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Journal articles on the topic 'Axilla'
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Das, Subhabrata, Sulata Choudhury, Siba Prasad Dash, V. Rajesh, and Chandan Das. "A prospective study to evaluate the axilla in cases of breast carcinoma to exclude axillary lymph node dissection in sentinel lymph node negative cases." Panacea Journal of Medical Sciences 13, no. 1 (April 15, 2023): 241–45. http://dx.doi.org/10.18231/j.pjms.2023.047.
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Sentinel lymph node biopsy (SLNB) has become standard to stage the axilla in cases of clinically and Ultrasound negative axilla avoiding unnecessary axillary Lymph node dissection which is associated with higher morbidity in patients 1. The Primary objective is to preoperatively detect axillary metastasis in USG confirmed node negative axilla and perform Sentinel Lymph node Biopsy, 2. To negate the need for axillary lymph node dissection and biopsy in the treatment of breast cancer patients with sentinel node negative A total number of 80 patients with core needle biopsy proved were subjected to USG of Breast and axilla. The patients who had suspicious features in USG axilla were subjected to USG Guided FNAC. The patient having positive (metastasis) over USG guided FNAC were subjected to ALND and those patients with USG guided FNAC Negative and Normal USG Axilla i.e. No suspicious over USG were subjected to SLNB using blue dye. The SLNB negative cases were followed up with Adjuvant Chemotherapy and every 3months in combination with sonography of the breast and the axilla. Mammograms, X-ray and abdominal sonography performed annually. All 80 biopsy proven patients were subjected to USG. From which 32 patients had suspicious of metastatic deposits which were subjected to USG Guided FNAC. Rest 48 patients Normal Axilla. From 32 suspicious patients undergone USG Guided FNAC 15 showed deposits in Axilla which were subjected to ALND. Rest 17 Negative under USG guided FNAC along with 48 Normal Axilla patients were subjected to blue dye SLNB i.e., Total of 65 cases. i). From these 65 cases which undergone SLNB 4 cases (23.5%) showed metastatic deposit in USG guided FNAC Negative cases (17 total cases) and 8 cases (16.6%) showed metastatic deposit in USG Normal Axilla (48 Total cases) in frozen section. Which brings total SLNB of 18.4% (12 out of 65 cases). ii). These 12 cases were subjected to Axillary Lymph node dissection. The Final HPE study showed 100% metastatic deposits. iii). Remaining 53 cases were followed up for a period of 12 months. No local or Axillary recurrence could be observed in 53 patients who underwent SLNB without ALND. Short term results were very promising with combination of USG along with SLNB without ALND in SLNB negative cases and holds a strong future perspective.
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Santosh, Tummidi, Manoj K. Patro, and Nagiredla Puneeta. "Fibroadenoma in axillary breast tissue - Utility of rapid on-site evaluation & report of two cases." Journal of Cancer Research and Therapeutics 19, no. 7 (2023): 2056–59. http://dx.doi.org/10.4103/jcrt.jcrt_1182_21.
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ABSTRACT Fibroadenoma of axillary breast tissue presents as a palpable mass, cyclic pain in the axilla, and with asthetic concerns. Axillary breast tissue can occur anywhere along the primitive embryonic milk lines, extending from the axilla to the groin, and can present unilaterally or bilaterally. The reported incidence of axillary breast tissue is 0.4%–6% in females. We had two cases of fibroadenoma in the axilla that were diagnosed on rapid on-site evaluation and later confirmed by routine cytology stains in young females. We report the cases for their rarity and high degree of clinical suspicion in the young reproductive age group female. We also emphasize the utility of ROSE in cytopathology.
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Goyal, Amit, Bruce Mann, and Alastair Mark Thompson. "Undissected Axilla and Axillary Radiotherapy." JAMA Oncology 5, no. 5 (May 1, 2019): 741. http://dx.doi.org/10.1001/jamaoncol.2019.0031.
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Shojaku, Hiroko, Kyo Noguchi, Tetsuya Kamei, Yasuko Tanada, Kouichi Yoshida, Yasuko Adachi, and Kazuhiro Matsui. "CT Findings of Axillary Tuberculosis Lymphadenitis: A Case Detected by Breast Cancer Screening Examination." Case Reports in Radiology 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/9016517.
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We report the first description of CT findings of axillary tuberculous lymphadenitis confirmed by the pathological specimen. The breast cancer screening examination is one of the prime methods of detection of axillary tuberculous lymphadenitis. The most common site of axillary tuberculous lymphadenitis is the deep axilla. Screening mammography often fails to cover the whole axilla. The presence on the contrast-enhanced CT of unilateral multiple circumscribed dense nodes, some of which have large and dotted calcifications, might suggest tuberculous lymphadenitis in axillary region.
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Gibbons, Ciara Ellen, Cecily Mary Quinn, and David Gibbons. "Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma." Acta Cytologica 63, no. 4 (2019): 314–18. http://dx.doi.org/10.1159/000496159.
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Context: Fine-needle aspiration biopsy (FNAB) is frequently used to stage the axilla preoperatively in patients with primary breast carcinoma. In the light of the ACOSOG-Z0011 and AMAROS trials that specified sentinel lymph node biopsy as an inclusion criterion, the role of FNAB in axillary staging is changing. Objective: This article will review the diagnostic accuracy of FNAB in staging of the axilla in patients with primary breast carcinoma. The efficacy of axillary FNAB compared with core-needle biopsy will be evaluated. The evolving approach to staging of the axilla, in the light of ACOSOG-Z0011 and AMAROS trials, will be discussed. Data Sources: Data were sourced from published peer-reviewed articles in PubMed (US National Library of Medicine) and published guidelines including the European Guidelines for Quality Assurance in Breast Cancer and those from the European Society of Medical Oncology (ESMO), Union for International Cancer (UICC), American Society of Clinical Oncology (ASCO), and the American Society of Breast Surgeons. Conclusions: FNAB of the axilla is almost 100% specific with a sensitivity between 40 and 90%. A positive FNAB reduces the need for a second axillary procedure by up to 20% with reduced morbidity and cost. The recent ACOSOG-Z0011 and AMAROS trials have reduced the use of FNAB axilla in American protocols, but it remains the standard of care in Europe.
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Mamounas, P. "Abstract ES8-3: Refining axillary management after neoadjuvant chemotherapy - what does the evidence support." Cancer Research 82, no. 4_Supplement (February 15, 2022): ES8–3—ES8–3. http://dx.doi.org/10.1158/1538-7445.sabcs21-es8-3.
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Abstract The surgical management of the axilla in patients with operable breast cancer has undergone significant evolution over the past 25 years. Axillary lymph node dissection (ALND), the undisputed standard since the end of the 19th century, has largely been replaced by sentinel lymph node biopsy (SLNB) in most patients with clinically negative axilla with considerable reduction in axillary morbidity. Neoadjuvant chemotherapy (NAC) has been increasingly used in early-stage breast cancer, particularly in patients with triple-negative and HER-2 neu positive tumors. Rates of sterilization of involved axillary lymph nodes with NAC in appropriately selected patients have been steadily increasing with the adoption of more effective NAC regimens. Adoption of SLNB after NAC has lagged behind that of upfront SLNB. Recent data support the feasibility and accuracy of the procedure after NAC in patients who present with clinically negative axilla. Although the accuracy of SLNB is lower after NAC in patients who present with documented involvement of the axilla, identification and removal of the previously biopsied axillary lymph node(s) in addition to performing SLNB (“targeted axillary dissection”) greatly improves the accuracy to levels equivalent to those with upfront SLNB. Citation Format: P Mamounas. Refining axillary management after neoadjuvant chemotherapy - what does the evidence support [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr ES8-3.
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Rai, B. K., and Dr Shashikar. "The cysticercosis in muscles is one of the causes of lumps in human." Health Renaissance 10, no. 2 (July 30, 2012): 160–61. http://dx.doi.org/10.3126/hren.v10i2.6591.
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Introduction: Cysticercosis is commonly encountered in this part of the world. It can manifest in many different form. Objective: To report a case of cysticercosis which presented with a lump in axilla. Case: A 36 year old man from Dharan presented with the chief complaint of lump in the right axilla for 9 months and two lumps in left axilla for 3 months. The onset of lump was insidious and gradually progressive in nature. The examination revealed a single mass in the medial surface of right upper arm, approximately 3x3cm in size, not fixed with the skin, slightly movable and mildly tender and another two masses around 1x2 cm in left axilla with similar characteristics as the right one. The ultrasonography showed heterogenous lesion measuring 27mm x 18 mm in medial aspect of right upper arm and two similar lesions measuring 14.5 x11mm and 11 x 10 mm in left axilla suggesting "Cysticercosis". The lumps were surgically removed successfully. Conclusion: Cysticercosis is one of the causes of lump in axillay region. It can be diagnosed ultrasonographically and treated by surgical removal.DOI: http://dx.doi.org/10.3126/hren.v10i2.6591 Health Renaissance 2012; Vol 10 (No.2); 160-161
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Bennani, Mounia, Rhizlane Chaoui, Sara Elloudi, Zakia Douhi, Hanane BayBay, and Fatima Zahra Mernissi. "Axillary basal cell carcinoma: New case report." Journal of Clinical Research and Reports 3, no. 4 (March 13, 2020): 01–03. http://dx.doi.org/10.31579/2690-1919/058.
