Axillary Nodal Burden in Breast Cancer Patients With Pre-operative Fine Needle Aspiration-proven Positive Lymph Nodes Compared to Those With Positive Sentinel Nodes

Cipolla, Calogero; Valerio, Maria Rosaria; Grassi, Nello; Calamia, Sergio; Latteri, S; Latteri, M; Graceffa, Giuseppa; Vieni, Salvatore

doi:10.21873/invivo.11831

Cited by 6 publications

(6 citation statements)

References 27 publications

(42 reference statements)

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“…In the past decades, surgical treatment for breast cancer has evolved from the Halstead radical mastectomy to breast conservation or skin-sparing mastectomy with immediate reconstruction. ALN status remains the most important prognostic factor, despite the implementation of new genomic analyses and advances in routine pathology, and frequently affects the choice of therapy (21,22). As an alternative to complete ALND, lymphatic mapping with SLNB, has been applied to patients with breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Impact of BMI on Preoperative Axillary Ultrasound Assessment in Patients With Early Breast Cancer

et al. 2020

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Background: The accuracy of axillary ultrasound (AUS) with fine-needle aspiration with varying patient body mass index (BMI) is still unclear. The aim of our study was to evaluate whether the US features of axillary lymph nodes changes with BMI of patients. Patients and Methods: A retrospective review was performed involving 144 out of 270 patients with early breast cancer who underwent breast surgery with sentinel lymph node biopsy. Diagnostic efficacy of AUS in preoperative axillary nodal staging was assessed in relation to BMI. Results: Negative predictive values of AUS for the overweight and obese groups were statistically significantly lower compared to the normal/underweight group (p=0.02 and p=0.003, respectively). Additionally, Spearman's correlation coefficient R between BMI and positive sentinel lymph node biopsy was 0.257, suggesting a significantly positive linear relationship between the two variables in the cohort overall. Conclusion: Our results demonstrate how in our cohort the negative predictive value of AUS was significantly influenced by adipose tissue and that the selection of the most suitable instrumental diagnostic technique might contribute to improving heterogeneous results.

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Section: Discussionmentioning

confidence: 99%

Impact of BMI on Preoperative Axillary Ultrasound Assessment in Patients With Early Breast Cancer

et al. 2020

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“…However, as previously mentioned, patients included in the Z0011 trial seem to be more representative of patients with non-suspicious nodes on AU than of patients with 1 or 2 suspicious nodes. This statement is supported not only by the 2017 meta-analysis by Ahmed et al (9) but also by subsequent studies (15)(16)(17).…”

Section: Discussionmentioning

confidence: 79%

Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial

Vernet-Tomas¹,

Argudo²,

Jimenez³

et al. 2023

Gland Surg

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Background: Some studies suggested that the patients included in the Z0011 trial may represent patients with ultrasound-negative axillary nodes and axillary invasion diagnosed by sentinel node (SN) biopsy.Nevertheless, the National Comprehensive Cancer Network (NCCN) guidelines recommend SN mapping if 1 or 2 suspicious lymph nodes are identified on axillary ultrasound (AU). The aim of this preliminary phase of the Multimodal Targeted Axillary Surgery (MUTAS) trial was to establish the accuracy of SN mapping in patients with axillary involvement undergoing upfront surgery.Methods: Between September 2019 and March 2022, we recruited patients with biopsy-proven metastatic axillary nodes and upfront surgery from a single center. We performed SN mapping in these patients before the surgical intervention, which included axillary lymph node dissection. The biopsy-proven metastatic node, SNs and the remaining axillary nodes were excised separately. SN status was considered representative of the status of the remaining axillary nodes. We calculated the sensitivity, specificity, negative predictive value and positive predictive value of the SN, overall and in patients with palpable nodes, in those with non-palpable nodes and an AU leading to diagnosis of axillary involvement, in those with 1 or 2 suspicious nodes on AU, and in patients with a single suspicious node on AU. We evaluated clinical, imaging and pathology features as predictors of the status of the remaining axillary nodes, false-negatives, and false-positives. Results:We included 25 patients in this phase. The false-negative rate of SN mapping was 28% overall, 21.42% for patients with palpable nodes, 36.36% for patients with non-palpable nodes and an AU diagnosis of axillary involvement, 28.75% for those with 1 or 2 suspicious nodes on AU, and 15.38% in patients with a single suspicious node on AU. The negative predictive value was highest in patients with a single suspicious node on AU (75%). The only significant predictive factor was that FN showed a higher Ki67 index score.Conclusions: In this study, SN mapping was not reliable in patients with biopsy-proven metastatic axillary

