Lymph Node Involvement In Breast Cancer Research Articles

Prediction of lymph node involvement in breast cancer by detection of altered glycosylation in the primary tumour

Axillary lymph node metastases at the time of diagnosis of breast cancer is the most accurate predictor of long-term prognosis. However, in patients treated by conservative surgery lymph node status often remains unknown. We have investigated the relation between changes in glycosylation of primary breast cancer cells, as judged by lectin binding, and the presence of axillary lymph node metastases. In a 24-year retrospective study, paraffin-embedded sections of 373 primary breast cancers were stained for the binding of Helix pomatialectin (HPA). There was a strong association between HPA binding and presence of lymph node metastases, but no association with tumour size, histological grade, S-phase fraction, or patient age at diagnosis. This relation was confirmed by multiple regression analysis (in both survival and relapse free survival models) in which the prognostic significance of HPA binding was lost once nodal status had been introduced into the models. Life tables calculated for lymph-node positive versus lymph-node negative and HPA staining versus non-staining patients were almost identical over 15 years of follow-up. We propose that H PA recognises a glycoprotein that is associated with metastasis (to axillary lymph nodes and elsewhere) and poor prognosis in breast cancer. HPA binding to paraffin sections of primary tumour could aid difficult treatment decisions by providing an additional assessment of staging and likely long-term patient prognosis.

Patterns of axillary nodal involvement in breast cancer. Predictability of level one dissection.

Two hundred consecutive mastectomies with total axillary dissection were analyzed for patterns of involvement at levels one, two and three. The purpose was to determine the accuracy of level one axillary dissection in predicting the status of the entire lymph node chain in carcinoma of the breast. Level one was defined as latissimus dorsi to lateral pectoralis minor; level two behind the pectoralis minor and level three medial pectoralis minor to thoracic inlet. The average number of nodes analyzed per patient was 22. The average number of nodes recovered per level was 14 at level one, 11.5 at level two and eight at level three. One hundred twenty patients (60%) had no nodal involvement, while 80 patients had metastases to axillary lymph nodes. There were seven patients (3.5% of the entire 200) who had positive nodes at levels two and/or three without metastasis to level one. This represents the incidence of "skip" metastases. The group exhibiting "skip" metastases comprise 5.5% of patients (seven of 127) with negative axillary nodes at level one and 8.7% of patients (seven of 80) with axillary metastases secondary to carcinoma of the breast. In the authors' experience, level one lymph node dissection is an accurate predictor of the status of the entire lymph node chain. Negative nodes at level one would indicate lack of involvement at levels two and three with nearly 95% accuracy.