Background: We investigated the incidence of axillary lymph node metastases in patients with T1a (⩽0.5 cm) and T1b (>0.5 cm and ⩽1.0 cm) breast cancers.
Methods: The charts of 2000 patients who underwent axillary lymph node dissection for breast cancer at our institution from 1989 to 1991 were reviewed. Of these, 81 patients had T1a and 166 had T1b primary breast cancers.
Results: Among the 247 patients with T1a and T1b breast cancers, nodal metastases were present in 30 (12.1%), with a 7.4% positivity rate for patients with T1a and 14.5% positivity rate for T1b tumors. Of the 212 patients who had ⩾10 nodes dissected, 29 (13.7%) had positive nodes. Of those, 6 of 60 (10.0%) patients with T1a and 23 of 152 (15.1%) with T1b tumors had positive nodes. The presence of lymphovascular invasion (LVI) predicted a significantly higher nodal positivity rate (27.8% vs. 10.9%,p=0.05).
Conclusions: Of patients with adequately evaluated axillae, 10% with T1a and 15% with T1b cancers were found to have nodal metastases. Although LVI was significantly associated with a higher risk of lymph node metastases, we could not characterize any subgroup at acceptably low risk of nodal positivity. Until a more useful prognostic indicator is discovered, axillary dissection should continue to be part of the mainstay of management for small breast cancers.
Early breast cancer Axillary lymph node metastases Axillary dissection Regional metastases
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Rosen PP, Groshen S, Saigo PE, Kinne DW, Hellman S. Pathologic prognostic factors in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma: a study of 644 patients with median follow-up of 18 years.J Clin Oncol 1989;7:1239–51.PubMedGoogle Scholar
Fisher B, Bauer M, Wickerham DL, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer.Cancer 1983;52:1551–7.PubMedGoogle Scholar
Ruffin WK, Stacey-Clear A, Younger J, Hoover H. Rationale for the routine axillary dissection in carcinoma of the breast.J Am Coll Surg 1995;180:245–51.PubMedGoogle Scholar
Hayward J, Caleffi M. The significance of local control in the primary treatment of breast cancer.Arch Surg 1987;122:1244–7.PubMedGoogle Scholar
Langlands AO, Prescott RJ, Hamilton T. A clinical trial in the management of operable breast cancerBr J Surg 1980;67:170–4.PubMedGoogle Scholar
White RE, Vezeridis MP, Konstadoulakis M, Cole BF, Wanebo HJ, Bland KI. Therapeutic options and results for the management of minimally invasive carcinoma of the breast: influence of axillary dissection for treatment of T1a and T1b lesions.J Am Coll Surg 1996;183:575–82.PubMedGoogle Scholar
Cady B, Stone MD, Wayne J. New therapeutic possibilities in primary invasive breast cancer.Ann Surg 1993;218:338–49.PubMedGoogle Scholar
Silverstein MJ, Gierson ED, Waisman JR, Senofsky GM, Colburn WJ, Gamagami P. Axillary lymph node dissection for T1a breast carcinoma, is it indicated?Cancer 1994;73:664–7.PubMedGoogle Scholar
Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases.Cancer 1989;63:181–7.PubMedGoogle Scholar
Veronesi U, Luini A, Galimberti V, Marchini S, Sacchini V, Rilke F. Extent of metastatic axillary involvement in 1446 cases of breast cancer.Eur J Surg Oncol 1990;16:127–33.PubMedGoogle Scholar
Silverstein MJ, Gierson ED, Waisman JR, Colburn WJ, Gamagami P. Predicting axillary node positivity in patients with invasive carcinoma of the breast by using a combination of T category and palpability.J Am Coll Surg 1995;180:700–4.PubMedGoogle Scholar
Halverson KJ, Taylor ME, Perez CA, et al. Management of the axilla in patients with breast cancers one centimeter or smaller.Am J Clin Oncol 1994;17:461–6.PubMedGoogle Scholar
Baxter N, McCready D, Chapman JA, et al. Clinical behavior of untreated axillary nodes after local treatment for primary breast cancer.Ann Surg Oncol 1996;3:235–40.PubMedGoogle Scholar
Kiricuta CI, Tausch J. A mathematical model of axillary lymph node involvement based on 1446 complete dissections in patients with breast carcinoma.Cancer 1992;69:2496–2501.PubMedGoogle Scholar
Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ, eds. Manual for Staging of Cancer, 4th ed. Philadelphia: JB Lippincott, 1992:149–54.Google Scholar
Walls J, Boggis CRM, Wilson M, Asbury DL, Roberts JV, Bundred NJ, Mansel RE. Treatment of the axilla in patients with screen-detected breast cancer.Br J Surg 1993;80:436–8.PubMedGoogle Scholar
Early Breast Cancer Trialists' Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy.Lancet 1992;339:1–15, 71–85.Google Scholar
Fisher B, Montague E. Comparison of radical mastectomy with alternative treatments for primary breast cancer.Cancer 1977;39:2829–39.Google Scholar
Fisher B, Wolmark N, Bauer M, Redmond C, Gebhardt M. The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast.Surg Gynecol Obstet 1981;152:765–72.PubMedGoogle Scholar
Harris JR, Osteen RT. Patients with early breast cancer benefit from effective axillary treatment.Breast Cancer Res Treat 1985;5:17–21.PubMedGoogle Scholar
Cabanes PA, Salmon RJ, Vilcoq JR, Durand JC, Fourquet A, Gautier C, Asselain B. Value of axillary dissection in addition to lumpectomy and radiotherapy in early breast cancer.Lancet 1992;339:1245–8.CrossRefPubMedGoogle Scholar
Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer.Ann Surg 1994;220:391–401.PubMedGoogle Scholar