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“…Other studies have demonstrated that certain high-risk features do predict for higher nodal stage, which led authors to conclude that patients with clinically positive nodes should not be considered for omission of ALND [3][4][5][6] . However, a disproportionately high number of patients in these studies had ER-negative (23.9%-29.7%) or Her2-positive (18.7%-31.2%) disease.…”

Section: Discussionmentioning

confidence: 99%

“…The concern for de-escalation of axillary surgery for patients with clinically positive nodes appears to stem from data that demonstrate that these patients have less favorable tumor characteristics than patients with SLN+ disease [3][4][5][6] . Our data of primarily ER-positive patients support these ndings and demonstrate that progression of tumor characteristics from lower to higher risk mirrors the progression of clinical nodal disease from SLN+ to cNUS to cNpalp, with statistically signi cant differences existing at both ends of the nodal spectrum.…”

Section: Discussionmentioning

confidence: 99%

“…Studies comparing patients with sentinel node-positive (SLN+) disease to those with lymph node metastases diagnosed by preoperative ultrasound and biopsy (cNUS) suggest that cNUS patients have higher risk features and greater pathologic nodal burden [3][4][5][6] . Few studies have evaluated patients with palpable adenopathy (cNpalp), but the assumption exists that increasing clinical nodal burden re ects higher risk features and greater pathologic nodal disease.…”

Section: Introductionmentioning

confidence: 99%

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Tumor Size and Lobular Histology Predict for Higher Pathologic Nodal Stage Regardless of Clinical Presentation of Nodal Disease in Patients With Breast Cancer

Ye¹,

Rünger²,

Angarita³

et al. 2021

Preprint

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Purpose: Omission of axillary lymph node dissection (ALND) is considered for patients with sentinel lymph node-positive (SLN+) breast cancer, but ALND remains the standard of care for clinically node-positive (cN+) patients treated with surgery first. Here, we evaluate differences in patient and tumor characteristics and pathologic nodal stage in patients with positive lymph nodes who underwent ALND. Methods: Retrospective chart review from 2010-2019 identified three groups of patients who underwent ALND for positive nodes: SLN+ (positive node identified at SLN biopsy), cNUS (abnormal preoperative US and biopsy), and cNpalp (palpable adenopathy). Patients who received neoadjuvant chemotherapy or presented with axillary recurrence were excluded. Results: Of 218 patients, 107 were SLN+, 43 were cNUS, and 68 were cNpalp. SLN+ patients compared with cNpalp were more likely to be younger (56 vs 64,p<.01), pre-menopausal (39%vs15%,p<.01), and white (62%vs37%,p<.01) with more tumors that were progesterone receptor-positive (6%vs21%,p=.02), low grade (35%vs6%,p<.01) and without lymphovascular invasion (11%vs27%,p=.02). SLN+ patients had more pN1 disease than cNUS and cNpalp (67.3% vs 39.5% vs 42.6%, p<.01). Greater tumor size and lobular histology were significantly associated with higher nodal stage in univariable regression analysis of SLN+ patients as well as a pooled analysis of the three clinical groups.Conclusion: Patient and tumor characteristics differ on either end of the nodal spectrum, with cNpalp patients having higher risk features than SLN+ patients. These higher risk features have historically resulted in ALND for patients with clinically positive nodes. However, only tumor size and histology are associated with higher pathologic nodal stage.

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Axillary Nodal Burden in Breast Cancer Patients With Pre-operative Fine Needle Aspiration-proven Positive Lymph Nodes Compared to Those With Positive Sentinel Nodes

Cited by 6 publications

References 27 publications

Impact of BMI on Preoperative Axillary Ultrasound Assessment in Patients With Early Breast Cancer

Impact of BMI on Preoperative Axillary Ultrasound Assessment in Patients With Early Breast Cancer

Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial

Tumor Size and Lobular Histology Predict for Higher Pathologic Nodal Stage Regardless of Clinical Presentation of Nodal Disease in Patients With Breast Cancer

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