Predicting the status of axillary sentinel lymph nodes in 4351 patients with invasive breast carcinoma treated in a single institution

Abstract

BACKGROUND. Reliable predictors of metastatic involvement would enable a better selection of candidate patients for sentinel lymph node biopsy (SLNB) and possibly allow identification of patients with such a low risk of axillary sentinel lymph node (SLN) involvement to be even spared SLNB. METHODS. The authors evaluated 4351 consecutive patients surgically treated for breast carcinoma who also underwent SLNB. Clinicopathologic features significantly associated with SLN metastases by univariate analysis were included in a multivariate model. RESULTS. By multivariate analysis, the prevalence of SLN metastases was associated directly with tumor size, multifocality, and with the occurrence of peritumoral vascular invasion (PVI; all P < 0.0001), and was associated inversely with a favorable histotype (P = 0.0007) and lack of progesterone receptors (P = 0.004). A predictive model based on the features more closely associated with SLN status documented that the patients with a favorable tumor type less than or equal to 1 cm in size and without PVI (n = 178 [4% of the population]) had the lowest risk of SLN metastases (9.5%) whereas patients with tumors > 2 cm and with PVI (n = 250 [5.7% of the population]) had the highest risk (77.2%) of SLN involvement. CONCLUSIONS. Tumor size and PVI emerged as the most powerful independent predictors of SLN metastases. Although no combination of features identified patients with a < 9.5% risk of SLN metastases, the current data may be used to tailor the management of patients with breast carcinoma with the aim of minimizing as much as possible the diagnostic and therapeutic procedures, thus improving the quality of life of the patients without any adverse effect on their survival rates. (C) 2004 American Cancer Society

Axillary Lymph Node Nanometastases Are Prognostic Factors for Disease-Free Survival and Metastatic Relapse in Breast Cancer Patients

“…Ductal carcinomas carried a higher risk. On the other hand, lobular carcinomas and better prognosis tumor types (cribriform, medullary, mucinous, and tubular) showed a lower incidence of metastatic lymph nodes (28). Small occult metastases were detected in 13% of the cases, consistently with earlier reports (5, 6, 8 -11, 24), and were more frequent in lobular than in ductal carcinomas (Table 1), consistent with previous reports (10,13).…”

“…Consistent with previous studies (28), histologic tumor types were found to correlate with the likelihood of macroscopic lymph node metastases. Ductal carcinomas carried a higher risk.…”

Factors Predicting the Axillary Lymph Node Metastasis in Breast Cancer: Is Axillary Node Clearance Indicated in Every Breast Cancer Patient?

“…Positive expression for ER and PR was significantly correlated with histological grade, mitotic score and nuclear pleomorphism [16]. In one of the series it has been documented that patients who underwent sentinel lymph node biopsy (SLNB), showed that the prevalence of SLN metastases had an inverse relationship with a lack of progesterone receptors [17]. The ER and PR levels do not contribute to the prediction of lymph node metastases since there was no correlation with node positivity [18].…”

Axillary lymph node status of operable breast cancers by combined steroid receptor and HER-2 status: triple positive tumours are more likely lymph node positive

“…higher than breast cancers of any other ERPRHER-2 phenotype (OR = 2.309). Triple positive breast tumours were diagnosed at a younger age and tumour characteristics like tumour size and grade could have been the main reason for this higher probability of ALN involvement [26][27][28][29][30][31][32]. However, the multivariate logistic regression analysis identified ''being triple positive'' as an independent predictor for lymph node involvement.…”