Abstract
Background: The need for routine axillary lymph node dissection (ALND) in patients with invasive breast cancer and low-volume sentinel node (SN) involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND. Methods: A consecutive series of 317 patients with invasive breast cancer and a tumor positive axillary SN followed by ALND was reviewed. Clinicopathologic features of the primary tumor and the SN were assessed as possible predictors of second echelon lymph node involvement. Results: Second echelon metastases were found in 116/317 cases (36.6%). Frequency of second echelon lymph node involvement in patients with isolated tumor cells (ITC, N = 23), micro- (N = 101) and macrometastases (N = 193) was 13%, 20% and 48%, respectively (p < 0.001). Based on the area % of SN occupied by tumor no subgroup of patients could be selected with less than 20% second echelon lymph node involvement. However, none of the patients with SN ITC or micrometastases and a primary tumor size ≤1 cm (N = 12, 3.8%) had second echelon lymph node involvement. Conclusions: Accurately measured SN tumor load predicts second echelon lymph node involvement. However, even in patients with ITC, the second echelon lymph nodes are involved in 13% justifying ALND.
Highlights
The presence and extent of axillary lymph node involvement in patients with breast cancer is a powerful prognosticator, primary tumor features may provide strong prognostic value [20,23]
It reduces the morbidity of breast cancer surgery by avoiding unnecessary axillary lymph node dissection (ALND) in patients
A retrospective database was analysed including consecutive patients with clinically node-negative invasive breast cancer and a tumor positive axillary sentinel node (SN) followed by ALND after full SN examination, treated at the University Medical Center Utrecht or the Antonius Hospital in Nieuwegein, The Netherlands, from January 2000 to June 2006
Summary
The presence and extent of axillary lymph node involvement in patients with breast cancer is a powerful prognosticator, primary tumor features may provide strong prognostic value [20,23]. SN biopsy combined with an intensive pathological analysis is a highly accurate and minimally invasive technique to assess regional lymph node involvement [10,16,31]. It reduces the morbidity of breast cancer surgery by avoiding unnecessary ALND in patients. C.H.M. van Deurzen / Predictive value of tumor load in breast cancer and extracapsular extension (ECE) [4,22,24,33,36,38] showed a correlation with second echelon lymph node status None of these factors could reliably identify a subgroup of patients with such a low risk of second echelon lymph node involvement that they might be spared ALND [26].
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