A predictive index of axillary nodal involvement in operable breast cancer

Laurentiis, Michelino De; Gallo, Ciro; Placido, Sabino De; Perrone, F.; Pettinato, Guido; Petrella, Giuseppe; Carlomagno, Chiara; Panico, Luigi; Delrio, Paolo; Bianco, A. R.

doi:10.1038/bjc.1996.238

Cited by 25 publications

(12 citation statements)

References 45 publications

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“…After 1987, in prognostic surveys and various new adjuvant treatment studies, based on these surveys investigators separated patients into distinct groups according to the number of metastatic axillary lymph nodes (e.g. 1-3 and Ͼ 3 positive lymph nodes [8][9][10][11][12] ; 1-3, 4 -7, and Ͼ 7 positive lymph nodes 13 ; 1-3, 4 -10, and Ͼ 10 positive lymph nodes 14,15 ; and 1-3, 4 -9, and Ն 10 positive lymph nodes [16][17][18] ). In studies of the use of bone marrow-supported, adjuvant high-dose chemotherapy in high-risk patients, patient groups were comprised of those patients with Ն 10 metastatic lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of the 2002 TNM classification for breast carcinoma with regard to the number of metastatic axillary lymph nodes

Duraker¹,

Çaynak²

2005

Cancer

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BACKGROUNDThe American Joint Committee on Cancer (AJCC) TNM classification for breast carcinoma had not been changed for 15 years, since the publication of the third edition in 1987. However, in the sixth edition, published in 2002, significant modifications were made with regard to the number of metastatic axillary lymph nodes. The authors investigated whether the sixth edition of the TNM classification provided more reliable prognostic information compared with the third edition.METHODSThe records of 1230 patients who underwent surgery for invasive breast carcinoma between 1993 and 1999 were reviewed. Each patient was assigned to axillary lymph node and disease stage groups according to the 1987 and 2002 AJCC TNM classifications. Disease–free survival (DFS) curves were calculated and plotted using the Kaplan–Meier method and the two‐sided log‐rank test was used to compare the survival curves of the patient groups.RESULTSOf the 1067 patients who were classified as having Stages II and III disease according to the 1987 classification, 411 (38.5%) were shifted to higher disease stages using the 2002 classification. Among the 1987 Stage IIA, Stage IIB, and Stage IIIA patients, the DFS rates of the patients who were shifted to higher stages of disease were significantly worse than those of the patients for whom the stage of disease was not changed. Among those patients classified as having T4anyNM0 (Stage IIIB) disease according to the 1987 classification, there was no survival difference noted between those patients with T4N0,1,2M0 disease (who formed the Stage IIIB group) and those with T4N3M0 disease (who formed the Stage IIIC group) according to the new staging system. Of the 221 patients who formed the new Stage IIIC group, 12.2% were classified as having Stage IIA disease, 42.1% as having Stage IIB disease, 38.9% as having Stage IIIA disease, and 6.8% as having Stage IIIB disease according to the 1987 classification. The survival rates of these Stage IIA, Stage IIB, and Stage IIIA patients were not found to be significantly different; however, the survival of patients in the Stage IIIB group was found to be significantly worse than the survival of the patients in the other disease stage groupings, and the patients in the Stage IIIC group were not a prognostically homogeneous group. On the basis of these results, the authors placed patients with T4anyNM0 disease in the same group (Stage IIIB). When the 2002 classification was rearranged in this manner, patients with Stage IIIC disease formed a homogeneous group; the 5‐year DFS rate of patients with Stage IIIB disease was found to be significantly worse than that for patients with Stage IIIC disease (P = 0.0011).CONCLUSIONSIn the 2002 TNM classification for breast carcinoma, patients with T4anyNM0 disease should form a distinct stage grouping and this stage grouping (Stage IIIC) should be placed before Stage IV, and Stage IIIB disease groupings should include patients with T1,2,3N3M0 disease. In this way, the authors hope that the 2002 AJCC TNM classification, which provides more reliable prognostic information than the 1987 classification, will become more refined. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of the 2002 TNM classification for breast carcinoma with regard to the number of metastatic axillary lymph nodes

Duraker¹,

Çaynak²

2005

Cancer

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“…[2][3][4][5][6][7][8][9] LVI has also been shown to be a predictor of axillary lymph node metastasis. 7,[10][11][12][13] It has been proposed that LVI could be used to identify a subgroup of axillary node-negative patients with an unfavorable prognosis that are likely to benefit from adjuvant chemotherapy. [6][7][8] Furthermore the presence of peritumoral LVI, as assessed on haematoxylin and eosin-(H&E) stained slides, has recently been added to the St Gallen criteria for the selection of adjuvant systemic therapy in operable breast cancer.…”

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Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer

et al. 2007

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Monoclonal antibody D2-40, a marker of lymphatic endothelium, identifies tumor emboli in lymph vessels. The aim of the study was to assess whether D2-40 þ lymph vessel invasion (LVI) correlates with clinicopathologic factors including lymphovascular invasion (LVI) as assessed by haematoxylin and eosin-stained sections (H&E þ or H&EÀ) and to assess the prognostic significance in node-negative breast cancer. The study group consisted of 303 node-negative breast cancer patients that had a median follow-up of 7.6 years. Clinical and pathological data were retrieved from the Henrietta Banting database. Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded tissue sections of the primary invasive carcinoma using D2-40. Immunostaining with CD31 was performed on the discordant cases that were H&E þ /D2-40À. D2-40 þ lymph vessel invasion was detected in 82/303 (27%) cases. The foci of lymphatic invasion occurred predominantly at the invasive front of the tumor. The absence of D2-40 and CD31 in 13/17 discordant cases was suggestive of retraction artefact. D2-40 þ lymph vessel invasion correlated significantly with age (P ¼ 0.0003), tumor size (P ¼ 0.005), histological grade (P ¼ 0.0001), H&E þ (P ¼ o0.0001) and estrogen receptor status (P ¼ 0.005) but not with histological type or progesterone receptor status. Multivariate analysis revealed that D2-40 þ lymph vessel invasion was the only significant predictor of distant recurrence. There was no significant association between D2-40 status and local recurrence (P ¼ 0.752) or regional recurrence (P ¼ 0.13). Both D2-40 þ lymph vessel invasion (P ¼ 0.009) and H&E þ LVI cases (P ¼ 0.02) were associated with overall shorter survival in univariate analysis. These data indicate that D2-40 identifies lymphatic invasion in breast tumors and is a significant predictor of outcome in breast cancer.

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“…This anatomically distinct lymphatic plexus originates in the dermis of the nipple‐areolar complex and terminates in the regional lymph nodes, potentially providing a direct pathway for tumor spread 34 . Involvement of the nipple has been reported to be a significant risk factor for axillary lymph node involvement in breast cancer 35,36 . It is possible, however, that the high metastatic rate of nipple BCCs may only reflect the fact that the nipple tumors reported in the literature were large, ulcerated tumors at higher risk for such an occurrence.…”

Section: Discussionmentioning

confidence: 99%