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Basal cell carcinoma (BCC) is the most common skin cancer, but significant differences exist in its incidence in the various anatomical locations. Unusual sites include the axillae, breasts, perianal area, genitalia, palms, and soles the axilla is one of the most sun-protected body sites and represents a rare location at which BCC develops, up to 2014, 70 cases of axillary BCC were reported in 69 patients (4) then in 2017, 6 new cases were reported in a Japanese study out of a total of 333 CBC, probably the real incidence is underestimated because no systematic study of axillary BCC has generally been conducted.
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Gatphoh, Soram Gayatri, Badrinath Venkatesh, and Khagokpam Ambala Devi. "Cytopathological Spectrum of Lesions in the Axilla - A Population Based Study from a Tertiary Care Centre in North-East India." Journal of Evidence Based Medicine and Healthcare 8, no. 32 (August 9, 2021): 2988–92. http://dx.doi.org/10.18410/jebmh/2021/545.
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BACKGROUND The axilla is a triangular space between the lateral wall of thorax and the upper part of arm. The component of axilla can give rise to different diseases ranging from developmental and reactive to neoplastic. Various mesenchymal tissues present in the axilla can give rise to different lesions. Fine needle aspiration cytology (FNAC) is a safe, quick, easy, and a cheap diagnostic tool to decipher the benign or the malignant nature of the swelling. Imaging techniques and FNAC, both used individually or coupled, improve the accuracy of diagnosis and help in avoiding unnecessary invasive procedures. The most common lymph node lesion in axilla is benign reactive lymph node hyperplasia. It is caused by inflammation of the lymph nodes or the adjacent organs, such as the breast or lung. METHODS The present study is a retrospective review of swellings aspirated from axillary region. FNAC was performed following strict aseptic precautions. Inadequate aspirates were excluded from the study. The aspirated sample was blown on clean glass slides and smears were made using squash preparation. Smears were fixed using air dried and alcohol fixation method. Smears were stained with Giemsa stain, and the alcohol - fixed smears were stained with haematoxylin and eosin and Papanicolaou stains. Cytological smears were evaluated for adequacy, cellularity, type of cells, arrangement of cells and nuclear as well as cytoplasmic features. RESULTS A total of 191 axillary swelling were aspirated during the study period. Out of which 148 (77.5 %) cases were females and 43 (22.5 %) cases were males. Most common lesion was lipoma followed by axillary tail of breast. CONCLUSIONS Various pathological processes may affect the axilla. There is overlap in the imaging findings of these diseases. FNAC is a diagnostic tool which is required for conformation of diagnosis of axillary lesions. KEYWORDS Axillary Swelling, Fine Needle Aspiration, Lipoma
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Abasaheb Madhukar Tidake, Anagha S Varudkar, and Balaji Shankarrao Mane. "A prospective audit to assess the feasibility of sentinel lymph node biopsy and/or low axillary sampling in clinicoradiologically node-negative axilla for early breast carcinoma." Asian Journal of Medical Sciences 14, no. 12 (December 1, 2023): 192–97. http://dx.doi.org/10.3126/ajms.v14i12.57240.
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Background: Sentinel lymph node (SLN) dissection was designed to minimize side effects of lymph node surgery but still offer outcomes of axillary lymph node dissection. Aims and Objectives: Our study is designed to determine whether SLN resection achieves the same therapeutics outcome as complete axillary dissection but with fewer side effects for node-negative axilla in clinicoradiologically operable breast cancer patients. Materials and Methods: Duration-based prospective observational study was carried out at the General Surgery and Surgical Oncology Department at Government Medical College and Hospital, Aurangabad with a duration of 2 ½ years from July 2019 to January 2022. A total of 36 patients of breast cancers with stages T1-T2, N0 with clinically and radiologically negative axilla from July 2019 to January 2022 duration were included in our study. Results: When the histopathological status of axillary lymph nodes was compared to the histopathology of SLNs it was seen that out of 36 patients, the histopathology of sentinel node was positive in 10 patients (10/36) however the rest of the axilla was positive in 6 cases and negative in 4 cases and the histopathology sentinel node was negative in 26 patients out of 36 cases (26/36) however the rest of the axilla was also negative in 24 cases and positive in 2 cases. Conclusion: SLN biopsy using methylene blue dye alone is a highly reliable and predictable technique to stage the axilla in breast cancer patients as this study shown a low false-negative rate (7.69%). This technique may help to avoid complete axillary lymph node dissection in sentinel node-negative patients thereby minimizing the morbidity of axillary lymph node dissection. This study demonstrates that sentinel node localization is possible with methylene blue dye alone.
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Parmar, Vani, Zeal Sanghvi, Shalaka Joshi, Nita Nair, Palak Popat, Seema Kembhavi, Souwmyashree KN, et al. "Abstract PO3-03-03: Prospective non-randomized study to compare accuracy of clinical examination under anesthesia, axillary ultrasound and histo-pathological evaluation for axillary nodal staging in women with clinically N0 early breast cancer." Cancer Research 84, no. 9_Supplement (May 2, 2024): PO3–03–03—PO3–03–03. http://dx.doi.org/10.1158/1538-7445.sabcs23-po3-03-03.
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Abstract Introduction: Accurate assessment of axillary lymph nodes is crucial in the management of early breast cancer (EBC), especially in clinically node negative (cN0) axilla to avoid extensive axillary surgery. Clinical examination alone underestimates nodal disease in nearly 30% women with cN0 axilla. The current study compares, in cN0 axilla, the benefit of axillary ultrasonography (USG) and clinical axillary examination under anesthesia (EUA) to predict involvement of axillary lymph nodes. The gold standard in these patients however remains pathological evaluation after sentinel node biopsy/low axillary sampling (SNB/LAS) and a complete axillary lymph node dissection (ALND) if node positive. Methodology: Prospectively, 500 women with cN0 EBC were enrolled from Aug 2015 to April 2023 in a study approved by Institutional Ethics Committee. After informed consenting, a preoperative axillary USG was carried out in addition to standard breast imaging to determine number of axillary node(s) and its architecture. The USG assessment was labeled as suspicious or not and the result was blinded to the surgeons. A USG-guided FNAC was not performed as it would then be difficult to blind the surgeon and pathologist preoperatively. During surgery, an initial axillary EUA was performed before starting and any suspicious node was documented. This was followed by axillary staging by standard dual tracer SNB/LAS. A complete axillary dissection was done (level 1-3) if any node was positive on frozen section evaluation or final histopathology. Axillary node histopathology was the gold standard for comparison of effectiveness of clinical exam, USG, EUA, and SNB/LAS for prediction of axilla. Standard diagnostic tests such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were used. Results: Thirty-six patients were excluded in the final analysis (disease progression, chemotherapy first, or had a surgery elsewhere). Of the eligible 464 cN0 patients, 129 were detected to have axillary metastases (27.8%) in final histopathology. The 2 interventions namely USG axilla, EUA were compared to final axillary nodal histopathology. Axillary USG reported suspicious/indeterminate node(s) in 129 (27.8%) patients. USG had a low sensitivity of 46.5% and a low PPV of 46.5% to identify a positive node. However, the specificity and NPV both were 79.4%. Axillary USG was 70.2% accurate in predicting axillary nodal involvement. EUA also had sensitivity of 60% and low PPV of 14.8%. However, the specificity of EUA was 73.4%, NPV of 95.9%; higher than that of USG. EUA was 72.4% accurate. SNB/LAS had the sensitivity of 93.3%, specificity 79.2%, NPV 82.9%, PPV 91.6% and accuracy rate 89.2% in predicting a positive axilla. Conclusions: While the fallacy of clinical exam remains at 27.8%, both USG alone (without FNAC) and EUA failed in predicting a positive axillary node. EUA fared better at predicting a negative axilla. USG guided FNAC would perhaps improve the sensitivity of USG, however additional investigations are difficult in resource constraint and high-volume center, especially, when surgical interventions like SNB or LAS remain standard of care. Table 1 Citation Format: Vani Parmar, Zeal Sanghvi, Shalaka Joshi, Nita Nair, Palak Popat, Seema Kembhavi, Souwmyashree KN, Soujanya Mynalli, Purvi Thakkar, Garvit Chitkara, Sangeeta Desai, Tanuja Shet, Rajendra Badwe. Prospective non-randomized study to compare accuracy of clinical examination under anesthesia, axillary ultrasound and histo-pathological evaluation for axillary nodal staging in women with clinically N0 early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-03-03.
