Skip to main content
SpringerLink
Log in

Predictive Factors for the Status of Non-sentinel Nodes in Breast Cancer Patients with Tumor Positive Sentinel Nodes

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

In patients with tumor positive sentinel nodes, axillary lymph node dissection is routinely performed while a majority of these patients have no tumor involvement in the non-sentinel nodes. The authors tried to identify a subgroup of patients with a tumor positive sentinel node without non-sentinel node tumor involvement. In 135 consecutive patients with tumor positive sentinel nodes and axillary lymph node dissection performed, the incidence of non-sentinel node involvement according to tumor and sentinel node related factors was examined. The size of the sentinel node metastasis, size of primary tumor and number of tumor positive sentinel nodes were the three factors significantly predicting the status of the non-sentinel nodes. The size of the sentinel node metastasis was the strongest predictive factor (P < 0.0001). In a subgroup of 41 patients with a stage T1 tumor and micrometastatic involvement in the sentinel node only 2 patients (5%) had non-sentinel node involvement. In patients with small primary tumors and micrometastatic involvement of the sentinel nodes, the chance of non-sentinel node involvement is small but cannot be discarded. Because the clinical relevance of micrometastases in lymph nodes is still unclear it is not advisable to omit axillary lymph node dissection even in these patients.

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

Similar content being viewed by others

References

  1. Hoe AL, Iven D, Royle GT, Taylor I: Incidence of arm swelling following axillary clearance for breast cancer. Br J Surg 79: 261-262, 1992

    Google Scholar 

  2. Kakuda JT, Stuntz M, Trivedi V, Klein SR, Vargas HI: Objective assessment of axillary morbidity in breast cancer treatment. Am Surg 65: 995-998, 1999

    Google Scholar 

  3. Rockson SG: Precipitating factors in lymphedema: myths and realities. Cancer 83: 2814-2816, 1998

    Google Scholar 

  4. Ganz PA: The quality of life after breast cancer-solving the problem of lymphedema. N Engl J Med 340: 383-385, 1999

    Google Scholar 

  5. Kissin MW, Querci della Rovere G, Easton D, Westbury G: Risk of lymphoedema following the treatment of breast cancer. Br J Surg 73: 580-584, 1986

    Google Scholar 

  6. Logan V: Incidence and prevalence of lymphoedema: a literature review. J Clin Nurs 4: 213-219, 1995

    Google Scholar 

  7. Leidenius M, Leppanen E, Krogerus L, von Smitten K: Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg 185: 127-130, 2003

    Google Scholar 

  8. Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT: Assessment of morbidity from complete axillary dissection. Br J Cancer 66: 136-138, 1992

    Google Scholar 

  9. Velanovich V, Szymanski W: Quality of life of breast cancer patients with lymphedema. Am J Surg 177: 184-187; discussion 188, 1999

    Google Scholar 

  10. Jaderborg JM, Harrison PB, Kiser JL, Maynard SL: The feasibility and accuracy of the sentinel lymph node biopsy for breast carcinoma. Am Surg 65: 699-703; discussion 704-705, 1999

    Google Scholar 

  11. Cox CE, Bass SS, McCann CR, Ku NN, Berman C, Durand K, Bolano M, Wang J, Peltz E, Cox S, Salud C, Reintgen DS, Lyman GH: Lymphatic mapping and sentinel lymph node biopsy in patients with breast cancer. Annu Rev Med 51: 525-542, 2000

    Google Scholar 

  12. Bass SS, Cox CE, Ku NN, Berman C, Reintgen DS: The role of sentinel lymph node biopsy in breast cancer. J Am Coll Surg 189: 183-194, 1999

    Google Scholar 

  13. Giuliano AE: Current status of sentinel lymphadenectomy in breast cancer. Ann Surg Oncol 8: 52S-55S, 2001

    Google Scholar 

  14. Giuliano AE, Jones RC, Brennan M, Statman R: Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15: 2345-2350, 1997

    Google Scholar 

  15. Veronesi U, Paganelli G, Viale G, Galimberti V, Luini A, Zurrida S, Robertson C, Sacchini V, Veronesi P, Orvieto E, De Cicco C, Intra M, Tosi G, Scarpa D: Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 91: 368-373, 1999

