Primary Breast Cancer Features Can Predict Additional Lymph Node Involvement in Patients with Sentinel Node Micrometastases

Carcoforo, Paolo; Maestroni, Umberto; Querzoli, Patrizia; Lanzara, Serena; Maravegias, Konstantinos; Feggi, Luciano; Soliani, Giorgio; Basaglia, Ernesto

doi:10.1007/s00268-005-0083-0

Cited by 15 publications

(13 citation statements)

References 24 publications

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“…Similar to other studies including only patients with micrometastases, we could not show an association between HER2 status19, 14 and NSN status. Location of metastases in the parenchyma of the sentinel node has in previous studies been associated with NSN metastases 37, 38.…”

Section: Discussionsupporting

confidence: 88%

“…The unique size of our study population enabled us to test several possible risk factors for NSN metastases in breast cancer patients with micrometastases or ITC in the sentinel node. We confirmed that increasing tumor size and lymphovascular invasion are predictors of NSN metastases in these patients 14, 19–21, 23. We furthermore identified increased proportion of positive sentinel nodes, negative hormone receptor status and younger age at diagnosis as risk factors.…”

Section: Discussionsupporting

confidence: 76%

“…Unfortunately, these scoring systems are not very precise in patients with only small metastases 14–18. Studies indicate that tumor size and lymphovascular invasion are associated with further metastatic spread to NSN in patients with minimal metastatic disease in the sentinel node,8, 19–24 but most studies have been too small to develop a useful risk‐model to support the decision for omitting ALND in selected patients.…”

mentioning

confidence: 99%

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Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Genevay¹,

Viatte²,

Finckh³

et al. 2010

Arthritis & Rheumatism

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Objective. Based on several experimental results and on a preliminary study, a trial was undertaken to assess the efficacy of adalimumab, a tumor necrosis factor ␣ inhibitor, in patients with radicular pain due to lumbar disc herniation.Methods. A multicenter, double-blind, randomized controlled trial was conducted between May 2005 and December 2007 in Switzerland. Patients with acute (duration of <12 weeks) and severe (Oswestry Disability Index score of >50) radicular leg pain and imagingconfirmed lumbar disc herniation were randomized to receive as adjuvant therapy either 2 subcutaneous injections of adalimumab (40 mg) at 7-day intervals or matching placebo. The primary outcome was the score for leg pain, based on a visual analog scale (0-100 mm), which was recorded every day for 10 days and at 6 weeks and 6 months.Results. Of the 265 patients screened, 61 were enrolled; 31 patients were assigned to receive adalimumab, and 4 patients in the placebo group were lost to followup. Over time, the course of leg pain was more favorable in the adalimumab group than in the placebo group (P ‫؍‬ 0.002). However, the effect size was relatively small, and at the last followup visit the difference was 13.8 (95% confidence interval ؊11.5, 39.0). Compared with patients in the placebo group, approximately twice as many patients in the adalimumab group fulfilled the criteria for "responders" and for "low residual disease impact" (P < 0.05), and fewer surgical discectomies were performed (6 versus 13 in the placebo group; P ‫؍‬ 0.04).Conclusion. The addition of a short course of adalimumab to the treatment regimen of patients experiencing acute and severe sciatica resulted in a small decrease in leg pain and in significantly fewer surgical procedures.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 76%

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confidence: 99%

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Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Genevay¹,

Viatte²,

Finckh³

et al. 2010

Arthritis & Rheumatism

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“…Previously, clinical predictors found to display risk for NSN involvement include: age, menopausal status, primary tumor size, grade, number of SNs, number of positive lymph nodes, size of SN metastases, lymphovascular invasion and identification by H&E or IHC staining [17,25,26,27,28,29]. In our study the number of SNs removed during the SN procedure was a significant predictor of positive NSN status.…”

