Skip to main content

Advertisement

SpringerLink
Log in

Clinical effect of the pathological axillary assessment method in breast cancer without clinical nodal metastasis

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

This study aimed to assess the clinical effect of the pathological axillary assessment method in breast cancer without clinical lymph node metastasis.

Methods

Data of patients with clinically node-negative breast cancer were retrospectively reviewed. The study period was divided into early (January 2000–July 2007) and late (August 2007–December 2014) periods based on the pathological assessment method used (single-sectional and detailed multi-sectional lymph node processing). In the late period, lymph nodes were evaluated at six levels including immunohistochemistry on each 1.5–2 mm interval section. The axillary diagnostic accuracy and role of chemotherapy were assessed.

Results

In 1698 patients, 27 isolated tumor cells (ITCs), 39 micrometastases, and 205 macrometastases were noted. The sensitivity for pathological N0 diagnosis was dependent on clinical T stage, Tis (97.8%), T1 (83.0%), T2 (74.2%), T3 (54.5%), and T4 (63.6%). ITCs and micrometastases were detected only in the late period, and 84.7% and 91.6% of cases in the early and late period, respectively, did not have macrometastases. The 5-year disease-free interval (DFI) rates were 95.2% in node-negative cases, 98.4% in ITCs/micrometastases, and 91.4% in macrometastases (P < 0.001). In multivariate analysis, the predictor for DFI was estrogen receptor negativity (P = 0.013). Chemotherapy did not improve DFI in patients with node-positive breast cancer.

Conclusions

The detailed multi-sectional pathological assessment of axillary lymph nodes detected ITCs and micrometastases. Implementation of chemotherapy should not be based on the minimal nodal metastasis and this type of serially nodal sectioned processing had little clinical significance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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.

    Article  CAS  Google Scholar 

  2. NCCN Clinical Practice Guidelines in Oncology Breast Cancer. 2018. Available. Accessed 09 June 2018.

  3. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33. https://doi.org/10.1016/s1470-2045(10)70207-2.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93–9. https://doi.org/10.3322/caac.21388.

    Article  PubMed  Google Scholar 

  5. de Boer M, van Dijck JA, Bult P, Borm GF, Tjan-Heijnen VC. Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. J Natl Cancer Inst. 2010;102:410–25. https://doi.org/10.1093/jnci/djq008.

    Article  PubMed  Google Scholar 

  6. Chen SL, Hoehne FM, Giuliano AE. The prognostic significance of micrometastases in breast cancer: a SEER population-based analysis. Ann Surg Oncol. 2007;14:3378–84. https://doi.org/10.1245/s10434-007-9513-6.

    Article  PubMed  Google Scholar 

  7. Houvenaeghel G, Classe JM, Garbay JR, Giard S, Cohen M, Faure C, et al. Prognostic value of isolated tumor cells and micrometastases of lymph nodes in early-stage breast cancer: a French sentinel node multicenter cohort study. Breast. 2014;23:561–6. https://doi.org/10.1016/j.breast.2014.04.004.

    Article  PubMed  Google Scholar 

  8. Hansen NM, Grube B, Ye X, Turner RR, Brenner RJ, Sim MS, et al. Impact of micrometastases in the sentinel node of patients with invasive breast cancer. J Clin Oncol. 2009;27:4679–84. https://doi.org/10.1200/jco.2008.19.0686.

    Article  PubMed  Google Scholar 

  9. Iqbal J, Ginsburg O, Giannakeas V, Rochon PA, Semple JL, Narod SA. The impact of nodal micrometastasis on mortality among women with early-stage breast cancer. Breast Cancer Res Treat. 2017;161:103–15. https://doi.org/10.1007/s10549-016-4015-5.

    Article  PubMed  Google Scholar 

  10. Andersson Y, Frisell J, Sylvan M, de Boniface J, Bergkvist L. Breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. J Clin Oncol. 2010;28:2868–73. https://doi.org/10.1200/jco.2009.24.5001.

    Article  PubMed  Google Scholar 

  11. Galimberti V, Cole BF, Viale G, Veronesi P, Vicini E, Intra M, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018;19:1385–93. https://doi.org/10.1016/s1470-2045(18)30380-2.

