Objective To analyze the correlation among the clinicopathologic features, ultrasound imaging features, and axillary lymph node metastasis in breast cancer patients with negative clinical evaluation of axillary lymph nodes (cN0), and to establish a logistic regression model to predict axillary lymph node metastasis, so as to provide a reference for more accurate evaluation of axillary lymph node status in cN0 breast cancer patients. Methods The data of 501 female patients with cN0 breast cancer who were hospitalized and operated in the Affiliated Hospital of Wuhan University of Science and Technology (Xiaogan Central Hospital) from December 2013 to October 2020 were collected. Among them, 376 patients from December 2013 to December 2019 were selected to establish a prediction model for axillary lymph node metastasis of cN0 breast cancer. In the modeling group, the basic information, clinical pathological characteristics, and ultrasound imaging features of patients were analyzed by single factor analysis. The factors with statistical significance were included in the multivariate logistic regression analysis, and the logistic regression prediction model was established. The model was evaluated by the correction curve and Hosmer-Lemeshow test goodness of fit. The model was validated in the validation group (125 patients from January to October 2020), and the receiver operation characteristic (ROC) curve was drawn. Results The probability of positive axillary lymph nodes in 501 patients with cN0 breast cancer was 28.14% (141/501). The univariate analysis results of the modeling group showed that the histological grade, vascular invasion, progesterone receptor (PR), Ki-67, age, molecular typing, ultrasound breast imaging-reporting and data system (BI-RADS) grade were associated with axillary lymph node metastasis. Multivariate logistic regression analysis showed that the vascular infiltration, positive estrogen receptor (ER) , ultrasound BI-RADS grade 4C and Ki-67≥14% increased the probability of axillary lymph node metastasis (P<0.05). Using the above prediction factors to establish the prediction nomogram, the area under the ROC curve (AUC) of the modeling group was 0.72 [95%CI (0.66, 0.78)], the cut-off value was 0.30, the sensitivity was 61.00%, and the specificity was 71.20%. The newly established axillary lymph node transfer logistic regression model was applied to the validation group (n=125), and the AUC was 0.72 [95%CI (0.53, 0.76)]. The truncation value was 0.40, and the total coincidence rate was 69.60% (87/125), positive predictive value was 47.37% (18/38), and negative predictive value was 91.95% (80/87). Conclusions Vascular invasion, positive ER , ultrasound BI-RADS grade 4C, and Ki-67≥14% are risk predictors of axillary lymph node metastasis in cN0 breast cancer patients. The negative predictive value of the model is 91.95%, which has a higher value in predicting axillary lymph node metastasis in early breast cancer patients, and can provide a reference for screening exempt sentinel lymph node biopsy population.
Malignant melanoma is a kind of highly malignant tumor, which mainly occurs in the skin, mucous membrane, and rarely in the breast. Here we reported a case of malignant melanoma in the chest wall skin with mammary metastasis. A sizable pigment spot on the skin of the thoracic region was found at the patient’s birth, existing for 50 years with quite atypical clinical manifestation. A nodule at 12 o’clock of the left breast was found by ultrasound four months ago, who was mistaken for a fibroadenoma. As a result, the patient received a minimally invasive excision of the breast lesion, after which the pathological report suggested malignant melanoma. By sharing this case, we aimed to discuss the diagnosis and treatment of this kind of atypical malignant melanoma in detail and provide some clinical experience.
