Characteristics of the Sentinel Lymph Node in Breast Cancer Predict Further Involvement of Higher-Echelon Nodes in the Axilla

Kamath, Vidyulata; Giuliano, Rosemary; Dauway, Emilia L.; Cantor, Alan; Berman, Claudia G.; Ku, Ni Ni; Cox, Charles E.; Reintgen, Douglas S.

doi:10.1001/archsurg.136.6.688

Cited by 163 publications

(99 citation statements)

References 24 publications

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“…3). 14 • • a Mignotte et al 15 ⅙ c ⅙ a,c Canavese et al 16 ⅙ Three of four studies evaluating EE found a statistically higher proportion of patients with positive NSNs when EE was present (Fig. 4).…”

Section: Resultsmentioning

confidence: 95%

“…12 In the remaining three studies, the histologic evaluation of the NSNs was not able to be determined. 13,14,16 One study reported data concerning NSNs both with and without the use of IHC for three characteristics: tumor size, metastasis size, and lymphovascular invasion (LVI). 10 Data regarding the remaining factors reported in that study reflect the use of IHC on NSNs.…”

Section: Resultsmentioning

confidence: 99%

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Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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BACKGROUNDIn breast carcinoma patients with a positive sentinel lymph node (SN), the value of complete axillary lymph node dissection has been questioned. Multiple published reports have attempted to identify clinicopathologic characteristics of the primary tumor and SN that are associated with an increased likelihood of positive nonsentinel lymph nodes (NSN). Because of differences in lymph node evaluation techniques and limited patient numbers in each study, the authors performed a meta‐analysis to assess the regularity and relative strength of association between various characteristics and the risk of NSN metastasis.METHODSA MEDLINE search identified 15 candidate studies, 11 of which met the criteria for analysis. General elements of the studies, the pathologic characteristics evaluated, and the results for selected characteristics were compared. Original data were abstracted from each study and used to calculate odds ratios. The Mantel–Haenszel common odds ratios were calculated to determine the relative strength of the associations.RESULTSDespite methodologic differences, the correlation between positive NSNs and certain pathologic characteristics was found to be remarkably similar among studies. The 5 individual characteristics found to be associated with the highest likelihood of NSN metastasis are SN metastasis > 2 mm in size, extranodal extension in the SN, tumor size > 2 cm, > 1 positive SN, and lymphovascular invasion in the primary tumor.CONCLUSIONSThere is general concordance among studies regarding the association between pathologic characteristics and NSN metastasis in breast carcinoma patients with a positive SN. The pooled analysis identified those factors with the strongest associations that should be evaluated routinely in SN specimens and included in prospective databases for the development of a predictive model. Cancer 2003. © 2003 American Cancer Society.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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“…The risk of further nonsentinel lymph node involvement was reported to be approximately 15% to 20% in patients with sentinel lymph node micrometastasis detected by histological examination [25][26][27][28][29] ; however, it remains controversial whether completion axillary lymph node dissection is needed for patients with sentinel lymph node micrometastasis [30][31][32][33][34] or micrometastasis has a prognostic impact. 2,19,21,35,36 One of the reasons for these controversies is that the conventional histopathological examination is not standardized, and its ability to measure accurate total metastatic volume in a lymph node, particularly for low-volume metastases, is limited.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative molecular assay for sentinel lymph node metastases in early stage breast cancer

Osako

Iwase

Kimura

et al. 2011

Cancer

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BACKGROUND: Conventional histopathological examination is limited in measuring accurate total metastatic volume in a lymph node. Recently, a molecular-based procedure to detect lymph node metastases, one-step nucleic acid amplification (OSNA) assay, has been developed. OSNA assay can assess a whole lymph node and yields semiquantitative results. The authors compared the performance in intraoperative detection of sentinel lymph node metastases with OSNA assay using a whole lymph node versus routine frozen section (FS) histology with a 2 mm-sectioned lymph node. METHODS: Subjects comprised 531 consecutive patients diagnosed with OSNA assay and 618 consecutive patients diagnosed with FS histological examination. The authors compared the sentinel lymph node-positive rate between the OSNA and FS cohorts, and investigated characteristics of patients for whom OSNA could detect metastases but FS could not. OSNA (þ) was defined as micrometastasis, and OSNA (þþ) and (þI) were defined as macrometastasis. RESULTS: OSNA assay detected more cases of sentinel lymph node metastases than FS histology (OSNA 121 of 531, 22.8% vs FS 109 of 618, 17.6%; P ¼ .036), particularly micrometastases (46 of 531, 8.7% vs 28 of 618, 4.5%; P ¼ .0064). There was no difference in macrometastasis detection between OSNA and FS (75 of 531, 14.1% vs 81 of 618, 13.1%; P ¼ .68). OSNA detected more metastases than FS in postmenopausal patients (77 of 302, 25.5% vs 43 of 351, 12.3%; P < .0001), and in tumors without fat invasion (23 of 156, 14.7% vs 6 of 151, 4.0%; P ¼ .012) or lymphovascular invasion (67 of 395, 17.0% vs 45 of 458, 9.8%; P ¼ .042). CONCLUSIONS: Intraoperative OSNA assay detects more sentinel lymph node metastases, particularly micrometastases, than does FS histology. OSNA assay can also detect more metastases in postmenopausal patients or from less aggressive primary tumors compared with FS histology. Cancer 2011;117:4365-

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“…Only 40%-50% of patients with a positive SLN will be found to have further disease in the nonsentinel lymph nodes. Studies have shown that the size of the primary tumor and tumor burden in the SLN are the major determinants for nonsentinel lymph node involvement with metastatic disease [46,47]. However, the risk of further nonsentinel lymph node disease is significant, even with micrometastasis in the SLNs.…”

Section: Breastmentioning

confidence: 99%

Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

2003

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Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. Morton first described the application of lymphatic mapping for melanoma only a decade ago, and this technique is now accepted as the standard of care. The application for lymphatic mapping and sentinel lymph node biopsy in breast cancer remains approximately 5 years behind its utilization in melanoma.This technique has the potential to be utilized in all solid tumors. The rapid assent of this technique in clinical practice is the result of multiple factors, including accuracy, decreased morbidity, and supplying the pathologist with only a few nodes to allow a more focused and sensitive pathologic evaluation. Despite the success and acceptance of lymphatic mapping, many controversies remain. We have attempted to clearly highlight these controversies in this review.

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Characteristics of the Sentinel Lymph Node in Breast Cancer Predict Further Involvement of Higher-Echelon Nodes in the Axilla

Cited by 163 publications

References 24 publications

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Intraoperative molecular assay for sentinel lymph node metastases in early stage breast cancer

Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

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