical significance of total lesion glycolysis (TLG) and metabolic tumor volume (MTV) of primary breast cancer using 18F-FDG PET/CT. To predict positive axillary lymph node metastasis in clinically negative axillary lymph nodes in breast cancer patients. Methods Between November 2020 and May 2021, The study was carried out on 40 female breast cancer patients with clinically negative axillary lymph nodes who had undergone surgical resection of the primary breast tumor followed by sentinel lymph node biopsy only or axillary lymph node dissection along with sentinel lymph node biopsy. Results We found that, 10 (25.0%) of total 40 patients were proven to have ALN metastasis based on the final pathology. A primary breast tumor with TLG &amp;gt; 6.2 &amp;MTV &amp;gt; 4 was associated with a significantly higher prevalence of ALN metastasis than tumors with TLG ≤ 6.2&amp; MTV ≤ 4. Conclusion We suggest that the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary breast tumor were independent predictive factors for ALN metastasis. Since the incidence of pathologic ALN metastasis in breast cancer with cN-ALN is not negligible, volume-based PET/CT parameters of primary breast tumors upon preoperative workup may be potentially helpful to enhance the negative predictive value for occult ALN metastasis and to determine patient selection for surgical procedures.

Evaluation of the diagnostic accuracy of preoperative ultrasound for axillary lymph nodes in breast cancer patients

Background Breast cancer is the most prevalent cancer and the second leading cause of death among women is breast cancer. The likelihood of survival rises with early breast cancer diagnosis, which lowers death rates. For the treatment of breast cancer, axillary lymph nodes (ALNs) must be correctly staged and managed. The main goals of ALNs staging are to gather prognostic data and information that might influence management decisions. Objective To evaluate the accuracy of the preoperative ultrasound in detection of malignant ALNs in breast cancer patients. Methods The records of breast cancer patients at the breast surgery unit of Kasr Alainy Hospital, between 2017 and 2020, were reviewed. Patients with an axillary ultrasound report who underwent a sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) were enrolled in the present study. Demographic and clinicopathologic characteristics including age, family history, body mass index (BMI), primary tumor size, histological and biological grade, Lymphovascular invasion (LVI), extracapsular invasion (ECE), were evaluated. Results Out of the 348 Breast Cancer patients who were managed in our department, the age range was 28–89 years (median age 52 years). The histopathology results of the tumor were 96% with invasive duct carcinoma (IDC) 2.3% invasive lobular carcinoma (ILC) and 1.7% were mixed ductal/lobular. Cortical thickness greater than 3 mm had a significant difference for positive nodal status, effacement of hilum had a sensitivity 56.2% in detecting positive lymph nodes (LNs), round LNs shape had a sensitivity of 82.3% in detecting true positive LNs. Pathological LNs by ultrasound had a sensitivity of 93% and specificity of 77% in detecting true positive LNS, BMI was not significant in ultrasound detection of pathological LNs. Conclusion The data shows that axillary ultrasound by its assessment has revealed to be useful in detection of malignant LNs with a sensitivity of 93.1% and specificity 77% in detecting true malignant LNs.

Breast cancer associated CD169+ macrophages possess broad immunosuppressive functions but enhance antibody secretion by activated B cells.

CD169+ resident macrophages in lymph nodes of breast cancer patients are for unknown reasons associated with a beneficial prognosis. This contrasts CD169+ macrophages present in primary breast tumors (CD169+ TAMs), that correlate with a worse prognosis. We recently showed that these CD169+ TAMs were associated with tertiary lymphoid structures (TLSs) and Tregs in breast cancer. Here, we show that CD169+ TAMs can be monocyte-derived and express a unique mediator profile characterized by type I IFNs, CXCL10, PGE2 and inhibitory co-receptor expression pattern. The CD169+ monocyte-derived macrophages (CD169+ Mo-M) possessed an immunosuppressive function in vitro inhibiting NK, T and B cell proliferation, but enhanced antibody and IL6 secretion in activated B cells. Our findings indicate that CD169+ Mo-M in the primary breast tumor microenvironment are linked to both immunosuppression and TLS functions, with implications for future targeted Mo-M therapy.