ObjectiveTo investigate the metastatic status and risk factors of axillary non-sentinel lymph node (NSLN) in breast cancer patients with 1–2 positive sentinel lymph nodes (SLN), and to provide theoretical basis for exemption of axillary lymph node dissection (ALND) in these patients. Methods A retrospective analysis was performed on 54 patients diagnosed with breast cancer who underwent sentinel lymph node biopsy (SLNB) and confirmed to have 1–2 positive sentinel lymph nodes (SLNS) and received ALND in the Department of Thyroid and Breast Surgery of Tongling People’s Hospital from January 2018 to April 2023. The patients were divided into NSLN metastatic group (17 cases) and NSLN non-metastatic group (37 cases) according to whether there was metastasis. Chi-square test was used to compare the basic information and clinicpathological features of the two groups. The independent risk factors for axillary NSLN metastasis were screened out by multivariate binary logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of independent risk factors combined with axillary NSLN metastasis. Results There were 54 cases with 1–2 metastasis of SLN, 17 cases with axillary NSLN metastasis (31.5%). The incidence of axillary NSLN metastasis in patients with tumor at T1 stage (maximum diameter ≤2 cm) was only 14.3% (4/28), however, the metastatic rate of axillary NSLN in patients with tumor in T2–T3 stage (maximum diameter >2 cm) was as high as 50.0% (13/26). The axillary NSLN metastasis rate was only 21.2% (7/33) with 1 SLN metastasis, while the axillary NSLN metastasis rate was 47.6% (10/21) with 2 SLN metastasis. Univariate analysis showed that T stage (tumor diameter >2 cm), 2 SLN metastases, number of SLN >5 and tumor with vascular embolus were more likely to develop axillary NSLN metastases (P<0.05). Multivariate binary logistic regression analysis showed that T stage (tumor diameter >2 cm) and 2 SLN metastases were independent risk factors for axillary NSLN metastasis in breast cancer patients, the area under ROC curve of combined prediction of axillary NSLN metastasis by the two was 0.747, 95%CI was (0.657, 0.917), sensitivity was 0.765 and specificity was 0.649. Conclusions The combination of tumor T stage and the number of SLN metastases can better predict axillary NSLN metastasis in breast cancer patients. ALND is recommended for breast cancer patients with T stage (tumor diameter >2 cm) and 2 SLN metastases to reduce the risk of residual axillary NSLN metastasis.
Objective To explore the feasibility of breast cancer patients in China with 1–2 positive sentinel lymph nodes (SLN) to avoid axillary lymph node dissection (ALND). Methods A total of 328 patients who received sentinel lymph node biopsy (SLNB) in our hospital from 2010 to 2016 were collected retrospectively, and patients met the criteria of Z0011 clinical trials (which required no acceptance of neoadjuvant therapy, clinical tumor size was in T1/T2 stage, two or less positive SLNs were detected, received breast-conservation surgery, acceptance of whole breast radiotherapy after surgery and neoadjuvant systemic treatment) were enrolled to breast-conservation group. Patients met the criteria of Z0011 clinical trials, excepting the surgery (received non-breast-conservation surgery), were enrolled to non- breast-conservation group. Comparison of clinicopathological features between the breast-conservation group/non-breast-conservation group and the Z0011 ALND group was performed. Results Among the 328 patients, only 29 patients (8.8%) completely correspond with the results of Z0011 clinical trials. There was no statistical significance between the breast-conservation group and the Z0011 ALND group in the age, clinical T stage, expression of estrogen (ER), expression of progesterone (PR), pathological type, histological grade, number of positive lymph nodes, and incidence of non-sentinel node metastasis (P>0.05). A total of 81 patients were included in the non-breast-conservation group. It showed no statistical significance between the non-breast-conservation group and the Z0011 ALND group in expressions of ER and PR, and histological grade (P>0.05), while there was statistically significant difference in age, clinical T stage, pathological type,number of positive lymph nodes, and incidence of non-sentinel node metastasis (P<0.05). Patients in the non-breast-conservation group showed a lower age, higher percentage of lobular carcinoma and T2 stage, more positive lymph nodes, and high incidence of non-sentinel node metastasis. Conclusion It’s feasible for Z0011 clinical trials results to be used in the clinical practice of our country, but the actual situation of breast conservation in our country may lead to low adaptive population.
