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In breast cancer patients sentinel lymph node metastasis characteristics predict further axillary involvement

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Abstract

The aim of the study was to correlate various primary tumor characteristics with lymph node status, to examine sentinel lymph node (SLN) metastasis size and non-SLN axillary involvement, to look for a cut-off size/number value possibly predicting additional axillary involvement with more accuracy and to examine the relationship of SLN metastasis size to overall survival. Of 301 patients who underwent SLN biopsy, 75 had positive SLNs. The size of the metastases was measured. For different size categories, association with the prevalence of non-SLN metastases was assessed. Associations between metastasis size and tumor characteristics and overall survival (OS) were studied. The prevalence of axillary lymph node (ALN) involvement was not significantly different between cases with micrometastasis or macrometastasis in SLNs (p = 0.124). However, for metastases larger than 6, 7, and 8 mm, the prevalence of ALN involvement was significantly higher (p = 0.046, 0.022, and 0.025). OS was significantly lower in SLN-positive than in SLN-negative cases (p = 0.0375). Primary tumor size larger than 20 mm was associated with a significantly higher incidence of SLN metastasis (p < 0.001), and primary tumor size over 26 mm was associated with additional positive non-SLN (p < 0.001). Higher mitotic index (≥7) in primary tumors was significantly (p < 0.001) associated with ALN involvement in SLN-positive cases, whereas higher Ki67 labeling index was not significantly correlated with SLN or ALN involvement. Lymphovascular invasion (LVI) in primary tumors was significantly correlated with SLN positivity (p < 0.001) but not with further ALN involvement or OS. Tumor size and LVI are predictive for SLN metastasis. Mitotic index, primary tumor size, and larger volume SLN involvement are determinants of further ALN involvement. SLN metastasis size over 6 mm is a strong predictor of further axillary involvement. OS is shorter in the presence of positive SLN.

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Acknowledgments

Authors would like to thank Erzsébet Azumah and Csilla Jaczó for preparing the step sectioning of ALND specimens and for performing the additional immunohistochemical reactions, and thanks also go to György Illyés, Elvira Kálé, and Paul Ryan for the careful reading and correction of the manuscript. This work was supported by the TÁMOP 4.2.4.A/2-11-1-2012-0001 and the TÁMOP-4.2.2/B-10/1-2010-00013 (Magiszter) grant by the National Development Agency of Hungary.

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. 2nd Department of Pathology, Semmelweis University, Ulloi ut 93, H-1091, Budapest, Hungary

    Ildiko Illyes, Anna-Maria Tokes, Attila Kovacs, A. Marcell Szasz, Istvan Kenessey & Janina Kulka

  2. MTA-SE Tumour Progression Research Group, Budapest, Hungary

    Anna-Maria Tokes

  3. 1st Department of Surgery, Semmelweis University, Ulloi ut 78, H-1082, Budapest, Hungary

    Bela A. Molnar & Istvan A. Molnar

  4. Department of Pathology, Szt. Margit Hospital, Becsi ut 132, H-1032, Budapest, Hungary

    Ilona Kaszas

  5. Department of Surgery, Ministry of Defense State Health Centre, Robert Karoly korut 44, H-1134, Budapest, Hungary

    Zsuzsanna Baranyak

  6. Department of Surgery, Szt. Janos Hospital, Dios arok 1-3, H-1125, Budapest, Hungary

    Zsolt Laszlo

  7. Mamma Klinika, Corporation, Budapest, Hungary

    Zsolt Laszlo

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  1. Ildiko Illyes
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Correspondence to Anna-Maria Tokes.

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Ildiko Illyes and Anna-Maria Tokes contributed equally.

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Suppl. Figure 1

ROC analysis of primary tumor size and mitotic index. A Primary tumor size larger than 20 mm is associated with a significantly higher incidence of SLN metastasis (p < 0.001). (PDF 45 kb)

B Primary tumor size over 26 mm is associated with additional positive non-SLN (p < 0.001). (PDF 45 kb)

428_2014_1579_MOESM3_ESM.pdf

C Higher mitotic index (≤7) in primary tumors is significantly associated with non-SLN metastases in SLN positive cases (p = 0.017). (PDF 44 kb)

Suppl. Figure 2

Kaplan–Meier survival based on the presence of micro and/or ITC metastases in SLN. There is a trend towards better survival in cases without micrometastases and/or ITC, but the number of cases with micrometastases is too low to reach a significance level (p = 0.0558). (DOC 249 kb)

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Illyes, I., Tokes, AM., Kovacs, A. et al. In breast cancer patients sentinel lymph node metastasis characteristics predict further axillary involvement. Virchows Arch 465, 15–24 (2014). https://doi.org/10.1007/s00428-014-1579-5

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