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Sarker, Bidhan, Lutfar Kader Lenin, and Md Zakir Hossain. "Various Methods of Reconstruction of Axillary Burn Contracture." Bangladesh Journal of Plastic Surgery 4, no. 1 (April 24, 2014): 16–19. http://dx.doi.org/10.3329/bdjps.v4i1.18686.
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Post burn contracture is a burn sequel, which was not properly treated in initial burn management. Deep partial and full thickness burn of axillary region can result in scar contracture which limits shoulder abduction and extension. The axillary contracture has functional morbidity along with aesthetic disfigurement. Difficulties in rehabilitation of shoulder abduction during the initial period and the contractile evolution of the scar contribute to this problem. The goal of the surgical correction of axillary scar contractures is to provide a maximum release with minimum or no local anatomic distortion. 42 patients with post burn contracture of the axillas were operated in the Department of Burn and Plastic Surgery Unit, Dhaka Medical College Hospital and in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka in the period between November 2007 & December 2011. Among them 26(61.9%) were males and 16(38.1%) were females. Age ranged from 6 to 38 years with a mean age 14.7 years. Unilateral axilla were involved in 34 patients(81%) and bilateral axilla was involved in 8 patients(19%). 18 cases (42.8%) had contracture of anterior axillary fold, 12 cases (28.5%) cases had contracture of posterior axillary fold, 8 cases (19%) had contracture of both folds and 4 cases (9.5%) had contracture involving axillary dome. Pre operative X-ray of shoulder joints of affected axilla revealed normal joint spaces. The operative procedure was chosen according to the pattern of scar and state of surrounding skin. Surgical procedures included release of post burn axillary contracture by recontructive procedures single Z plasties were done in 2 cases(4.7%), multiple Z plasties were done in 12 cases(28.6%), five flap plasty was done in 1 case (2.4%), local fascio cuteneous flaps were done in 25 cases(59.5%), parascapular flap was done in 1case (2.4%) and split thickness skin grafting was done in 1 case (2.4%). Axilla was immobilized with plaster cast for two weeks. The rate of complication was 9.5%. All of them were minor. Functional improvement was quite satisfactory, except for one case of skin grafting which had re-contracture. Choice of surgical procedure for reconstruction of post burn axillary contracture can be made according to the pattern of scar contracture and the state of surrounding skin. The choice of a flap should have priority to skin graft because of the superior functional and cosmetic results of flaps. Long term splinting and physical therapy are mandatory to prevent re contracture. Proper pre-operative planning, appropriate surgical method, post operative immobilization, physiotherapy and follow up can make good outcome of post burn axillary contracture reconstruction. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18686 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 16-19
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Ogawa, Haruo, Haruki Nakayama, Shinichi Nakayama, and Shinya Tahara. "Reconstruction of Axillary Defect due to Necrotizing Fasciitis and Debridement Using a Free-Flap Transfer: A Report of Three Cases." Journal of Reconstructive Microsurgery Open 06, no. 02 (July 2021): e63-e69. http://dx.doi.org/10.1055/s-0041-1736422.
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Abstract Background Necrotizing fasciitis is a well-known disease that causes extensive tissue infection and requires radical debridement of the infected tissue. It can occur in all parts of the body, but there are few reports of necrotizing fasciitis in the axilla. We treated three patients with axillary necrotizing fasciitis. Methods In all cases, patients were referred to us after radical debridement of the infected soft tissue in the emergency department. At the first visit to our department, there were fist-sized soft tissue defects in the axilla. Moreover, the ipsilateral pectoralis major and latissimus dorsi muscles were partially resected because of the debridement of necrotizing fasciitis. In all cases, the ipsilateral thoracodorsal vessels were severely damaged and free-flap transfer was performed to close the axillary wound. Results All free flaps survived without complications. The patient's range of motion for shoulder abduction on the affected side was maintained postoperatively. Conclusion If necrotizing fasciitis occurs in the axilla, tissue infection can spread beyond it. In such a case, free-flap transfer can be an optimal treatment. Radical resection of the infected tissue results in the absence of recipient vessels in the axilla. Surgeons should bear in mind that, because of radical resection of the infected tissue, they may need to seek recipient vessels for free-flap transfer far from the axilla.
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Siguan, Stephen Sixto, and Mary Nicole Velez. "Adult-Onset Cystic Hygroma in the Axilla in a 44-year old Female: A Case Report." Philippine Journal of Surgical Specialties 74, no. 2 (December 1, 2019): 44–49. http://dx.doi.org/10.61662/pcs_dzft1350.
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This is a case of a 44- year old female presenting with an 18cm x 17cm soft, movable, non-tender mass at the right axilla extending to the lateral aspect of the right breast. Computerized tomographic scan of the chest revealed a lobulated, multi-septated hypodense mass. The patient underwent excision of the right axillary mass and final histopathology revealed cystic lymphangioma. Adult-onset cystic hygroma of the axilla is a rare case, with less than 10 studies documented in PubMed. Total surgical excision remains to be its primary treatment. Key words: Adult-onset cystic hygroma, cystic hygroma, lymphangioma, axilla
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Munck, Frederikke, Maj-Britt Jensen, Ilse Vejborg, Maria Gerlach, Maja Maraldo, Niels Kroman, and Tove Tvedskov. "Abstract PO3-22-07: Predicting Additional Axillary Metastases in Breast Cancer Patients with Positive Targeted Axillary Dissection Lymph Nodes after Neoadjuvant Treatment." Cancer Research 84, no. 9_Supplement (May 2, 2024): PO3–22–07—PO3–22–07. http://dx.doi.org/10.1158/1538-7445.sabcs23-po3-22-07.
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Abstract Background: Neoadjuvant chemotherapy (NACT) is increasingly used for axillary downstaging in clinically node-positive breast cancer patients, and a considerable proportion achieves axillary pathological complete response (ax-pCR). After NACT, axillary staging can be done by targeted axillary dissection (TAD). In case of metastases at TAD, axillary lymph node dissection (ALND) is offered regardless of metastases size. This contrasts primary surgery, where small sentinel node metastases (ypN0(i) and ypN1mi) and ≤2 positive sentinel nodes do not confer ALND, although a proportion of patients with small metastases have additional metastatic lymph nodes (LNs) in the axilla. So far, the residual metastatic burden in the axilla when TAD LNs are positive after NACT is unknown. If subgroups of patients with low residual metastatic burden in the axilla (non-TAD LNs) could be identified, these subgroups may be offered de-escalated axillary treatment. Therefore, we investigated the risk of residual metastatic burden in the axilla when the TAD LNs harbored metastases. Methods: We retrospectively retrieved DBCG data on patients staged by TAD after NACT in Denmark between 1.1.2016-31.8.2021. We registered: age, breast biopsy date, type of surgery, type of axillary surgery, count of LNs, sentinel nodes, and marked lymph nodes with and without metastases, including metastasis size, breast tumor histology and receptor subtype, breast tumor size at diagnosis and in the surgical specimen, malignancy grade and type of neoadjuvant treatment. We excluded patients with inflammatory breast cancer, < 4/>8 cycles of NACT, or a non-standard NACT regimen. The primary outcome was risk factors for having high ( >3), low (1-3), or no residual metastatic burden in the axilla when the TAD LNs harbored metastases. We modeled risk factors for both high and low residual metastatic burden in the axilla using multivariable logistic regression and constructed risk models based on the regression coefficients. Results: We identified 1626 patients receiving NACT and TAD in the inclusion period. After excluding ineligible patients and patients who achieved ax-pCR with no subsequent ALND (46%), the study included 383 patients with positive LNs at TAD for further analysis: thereof 188, 127, and 68 with 0, 1-3 and >3 positive non-TAD LNs, respectively. In the adjusted logistic regression analysis, we found that breast pCR (OR= 0.06, 95% CI < .01-0.41, p < .001) and a low proportion of positive TAD LNs (0-66% vs >66%) (OR=0.32, 95% CI 0.17-0.58, p = < .001) were associated with low risk of high residual metastatic burden in the axilla. Patients with one or both low-risk factors present had an 8% (14 of 176 patients) risk of high residual metastatic burden in the axilla. The predictive value of the model for having < 3 non-TAD LN metastases was 92%. When analyzing the 315 patients with ≤3 positive non-TAD LNs, the adjusted logistic regression analysis of 1-3 vs 0 positive non-TAD LNs showed that ypN0(i) in the TAD LN (OR=0.14, 95% CI 0.04-0.53, p = 0.002), small tumor size at diagnosis (20-49 mm vs ≥ 50 mm) (OR = 0.29, 95% CI 0.14-0.60, p = 0.002), breast pCR (OR= 0.38, 95% CI 0.15-0.98, p = 0.04) and low proportion of positive TAD LNs (33-66% vs >66%) (OR= 0.46, 95% CI 0.27-0.77, p = 0.01) were associated with no residual metastases in the axilla. Using these risk factors, 19% (11/58) of the patients in the lowest risk quartile had further metastatic spread to the axilla. Conclusion: Based on an extensive breast cancer registry, we find that breast pCR, low proportion of positive TAD LNs, small metastases, and small tumor size are associated with low risk of residual metastatic LNs in the axilla when the TAD LNs are positive after NACT. With these risk factors, we propose two models to identify patients with low non-TAD residual metastatic burden and patients with a high likelihood of no further metastases. The models can guide breast surgeons in de-escalating axillary treatment in these groups. Citation Format: Frederikke Munck, Maj-Britt Jensen, Ilse Vejborg, Maria Gerlach, Maja Maraldo, Niels Kroman, Tove Tvedskov. Predicting Additional Axillary Metastases in Breast Cancer Patients with Positive Targeted Axillary Dissection Lymph Nodes after Neoadjuvant Treatment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-22-07.