Objective To explore the axillary lymph node dissection (ALND) could be safely exempted in younger breast cancer patients (≤40 years of age) who receiving breast-conserving surgery combined with radiotherapy in metastasis of 1–2 sentinel lymph node (SLN) and T1–T2 stage. Methods The data of pathological diagnosis of invasive breast cancer from 2004 to 2015 in SEER database were extracted. Patients were divided into SLN biopsy group (SLNB group) and ALND group according to axillary treatment. Propensity matching score (PSM) method was used to match and equalize the clinicopathological features between two groups at 1∶1. Multivariate Cox proportional risk model was used to analyze the relationship between axillary management and breast cancer specific survival (BCSS), and stratified analysis was performed according to clinicopathological features. Results A total of 1 236 patients with a median age of 37 years (quartile: 34, 39 years) were included in the analysis, including 418 patients (33.8%) in the SLNB group and 818 patients (66.2%) in the ALND group. The median follow-up period was 82 months (quartile: 44, 121 months), and 111 cases (9.0%) died of breast cancer, including 33 cases (7.9%) in the SLNB group and 78 cases (9.5%) in the ALND group. The cumulative 5-year BCSS of the SLNB group and the ALND group were 90.8% and 93.4%, respectively, and the log-rank test showed no significant difference (χ2=0.70, P=0.401). After PSM, there were 406 cases in both the SLNB group and the ALND group. The cumulative 5-year BCSS rate in the ALND group was 4.1% higher than that in the SLNB group (94.8% vs. 90.7%). Multivariate Cox proportional hazard analysis showed that ALND could further improve BCSS rate in younger breast cancer patients [HR=0.578, 95%CI (0.335, 0.998), P=0.049]. Stratified analyses showed that ALND improved BCSS in patients diagnosed before 2012 or with a character of lymph node macrometastases, histological grade G3/4, ER negative or PR negative. Conclusions It should be cautious to consider the elimination of ALND in the stage T1–T2 younger patients receiving breast-conserving surgery combined with radiotherapy when 1–2 SLNs positive, especially in patients with high degree of malignant tumor biological behavior or high lymph node tumor burden. Further prospective trials are needed to verify the question.
Objective To investigate the proportions of CD4+ T cells, CD8+ T cells, and mutant of p53 gene in the microenvironment of breast infiltrating ductal carcinoma, and to explore its’ correlation with prognosis of breast infiltrating ductal carcinoma. Methods Eighty-five cases of breast infiltrating ductal carcinoma were collected who underwent surgery in the 371st Central Hospital of Peoples’ Liberation Army from 2010 to 2012, and then detected the proportion of CD4+ T cells and CD8+ T cells, ratio of CD4+ T cells to CD8+ T cells, and mutant of p53 gene in the cancer tissues with immunohistochemistry. Comparison between the sentinel lymph node metastasis group and non-sentinel lymph node metastasis group, mutant of p53 gene group and non-mutant of p53 gene group on the proportions of CD4+ T cells, CD8+ T cells, and ratio of CD4+ T cells to CD8+ T cells were performed, as well as the relationship between proportion of CD8+ T cells/mutant of p53 gene and prognosis of breast infiltrating ductal carcinoma. Results ① The relationship between proportion of CD4+ T cells/proportion of CD8+ T cells/ratio of CD4+ T cells to CD8+ T cells and situation of sentinel lymph node metastasis: at cluster, compared with the sentinel lymph node metastasis group, the proportion of CD8+ T cells was lower in the non-sentinel lymph node metastasis group (P<0.05), but there was no significant difference on the proportion of CD4+ T cells and ratio of CD4+ T cells to CD8+ T cells (P>0.05); at stroma, compared with the sentinel lymph node metastasis group, the proportions of CD4+ T cells and CD8+ T cells were lower, but the ratio of CD4+ T cells to CD8+ T cells was higher in the non-sentinel lymph node metastasis group (P<0.05). ② The relationship between proportion of CD4+ T cells/proportion of CD8+ T cells/ratio of CD4+ T cells to CD8+ T cells and mutant of p53 gene: both at the cluster and stroma, compared with the mutant of p53 gene group, the proportions of CD4+ T cells and CD8+ T cells were lower, but the ratio of CD4+ T cells to CD8+ T cells was higher in the non-mutant of p53 gene group (P<0.05). ③ The relationship between proportion of CD8+ T cells/mutant of p53 gene and prognosis of breast infiltrating ductal carcinoma: the prognosis was worse in patients with high degree of infiltration of CD8+ T cells and mutant of p53 gene than those patients with low degree of infiltration of CD8+ T cells and non-mutant of p53 gene (P<0.05). Conclusions The proportions of CD4+ T cells and CD8+ T cells, and ratio of CD4+ T cells to CD8+ T cells are associated with the situation of sentinel lymph node metastasis and mutant of p53 gene, and the degree of infiltration of CD8+ T cells and mutant of p53 gene are associated with the prognosis of breast infiltrating ductal carcinoma.
