Abstract
Predicting the risk of sentinel lymph node (SLN) metastasis is important for clinical decision-making in the setting of early breast cancer (EBC). This study is aimed to identify tumor and patient characteristics that influenced the SLN metastatic involvement, with a focus on luminal subtypes. An observational study including women treated for EBC from 2005 to 2013 was conducted. Regression analyses were used to assess the association between SLN metastasis and age, menopausal status, tumor size, histological grading, presence of extensive “in situ” carcinoma components, lymphovascular invasion (LVI), and expression of Ki-67, hormone receptors, and HER2. Of 345 women, 84 (24.3 %) had at least one SLN metastasis; 63.1 % were macrometastases. Among all patients, 31.6 % exhibited LVI. In univariate analyses, tumor size, histological grade, and LVI were associated with SLN metastasis. The multivariate model confirmed only the association between LVI and SLN status (OR 3.27, 95 % CI 1.85–5.68; p < 0.0001). Luminal subtypes were detected in 86.1 % of women. In this subgroup, the multivariate model confirmed a significant relationship between LVI and SLN status (OR 3.47, 95 % CI 1.90–6.33; p < 0.0001). Since a proper histopathological assessment of LVI is not possible prior to surgery, this factor cannot be used to guide decisions on performing SLN biopsies. Nevertheless, when a SLN biopsy is refused or contraindicated, an LVI assessment on an excisional biopsy of the tumor could facilitate prognosis determination and treatment management.
Highlights
Early-stage breast cancer (EBC) is confined to the breast with or without regional lymph node involvement (NHSBSP and RCPath 2005)
Predicting the risk of sentinel lymph node (SLN) metastatic involvement is an important aspect of clinical decision-making in the setting of EBC
We found that lymphovascular invasion (LVI) was an independent risk factor for SLN metastatic involvement
Summary
Early-stage breast cancer (EBC) is confined to the breast with or without regional lymph node involvement (NHSBSP and RCPath 2005). La Verde et al SpringerPlus (2016) 5:114 disease-free survival (DFS), irrespective of the use of ALND (Giuliano et al 2011) According to those results, in the near future, prognosis may be predicted more accurately with alternative, intrinsic biological tumor features, obtained with conventional histopathological, immunohistochemical, or molecular biological characterizations, which can assess the potential of local and systemic tumor aggressiveness. In the near future, prognosis may be predicted more accurately with alternative, intrinsic biological tumor features, obtained with conventional histopathological, immunohistochemical, or molecular biological characterizations, which can assess the potential of local and systemic tumor aggressiveness These approaches may be more informative than the conventional T (tumor size), N (lymph node involvement) and M (metastasis) classifications for decisions concerning the optimal choice of locoregional and systemic treatments. It has become increasingly desirable to devise a means to identify patients with EBC that can be treated safely without invasive, mutilating axillary procedures, based on patient clinical parameters and biological features intrinsic to the tumor
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