Correlation of magnetic resonance imaging and pathologic size of infiltrating lobular carcinoma of the breast

BACKGROUND: Determining the extent of infiltrating lobular carcinoma (ILCA) in the breast is difficult. This study was designed to determine if the size of ILCA on magnetic resonance imaging (MRI) correlated with final pathology. METHODS: Retrospective study of patients between 1998 and 2004, who were evaluated for extent of ILCA prior to definitive treatment, was conducted. Demographic data and radiology and pathology results were obtained. Spearman correlation coefficient was used. RESULTS: Twenty-nine patients (median age 62 years) had MRI of breast. Fourteen patients (48%) had contralateral MRIs; 13 (45%) normal; 1 (8%) prompted core biopsy; 6 of 13 patients underwent contralateral mastectomies, which were benign. The distribution of tumor size was: T1 = 15 (52%); T2 = 7 (24%); T3 = 5 (17%); T4 = 2 (7%). Spearman correlation coefficient between tumor size on ultrasound and MRI with pathology was .19 (P = .5) and .88 (P < .001), respectively. CONCLUSION: MRI provided superior correlation between tumor size and pathology.     

Subareolar sentinel node biopsy for multiple breast cancers

BACKGROUND: Sentinel lymph node biopsy (SLNB) is deemed suitable only for unifocal breast cancers since multiple foci of cancers may drain to different nodes. We hypothesized that subareolar injection (SI) could identify the sentinel lymph nodes (SLN) accurately in patients with multiple cancers (MC) in the breast. METHODS: We prospectively employed SI of lymphazurin or technetium sulfur colloid, or both, for the identification of SLN in patients with MC in the breast. All patients underwent axillary dissection to compute the accuracy of SLNB. RESULTS: Forty patients presented with MC in the same breast between January 1996 and July 2002. Fifty-two percent (21 of 40) of patients had involvement of more than 1 quadrant; 18% (7 of 40) had more than 1 histologic type of cancers. SLNs were successfully identified in 100% of patients. Axillary disease was present in 63% (25 of 40) of patients. Sensitivity of SLNB was 100% and false negative rate was 0%. The SLN was the only node involved in 45% (18 of 40) of patients. CONCLUSIONS: SLNB using the SI technique may be an alternative to complete axillary dissection in patients with multiple breast cancers.     

Stage migration with sentinel node biopsy in breast cancer

Background

Axillary staging provides the single most important piece of prognostic information in breast cancer patients. This retrospective study was performed to document the phenomenon of stage migration.

Methods

Of 392 patients, 5 (1%) failed identification of sentinel lymph nodes (SLNs) and therefore underwent axillary lymph node dissection (ALND). Four patients (80%) had metastatic lymph nodes, 302 (77%) patients had negative SLNs, 47 (15%) underwent ALND, 85 (22%) had positive SLNs, 11 (13%) received adjuvant radiation treatment to the axilla, and 74 (87%) underwent completion ALND.

Results

The median (quartiles) follow-up period was 29 months (19-46 mo). Twenty of 392 (5%) patients had disease relapse; 2 of which were local (.5%) and the rest were systemic. Earlier relapse was related significantly to lymph node status, tumor grade, and tumor size. SLN-negative patients who did not receive ALND had a relapse rate of 2.3% (6 of 256) compared with 0% in those who were truly negative based on confirmatory ALND. SLN-positive patients who did not receive ALND had a 9% (1 of 11) relapse rate.

Discussion

The stage-matched pattern of relapse between SLN biopsy and ALND patients revealed lower relapse rates in SLN biopsy-staged patients, documenting the stage migration phenomenon.     

ASO Author Reflections: How can we Measure an Abscopal Effect Seen with Cryoablation?

Annals of Surgical Oncology -     

Oppression and resistance: An analysis of Muslims' experiences of structural violence

Discrimination and vilification of Muslims in the United States have historical and political roots. This study explores everyday incidents of marginalization and oppression through the framework of structural violence. Structural violence refers to the systemic inequalities embedded within societal structures that create and support these oppressive conditions. In this community-engaged qualitative study, 10 self-identified Muslims from the northeastern United States were interviewed to understand their lived experiences of structural violence. Using thematic analysis, seven themes were identified: Racialized and xenophobic Islamophobia; normalized violence against Muslims and fear of safety; exclusion, marginalization, and subjugation through policies; Muslims as spokespersons for Islam; Intersecting marginalized identities and oppression; challenges of navigating Muslim identities; resilience and resistance through faith, activism, and community. This study aims to understand and contextualize the experiences of Muslims within a systemic and geopolitical framework. Another critical objective is to promote a discourse to address how academics and clinicians reproduce and maintain structural violence and to instead engage in socially transformative approaches embedded in the principles of decolonizing and mutually-liberating cross-struggle solidarity. These must be cultivated through community-informed intersectional collaborative strategies for dismantling oppressive structures and promoting agency, resilience, activism, and resistance.