Lymph Nodes in Breast Cancer - What Can We Learn from Translational Research

Abstract

Clinical observations about lack of survival benefit after extensive axillary surgery and biological discordance between primary breast tumors and axillary lymph nodes raise the question of the actual metastatic potential of axillary nodal disease. The exploration of intratumoral heterogeneity and detection of genomic differences between the primary and lymph nodes indicate some similarity between the number of mutations in synchronous axillary node metastases and those in the primary lesion, suggesting a favorable prognosis. The hematogenous route of metastasis needs to be considered in findings of different subclones between nodal and distant metastases. Modern tools such as whole-genome sequencing applied in multiple tumor areas may guide more precisely the extent of axillary surgery.

Central Review of Radiation Therapy Planning Among Patients with Breast-Conserving Surgery: Results from a Quality Assurance Process Integrated into the INSEMA Trial

“…To date, the available evidence on the possible predictive value of gene expression assays for radiation therapy or axillary surgery does not support their inclusion in the decision-making process. 36,37 Previously, the Memorial Sloan-Kettering Cancer Center developed a nomogram to predict the likelihood of a positive SLNB. This nomogram is a statistical approach for calculation of metastatic axillary risk by combining different histopathologic factors (plus age) and is still available online using Memorial Sloan-Kettering Cancer Center home page.…”

Comparison of diagnostic accuracy of conventional ultrasonography for characterization of axillary lymph nodes with histological findings.

“…7,8 The prognosis of the cancer greatly depend upon the stage of the disease and early diagnosis with early treatment provides better outcome and remain cost effective. 9 For breast cancers, the investigations regarding involvement of axillary lymph nodes (ALN) is said to be important factor in the prognosis as the common pathway of metastasis of this cancer is ALN metastasis. This is because once the III-IV cancer cells capture the lymphatic vessels; they start growth and reproduction that causes obstructions in the lymphatic vessels leading to skin edema.…”

Predictive value of intravoxel incoherent motion combined with diffusion kurtosis imaging for breast cancer axillary lymph node metastasis: a retrospective study

“…Axillary nodal status is an important factor in the prognosis of and therapeutic decision-making for patients with breast cancer (1,2). At present, sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) are useful methods for determining the axillary nodal status for appropriate treatment planning (3).…”