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Micrometastatic Disease and Isolated Tumor Cells as a Predictor for Additional Breast Cancer Axillary Metastatic Burden

  • American Society of Breast Surgeons
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Our study aims were to investigate breast cancer patients with micrometastases or isolated tumor cells (ITCs) in sentinel lymph nodes (SLNs) to determine the rate of non-SLN metastasis and axillary recurrences, and to compare actual non-SLN metastasis rates with those predicted by the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram.

Methods

We identified 116 stage I to III breast cancer patients who underwent sentinel lymph node biopsy and had micrometastases or ITCs (<2-mm deposits). Patients underwent completion axillary lymph node dissection (ALND) (group 1) or had no further axillary surgery (group 2). P < 0.05 was considered statistically significant.

Results

Of 116 patients with micrometastases or ITCs in SLNs, 55 (47%) underwent completion ALND (group 1), and 61 (53%) had no further axillary surgery (group 2). The rate of non-SLN metastases in group 1 patients was 9 (16%) of 55, which was significantly less than that predicted by the MSKCC nomogram (median 30%, P < 0.001). Patient age, race, tumor histology, tumor grade, estrogen receptor/Her-2neu status, and lymphovascular invasion did not differ significantly between group 1 patients with positive non-SLNs and those with negative non-SLNs (P > 0.05 for each), but patients with positive non-SLNs had larger tumors (P < 0.001). No patient in group 1 experienced an axillary recurrence, while only one patient (1.6%) in group 2 experienced axillary recurrence.

Conclusions

The actual rate of positive non-SLNs for breast cancer patients with SLN micrometastases or ITCs who underwent completion ALND was significantly less than that predicted by the MSKCC nomogram. The rate of axillary recurrence is negligible, regardless of the extent of axillary staging.

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References

  1. Green FL, Page DL, Fleming ID, et al., eds. (2002) AJCC cancer staging manual. 6th ed. Chicago: American Joint Commission on Cancer.

  2. Cote RJ, Peterson HF, Chaiwun B, et al. Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast Cancer Study Group. Lancet. 1999;354:896–900.

    Article  CAS  PubMed  Google Scholar 

  3. Cox CE, Kiluk VJ, Riker AI, et al. Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg. 2008;206:261–8.

    Article  PubMed  Google Scholar 

  4. International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancer. Lancet. 1990;335:1565–8.

    Google Scholar 

  5. Reed J, Rosman M, Verbanac KM, et al. Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center sentinel node multicenter study. J Am Coll Surg. 2009;208:333–40.

    Article  PubMed  Google Scholar 

  6. De Boer M, van Deurzen C, van Dijck J, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009;361:653–63.

    Article  PubMed  Google Scholar 

  7. Truong PT, Vinh-Hung V, Cserni G, et al. The number of positive nodes and the ratio of positive to excised nodes are significant predictors of survival in women with micrometastatic node-positive breast cancer. Eur J Cancer. 2008;44:1670–7.

    Article  PubMed  Google Scholar 

  8. Colleoni M, Rotmensz N, Peruzzotti G, et al. Size of breast cancer metastases in axillary lymph nodes: clinical relevance of minimal lymph node involvement. J Clin Oncol. 2005;23:1379–89.

    Article  PubMed  Google Scholar 

  9. Kahn HJ, Hanna WM, Chapman JA, et al. Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent American Joint Committee on Cancer breast cancer staging system. Breast J. 2006;12:294–301.

    Article  PubMed  Google Scholar 

  10. Fournier K, Schiller A, Perry RR, Laronga C. Micrometastasis in sentinel lymph nodes of breast cancer does not mandate completion axillary dissection. Ann Surg. 2004;239:859–63.

    Article  PubMed  Google Scholar 

  11. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.

    Article  PubMed  Google Scholar 

  12. Cserni G, Gregori D, Merletti F, et al. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg. 2004;91:1245–52.

    Article  CAS  PubMed  Google Scholar 

  13. Van Zee KJ, Manasseh DME, Bevilacqua JLB, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10:1140–51.

    Article  PubMed  Google Scholar 

  14. Asad J, Jacobson AF, Estabrook A, et al. Does oncotype DX recurrence score affect the management of patients with early-stage breast cancer? Am J Surg. 2008;196:527–9.

