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At least 271 records · Page 15Linked to original sources
PubMed1996

Breast cancer: two micrometastatic variants in the axilla that differ in prognosis.

Measurement of the area of the tumour deposits present in routine sections from the axillary nodes from a series of 1069 breast cancer patients showed that 138 cases had a single micrometastasis (0.2 cm2 or less), while in 29 a similar load was spread over two or more nodes. These 167 cases represent 15% of the patients in the series. Twentyfive of them had died of breast cancer within a mean follow-up of 6 years. They had smaller micrometastases than those surviving (P < 0.0025). Histological examination in the 138 with single micrometastases showed that two variants were present. In one, tumour growth was confined to the capsular lymphatics and/or the subcapsular sinus. In the other, tumour growth was present in the nodal lymphoid tissue, and, on occasion, at the other sites as well. Those with growth in the lymphoid tissue had a better prognosis than those without (P < 0.0035). Prognosis in the former was comparable to that in the node-negative cases, while in those lacking such growth it was similar to that in the node-positive. The presence of these two variants could explain divergent reports in the literature on prognosis in cases with micrometastases. While the mechanisms behind this apparent paradox remain speculative, the observation can be of diagnostic interest in routine surgical pathology.

Axilla↗
PubMed2001

Sentinel lymph-node biopsy-based prediction of further breast cancer metastases in the axilla.

BACKGROUND: Histopathological factors may help identifying a subgroup of breast cancer patients with metastases confined to the sentinel lymph nodes (SLNs). METHODS: A retrospective analysis was carried out on 111 tumours successfully mapped with Patent blue, 69 of which had SLN metastases. RESULTS: Multivariate analysis revealed that SLN metastases situated in the sinuses and a small tumour size are the two most important predictors of involvement of only one SLN. The metastasis size and a small tumour size were found important in the model discriminating between tumours with metastases to SLNs only and those with non-SLN involvement. Classification of tumours with only one SLN metastasis and those with a multinodal involvement resulted in a smaller error rate, falsely classified as lesser nodal involvement. Patients with tumours <1.8 cm and metastatic to the sinuses of a single SLN had a low probability of non-SLN metastasis, and might be candidates for axillary sparing after a positive SLN biopsy. CONCLUSIONS: Further investigations are required to assess the validity of such predictive models for the identification of patients with no metastases beyond the SLN. Axillary treatment must remain the rule until predictive models of non-SLN involvement are fully validated.

Adult↗
PubMed1999

Postoperative suction drainage of the axilla: for how long? Prospective randomised trial.

OBJECTIVE: To define the correct time to remove the drain after axillary dissection for carcinoma of the breast. DESIGN: Prospective randomised trial. SETTING: Two public hospitals, Israel. SUBJECTS: 90 women who required axillary dissection for carcinoma of the breast. INTERVENTIONS: 42 were randomised to have the drain removed on postoperative day 3, and 48 to keep the drain in until discharge had decreased to less than 35 ml/24 hours. MAIN OUTCOME MEASURES: Formation of seromas or wound infections, need to reinsert the drain, and duration of hospital stay. RESULTS: Early removal of the axillary drain was associated with a significantly higher incidence of seromas (9/42 compared with 2/48, p = 0.02) unless the total amount of fluid drained during the first three postoperative days was less than 250 ml. CONCLUSION: Drains should be removed after axillary dissection only when the daily amount of fluid discharged is low, unless the drainage during the first three days is less than 250 ml.

Axilla↗
PubMed1999

Soft tissue masses of the chest wall and axilla: has metastatic melanoma been considered?

Isolated axillary and chest wall soft tissue masses are an uncommon presentation of metastatic cancer. The authors present three patients in whom malignant melanomas metastatic to these sites had been misdiagnosed, leading to inappropriate oncologic treatment planning in all three cases. The presumed diagnoses, even after fine-needle aspiration or trucut biopsies, were soft-tissue sarcoma (n = 2) and undifferentiated breast cancer (n = 1). The combination of taking a thorough history and performing proper immunohistochemical analysis of the biopsy material would have suggested the presence of malignant melanoma in all cases. As the disease appeared locoregionally limited in all patients, radical surgical resection with extended lymphadenectomy was performed without significant dysfunction of the upper extremity. One patient agreed to postoperative immunotherapy with interferon-alpha. Two patients are currently alive 17 and 14 months after operation. One patient was found to have systemic recurrence at 5 months, one experienced two isolated local recurrences in a prior operative site that were amenable to reresection and presently has no evidence of disease 12 months after resection, and one patient remains free of disease at 14 months. Clinical presentation, suggested diagnostic workup, and therapeutic implications are discussed to avoid misdiagnoses in this setting of possible clinical presentations of metastatic melanoma.

Adult↗