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Nikola Besic - One of the best experts on this subject based on the ideXlab platform.
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Patients with preoperatively ultrasonically uninvolved Axillary Lymph Nodes: a distinct subgroup of early breast cancer patients
Breast cancer research and treatment, 2005Co-Authors: Janez Zgajnar, Maja Podkrajsek, Kristijana Hertl, Snjezana Frkovic-grazio, Marko Hočevar, Gaj Vidmar, Nikola BesicAbstract:Introduction Ultrasound (US) preoperative examination of the Axillary Lymph Nodes combined with the fine needle aspiration biopsy (FNAB) is often used in order to reduce the number of sentinel Lymph node (SLN) biopsy procedures in clinically node negative breast cancer patients. The pathohistological characteristics of the ultrasonically negative Axillary Lymph Nodes in clinically negative Axillary Lymph Nodes are not known. The aim of our study was to compare the pathohistological characteristics of ultrasonically uninvolved Axillary Lymph Nodes (US group) versus clinically uninvolved Axillary Lymph Nodes (non-US group) in SLN biopsy candidates.
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Minimal risk of macrometastases in the non-sentinel Axillary Lymph Nodes in breast cancer patients with micrometastatic sentinel Lymph Nodes and preoperatively ultrasonically uninvolved Axillary Lymph Nodes
European journal of cancer (Oxford England : 1990), 2005Co-Authors: Janez Zgajnar, Nikola Besic, Maja Podkrajsek, Kristijana Hertl, Snjezana Frkovic-grazio, Marko HočevarAbstract:Micrometastases in the sentinel Lymph node (SLN) carry a considerable risk of macrometastases in the non-sentinel Lymph Nodes (NSLN), resulting in Axillary Lymph node dissection (ALND). Preoperative ultrasound (US) examination of the Axillary Lymph Nodes combined with a fine-needle aspiration biopsy (FNAB) has been proved to discover metastases in the Axillary Lymph Nodes. The aim of our study was to assess the risk of macrometastases in NSLN in patients with micrometastatic SLN after a preoperative US examination of the Axillary Lymph Nodes. The study included 36 patients in whom, after preoperative Axillary US, micrometastases in the SLN were revealed and ALND was subsequently performed. At final histopathology, no macrometastases were discovered in the NSLN. In four patients, additional micrometastases were discovered in the NSLN. In conclusion, the risk of macrometastases in the NSLN in patients with preoperatively ultrasonically uninvolved Axillary Lymph Nodes is minimal.
Kelly K Hunt - One of the best experts on this subject based on the ideXlab platform.
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cortical morphologic features of Axillary Lymph Nodes as a predictor of metastasis in breast cancer in vitro sonographic study
American Journal of Roentgenology, 2008Co-Authors: Deepak G Bedi, Rajesh Krishnamurthy, Savitri Krishnamurthy, Beth S Edeiken, Huong Lepetross, Bruno D Fornage, Roland L Bassett, Kelly K HuntAbstract:OBJECTIVE. The purpose of this study was in vitro sonographic–pathologic correlation of findings in dissected Axillary Lymph Nodes from breast cancer patients undergoing Axillary Lymph node dissection and classification of the sonographic appearance of the Nodes on the basis of cortical morphologic features to facilitate early recognition of metastatic disease.MATERIALS AND METHODS. High-resolution sonography was used for in vitro examination of 171 Lymph Nodes from 19 axillae in 18 patients with unknown nodal status who underwent Axillary Lymph node dissection for early infiltrating breast cancer. The images were evaluated by two blinded observers, and discordant readings were referred to a third blinded observer. Each Lymph node was classified as one of types 1–6 according to cortical morphologic features. Types 1–4 were considered benign, ranging from hyperechoic with no visible cortex to thickened generalized hypoechoic cortical lobulation. Type 5 (focal hypoechoic cortical lobulation) and type 6 (hyp...
