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1.
BMC Surg ; 22(1): 16, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35033032

RESUMO

BACKGROUND: Gallbladder cancer is a very aggressive type of biliary tract cancer. The only curative treatment is complete surgical excision of the tumour. However, even after surgery, there is still a risk of recurrence of the cancer. CASE PRESENTATION: A 63-year-old gentleman presented with the complaint of a non-healing ulcer at upper abdomen for the last 1 month. He had undergone a laparoscopic cholecystectomy at a private centre 4 months ago. Investigations confirmed the diagnosis of epigastric port site metastasis from a primary from gall bladder adenocarcinoma. After undergoing completion radical cholecystectomy with wide local excision of the epigastric ulcer, he received 6 cycles of concurrent chemoradiotherapy. Eighteen months later, he presented to us with bilateral axillary swellings. Investigations confirmed isolated bilateral axillary metastasis and the patient underwent a bilateral axillary lymphadenectomy (Level 3). However, PET scan after 6 months showed widespread metastasis and the patient succumbed to the illness 1 month later. CONCLUSION: Axillary metastasis probably occurs due to the presence of microscopic systemic metastasis at the time of development of port site metastasis. An R0 resection of the malignancy is the only viable option for effective therapy. The present case highlights the rare involvement of isolated bilateral axillary lymph nodes as a distant metastatic site with no evidence of disease in the locoregional site. However, the prognosis after metastasis remains dismal despite multiple treatment modalities.


Assuntos
Colecistectomia Laparoscópica , Neoplasias da Vesícula Biliar , Agressão , Axila , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade
2.
Clin Nucl Med ; 47(1): e56-e58, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34028403

RESUMO

ABSTRACT: COVID vaccination has begun in most of the countries. Older population and high-risk groups are prioritized for vaccination. Postvaccination imaging in cancer patients may show effects of the immune response to the vaccine. As such, it is important to know the timing and laterality of the vaccination as the reactive lymph nodes in the ipsilateral axilla can be seen on the imaging. We present a case of DOTATATE-avid nonpathologically enlarged lymph nodes in ipsilateral axilla and linear tracer uptake in the deltoid muscle on a patient imaged for a recent diagnosis of rectal neuroendocrine neoplasm.


Assuntos
Vacinas contra COVID-19/administração & dosagem , Linfonodos , Neoplasias/diagnóstico por imagem , Receptores de Somatostatina , Axila , COVID-19/prevenção & controle , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Cintilografia
3.
Eur Radiol ; 32(1): 630-638, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34165620

RESUMO

OBJECTIVES: This study aims to evaluate the whole axillary status of patients with breast cancer by lymphatic contrast-enhanced ultrasound (LCEUS). METHODS: LCEUS was applied for 169 patients with suspected breast cancer. Abnormal patterns in lymphatic channels, sentinel lymph nodes (SLNs), and non-enhanced but abnormal lymph nodes were investigated. The signs of distorted, attenuated, netted, or interrupted lymphatic channels, defective-filling or no-filling SLNs, and the appearance of non-enhanced but abnormal lymph nodes were designated as features of axillary metastasis. A positive outcome was given when any of the abnormal patterns was found in the LCEUS. The diagnostic efficiencies were calculated to differentiate the axillary lymphatic status using LCEUS for the whole axilla, compared with conventional ultrasound (US) and LCEUS for SLNs. RESULTS: The LCEUS procedure was successfully performed for 157 breast cancer patients with axillary dissection. Compared to normal axillae, abnormal patterns had a significantly higher frequency in metastatic axillae (p = 0.000). Using conventional US to evaluate the whole axillae, the diagnostic sensitivity, specificity, and accuracy were 69.1%, 71.9%, and 70.7%, respectively. When LCEUS was used for SLN evaluation to predict the whole axilla, the diagnostic sensitivity, specificity, and accuracy were 66.2%, 89.9%, and 79.6%, respectively. When LCEUS was used as the whole axillary evaluation method, the diagnostic sensitivity, specificity, and accuracy were 76.5%, 86.5%, and 82.2%, respectively. CONCLUSION: LCEUS can be an accurate method to observe the whole axillae in breast cancer patients. Lymphatic channels, SLNs, and non-enhanced but abnormal lymph nodes constitute the LCEUS for whole axillary evaluation. KEY POINTS: • LCEUS can be an accurate method to observe the whole axillae in breast cancer patients. • Three aspects in the LCEUS for whole axillary evaluation are the lymphatic channels, sentinel lymph nodes (SLNs), and non-enhanced but abnormal lymph nodes. • Signs of distorted, attenuated, netted, or interrupted lymphatic channels, defective-filling or no-filling SLNs, and the appearance of non-enhanced but abnormal lymph nodes were considered as features of axillary metastasis.


