ObjectiveTo explore the risk factors affecting sentinel lymph node (SLN) metastasis in patients with early-stage (N0) breast cancer and establish a predictive model for SLN metastasis, so as to assist in decision-making of axillary surgery in clinical practice. MethodsThe unilateral early-stage breast cancer patients who underwent surgical treatment and SLN biopsy at the Affiliated Hospital of Southwest Medical University from September 2020 to December 2023 were selected as the study subjects. The univariate and multivariable logistic regression analyses were adopted to analyze the relevant risk factors of SLN metastasis, then a predictive model evaluating the risk of SLN metastasis was constructed. The area under receiver operating characteristic curve (AUC) was used to assess the distinguishing ability of risk factors for SLN metastasis. ResultsA total of 351 patients with early-stage breast cancer patients who met the inclusion criteria were enrolled, 136 of whom with SLN metastasis, the SLN metastasis rate was 38.7%. The results of the multivariate logistic regression analysis showed that the maximum tumor diameter >2.5 cm, estrogen receptor (ER) positive, Ki-67 >20%, and vascular invasion were the risk factors affecting SLN metastasis [maximum tumor diameter: OR(95%CI)=1.897(1.186, 3.034), P=0.008; ER positive: OR(95%CI)=2.721(1.491, 4.967), P=0.001; Ki-67 >20%: OR(95%CI)=1.825(1.125, 2.960), P=0.015; vascular invasion: OR(95%CI)=2.858(1.641, 4.976), P<0.001]. The AUC for the SLN metastasis by these four factors was 0.693(0.637, 0.749), with a sensitivity and specificity of 70.59% and 57.21%, respectively. ConclusionsThe results from this study suggest that SLN biopsy is recommended to guide postoperative adjuvant treatment strategies for cN0 early-stage breast cancer patients with a maximum tumor diameter >2.5 cm, ER positivity, Ki-67>20%, and vascular invasion. However, the predictive model constructed based on these four factors in this study has a general ability to distinguish the occurrence of SLN metastasis, then the reasons can be further analyzed in the future.
Malignant melanoma is a kind of highly malignant tumor, which mainly occurs in the skin, mucous membrane, and rarely in the breast. Here we reported a case of malignant melanoma in the chest wall skin with mammary metastasis. A sizable pigment spot on the skin of the thoracic region was found at the patient’s birth, existing for 50 years with quite atypical clinical manifestation. A nodule at 12 o’clock of the left breast was found by ultrasound four months ago, who was mistaken for a fibroadenoma. As a result, the patient received a minimally invasive excision of the breast lesion, after which the pathological report suggested malignant melanoma. By sharing this case, we aimed to discuss the diagnosis and treatment of this kind of atypical malignant melanoma in detail and provide some clinical experience.
Objective To analyze the correlation among the clinicopathologic features, ultrasound imaging features, and axillary lymph node metastasis in breast cancer patients with negative clinical evaluation of axillary lymph nodes (cN0), and to establish a logistic regression model to predict axillary lymph node metastasis, so as to provide a reference for more accurate evaluation of axillary lymph node status in cN0 breast cancer patients. Methods The data of 501 female patients with cN0 breast cancer who were hospitalized and operated in the Affiliated Hospital of Wuhan University of Science and Technology (Xiaogan Central Hospital) from December 2013 to October 2020 were collected. Among them, 376 patients from December 2013 to December 2019 were selected to establish a prediction model for axillary lymph node metastasis of cN0 breast cancer. In the modeling group, the basic information, clinical pathological characteristics, and ultrasound imaging features of patients were analyzed by single factor analysis. The factors with statistical significance were included in the multivariate logistic regression analysis, and the logistic regression prediction model was established. The model was evaluated by the correction curve and Hosmer-Lemeshow test goodness of fit. The model was validated in the validation group (125 patients from January to October 2020), and the receiver operation characteristic (ROC) curve was drawn. Results The probability of positive axillary lymph nodes in 501 patients with cN0 breast cancer was 28.14% (141/501). The univariate analysis results of the modeling group showed that the histological grade, vascular invasion, progesterone receptor (PR), Ki-67, age, molecular typing, ultrasound breast imaging-reporting and data system (BI-RADS) grade were associated with axillary lymph node metastasis. Multivariate logistic regression analysis showed that the vascular infiltration, positive estrogen receptor (ER) , ultrasound BI-RADS grade 4C and Ki-67≥14% increased the probability of axillary lymph node metastasis (P<0.05). Using the above prediction factors to establish the prediction nomogram, the area under the ROC curve (AUC) of the modeling group was 0.72 [95%CI (0.66, 0.78)], the cut-off value was 0.30, the sensitivity was 61.00%, and the specificity was 71.20%. The newly established axillary lymph node transfer logistic regression model was applied to the validation group (n=125), and the AUC was 0.72 [95%CI (0.53, 0.76)]. The truncation value was 0.40, and the total coincidence rate was 69.60% (87/125), positive predictive value was 47.37% (18/38), and negative predictive value was 91.95% (80/87). Conclusions Vascular invasion, positive ER , ultrasound BI-RADS grade 4C, and Ki-67≥14% are risk predictors of axillary lymph node metastasis in cN0 breast cancer patients. The negative predictive value of the model is 91.95%, which has a higher value in predicting axillary lymph node metastasis in early breast cancer patients, and can provide a reference for screening exempt sentinel lymph node biopsy population.
ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.
ObjectiveTo explore the feasibility and clinical efficacy of laparoscopic sentinel lymph node biopsy combined with endoscopic submucosal dissection(ESD) for patients with early gastric cancer(EGC). MethodsThe clinical data of 26 cases who received ESD combined with laparoscopic sentinel lymph node biopsy for EGC between March 2009 to August 2013 in Affiliated Hospital of Jiangnan University were analyzed retrospectively. These patients first underwent laparoscopic sentinel lymph node(SLN) biopsy. If frozen sectioning examination suggested there was lymph node metastasis, laparoscopic D2 radical gastrectomy would be operated. However, the ESD would be operated if the frozen sectioning examination was negative. ResultsThe total numbers of SLN were 95, and mean numbers of SLN were 3.7±1.4(range from 1 to 6). Two patients with positive SLN underwent laparoscopic-assisted distal gastrectomy and 24 patients with negative SLN underwent ESD. The disease free survival(DFS) and local recurrence rate after ESD for EGC was 91.7%(22/24) and 4.2%(1/24), respectively. And the total DFS for all patients was 96.2% (25/26). ConclusionESD for EGC is a safe and feasible procedure, combined with laparoscopic sentinel lymph node biopsy conforms more to the concept of principle of radical operation.
ObjectiveTo investigate the metastatic status and risk factors of axillary non-sentinel lymph node (NSLN) in breast cancer patients with 1–2 positive sentinel lymph nodes (SLN), and to provide theoretical basis for exemption of axillary lymph node dissection (ALND) in these patients. Methods A retrospective analysis was performed on 54 patients diagnosed with breast cancer who underwent sentinel lymph node biopsy (SLNB) and confirmed to have 1–2 positive sentinel lymph nodes (SLNS) and received ALND in the Department of Thyroid and Breast Surgery of Tongling People’s Hospital from January 2018 to April 2023. The patients were divided into NSLN metastatic group (17 cases) and NSLN non-metastatic group (37 cases) according to whether there was metastasis. Chi-square test was used to compare the basic information and clinicpathological features of the two groups. The independent risk factors for axillary NSLN metastasis were screened out by multivariate binary logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of independent risk factors combined with axillary NSLN metastasis. Results There were 54 cases with 1–2 metastasis of SLN, 17 cases with axillary NSLN metastasis (31.5%). The incidence of axillary NSLN metastasis in patients with tumor at T1 stage (maximum diameter ≤2 cm) was only 14.3% (4/28), however, the metastatic rate of axillary NSLN in patients with tumor in T2–T3 stage (maximum diameter >2 cm) was as high as 50.0% (13/26). The axillary NSLN metastasis rate was only 21.2% (7/33) with 1 SLN metastasis, while the axillary NSLN metastasis rate was 47.6% (10/21) with 2 SLN metastasis. Univariate analysis showed that T stage (tumor diameter >2 cm), 2 SLN metastases, number of SLN >5 and tumor with vascular embolus were more likely to develop axillary NSLN metastases (P<0.05). Multivariate binary logistic regression analysis showed that T stage (tumor diameter >2 cm) and 2 SLN metastases were independent risk factors for axillary NSLN metastasis in breast cancer patients, the area under ROC curve of combined prediction of axillary NSLN metastasis by the two was 0.747, 95%CI was (0.657, 0.917), sensitivity was 0.765 and specificity was 0.649. Conclusions The combination of tumor T stage and the number of SLN metastases can better predict axillary NSLN metastasis in breast cancer patients. ALND is recommended for breast cancer patients with T stage (tumor diameter >2 cm) and 2 SLN metastases to reduce the risk of residual axillary NSLN metastasis.
