Underwent Sentinel Lymph Node Biopsy Research Articles

Abstract PO2-22-05: A prospective phase I-II study of hypofractionated accelerated breast and nodal intensity modulated radiation therapy delivered in the prone position

Abstract Background In patients with breast cancer, prone radiotherapy (RT) has been shown to reduce heart and lung dose. Routinely used for whole breast (WB) RT, its use to treat regional lymph nodes (LNs) is not widespread. Methods In this phase I-II study (NCT02308488) patients treated with lumpectomy or mastectomy with 1-5 pathologically involved LNs underwent WBRT or post-mastectomy RT plus regional nodal RT using IMRT to the supraclavicular and level III axillary LNs. The prescription was 40.5Gy in 15 daily 2.7Gy fractions with a daily concomitant 0.5Gy tumor bed boost. Patients who underwent sentinel LN biopsy (SLNB) alone (no axillary dissection) had the level I-II axilla included in the RT field. The primary endpoints were incidence of >grade 2 acute toxicity per CTCAE v 3.0 and dosimetric feasibility. The secondary endpoint was late toxicity. Clinical outcomes were local recurrence (LR), disease free survival (DFS), distant recurrence free survival (DRFS) and overall survival (OS). Coverage constraints included planning target volume [PTV] V48Gy ≥ 98%, PTV breast V40.5Gy ≥ 95% and PTV nodes V38.5Gy ≥ 95%. Normal tissue constraints included heart V5Gy < 5%, ipsilateral lung V10Gy < 20%, contralateral lung V5Gy < 15%, ipsilateral brachial plexus (BP) maximal dose (Dmax) < 42Gy, spinal cord Dmax ≤ 3 7.5Gy, thyroid contralateral lobe Dmax ≤ 15Gy, esophagus V30Gy < 50% and Dmax ≤ 40.5Gy. Results From 2011-2016, 97 patients with stage IB-IIA breast cancer were enrolled. 66 underwent lumpectomy and 31 underwent mastectomy. 16 had SLNB alone. There were no grade 3 acute toxicities meeting the primary toxicity endpoint. Common acute low-grade toxicities included fatigue (grade 1: 65 [66.3%]; grade 2: 7 [7.1%]), esophagitis (grade 1: 7 [7.1%]; grade 2: 10 [10.2%]), dermatitis (grade 1: 82 [83.7%]; grade 2: 7 [7.1%]). At median and maximum follow up of 8.02 (IQR: 3.31) and 13.3 years, respectively, there were 2 LRs (2.1%). 8-year DRFS, DFS and OS were 88.1% (95% CI 81.3%, 95.4%), 85.7% (95% CI 78.4%, 94.6%) and 90.5% (95% CI 84%, 97.6%), respectively. Clinician-rated cosmesis (n=64) was excellent/good in 67.2% of cases and fair/poor in 6.3%. Patient- rated cosmesis (n=47) was excellent/good in 91.5% and fair/poor in 8.5%, with patients rating themselves more favorably than their physicians (p=0.0014). The incidence of maximum grade 1, 2 and 3 late toxicities were 49 (62.8%), 15 (19.2%), and 3 (3.8%), respectively. This included 2 grade 3 asymmetries,1 grade 3 pigmentation change, and 1 grade 2 pneumonitis. There was no brachial plexopathy. Among the 28 patients who underwent reconstruction, 17 were implant-based and 11 were autologous. Of the implant-based, 9 underwent RT to the tissue expander and 8 to the permanent implant. 11/28 patients had long-term plastic surgery follow up. There were 3 hospitalizations with reoperation post-RT (1 unplanned revision, 1 implant removal for threatened exposure, and 1 excision of fat necrosis). There was 1 incident of wound infection/cellulitis. With regard to dosimetric constraints, 54.3% of plans (95% CI 43.6%, 64.8%) met all constraints. 92% (95% CI 83%, 97%), 98% (95% CI 93%, 100%) and 89% (95% CI 80%, 94%) met the PTV tumor V48Gy, PTV breast V40.5Gy, and PTV nodes V38.5Gy coverage constraints, respectively. Heart, contralateral lung, spinal cord, and esophagus constraints were met by all patients. 95% (95% CI 88.6%, 98.4%) met the ipsilateral lung V10Gy and 99% (95% CI 94%, 100%) met the thyroid contralateral lobe constraint. The BP constraint was met in 73% (95% CI 63.0%, 81.0%) of plans with a mean increase of 1.61 Gy (SD 1.96 Gy) over target. Conclusion Toxicity was low and outcomes were excellent in this prospective trial of hypofractionated regional nodal RT in the prone position. Dosimetric constraints were only met in 54% of plans with the nodal coverage and the BP constraint as the most frequently unmet. These constraints may need to be modified and/or techniques refined to optimize hypofractionated prone nodal RT. Citation Format: Juhi Purswani, Olivier Maisonet, Julie Xiao, Jose R Teruel, Christine Hitchen, Xiaochun Li, Judith D. Goldberg, Carmen A. Perez, Silvia C. Formenti, Naamit K. Gerber. A prospective phase I-II study of hypofractionated accelerated breast and nodal intensity modulated radiation therapy delivered in the prone position [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 PO2-22-05.

