Marker Panel Predictive of Lymph Node Metastasis in Young Patients with Breast Carcinoma

Abstract

Breast cancer is being diagnosed more frequently in young women. It is important to identify tumors with greater metastatic potential since this information will provide a basis for noninvasive staging of the axilla. The studied population consisted of 66 patients with infiltrating breast carcinoma (56 ductal, 10 lobular) aged 20-34 (mean 29) years. Lymph node status was correlated with the following parameters: size, grade, p53 expression, MIB-1, CD44, c-Erb-2, estrogen, progesterone receptors, and a family history of breast cancer. Immunohistochemical studies utilizing avidinbiotin-peroxidase complex method were performed on formalin-fixed, paraffinembedded tissue. Thirty-nine patients (59%) had positive lymph nodes and 27 (41%) had negative lymph nodes. In multivariate logistic regression analysis, two models with size (p=.0002) and p53 (p=.0379) or size (p=.0002) and MIB-1 (p=.0462) were predictive of nodal involvement. For TI lesions, p53 positivity increased the probability of nodal involvement from 18% to 46% and, for T2 lesions, from 65% to 89%. In the second model, for TI lesions MIB-1 positivity increased the probability of nodal involvement from 10% to 36% and, for T2 lesions, from 48% to 82%. Size, p53, and MIB-1 were found to be valid independent predictors of lymph node metastasis in TI and T2 breast carcinomas in young women. The combination of size with p53 or MIB-1 increases dramatically the predictive impact of these parameters on nodal status. These data may prove useful in selecting patients with increased risk of dissemination and provide a basis for staging the axilla noninvasively.