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Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3440–3447 | Cite as

Predicting the Extent of Nodal Disease in Early-Stage Breast Cancer

  • Abigail S. CaudleEmail author
  • Henry M. Kuerer
  • Huong T. Le-Petross
  • Wei Yang
  • Min Yi
  • Isabelle Bedrosian
  • Savitri Krishnamurthy
  • Bruno D. Fornage
  • Kelly K. Hunt
  • Elizabeth A. Mittendorf
Breast Oncology

Abstract

Background

The role of regional nodal ultrasound (US) has been questioned since publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 data. The goal of this study was to determine if imaging and clinicopathologic features could predict the extent of axillary nodal involvement in breast cancer.

Study Design

Patients with T1–T2 tumors who underwent regional nodal US and axillary lymph node dissection from 2002 to 2012 were identified from a prospective database excluding those who received neoadjuvant chemotherapy. Patients whose metastases were identified by US confirmed by needle biopsy were compared with those identified by sentinel lymph node dissection (SLND) after a negative US.

Results

Metastases were identified by US in 190 patients, and by SLND in 518 patients. SLND patients had fewer positive nodes (2.2 vs. 4.1; p < 0.0001), smaller metastases (5.3 vs. 13.8 mm; p < 0.0001), and a lower incidence of extranodal extension (24 vs. 53 %; p < 0.0001) than the US group. Even when US identified ≤2 abnormal nodes, patients were still more likely to have ≥3 positive nodes (45 %) than SLND patients (19 %; p < 0.001). After adjusting for tumor size, receptor status, and histology, multivariate analysis revealed that metastases identified by US [odds ratio (OR) 4.01; 95 % confidence interval (CI) 2.75–5.84] and lobular histology (OR 1.77; 95 % CI 1.06–2.95) predicted having ≥3 positive nodes.

Conclusions

Imaging and clinicopathologic features can be used to predict the extent of nodal involvement. Patients with US-detected metastases, even if small volume, have a higher burden of nodal involvement than patients with SLND-detected metastases and may not be comparable with patients in the ACOSOG Z0011 trial.

Keywords

Hormone Receptor Positive Lymph Node Axillary Lymph Node Dissection Sentinel Lymph Node Dissection Suspicious Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The University of Texas MD Anderson Cancer Center is supported in part by a Cancer Center Support Grant (CA016672) from the National Institutes of Health.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Abigail S. Caudle
    • 1
    Email author
  • Henry M. Kuerer
    • 1
  • Huong T. Le-Petross
    • 1
  • Wei Yang
    • 1
  • Min Yi
    • 1
  • Isabelle Bedrosian
    • 1
  • Savitri Krishnamurthy
    • 1
  • Bruno D. Fornage
    • 1
  • Kelly K. Hunt
    • 1
  • Elizabeth A. Mittendorf
    • 1
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA

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