Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy

To evaluate the oncological outcomes of patients with breast cancer after nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM), followed by immediate reconstruction, as compared to conventional mastectomy (CM).SSM/NSM has been increasingly used to treat women with breast cancer who wish to preserve the overlying breast skin, but concern exist regarding its oncological safety due to the potential for residual breast tissue. We report our experience performing SSM/NSM for breast cancer treatment compared to CM with a long follow-up period.All consecutive patients who underwent mastectomy for breast cancer at Asan Medical Center between January 1993 and December 2008 were identified by retrospective medical chart review. The patients who underwent NSM/SSM, followed by immediate breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap (TRAM), were compared to the patients who underwent CM in terms of breast-cancer specific survival (BCSS) rate, distant metastasis-free survival (DMFS) rate, and local recurrence (LR) rate.During the study period, 6028 patients underwent mastectomy for breast cancer. Of these, 1032 and 4996 underwent NSM/SSM with TRAM and CM, respectively. Their median follow-up durations were 94.4 (range, 8.1-220.2) and 110.8 (range, 6.1-262.0) months, respectively. Their 5 year BCSS rates were 95.4% and 88.1%, respectively (log-rank, P < .001). Their 5 year DMFS rates were 93.0% and 85.6%, respectively (log-rank, P < .001).Relative to CM, NSM/SSM, followed by immediate breast reconstruction, may be a viable and oncologically safe surgical treatment in selected patients with breast cancer.

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“…These advances mean that the quality of life after surgery can now be included in the treatment decision-making process. [3,5]…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction

Lee

Kim

et al. 2018

Medicine

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“…Axillary ultrasound (AUS) has a sensitivity of detecting LN metastases ranging from 36 to 68% in patients with ILC. 18 Thus far, sentinel lymph node biopsy has been the standard method for assessing the axilla. 18 Formal axillary lymph node dissection should be performed in patients with nodal involvement.…”

Section: Discussionmentioning

confidence: 99%

“… 18 Thus far, sentinel lymph node biopsy has been the standard method for assessing the axilla. 18 Formal axillary lymph node dissection should be performed in patients with nodal involvement. 13 …”

Section: Discussionmentioning

confidence: 99%

Occult Invasive Lobular Carcinoma Presenting as an Axillary Skin Metastatic Lesion Underwent Neoadjuvant Endocrine Therapy and Surgical Resection: A Case Report and Review of Literature

Busbait¹,

Alkhalifa²,

Aljohani³

et al. 2022

BCTT

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Introduction Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5–15% of all breast cancer cases. It usually presents with nonspecific signs and symptoms. Occult breast cancer presenting as an axillary mass is rare, with prevalence of 0.3–1%, less likely with isolated cutaneous breast metastasis as a first presentation. There are limited data in the literature on patients who underwent endocrine therapy and complete surgical resection. Case Presentation A 54-year-old woman with left axillary skin swelling that had been persisting for 6 years was diagnosed with ILC 18 months ago presenting with an ulcerated axillary skin lesion and was managed with letrozole in another facility as she was estrogen receptor (ER) and progesterone receptor (PR) positive. She received letrozole for 18 months and had a partial response in the form of healing of the ulcer with persistent subcutaneous nodules. Her breast mammogram, ultrasound, and magnetic resonance imaging findings were unremarkable; however, there were few prominent left axillary lymph nodes. A biopsy of the left axillary lymph node was positive for malignancy, consistent with ILC. A skin punch biopsy of the axillary skin lesion showed ILC extending to the dermis with no background breast tissue. The patient underwent left modified radical mastectomy with excision of the left axillary skin lesion. The breast specimen comprised 0.4 mm of ILC as the primary malignancy and nine positive axillary lymph node malignancies. The patient received adjuvant radiotherapy and continued to receive letrozole. There were no signs of complications or recurrence during the follow-up period. Conclusion Ulcerated skin lesions in the axilla should raise concerns regarding breast cancer metastasis. In cases of isolated cutaneous breast metastases, surgical excision can be considered in combination with endocrine therapy.

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“…Sentinel node biopsy was not practiced then. The incidence of lymphedema increases when axillary radiotherapy follows axillary clearance and may be avoided [11].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of the axilla after axillary radiation in breast cancer: A retrospective study from MNJIO & RCC Hyderabad

Rr¹

2018

J Med sci Res.

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aim: To study the axillary recurrences after calculation of radiation dose delivered to the mid axillary plane in breast cancer patients receiving adjuvant radiation.Materials: 208 patients (148 cobalt, 60 linear accelerator) attending the follow up clinics from May 2007 to Dec 2012, had their axillary separation measured at the first visit and the dose to mid plane of axilla was extrapolated from PDD's. results:The actual mean dose received by the axilla was in the cobalt arm 4058.9 cGy (range 3301cGy to 4705cGy) and 4134.77 cGY (range 3597cGy to 4824cGy) in the LA arm, which is less than the usual recommended dose of 4500cGy to 5000cGy to midplane. The doses were subclinical as posterior axillary boost was not planned. There were 10 recurrences including only 1 axillary recurrence (0.48%). Discussion:The role of PMRT in breast cancer is well established and so is the morbidity of combined axillary dissection and radiation. The adoption of certain techniques of planning can result in sub optimal doses to the axillary mid plane. However suboptimal dosing may not affect the outcome of axillary recurrences. conclusion:The incidence of axillary recurrences in a heterogeneous population receiving locoregional postmastectomy radiation to the axilla is less than one percent in the region of Andhra Pradesh.

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Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy

Cited by 9 publications

References 29 publications

Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction

Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction

Occult Invasive Lobular Carcinoma Presenting as an Axillary Skin Metastatic Lesion Underwent Neoadjuvant Endocrine Therapy and Surgical Resection: A Case Report and Review of Literature

Clinical outcome of the axilla after axillary radiation in breast cancer: A retrospective study from MNJIO & RCC Hyderabad

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