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Radiology Jun 2020Axillary lymph node (LN) metastasis is the most important predictor of overall recurrence and survival in patients with breast cancer, and accurate assessment of...
Axillary lymph node (LN) metastasis is the most important predictor of overall recurrence and survival in patients with breast cancer, and accurate assessment of axillary LN involvement is an essential component in staging breast cancer. Axillary management in patients with breast cancer has become much less invasive and individualized with the introduction of sentinel LN biopsy (SLNB). Emerging evidence indicates that axillary LN dissection may be avoided in selected patients with node-positive as well as node-negative cancer. Thus, assessment of nodal disease burden to guide multidisciplinary treatment decision making is now considered to be a critical role of axillary imaging and can be achieved with axillary US, MRI, and US-guided biopsy. For the node-positive patients treated with neoadjuvant chemotherapy, restaging of the axilla with US and MRI and targeted axillary dissection in addition to SLNB is highly recommended to minimize the false-negative rate of SLNB. Efforts continue to develop prediction models that incorporate imaging features to predict nodal disease burden and to select proper candidates for SLNB. As methods of axillary nodal evaluation evolve, breast radiologists and surgeons must work closely to maximize the potential role of imaging and to provide the most optimized treatment for patients.
Topics: Axilla; Breast Neoplasms; Female; Humans; Image-Guided Biopsy; Interdisciplinary Communication; Intersectoral Collaboration; Lymph Nodes; Lymphatic Metastasis; Neoplasm Recurrence, Local; Prognosis; Sentinel Lymph Node
PubMed: 32315268
DOI: 10.1148/radiol.2020192534 -
Lancet (London, England) Nov 2023Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce risks of recurrence and death. Its effects have been studied in randomised trials, some before the 1980s and some after. We aimed to assess the effects of regional node radiotherapy in these two eras.
METHODS
In this meta-analysis of individual patient data, we sought data from all randomised trials of regional lymph node radiotherapy versus no regional lymph node radiotherapy in women with early breast cancer (including one study that irradiated lymph nodes only if the cancer was right-sided). Trials were identified through the EBCTCG's regular systematic searches of databases including MEDLINE, Embase, the Cochrane Library, and meeting abstracts. Trials were eligible if they began before Jan 1, 2009. The only systematic difference between treatment groups was in regional node radiotherapy (to the internal mammary chain, supraclavicular fossa, or axilla, or any combinations of these). Primary outcomes were recurrence at any site, breast cancer mortality, non-breast-cancer mortality, and all-cause mortality. Data were supplied by trialists and standardised into a format suitable for analysis. A summary of the formatted data was returned to trialists for verification. Log-rank analyses yielded first-event rate ratios (RRs) and confidence intervals.
FINDINGS
We found 17 eligible trials, 16 of which had available data (for 14 324 participants), and one of which (henceforth excluded), had unavailable data (for 165 participants). In the eight newer trials (12 167 patients), which started during 1989-2008, regional node radiotherapy significantly reduced recurrence (rate ratio 0·88, 95% CI 0·81-0·95; p=0·0008). The main effect was on distant recurrence as few regional node recurrences were reported. Radiotherapy significantly reduced breast cancer mortality (RR 0·87, 95% CI 0·80-0·94; p=0·0010), with no significant effect on non-breast-cancer mortality (0·97, 0·84-1·11; p=0·63), leading to significantly reduced all-cause mortality (0·90, 0·84-0·96; p=0·0022). In an illustrative calculation, estimated absolute reductions in 15-year breast cancer mortality were 1·6% for women with no positive axillary nodes, 2·7% for those with one to three positive axillary nodes, and 4·5% for those with four or more positive axillary nodes. In the eight older trials (2157 patients), which started during 1961-78, regional node radiotherapy had little effect on breast cancer mortality (RR 1·04, 95% CI 0·91-1·20; p=0·55), but significantly increased non-breast-cancer mortality (1·42, 1·18-1·71; p=0·00023), with risk mainly after year 20, and all-cause mortality (1·17, 1·04-1·31; p=0·0067).
