Axillary Sentinel Node and Tumour-related Factors Associated with Non-sentinel Node Involvement in Breast Cancer

Cserni, Gábor; Burzykowski, Tomasz; Vinh-Hung, Vincent; Kocsis, Lajos; Boross, Gábor; Sinkó, Mária; Tarján, Miklós; Bori, Rita; Rajtár, Mária; Tekle, Eliza; Maráz, Róbert; B, Baltás; Svébis, Mihály

doi:10.1093/jjco/hyh090

Cited by 39 publications

(26 citation statements)

References 43 publications

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“…The median number of nonsentinel axillary LNs resected was 13 (3 -29). Metastatic involvement of at least one nonsentinel axillary LN was found in 37 of 65 (56.9%) patients, with the median number of involved nonsentinel axillary LNs being 3 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Neither the size of the primary tumor, nor Nottingham grade, nor estrogen receptor, progesterone receptor, or Her2 status, nor the involvement of more than one sentinel LN, were correlated with the presence of nonsentinel LN metastases.…”

Section: Resultsmentioning

confidence: 95%

“…The size of the sentinel LN metastasis has emerged as a most powerful independent predictor in several studies (3 -15). Furthermore, the number of involved sentinel LNs (3,4,7,10,11,16), extracapsular growth of the sentinel LN metastasis (3,6,15), the size of the primary tumor (7,9,10,13,14), and the presence of lymphovascular invasion (4,7,9,14,15) have also been associated with metastatic involvement of nonsentinel axillary LNs. Based on these factors and on other clinicopathologic variables, Van Zee et al developed a nomogram to predict the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy (17).…”

Section: Primary Breast Tumors Can Metastasize In Two Different Waysmentioning

confidence: 99%

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Increased Sentinel Lymph Node Lymphangiogenesis is Associated with Nonsentinel Axillary Lymph Node Involvement in Breast Cancer Patients with a Positive Sentinel Node

Eynden

Vandenberghe

Dam

et al. 2007

Clinical Cancer Research

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Purpose: Lymph node (LN) lymphangiogenesis has recently been shown to be important in the premetastatic niche of sentinel LNs. To study its role in the further metastatic spread of human breast cancer, we investigated the association of angiogenesis and lymphangiogenesis in sentinel LN metastases with the presence of nonsentinel LN metastases in breast cancer patients with a positive sentinel LN. Experimental Design: Angiogenesis and lymphangiogenesisöquantified as endothelial cell proliferation fraction (ECP%) and lymphatic ECP fraction (LECP%)öwere assessed in sentinel LN metastases of 65 T 1 /T 2 patients with breast cancer using CD34/Ki67 and D2-40/Ki67 immunohistochemical double stains. Correlations were analyzed between nonsentinel LN status, LECP%, and other clinicopathologic variables (number of involved sentinel LNs, size of the primary tumor and LN metastasis, presence of lymphovascular invasion in the primary tumor, and of extracapsular growth in the sentinel LN metastasis). Results: Thirty seven out of 65 patients (56.9%) had at least one involved nonsentinel LN. Size of the sentinel LN metastasis (P = 0.001), lymphovascular invasion (P = 0.02), extracapsular growth (P = 0.02), and LECP% (P = 0.01) were correlated with a positive nonsentinel LN status. The multivariate logistic regression model retained high LECP% (odds ratios = 4.2, P = 0.01) and the presence of extracapsular growth (odds ratios = 3.38, P = 0.04) as independently associated with the presence of nonsentinel LN metastases. Conclusions: Increased sentinel LN metastasis lymphangiogenesis is associated with metastatic involvement of nonsentinel axillary LNs. These are the first data sustaining the hypothesis that sentinel LN lymphangiogenesis is involved in further metastatic spread of human breast cancer. Primary breast tumors can metastasize in two different ways:tumor cells can leave the primary tumor and spread by the lymphatic or by the hematogenous route leading to the formation of locoregional lymph node (LN) and distant metastases, respectively (1). In the lymphatic pathway, the sentinel LN is the first metastatic station and a sentinel LN free of carcinoma has a very high negative predictive value for further lymphatic dissemination in patients with breast cancer.Axillary LN dissection and associated morbidity could therefore be avoided in 65% to 70% of patients with breast cancer (2). Even in cases of metastatic involvement of the sentinel LN, metastases in further axillary LNs will only be present in 30% to 60% of the patients. Several authors studied the features of sentinel LN metastasis and of the primary tumor that can predict axillary nonsentinel LN involvement. The size of the sentinel LN metastasis has emerged as a most powerful independent predictor in several studies (3 -15). Furthermore, the number of involved sentinel LNs (3,4,7,10,11,16), extracapsular growth of the sentinel LN metastasis (3,6,15), the size of the primary tumor (7,9,10,13,14), and the presence of lymphovascular invasion (4,7,9,14,15) have ...