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Rahman, Mohd Shafiq, and Norly Salleh. "Axillary Mass Turned Out to be A Phyllodes Tumour in An Ectopic Breast Tissue– A Rare Case Report." New Emirates Medical Journal 2, no. 2 (July 27, 2021): 181–84. http://dx.doi.org/10.2174/0250688202666210624165530.
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Background: Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast neoplasm. However, phyllodes tumours arising from ectopic breast tissue are even rarer, with less than 15 cases ever reported involving the axilla, vulva and groin. Case Presentation: A 27-year-old lady presented to the surgical clinic with left axillary swelling, measuring 5cm x 6cm. Ultrasound of the axilla revealed heterogenous mass displacing the left axillary artery and vein medially. Excision was performed, and histopathological examination confirmed the diagnosis of a benign phyllodes tumour. Conclusion: Phyllodes tumour in ectopic breast tissue over the axilla is a rare occurrence, and our case is the fourth case ever reported. Despite its rarity, diagnosis and treatment modalities are similar to phyllodes tumour of the breast. Regular follow-up is recommended owing to the risk of local recurrence.
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Mehta, Gyata, and Varsha Mokhasi. "Duplication in the formation of median nerve - a case report." National Journal of Clinical Anatomy 04, no. 01 (January 2015): 043–45. http://dx.doi.org/10.1055/s-0039-3401543.
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AbstractThe median nerve is formed in the axilla by fusion of the two roots from the lateral and medial cords. The present case report describes an anomalous presentation of double formation of median nerve and its relation with axillary and brachial arteries. The median nerve was formed in two stages at different levels, first in the axilla and then in the upper arm by receiving double contribution from the lateral root of the lateral cord, which fuse with the medial root of the medial cord to form the median nerve. The formation took place medial to the axillary artery in the axilla and antero-medial to the brachial artery in the arm. Such anatomical variations and their relation with the arteries are important for the surgeons and anesthesiologists and of great academic interest to the anatomists.
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Karanlik, Hasan, Neslihan Cabioglu, Adela Luciana Oprea, Ilker Ozgur, Naziye Ak, Adnan Aydiner, Semen Onder, Süleyman Bademler, and Bahadir M. Gulluoglu. "Sentinel Lymph Node Biopsy May Prevent Unnecessary Axillary Dissection in Patients with Inflammatory Breast Cancer Who Respond to Systemic Treatment." Breast Care 16, no. 5 (December 16, 2020): 468–74. http://dx.doi.org/10.1159/000512202.
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Background and Objectives: Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer treated up-front with systemic treatment. Both breast-conserving surgery and sentinel lymph node biopsy (SLNB) are controversial issues in the management of IBC. In this study, we aimed to assess the feasibility of SLNB in pathologically proven node-positive IBC patients. Methods: All patients with a histopathological diagnosis of IBC and biopsy-proven metastatic axillary lymph nodes underwent systemic treatment. Patients with a complete clinical response in the axilla who underwent SLNB followed by standard axillary dissection were analyzed. Results: The study consisted of 25 female patients. The identification rate (IR) and the false negativity rate (FNR) were 17/25 and 2/10, respectively. Overall, 9/25 and 7/25 of patients had a complete pathological response (pCR) in the breast and axilla after systemic treatment, respectively. Although the pCR in the axilla was 2/4 in nonluminal HER2-positive patients, the highest IR 4/4 and the lowest FNR 0/2 were determined in these patients. In triple-negative patients, however, the IR was 2/4 and the FNR was found to be 0/2. Conclusions: SLNB may be considered in selected axilla-downstaged IBC patients including patients with a pCR with HER2-positive and triple-negative tumors. Axillary dissection may be, therefore, omitted in those with negative SLNs.
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Farhan, Thaer M., and Mohammad O. Selman. "Anatomical Study of Axillary Artery Variation." Journal of the Faculty of Medicine Baghdad 52, no. 3 (October 3, 2010): 324–27. http://dx.doi.org/10.32007/jfacmedbagdad.523986.
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Background: The axillary artery is a direct continuation of the subclavian artery. The axillary artery is usually described as giving off six branches. The first part gives superior thoracic artery. The second part gives lateral thoracic (LT) and thoracoacromial(TAC) arteries. The third part gives three, subscapular(SS), anterior circumflex humeral(ACH)and posterior circumflex humeral(PCH) arteries. Anatomical variations in the branching pattern of axillary artery are quiet common and typically include the subscapular artery(SS), lateral thoracic artery(LT) and the posterior circumflex humeral artery(PCH). The variation of the axillary artery branching pattern has anatomical as well as clinical and surgical relevance given the proximity to the shoulder joint and humerus.Patients & Method: Bilateral axilla dissection was conducted on 26 embalmed axillae (13 cadavers) to allow examination of the axillary artery and its branches. The study was carried out in Department of Human Anatomy, College of Medicine.Results: The classical branching pattern of the LT originating from the axillary artery posterior to the pectoralis minor muscle and the SS producing the circumflex scapular (CS) artery and thoracodorsal(TD) occurred in 77%. The SS was observed originating from the LT 7% of the time. The LT was observed originating from the SS 5% of the time. The LT was observed producing the circumflex scapular artery and TD in the absence of SS 2.5% of the time. The PCH originated from four different sources, from the third part of axillary artery as is classically described in 77%. From the SS 11%. From deep brachial artery DB 9% and from LT 2%.Conclusion: Vascular variation in the axillary artery and its branches is quiet common , This variation should be considered seriously as will implicate risk of bleeding during surgery in the axilla and also the difficulty in interpretation of the angiography after axillary catheterization.
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Joshi, Mohini M., and Rajendra N. Wabale. "Axillary arch: a variation of latissimus dorsi muscle." National Journal of Clinical Anatomy 02, no. 03 (July 2013): 158–61. http://dx.doi.org/10.1055/s-0039-3401714.
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AbstractThe axillary arch of Langer (Axillopectoral muscle) is the most common anatomical variant of the axillary musculature. During the dissection of a 63 year old male cadaver, an unusual muscle band was encountered bilaterally and identified as an axillary arch. We here describe the morphology and relationships of the axillary arch in the light of previous such reports. The knowledge of this muscle variation is important for the clinicians, with regards to its potential to cause significant iatrogenic functional defects. Anatomical variations of the axilla are of relevance to surgeons, neurologist, radiologists and cosmetic surgeons due to the increasing surgical importance of this region during axillary surgery for breast cancer, reconstruction procedures, and axillary bypass operations. It is important that surgeons operating in the axilla be aware of this common anatomic variant.
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Reddy, Gopidi Sai Nidhi, Suresh Vasant Phatak, Prashanthi Ganta, and Nagendra Vadlamudi. "Benign Phyllodes Tumor of Axillary Tail USG and Elastography Evaluation with Histopathological Correlation." Journal of Medical Ultrasound 32, no. 1 (January 17, 2023): 86–88. http://dx.doi.org/10.4103/jmu.jmu_58_22.
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Abstract The axillary tail, also known as spencer’s tail or axillary process, is a continuation of tissue from the upper lateral quadrant of the breast that travels into the axilla through a foramen of Langer in the deep fascia. Axillary inflammation or lump is a typical clinical symptom that necessitates imaging evaluation. Since the axilla consists of lymph nodes as well as nonlymphatic tissue such as accessory breast tissue, skin, fat, muscles, nerves, and blood vessels, it has a wide variety of differential diagnoses. The radiologists should be well acquainted with axillary anatomy and imaging aspects of various axillary lesions. Here, we present a 35-year-old female with a right axillary lump which was suggestive of benign tumor on ultrasonography and was proven to be benign phyllodes tumor on histopathology.
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Ramirez, Sarah Ines, Max Scholle, Jennifer Buckmaster, and Gopal Chandru Kowdley. "Assessment of the accuracy of ultrasound compared to magnetic resonance imaging in the ability to detect metastatic breast cancer to the axilla." Surgical Techniques Development 2, no. 1 (January 31, 2012): 4. http://dx.doi.org/10.4081/std.2012.e4.
