Indication and adequacy of application of SLNB in lymph node evaluation of patients with pre-operative (pre-OP) DCIS diagnosed by biopsy remained a debated issue as SLNB remains an invasive procedure and not morbidity free. DCIS as determined by pathologic analysis of biopsy specimens, however, does not preclude invasive disease in excised specimens, and up to 50% (range, 3.5–56%) of core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) diagnosed DCIS would upgrade to have an invasive component (IC). In theory, ductal carcinoma in situ (DCIS) does not metastasize to adjacent lymph nodes, and axillary lymph node evaluation or surgery had limited role. Lymph node evaluation plays important role of breast cancer staging and management, and had been evolved from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB). Conclusionīreast MRI had high NPV to predict ALN metastasis in pre-OP DCIS patients, which is useful and could be provided as shared decision-making reference. Pre-OP diagnosed DCIS patients with MRI tumor size < 3 cm and node negative suitable for BCS could safely omit SLNB if whole breast radiotherapy is to be performed. In MRI node-negative breast cancer patients with MRI tumor size < 3 cm, the NPV was 96.4%, and all these false-negative cases were N1. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients who received breast conserving surgery and 40.7% for mastectomy ( p < 0.01). ResultsĪ total of 682 cases with pre-operative diagnosis of DCIS were enrolled in current study. The value of breast MRI for ALN evaluation, predictors of breast and ALN surgeries, upgrade from DCIS to invasive cancer, and ALN metastasis were analyzed. Patients with primary DCIS with or without pre-operative breast MRI evaluation and underwent breast surgery were recruited from single institution. The value of breast magnetic resonance imaging (MRI) to predict ALN metastasis pre-operative DCIS patients was evaluated. The risk of lymphedema with a sentinel lymph node biopsy is universal.The optimal axillary lymph node (ALN) management strategy in patients diagnosed with ductal carcinoma in situ (DCIS) preoperatively remains controversial. The most serious side effect is swelling in the arm, known as lymphedema. Infection is uncommon and can develop up to seven days later. Swelling or fluid builds up under the incision and can remain for several weeks. Lymph node biopsy surgery always produces some discomfort for about a week after the operation. Blue nodes, or "hot" nodes (nodes with high radioactive counts), are removed and called sentinel nodes. One or more sentinel lymph nodes are removed and looked at under a microscope. Blue-stained lymphatic channels are identified and followed to the sentinel node or nodes.Ĥ. A small cut is made in the armpit to search for the sentinel node or nodes. The lymphatic channels then absorb the dye.ģ. During the operation, the patient is injected with a blue dye around the nipple or breast cancer site.Ģ. No negative reactions have been reported when using this method.ġ. The radiation in the injection is no more than what is produced by chest X-rays or mammograms. The doctor uses a radiation detector during surgery to pinpoint the lymph node that has the highest radiation counts. This flows toward the lymph nodes and allows an X-ray image of the lymph nodes.ģ. A special substance with a small amount of radioactivity is injected where the tumor is.Ģ. The doctor will inject the radioactive material before surgery (preoperative) and the blue dye during surgery (intraoperative).ġ. This is called lymphoscintigraphy, or sentinel lymph node mapping. This will make it easier for the doctor to find the node. These will identify the first lymph node. To find the node, a special blue dye or radioactive substance is injected. A specialist will look at the node to see if there are any cancer cells. Only the first lymph node in a group is removed during the biopsy. Removing the nodes from the areas is known as axillary lymph node dissection. If cancer cells are present in the first node, the lymph nodes in the affected area may require removal. If no cancer is found in the first node, the cancer has probably not spread to other nodes in the area. The first node in the group is known as a sentinel node. Breast cancer can spread to the nearby tissue in the underarms (axillary).
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |