Estrogen Receptor, Progesterone Receptor, and HER2 Status Predict Lymphovascular Invasion and Lymph Node Involvement

Ugras, Stacy; Stempel, Michelle; Patil, Sujata; Morrow, Monica

doi:10.1245/s10434-014-3851-y

Cited by 72 publications

(55 citation statements)

References 38 publications

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“…This supports previous evidence from different studies in which patients with these tumor types did not show differences in axillary cancer burden although presenting a greater risk of recurrence and poor prognosis [22,23]. Therefore, these patients should not be excluded from being given the option of avoiding ALND.…”

Section: Discussionsupporting

confidence: 88%

Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria

et al. 2018

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Background: Nodal staging constitutes an element of great importance in the treatment planning for early breast cancer. The ACOSOG Z0011 trial demonstrated that sentinel lymph node (SLN) biopsy alone results in rates of local control, disease-free survival, and overall survival equivalent to those seen after axillary lymph node dissection. The purpose of this study was to determine the rate of patients that fulfill the ACOSOG Z0011 inclusion criteria and to define predictive factors for non-SLN positivity. Methods: A retrospective analysis of the breast surgery database of the Argentinian Society of Mastology was carried out. Patients were selected if they fulfilled the ACOSOG Z0011 inclusion criteria. The association of clinical and pathological factors with non-SLN positivity was evaluated in univariate and multivariate analysis. Results: Among 8,262 patients, 973 had positive SLN, and 348 satisfied the inclusion criteria. Histological grade (G3 vs. G1-2, odds ratio (OR) 1.81; p = 0.024), tumor size (T2 vs. T1, OR 2.39; p = 0.001), and age (>50 vs. <50 years, OR 1.95; p = 0.007) were associated with non-SLN positivity in multivariate analysis. Conclusion: Although the clinical relevance of our data is not established, older women with tumors bigger than 2 cm and/or high histological grade are at greater risk of having metastatic disease in the lymph nodes if axillary lymph node dissection is avoided. This subgroup of patients represents only 30% of the trial population.

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Section: Discussionsupporting

confidence: 88%

Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria

et al. 2018

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“…Detection of LVI in the primary tumour is a marker of metastatic potential. The prognostic value of LVI has been demonstrated by several independent studies [6,7,8,9,10,11,12,13,14]. In a previous study of 3,812 cases of BC [7], it has been demonstrated that LVI is not only an independent prognostic variable in the whole series but also in the various prognostic subgroups, including the lymph node-negative cohort.…”

Section: Introductionmentioning

confidence: 93%

“…There is also a correlation between LVI and BC molecular subtype. Triple-negative or basal-like molecular classes showed the least association with LVI despite their poor prognosis and higher tendency to local recurrence [10]. Contrasting this, luminal and HER2-positive classes showed the highest incidence of LVI.…”

Section: Tumour Histological Features and LVImentioning

confidence: 99%

Molecular Mechanisms Underlying Lymphovascular Invasion in Invasive Breast Cancer

et al. 2015

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Lymphovascular invasion (LVI), the presence of malignant cells within lymphovascular channels, is a crucial step in the invasion-metastasis cascade. LVI, when identified morphologically in the peritumoural area, is regarded as an indicator of metastatic potential and is strongly associated with a poor prognosis in many solid tumours, including breast cancer (BC). Although molecular mechanisms associated with the development of LVI have been extensively studied, details of driver genes, and molecular pathways and mechanisms involved in its development in BC, remain poorly defined. Although invasive BC cells have the ability to invade surrounding stroma, only those that can interact with endothelial cells, penetrate the vascular wall and withstand the intravascular stress will develop LVI and complete metastatic dissemination. Identification of additional molecular events associated with LVI in the primary tumour and characterisation of the contribution of the tumour micro-environment to modulating biological processes leading to LVI in BC remain a challenging task. This stems not only from the complexity of the molecular alterations in the primary tumour and the interactions with different components of its micro-environment but also from the subjective nature of LVI assessment in human BC. In this review, we discuss the clinicopathological features and the current knowledge of the molecular mechanisms underlying LVI in BC.

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“…Triple-negative breast tumors, however, have the lowest risk of high-volume nodal involvement of all molecular subtypes [26]. It is a significant clinical question whether specific subtypes may need differential consideration when deciding on axillary management in pN1(sn) cases.…”

Section: What Is the Best Management Of Cn0pn1(sn) Breast Cancer Patimentioning

confidence: 99%

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

et al. 2018

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Although the majority of breast cancer patients are clinically node-negative (cN0) at diagnosis, 15-20% will have a metastatic sentinel lymph node (SLN, pN1(sn)). While a less radical approach regarding axillary surgery in cN0 patients with a positive SLN biopsy is advocated, the limitations of 5 published trials on axillary management in pN1(sn) are discussed intensely in the literature and support the performance of ongoing validation and extension trials, especially considering the lack of data in the setting of mastectomy. As locoregional radiotherapy has a significant effect on both recurrence and survival, a standardization of locoregional radiotherapy in the situation of SLN biopsy alone in pN1(sn) patients has to be defined in the future, and de-escalation trials should embrace a truly multidisciplinary approach. This is also of utmost importance considering the fact that high-volume nodal disease requires an intensified adjuvant chemotherapy strategy to which patients omitting axillary dissection cannot be stratified. Finally, there is mounting evidence that the therapeutic role of extensive axillary surgery in low-volume nodal disease is negligible, and multidisciplinary and translational efforts must be undertaken to individualize treatment in order to gain a reasonable balance between necessary staging information and unnecessary treatment-related morbidity.

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Estrogen Receptor, Progesterone Receptor, and HER2 Status Predict Lymphovascular Invasion and Lymph Node Involvement

Cited by 72 publications

References 38 publications

Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria

Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria

Molecular Mechanisms Underlying Lymphovascular Invasion in Invasive Breast Cancer

What Is the Best Management of cN0pN1(sn) Breast Cancer Patients

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