Necessity of Axillary Scanning After Negative Finding on Both Mammography and Subsequent Breast Ultrasound

The purpose of our study was to assess the cancer detection rate and positive predictive value (PPV) for incidentally detected abnormal axillary lymph nodes with negative mammography and subsequent breast ultrasound (US). We included 7039 screened patients (mean age, 52 y) from January 2012 to March 2015 with negative mammography and subsequent breast US results. In two patients with positive lymph nodes, neither were from breast malignancy. The calculated cancer detection rate, PPV for biopsy and axillary biopsy rate was 0.3 per 1000 axillary US, 14.3% and 0.2%. Cancer rates for patients with a family or personal operation history, with cancer history and with no family/operation/cancer history were 0%, 0.1% and 0.2%, respectively. Our results indicate that the cancer detection rate and PPV for US were too low to recommend routine axillary scanning including screening breast US in patients with negative mammography and subsequent breast US, especially with no history of any cancers.     

Lymphatic mapping: a technique providing accurate staging for breast cancer

Conclusion  Lymphatic mapping and selective lymphade-nectomy is an accurate method for staging breast cancer patients, providing a conservative approach to the surgical management and more information from a detailed examination. The histology of the SLN is reflective of the remaining axillary lymph nodes, particularly when the SLN is negative. The procedure can be accomplished as an outpatient procedure when there is negative nodal staging. Similar to breast preservation as a viable alternative to mastectomy in the management of breast cancer patients, the ability to decrease morbidity without compromising patient care is the greatest advantage.     

Bilateral Metachronous Paget's Disease of the Accessory Breasts in a Male

Bilateral axillary Paget''s disease in men is a rare occurrence with limited reports on its diagnosis, treatment, and prognosis. Here, we report the case of a 55-year-old Korean male, who presented with a palpable mass and eczematous skin lesion on the left axilla. An incisional biopsy and histopathologic examination indicated invasive ductal carcinoma with Paget''s disease arising in the accessory breast. Magnetic resonance imaging and positron emission tomography revealed no malignancy in the normal breast and other organs. The patient was subjected to a wide excision, wherein the left axillary lymph node was dissected, followed by the administration of adjuvant chemotherapy and radiation therapy. After 17 months of disease-free survival, the patient was diagnosed with Paget''s disease of the contralateral accessory breast. He underwent wide excision surgery along with radiation therapy. To the best of our knowledge, this is the first report of bilateral extramammary Paget''s disease in a male.     

腋窝腺泡状软组织肉瘤一例

患者男性,36岁,发现右腋窝肿物1年,肿物逐渐长大,于2009年12月3日入院.入院查体:右腋窝扪及肿物,大小约7 cm×5 cm,位置较深,质硬,边界不清,皮肤无异常.     

Assessing the Impact of Neoadjuvant Chemotherapy on the Management of the Breast and Axilla in Breast Cancer

BackgroundNodal status is a sensitive prognostic indicator in breast cancer. Axillary metastases may be an indication for neoadjuvant systemic therapy. The aims of this study were to compare pathologic response rates to neoadjuvant chemotherapy (NAC) in the breast and axilla across different molecular subtypes of breast cancer and to compare the predictive value of axillary assessment before and after chemotherapy in determining final nodal status in this cohort of patients.Patients and MethodsThe cohort comprised patients undergoing NAC from 2003 to November 2012. Data regarding patient and tumor characteristics, management, and outcomes were obtained from a prospectively maintained database and analyzed using PASW Statistics, version 18 (SPSS Inc, Chicago, IL).ResultsTwo hundred two cancers were identified in 196 patients. One hundred thirty-one (65%) diagnostic axillary procedures were performed, 105 (80%) before NAC, of which 93 (89%) were positive. In 28 (30%), downstaging was noted before NAC. Human epidermal growth factor receptor 2 (HER2) subtypes had the highest rate of complete pathologic response (n = 11 [61%]) and negative axillary clearance (AXCn) (n = 11 [69%]). Of 177 AXCns, 68 (38%) were negative before NAC.ConclusionAXCn in patients undergoing NAC remains controversial. HER2 subtypes are less likely to have axillary involvement after NAC and may demand different management.     

Clear Cell Hidradenoma of the Axilla: a Case Report with Literature Review

Clear cell hidradenoma is an uncommon benign skin appendageal tumor that typically involves the dermal layer of the head, face, and extremities. The breast is a rare site for this lesion, with only two documented cases, which were determined based on mammogram and sonogram findings. We present a case of clear cell hidradenoma of the axillary tail with radiological findings and a literature review.     

