• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.135-141
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• 2018

Purpose: Axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) are important for staging of patients with node-positive breast cancer. However, these can be avoided in select micrometastatic diseases, preventing postoperative complications. The present study evaluated the ability of axillary lymph node maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) to predict axillary metastasis of breast cancer. Methods: The records of invasive breast cancer patients who underwent pretreatment (surgery and/or chemotherapy) PET-CT between January 2006 and December 2014 were reviewed. ALNs were preoperatively evaluated by PET-CT. Lymph nodes were dissected by SLNB or ALND. SUVmax was measured in both the axillary lymph node and primary tumor. Student t-test and chi-square test were used to analyze sensitivity and specificity. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) analyses were performed. Results: SUV-tumor (SUV-T) and SUV-lymph node (SUV-LN) were significantly higher in the triple-negative breast cancer (TNBC) group than in other groups (SUV-T: 5.99, P<0.01; SUV-LN: 1.29, P=0.014). The sensitivity (0.881) and accuracy (0.804) for initial ALN staging were higher in fine needle aspiration+PET-CT than in other methods. For PET-CT alone, the subtype with the highest sensitivity (0.870) and negative predictive value (0.917) was TNBC. The AUC for SUV-LN was greatest in TNBC (0.797). Conclusion: The characteristics of SUV-T and SUV-LN differed according to immunohistochemistry subtype. Compared to other subtypes, the true positivity of axillary metastasis on PET-CT was highest in TNBC. These findings could help tailor management for therapeutic and diagnostic purposes.

• Korean Journal of Head & Neck Oncology
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• v.25 no.1
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• pp.43-46
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• 2009

Nasopharyngeal carcinomas are epithelial neoplasm derived from nasopharyngeal mucosa. Nasopharyngeal carcinoma involved cervical lymph nodes frequently. However, nasopharyngeal carcinoma with metastatic axillary node after concurrent chemoradiotherapy was reported rarely. We report the patients who was a 34-year-old man diagnosed as nasopharyngeal carcinoma. He was treated by concurrent chemo-radiotherapy. But axillary node metastasis was found after treatment in 2 years. After surgical resection of axillary lymph node, there is no evidence of disease.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.8
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• pp.3435-3441
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• 2014

Background: Axillary lymph node status at diagnosis remains the strongest predictor of long-term survival in breast cancer. Patients with more than ten axillary lymph nodes at diagnosis have a poor long-term survival. In this single institutional study, we set out to evaluate the prognosis of this high-risk group in the era of multimodality therapy. Materials and Methods: In this retrospective study, we looked at all breast cancer patients with greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st 1990 to December 31st 2007 (n=161). In the univariate analysis, descriptive frequencies, median survival, and 5- and 10-year survival rates were estimated for common prognostic factors. A multivariate prognostic analysis for time-to-event data, using the extended Cox regression model was carried out. Results: With a median and mean follow-up of 70 and 89.9 months, respectively, the overall median survival was estimated to be 99 months. The five-year disease-free survival (DFS) was 59.3% and the ten-year DFS was 37.9%, whereas the five- and ten-year overall survival (OS) was 66.6% and 43.9%, respectively. Multivariate analysis revealed a significant improvement in DFS among black patients compared to whites (p=0.05), improved DFS and OS among young patients (ages 21-45) compared to elderly patients (age greater than 70) (p=0.00176, p=0.0034, respectively), and improved DFS and OS among patients whose tumors were ER positive (p=0.049, p=0.0034). Conclusions: In this single institution study of patients with greater than 10 positive axillary nodes, black patients had a significantly improved DFS compared with white patients. Young age and ER tumor positivity was associated with improved outcomes. Using multivariate analysis, there were no other variables associated with statistically significant improvements in DFS or OS including date of diagnosis. Further work is needed to improve breast cancer survival in this subgroup of patients.