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role of ultrasound guided fine needle aspiration of indeterminate and suspicious Axillary Lymph Nodes in the initial staging of breast carcinoma
Cancer, 2002Co-Authors: M Savitri D Krishnamurthy, M Nour D Sneige, G Deepak M D Bedi, S Beth M D Edieken, D Bruno M D Fornage, Eva S Singletary, Henry Mark Kuerer, Kelly K HuntAbstract:BACKGROUND. Ultrasound (US) is more sensitive than physical examination alone in determining Axillary Lymph node involvement during preliminary staging of breast carcinoma. Due to occasional overlap of sonographic features of benign and indeterminate Lymph Nodes, fine-needle aspiration (FNA) of sonographically indeterminate/suspicious Lymph Nodes can provide a more definitive diagnosis than US alone. This study was undertaken to determine the diagnostic accuracy of US-guided FNA of indeterminate/suspicious/metastatic-appearing Axillary Lymph Nodes during the initial staging of breast carcinoma. METHODS. The cytology of 103 cases of US-guided FNA of nonpalpable indeterminate/suspicious/metastatic-appearing Lymph Nodes was compared with the final histopathologic status of the entire axilla after Axillary dissection. The final Axillary Lymph node status was categorized as either negative when all Lymph Nodes were negative for metastasis or positive when there was evidence of metastasis in one or more Lymph Nodes. The sensitivity, specificity, diagnostic accuracy, and falsenegative rate of US-guided FNA of nonpalpable Axillary Lymph Nodes in the preliminary staging process were calculated. RESULTS. In 51 of 103 cases (49.5%), the US-guided FNA and histopathology were both positive for metastasis. In 24 of 103 cases (23.3%), both were negative. The apparent false-positive FNA in 16 (15.5%) cases was explained by the complete response of the metastatic Lymph Nodes to neoadjuvant chemotherapy in the interval between FNA and Axillary dissection. In 12 cases (11.6%), US-guided FNA was negative, but metastasis was seen in histologic sections. All cases with three or more Lymph Nodes with metastatic disease and 93% of those with metastatic deposit measuring more than 0.5 mm were detected by US-guided FNA. The probability of detecting Lymph Nodes with smaller metastatic deposit measuring less than 0.5 cm was 44%. The overall sensitivity of US-guided FNA was 86.4%, the specificity was 100%, the diagnostic accuracy was 79.0%, the positive predictive value was 100%, and the negative predictive value was 67%. CONCLUSIONS. US-guided FNA of nonpalpable indeterminate and suspicious Axillary Lymph Nodes is a simple, minimally invasive, and reliable technique for the initial determination of Axillary Lymph node status in breast carcinoma. The common causes of discrepancy between the initial and final Axillary Lymph node status include failure to visualize all Lymph Nodes during US examination, small-sized metastases, and preoperative neoadjuvant chemotherapy. Cancer 2002;95:982– 8. © 2002 American Cancer Society. DOI 10.1002/cncr.10786
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role of ultrasound guided fine needle aspiration of indeterminate and suspicious Axillary Lymph Nodes in the initial staging of breast carcinoma
Cancer, 2002Co-Authors: M Savitri D Krishnamurthy, M Nour D Sneige, G Deepak M D Bedi, S Beth M D Edieken, D Bruno M D Fornage, Eva S Singletary, Henry Mark Kuerer, Kelly K HuntAbstract:Background Ultrasound (US) is more sensitive than physical examination alone in determining Axillary Lymph node involvement during preliminary staging of breast carcinoma. Due to occasional overlap of sonographic features of benign and indeterminate Lymph Nodes, fine-needle aspiration (FNA) of sonographically indeterminate/suspicious Lymph Nodes can provide a more definitive diagnosis than US alone. This study was undertaken to determine the diagnostic accuracy of US-guided FNA of indeterminate/suspicious/metastatic-appearing Axillary Lymph Nodes during the initial staging of breast carcinoma. Methods The cytology of 103 cases of US-guided FNA of nonpalpable indeterminate/suspicious/metastatic-appearing Lymph Nodes was compared with the final histopathologic status of the entire axilla after Axillary dissection. The final Axillary Lymph node status was categorized as either negative when all Lymph Nodes were negative for metastasis or positive when there was evidence of metastasis in one or more Lymph Nodes. The sensitivity, specificity, diagnostic accuracy, and false-negative rate of US-guided FNA of nonpalpable Axillary Lymph Nodes in the preliminary staging process were calculated. Results In 51 of 103 cases (49.5%), the US-guided FNA and histopathology were both positive for metastasis. In 24 of 103 cases (23.3%), both were negative. The apparent false-positive FNA in 16 (15.5%) cases was explained by the complete response of the metastatic Lymph Nodes to neoadjuvant chemotherapy in the interval between FNA and Axillary dissection. In 12 cases (11.6%), US-guided FNA was negative, but metastasis was seen in histologic sections. All cases with three or more Lymph Nodes with metastatic disease and 93% of those with metastatic deposit measuring more than 0.5 mm were detected by US-guided FNA. The probability of detecting Lymph Nodes with smaller metastatic deposit measuring less than 0.5 cm was 44%. The overall sensitivity of US-guided FNA was 86.4%, the specificity was 100%, the diagnostic accuracy was 79.0%, the positive predictive value was 100%, and the negative predictive value was 67%. Conclusions US-guided FNA of nonpalpable indeterminate and suspicious Axillary Lymph Nodes is a simple, minimally invasive, and reliable technique for the initial determination of Axillary Lymph node status in breast carcinoma. The common causes of discrepancy between the initial and final Axillary Lymph node status include failure to visualize all Lymph Nodes during US examination, small-sized metastases, and preoperative neoadjuvant chemotherapy.
