Axillary Metastases In Breast Cancer Research Articles

Abstract PO4-07-10: Validation of An Ultrasound-Based Scoring System of Axillary Metastasis in Breast Cancer

Abstract Introduction: Ultrasound is the imaging modality of choice in the evaluation of axillary involvement in breast cancer. Our group previously created a scoring method to predict axillary lymph node metastasis (ALNM) based on ultrasound characteristics. In this study we validated the model and tested it among different Memorial Sloan Kettering Breast Cancer Sentinel Lymph Node Metastasis Nomogram1 (MSK) subgroups. Methods: The ultrasound score (table 1) was previously developed using data collected at a single institution from 2019 – 2021 by allocating points based on the regression coefficients of variables found to significantly predict ALNM. Subsequent evaluation of the discrimination of this model found it was robust to different patient demographic and tumor characteristics based on receiver operating characteristic curve analysis2. In this study, we validated the test statistics of our score at an outside institution. We also pooled patients from both institutions and evaluated the score performance in different MSK subgroups by the likelihood for sentinel node metastasis based off of clinical and pathologic data without accounting for imaging findings. Results: Between 2019-2021, 140 patients with breast cancer were analyzed for validation of the axillary ultrasound scoring system and when combined with the dataset of patients from the index institution, 358 pooled patients were stratified by predicted ALNM positivity according to MSK. In the validation cohort, the NPV for low risk (0-1) scores was 87%, while the PPV for high-risk (5+) scores was 71%. Overall in the combined cohort, 241 (67%) patients had low risk (0-1) axillary ultrasound scores and 33 (9%) had high risk (5+) scores. In this combined cohort, NPV was 84% (203/241 low-risk score patients were node negative), while PPV for high-risk scores was 85% (28/33 high risk score patients were node positive). When analyzed according to level of MSK predicted ALNM rates, for patients with < 50% predicted ALNM positivity, the NPV of low-risk scores was 87-89% and the PPV for high-risk axillary scores was 100%. For patients with >50% predicted ALNM positivity, the NPV of low-risk scores was 66% and the PPV of high-risk scores was 82%. Conclusions: A scoring system to predict ALNM among biopsy proven breast cancer patients undergoing upfront surgery was successfully developed from a multivariate model based on axillary ultrasound characteristics. This model was validated at a separate institution. The scoring system shows advantageous negative and positive predictive values for axillary node metastasis, especially among patients with < 50% predicted nodal involvement based on the MSK nomogram. This data may help foster better communication about ALNM risk between radiologists and treating clinicians to inform treatment decisions. Table. Scoring System for Likelihood of ALNM based on Ultrasound Characteristics Citation Format: Spencer Van Decar, Elizabeth Carpenter, Alexandra Adams, Jason Shore, Iulian Dragusin, Erika Davis, Craig Tork, Robert Krell, Troy Graybeal, Katherine Clifton, Arianna Buckley, Guy Clifton. Validation of An Ultrasound-Based Scoring System of Axillary Metastasis in Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-07-10.

Survival After Contralateral Axillary Metastasis in Breast Cancer.

Despite stage IV categorization, survival outcomes for breast cancer patients who experience contralateral axillary lymph node metastasis (CAM) remain uncertain. This study aimed to investigate the clinical outcomes for patients with metachronous CAM to provide insights into its prognosis and treatment recommendations. This study retrospectively reviewed medical records of patients who underwent curative surgery for breast cancer and experienced CAM as the first site of distant metastasis (DM) during the follow-up period between January 2001 and April 2023. Survival outcomes of the CAM patients were compared with those of breast cancer patients with other DM via propensity score-matching (PSM). The study identified 40 breast cancer patients with metachronous CAM. The estimated 5-year overall survival (OS) was 39.6%, and the progression-free survival was 39.4%. The patients with CAM exhibited marginally better OS than the patients with DM (p = 0.071), but survival similar to that of the patients with isolated supraclavicular node recurrence (SCN) (p = 0.509). Moreover, matching of CAM with DM using two PSM models showed a consistently insignificant survival difference (hazard ratio [HR], 1.47; p = 0.124 vs. HR, 1.19; p = 0.542). Ipsilateral breast tumor recurrences (IBTRs) were experienced by 12 patients before or concurrently with the CAM. These patients exhibited significantly better survival than the remaining patients (HR, 0.28; p = 0.024). The breast cancer patients with CAM showed survival similar to that for the patients with DM, supporting the current stage IV classification of the CAM. However, CAM associated with IBTR exhibited superior survival outcomes, suggesting that this subset of CAM may benefit from treatments with curative intent.

