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Difference between revisions of "Invasive breast cancer"
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more indication for LN sampling
(→Staging breast cancer: tweak) |
(more indication for LN sampling) |
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=Staging breast cancer= | =Staging breast cancer= | ||
==Sentinel lymph node biopsy== | |||
===General=== | |||
*Used for staging, positive LNs = poorer prognosis. | |||
Notes: | |||
*If there is no palpable disease, there is '''no''' mortality benefit from axillary lymph node dissection, i.e. positive axillary lymph nodes can be left in situ without affecting outcome.<ref>{{cite journal |author=Giuliano AE, Hunt KK, Ballman KV, ''et al.'' |title=Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial |journal=JAMA |volume=305 |issue=6 |pages=569–75 |year=2011 |month=February |pmid=21304082 |doi=10.1001/jama.2011.90 |url=}}</ref> | |||
**This does not negate the fact that a positive sentinel LN biopsy (vs. negative sentinel LN biopsy) portends a poorer prognosis. | |||
===Microscopic=== | |||
Features: | |||
*Atypical cells. | |||
**Nuclear changes of malignancy: | |||
***Nuclear enlargement + variation in size. | |||
***Variation in shape. | |||
***Hyperchromasia and variation in staining. | |||
**Usually in the subcapsular sinuses. | |||
Pitfalls: | |||
*Naevus cell rests.<ref>URL: [http://www.breastpathology.info/Case_of_the_month/2007/COTM_1107%20discussion.html http://www.breastpathology.info/Case_of_the_month/2007/COTM_1107%20discussion.html]. Accessed on: 28 November 2010.</ref> | |||
===IHC=== | |||
Some hospitals use: | |||
*CAM5.2 (LMWK) - to look for isolated tumour cells and small lymph node metstases. | |||
==N stage== | ==N stage== | ||
===Indictionas for lymph node sampling=== | |||
Indications for lymph node sampling:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf]. Accessed on: 2 April 2012.</ref> | |||
*Extensive [[DCIS]]. | |||
*Biopsy suspicious for invasion ''or'' with microinvasion. | |||
*Clinical findings (large palable mass) or radiology findings (irregular features) suggestive of invasion. | |||
*Planned mastectomy. | |||
===Definitions=== | |||
Definitions:<ref name=acs_website>URL: [http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging]. Accessed on: 8 July 2010.</ref> | Definitions:<ref name=acs_website>URL: [http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging]. Accessed on: 8 July 2010.</ref> | ||
*Isolated tumour cells: <=0.2 mm ''or'' <=200 cells -- in a single cross-section. † | *Isolated tumour cells: <=0.2 mm ''or'' <=200 cells -- in a single cross-section. † | ||
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* † The ''American Cancer Society'' web site says "or".<ref name=acs_website/> The CAP protocol says "and/or" and notes it is all subjective. | * † The ''American Cancer Society'' web site says "or".<ref name=acs_website/> The CAP protocol says "and/or" and notes it is all subjective. | ||
===Details=== | |||
Lymph nodes:<ref>URL: [http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging]. Accessed on: 8 July 2010.</ref> | Lymph nodes:<ref>URL: [http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging]. Accessed on: 8 July 2010.</ref> | ||
*pN0: nil. | *pN0: nil. | ||
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IHC & DDx: | IHC & DDx: | ||
*See ''[[Paget disease]]''. | *See ''[[Paget disease]]''. | ||
==Trivia== | ==Trivia== | ||