Factors predicting the sentinel and non-sentinel lymph node metastases in breast cancer

Abstract

The sentinel lymph node (SLN) is the only focus of axillary metastasis in a significant proportion of patients. In this single institutional study, clinicopathologic characteristics were investigated to determine the factors predicting the status of a SLN biopsy and the metastatic involvement of non-SLNs. Data were retrospectively reveiwed for 400 consecutive patients with clinical T1/T2 N0 breast cancer who underwent a SLN biopsy including axillary and/or internal mammary lymph nodes. The SLNs were evaluated by using the new AJCC staging criteria following multiple sectioning and immunohistochemical (IHC) analyses of nodes. The SLN contained metastases in 148 patients (38.5%) including 18 patients (12.2%) with micrometastases (<or=0.2 mm) and 130 patients (87.8%) with macrometastases (>0.2 cm). Five patients had isolated tumor cells detected by IHC (<or=0.2 mm, N(0i)). Patients with tumor size more than 2 cm (T1, 29.8% versus T2, 51.6%; OR=2.31, 95% CI, 1.50-3.56) and lymphovascular invasion (LVI-, 30.3% versus LVI+, 51.3%; OR=2.07, 95% CI, 1.34-3.19) were more likely to have positive SLNs in both univariate and multivariate analyses. Among patients with a positive SLN biopsy, those with T2 tumors (versus T1; 63.1% versus 36.9; OR=2.93, 95% CI, 1.43-6.04), macrometastases in SLNs (versus micrometastases; 88.9% versus 11.1%; OR=8.83; 95% CI, 1.82-42.87) and extracapsular node extension (versus without extracapsular node extension; 65.4% versus 34.6%; OR, 2.23; 95% CI, 1.05-4.72) were more likely to have non-SLN metastases in both univariate and multivarite analyses. These results indicate that clinicopathologic factors might be helpful to select patients who were less likely to have negative SLN or non-SLNs. However, additional factors are still needed to be identified to omit surgical axillary staging.

Factors Predicting Microinvasion in Ductal Carcinoma in situ

“…Similarly, according to a study by Baxter et al (2004), the rate of mastectomy decreased from 43% in 1992 to 28% in 1999, and the rate of ALND decreased from 34 to 15% during the same time period (Baxter et al, 2004). In agreement with all these studies, we also found an increased rate of BCS and SLNB in patients with DCIS or DCISM at our institution after 2004, whereas the mastectomy rate and ALND rate were significantly decreased between 2004 and 2008 compared to the corresponding rates for the period between 1996-2004 (Ozmen et al, 2006).…”

Increased Sentinel Lymph Node Lymphangiogenesis is Associated with Nonsentinel Axillary Lymph Node Involvement in Breast Cancer Patients with a Positive Sentinel Node

“…The median number of nonsentinel axillary LNs resected was 13 (3 -29). Metastatic involvement of at least one nonsentinel axillary LN was found in 37 of 65 (56.9%) patients, with the median number of involved nonsentinel axillary LNs being 3 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Neither the size of the primary tumor, nor Nottingham grade, nor estrogen receptor, progesterone receptor, or Her2 status, nor the involvement of more than one sentinel LN, were correlated with the presence of nonsentinel LN metastases.…”

Clinicopathologic Features Predicting Involvement of Nonsentinel Axillary Lymph Nodes in Iranian Women with Breast Cancer

“…ECI of the axillary lymph node is an index for aggressive tumor behavior in breast cancer and the patients with ECI have an obvious poorer outcome (Altinyollar et al, 2007). In many studies, ECI was a predictor of NSLNM (Stitzenberg et al, 2003;Van Zee et al, 2003;Ozmen et al, 2006;Beriwal et al, 2008;Fujii et al, 2010;Boler et al, 2012;Derici et al, 2012;Scomersi et al, 2012), although in some other studies this relationship was not found or evaluated (Yu et al, 2005;Wada et al, 2006;Guray Durak et al, 2011). In a meta-analysis by Degmin et al, the size of the SLN metastasis, ECI, primary tumor size, and LVI, were defined as predicting factors of NSLNM (Degnim et al, 2003).…”

“…Some investigations have revealed that multifocality of the primary tumor is a predictor of NSLNM (Ozmen et al, 2006;Fougo et al, 2009). In the present study, the relationship between multifocality of the primary tumor and NSLNM was significant in univariate analysis, but it was not significant in multivariate analysis.…”

“…Nowadays, there is an increased tendency to avoid completion ALND in selected patients with a positive SLN (Noguchi, 2008). Many studies have identified factors including tumor size, histological type, nuclear and histological grade, lymphovascular invasion (LVI), estrogen and progesterone receptor (ER and PR) status, and HER-2/neu expression, as predictors of NSLN metastasis (NSLNM) in patients with a positive SLN (Yu et al, 2005;Ozmen et al, 2006;Wada et al, 2006;Kapur et al, 2007;Boler et al, 2012;Eldweny et al, 2012). These factors have been used to develop nomograms to predict the risk of NSLNM (Van Zee et al, 2003;Barranger et al, 2005;Kohrt et al, 2008;Pal et al, 2008).…”