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Purpose: The optimal method for axillary staging in patients with initially node-positive breast cancer after NACT remains unclear. Methods: We conducted a prospective, single-center trial to investigate the diagnostic performance of sentinel lymph node biopsy (SLNB) combined with wire localized lymph node biopsy (WLNB) of the clip-marked node as an axillary staging technique in patients with node-positive breast cancer after neoadjuvant chemotherapy (NACT). Results: A total of 233 patients were enrolled, 208 of whom were included in the analysis. The IR of SLNB and WLNB alone were 63.0% and 70.7%, respectively. The identification rate (IR) of targeted axillary dissection (TAD) was 87.5%. The FNR of and NPV were 6.9% (95% confidence interval [CI]:2.0–11.8%) and 92.0% (95% CI 86.3–97.7%), respectively, for the TAD procedure, 17.1% (95% CI 8.2–25.6%) and 83.3% (95% CI:74.7–91.9%) for SLNB alone, and 6.7% (95% CI:1.5–12.0%) and 90.6% (95% CI:83.5–97.7%) for WLNB alone. Conclusions: The diagnostic performance of TAD using wire localization was similar to that of the procedure performed using radioactive seed localization. (Clinical Trial Registration: NCT03715686). [ABSTRACT FROM AUTHOR]

Background Lymphedema can occur in patients undergoing axillary lymph node dissection (ALND) and radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed to decrease the risk of lymphedema in patients after ALND. Some patients who ultimately require ALND are candidates for attempted sentinel lymph node biopsy (SLNB) or targeted axillary excision. In those scenarios, ALND can be performed (1) immediately if frozen sections are positive or (2) as a second operation following permanent pathology. The purpose of this study is to evaluate immediate ALND/ILR following positive intraoperative frozen sections to guide surgical decision-making and operative planning. Methods A single-center retrospective review was performed (2019–2022) for breast cancer patients undergoing axillary node surgery with breast reconstruction. Patients were divided into two groups: immediate conversion to ALND/ILR (Group 1) and no immediate conversion to ALND (Group 2). Demographic data and operative time were recorded. Results There were 148 patients who underwent mastectomy, tissue expander (TE) reconstruction, and axillary node surgery. Group 1 included 30 patients who had mastectomy, sentinel node/targeted node biopsy, TE reconstruction, and intraoperative conversion to immediate ALND/ILR. Group 2 had 118 patients who underwent mastectomy with TE reconstruction and SLNB with no ALND or ILR. Operative time for bilateral surgery was 303.1 ± 63.2 minutes in Group 1 compared with 222.6 ± 52.2 minutes in Group 2 (p = 0.001). Operative time in Group 1 patients undergoing unilateral surgery was 252.3 ± 71.6 minutes compared with 171.3 ± 43.2 minutes in Group 2 (p = 0.001). Conclusion Intraoperative frozen section of sentinel/targeted nodes extended operative time by approximately 80 minutes in patients undergoing mastectomy with breast reconstruction and conversion of SLNB to ALND/ILR. Intraoperative conversion to ALND adds unpredictability to the operation as well as additional potentially unaccounted operative time. However, staging ALND requires an additional operation. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aimed to evaluate and analyze the neoadjuvant chemotherapy (NACTx) processes and surgical and pathological outcomes in breast cancer (BC). NACTx for BC caused grade ≥ 3 adverse events in one-fifth of the patients in our study. Anthracyline cardiotoxicity (2.2%) resulted in one death (0.4%). Clinical disease progression occurred in 3.9% of the cases (14% in triple-negative BC). Cavity shaving was required in one-fifth of the patients. We found that invasive lobular carcinoma (ILC) and tumors with low SUVmax values are very risky for positive surgical margins. Axillary clinical complete response is not reliable for luminal A (LA) BC and ILC, but trustworthy for HER2-enriched and triple-negative BC. It was also found that the need for ALND decreases with HER2(+) disease and higher SUVMax values of axillary lymph nodes, but increases with ER positivity and higher PR expression levels. A pathologic complete response is unlikely in well-defined LA BC. Objectives: To evaluate the neoadjuvant chemotherapy (NACTx) process in breast cancer (BC), its significant treatment-related adverse events (trAEs), tumor clinical response rates, and surgical and pathological outcomes, and to analyze factors influencing cavity shaving and axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB). Methods: A comprehensive retrospective study was conducted at a single center on patients who received NACTx for BC between 2015 and 2021. Results: Medical records of 242 patients were reviewed. Approximately one-fifth encountered grade ≥ 3 trAEs (21.5%), leading 3.3% to discontinue chemotherapy. Anthracycline cardiotoxicity (2.2%) caused one death (mortality rate = 0.4%). For clinical response and surgical and pathological outcomes, 229 patients were eligible. Clinical progression occurred in 3.9% of the patients (14% in triple-negative BC, p = 0.004). Breast-conserving surgery (BCS) was performed in 55% of the patients. There was no significant difference between the type of breast surgery (BCS vs. mastectomy) and molecular subtype, histology, tumor size, or tumor's pathological response degree. Cavity shaving was required in one-fifth of the patients who underwent BCS (n = 134) due to an invasive tumor at the surgical margin (SM). Tumor histology (invasive ductal vs. invasive lobular carcinoma; OR: 4.962, 95% CI 1.007–24.441, p = 0.049) and tumor SUVMax value (OR: 0.866, 95% CI 0.755–0.993, p = 0.039) had significant independent efficacy on SM positivity. Initially, 75% underwent SLNB, but nearly half of them needed ALND. ALND rates were significantly higher in the luminal A and LB-HER2(−) groups (87% vs. 69%) than in the HER2(+) and TN groups (43% to 50%) (p = 0.001). All luminal A patients and those with lobular histology required ALND after SLNB, but no patients in the HER2-enriched group required ALND. ER positivity and higher PR expression levels were associated with an increased need for ALND after SLNB, whereas HER2 positivity and higher SUVMax values of LN(s) were associated with a significantly reduced need for ALND. About 27% of the patients achieved overall pCR. No pCR was achieved in the LA group. Conclusions: The BC NACTx process requires close monitoring due to severe AEs and disease progression. NACTx decisions must be made on experienced multidisciplinary tumor boards, considering tumor characteristics and expected targets. [ABSTRACT FROM AUTHOR]

Breast cancer is one of the most common cancers diagnosed in both countries with high and low levels of socio-academic development. Routine, regular screening tests being introduced in an increasing number of countries make it possible to detect breast cancer at an early stage of development, as a result of which the trend in the incidence of metastatic breast cancer has been decreasing in recent years. The latest guidelines for the treatment of this tumor do not recommend axillary dissection, which limits the need for rapid assessment of the nodes during surgery. Regardless of the progression of the disease, lymph node biopsy and their analysis is one of the most common diagnostic methods for detecting metastases. Systems using one-step amplification of nucleic acids have been present in the diagnosis of breast cancer for nearly 20 years. The one-step nucleic acid amplification (OSNA) test semi-quantitatively detects the number of cytokeratin 19 mRNA copies, a well-known tumor marker, which can be used to infer the presence of metastases in non-sentinel lymph nodes (SLN). Aim: OSNA is a widely used molecular method for SLN, intra-, or postoperative analysis. Its high accuracy has been proved over the years in clinical use. In this review, we checked current state of this technology and compared it to its competitors in the field of breast cancer diagnosis in the era of Axillary Lymph Nodes Dissection (ALND) importance decrease with intention to foresee its further potential use. Objectives: To evaluate OSNA current place in breast cancer diagnosis and treatment we compared OSNA to other lymph node assessing methods. We based our review on original articles and metanalyses published in the last decade. The research was conducted with PubMed, Science Direct, Google Scholar, and NCBI databases. The collected data allowed us to assess the accuracy of OSNA, its cost effectiveness, and its application in other cancers. Results: Regardless of the progression of the disease, a lymph node biopsy and its analysis constitutes one of the most common diagnostic methods for detecting metastases. The OSNA method is characterized by high sensitivity and specificity, and its predictive value has been confirmed by many studies over the years. While its cost effectiveness is still a matter of discussion, this method has been tested more thoroughly than other new lymph nodes assessing technologies. Conclusions: Despite the emergence of competing methods, this test is still widely used as a routine intraoperative examination of lymph nodes. Research carried out in recent years has proved its effectiveness in the diagnosis of other cancers, in the research field, and as a provider of additional data for prognosis improvement. [ABSTRACT FROM AUTHOR]

Background: The aims of this cohort study were to identify (1) the incidence and risk factors for axillary web syndrome (AWS) with shoulder movement limitation within 4 weeks after axillary lymph node dissection (ALND) for Asian women with breast cancer (BC), and (2) whether early intervention with physical therapy (PT) could improve AWS, and how many PT sessions would be needed. Methods: A cohort study of patients with BC receiving ALND was performed at Changhua Christian Hospital, Taiwan, between January 2019 and December 2020. Those patients who were diagnosed with AWS with shoulder movement limitation were referred to receive PT twice weekly at the Department of Physical Medicine and Rehabilitation. Results: A total 173 BC patients receiving ALND were enrolled. The incidence of AWS with shoulder movement limitation was 18%, and the time to diagnosis was 26.3 days. In a subsequent multivariate analysis, younger age (OR = 0.95; 95% CI = 0.91–0.99; p = 0.019), higher number of removed lymph nodes (OR = 1.09; 95% CI = 1.03–1.16; p = 0.007) and receiving neoadjuvant chemotherapy (NAC) (OR = 2.96; 95% CI = 1.25–6.98; p = 0.013) were associated with an increased risk of developing AWS with shoulder movement limitation. The corresponding area under the curve was 0.762. Initial shoulder flexion and abduction were 132.1° and 123.4°, respectively. After 14.8 PT sessions, shoulder flexion and abduction improved to 172.3° and 171.8°, respectively. Improvement in shoulder range of motion was 40.2° and 48.4° in flexion and abduction, respectively, which was significant (p < 0.001). Conclusions: In conclusion, we demonstrated a prediction model for AWS with shoulder movement limitation using 3 risk factors: younger age, a higher number of removed lymph nodes, and receiving NAC. Approximately 18% of BC survivors will have AWS with shoulder function limitation during the first month after ALND. An early intervention protocol with a PT program could effectively restore shoulder function. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aims to explore the risk factors associated with poor survival outcomes in geriatric female patients with breast cancer. Methods: This study utilized data from the METABRIC database to evaluate the risk factors associated with poor survival outcomes among geriatric breast cancer patients. A total of 2909 female patients, 766 of whom were geriatric, were included in the study. The effects of the type of surgery; breast cancer types; cellularity; Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status; molecular class; axillary lymph nodes; Nottingham prognostic index (NPI); status of receiving systemic chemotherapy (SCT), hormone therapy (HT), and radiotherapy (RT); tumor size and tumor on overall survival (OS); and progression-free status (PFS) of geriatric patients were investigated. Additionally, the disease-specific survival of geriatric patients was compared with other patients. Results: HER2 receptor positivity, advanced-stage tumors (T3–T4), a high NPI, and Luminal B subtypes were significant predictors of worse outcomes. Conversely, Luminal A tumors, associated with favorable hormonal responsiveness, demonstrated the best progression-free survival (PFS). HER2-positive patients exhibited a poorer PFS compared to their HER2-negative counterparts, underscoring the need for careful management of aggressive subtypes in older adults. Additionally, patients undergoing mastectomy were less likely to receive adjuvant therapies, contributing to inferior outcomes compared to breast-conserving surgery (BCS). Conclusions: Mastectomy, HER2 positivity, high NPI, advanced stages, and Luminal B tumors are significant prognostic factors in geriatric breast cancer patients. [ABSTRACT FROM AUTHOR]

Background: The omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC. Methods: A joint analysis of two different multicenter cohorts—the retrospective cohort registry MF18‐02 and the prospective observational cohort registry MF18‐03 (NCT04250129)—was conducted between January 2004 and August 2022. All patients received regional nodal irradiation. Results: Five hundred and one patients with cT1‐4, N1‐3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow‐up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease‐free survival (DFS) and disease‐specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus ≥2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence. Conclusions: The omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes. Axillary lymph node dissection (ALND) may not be needed for patients with limited residual nodal burden in all biologic subtypes. Omission of ALND could be safely considered for patients who achieve a clinical complete response after neoadjuvant chemotherapy but still have residual disease detected by pathologic examination as long as adjuvant radiotherapy is administered. [ABSTRACT FROM AUTHOR]

Background: There is a clinical need to omit axillary lymph node dissection (ALND) when residual disease in sentinel lymph nodes (SLNs) is low after neoadjuvant chemotherapy (NAC). This study aimed to clarify the relationship between micrometastasis in SLNs after NAC and additional non‐SLN metastases by analyzing SLN biopsy results followed by ALND. Methods: This retrospective study reviewed clinical records of patients who underwent breast cancer surgery between January 2010 and June 2022 after NAC at Samsung Medical Center. Of 3944 patients, 806 underwent SLN biopsy followed by ALND. Intraoperative frozen SLN biopsy results were examined, including the number and size of metastases in SLNs, and further investigated the number of additional non‐SLN metastases. Results: Among the 806 patients, 95 (11.8%) had micrometastasis on SLNs in frozen sections, of which 89 (93.7%) had clinically node‐positive (cN1‐3) breast cancer before NAC. Twenty‐three patients (24.2%) exhibited positive additional non‐SLNs after ALND. The presence of lymphovascular invasion (vs. absence; odds ratio [OR] = 4.02, p =.0151) and having two or more SLNs with micrometastasis (vs. a positive SLN; OR = 3.65, p =.0301) were significantly associated with additional non‐SLN metastases. Tumor subtypes and breast pathological complete response after NAC showed no correlation with the additional non‐SLN metastases. Conclusion: The study identified a 24.2% possibility of additional non‐SLN metastasis if micrometastases was detected in the SLN after NAC. This rate is significant, indicating that ALND cannot be omitted if low volume residual disease, such as micrometastasis, is identified in the SLN after NAC. This study analyzed the relationship between micrometastasis in sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy and additional non‐SLN metastases, finding a 24.2% incidence of additional non‐SLN metastases despite micrometastasis‐only detection in SLNs. Notably, lymphovascular invasion and having two or more micrometastatic SLNs significantly increased the risk of further metastases, highlighting the need for further research to determine the necessity of axillary lymph node dissection in these cases. [ABSTRACT FROM AUTHOR]

Background & Objective: Determination of axillary lymph-node status plays a pivotal role in decision making for breast cancer treatment. Biopsy is the current standard of care but hold risks of complications as well. We aimed to find out the correlation of sonographic features of lymph node and histo-pathological findings, to predict axillary lymph-node metastasis in breast cancer patients. Method: This retrospective observational study included 176 breast cancer patients at a private tertiary care hospital from January 2019 to December 2023. The study calculated sensitivity, specificity and accuracy of ultrasound (US) in identifying ALN metastasis. Also, binary logistic regression analysis was used to demonstrate the association between suspicious findings on axillary US with pathology report. Patients who never had undergone axillary surgery or with insufficient data, were excluded from our study. Results: In our study Axillary US was found to be 84.2% sensitive, 48.1% specific, and 67.6% accurate in identifying nodal metastases. In this context, ALN metastases was strongly and independently correlated with cortical thickness > 3 mm and the absence of a fatty hilum (P <.05). Conclusion: Ultrasound was found to be highly sensitive but not specific in predicting metastatic lymph nodes in patients with breast cancer. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although breast surgery has undergone a drastic de-escalation in recent decades, axillary dissection is still indicated in some selected cases. Unfortunately, in 3–85% of cases, complications such as seroma formation occur, highlighting the need for more accurate hemostasis systems. The aim of this study is to evaluate the effectiveness of absorbable polysaccharide hemostatic such as HaemocerTM in preventing postoperative seroma. Materials and Methods: Patients referred to two surgery centers for a diagnosed breast cancer and candidates for axillary lymph node dissection were retrospectively evaluated and included in Group A (treated with HaemocerTM) and B (control group). The primary endpoints were the drain output after 48 h, the daily amount just before the removal, and the duration of axillary drainage placement. Secondary endpoints included the presence of seroma at the ultrasound (US) follow-up, significant blood loss, hematoma, the duration of surgery, and postsurgical complications. Results: The drain output within 48 h was 196 ± 93 vs. 286 ± 38 mL in Groups A and B, respectively (p = 0.013). The daily output before the removal was 40 ± 7 mL in Group A and 47 ± 2 mL in Group B (p = 0.049). The duration of axillary drainage placement was shorter in the experimental group (7 ± 3 days) compared to the control group (10 ± 1 days) with a statistically significant difference (0.037). During the US follow-up, on days 7, 15, and 30, the number of patients affected by seroma and the volumes were lower in the experimental group. Conclusions: The adsorbable hemostatic powder proved to be effective both in reducing the volume of drained fluid postoperatively and in decreasing the number and volume of reported seromas during the US follow-up. [ABSTRACT FROM AUTHOR]

Objectives: This study is aimed at evaluating the effectiveness of TachoSil in controlling lymphatic leakage in breast cancer patients undergoing axillary dissection. By examining its ability to reduce postsurgical lymphatic drainage, the study will assess its impact on complications like seroma formation, recovery time, and overall patient outcomes, including quality of life and reduced healthcare costs. Methods: Breast cancer patients treated in the Department of Surgical Oncology at King Abdulaziz Medical City were enrolled to receive either TachoSil or undergo drain placement after axillary dissection. Repeated measures multivariate analysis of variance (MANOVA) was used to observe the difference in lymphatic drainage volume over time considering other covariates, such as age, sex, family history, neoadjuvant chemotherapy (NAC), and stage. Results: The TachoSil group showed significantly lower lymphatic drainage volumes at 24 h (106.5 ± 11.3) than the control group (141.7 ± 13.0) (p < 0.001). There were no significant differences in lymphatic drainage volume at 3 days (p = 0.176) and 7 days (p = 0.091). However, at 10 days, the TachoSil group exhibited significantly lower lymphatic drainage volume (19.9 ± 6.1) than the control group (44.5 ± 9.2) (p < 0.001). Repeated measures MANOVA showed a statistically significant difference in lymphatic drainage over time, with a moderate effect (p < 0.001). Conclusion: The findings suggest that TachoSil sealant effectively reduces early postoperative lymphatic drainage volume and maintains lower drainage rates up to 10 days following axillary dissection in breast cancer patients. The use of TachoSil sealant may have potential benefits in reducing the incidence of complications associated with lymphatic drainage and improving patient outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Trial Registration Sentinel lymph node biopsy (SLNB) using radioisotope tracer plus blue dye is the gold standard after neoadjuvant chemotherapy (NAC) in initially cN1 breast cancer patients, but clinical use still has limitations. This study aims to examine diagnostic performance of dual indocyanine green (ICG) and methylene blue tracing for SLNB in patients who have completed NAC for breast cancer with initially cN1 disease.Adult women (20–80 years of age) scheduled to undergo NAC for biopsy‐proven cT0‐3N1M0 primary invasive breast cancer were consecutively enrolled in this prospective, multicenter, cohort study. Upon the completion of NAC, SLNB was conducted using ICG and methylene blue, followed by axillary lymph node dissection. The primary outcome was the detection rate (DR); secondary outcomes included the false‐negative rate (FNR) and adverse events associated with the use of tracers.A total of 156 patients were enrolled; all underwent SLNB after NAC. The median number of lymph nodes retrieved during SLNB was 3 (range: 0–11). The DR was 97.4% (152/156; 95% CI, 93.6%–99.0%). The FNR was 6.7% (4/60; 95% CI, 2.6%–15.9%). Negative predictive value was 95.7% (88/92; 95% CI, 89.4%–98.3%). In the subgroup analysis stratified by ycN status, FNR was 4.0% (1/25; 95% CI, 0.7%–19.5%) and 8.6% (3/35; 95% CI, 3.0%–22.4%) in the ycN0 and ycN+ subgroups, respectively. No allergic reaction was reported.SLNB with ICG plus methylene blue achieved a high DR and a very low FNR in breast cancer patients with initially cN1 disease.ClinicalTrials.gov (https://www.clinicaltrials.gov/), NCT02869815 [ABSTRACT FROM AUTHOR]

Background: Axillary lymph node dissection (ALND) is an essential step in the management of breast cancer. ALND is conventionally performed using radio frequency electrosurgery. The post-operative complications of utilizing such energy (such as prolonged drainage time, seroma, or infection) lead to prolonged recovery. Hence, it may delay the initiation of adjuvant chemo/radiotherapy for this critical category of patients. Using ultrasound shears provides a wide spectrum of tissue effects via mechanical oscillation. The absence of an electric circuit in ultrasound shears reduces thermal injury and accordingly cellular damage. Objective: Comparing utilization of ultrasound shears in axillary lymph node dissection to conventional radio frequency electrosurgery in terms of operative time, post-operative drainage amount and days, post-operative pain, the incidence of seroma or infection, and lymph node yield. Methods: This study is a randomized control trial. It includes 56 breast cancer ALND cases performed in conjunction with either BCS or MRM; being upfront surgery cases or post-neoadjuvant therapy cases, 28 patients underwent ALND using ultrasound shears and 28 underwent ALND using radio frequency electrosurgery. Results: The mean age of the study population was 51 ± 11.7 years, with a mean BMI of 39. The mean operative time in the ultrasound shear group was 29.4. ± 7.6 min and 31.6 ± 5.1 min in the conventional group. The mean amount of drainage in the ultrasound shear group was 319.6 ± 75.4 ml and 407.5 ± 75.2 ml in the conventional group. The mean drainage days in the ultrasound shear group were 8 ± 1 day and 12 ± 2.2 days in the conventional group. Seroma formation was recorded in 6 of the ultrasound shear groups and 9 in the conventional group. Seroma followed by infection was found in 10% of the ultrasound shear group versus 21% in the conventional group. Seroma formation and wound infection were significantly related to the conventional group (p-value = 0.01). Conclusion: Our study recommends the utilization of ultrasound shears in ALND as it is a safe and accurate method that allows faster post-operative recovery with shorter drainage time and lower incidence of seroma or infection, without affecting operative time or lymph node yield. Trial registration: Trial no.: PACTR202402831197428. Date of approval: 19/02/2024 [ABSTRACT FROM AUTHOR]

Background: Endoscopic‐assisted breast surgery (EABS) provides better cosmetic outcomes for breast cancer patients with small incisions in an inconspicuous area. However, an extended incision and heavy assistant retraction are usually required for an adequate exposure for conventional axillary lymph node dissection (ALND). Therefore, we propose an innovative single‐port three‐dimensional endoscopic‐assisted ALND (S‐P 3D E‐ALND) to facilitate better visualization, and report its preliminary outcomes herein. Methods: The surgical technique of the S‐P 3D E‐ALND, using either monopolar Endo Hook, LigaSure, or Sonicision, is described. A total of 11 breast cancer patients who received the S‐P 3D E‐ALND in a single institution from January 2023 to September 2023 were enrolled. The preliminary results of the S‐P 3D E‐ALND, including perioperative parameters, complication, and short‐term oncological outcomes, were retrospectively analyzed. Results: Endoscopic breast and axillary procedures were conducted via a single axillary incision. The primary success rate of the S‐P 3D E‐ALND was 100% without a conversion to open surgery. The median operative time for the S‐P 3D E‐ALND was 39 (IQR = 28, 49) minutes. Average blood loss during E‐ALND was 3 (IQR = 3, 5) mL. The median number of harvested LN was 10 (IQR = 8, 11) LNs. During the median follow‐up time of 7 months, there was no complication, lymphedema, shoulder stiffness, or chronic arm numbness found. None of the patients reported locoregional recurrence, distant metastasis, or mortality. Conclusion: The S‐P 3D E‐ALND can serve as an alternative approach for ALND in breast cancer patients undergoing EABS, as our findings indicate it results in only minor complications. [ABSTRACT FROM AUTHOR]

Purpose: After primary systemic therapy (PST), agreement on the extent of locoregional therapy is lacking in breast cancer patients who convert from a node-positive to a node-negative status. The aim of this survey was to investigate radiation therapy approaches after PST according to different axillary surgical strategies and disease responses. Materials and Methods: The European Breast Cancer Research Association of Surgical Trialists developed a web-based survey containing 39 questions on locoregional management based on clinical scenarios in initially node positive breast cancer patients undergoing PST. Twelve international breast cancer societies distributed the link to breast surgeons and radiation oncologists. Results: Responses from 349 breast specialists were recorded, 72 of whom (20.6%) were radiation oncologists from 17 countries. Nodal status at diagnosis informed the decision for postoperative regional nodal irradiation (RNI) for 44/72 (61.1%) responders. RNI in node positive patients having undergone axillary lymph node dissection (ALND) is delivered in selected cases by 30/72 (41.7%) responders and systemically recommended by 26/72 (36.1%) responders. In case of macrometastases found on ALND, 43/72 (59.7%) responders always deliver RNI. In case of micrometastases in the sentinel lymph node(s) or targeted lymph node(s), 45/72 (62.5%) responders prefer RNI to completion ALND. A majority of responders (59.7%) determine the target volume for RNI according to European Society for Radiotherapy and Oncology guidelines. Significant heterogeneity was observed regarding nodal basins and volumes of interest for dose coverage by RNI. Conclusions: There is significant heterogeneity in radiation-therapy delivered to the axilla after PST. A more standardized approach engaging both radiation oncologists and breast surgeons will help to optimize the harm-benefit equilibrium of axillary surgery and RNI. [ABSTRACT FROM AUTHOR]

Simple Summary: Ovarian cancer is often diagnosed at advanced stages, making treatment more challenging. One key factor that affects survival is the amount of cancer left after surgery. There is ongoing debate about whether removing enlarged lymph nodes outside the abdomen during surgery improves outcomes. These lymph nodes can be seen through advanced imaging techniques so that the best surgical methods can be adopted. This approach aims to ensure that as much of the cancer is removed as possible, which is crucial for improving patient prognosis. This review emphasizes the importance of careful knowledge of focused anatomy, imaging, and surgical treatment for advanced ovarian cancer patients with extra-abdominal lymphadenopathies. Ovarian cancer typically presents at advanced stages, with prognosis heavily influenced by the presence of residual disease following cytoreductive surgery. The role of resecting enlarged extra-abdominal lymph nodes during cytoreductive procedures remains contentious. These enlarged lymph nodes are commonly identified through high-resolution imaging techniques such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography–computed tomography (PET-CT). A comprehensive understanding of the relevant anatomy, imaging modalities, and surgical techniques for addressing lymphadenopathy in regions such as the supraclavicular fossa, axillae, mediastinum, and pericardiophrenic fat is crucial in determining the feasibility of surgical intervention. An appropriate evaluation of these factors is essential to optimize debulking, which is recognized as the most significant prognostic determinant in patients with ovarian cancer. This review underscores the importance of multidisciplinary approaches in managing advanced ovarian cancer with extra-abdominal lymph node involvement to enhance patient outcomes. [ABSTRACT FROM AUTHOR]

Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancer cases. Sentinel lymph node biopsy (SLNB) has emerged as a less invasive alternative to axillary lymph node dissection (ALND) for axillary staging in breast cancer, offering reduced morbidity and comparable accuracy. However, the application of SLNB in MBC remains underexplored, with limited male-specific data and treatment protocols often extrapolated from female breast cancer studies. Available evidence suggests that SLNB in men demonstrates high diagnostic accuracy, with low false-negative rates and a high sentinel lymph node identification rate. Despite this, there is ongoing debate about its long-term impact on clinical outcomes, particularly for patients with sentinel node metastasis, where ALND may still provide superior survival outcomes in some cases. Predictive tools are being developed to identify better patients who may benefit from SLNB alone, potentially reducing the need for more invasive procedures. As the role of SLNB continues to evolve in MBC management, further prospective research is needed to refine its application and assess its long-term oncologic outcomes. [ABSTRACT FROM AUTHOR]

The article "The History of Breast Cancer Early Detection: 1865 – 2020" explores the evolution of early detection in breast cancer treatment. It discusses the shift from radical surgery to systemic therapies, highlighting the challenges faced by pioneers like Bernard Fisher. Fisher's hypothesis that breast cancer is systemic from its inception challenged the necessity of radical surgeries and emphasized the role of biologic factors in treatment outcomes. The review traces the transition from a focus on local control to a broader understanding of cancer's systemic nature, with tumor biology emerging as a crucial determinant of patient prognosis. The future of breast cancer management lies in integrating systemic insights with innovations in detection and treatment, such as blood-based screening tests for cancer. [Extracted from the article]

Women undergoing breast surgery with axillary lymph node dissection continue to experience complications in the ipsilateral upper limb, impacting their daily lives and quality of life. This study aims to evaluate the relationship between quality of life (overall and specific) and the functional capacity of patients undergoing breast surgery with lymph node clearance before and after implementing a rehabilitation program. This short-term quasi-experimental study included 48 women, and the design did not include control groups. Data collection involved a sociodemographic and clinical characterization questionnaire, the Disabilities of the Arm, Shoulder and Hand questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and Breast Cancer questionnaires. The study revealed a significant negative association between all general functional subscales and the functionality of the ipsilateral upper limb, except for emotional (p 0.941) and cognitive (p 0.927) functional scales. The functional capacity of the ipsilateral upper limb following surgery influences the quality of life of women undergoing breast surgery. The study concluded that monitoring the quality of life is essential to underscore the importance of providing access to rehabilitation to minimize or eliminate these changes, thus contributing to a better quality of life for these women. [ABSTRACT FROM AUTHOR]

Background: Axillary management after neoadjuvant chemotherapy (NAC) is evolving but axillary lymph node dissection (ALND) remains the standard of care for patients with residual nodal disease. The results of the Alliance A011202 trial evaluating the oncologic safety of ALND omission in this cohort are pending but we hypothesize that ALND omission is already increasing. Methods: The National Cancer Database was queried to identify patients diagnosed with cT1-3N1M0 breast cancer who underwent NAC and had residual nodal disease (ypN1mi-2) from 2012 to 2021. Temporal trends in omission of completion ALND were assessed annually. Multivariable logistic and Cox regression models were used to identify factors associated with ALND omission and overall survival (OS), respectively. Results: A total of 6101 patients were included; the majority presented with cT2 disease (57%), with 69% HER2+, 23% triple-negative, and 8% hormone receptor-positive/HER2−. Overall, 34% underwent sentinel lymph node biopsy (SLNB) alone. Rates of ALND were the lowest in the last 4 years of observation. After adjustment, treatment at community centers (vs. academic) and lower pathologic nodal burden were associated with omission of ALND. ALND omission was associated with a higher unadjusted OS (5-year OS: 86% SLNB alone vs. 84% ALND; log-rank p = 0.03), however this association was not maintained after adjustment. Conclusions: Despite the impending release of the Alliance A011202 results, omission of ALND in patients with residual nodal disease after NAC is increasing. This practice appears more prominent in community centers and in patients with a lower burden of residual nodal disease. No association with OS was noted. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy is currently the gold standard for clinically node-negative patients of carcinoma breast. Fluorescein is a safe, low-cost agent, and easily available. Fluorescein has shown a promising role in sentinel lymph node evaluation in carcinoma breast in combination with methylene blue dye with a detection rate of more than 90% and a false-negative rate of less than 10% in previous studies. This study aims to determine the detection rate and diagnostic accuracy of fluorescein and methylene blue dye in early breast cancer. The identification rate and false-negative rate of the combined blue and fluorescent dye method were 100% and 7.14% respectively. The accuracy of the combined blue and fluorescein dye method was 98.3%. The sensitivity, specificity, negative predictive value, and positive predictive value of the combined blue dye and fluorescein dye method were 92.8%, 100%, 97.8%, and 100% respectively. Thus, the combined blue and fluorescein dye method is an easy, safe, cost-effective, and reliable method of sentinel lymph node biopsy in early breast cancer patients. [ABSTRACT FROM AUTHOR]

Background Arm symptoms commonly endure in post-breast cancer period and persist into long-term survivorship. However, a knowledge gap existed regarding the interactions among these symptoms. This study aimed to construct symptom networks and visualize the interrelationships among arm symptoms in breast cancer survivors (BCS) both with and without lymphedema (LE). Patients and Methods We conducted a secondary analysis of 3 cross-sectional studies. All participants underwent arm circumference measurements and symptom assessment. We analyzed 17 symptoms with a prevalence >15%, identifying clusters and covariates through exploratory factor and linear regression analysis. Contemporaneous networks were constructed with centrality indices calculated. Network comparison tests were performed. Results 1116 cases without missing data were analyzed, revealing a 29.84% prevalence of LE. Axillary lymph node dissection [ALND] (vs sentinel lymph node biopsy [SLNB]), longer post-surgery duration, and radiotherapy significantly impacted overall symptom severity (P  < .001). "Lymphatic Stasis," "Nerve Injury," and "Movement Limitation" symptom clusters were identified. Core symptoms varied: tightness for total sample network, firmness for non-LE network, and tightness for LE network. LE survivors reported more prevalent and severe arm symptoms with stronger network connections than non-LE group (P  = .010). No significant differences were observed among different subgroups of covariates (P  > .05). Network structures were significantly different between ALND and SLNB groups. Conclusion Our study revealed arm symptoms pattern and interrelationships in BCS. Targeting core symptoms in assessment and intervention might be efficient for arm symptoms management. Future research is warranted to construct dynamic symptom networks in longitudinal data and investigate causal relationships among symptoms. [ABSTRACT FROM AUTHOR]

Abstract Background Axillary lymph node dissection (ALND) is an essential step in the management of breast cancer. ALND is conventionally performed using radio frequency electrosurgery. The post-operative complications of utilizing such energy (such as prolonged drainage time, seroma, or infection) lead to prolonged recovery. Hence, it may delay the initiation of adjuvant chemo/radiotherapy for this critical category of patients. Using ultrasound shears provides a wide spectrum of tissue effects via mechanical oscillation. The absence of an electric circuit in ultrasound shears reduces thermal injury and accordingly cellular damage. Objective Comparing utilization of ultrasound shears in axillary lymph node dissection to conventional radio frequency electrosurgery in terms of operative time, post-operative drainage amount and days, post-operative pain, the incidence of seroma or infection, and lymph node yield. Methods This study is a randomized control trial. It includes 56 breast cancer ALND cases performed in conjunction with either BCS or MRM; being upfront surgery cases or post-neoadjuvant therapy cases, 28 patients underwent ALND using ultrasound shears and 28 underwent ALND using radio frequency electrosurgery. Results The mean age of the study population was 51 ± 11.7 years, with a mean BMI of 39. The mean operative time in the ultrasound shear group was 29.4. ± 7.6 min and 31.6 ± 5.1 min in the conventional group. The mean amount of drainage in the ultrasound shear group was 319.6 ± 75.4 ml and 407.5 ± 75.2 ml in the conventional group. The mean drainage days in the ultrasound shear group were 8 ± 1 day and 12 ± 2.2 days in the conventional group. Seroma formation was recorded in 6 of the ultrasound shear groups and 9 in the conventional group. Seroma followed by infection was found in 10% of the ultrasound shear group versus 21% in the conventional group. Seroma formation and wound infection were significantly related to the conventional group (p-value = 0.01). Conclusion Our study recommends the utilization of ultrasound shears in ALND as it is a safe and accurate method that allows faster post-operative recovery with shorter drainage time and lower incidence of seroma or infection, without affecting operative time or lymph node yield. Trial registration Trial no.: PACTR202402831197428. Date of approval: 19/02/2024

This article aims to analyze modern endoscopic techniques of sentinel lymph node biopsy and axillary lymph node dissection in breast cancer surgery.Owing to more accurate diagnosis and minimized patient morbidity and risks, endoscopic techniques have significantly expanded capabilities of breast cancer surgery.We review the main endoscopic techniques of sentinel lymph node biopsy and axillary lymph node dissection, analyze their efficacy and safety, and compare their benefits with those of conventional open techniques.The article discusses results of recent studies regarding diagnostic accuracy and complication rates. Furthermore, we discuss the impact of endoscopic axillary lymph node dissection on the prognosis and quality of life in patients with breast cancer.

Abstract Background Sentinel lymph node biopsy (SLNB) is widely used in patients who receive neoadjuvant chemotherapy (NAC). Still, axillary lymph node dissection (ALND) is recommended for patients with any axillary residual disease after NAC. The necessity of ALND in patients with minimal axillary disease is unclear. We aim to investigate regional recurrence rates in patients with limited axillary residual disease after NAC underwent SLNB + image-tailored axillary surgery and adjuvant radiotherapy (RT). Methods Patients with clinical stages were T1-3 and N1 at the time of diagnosis, clinically good or complete axillary response after NAC, and limited axillary residue (≤ 3 pathological lymph nodes) with favorable response to NAC in the final pathological examination were included in the study. All patients underwent SLNB + image-tailored axillary surgery. Peripheral lymphatic radiotherapy was applied, and no further surgery was performed in patients with compatible radiology and pathology results. Results Our study, which evaluated 139 patients with a median age of 47 years, found that the median number of excised lymph nodes was 4. Notably, 46% of patients had between 1 and 3 lymph nodes excised, while 45% had between 4 and 6. Only 9% of patients had ≥ 7 lymph nodes. 83(60%) of the patients underwent breast-conserving surgery (BCS), and 56(40%) underwent mastectomy. The study’s median follow-up period was 44 months. During this duration, one breast recurrence (0.7%), one supraclavicular recurrence (0.7%), and six systemic recurrences (4.3%) were observed. No axillary recurrence occurred within the follow-up period. Conclusions Patients presenting with pathological-suspicious ≤ 3 lymph nodes on imaging and showing a good response to NAC can be considered suitable candidates for SLNB + image-tailored axillary surgery, followed by adjuvant RT instead of ALND.

Women undergoing breast surgery with axillary lymph node dissection continue to experience complications in the ipsilateral upper limb, impacting their daily lives and quality of life. This study aims to evaluate the relationship between quality of life (overall and specific) and the functional capacity of patients undergoing breast surgery with lymph node clearance before and after implementing a rehabilitation program. This short-term quasi-experimental study included 48 women, and the design did not include control groups. Data collection involved a sociodemographic and clinical characterization questionnaire, the Disabilities of the Arm, Shoulder and Hand questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and Breast Cancer questionnaires. The study revealed a significant negative association between all general functional subscales and the functionality of the ipsilateral upper limb, except for emotional (p 0.941) and cognitive (p 0.927) functional scales. The functional capacity of the ipsilateral upper limb following surgery influences the quality of life of women undergoing breast surgery. The study concluded that monitoring the quality of life is essential to underscore the importance of providing access to rehabilitation to minimize or eliminate these changes, thus contributing to a better quality of life for these women.

Abstract Background Axillary lymph node dissection (ALND) is a standard procedure for early-stage breast cancer (BC) patients with three or more positive sentinel lymph nodes (SLNs). However, ALND can lead to significant postoperative complications without always providing additional clinical benefits. This study aims to develop machine-learning (ML) models to predict non-sentinel lymph node (non-SLN) metastasis in Chinese BC patients with three or more positive SLNs, potentially allowing the omission of ALND. Methods Data from 2217 BC patients who underwent SLN biopsy at Shantou University Medical College were analyzed, with 634 having positive SLNs. Patients were categorized into those with ≤ 2 positive SLNs and those with ≥ 3 positive SLNs. We applied nine ML algorithms to predict non-SLN metastasis. Model performance was evaluated using ROC curves, precision-recall curves, and calibration curves. Decision Curve Analysis (DCA) assessed the clinical utility of the models. Results The RF model showed superior predictive performance, achieving an AUC of 0.987 in the training set and 0.828 in the validation set. Key predictive features included size of positive SLNs, tumor size, number of SLNs, and ER status. In external validation, the RF model achieved an AUC of 0.870, demonstrating robust predictive capabilities. Conclusion The developed RF model accurately predicts non-SLN metastasis in BC patients with ≥ 3 positive SLNs, suggesting that ALND might be avoided in selected patients by applying additional axillary radiotherapy. This approach could reduce the incidence of postoperative complications and improve patient quality of life. Further validation in prospective clinical trials is warranted.

Background Methods Results Conclusion Investigate incidence and identify predictors of axillary lymph node metastases in early breast cancer in women >74 years Australia and New Zealand to inform decision making about sentinel lymph node (SLN) biopsy in this population.Retrospective review of invasive breast cancer in women in Australia and New Zealand between 2010 and 2022 using BreastSurgANZ Quality Audit Database. Data included patient demographics, tumour characteristics, surgery type, axillary nodal status and adjuvant therapy. Descriptive analysis of incidence of axillary nodal metastases and use of adjuvant therapy in various patient and tumour groups was performed, followed by statistical analysis using multivariate logistic regression to identify predictors of axillary nodal positivity and correlation between nodal status and prescription of adjuvant therapy.Review of 127 436 cases of invasive breast cancer, 17 599 cases >74 years. Two thirds of the overall population and in those >74 years were node negative. In patients >74 years with grade 1–2, T1a‐b cancers, ER+/HER2− 94% were node negative. Patient age, tumour size, grade and biomarker profile correlated with axillary nodal status and analysis of adjuvant therapy revealed significant correlation between nodal stage and adjuvant radiotherapy, chemotherapy and endocrine therapy.A total of 94% of patients >74 years with T1a/b, ER positive HER2 negative breast cancer were node negative. Nodal status significantly influences adjuvant treatment in this patient group and therefore, we recommend clinicians consider tumour factors and patient fitness in their decision making about SLN biopsy in the elderly population with hormone receptor positive early breast cancer. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemotherapy (NAC) with anthracycline sequential paclitaxel is the standard regimen for triple negative breast cancer (TNBC), while TNBC with residual positive axillary lymph node after standard NAC indicates poor prognosis. There is no evidence that vinorelbine alone can be used as an adjuvant intensive therapy for such patients at present. Methods: We recruited TNBC patients with clinical stage of T1-4/N1-3/M0, who received NAC with 8 cycles of anthracycline sequential paclitaxel and had residual tumor in axillary lymph node after surgery. The patients were randomly divided into adjuvant intensive treatment group (Group A) and control group (Group B). The patients in group A received vinorelbine at a dose of 25 mg/m2 on days 1/8 of a 21-day cycle with four planned cycles, while the control group received no therapy. Stratified according to the Miller-Payne system of the primary lesion (G1-2/G3-5). The endpoints included distant disease-free survival (DDFS), recurrence-free survival (RFS), overall survival (OS), and safety. Results: A total of 22 eligible patients were enrolled in this study, the 3-year DDFS and RFS rates in the group A were significantly higher than those in group B (90.0% vs. 42.4%, p = 0.022, both) at a median follow-up of 36 months. All patients in the group A completed the scheme in full dose, and no grade 3/4 adverse event occurred. Conclusions: TNBC patients with residual positive axillary lymph nodes after NAC of anthracycline sequential paclitaxel could benefit from adjuvant intensive therapy of vinorelbine with a good safety. Trail registration: The study was registered on the Clinical Trial registry website (https://register.clinicaltrials.gov, NCT03270007) (Registration Date: 08/30/2017). [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer-related lymphedema (BCRL) is a common complication among breast cancer survivors. Most BCRL studies have focused on patients receiving adjuvant chemotherapy, with relatively little attention paid to BCRL in patients undergoing neoadjuvant chemotherapy (NAC). This study aimed to investigate the risk factors associated with BCRL in Chinese women undergoing NAC and axillary lymph node dissection (ALND). Methods: At our institution, this cohort study collected data from 336 women with breast cancer and documented axillary nodal metastasis at diagnosis, who received NAC and ALND surgery between 2015 and 2020. BCRL was assessed through both objective limb circumference measurements and subjective self-reported symptoms. Multivariate logistic regression was employed to identify risk factors for BCRL, considering clinical, demographic, and lifestyle-related characteristics. Results: The cumulative incidence of BCRL within 2.5 years was 43.75%. Factors independently associated with BCRL included radiotherapy (versus no radiotherapy; hazard ratio (HR) = 1.611; P = 0.020), NAC duration of 105 days or shorter (versus 105-143 days; HR = 0.471; P = 0.020), removal of more than 15 lymph nodes (versus 15 or fewer lymph nodes; HR = 1.593; P = 0.036), drainage duration of 20-29 days (versus 10-19 days; HR = 1.568; P = 0.028), and sleeping biased toward the affected arm (versus sleeping biased toward the healthy arm; HR = 2.033; P = 0.019). Conclusion: This study identified several risk factors for BCRL in breast cancer patients following NAC and ALND. Patients presenting with one or more of these factors should be monitored closely for early detection and intervention. Further research is warranted to explore the impact of drainage duration and sleep position on the development of BCRL. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SLNB) has become standard procedure for early breast cancer patients with clinically node negative disease. The patients with SLN metastasis normally underwent axillary lymph node dissection (ALND). However, the metastatic status of non-sentinel Lymph nodes (non-SLNs) varied significantly in different reports. Here, we evaluated the prevalence of non-SLNs metastasis among breast cancer patients with sentinel lymph node metastasis and its impact on clinical decision-making. Materials and Methods: We identified 892 female patients with operable cT1-3N0 invasive breast cancer who underwent ALND in our center due to SLN metastasis from 2017 to 2023, retrospectively. The prevalence of non-SLN metastasis among different clinicopathological traits and its correlation with the number of positive SLNs were analyzed. The optimal clinical decision-making was generalized. Results: The median number of SLN+, SLN, non-SLN+ and non-SLN was 2, 4, 1 and 14 among the enrolled 892 female patients, respectively. 504 (56.50%) patients with SLN + had at least one metastatic lymph node in the harvested non-SLNs. Among the enrolled 892 female patients, 435 (48.77%) patients with 1 positive SLN, of which 180 (41.38%) had at least one additional metastatic non-SLNs. 242 (27.13%) patients with 2 positive SLNs, of which 146 (60.33%) had at least one metastatic non-SLNs. For the rest 215 (24.10%) patients with at least 3 metastatic SLNs, 178 (82.79%) had at least one metastatic non-SLNs. In the univariate analysis, the non-SLNs metastatic status was correlated with the number of SLNs+, tumor size, tumor grade, lymphovascular invasion (LVI) and molecular subtypes, but not histopathologic type. In the multivariate analysis, the risk of additional non-SLNs metastasis correlated with the number of SLNs+, SLNs, non-SLNs and LVI. Conclusion: Omiting ALND in patients with higher non-SLNs + rate outside the American College of Surgeons Oncology Group (ACSOG) Z0011 and the European Organization for Research and Treatment of Cancer (EORTC) 10,981–22023 AMAROS criteria should be considered with caution in clinical decision-making. To evaluate whether axillary radiotherapy and ALND provides equivalent regional control in breast cancer patients with obvious residual metastatic lymph nodes undesected in the axilla, a well-matched prospective randomized controlled trial is an urgent need. [ABSTRACT FROM AUTHOR]

