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At least 307 records · Page 17Linked to original sources

Preoperative breast cancer staging: MR imaging of the axilla with ultrasmall superparamagnetic iron oxide enhancement.

PURPOSE: To evaluate magnetic resonance (MR) imaging with ultrasmall superparamagnetic iron oxide (USPIO) enhancement for preoperative axillary lymph node staging in patients with breast cancer by using histopathologic findings as the standard of reference. MATERIALS AND METHODS: MR imaging was performed with a 1.5-T system within 24-36 hours after the start of intravenous slow-drip infusion of USPIO in 20 patients with breast cancer who were scheduled for surgery, followed by gadolinium-enhanced MR imaging. Lymph nodes were staged prospectively by using newly established criteria, and results were correlated with histologic findings. RESULTS: In two patients, preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given; both patients were excluded from statistical analysis. Results of axillary staging with USPIO-enhanced MR imaging were true-positive in nine, true-negative in seven, false-positive in zero, and false-negative in two of 18 patients (sensitivity, 82%; specificity, 100%; positive predictive value, 100%; second reader, kappa = 1.0). Four hundred five lymph nodes were detected with MR imaging. For first and second readers, respectively, lymph node-based sensitivity was 83% and 73% and specificity was 96% and 97% (kappa = 0.68). USPIO as the intravascular contrast agent could not replace gadolinium for assessment of the primary tumor; however, no clinically relevant interaction was seen. Thus, an integrated imaging approach was feasible in all patients. CONCLUSION: USPIO-enhanced MR imaging has the potential to become an adjunct to conventional MR imaging of the breast for preoperative assessment of axillary lymph nodes in patients with breast cancer.

Adult↗

Accessory breast tissue in the axilla: mammographic appearance.

Mammographic features of normal accessory axillary breast tissue were analyzed in 13 women, 54% of whom had positive findings on physical examination. Radiographically the accessory tissue resembled the remaining normal glandular tissue but was separate from it. The mean radiographic dimension of the accessory tissue, which was best seen on oblique or exaggerated craniocaudal views, was 3.9 cm. In most cases the accessory tissue was either bilateral or confined to the right side. When found on mammography, accessory axillary breast tissue should be recognized as a normal developmental variant rather than considered a pathologic lesion, although carcinoma can develop in the accessory tissue. A specific, radiography-aided diagnosis of accessory axillary breast tissue can eliminate unnecessary biopsy.

Adult↗

[Sentinel lymphonodectomy -- new surgical standard for the evaluation of the axilla:an overview. Part 1].

Complete axillary dissection is still integral component of breast cancer treatment, but significant morbidity is associated with this procedure. Sentinel lymphonodectomy can replace complete axillary dissection in selected cases and can significantly reduce morbidity. Sentinel lymphonodectomy has become a new surgical standard and should be offered to all patients with unicentric tumors of less than 3 cm in diameter. Open questions concern the localization of the market injection, the significance of detecting and extirpation of extra-axillary lymph nodes, the applicability of the method to multicentric tumors, after neoadjuvant chemotherapy, after previous breast biopsy, to DCIS and tumors of more than 3 cm in diameter. Clinical trials have to establish whether axillary dissection after finding a micrometastasis in the sentinel node is necessary or not.

Antineoplastic Agents↗

An anomalous muscle (accessory subscapularis-teres-latissimus muscle) in the axilla penetrating the brachial plexus in man.

An anomalous muscle passing through the brachial plexus was found in 10 cases out of 380 sides of 190 human cadavers in the dissection course. The muscle was designated as 'accessory subscapularis-teres-latissimus muscle'. This muscle arose near the lateral margin of the scapula, either from the surface of the subscapularis muscle or from the border of the quadrangular terminal tendon of the latissimus dorsi or from both of those sources when the muscle was divided into two heads. It ran obliquely upward to fuse with the insertion of the subscapularis. The largest anomaly was 2.5 cm in width and 7 cm in length. This muscle could be classified into three types on the basis of its nerve supply and its relation to the brachial plexus. The type I muscle crossed over the axillary and lower subscapular nerves, behind the radial nerve and was innervated by the lower subscapular nerves. The type II musclepenetrated the brachial plexus separating the radial nerve into two roots; the upper from the posterior division of the upper trunk and the lower from the posterior divisions of the middle and lower trunks. The type II muscle was supplied by a branch of the radial nerve, which originated always at the same level as the origin of the thoracodorsal nerve. The type III muscle passed through the further more ventrocaudal level of the plexus; in one case it divided the radial nerve into an upper root from the posterior divisions of the upper and middle trunks and a lower root from the lower trunk, and, in another case, into an upper main root from all the three trunks and a lower slender root from the lower trunk. The type III muscle was supplied by branches from the radial and in addition from the thoracodorsal nerve in one case. In four out of ten cases, the subscapular or thoracodorsal artery also passed posterior to the anomalous muscle. A discussion was made on the nature of the anomalous muscle.

Autopsy↗

[Endoscopic axilla dissection in invasive breast carcinoma. Initial experiences with a new technique].

The presence or absence of involved axillary lymph nodes is the single best predictor of survival of breast cancer, and important treatment decisions are based on it. For staging purpose as well as for local control a level I and II dissection is recommended. In order to lower the morbidity of axillary lymph node dissection less invasive treatment modalities have been evaluated. Beside the sentinel lymph node biopsy another new method is discussed: the endoscopic axillary lymph node dissection. After liposuction of the axillary fat the lymph nodes of level I and II are removed by endoscopy. With this technique enough lymph node can be removed which allows a sufficient staging as well as local control. This technique is not to be recommended for general use unless long term results have proven its value.

Axilla↗