Predicting axillary metastasis in breast cancer using lymphatic contrast-enhanced ultrasound-guided fine-needle aspiration of one lymph node.

Fine-needle aspiration (FNA) is a microinvasive method to diagnose lymph nodes. This study aims to determine the capability of lymphatic contrast-enhanced ultrasound (LCEUS)-guided FNA in predicting the axillary metastasis with the target of one lymph node (LN) in patients with breast cancer. LCEUS was prospectively performed in 105 patients with breast cancer. The most suspicious LN was targeted based on the characters of LCEUS. FNA was performed in the LN, followed by localization using a guide wire. The detection of lymph cells and/or tumour cells was recognized as a puncture success. Cytologic diagnosis was compared with histologic diagnosis of wire-marked LN for diagnosing accuracy and compared with histologic diagnosis of axillary LNs for predicting accuracy. LCEUS-guided FNA was performed in all 105 female patients who underwent axillary dissection. The puncture success rates were 74.3%, 91.4%, and 97.1% for three sequential groups (P = .010). In diagnosing LN metastasis, the sensitivity, specificity, and accuracy values of LCEUS-guided FNA were 89.7%, 100%, and 95.7%, respectively. In predicting axillary metastasis, the sensitivity, specificity, and accuracy values of LCEUS-guided FNA were 81.4%, 100%, and 91.3%, respectively. The microinvasive LCEUS-guided FNA of one lymph node can be an accurate method and may help predict axillary metastasis in patients with breast cancer. This study presented that LCEUS combined with FNA would be practical in clinic. The characters of LCEUS could indicate the suspicious LNs and promote the accuracy in predicting axillary metastasis.

Sonographic Characteristics of Enlarged Axillary Lymph Node in Breast Cancer

Background: Breast cancer, the most prevalent cancer in women globally, presents unique challenges in Pakistan, particularly due to the younger average age of diagnosis compared to Western countries. Accurate assessment of axillary lymph nodes using ultrasound (US) is essential for effective breast cancer staging and prognosis. Objective: This study aimed to evaluate the sonographic characteristics of axillary lymph nodes in breast cancer patients in Pakistan and to assess the diagnostic efficacy of ultrasound in differentiating between benign and malignant lymph nodes. Methods: Conducted at Shalamar Hospital, Lahore, this cross-sectional study spanned four months and included 150 breast cancer patients aged 45-70 years, selected through convenient sampling. Ultrasound examinations were performed using a GE Ultrasound Machine Evolsion E7 with a linear probe (7.5-12Hz). Key sonographic parameters, including the shape, size (length and width), and echogenicity of lymph nodes, were meticulously recorded and analyzed by using SPSS 24.0. Results: The average length and width of lymph nodes were 5.86 mm (SD = 1.35) and 3.90 mm (SD = 0.77), respectively. A significant proportion of lymph nodes (74.2%) presented with a round shape in patients experiencing pain, and a predominance of hyperechoic nodes was noted, diverging from established literature that often associates hypoechoic nodes with malignancy. Additionally, an irregular shape was identified as a potential predictive marker for axillary lymph node metastasis. Conclusion: This study highlights the efficacy of axillary sonography in diagnosing axillary metastasis in breast cancer, showing moderate sensitivity and substantial specificity. It also identifies a notable association between older age and the likelihood of axillary lymph node metastasis, especially in women in their forties.