Axillary Lymph Nodes in Breast Cancer Patients After COVID-19 Vaccine.

One of the side effects of vaccines used to end the COVID-19 epidemic is non-specifically enlarged axillary lymph nodes. Such lymphadenopathy detected during clinical examination of breast cancer patients may require additional imaging or interventional procedures that should not normally be performed. This study has been designed to estimate the incidence of palpable enlarged axillary lymph node in breast cancer patients who had received COVID-19 vaccination in the past 3months in the same arm as compared to those without vaccination. Breast cancer patients admitted to M.U. Medical Faculty Breast polyclinic between January 2021 and March 2022 were screened, and clinical staging was performed after thorough clinical examination. Among these patients with suspected enlarged axillary lymph node and those undergoing sentinel lymph node biopsy (SLNB), they were divided into two groups as vaccinated and unvaccinated. Age, menopausal status, tumor size, tumor location, surgery, pathology results, hormonal receptor status, and SLNB results were statistically compared with groups. There was no significant difference between groups in terms of age, menopause, tumor size, tumor location, surgery, pathological results, and hormone receptor status. The SLNB being reported as reactive only was 89.1% in the vaccinated group and 73.2% in the non-vaccinated group which was statistically significant different. Reactive lymph nodes were commonly found with an excess of 16% in patients who had received COVID-19 vaccination in the past 3months. This required caution and additional examination of the axillary lymph nodes in this period.

Detection of Sentinel Lymph Nodes During Breast Cancer Surgery: A Literature Overview

Introduction. Detecting metastases is an important part of successful breast cancer treatment. Usually, the tumor tissue first spreads to the sentinel lymph nodes. Removal of the latter during surgery and histological examination allows to assess the patient’s di­sease stage, prognosis and treatment. The literature provides more than one approach or a combination of them, allowing us to accurately identify the breast’s sentinel lymph nodes and avoid removing all axillary lymph nodes. Purpose. To review the methods of intraoperative detection of breast sentinel lymph nodes presented in the literature. Research material and methods. Publications were searched using the specialized information search system Google Scholar. Keywords used in the search: breast sentinel lymph nodes, intraoperative detection. After evaluating the exclusion criteria, the review was based on 25 scientific publications. Results. 4 individual measures and 2 combinations of them can be used to detect sentinel breast lymph nodes during surgery. The materials used can be injected in 6 different ways. Conclusions. The combination of technetium-99m radiocolloid and methylene blue can be evaluated as the best method for intraoperative detection of sentinel lymph nodes in breast cancer patients. On the other hand, due to radiation and operating costs, more attention is being paid to the use of indocyanine green, superparamagnetic iron oxide, methylene blue dye, and the detection of metastases without surgery. Superficial methods of injecting the substance should be combined with deep ones due to the possibility of detecting extra-axillary sentinel lymph nodes of the breast. Ultimately, all decisions must be made on a case-by-case basis.

Ultrasonographic signs as predictors of metastatic involvement in the axillary lymph nodes in breast cancer patients: from minimal changes to the appearance of the pathological lymph node. A retrospective analysis.

The aim of this study was to retrospectively analyse the ultrasound findings in the axillary lymph nodes in breast cancer patients with morphological changes that required biopsy. In most cases the morphological changes were minimal. Between January 2014 and September 2019 examination of axillary lymph nodes with subsequent core-biopsy was performed in 185 breast cancer patients at the Department of Radiology. Lymph node metastases were detected in 145 cases, while in the remaining 40 cases benign changes or normal lymph node (LN) histology was observed. Ultrasound morphological characteristics and the sensitivity and specificity were evaluated retrospectively. Seven ultrasound characteristics were evaluated - diffuse cortical thickening, focal cortical thickening, absence of the hilum, cortical non-homogeneities, L/T ratio (longitudinal to transverse axis), type of vascularization and perinodal oedema. It is a diagnostic challenge to recognize metastases in the lymph nodes with minimal morphological changes. The most specific signs are non-homogeneities in the cortex of the lymph node as well as the absence of fat hilum and perinodal oedema. Metastases are significantly more frequent in LNs with a lower L/T ratio, in LNs with perinodal oedema and with a peripheral type of vascularization. Biopsy of these lymph nodes is necessary to confirm or exclude metastases, especially if it affects the type of treatment.

