World Journal of Surgery

, Volume 25, Issue 6, pp 767–772

Predicting Axillary Nodal Positivity in 2282 Patients with Breast Carcinoma

  • Melvin J. Silverstein
  • Kristin A. Skinner
  • Thomas J. Lomis
Article

DOI: 10.1007/s00268-001-0003-x

Cite this article as:
Silverstein, M., Skinner, K. & Lomis, T. World J. Surg. (2001) 25: 767. doi:10.1007/s00268-001-0003-x

Asbtract

Axillary lymph node status continues to be the single most important prognostic variable for breast cancer survival despite significant progress in the molecular and genetic characterization of breast malignancies. All patients with invasive breast cancer who underwent axillary lymph node dissection as part of their treatment were evaluated by 11 clinical and pathologic factors, including the primary lesion’s T category (TNM staging system), whether the lesion was clinically palpable, the presence of lymphatic or vascular invasion, nuclear grade, estrogen and progesterone receptors, S-phase, age, HER2/neu overexpression, histology (infiltrating lobular or ductal), and ploidy. A total of 2282 axillary dissections were performed: 391 in patients with ductal carcinoma in situ (DCIS) [3 of which (0.8%) contained metastases] and 1891 in patients with invasive breast cancer [680 of which (36%) contained metastases]. Multivariate analysis of patients with invasive cancer identified four factors as independent predictors of axillary lymph node metastases: lymph/vascular invasion, tumor size, nuclear grade, tumor palpability. Among a group of 189 patients with nonpalpable, non-highgrade invasive lesions 15 mm or smaller without lymph/vascular invasion, only 6 (3%) had metastases to lymph nodes. If any three of the favorable factors were present, lymph node positivity was 6% or less. Clinical and pathologic feature of the primary lesions can be used to estimate the risk of axillary lymph node metastases. Such risk assessment can be used for the treatment decision-making process.

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Copyright information

© Société Internationale de Chirurgie 2001

Authors and Affiliations

  • Melvin J. Silverstein
    • 1
  • Kristin A. Skinner
    • 1
  • Thomas J. Lomis
    • 2
  1. 1.Department of Surgery, University of Southern California School of Medicine, Harld E. and Henrietta C. Lee Breast Center, Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Room 7415, Los Angeles, California 90033, USAUSA
  2. 2.General Surgery and Surgical Oncology, Century City Hospital, 20 80 Century Park East, Suite 1408, Los Angeles, California 90067, USA and Orange Coast Memorial Hepato-Biliary Cancer Program, 9900 Talbert Avenue, Fountain Valley, California 92708, USAUSA

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