The predictive value, sensitivity, specificity, and accuracy of PET CT in the evaluation of axillary metastases in breast cancer.

This study aims to evaluate the accuracy of preoperative 18F-FDG PET CT in detecting axillary lymph node (ALN) metastases in patients with breast cancer. A retrospective analysis was performed on the medical records of 114 patients who underwent PET CT for breast cancer between January 2017 and January 2020. Clinicopathological features and the relationship between lymph node metastasis were evaluated. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated based on the PET CT findings compared to histopathological results. Among the 67 patients included in this study, 29 were identified as having no axillary involvement, while 38 showed axillary involvement according to preoperative PET CT. Of the 34 patients with histopathologically confirmed metastatic lymph nodes, 28 had PET CT-detected axillary involvement, while 6 did not. Similarly, among the 33 patients without histopathological evidence of lymph node metastasis, 23 had no axillary involvement according to PET CT, while 10 showed axillary involvement. The calculated values were as follows: sensitivity = 82.4% (67-92%), specificity = 69.7% (53-83%), positive predictive value = 73.7% (62-83%), negative predictive value = 79.3% (64%-89%), and accuracy = 76.1% (64-86%). The results suggest that preoperative 18F-FDG PET CT, particularly p SUVmax, can serve as an independent prognostic factor for ALN metastasis in breast cancer patients. Therefore, it may be beneficial for preoperative risk stratification and personalized treatment planning.

Diagnostic value of delta neutrophil index in determining axillary metastases in breast cancer

Aim: The delta neutrophil index (DNI), which shows the percentage of immature granulocytes (IG) in peripheral blood in inflammatory conditions, is an indicator of increased bone marrow activation. Its ability to predict prognosis has been demonstrated in many cancer studies. This study aims to investigate the value of DNI in predicting axillary metastases in breast cancer.
 Material and Method: Patients diagnosed with breast cancer and operated on axillary lymph node dissection were screened and 127 patients were included in the study. The patient’s age, gender, operation time, length of hospital stay, immature granulocyte (IG) percentages (IG#), and axillary lymph node pathology results were retrospectively scanned from the archive system.
 Results: DNI and IG were statistically higher in the group with lymph node metastasis. When examined for IG#, the mean of the group with reactive lymph nodes was 0.02±0.02, while the mean of the metastatic group was 0.04±0.05. This statistically significant difference was high (p

Systematic review of synchronous contralateral axillary metastases in breast cancer: really M1 disease?

The objective of the study is to assess and quantify the effect of the appearance of synchronous contralateral axillary on breast cancer survival. Breast cancer with contralateral axillary metastases (CAM) is classified as a metastatic disease. There are few cases reported and a lack of evidence of the significance of CAM when synchronous appearance with a primary tumor and no other site of disease. A systematic review following PRISMA guidelines to evaluate the prognosis of patients with synchronous CAM without other metastatic diseases comparing with metastatic disease is conducted through a search in PubMed, Embase, Clinical Key, and Cochrane Library databases. We present one case. The median age, follow-up, clinico-pathological characteristics, status of lymph nodes, treatments, and outcomes are analyzed. A total of 23 articles (10 case reports and 13 case series) with a total 68 patients, including our case. Median age was 48 years old. Median follow-up was 27months. Overall survival of the series was 71.4%. Twenty-one of 49 patients reported (36.2%) were alive without disease, fourteen (28.6%) were alive with disease while the rest fourteen (28.6%) died. Inflammatory presentation and ipsilateral axilla status were related to overall survival. Synchronous CAM in breast cancer show better outcomes in terms of overall survival than other metastatic diseases. The absence of comparative studies may not allow definitive conclusions, meanwhile, together with other authors we suggest treatment with curative intention. More studies may lead to consider a modification of TNM system.

Contralateral Axillary Metastasis in Breast Cancer : case report

Contralateral Axillary Metastasis in Breast Cancer : case report

Solitary contralateral axillary metastasis in breast cancer: Is it a true distant spread?

