Axillary dissection in patients with preoperative positive nodal cytology: Genuine need or overtreatment?

Recent studies demonstrated the possibility to avoid axillary dissection (ALND) in selected patients with one or two metastatic nodes. Otherwise, patients with positive nodal ultrasound-guided fine-needle aspiration cytology (US-FNAC) currently undergo ALDN. The aim of this study is to quantify the nodal burden in patients with positive US-FNAC treated with ALND and to evaluate if clinical or pathological characteristics associated with low nodal involvement can be identified. This is a multicentric retrospective study involving 297 patients who underwent ALND because of a positive preoperative US-FNAC. A total of 157 patients showed bulky axillary lymph nodes at diagnosis, and 70% of them had three or more metastatic nodes. One hundred and forty patients had a clinically negative axilla and in 50% of them, 4 or more metastatic nodes were found with axillary dissection. Overall, the median number of metastatic nodes was 5. Favorable pathological characteristics of tumors were found in patients with only one or two metastatic nodes: smaller primary tumor, a lower proportion of grade 3, invasive lobular carcinomas and a higher proportion of low-Ki67 tumors. In the group of patients with clinically negative axilla and potentially meeting ACOSOG Z0011 criteria, 22 (31%) showed less than three metastatic axillary nodes. A preoperative positive axillary FNAC is associated with a metastatic nodal burden significantly higher than in patients with positive sentinel lymph node biopsy (SLNB). Nevertheless, about 30% of patients with cN0 axilla, positive axillary FNAC performed because of suspicious nodes on imaging, T1-2 primary tumor and breast-conserving surgery showed less than three metastatic axillary nodes, thus meeting ACOSOG Z0011 trial's criteria and therefore would be eligible for skipping ALND according to current guidelines

492 Endometrial cancer: the role of prognostic factors and their impact on recurrence pattern

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GINGER

In this paper, we outline the scientific objectives, the experimental layout, and the collaborations envisaged for the GINGER (Gyroscopes IN GEneral Relativity) project. The GINGER project brings together different scientific disciplines aiming at building an array of Ring Laser Gyroscopes (RLGs), exploiting the Sagnac effect, to measure continuously, with sensitivity better than picorad/ s, large bandwidth (ca. 1 kHz), and high dynamic range, the absolute angular rotation rate of the Earth. In the paper, we address the feasibility of the apparatus with respect to the ambitious specifications above, as well as prove how such an apparatus, which will be able to detect strong Earthquakes, very weak geodetic signals, as well as general relativity effects like Lense-Thirring and De Sitter, will help scientific advancements in Theoretical Physics, Geophysics, and Geodesy, among other scientific fields.Comment: 21 pages, 9 figure