A case of ductal apocrine carcinoma in the left axilla with tubular apocrine adenoma in the right axilla.
Explore the source record for details and available documents.
Adenoma↗
SEARCH · PubMed Health
Results for “AXILLA”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Sentinel nodes outside level I-II of the axilla and staging in breast cancer.
BACKGROUND: The aim of the study was to evaluate the incidence of sentinel nodes and sentinel node metastases outside levels I-II of the axilla in breast cancer. PATIENTS AND METHODS: Altogether 170 breast cancer patients with 172 clinically node-negative T1-T2 tumours underwent lymphoscintigraphy and were included in a prospective study. RESULTS: The lymphoscintigraphy showed sentinel node(s) in the axilla in 150 (87%) breast cancer cases. Thirty (17%) patients had sentinel nodes outside the axilla. Lymphatic drainage solely outside the axilla was encountered in two patients. Lymph node metastases were found in the axilla in 40% and outside the axilla in 17% of the 30 patients with extra-axillary sentinel nodes. Two patients with sentinel node metastases outside the axilla had no axillary metastases. CONCLUSION: The biopsy of sentinel nodes outside the axilla is a potential tool for more accurate staging in breast cancer, since it provides additional information as compared to axillary staging alone.
Adult↗
A comparison of the suitabilities of rectal, gut, and insulated axilla temperatures for measurement of the circadian rhythm of core temperature in field studies.
Eight healthy males were studied for a total of 13 subject-days to assess if gut (from an ingested pill) and axilla (from a thermally insulated skin probe) temperatures would act as a substitute for rectal temperature in field studies of the circadian rhythm of core temperature. Subjects slept and went about their activities, indoors and outdoors, normally. Regular recordings (at 6 min intervals) were made of temperatures from the three sites. In addition, activity was measured (by a sensor on the nondominant wrist) so that the raw temperature data could be "purified," that is, corrected for the direct effects of sleep and activity. Inspection of the raw data indicated that there was a close parallelism between rectal and gut temperatures, but that the parallelism between rectal and insulated axilla temperatures was less reliable. This parallelism was supported by initial calculations of the correlations between rectal and gut temperatures (high and positive) and between rectal and insulated axilla (lower, though still positive) temperatures. Calculation of the limits of agreement between the parameters of the cosine curves fitted to the raw data confirmed that the rectal and gut temperatures were far closer with regard to acrophase and amplitude than were rectal and insulated axilla temperatures (-0.31 +/- 0.89 vs. +0.75 +/- 6.03 h and +0.002 +/- 0.116 vs. +0.083 +/- 0.625 degrees C, respectively). After purification of the temperature data, the limits of agreement for the cosine parameters acrophase and amplitude still indicated that there was a closer agreement between rectal and gut temperatures than between rectal and insulated axilla temperatures (-0.30 +/- 1.12 vs. +0.58 +/- 6.69 h, and +0.007 +/- 0.116 vs. +0.104 +/- 0.620 degrees C, respectively). Part of the explanation of this difference was the unreliable relationships between temperature changes in insulated axilla temperature and bursts of activity and going to bed. It is concluded that, whereas gut temperature is a viable alternativ to rectal temperature (from the viewpoints of both user acceptability and the reliability of data obtained), insulated axilla temperature, though acceptable to subjects, is unreliable from an experimental viewpoint.
Adult↗
Occurrence of mental and thermal sweating on the human axilla.
Sweat responses to mental arithmetic were recorded simultaneously on the axilla, palm, and general body surface (chest and forearm) by resistance or capacitance hygrometry at different ambient temperatures. Sweat expulsions observed on the axilla were fully synchronized with those on the general body surface, but not always with those on the palm. In some subjects the sweat responses to mental arithmetic on the general body surface were different in pattern from those on the palm. In such subjects the sweat response pattern on the axilla was similar to that on the general body surface. The sweat response to mental arithmetic occurred at a considerably lower environmental temperature on the axilla than on the general body surface. The occurrence of the sweat response on the axilla can be related to the peculiar feature of axillary thermal sweating: a lower threshold temperature and less responsiveness to thermal load compared with thermal sweating on the general body surface. This suggests that mental sweating on the axilla occurs due to the characteristic feature of thermal sweating on the axilla. Axillary eccrine sweating is not different qualitatively from sweating on the general body surface.
