Micrometastases in Sentinel Lymph Node in a Multicentric Study: Predictive Factors of Nonsentinel Lymph Node Involvement—Groupe Des Chirurgiens De La Federation Des Centres De Lutte Contre Le Cancer

Abstract

This study confirms the value of serial sections and the vital role played by IHC in screening for small micrometastases. Omission of additional ALND may be envisaged with minimal risk for pT1a and pT1b tumors, and pT1a-b-c tumors corresponding to tubular, colloidal, or medullar cancers.

Axillary Lymph Node Status in Early-Stage Breast Cancer Patients with Sentinel Node Micrometastases (0.2-2 mm)

“…Previously, clinical predictors found to display risk for NSN involvement include: age, menopausal status, primary tumor size, grade, number of SNs, number of positive lymph nodes, size of SN metastases, lymphovascular invasion and identification by H&E or IHC staining [17,25,26,27,28,29]. In our study the number of SNs removed during the SN procedure was a significant predictor of positive NSN status.…”

“…The risk of harboring additional NSN metastases if the SN is afflicted with micrometastatic disease (pN1mi) reportedly ranges from 13.4 to 26% [17,18,19,20]. Cserni and colleagues estimated the risk to hover between 10% and 15% for micrometastases and isolated tumor cells [21].…”

The clinical significance of sentinel lymph node micrometastasis in breast cancer

“…Furthermore, within those with SLN MM no subgroup of tumour size or grade could be identified that did not have non-SLN involvement. Interestingly, Houvenaeghel et al [50] found that the method employed for MM detection was a significant predictive factor for non-SLN involvement. Furthermore, Tommaso et al [51] demonstrated that the anatomical location of MM within the SLN was an independent predictor of non-SLN involvement, with intranodal lesions being more strongly associated with non-SLN metastasis than sinusal lesions.…”

Clinical significance of sentinel lymph node isolated tumour cells in breast cancer

“…Cserni et al [40,41] found SLN ITC to be associated with a non-SLN metastatic rate of 8.5-13.5%. The French multicentre study reported relatively high rates (16%) of non-SLN metastases associated with SLN ITC, without a statistically significant difference between ITC and MM for predicting non-SLN positivity (16% vs. 14.3%) [55]. Interestingly, the detection method was a significant predictor of non-SLN involvement.…”