Axillary nodal metastatic burden in patients with breast cancer with clinically positive axillary nodes

Abstract

Background: The aim of this study was to determine preoperative factors and tumour characteristics related to a high nodal tumour burden in patients with clinically node-positive breast cancer. These findings were used to construct a predictive tool to evaluate the patient-specific risk of having more than two axillary lymph node metastases. Methods: Altogether, 507 consecutive patients with breast cancer and axillary lymph node metastasis diagnosed by preoperative ultrasound-guided needle biopsy were reviewed. These patients underwent breast surgery and axillary lymph node dissection at Helsinki University Hospital between 2010 and 2014. Patients were grouped into those with one or two, and those with more than two lymph node metastases. Results: There were 153 patients (30⋅2 per cent) with one or two lymph node metastases and 354 (69⋅8 per cent) with more than two metastases. Five-year disease-free survival was poorer for the latter group (P = 0⋅032). Five-year overall survival estimates for patients with one or two and those with more than two lymph node metastases were 87⋅0 and 81⋅4 per cent respectively (P = 0⋅215). In multivariable analysis, factors significantly associated with more than two lymph node metastases were: age, tumour size, lymphovascular invasion in the primary tumour, extracapsular extension of metastasis in lymph nodes, and morphology of lymph nodes. These factors were included in a multivariable predictive model, which had an area under the curve of 0⋅828 (95 per cent c.i. 0⋅787 to 0⋅869). Conclusion: The present study provides a patient-specific prediction model for evaluating nodal tumour burden in patients with clinically node-positive breast cancer.

Decreased Survival of Invasive Ductal Breast Cancer Patients With Two Macrometastatic Lymph Nodes Among Few Resected Ones: Should Current Sentinel-Lymph-Node Guidelines Be Revised?

“…Several factors suggest that patients from this database generally received correct management according to the standard of care ( 42 , 43 ), such as strong association of SLNBL with pN0, increased number of dissected LNs in those that received mastectomy ( 1 , 2 ), increased survival of luminal hybrid (HR + /HER2 + ) patients (not shown) as a function of the benefits of anti-HER2 therapy ( 44 – 46 ), and decreased survival of patients submitted to mastectomy/radical surgery (data not shown) ( 47 ). However, as already mentioned, no report of SLNB or clinical staging of the axilla is available in the SEER database ( 4 ).…”

“…However, as already mentioned, no report of SLNB or clinical staging of the axilla is available in the SEER database ( 4 ). It is important to state that, although reduced for pT1–T2 patients, the clinical axillary staging is predictive of increased axillary burden ( 42 ), but the clinical staging is inferior and does not replace the pathological staging ( 43 ). More importantly, similar results in the matched analysis by propensity score between subsets of pN1 patients and pN2 patients, and those obtained of the prognostic value of affected to removed lymph node ratio in pN1, strengthen our conclusions that an intrinsic (basal) prognostic difference exists according to the number of resected lymph nodes by a probable downstaging.…”

Distally Based Lymphatic Microsurgical Preventive Healing Approach—A Modification of the Classic Approach

“…The surgical approach to nodal metastasis in breast cancer has undergone numerous evolutions with the aim of reducing morbidity and BCRL rates related to ALND. The advent of SLNB mitigated unnecessary ALND in clinically node-negative patients, and drastically reduced the rates of lymphedema in this group of patients [6]. The ACOSOG Z-0011 and EROTC AMAROS trials demonstrated that patients one or two metastatic sentinel nodes after SLNB, could safely avoid a completion ALND with the use of adjuvant radiotherapy [7,8].…”

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

“…According to the literature, a normal lymph usually shows as a reniform shape, uniformly hypoechoic cortex with a maximal thickness less than 3 mm, smooth margins, and intact central fatty hilum [18]. On the contrary, suspicious ndings of ALN are cortical thickness greater than 2.5-3.0 mm, focal cortical lobulation, loss of the fatty hilum, a round shape, and abnormal cortical blood ow [19]. Kuna SK suggested that the short diameter of lymph nodes > 0.5 cm should be used as the index of judging the pathological lymph nodes, and especially when the short diameter > 1 cm, it should be suspected to be malignant [20].…”