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Impact of Multifocality and Lymph Node Metastasis on the Prognosis and Management of Microinvasive Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There are few data on the long-term outcome of patients with microinvasive (T1mi) breast cancer. Moreover, predictors of lymph node involvement and the impact of multifocal microinvasion are not well understood.

Methods

Patients with T1mi cancer, defined as tumors ≤1 mm, surgically managed at our institute and who underwent axillary lymph node evaluation were identified. Specimen slides were independently reviewed. Multivariate analysis was used to identify factors predictive of lymph node involvement.

Results

Forty-five patients with T1mi cancer were identified. Median patient age was 52 years, and median size of in situ disease was 4 cm. Nine tumors (20.0 %) had more than one focus of microinvasion. Lymph nodes metastasis were identified in 9 patients: 1 macrometastasis (2.2 %), 4 micrometastases (8.9 %), and 4 isolated tumor cells (8.9 %). Seven of 9 patients with lymph node involvement underwent adjuvant chemotherapy. Estrogen receptor–negative invasive disease was a significant predictor of lymph node metastasis by multivariable analysis (p < 0.02). There was also a trend toward lymph node involvement in patients with multifocal microinvasion compared to unifocal disease (33.3 vs. 16.7 %, respectively). At a median follow-up of 83 months, 3 patients (6.3 %) had disease recurrence (1 local, 1 distant, 1 local and distant). All patients with recurrence initially had tumor-free lymph nodes and only one focus of microinvasion.

Conclusions

Microinvasive breast cancer clearly has the ability to metastasize and recur, but in this series, only 2 % of patients with nodal macrometastasis. Only two patients experienced local recurrence, neither of whom had lymph node metastasis. The importance of identifying nodal micrometastasis in T1mi disease needs to be further explored.

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Acknowledgment

Supported in part by the Associates for Breast and Prostate Cancer Studies, Santa Monica, California; QVC and the Fashion Footwear Association of New York Charitable Foundation, New York, NY; and the Margie and Robert E. Petersen Foundation, Los Angeles, CA.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, John Wayne Cancer Institute, Santa Monica, CA, USA

    Nimmi S. Kapoor MD

  2. Department of Surgery, Cedars-Sinai Medical Center, West Hollywood, CA, USA

    Nimmi S. Kapoor MD

  3. Department of Pathology, Saint John’s Health Center, Santa Monica, CA, USA

    Jaime Shamonki MD

  4. Department of Biostatistics, Saint John’s Health Center, Santa Monica, CA, USA

    Myung-Shin Sim PhD

  5. Department of Medical Oncology, John Wayne Cancer Institute, Santa Monica, CA, USA

    Cathie T. Chung MD

  6. Department of Surgical Oncology, Cedars-Sinai Medical Center, West Hollywood, CA, USA

    Armando E. Giuliano MD

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  1. Nimmi S. Kapoor MD
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  2. Jaime Shamonki MD
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  3. Myung-Shin Sim PhD
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  4. Cathie T. Chung MD
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  5. Armando E. Giuliano MD
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Correspondence to Nimmi S. Kapoor MD.

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Kapoor, N.S., Shamonki, J., Sim, MS. et al. Impact of Multifocality and Lymph Node Metastasis on the Prognosis and Management of Microinvasive Breast Cancer. Ann Surg Oncol 20, 2576–2581 (2013). https://doi.org/10.1245/s10434-013-2924-7

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  • DOI: https://doi.org/10.1245/s10434-013-2924-7

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