Predicting the Likelihood of Additional Nodal Metastases in Breast Carcinoma Patients With Positive Sentinel Node Biopsy

Abstract

Axillary lymph node dissection (ALND) is an important procedure in the staging of breast cancer patients. However, it is associated with a significant morbidity rate. In addition, using early diagnosis a high number of cases with negative lymph nodes can be identified. A lymph node defined as sentinel lymph node (SLN) would be the first to receive tumoral drainage. A less morbid but accurate staining procedure using mapping and SLN biopsy has been introduced. The aim of this study was to estimate the likelihood of additional disease in the axilla after SLN analysis. A total of 259 breast carcinomas and SLN biopsies followed by ALND were examined. The patient median age was 59 years, approximately 75% of them postmenopausal. Tumor size was 1.4 +/- 0.8 cm (almost 80% in pT1). SLNs were positive in 59 of 259 (22.8%) carcinomas, 30 (11.6%) with micrometastases (<2.0 mm) and 29 (11.2%) with metastases. Tumor size ( P = .004) and presence of lymphovascular invasion (LVI; P = .034) were found to be significant predictors of pathologically positive SLN. Following ALND, positive non-SLNs were present mostly in patients with metastasis >2 mm in SLN (P = .003), in carcinoma with higher nuclear grade ( P = .044), decreased estrogen receptor (ER; P = .042), and progesterone receptor (PR; P = .042). Finally, lymph node status (pN) following SLN and ALND was found to be significantly associated with tumor size ( P = .006), LVI (P = .037), PR (P = .023), and Her-2 status (P < .001). These results point to detailed analysis of primary tumor and SLN that may increase the precision of patient selection for further axillary surgery or radiotherapy.

Nine years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1,050 Cases

“…By monovariate analysis of the factors that influenced axillary nodal status, our data confirm a linear correlation between tumor size and the number of metastatic nodes [27]. The patient's age proved to have a controversial role among SLNB indicators, and it should not be an absolute exclusion criterion for this procedure.…”

Sentinel Lymph Node Biopsy in Breast Cancer: Predictors of Axillary and Non-Sentinel Lymph Node Involvement

“…Age, menopausal status, HT, HG, size of the tumour, lymphatic and blood vessel invasion, and hormone receptor status are previously studied factors. Despite the inhomogeneity of data concerning predictors of axillary positivity, the literature review and our results pointed to tumour size and lymphovascular invasion as factors having an influence on axillary metastatic rates (9,(15)(16)(17)(18)(19). Recently, in a prospective study of 177 patients concerning early invasive breast cancer treatment via tumour excision and SLNB, TS (p=0.003) and LVI (p=0.01) appeared to be the only histopathological characteristics having a significant association with lymph node positivity in multivariate analysis (36).…”

“…However, the Cambridge model and a novel Turkish formula seem to be uninfluenced by SLN micrometastasis and non-SLN positivity Table 6. Analysis of the impact of lymphovascular invasion on sentinel lymph node metastasis (literature review) (9,(15)(16)(17)(18)(19) rates and have an area under the ROC curve of over 80% each, and thus deserve further validation in prospective trials (13,14,35). Age, menopausal status, HT, HG, size of the tumour, lymphatic and blood vessel invasion, and hormone receptor status are previously studied factors.…”

“…The primary objective was to determine the PPV of the statistically significant prognosticators of SLN involvement in independent studies (9,(15)(16)(17)(18)(19).…”

A New and Simple Predictive Formula for Non-Sentinel Lymph Node Metastasis in Breast Cancer Patients with Positive Sentinel Lymph Nodes, and Validation of 3 Different Nomograms in Turkish Breast Cancer Patients

“…Cerb-2 is a well known negative prognostic factor in breast cancer; however, our knowledge about its effect on lymph node metastasis is limited. Only in 1 article by Mustac et al [25] Cerb-2 status was found to correlate with the overall status of the axilla (pN). In addition, the authors of the models that were used in our study did not state whether they tested Cerb-2 as a variable in their models.…”