Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node

Turner, Roderick R.; Chu, Kyo U.; Qi, Karen; Botnick, Leslie E.; Hansen, Nora M.; Glass, Edwin C.; Giuliano, Armando E.

doi:10.1002/1097-0142(20000801)89:3<574::aid-cncr12>3.0.co;2-y

Cited by 267 publications

(168 citation statements)

References 32 publications

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“…3,6 -19 One study 3 was excluded because of presumed overlap of the dataset with another study. 10 Two studies 17,18 were excluded because the evaluations were limited to patients with micrometastatic disease in the SN, a group that was potentially dissimilar from the populations of the remaining studies. A fourth study 19 was excluded because the data regarding completion ALND findings were correlated with features among the collective group of SN cases; data concerning the subset of SN-positive patients were not reported.…”

Section: Resultsmentioning

confidence: 99%

“…6,7,9,11,15 In addition to H & E staining, three studies performed IHC and additional sections on NSNs. Of these 3 studies, 1 evaluated NSNs on 2 levels with a 250-m interval, 8 1 evaluated NSNs on 2 levels with a 40-m interval, 10 and 1 evaluated 3-8 levels in the subgroup of patients with primary tumors measuring Ͻ 2 cm and micrometastasis in the SN. 12 In the remaining three studies, the histologic evaluation of the NSNs was not able to be determined.…”

Section: Resultsmentioning

confidence: 99%

“…13,14,16 One study reported data concerning NSNs both with and without the use of IHC for three characteristics: tumor size, metastasis size, and lymphovascular invasion (LVI). 10 Data regarding the remaining factors reported in that study reflect the use of IHC on NSNs. We constructed graphs based on data reporting NSNs found to be positive by H & E evaluation unless otherwise specified.…”

Section: Resultsmentioning

confidence: 99%

“…The third study found that utilizing IHC as the method of detection of metastasis in the SN was correlated with a lower likelihood of NSN metastasis, 10 although it could be argued this is a surrogate assessment of size of metastasis in the SN. Other characteristics evaluated that were not found to be statistically significant included type of breast procedure, 9 mitotic count 12 or mitotic activity index, 8 palpable axillary lymph node, 10 S-phase fraction, 10 and DNA ploidy. 10 The apparent increase in the proportion of positive NSNs as the tumor size increases is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Other characteristics evaluated that were not found to be statistically significant included type of breast procedure, 9 mitotic count 12 or mitotic activity index, 8 palpable axillary lymph node, 10 S-phase fraction, 10 and DNA ploidy. 10 The apparent increase in the proportion of positive NSNs as the tumor size increases is shown in Figure 1. Despite some variability among the studies, there appears to be general concordance that the proportion of patients with positive NSNs increases with increasing tumor size.…”

Section: Resultsmentioning

confidence: 99%

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

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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BACKGROUNDIn breast carcinoma patients with a positive sentinel lymph node (SN), the value of complete axillary lymph node dissection has been questioned. Multiple published reports have attempted to identify clinicopathologic characteristics of the primary tumor and SN that are associated with an increased likelihood of positive nonsentinel lymph nodes (NSN). Because of differences in lymph node evaluation techniques and limited patient numbers in each study, the authors performed a meta‐analysis to assess the regularity and relative strength of association between various characteristics and the risk of NSN metastasis.METHODSA MEDLINE search identified 15 candidate studies, 11 of which met the criteria for analysis. General elements of the studies, the pathologic characteristics evaluated, and the results for selected characteristics were compared. Original data were abstracted from each study and used to calculate odds ratios. The Mantel–Haenszel common odds ratios were calculated to determine the relative strength of the associations.RESULTSDespite methodologic differences, the correlation between positive NSNs and certain pathologic characteristics was found to be remarkably similar among studies. The 5 individual characteristics found to be associated with the highest likelihood of NSN metastasis are SN metastasis > 2 mm in size, extranodal extension in the SN, tumor size > 2 cm, > 1 positive SN, and lymphovascular invasion in the primary tumor.CONCLUSIONSThere is general concordance among studies regarding the association between pathologic characteristics and NSN metastasis in breast carcinoma patients with a positive SN. The pooled analysis identified those factors with the strongest associations that should be evaluated routinely in SN specimens and included in prospective databases for the development of a predictive model. Cancer 2003. © 2003 American Cancer Society.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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Predicting the Status of the Nonsentinel Axillary Nodes

et al. 2001

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Predictors of Nonsentinel Node Metastasis in Patients With Breast Cancer After Sentinel Node Metastasis

Joseph¹

2004

Arch Surg

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The presence of nonsentinel lymph node (NSLN) metastasis after having a positive sentinel lymph node dissection finding is associated with tumor size and stage, the presence of lymphovascular invasion, micrometastasis, and extranodal extension. Design: Retrospective case series. Setting: University hospital. Patients: Four hundred seven consecutive patients at a single institution who underwent sentinel lymph node dissection as part of breast conservation or mastectomy with biopsy-proved cancer. Intervention: Completion axillary lymph node dissection and definitive therapy. Main Outcome Measures: Sentinel node metastasis, NSLN metastasis, tumor size and stage, lymphovacular invasion, micrometastasis, extronodal extension, histological tumor characteristics, and number of sentinel nodes removed. Results: In a univariate analysis, size of the primary tumor and extranodal extension were associated with having positive NSLN findings. The presence of micrometastasis was associated with negative NSLN findings. When all factors were included in a logistic regression analysis, the significant predictor of NSLN metastasis was extranodal extension (P = .002). Lymphovascular invasion was not associated with positive NSLN findings (P=.11). The number of sentinel nodes removed also had no bearing on the status of the NSLNs (P =.37). Conclusions: Although primary tumor size and micrometastases correlate with the status of the NSLNs, extranodal extension is the most important independent predictor of NSLN metastasis. These findings may ultimately spare patients a full axillary lymph node dissection. However, pending results of larger clinical trials, full axillary lymph node dissection is still recommended for patients with sentinel lymph node metastases.

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Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node

Cited by 267 publications

References 32 publications

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

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

Predicting the Status of the Nonsentinel Axillary Nodes

Predictors of Nonsentinel Node Metastasis in Patients With Breast Cancer After Sentinel Node Metastasis

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