Adult↗
[Management of the axilla in breast cancer: evidences and unresolved issues].
In this study the evidences governing the management of the axilla were examined and on the base of these evidences, the optimal clinical practice was outlined. Computerized searches for publications, debating specific treatment of axilla, were done of MEDLINE data. Level of evidence was determined using standard criteria: 1. metaanalysis of randomized trials, 2. randomized trial, 3. prospective and retrospective studies, 4. reports and opinion of expert committees and working teams. The probability of lymph node involvement is related directly to the size of the primary tumour, and even with small tumour (up to 10 mm), the risk of nodal metastases is in the order of 10-20%. To date, the best strategy for determining complete lymph node status (qualitative and quantitative information) is through axillary dissection. For an accurate staging, at least ten nodes have to be obtained. Formal axillary sampling does not provide total quantitative data in patients with involved axilla. Sentinel node biopsy is a promising alternative to axillary dissection for staging but it is still under way. Axillary dissection should be omitted in patients with ductal carcinoma in situ since the probability of nodal involvement is less than 1%. In invasive breast cancer, the risk of axillary recurrence in the untreated axilla varies from about 10% to 40%. For women with stage I-II breast cancer at least level I and II axillary node dissection should be offered as the standard procedure to reduce the risk of regional recurrence. Women at high risk of axillary recurrence (> or = 4 involved nodes, < 6 nodes were obtained from a positive axilla) will require axillary irradiation after axillary dissection. However, there is a lack of higher level evidence to support the benefit of post-dissection axillary irradiation. Evidences suggest that axillary irradiation is as effective as axillary dissection in preventing regional recurrence. The following factors have to be considered for decisions regarding dissection or irradiation: patient wishes, general condition, age, the necessity of pathological nodal status for systemic therapy and the risk of post-treatment morbidity. At this time, there is no well defined subgroup of patients in whom axillary intervention can be safely omitted. In selected patients with clinically negative axilla, the decision to observe the axilla rather than use surgery or irradiation should be made jointly between the women and her specialists (surgeon, radiation and medical oncologist). The benefits of axillary treatment in prolonging survival are unclear. Studies have reported different effects on survival. Until evidences remain insufficient, the risk of axillary recurrence has to be minimized, and more and more patients have to be provide to get treatments in randomized clinical trials. Patient should be fully informed about the benefits and the potential side effects of treatments. A combination of radiotherapy and axillary dissection results an increased morbidity rate compared with either alone.
Axilla↗
Axillary node sample to evaluate the axilla.
Lymphatic drainage from the breast is principally to the ipsilateral axilla. In patients with breast cancer the status of the lymph nodes in the axilla is an important prognostic factor and can be used to determine local and systemic therapies. Clinical assessment of the axillary lymph nodes is unreliable, and imaging techniques, although they show some promise, are at present not practical. Standard policy for management of the axilla is clearance of the axillary lymph nodes (either level II or level III), which is justified on the grounds that it both stages and treats the axilla. In those who are axillary node-negative, however, it is an unnecessary operation and is associated with some morbidity. Various methods to obtain lymph nodes for histologic assessment in an attempt to stage the axilla have been tried. The pectoral node biopsy, where a single node is removed from the axillary tail, has been shown to be unreliable. A triple-node biopsy (pectoral node, apical node, internal mammary node) provides excellent prognostic data but is difficult to perform in patients who have been treated by breast conservation. The four-node sampling technique has been evaluated in Edinburgh in two randomized trials comparing node sampling to level III axillary clearance. It was shown to be reliable for staging the axilla; and in those who are node-negative no further treatment is required. Detailed morbidity has been assessed in patients who underwent axillary clearance; and node sampling plus radiotherapy and node sampling without radiotherapy showed that those with node sampling had the least morbidity. Those who had node sampling plus radiotherapy have reduced movement around the shoulder joint, and the axillary clearance group have increased swelling of the upper limb and slightly reduced abduction. The sentinel node biopsy is presently being assessed in several centers by randomized studies. Several large series have shown the technique to be accurate (98%) when the sentinel node is identified (around 90% of cases).