Assuntos
Neoplasias da Mama , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Biópsia de Linfonodo Sentinela
6.
Rev Assoc Med Bras (1992) ; 67(11): 1719-1723, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34909904

RESUMO

OBJECTIVE: This study aims to investigate magnetic resonance imaging (MRI) findings in adhesive capsulitis (AC) and determine the most valuable MRI finding in diagnosis using easily applied quantitative methods. METHODS: Shoulder MRI was performed on 193 patients who were diagnosed with AC by clinical examination and 116 controls. Axillary pouch thickness (APT), superior and inferior glenohumeral ligament (SGHL and IGHL) thickness, coracohumeral ligament (CHL) thickness, fluid increase and soft-tissue thickness in the rotator interval (RI), and increases in the fluid and signal in the localization of biceps tendon attachment were evaluated. MRI examinations were assessed by three radiologists blinded to the clinical findings of the patients, and the results were obtained based on consensus and records. RESULTS: There were 119 women and 74 men in the AC group and 80 women and 36 men in the control group. IGHL, SGHL, RI, and CHL thicknesses were measured thicker in AC patients than in the control group. When IGHL=4, RI=3.6, SGHL=2.0, CHL=4.6-mm cutoff, the area under the receiver operating characteristic (ROC) curve (AUC) values were 0.700, 0.922, 0.972, and 0.783, respectively. CONCLUSIONS: According to the results obtained in this study, IGHL=4 mm, RI=3.6 mm, SGHL=2.0 mm, and CHL=4.6 mm can support the diagnosis of AC. Using the quantitative values in diagnosis can provide objective criteria and prevent variability among interpreters.


Assuntos
Bursite , Articulação do Ombro , Axila , Bursite/diagnóstico por imagem , Feminino , Humanos , Ligamentos Articulares , Imageamento por Ressonância Magnética , Masculino , Articulação do Ombro/diagnóstico por imagem
7.
Cells ; 10(12)2021 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-34943854

RESUMO

Previous studies have revealed that high-intensity focused ultrasound (HIFU) ablation can trigger an antitumor immune response. The aim of this study was to investigate immune response in tumor-draining lymph nodes (TDLNs) after HIFU treatment. Forty-eight female patients with biopsy-confirmed breast cancer were divided into a control group and an HIFU group. In the control group, 25 patients underwent modified radical mastectomy, but 23 patients in the HIFU group received HIFU ablation of primary cancer, followed by the same operation. Using HE and immunohistochemical staining, the immunologic reactivity pattern and immune cell profile were assessed in paraffin-embedded axillary lymph nodes (ALNs) in all patients. The results showed that ALNs presented more evident immune reactions in the HIFU group than in the control group (100% vs. 64%). Among the ALNs, 78.3% had mixed cellular and humoral immune response, whereas 36% in the control group showed cellular immune response. The numbers of CD3+, CD4+, NK cell, and activated CTLs with Fas ligand+, granzyme+ and perforin+ expression were significantly higher in the ALNs in the HIFU group. It was concluded that HIFU could stimulate potent immune response and significantly increase T cell, activated CTLs and NK cell populations in the TDLNs of breast cancer.


Assuntos
Neoplasias da Mama/imunologia , Neoplasias da Mama/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade , Imunidade , Linfonodos/imunologia , Adulto , Idoso , Axila/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Linfócitos T Citotóxicos/imunologia , Adulto Jovem
8.
Chirurgia (Bucur) ; 116(500): S140-S142, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34967323

RESUMO

Ductal carcinoma in situ (DCIS) is a noninvasive disease. Pure DCIS is not associated with the risk of metastasizing. Some areas of DCIS may rarely contain invasive islands. For patients who undergo breast conserving therapy sentinel lymph node biopsy (SLNB) is recommended as a second procedure, while all mastectomy patients should undergo SLNB. The paper analyses which patients require primary sentinel lymph node biopsy (SLNB) and what is the best technique to identify the sentinel lymph node.


Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Carcinoma Intraductal não Infiltrante , Axila , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Mastectomia , Biópsia de Linfonodo Sentinela , Resultado do Tratamento
10.
Minerva Surg ; 76(6): 538-549, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34935322

RESUMO

INTRODUCTION: Breast cancer treatment in elderly women remains a complex issue due to pre-existing comorbidities, therapy-related toxicities, and the lack of evidence-based data in this population, leading to both overtreatment and undertreatment. EVIDENCE ACQUISITION: The aim was to investigate the literature on breast surgical oncology in the older woman as a major therapeutic challenge: the 86 more consistent articles amongst 1440 potential citations according to PRISMA guidelines were retained. EVIDENCE SYNTHESIS: Studies demonstrated that despite low-grade tumor types, lower incidence of axillary lymph node involvement, ER+ disease, and less aggressive tumor biology, elderly breast cancer patients often receive less than the standard-of-care when compared to their younger counterparts. The surgery omission in elderlies and the preference for the primary endocrine treatment is associated with worse survival, especially in patients aged 80 years or over - a cohort with no specific recommendations concerning breast and axillary surgical procedures. On the other hand, a higher mastectomy rate is still considered the standard treatment in older women with higher T2:T1 tumor ratio and greater difficulties to attend radiotherapy due to severe comorbidities. Surgical de-escalation procedures even in an-ambulatory setting are recognized as a feasible option in these patients to prevent or palliate breast or chest wall symptoms. CONCLUSIONS: Benefits and disadvantages from surgery only or coupled with adjuvant therapies for elderly women were analyzed in literature, outlining a growing need for a proper geriatric assessment and short-stay surgical programs which are feasible today owing to the availability of less invasive approaches.


Assuntos
Neoplasias da Mama , Oncologia Cirúrgica , Idoso , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia
11.
Zhonghua Wai Ke Za Zhi ; 59(11): 918-922, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34743454

RESUMO

Objective: To examine the surgical outcome, completeness and safety of robotic thyroidectomy by bilateral axillo-breast approach (BABA). Methods: From February 2014 to May 2019, 1 000 cases of robotic thyroidectomy via BABA at the Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army were performed. The clinicopathologic characteristics, operation times, perioperative complications, and oncologic outcomes of patients underwent robotic thyroidectomy were collected and reviewed retrospectively. There were 216 males and 784 females, aging (42.3±11.5) years (range: 7 to 75 years). There were 270 cases with benign tumors, and 730 cases with malignant cancers (the tumor diameter was (7.9±6.7) mm (range: 0.1 to 60.0 mm)). Results: There were 999 patients received robotic thyroidectomy using BABA approach successfully, while only 1 case conversed to open operation. The postoperative hospital stay was (7.5±2.5) days (range: 2 to 30 days). Among the 730 patients with thyroid cancers, 725 cases (99.3%) were papillary thyroid carcinoma, 579(79.3%) cases were with papillary thyroid microcarcinoma. Lymph node metastasis was observed in 371(50.8%) cases. The retrieved central lymph node number was 11.2±6.1 (range: 1 to 44),and the retrieved lateral lymph node number was 14.0±8.8 (range: 1 to 52). Postoperative transient hypoparathyroidism and vocal cord palsy occurred in 247(24.70%) and 56(5.60%) cases. Both of permanent hypoparathyroidism and vocal cord palsy occurred in 2 (0.20%) cases. Other surgical complications included chyle leakage (6.1%, 28/460), trachea injury (0.40%, 4/1 000), carotid artery injury (0.10%, 1/1 000). Local regional lymph node recurrence was developed in 4 patients. All patients were satisfied with the postoperative cosmetic outcomes. Conclusions: Robotic thyroidectomy by BABA is safe and effective, suitable for large benign tumors and early thyroid cancers with central or lateral lymph node metastasis. It could obtain superior cosmetic results.


