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.
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.
Objective To evaluate the feasibility of sentinel lymph node (SLN) mapping after 99Tcm sulfur colloid (99Tcm-sc) and carbon nanoparticles injection in patients with colon cancer. Methods Forty patients with colon cancer underwent complete mesocolic excision between August 2015 and July 2016 at Qingdao Central Hospital were considered for prospective inclusion. Before resection, SLN mapping was performed with injection of 99Tcm-sc and carbon nanopar-ticles, then all dissected lymph nodes were detected by pathological examination. Results A total of 660 cases of lymph nodes were found in the 40 patients (average of 16.5 cases per patient). Of them, 88 nodes (average of 2.2 cases per patient) were identified as SLN in 36 of 40 patients, with a successful detection rate of 90.0% (36/40). The diagnostic accuracy, sensitivity, and false-negative rate were 87.5% (35/40), 96.2% (25/26), and 3.8% (1/26) respectively. Conclusion 99Tcm-sc and carbon nanoparticles suspension injection for mapping SLN is a feasiblely diagnostic method for predicting local lymph node metastasis in the patient with colon cancer.
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.
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.
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.
Objective To explore the feasibility of breast cancer patients in China with 1–2 positive sentinel lymph nodes (SLN) to avoid axillary lymph node dissection (ALND). Methods A total of 328 patients who received sentinel lymph node biopsy (SLNB) in our hospital from 2010 to 2016 were collected retrospectively, and patients met the criteria of Z0011 clinical trials (which required no acceptance of neoadjuvant therapy, clinical tumor size was in T1/T2 stage, two or less positive SLNs were detected, received breast-conservation surgery, acceptance of whole breast radiotherapy after surgery and neoadjuvant systemic treatment) were enrolled to breast-conservation group. Patients met the criteria of Z0011 clinical trials, excepting the surgery (received non-breast-conservation surgery), were enrolled to non- breast-conservation group. Comparison of clinicopathological features between the breast-conservation group/non-breast-conservation group and the Z0011 ALND group was performed. Results Among the 328 patients, only 29 patients (8.8%) completely correspond with the results of Z0011 clinical trials. There was no statistical significance between the breast-conservation group and the Z0011 ALND group in the age, clinical T stage, expression of estrogen (ER), expression of progesterone (PR), pathological type, histological grade, number of positive lymph nodes, and incidence of non-sentinel node metastasis (P>0.05). A total of 81 patients were included in the non-breast-conservation group. It showed no statistical significance between the non-breast-conservation group and the Z0011 ALND group in expressions of ER and PR, and histological grade (P>0.05), while there was statistically significant difference in age, clinical T stage, pathological type,number of positive lymph nodes, and incidence of non-sentinel node metastasis (P<0.05). Patients in the non-breast-conservation group showed a lower age, higher percentage of lobular carcinoma and T2 stage, more positive lymph nodes, and high incidence of non-sentinel node metastasis. Conclusion It’s feasible for Z0011 clinical trials results to be used in the clinical practice of our country, but the actual situation of breast conservation in our country may lead to low adaptive population.
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 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.
ObjectiveTo explore influence of molecular classification of breast cancer on surgical treatment of axillary lymph nodes. MethodThe related literatures which discussed the relation between molecular classification and axillary lymph node metastasis were reviewed and analyzed. ResultsThe triple negative breast cancer had a lower rate of sentinel lymph node or non-sentinel lymph node metastasis. The axillary lymph node metastasis rate was higher in the luminal B or HER-2 overexpression subtypes. Especially, luminal B subtype had a higher risk of sentinel lymph node or non-sentinel lymph node metastasis as compared with the other subtypes. Elderly patients with breast conserving operation could be free for axillary lymph node dissection when only 1-2 sentinel lymph node metastases. There was still a positive possibility of non-sentinel lymph node for younger patients with a larger tumor size, even if the sentinel lymph node negative, the lymph node dissection may benefit these patients. ConclusionBreast cancer molecular classification should be considered for the surgery selection of axillary lymph node dissection.