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Sentinel lymph node biopsy (SLNB) is routinely used in the staging of invasive breast cancer. The aim of this study was to investigate the diagnostic accuracy of ultrasonography (US) compared to magnetic resonance imaging (MRI) in the pre-operative assessment of metastatic disease to the axilla in breast cancer patients at our community hospital. We retrospectively reviewed a prospectively collected database of 277 patients seen at our breast center from 2009 to 2010. Patients with invasive breast cancer were then evaluated for axillary metastasis. Lymph nodes were sampled using fine needle aspiration (FNAB) or core biopsy. Histopathology of the sentinel lymph nodes (SLN) or results of the axillary dissection were compared to US or MRI results. A total of 228 patients had invasive breast cancer. In these patients, 122 lymph nodes were sampled. Pathology proven metastases to axillary lymph nodes were found in 76 cases. Accuracy and sensitivity were higher in US than MRI in detecting metastatic disease to the axilla (70.2%, 84.6%, P<0.001 and 60.0%, 52.6%, P <0.1, respectively). US was more accurate than MRI at detecting metastatic breast cancer in the axilla in our community hospital. Axillary US should be a routine part of assessment of breast cancer patients.
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Hatada, Takuya, Hiromitsu Ishii, Katsunari Sai, Shigetoshi Ichii, Kaoru Okada, and Joji Utsunomiya. "Accessory Breast Cancer: A Case Report and Review of the Japanese Literature." Tumori Journal 84, no. 5 (September 1998): 603–5. http://dx.doi.org/10.1177/030089169808400518.
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The case of a 31-year-old woman with accessory breast cancer in the left axilla is described. She had noticed a swelling in the left axilla during her three pregnancies. The preoperative diagnosis of accessory breast cancer was made on the basis of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) and clinical history. She was treated by wide local resection and regional lymph node dissection. Although cancer originating from accessory breast tissue has been reported very rarely, knowledge of this disorder may facilitate the correct diagnosis of axillary tumors. US-FNAB is a useful and simple technique for the tissue diagnosis of axillary tumors.
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Nikam, Vasudha, Priya Patil, Ashalata Patil, Aanand Pote, and Anita Gune. "Axilla; a rare variation: axillary arch muscle." International Journal of Research in Medical Sciences 2, no. 1 (2014): 330. http://dx.doi.org/10.5455/2320-6012.ijrms20140263.
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ChettyCh.B., Udi. "Axillary Node Sample to Evaluate the Axilla." World Journal of Surgery 25, no. 6 (June 2001): 773–79. http://dx.doi.org/10.1007/s00268-001-0004-9.
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Morrow, Monica, Reshma Jagsi, and Steven J. Katz. "Undissected Axilla and Axillary Radiotherapy—In Reply." JAMA Oncology 5, no. 5 (May 1, 2019): 742. http://dx.doi.org/10.1001/jamaoncol.2019.0050.
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Chaudhary, Nitinkumar D., and Dhaval Chaudhari. "Evaluation of the combined role of axillary ultrasound with fine-needle aspiration cytology and sentinel lymph node biopsy in detecting axillary metastasis in clinically N0 axilla at tertiary care center Kerala." International Surgery Journal 8, no. 10 (September 28, 2021): 3041. http://dx.doi.org/10.18203/2349-2902.isj20213991.
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Background: Sentinel lymph node biopsy (SLNB) is the gold standard for histopathological staging of early breast cancer. Combination of axillary ultrasound with fine-needle aspiration cytology (Ax US with FNAC) of suspicious lymph nodes, specificity for diagnosis of metastatic lymph nodes can be increased.Methods: This prospective study was done among 205 cases with clinically N0 axilla visited at surgical oncology department at Amrita institute of medical sciences from January 2014 to February 2017. Exclusion criteria was patients with locally advanced breast cancer, previous axillary surgery, prior breast irradiation, proven distant metastasis, inflammatory breast cancer and neo-adjuvant chemotherapy. All patients were subjected to ultrasound of breast and axilla during preoperative evaluation. Suspicious looking nodes were subjected to image guided FNAC. Benign appearing nodes or a negative FNAC, a SLNB procedure with intra-operative frozen section sentinel node (FS SN) was performed at the time of surgery.Results: Present study found sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ax US was 62.9%, 84.4%, 67.7%, 81.4% and 77.1% respectively. Sensitivity, specificity, PPV, NPV and accuracy of Ax US with FNAC was 90.0%, 100.0%, 100.0%, 83.3% and 93.3% respectively. Sensitivity, specificity, PPV, NPV and accuracy of SLNB with FS SN was 64.5%, 97.5%, 87.0%, 91.5% and 90.8% respectively.Conclusions: US guided fine-needle aspiration biopsy (FNAB) has highest specificity and sensitivity. Combining Ax US±FNAC and intra-operative FS SN in the detecting axillary metastasis very much decrease the chance of false results. The results of sonography would allow patients with sonographically positive axillae to be directed to axillary lymph node dissection (ALND). The remaining patients would be candidates for SN biopsy.
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Tsuji, Wakako. "Metachronous bilateral ectopic breast carcinoma in the axilla: A case report and literature review." Breast Disease 39, no. 3-4 (January 6, 2021): 149–53. http://dx.doi.org/10.3233/bd-200452.
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Bilateral ectopic axillary breast carcinoma is extremely rare. Here, we report the case of a 68-year-old woman who presented with a palpable mass in the right axilla. After ectopic breast carcinoma diagnosis, the patient underwent partial mastectomy and sentinel lymph node biopsy, followed by radiotherapy of the whole breast. Adjuvant endocrine therapy was administered for 5 years. Seven years after the first carcinoma diagnosis, the patient noticed a second tumor in the left axilla by herself at the age of 75 years. Core needle biopsy revealed second primary breast carcinoma of the axilla. She underwent partial mastectomy and sentinel lymph node biopsy followed by chemotherapy, radiotherapy, and endocrine therapy. No recurrence has been observed so far. Therefore, ectopic breast carcinoma should be treated as typical breast carcinoma.
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Sachdeva, Kanika, Monika Lalit, Anupama Mahajan, and Poonam Delmotra. "Axillary arch muscle- a case report." National Journal of Clinical Anatomy 04, no. 01 (January 2015): 046–49. http://dx.doi.org/10.1055/s-0039-3401545.
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AbstractAnomalous muscles donot usually cause symptoms but are of academic interest. Axillary arch is a variable muscular slip encountered in axilla. Purpose of the present study was to report a rare case of axillary arch muscle. Knowledge of this muscle variation and the possibility of finding it during axillary procedures are crucial for lymph node staging, lymphaedenectomy and for differential diagnosis in compressive pathologies of axillary vessels and brachial plexus. During routine dissection of left axilla in a 60-year old male cadaver, an anomalous muscular slip was encountered. The slip was extending between latissimus dorsi muscle to coracoid process, deltoid muscle, fascia covering biceps and coracobrachialis and was confirmed as axillary arch muscle. The embryological basis, genetics and clinical implications have been discussed. This rare variation will be of interest not only to anatomists but also for clinicians and surgeons dealing with this area.
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Wahl, Richard L., Barry A. Siegel, R. Edward Coleman, and Constantine G. Gatsonis. "Prospective Multicenter Study of Axillary Nodal Staging by Positron Emission Tomography in Breast Cancer: A Report of the Staging Breast Cancer With PET Study Group." Journal of Clinical Oncology 22, no. 2 (January 15, 2004): 277–85. http://dx.doi.org/10.1200/jco.2004.04.148.
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PurposeTo determine the accuracy of positron emission tomography with fluorine-18–labeled 2-fluoro-2-deoxy-d-glucose (FDG-PET) in detecting axillary nodal metastases in women with primary breast cancer.Patients and MethodsIn this prospective multicenter study, 360 women with newly diagnosed invasive breast cancer underwent FDG-PET. Images were blindly interpreted by three experienced readers for abnormally increased axillary FDG uptake. Imaging results from 308 assessable axillae were compared with axillary node pathology.ResultsFor detecting axillary nodal metastasis, the mean estimated area under the receiver operator curve for the three readers was 0.74 (range, 0.70 to 0.76). If at least one probably or definitely abnormal axillary focus was considered positive, the mean (and range) sensitivity, specificity, and positive and negative predictive values for PET were 61% (54% to 67%), 80% (79% to 81%), 62% (60% to 64%), and 79% (76% to 81%), respectively. False-negative axillae on PET had significantly smaller and fewer tumor-positive lymph nodes (2.7) than true-positive axillae (5.1; P < .005). Semiquantitative analysis of axillary FDG uptake showed that a nodal standardized uptake value (lean body mass) more than 1.8 had a positive predictive value of 90%, but a sensitivity of only 32%. Finding two or more intense foci of tracer uptake in the axilla was highly predictive of axillary metastasis (78% to 83% positive predictive value), albeit insensitive (27%).ConclusionFDG-PET has moderate accuracy for detecting axillary metastasis but often fails to detect axillae with small and few nodal metastases. Although highly predictive for nodal tumor involvement when multiple intense foci of tracer uptake are identified, FDG-PET is not routinely recommended for axillary staging of patients with newly diagnosed breast cancer.