Assuntos
Procedimentos Cirúrgicos Robóticos , Neoplasias da Glândula Tireoide , Axila , Mama , Feminino , Humanos , Masculino , Esvaziamento Cervical , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Resultado do Tratamento
12.
Chirurgia (Bucur) ; 116(5): 533-541, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34749849

RESUMO

Sentinel Lymph node biopsy (SLNB) represents the standard approach in a newly diagnosed breast cancer for axillary staging in cases of clinical node negative. This represents a major prognostic factor and the biopsy of sentinel lymph node for early breast cancer is used as guidance in surgical and oncological treatment. Although for many decades, axillary lymph node dissection was the standard approach for breast cancer treatment and staging, this pathway was abandoned due to significant risk of lymphedema, infection, nerve and vessels injury or dysfunction of the shoulder. Therefore, significant improvement in the quality of life was seen for patients diagnosed with early breast cancer after SLNB was introduced as standard. The principle of SLNB is based on the hypothesis that tumor drains in the lymphatic system in an orderly manner and if the first lymphatic station is clear of disease, it is highly unlike that the tumor has spread further above. We present in our paper the indications with principles and difficulties in identification of sentinel node.


Assuntos
Neoplasias da Mama , Biópsia de Linfonodo Sentinela , Axila/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Estadiamento de Neoplasias , Qualidade de Vida , Resultado do Tratamento
13.
Korean J Radiol ; 22(12): 1938-1945, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34719892

RESUMO

Breast radiologists are increasingly seeing patients with axillary adenopathy related to COVID-19 vaccination. Vaccination can cause levels I-III axillary as well as cervical lymphadenopathy. Appropriate management of vaccine-related adenopathy may vary depending on clinical context. In patients with current or past history of malignancy, vaccine-related adenopathy can be indistinguishable from nodal metastasis. This article presents imaging findings of oncology patients with adenopathy seen in the axilla or neck on cross-sectional imaging (breast MRI, CT, or PET-CT) after COVID-19 vaccination. Management approach and rationale is discussed, along with consideration on strategies to minimize false positives in vaccinated cancer patients. Time interval between vaccination and adenopathy seen on breast MRI, CT, or PET-CT is also reported.


Assuntos
Neoplasias da Mama , COVID-19 , Linfadenopatia , Vacinas , Axila , Neoplasias da Mama/diagnóstico por imagem , Vacinas contra COVID-19 , Feminino , Fluordesoxiglucose F18 , Humanos , Linfadenopatia/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , SARS-CoV-2
14.
Surg Clin North Am ; 101(6): 1033-1044, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774266

RESUMO

Breast surgical oncology is a rapidly evolving field with significant advances shaped by practice-changing research. Three areas of ongoing controversy are (1) high rates of contralateral prophylactic mastectomy (CPM) in the United States despite uncertain benefit, (2) indications for and use of neoadjuvant chemotherapy (NACT) and endocrine therapy (NET), and (3) staging and treatment of the axilla, particularly after neoadjuvant systemic therapy. We discuss the patient populations for whom CPM may or may not be beneficial, indications for NACT and NET, and the trend toward de-escalation of locoregional axillary treatment.


Assuntos
Neoplasias da Mama/cirurgia , Antineoplásicos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Axila , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Humanos , Excisão de Linfonodo , Mamoplastia , Mastectomia , Terapia Neoadjuvante , Estadiamento de Neoplasias , Mastectomia Profilática
15.
Medicina (Kaunas) ; 57(11)2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34833492

RESUMO

Breast cancer is one of the most important causes of premature mortality among women and it is one of the most frequently diagnosed tumours worldwide. For this reason, routine screening for prevention and early diagnosis is important for the quality of life of patients. Breast cancer cells can enter blood and lymphatic capillaries, then metastasizing to the regional lymph nodes in the axilla and to both visceral and non-visceral sites. Rather than at the primary site, they seem to enter the systemic circulation mainly through the sentinel lymph node and the biopsy of this indicator can influence the axillary dissection during the surgical approach to the pathology. Furthermore, secondary lymphoedema is another important issue for women following breast cancer surgical treatment or radiotherapy. Considering these fundamental aspects, the present article aims to describe new methodological approaches to assess the anatomy of the lymphatic network in the axillary region, as well as the molecular and physiological control of lymphatic vessel function, in order to understand how the lymphatic system contributes to breast cancer disease. Due to their clinical implications, the understanding of the molecular mechanisms governing lymph node metastasis in breast cancer are also examined. Beyond the investigation of breast lymphatic networks and lymphatic molecular mechanisms, the discovery of new effective anti-lymphangiogenic drugs for future clinical settings appears essential to support any future development in the treatment of breast cancer.


