T1 Breast Cancer: Identification of Patients at Low Risk of Axillary Lymph Node Metastases

Bader, Arnim A.; Tio, Joke; Petru, Edgar; Bühner, M.; Pfahlberg, Annette; Volkholz, H.; Tulusan, A. H.

doi:10.1023/a:1020231300974

Cited by 49 publications

(46 citation statements)

References 21 publications

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“…However, even in this low-risk group, the few cases (17 out of 158, 11%) with LVI had an incidence of Lymph node metastasis higher than 40%. The effect of LVI on nodal status was also evident in pT1c and pT2 tumors, a finding reported by other authors and in a previous study by our group (6,19,22). The strong association with Lymph node metastasis indicates that LVI could probably be regarded as the precursor of nodal involvement (23).…”

Section: -------------------------------------------------supporting

confidence: 80%

“…Several studies have investigated the role of the proliferation index in breast cancer patients and a strong correlation between the MIB-1 labelling index and Lymph node metastasis has been reported (5,6), although this finding has not been confirmed by others (7)(8)(9)(10). Similarly, conflicting results regarding the prognostic significance of the proliferation index have been found (9,(11)(12)(13).…”

Section: Introductionmentioning

confidence: 94%

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Mib-1 proliferation index is an independent predictor of lymph node metastasis in invasive breast cancer: A prospective study on 675 patients

Marrelli

Pinto²,

Neri³

et al. 2006

Oncol Rep

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Abstract. In order to evaluate the potential risk factors for Lymph node metastasis in invasive breast cancer patients submitted to axillary dissection, 675 patients who received surgery between January 1995 and December 2002 were included in a prospective study. In all cases, MIB-1 proliferation index was investigated by immunohistochemistry. Lymph node involvement was found in 248 out of 675 patients. Univariate analysis showed that peritumoral lymphovascular invasion, pT stage, tumor multiplicity, MIB-1 proliferation index >10%, oestrogen receptor status, histological type, tumor grade and progesterone receptor status were related to a higher incidence of Lymph node metastasis, with various levels of statistical significance. Multivariate analysis identified lymphovascular invasion [relative risk (RR, 7.69; p<0.001), pT stage (RR, 3.08; p<0.001), tumor multiplicity (RR, 3.89; p<0.001), and MIB-1 proliferation index (RR, 1.66; p=0.019)] as independent predictive variables. The impact of MIB-1 positivity on the incidence of Lymph node metastasis was particularly evident in intermediate risk groups (pT1c, pT2 without lymphovascular invasion), as well as in grade-2 tumors. In conclusion, the MIB-1 proliferation index could provide additional information about the risk of Lymph node metastasis in invasive breast cancer, and may be useful to identify grade-2 tumors with a more aggressive clinical behaviour. IntroductionNodal status is a strong prognostic factor in breast cancer and is one of the most important variables considered in deciding on adjuvant treatment after surgery. Sentinel node biopsy, although not the standard of care, is rapidly becoming widely accepted as an alternative staging procedure for the axilla in breast cancer. However, in subgroups of patients with a high risk of Lymph node metastasis, this procedure may not provide a clinical benefit and may involve a waste of resources as, in a high percentage of cases, it is followed by axillary dissection. The definition of tumor characteristics that are predictive of Lymph node metastasis may be useful in order to better select which patients to submit to axillary surgery (1).Besides commonly used pathological factors, cell proliferation has an important role as an indicator of biological aggressiveness in breast cancer. Ki-67 antibody reacts with a nuclear antigen which is present in G1, S, G2 phases and mitosis but is absent in G0 and is therefore considered a marker of the proliferative activity of the tumor (2). Unfortunately, the epitope that recognizes Ki-67 is destroyed in the fixation and paraffin embedding process. More recently, the MIB-1 antibody, which recognizes Ki-67 antigen in formalin-fixed, paraffin-embedded tissue, has been described and applied to breast cancer (3,4).Several studies have investigated the role of the proliferation index in breast cancer patients and a strong correlation between the MIB-1 labelling index and Lymph node metastasis has been reported (5,6), although this finding has not been confirmed by others (7-10)....