• The Korean Journal of Nuclear Medicine
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• v.34 no.6
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• pp.478-486
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• 2000

Purpose: The sentinel lymph node is defined as the first draining node from a primary tumor and reflects the histologic feature of the remainder of the lymphatic basin status. The aim of this study was to evaluate the usefulness of lymphoscintigraphy and intraoperative radioguided gamma probe for identification and removal of sentinel lymph node in breast cancer. Materials and Methods: Lymphoscintigraphy was performed preoperatively in 15 patients with biopsy proven primary breast cancer. Tc-99m antimony sulfide colloid was injected intradermally at four points around the tumor. Imaging acquisition included dynamic imaging, followed by early and late static images at 2 hours. The sentinel lymph node criteria on lymphoscintigraphy is the first node of the highest uptake in early and late static images. We tagged the node emitting the highest activity both in vivo and ex vivo. Histologic study for sentinel and axillary lymph node investigation was done by Hematoxylin-Eosin staining. Results: On lymphoscintigraphy, three of 15 patients had clear lymphatic vessels in dynamic images, and 11 of 15 patients showed sentinel lymph node in early static image and three in late static 2 hours image. Mean detection time of sentinel lymph node on lymphoscintigraphy was $33.5{\pm}48.4$ minutes. The sentinel lymph node localization and removal by lymphoscintigraphy and intraoperative gamma probe were successful in 14 of 15 patients (detection rate: 93.3%). On lymphoscintigraphy, 14 of 15 patients showed $2.47{\pm}2.00$ sentinel lymph nodes. On intraoperative gamma probe, $2.36{\pm}1.96$ sentinel lymph nodes were detected. In 7 patients with positive results of sentinel lymph node metastasis, 5 patients showed positive results of axillary lymph node (sensitivity: 72%) but two did not. In 7 patients with negative results of sentinel lymph node metastasis, all axillary nodes were free of disease (specificity: 100%). Conclusion: Sentinel lymph node biopsy with lymphoscintigraphy and intraoperative gamma probe is a reliable method to predict axillary lymph node metastasis in breast cancer, and unnecessary axillary lymph node dissection can be avoided.

• Korean Journal of Radiology
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• v.25 no.2
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• pp.146-156
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• 2024

Objective: Automated breast ultrasound (ABUS) is a relevant imaging technique for early breast cancer diagnosis and is increasingly being used as a supplementary tool for mammography. This study compared the performance of ABUS and handheld ultrasound (HHUS) in detecting and characterizing the axillary lymph nodes (LNs) in patients with breast cancer. Materials and Methods: We retrospectively reviewed the medical records of women with recently diagnosed early breast cancer (≤ T2) who underwent both ABUS and HHUS examinations for axilla (September 2017-May 2018). ABUS and HHUS findings were compared using pathological outcomes as reference standards. Diagnostic performance in predicting any axillary LN metastasis and heavy nodal-burden metastases (i.e., ≥ 3 LNs) was evaluated. The ABUS-HHUS agreement for visibility and US findings was calculated. Results: The study included 377 women (53.1 ± 11.1 years). Among 385 breast cancers in 377 patients, 101 had axillary LN metastases and 30 had heavy nodal burden metastases. ABUS identified benign-looking or suspicious axillary LNs (average, 1.4 ± 0.8) in 246 axillae (63.9%, 246/385). According to the per-breast analysis, the sensitivity, specificity, positive and negative predictive values, and accuracy of ABUS in predicting axillary LN metastases were 43.6% (44/101), 95.1% (270/284), 75.9% (44/58), 82.6% (270/327), and 81.6% (314/385), respectively. The corresponding results for HHUS were 41.6% (42/101), 95.1% (270/284), 75.0% (42/56), 82.1% (270/329), and 81.0% (312/385), respectively, which were not significantly different from those of ABUS (P ≥ 0.53). The performance results for heavy nodal-burden metastases were 70.0% (21/30), 89.6% (318/355), 36.2% (21/58), 97.3% (318/327), and 88.1% (339/385), respectively, for ABUS and 66.7% (20/30), 89.9% (319/355), 35.7% (20/56), 97.0% (319/329), and 88.1% (339/385), respectively, for HHUS, also not showing significant difference (P ≥ 0.57). The ABUS-HHUS agreement was 95.9% (236/246; Cohen's kappa = 0.883). Conclusion: Although ABUS showed limited sensitivity in diagnosing axillary LN metastasis in early breast cancer, it was still useful as the performance was comparable to that of HHUS.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.6
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• pp.546-552
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• 2007