Assuntos
Neoplasias da Mama , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos , Sistema Linfático , Qualidade de Vida , Biópsia de Linfonodo Sentinela
16.
Am J Case Rep ; 22: e931772, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34764233

RESUMO

BACKGROUND The incidence of multiple primaries in cancer patients is 2-17%. However, the synchronous co-occurrence of adenocarcinoma of the breast and follicular lymphoma is rare. CASE REPORT We describe a case series of 3 post-menopausal women who presented to our institute with a breast lump. On further investigations, 2 of them had invasive ductal carcinoma and 1 had invasive lobular carcinoma of the breast. All 3 cancers were estrogen/progesterone receptor (ER/PR)-positive and human epidermal growth factor receptor 2 (HER-2)-negative. During the staging PET scans, all 3 patients had increased FDG uptake in axillary, mesenteric, and inguinal lymph nodes, respectively, raising concerns for metastatic disease. However, subsequent biopsies revealed them as follicular lymphomas occurring as a second concurrent primary malignancy. All patients underwent radical mastectomies with sentinel lymph node dissection followed by chemotherapy and hormonal therapy. Most of the lymphomas were low grade, which the oncologist closely followed. CONCLUSIONS Very few cases of breast cancer and follicular lymphoma co-occur; this is not limited to the axillary lymph nodes and can occur in any part of the lymphatic chain. Regional lymph node enlargement detected on examination or imaging does not always indicate metastasis. A high index of suspicion is needed followed by lymph node biopsy to rule out any second primary malignancy.


Assuntos
Neoplasias da Mama , Linfoma Folicular , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Metástase Linfática , Linfoma Folicular/diagnóstico , Biópsia de Linfonodo Sentinela
17.
Zhonghua Yi Xue Za Zhi ; 101(38): 3141-3145, 2021 Oct 19.
Artigo em Chinês | MEDLINE | ID: mdl-34674424

RESUMO

Objective: To investigate the different tracer materials in identifying the axillary reverse mapping(ARM) lymph nodes. Methods: A retrospective analysis of clinical and pathological data of 478 breast cancer female patients(mean age: 50.5±8.0) under axillary lymph node dissection(ALND) with ARM technique was conducted between March 2019 and November 2020 in Wuhan University Zhongnan Hospital. Of the 478 patients, methylene blue was applied in 147 patients, indocyanine green in 119, and indocyanine green plus methylene blue in 212 patients. Wilcoxon rank-sum test, Chi-squire test or Fisher test, and binary logistic regression were carried out to identify the factors associated with identifying ARM lymph nodes. Results: The recognition rates of ARM lymph nodes were 73.5%, 79.0%, and 83.0%(P=0.091), and the recognition rate of ARM lymphatic vessels was 62.6%, 92.4%, 89.6%(P<0.001), respectively. The coincidence rate of ARM lymph node and SLN was 8.1%(12/148), and the metastasis rate was 16.1%(61/378). Supplemental injection of 1 ml of methylene blue or indocyanine green can improve the identification of ARM lymph nodes. The larger BMI and the performance of neoadjuvant therapy were associated with the lower recognition rate of ARM lymph nodes. Neoadjuvant therapy was an independent factor for the identification rate of ARM lymph nodes. Conclusions: Indocyanine green combined with methylene blue can improve the recognition rate of ARM lymph nodes. Obese patients have a lower recognition rate of ARM lymph nodes, and the supplemental injection tracer can be injected to improve the recognition rate. In breast cancer patients whose ARM lymph nodes are not successfully identified during operation, it may be that the ARM lymph nodes are not located in the axilla.


Assuntos
Neoplasias da Mama , Adulto , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfonodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela
18.
J Int Med Res ; 49(10): 3000605211047279, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34644211