Simple Summary: This study raises the question whether all breast cancer patients need axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NAC). Researchers assessed a novel clinical variable: the sentinel lymph node ratio (SLN-R) to predict additional cancerous lymph nodes during ALND. SLN-R was defined as total number of positive sentinel nodes among all sentinel nodes removed during axillary staging after NAC. Axillary surgery included Targeted Axillary Dissection (TAD) technique for cN1 breast cancer patients. We analyzed data from 1521 patients, focusing on 118 with specific cancer stages and positive sentinel /TAD nodes results after NAC. The results indicated that an SLN-R value below 0.35 could suggest a lower chance of finding more cancerous nodes, with a 10.2% false-negative rate. This means SLN-R could help identify patients who might avoid unnecessary surgeries. By combining SLN-R with other clinical factors, the study aims to create a predictive tool, enhancing personalized care and improving patients' quality of life. Background/Objectives: The aim of the study was to determine the clinical value of the sentinel lymph node ratio (SLN-R) in predicting additional positive lymph nodes during axillary lymph node dissection (ALND) in breast cancer patients following neoadjuvant chemotherapy (NAC). Methods: A cross-sectional study was performed at a single institution evaluating data from 1521 BC patients. Inclusion criteria comprised cT1/cT4, cN0/cN1 status with positive post-NAC axillary staging by SLN/TAD, respectively, and subsequent ALND. Results: The study included 118 patients, divided into two groups based on the presence or absence of additional node metastasis at ALND: 39 in the residual disease group (RD) and 79 in the non-residual disease group (nRD). Univariate logistic regression analysis of SLN-R was conducted to assess its predictive value, yielding an odds ratio (OR) of 7.79 (CI 1.92–29.5, p = 0.003). An SLN-R cut-off point of <0.35 was identified using ROC curve analysis, with a false-negative rate of 10.2%, as a predictor for no additional metastasis at ALND following post-NAC SLN/TAD positivity. Conclusions: The study concludes that SLN-R is a valuable predictor for determining the omission of ALND in cases where SLN/TAD is positive after NAC. This metric, in combination with other clinical variables, could help develop a nomogram to spare patients from ALND. [ABSTRACT FROM AUTHOR]

Background: Seroma is the most common complication after breast surgery. Some studies showed that tranexamic acid (TA) can be used in breast surgery to reduce seroma formation and drain volume. We studied the effect of intra‐operative and postoperative topical TA on the duration of drain and volume of seroma in patients undergoing axillary lymph node dissection (ALND) for breast cancer. Patients and Methods: Breast cancer patients planned for ALND were enrolled in the study between July 2020 and July 2021. Patients were randomized into three groups where one group (n = 50) received a single intraoperative dose of diluted topical TA, the second group, in addition, received daily postoperative doses till day 5 through the suction drain, and the third group (n = 50) did not receive any dose. Chi‐square tests and ANOVA were used to analyze the primary outcomes—the total volume of drain fluid and total drain duration, and secondary outcomes—daily drain output till postoperative‐day‐5, wound infection, and seroma rates. Results: Patients receiving multiple doses of topical TA had a decreasing trend in total drain volume, although this was not statistically significant (1597 vs. 1763 vs. 1773 mL: p = 0.269). There was no significant change in the duration of the postoperative drain (21.6 vs. 19.2 vs. 19.55 days: p = 0.54). There was no statistically significant difference in complications between the groups. Conclusion: There is no significant reduction in drain duration, total drain volume, or the rate of complications with the use of single or multiple doses of topical TA. Key points: We evaluated the use of single and multiple doses of topical tranexamic acid for reducing drain volume and duration.We noticed no significant effects.There were no increased complications or drug side effects noticed. [ABSTRACT FROM AUTHOR]

Objectives: Developing a deep learning radiomics model from longitudinal breast ultrasound and sonographer's axillary ultrasound diagnosis for predicting axillary lymph node (ALN) response to neoadjuvant chemotherapy (NAC) in breast cancer. Methods: Breast cancer patients undergoing NAC followed by surgery were recruited from three centers between November 2016 and December 2022. We collected ultrasound images for extracting tumor-derived radiomics and deep learning features, selecting quantitative features through various methods. Two machine learning models based on random forest were developed using pre-NAC and post-NAC features. A support vector machine integrated these data into a fusion model, evaluated via the area under the curve (AUC), decision curve analysis, and calibration curves. We compared the fusion model's performance against sonographer's diagnosis from pre-NAC and post-NAC axillary ultrasonography, referencing histological outcomes from sentinel lymph node biopsy or axillary lymph node dissection. Results: In the validation cohort, the fusion model outperformed both pre-NAC (AUC: 0.899 vs. 0.786, p < 0.001) and post-NAC models (AUC: 0.899 vs. 0.853, p = 0.014), as well as the sonographer's diagnosis of ALN status on pre-NAC and post-NAC axillary ultrasonography (AUC: 0.899 vs. 0.719, p < 0.001). Decision curve analysis revealed patient benefits from the fusion model across threshold probabilities from 0.02 to 0.98. The model also enhanced sonographer's diagnostic ability, increasing accuracy from 71.9% to 79.2%. Conclusion: The deep learning radiomics model accurately predicted the ALN response to NAC in breast cancer. Furthermore, the model will assist sonographers to improve their diagnostic ability on ALN status before surgery. Clinical relevance statement: Our AI model based on pre- and post-neoadjuvant chemotherapy ultrasound can accurately predict axillary lymph node metastasis and assist sonographer's axillary diagnosis. Key Points: Axillary lymph node metastasis status affects the choice of surgical treatment, and currently relies on subjective ultrasound. Our AI model outperformed sonographer's visual diagnosis on axillary ultrasound. Our deep learning radiomics model can improve sonographers' diagnosis and might assist in surgical decision-making. [ABSTRACT FROM AUTHOR]

