The risk of nodal metastases in breast cancer patients with clinically negative lymph nodes: a population-based analysis

Abstract

A population-based study was performed to assess the likelihood of axillary lymph node metastases in patients with clinically negative lymph nodes, according to patient age, tumor size and site, estrogen receptor status, histologic type and mode of detection. Data were obtained from the population-based Eindhoven Cancer Registry. During the period 1984-1997, 7680 patients with invasive breast cancer were documented, 6663 of whom underwent axillary dissection. Of the 5125 patients who were known to have clinically negative lymph nodes and underwent axillary dissection, 1748 (34%) had positive lymph nodes at pathological examination. After multivariate analysis, histologic type, tumor size, tumor site and the number of lymph nodes in the axillary specimen remained as independent predictors of the risk of nodal involvement (P < 0.001). Lower risks were found for patients with medullary or tubular carcinoma, smaller tumors, a tumor in the medial part of the breast and patients with less than 16 nodes examined. This study gives reliable estimates of the risk of finding positive lymph nodes in patients with a clinically negative axilla. Such information is useful when considering the need for axillary dissection and to predict the risk of a false-negative result when performing sentinel lymph node biopsy.

Variability in axillary lymph node dissection for breast cancer

“…Size and location of the tumor also predicted the presence and number of positive nodes, which is in agreement with other reports [2][3][4]9,18,[31][32][33][34]. An explanation for the association between the type of surgery and the number of positive nodes may be residual confounding by tumor size, the main indicator for the choice of surgery.…”

Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer

“…A more aggressive approach to the axilla might have been chosen for younger patients to optimise their chances of cure, probably resulting in a higher risk of tissue damage. This hypothesis is supported by the results of another study in the south east of The Netherlands among 6663 breast cancer patients, in which the mean number of nodes examined appeared to decrease with age from 11.1 for patients < 40 years of age to 9.3 for those of 80 years or older [28]. Younger women also encountered more problems doing their household chores, which may be explained by the fact that younger women often combine a job, taking care of children and running the household; as a result they may be under greater physical strain so that the problems with the arm or shoulder are intensified.…”

Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN

“…Two studies were excluded because the full text was not available [52;53]. Seventeen studies only presented predictive factors for positive axillary lymph nodes (SLN biopsy was not performed) [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69].…”

“…Potentially appropriate references to be included in review, n= 64 Predictive factors in SLN micromets, n= 7 excluded [5,[75][76][77][78][79][80] References retrieved for more detailed evaluation, n= 85 Predictive factors for ≥ 4 positive axillary nodes, n= 6 excluded [69][70][71][72][73][74] No SLN performed, only predictive factors of positive ALND, n= 17 excluded [4,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] References with usable information, n= 56 -SNB performed -completion ALND in SLN+ cases -data on predictive factors for positive NSN Meta-analysis, n= 1 excluded [87] No raw data, n= 4 excluded [13,20,81,82] Overlap of data between studies, n= 5 excluded [11,22,23,88,89] SLN positive with CK-IHC only, n= 2 excluded [83][84] Only tumours < 15 mm, n= 1 excluded [86] Only special types of breast cancer, n=1 excluded …”