Abstract PO1-01-07: Cryoablation and endocrine therapy for clinical stage I/II, ER+ breast cancer in patients with omission of surgical axillary staging. A retrospective study

Abstract OBJECTIVE To evaluate the efficacy of combined treatment with ultrasound-guided cryoablation and endocrine therapy (ET) in hormone receptor-positive (ER+), HER2-negative (HER-) invasive breast cancer (BC) patients with clinical stage I/II who are not candidates for axillary surgery. PATIENTS AND METHODS Patients with ER+, HER- invasive BC in clinical stage I/II who did not undergo sentinel lymph node biopsy (SLNB) or target axillary dissection (TAD) were included. They received treatment consisting of ultrasound-guided cryoablation combined with daily letrozole 2.5 mg orally. Cryoablation was performed as the initial treatment for BC < 15mm, followed by adjuvant ET, while neoadjuvant ET was administered for 6-12 months before cryoablation for BC ≥ 15mm. Cryoablation was performed using the ICEfx Galil argon gas system (Boston Scientific, USA) and the ProSense liquid nitrogen system (IceCure Medical Ltd, Caesarea, Israel). Follow-up breast ultrasound examinations were conducted every six months. Patients with a minimum follow-up of 12 months after cryoablation were included in the study. Core needle biopsies were performed if recurrence was suspected, and rescue cryoablation was considered for confirmed relapse. The tolerance and safety of the procedures were recorded. RESULTS From March 2019 to July 2023, a total of 96 patients with 105 ER+, HER2- invasive BC in clinical stage I/II who did not undergo SLNB or TAD were treated with ultrasound-guided cryoablation and ET. Among them, 58 patients (aged 58-96 years, mean 83, SD ±7.64) with 64 BC lesions (ranging from 5 to 60mm, mean 17, SD ±13.75) were followed up for a minimum of 12 months, with a mean follow-up period of 24 months (ranging from 12 to 50 months). The invasive carcinomas included 40 ductal, 16 lobular, 5 colloid, and 3 papillary cases. The ipsilateral breast tumor recurrence rate was 1,72% (1/58 patients). One patient with lobular carcinoma experienced a relapse at 17 months. Rescue cryoablation was performed, and after 25 months, she remains free of recurrence. Therefore, local control was achieved in all patients. Six patients died from causes unrelated to BC during the follow-up period. All procedures were well-tolerated with local anesthesia, and no serious complications were reported. CONCLUSION Ultrasound-guided cryoablation with ET constitutes an effective combined treatment for the local control of ER+, HER2- BC in patients with clinical stage I/II and omission for surgical axillary staging. Cryoablation is a very well tolerated procedure without morbidity. Citation Format: José María Oliver Goldaracena, Pilar Zamora, Covadonga Marti, Vicenta Córdoba Chicote, Maria José Roca Navarro, Diego Garrido Alonso, Ylenia Navarro Monforte, Teresa Diaz de Bustamante Durban, Fernando García Martínez, Jose Ignacio Sanchez-Mendez, Elisa York Pineda, Laura Yebenes Gregorio, Adolfo Loayza, Laura Frías Aldeguer, Elisa Moreno Palacios, Marcos Melendez Gisper, Joaquin Gomez Ramirez, Luis Asensio Gómez, Virginia Martínez Marín, David Hardisson Hernáez, Alberto Berjón García. Cryoablation and endocrine therapy for clinical stage I/II, ER+ breast cancer in patients with omission of surgical axillary staging. A retrospective study [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 PO1-01-07.

Abstract PO4-23-05: Magnetic lymphatic tracing for omission of sentinel lymph node biopsies in mastectomy patients: a community cancer center experience

Abstract Background Patients with ductal carcinoma in situ (DCIS) and patients undergoing risk reduction mastectomy traditionally undergo sentinel lymph node biopsy (SLNB) at the time of mastectomy to complete axillary staging were invasive malignancy to be identified on final pathology. About 10% of patients with DCIS undergoing mastectomy will have invasive disease on final pathology; thus, about 90% would be able to avoid SLNB. Standard lymphatic mapping for SLNB includes a combination of radioisotope and blue dye, which have a short half-life. Superparamagnetic tracers, such as Magtrace®, are non-inferior to this standard and remain active for several weeks, allowing many patients to avoid SLNB in the setting of mastectomy. Reducing SLNB may also reduce associated risks with SLNB such as hematoma, seroma, and subsequent lymphedema. Objective We hypothesized using Magtrace® would reduce the number of SLNB in patients undergoing mastectomy for DCIS or risk reduction. Consequently, this would reduce the number of SLNB-associated complications. We report a community cancer center experience with Magtrace® for omission of SLNB in select mastectomy patients. Methods This was a retrospective review of 52 female patients with DCIS or known genetic predisposition undergoing mastectomy. Magtrace® was injected ipsilateral to DCIS or bilateral for prophylactic mastectomy patients. Our primary outcome was rate of return to the OR for delayed SLNB. Secondary outcomes included post operative complications within 30 days of surgery and OR time. We compared outcomes to a control group of 28 women undergoing mastectomy for DCIS or risk reduction who underwent SLNB at their index operation. Continuous variables were reported using median and interquartile range (IQR) and were compared using the Mann-Whitney U-test. Categorical data were reported using frequency and percent; they were compared using Pearson’s Chi-Square or Fisher’s Exact test, as appropriate. Alpha was set to 0.05 to determine statistical significance. Results There were a total of 80 patients (52 Magtrace®, 28 control). Median age of Magtrace patients was 49.5 (IQR 40-60.75) vs. 54.5 (IQR 48-65) years for the controls. 57.7% of Magtrace® patients underwent mastectomy for DCIS vs. 89.3% in the control group. 8 Magtrace® patients (15.4%) had invasive ductal carcinoma on final pathology and 7 of those patients underwent SLNB and none were positive for metastatic disease. Of these, 6 patients underwent mastectomy for DCIS. Average number of sentinel lymph nodes was 1.57 in Magtrace® patients and 1.60 in the control patients. Rates of post operative complications were similar between the groups, including hematoma, seroma, surgical site infection, skin necrosis. OR times were also similar with median OR time 202 minutes (min) for the Magtrace® group vs. 195 min for the control group. Conclusion Use of Magtrace® avoided SLNB in 84.6% of our patients. We found no difference in rates of postoperative complications or operative times in patients using Magtrace® for omission of SLNB at time of mastectomy compared to the control group. Our findings suggest SLNB can be avoided in a majority of patients undergoing mastectomy for DCIS or risk reduction in the setting of genetic predisposition. Table. Citation Format: Mia Samaha, Barbara Wexelman, Anne Kurtizky, Kathleen Raque, Angie Fellner. Magnetic lymphatic tracing for omission of sentinel lymph node biopsies in mastectomy patients: a community cancer center experience [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 PO4-23-05.