    Article  PubMed  Google Scholar 

  15. Knauer M, Mook S, Rutgers E, et al. The predictive value of the 70-gene signature for adjuvant chemotherapy in early breast cancer. Breast Cancer Res Treat. 2010;120:655–61.

    Article  CAS  PubMed  Google Scholar 

  16. Van de Vijver MJ, He YD, van’t Veer LJ, et al. A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med. 2002;347:1999–2009.

    Article  PubMed  Google Scholar 

  17. Alran S, De Rycke Y, Fourchotte V, et al. Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node involvement after positive sentinel node biopsy. Ann Surg Oncol. 2007;14:2195–201.

    Article  PubMed  Google Scholar 

  18. Menes TS, Tartter PI, Mizrachi H, et al. Breast cancer patients with pN0(i+) and pN1(mi) sentinel nodes have high rate of nonsentinel node metastases. J Am Coll Surg. 2005;200:323–7.

    Article  PubMed  Google Scholar 

  19. Van Rijk MC, Peterse JL, Nieweg OE, et al. Additional axillary metastases and stage migration in breast cancer patients with micrometastases or submicrometastases in sentinel lymph nodes. Cancer. 2006;107:467–71.

    Article  PubMed  Google Scholar 

  20. Hwang RF, Gonzalez-Angulo AN, Yi M, et al. Low locoregional failure rates in selected breast cancer patients with tumor-positive sentinel lymph nodes who do not undergo completion axillary dissection. Cancer. 2007;110:723–30.

    Article  PubMed  Google Scholar 

  21. Fant JS, Grant MD, Knox SM, et al. Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol. 2003;10:126–30.

    Article  PubMed  Google Scholar 

  22. Jeruss JS, Sener SF, Brinkmann EM, et al. Axillary recurrence after sentinel node biopsy. Ann Surg Oncol. 2005;12:34–40.

    Article  PubMed  Google Scholar 

  23. Naik AM, Fey JV, Gemignani M, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection. Ann Surg. 2004;240:462–71.

    Article  PubMed  Google Scholar 

  24. Sosa JA, Diener-West M, Gusez Y, et al. Association between extent of axillary lymph node dissection and survival in patients with stage I breast cancer. Ann Surg Oncol. 1998;5:140–9.

    Article  CAS  PubMed  Google Scholar 

  25. Hayward J, Caleffi M. The significance of local control in the primary treatment of breast cancer. Arch Surg. 1987;122:1244–7.

    CAS  PubMed  Google Scholar 

  26. Grube BJ, Giuliano AE. Observation of the breast cancer patient with a tumor-positive sentinel node: implications of the ACOSOG Z0011 trial. Semin Surg Oncol. 2001;20:230–7.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We thank the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri, for the use of the Biostatistics Core. The Core is supported in part by the National Cancer Institute Cancer Center Support Grant P30 CA91842 to the Siteman Cancer Center. We also thank Marsha Woodall for her maintenance of the surgical breast cancer database.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Amy Cyr MD, William E. Gillanders MD, Rebecca L. Aft MD, Timothy J. Eberlein MD & Julie A. Margenthaler MD, FACS

  2. Department of Surgery, John Cochran Veterans Hospital, St. Louis, MO, USA

    Rebecca L. Aft MD

  3. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA

    Feng Gao PhD

Authors
  1. Amy Cyr MD
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  2. William E. Gillanders MD
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  3. Rebecca L. Aft MD
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  4. Timothy J. Eberlein MD
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  5. Feng Gao PhD
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  6. Julie A. Margenthaler MD, FACS
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Corresponding author

Correspondence to Julie A. Margenthaler MD, FACS.

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Cyr, A., Gillanders, W.E., Aft, R.L. et al. Micrometastatic Disease and Isolated Tumor Cells as a Predictor for Additional Breast Cancer Axillary Metastatic Burden. Ann Surg Oncol 17 (Suppl 3), 303–311 (2010). https://doi.org/10.1245/s10434-010-1255-1

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  • DOI: https://doi.org/10.1245/s10434-010-1255-1

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