Breast cancer subtypes can be determinant in the decision making process to avoid surgical axillary staging: A retrospective cohort study

Marrazzo, Antonio; Boscaino, Giovanni; Marrazzo, Emilia; Taörmina, P; Toesca, Antonio

doi:10.1016/j.ijsu.2015.07.702

Cited by 17 publications

(11 citation statements)

References 32 publications

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“…This hypothesis implies that in cases in which papillary invasion is identified on the final pathologic examination, the status of the axillary lymph nodes should be interpreted cautiously. We also found that patients in the non–triple‐negative group were 2.34 times more likely than those in the triple‐negative group to have a heavy nodal tumor burden at the axilla, which was in line with the previous findings . However, Dent et al stated that the positivity rate of lymph nodes was slightly higher in the triple‐negative group compared with non–triple‐negative groups.…”

Section: Discussionsupporting

confidence: 91%

Clinicopathologic and Ultrasound Variables Associated With a Heavy Axillary Nodal Tumor Burden in Invasive Breast Carcinoma

Tong

Jiang

et al. 2018

J of Ultrasound Medicine

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Objectives-To identify clinicopathologic and ultrasound (US) variables that were associated with a heavy nodal tumor burden, which was defined as 3 or more lymph nodes involved with metastasis to the axilla after invasive breast carcinoma.Methods-With ethical approval, 621 patients with a pathologic diagnosis of invasive breast carcinoma were retrospectively analyzed for clinical, pathologic, and US data. Pathologic findings were ascertained by the final paraffin pathologic analysis. Ultrasound characteristics were evaluated on the basis of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS). Univariate and multivariate logistic regression analyses were used to assess the clinicopathologic and US variables that were associated with a heavy nodal tumor burden at the axilla.Results-There were 107 cases (17.2%) of invasive breast carcinoma with a heavy tumor burden at the axilla. The independent clinicopathologic variables for a heavy tumor burden at the axilla included a tumor size of 2 to 5 cm (odds ratio [OR], 1.86; P = .036), the presence of lymphovascular invasion (OR, 23.52; P < .001), the presence of papillary invasion (OR, 2.93; P = .043), and a non-triple-negative subtype (OR, 2.34; P = .04). The independent US features of breast tumors that were associated with a heavy tumor burden at the axilla included BI-RADS category 5 (OR, 5.50; P = .024) and a posterior acoustic shadow (OR, 1.94; P = .024).Conclusions-A large tumor size, lymphovascular invasion, papillary invasion, and a non-triple-negative subtype on the pathologic analysis as well as BI-RADS category 5 and a posterior acoustic shadow on a US assessment were associated with a heavy nodal tumor burden at the axilla. These US characteristics of the primary breast carcinoma might provide additional information to axillary US for the prediction of axillary nodal tumor loads.

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Section: Discussionsupporting

confidence: 91%

Clinicopathologic and Ultrasound Variables Associated With a Heavy Axillary Nodal Tumor Burden in Invasive Breast Carcinoma

Tong

Jiang

et al. 2018

J of Ultrasound Medicine

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“…The relatively low values of lymphovascular invasion in triple negative subtype are interesting to comment (44.44%), with low axillary lymph node involvement (62.96%), which correlates with the findings in the literature. Knowing the aggression of triple negative subtype of breast cancer, we can conclude that the spreading of malignant cells follows other pathways other than lymphatic [ 14 ] [ 17 ] [ 30 ] [ 31 ] [ 32 ] [ 33 ] [ 34 ] [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Presentation of the Molecular Subtypes of Breast Cancer Detected By Immunohistochemistry in Surgically Treated Patients

Кондов¹,

Milenkovikj²,

Кондов³

et al. 2018

Open Access Maced J Med Sci

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INTRODUCTION:The detection of estrogen, progesterone and HER-2 neu receptors on the surface of the tumour cell is a significant prognostic factor, alone or in combination. The presence or absence of receptors on the surface of the tumour cell is associated with the conditional gene expression in the tumour cell itself. Based on these genetically determined expressions of the tumour cell, five molecular subtypes of breast cancer have been classified on the St. Gallen International Expert Consensus in 2011 that can be immunohistochemically detected, with each subtype manifesting certain prognosis and aggression.AIM:Analyzing the presentation of molecular subtypes of breast cancer that are immunohistochemically detected in surgically treated patients at the Clinic for Thoracic and Vascular Surgery.MATERIAL AND METHODS:We used the international classification on molecular subtypes of breast cancer which divides them into: Luminal A (ER+ and/or PR+, HER-2 negative, Ki-67 < 14%), Luminal B with HER-2 negative (ER+ and/or PR+, HER-2 negative, Ki-67 ≥ 14%), Luminal B with HER-2 positive (ER+ and/or PR+, HER-2+, any Ki-67), HER-2 enriched (ER-, PR-, HER-2+), and basal-like (triple negative) (ER-, PR-, HER-2 negative, CK5/6+ and/or EGFR+). A total of 290 patients, surgically treated for breast cancer, were analysed during 2014.RESULTS:In our analysis, we found that Luminal A was present in 77 (26.55%) patients, Luminal B HER-2 negative was present in 91 (31.38%) patients, Luminal B HER-2 positive was present in 70 (24.14%) patients, HER-2 enriched was present in 25 (8.62%) patients and basal-like (or triple negative) was present in 27 (9.31%) patients.CONCLUSION:Detecting the subtype of breast cancer is important for evaluating the prognosis of the disease, but also for determining and providing an adequate therapy. Therefore, determining the subtype of breast cancer is necessary for the routine histopathological assay.

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“…Furthermore, several studies have suggested that the triplenegative tumor subtype may predict a lower risk of nodal involvement. [35][36][37][38][39] Because biology and systemic therapy influence the natural evolution of disease, the indications for axillary surgery should take these factors into consideration. Single-center studies do not demonstrate any benefits in performing axillary surgery, but meta-analyses lead to a different conclusion.…”

Section: Author's Personal Copymentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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We performed a retrospective analysis of 1156 patients affected by early breast cancer in order to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. Background: The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB. Patients and Methods: We performed a retrospective analysis of 1156 patients with early breast cancer to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. Results: Of the 1156 cases, only 106 (9.2%) had > 2 axillary metastatic lymph nodes. More specifically, 38 (4.3%) of 884 T1 cases, and 6 (2.3%) of 257 of T1b cases had > 2 metastatic lymph nodes. Conclusion: The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. The ongoing studies on avoiding SLNB will likely prove the noninferiority of omitting biopsy because these studies are conducted in the whole population of early breast cancers. It is necessary to identify more accurately the subpopulation of patients who may benefit from axillary surgery.

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Breast cancer subtypes can be determinant in the decision making process to avoid surgical axillary staging: A retrospective cohort study

Abstract: This work shows correlation between subtypes and the probability of having positive SLN. Patients not expressing vascular invasion, lymphatic invasion and, moreover, a triple-negative tumor subtype may be good candidates for breast conservative surgery without axillary surgical staging.

Cited by 17 publications

References 32 publications

Clinicopathologic and Ultrasound Variables Associated With a Heavy Axillary Nodal Tumor Burden in Invasive Breast Carcinoma

Clinicopathologic and Ultrasound Variables Associated With a Heavy Axillary Nodal Tumor Burden in Invasive Breast Carcinoma

Presentation of the Molecular Subtypes of Breast Cancer Detected By Immunohistochemistry in Surgically Treated Patients

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

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