Axilla↗
Reconstruction of the axilla with a posterior arm fasciocutaneous flap.
We present our experience with the use of the posterior arm fasciocutaneous flap in the reconstruction of 22 axillae in 17 patients. These patients all suffered from long-standing, severe hidradenitis suppurativa and this flap was used to reconstruct the axilla after surgical excision of the whole hair-bearing area of the axilla and the underlying axillary disease. In most cases, excision included all of the axillary contents up to the axillary vessels but excluded the apex of the axilla. Nineteen axillae were reconstructed with a pedicled flap. Three axillae were reconstructed more recently with an island flap. All reconstructions were achieved without flap complications.
Adult↗
A specific bacterial aminoacylase cleaves odorant precursors secreted in the human axilla.
Human axillary odor is known to be formed upon the action of Corynebacteria sp. on odorless axilla secretions. The known axilla odor determinant 3-methyl-2-hexenoic acid was identified in hydrolyzed axilla secretions along with a chemically related compound, 3-hydroxy-3-methylhexanoic acid. The natural precursors of both these acids were purified from non-hydrolyzed axilla secretions. From liquid chromatography/mass spectrometry analysis, it appeared that the acids are covalently linked to a glutamine residue in fresh axilla secretions, and the corresponding conjugates were synthesized for confirmation. Bacterial isolates obtained from the human axilla and belonging to the Corynebacteria were found to release the acids from these odorless precursors in vitro. A Zn(2+)-dependent aminoacylase mediating this cleavage was purified from Corynebacterium striatum Ax20, and the corresponding gene agaA was cloned and heterologously expressed in Escherichia coli. The enzyme is highly specific for the glutamine residue but has a low specificity for the acyl part of the substrate. agaA is closely related to many genes coding for enzymes involved in the cleavage of N-terminal acyl and aryl substituents from amino acids. This is the first report of the structure elucidation of precursors for human body odorants and the isolation of the bacterial enzyme involved in their cleavage.
Amidohydrolases↗
Endoscopic surgery to the axilla--a substitute for conventional axillary clearance?
Nonpalpable, mammographically detected breast cancers are on the increase. The percentage of patients with histologically involved nodes is therefore decreasing. Axillary clearance aims at reducing the probability of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning. Minimally invasive techniques have been applied to a growing number of surgical procedures now including exploration of the axilla. The technique used and results achieved in a series of 50 consecutive patients treated by liposuction and axilloscopy by one single surgeon, including all the patients from the very first attempt, are presented here. Patients were excluded with palpable lymph nodes or a primary tumor in the direct vicinity of the axilla that could be injured by the liposuction canula. The average number of lymph nodes removed was 13.4. Thirty-four percent of patients had involved nodes. The mean number of involved nodes in these patients was 3.1. After a median follow-up time of only 15 months no axillary recurrences or trocar site metastases have been found in the first 40 patients. Using a self-assessment questionnaire, the patients rate this technique as excellent. There was no lymphedema. The cosmetic result is certainly better than after conventional axillary clearance. Great experience of laparoscopic surgery and an excellent knowledge of the axillary anatomy are prerequisites for the practice of axilloscopic treatment of the axilla. The working space within the axilla is small and a number of structures need absolutely to be preserved. A longer follow-up period than the one so far achieved in this series or any other in the literature to date is necessary before this technique can be generally recommended.
Axilla↗
Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer.