Abstract PO3-12-07: Utility of Volumetric Measurement for Clinical Diagnosis of Breast Cancer-Related Lymphedema

Abstract Background: Early detection of Breast cancer-related lymphedema (BCRL) is crucial since it can significantly reduce the negative impact on a patient’s quality of life after breast cancer treatment. Several objective screening methods have been used in prior studies but have not proven accurate due to a lack of standardization. Bioimpedance spectroscopy (BIS), which assesses tissue resistance to an electric current and converts it into a score to measure interstitial fluid content, has proven to be an accurate tool in diagnosing lymphedema. SOZO® is a BIS device that generates quantitative results in real time and provides a Lymphedema Index (L-Dex) score by measuring the patient's extracellular fluid volume. However, there is a paucity of literature highlighting its clinical applicability. Thus, we aimed to evaluate the clinical utility of SOZO® in diagnosing BCRL in patients undergoing breast cancer surgery. Materials & Methods: A retrospective chart review was carried out of patients who underwent axillary surgery from January 2019 to December 2022. Demographic information such as age, body mass index (BMI), gender, ethnicity, disease pathology, cancer stage, type of axillary surgery, neoadjuvant and adjuvant treatment received was recorded. Patients undergoing sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) were assessed for their preoperative L-Dex score, and they were followed up postoperatively with repeated measurements of their L-Dex score to diagnose lymphedema for a year at 3 months intervals. Clinical lymphedema was defined as those having an absolute L-Dex score of more than +10 and an increase in L-Dex score by 6.5 from the baseline. SOZO® scores measured at each follow-up were compared to their preoperative baseline scores. Results: A total of 200 patients’ data was evaluated whose mean age and BMI were 57.5+10.9 years and 29.6+5.6 kg/m2, respectively. Eighty-five percent of the patients belonged to ethnic minority groups. Furthermore, 84.5% (n=169) of the patients had SLNB, and 15.5% (n=31) had ALND. All the patients included in the study had their preoperative and postoperative quarterly L-Dex scores recorded. Pre- and post-operative L-Dex scores had a mean of -0.20+6.6 and 0.61+6.8, respectively. A total of 20 (10%) patients developed lymphedema without symptoms detected by SOZO®, with 19 (9.5%) resolving at their respective 3-month follow-up and 1 (0.5%) patient with persistent lymphedema at the end of the 24-month follow-up. All 20 patients were treated with a compression sleeve. Of the 20 patients with lymphedema, 4 patients underwent ALND, whereas 16 patients had SLNB. When compared to their preoperative baseline scores, all patients' SOZO® measurements had an absolute score of more than 10 and an increase of 6.5 from their baseline score. Additionally, 21 other patients had an increase in score of 6.5 from their baseline measurements but did not meet the cut-off range of an absolute score of +10. Therefore, we excluded them from the diagnosis of BCRL, and none of these patients later developed any signs of BCRL, such as swelling, pain, or discomfort. Conclusion: SOZO® procedure can accurately detect BCRL. In our study, 1 patient developed clinical lymphedema after undergoing SLNB and was diagnosed using SOZO®. Additionally, 19 patients who were initially diagnosed with lymphedema were later categorized as transient due to the resolution of lymphedema on follow-up. Early identification of transient lymphedema using SOZO® resulted in the prevention of a potentially life-long debilitation in our patients. Moreover, our findings underscore that an increase in SOZO® score from the baseline by > 6.5 with an absolute score of more than +10 should be the threshold to clinically diagnose lymphedema. Future studies with larger sample sizes and longer follow-up duration are necessary to understand better the utility of SOZO® in diagnosing BCRL. Table 1: Baseline characteristics and follow-up data of the patients included in the study. Citation Format: Fardeen Bhimani, Sheldon Feldman, Yu Chen, Anjuli Gupta, Jessica Pastoriza, Areej Shihabi, Maureen McEvoy. Utility of Volumetric Measurement for Clinical Diagnosis of Breast Cancer-Related Lymphedema [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 PO3-12-07.

Abstract PO1-12-03: Quality of Life in Patients Diagnosed and Treated for Breast Cancer in Uruguay

Abstract Introduction: Breast cancer (BC) and its treatment can impair patient quality of life (QOL), and those undergoing more aggressive treatments may be more severely impacted. Objective: Assess the level of perception of the QOL of patients treated for BC at the Hospital de Clínicas and the Hospital Departamental de Soriano. Materials and Methods: A questionnaire for cancer patients (EORTC, QLQ-C30) and one specific for BC (EORTC QLQ-BR23) were used. Results: A total of 158 patients who had completed chemotherapy treatment at least one year prior to the evaluation were enrolled. The average age was 61 years old. QLQ-C30 questionnaire: the global QOL score (GQOL) was high: 70.9. Patients undergoing conservative surgery (CS) had better scores in physical and emotional functioning (p < 0.005) and presented less frequently with: pain, constipation and financial difficulties (p < 0.005). Those undergoing sentinel lymph node biopsy (SLNB) had higher scores for GQOL and for physical, role and social functioning scales (p < 0.001) and had less fatigue, pain, insomnia and financial difficulties (p < 0.005). Questionnaire QLQ-BR23: sexual functioning and sexual enjoyment scales were relatively low. Patients undergoing CS had better scores on the functional scales: body image and future outlook; and fewer breast symptoms (p < 0.005). Those undergoing SLNB also had better scores on the functional scales for body image and future outlook future and presented less frequently with symptoms (p < 0.005). Conclusion: Patients had high values on the GQOL scale, those undergoing CS and SLNB had better scores on most functional and problem/symptom scales. The implementation of intervention strategies aimed at improving the quality of life and the physical and emotional care of patients is recommended. Citation Format: Natalia Camejo, Dahiana Amarillo, Cecilia Castillo, Maria Guerrina, Florencia Savio, Mariana Carrasco, Noelia Strazzarino, Ana laura Hernandez, Guadalupe Herrera, Gabriel Krygier. Quality of Life in Patients Diagnosed and Treated for Breast Cancer in Uruguay [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 PO1-12-03.