Purpose: In the breast cancer patient, lymphatic mapping and sentinel lymph node biopsy are the most important procedure for axillary lymph node staging. We aimed to compare the three radiocolloids [$^{99m}Tc$-antimony trisulfide colloid (ASC), $^{99m}Tc$-tin colloid (TC), and $^{99m}Tc$-human serum albumin (HSA)] for sentinel lymph node mapping. Subjects and Methods: Totally, 397 patients with clinically N0 stage were enrolled. $^{99m}Tc$-ASC was injected in 202 out of 397 patients, $^{99m}Tc$-TC was injected in 120 patients, and $^{99m}Tc$-HSA was injected in the remaining 75 patients. The sentinel lymph nodes were localized by lymphoscintigraphy and selected using intraoperative gamma probe. All sentinel lymph nodes were investigated by intraoperative pathologic consultation. The axillary lymph nodes which were harvested by the lymph node dissection were also investigated. Results: The patients of each group showed similar clinical characteristics. There were no significant differences (p>0.05) in the identification rate of sentinel lymph nodes (IR), false negative rate (FNR), and negative predictive value (NPV). The axillary lymphadenectomy revealed axillary lymph node metastases in those three groups (ASC-33.2%, TC-31.7%, HSA-22.7%). The IR, FNR, and NPV were not significantly different among those groups. Conclusion: Those three $^{99m}Tc$-labeled radiocolloids showed equivalent results in sentinel lymph node mapping of breast cancer.

• The Korean Journal of Physiology and Pharmacology
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• v.21 no.3
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• pp.335-343
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• 2017

Atopic dermatitis (AD) is an inflammatory skin condition accompanied by symptoms such as edema and hemorrhage. Kimchi is a traditional fermented Korean dish consisting of various probiotics. In this study, the therapeutic effect of Lactobacillus plantarum CJLP55 isolated from Kimchi was studied in AD-induced mice. Orally administered Lactobacillus strain, CJLP55, suppressed AD symptoms and high serum IgE levels. CJLP55 administration reduced the thickness of the epidermis, infiltration of mast cells and eosinophils into the skin lesion, enlargement of axillary lymph nodes, and increase in cell population in axillary lymph nodes. CJLP55 treatment decreased the production of type 2 cytokines, such as interleukin (IL)-4, IL-5, IL-10, IL-12, interferon (IFN)-${\gamma}$, and IL-6,which were stimulated by house dust mite extracts, in the axillary lymph node cells. Orally administered CJLP55 exhibited a therapeutic effect on house dust mite-induced AD in NC/Nga mice after onset of the disease by altering immune cell activation. The Lactobacillus strain, CJLP55, isolated from Kimchi, suppressed AD. Our results suggest its possible use as a potential candidate for management of AD.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.2
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• pp.717-722
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• 2013