Currently, breast cancer patients without clinically suspicious lymph nodes are candidates for sentinel lymph node procedures (SLNPs). The aims of this study were to investigate whether preoperative axillary ultrasonography and fine-needle aspiration cytology (FNA) can reduce the number of the more time-consuming SLNPs, and to identify a subset of quantitative nodal features to predict metastatic involvement. 268 axillae were ultrasonographically examined. FNA was performed on suspicious nodes (smallest diameter > or =5 mm or atypical cortex appearance). SLNP was omitted if a tumour-positive node was found on FNA. Length, width, maximum cortex thickness and appearance of cortex and hilus were ultrasonographically established. In 93 axillae (35%), at least one node was detected with ultrasound. FNA was performed once per axilla on 66 nodes; 37 (56%) contained tumour cells. 31% of all tumour-positive axillae (macro-+micrometastases) was found by ultrasound and FNA (37/121). 41% of all axillae containing macrometastases was found by ultrasound and FNA (36/87). SLNPs were reduced by 14% (37/268). Maximum cortex thickness is the main feature to predict metastatic involvement (area under Receiver Operating Characteristic (ROC) curve (A(Z))=0.87).
Adult↗
Core body temperature measurement: a comparison of axilla, tympanic membrane and pulmonary artery blood temperature.
This research study was undertaken to examine the relationship between pulmonary artery blood temperature (regarded as the 'gold standard' measurement for core body temperature), axilla temperature using the Tempa.DOT Ax chemical thermometer and tympanic membrane temperature using the Diatek 9000 InstaTemp thermometer. Sixty adult intensive care patients had their temperatures monitored. A single set of five simultaneous temperatures, i.e. left and right axilla, left and right tympanic membrane (TM), and pulmonary artery (PA) blood were recorded. The mean difference between left and right TM temperatures was 0.58 degree C, and although both were moderately well correlated with PA temperature (r = 0.63 and 0.78, respectively) the mean differences between the two sites were clinically significant (0.85 degree C and 0.94 degree C, respectively). The range of differences between the sites was significant. Plotting limits of agreement showed that both left and right TM temperatures may be up to 1.2 degrees C above or 1.3 degrees C below PA blood temperature: a clinically unacceptable range. In particular, large temperature differences were recorded when patients were lying with one side of their head to a pillow. Fan therapy directed to the head was not found to affect these differences significantly. The mean difference between left and right axilla temperatures was 0.36 degree C, and although both were modestly correlated with PA temperature (r = 0.48 and 0.53, respectively) the mean differences between the two sites were clinically significant (0.47 degree C and 0.50 degree C, respectively). The range of differences between the sites was particularly significant. Plotting limits of agreement showed that both left and right axilla temperatures may be up to 1.2 degrees C above or 1.6 degrees C below PA blood temperature: a clinically unacceptable range. Because the range of temperature differences found between PA blood and the other sites was so great, it is concluded that neither the chemical axilla thermometer nor the tympanic membrane thermometer used in this study are clinically reliable tools for adult intensive care patients.
Adult↗
Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial. Edinburgh Breast Unit.
BACKGROUND: In the treatment of operable breast cancer by breast conservation, the extent of axillary dissection, the need for radiotherapy to the axilla and the morbidity associated with these procedures have not been assessed adequately. METHODS: Patients with operable breast cancer were randomized to have level III axillary node clearance (232 patients) or axillary node sample (234 patients). Radiotherapy to the axilla was given selectively. Radiotherapy was not given to those who had an axillary clearance. In the early part of the study all patients who had node sample were treated by radiotherapy (54 patients); subsequently this was modified to include only those who were node positive. The morbidity to the shoulder and arm was assessed before and after operation by measuring upper limb volume and circumference, and combined glenohumeral and scapular movement and muscle power. RESULTS: Comparing the two surgical policies, no difference was found in local (axillary clearance 14 versus sample 15), axillary (eight versus seven) or distant (29 versus 29) recurrence. There was no statistically significant difference in 5-year survival rate (clearance 82.1 versus sample 88.6 per cent). Morbidity was least in those who had a node sample and no radiotherapy to the axilla. Radiotherapy to the axilla in patients who had a node sample resulted in a significant reduction in range of movement of the shoulder, e.g. mean(s.e.) 2.2(0.6) cm reduction in lateral rotation at 3 years. Surgical axillary clearance was associated with significant lymphoedema of the upper limb, e.g. 4.1(0.7) per cent increase in arm volume at 3 years. CONCLUSION: A selective policy for the management of the axilla is associated with no increase in axillary recurrence or mortality rate compared with routine axillary node clearance. Patients who are node negative after axillary sample can avoid radiotherapy or axillary clearance.
