Annals of Surgical Oncology

, Volume 20, Issue 8, pp 2576–2581 | Cite as

Impact of Multifocality and Lymph Node Metastasis on the Prognosis and Management of Microinvasive Breast Cancer

  • Nimmi S. Kapoor
  • Jaime Shamonki
  • Myung-Shin Sim
  • Cathie T. Chung
  • Armando E. Giuliano
Breast Oncology

Abstract

Background

There are few data on the long-term outcome of patients with microinvasive (T1mi) breast cancer. Moreover, predictors of lymph node involvement and the impact of multifocal microinvasion are not well understood.

Methods

Patients with T1mi cancer, defined as tumors ≤1 mm, surgically managed at our institute and who underwent axillary lymph node evaluation were identified. Specimen slides were independently reviewed. Multivariate analysis was used to identify factors predictive of lymph node involvement.

Results

Forty-five patients with T1mi cancer were identified. Median patient age was 52 years, and median size of in situ disease was 4 cm. Nine tumors (20.0 %) had more than one focus of microinvasion. Lymph nodes metastasis were identified in 9 patients: 1 macrometastasis (2.2 %), 4 micrometastases (8.9 %), and 4 isolated tumor cells (8.9 %). Seven of 9 patients with lymph node involvement underwent adjuvant chemotherapy. Estrogen receptor–negative invasive disease was a significant predictor of lymph node metastasis by multivariable analysis (p < 0.02). There was also a trend toward lymph node involvement in patients with multifocal microinvasion compared to unifocal disease (33.3 vs. 16.7 %, respectively). At a median follow-up of 83 months, 3 patients (6.3 %) had disease recurrence (1 local, 1 distant, 1 local and distant). All patients with recurrence initially had tumor-free lymph nodes and only one focus of microinvasion.

Conclusions

Microinvasive breast cancer clearly has the ability to metastasize and recur, but in this series, only 2 % of patients with nodal macrometastasis. Only two patients experienced local recurrence, neither of whom had lymph node metastasis. The importance of identifying nodal micrometastasis in T1mi disease needs to be further explored.

Notes

Acknowledgment

Supported in part by the Associates for Breast and Prostate Cancer Studies, Santa Monica, California; QVC and the Fashion Footwear Association of New York Charitable Foundation, New York, NY; and the Margie and Robert E. Petersen Foundation, Los Angeles, CA.

Disclosure

The authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Nimmi S. Kapoor
    • 1
    • 2
  • Jaime Shamonki
    • 3
  • Myung-Shin Sim
    • 4
  • Cathie T. Chung
    • 5
  • Armando E. Giuliano
    • 6
  1. 1.Department of SurgeryJohn Wayne Cancer InstituteSanta MonicaUSA
  2. 2.Department of SurgeryCedars-Sinai Medical CenterWest HollywoodUSA
  3. 3.Department of PathologySaint John’s Health CenterSanta MonicaUSA
  4. 4.Department of BiostatisticsSaint John’s Health CenterSanta MonicaUSA
  5. 5.Department of Medical OncologyJohn Wayne Cancer InstituteSanta MonicaUSA
  6. 6.Department of Surgical OncologyCedars-Sinai Medical CenterWest HollywoodUSA

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