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Implication of Extracapsular Invasion of Sentinel Lymph Nodes in Breast Cancer: Prediction of Nonsentinel Lymph Node Metastasis

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Abstract

Background

Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients who require axillary lymph node dissection (ALND). However, many patients with positive SLN do not show metastasis to other axillary lymph nodes. In this study, we investigated the factors that may determine the likelihood of additional positive nodes in the axilla when metastasis is found in the SLN.

Methods

SLN biopsy was performed on 276 patients with breast cancer with clinically negative nodes, of which 46 (16.6%) had positive SLNs and underwent ALND. Eleven (23.9%) of these 46 cases had additional metastasis in nonsentinel lymph nodes (NSLN). The clinical and pathological features of these cases were reviewed and statistical analysis was performed.

Results

All cases of positive nodes in NSLN in our series had extracapsular invasion (ECI) at the metastatic SLNs. Furthermore, the absence of ECI of SLN was significantly associated with the absence of metastasis in the NSLN (P < 0.001). As contributing factors, the absence of lymphatic invasion at the primary tumor, primary tumor size (<2 cm) and foci size in the metastatic SLN fell short of reaching statistical significance. Other factors, including histological type, pathological grade, estrogen receptor status, HER2 status, and age, were not significantly associated with metastatic involvement of NSLN.

Conclusions

Our results suggest that the presence of ECI at metastatic SLNs is a strong predictor for residual disease in the axilla. These findings imply the possibility that ALND might be foregone in the treatment of patients with breast cancer without ECI at metastatic SLNs.

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References

  1. Giuliano AE, Kirgan DM, Guenther JM et al (1994) Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220:391–401

    Article  CAS  PubMed  Google Scholar 

  2. Albertini JJ, Lyman GH, Cox C et al (1996) Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 276:1818–1822

    Article  CAS  PubMed  Google Scholar 

  3. Clarke D, Khonji NI, Mansel RE (2001) Sentinel node biopsy in breast cancer: ALMANAC trial. World J Surg 25:819–822

    Article  CAS  PubMed  Google Scholar 

  4. Krag D, Weaver D, Ashikaga T et al (1998) The sentinel node in breast cancer: a multicenter validation study. N Engl J Med 339:941–946

    Article  CAS  PubMed  Google Scholar 

  5. Veronesi U, Paganelli GT, Galimberti V et al (1997) Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 349:1864–1867

    Article  CAS  PubMed  Google Scholar 

  6. 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 229:536–541

    Article  CAS  PubMed  Google Scholar 

  7. Kamath VJ, Giuliano R, Dauway EL et al (2001) Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection. Arch Surg 136:688–692

    Article  CAS  PubMed  Google Scholar 

  8. Changsri C, Prakash S, Sandweiss L et al (2004) Prediction of additional axillary metastasis of breast cancer following sentinel lymph node surgery. Breast J 10:392–397

    Article  PubMed  Google Scholar 

  9. Liang WC, Sickle-Santanello BJ, Nims TA (2001) Is a completion axillary dissection indicated for micrometastases in the sentinel lymph node? Am J Surg 182:365–368

    Article  CAS  PubMed  Google Scholar 

  10. Guenther JM, Hansen NM, DiFronzo LA et al (2003) Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes. Arch Surg 138:52–56

    Article  PubMed  Google Scholar 

  11. Viale G, Maiorano E, Pruneri G et al (2005) Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg 241:319–325

    Article  PubMed  Google Scholar 

  12. Weiser MR, Montgomery LL, Tan LK et al (2001) Lymphovascular invasion enhances the prediction of non-sentinel node metastasis in breast cancer patients with positive sentinel nodes. Ann Surg Oncol 8:145–149

    Article  CAS  PubMed  Google Scholar 

  13. Rivers AK, Griffith KA, Hunt KK et al (2006) Clinicopathologic features associated with having four of more metastatic axillary nodes in breast cancer patients with a positive sentinel lymph node. Ann Surg Oncol 13:36–44

    Article  PubMed  Google Scholar 

  14. Wada N, Imoto S, Yamauchi C et al (2006) Predictors of tumor involvement in remaining axillary lymph nodes of breast cancer patients with positive sentinel lymph node. Eur J Surg Oncol 32:29–33

    Article  CAS  PubMed  Google Scholar 

  15. Travagli JP, Atallah D, Mathieu MC et al (2003) Sentinel lymphadenectomy without systematic axillary dissection in breast cancer patients: predictors of non-sentinel lymph node metastasis. Eur J Surg Oncol 29:403–406

    Article  PubMed  Google Scholar 

  16. Cho J, Han W, Lee JW et al (2008) A scoring system to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a comparison with other scoring systems. Ann Surg Oncol 15:2278–2286

    Article  PubMed  Google Scholar 

  17. Goyal A, Douglas Jones A, Newcombe RG et al (2004) Predictors of non-sentinel lymph node metastasis in breast cancer patients. Eur J Cancer 40:1731–1737

    Article  CAS  PubMed  Google Scholar 

  18. Changsri C, Prakash S, Sandweiss L et al (2004) Prediction of additional axillary matastasis of breast cancer following sentinel lymph node surgery. Breast J 10:392–397