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Section: Resultsmentioning

confidence: 95%

Section: Primary Breast Tumors Can Metastasize In Two Different Waysmentioning

confidence: 99%

Increased Sentinel Lymph Node Lymphangiogenesis is Associated with Nonsentinel Axillary Lymph Node Involvement in Breast Cancer Patients with a Positive Sentinel Node

Eynden

Vandenberghe

Dam

et al. 2007

Clinical Cancer Research

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“…Accordingly, up to 50-60% of the patients with positive SLNs seem to undergo ALND with negative NSLNs. Our current understanding of breast cancer suggests that these patients do not benefit from complete ALND and are exposed to its potential morbidity (14). Several studies (1,2,5,14-41) have attempted to identify factors that may be associated with NSLN metastases and predict the incidence using data from patients with positive SLNs.…”

Section: ) -------------------------------------------------mentioning

confidence: 99%

Clinicopathological parameters and biological markers predicting non-sentinel node metastasis in sentinel node-positive breast cancer patients

Kwon

Kang

et al. 2011

Oncol Rep

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Abstract. The value of complete axillary lymph node dissection (ALND) has been questioned in invasive breast cancer (IBC) patients with positive sentinel lymph nodes (SLNs) who have no non-sentinel lymph node (NSLN) metastases. Because biological markers have not been systematically studied in this setting, we sought to identify clinicopathological characteristics and biological markers for predicting NSLN metastases in SLN-positive IBC patients. Two hundred and five IBC patients who had at least one positive SLN and received SLN biopsy and ALND were included in our study. We examined the clinicopathological characteristics of their primary tumors, SLNs and NSLNs. We also evaluated the biological markers of the primary tumors by tissue microarray and immunohistochemistry. Of the 205 patients with SLN metastases, 89 patients (43.4%) had additional metastases in NSLNs. The following factors were found to be associated with NSLN metastases: peritumoral lymphovascular invasion (p=0.01), two or more metastatic SLNs (p<0.01), SLN metastasis >2.0 mm (p<0.01) and extranodal extension (p<0.01). Primary tumors >2.0 cm showed more NSLN metastases, but the association was statistically insignificant (p=0.08). In contrast, NSLN metastases were not associated with histologic grade, histologic type, presence of extensive intraductal component, presence of high grade ductal carcinoma in situ and number of harvested SLNs. Biological markers such as E-cadherin, CD44, cyclin D1, p21, ER, PR, c-erbB2, p53, Ki-67, luminal (CK7, CK18, CK19) and basal (CK5, p63) markers were not useful predictors of NSLN metastasis in IBC patients with SLN metastases. Multivariate analysis revealed that SLN metastasis >2.0 mm (p=0.01), two or more metastatic SLNs (p=0.03) and extranodal extension (p<0.01) were independent predictors of NSLN metastasis. For the prediction of NSLN metastasis in IBC patients with SLN metastases, light microscopic evaluation of the number, size and extranodal extension of metastatic SLNs by hematoxylin and eosin staining appeared to be critical. However, the biological markers of primary tumor characterized by immunohistochemical staining, such as luminal and basal markers, hormone receptors, E-cadherin, CD44, cyclin D1, p21, c-erb-B2, p53 and Ki-67, did not appear to be helpful predictors.

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“…Although a positive SLN lead to an ALND in most patients, evidence suggests that a majority of SLN-positive patients do not have further lymph node involvement [24,25]. It is even evident that further lymph node involvement does not manifest itself in recurrent disease in the majority of patients, provided adjuvant therapies are used according to current standards [26][27][28][29].…”

Section: List Of Tablesmentioning

confidence: 99%

Current issues in breast surgery

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Axillary Sentinel Node and Tumour-related Factors Associated with Non-sentinel Node Involvement in Breast Cancer

Cited by 39 publications

References 43 publications

Increased Sentinel Lymph Node Lymphangiogenesis is Associated with Nonsentinel Axillary Lymph Node Involvement in Breast Cancer Patients with a Positive Sentinel Node

Increased Sentinel Lymph Node Lymphangiogenesis is Associated with Nonsentinel Axillary Lymph Node Involvement in Breast Cancer Patients with a Positive Sentinel Node

Clinicopathological parameters and biological markers predicting non-sentinel node metastasis in sentinel node-positive breast cancer patients

Current issues in breast surgery

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