Abstract PO2-17-10: Metaplastic breast cancer: description of 16 cases treated at a reference center and review of the literature

Abstract Background: Metaplastic breast carcinomas (MBC) are very rare and represent less than 1% of all invasive breast carcinomas. It is a heterogeneous neoplasm characterized by a mixture of adenocarcinoma with other histological elements such as squamous cells, spindle cells or other mesenchymal differentiation. Most MBC are hormone receptor and Her2 negative and tend to have a worse prognosis when compared to triple negative carcinomas. Clinically, they manifest as a rapidly growing palpable mass, without necessarily involving lymph nodes. According to the nomenclature of the WHO Classification of Tumors of the Breast (2012), tumors were classified into 4 variants: spindle cell, squamous cell, mesenchymal and mixed. Since publications on MBC are scarce in the literature, we studied the cases that were attended at Hospital Pérola Byington in the period 2010-2021. Methods: A retrospective study was carried out by reviewing the medical records of patients treated at the Reference Center for Women's Health - Pérola Byington Hospital, São Paulo, Brazil. Patients with breast cancer, with anatomopathological result confirming the diagnosis of metaplastic carcinoma were reviewed. Clinical data and histopathological characteristics were evaluated, as well as the type of treatment performed and the evolution. Results: A total of 16 female patients diagnosed with MBC were included. The median age was 56 years (ranging from 34 to 88). The mean initial size observed was 7 cm (ranging from 2 to 20 cm) and 94% of patients presented with a palpable mass. The initial clinical staging were I (12%), II (32%), III (50%) and IV (6%). The most common histological subtype was spindle cell (50%), of which 2 were squamous (12%), 3 mesenchymal (20%), 1 mixed spindle/squamous (6%) and 2 were not classified. Regarding immunohistochemistry, 14 patients (88%) had hormone negative and Her2 negative (triple negative). Of the 16 cases, 8 underwent mastectomy and 6 partial mastectomiy and 2 patients did not undergo surgical treatment because they died despite treatment with neoadjuvant chemotherapy. All operated patients underwent sentinel lymph node biopsy or axillary dissection and 85% of them did not have axillary lymph node involvement. Radiotherapy was indicated in 13 patients. Chemotherapy was performed in 10 patients, 6 of which were neoadjuvant (since the tumors were not resectable) and 4 received adjuvant chemotherapy. Of the 6 patients that underwent neoadjuvant chemotherapy, 2 had disease progression, 3 partial response and 1 complete pathological response. During follow-up, 4 (25%) evolved with locoregional recurrence and 5 (31%) with metastatic disease. Of these women, 44% (7) are still alive. We also found that 6 of the 16 cases (37%) did not receive a diagnosis of MBC in the initial biopsy, requiring revision, a new biopsy or study of the surgical specimen for confirmation. Conclusion: As verified in the literature, MBC is a very rare histological type and corresponded to 0.2% of all cases of breast cancer in the period described above. Most patients have an advanced tumor at the time of diagnosis and little axillary involvement. The most common histological classification is the spindle cell variant and almost all tumors are triple negative. The CMM has an aggressive behavior and little response to chemotherapy treatments. Therefore, radical surgical treatments are preferred. Due to the rarity of this entity there is little data published in the international literature. Citation Format: Andre Mattar, Marcelo Antonini, Marina Diogenes, Andressa Amorim, Francisco Pimentel Cavalcante, Luiz Henrique Gebrim. Metaplastic breast cancer: description of 16 cases treated at a reference center and review of the literature [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 PO2-17-10.

Abstract PO5-01-12: Factors Influencing Late Recurrence in Breast Cancer: A Comprehensive Analysis of the Impact of Hormone Therapy Regimens

Abstract Late recurrence of breast cancer remains a significant challenge in patient management. Despite the established efficacy of hormone therapy, factors influencing late recurrence and the impact of different hormone therapy regimens on this outcome are not yet fully understood. This study aims to investigate the key determinants contributing to late recurrence within the context of different hormone therapy regimens. This study is a retrospective analysis of medical records from two institutions between 1988 and 2018, specifically examining patients who had HR-receptor positive breast cancer who underwent surgery and completed a 5-year course of standard hormone therapy. Primary endpoint is to identify the demographic, clinical and pathologic factors as associated with late recurrence. Out of 1929 eligible patients, 49.6% (956) received Tamoxifen (TMX), 37.6% (726) received Aromatase inhibitors (AI), and 12.8% (247) switched between regimens (TMX to AI or AI to TMX). Median follow-up was 12.1 years (3.75 - 21.41 years). During this period, all-type recurrence (ATR) occurred in 9.3% of all patients, with higher rates in the TMX recipients (12.2%). Locoregional and contralateral recurrence were identified in 10.6% of TMX recipients, 6.5% of patients who switched regimens, and 5% of AI recipients. In all patients, 5.4% were diagnosed with distant metastasis, with slightly higher rates in the TMX recipients (6.4%). Multiple sites in the bone, lung, liver and brain (34.3%) was the most prevalent location of distant metastasis (DM), followed by soft tissue (20%), liver (16.2%), bone (10.5%), lung (8.6%), and other locations. Significant differences in recurrence-free survival (RFS) were observed between hormone therapy groups (p=0.004, log-rank test). Mean overall RFS was 20.4 years (95% C.I. 20.1-20.9 years). TMX recipients had a mean RFS of 19.8 years, AI recipients had a mean RFS of 18.3 years and those who switched regimens had a mean RFS of 21.9 years. Further analysis showed premenopausal patients who switched regimens had higher RFS (p=0.014). No significant difference in RFS was seen between premenopausal patients receiving AI or Tamoxifen, or amongst post-menopausal patients with different hormone therapy regimens. No significant difference in distant metastasis-free survival (DMFS) was observed between hormone therapy groups (p=0.442). Mean overall DMFS was 21.5 years (95% C.I. 21.2 - 21.8 years), with TMX patients 21.1 years, AI patients at 18.6 years, and those who switched regimens at 21.4 years. Sub-analyses of DMFS in pre and postmenopausal patients with different hormone therapy regimens showed no significant differences. Multivariate analysis showed tumor size ≤ 2cm (p= 0.0001) and negative axillary node involvement (p= 0.0001) significantly decreased odds of developing late all-type recurrence (ATR) in TMX recipients. In patients who switched regimens, Her2 positivity (p=0.04) significantly decreased the odds of late ATR. In AI recipients, not undergoing axillary operation (p = 0.008) significantly increased the odds of late ATR. For TMX recipients, negative axillary node involvement (p=0.004), tumor size ≤ 2cm (p=0.03), and undergoing mastectomy (p=0.02) significantly decreased odds of distant metastasis (DM). Among patients who switched regimens, adjuvant anti-Her2 therapy (p=0.02) significantly decreased odds of DM. For AI recipients, high PR score (p=0.02) and undergoing sentinel lymph node biopsy significantly decreased odds of DM, while age < 50 years significantly increased odds of developing DM. These findings emphasize the significance of the relationship between hormone therapy regimens and factors affecting late recurrence, thereby providing valuable insights for clinical decision-making. Risk stratification based on identified factors can help in identifying patients at higher risk of late recurrence allowing for more intensive surveillance and potentially early intervention. Univariate (Chi-square, Logistic Regression) and Multivariate Analysis (Logistic Regression) for Clinicopathologic factors associated with all-type recurrence and distant metastasis after surgery and completion of 5-years endocrine therapy Table. a. LN lymph node b. SLNB, Sentinel lymph node biopsy c. ALND, Axillary lymph node dissection d. Cutoff values of Ki67 14% in KUAH and 10%in SNUH e. ER and PR cutoff value is 10% f. UV, Univariate analysis, MV multivariate analysis, O.R. Odds Ratio, C.I. Confidence Interval Citation Format: Mary Rose Mendoza, Eun-Shin Lee. Factors Influencing Late Recurrence in Breast Cancer: A Comprehensive Analysis of the Impact of Hormone Therapy Regimens [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 PO5-01-12.

