Impact of Multifocality and Lymph Node Metastasis on the Prognosis and Management of Microinvasive Breast Cancer
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
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.
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.
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.
- Hoda SA, Chiu A, Prasad ML, Giri D, Hoda RS. Are microinvasion and micrometastasis in breast cancer mountains or molehills? Am J Surg. 2000;180:305–8. CrossRef
- Fleming ID, Cooper JS, Henson DE, Hutter RV, Kennedy BJ, Murphy GP et al., editors. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven; 1997.
- Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63:181–7. CrossRef
- Rivadeneira DE, Simmons RM, Christos PJ, Hanna K, Daly JM, Osborne MP. Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients. J Am Coll Surg. 2000;191:1–6. CrossRef
- Coombs NJ, Boyages J. Multifocal and multicentric breast cancer: does each focus matter? J Clin Oncol. 2005;23:7497–502. CrossRef
- Andea AA, Bouwman D, Walis T, Visscher DW. Correlation of tumor volume and surface area with lymph node status in patients with multifocal/multicentric breast carcinoma. Cancer. 2004;100:20–7. CrossRef
- Chung A, Huynh K, Kidner T, Mirzadehgan P, Sim MS, Giuliano AE et al. Comparison of outcomes of breast conserving therapy in multifocal or multicentric and unifocal invasive breast cancer. J Am Coll Surg. 2012;215:137–46. CrossRef
- Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, et al. editors. AJCC cancer staging manual. 7th ed. Springer; 2010.
- Wong JH, Kopald KH, Morton DL. The impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer. Arch Surg. 1990;125: 1298–301. CrossRef
- Ko BS, Lim WS, Kim HJ, Yu JH, Lee JW, Kwan SB, et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol. 2012;19:212–6. CrossRef
- Lyons JM, Stempel M, Van Zee KJ, Cody HS. Axillary node staging for microinvasive breast cancer: is it justified? Ann Surg Oncol. 2012;19:3416–21.
- Guth AA, Mercado C, Roses DF, Darvishian F, Singh B, Cangiarella JF et al. Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature. Breast J. 2008;14:335–9. CrossRef
- Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007;25:3657–63. CrossRef
- Katz A, Gage I, Evans S, Shaffer M, Fleury T, Smith FP, et al. Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2006;191:761–6. CrossRef
- Intra M, Zurrida S, Maffini F, Sonzogni A, Trifirò G, Gennari R, et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol. 2003;10:1160–5. CrossRef
- Zavotsky J, Hansen N, Brennan MB, Turner RR, Giuliano AE. Lymph node metastasis from ductal carcinoma in situ with microinvasion. Cancer. 1999;85:2439–43. CrossRef
- Klauber-DeMore N, Tan LK, Liberman L, Kaptain S, Fey J, Borgen P et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in situ and ductal carcinoma-in situ with microinvasion? Ann Surg Oncol. 2000;7:636–42. CrossRef
- Silverstein MJ, Poller DN, Waisman JR, Colburn WJ, Barth A, Gierson ED et al. Prognostic classification of breast ductal carcinoma in situ. Lancet. 1995;345:1154–7. CrossRef
- Giuliano AE, Hawes D, Ballman KV, Whitworth PW, Blumencranz PW, Reintgen DS, et al. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. JAMA. 2011;306:385–93. CrossRef
- Weaver DL, Ashikaga T, Krag DN, Skelly JM, Anderson SJ, Harlow SP, et al. Effect of occultmetastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21. CrossRef
- Kapoor NS, Sim MS, Lin J, Giuliano AE. Long-term outcome of patients managed with sentinel lymph node biopsy alone for node-negative invasive breast cancer. Arch Surg. 2012;147:1047–52.
- Hansen NM, Grube B, Ye X, Turner RR, Brenner RJ, Sim MS, et al. Impact of micrometastases in the sentinel node of patients with invasive breast cancer. J Clin Oncol. 2009;27:4679–84. CrossRef
- Tvedskov TF, Jensen MB, Balslev E, Ejlertsen B, Kroman N. Stage migration after introduction of sentinel lymph node dissection in breast cancer treatment in Denmark: a nationwide study. Eur J Cancer. 2011;47:872–8. CrossRef
- Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134:459–78. CrossRef
- Chlebowski RT, Geller ML. Adherence to endocrine therapy for breast cancer. Oncology. 2006;71:1–9.
- Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75. CrossRef
- Morrow M, Harris JR. Ductal carcinoma in situ and microinvasive carcinoma. In: Diseases of the breast. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2010. p. 349–62.
- Rosner D, Lane WW, Pentrante R. Ductal carcinoma in situ with microinvasion. A curable entity using surgery alone without need for adjuvant therapy. Cancer. 1991;67:1498–503. CrossRef
- Kinne DW, Petrek JA, Osborne MP, Fracchia AA, DePalo AA, Rosen PP, et al. Breast carcinoma in situ. Arch Surg. 1989;124:33–6. CrossRef
- Impact of Multifocality and Lymph Node Metastasis on the Prognosis and Management of Microinvasive Breast Cancer
Annals of Surgical Oncology
Volume 20, Issue 8 , pp 2576-2581
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, John Wayne Cancer Institute, Santa Monica, CA, USA
- 2. Department of Surgery, Cedars-Sinai Medical Center, West Hollywood, CA, USA
- 3. Department of Pathology, Saint John’s Health Center, Santa Monica, CA, USA
- 4. Department of Biostatistics, Saint John’s Health Center, Santa Monica, CA, USA
- 5. Department of Medical Oncology, John Wayne Cancer Institute, Santa Monica, CA, USA
- 6. Department of Surgical Oncology, Cedars-Sinai Medical Center, West Hollywood, CA, USA