Solitary contralateral axillary metastasis in breast cancer: Is it a true distant spread?

Contralateral Axillary Metastases in Breast Cancer: Stage IV Disease or a Locoregional Event?

Contralateral axillary metastasis (CAM) in breast cancer is presently treated as a stage IV disease. We hypothesized that this disease pattern is a manifestation of direct aberrant lymphatic drainage and would behave more similar to advanced locoregional disease. This is a single-site, retrospective review of patients with biopsy-proven CAM from 2008-2017. Descriptive analysis was performed. Twenty-three patients met the inclusion criteria. The median disease-free interval from primary tumor treatment to diagnosis of CAM was 68 months (range, 36-155 months). This population had aggressive disease (74% local recurrences and 61% clinical evidence of cutaneous or underlying muscular invasion) and extensive locoregional therapy (70% radiated, 57% mastectomy, and 65% axillary lymph node dissection) before their presentation with CAM. Fifteen (65.2%) patients recurred after treatment of CAM; the median recurrence-free interval was 11 months (range, 5-23 months), and 12 (52.2%) patients developed distant metastases. The median distant metastasis-free survival was 14 months (range, 11-23 months), and the median overall survival was 31 months (range, 22-67.5 months). Development of CAM is associated with aggressive disease and extensive prior locoregional surgery and/or radiation. The short recurrence-free interval and high progression to additional stage IV disease suggest these patients behave similar to traditional stage IV patients with resected oligometastatic disease.

Diagnostic value of magnetic resonance imaging using superparamagnetic iron oxide for axillary node metastasis in patients with breast cancer: a meta-analysis

Objectives Identification of axillary metastases in breast cancer is important for staging disease and planning treatment, but current techniques are associated with a number of adverse events. This report evaluates the diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) techniques for identification of axillary metastases in breast cancer patients. Methods We performed a meta-analysis of previous studies that compared SPIO enhanced MRI with histological diagnosis after surgery or biopsy. We searched PubMed, Ovid, Springer Link, and Cochrane library to identify studies reporting data for SPIO enhanced MRI for detection of axillary lymph node metastases in breast cancer until December 2013. The following keywords were used: “magnetic resonance imaging AND axilla” and “superparamagnetic iron oxide AND axilla”. Eligible studies were those that compared SPIO enhanced MRI with histological diagnosis. Sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analyses were done. Study quality and heterogeneity were also assessed. Results There were 7 publications that met the criteria for inclusion in our meta-analysis. SROC curve analysis for per patient data showed an overall sensitivity of 0.83 (95% Confidence interval (CI): 0.75–0.89) and overall specificity of 0.97 (95% CI: 0.94–0.98). Overall weighted area under the curve was 0.9563. Conclusions SPIO enhanced MRI showed a trend toward high diagnostic accuracy in detection of lymph node metastases for breast cancer. So, when the breast cancer patients has axillary metastases histologically, SPIO enhanced MRI may be effective diagnostic imaging modality for axillary metastases.

Efficacy of Sentinel Lymph Node Biopsy in Detecting Axillary Metastasis in Breast Cancer Using Methylene Blue.

Breast cancer is the leading malignancy and the second leading cause of cancer-related deaths. Axillary lymph node status is a very important prognostic factor in breast cancer patients; nodal evaluation is therefore a critical part of breast cancer management. Axillary lymph node dissection results in significant morbidity. Sentinel lymph node biopsy (SLNB) is being used in many centers to stage the axilla in planning axillary dissection management of patients and hence plays an important part in reducing morbidity among patients with carcinoma breast. The objectives of this paper is to study the (1) efficacy of sentinel lymph node biopsy in detecting axillary metastasis, (2) location of sentinel lymph node in the axilla, (3) rate of involvement of sentinel lymph nodes, and (4) incidence of skip metastasis. Thirty-five patients with breast cancer with clinically node-negative axilla were selected for the study. Methylene blue dye was injected intralesional and perilesional 20min prior to surgery. All patients underwent modified radical mastectomy with sentinel lymph node biopsy and axillary dissection and after pathological examination diagnostic statics, namely sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were computed. Sentinel lymph node was identified in all of these patients. Sixty percent patients had pathologically positive lymph nodes in the axilla. 90.48% patients of these had sentinel lymph nodes positive for malignant cells. Incidence of skip metastasis is 9.52%. 88.57% patients had sentinel lymph node mapped to level I lymph nodes. Sensitivity of SLNB is 90.48%, specificity is 85.71%, PPV of is 90.48%, NPV is 85.71%, and accuracy is 88.57%. Sentinel lymph node biopsy is an effective method of staging the axilla and deciding on axillary clearance in patients of carcinoma breast. Unnecessary axillary dissection and associated complications can be prevented in most of patients due to sentinel lymph node biopsy.

