The clinical significance of metastatic breast carcinoma to intramammary lymph node.

Abstract

The incidence of involved intramammary lymph node (intra-MLN) with breast carcinoma (BC) is rare. Its clinical significance and impact on the clinical decision making is unclear. A total of 113 BC cases with at least one positive intra-MLN were collected from 11 academic institutions. The inclusion criteria were subsequent axillary lymph node dissection, and the availability of information on T-stage, size of node metastasis, extranodal extension status, biomarkers status, and clinical follow-up. Stage 4 cases and/or neo-adjuvant treated patients were excluded. AJCC TN-stage was calculated twice, with and without intra-MLN. Five-year overall survival (OS) and relapse (local and/or distant)-free survival (RFS) were calculated and correlated with the clinicopathologic variables. Excluding intra-MLN, TN-stage correlated with OS (P=.016) but not with RFS (P=.19). However, when intra-MLN was included, TN-stage correlated with both OS (P<.001) and RFS (P=.016). In the multivariate analysis, when intra-MLN was excluded, only radiation therapy (RT) correlated with RFS (HR=0.19, 95% CI: 0.054-0.66, P=.009). However, when intra-MLN was included in the TN-stage both RT (HR=0.13, 95% CI: 0.04-0.45, P=.001) and TN-stage 3 (HR=8.92, 95% CI: 1.47-54, P=.017) correlated with RFS. Tumor multifocality was the only variable correlated with OS when the intra-MLN involvement was excluded. When intra-MLN was included, multifocality became insignificant but TN-stage 3 correlated with OS (HR=8.59, 95% CI: 1.06-69.71, P=.044). Positive intra-MLN is an independent factor in predicting both RFS and OS.