Aged↗
Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer.
BACKGROUND: Lymphatic mapping in patients with breast cancer can reveal sentinel lymph nodes that are not located at level I-II of the axilla. Little is known about the clinical relevance of these nodes. METHODS: Some 113 consecutive patients with clinical stage T1-3 N0 M0 breast cancer were studied. Based on preoperative lymphoscintigraphy, sentinel node biopsy was performed guided by a gamma probe and patent blue dye. All sentinel nodes that were visible on lymphoscintigraphy were sought. Pathological examination of the sentinel nodes included step-sections and staining with CAM 5. 2. Axillary node dissection was performed regardless of sentinel lymph node status. RESULTS: Twenty-one (19 per cent) of 113 patients had sentinel lymph nodes outside level I-II of the axilla, mostly in the internal mammary chain. Twenty-two of the 30 sentinel nodes at these sites were harvested. Three patients had sentinel nodes only outside the axilla. Four other patients had metastases outside the axilla. This changed postoperative treatment in three patients. No postoperative complication occurred. CONCLUSION: Sentinel lymph nodes outside level I-II of the axilla were present in 19 per cent of patients with breast cancer in this series. Biopsy of these nodes was technically demanding but was performed without additional morbidity. The clinical impact was limited; treatment changed in only 3 per cent. Presented to the 52nd annual meeting of the Society of Surgical Oncology in Orlando, Florida, USA, March 1999 and the First International Congress on the Sentinel Node in Diagnosis and Treatment of Cancer in Amsterdam, The Netherlands, April 1999, and published in abstract form as Eur J Nucl Med 1999; 26(Suppl): S71
Adult↗
Management of the axilla in early breast cancer: is it time to change tack?
The standard surgical treatment of the axilla in patients with early breast cancer is about to undergo a radical change. Although axillary dissection is an excellent procedure for both staging and local control, particularly in the clinically positive axilla, it has considerable morbidity and may understage a significant proportion of patients, because it will usually miss micrometastases that can occur in approximately 10% of 'node negative' patients. An increasing number of patients whose tumours are either non-invasive (ductal carcinoma in situ; DCIS), micro-invasive, tubular cancers or low-grade T1a tumours without lymphovascular invasion may be spared axillary surgery because the risk of axillary disease is 0-3%. Many studies, both prospective trials and large retrospective series, show that axillary radiotherapy alone provides similar local control rates to axillary dissection in patients with clinically negative axillas. Primary treatment of the axilla with radiotherapy alone, however, does not allow appropriate staging. Sentinel lymph node biopsy is being increasingly used in patients with breast cancer to provide this information. When a sentinel node is identified it is equal to or better than axillary dissection for staging the axilla and, if the node is positive, it will help select patients who should then proceed to further axillary surgery or axillary radiotherapy. Although sentinel lymph node biopsy is being rapidly adopted in many centres worldwide, the results of randomized controlled trials are needed before it can be recommended as the standard of care.
Axilla↗
A prospective randomized trial of single versus multiple drains in the axilla after lymphadenectomy.
