Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer

Abstract

Background Women with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC. Methods Data from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC. Results Of the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients. Conclusion This study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.

Anatomical site and size of sentinel lymph node metastasis predicted additional axillary tumour burden and breast cancer survival

“…Regarding tumour features, larger tumour size was the only feature associated with ALN metastasis in the current analysis. However, a 2-cm-sized cut-off, as reported by others, 11,31,32,34 did not appear to be predictive here. Additional predictive clinicopathological parameters demonstrated by other studies includes older patient age 21,34 and the presence of LVI.…”

“…However, a 2-cm-sized cut-off, as reported by others, 11,31,32,34 did not appear to be predictive here. Additional predictive clinicopathological parameters demonstrated by other studies includes older patient age 21,34 and the presence of LVI. 11,22 The significance of hormonal status and HER2 profile was controversial.…”

“…11,22 The significance of hormonal status and HER2 profile was controversial. Lale et al 10 showed that HER2+ diseases were associated with more frequent non-SLN metastases, while Dave et al 34 found that HER2+ tumours had a lower incidence of non-SLN metastases. Conversely, Lee et al reported that triple-negative breast cancers had a high incidence of nodal metastasis in ALN.…”

“…Lale et al 10 . showed that HER2+ diseases were associated with more frequent non‐SLN metastases, while Dave et al 34 . found that HER2+ tumours had a lower incidence of non‐SLN metastases.…”

[Retracted] MRI Diagnosis and Pathological Examination of Axillary Lymph Node Metastasis in Breast Cancer Patients

“…Dave et al [ 9 ] pointed out that the location of breast cancer would affect axillary lymph node metastasis. The maximum diameter of lymph nodes in patients without metastasis was significantly smaller than that in patients with axillary lymph node metastasis and was a risk factor for axillary lymph node metastasis, suggesting that patients with large diameter lymph nodes had a higher risk of metastasis.…”