Dressing of the Axilla Using a Water-Filled Surgical Glove After Axilla Grafting

Usually, after grafting of the axilla, it is difficult to obtain a reliable dressing using traditional materials including tulls and fluffy gauzes. As an alternative to this traditional approach, a sterile surgical glove filled with saline can be used to obtain a bulky dressing.     

Retrospective study of the surgical management and outcome of nonrhabdomyosarcoma soft tissue sarcomas of the groin and axilla in children

Purpose

The incidence of pediatric nonrhabdomyosarcoma soft tissue sarcomas (NRSTSs) of the groin and axilla is unknown, and the optimal surgical approach to these patients is unclear.

Methods

We conducted a retrospective study of patients treated at St Jude Children's Research Hospital from January 1962 to March 2007 for NRSTSs of the groin and axilla. Demographic variables, tumor pathology, clinical management, and outcome were reviewed.

Results

Of the 300 patients treated for NRSTSs, only 10 had tumors of the axilla or groin (6 of whom had synovial sarcoma). Surgical interventions included wide resection of the tumor (n = 7), marginal resection (n = 1), subtotal resection (n = 1), and biopsy only (n = 1). Six patients underwent lymph node sampling; all were negative for tumor. Short- and long-term surgical complications were rare. Four patients received adjuvant chemotherapy (n = 3) and/or radiotherapy (n = 2). At a median follow-up of 8.5 years, 7 of the 10 were surviving free of disease. Two of these patients died of tumor progression (1 with metastases at diagnosis and 1 with an unresectable tumor at diagnosis), and one patient who was free of NRSTS died of secondary breast carcinoma.

Conclusions

Pediatric NRSTSs of the axilla and groin are rare, but outcomes are similar to those of other patients with NRSTS. Wide local excision of the tumor with preservation of good limb function should be the surgical goal and may be sufficient therapy in some cases.     

Sentinel Lymph Node Biopsy Alone after Neoadjuvant Chemotherapy in Patients with Initial Cytology-Proven Axillary Node Metastasis

Purpose

Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis.

Methods

From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results.

Results

At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050).

Conclusion

SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.     

Incidental radiation to axilla in early breast cancer treated with intensity modulated tangents and comparison with conventional and 3D conformal tangents

PurposeTo analyze incidental radiation doses to minimally dissected axilla with Intensity modulated radiotherapy (IMRT), 3D conformal radiotherapy (3DCRT) and standard tangents (ST).Methods & materialsWe prospectively evaluated incidental radiation to axilla in fifty cases of early breast cancer treated with breast conservation surgery with sentinel node biopsy alone followed by whole breast irradiation with IMRT. Three plans were devised for each CT dataset, comprising ST, 3DCRT and IMRT tangents. Doses to axillary nodal levels I, II and III were evaluated for mean dose, V95, V90, V80 and V50. Comparisons were made using ANOVA.ResultsThe mean doses delivered to axilla by the three techniques (IMRT, 3DCRT, ST) were: 78% (range 67–90, SD ± 5.2%), 80% (63–95, ±7.5%) and 87% (73–98, ±4.8%) for level I (IMRT vs ST; p = 0.037); 70% (46–89, ±12.4%), 72% (34–93, ±15.5%) and 65% (29–87, ±11.8%) for level II; and 51% (28–76, ±11.1%), 53% (19–86, ±13.7%) and 41% (6–72, ±10.6%) for level III, respectively. V90 values (volume receiving 90% of dose) for the three techniques were 49% (43–53, ±2.7%), 57% (51–65, ±3.1%) and 73% (65–80, ±3.4%) for level I (IMRT vs ST; p = 0.029); 35% (26–42, ±4.7%), 41% (33–50, ±4.2%) and 25% (17–36, ±4.5%) for level II (IMRT vs ST; p = 0.068); and 15% (9–22, ±3.4%), 16% (10–24, ±3.7%) and 8 (5–12, ±3.1%) for level III (IMRT vs ST; p = 0.039), respectively.ConclusionAxillary levels I and II (lower axilla) receive substantial amount of incidental radiation doses with all the three techniques; however, conformal techniques (IMRT, 3DCRT) deliver significantly lesser incidental radiation to lower axilla than ST technique.