Correlation of axillary lymph nodes involvement and Nottingham prognostic index with various histopathologic prognostic factors in invasive breast carcinoma

Abstract

Background: Breast cancer is the commonest cancer of urban Indian women and the second commonest in the rural women. The clinical management of this tumor relies on various prognostic factors, most importantly lymph node stage, tumor size and histologic grade. There have been attempts at integration of these factors into meaningful indices. The most widely used of these is the Nottingham prognostic index (NPI), this study was aimed to evaluate the NPI in a group of breast cancer patients and to correlate NPI with other clinical and histo-morphological features.Methods: This was a two-year prospective, observational study was done in the Department of Surgery, Tertiary Care Teaching Hospital of Maharashtra, India. A total of 50 patients who presented with invasive carcinoma of breast from October 2016 to October 2018 were enrolled.Results: Most of the patients belonged to the age group of 41 to 50 years (34%) and the mean age of patients in study was 51.18±11.93 years. Left breast was more affected (62%) than the right breast (38%). Majority of the cases had tumor size of <5 cm (70%) and the mean size of was 4.65±1.89 cms. Majority of the patients (62%) belonged to Bloom Richardson (BR) Grade II and 24% of the patients were ER and PR positive. Lymphovascular invasion was present in 74% of the patients. There was significant positive correlation between tumor size and lymph node involvement. Significant correlation was noted between NPI score and tumor size, positive lymph nodes and BR grade. The mean NPI scores in patients with lymphovascular invasion were noted as 4.92±1.05, compared to 4.83±0.93 among the patients in whom lymphovascular invasion was absent (p=0.779). The mean NPI scores in patients with ER-, PR- were slightly high (4.91±0.94) compared to ER+, PR+ patients (4.76±1.19) (p=0.778).Conclusions: NPI is an essential and valuable prognostic indicator, which should be incorporated in breast cancer reporting by the histopathologists and also primary tumor size, lymph node stage and histological grade which provides further guideline to treating clinicians to choose treatment modalities for the patient and in deciding to follow up plan as well.

Axillary lymph nodes and breast cancer metastasis.

“…Shukla A et al in their study have also mentioned the mean age of patients 51.18±11.93 years. 18 This indicates earlier involvement of breast cancer in our population. Sharif MA et al in their study have mentioned that Majority (62%) patients with breast cancer were under 50 years as against the Western epidemiology.…”

“…but this does not have any influence on metastasis. 18 Like age, menopausal status has great influence breast carcinoma. 19 61.11% of patients were in pre-menopausal state.…”

Correlation of Expression of Estrogen Receptor, Progesterone Receptor and Human Epidermal Growth Factor Receptor-2 with Histopathological Grade in Cases of Carcinoma Breast

“…Our findings correlated well with the studies of Bhagat et al 3 and Thiyagarajan et al 16 with lymph node involvement seen in 53.44% and 53.3% of the cases respectively. However, Ahmed et al 19 , Nisa et al 18 and Siadati et al 8 21 , Agarwal et al 22 , Thangjam et al 23 and Shukla et al 24 We observed that positivity for estrogen receptor decreased as the grades increased. Maximum percentage of ER positivity was observed in cases with grade I (75%) which declined in grade II (44.11%) followed by grade III (11.11%).…”

Nottingham Prognostic Index: Useful tool to assess outcome inpatients of breast carcinoma

“…In our study 5out of 7 variables namely tumor size, Axillary lymph node score, grade of tumor, stage of disease and NPI were found to be statistically significant with p value less than 0.05.NPI with p value 0.001 was found to be the most significant variable in univariate analysis mirroring the findings of. 11,17,18 We found the positive correlation between NPI and outcome of patients having breast cancer. This outcome was assessed as recurrence at previously operated site, distant organ/lymph node metastasis and death.…”