• Axillary surgery
• Breast cancer
• FDG-PET/CT
• Preoperative systemic therapy
• Regional radiation therapy

• Humans
• Female
• Positron Emission Tomography Computed Tomography/methods
• Breast Neoplasms/diagnostic imaging
• Breast Neoplasms/therapy
• Breast Neoplasms/pathology
• Middle Aged
• Retrospective Studies
• Fluorodeoxyglucose F18
• Aged
• Neoplasm Staging
• Adult
• Radiopharmaceuticals
• Clinical Decision-Making/methods
• Neoadjuvant Therapy
• Lymphatic Metastasis/diagnostic imaging
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/pathology
• Aged, 80 and over
• Preoperative Care

• Breast Neoplasms/drug therapy
• Breast Neoplasms/radiotherapy
• Disease-Free Survival
• Female
• Humans
• Lymph Node Excision
• Lymph Nodes/pathology
• Mastectomy
• Neoplasm Recurrence, Local
• Prognosis
• Retrospective Studies

• R01 CA207216 NCI NIH HHS
• R01 CA225646 NCI NIH HHS

Although stage IIIC (any TN3M0) breast cancer is known to have a dismal prognosis, the clinical outcome of current standard management and the prognostic differences between N3a, N3b and N3c remain to be further investigated.

Data from our center on pathologic N3 (pN3) (n=284) breast cancer and the US Surveillance, Epidemiology, and End Results (SEER) database on clinical N3 (cN3) (n=15,291) and M1 (n=23,623) breast cancer between January 2004 and December 2015 were systematically analyzed for clinicopathological characteristics and survival outcomes.

In our institution, patients with pN3c had the worst survival, with 5-year OS and DFS rates of 52.4% and 41.5%, respectively. Patients with pN3b had a relatively good prognosis, with a 5-year OS rate of 75.3% vs 63.9% for the pN3a group (p=0.045). For DFS, the 5-year survival rate was 63.1% in the pN3b group compared with 40.3% in the pN3a group (p=0.030). In the US SEER database, patients with cN3c had the worst survival in the cN3 group, but the prognosis of cN3c was much better than that of M1. Similarly, patients with cN3b had a better prognosis compared with patients in other groups, with a 5-year OS rate of 68.9% vs 61.9% for the cN3a group (p<0.001) and a 5-year BCSS rate of 73.4% vs 67.1% for the cN3a group (p<0.001).

Breast cancer patients with N3c had the worst clinical outcomes, while the prognosis of N3b patients was better than that of N3a patients.

• N3
• breast cancer
• stage IIIC
• survival

To evaluate the dosimetric impact of four different radiotherapy techniques for a case of left-sided breast cancer with Internal Mammary lymph Nodes (IMN) involvement.

To identify the best radiotherapy technique for this patient, four methods were compared: 3D Conformal Radiotherapy (3D-CRT), Volumetric Modulated Arc Therapy (VMAT), Tomotherapy (TOMO) and Intensity Modulated Proton Therapy (IMPT). Patient was treated using deep inspiration breath-hold (DIBH) technique. Prescribed dose was 40.05y in 15 fractions. Plan evaluation was performed on target coverage and dose to the organs-at-risk (OARs) using 3D-CRT as a baseline.

TOMO has the most ideal Conformity Index (CI) at 1.139, followed by IMPT at 1.158, VMAT at 0.765, and 3D-CRT at 0.685. Using 3D-CRT as a baseline, VMAT, TOMO and IMPT all showed improved dose coverage. IMPT has the best dose coverage. TOMO has the most ideal homogeneity index (HI) and Conformity Number (CN). Mean heart dose (MHD) is lowest for IMPT at 0.55 Gy and highest for VMAT at 4.79 Gy. V20Gy of left lung is the lowest for IMPT at 11.11%, compared to 17.53% for TOMO, 18.19% for VMAT and 33.33% for 3D-CRT. V5Gy for the contralateral breast ranges from 0.01% in IMPT to 72.32% in TOMO.

3D-CRT compromising target coverage but achieving good OAR sparing for the contralateral right breast, left lung and right lung. Overall, IMPT performed best in terms of target coverage and OAR-sparing. Protons delivered superior target dose coverage and sparing of normal structures for this patient. As dose value parameters are expected to correlate with acute and chronic toxicities, proton therapy should be given due consideration as the preferred technique for the treatment of left-sided breast cancers with IMN involvement. Further studies with more patients can be done to evaluate the effectiveness of proton therapy on acute and chronic toxicities.