Abstract PO3-17-09: Outcome after the introduction of personalized treatment for axilla in patients with clinically node-negative early breast cancer

Abstract Background : After the results of ACOSOG Z0011 and AMAROS trials were reported, axillary treatment has been promoted to de-escalation. For clinically negative cases of axillary lymph node metastasis (cN0), axillary dissection (Ax) has been the standard treatment when sentinel lymph node (SN) metastasis is positive. In our hospital, for patients with cN0, if SN macro metastasis is positive, Ax or irradiation (RT) is selected after sufficient explanation to the patients. Five years have passed since the introduction of treatment selection for the axilla, we examined treatment outcomes retrospectively. Methods : The subjects were 1376 patients who underwent SN biopsy for primary breast cancer with cN0 at our hospital from October 2004 to December 2018 (median observation period 79 months). Cases who underwent preoperative chemotherapy were excluded. We have introduced the treatment choice system since December 2015, and compared prognosis (local recurrence, distant recurrence and breast cancer specific death) before and after introduction using the log-rank test. Results : There were 947 cases before introduction of treatment choice system (pre group) and 429 cases after introduction (post group). The median observation period for each group was 91 months and 41 months. The maximum observation period post group was 67 months, then we compared the number of events in patients with observation period less than 67 months in pre group. There was no significant difference between two groups (Pre/Post) in terms of age (p=0.52), menopausal status (p=0.90), invasion of primary lesion (p=0.19), biology and SN metastasis status (p=0.41). There were 54 patients (12.6%) in pre group and 135 (14.3%) patients in post group had positive sentinel lymph nodes. In post group, 33 patient (61.1%) were macrometastasis of SN, 28 of whom underwent Ax and 5 underwent RT. Local recurrence was 4 cases (1.7%) in pre group, 9 cases (2.1%) in post group (p=0.84), distant recurrence was 13 cases (5.6%) and 5 cases (1.2%) (p=0.0002), and breast cancer specific death was 8 cases (0.8%) and 1 case (0.2%) (p=0.0003), respectively. Discussion : There was no significant difference in local recurrence rate within 67 months, but were poor prognosis in pre introduction group for distant metastasis and breast cancer specific survival. In the results of this study, there was no significant difference in local recurrence, but the prognosis for distant recurrence and breast cancer-specific death was poor in the before introduction group. The median observation period in the post introduction group was 47 months, and late recurrence of ER-positive breast cancer occurs later. It is necessary to continue the study by extending period and accumulation cases. Conclusion : For cN0 cases, if the case is suitable, we introduced the treatment choice system that allows omitting Ax by performing radiotherapy in SN macrometastasis positive patients. After introduction, there was no increase in the relapse rate after introduction in the short term. Appropriate case selection allowed the safety introduction of individualizes treatment for axilla. Citation Format: Mai Tomiguchi, Kaori Hidaka, Lisa Goto-Yamaguchi, Ayako Kajiwara, Kanako Nishikido, Toko Inao, Yutaka Yamamoto. Outcome after the introduction of personalized treatment for axilla in patients with clinically node-negative early breast cancer [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 PO3-17-09.

Changes in lymph node surgery in breast cancer and preoperative drug prescription analysis for postoperative pain management: A retrospective, cross-sectional study.