Background: Breast cancer is the most common cancer among women worldwide. The aim of this study was to investigate the relationship between tumor size and axillary lymph node involvement (ALNI) in patients with invasive lesions, to find the best candidates for a full axillary dissection. Additionally, we evaluated the association between tumor size and invasive behavior. The study was based on data from 789 patients with histopathologically proven invasive breast cancer diagnosed in Shohada University hospital in Tehran, Iran (1993-2009). Cinical and histopathological characteristics of tumors were collected. Patients were divided into 6 groups according to primary tumor size: group I ($0.1-{\leq}1cm$), II ($1.1-{\leq}2cm$), III ($2.1-{\leq}3cm$), IV ($3.1-{\leq}4cm$), V ($4.1-{\leq}5cm$) and VI (>5cm). The mean(${\pm}SD$) size of primary tumor at the time of diagnosis was $3.59{\pm}2.69$ cm that gradually declined during the course of study. There was a significant correlation between tumor size and ALNI (p<0.001). A significant positive correlation between primary tumor size and involvement of surrounding tissue was also found (p<0.001). The mean number of LNI in group VI was significantly higher than other groups (p<0.05). We observed more involvement of lymph nodes, blood vessels, skin and areola-nipple tissue with increase in tumor size. We found 15.3% overall incidence of ALNI in tumors ${\leq}2cm$, indicating the need for more investigation to omit full axillary lymph node dissection with an acceptable risk for tumors below this diameter. While in patients with tumors ${\geq}2cm$, 84.3% of them had nodal metastases, so the best management for this group would be a full ALND. Tumor size is a significant predictor of ALNM and involvement of surrounding tissue, so that an exact estimation of the size of primary tumor is necessary prior to surgery to make the best decision for management of patients with invasive breast cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.4
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• pp.2509-2514
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• 2013

Background: The purpose of this study was to identify predictive factors for supraclavicular lymph node recurrence (SCLR) in N1 breast cancer patients and define a high-risk subgroup who might benefit from supraclavicular nodal radiotherapy (RT). Materials and Methods: From January 1995 to December 2009, 113 breast cancer patients with 1 to 3 positive axillary lymph nodes were enrolled in this study. All patients underwent breast-conserving surgery (BCS) or modified radical mastectomy (MRM). RT was given to all patients who received BCS. Among the patients given MRM, those with breast tumors >5 cm in size received RT. Regional nodal irradiation was not applied. Systemic chemotherapy was given to 105 patients (92.9%). Patient data were retrospectively reviewed and analyzed to identify predictive factors for SCLR. Results: The median follow-up duration was 6.5 years, with 5- and 10-year actuarial SCLR rates of 9.3% and 11.2%, respectively. Factors associated with SCLR on univariate analysis included histologic grade, number of dissected axillary lymph nodes, lymphovascular invasion, extracapsular extension (ECE), and adjuvant chemotherapy. On multivariate analysis, histologic grade and ECE remained significant. The patient group with grade 3 and ECE had a significantly higher rate of SCLR compared with the remainder (5-year SCLR rate; 71.4% vs. 4.0%, p<0.001). Conclusions: Histologic grade and ECE status are significant predictive factors for SCLR. Supraclavicular nodal RT is necessary in N1 breast cancer patients featuring histologic grade 3 and ECE.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.4
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• pp.2225-2229
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• 2013

Background: As data on the relation between obesity and lymph node ratio are missing in the literature, we here aimed to assess the impact of obesity on this parameter and other clinicopathological features of breast cancer cases and patient survival. Materials and Methods: Medical data of 646 patients, all referred to two centers in Tehran, Iran, were reviewed. Factors that showed significant association on univariate analysis were entered in a regression model. Kaplan-Meier and Cox-regression were employed for survival analysis. Results: Obesity was correlated with the expression of estrogen and progesterone receptor (p=0.004 and p=0.039, respectively), metastasis to axillary lymph nodes (p=0.017), higher lymph node rate (p<0.001) and larger tumor size (p<0.001). The effect of obesity was stronger in premenopausal women. There was no association between obesity and expression of human epidermal growth factor receptor. Three factors showed independent association with BMI on multivariate analysis; tumor size, estrogen receptor and lymph node ratio. Obesity was predictive of shorter disease-free survival with a hazard ratio of 3.324 (95%CI: 1.225-9.017) after controlling for the above-mentioned variables. Conclusions: The findings of this study support the idea that obese women experience more advanced disease with higher axillary lymph node ratio, and therefore higher stage at the time of diagnosis. Furthermore, obesity was associated with poorer survival independent of lymph node rate.