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Saood, Mahmood J., Mohanad Hamed Abdulla, and Naser R. Tawfiq. "Lymphedema following axillary lymphnode sampling versus axillary lymphnode dissection for patients with breast carcinoma in Al-Karama Teaching Hospital, Iraq." International Surgery Journal 4, no. 8 (July 24, 2017): 2409. http://dx.doi.org/10.18203/2349-2902.isj20173161.
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Background: Lymphedema is a collection of fluid in some parts of the body. It is common after surgical intervention. Different approaches of dealing with lymphnode involvement in axilla have been describe. The main objective of present study is to determine the prevalence of lymphedema after different methods of axillary lymphadenectomy and axillary sampling techniques in Iraq.Methods: This was a cross-sectional study in which post-operative lymphedema of the operated arm was compared in 25 patients with breast cancer after axillary ALND (the excised node more than 4 lymph node up to 18 node) and 25 patients following axillary ALNS of only enlarged hard lymphnode.Results: The results of post-operative follow up from three months to three years following ALND patients showed significant increase in the arm circumference over those exposed to ALNS of the axilla.Conclusions: It can be concluded that axillary lymphnode sampling of axilla associated with negligible lymphedema compared with ALND the routine performance of axillary dissection should be considered with caution.
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Kitajima, Hironori, Toru Ichiseki, Ayumi Kaneuji, and Norio Kawahara. "A Case of Axillary Web Syndrome Caused by Venous Blood Sampling." Healthcare 11, no. 17 (August 25, 2023): 2390. http://dx.doi.org/10.3390/healthcare11172390.
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Axillary web syndrome (AWS) occurs after breast cancer surgery, sentinel lymph node dissection, or sentinel lymph node biopsy. Here, cord-like structures from the axilla to the forearm limit the range of motion of the shoulder joint and cause pain. Although the etiology is unknown, AWS has been attributed to the blockage of normal lymphatic flow. Here, we report a novel case of AWS after venous blood sampling in a patient. A healthy, 31-year-old male patient experienced pain with a limited range of motion of the shoulder joint the day after venous blood was collected from the left upper extremity for a medical checkup, and he presented to an orthopedic outpatient clinic on the day. Palpation of the axillary region disclosed a cord-like structure in the axillary region of the shoulder joint during abduction, and the patient was diagnosed with AWS. The cord-like structure was noted to be a hypoechogenic luminal structure on ultrasound (US) examination of the axilla, extending from the axilla to below the ulnar cutaneous vein from which the blood was drawn. In patients with pain and a limited range of motion of the shoulder joint, only the shoulder joint is examined during an orthopedic examination. It is important to obtain appropriate physical findings for possible AWS.
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Baka, Margarita, Dimitrios Doganis, Apostolos Pourtsidis, Maria Tsolia, Despina Bouhoutsou, Maria Varvoutsi, Katerina Strantzia, and Helen Kosmidis. "Successful Treatment in a Child with Anaplastic Large Cell Lymphoma and Coexistence of Pulmonary Tuberculosis." Case Reports in Pediatrics 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/928701.
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A 13-year-old girl was admitted to our department with a history of severe pain of her left axilla and fever. On physical examination, a block of lymph nodes in her left axilla, diffuse papular rash, and red-violet swelling of her supraclavicular and subclavian region were noted. Imaging investigations revealed left axillar and supraclavicular lymphadenopathy and a small nodular shade in the upper lobe of her left lung. A biopsy from an axillary lymph node established the diagnosis of anaplastic large cell lymphoma (ALCL), whereas DNA ofMycobacterium tuberculosiswas detected by polymerase chain reaction (PCR) in the same tissue biopsy. Patient was started on chemotherapy for ALCL and achieved remission of all initially involved fields. Nevertheless, two new nodular lesions were detected in the left lower lobe. Biopsy revealed granulomas, and PCR was positive forM. tuberculosis. Our patient received treatment with the combination of isoniazid and rifampin (12 months), pyrazinamide (the first 2 months), and maintenance chemotherapy for her ALCL for one year simultaneously. Four years later, she is disease free for both mycobacterial infection and lymphoma. We are reporting this successful management of mycobacterial infection in a patient with ALCL despite intensive chemotherapy that the patient received at the same time.
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Gumber, Ashutosh, and Manish Mudgal. "Role of sentinel lymph node biopsy in assessing the cancer spread to axilla in early breast cancer." International Surgery Journal 4, no. 1 (December 13, 2016): 53. http://dx.doi.org/10.18203/2349-2902.isj20164445.
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Background:Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to axillary lymph node dissection as a way to stage breast cancer in clinically node-negative patients. Objective of the study was to determine the safety and reliability of sentinel lymph node biopsy without axillary lymph node dissection (ALND) in early breast cancer patients.Methods: This prospective study was conducted in patients with operable breast cancer in a single surgical unit of our hospital. Patients with T1-T3 breast cancer with clinically negative axilla and patients with previous lumpectomy were included. All the patients had undergone complete axillary lymph node dissection after sentinel lymph node biopsy. All the specimens were sent separately for paraffin section histopathology.Results:Mean age of 35 female patients included was 54 years. SLN was identified in 94.29% cases and it could not be identified in 2 cases. SLN (96.97%) was most commonly identified at level I. Mean numbers of sentinel node and axillary node were 1.52 and 16.11 respectively. Study of SLN biopsy with methylene blue dye for staging the axilla was done with 81.25% sensitivity and 100% specificity. Positive predictive value was 100% and was able to negatively predict the axilla in 86.36% with an overall accuracy of staging of 96.97% and false negative rate of 18.75%.Conclusions:Sentinel lymph node biopsy without axillary lymph node dissection in sentinel lymph node negative breast cancers appears to be a safe and reliable procedure for determining the nodal status and ensuring the loco-regional control.
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Hassan, Mohammad Jaseem, Saqib Ahmed, Bushra Siddiqui, Kafil Akhtar, Afzal Anees, Sayeedul Hasan Arif, and Mahboob Hasan. "Borderline phyllodes tumor arising in ectopic breast tissue in the axilla: Report of a rare case with brief review of literature." Breast Disease 42, no. 1 (July 28, 2023): 245–49. http://dx.doi.org/10.3233/bd-230007.
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Development of a neoplasm in an ectopic breast is uncommon, while the development of phyllodes tumor in an ectopic breast in the axilla is even rarer. We report a rare case of a 51-year-old female who presented with a complain of swelling and pain in the right axilla with no associated complaints in other organs. Magnetic resonance imaging suggested a possibility of metastatic lymphadenopathy. Complete excision of the right axillary mass was performed and sent for histopathological examination which was examined thoroughly and sections were given. On microscopic examination, stromal proliferation in a leaf-like pattern with mild stromal atypia and focal permeation of borders were seen, and a diagnosis of Ectopic borderline phyllodes tumor in axilla was made, which is extremely rare and needs to be differentiated from its close differentials like fibroadenoma and periductal stromal sarcoma.
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Raymond, Wendy A., and Pakan Kleinig. "The Value of Fine Needle Aspiration Biopsy in the Pre-Operative Assessment of the Axilla in Breast Cancer Patients." Journal of Molecular Pathology 3, no. 4 (October 18, 2022): 228–42. http://dx.doi.org/10.3390/jmp3040020.
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This paper reviews the role of fine needle aspiration biopsy (FNAB) in assessing the axilla prior to definitive surgery or neoadjuvant therapy in breast cancer patients. The radiological criteria for biopsy are discussed and pathological techniques and pitfalls illustrated. The sensitivity and specificity of the technique and the clinical utility are addressed, with particular reference to the current controversies in the management of the axilla in the light of the American College of Surgeons Oncology Group Z0011 trial results. The low morbidity procedure of FNAB is recommended when the radiological and clinical features suggest a high yield from the abnormal axillary nodes, with consideration of core biopsy if an expected positive result is not obtained or the circumstances require tissue for ancillary studies. In conclusion, FNAB of the axilla is a highly sensitive procedure which can offer further valuable information to assist in clinical decision making. The technique is of particular value in the setting of a large primary tumour size and multiple enlarged nodes. A summary flow chart is provided to facilitate pre-operative management of the axilla and to encourage a universal approach.
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Cserni, Gábor. "Sentinel lymph node status and axillary lymph node dissection in the surgical treatment of breast cancer." Orvosi Hetilap 155, no. 6 (February 2014): 203–15. http://dx.doi.org/10.1556/oh.2014.29816.
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Axillary lymph node dissection has been traditionally perceived as a therapeutic and a staging procedure and unselectively removes all axillary lymph nodes. There still remains some controversy as concerns the survival benefit associated with axillary clearance. Sentinel lymph node biopsy removes the most likely sites of regional metastases, the lymph nodes directly connected with the primary tumour. It allows a more accurate staging and a selective indication for clearing the axilla, restricting this to patients who may benefit of it. Axillary dissection was performed in all patients during the learning phase of sentinel lymphadenectomy, but later only patients with metastasis to a sentinel node underwent this operation. Currently, even some patients with minimal sentinel node involvement, including some with macrometastasis may skip axillary clearance. This review summarizes the changes that have occurred in the surgical management of the axilla, the evidences and controversies behind these changes, along with current recommendations. Orv. Hetil., 2014, 155(6), 203–215.
