Micrometastases Mangement

Background: Sentinel lymph node biopsy (SLNB) is now the standard of care used in the staging of the regional lymph nodes in breast cancer. As result of the wide adoption of SLNB attention turned into a detailed examination of the biopsied lymph node(s) and subsequent rise in the incidence of finding lymph node micrometastases. Micrometastases(pN1mi) is defined as a metastatic disease in the lymph node that is less than 2.0 mm but larger than 0.2mm. Isolated tumor cells (ITC) is defined as a metastatic disease in the lymph node that is smaller or equal to 0.2mm. With the rise of incidence of axillary micrometastases, there is a considerable debate on the prognostic significance and appropriate treatment recommendations for such patients.

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Triple Negative Metastatic Breast Cancer

Triple negative (TNBC) metastatic breast cancer is a heterogeneous disease, chemotherapy remains the mainstay of treatment, however, new treatments based on identifying molecular subtypes, stratifying TNBC based on gene expression assays with subsequent specific targeted therapy is an area of intense clinical research. In this post, I will review our current standard clinical practice and explore ongoing and future clinical directions.

Metastatic TNBC is very heterogenous, and while Basal type is most common, it only account for nearly 80% of all cases.


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Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer

The standard of care for evaluating the axilla in breast cancer is sentinel lymph node biopsy. For patients who happen to have positive lymph node involvement by sentinel lymph node biopsy, additional treatment of the axilla is necessary. Proceeding with total axillary lymph node dissection (ALND)while effective is associated with significant morbidity and may not be needed in all patients with positive sentinel lymph node biopsy. The AMAROS trial came to provide a needed answer, ” Can axillary radiation therapy to the axilla in a specific subset of patients with positive sentinel lymph node be done in place of ALND?”

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Pregnancy-Associated Breast Cancer

Pregnancy-associated breast cancer (PABC) is relatively rare. PABC is defined as breast cancer occurring during pregnancy, first postpartum year, or anytime during lactation. It is estimated to occur in 1 every 3000 pregnancies. On the other hand, it is the most common cancer during pregnancy, the incidence of PABC is expected to rise in developed countries, while historically PABC was always thought to have poor prognosis this is not universally true, it continues to represent a special challenge for early diagnosis and treatment options.

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