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residual metastatic Axillary Lymph Nodes following neoadjuvant chemotherapy predict disease free survival in patients with locally advanced breast cancer
American Journal of Surgery, 1998Co-Authors: Henry Mark Kuerer, Kelly K Hunt, Lisa A Newman, Aman U Buzdar, Kapil Dhingra, Thomas A Buchholz, Susan M Binkley, Frederick C Ames, Barry W Feig, Merrick I RossAbstract:Abstract Background: This study was performed to validate the prognostic significance of residual Axillary Lymph node metastases in patients with locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy and to analyze other clinicopathologic factors that might be independent predictors of disease-free survival (DFS) in an attempt to identify patients in whom Axillary dissection might be omitted. Methods: One hundred sixty-five assessable patients with LABC were treated in a prospective trial of neoadjuvant chemotherapy utilizing four cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide. Responding patients were treated with segmental mastectomy and Axillary dissection or modified radical mastectomy. Patients subsequently received additional chemotherapy followed by irradiation of the breast or chest wall and draining Lymphatics. The median follow-up was 35 months. Results: Clinical tumor response to neoadjuvant chemotherapy (P = 0.046) and the number of residual metastatic Axillary Lymph Nodes found at Axillary dissection (P = 0.05) were the only independent predictors of DFS. Patients with a complete clinical response had a predictably excellent DFS and those with no change or progressive disease had a poor DFS. In patients with a partial response, the number of residual metastatic Lymph Nodes further stratified patients with respect to DFS (P = 0.006). Conclusions: Clinical response and residual metastatic Axillary Lymph Nodes following neoadjuvant chemotherapy are important predictors of DFS. Patients with a clinically positive axilla following neoadjuvant chemotherapy should undergo Axillary dissection to ensure local control. However, the benefit of Axillary dissection in patients with a clinically negative axilla may be minimal if the axilla will be irradiated, and histologic staging does not affect subsequent systemic treatment. A prospective randomized trial of Axillary dissection versus Axillary radiotherapy in patients with a clinically negative axilla following neoadjuvant chemotherapy is presently under way to evaluate this hypothesis.
Janez Zgajnar - One of the best experts on this subject based on the ideXlab platform.
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Patients with preoperatively ultrasonically uninvolved Axillary Lymph Nodes: a distinct subgroup of early breast cancer patients
Breast cancer research and treatment, 2005Co-Authors: Janez Zgajnar, Maja Podkrajsek, Kristijana Hertl, Snjezana Frkovic-grazio, Marko Hočevar, Gaj Vidmar, Nikola BesicAbstract:Introduction Ultrasound (US) preoperative examination of the Axillary Lymph Nodes combined with the fine needle aspiration biopsy (FNAB) is often used in order to reduce the number of sentinel Lymph node (SLN) biopsy procedures in clinically node negative breast cancer patients. The pathohistological characteristics of the ultrasonically negative Axillary Lymph Nodes in clinically negative Axillary Lymph Nodes are not known. The aim of our study was to compare the pathohistological characteristics of ultrasonically uninvolved Axillary Lymph Nodes (US group) versus clinically uninvolved Axillary Lymph Nodes (non-US group) in SLN biopsy candidates.