RESUMO

OBJECTIVE: To determine whether aldehyde dehydrogenase 1 (ALDH1) immunostaining in axillary lymph node metastases in patients with breast cancer is associated with poor clinical prognosis. METHODS: This retrospective study reviewed data from the medical records of patients with immunohistochemistry-confirmed invasive ductal carcinoma (IDC) and 1-3 metastatic lymph nodes in the ipsilateral axilla between December 2012 and July 2015. The association between ALDH1 immunostaining in axillary lymph node metastases and clinical parameters and prognosis was analysed using χ2-test, Kaplan-Meier survival analysis, univariate and multivariate Cox regression analyses. RESULTS: A total of 229 patients with IDC were enrolled in the study. The median follow-up was 61 months (range, 20-89 months). Patients with ALDH1-positive axillary lymph node metastases had significantly shorter relapse-free survival and overall survival compared with those with ALDH1-negative axillary lymph node metastases. ALDH1 immunostaining in axillary lymph node metastases was a significant predictor of poor prognosis in univariate and multivariate analyses. CONCLUSION: This large study with long-term follow-up suggests that ALDH1 immunostaining in axillary lymph node metastases is an independent predictor of poor prognosis in patients with breast cancer. The clinical relevance of this finding should be confirmed in further well-designed prospective studies.


Assuntos
Neoplasias da Mama , Família Aldeído Desidrogenase 1 , Axila , Feminino , Humanos , Linfonodos , Metástase Linfática , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
19.
Cancer Treat Rev ; 101: 102297, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34656018

RESUMO

Introduction of sentinel lymph node biopsy, initially in clinically node-negative and subsequently in patients presenting with involved axilla and downstaged by primary systemic therapy, allowed for significant decrease in morbidity compared to axillary lymph node dissection. Concurrently, regional nodal irradiation was demonstrated to improve outcomes in most node-positive patients. Additionally, over the last decades, introduction of more effective systemic therapies has resulted in improvements not only at distant sites, but also in locoregional control, creating space for de-escalation of locoregional treatments. We discuss the data on de-escalation in axillary surgery and irradiation, both in patients undergoing upfront surgery and primary systemic therapy, with special emphasis on the feasibility of omission of nodal irradiation in patients undergoing primary systemic therapy. In view of the accumulating evidence, omission of axillary irradiation may be considered in clinically node-positive patients converting after primary systemic therapy to pathologically negative nodes on sentinel lymph node biopsy (preferably also with in-breast pCR), presenting with lower initial nodal stage, older age and were treated with breast-conserving surgery followed by whole breast irradiation. Omission of regional nodal irradiation in patients with aggressive tumor phenotypes achieving a pCR is under investigation. In patients undergoing preoperative endocrine therapy the adoption of axillary management strategies utilized in case of upfront surgery seems more suitable than those used in post chemotherapy-based primary systemic therapy setting.


Assuntos
Neoplasias da Mama , Linfonodos , Protocolos Antineoplásicos , Axila , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Terapia Combinada , Humanos , Excisão de Linfonodo/métodos , Linfonodos/efeitos dos fármacos , Linfonodos/patologia , Linfonodos/efeitos da radiação , Linfonodos/cirurgia , Irradiação Linfática/métodos , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela
20.
World J Surg Oncol ; 19(1): 306, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666764

RESUMO

BACKGROUND: Sentinel lymph node biopsy is the gold standard surgical technique for axillary staging in patients with clinically node-negative. However, it is still uncertain what is the optimal number of sentinel lymph nodes (SLNs) to be removed to reduce the false-negative rate. The aim of this study was to investigate whether patients with a single negative SLN have a worse prognosis than those with two or more negative SLNs. METHODS: A retrospective review was conducted on a large series of SLN-negative breast cancer patients. Survival outcomes and regional recurrence rate were evaluated according to the number of removed SLNs. Secondly, the contribution of different adjuvant therapies on disease-free survival was explored. Statistical analysis included the chi-square, Wilcoxon-Mann-Whitney test, and Kaplan-Meier survival analysis. RESULTS: A total of 1080 patients were included in the study. A first group consisted of 328 patients in whom a single SLN was retrieved, and a second group consisted of 752 patients in whom two or more SLNs were retrieved. There was no relevant difference in median DFS (64.9 vs 41.4) for SLN = 1 vs SLN > 1 groups (HR 0.76, CI 95% 0.39-1.46; p = 0.38). A statistically significant difference in mDFS was showed only for HT-treated patients who were SLN = 1 if compared to SLN > 1 (100.6 months versus 35.3 months). CONCLUSIONS: There is likely a relationship between the number of resected SNL and mDFS. Our results, however, showed no relevant difference in median DFS for SLN = 1 vs SLN > 1 group, except for a subset of the patients treated with hormone therapy.


Assuntos
Neoplasias da Mama , Linfonodo Sentinela , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos Retrospectivos , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela
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