    Article  PubMed  Google Scholar 

  12. Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14:297–305. https://doi.org/10.1016/s1470-2045(13)70035-4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sola M, Alberro JA, Fraile M, Santesteban P, Ramos M, Fabregas R, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013;20:120–7. https://doi.org/10.1245/s10434-012-2569-y.

    Article  PubMed  Google Scholar 

  14. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8:881–8. https://doi.org/10.1016/s1470-2045(07)70278-4.

    Article  CAS  PubMed  Google Scholar 

  15. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol. 2006;7:983–90. https://doi.org/10.1016/S1470-2045(06)70947-0.

    Article  PubMed  Google Scholar 

  16. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer. 2006;106:4–16. https://doi.org/10.1002/cncr.21568.

    Article  PubMed  Google Scholar 

  17. Weaver DL, Ashikaga T, Krag DN, Skelly JM, Anderson SJ, Harlow SP, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21. https://doi.org/10.1056/NEJMoa1008108.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Weaver DL, Le UP, Dupuis SL, Weaver KA, Harlow SP, Ashikaga T, et al. Metastasis detection in sentinel lymph nodes: comparison of a limited widely spaced (NSABP protocol B-32) and a comprehensive narrowly spaced paraffin block sectioning strategy. Am J Surg Pathol. 2009;33:1583–9. https://doi.org/10.1097/PAS.0b013e3181b274e7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yared MA, Middleton LP, Smith TL, Kim HW, Ross MI, Hunt KK, et al. Recommendations for sentinel lymph node processing in breast cancer. Am J Surg Pathol. 2002;26:377–82.

    Article  CAS  Google Scholar 

  20. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8. https://doi.org/10.1038/bmt.2012.244.

    Article  CAS  Google Scholar 

  21. Farshid G, Pradhan M, Kollias J, Gill PG. Computer simulations of lymph node metastasis for optimizing the pathologic examination of sentinel lymph nodes in patients with breast carcinoma. Cancer. 2000;89:2527–37.

    Article  CAS  Google Scholar 

  22. Meyer JS. Sentinel lymph node biopsy: strategies for pathologic examination of the specimen. J Surg Oncol. 1998;69:212–8. https://doi.org/10.1002/(sici)1096-9098(199812)69:4%3c212::aid-jso4%3e3.0.co;2-v.

    Article  CAS  PubMed  Google Scholar 

  23. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol. 2007;18:1133–44. https://doi.org/10.1093/annonc/mdm271.

    Article  CAS  PubMed  Google Scholar 

  24. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ, et al. Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22:1736–47. https://doi.org/10.1093/annonc/mdr304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Shigematsu H, Nishina M, Yasui D, Hirata T, Ozaki S. Minimal prognostic significance of sentinel lymph node metastasis in patients with cT1-2 and cN0 breast cancer. World J Surg Oncol. 2019;17:41. https://doi.org/10.1186/s12957-019-1585-9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tucker NS, Cyr AE, Ademuyiwa FO, Tabchy A, George K, Sharma PK, et al. Axillary ultrasound accurately excludes clinically significant lymph node disease in patients with early stage breast cancer. Ann Surg. 2016;264:1098–102. https://doi.org/10.1097/SLA.0000000000001549.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the Department of Anatomical Pathology for their pathological assessment. They also thank Ai Shimamoto for data management. This study did not receive any funding.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan

    Shinsuke Sasada, Norio Masumoto, Akiko Emi, Takayuki Kadoya & Morihito Okada

  2. Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan

    Koji Arihiro

Authors
  1. Shinsuke Sasada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Norio Masumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akiko Emi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takayuki Kadoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koji Arihiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Morihito Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SS, NM, AE and TK. The first draft of the manuscript was written by SS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shinsuke Sasada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 24 KB)

Supplementary file2 (TIF 1043 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sasada, S., Masumoto, N., Emi, A. et al. Clinical effect of the pathological axillary assessment method in breast cancer without clinical nodal metastasis. Breast Cancer 28, 1016–1022 (2021). https://doi.org/10.1007/s12282-021-01236-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-021-01236-x

Keywords

Search

Navigation