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Minimal risk of macrometastases in the non-sentinel Axillary Lymph Nodes in breast cancer patients with micrometastatic sentinel Lymph Nodes and preoperatively ultrasonically uninvolved Axillary Lymph Nodes
European journal of cancer (Oxford England : 1990), 2005Co-Authors: Janez Zgajnar, Nikola Besic, Maja Podkrajsek, Kristijana Hertl, Snjezana Frkovic-grazio, Marko HočevarAbstract:Micrometastases in the sentinel Lymph node (SLN) carry a considerable risk of macrometastases in the non-sentinel Lymph Nodes (NSLN), resulting in Axillary Lymph node dissection (ALND). Preoperative ultrasound (US) examination of the Axillary Lymph Nodes combined with a fine-needle aspiration biopsy (FNAB) has been proved to discover metastases in the Axillary Lymph Nodes. The aim of our study was to assess the risk of macrometastases in NSLN in patients with micrometastatic SLN after a preoperative US examination of the Axillary Lymph Nodes. The study included 36 patients in whom, after preoperative Axillary US, micrometastases in the SLN were revealed and ALND was subsequently performed. At final histopathology, no macrometastases were discovered in the NSLN. In four patients, additional micrometastases were discovered in the NSLN. In conclusion, the risk of macrometastases in the NSLN in patients with preoperatively ultrasonically uninvolved Axillary Lymph Nodes is minimal.
Marko Hočevar - One of the best experts on this subject based on the ideXlab platform.
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Patients with preoperatively ultrasonically uninvolved Axillary Lymph Nodes: a distinct subgroup of early breast cancer patients
Breast cancer research and treatment, 2005Co-Authors: Janez Zgajnar, Maja Podkrajsek, Kristijana Hertl, Snjezana Frkovic-grazio, Marko Hočevar, Gaj Vidmar, Nikola BesicAbstract:Introduction Ultrasound (US) preoperative examination of the Axillary Lymph Nodes combined with the fine needle aspiration biopsy (FNAB) is often used in order to reduce the number of sentinel Lymph node (SLN) biopsy procedures in clinically node negative breast cancer patients. The pathohistological characteristics of the ultrasonically negative Axillary Lymph Nodes in clinically negative Axillary Lymph Nodes are not known. The aim of our study was to compare the pathohistological characteristics of ultrasonically uninvolved Axillary Lymph Nodes (US group) versus clinically uninvolved Axillary Lymph Nodes (non-US group) in SLN biopsy candidates.
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Minimal risk of macrometastases in the non-sentinel Axillary Lymph Nodes in breast cancer patients with micrometastatic sentinel Lymph Nodes and preoperatively ultrasonically uninvolved Axillary Lymph Nodes
European journal of cancer (Oxford England : 1990), 2005Co-Authors: Janez Zgajnar, Nikola Besic, Maja Podkrajsek, Kristijana Hertl, Snjezana Frkovic-grazio, Marko HočevarAbstract:Micrometastases in the sentinel Lymph node (SLN) carry a considerable risk of macrometastases in the non-sentinel Lymph Nodes (NSLN), resulting in Axillary Lymph node dissection (ALND). Preoperative ultrasound (US) examination of the Axillary Lymph Nodes combined with a fine-needle aspiration biopsy (FNAB) has been proved to discover metastases in the Axillary Lymph Nodes. The aim of our study was to assess the risk of macrometastases in NSLN in patients with micrometastatic SLN after a preoperative US examination of the Axillary Lymph Nodes. The study included 36 patients in whom, after preoperative Axillary US, micrometastases in the SLN were revealed and ALND was subsequently performed. At final histopathology, no macrometastases were discovered in the NSLN. In four patients, additional micrometastases were discovered in the NSLN. In conclusion, the risk of macrometastases in the NSLN in patients with preoperatively ultrasonically uninvolved Axillary Lymph Nodes is minimal.
Tomohiko Aihara - One of the best experts on this subject based on the ideXlab platform.
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Mammaglobin B as a novel marker for detection of breast cancer micrometastases in Axillary Lymph Nodes by reverse transcription-polymerase chain reaction.
Breast cancer research and treatment, 1999Co-Authors: Tomohiko Aihara, Yoshiyuki Fujiwara, Masaru Ooka, Isao Sakita, Yasuhiro Tamaki, Morito MondenAbstract:A novel reverse transcription-polymerase chain reaction (RT-PCR) assay using mammaglobin B gene was developed for detection of breast cancer micrometastases in Axillary Lymph Nodes. Fourteen primary breast cancers and 56 Axillary Lymph Nodes from six patients with primary breast cancer and 15 control Lymph Nodes from non-cancer bearing patients were subjected to this assay. The transcript of mammaglobin B gene was detected in none of the control Lymph Nodes, but in all of the 14 primary breast cancers. Eleven out of the 56 Lymph Nodes from the patients, which were shown to be positive by histological examination, were also proven positive by this assay. On the other hand, fourteen of the 45 (31%) histologically negative Lymph Nodes were also shown to express mammaglobin B mRNA, which suggested the presence of micrometastases in these Lymph Nodes. RT-PCR using mammaglobin B gene could therefore be a useful tool for detection of micrometastases of breast cancer.
