Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma of the Breast

Güven, Hikmet Erhan; Kültüroğlu, Mahmut Onur; Gülçelik, Mehmet Ali; Özaslan, Cihangir

doi:10.5152/ejbh.2018.3712

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…The predictors for the involvement of lymph nodes have been widely studied, while the risk factors for positive SLNs have rarely been explored. We found that tumor size was the only influencing factor affecting positive rate of SLNs in participants with ILC, which was in line with a previous study (23). For patients with IDC, age at diagnosis, molecular subtype, and pathologic tumor size were independent factors for the positive rate of SLNs.…”

Section: Discussionsupporting

confidence: 91%

Analysis of sentinel lymph node biopsy and non-sentinel lymph node metastasis in invasive ductal and invasive lobular breast cancer: a nationwide cross-sectional study (CSBrS-001)

et al. 2021

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Background: Information regarding the implementation of sentinel lymph node biopsy (SLNB) in invasive lobular carcinoma (ILC) is scarce, and whether ILC patients with 1-2 positive sentinel lymph nodes (SLNs) can be omitted from axillary lymph node dissection (ALND) remains controversial. This study aimed to compare involvement of SLNs and non-SLNs between patients with invasive ductal carcinoma (IDC) and ILC.Methods: We retrospectively collected the clinical and pathological data of invasive breast cancer patients from 37 medical centers in China from January 2018 to December 2018. The number of resected SLNs, positive rate of SLNs, and non-SLNs metastasis were compared between patients with IDC and ILC.Results: A total of 6,922 patients were included, comprising 6,650 with IDC (96.1%) and 272 with ILC (3.9%). No difference was observed in the number of resected SLNs between patients with IDC and ILC (IDC: 4.0±1.9 vs. ILC: 3.9±1.6, P=0.352). The positive rate of SLNs was significantly higher in patients with IDC than that in patients with ILC (19.3% in IDC vs. 12.9% in ILC, P=0.008). The difference in positive rate of SLNs between IDC and ILC was mainly attributed to macro-metastasis. For patients with positive SLNs who received ALND, and those with 1-2 positive SLNs, the metastatic rate of non-SLNs in the ILC group was higher than that in the IDC group (for patients with positive SLNs: 50.0% in ILC vs. 39.9% in IDC, P=0.317; for patients with 1-2 positive SLNs: 45.4% in ILC vs. 34.8% in IDC, P=0.366), but the differences were not statistically significant.Conclusions: Patients with ILC had similar number of resected SLNs and lower positive rate of SLNs compared to those with IDC. In participants with 1-2 positive SLNs, the ILC group had an increased tendency for non-SLNs metastasis compared with the IDC group. Surgeons may need to be more cautious about omitting ALND for ILC patients with 1-2 positive SLNs.

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Section: Discussionsupporting

confidence: 91%

Analysis of sentinel lymph node biopsy and non-sentinel lymph node metastasis in invasive ductal and invasive lobular breast cancer: a nationwide cross-sectional study (CSBrS-001)

et al. 2021

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“…Sentinel lymph node biopsy in clinically axillary node negative patients Following the first successful report of SLNB (14,15), this technique was rapidly introduced to clinical practice in cT1-2 patients with clinically axillary node negative (16)(17)(18)(19)(20)(21). Overall identification rate of SLNB and the false negative rate (FNR) of SLNB are over 90% and under 10%, respectively (Table 1) (22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Clinical and Research Consequencesmentioning

confidence: 99%

The Adventure of Axillary Treatment in Early Stage Breast Cancer

Kuru

2020

Eur J Breast Health

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Axillary lymph node dissection (ALND) which was an essential part of breast cancer treatment and the gold standard in evaluation of the status of axillary lymph node had notorious with increased arm morbidity and reduction of quality of life. Sentinel lymph node biopsy (SLNB) accurately stages the axilla in early breast cancer and ALND is omitted in SLNB negative patients. In patients with positive SLNB the omission of ALND with or without replacement of axillary radiotherapy has also been recommended by guidelines. The neoadjuvant chemotherapy (NAC) which has been increasingly used for large breast cancers to downstage the tumours for allowing breast conserving surgery and decreasing mastectomy rate has also been used in axillary node positive patients to reduce the need for ALND. The issues surrounding the treatment of axilla in patients treated with NAC; application and false negative rate of SLNB, number of identified sentinel lymph nodes, and axillary radiotherapy instead of ALND are currently the discussed and practiced hot topics. The quests for decreasing arm morbidity without compromising outcome in breast cancer treatment which have begun with the invention of SLNB continue for axilla conserving surgery. This article reviews the adventure of axillary treatment in breast cancer patients treated with or without NAC.

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“…1 Previous retrospective analyses have demonstrated that ILC is more likely to present with extensive disease that is underappreciated on preoperative imaging. 2 , 3 Given that the size of ILC has been associated with an increased risk of sentinel lymph node metastasis, 4 , 5 this underestimation in ILC size from imaging calls into question whether avoidance of routine SLNBx in patients with ILC over 70 years of age is oncologically safe and appropriate.…”

mentioning

confidence: 99%

Is Choosing Wisely Wise for Lobular Carcinoma in Patients Over 70 Years of Age? A National Cancer Database Analysis of Sentinel Node Practice Patterns

Goldhaber,

O’Keefe,

Kang

et al. 2023

Ann Surg Oncol

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Background Controversy continues in the treatment of breast cancer in women over 70 years of age. In 2016, the Society of Surgical Oncology recommended against routine use of sentinel lymph node biopsy (SLNBx) as part of the ‘Choosing Wisely Campaign’. This study examines the oncologic safety of avoidance of routine SLNBx in patients over 70 years of age with invasive lobular carcinoma (ILC). Methods The National Cancer Database was used to identify women with invasive ductal carcinoma (IDC) and ILC diagnosed between 2012 and 2020. Clinical and pathological staging, axillary staging, surgery type, and lymph node positivity between patients with IDC or ILC were compared. Results Among women with T1 tumors, 85,949 (79.6%) patients with IDC and 12,761 (81.5%) patients with ILC underwent SLNBx (p < 0.001). Among patients who underwent SLNBx, those with IDC were more likely to have positive nodes (n = 7535, 8.8%) than those with ILC (n = 1041, 8.2%; p = 0.02). During the time interval of interest, for both IDC and ILC patients, the rate of axillary lymph node dissection decreased and rates of SLNBx or no axillary staging increased. On multivariate analysis, ILC histology was associated with use of SLNBx, but without nodal positivity. Conclusion A trend de-escalation of axillary staging was identified in this study, however the majority of patients meeting the ‘Choosing Wisely’ criteria are still undergoing SLNBx. No increased risk of nodal positivity was identified among patients with ILC, suggesting that surgeons can continue to choose wisely and limit the use of SLNBx in women over 70 years of age with T1 ILC tumors.

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Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma of the Breast

Cited by 5 publications

References 13 publications

Analysis of sentinel lymph node biopsy and non-sentinel lymph node metastasis in invasive ductal and invasive lobular breast cancer: a nationwide cross-sectional study (CSBrS-001)

Analysis of sentinel lymph node biopsy and non-sentinel lymph node metastasis in invasive ductal and invasive lobular breast cancer: a nationwide cross-sectional study (CSBrS-001)

The Adventure of Axillary Treatment in Early Stage Breast Cancer

Is Choosing Wisely Wise for Lobular Carcinoma in Patients Over 70 Years of Age? A National Cancer Database Analysis of Sentinel Node Practice Patterns

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