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

Degnim, Amy C.; Griffith, Kent A.; Sabel, Michael S.; Hayes, Daniel F.; Cimmino, Vincent M.; Diehl, Kathleen M.; Lucas, Peter C.; Snyder, Matthew L.; Chang, Alfred E.; Newman, Lisa A.

doi:10.1002/cncr.11803

Cited by 139 publications

(79 citation statements)

References 32 publications

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“…29,30 Degnim et al performed a meta-analysis of 15 previous studies in which it was shown that the presence of any one of these characteristics would increase the likelihood of nonsentinel node metastasis by at least twofold, and that any subgroup with just one of these characteristics present had a 410% chance of nonsentinel node metastasis. While in this series, tumor size (T1 vs T2 or greater), size of sentinel node metastasis (macro-vs micrometastasis), tumor grade, presence of lymphvascular invasion, and extranodal extension of sentinel node metastases were all found to significantly increase the chance for metastatic disease (either micro or macrometastatic) in sentinel and nonsentinel nodes as expected, they did not necessarily discriminate between patients with micro-vs macrometastatic nodal disease.…”

Section: Discussionmentioning

confidence: 99%

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

et al. 2005

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The decision whether to proceed with complete axillary node dissection based on sentinel node status is clear for patients with negative or macrometastatic disease. However, the course of action based on sentinel node micrometastasis remains controversial. We reviewed 358 cases from 6/1999 to 7/2003. All sentinel nodes were evaluated at three levels by frozen section, touch preparation, and scrape preparation. Micrometastasis was defined as tumor deposits between 0.2 and 2 mm. Size, grade, and lymphvascular invasion of the primary tumor, as well as number, status, size of metastatic disease, and presence of extranodal capsular extension of sentinel and nonsentinel nodes were recorded. Of the 358 cases, 89 had positive sentinel nodes, 29 of which represented micrometastases. Only one (3%) of the 29 cases contained a nonsentinel node with macrometastasis. In 60 of the 89 cases sentinel nodes contained macrometastases. Of these, 38 cases (63%) had metastatic tumor in nonsentinel nodes. Intraoperative consult was performed in 53 of the 89 cases with positive sentinel nodes. Only 1 of the 19 (5%) intraoperative consult cases with micrometastatic sentinel nodes had positive nonsentinel nodes, while 21 of 34 (62%) of macrometastatic sentinel nodes at intraoperative consult had tumor in nonsentinel nodes. No single variable studied discriminated between micro-vs macrometastatic disease. At intraoperative consult, macrometastatic disease was present in all three diagnostic preparations, while diagnostic material in micrometastatic sentinel nodes was usually present in only one modality. This analysis suggests that the risk of finding tumor in nonsentinel nodes differs significantly between cases with micro (3%)-vs macro (63%)-metastatic disease in sentinel nodes. This holds true for cases assessed by intraoperative consult. Considering the known morbidity of complete axillary dissection, assessments of risk vs benefit of undertaking this procedure should be performed on a case-by-case basis in patients with sentinel node micrometastases. Modern Pathology (2005) 18, 762-768, advance online publication, 11 March 2005; doi:10.1038/modpathol.3800394Keywords: axillary node dissection; breast cancer; intraoperative consult; macrometastasis; micrometastasis; nonsentinel node; sentinel node Sentinel node mapping for patients with breast cancer and clinically negative axilla has become the standard of care in many cancer centers. While it is well documented that this technique accurately predicts axillary node status in over 90% of the cases, 1-8 there are many relevant clinical decisions and surgical practices that have not been completely standardized. These include: (a) immediate complete axillary dissection based on sentinel node status at intraoperative consult vs complete axillary dissection as part of a second surgical procedure; (b) clinical value of complete axillary dissection following sentinel node micrometastasis; 9-11 (c) clinical significance of tumor deposits less than 0.2 mm in size, detected either by hematoxyli...

