-
Surgery Nov 2014We hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping [ARM]) during axillary lymphadenectomy decreases the likelihood of...
BACKGROUND
We hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping [ARM]) during axillary lymphadenectomy decreases the likelihood of disruption of lymphatics and subsequent lymphedema.
METHODS
This institutional review board-approved study involved 360 patients undergoing sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) from May 2006 to October 2011. Technetium sulfur colloid (4 mL) was injected subareolarly, and 5 mL of blue dye was injected subcutaneously in the volar surface ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage, successful identification and protection of arm lymphatics, crossover, and occurrence of lymphedema.
RESULTS
A group of 360 patients underwent SLNB and/or ALND, 348 of whom underwent a SLNB. Of those, 237 (68.1%) had a SLNB only, and 111 (31.9%) went on to an ALND owing to a positive axilla. An additional 12 of 360 (3.3%) axilla had ALND owing to a clinically positive axilla/preoperative core needle biopsy. In 96% of patients with SLNB (334/348), breast SLNs were hot but not blue; crossover (SLN hot and blue) was seen in 14 of 348 patients (4%). Blue lymphatics were identified in 80 of 237 SLN incisions (33.7%) and in 93 of 123 ALND (75.4%). Average follow-up was 12 months (range, 3-48) and resulted in a SLNB lymphedema rate of 1.7% (4/237) and ALND of 2.4% (3/123).
CONCLUSION
ARM identified substantial lymphatic variations draining the upper extremities and facilitated preservation. Metastases in ARM-identified lymph nodes were acceptably low, indicating that ARM is safe. ARM added to present-day ALND and SLNB may be useful to lesser rates of lymphedema.
Topics: Axilla; Breast Neoplasms; Coloring Agents; Female; Follow-Up Studies; Humans; Lymph Nodes; Lymphatic Vessels; Lymphedema; Middle Aged; Radiopharmaceuticals; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid
PubMed: 25444319
DOI: 10.1016/j.surg.2014.05.011 -
The British Journal of Dermatology Jun 2021Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle unit that typically develops after puberty. The... (Review)
Review
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle unit that typically develops after puberty. The disorder is characterized by comedones, painful inflammatory nodules, abscesses, dermal tunnels and scarring, with a predilection for intertriginous areas of the body (axillae, inguinal and anogenital regions). Recruitment of neutrophils to HS lesion sites may play an essential role in the development of the painful inflammatory nodules and abscesses that characterize the disease. This is a review of the major mediators involved in the recruitment of neutrophils to sites of active inflammation, including bacterial components (endotoxins, exotoxins, capsule fragments, etc.), the complement pathway anaphylatoxins C3a and C5a, tumour necrosis factor-alpha, interleukin (IL)-17, IL-8 (CXCL8), IL-36, IL-1, lipocalin-2, leukotriene B4, platelet-activating factor, kallikreins, matrix metalloproteinases, and myeloperoxidase inhibitors. Pharmacological manipulation of the various pathways involved in the process of neutrophil recruitment and activation could allow for successful control and stabilization of HS lesions and the remission of active, severe flares.
Topics: Axilla; Hidradenitis Suppurativa; Humans; Leukotriene B4; Neutrophils; Peroxidase
PubMed: 32893875
DOI: 10.1111/bjd.19538 -
British Medical Journal Jul 1978
Topics: Administration, Topical; Axilla; Humans; Hyperhidrosis
PubMed: 687921
DOI: 10.1136/bmj.2.6133.357-c -
The Indian Journal of Medical Research Feb 2017
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Nodes; Neoplasm Metastasis; Neoplasm Staging
PubMed: 28639588
DOI: 10.4103/ijmr.IJMR_1837_16 -
Current Oncology (Toronto, Ont.) Apr 2023Lymphedema remains a risk for 13-34% of breast cancer patients who require an axillary dissection (ALND) and radiation. Immediate lymphovenous anastomosis (LVA) may... (Review)
Review
Incorporating Lymphovenous Anastomosis in Clinically Node-Positive Women Receiving Neoadjuvant Chemotherapy: A Shared Decision-Making Model and Nuanced Approached to the Axilla.
INTRODUCTION
Lymphedema remains a risk for 13-34% of breast cancer patients who require an axillary dissection (ALND) and radiation. Immediate lymphovenous anastomosis (LVA) may mitigate lymphedema by up to 30% by restoring the physiologic lymphatic drainage immediately after ALND. Currently, completion of ALND (cALND) versus radiation after neoadjuvant therapy (NAC) is being addressed by the Alliance A11202 trial, leaving a paucity of data to guide practice. Our study describes the implementation process of LVA into clinical practice after NAC for node-positive breast cancer in the current clinical context.