Explore whether the axillary outcomes differ among HER2 positive subgroups receiving standard dual-targeted therapy, aiming to identify subgroups exhibiting enhanced sensitivity to NAT among HER2-positive/node-positive breast cancer patients. HER2 positive female patients with biopsy-proven node-positive disease from April 2020 to May 2023 were included. All patients underwent standard Neoadjuvant HER2-targeted dual therapy and axillary lymph node dissection (ALND) at Breast Surgery Center of Sichuan Cancer Hospital. Univariate and multivariate analyses were used to identify factors associate with axillary pathological complete response (ApCR). Statistical analysis and graphing were performed using SPSS 24.0 and GraphPad Prism 9.0 software. This study enrolled 215 HER2 positive patients with a total ApCR rate of 76.7%, which included 49 HER2 2+/FISH + and 166 HER2 3 + cases with approximate ApCR rates of 63.3% and 80.7% (P = 0.011). Univariate and multivariate analysis indicated that HER2 3 + disease (OR = 2.43, 95% CI 1.21–4.88, P = 0.012), Ki-67 ≥ 20% disease (OR = 3.00, 95% CI 1.26–7.13, P = 0.013) and NAC regimen of TCb (OR = 2.71, 95% CI 1.39–5.38, P = 0.004) were more likely to achieve ApCR. Further subgroup analysis revealed that HER2 3 + patients receiving TCb regimen showed the highest ApCR rate of 88% compared to other subgroups. HER2 3 + breast cancer had a higher ApCR rate than HER2 2+/FISH + breast cancer during Neoadjuvant HER2-targeted dual therapy. HER2 positive patients could benefit from NAC regimen of TCb in axillary response. [ABSTRACT FROM AUTHOR]

The 2024 Canadian Surgery Forum in Winnipeg, Manitoba, showcased various studies on surgical topics, including the use of tap water in endoscopy, wait time disparities for elective surgeries between immigrants and non-immigrants, and the use of holographic technology in surgical hand ties. These studies shed light on advancements and challenges in the field of surgery. Additionally, research on the implementation of an HE program for anorectal surgery and the MMaT-3 exception points system for liver transplants demonstrated improved efficiency and equitable allocation of resources. Studies on the effectiveness of pelvic binders in achieving hemostasis in traumatic pelvic fractures emphasized the importance of considering pelvic binders as a standard practice in managing such injuries. Further research is needed to guide treatment decisions due to existing biases and confounders in current studies. [Extracted from the article]

Background Studies have shown a significant reduction in breast cancer-related lymphedema (BCRL) rates in patients undergoing complete axillary lymph node dissection (cALND) combined with immediate lymphatic reconstruction (ILR) using lymphovenous bypass (LVB).The purpose of this study was to determine if ILR with LVB at the time of cALND results in a decreased incidence of BCRL and its impact on patient quality of life (QOL). Methods In this prospective cohort study, patients ≥ 18 years requiring cALND underwent ILR from 2019 to 2021. The primary outcome was bilateral upper limb volumes measured by Brørson's truncated cone formula and the Pero-System (3D Körper Scanner). The secondary outcome was QOL measured by the Lymphedema Quality of Life (LYMQOL) arm patient-reported outcome measurement. Results Forty-two patients consented to ILR using LVB. ILR was completed in 41 patients with a mean of 1.9 ± 0.9 lymphovenous anastomosis performed. Mean age of patients was 52.4 ± 10.5 years with a mean body mass index of 27.5 ± 4.9 kg/m 2. All patients (n = 39, 100%) received adjuvant therapy after ILR. Mean follow-up was 15.2 ± 5.1 months. Five patients met criteria for lymphedema throughout the duration of the study (12.8%), with two patients having resolution, with an overall incidence of 7.7% by the end of the study period. Patients with lymphedema were found to have statistically significant lower total LYMQOL values at 18 months (8.44 ± 1.17 vs. 3.23 ± 0.56, p < 0.001). A mean increase of 0.73 ± 3.5 points was observed for overall QOL average for upper limb function at 18 months compared with 3 months (t = 0.823, p = 0.425). Conclusion This study showed an incidence of 7.7% lymphedema development throughout the duration of study. We also showed that ILR has the potential to reduce the significant long-term adverse outcomes of lymphedema and improve QOL for patients undergoing cALND [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SLNB) has become a method more and more frequently used in loco-regional breast cancer in the initial stages. Starting from the first report on the technical feasibility of the sentinel node method in breast cancer, published by Krag (1993) and Giuliano (1994), the method underwent numerous improvements and was also largely used worldwide. Methods: This article is a prospective study that took place at the "SJUPBT Surgery Clinic Timisoara" over a period of 1 year between July 2023 and July 2024, during which 137 underwent sentinel lymph node biopsy (SLNB) based on the current guidelines. For the identification of sentinel lymph nodes, we used various methods, including single traces and also a dual tracer and triple tracer. Results: Breast density represents a predictive biomarker for the identification rate of a sentinel node, being directly correlated with BMI (above 30 kg/m2) and with an age of above 50 years. The classification of the patients according to breast density represents an important criterion given that an adipose breast density (Tabar-Gram I-II) represents a lower IR of SLN compared with a density of the fibro-nodular type (Tabar-Gram III-V). We did not obtain any statistically significant data for the linear correlations between IR and the molecular profile, whether referring to the luminal subtypes (Luminal A and Luminal B) or to the non-luminal ones (HER2+ and TNBC), with p > 0.05, 0.201 [0.88, 0.167]; z = 1.82. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the efficacy of MRI-based Apparent Diffusion Coefficient (ADC) measurements in detecting axillary lymph node metastasis in breast cancer patients. By comparing preoperative MRI findings with intraoperative sentinel lymph node biopsy (SLNB) and postoperative pathological results, we sought to explore the potential of ADC values as a non-invasive alternative to axillary interventions. Methods: A total of 104 female patients diagnosed with breast cancer between 2019 and 2021 were included in this prospective study. ADC values of axillary lymph nodes, tumors, and muscle tissues were measured using a 3T MRI system. The correlation between these measurements and pathological outcomes was analyzed. Statistical analyses, including t-tests, ANOVA, and ROC curve analysis, were employed to assess the diagnostic performance of ADC values. Results: The results indicated that, while the mean ADC values of metastatic lymph nodes were lower than those of benign nodes, the sensitivity and specificity of MRI-based ADC measurements were inferior to the expected standards. The tumor ADC value and the tumor-to-lymph node ADC ratio were found to be more reliable indicators of metastasis than the lymph node ADC value alone. The diagnostic power of the tumor ADC value was significant, with a sensitivity of 75% and a specificity of 73%. Conclusions: MRI-based ADC measurements, particularly the tumor ADC value and the tumor-to-lymph node ADC ratio, show promise as potential non-invasive markers for axillary lymph node metastasis in breast cancer patients. However, the current results suggest that ADC measurements cannot yet replace SLNB in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in evaluating axillary lymph nodes (ALNs) status in breast cancer patients. Methods: We retrospectively analyzed 590 female breast cancer patients who had undergone both ultrasound and MRI to assess ALNs prior to any invasive procedures. Using pathological results as the standard, we compared the diagnostic performance of the two imaging modalities. Results: For differentiating between malignancy and benign ALNs, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 68.98%, 38.14%, 86.67%, 62.12% and 70.96%, respectively. MRI demonstrated corresponding values of 72.03%, 38.60%, 91.20%, 71.55% and 72.15%. In assessing the burden status of ALNs (high vs low), ultrasound yielded values of 78.47%, 52.75%, 83.17%, 36.36% and 90.61%, while MRI showed corresponding values of 81.19%, 52.75%, 86.37%, 41.38% and 90.93%. There were no statistically significant differences between the two imaging modalities in their ability to evaluate ALN malignancy or burden status. Conclusion: Both ultrasound and MRI offer comparable value in assessing ALN status. Whether evaluating for metastatic involvement or determining ALN burden, it may not be necessary for patients to undergo both imaging tests. Plain Language Summary: 1. Both ultrasound and MRI have shown equally good value in assessing the ALNs status. 2. Whether evaluating for the metastatic ALNs or assessing the burden status of the ALNs, it is unnecessary for patients to undergo both tests. [ABSTRACT FROM AUTHOR]

