Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

Abstract

Background:The survival benefit of a completion axillary lymph node dissection (ALND) in patients after removal of a metastatic sentinel lymph node (SLN) is uncertain and is under study in ongoing clinical trials. The completion ALND remains necessary, however, for the identification of cases with at least four metastatic lymph nodes, in which extended-field locoregional and/or postmastectomy radiation will be recommended. Our goal was evaluate clinicopathologic features that might serve as surrogates for determining which patients with a positive SLN are likely or unlikely to belong to this high-risk subset.Methods: Records were reviewed for 285 patients from 2 comprehensive cancer centers who underwent completion ALND after resection of a metastatic SLN from 1995 to 2002. Clinicopathologic features were analyzed by univariate and multivariate logistic regression. Fortyone cases (14%) were found to have at least four positive nodes after ALND.Results: FisherÕs exact test revealed the following features to be significantly (P < .05) associated with having four or more nodal metastases: tumor size >2 cm, lymphovascular invasion, an increasing ratio of positive SLNs to the total number of resected SLNs, extranodal extension, and the size of the SLN metastasis. Patients whose largest SLN metastasis was <2 mm had only a 1.4% risk of having four or more metastatic nodes (P < .0001).Conclusions: We conclude that patients with SLN micrometastases face an extremely low likelihood of having extensive nodal disease on completion ALND. Patients with larger primary tumors, lymphovascular invasion, and extranodal extension are more likely to have ALND findings that will affect their cancer management.

Factors that determine whether a patient receives completion axillary lymph node dissection after a positive sentinel lymph node biopsy in breast cancer in British Columbia

“…Breast lesions exceeding 2 cm in size have been reported to be predictors of a high number of lymph node metastases. 16 In this study, however, the size of breast lesions was similar between the 2 groups at a median of less than 2 cm. Since more than 50% of tumours were T1 stage, the size of the tumour did not appear to influence the type of surgery.…”

“…Since the total number of nodes removed on CALND was expected to be higher than that in SLNB, we did not perform a statistical comparison. However, a higher percentage of positive SLNs was strongly predictive of further CALND, a course of action supported by the literature, which shows a higher percentage of positive SLNs to be predictive of higher likelihood of axillary lymph node (ALN) involvement 16 as well as decreased survival. 17 Interestingly, the size of metastasis in the largest node was not a predictor of further CALND, but having microscopic disease made it less likely for a patient to undergo further CALND.…”

Histopathologic Characteristics of Sentinel Lymph Node Biopsy in Breast Carcinoma: Uludağ University Faculty of Medicine Experience

“…17 In our study we found the same results. Bols ter et al and Co u fal et al sta ted that the in ciden ce of n-SLN me tas ta ses was re la ted to the si ze of the SLN me tas ta ses.…”

304 Meta-analysis of predictive factors for non sentinel lymph node metastases in breast cancer patients with a positive SLN

“…Six studies only focused on predictive factors for having at least 4 positive axillary nodes [70][71][72][73][74][75]. Seven studies only evaluated patients with SLN micrometastases [8;76-81].…”

“…Potentially appropriate references to be included in review, n= 64 Predictive factors in SLN micromets, n= 7 excluded [5,[75][76][77][78][79][80] References retrieved for more detailed evaluation, n= 85 Predictive factors for ≥ 4 positive axillary nodes, n= 6 excluded [69][70][71][72][73][74] No SLN performed, only predictive factors of positive ALND, n= 17 excluded [4,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] References with usable information, n= 56 -SNB performed -completion ALND in SLN+ cases -data on predictive factors for positive NSN Meta-analysis, n= 1 excluded [87] No raw data, n= 4 excluded [13,20,81,82] Overlap of data between studies, n= 5 excluded [11,22,23,88,89] SLN positive with CK-IHC only, n= 2 excluded [83][84] Only tumours < 15 mm, n= 1 excluded [86] Only special types of breast cancer, n=1 excluded …”