This study aimed to investigate the changes in lymph node surgery types and prescription patterns of postoperative medications for pain management in patients with breast cancer using national health insurance claim data from South Korea. The study population comprised patients with at least one record of a principal diagnosis of breast cancer (ICD-10 code: C50) from the national health insurance claim database between 2010 and 2019. Patients who underwent mastectomy or lumpectomy only once were selected for the analysis. Patients who underwent axillary lymph node dissection (ALND) with mastectomy or lumpectomy on the day of surgery were included in the ALND group, whereas those who underwent sentinel lymph node biopsy (SLNB) were included in the SLNB group. Prescription records of opioids before, after and on the date of breast cancer surgery were collected and categorized according to the opioid type. Multivariate logistic regression modeling was used to compare postoperative opioid prescriptions. The proportion of those undergoing ALND among 3,080 patients decreased consistently after 2014, while the proportion undergoing SLNB increased. Although the rate of pain medication prescription on the day of surgery was similar between the two groups, the rate of prescription of postoperative pain medication and anticancer agents was lower in the SLNB group than in the ALND group. Logistic regression modeling showed that the SLNB group had lower odds of receiving opioids than did the ALND group (Odds ratio (OR) = 0.727, Confidence Interval (CI) = 0.546-0.970). A consistent trend was observed when the model was adjusted for neoadjuvant chemotherapy and the use of preoperative pain medications (OR = 0.718, CI = 0.538-0.959). To manage postoperative pain and prevent chronic pain with minimal side effects, sufficient discussion among clinicians, patients, and other healthcare professionals is imperative, along with adequate treatment planning.

Development and validation of a novel model to predict recurrence-free survival and melanoma-specific survival after sentinel lymph node biopsy in patients with melanoma: an international, retrospective, multicentre analysis

The introduction of adjuvant systemic treatment for patients with high-risk melanomas necessitates accurate staging of disease. However, inconsistencies in outcomes exist between disease stages as defined by the American Joint Committee on Cancer (8th edition). We aimed to develop a tool to predict patient-specific outcomes in people with melanoma rather than grouping patients according to disease stage. Patients older than 13 years with confirmed primary melanoma who underwent sentinel lymph node biopsy (SLNB) between Oct 29, 1997, and Nov 11, 2013, at four European melanoma centres (based in Berlin, Germany; Amsterdam and Rotterdam, the Netherlands; and Warsaw, Poland) were included in the development cohort. Potential predictors of recurrence-free and melanoma-specific survival assessed were sex, age, presence of ulceration, primary tumour location, histological subtype, Breslow thickness, sentinel node status, number of sentinel nodes removed, maximum diameter of the largest sentinel node metastasis, and Dewar classification. A prognostic model and nomogram were developed to predict 5-year recurrence-free survival on a continuous scale in patients with stage pT1b or higher melanomas. This model was also calibrated to predict melanoma-specific survival. Model performance was assessed by discrimination (area under the time-dependent receiver operating characteristics curve [AUC]) and calibration. External validation was done in a cohort of patients with primary melanomas who underwent SLNB between Jan 30, 1997, and Dec 12, 2013, at the Melanoma Institute Australia (Sydney, NSW, Australia). The development cohort consisted of 4071 patients, of whom 2075 (51%) were female and 1996 (49%) were male. 889 (22%) had sentinel node-positive disease and 3182 (78%) had sentinel node-negative disease. The validation cohort comprised 4822 patients, of whom 1965 (41%) were female and 2857 (59%) were male. 891 (18%) had sentinel node-positive disease and 3931 (82%) had sentinel node-negative disease. Median follow-up was 4·8 years (IQR 2·3-7·8) in the development cohort and 5·0 years (2·2-8·9) in the validation cohort. In the development cohort, 5-year recurrence-free survival was 73·5% (95% CI 72·0-75·1) and 5-year melanoma-specific survival was 86·5% (85·3-87·8). In the validation cohort, the corresponding estimates were 66·1% (64·6-67·7) and 83·3% (82·0-84·6), respectively. The final model contained six prognostic factors: sentinel node status, Breslow thickness, presence of ulceration, age at SLNB, primary tumour location, and maximum diameter of the largest sentinel node metastasis. In the development cohort, for the model's prediction of recurrence-free survival, the AUC was 0·80 (95% CI 0·78-0·81); for prediction of melanoma-specific survival, the AUC was 0·81 (0·79-0·84). External validation showed good calibration for both outcomes, with AUCs of 0·73 (0·71-0·75) and 0·76 (0·74-0·78), respectively. Our prediction model and nomogram accurately predicted patient-specific risk probabilities for 5-year recurrence-free and melanoma-specific survival. These tools could have important implications for clinical decision making when considering adjuvant treatments in patients with high-risk melanomas. Erasmus Medical Centre Cancer Institute.

O71: Sentinel Lymph Node Biopsy in Elderly Patients with Early ER+ Breast Cancer: A Systematic Review of the Literature

Abstract Purpose In 2016, the Choosing Wisely guidelines recommended that women over 70 years of age with Oestrogen Receptor positive (ER+), HER2-negative (HER2-), early-stage (T1, T2), clinically node-negative (cN0) invasive breast cancer (BC) should not routinely undergo sentinel lymph node biopsy (SLNB). The aim of this systematic review is to analyse subsequent literature on the influence of SLNB on management and outcomes. Methods An electronic search of Medline (OVID), EMBASE and Cochrane Reviews was conducted Studies comparing SLNB vs. no SLNB were included. 4 studies were eligible for final inclusion. Overall survival (OS), breast cancer-specific survival (BCSS) and influence on adjuvant therapy decisions were analysed. Results Chagpar et al. found SLNB was independently associated with significantly better OS (HR=0.633) in 157,584 patients and better BCSS (HR=0.452) in a subset of 116,059 patients compared to no SLNB. In 24,995 patients, Xu et al. found better OS in those who received SLNB (HR= 0.585) and better BCSS (HR=0.864) vs. those who did not. Castelo et al. performed 2 studies: the first included 126,047 patients, worse BCSS was observed in the no-SLNB group (sub-distribution HR=1.17); the second included 6,286 patients, both worse OS (adjusted HR=1.22), and BCSS (adjusted HR=1.08) were also associated with not receiving SLNB. Conclusion Better OS and BCSS were seen in patients who received SLNB vs. no SLNB despite adjusting for confounders across these studies. While some selection bias may have influenced results, clinicians should remain cautious in omitting SLNB in this cohort.

