Impact of size of the tumor, persistence of estrogen receptors, progesterone receptors, HER2neu receptors and Ki67 values on positivity of axillar lymph nodes at patients with early breast cancer with clinically negative axillar examination

Abstract

AIM:The study aimed to identify factors that influence the positivity of axillary lymph nodes in patients with early breast cancer and clinically negative axillary lymph nodes, who were subjected for modified radical mastectomy and axillary lymphadenectomy.MATERIAL AND METHODS:This study included 81 surgically treated, early breast cancer patients during the period from 08-2015 to 05-2017. All the cases have been analysed by standard histological analysis including macroscopic and microscopic examination by routine H&E staining. For determination of molecular receptors, immunostaining by PT LINK immunoperoxidase has been done for HER2neu, ER, PR, p53 and Ki67.RESULTS:Patients age ranged between 31-73 years, an average of 56.86 years. The mean size of a primary tumour in the surgically treated patient was 20.33 ± 6.0 mm. Axillary dissection revealed from 5 to 32 lymph nodes, with an average of 14. Metastases have been found in 1 to 7 lymph nodes, with an average 0.7. Only 26 (32.1%) of the patients showed metastases in the axillary lymph nodes. The univariant regression analysis showed that the size of a tumour and presence of HER2neu receptors on cancer cells influence the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors have no influence on the positivity for metastatic deposits of lymph nodes. Multivariant model and logistic regression analysis as significant independent factors or predictors of positivity of the axillary lymph nodes are influenced by the tumour size only.CONCLUSION:Our study showed that the metastatic involvement of the axillary lymph nodes is mainly influenced by the size of a tumour and presence of HER2neu receptors in the univariant analysis. This point to the important influence of positivity of the axillary lymph nodes but, in multi-variant regressive analysis the lymph node status correlates with the tumour size only.

Factors Influencing Lymph Node Positivity in HER2/neu+ Breast Cancer Patients

“…Our analysis also suggests that tumor size is correlated with increased likelihood of metastasis in HER2/neu+ breast cancer. This is consistent with previous research that larger tumors are more likely to metastasize among all subtypes of breast cancer [ 2 , 3 , 7 , 15 ]. 62.7% of HER2/neu+ patients in this study had grade 3 tumors.…”

“…HER2/neu overexpression has been implicated as a negative prognostic factor in patients diagnosed with breast cancer due to higher rates of recurrence and metastasis [ 3 , 6 , 15 ]. Our study sought to evaluate the relationship between tumor size, location, imaging results and axillary lymph node disease for patients with stage I-III HER2/neu+ breast cancer.…”

“…Many factors that influence nodal involvement have been evaluated, including tumor size, distance from the nipple, location, and receptor subtype. Tumor size has been shown to be a predictor of nodal involvement in several studies [ 2 , 3 , 4 , 5 ]. Smaller tumor distance to the nipple has also been reported as an independent predictor of axillary nodal involvement [ 5 ].…”

“…Consequently, the HER2/neu+ subtype is associated with higher rates of early recurrence and metastasis [ 6 ]. Several studies have shown that HER2/neu positivity correlates with higher lymph node positivity [ 3 , 4 , 7 ].…”

“…Further evaluation of the behavior of specific subtypes of breast cancer is necessary to individualize treatment of patients. This is particularly important in the HER2/neu positive subtype, as these patients often experience earlier recurrence and higher rates of metastasis [ 3 ]. The primary aim of our study was to evaluate the relationship between tumor size and axillary lymph node disease for patients with stage I–III HER2/neu+ breast cancer.…”