    Google Scholar 

  16. Miltenburg DM, Miller C, Karamlou TB, Brunicardi FC: Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res 84: 138-142, 1999

    Google Scholar 

  17. Turner RR, Ollila DW, Krasne DL, Giuliano AE: Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 226: 271-276; discussion 276-278, 1997

    Google Scholar 

  18. Giuliano AE, Haigh PI, Brennan MB, Hansen NM, Kelley MC, Ye W, Glass EC, Turner RR: Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 18: 2553-2559, 2000

    Google Scholar 

  19. Schrenk P, Hatzl-Griesenhofer M, Shamiyeh A, Waynad W: Follow-up of sentinel node negative breast cancer patients without axillary lymph node dissection. J Surg Oncol 77: 165-170, 2001

    Google Scholar 

  20. Sener SF, Winchester DJ, Martz CH, Feldman JL, Cavanaugh JA, Winchester DP, Weigel B, Bonnefoi K, Kirby K, Morehead C: Lymphedema after sentinel lymphadenectomy for breast carcinoma. Cancer 92: 748-752, 2001

    Google Scholar 

  21. Miguel R, Kuhn AM, Shons AR, Dyches P, Ebert MD, Peltz ES, Nguyen K, Cox CE: The effect of sentinel node selective axillary lymphadenectomy on the incidence of postmastectomy pain syndrome. Cancer Control 8: 427-430, 2001

    Google Scholar 

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

    Google Scholar 

  23. Chu KU, Turner RR, Hansen NM, Brennan MB, Bilchik A, Giuliano AE: Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 229: 536-541, 1999

    Google Scholar 

  24. Wong SL, Edwards MJ, Chao C, Tuttle TM, Noyes RD, Woo C, Cerrito PB, McMasters KM: Predicting the status of the nonsentinel axillary nodes: a multicenter study. Arch Surg 136: 563-568, 2001

    Google Scholar 

  25. Kamath VJ, Giuliano R, Dauway EL, Cantor A, Berman C, Ku NN, Cox CE, Reintgen DS: 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, 2001

    Google Scholar 

  26. Abdessalam SF, Zervos EE, Prasad M, Farrar WB, Yee LD, Walker MJ, Carson WB, Burak Jr WE: Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg 182: 316-320, 2001

    Google Scholar 

  27. Mignotte H, Treilleux I, Faure C, Nessah K, Bremond A: Axillary lymph-node dissection for positive sentinel nodes in breast cancer patients. Eur J Surg Oncol 28: 623, 2002

    Google Scholar 

  28. Santin AD: Lymph node metastases: the importance of the microenvironment. Cancer 88: 175-179, 2000

    Google Scholar 

  29. Camp RL, Rimm EB, Rimm DL: A high number of tumor free axillary lymph nodes from patients with lymph node negative breast carcinoma is associated with poor outcome. Cancer 88: 108-113, 2000

    Google Scholar 

  30. Cserni G: Sentinel lymph-node biopsy-based prediction of further breast cancer metastases in the axilla. Eur J Surg Oncol 27: 532-538, 2001

    Google Scholar 

  31. Rahusen FD, Torrenga H, van Diest PJ, Pijpers R, van derWall E, Licht J, Meijer S: Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg 136: 1059-1063, 2001

    Google Scholar 

  32. Reynolds C, Mick R, Donohue JH, Grant CS, Farley DR, Callans LS, Orel SG, Keeney GL, Lawton TJ, Czerniecki BJ: Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol 17: 1720-1726, 1999

    Google Scholar 

  33. Sachdev U, Murphy K, Derzie A, Jaffer S, Bleiweiss IJ, Brower S: Predictors of nonsentinel lymph node metastasis in breast cancer patients. Am J Surg 183: 213-217, 2002

    Google Scholar 

  34. Turner RR, Chu KU, Qi K, Botnick LE, Hansen NM, Glass EC, Giuliano AE: Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node. Cancer 89: 574-581, 2000

    Google Scholar 

  35. den Bakker MA, van Weeszenberg A, de Kanter AY, Beverdam FH, Pritchard C, van der Kwast TH, Menke-Pluymers M: Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance. J Clin Pathol 55: 932-935, 2002

    Google Scholar 

  36. McGuckin MA, Cummings MC, Walsh MD, Hohn BG, Bennett IC, Wright RG: Occult axillary node metastases in breast cancer: their detection and prognostic significance. Br J Cancer 73: 88-95, 1996