Objective To investigate the value of sentinel lymph node biopsy (SLNB) in predicting the metastasis of central cervical lymph nodes (CCLN) in differentiated thyroid carcinoma, and to explore reasonable program for CCLN dissection. Methods This retrospective analysis was performed basing on the clinical data of 407 patients with differentiated thyroid carcinoma who were admitted to the Department of General Surgery of Xuanwu Hospital from June 2013 to December 2016, including 237 patients with microcarcinoma. Results ① The results of the lymph nodes detection. All patients had detected 7 766 lymph nodes (1 238 metastatic lymph nodes were detected from 219 patients), and 2 085 sentinel lymph nodes were detected (448 metastatic sentinel lymph nodes were detected from 189 patients). In the patients with microcarcinoma, there were 3 614 lymph nodes were detected (390 metastatic lymph nodes were detected from 97 patients), and 1 202 sentinel lymph nodes were detected (149 metastatic sentinel lymph nodes were detected from 82 patients). ② The value of SLNB to predict CCLN metastasis. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict CCLN metastasis for all patients was 86.30% (189/219), 100% (188/188), 0 (0/189), 13.70% (30/219), 100% (189/189), and 86.24% (188/218) respectively; for patients with microcarcinoma was 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82), and 90.32% (140/155), respectively. ③ The value of SLNB to predict the presence of additional positive lymph nodes (APLN). The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict the APLN for all patients was 81.48% (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189) and 86.24% (188/218), respectively; for patients with microcarcinoma was 73.68% (42/57), 77.78% (140/180), 22.22% (40/180), 26.32% (15/57), 51.22% (42/82) and 90.32% (140/155) respectively. ④ The value of positive sentinel lymph node ratio (PSLNR) to predict the presence of the APLN. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN for all patients was 71.97%, 78.95%, 21.05%, 28.03%, 88.79%, and 54.88% respectively, and the cutoff for PSLNR was 0.345 2. For patients with microcarcinoma, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN was 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41% respectively, and the cutoff for PSLNR was 0.291 7. Conclusion There is an important predicted value of SLNB for CCLN dissection in the patients suffered from differentiated thyroid carcinoma, and the PSLNR is a reliable basis for CCLN dissection.
ObjectiveTo systematically review the diagnostic value of ultrasound for breast cancer with axillary sentinel lymph nodes, so as to provide evidence for clinical decision-making. MethodsWe searched the databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CBM, CNKI, WanFang Data and VIP for studies about ultrasound in the diagnosis of breast cancer with axillary sentinel lymph nodes till December 31st, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and methodological quality of the included studies was evaluated. Meta-analysis was then conducted using Meta-Disc 1.4 software. ResultsA total of 12 studies involving 2 188 cases were included. The pooled results of meta-analysis showed that sensitivity and specificity were 0.75 (95%CI 0.72 to 0.77) and 0.91 (95%CI 0.89 to 0.92), respectively; positive likelihood ratio and negative likelihood ratio were 6.54 (95%CI 4.68 to 8.89) and 0.22 (95%CI 0.15 to 0.33), respectively; diagnostic odds ratio was 33.59 (95%CI 17.87 to 63.12); and the AUC was 0.934 3. ConclusionUltrasound is has relatively high value in diagnosis of breast cancer with axillary sentinel lymph nodes. However, due to the influence caused by the limited quality and various potential heterogeneity, more high quality RCTs with large sample size are needed to further verify the above conclusion.
