Prediction of axillary lymph node involvement of women with invasive breast carcinoma

Abstract

BACKGROUND The increasing use of systemic therapy for women with lymph node negative breast carcinoma and earlier stage of disease at mammographic detection raises questions regarding the need for routine axillary lymph node dissection. Predictive modeling for lymph node involvement may be one way to reduce the need for axillary lymph node dissection and its morbidity. METHODS A multivariate analysis of 12 factors predictive of axillary lymph node involvement was conducted in a population‐based cohort of 4312 women with invasive breast carcinoma diagnosed between January 1. 1993 and December 31, 1996. RESULTS Clinical palpability, lymphatic or vascular invasion, lesion size, margin status, histology, and patient age were independent predictors of axillary lymph node involvement. The model correctly identified lymph node status in 76.6% of cases. Model accuracy and fit were equally high when applied to randomly selected halves of the study subjects. Approximately 32.0% of the patients in the study sample (1363/4312) were identified as having an extremely high (91%; n = 1102) or low (10%; n = 261) risk of lymph node involvement. In a second analysis, a clinically useable, three‐variable model identified a very low risk group of patients (n = 147) with a 4.8% risk of lymph node metastasis and a high risk group of patients (n = 1008) with a 74.2% risk of lymph node metastasis. Greater than 90% of subjects in the high risk group received adjuvant systemic therapy even if they were lymph node negative pathologically. CONCLUSIONS A clinically useable, three‐variable model employing tumor and lymph node palpability, size, and lymphatic or vascular invasion can identify women with invasive breast carcinoma in whom axillary lymph node dissection is very unlikely to alter recommendations regarding adjuvant systemic therapy. Cancer 1998;83:948‐955. © 1998 American Cancer Society.

Six-Year Follow-Up of Patients With Microinvasive, T1a, and T1b Breast Carcinoma

“…18 Unfortunately our series does not contribute significantly to the issue of whether impalpable tumors are at lower risk, as has been suggested by some recent publications. 10,25,26 Our subset analysis, although yielding some interesting trends, did not identify any group with an extremely low risk of recurrence, with the possible exception of patients with microinvasive disease. Thus, we continue to favor axillary assessment in most patients.…”

“…This is in contrast to other series of studies in which factors including LVI, tumor palpability, nuclear grade, and tumor size were predictive of nodal metastases. Impalpable tumors smaller than or equal to 5 mm had no axillary metastases in one series 25 ; impalpable, non-high-grade tumors Յ1 cm without LVI had a 3% incidence of metastases in another 10 and impalpable tumors Յ5 mm without LVI a 4.8% incidence in another, 26 while tumors smaller than 1 cm without LVI had a 9% incidence in another. 24 Unfortunately tumor palpability was unknown for many of our patients who had initial biopsy at other institutions.…”

A risk stratification by hormonal receptors (ER, PgR) and HER-2 status in small (≤1 cm) invasive breast cancer: who might be possible candidates for adjuvant treatment?

“…A positive correlation between tumor size and node status has been generally reported [43,44]. Accordingly, the identified predictive factors for lymph node involvement may help to explain poor clinical outcomes with early systemic failure.…”

Factors Correlating With Lymph Node Metastases in Patients With T1 Breast Cancer

“…3,19 It is generally accepted that the incidence of ALNM increases with tumor size. 6,19,20 Our study of women with T1 breast cancers indicates that the presence of ALNM is strongly associated with larger tumor size, the presence of LI, high tumor grade, and the presence of a true positive margin. Women with T1a-size tumors were found to have ALNM in 11% of the cases compared with 29% in women with T1c-size tumors (P ϭ .001).…”