Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance

Bakker, Marleen

doi:10.1136/jcp.55.12.932

Cited by 79 publications

(31 citation statements)

References 32 publications

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“…3,6 -19 One study 3 was excluded because of presumed overlap of the dataset with another study. 10 Two studies 17,18 were excluded because the evaluations were limited to patients with micrometastatic disease in the SN, a group that was potentially dissimilar from the populations of the remaining studies. A fourth study 19 was excluded because the data regarding completion ALND findings were correlated with features among the collective group of SN cases; data concerning the subset of SN-positive patients were not reported.…”

Section: Resultsmentioning

confidence: 99%

“…30 Another factor that supports completion ALND is the finding of macroscopic residual disease in some patients whose SNs have only micrometastatic disease; among those studies reporting this finding, the incidence rate was reported to be as high as 16%. 8,10,17,18 Although it may appear logical to eliminate completion ALND for patients unlikely to have positive NSNs, Morrow argues that patients with small primary tumors and only one to three positive lymph nodes may be those individuals most likely to obtain a survival benefit from aggressive locoregional therapy. 31 With the therapeutic value of ALND still in question, information regarding the likelihood of metastasis in NSNs can be very helpful when counseling breast carcinoma patients with positive SNs.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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BACKGROUNDIn breast carcinoma patients with a positive sentinel lymph node (SN), the value of complete axillary lymph node dissection has been questioned. Multiple published reports have attempted to identify clinicopathologic characteristics of the primary tumor and SN that are associated with an increased likelihood of positive nonsentinel lymph nodes (NSN). Because of differences in lymph node evaluation techniques and limited patient numbers in each study, the authors performed a meta‐analysis to assess the regularity and relative strength of association between various characteristics and the risk of NSN metastasis.METHODSA MEDLINE search identified 15 candidate studies, 11 of which met the criteria for analysis. General elements of the studies, the pathologic characteristics evaluated, and the results for selected characteristics were compared. Original data were abstracted from each study and used to calculate odds ratios. The Mantel–Haenszel common odds ratios were calculated to determine the relative strength of the associations.RESULTSDespite methodologic differences, the correlation between positive NSNs and certain pathologic characteristics was found to be remarkably similar among studies. The 5 individual characteristics found to be associated with the highest likelihood of NSN metastasis are SN metastasis > 2 mm in size, extranodal extension in the SN, tumor size > 2 cm, > 1 positive SN, and lymphovascular invasion in the primary tumor.CONCLUSIONSThere is general concordance among studies regarding the association between pathologic characteristics and NSN metastasis in breast carcinoma patients with a positive SN. The pooled analysis identified those factors with the strongest associations that should be evaluated routinely in SN specimens and included in prospective databases for the development of a predictive model. Cancer 2003. © 2003 American Cancer Society.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Degnim

Griffith

Sabel

et al. 2003

Cancer

139

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“…This rationale is relevant as the clinical significance and morphologic definition of micrometastatic disease in breast carcinoma are currently under scrutiny. 9,12,25,26 Clinicians should be aware of the diagnostic limitations of the frozen section, not only in terms of sensitivity, but also in terms of accurate representation of metastatic tumor size. Surgical pathologists should also understand the clinical implication of a complete axillary dissection based on a positive sentinel node intraoperative consult evidenced by single or limited clusters of malignant cells present only in cytologic preparations.…”

Section: Discussionmentioning

confidence: 99%

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

et al. 2005

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The decision whether to proceed with complete axillary node dissection based on sentinel node status is clear for patients with negative or macrometastatic disease. However, the course of action based on sentinel node micrometastasis remains controversial. We reviewed 358 cases from 6/1999 to 7/2003. All sentinel nodes were evaluated at three levels by frozen section, touch preparation, and scrape preparation. Micrometastasis was defined as tumor deposits between 0.2 and 2 mm. Size, grade, and lymphvascular invasion of the primary tumor, as well as number, status, size of metastatic disease, and presence of extranodal capsular extension of sentinel and nonsentinel nodes were recorded. Of the 358 cases, 89 had positive sentinel nodes, 29 of which represented micrometastases. Only one (3%) of the 29 cases contained a nonsentinel node with macrometastasis. In 60 of the 89 cases sentinel nodes contained macrometastases. Of these, 38 cases (63%) had metastatic tumor in nonsentinel nodes. Intraoperative consult was performed in 53 of the 89 cases with positive sentinel nodes. Only 1 of the 19 (5%) intraoperative consult cases with micrometastatic sentinel nodes had positive nonsentinel nodes, while 21 of 34 (62%) of macrometastatic sentinel nodes at intraoperative consult had tumor in nonsentinel nodes. No single variable studied discriminated between micro-vs macrometastatic disease. At intraoperative consult, macrometastatic disease was present in all three diagnostic preparations, while diagnostic material in micrometastatic sentinel nodes was usually present in only one modality. This analysis suggests that the risk of finding tumor in nonsentinel nodes differs significantly between cases with micro (3%)-vs macro (63%)-metastatic disease in sentinel nodes. This holds true for cases assessed by intraoperative consult. Considering the known morbidity of complete axillary dissection, assessments of risk vs benefit of undertaking this procedure should be performed on a case-by-case basis in patients with sentinel node micrometastases. Modern Pathology (2005) 18, 762-768, advance online publication, 11 March 2005; doi:10.1038/modpathol.3800394Keywords: axillary node dissection; breast cancer; intraoperative consult; macrometastasis; micrometastasis; nonsentinel node; sentinel node Sentinel node mapping for patients with breast cancer and clinically negative axilla has become the standard of care in many cancer centers. While it is well documented that this technique accurately predicts axillary node status in over 90% of the cases, 1-8 there are many relevant clinical decisions and surgical practices that have not been completely standardized. These include: (a) immediate complete axillary dissection based on sentinel node status at intraoperative consult vs complete axillary dissection as part of a second surgical procedure; (b) clinical value of complete axillary dissection following sentinel node micrometastasis; 9-11 (c) clinical significance of tumor deposits less than 0.2 mm in size, detected either by hematoxyli...

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“…In their study of 542 women with BC, Giard et al [48] identified 55 cases of SLN MM of which 40 underwent ALND and 6 were found to harbour additional metastatic foci. Similarly, den Bakker et al [49] identified one or more involved non-SLN in approximately one-third of their 32 patients with SLN MM. Furthermore, within those with SLN MM no subgroup of tumour size or grade could be identified that did not have non-SLN involvement.…”

Section: Analysis Of the Sentinel Lymph Nodementioning

confidence: 99%

The clinical significance of sentinel lymph node micrometastasis in breast cancer

Patani

Mokbel

2008

Breast Cancer Res Treat

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Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance

Cited by 79 publications

References 32 publications

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

The clinical significance of sentinel lymph node micrometastasis in breast cancer

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