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Related Concept Videos

Metastasis02:30

Metastasis

Metastasis is the spread of cancer cells from the original site to distant locations in the body. Cancer cells can spread via blood vessels (hematogenous) as well as lymph vessels in the body.
Epithelial-to-Mesenchymal Transition
The epithelial-to-mesenchymal transition or EMT is a developmental process commonly observed in wound healing, embryogenesis, and cancer metastasis. EMT is induced by transforming growth factor-beta (TGF-β) or receptor tyrosine kinase (RTK) ligands, which further...

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Identifying Axillary Metastases in Patients with T3 Invasive Lobular Carcinoma.

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Axillary ultrasound and MRI have poor accuracy for detecting axillary metastases in invasive lobular carcinoma (ILC) tumors over 5 cm. Nearly half of patients initially classified as node-negative (cN0) were found to have metastases (pN1-3) after surgery.

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Area of Science:

  • Oncology
  • Radiology
  • Surgical Pathology

Background:

  • Axillary lymph node (ALN) metastases pose diagnostic challenges in invasive lobular carcinoma (ILC).
  • Patients with ILC tumors >5 cm face a high risk of axillary metastases.
  • Accurate preoperative staging is crucial for effective treatment planning in ILC.

Purpose of the Study:

  • To evaluate the predictive accuracy of axillary ultrasound (AUS) and magnetic resonance imaging (MRI) for ALN metastases in large ILC tumors (>5 cm).
  • To assess the sensitivity and specificity of these imaging modalities in identifying nodal involvement.
  • To determine the rate of conversion from clinical node-negative (cN0) to pathological node-positive (pN1-3) disease.

Main Methods:

  • Retrospective review of 139 patients with pT3 ILC (2014-2023).
  • Analysis of clinicopathologic features, preoperative AUS, MRI, and surgical pathology data.
  • Calculation of sensitivity, specificity, positive predictive value, and negative predictive value.

Main Results:

  • Nearly half (49.5%) of cN0 patients were upstaged to pN1-3 after surgery.
  • AUS and MRI demonstrated low sensitivity and negative predictive value for detecting ALN metastases.
  • Fine-needle aspiration also showed a significant false negative rate (25.7%).

Conclusions:

  • Current preoperative imaging (AUS and MRI) exhibits poor accuracy for axillary staging in T3 ILC.
  • A high index of suspicion for axillary disease is warranted in ILC patients, even with negative preoperative imaging.
  • Further improvements in imaging or diagnostic strategies are needed for accurate ALN assessment in ILC.