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Is risk of axillary lymph node metastasis associated with proximity of breast cancer to the skin?

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

Abstract

Introduction

Risk of axillary lymph node metastasis, the most important predictor of disease-free and overall survival in breast cancer patients, is estimated primarily from histologic features of the primary cancer including tumor size, histologic type and grade, and hormone receptor expression. Based upon a clinical impression, and research showing that palpable cancers are more likely to be node positive, we hypothesized that primary breast cancers more proximal to the skin of the breast are more likely to be positive for axillary lymph node metastasis.

Methods

This is a retrospective medical record review of 209 women with stage T1 or T2 (≤5.0 cm) invasive breast cancer who received dedicated breast ultrasound at a single mammography clinic in Columbia, South Carolina, between 1997 and 2002.

Results

None of the 26 cancers more than 14 mm from the skin had metastasized to axillary lymph nodes. In logistic regression modeling only tumor size, histologic grade and tumor proximity to the skin (as a categorical variable) were significantly associated with odds of axillary metastasis. Among cancers within 14 mm of the skin, proximity was not an independent predictor.

Conclusions

Stage T1 and T2 breast cancers located less proximally to the skin may be less likely to spread to the axillary lymph nodes. We observed what appears to be a threshold at approximately 14 mm from the skin (based upon this group of patients): none of 26 cancers below this level had spread to axillary nodes. Further research is needed to confirm these provocative findings.

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Abbreviations

ACR:

American College of Radiology

ER:

Estrogen receptor

HRT:

Hormone replacement therapy

MHz:

Megahertz

N :

Number of patients

N+:

Axillary lymph nodes positive for metastatic cells

N0:

Axillary lymph nodes negative for metastatic cells

NA:

Not available

NOS:

Not otherwise specified

OR:

Odds ratio

P :

P-value

PACS:

Picture archiving and communication system

PR:

Progesterone receptor

SCCBC:

South Carolina Comprehensive Breast Center

SD:

Standard deviation

T1:

Invasive cancers ≤2 cm

T2:

Invasive cancers >2 and ≤5 cm

T3:

Invasive cancers >5 cm

WHO:

World Health Organization

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Acknowledgements

We thank Alice Lathrop, Administrative Director of the SCCBC Palmetto Richland Memorial Hospital Breast Center; Carroll Szews, mammography file manager at the Breast Center; and Dr. Boubacar Touré (now in Guinea, West Africa) for their invaluable assistance. The project was supported in part by the University of South Carolina Research and Productive Scholarship Grant Program.

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Authors and Affiliations

  1. South Carolina Cancer Center, University of South Carolina, 14 Medical Park, Suite 500, Columbia, SC, 29203, USA

    Joan E. Cunningham & Daniela K. Nitcheva

  2. South Carolina Department of Health and Environmental Control, Bureau of Community Health and Chronic Disease Prevention, 1777 St. Julian Place, Columbia, SC, 29204, USA

    Adriana L. Jurj

  3. Northwest Arkansas Surgical Clinic, Springdale, AR, 72761, USA

    Leah Oman

  4. Indiana University School of Medicine, Indianapolis, IN, 46201, USA

    Amy E. Stonerock

  5. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA

    Daniela K. Nitcheva

  6. Women’s Care at Image Care, 710 Rabon Rd., Suite 101, Columbia,, SC 29203, USA

    Tommy E. Cupples

  7. School of Medicine, University of South Carolina, Columbia, SC, USA

    Tommy E. Cupples

Authors
  1. Joan E. Cunningham
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  2. Adriana L. Jurj
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  3. Leah Oman
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  4. Amy E. Stonerock
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  5. Daniela K. Nitcheva
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  6. Tommy E. Cupples
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Corresponding author

Correspondence to Joan E. Cunningham.

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Cunningham, J.E., Jurj, A.L., Oman, L. et al. Is risk of axillary lymph node metastasis associated with proximity of breast cancer to the skin?. Breast Cancer Res Treat 100, 319–328 (2006). https://doi.org/10.1007/s10549-006-9256-2

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  • DOI: https://doi.org/10.1007/s10549-006-9256-2

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