Background/Purpose: Seroma is a common complication after axillary dissection in women with node-positive breast cancer. We aim to determine the effect of Cyanoacrylate on reducing seroma formation in patients undergoing axillary dissection. This a randomized clinical trial. Methods: This is a single-center, randomized, single-blinded, and two-arm parallel study. Women with node-positive breast cancer eligible for axillary dissection were enrolled. Patients with a Body Mass Index (BMI) greater than 35 kg/m2, those who underwent immediate breast reconstruction, and/or received neoadjuvant chemotherapy were excluded. Patients were randomized in a 1:1 ratio, and were stratified according to their age, BMI, tumor size, and operation type. The primary endpoint was the total seroma volume (the total drained volume and the total aspirated volume after drain removal). Data presented as mean and range when applicable. Results: 111 patients were randomized (Cyanoacrylate 57; control 54). 105 patients were analyzed. Sixty-nine patients underwent breast conserving surgery, and 36 underwent modified radical mastectomy. There was no difference in the total seroma volume between the Cyanoacrylate vs. control arms (1,304 (60-4,950) vs. 1,446 (100-5,223) ml, p=0.458). Wound infection, flap necrosis, number of manual aspirates, and hematoma formation were not statistically different between the two groups. Time to drain removal was shorter in the Cyanoacrylate arm (11.04(3-23) vs. 13.84(3-37) days, p=0.015). The use of Cyanoacrylate was not cost effective ($586.93 (550-748) vs. $29.63 (0-198), p<0.001). Higher seroma volume was correlated with modified radical mastectomy, older age, and BMI more than 30 kg/m². Conclusion: Cyanoacrylate did not reduce seroma formation and its use was not cost effective. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SLNB) is widely used in patients who receive neoadjuvant chemotherapy (NAC). Still, axillary lymph node dissection (ALND) is recommended for patients with any axillary residual disease after NAC. The necessity of ALND in patients with minimal axillary disease is unclear. We aim to investigate regional recurrence rates in patients with limited axillary residual disease after NAC underwent SLNB + image-tailored axillary surgery and adjuvant radiotherapy (RT). Methods: Patients with clinical stages were T1-3 and N1 at the time of diagnosis, clinically good or complete axillary response after NAC, and limited axillary residue (≤ 3 pathological lymph nodes) with favorable response to NAC in the final pathological examination were included in the study. All patients underwent SLNB + image-tailored axillary surgery. Peripheral lymphatic radiotherapy was applied, and no further surgery was performed in patients with compatible radiology and pathology results. Results: Our study, which evaluated 139 patients with a median age of 47 years, found that the median number of excised lymph nodes was 4. Notably, 46% of patients had between 1 and 3 lymph nodes excised, while 45% had between 4 and 6. Only 9% of patients had ≥ 7 lymph nodes. 83(60%) of the patients underwent breast-conserving surgery (BCS), and 56(40%) underwent mastectomy. The study's median follow-up period was 44 months. During this duration, one breast recurrence (0.7%), one supraclavicular recurrence (0.7%), and six systemic recurrences (4.3%) were observed. No axillary recurrence occurred within the follow-up period. Conclusions: Patients presenting with pathological-suspicious ≤ 3 lymph nodes on imaging and showing a good response to NAC can be considered suitable candidates for SLNB + image-tailored axillary surgery, followed by adjuvant RT instead of ALND. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemotherapy (NAC) for breast cancer enables pathological complete response (pCR) in patients initially diagnosed with axillary lymph node metastases, potentially obviating the need for axillary lymph node dissection (ALND). Current targeted axillary dissection (TAD) techniques, guided by traditional tissue markers placed prior to NAC, face challenges such as marker loss and high costs. Carbon nanoparticle suspension injection (CNSI) offers a stable and reliable alternative for marking, which could enhance the TAD procedure. This study aims to evaluate the feasibility and accuracy of different TAD strategies using CNSIs and to explore their clinical utility in locally advanced breast cancer. Methods: This prospective, multicenter, randomized controlled trial will enroll 126 biopsy-proven breast cancer patients with suspicious axillary lymph node metastases (cN1-2a) who achieve ycN0 status following NAC. Participants will be randomized in a 1:1:1 ratio to undergo TAD guided by: [1] conventional tissue clips (CG-TAD); [2] CNSI lymph node marking (CN-LNM); or [3] peritumoral CNSI mapping (PCN-MAP). Primary endpoints include retrieval rate of marked lymph nodes, number of sentinel and marked lymph nodes, concordance rates, and complication rates. Secondary endpoints encompass regional and distant recurrence rates, survival outcomes, surgical duration, postoperative complications, quality of life scores, and margin status in breast-conserving surgery. Statistical analyses will adhere strictly to the CONSORT guidelines. Discussion: This study aims to evaluate the feasibility and accuracy of CNSI for targeted axillary dissection in breast cancer patients following neoadjuvant chemotherapy and to explore its clinical significance in reducing surgical complications and costs, as well as improving surgical precision. Trial registration: Clinicaltrials.gov, NCT04744506, Registered 27 December 2020, Updated 24 September 2024. Protocol Version Ver 1.2, 17/9/2024. [ABSTRACT FROM AUTHOR]

Background: The Choosing Wisely® (CW) campaign recommended de-implementation of surgical management of axillary nodes in specified patients. This study aimed to assess trends in the application of CW guidelines for lymph node (LN) surgery in males with breast cancer. Methods: The National Cancer Database was queried for males diagnosed with breast cancer from 2017 to 2020. Patients were categorized into two cohorts based on CW criteria. Cohort 1 included all T1-2, clinically node-negative patients who underwent breast-conserving therapy and with ≤ 2 positive nodes, and Cohort 2 included all T1-2, node-negative, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative patients aged ≥ 70 years. In Cohort 1, patients who underwent sentinel LN biopsy (SLNB) alone were compared with axillary LN dissection (ALND) or no LN surgery, while in Cohort 2, patients who underwent LN surgery were compared with those with no LN surgery. Results: Of 617 patients who met the criteria for Cohort 1, 73.1% underwent SLNB alone compared with ALND (11.8%) or no LN surgery (15.1%). Those who received SLNB alone were younger (65 vs. 68 vs. 73 years; p < 0.001). The annual proportion of males who underwent SLNB alone remained stable from 2017 to 2020. Overall, 1565 patients met the criteria for Cohort 2, and 84.9% received LN surgery. LN surgery was omitted in older patients (81 vs. 77; p < 0.001). The proportion of elderly males with early-stage breast cancer who underwent LN surgery increased from 2017 to 2020. Conclusion: This study demonstrates that CW recommendations are not being routinely applied to males. These findings reinforce the need for additional studies and subsequent recommendations for optimal application of axillary surgery de-implementation for males diagnosed with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Cancer of unknown primary (CUP) accounts for less than 5% of all cancers. Male breast cancer is a rare disease. The occurrence of bilateral breast involvement is even rarer, at approximately 0.5-2.5%. Genetic factors contribute to about 5-10%, with partner and localizer of BRCA2 (PALB2) gene mutations accounting for 1-2%. Case Report: We found a male with breast cancer who initially presented with metastatic adenocarcinoma at the axillary lymph node of unknown primary origin. After axillary lymph node dissection (ALND) with radiation therapy (RT), adjuvant chemotherapy, and regular surveillance, recurrence was observed on the same other side as the axillary lymph node. The PALB2 gene abnormality was also identified. Finally, he underwent prophylactic bilateral mastectomy, and the pathology report included bilateral benign breast tissue. Conclusion: Patients without Breast cancer gene (BRCA)mutations should be offered next-generation sequencing (NGS) multi-gene panel testing to detect other abnormalities when personal is suggestive of a hereditary syndrome. The roles of bilateral prophylactic mastectomy, ALND, and RT will be discussed with the patien. [ABSTRACT FROM AUTHOR]

Simple Summary: Axillary management in breast cancer has undergone significant changes over the past decades, especially with the introduction of neoadjuvant chemotherapy (NACT). NACT aims to shrink tumors before surgery, allowing for less invasive axillary approaches such as sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). These techniques help reduce the need for axillary lymph node dissection (ALND), which is associated with higher risks of complications like lymphedema. However, patient selection for these procedures depends on factors such as tumor biology, response to NACT, and the extent of nodal disease. This review discusses the latest evidence supporting de-escalation strategies in axillary surgery and highlights ongoing research that aims to further refine the selection criteria for these approaches. Multidisciplinary collaboration remains key to implementing personalized treatments that optimize patient outcomes while minimizing surgical morbidity. Background. In breast cancer (BC) patients, axillary management has undergone major improvements over the last few years, and efforts to identify the optimal strategy for the management of axillary surgery are still ongoing. Methods. In current clinical practice, women with clinically node-positive (cN+) BC usually receive neoadjuvant chemotherapy (NACT) with the aim of reducing the extent of primary disease and, thus, allowing for axillary-conservative surgery. Remarkably, after NACT, up to one out of three patients achieves an axillary pathologic complete response, which, in turn, is associated with a more favorable prognosis than residual axillary disease. However, NACT is not without drawbacks, as NACT-associated inflammation can damage lymphatic vessels. Furthermore, varying degrees of response may occur in the axillary lymph nodes, increasing the false negative rate for sentinel biopsy. Results. At present, there is no consensus on the optimal approach in patients with cN+ BC undergoing NACT, although multidisciplinary management seems to be recommended. Conclusions. This narrative review provides a comprehensive overview of axillary management in cN+ BC patients undergoing NACT. It uses a multidisciplinary approach that encompasses the oncological management perspectives, as well as surgical and chemotherapeutic viewpoints. [ABSTRACT FROM AUTHOR]