Increasing duration and amount of postoperative fluid formation after axillary lymphadenectomy delays final healing. We postulated that multiple drains (instead of a single drain) might decrease postoperative fluid accumulation by their greater proximity to points of leakage. We randomized 65 women with clinical stage I or II carcinoma of the breast to single or multiple drains. They were stratified for axillary dissection or modified radical mastectomy. For axillary dissection, randomization to multiple drains meant placement of four catheters in the axilla, and randomized to the single drain, one catheter in the axilla. For modified radical mastectomy, the patients randomized to multiple drains received four catheters in the axilla and one catheter under the inferior flap; the patients randomized to single drains had one catheter in the axilla and one catheter under the inferior flap. All catheters exited separately. The two arms (single versus multiple drains) were determined to be homogeneous in other variables that may affect postoperative fluid formation--age, size of the breast, weight, height, obesity, presence of previous surgical biopsy, excision of pectoralis minor muscle, excision of thoracodorsal complex, level of axillary dissection, number of lymph nodes, number and proportion of positive lymph nodes and whether or not the dominant hand was on the side operated upon. Single versus multiple drains had no clinically significant effect on the amount or duration of drainage, as an inpatient or outpatient, or total. We recommend a single drain to the axilla after lymphadenectomy.
Adult↗
111Indium-bleomycin breast and axilla imaging.
111Indium-Bleomycin (111In-Blm), a new radiopharmaceutical, was administered intravenously to 37 patients with benign and malignant breast lesions. Early and delayed images of both the breasts and axillae were made, and results were correlated with physical examination, histopathology of the excised lesion, mammography, and thermography. In 18 patients with malignant disease, clinical examination of the breast and axilla correlated with histopathology in 78 and 54% of the cases, respectively. Images of the breast were accurate (true positives) in 83% of the cases. Images of the axilla were accurate in 62% of the cases. Mammography was correct and suggested malignancy in 88%, and thermography in 73% of the cases. In 19 patients with benign breast lesions, clinical examination of the breast and axilla correlated with histopathology in 68 and 95% of the cases, respectively. Scans of the breast and axilla were correct (true negative) 79 and 95% of the time, respectively. Mammography was correct, and suggested benignancy, in 53% and thermography in 25% of the cases. Imaging of the breasts using 111In-Blm appears to be as accurate as physical examination and mammography for palpable benign and malignant breast tumors. It is less accurate than mammography for microscopic malignancies. Axillary imaging does not appear to be worthwhile because many axillary metastases are too small for detection with current nuclear medicine instrumentation.
Adolescent↗
Radiotherapy and the management of the axilla in early breast cancer.
The role of radiotherapy in the management of the axilla in early breast cancer is examined. A few, carefully selected, clinically node-negative postmenopausal women may require no intervention to the axilla. Otherwise, surgical clearance is the preferred sole management of the axilla, resulting in an excellent level of local control and providing optimal information for the use of systemic adjuvant therapy. Axillary radiotherapy can also provide equivalent levels of long-term control in the clinically node-negative axilla, but the chronic disabling syndrome of brachial plexopathy is documented at all radiation doses that can sterilize microscopic disease, irrespective of the radiotherapy technique. A combination of radiotherapy and axillary surgery results in an increased morbidity rate compared with either alone. Women who receive radiotherapy to the breast alone are not at risk of brachial plexopathy.
Axilla↗
Axilla to elbow radial nerve conduction.
Numerous techniques that evaluate radial nerve conduction from the axilla or supraclavicular fossa to the elbow have been reported. A shortcoming of most protocols is determining the precise radial nerve length as it proceeds along the spiral groove. The present study dissected out and measured directly eight cadaver radial nerves from the axilla to the elbow. These values were compared with a new surface tape measurement technique from axilla to elbow across the bicep muscle, obstetrical calipers over this region, and a surface determination approximating the course of the radial nerve posteriorly in the spiral groove. The anterior surface tape-measuring procedure compared most favorably with the actual anatomic length. Nerve conduction velocities were then calculated in 20 volunteers using all 3 techniques and compared with the median nerve in the arm. The anterior and posterior tape measurements yielded a conduction velocity of 72.5 +/- 4.7 and 86.6 +/- 7.0 m/s, respectively, whereas the caliper resulted in 65.7 +/- 3.9 m/s. We conclude that proximal radial nerve length assessment employing an anterior tape measurement from axilla to elbow across the bicep musculature is precise and compares favorably with the actual anatomic length of the radial nerve.
Adult↗