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Predicting the Extent of Nodal Disease in Early-Stage Breast Cancer

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

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Abstract

Background

The role of regional nodal ultrasound (US) has been questioned since publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 data. The goal of this study was to determine if imaging and clinicopathologic features could predict the extent of axillary nodal involvement in breast cancer.

Study Design

Patients with T1–T2 tumors who underwent regional nodal US and axillary lymph node dissection from 2002 to 2012 were identified from a prospective database excluding those who received neoadjuvant chemotherapy. Patients whose metastases were identified by US confirmed by needle biopsy were compared with those identified by sentinel lymph node dissection (SLND) after a negative US.

Results

Metastases were identified by US in 190 patients, and by SLND in 518 patients. SLND patients had fewer positive nodes (2.2 vs. 4.1; p < 0.0001), smaller metastases (5.3 vs. 13.8 mm; p < 0.0001), and a lower incidence of extranodal extension (24 vs. 53 %; p < 0.0001) than the US group. Even when US identified ≤2 abnormal nodes, patients were still more likely to have ≥3 positive nodes (45 %) than SLND patients (19 %; p < 0.001). After adjusting for tumor size, receptor status, and histology, multivariate analysis revealed that metastases identified by US [odds ratio (OR) 4.01; 95 % confidence interval (CI) 2.75–5.84] and lobular histology (OR 1.77; 95 % CI 1.06–2.95) predicted having ≥3 positive nodes.

Conclusions

Imaging and clinicopathologic features can be used to predict the extent of nodal involvement. Patients with US-detected metastases, even if small volume, have a higher burden of nodal involvement than patients with SLND-detected metastases and may not be comparable with patients in the ACOSOG Z0011 trial.

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References

  1. National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: breast. Version 2012. NCCN; 2012.

  2. Giuliano, A, Hunt K, Ballman K, et al. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis. JAMA. 2011;305(6):569–575.

    Article  PubMed  CAS  Google Scholar 

  3. Giuliano A, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426–32.

    PubMed  Google Scholar 

  4. Galimberti V, Cole B, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Caudle A, Hunt K, Tucker S, et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19(10):3144–51.

    Article  PubMed  Google Scholar 

  6. Gainer S, Hunt K, Beitsch P, Caudle A, Mittendorf E, Lucci A. Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons. Ann Surg Oncol. 2012;19(10):3152–8.

    Article  PubMed  Google Scholar 

  7. van Rijk M, Deurloo E, Nieweg O, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 2006;13(1):31–5.

    Article  PubMed  Google Scholar 

  8. Boughey J, Moriarty J, Degnim A, Gregg M, Egginton J, Long K. Cost modeling of preoperative axillary ultrasound and fine-needle aspiration to guide surgery for invasive breast cancer. Ann Surg Oncol. 2010;17(4):953–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Krishnamurthy S, Sneige N, Bedi D, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95(5):982–8.

    Article  PubMed  Google Scholar 

  10. Rao R, Lilley L, Andrews V, Radford L, Ulissay M. Axillary staging by percutaneous biopsy: sensitivity of fine-needle aspiration versus core needle biopsy. Ann Surg Oncol. 2009;16(5):1170–5.

    Article  PubMed  Google Scholar 

  11. Kwak H, Chae B, Bae J, et al. Feasibility of sentinel lymph node biopsy in breast cancer patients clinically suspected of axillary lymph node metastasis on preoperative imaging. World J Surg Oncol. 2013;21(11):104.

    Article  Google Scholar 

  12. Leenders M, Broeders M, Croese C, et al. Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer. To do or not to do? Breast. 2012;21(4):578–83.

    Article  PubMed  CAS  Google Scholar 

  13. Cserni G, Bianchi S, Vezzosi V, et al. The value of cytokeratin immunohistochemistry in the evaluation of axillary sentinel lymph nodes in patients with lobular breast carcinoma. J Clin Pathol. 2006;59(5):518–22.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  14. Mittendorf E, Sahin A, Tucker S, et al. Lymphovascular invasion and lobular histology are associated with increased incidence of isolated tumor cells in sentinel lymph nodes from early-stage breast cancer patients. Ann Surg Oncol. 2008;15(12):3369–77.

