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Sentinel lymph node biopsy (SLNB) is standard of care for clinically negative operable breast cancer. However, the best technique for intra-operative assessment of SLN still remains a matter of research. Accuracy of frozen section (FS), which is widely used for detecting metastasis in SLN varies from 79 to 89% with false negative rate being 5.5 to 43%. This study was hence done to evaluate if combined intraoperative FS and imprint cytology (IC) evaluation improves accuracy and reduces false negative rate for SLN evaluation in breast cancer. In this prospective cohort study, patients with operable breast cancer with negative axillary lymph node status (N0) were included. SLNB was done using combination technique with a radionuclide tracer and blue dye. Smears were prepared from SLNs for imprint cytology evaluation and excised SLNs were then sent for frozen section. Diagnostic indices of frozen section, imprint cytology, and combined technique were assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, false negative rate, and overall accuracy with 95% confidence intervals taking final histopathology as “gold standard.” Eighty-one cases of SLNB in which both FS and IC reports were available were included for analysis. Sensitivity (93.8%; CI 69.8–99.8%), specificity (100%; CI 89.3–100%), positive predictive value (100%; CI 66.3–100%), negative predictive value (98.4%; CI 91.6–100%), false negative rate (6.25%), and overall diagnostic accuracy (98.7%) of combined evaluation were superior as compared to either of the techniques. Combination of frozen section and imprint cytology has better diagnostic accuracy and reduced false negative rate as compared to either of them alone.

In the present research, a full series of 44 cases investigating metaplastic breast carcinoma (MBC) have been presented to clarify uncertainty in variables for diagnosis, categorization, and treatment strategies. Forty-four MBC female patients have been treated between Jan 2009 and Dec 2019 were retrospectively investigated and presented in this research. Demographic characteristics of the patients, types of surgery, tumor sizes, axillary involvement, tumor stages, and planned adjuvant treatments were considered and evaluated using the database of the hospital. Tumor diameter was less than 20 mm in 8 cases (18.8%), in between 20 and 50 mm in 23 cases (52.2%), and greater than 50 mm in 13 cases (29.5%). Both estrogen and progesterone receptors were found negative in 38 cases, and positive in 6 cases. The mean Ki-67 expression was determined as 51.36 ± 31.20 (range, 2 to 90) in 44 cases (100%). The mean follow-up period was 59.8 ± 39.4 (range, 10 to 120) months. All cases were alive during the follow-up. In the present research, an investigation with one of the largest single-institution data with the patients with MBC is presented. It is also critical that MBC has been associated with a poor prognosis, despite the low nodal involvement. Most patients in the series had negative axillary lymph node involvement, large tumor diameter, and hormone receptor negativity. Therefore, the present research is valuable in the literature and beneficial for researchers and readers.

This study aimed to demonstrate the clinical significance of total lesion glycolysis (TLG) of primary breast cancer using 18F-FDG PET/CT to predict axillary lymph node (ALN) metastasis in invasive ductal breast cancer (IDC) with a clinically negative axillary lymph node (cN-ALN). 135 patients, newly diagnosed with IDC with CN-ALN between July 2016 and October 2017, were retrospectively enrolled. We estimated primary tumor PET/CT parameters including the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and TLG, as well as clinicopathologic findings. All patients received breast surgery followed by pathologic axillary lymph node examination. Of the 135 patients, 31 (23.0%) were diagnosed with pathologically proven metastatic ALN. In univariate analysis, SUVmax, MTV, and TLG of the primary breast tumor were correlated with metastatic ALN along with tumor size, lymphovascular invasion, CD34, and D2-40. On multivariate analysis, TLG (> 5.74, p = 0.009) had independent significance for predicting ALN metastasis in IDC with cN-ALN. We demonstrated that TLG of primary tumors can be useful in predicting pathologic ALN metastasis in IDC patients with cN-ALN.

Background Generally, sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI). Methods A prospectively maintained database of 767 breast cancer patients enrolled between January 2006 and December 2009 was reviewed. All patients were offered preoperative breast ultrasound, magnetic resonance imaging, and positron emission tomography scanning. SI patients were regarded as those for whom preoperative imaging was “suspicious for axillary LN metastasis” and NSI as “non-suspicious for axillary LN metastasis” on preoperative imaging techniques. Patients were subgrouped by presence of SI and types of axillary operation, and analyzed. Results For 323 patients who received SLNB, there was no statistically significant difference in axillary recurrence (P=0.119) between SI and NSI groups. There also was no significant difference in axillary recurrence between SLNB and axillary lymph node dissection (ALND) groups in 356 SI patients (P=0.420). The presence of axillary LN metastasis on preoperative imaging carried 82.1% sensitivity and 45.9% specificity for determining axillary LN metastasis on the final pathology. Conclusions SLNB in SI patents is safe and feasible. Complications might be avoided by not performing ALND. Therefore, we recommend SLNB, instead of a direct ALND, even in SI patients, for interpreting the exact nodal status and avoiding unnecessary morbidity by performing ALND.