BACKGROUNDUltrasound (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.METHODSThe 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.RESULTSIn 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%.CONCLUSIONSUS‐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

In breast cancer, axillary lymph nodes can be classified according to cortical morphologic features. Predominantly hyperechoic nodes (types 1-3) can be considered benign. Generalized cortical lobulation (type 4) is uncommonly a false-negative finding, but metastasis, if present, is invariably detected at sentinel node mapping. The presence of asymmetric focal hypoechoic cortical lobulation (type 5) or a completely hypoechoic node (type 6) should serve as a guideline for universal performance of fine-needle aspiration for preoperative staging of breast cancer. This classification, when verified with larger samples, may serve as a useful clinical guideline if proven with results of in vivo studies.

Context In pancreatic cancer, the presence of obesity or weight loss is associated with higher mortality. Objectives To explore the relationships among body mass index (BMI), longitudinal body composition alterations, and clinical outcomes in pancreatic cancer patients. Methods Records of 41 patients with inoperable, locally advanced pancreatic cancer who participated in a prospective chemo-radiation study were reviewed. Body composition was analyzed from two sets of computed-tomography images obtained before and after radiation treatment (median interval 104 days). Results Median age was 59 years, and 56% of patients female. Twenty-four (59%) patients were either overweight (22%) or obese (37%). Sarcopenia was present in 26 (63%) patients. At follow-up, weight loss was experienced by 33 (81%) patients. The median losses (%) before and after treatment were: weight 5% (P< 0.001), skeletal muscle (SKM) 4% (P=0.003), visceral adipose tissue (VAT) 13% (P< 0.001), and subcutaneous adipose tissue (SCAT) 11% (P=0.002). SKM loss positively correlated with age (P=0.03), baseline BMI (P < 0.001), and VAT (P=0.04) index. Obese patients experienced higher losses in weight (P=0.009), SKM (P=0.02), and VAT (P=0.02). Median survival was 12 months. In univariate analysis, age, baseline obesity, sarcopenic obesity, and losses (%) in weight, SKM, and VAT were associated with worse survival. In multivariate analysis, only age (hazard ratio (HR)=1.033, P=0.04 and higher VAT loss (HR=2.6, P=0.03) remained significant. Conclusion Our preliminary findings suggest that obese patients experience higher losses in weight, SKM and VAT, which may contribute to poorer survival in these patients.

Microgravity-induced anatomical changes that occurred during the first mission may have set the stage for recurrent or additional changes when the astronaut was subjected to physiological stress of repeat space flight.

Background We evaluated a two stage ovarian cancer screening strategy that incorporates change of CA 125 over time and age to estimate risk of ovarian cancer. Women with high risk scores were referred for transvaginal ultrasound (TVS). Methods A single-arm, prospective study of post-menopausal women was conducted. Participants underwent an annual CA 125 blood test. Based on the Risk of Ovarian Cancer Algorithm (ROCA) result, women were triaged to next annual CA 125 (low risk), repeat CA 125 in three months (intermediate risk), or TVS and referral to a gynecologic oncologist (high risk). Results 4051 women participated over 11 years. The average annual rate of referral to a CA125 in three months was 5.8%, and the average annual referral rate to TVS and review by a gynecologic oncologist was 0.9%. Ten women underwent surgery based on TVS, with four invasive ovarian cancers (one Stage 1A, two Stage 1C and one Stage IIB), two ovarian tumors of low malignant potential (both Stage 1A), one endometrial cancer (Stage 1), and three benign ovarian tumors, providing a positive predictive value of 40% (95% CI 12.2%, 73.8%) for detecting invasive ovarian cancer. The specificity was 99.9% (95% CI 99.7%, 100%). All four women with invasive ovarian cancer were enrolled in the study for at least three years with low risk, annual CA 125 values prior to a rising CA 125. Conclusions ROCA followed by TVS demonstrated excellent specificity and PPV in a population of U.S. women at average risk for ovarian cancer.

The effect of nasal airway positive pressure (NAPP) on upper airway size and configuration during wakefulness was studied by computerized tomography in 12 obese subjects with obstructive sleep apnea (OSA), seven weight- and age-matched subjects without OSA, and 12 normal subjects. NAPP of 10 to 12 cm H2O was associated with a significant increase in airway area throughout the upper airway in all three groups. The change in airway area per cm H2O NAPP increased from nasopharynx to hypopharynx. The change in airway area per cm H2O NAPP was significantly smaller in the OSA than in the normal subjects in the region of the soft palate. Electromyographic recordings of the genioglossus and alae nasi muscles with and without NAPP during wakefulness in five of the OSA and five of the normal subjects showed either a decrease or no change in phasic and tonic activity with NAPP. In a separate series of experiments in an additional five OSA and five normal subjects, NAPP of zero, 5, 10, and 15 cm H2O was associated with a linear increase in airway area at a given airway level. These results indicate that (1) the increase in pharyngeal cross-sectional area with application of NAPP during wakefulness is smaller in OSA than in normal subjects in the region of the soft palate and (2) changes in upper airway muscle activity may accompany changes in upper airway size and configuration.

Ultrasonographically suggested nodal metastasis is associated with the finding of nodal disease on final pathological examination. No significant clinicopathologic criteria were found to impact sensitivity of ultrasonography; however, excisional biopsy for diagnosis may be a confounding variable in subsequent axillary ultrasonography.

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