Clinical implications of axillary sentinel lymph node ‘micrometastases’ in breast cancer

Krauth, J.-S.; Charitansky, H.; Isaac, Sylvie; Bobin, J. Y.

doi:10.1016/j.ejso.2006.01.003

Cited by 15 publications

(3 citation statements)

References 21 publications

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“…Some argue that the prognosis of patients with N1mi is similar to the outcome of patients with no lymph node (N0) involvement. Others, however, believe that N1mi is of prognostic significance and hence consider TNM-stage N1mi as an indication for adjuvant systemic therapy [15,16,18,22].…”

Section: Introductionmentioning

confidence: 99%

Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

et al. 2008

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Due to the extensive pathologic evaluation of the sentinel lymph node (SLN), micrometastases are frequently observed. If micrometastases are clinically relevant, the histopathologic examination of SLNs should be sensitive enough to detect them. The probability of detecting micrometastases was calculated when examining the SLN according to the current Dutch pathology protocol and strategies evaluated to optimize the chance of detection. The dimensions of 20 consecutive axillary SLNs in patients with cT1-2N0 breast cancer were measured. In a mathematical model, the probability of detecting micrometastases in a SLN was calculated. Similarly, strategies to optimize the probability of detecting micrometastases were explored. When applying the pathology guidelines, the calculated probability to detect a micrometastasis was 18% for a 200-microm micrometastasis and 69% for a 2.0-mm metastasis in a median sized SLN. To detect the smallest micrometastasis in a median-sized SLN with a 95% probability, the interval between the sections must be decreased to 200 microm, and 20 levels from both halves must be examined. Given a prognostic significance of micrometastases, our current pathology guidelines are not sensitive enough. The number of sections should be increased, while the interval between cuts should be no more than 200 microm.

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Section: Introductionmentioning

confidence: 99%

Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

et al. 2008

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“…Cox et al 13 suggests that micrometastatic disease occupies a separate level of risk stratification from node-negative disease and that significant differences in survival are present, enough to warrant ALND. Krauth et al 14 reports an average of 15 to 20 per cent of SLN micrometastasis cases associated with NSLN metastasis. Detractors of the ALND procedure, however, will submit that node-negative disease and SLN micrometastatic disease had similar recurrence rates in the setting of sentinel lymph node biopsy (SLNB) alone versus use of ALND.…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of Micrometastasis in Nonsentinel Lymph Nodes

Glasgow

Satchidanand

Kowdley

2012

The American Surgeon

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The rate of micrometastatic disease (MMD) to nonsentinel lymph nodes (NSLNs) has been shown to vary considerably in the literature. We identified patients with breast cancer with MMD (N1mi) and measured the incidence of NSLN involvement. We then compared these patients with those who had no metastasis to the SLN (N0) and those who had macrometastasis to the SLN (N2) in an attempt to better understand the behavior of patients with N1mi positivity. A retrospective analysis was conducted on 574 patients with invasive breast cancer between January 2000 and December 2007. Patients were stratified into three groups: no metastasis (N0), MMD (N1mi), and macrometastasis (N2). Chi square analysis and logistic regression models using SPSS software were applied to determine significance between groups. MMD rate was 7.7 per cent (44 of 574). Of this subset of patients, 33 underwent completion axillary dissection, and only two were found to have NSLN-positive disease. Statistical significance was achieved for NSLN positivity when comparing all three nodal groups against one another (χ22,572 = 337.084, P = 0.000). Logistic regression showed multifocality and lymphovascular invasion to be significant predictors of NSLN metastasis. NSLN positivity in patients with MMD acts similarly to node-positive disease and therefore cannot completely exclude axillary dissection from therapeutic algorithm.

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“…It remains to be determined whether ALND is always required for women with SN positivity on final histology, because 40-70% of these patients have no metastatic non-sentinel nodes (non-SN) [4][5][6][7][8][9][10]. The likelihood of non-SN metastasis depends on several factors, such as histological primary tumor size, the size of SN metastasis, the number of positive SN, the ratio of positive SN to all removed SN, and the extracapsular extension status of the positive SN [5,[8][9][10][11][12][13][14][15][16]. However, none of these characteristics can alone identify a subset of patients in whom ALND is unnecessary.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Tenon breast cancer score for predicting non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis: a prospective multicenter study

Coutant

Rouzier

Fondrinier³

et al. 2008

Breast Cancer Res Treat

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Clinical implications of axillary sentinel lymph node ‘micrometastases’ in breast cancer

Cited by 15 publications

References 21 publications

Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients

The Predictive Value of Micrometastasis in Nonsentinel Lymph Nodes

Validation of the Tenon breast cancer score for predicting non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis: a prospective multicenter study

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