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Prognostic Value of Extracapsular Invasion of Axillary Lymph Nodes Combined with Peritumoral Vascular Invasion in Patients with Breast Cancer

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

Abstract

Background

Extracapsular invasion (ECI) of metastatic axillary lymph nodes has been associated with aggressive nodal disease but its prognostic role in breast cancer is unclear. The present study evaluated nodal ECI as a predictor of breast cancer recurrence.

Methods

We evaluated 154 women with histologically proven node-positive breast cancer who were diagnosed with invasive ductal carcinoma, and investigated the relationships between ECI and recurrences and other clinicopathological factors, particularly vascular invasion and the number of lymph node metastases.

Results

The presence of ECI at positive nodes was significantly associated with the number of positive nodes, and with disease recurrence and survival in univariate (but not multivariate) analysis. Interestingly, all ECI+ patients with distant metastases in our series had peritumoral vascular invasion (PVI), which may have reflected systemic disease; ECI with PVI of the primary tumor strongly predicted recurrent disease and shorter survival.

Conclusion

ECI of axillary metastases combined with PVI indicates high tumor aggressiveness. Patients with ECI and PVI may be considered for stronger adjuvant therapies because of their high risk for distant recurrences.

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Acknowledgment

We thank Ms Chizuko Tomioka and Ms Kozue Yoneyama for their assistance in slide preparation.

Discloures

Reina Yajima, Takaaki Fujii, Yasuhiro Yanagita, Tomomi Fujisawa, Takeshi Miyamoto, Tomoko Hirakata, Soichi Tsutsumi, Misa Iijima, and Hiroyuki Kuwano declare that they have no competing financial interests.

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Authors and Affiliations

  1. Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan

    Reina Yajima MD, Takaaki Fujii MD, PhD, Soichi Tsutsumi MD, PhD & Hiroyuki Kuwano MD, PhD

  2. Department of Breast Oncology, Gunma Prefectural Cancer Center, Ota, Gunma, Japan

    Yasuhiro Yanagita MD, PhD, Tomomi Fujisawa MD, PhD, Takeshi Miyamoto MD, PhD & Tomoko Hirakata MD, PhD

  3. Department of Pathology, Gunma Prefectural Cancer Center, Ota, Gunma, Japan

    Misa Iijima MD, PhD

Authors
  1. Reina Yajima MD
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  2. Takaaki Fujii MD, PhD
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  3. Yasuhiro Yanagita MD, PhD
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  4. Tomomi Fujisawa MD, PhD
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  5. Takeshi Miyamoto MD, PhD
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  6. Tomoko Hirakata MD, PhD
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  7. Soichi Tsutsumi MD, PhD
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  8. Misa Iijima MD, PhD
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  9. Hiroyuki Kuwano MD, PhD
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Corresponding author

Correspondence to Reina Yajima MD.

Electronic supplementary material

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Supplement File 1

Examples of scanned H&E staining sections of metastatic breast cancer lymph nodes. Representative ECI– slides; original magnifications: ×40 (a) and ×400 (b). ECI+ slides; original magnifications: ×40 (c) and ×400 (d). Supplementary material 1 (TIFF 439 kb)

Supplement File 2

Time to tumor recurrence determined from Kaplan–Meier curves varies among patients depending on the presence of PVI in positive nodes. Recurrence-free survival curve (A) and breast cancer-specific survival curve (B).Supplementary material 2 (PDF 231 kb)

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Yajima, R., Fujii, T., Yanagita, Y. et al. Prognostic Value of Extracapsular Invasion of Axillary Lymph Nodes Combined with Peritumoral Vascular Invasion in Patients with Breast Cancer. Ann Surg Oncol 22, 52–58 (2015). https://doi.org/10.1245/s10434-014-3941-x

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  • DOI: https://doi.org/10.1245/s10434-014-3941-x

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