No abstract

The present guidelines for nuclear medicine practitioners offer assistance in optimizing the diagnostic information from the SLN procedure. These guidelines describe protocols currently used routinely, but do not include all existing procedures. They should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary.

Persistent pain following breast cancer treatments remains a significant clinical problem despite improved treatment strategies. 1 Data on factors associated with persistent pain are needed to develop prevention and treatment strategies and to improve the quality of life for breast cancer patients. This prospective study examined the prevalence and severity of and the factors associated with chronic pain after breast cancer surgery and adjuvant treatments. Methods | Consecutive patients younger than 75 years with unilateral nonmetastasized breast cancer treated at the Helsinki University Central Hospital in 2006-2010 with either breastconserving surgery or mastectomy with axillary surgery were eligible. Patients receiving neoadjuvant treatment or immediate or delayed breast reconstruction or who had no breast cancer in the final histology were excluded. All women gave informed written consent. The ethics committee of the Helsinki University Central Hospital approved the study. Preoperatively, medical history, demographic data, Beck Depression Inventory, 2 and Spielberger State-Trait Anxiety Inventory 3 were obtained. Preoperative pain in the operative area (breast, axilla, arm) during the previous week was assessed with a numerical rating scale of 0 to 10 (0 = no pain; 1-3 = mild; 4-6 = moderate; ≥7 = severe). 4 Perioperative analgesia was standardized. All patients received acetaminophen and patient-controlled analgesia with intravenous oxycodone. Postoperatively, data were acquired on tumor and lymph node characteristics, complications of surgery, reoperations, and the prognostic risk category. 5 Adjuvant treatments were given according to international guidelines. 5 A questionnaire was sent to patients 12 months after surgery, with identical assessments of presence and intensity of pain. A bivariable analysis was conducted to determine factors related to pain at 12 months after surgery. The worst pain in any area was used for statistical analysis, in which pain was considered an ordinal variable. Variables with P < .10 in bivariable analyses were entered into an ordinal logistic regression analysis. All statistical tests were 2-sided with P < .05 considered statistically significant. SPSS Statistics version 20 (SPSS Inc) software was used.

The risk of remarkable long-time arm morbidity after SNB is minimal. Work-related events seem uncommon due to arm morbidity, regardless of the extent of axillary surgery.

BackgroundThere is evidence that the immune systems of patients with breast cancer are dysfunctional. Regulatory T cells (Tregs), and IDO, an immunosuppressive enzyme, are associated with more advanced disease in some cancers and may promote immunologic tolerance to tumors. Our aim was to assess whether expression of Foxp3, a marker of Tregs, and IDO were linked with nodal metastasis in breast cancer patients. Inhibitors of IDO are available and could potentially demonstrate utility in breast cancer if IDO drives progression of disease.MethodsSentinel lymph nodes (SLN) of 47 breast cancer patients with varying degrees of nodal disease and 10 controls were evaluated for expression of Foxp3 and IDO using immunohistochemistry. Positively stained cells were quantified and their distribution within the SLN noted.ResultsThe proportion of Foxp3+ cells was higher in SLN of cancer patients than controls (19% v. 10%, p < 0.001). Specifically, there were more Foxp3+ cells in SLN with metastasis than tumor-free SLN (20% v. 14%, p = 0.02). The proportion IDO+ cell in SLN of cancer patients was not statistically different than controls (4.0% v. 1.6%, p = 0.08). In order to demonstrate the combined immunosuppressive effect of Foxp3 and IDO, we categorized each SLN as positive or negative for Foxp3 and IDO. The Foxp3+/IDO+ group almost exclusively consisted of cancer patients with node positive disease.ConclusionIn conclusion, our study shows that Foxp3+ cells are associated with more advanced disease in breast cancer, a finding that is proving to be true in many other cancers. As IDO has been found to promote differentiation of Tregs, IDO may become a suitable target to abrogate the development of T-cell tolerance and to promote an effective immune response to breast cancer. Our results about the combined expression of IDO and Foxp3 in metastastic SLN support this assumption.