METHODS
We reviewed a prospective database of LVA in node-positive patients (cT1-4,Nany) who received NAC followed by axillary surgery ± immediate LVA from October 2021 to 2022. The evolution of the surgical approach is described. Specifically, patients who downstaged to clinically negative nodes post-NAC were offered targeted SLNB with dual-tracer and intraoperative frozen section (FS). Patients were reminded that the standard of care for any node positive is cALND. Immediate cALND with LVA was performed for grossly positive nodes or all positive SLNs; cALND was omitted for those with negative SLNs. For a microscopic disease on a frozen section, a shared decision was made pre-operatively, given each patient's differing valuations of the benefit and risks of cALND ± LVA versus no cALND with planned regional radiation postoperatively. LVA was offered as an option as part of our institutional evaluation of the procedure.
RESULTS
A total of 15 patients were included; the mean age was 49.9 (range 32-75) with stage IIA to IIIB breast cancer. Of these, 6 (40%) were triple negative, 5 (33.3%) HER-2 positive, and 4 (26.7%) ER/PR+ HER-2 negative. There were 13 women (86.7%) who had persistent axillary adenopathy based on clinical and/or ultrasound assessment, with 8 patients proceeding directly to ALND with LVA. Among these patients, 3 (37.5%) had pathologic nodal disease, and 5 (62.5%) were node negative, confirming the limitations of pre-operative imaging. As a result, the subsequent 7 (46.7%) underwent targeted SLNB with FS, with 3 patients (42.9%) avoiding an ALND as a result of a negative FS. A total of 4 patients (57.1%) had 1 or more positive lymph nodes on FS: 3 proceeded with a cALND and LVA, and 1 patient (14.2%) opted for no cALND based on a pre-operative discussion and received adjuvant radiation and chemotherapy. Of the 11 patients who underwent ALND and LVA, 1 patient (9.1%) developed lymphedema at 6.9 months following their surgery. The accuracy, sensitivity, and specificity of pre-operative US were 46.7%, 85.7%, and 12.5% and intraoperative FS were 88.0%, 72.7%, and 100%, respectively.
CONCLUSIONS
As adjuvant nodal radiation and systemic therapy continue to improve, the benefit of a cALND in patients with the limited residual disease remains unclear as we await the outcomes from clinical trials. In the era of clinical uncertainty, we propose a nuanced approach to the axilla by utilizing a shared decision model with patients, incorporating targeted SLNB with FS and completion node dissection when required and desired by the patient, coupled with LVA in a simple stepwise treatment pathway.
Topics: Humans; Female; Middle Aged; Sentinel Lymph Node Biopsy; Neoadjuvant Therapy; Axilla; Clinical Decision-Making; Uncertainty; Breast Neoplasms; Lymphedema; Anastomosis, Surgical
PubMed: 37185419
DOI: 10.3390/curroncol30040306 -
Dermatology Online Journal Nov 2004A 71-year-old man developed a pruritic axillary eruption. Histopathologic examination showed laminated orthokeratosis, parakeratosis, and hypergranulosis. There changes...
A 71-year-old man developed a pruritic axillary eruption. Histopathologic examination showed laminated orthokeratosis, parakeratosis, and hypergranulosis. There changes were consistent with a diagnosis of axillary granular parakeratosis. Axillary granular parakeratosis is an intertriginous eruption that is usually found in the axillae of middle-aged women and is characterized clinically by pruritic, erythematous, hyperkeratotic plaques and histologically by parakeratosis with retention of keratohyaline granules. Pathophysiology is thought to involve a defective profilaggrin-filaggrin pathway. Evidence-based treatment of this disorder is not available.
Topics: Aged; Axilla; Filaggrin Proteins; Humans; Male; Parakeratosis
PubMed: 15748590
DOI: No ID Found -
Cancer Jul 2004For more than 50 years, Cancer has explored every facet of malignant disease, including morphology, therapy, epidemiology, biology, historical perspective, and basic...
For more than 50 years, Cancer has explored every facet of malignant disease, including morphology, therapy, epidemiology, biology, historical perspective, and basic science. However, the Editors of Cancer believe that the human beings who bear the burden of this illness have much to teach us, and we now solicit essays from patients and family members about their experience.
Topics: Arm; Axilla; Breast Neoplasms; Carcinoma, Ductal; Female; Humans; Lymph Node Excision; Lymphedema; Middle Aged
PubMed: 15221984
DOI: 10.1002/cncr.20331 -
Medicine Nov 2021The interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery;... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) and axillary Nerve Block (ANB) has been reported as an alternative nerve block with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ANB with ISB during shoulder arthroscopy surgery.