• Breast cancer
• IMPT
• Internal Mammary Lymph nodes (IMN)
• Proton
• TOMO
• VMAT

• Biopsy
• Breast cancer
• Internal mammary nodes
• Prognosis
• Risk factor

• Axilla
• Carcinoma, Ductal, Breast
• Lymph Nodes
• Positron-Emission Tomography
• Tomography, X-Ray Computed

• Breast cancer
• Internal thoracic lymph nodes
• Sentinel node biopsy

• Adult
• Aged
• Aged, 80 and over
• Breast Neoplasms/pathology
• Breast Neoplasms/surgery
• Cadaver
• Female
• Follow-Up Studies
• Humans
• Lymph Node Excision
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Middle Aged
• Neoplasm Staging
• Prognosis
• Sentinel Lymph Node Biopsy
• Thoracic Wall/pathology
• Thoracic Wall/surgery
• Young Adult

• Breast neoplasm
• Molecular subtype
• Prognosis
• Tumor location

• Breast cancer
• Internal mammary lymph nodes
• Neoadjuvant chemotherapy
• Radiotherapy
• Supraclavicular lymph nodes

The importance of internal mammary nodes (IMNs) in the staging and treatment of breast cancer patients is controversial.

A retrospective cohort of patients diagnosed with primary breast cancer over a 4-year period (January 2009 to December 2012) was assessed. The number and size of any IMNs visible on spiral computed tomography (CT) were recorded.

A total of 830 patients were diagnosed with primary breast cancer within the identified time frame, of which 150 patients met the inclusion criteria. Of these 42% (63) had IMNs present, although the majority were small (<5 mm). However, 16% (25) had larger nodes, greater than 5 mm in short axis, present on CT. Significantly more patients with the presence of large (>5 mm) IMNs had more advanced disease with CT evidence of other distant spread.

We have demonstrated that IMNs are present in a substantial number of our primary breast cancer patients. We suggest that further histological research is required to establish reliable CT size criterion for pathological IMNs. In addition, routine imaging of the IM chain, as well as axilla, should be considered in the staging of breast cancer.

• breast cancer
• breast carcinoma
• computer tomography (CT)
• imaging
• internal mammary nodes (IMN)
• staging

Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.

• Breast cancer
• Fluorodeoxyglucose positron emission tomography/computed tomography
• Locoregional nodal disease
• Axillary lymph node
• Internal mammary lymph node
• Axillary lymph node dissection
• Sentinel lymph node biopsy

• Breast cancer
• Cáncer de mama
• Ganglio centinela
• Imagen intraoperatoria
• Intraoperative imaging
• Melanoma
• SPECT/CT
• SPECT/TC
• Sentinel node

• Breast cancer
• Radiotherapy
• Sentinel lymph-nodes

• Adult
• Aged
• Aged, 80 and over
• Axilla
• Breast Neoplasms/diagnostic imaging
• Breast Neoplasms/mortality
• Breast Neoplasms/pathology
• Carcinoma, Ductal, Breast/diagnostic imaging
• Carcinoma, Ductal, Breast/mortality
• Carcinoma, Ductal, Breast/pathology
• Carcinoma, Lobular/diagnostic imaging
• Carcinoma, Lobular/mortality
• Carcinoma, Lobular/pathology
• Drainage
• Female
• Follow-Up Studies
• Humans
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymphatic Metastasis
• Lymphoscintigraphy
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local/diagnostic imaging
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/pathology
• Neoplasm Staging
• Preoperative Care
• Prognosis
• Prospective Studies
• Retrospective Studies
• Sentinel Lymph Node Biopsy
• Survival Rate
• Technetium Tc 99m Sulfur Colloid
• Young Adult

• P30 CA016672 NCI NIH HHS
• CA16672 NCI NIH HHS

Internal mammary lymph node (IMLN) metastasis is an important prognostic indicator in breast cancer. However, the necessity of internal mammary sentinel lymph node biopsy for accurate staging, for choosing adjuvant treatment, and as a prognostic indicator, has remained controversial.

From January 2001 to December 2006, 525 female breast cancer patients underwent radical surgery after preoperative lymphatic scintigraphy. We retrospectively analyzed the follow-up results, recurrences, and deaths of all patients.

There was no significant difference in the clinicopathological characteristics between the axilla and the IMLN groups. The median follow-up period was 118.8 months (range, 7-122 months) in the axilla group and 107.7 months (range, 14-108 months) in the IMLN group. During the median follow-up period, the breast cancer-related death rate in the axilla group was 3.6%, which was not significantly different from that of the IMLN group (1.3%) (p=0.484). The five-year survival rates did not differ between the two groups (p=0.306). The overall recurrence rate and the locoregional recurrence rate also did not differ between the two groups (p=0.835 and p=0.582, respectively). The recurrence rate of IMLN (both ipsilateral and contralateral) metastasis was very low, accounting for 0.5% in the axilla group and 1.3% in the IMLN group (p=0.416).

The long-term follow-up results showed that there was no significant difference in both overall outcome and regional recurrence between the two groups. Therefore, the requirement for identification of nodal basins outside the axilla or IMLN sentinel biopsy should be reconsidered.

• Breast
• Carcinoma
• Internal mammary
• Prognosis
• Sentinel lymph node biopsy

• fdg pet
• pet/ct
• recurrence
• metastases
• breast cancer
• restaging

• P01 CA042045 NCI NIH HHS
• R01 CA072064 NCI NIH HHS
• R01 CA090771 NCI NIH HHS

Biopsy of the sentinel lymph node now forms part of routine management in many centres dealing with early stage breast cancer. This article seeks to discuss developments over the past number of years and to summarise current practice.