    Article  PubMed  Google Scholar 

  19. Joseph KA, El-Tamer M, Komenaka I et al (2004) Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis. Arch Surg 139:648–651

    Article  PubMed  Google Scholar 

  20. Stizenberg KB, Meyer AA, Stem SL et al (2003) Extracapsular extension of the sentinel lymph node metastasis: a predictor of nonsentinel node tumor burden. Ann Surg 237:607–613

    Article  Google Scholar 

  21. Beriwal S, Soran A, Kocer B et al (2008) Factors that predict the burden of axillary disease in breast cancer patients with a positive sentinel node. Am J Clin Oncol 31:34–38

    Article  PubMed  Google Scholar 

  22. Hung WK, Chan MC, Mak KL et al (2005) Non-sentinel lymph node metastases in breast cancer patients with metastatic sentinel nodes. ANZ J Surg 75:27–31

    Article  PubMed  Google Scholar 

  23. Greene FL, Page DL, Fleming ID (2002) AJCC cancer staging manual, 6th edn. Springer, New York

    Google Scholar 

  24. Allred DC, Harvey JM, Berardo M et al (1998) Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Mod Pathol 11:155–168

    CAS  PubMed  Google Scholar 

  25. Shousha S (2008) Oestrogen receptor status of breast carcinoma: Allred/H score conversion table. Histopathology 53:346–347

    Article  CAS  PubMed  Google Scholar 

  26. Krag DN (1999) The sentinel node for staging breast cancer: current review. Breast Cancer 6:233–236

    Article  PubMed  Google Scholar 

  27. Morrow M (2001) Is axillary dissection necessary after positive sentinel node biopsy? Yes!. Ann Surg Oncol 8:S74–S76

    Google Scholar 

  28. Bucci JA, Kennedy CW, Burn J et al (2001) Implication of extranodal spread in node positive breast cancer: a review of survival and local recurrence. Breast 10:213–219

    Article  CAS  PubMed  Google Scholar 

  29. Hasebe T, Sasaki S, Imoto S et al (2003) Tumor cells in lymph vessels and lymph nodes closely associated with nodal metastasis by invasive ductal carcinoma of the breast. Cancer Sci 94:508–514

    Article  CAS  PubMed  Google Scholar 

  30. Donegan WL, Stine SB, Samter TG (1993) Implications of extracapsular nodal metastases for treatment and prognosis of breast cancer. Cancer 72:778–782

    Article  CAS  PubMed  Google Scholar 

  31. Leonard C, Corkill M, Tompkin J et al (1995) Are axillary recurrence and overall survival affected by axillary extranodal tumor extension in breast cancer? Implications for radiation therapy. J Clin Oncol 13:47–53

    CAS  PubMed  Google Scholar 

  32. Mignano JE, Zahurak ML, Chakravarthy A et al (1999) Significance of axillary lymph node extranodal soft tissue extension and indications for postmastectomy irradiation. Cancer 86:1258–1262

    Article  CAS  PubMed  Google Scholar 

  33. Rutgers EJ (2008) Sentinel node biopsy: Interpretation and management of patients with immunohistochemistry-positive sentinel nodes and those with micrometastases. J Clin Oncol 26:698–702

    Article  PubMed  Google Scholar 

  34. Chen SL, Hoehne FM, Giuliano AE (2007) The prognostic significance of micrometastases in breast cancer: a SEER population-based analysis. Ann Surg Oncol 14:3378–3384

    Article  PubMed  Google Scholar 

  35. Wada N, Imoto S (2008) Clinical evidence of breast cancer micrometastasis in the era of sentinel node biopsy. Int J Clin Oncol 13:24–32

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Y. Saitoh, T. Yano, M. Ohno, M. Ida, and H. Emura for their secretarial assistance.

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Authors and Affiliations

  1. Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Takaaki Fujii, Yasuhiro Yanagita, Tomomi Fujisawa, Tomoko Hirakata & Hiroyuki Kuwano

  2. Department of Breast Oncology, Gunma Cancer Center, 617-1 Takabayashinishi-machi, Ohta, Gunma, 373-8550, Japan

    Yasuhiro Yanagita, Tomomi Fujisawa & Tomoko Hirakata

  3. Department of Pathology, Gunma Cancer Center, 617-1 Takabayashinishi-machi, Ohta, Gunma, 373-8550, Japan

    Misa Iijima

Authors
  1. Takaaki Fujii
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  2. Yasuhiro Yanagita
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  3. Tomomi Fujisawa
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  4. Tomoko Hirakata
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Correspondence to Takaaki Fujii.

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Fujii, T., Yanagita, Y., Fujisawa, T. et al. Implication of Extracapsular Invasion of Sentinel Lymph Nodes in Breast Cancer: Prediction of Nonsentinel Lymph Node Metastasis. World J Surg 34, 544–548 (2010). https://doi.org/10.1007/s00268-009-0389-4

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  • DOI: https://doi.org/10.1007/s00268-009-0389-4

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