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Azar, M. Eugenia, M. Dolores Mansilla F., Jorgelina Cavallero, Ornella Sturla, Hernan Ursino, Gaston Berman, Martin Ipiña, Andrea Aguilar, Valeria Caceres, and Eduardo Gonzalez. "Abstract P1-01-08: Axillary surgery after neoadjuvant chemotherapy in breast cancer - Survey among Argentinian breast surgeons." Cancer Research 82, no. 4_Supplement (February 15, 2022): P1–01–08—P1–01–08. http://dx.doi.org/10.1158/1538-7445.sabcs21-p1-01-08.
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Abstract Background: Over the last years, decreasing invasiveness to achieve less morbidity has been the trend for surgical procedure but axillary management after neoadjuvant chemotherapy (NAC) remains controversial. Different authors have shown the efficacy of sentinel lymph node biopsy (SLNB) to assess axillary response in patients who underwent NAC encouraging the use of these techniques instead of axillary lymph node dissection (ALND) in breast cancer patients. Argentinian surgeons don’t have a consensus guideline on the management of the axilla in patients after NAC, therefore the treatment of the axilla widely varies. This survey has been developed to assess the management of the axilla after NAC among argentinian breast surgeons. Methods: Members of the Argentinian Society of Breast Surgeons were invited by e-mail to complete an anonymous online survey between April 1st and May 31th of 2021. The survey consisted in 17 single-answer multiple choice questions (each question having 4 options). The surgeons had the option to write their own custom response on a comment field. Results: Of the 731 members, 263 answered the survey. 71% treated less than 50 neoadjuvant breast cancer patients last year. Axillary ultrasound is considered a standard tool in the initial evaluation of the axilla by 81% of participants and 73% performed core needle biopsy in case of suspicious node before NAC. 78% marked suspicious nodes before NAC (the majority with charcoal). 24% supported that ALND could be omitted only in cN0 patients, 55% in cN0- cN1, 9% in cN0-cN1-cN2 and 15% in any initial stage with a favorable response to NAC. 75% of the respondents evaluated axillary response after NAC using axillary ultrasound prior surgery. 15% performed ALND when there were any suspicious node by ultrasound. Most of the surgeons (76%) considered that double method (blue dye and radioisotope) allows better identification rate. 77% considered that at least three nodes and resection of the marked node is mandatory to reduce the false negative rate of the sentinel lymph node biopsy (SLNB) after NAC. 63% considered that pathologic complete response in the axilla is necessary to omit ALND and 37% omitted the ALND in the presence of positive sentinel node after NAC. 131 of the interviewed work in a public hospital and private practice, 27 of them (20%) can’t manage the axilla in the same way in both places because the lack of technology (gamma detection probe technology for example) at public hospitals. Discussion: The management of the axilla after NAC is a challenge for breast surgeons and forces them to personalize treatments and stay informed regarding changes in the scientific evidence. Axillary ultrasound is a widely-used method by argentine surgeons, it allows them to identify suspicious lymph nodes, perform core needle biopsies, and mark them, but an excessive use can also lead to unnecessary ALND. There is not consensus about the importance of pre- and post-NAC stage in deciding to perform only SLNB or ALND. Twenty percent of the surgeons perform SNLB only in cN0 patients, and on the other hand, 37% will omit the ALND even in the presence of positive sentinel node after NAC, extrapolating results from trials that may not fit in these patients. The high fragmentation and decentralization in the provision of health care services that characterizes Argentina’s health system is an obstacle to manage the complexity of neoadjuvant breast cancer patients. Conclusions: There is no standard management of the axilla in patients that undergo NAC in Argentina. Breast surgeons should gathered together to develop clinical practice guidelines in this matter and design strategies to improve the management of the neoadjuvant breast cancer patients in Argentina. Citation Format: M. Eugenia Azar, M. Dolores Mansilla F., Jorgelina Cavallero, Ornella Sturla, Hernan Ursino, Gaston Berman, Martin Ipiña, Andrea Aguilar, Valeria Caceres, Eduardo Gonzalez. Axillary surgery after neoadjuvant chemotherapy in breast cancer - Survey among Argentinian breast surgeons [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-08.
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Hergan, K., B. Morrigl, A. Katherein, W. Buchberger, W. Judmaier, S. Peer, and W. Oser. "MR and CT anatomy of the axilla." Acta Radiologica 38, no. 2 (March 1997): 198–205. http://dx.doi.org/10.1080/02841859709172049.
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Purpose: to depict the complex anatomy of the axilla with CT and MR imaging. Material and Methods: the axillary regions of 2 cadavers (with arms hyperabduct-ed) were examined by means of CT and MR. in this position the cadavers were frozen and cryosectioned. the anatomical sections documented by the MR and CT images were compared and anatomical structures were designated. to show the reproducibility of the anatomical structures and to find variations, 20 volunteers were also examined by MR, and 20 consecutive patients without axillary symptoms were examined by CT. Results: the complexity of the axilla was excellently shown by both CT and MR, but MR was able to demonstrate more detail in the small vessels and in the brachial plexus. the comparability of the examinations of the different individuals was best in the axial plane. Some differences appeared in the coronal and sagittal planes caused by different positions of the arm. Conclusion: Axillary anatomy was demonstrated in detail and was reproducible with CT and MR imaging.
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Pazaiti, Anastasia, and Ian S. Fentiman. "Which Patients Need an Axillary Clearance after Sentinel Node Biopsy?" International Journal of Breast Cancer 2011 (2011): 1–9. http://dx.doi.org/10.4061/2011/195892.
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Sentinel lymph node biopsy (SLNB) is a safe and accurate minimally invasive method for detecting axillary lymph node (ALN) involvement in the clinically negative axilla thereby reducing morbidity in patients who avoid unnecessary axillary lymph node dissection (ALND). Although current guidelines recommend completion ALND when macro- and micrometastatic diseases are identified by SLNB, the benefit of this surgical intervention is under debate. Additionally, the management of the axilla in the presence of isolated tumour cells (ITCs) in SLNB is questioned. Particularly controversial is the prognostic significance of minimal SLNB metastasis in relation to local recurrence and overall survival. Preliminary results of the recently published Z0011 trial suggest similar outcomes after SNB or ALND when the SN is positive, but this finding has to be interpreted with caution.
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Papazafiropoulou, Athanasia K., Angeliki M. Angelidi, Antonis A. Kousoulis, Georgios Christofilidis, Chariklia Sagia, Liountmila Kaftanidou, Kassiani Manoloudaki, et al. "A Palpable Painless Axillary Mass as the Clinical Manifestation of Castleman’s Disease in a Patient with Hepatitis C Disease." Case Reports in Medicine 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/1970276.
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Introduction. Castleman’s disease (CD) is a rare lymphoproliferative disorder. CD is divided into two clinical subtypes: the most common unicentric and the less usual multicentric subtype. The majority of unicentric CD affects the mediastinum, while neck, abdomen, and axilla are less common locations.Case Presentation. Herein, we describe a rare case of unicentric CD in the right axilla in a 36-year-old white male with a medical history of hepatitis C virus infection admitted to our hospital due to palpation of a painless mass in the right axilla. Complete excision of the lesion was performed and, one year after the diagnosis, patient was free of the disease.Conclusions. Although infrequent, it is important to include CD in the differential diagnosis when evaluating axillary lymphadenopathy particularly in young patients with a low-grade inflammation process and chronic disease even in the absence of an abnormal blood picture or organomegaly.
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Di Micco, Rosa, Letizia Santurro, Maria Luisa Gasparri, Veronica Zuber, Giovanni Cisternino, Sara Baleri, Manuela Morgante, et al. "PET/MRI for Staging the Axilla in Breast Cancer: Current Evidence and the Rationale for SNB vs. PET/MRI Trials." Cancers 13, no. 14 (July 16, 2021): 3571. http://dx.doi.org/10.3390/cancers13143571.
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Axillary surgery in breast cancer (BC) is no longer a therapeutic procedure but has become a purely staging procedure. The progressive improvement in imaging techniques has paved the way to the hypothesis that prognostic information on nodal status deriving from surgery could be obtained with an accurate diagnostic exam. Positron emission tomography/magnetic resonance imaging (PET/MRI) is a relatively new imaging tool and its role in breast cancer patients is still under investigation. We reviewed the available literature on PET/MRI in BC patients. This overview showed that PET/MRI yields a high diagnostic performance for the primary tumor and distant lesions of liver, brain and bone. In particular, the results of PET/MRI in staging the axilla are promising. This provided the rationale for two prospective comparative trials between axillary surgery and PET/MRI that could lead to a further de-escalation of surgical treatment of BC. • SNB vs. PET/MRI 1 trial compares PET/MRI and axillary surgery in staging the axilla of BC patients undergoing primary systemic therapy (PST). • SNB vs. PET/MRI 2 trial compares PET/MRI and sentinel node biopsy (SNB) in staging the axilla of early BC patients who are candidates for upfront surgery. Finally, these ongoing studies will help clarify the role of PET/MRI in BC and establish whether it represents a useful diagnostic tool that could guide, or ideally replace, axillary surgery in the future.