Abstract P3-01-15: Molecular subtypes and axillary metastases in breast cancer

Abstract Objective To assess differences in axillary infiltration (global, sentinel, and non-sentinel lymph nodes) according to breast cancer molecular subtype. Material and methods Patients with infiltrating breast carcinoma diagnosed in the years 2011 to 2014 in our institution were included. Sentinel lymph node biopsy (SLNB) was performed in all patients staged N0 by clinical examination and axillary ultrasound. One-step nucleic acid amplification (OSNA) was performed in cases positive for cytokeratin-19. Complete lymphadenectomy was done in patients with axillary macrometástasis and, until February 2012, also in those with micrometastasis in the SLNB. Immunohistochemistry-based St. Gallen 2013 criteria were used to assign the molecular subtype (hormonal receptors, ki67 and HER2). Results Overall 720 patients were included, 53.9% of whom had axillary infiltration (75.8% macrometastases). Axillary infiltration was most common in the HER2 subtype -82.1% (91.3% macrometastases) and least common in the basal subtype -42.7%. Global and Sentinel nodeFENOTYPELUMINAL ALUMINAL BLUM B HER2HER 2BASALTOTAL Axilla312255502875720 Negative160 (51.3%)103 (40.4%)21 (42.0%)5 (17.9%)43 (57.7%)33246.1%Positive152 (48.7%)152 (59.6%)29 (58.0%)23 (82.1%)32 (42.3%)38853.9% Macrom.112 (73.7%)115 (75.7%)23 (79.6%)21 (91.3%)23 (71.9%)29475.8%Microm40 26.3%)37 24.3%)6 (20.3%)2 (8.7%)9 (28.1%)9424.2% Sentinel Node23415817734450 Negative152 (65%100 (63.3%)12 (70.6)6 (85.7%)22 (64.7%)29264.9%Positive82 (35%)58 (36.7%)5 (29.4)1 (14.3%)12 (35.3%)15835.1% Macrom44 (53.7%)26 (44.8%)2 (40%)0 (0.0%)4 (33.3%)7648.1%Microm38 (43.3%)32 (55.2%)3 (60%)1 (100%)8 (66.7%)8251.9% On the contrary, the HER2 subtype had the lowest risk of axillary infiltration in patients subjected to SLNB (14.3%). No differences were seen in the other subtypes subjected to SLNB. 90 patients underwent complete lymphadenectomy. Positive non-sentinel lymph nodes were most commonly seen in luminal A tumors (30%). Non Sentinel NodesFENOTYPELUMINAL ALUMINAL BLUM B HER2HER 2BASALTOTAL Non SN503320590 Negative35 (70%)27 (81.8%)2 (100%)04 (80%)6875.6%Positive15 (30%)6 (18.2%)001 (20%)2224.4% Macrom.14 (93.3%)5 (83%)001 (100%)2090.9%Microm1 (6.7%)1 (16,7%)00029.1% Conclusions 1. Significant differences in axillary infiltration were seen according to molecular subtypes. 2. Most HER2+ tumors had N+ disease detected by ultrasound. However, in those HER2+ with negative ultrasound, the SLNB was usually negative. If positive, non-sentinel lymph nodes were most commonly negative. 3. Half of luminal A tumors had N+ disease detected by ultrasound. In the other half, there was an increased risk of positive SLNB and non-sentinel lymph nodes with regard to other subtypes. Citation Format: Sánchez-Méndez JI, Alonso P, Martí C, Pinto A, Escabias C, Espinosa E, De Santiago J, Zamora P. Molecular subtypes and axillary metastases in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-15.

