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Extranodal Tumor Deposits in the Axillary Fat Indicate the Need for Axillary Dissection Among T1–T2cN0 Patients with Positive Sentinel Nodes

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

Abstract

Background

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated the safety of omitting axillary lymph node dissection (ALND) in T1–T2cN0 patients with fewer than three positive sentinel nodes (SLNs) undergoing breast-conservation therapy. While microscopic extracapsular extension (mECE) > 2 mm is associated with increased nodal burden, the significance of extranodal tumor deposits (ETDs) in the axillary fat is uncertain.

Methods

Consecutive patients with T1–T2cN0 breast cancer undergoing sentinel node biopsy and ALND for SLN metastases from January 2010 to December 2018 were identified. ETDs were defined as intravascular tumor emboli or metastatic deposits in the axillary fat. Clinicopathologic characteristics and nodal burden were compared by ETD status.

Results

Among 1114 patients, 113 (10%) had ETDs: 81 (72%) were intravascular tumor emboli and 32 (28%) were soft tissue deposits. Patients with ETDs had larger tumors (median 2.2 vs. 2.1 cm; p = 0.033) and more often had mECE (83% vs. 44%; p < 0.001). On univariable analysis, presence of ETDs (odds ratio [OR] 9.66, 95% confidence interval [CI] 6.36–14.68), larger tumors (OR 1.47, 95% CI 1.25–1.72), and mECE (OR 10.73, 95% CI 6.86–16.78) were associated with four or more additional positive non-SLNs (NSLNs; all p < 0.001). On multivariable analysis, ETDs remained associated with four or more positive NSLNs (OR 5.67, 95% CI 3.53–9.08; p < 0.001). ETDs were strongly associated with four or more positive NSLNs (OR 7.15, 95% CI 4.04–12.67) among patients with one to two positive SLNs (n = 925).

Conclusions

Among T1–T2cN0 patients with SLN metastases, ETDs are strongly associated with four or more positive NSLNs at ALND. Even among those who may otherwise meet the criteria for omission of ALND, the presence of ETDs in axillary fat warrants consideration of ALND.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Anita Mamtani MD, Andrea V. Barrio MD, Alain Vincent BS & Monica Morrow MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Debra A. Goldman MS

  3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Hannah Y. Wen MD

Authors
  1. Anita Mamtani MD
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  2. Andrea V. Barrio MD
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  3. Debra A. Goldman MS
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  4. Hannah Y. Wen MD
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  5. Alain Vincent BS
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  6. Monica Morrow MD
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Corresponding author

Correspondence to Monica Morrow MD.

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Disclosures

The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center. Dr. Monica Morrow has received honoraria from Genomic Health; Dr. Andrea V. Barrio has received honoraria from Roche; and Debra Goldman owns stock in Johnson & Johnson unrelated to the study presented here. Anita Mamtani, Hannah Y. Wen, and Alain Vincent have no conflicts of interest to declare.

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Mamtani, A., Barrio, A.V., Goldman, D.A. et al. Extranodal Tumor Deposits in the Axillary Fat Indicate the Need for Axillary Dissection Among T1–T2cN0 Patients with Positive Sentinel Nodes. Ann Surg Oncol 27, 3585–3592 (2020). https://doi.org/10.1245/s10434-020-08632-1

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  • DOI: https://doi.org/10.1245/s10434-020-08632-1

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