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Detection of breast cancer micrometastases in Axillary Lymph Nodes by means of reverse transcriptase-polymerase chain reaction. Comparison between MUC1 mRNA and keratin 19 mRNA amplification.
American Journal of Pathology, 1996Co-Authors: Shinzaburo Noguchi, Tomohiko Aihara, Shingi Imaoka, Kazuyoshi Motomura, Hideo Inaji, Hiroki KoyamaAbstract:Usefulness of MUC1 mRNA and keratin 19 mRNA as a target of reverse-transcriptase polymerase chain reaction (RT-PCR) was compared in the detection of breast cancer micrometastases in Axillary Lymph Nodes. RT-PCR amplification of MUC1 mRNA and keratin 19 mRNA was conducted using total RNA samples. RT-PCR products were stained with ethidium bromide and analyzed by agarose gel electrophoresis. Expression of both MUC1 mRNA and keratin 19 mRNA was detected by RT-PCR in a breast cancer cell line (MRK) and in all the 23 primary breast cancers but not in the control Lymph Nodes obtained from patients with benign diseases. A serial dilution study of MRK cells against normal Lymph node cells has shown that detection sensitivity of MUC1 RT-PCR and keratin 19 RT-PCR were 1/10(5) and 1/10(6) (cancer/Lymph node cells), respectively. Sixty-three Axillary Lymph Nodes were obtained from 23 patients with primary breast cancer, and metastases in each Lymph node were investigated by histological examination (hematoxylin and eosin sections) and RT-PCR method. In all 10 Lymph Nodes, which were histologically metastasis-positive, both MUC1 mRNA and keratin mRNA were detected by RT-PCR. Of the 53 histologically negative Lymph Nodes, 3 (6%) and 5 (9%) Lymph Nodes were found to express MUC1 mRNA and keratin 19 mRNA, respectively, indicating the presence of micrometastases which could be detected by RT-PCR but not by histological examination. These results demonstrate the usefulness of both MUC1 RT-PCR and keratin 19 RT-PCR in the detection of breast cancer micrometastases in Lymph Nodes, and also indicate the superiority of keratin 19 RT-PCR over MUC1 RT-PCR because of its higher detection sensitivity.
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the detection of breast carcinoma micrometastases in Axillary Lymph Nodes by means of reverse transcriptase polymerase chain reaction
Cancer, 1994Co-Authors: Shinzaburo Noguchi, Tomohiko Aihara, Shingi Imaoka, Kazuyoshi Motomura, Hideo Inaji, Shoji Nakamori, Hiroki KoyamaAbstract:Background. The development of a sensitive method for the detection of breast carcinoma micrometastases in Axillary Lymph Nodes is reported. Methods. The method was based on amplification of MUCl mRNA, which encodes a core protein of polymorphic epithelial mucin, by a reverse transcriptase-polymerase chain reaction (RT-PCR). Total RNA, which was extracted from a breast carcinoma cell line (MCF-7), primary breast carcinomas, and Axillary Lymph Nodes, was subjected to analysis of MUCl mRNA expression by the RT-PCR method. Results. MUCl mRNA expression was detected by RT-PCR in MCF-7 cells and in all 15 primary breast carcinomas but not in control Lymph Nodes taken from patients with benign diseases. A serial dilution study revealed that MUCl RT-PCR was a very sensitive method, detecting one MCF-7 cell per 1,000,000 Lymph node cells. The detection sensitivity of MUCl RT-PCR method was compared with that of immunohistochemical staining of an epithelial marker (polymorphic epithelial mucin). Fifty Axillary Lymph Nodes were obtained from 15 patients with primary breast carcinomas, and metastasis in each Lymph node was investigated by both methods. The immunohistochemical method demonstrated metastasis in nine Lymph Nodes, and MUCl mRNA was detected in all of them. Of the 41 Lymph Nodes that were diagnosed to be devoid of metastasis by immunohistochemistry, MUCl mRNA was expressed by 6 but not by the other 35, indicating the presence of micrometastases in these 6 Lymph Nodes that could be detected only by the MUCl RT-PCR method. Conclusions. The MUCl RT-PCR method is more sensitive than immunohistochemistry for the detection of micrometastases in Axillary Lymph Nodes. This new method would be of practical value in selecting the patients at high risk for relapse from those who are histologically Lymph node negative.