Abstract OT1-06-01: Preservation of axillary lymph nodes in breast cancer patients undergoing mastectomy with 1-2 metastatic sentinel lymph nodes: The current status and future perspectives of the multicenter randomized clinical trial SINODAR-ONE

Abstract Introduction: Axillary lymph node dissection (ALND) has always been part of breast cancer (BC) treatment. However, during the past 25 years, the surgical management of the axilla has shifted towards a more conservative approach. Until now, ALND has remained the standard surgical technique when the sentinel lymph node (SLN) is macrometastatic. However, ALND may now be considered overtreatment for early-stage BC. The SINODAR-ONE trial is a prospective non-inferiority multicenter randomized study aimed at assessing the role of ALND in patients undergoing either breast-conserving surgery (BCS) or mastectomy for T1-2 BC presenting 1-2 macrometastatic SLNs. Objectives: The primary endpoint was to evaluate whether sentinel lymph node biopsy (SLNB) only was associated with clinically relevant worsening of the prognosis compared with ALND in terms of overall survival (OS). The secondary endpoint was to evaluate whether there was increased regional (lymph node recurrence) or distant recurrence in terms of recurrence-free survival (RFS) in patients with macrometastatic SLN who did not undergo ALND. Methods: Patients were randomly assigned (1:1 ratio) to either removal of ≥10 axillary level I/II non-SLNs followed by adjuvant therapy (standard arm) or no further axillary treatment (experimental arm). Results: The trial started in April 2015 and ceased in April 2020, involving 889 patients. The majority of the patients (75.2%) underwent BCS; 328 of 439 patients (74.7%) in the standard treatment arm, and 333 of 440 patients (75.7%) in the experimental treatment arm. 218 patients (24.8%) underwent mastectomy. SLN status at randomization was comparable between the two groups of treatment, with a median number of two SLNs removed and a median number of one positive SLN in both arms. The median number of non-SLNs identified at definitive histopathological evaluation was 16 (interquartile range [IQR] 12–21) in the ALND group. Overall, 193 of 439 patients (44.0%) in the standard treatment arm had additional macrometastases in the removed axillary lymph nodes. However, the median number of positive non SLNs was 0 (IQR 0–1) in the ALND group. Median follow-up was 34.0 months. There were eight deaths (ALND, 4; SNLB only, 4), with a 5-year cumulative mortality of 5.8% and 2.1% in the standard and experimental arm, respectively (p = 0.984). There were 26 recurrences (ALND 11; SNLB only, 15), with a 5-year cumulative incidence of recurrence of 6.9% and 3.3% in the standard and experimental arm, respectively (p = 0.444). Only one axillary lymph node recurrence was observed in each arm. The 5-year OS rates were 98.9% and 98.8%, in the ALND and SNLB only arm, respectively (p = 0.936). Conclusion: The 3-year survival and relapse rates of T1-2 BC patients with 1-2 macrometastatic SLNs treated with SLNB only, and adjuvant therapy, were not inferior to those of patients treated with ALND. These results do not support the use of routine ALND in patients undergoing BCS. However, given the low number of patients treated with mastectomy, there is no certainty that ALND omission can be extended also to this sub-group. In order to collect further evidence regarding the safety of the experimental treatment in patients candidates for mastectomy, the reopening of the enrollment of these patients as part of a single-arm experimental study started in June 2022. Citation Format: Damiano Gentile, Wolfgang Gatzemeier, Andrea Sagona, Erika Barbieri, Alberto Testori, Valentina Errico, Alberto Bottini, Simone Di Maria Grimaldi, Giulia Caraceni, Luca Boni, Paolo Bruzzi, Bethania Fernandes, Davide Franceschini, Ruggero Spoto, Rosalba Torrisi, Marta Scorsetti, Armando Santoro, Giuseppe Canavese, Corrado Tinterri. Preservation of axillary lymph nodes in breast cancer patients undergoing mastectomy with 1-2 metastatic sentinel lymph nodes: The current status and future perspectives of the multicenter randomized clinical trial SINODAR-ONE [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 OT1-06-01.