P356 Occult axillary metastases in breast cancer. Outcomes for post neoadjuvant chemotherapy

P356 Occult axillary metastases in breast cancer. Outcomes for post neoadjuvant chemotherapy

Diagnostic Effectiveness of USPIO versus Gadolinium Based MRI for Axillary Metastasis in Breast Cancer: A Meta-analysis

Breast cancer is the third leading cause of death after lung and colorectal cancer in United States (1). It preferentially tends to metastasize to axillary lymph nodes (2). Traditionally, axillary lymph node dissection was performed to decide the stage of the disease and the planning of postsurgical treatment (3, 4). However, this method can cause many complications, such as lymphedema, nerve injury, shoulder movement This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received: January 13, 2015 Revised: February 28, 2015 Accepted: March 8, 2015

Analysis of detecting value of ultrasound and the clinic-pathological features of axillary metastasis in breast cancer

To evaluate the value of ultrasound (US) in predicting axilla status and to investigate the clinic pathologic characters in the axillary node metastasis. From June 2012 to June 2013, 323 female primary breast cancer patients who received both axilla ultrasound and pathology examinations were reviewed retrospectively. The features of axillary nodes including diameter, longitudinal-transverse axis ratio, cortical thickness and blood flow grade were used to evaluate axillary status. US accuracy of axillary node metastasis was analyzed correlated with the final pathology results. The clinical and histological features associated with axillary node metastasis was analyzed by χ² test. The proportions of Luminal A-like, Luminal B-like, human epidermalgrowth factor receptor-2 positive and triple negative breast cancer were 11.1% (36/323), 58.5% (189/323), 13.3% (43/323) and 17.0% (55/323) . The sensitivity, specificity, positive predictive value and negative predictive value of axilla US in the diagnosis of nodal metastasis were 35.6% (46/129), 98.9% (181/183), 95.8% (46/48) and 68.6% (181/264). Axillary lymph node metastasis had statistically significant correlation with menopausal status and clinical tumor size (χ² = 4.337, 11.100; P = 0.037, 0.001). Standardized ultrasound is the basic way to evaluate axilla status. Sentinel lymph node biopsy should be done to acquire accurate preoperative staging of axilla when US shows no signs of metastasis. Axillary lymph node metastasis is significantly related to menopausal status and clinical tumor size, but not significantly related to subtype classification of primary breast cancer.

Re-evaluating the perioperative diagnosis of axillary metastasis in breast cancer patients treated with breast conserving surgery

Introduction: Perioperative diagnosis of axillary metastasis in breast cancer can be achieved using axillary ultrasound with fine needle aspiration cytology (Ax US + FNAC) and intraoperative frozen section analysis of the sentinel node (FS SN). The Z0011 trial confirms that SN biopsy alone in patients with SN metastasis, treated with breast conservation and systemic therapy can provide excellent regional control and survival. The role of immediate axillary clearance (AC) in patients with a perioperative diagnosis of nodal metastasis needs to be re-evaluated.

The clinical impact and outcomes of immunohistochemistry-only metastasis in breast cancer

Background Modern surgical and pathological techniques can detect small-volume axillary metastases in breast cancer with unknown clinical significance. Methods A retrospective database review from 1996 through 2004 identified all patients with immunohistochemical (IHC)-only sentinel node (IHC-SN) metastases and compared them with negative controls (Neg-SN). Results When comparing the 232 IHC-SN patients with the 252 Neg-SN controls, the IHC-SN patients had larger tumors, more lobular histology, a higher grade, and more HER2/neu positivity. They also received more systemic therapy. With a median follow-up of 5 years, there were no differences in recurrence-free survival or overall survival. In 123 IHC-SN patients treated with axillary dissection (axillary lymph node dissection), 16% had positive non-SLNs. Patients with positive non-SLNs tended to have worse outcomes. Conclusions IHC-only sentinel lymph node (SLN) metastases were associated with worse prognostic features and higher rates of systemic therapy. However, no outcomes differences were noted.