METHODS
A meta-analysis was conducted to identify relevant randomized or quasirandomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. We searched Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database from 2010 through August 2021.
RESULTS
We identified 641 patients assessed in 10 randomized or quasirandomized controlled trials. Compared with the ISB group, the SSNB+ANB group had higher visual analog scale or numerical rating scale in PACU (P = .03), 4 hour (P = .001),6 hour after the operation (P = .002), and lower incidence of complications such as Numb/Tingling (P = .001), Weakness (P <.00001), Horner syndrome (P = .001) and Subjective dyspnea (P = .002). No significant difference was found for visual analog scale or numerical rating scale 8 hour (P = .71),12 hour (P = .17), 16 hour (P = .38),1day after operation (P = .11), patient satisfaction (P = .38) and incidence of complications such as hoarseness (P = .07) and nausea/vomiting (P = .41) between 2 groups.
CONCLUSION
Our high-level evidence has established SSNB+ ANB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis's relevant possible biases, we required more adequately powered and better-designed randomized controlled trial studies with long-term follow-up to reach a firmer conclusion.
Topics: Anesthetics, Local; Arthroscopy; Axilla; Brachial Plexus Block; Humans; Pain, Postoperative; Randomized Controlled Trials as Topic; Shoulder
PubMed: 34871240
DOI: 10.1097/MD.0000000000027661 -
Breast (Edinburgh, Scotland) Mar 2022Breast and axillary surgery after neoadjuvant systemic treatment for women with breast cancer has undergone multiple paradigm changes within the past years. In this... (Review)
Review
Breast and axillary surgery after neoadjuvant systemic treatment for women with breast cancer has undergone multiple paradigm changes within the past years. In this review, we provide a state-of-the-art overview of breast and axillary surgery after neoadjuvant systemic treatment from both, a clinical routine perspective and a clinical research perspective. For axillary disease, axillary lymph node dissection, sentinel lymph node biopsy, or targeted axillary dissection are nowadays recommended depending on the lymph node status before and after neoadjuvant systemic treatment. For the primary tumor in the breast, breast conserving surgery remains the standard of care. The clinical management of exceptional responders to neoadjuvant systemic treatment is a pressing knowledge gap due to the increasing number of patients who achieve a pathologic complete response to neoadjuvant systemic treatment and for whom surgery may have no therapeutic benefit. Current clinical research evaluates whether less invasive procedures can exclude residual cancer after neoadjuvant systemic treatment as reliably as surgery to possibly omit surgery for those patients in the future.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Neoadjuvant Therapy; Sentinel Lymph Node Biopsy
PubMed: 35135710
DOI: 10.1016/j.breast.2022.01.008 -
Journal of Ayub Medical College,... 2023Breast cancer is the most common malignancy found in females all over the world and the second leading cause of cancer death in European countries. The purpose of this...
BACKGROUND
Breast cancer is the most common malignancy found in females all over the world and the second leading cause of cancer death in European countries. The purpose of this study was to find out the pattern of disease presentation in our region where a proper tumour registry system is lacking.
METHODS
This descriptive study was carried out in the Department of Surgery, Ayub Teaching Hospital Abbottabad, from July 2021 to June 2022. All female patients with biopsy-proven breast cancer were included in the study: benign lumps, refused to enrol, and those who were lost to follow-up were excluded.
RESULTS
A total of 87 patients with carcinoma breast were included: 92 % (n=80) had invasive ductal carcinoma. Axillary lymph nodes were involved in 88.5% (n=77), 75.8% of the tumours, (n=66), were Grade 2, 34.5% (n=30) were in the 40-49 years age group, and 30 % (n=27) of the disease was categorized as Stage III or IV. In 55 % (n=48), the tumour was on the right side and in 39% (n=34), the upper outer quadrant was involved. Most of the patients, 90.8% (n=79), were married and had used contraceptive measures. Only 19.5% of patients (n=17), had a history of nipple discharge and 56% (n=49) had a positive family history: 71% (n=62) had nipple retraction, and 54% (n=47), proved to be ER PR positive.
CONCLUSIONS
Our patients presented late: axilla was commonly involved and a third had advanced disease. Screening and community awareness programs may help in early detection. Hormone use for contraception needs to be weighed carefully. Better data collection may help in designing screening and care programs.
Topics: Humans; Female; Breast Neoplasms; Lymph Nodes; Hospitals, Teaching; Biopsy; Axilla
PubMed: 38406950
DOI: 10.55519/JAMC-04-12089