INTERPRETATION
Regional node radiotherapy significantly reduced breast cancer mortality and all-cause mortality in trials done after the 1980s, but not in older trials. These contrasting findings could reflect radiotherapy improvements since the 1980s.
FUNDING
Cancer Research UK, Medical Research Council.
Topics: Female; Humans; Breast Neoplasms; Lymph Nodes; Axilla; Neoplasm Recurrence, Local
PubMed: 37931633
DOI: 10.1016/S0140-6736(23)01082-6 -
The American Journal of Dermatopathology Oct 2020Apocrine chromhidrosis is a rare diagnosis that occurs due to colored sweat being secreted from the apocrine glands, which are located in the axillae, anogenital skin,...
Apocrine chromhidrosis is a rare diagnosis that occurs due to colored sweat being secreted from the apocrine glands, which are located in the axillae, anogenital skin, and areolae and over the skin of the trunk, face, and scalp. We present the case of a 65-year-old woman who presented with a sudden onset of pink sweating affecting mainly her axillae but also her pelvis, causing staining of clothing and bed sheets. There was nil to note on examination and histology with immunostaining demonstrated focally prominent yellow-brown lipofuscin granules in the cytoplasm of the apocrine secretory cells confirming the diagnosis. The disease can have a significant psychosocial impact, and treatment remains challenging. Our case is unique because the red and pink coloring of sweat is less common in cases of apocrine chromhidrosis, which is often in favor of darker colored sweat, and the distribution involved the inguinal canal, which is also less often seen.
Topics: Aged; Apocrine Glands; Axilla; Color; Female; Groin; Humans; Lipofuscin; Sweat; Sweat Gland Diseases
PubMed: 32568832
DOI: 10.1097/DAD.0000000000001712 -
Seminars in Radiation Oncology Jul 2022While historically reserved for patients with locally advanced breast cancer, the indications for preoperative systemic therapy have expanded in parallel with our... (Review)
Review
While historically reserved for patients with locally advanced breast cancer, the indications for preoperative systemic therapy have expanded in parallel with our increased understanding of breast cancer biology. Patient selection for preoperative chemotherapy is now primarily driven by breast cancer subtype and the incorporation of targeted therapies in HER2+ disease as well as immunotherapy in triple negative breast cancer have resulted in increasing response rates and more tailored treatment approaches. Potential benefits with respect to local therapy, now include both tumor downstaging to facilitate breast conservation as well as de-escalation of both axillary surgery and/or nodal radiation for patients who experience a pathologic complete response. Implementing these strategies requires a multidisciplinary approach and best practices for managing the breast and axilla after preoperative chemotherapy continue to evolve. Here we review the current landscape and future directions for local therapy considerations after preoperative chemotherapy.
Topics: Axilla; Breast Neoplasms; Female; Humans; Immunotherapy; Lymphatic Metastasis; Neoadjuvant Therapy
PubMed: 35688521
DOI: 10.1016/j.semradonc.2022.01.003 -
Ugeskrift For Laeger Mar 2024Surgical treatment of breast cancer has changed towards less invasive procedures as summarised in this review. Breast conserving surgery (BCS) and radiotherapy (RT) are... (Review)
Review
Surgical treatment of breast cancer has changed towards less invasive procedures as summarised in this review. Breast conserving surgery (BCS) and radiotherapy (RT) are now recommended as standard of care. Several flexible marking methods for removal of non-palpable tumours have gradually replaced wire-guided localisation. Neoadjuvant systemic treatment increases tumour shrinkage and BCS and may lead to omission of axillary clearance (AC). The prognostic significance of AC in patients with metastases to 1-2 sentinel nodes at primary surgery is questioned. Results from the SENOMAC trial are expected to change guidelines from AC to axillary RT.
