The 31-gene expression profile test informs sentinel lymph node biopsy decisions in patients with cutaneous melanoma: results of a prospective, multicenter study.

BACKGROUND: The 31-gene expression profile test (Class 1A: low-risk; 1B/2A: intermediate-risk; 2B: high-risk) is validated to identify patients with cutaneous melanoma who can safely forego sentinel lymph node biopsy (SLNB). The objective of the current study is to quantify SLNB reduction by clinicians using 31-GEP. METHODS: Patients with T1-T2 tumors eligible for SLNB were seen by surgical oncologists (89.1%), dermatologists (7.8%), and medical oncologists (3.1%). After receiving 31-GEP results but before SLNB, clinicians were asked which clinical and pathological features influenced SLNB decisions (n = 191). The Exact binomial test was used to compare SLNB procedure rates to a contemporary study (78% SLNB baseline rate). Logistic regression modeling (odds ratio [OR], 95% CI) was used to identify features associated with SLNB procedure rates. RESULTS: One hundred clinical decisions (52.4%) were influenced by the 31-GEP to forego SLNB and 70% (70/100) were not performed. Of the 30 performed, 0% (0/30) were positive. The 31-GEP influenced sixty-three clinical decisions (33.0%) to perform SLNB, and 92.1% (58/63) were performed. There was a clinically meaningful 29.4% reduction of SLNBs performed in patients with a Class 1A result relative to the baseline rate of 78.0% (p < .01). In patients ≥55 or ≥65-year-old, SLNB reduction was 32.3% (p < .01), 28.3% (p < .01), respectively. Overall, 85.3% of decisions relating to SLNB were influenced by 31-GEP results. CONCLUSION: In this prospective, multicenter study, clinicians demonstrated clinically meaningful use of the 31-GEP test to forego or pursue SLNB in patients with T1-T2 tumors resulting in a significant, risk appropriate decrease in SLNBs.

The likelihood of additional nodal disease following a positive sentinel lymph node biopsy in breast cancer patients: validation of a nomogram.

BACKGROUND: Sentinel lymph node (SLN) biopsy examination is the current modality for evaluating the axilla in breast cancer patients. A nomogram has been developed to predict the likelihood of non-SLN metastases after a positive SLN biopsy examination. The purpose of this study was to validate the nomogram in a community breast center. METHODS: A prospective database was used to identify breast cancer patients with a positive SLN biopsy examination who underwent a completion axillary lymph node dissection. The nomogram was used to calculate the probability of having non-SLN involvement, and was compared with the observed numbers. RESULTS: The observed incidence of non-SLN involvement showed excellent correlation with the nomogram predicted probability (chi-square test statistic = 5.87; P = .83). CONCLUSIONS: Predicting the risk of additional nodal metastases allows the surgeon and patient to make an individualized decision regarding the need for completion axillary lymph node dissection.

Correlation of targeted ultrasound with magnetic resonance imaging abnormalities of the breast.

BACKGROUND: Magnetic resonance imaging (MRI) of the breast is highly sensitive for cancer. However, MRI frequently detects additional lesions that mandate further evaluation. The intent of this study was to assess the ability of targeted ultrasound to identify additional lesions detected on MRI in patients undergoing evaluation for breast cancer. METHODS: Between January 1, 1999, and July 15, 2004, 270 women underwent breast MRI at Grant Medical Center. MRI was obtained in 191 women during evaluation for documented or suspected breast cancer. Fifty-two patients had additional suspicious lesions on MRI, prompting targeted ultrasound; these patients constituted our study population. RESULTS: Seventy-five additional suspicious lesions were detected on breast MRI in 52 women. Two women underwent mastectomy without targeted ultrasound. Targeted ultrasound identified 65 of the remaining 73 lesions (89%). Eight lesions (11%) were not visible on targeted ultrasound. CONCLUSION: Targeted ultrasound can be a reliable method to correlate MRI abnormalities in breast cancer patients.

Primary leiomyosarcoma of the breast: a case report with review of the literature.

Breast sarcomas account for about 1% of all malignant breast cancers. Leiomyosarcoma (LMS), one of the rarest, was first described 20 years ago, and yet few published reports exist. A case of primary LMS in a 25-year-old woman is presented and is only the 18th well-documented case in the literature. The clinical presentation, diagnosis, therapy, and pathologic features are reviewed.

Do not contemplate invasive surgery for ductal carcinoma in situ.

BACKGROUND: Ductal carcinoma in-situ (DCIS), by definition, has no metastatic potential. The routine examination of axillary lymph nodes in these patients may expose them to unnecessary operative morbidity and is the subject of continuing controversy. This study evaluates the lymph node status of patients with DCIS. METHODS: A retrospective review of all tumor registry patients diagnosed with DCIS between January 1996 and December 2000 was performed. Data obtained included (1) patient demographics, (2) the surgical procedure performed, (3) the histologic grade of the tumor, and (4) the lymph node status, if obtained. All analysis was by hematoxylin and eosin (H&E) stain only. RESULTS: In all, 380 patients were diagnosed with DCIS. Surgical therapy for these patients varied from lumpectomy (with negative margins) to modified radical mastectomy. Ninety-seven (25.5%) had their axillary lymph nodes (average 9, range 1 to 33) analyzed by H&E stain and are the subject of this study. One patient (1%) was found to have a lymph node micrometastasis. CONCLUSIONS: This study demonstrates that axillary lymph node examination is a low-yield endeavor for patients diagnosed with DCIS, regardless of the histologic grade of the tumor. Routine sampling of lymph nodes in these patients is not warranted.