    Article  PubMed  Google Scholar 

  15. Park S, Kim M, Park B, Moon H, Kwak J, Kim E. Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol. 2011;18(3):738–44.

    Article  PubMed  Google Scholar 

  16. Baruah B, Goyal A, Young P, Douglas-Jones A, Mansel R. Axillary node staging by ultrasonography and fine-needle aspiration cytology in patients with breast cancer. Br J Surg. 2010;97(5):680–3.

    Article  PubMed  CAS  Google Scholar 

  17. Mittendorf E, Boughey J, Bassett R, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonSLN involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg. 2012;255(1):109–115.

    Article  PubMed  Google Scholar 

  18. Van Zee K. Manasseh D, Bevilacqua J, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10(10):1140–51.

    Article  PubMed  Google Scholar 

  19. Hieken T, Trull B, Boughey J, Jones K, Reynolds C, Shah S, et al. Preoperative axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer. Surgery. 2013;154(4):831–40.

    Article  PubMed  Google Scholar 

  20. Huang E, Tucker S, Strom E, et al. Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol. 2004;22(23):4691–9.

    Article  PubMed  Google Scholar 

  21. Truong P, Olivotto I, Kader H, Panades M, Speers C, Berthelet E. Selecting breast cancer patients with T1–T2 tumors and one to three positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 2005;51(5):1337–47.

    Article  Google Scholar 

  22. Whelan T, Olivotto I, Ackerman I, et al. NCIC-CTG MA.20: an intergroup trial of regional nodal irradiation in early breast cancer (abstract LBA1003). J Clin Oncol. 2011;29(18 Suppl).

  23. Dominici L, Mittendorf E, Wang X, et al. Implications of constructed biologic subtype and its relationship to locoregional recurrence following mastectomy. Breast Cancer Res. 2012;14(3):R82.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Caudle A, Hunt K, Kuerer H, et al. Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol. 2011;19(8):2407–12.

    Article  Google Scholar 

  25. Nguyen P, Taghian A, Katz M, et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol. 2008;26(14):2373–8.

    Article  PubMed  Google Scholar 

  26. Voduc K, Cheang M, Tyldesley S, Gelmon K, Nielson T, Kennecke H. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010;28(10):1684–91.

    Article  PubMed  Google Scholar 

  27. Dowsett M, Dunbier A. Emerging biomarkers and new understanding of traditional markers in personalized therapy for breast cancer. Clin Cancer Res. 2008;14(24):8019–26.

    Article  PubMed  CAS  Google Scholar 

  28. Kim M, Ro J, Ahn S, Kim H, Gong G. Clinicopathologic significance of the basal-like subtype of breast cancer: a comparison with hormone receptor and Her2/neu-overexpressing phenotypes. Hum Pathol. 2006;37(9):1217–26.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

The University of Texas MD Anderson Cancer Center is supported in part by a Cancer Center Support Grant (CA016672) from the National Institutes of Health.

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Authors and Affiliations

  1. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Abigail S. Caudle MD, MS, Henry M. Kuerer MD, PhD, Huong T. Le-Petross MD, Wei Yang MD, Min Yi MD, PhD, Isabelle Bedrosian MD, Savitri Krishnamurthy MD, Bruno D. Fornage MD, Kelly K. Hunt MD & Elizabeth A. Mittendorf MD, PhD

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  1. Abigail S. Caudle MD, MS
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  2. Henry M. Kuerer MD, PhD
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  3. Huong T. Le-Petross MD
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  4. Wei Yang MD
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  5. Min Yi MD, PhD
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  6. Isabelle Bedrosian MD
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  7. Savitri Krishnamurthy MD
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  8. Bruno D. Fornage MD
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  9. Kelly K. Hunt MD
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  10. Elizabeth A. Mittendorf MD, PhD
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Corresponding author

Correspondence to Abigail S. Caudle MD, MS.

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Caudle, A.S., Kuerer, H.M., Le-Petross, H.T. et al. Predicting the Extent of Nodal Disease in Early-Stage Breast Cancer. Ann Surg Oncol 21, 3440–3447 (2014). https://doi.org/10.1245/s10434-014-3813-4

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  • DOI: https://doi.org/10.1245/s10434-014-3813-4

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