Advertisement

Clinicopathologic features of sentinel node metastases predictive of positive axillary clearance in grade 1 invasive breast carcinoma

  • B. Hayes
  • O. Mc Cormack
  • C. M. Quinn
  • E. W. McDermott
  • D. Evoy
Original Article
  • 52 Downloads

Abstract

Background

Sentinel node (SN) biopsy is widely used to stage breast carcinoma and, when positive, typically leads to axillary clearance (AC).

Aims

This study assesses clinicopathologic features of grade 1 breast carcinoma SNs with the aim of identifying a group of patients, who are likely to have a negative AC and can, therefore, safely be spared further surgery.

Results

Two hundred and forty-seven patients with grade 1 invasive carcinoma were identified, of whom 29 had a positive SN. Four patients (13.8%) had a positive AC. Positive AC occurred in 3 of 6 (50%) patients whose SN showed extranodal extension (EE), but in only 1 of 23 (4.3%) patients without EE. All patients were staged as pN1(sn) following SN biopsy: only one, who had a 5.27 mm metastasis with EE, was pN2 following AC.

Conclusions

Extranodal extension is a significant predictor of a positive AC in this group. In its absence, AC did not alter the post-SN biopsy pN stage.

Keywords

Sentinel lymph node biopsy Breast cancer Metastasis Prognosis Staging 

Notes

Acknowledgments

The authors wish to acknowledge the Irish National Breast Screening Programme (“BreastCheck”) as the source of some of the data used in this study, and to acknowledge the work done by Dermot Carty in maintaining the breast cancer clinical database.

Conflict of interest statement

None.

References

  1. 1.
    Chu KU, Turner RR, Hansen NM et al (1999) Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 229(4):536–541. doi: 10.1097/00000658-199904000-00013 CrossRefPubMedGoogle Scholar
  2. 2.
    Turner RR, Chu KU, Qi K et al (2000) Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node. Cancer 89(3):574–581. doi: 10.1002/1097-0142(20000801)89:3<574::AID-CNCR12>3.0.CO;2-Y CrossRefPubMedGoogle Scholar
  3. 3.
    Fleming FJ, Kavanagh D, Crotty TB et al (2004) Factors affecting metastases to non-sentinel lymph nodes in breast cancer. J Clin Pathol 57:73–76. doi: 10.1136/jcp.57.1.73 CrossRefPubMedGoogle Scholar
  4. 4.
    Sobin LH, Wittekind C (2002) UICC TNM classification of malignant tumours. 6th edn. Wiley-Liss, USA, p 137Google Scholar
  5. 5.
    Lyman GH, Giuliano AE, Somerfield MR et al (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720. doi: 10.1200/JCO.2005.08.001 CrossRefPubMedGoogle Scholar
  6. 6.
    Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a meta-analysis. Cancer 106(1):4–16. doi: 10.1002/cncr.21568 CrossRefPubMedGoogle Scholar
  7. 7.
    Bassi KK, Seenu V, Ballehaninna UK et al (2006) Second echelon node predicts metastatic involvement of additional axillary nodes following sentinel node biopsy in early breast cancer. Indian J Cancer 43(3):103–109CrossRefPubMedGoogle Scholar
  8. 8.
    Van Zee KJ, Manasseh DME, Bevilacqua JL et al (2003) A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 10(10):1140–1151. doi: 10.1245/ASO.2003.03.015 CrossRefPubMedGoogle Scholar
  9. 9.
    Coutant C, Rouzier R, Fondrinier E, et al (2009) Validation of the Tenon breast cancer score for predicting non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis: a prospective multicentre study. Breast Cancer Res Treat 113(3):537–543. doi: 10.1007/s10549-008-9967-7 CrossRefPubMedGoogle Scholar
  10. 10.
    Katz A, Smith BL, Golshan M et al (2008) Nomogram for the prediction of having four or more involved nodes for sentinel lymph node-positive breast cancer. J Clin Oncol 26(13):2093–2098. doi: 10.1200/JCO.2007.11.9479 CrossRefPubMedGoogle Scholar
  11. 11.
    Gorgulu S, Can MF, Yagci G et al (2007) Extracapsular extension is associated with increased ratio of metastatic to examined lymph nodes in axillary node-positive breast cancer. Clin Breast Cancer 7(10):796–800. doi: 10.3816/CBC.2007.n.042 CrossRefPubMedGoogle Scholar
  12. 12.
    Cserni G (2008) Axillary sentinel lymph node micrometastases with extracapsular extension: a distinct pattern of breast cancer metastasis? J Clin Pathol 61(1):115–118. doi: 10.1136/jcp.2007.047357 CrossRefPubMedGoogle Scholar
  13. 13.
    Galea MH, Blamey RW, Elston CE et al (1992) The Nottingham prognostic index in primary breast cancer. Breast Cancer Res Treat 22(3):207–219. doi: 10.1007/BF01840834 CrossRefPubMedGoogle Scholar
  14. 14.
    Blamey RW, Ellis IO, Pinder SE et al (2007) Survival of invasive breast cancer according to the Nottingham Prognostic Index in cases diagnosed in 1990–1999. Eur J Cancer 43(10):1548–1555. doi: 10.1016/j.ejca.2007.01.016 CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2009

Authors and Affiliations

  • B. Hayes
    • 1
  • O. Mc Cormack
    • 2
  • C. M. Quinn
    • 1
  • E. W. McDermott
    • 2
  • D. Evoy
    • 2
  1. 1.Department of HistopathologySt Vincent’s University HospitalDublin 4Ireland
  2. 2.Department of Breast and Endocrine SurgerySt Vincent’s University HospitalDublinIreland

Personalised recommendations