Multicentre validation of different predictive tools of non-sentinel lymph node involvement in breast cancer

Boross, Gábor; Maráz, Róbert; Leidenius, Marjut; Meretoja, Tuomo J.; Heikkilä, Päivi; Regitnig, Peter; Luschin-Ebengreuth, G.; Žgajnar, Janez; Perhavec, Andraž; Gazić, Barbara; Lázár, György; Takács, Tibor; Vörös, András; Audisio, Riccardo A.

doi:10.1016/j.suronc.2011.12.001

Cited by 28 publications

(13 citation statements)

References 34 publications

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“…However, Wo et al [22] demonstrated that even patients with small tumours (<0.5 cm in diameter) could have several metastatic lymph nodes and that these patients have a higher breast cancer-specific mortality than those with larger tumours. As expected, our results confirmed that malignant axillary lymph nodes, following US-guided FNA, correlated with large tumour size (>20 mm) [23], [24]; nevertheless, 31% of the tumours were classified as pT1 (≤20 mm), and of these, 3 out of 27 (11.5%) were less than 1 cm. Moreover, in the same subgroup of pT1 cases with malignant US-guided FNA, 9 patients out to 27 showed 1 to 3 metastatic lymph nodes and the 18 cases had more than 3 metastatic lymph nodes.…”

Section: Discussionsupporting

confidence: 89%

Efficiency of a Preoperative Axillary Ultrasound and Fine-Needle Aspiration Cytology to Detect Patients with Extensive Axillary Lymph Node Involvement

et al. 2014

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BackgroundRecent studies have demonstrated that axillary lymph node dissection (ALND) does not affect patient survival, even in those with one or two positive sentinel lymph nodes (SLNs). On the other hand, patients with 3 or more metastatic lymph nodes are eligible for chemotherapy. Therefore, it is crucial to identify a priori patients at risk of having a high number of metastatic axillary lymph nodes for their surgical and/or clinical management. Ultrasound (US) guided Fine-Needle Aspiration (FNA) has been proven to be a useful and highly specific method for detecting metastatic axillary lymph nodes. However, only one recent study has evaluated the efficiency of this method in identifying patients with high metastatic nodal involvement. Our aim was to validate US-guided FNA as a reliable method to discriminate a priori patients with >3 metastatic lymph nodes.MethodsA retrospective series of 1287 breast cancer patients who underwent a simultaneous preoperative breast and axillary US to stage their axilla was collected. A total of 365 patients, with either positive SLNs (278) or positive axillary lymph nodes detected via US-guided FNA (87), underwent ALND. In these two subgroups, we compared the number of metastatic lymph nodes in the axilla.ResultsThe number of metastatic axillary lymph nodes in patients who underwent US-guided FNA was significantly higher (63% had >3 metastatic lymph nodes) than that in patients with SLNs positive for micro- or macrometastases (3% and 27%, respectively) (P<0.001, χ 2 = 117.897).ConclusionsPreoperative axillary US-guided FNA could act as a reliable tool in identifying breast cancer patients with extensive nodal involvement.

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Section: Discussionsupporting

confidence: 89%

Efficiency of a Preoperative Axillary Ultrasound and Fine-Needle Aspiration Cytology to Detect Patients with Extensive Axillary Lymph Node Involvement

et al. 2014

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“…Factors that are included in many of the nomograms are: tumor size, tumor differentiations, lymphovascular invasion, number of positive SLND, number of negative SLND, size of metastasis in SLND, type of SLND detection, type of histological examination of SLND, number of CK19 determined with OSNA, Ki 67 and others (49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60) (49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60). Some of them test some nomograms in their patients and suggest which is the best for prediction.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Factors on the Positivity for Metastases of the Axillary Lymph Nodes from Primary Breast Cancer

Кондов

Спировски

et al. 2017

Prilozi

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Aim: The aim of the study was to identify the impact of T stage, the presence of estrogen, progesterone, HER2neu receptors and the values of the Ki67 on the positivity for metastases of the axillary lymph nodes, from primary breast cancer. Material and methods: 290 surgically treated patients for breast cancer were included in the study. All cases have been analyzed by standard histological analysis including microscopic analysis on standard H&E staining. For determining the molecular receptors -HER2neu, ER, PR, p53 and Ki67, immunostaining by PT LINK immunoperoxidase has been done. Results: Patients age was ranged between 18-90 years, average of 57.6+11.9. The mean size of the primary tumor in the surgically treated patient was 30.27 + 18.3 mm. On dissection from the axillary pits 8 to 39 lymph nodes were taken out, an average of 13.81+5.56. Metastases have been found in 1 to 23 lymph nodes, an average 3.14+4.71. In 59% of the patients there have been found metastases in the axillary lymph nodes. The univariate regression analysis showed that the location, size of tumor, differentiation of the tumor, stage, the value of the Ki67 and presence of lymphovascular invasion influence on the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors and HER2neu receptors showed that they do not have influence on the positivity for metastatic deposits in axillary lymph nodes. The multivariate model and the logistic regression analysis as independent significant factors or predictors of positivity of the axillary lymph nodes are influenced by the tumor size and the positive lymphovascular invasion. Conclusion: Our study showed that the involving of the axillary lymph nodes is mainly influenced by the size of the tumor and the presence of lymphovascular invasion in the tumor. Ki67 determined proliferative index in the univariate analysis points the important influence of positivity in the axillary lymph nodes, but not in the multivariate regressive analysis.

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“…[13][14][15][16][17][18] In a multicentre validation study of different predictive systems Cserni et al showed that there are significant differences between various centres in the distribution of variables as used in the models and the proportion of cases classified as having a low risk for non-SLN metastasis. 18 Therefore, the generalization and applicability of the different predictive systems is limited. This is most likely due to variations in pathology settings and differences in baseline population characteristics.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…This is most likely due to variations in pathology settings and differences in baseline population characteristics. 13,14,18 Furthermore, there is also an unacceptably high variability in individual predictions when using the different predictive systems for the individual patient. 19 Besides that, we would like to highlight some of the following practical issues and pitfalls that are encountered in using predictive systems, and that are partly responsible for the insufficient performance in different patient populations.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…25 Finally, we agree with Cserni et al that it is imperative that such tools should be institutionally validated to reveal which predictive tool works best in which individual institute. 18,19 Such a development than would be the next step in the ongoing paradigm shift in axillary breast cancer treatment: from the treatment of "all -except", towards the treatment of "none -unless". …”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

See 1 more Smart Citation

A Paradigm Shift in Axillary Breast Cancer Treatment; From “Treat All-Except,” Toward “Treat None-Unless”

Hoven

Voogd

Roumen

2015

Clinical Breast Cancer

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Multicentre validation of different predictive tools of non-sentinel lymph node involvement in breast cancer

Cited by 28 publications

References 34 publications

Efficiency of a Preoperative Axillary Ultrasound and Fine-Needle Aspiration Cytology to Detect Patients with Extensive Axillary Lymph Node Involvement

Efficiency of a Preoperative Axillary Ultrasound and Fine-Needle Aspiration Cytology to Detect Patients with Extensive Axillary Lymph Node Involvement

Prognostic Factors on the Positivity for Metastases of the Axillary Lymph Nodes from Primary Breast Cancer

A Paradigm Shift in Axillary Breast Cancer Treatment; From “Treat All-Except,” Toward “Treat None-Unless”

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