Clinical Significance of Lymph Node Ratio in Locally Advanced Breast Cancer Molecular Subtypes

Abstract

Background: The ratio of metastatic to dissected lymph nodes (lymph node ratio; LNR) is a sensitive and superior prognostic factor for lymph node evaluation, but its relationship to cancer subtypes is unclear. Patients and Methods: Data from 469 patients with axillary lymph node metastasis out of 640 early breast cancer cases were retrospectively analyzed. They were classified into 4 molecular subtypes; luminal A, luminal B HER2(+), HER2 overexpression, basal-like. LNRs were compared between groups and with other prognostic factors. Results: The distribution of LNRs was 35.2% in luminal A, 43.2% in luminal B HER2(+), 46.9% in HER2 over-expression, and 39.1% in basal-like. A significant difference was found between luminal A and HER2 over-expression subtypes (p = 0.023). LNR was significantly correlated with tumor size and lymphovascular invasion, but not with other prognostic factors including menopausal status, laterality, grade, and perineural invasion. An LNR of 29.8% was defined as the cut-off value, and significant differences in survival rates were identified accordingly between basal-like and both luminal A (p = 0.003) and luminal B HER2(+) (p = 0.04). Conclusion: The LNR differs between some molecular subtypes of breast cancer, and it correlates with certain prognostic factors and survival. These data support using the LNR to assess breast cancer patients.

Association between digital breast tomosynthesis and molecular subtypes of breast cancer

“…In summary, the LNR was different in certain molecular subtypes of breast cancer and was associated with prognostic indicators and survival. These results support the use of LNR to evaluate breast cancer (31). In the present study, the imaging characteristics detected by DBT, including tumor margin, surrounding bright ring of tumor, vascular images and associations with surrounding glandular tissue were not markedly different in different molecular subtypes of breast cancer.…”

“…When certain cases could not be observed through the MLO view, lymph nodes were also observed by magnification mammography (data not shown); however, the lymph node could generally only be observed by MLO view. It has been suggested that the ratio of metastatic to dissected lymph nodes, termed the lymph node ratio (LNR), can be used as a superior prognostic factor with a high sensitivity for evaluating lymph nodes (31). In a previous study, among 640 early breast cancer cases, data collected from 469 cases with axillary lymph node metastasis were retrospectively analyzed (31).…”

“…It has been suggested that the ratio of metastatic to dissected lymph nodes, termed the lymph node ratio (LNR), can be used as a superior prognostic factor with a high sensitivity for evaluating lymph nodes (31). In a previous study, among 640 early breast cancer cases, data collected from 469 cases with axillary lymph node metastasis were retrospectively analyzed (31). The LNR in luminal A, luminal B HER-2 + , HER-2-overexpression and basal-like subtypes was 35.2, 43.2, 46.9 and 39.1%, respectively.…”