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Rastogi, Rakhi, Virendra Budhiraja, and Kshitij Bansal. "Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication." ISRN Anatomy 2013 (September 26, 2013): 1–3. http://dx.doi.org/10.5402/2013/501813.
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Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures.
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Shweta Mandavkar, Suhas Tivaskar, Juhi Barai, and Anurag Luharia. "The Role of Computed Tomography in carcinoma of the breast: Review Article." Journal of Pharmaceutical Negative Results 13, no. 3 (October 7, 2022): 1095–100. http://dx.doi.org/10.47750/pnr.2022.13.03.178.
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Breast malignancy is the most prevalent condition which occurs in young females. Breast malignancy frequently recurs in the axilla. The axilla is a common site for breast cancer recurrence. A nodal tumor can be felt, and computed tomography (C.T.) is usually used to differentiate reoccurring malignancy from the long-term surgery's consequences and radiation. The patient had a bulge that couldn't be felt, and C.T. was utilized to determine if a recurrent tumor was present. Because this patient's axilla had previously been irradiated, clinical examination was challenging. Only one patient had a lump that could not be palpated; thus, C.T. was utilized to rule out the possibility of a recurrent tumor. Clinical examination was impossible due to a previously irradiated 'wooden' axilla. C.T. scans failed to reveal the recurrence of cancer in the axilla. We conclude it is only beneficial when palpation of the axilla is difficult due to previous treatment. Careful palpation and aspiration cytology of any lump is key to diagnosing axillary tumor recurrence. A CT scan is unlikely to detect illness when there is no bulk on clinical examination. For decades, the chance of a breast cancer recurrence in the local-regional area following mastectomy has remained around the lo-30% range. External beam radiation therapy, the standard treatment, is effective in most cases in eradicating local illness, although recurrences occur in around half of the patients. Since 1982, 33 persons who have had such recurrences have obtained a computed tomography (C.T.) scan at our facility as it's all part of their diagnostic process. Accurate characterization and categorization of breast lump detected with C.T. enhance the value of the radiologist's report and contribute to relevant case management.
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Farrugia, Mark K., Carl Morrison, Francisco Hernandez-Ilizaliturri, and Saif Aljabab. "A Dose-Response Relationship to Radiotherapy for Cutaneous Lesions of Langerhans Cell Histiocytosis." Case Reports in Oncological Medicine 2021 (March 24, 2021): 1–6. http://dx.doi.org/10.1155/2021/6680635.
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Langerhans cell histiocytosis (LCH) is a rare disease, afflicting approximately 4.6 and 1-2 per 1 million children and adults, respectively. While LCH can involve numerous organ systems such as the lung or bone, it is uncommon for the disease to be limited to the skin. Radiotherapy has an established role for osseous lesions. However, the efficacy and dose for nonosseous manifestations of the disease are not well described. In the current case report, we detail a 49-year-old adult male with skin-limited LCH requiring palliative radiotherapy (RT) to numerous sites for pain control. The patient was initially diagnosed and treated with single agent cytarabine for approximately 6 months. Despite treatment, he had little symptomatic response of his cutaneous lesions. We delivered a single dose of 8 Gray (Gy) to 3 separate skin lesions, including the bilateral groin, right popliteal region, and right axillary lesion, which resulted in pain reduction and partial response at four-month follow-up. Subsequently, we decided to treat the left axillary untreated lesion to a higher dose of 24 Gy in 12 fractions. At four-month follow-up, the left axilla RT resulted in complete clinical response and improved pain control compared to the right axilla. Following RT treatments, the patient was found to have a BRAF mutation, and vemurafenib was initiated. Further follow-up with positron emissions tomography demonstrated complete metabolic response in numerous disease areas, including both axillae. Based on this case report’s findings, a higher radiotherapy dose may be more effective for treating cutaneous LCH.
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Gune, Anita Rahul, Vasudha R. Nikam, and Dhanaji T. Wagh. "Axillary Arch Muscle and Its Effect on Various Structures in Axilla." Indian Journal of Anatomy 6, no. 4 (2017): 447–51. http://dx.doi.org/10.21088/ija.2320.0022.6417.6.
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Cho, Hee Kyung, Woo Jung Sung, Youn Ju Lee, Sang Gyu Kwak, and Kang Lip Kim. "Two methods of extracorporeal shock-wave therapy in a rat model of secondary lymphedema: a pilot study." Journal of International Medical Research 49, no. 6 (June 2021): 030006052110244. http://dx.doi.org/10.1177/03000605211024473.
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Objectives To compare the effectiveness of two methods of extracorporeal shock-wave therapy (ESWT) in a rat model of forelimb lymphedema, induced by axillary lymph node dissection. Methods Sprague–Dawley rats were randomly allocated to a group that received 500 ESWT shocks only in the lymphedematous forelimb (Forelimb/ESWT) and a group that received 300 ESWT shocks in the axilla and 200 shocks in the lymphedematous forelimb (Axilla+Forelimb/ESWT). The circumferences of each limb were then measured. Immunohistochemistry for a pan-endothelial marker (cluster of differentiation [CD]31) and lymphatic vessel endothelial hyaluronan receptor-1, and western blot analysis for vascular endothelial growth factor receptor-3 (VEGFR3) and VEGF-C were performed. Results The circumferences of the limbs showed significant effects of group and time following surgery. The circumferences at the carpal joint and 2.5 cm above were smallest in the naïve limbs, larger in the Axilla+Forelimb/ESWT group, and the largest in the control group. VEGFR3 tended to be expressed at a higher level in the Axilla+Forelimb/ESWT group (1.96-fold) than in the Forelimb/ESWT group (1.20-fold) versus the opposite non-edematous forelimbs, although this difference was not statistically significant. Conclusions These data suggest that ESWT protocols have differential effects on angiogenesis and lymphangiogenesis in lymphedematous limbs.
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Kruijff, Schelto, Robert Vink, and Joost Klaase. "Salvage surgery for a giant melanoma on the back." Rare Tumors 3, no. 3 (October 1, 2011): 90–91. http://dx.doi.org/10.4081/rt.2011.e28.
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We report a case of a giant melanoma on the back with a very extreme Breslow thickness. On physical examination a large odorous and ulcerating tumour was seen adjacent to two large crusted lesions, probably in transit metastases. In the right and left axilla enlarged lymph nodes were palpated. The patient underwent salvage surgery consisting of a complete wide excision of the tumors on the back as well as axillary lymph node dissection on both sides. Histopathology showed a malignant melanoma with a Breslow thickness of 48 mm. Four of fifteen nodes in the right axilla and one of nine nodes in the left axilla, were positive for metastatic disease. Also various in transit and subcutaneous metastases were found in the wide excision specimen. The interest of our observation relies in the rarity of a melanoma with such an extreme Breslow thickness and the difficulty in performing adequate palliative therapy that offers quality of life by means of tumor control.
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Deodhar, Avinash. "An uncommon case of upper limb pterygia." Indian Journal of Plastic Surgery 45, no. 01 (January 2012): 128–29. http://dx.doi.org/10.4103/0970-0358.96610.
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ABSTRACTReporting images in a case of a 9-year-old boy who presented with bilateral congenital webbing (pterygium) of axillae and elbows. This deformity was restricting his axilla and elbow movements. This was successfully treated on one side with multiple Z-plasty. An outline of multiple pterygium syndrome is given herewith.
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M., Kingsly Paul, Geley Ete, Felix Cordelia M. J., Anirudha K. Akamanchi, and Shwetha Agarwal. "Simultaneous Bilateral Reconstruction of the Axilla with Posterior Arm Flap in Recurrent Hidradenitis Suppurativa." Indian Journal of Plastic Surgery 55, no. 01 (February 2022): 066–69. http://dx.doi.org/10.1055/s-0041-1740087.
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Abstract Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla being the most commonly affected site. Radical excision of the involved tissue is a definitive treatment. There are numerous techniques described for the reconstruction of the axilla. Patients and methods Patients with axillary HS who underwent wide excision and posterior arm flap cover between August 2017 and December 2020 were reviewed. Results A total of 15 flaps were done in eight patients in the study period. Bilateral radical excision of the disease was done simultaneously in all eight patients with the help of a two-team approach. Reconstruction of the axilla was done with a posterior arm flap bilaterally, except one side in a single patient, wherein the split-thickness skin graft was performed. All flaps settled well without significant complications. On follow-up ranging from 12 to 42 months, one patient complained of disease recurrence on one side. The flap and the donor site had settled well in all patients, causing no significant morbidity. Conclusion Radical excision of axillary hidradenitis must be considered early on presentation. After wide excision, simultaneous bilateral reconstruction with posterior arm flap is a simple and reliable technique with an excellent patient-reported outcome.