Concurrent endometrial cancer in atypical endometrial hyperplasia and the role of sentinel lymph nodes: clinical insights from a multicenter experience

ObjectiveThis study aimed to evaluate the prevalence of concurrent endometrial cancer in patients pre-operatively diagnosed with atypical endometrial hyperplasia undergoing hysterectomy. Additionally, we assessed the occurrence of high to intermediate-risk...

Risk factors and prognosis of sentinel lymph node metastasis in breast-conserving breast cancer: A retrospective study based on the SEER database.

At present, the risk factors and prognosis of sentinel lymph node metastasis (SLNM) are analyzed based on the study of axillary lymph node metastasis, but whether there is a difference between the two is unclear. Therefore, an accurate and appropriate predictive model needs to be proposed to evaluate patients undergoing sentinel lymph node biopsy (SLNB) for breast cancer. We selected 16983 women with breast cancer from the Surveillance Epidemiology and End Results (SEER) database. They were randomly assigned to two cohorts, one for development (n = 11891) and one for validation (n = 5092). multi-factor logistics regression was used to distinguish risk factors affecting SLNM. The potential prognostic factors were identified using the COX regression analysis. The hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for all results. Multiple Cox models are included in the nomogram, with a critical P value of .05. In order to evaluate the model's performance, Concordance index and receiver operating characteristic curves were used. Six independent risk factors affecting SLNM were screened out from the Logistic regression, including tumor location, number of regional lymph nodes (2-5), ER positive, PR positive, tumor size (T2-3), and histological grade (Grade II-III) are independent risk factors for SLNM in patients (P < .05). Eight prognostic factors were screened out in the multivariate COX regression analysis (P < .05): Age: Age 60 to 79 years, Age ≥ 80 years; Race; Histological grading: Grade II, Grade III; No radiotherapy; Tumor size: T2, T3; ER positive:, sentinel lymph node positive, married. Histological grade, tumor location, T stage, ER status, PR status and the number of SLNB are significantly correlated with axillary SLNM. Age, ethnicity, histological grade, radiotherapy, tumor size, ER status, SLN status, and marital status were independent risk factors for Breast cancer specific survival (BCSS). Moreover, the survival rate of patients with 3 positive SLNs was not significantly different from that with one or two positive SLNs, We concluded that patients with stage N1 breast cancer were exempt from axillary lymph node dissection, which is worthy of further study.

Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance

Introduction: We presented the key findings from Singapore’s Changi General Hospital Breast Centre’s lymphedema surveillance strategy that used patients’ reported symptoms, standard arm circumference measurements and clinical assessment in the diagnosis of breast cancer-related lymphedema (BCRL). Our secondary aim was to highlight and discuss important elements of a surveillance strategy that can be implemented to track this outcome measure of breast cancer treatment for future research. Method: We conducted a cross-sectional study of 511 breast cancer patients to assess the prevalence of BCRL and its associated risk factors. We defined BCRL prevalence rates based on patients’ self-reporting, objective arm circumference measure-ments and clinical diagnosis based on International Society of Lymphology (ISL) staging. Results: The median follow-up of patients was 88.8 months. The cumulative prevalence rate in the cohort was 30.9%. The cohort of BCRL patients were older (58.4 versus [vs] 54.9 years), had higher mean Body Mass Index (27.7 vs 25.2), higher proportion of mastectomy (77% vs 64.3%), axillary clearance, less likely breast reconstruction, higher-grade tumour, more lymph nodes excised, more advanced nodal disease, and had undergone adjuvant chemotherapy. However, clinically apparent BCRL was only 6.5% (33 out of 511 patients). The proportion of clinically significant BCRL in patients undergoing sentinel lymph node biopsy (SLNB) or axillary sampling was 1.7% compared to 9.9% in patients who had undergone axillary clearance. Majority of the BCRL were subclinical or mild in severity. Conclusion: Our study showed that our rates of BCRL were comparable to international rates and highlighted similar patient profiles who were at risk of developing the disease. Having a comprehensive lymphedema surveillance strategy is paramount in paving the way for future studies.

Estimation of Hand Function Impairment in Breast Cancer Survivors with Lymphedema

Breast cancer (BC) is one of the most frequent cancers in women, and breast cancer-related lymphedema (BCRL) is a common side effect of BC treatment. When the lymphatic drainage system is damaged, lymphedema develops, which further exacerbates swelling and leads to pain, an increase in limb circumference, a reduction in joint range of motion, and a decrease in the use of the affected hand for functional tasks. Handgrip strength is essential for performing upper limb functional daily activities. Less is known about the long-term effects of lymphedema on hand function. The objective of the study was estimation of hand function impairment in BC survivors with lymphedema. This study was carried out by randomly selecting 100 out of 1,200 women with lymphedema, aged between 40 and 80 years, and who underwent sentinel lymph node biopsy along with radiotherapy, were included in this study. The handgrip strength was tested using an electronic handheld dynamometer. The functional wrist and hand scales were used to evaluate hand function. The Michigan Hand Outcome Questionnaire (MHQ) was used to evaluate the hand's overall function. A statistical analysis was done using SPSS statistical software (version 23.0). Handgrip strength of the affected hand by BCRL when compared with the unaffected hand was reduced. Functional hand and wrist scale have shown very poor results of the affected hand when compared with the unaffected hand. Majority of participants in the MHQ were unsatisfied with the overall functioning of the hand (p &lt; 0.0001). This study concluded that there was significant hand function impairment in BC survivors with lymphedema. BCRL had a negative impact on daily activities of the individual and also affected the mental, emotional, and social aspects. BCRL also had an impact on overall self-reported physical function and quality of life.

Unplanned Return to Hospital After Same Day Oral Cavity Resection: A Dual Institution Study.