ObjectiveTo explore the feasibility and clinical efficacy of laparoscopic sentinel lymph node biopsy combined with endoscopic submucosal dissection(ESD) for patients with early gastric cancer(EGC). MethodsThe clinical data of 26 cases who received ESD combined with laparoscopic sentinel lymph node biopsy for EGC between March 2009 to August 2013 in Affiliated Hospital of Jiangnan University were analyzed retrospectively. These patients first underwent laparoscopic sentinel lymph node(SLN) biopsy. If frozen sectioning examination suggested there was lymph node metastasis, laparoscopic D2 radical gastrectomy would be operated. However, the ESD would be operated if the frozen sectioning examination was negative. ResultsThe total numbers of SLN were 95, and mean numbers of SLN were 3.7±1.4(range from 1 to 6). Two patients with positive SLN underwent laparoscopic-assisted distal gastrectomy and 24 patients with negative SLN underwent ESD. The disease free survival(DFS) and local recurrence rate after ESD for EGC was 91.7%(22/24) and 4.2%(1/24), respectively. And the total DFS for all patients was 96.2% (25/26). ConclusionESD for EGC is a safe and feasible procedure, combined with laparoscopic sentinel lymph node biopsy conforms more to the concept of principle of radical operation.
ObjectiveTo explore influence of molecular classification of breast cancer on surgical treatment of axillary lymph nodes. MethodThe related literatures which discussed the relation between molecular classification and axillary lymph node metastasis were reviewed and analyzed. ResultsThe triple negative breast cancer had a lower rate of sentinel lymph node or non-sentinel lymph node metastasis. The axillary lymph node metastasis rate was higher in the luminal B or HER-2 overexpression subtypes. Especially, luminal B subtype had a higher risk of sentinel lymph node or non-sentinel lymph node metastasis as compared with the other subtypes. Elderly patients with breast conserving operation could be free for axillary lymph node dissection when only 1-2 sentinel lymph node metastases. There was still a positive possibility of non-sentinel lymph node for younger patients with a larger tumor size, even if the sentinel lymph node negative, the lymph node dissection may benefit these patients. ConclusionBreast cancer molecular classification should be considered for the surgery selection of axillary lymph node dissection.
ObjectiveTo investigate the differences between indocyanine green (ICG) plus methylene blue and radioactive nuclide plus methylene blue for sentinel lymph node biopsy (SLNB) after Neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods A total of 77 breast cancer patients who accepted SLNB and axillary lymph node dissection (ALND) after NAC from June 2017 to February 2019 were involved, among them, 46 breast cancer patients accepted SLNB by ICG plus methylene blue and 31 breast cancer patients accepted SLNB by radioactive nuclide plus methylene blue, pathological and clinical data were collected and analyzed.ResultsThere were 43 patients in the ICG plus methylene blue group and 30 patients in radioactive nuclide plus methylene blue group, which totally 73 patients were detected at least one sentinel lymph node in all the 77 patients, and the detection rate was 94.80%. The SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy of the ICG plus methylene blue group were 93.48% (43/46), 2.32 per case, 82.61% (19/23), 17.39% (4/23), and 90.70% (39/43) respectively, as well as 96.77% (30/31), 2.6 per case, 83.33% (10/12), 16.67% (2/10), and 93.33% (28/30) in the radioactive nuclide plus methylene blue group. There was no significant difference between the ICG plus methylene blue group and radioactive nuclide plus methylene blue group in terms of SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy (P>0.05).ConclusionICG plus methylene blue showed similar SLN detection rate, SLN detected numbers, sensitivity, false negative rate, and accuracy as radioactive nuclide plus methylene blue for SLNB in breast cancer patients after NAC, and both of them can be performed easily and conveniently.
Objective To evaluate the feasibility of sentinel lymph node (SLN) mapping after 99Tcm sulfur colloid (99Tcm-sc) and carbon nanoparticles injection in patients with colon cancer. Methods Forty patients with colon cancer underwent complete mesocolic excision between August 2015 and July 2016 at Qingdao Central Hospital were considered for prospective inclusion. Before resection, SLN mapping was performed with injection of 99Tcm-sc and carbon nanopar-ticles, then all dissected lymph nodes were detected by pathological examination. Results A total of 660 cases of lymph nodes were found in the 40 patients (average of 16.5 cases per patient). Of them, 88 nodes (average of 2.2 cases per patient) were identified as SLN in 36 of 40 patients, with a successful detection rate of 90.0% (36/40). The diagnostic accuracy, sensitivity, and false-negative rate were 87.5% (35/40), 96.2% (25/26), and 3.8% (1/26) respectively. Conclusion 99Tcm-sc and carbon nanoparticles suspension injection for mapping SLN is a feasiblely diagnostic method for predicting local lymph node metastasis in the patient with colon cancer.