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Section: Discussionmentioning

confidence: 99%

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

et al. 2005

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“…Degnim et al 5 conducted a meta-analysis of studies involving SLN biopsy with concomitant ALND, and this pooled analysis provided a robust assessment of the clinicopathologic features associated with the likelihood of detecting metastatic disease in non-SLNs. Both of these investigators have found primary tumor size and extent of SLN pathology to be strong predictors of non-SLN disease.…”

Section: A K Rivers Et Almentioning

confidence: 99%

“…6,7 As shown in Table 5, approximately 10% to 16% of SLN-positive breast cancer patients will fall into this high-risk category, and these patients clearly benefit from aggressive surgical and radiotherapeutic approaches aimed at optimizing locoregional control of disease. We therefore sought to develop a model based on the clinicopathologic features studied by Van Zee et al 4 and Degnim et al 5 to specifically identify SLN-positive patients with extensive axillary nodal disease.…”

Section: A K Rivers Et Almentioning

confidence: 99%

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

et al. 2006

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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.

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“…The results of the recently published meta-analysis demonstrated that in the presence of any one of the five characteristics (metastatic size of SLN >2.0 mm, presence of extranodal extension in the SLN, size of primary tumor >2.0 cm, more than one positive SLN, or presence of lymphovascular invasion in the primary tumor), there is a >2-fold increase in the chance of additional metastasis in NSLNs (6). However, whether biological markers could be used to predict NSLN metastasis in breast cancer patients with SLN metastasis has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological parameters and biological markers predicting non-sentinel node metastasis in sentinel node-positive breast cancer patients

Kwon

Kang

et al. 2011

Oncol Rep

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Abstract. The value of complete axillary lymph node dissection (ALND) has been questioned in invasive breast cancer (IBC) patients with positive sentinel lymph nodes (SLNs) who have no non-sentinel lymph node (NSLN) metastases. Because biological markers have not been systematically studied in this setting, we sought to identify clinicopathological characteristics and biological markers for predicting NSLN metastases in SLN-positive IBC patients. Two hundred and five IBC patients who had at least one positive SLN and received SLN biopsy and ALND were included in our study. We examined the clinicopathological characteristics of their primary tumors, SLNs and NSLNs. We also evaluated the biological markers of the primary tumors by tissue microarray and immunohistochemistry. Of the 205 patients with SLN metastases, 89 patients (43.4%) had additional metastases in NSLNs. The following factors were found to be associated with NSLN metastases: peritumoral lymphovascular invasion (p=0.01), two or more metastatic SLNs (p<0.01), SLN metastasis >2.0 mm (p<0.01) and extranodal extension (p<0.01). Primary tumors >2.0 cm showed more NSLN metastases, but the association was statistically insignificant (p=0.08). In contrast, NSLN metastases were not associated with histologic grade, histologic type, presence of extensive intraductal component, presence of high grade ductal carcinoma in situ and number of harvested SLNs. Biological markers such as E-cadherin, CD44, cyclin D1, p21, ER, PR, c-erbB2, p53, Ki-67, luminal (CK7, CK18, CK19) and basal (CK5, p63) markers were not useful predictors of NSLN metastasis in IBC patients with SLN metastases. Multivariate analysis revealed that SLN metastasis >2.0 mm (p=0.01), two or more metastatic SLNs (p=0.03) and extranodal extension (p<0.01) were independent predictors of NSLN metastasis. For the prediction of NSLN metastasis in IBC patients with SLN metastases, light microscopic evaluation of the number, size and extranodal extension of metastatic SLNs by hematoxylin and eosin staining appeared to be critical. However, the biological markers of primary tumor characterized by immunohistochemical staining, such as luminal and basal markers, hormone receptors, E-cadherin, CD44, cyclin D1, p21, c-erb-B2, p53 and Ki-67, did not appear to be helpful predictors.

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

Cited by 139 publications

References 32 publications

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

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

Clinicopathological parameters and biological markers predicting non-sentinel node metastasis in sentinel node-positive breast cancer patients

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