Primary objective: describe rates of 30-days unplanned readmission following outpatient resection of oral cavity cancer. Secondary objective: evaluate for patient and treatment factors associated with readmission. Retrospective, dual-institution cohort study of 2 tertiary care referral centers involving adult patients undergoing resection of oral cavity cancer with plans for same-day discharge. Consecutive sample of 77 patients included. Primary outcome was unplanned readmission to emergency room or inpatient stay in the 30 days following surgery. Comparison testing was used between return and non-return groups. Among 77 patients treated with outpatient surgery for oral cavity cancer, 19 (25%) returned to the hospital within 30 days. Among the reasons for return, 16 (80%) were directly related to surgery, and 4 (20%) were related to perioperative medical complications not directly related to a surgical site. Among the 25 patients also undergoing sentinel lymph node biopsy with their oral cavity resection, none returned to the hospital for neck-related complications. While most patients could be safely observed and discharged after return to the hospital, 8 patients (10%) required inpatient readmission. No significant differences between return and non-return groups were identified, although there was a trend toward shorter driving distance from hospital for the return group (47.6 miles vs. 69.5 miles, P = 0.097). Unplanned return to the hospital following outpatient oral cavity resection is prevalent and primarily driven by postoperative primary resection site concerns. Among patients selected for same day discharge, no definite population at highest risk of unplanned return was identified.

Investigation of prognostic factors for non-sentinel lymph node metastasis in patients undergoing sentinel lymph node biopsy for cutaneous malignant melanoma: Experience from a reference centre in Turkey

BackgroundIn the light of the results of recent randomised controlled trials regarding the role of nodal observation and completion lymph node dissection (CLND), studies from different populations are needed. The aim of our study was to present our experience with sentinel lymph node biopsy (SLNB) and CLND and the clinical and histopathological factors associated with a positive non-sentinel node. MethodsIn this single-centre, retrospective study, we reviewed histopathological reports of patients with primary cutaneous melanoma who underwent SLNB and CLND over a period of 7 years. The primary outcomes were the positivity rates of SLNBs and CLNDs. Secondary outcomes were metastatic tumour burden in positive sentinel nodes and presence of perinodal invasion. ResultsAmong the 110 participants who underwent SLNB (53 females, 57 males), the mean Breslow thickness of the primary tumour was 4.1 (0.3–41) mm. Ulceration appeared in 62.7% of lesions. The SLNBs were positive in 38 patients (34.5%), with 35 (92.1%) undergoing CLND, among which 9 (25.7%) showed metaNBstasis. Positive SLNB was linked to a higher Breslow thickness (p = 0.022), whereas CLND results lacked such an association (p = 0.76). Perinodal invasion (p = 0.006) and sentinel lymph node metastasis exceeding 1 mm (p = 0.017) was associated with a higher probability of non-sentinel node metastasis. ConclusionTo adapt the results of the new cohort study on SLNB and melanoma to different populations, studies with different patient groups highlighting the problems and suggested solutions are needed.

Long-term outcomes after amputation and sentinel node biopsy for subungual melanoma: A single-institution series

BackgroundSubungual melanoma (SUM) is a rare tumor with historically poor outcomes. Thus, the benefit of proximal versus distal amputation in SUM remains unclear. MethodsWe performed a retrospective review of our prospectively-maintained institutional melanoma database, including SUM and non-subungual acral melanoma (AM) patients who underwent sentinel lymph node biopsy (SLNB) between 1999 and 2022. All SUMs had distal joint or proximal amputations. Primary endpoints were overall survival (OS) and recurrence free survival (RFS). Kaplan-Meier estimates, and Cox univariate and multivariate analyses were performed. Tests were repeated on propensity score matched (PSM) populations in a 2:1 ratio. Results123 patients underwent resection with SLNB for SUM (n ​= ​27) and AM (n ​= ​96). Median follow-up was 9.2 years. Unadjusted median OS was 149.1 months for AM and 198.1 months for SUM. In the PSM comparison, median OS and RFS remained comparable between SUM and AM (149.5 months versus 198.1 months; p ​= ​0.612). Sentinel node positivity was associated with significantly worse overall survival outcome (Hazard Ratio 5.49; CI (1.59–18.97), p ​= ​0.007). In the PSM population, male sex was also associated with a significant hazard of death (HR 3.00, CI (1.03–8.71), p ​= ​0.043). Proximal amputations were associated with significantly worse OS (p ​< ​0.002) and RFS (p ​< ​0.01) compared to distal amputations in SUM. ConclusionSUM was well-treated with distal amputations, and had better OS and RFS compared to SUM treated with proximal amputations. Sentinel lymph node status is an important prognostic factor for SUMs and AMs. SUMs can be treated similarly to AMs with comparably good long-term outcomes.

Feasibility and accuracy of targeted axillary dissection in breast cancer patients; single center experience.

Axillary complete response (pCR) was observed in approximately half of breast cancer patients who received neoadjuvant chemotherapy (NAC) due to axillary positivity. Preventing axillary morbidity due to unnecessary axillary lymph node dissection (ALND) is extremely important for patients' quality of life. Targeted axillary dissection (TAD) is a technique developed to improve axillary staging and reduce the false negative rate in sentinel lymph node biopsy. Patients with cN1-N2 (clinically node) breast cancer whose axillary lymph node metastasis was confirmed by biopsy and who received NAC marked with a clip were included in the study. Patients who achieved clinical response after systemic treatment underwent sentinel lymph node biopsy (SLNB) with additional methods such as methylene blue guided dissection, skin marking for clip on lymph node (CLN) localization, and wire guided with imaging excision of the CLN. TAD and ALND pathology results were evaluated and analyzed with patient and tumor characteristics. 83 patients who met the eligibility criterias for the study were examined retrospectively. 21 of the patients underwent TAD alone, and 62 patients underwent ALND after TAD. CLN rate was 98.8% in patients underwent only TAD and this rate was increased to 100% in patients underwent ALND after TAD. FNR in SLN, CLN, and TAD were 28.6%, 10.7%, and 3.6%, respectively. TAD is a feasible and reliable surgical approach to detect axillary residual disease with a high success rate.

Prognostic value of isolated tumor cells in sentinel lymph nodes in low risk endometrial cancer: results from an international multi-institutional study

ObjectiveThe prognostic significance of isolated tumor cells (≤0.2 mm) in sentinel lymph nodes (SLNs) of endometrial cancer patients is still unclear. Our aim was to assess the prognostic value of...