The Impact of Histopathology on Nodal Metastases in Minimal Breast Cancer

Mustafa, Isha A.; Cole, Bernard F.; Wanebo, Harold J.; Bland, Kirby I.; Chang, Helena R.

doi:10.1001/archsurg.1997.01430280058008

Cited by 67 publications

(26 citation statements)

References 28 publications

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“…1,3,[5][6][7][8][9][10]13 Three percent to 11% of T1a, 13% to 17% of T1b, and 26% to 35% of T1c cancers have lymph node metastases, irrespective of the presence or absence of lymphatic invasion. As tumors increase in size, they are more likely to exhibit both lymphatic invasion and positive lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Lymphatic Invasion, Tumor Size, and Age Are Independent Predictors of Axillary Lymph Node Metastases in Women With T1 Breast Cancers

Gajdos¹,

Tartter²,

Bleiweiss³

1999

Annals of Surgery

147

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ObjectiveTo identify characteristics of the primary tumor highly associated with lymph node metastases. Summary Background DataRecent enthusiasm for limiting axillary lymph node dissection (ALND) in women with breast cancer may increase the likelihood that nodal metastases will be missed. Identification of characteristics of primary tumors predictive of lymph node metastases may prompt a more extensive surgical and pathologic search for metastases in patients with negative sentinel lymph nodes or limited ALND. MethodsThe authors studied 850 consecutive patients who underwent ALND for T1 breast cancer. Age, tumor size, histopathologic diagnosis, tumor differentiation, presence of lymphatic invasion, and estrogen and progesterone receptor results were studied prospectively. Stepwise logistic regression was used to identify variables independently associated with axillary lymph node metastases. ResultsLymphatic invasion, tumor size, and age were independently associated with lymph node metastases. Fifty-one percent of the 181 patients with lymphatic invasion had axillary lymph node metastases, compared with 19% of the 669 patients without lymphatic invasion. Thirty-five percent of the 470 patients with tumors Ͼ1 cm had nodal involvement compared with 13% of the 380 patients with smaller cancers. Thirtyseven percent of the 63 women younger than age 40 had lymph node involvement compared with 25% of the 787 women older than age 40. Significant correlations were noted between lymphatic invasion and patient age and between lymphatic invasion and tumor size. The proportion of tumors with lymphatic invasion decreased progressively with increasing age and increased with increasing tumor size. ConclusionsAxillary lymph node metastases are most significantly related to lymphatic invasion in the primary tumor, followed, in order of significance, by tumor size and patient age. Axillary nodal metastases should be suspected in the presence of lymphatic invasion of large tumors in young patients.

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Section: Discussionmentioning

confidence: 99%

Lymphatic Invasion, Tumor Size, and Age Are Independent Predictors of Axillary Lymph Node Metastases in Women With T1 Breast Cancers

Gajdos¹,

Tartter²,

Bleiweiss³

1999

Annals of Surgery

147

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“…3 In a more recent analysis of both Rhode Island and Massachusetts tumor registries, records of 12,030 patients with T0 and T1 lesions were examined. 4 Of these, 2185 had invasive tumors 1.0 cm in diameter (T1a and T1b), which represented 18% of all breast cancers in this study. Although the diagnoses were made by many different pathologists, results from these 2185 patients showed a node positivity of 17%.…”

Section: My Colleagues At the H Lee Moffitt Cancer Center Inmentioning

confidence: 76%

Microstaging of Sentinel Lymph Nodes

Bland

1999

Ann Surg Oncol

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Surgical Oncology, Schreiber and colleagues 1 confirmed, with comparison of tumor size versus positive nodal status, that CK IHC staining of sentinel lymph nodes led to a significant upstaging in patients with tumor sizes under 2 cm (T1a, T1b, T1c lesions). Moreover, the authors note that CK IHC staining of sentinel nodes shifted 9.4% of patients from a diagnosis of stage I to stage II. This previously undetected presence of tumor (a microstaging shift, or upstaging) may account for a significant proportion of stage I breast cancer failures, not found previously by hematoxylin and eosin (H&E) histochemical staining alone. Of the 381 sentinel nodes evaluated in 210 breast cancer patients, CK IHC staining confirmed that 47 of 210 patients (22.4%) had histologically confirmed positive nodes; 63.8% of patients had H&E and CK-positive nodes, and an additional 36.2% (17/47 patients) had only CK-positive nodes. In a comparison of tumor size with the total number of nodepositive patients, 53% of the T0 and T1 patients were upstaged (22/39; 56.4% of nodes) were upstaged by CK IHC. As confirmed in this analysis, patients with more advanced T2 and T3 lesions were less frequently upstaged using sentinel node CK IHC: 5.9% of nodepositive patients and 20.6% of nodes for T2 and T3 lesions.In an analysis performed at Brown University using the Rhode Island State Tumor Registry, computerized data from nine hospitals of the Hospital Association of Rhode Island confirmed positive nodes in T1a and T1b lesions (9.8% and 19.4%, respectively). 2 This overall frequency of 18% node positivity found in T1aϩT1b lesions is in a median position compared to other reports, with the great variation perhaps due to the smaller sampling sizes of the other reports. 3 In a more recent analysis of both Rhode Island and Massachusetts tumor registries, records of 12,030 patients with T0 and T1 lesions were examined. 4 Of these, 2185 had invasive tumors 1.0 cm in diameter (T1a and T1b), which represented 18% of all breast cancers in this study. Although the diagnoses were made by many different pathologists, results from these 2185 patients showed a node positivity of 17%. The current series from the University of South Florida reported overall frequencies of 11.1% upstaging for T1a lesions and 15.7% for T1b lesions, which is very similar to frequencies in the combined Rhode Island and Massachusetts database.An additional effect, therefore, appears evident in the study for predicting enlargement of the frequency of nodal positivity in the small lesions which, for many patients, have fewer potential nodes to evaluate pathologically. Contemporary pathology evaluations in most academic centers include bivalving nodal tissue after dissection, with evaluation of only one or two surfaces, typically, from the node tissue in question. The authors have emphasized that the CK positivity adds even greater importance in early lesions to ensure accurate sensitivity (true positives) in Tis, T1a, and T1b lesions. The upstage frequency of CK-positive, H&E-negative lesi...

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“…The nodal micrometastases detected by immunohistochemical staining may be associated with a reduction of survival rates by 10% to 15%, as compared with the survival rate predicted by a negative histologic nodal status based on routine processing of the node dissection specimen. Thus, the intensive study of the SLN may actually be more accurate in predicting survival outcome than the standard axillary node dissection [26].…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy and axillary staging of T1–T2 N0 breast cancer: A multicenter study

Sandrucci

Mussa

1998

Semin. Surg. Oncol.

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The Impact of Histopathology on Nodal Metastases in Minimal Breast Cancer

Abstract: Selective nodal dissection may be possible through risk factor analysis. Prospective registration of complete histopathologic information will allow more comprehensive analysis and may further enhance the selective treatment of patients with minimally invasive breast cancer.

Cited by 67 publications

References 28 publications

Lymphatic Invasion, Tumor Size, and Age Are Independent Predictors of Axillary Lymph Node Metastases in Women With T1 Breast Cancers

Lymphatic Invasion, Tumor Size, and Age Are Independent Predictors of Axillary Lymph Node Metastases in Women With T1 Breast Cancers

Microstaging of Sentinel Lymph Nodes

Sentinel lymph node biopsy and axillary staging of T1–T2 N0 breast cancer: A multicenter study

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