Section: Discussionmentioning

confidence: 60%

Axillary Lymph Node Status in Early-Stage Breast Cancer Patients with Sentinel Node Micrometastases (0.2-2 mm)

et al. 2013

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Background: Omission of axillary lymph node dissection (ALND) is increasingly becoming the new standard of care for patients with sentinel lymph node micrometastases (SNMMs). However, a formidable proportion of patients is afflicted with non-sentinel node (NSN) macrometastatic tumor burden. Methods: Over 1 decade 5,000 patients underwent sentinel node biopsies (SNB) at 2 certified breast cancer centers in Austria. All available cases of SNMM during this time period were reviewed. Clinical, tumor and lymph node parameters were analyzed using univariate and multivariate analysis to retrieve predictors for further NSN involvement. Results: We identified 216 patients with SNMMs, of whom 181 subsequently underwent ALND. Of the latter patients, 16% (n = 29/181) presented with NSN axillary metastases. ALND revealed NSN macrometastases in 10.5% (n = 19/181) of all the investigated patients, and 66% of the NSN-positive patients (n = 19/29). In 28% (n = 8/29) of the NSN-positive patients, more than 1 macrometastasis was detected. The number of removed sentinel nodes was found to be a significant predictor (p = 0.007) for NSN involvement. Conclusion: In this retrospective investigation of breast cancer patients with SNMMs, a substantial proportion exhibited involvement of NSNs. Macrometastases accounted for the largest fraction of NSN tumor burden. Refraining from ALND in the face of SNMMs may entail substantial micro- and macrometastatic tumor burden in the remaining axillary lymph node basin.

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“…In contrast, Carcoforo et al. found a significantly increased Ki67 immunoreactivity in three of eight patients with NSN metastases (4), but the study size was small and no adjustment for confounders was done. In our study, where possible confounders were adjusted for by matching, we did not find any association between Ki67 immunoreactivity and the presence of NSN metastases.…”

Section: Discussionmentioning

confidence: 90%

Evaluating TIMP‐1, Ki67, and HER2 as markers for non‐sentinel node metastases in breast cancer patients with micrometastases to the sentinel node

Tvedskov

Bartels

Jensen

et al. 2011

APMIS

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The aim was to investigate whether the biochemical prognostic markers TIMP-1, Ki67, and HER2 could predict metastatic spread to non-sentinel nodes (NSN) in breast cancer patients with micrometastases to sentinel node (SN). We included all breast cancer patients with micrometastases to SN operated between 2001 and 2007 at the Department of Breast Surgery, Herlev Hospital. The study was designed as a matched case-control study with 25 cases with micrometastases to SN and, in addition, metastatic spread to NSN and 50 matched controls with micrometastases to SN, but without NSN metastases. Patient and tumor characteristics were retrieved from the Danish Breast Cancer Cooperative Group database. Immunohistochemical analyses of TIMP-1 and Ki67 and measurements of HER2 on formalin-fixed paraffin-embedded tumor tissue were performed. No significant differences in the immunoreactivity of TIMP-1 and Ki67 were found between patients with and without NSN metastases. Six of seven HER2 positive patients did not have NSN metastases, but the results did not reach statistical significance. Despite being prognostic markers in breast cancer, TIMP-1 and Ki67 could not predict NSN metastases in women with micrometastatic disease to SN. Larger studies are needed to further validate HER2 as a marker for NSN metastases in these patients.

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Primary Breast Cancer Features Can Predict Additional Lymph Node Involvement in Patients with Sentinel Node Micrometastases

Abstract: Analysis of the primary breast lesion in patients with micrometastatic SLN and metastatic NSLNs revealed the presence of lymphovascular invasion, Mib-1 index > 10%, and tumor size > 2 cm. Patients without lymphovascular invasion, Mib-1 < 10% and T size < 2 cm could avoid further ALND.

Cited by 15 publications

References 24 publications

Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Axillary Lymph Node Status in Early-Stage Breast Cancer Patients with Sentinel Node Micrometastases (0.2-2 mm)

Evaluating TIMP‐1, Ki67, and HER2 as markers for non‐sentinel node metastases in breast cancer patients with micrometastases to the sentinel node

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