Topics: Female; Humans; Axilla; Breast Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mastectomy, Segmental; Sentinel Lymph Node Biopsy
PubMed: 38533870
DOI: 10.61409/V01230033 -
Cutis Jun 2020
Topics: Axilla; Diagnosis, Differential; Female; Humans; Middle Aged; Parakeratosis
PubMed: 32717005
DOI: No ID Found -
Current Opinion in Oncology Nov 2022The standard of care in breast surgery has changed, from mastectomy to breast conserving surgery whenever possible, and from axillary dissection to sentinel node biopsy.... (Review)
Review
PURPOSE OF REVIEW
The standard of care in breast surgery has changed, from mastectomy to breast conserving surgery whenever possible, and from axillary dissection to sentinel node biopsy. Neoadjuvant systemic approaches have broadened the indications for organ-conserving and less mutilating surgery, but also raise important questions of balancing locoregional treatment de-escalation and protecting excellent long-term outcomes.
RECENT FINDINGS
Recent studies have aimed at investigating the safety of de-escalating surgical approaches not only in the upfront breast surgery situation but also after neoadjuvant systemic therapy. This pertains to both the safety of breast conserving surgery - including more complex oncoplastic approaches - within the new (posttherapeutic) anatomical extent of the residual disease, but more controversially to de-escalating surgical treatment of the axilla. While sentinel node biopsy appears to be the standard of care for node-negative disease also after primary systemic therapy, the optimal procedure in situations of posttherapeutic node-positive disease remains highly controversial.
SUMMARY
Both breast and axillary surgery after neoadjuvant systemic therapy for women with breast cancer has undergone multiple paradigm changes in recent years. For the primary tumor in the breast, breast-conserving surgery constitutes the standard of care, and unnecessary mastectomies should be strongly discouraged. For axillary surgery, sentinel-node biopsy should be aimed at, and completion axillary dissections minimized for situations of extensive disease and or poor neoadjuvant treatment response. Additional techniques such as targeted axillary dissection are currently under evaluation in clinical trials.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Mastectomy; Neoadjuvant Therapy; Sentinel Lymph Node Biopsy
PubMed: 36083127
DOI: 10.1097/CCO.0000000000000906 -
CMAJ : Canadian Medical Association... Dec 2021
Topics: Administration, Topical; Anti-Bacterial Agents; Axilla; Diagnosis, Differential; Erythrasma; Erythromycin; Groin; Humans; Male; Middle Aged
PubMed: 34903597
DOI: 10.1503/cmaj.210310-f -
Clinical and Experimental Dermatology Jul 2022A 71-year-old woman presented with a rash in the bilateral axillae. Histopathology showed hyperkeratosis and parakeratosis with retention of basophilic keratohyalin...
A 71-year-old woman presented with a rash in the bilateral axillae. Histopathology showed hyperkeratosis and parakeratosis with retention of basophilic keratohyalin granules.
Topics: Aged; Axilla; Exanthema; Female; Humans; Keratosis; Parakeratosis
PubMed: 35614868
DOI: 10.1111/ced.15169 -
Clinics in Plastic Surgery Jan 2023Breast augmentation with implants is becoming a more widely accepted and popular procedure in Asia. The axillary approach remains the preferred incision for Asian women.... (Review)
Review
Breast augmentation with implants is becoming a more widely accepted and popular procedure in Asia. The axillary approach remains the preferred incision for Asian women. Endoscope technique is the best option for transaxillary breast augmentation. It greatly increases control over the process, avoids various drawbacks, reduces the incidence of complications, and improves the stability of clinical effects of transaxillary implant breast augmentation. Freestyle endoscopic technique may greatly improve the flexibility and efficiency of the endoscope operation through the axillary approach. This article introduces the freestyle endoscopic-assisted transaxillary breast augmentation with high position dual-plane technique.
Topics: Female; Humans; Breast Implantation; Breast Implants; Axilla; Mammaplasty; Endoscopy
PubMed: 36396254
DOI: 10.1016/j.cps.2022.08.010