The clinical impact and outcomes of immunohistochemistry-only metastases in breast cancer

613 Background: Modern surgical and pathologic techniques can detect small volume axillary metastases in breast cancer. The clinical significance of these metastases was evaluated in comparison to patients with negative sentinel lymph nodes (Neg-SN). Methods: Retrospective database review from 1997 through 2003 for eligible patients with unilateral breast cancer and no history of significant non-breast malignancy identified 232 patients with sentinel lymph node (SLN) metastases identified only by immunohistochemical stains (IHC-SN). They were compared to 252 Neg-SN controls selected at random from the same database population. Statistical analysis was performed with 2-sample tests, Kaplan-Meier, and Cox regression methods. Results: IHC-SN patients had worse prognostic features and received more systemic therapy than controls (Table). Age and ER status were similar. In 123 IHC-SN patients treated with axillary dissection (ALND), 16% had macrometastases in the non-SLNs. Only one axillary recurrence occurred in the group of IHC-SN patients without ANLD (n=109). With median follow up of 5 years (range 0.01–12.0), 28 recurrences and 25 deaths occurred. There were no differences between cases and controls for recurrence-free survival (RFS) or overall survival (OS) both by univariate and multivariate models that included variables such as age, tumor size, chemotherapy and hormone therapy [HR 0.99 (95%CI 0.43–2.28, p=0.99) for RFS, HR 2.06 (95%CI 0.79–5.35) p=0.14 for OS]. In IHC-SN patients treated with ALND, patients with positive non-SLNs (n=20) tended to have worse RFS than those with negative non-SLNs (n=103) [RFS 89% vs. 97% at 5 yrs (p=0.06)]. Conclusions: A significant number of IHC-SN patients had a macrometastasis identified at ALND. In patients not undergoing dissection, axillary recurrence was a rare event. However, failure to identify additional metastases by omitting ALND may result in understaging and inadequate systemic treatment in some patients. [Table: see text] No significant financial relationships to disclose.

Cost utility analysis on one-step nucleic acid amplification method for the detection of axillary metastasis in breast cancer.

Abstract Abstract #1014 Back ground :OSNA method, One-step Nucleic Acid Amplification(OSNA) method is a new method for rapid detection of axillary lymph node metastases of breast cancer using PCR to detect cytokeratin 19's mRNA and different from conventional hsitopathological examination. It can be automated and can detect the axillary lymph node metastases quickly and precisely during operation. No cost effectiveness studies are conducted for this method.
 Materials and Method: We conducted the cost effectiveness analysis for this method comparing with conventional hsitopathological method using Markov models. We adopted the societal perspectives and the time horizon for fives years. We used TreeAge Pro 2005 (TreeAge Software Inc, Williamsontown, MA) to conduct Markov simulations. One way sensitivities analysis were conducted for all parameters. Cost and utilities data were collected from the studies and clinical trials for OSNA and conventional methods.
 Results: When the cost of OSNA is assumed as the same as intra-operative lymph node diagnosis by histopathology, the Markov model has shown the cost saving of $11,527/QALY by OSNA method. When the sensitivity analysis was performed by changing the cost of OSNA, the result has shown that OSNA can still show cost saving until the cost of OSNA method is $1,094 higher than the hsitopathological examination. Discussion: Our results clearly revealed OSNA methods is cost saving compared with convention intraoperative hsitopathological examinations. Result is robust for all parameters included in the model. Since OSNA method can avoid unnecessary re operations for axillary lymphadenectomy, this method can improve the quality of life for breast cancer patients. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1014.