ObjectiveTo investigate the differences between indocyanine green (ICG) plus methylene blue and radioactive nuclide plus methylene blue for sentinel lymph node biopsy (SLNB) after Neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods A total of 77 breast cancer patients who accepted SLNB and axillary lymph node dissection (ALND) after NAC from June 2017 to February 2019 were involved, among them, 46 breast cancer patients accepted SLNB by ICG plus methylene blue and 31 breast cancer patients accepted SLNB by radioactive nuclide plus methylene blue, pathological and clinical data were collected and analyzed.ResultsThere were 43 patients in the ICG plus methylene blue group and 30 patients in radioactive nuclide plus methylene blue group, which totally 73 patients were detected at least one sentinel lymph node in all the 77 patients, and the detection rate was 94.80%. The SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy of the ICG plus methylene blue group were 93.48% (43/46), 2.32 per case, 82.61% (19/23), 17.39% (4/23), and 90.70% (39/43) respectively, as well as 96.77% (30/31), 2.6 per case, 83.33% (10/12), 16.67% (2/10), and 93.33% (28/30) in the radioactive nuclide plus methylene blue group. There was no significant difference between the ICG plus methylene blue group and radioactive nuclide plus methylene blue group in terms of SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy (P>0.05).ConclusionICG plus methylene blue showed similar SLN detection rate, SLN detected numbers, sensitivity, false negative rate, and accuracy as radioactive nuclide plus methylene blue for SLNB in breast cancer patients after NAC, and both of them can be performed easily and conveniently.
ObjectiveTo investigate the value of a predictive model for sentinel lymph node (SLN) metastasis after neoadjuvant therapy (NAT) based on the radiomic features from multi-modality magnetic resonance imaging (MRI) in combination with clinicopathologic data. MethodsThe clinical data and MRI images of breast cancer patients (initially diagnosed with cN0, all underwent NAT and surgical treatment) from two hospitals (Affiliated Hospital of Southwest Medical University and Suining Central Hospital) from January 2018 to September 2024, were retrospectively collected. The radiomic features from the multi-modality images, including T2-weighted short tau inversion recovery (T2STIR), diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE), were extracted and selected. The predictive models for SLN metastasis after NAT were constructed using four algorithms: LightGBM, XGBoost, support vector machine (SVM), and logistic regression (LR), in combination with clinicopathologic data. The models were evaluated for performance and interpretability using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis, and Shapley additive explanation (SHAP) analysis. ResultsA total of 236 breast cancer patients were enrolled in this study. Among them, 216 patients from the Southwest Medical University were subdivided in an 8∶2 ratio into a training set (n=173) and internal validation set (n=43), while 20 patients from the Suining Central Hospital served as the external validation set. The multivariate logistic regression analysis showed that the lymphovascular invasion [OR (95%CI)=21.215 (4.404, 102.202), P ＜0.001] and perineural invasion [OR (95%CI)=25.867 (1.870, 357.790), P=0.002] were the risk factors, while high Ki-67 expression [OR (95%CI)=0.119 (0.035, 0.404), P＜0.001] was the protective factor of SLN metastasis after NAT. The predictive models utilizing multi-modality MRI and clinicopathologic data yielded area under the ROC curve values of the internal and external validation sets of 0.750 [95%CI=(0.395, 1.000)] / 0.625 [95%CI=(0.321, 0.926)] for LightGBM, 0.878 [95%CI=(0.707, 1.000)] / 0.778 [95%CI=(0.525, 0.986)] for XGBoost, 0.641 [95%CI=(0.488, 0.795)] / 0.681 [95%CI=(0.345, 1.000)] for SVM, and 0.667 [95%CI=(0.357, 0.945)] / 0.583 [95%CI=(0.196, 0.969)] for LR. The XGBoost demonstrated the best predictive performance. Further SHAP analysis revealed that the lymphovascular invasion, T2STAR-MRI_FIRSTORDER_Minimum, and platelet were the key features influencing the predictions of the models. ConclusionThe findings of this study suggest that XGBoost prediction model based on radiomic features derived from multi-modality MRI (T2STIR, DWI, and DCE) in combination with clinicopathologic data is able to predict SLN metastasis after NAT in patients with breast cancer.