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Section: -------------------------------------------------supporting

confidence: 80%

Section: Introductionmentioning

confidence: 94%

Mib-1 proliferation index is an independent predictor of lymph node metastasis in invasive breast cancer: A prospective study on 675 patients

Marrelli

Pinto²,

Neri³

et al. 2006

Oncol Rep

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“…It is known that axillary nodal metastases may stem from primaries \ 1 cm: in fact, in a report of 953 breast cancer patients, axillary metastases were detected in 20% of those with tumours smaller than 1 cm [38,39]. In our CUPAx review, a definition bias may be responsible for the high percentage of well differentiated tumours, as in several series adequate tissue differentiation towards glandular morphology was a prerequisite for inclusion in the CUPAx cohort.…”

Section: Discussionmentioning

confidence: 86%

Axillary nodal metastases from carcinoma of unknown primary (CUPAx): a systematic review of published evidence

Pentheroudakis

Lazaridis

Pavlidis

2009

Breast Cancer Res Treat

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Axillary lymph node metastases from adenocarcinoma or poorly differentiated carcinoma of unknown primary (CUPAx) represent a rare clinical entity without consensus on its biology, management and outcome. We systematically reviewed published CUPAx series and identified 24 retrospective studies enrolling 689 patients from 1975 till 2006. CUPAx affected women at a mean age of 52 years, 66% of whom post-menopausal harbouring low-volume (N1, 48%) or high-volume (52%) nodal disease from ductal adenocarcinoma (83%). Among a total of 446 patients managed with mastectomy, a small breast primary was identified histologically in 321 (72% of cases). Hormone receptor protein expression was observed in 40-50% of cases, while HER2 overexpression in 31%. CUPAx patients were managed with axillary lymph node dissection coupled to mastectomy (59%), primary breast irradiation (26%) or observation (15%). Observation was associated with high locoregional relapse rates (42%) and risk of metastatic spread. Mastectomy or radiotherapy provided locoregional disease control in 75-85% of cases, while adjuvant systemic therapy was associated with a nonsignificant trend for improved survival in few series. Five-year survival ranged from 59.4 to 88% at a median follow-up of 62 months (mean 5-year survival 72%), with axillary tumour burden being the pivotal prognostic factor. CUPAx is associated with similar presentation, biology and outcome to resected node-positive overt breast cancer and should be treated accordingly.

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“…Preoperative risk assessment using the tumor grade, the tumor size, the presence of lymphovascular invasion and the Ki-67 staining might be used to omit routine ALND in those patients who are at a low risk for ALNM (21). In another study of lymph node metastases in relation to the histological type and clinical palpation, the investigators concluded that routine ALND could be omitted in those clinically node negative patients with stage T1a disease, a lymphovascular-negative tumor or a small tubular or mucinous carcinoma (＜15 mm).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Axillary Lymph Node Metastases (ALNM) in a Korean Population with T1-2 Breast Carcinoma: Triple Negative Breast Cancer has a High Incidence of ALNM Irrespective of the Tumor Size

et al. 2010

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ResultsPositive axillary lymph nodes were detected in 104 patients for an overall incidence of 28.8%: 2 patients (5%) with T1a tumor, 5 (9.2%) with T1b tumor, 24 (21.8%) with T1c tumor and 73 (44.2%) with T2 tumor. On the multivariate analysis, an increased tumor size (adjusted OR= 11.87, p=0.02), the presence of lymphovascular invasion (adjusted OR=7.41, p＜0.01), a triple negative profile (ER/PR-, Her2-) (adjusted OR=2.09, p=0.04) and a palpable mass at the time of diagnosis (adjusted OR=2.31, p=0.03) were all significant independent factors for positive ALNM. ConclusionIn our study, the tumor size, the presence of lymphovascular invasion, a triple negative profile and a palpable mass were the independent predictive factors for ALNM. The tumor size was the strongest predictor of ALNM. Thus, the exact estimation of the extent of tumor is necessary for clinicians to optimize the patients' care. Patients with a triple negative profile have a high incidence of ALNM irrespective of the tumor size.

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T1 Breast Cancer: Identification of Patients at Low Risk of Axillary Lymph Node Metastases

Abstract: Primary tumor characteristics can be used to identify a subgroup of patients with a low risk of axillary lymph node metastases in T1 breast cancer. Preoperative risk assessment might be used to omit routine ALND in those patients at low risk of axillary lymph node metastases.

Cited by 49 publications

References 21 publications

Mib-1 proliferation index is an independent predictor of lymph node metastasis in invasive breast cancer: A prospective study on 675 patients

Mib-1 proliferation index is an independent predictor of lymph node metastasis in invasive breast cancer: A prospective study on 675 patients

Axillary nodal metastases from carcinoma of unknown primary (CUPAx): a systematic review of published evidence

Predictors of Axillary Lymph Node Metastases (ALNM) in a Korean Population with T1-2 Breast Carcinoma: Triple Negative Breast Cancer has a High Incidence of ALNM Irrespective of the Tumor Size

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