    Google Scholar 

  37. Hainsworth PJ, Tjandra JJ, Stillwell RG, Machet D, Henderson MA, Rennie GC, McKenzie IF, Bennett RC: Detection and significance of occult metastases in node-negative breast cancer. Br J Surg 80: 459-463, 1993

    Google Scholar 

  38. Maehara Y, Oshiro T, Endo K, Baba H, Oda S, Ichiyoshi Y, Kohnoe S, Sugimachi K: Clinical significance of occult micrometastasis lymph nodes from patients with early gastric cancer who died of recurrence. Surgery 119: 397-402, 1996

    Google Scholar 

  39. Siziopikou KP, Schnitt SJ, Connolly JL, Hayes DF: Detection and significance of occult axillary metastatic disease in breast cancer patients. Breast J 5: 221-229, 1999

    Google Scholar 

  40. Cote RJ, Peterson HF, Chaiwun B, Gelber RD, Goldhirsch A, Castiglione-Gertsch M, Gusterson B, Neville AM: Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast Cancer Study Group. Lancet 354: 896-900, 1999

    Google Scholar 

  41. Millis RR, Springall R, Lee AH, Ryder K, Rytina ER, Fentiman IS: Occult axillary lymph node metastases are of no prognostic significance in breast cancer. Br J Cancer 86: 396-401, 2002

    Google Scholar 

  42. Colpaert C, Vermeulen P, Jeuris W, van Beest P, Goovaerts G, Weyler J, Van Dam P, Dirix L, Van Marck E: Early distant relapse in ‘node-negative’ breast cancer patients is not predicted by occult axillary lymph node metastases, but by the features of the primary tumour. J Pathol 193: 442-449, 2001

    Google Scholar 

  43. Fisher B, Redmond C, Fisher ER, Bauer M, Wolmark N, Wickerham DL, Deutsch M, Montague E, Margolese R, Foster R: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312: 674-681, 1985

    Google Scholar 

  44. Orr RK: The impact of prophylactic axillary node dissection on breast cancer survival-a Bayesian meta-analysis. Ann Surg Oncol 6: 109-116, 1999

    Google Scholar 

  45. Axelsson CK, Rank F, Blichert-Toft M, Mouridsen HT, Jensen MB: Impact of axillary dissection on staging and regional control in breast tumors < or = 10mm-the DBCG experience. The Danish Breast Cancer Cooperative Group (DBCG), Rigshisoutalet, Copenhagen, Denmark. Acta Oncol 39: 283-289, 2000

    Google Scholar 

  46. Bland KI, Scott-Conner CE, Menck H, Winchester DP: Axillary dissection in breast-conserving surgery for stage I and II breast cancer: a National Cancer Data Base study of patterns of omission and implications for survival. J Am Coll Surg 188: 586-595; discussion 595-596, 1999

    Google Scholar 

  47. Chung MA, Steinhoff MM, Cady B: Clinical axillary recurrence in breast cancer patients after a negative sentinel node biopsy. Am J Surg 184: 310-314, 2002

    Google Scholar 

  48. Guenther JM, Hansen NM, DiFronzo LA, Giuliano AE, Collins JC, Grube BL, O'Connell TX: Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes. Arch Surg 138: 52-56, 2003

    Google Scholar 

  49. Nano MT, Kollias J, Farshid G, Gill PG, Bochner M: Clinical impact of false-negative sentinel node biopsy in primary breast cancer. Br J Surg 89: 1430-1434, 2002

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Breast Surgery Unit, Maria Hospital, Helsinki, Finland

    Vincent van Iterson, Marjut Leidenius & Karl von Smitten

  2. Department of Pathology, Helsinki University Hospital, Helsinki, Finland

    Leena Krogerus

Authors
  1. Vincent van Iterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marjut Leidenius
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leena Krogerus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karl von Smitten
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Iterson, V., Leidenius, M., Krogerus, L. et al. Predictive Factors for the Status of Non-sentinel Nodes in Breast Cancer Patients with Tumor Positive Sentinel Nodes. Breast Cancer Res Treat 82, 39–45 (2003). https://doi.org/10.1023/B:BREA.0000003918.59396.e4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:BREA.0000003918.59396.e4

Search

Navigation