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La Verde N, Biagioli E, Gerardi C, Cordovana A, Casiraghi C, Floriani I, Bernardin E, Farina G, Di Cosimo S, Dazzani MC, Gherardi G. Role of patient and tumor characteristics in sentinel lymph node metastasis in patients with luminal early breast cancer: an observational study. SPRINGERPLUS 2016; 5:114. [PMID: 26885467 PMCID: PMC4740469 DOI: 10.1186/s40064-016-1720-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/14/2016] [Indexed: 02/01/2023]
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.
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Affiliation(s)
- Nicla La Verde
- Oncology Department, Fatebenefratelli and Oftalmico Hospital, Corso di Porta Nuova 23, 20121 Milan, Italy
| | - Elena Biagioli
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156 Milan, Italy
| | - Chiara Gerardi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156 Milan, Italy
| | - Andrea Cordovana
- Oncology Department, Fatebenefratelli and Oftalmico Hospital, Corso di Porta Nuova 23, 20121 Milan, Italy
| | - Chiara Casiraghi
- Oncology Department, Fatebenefratelli and Oftalmico Hospital, Corso di Porta Nuova 23, 20121 Milan, Italy
| | - Irene Floriani
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156 Milan, Italy
| | - Elena Bernardin
- Oncology Department, Fatebenefratelli and Oftalmico Hospital, Corso di Porta Nuova 23, 20121 Milan, Italy
| | - Gabriella Farina
- Oncology Department, Fatebenefratelli and Oftalmico Hospital, Corso di Porta Nuova 23, 20121 Milan, Italy
| | - Serena Di Cosimo
- IRCCS - Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Maria Chiara Dazzani
- Oncology Department, Fatebenefratelli and Oftalmico Hospital, Corso di Porta Nuova 23, 20121 Milan, Italy
| | - Giorgio Gherardi
- Oncology Department, Fatebenefratelli and Oftalmico Hospital, Corso di Porta Nuova 23, 20121 Milan, Italy
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Iwuchukwu O, Wahed S, Wozniak A, Dordea M, Rich A. Recent advances in non-invasive axillary staging for breast cancer. Surg Oncol 2011; 20:253-8. [DOI: 10.1016/j.suronc.2010.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 03/21/2010] [Accepted: 05/31/2010] [Indexed: 01/17/2023]
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Moutafoff C, Coutant C, Bézu C, Antoine M, Werkoff G, Benbara A, Uzan S, Rouzier R. Facteurs prédictifs et pronostiques des cancers du sein multifocaux. ACTA ACUST UNITED AC 2011; 39:425-32. [DOI: 10.1016/j.gyobfe.2011.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 02/08/2011] [Indexed: 11/28/2022]
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Botteri E, Bagnardi V, Goldhirsch A, Viale G, Rotmensz N. Axillary Lymph Node Involvement in Women With Breast Cancer: Does It Depend on Age? Clin Breast Cancer 2010; 10:318-21. [DOI: 10.3816/cbc.2010.n.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Krikanova M, Biggar M, Moss D, Poole G. Accuracy of sentinel node biopsy for breast cancer using blue dye alone. Breast J 2010; 16:384-8. [PMID: 20545938 DOI: 10.1111/j.1524-4741.2010.00942.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Blue dye alone (BDA), lymphoscintigraphy alone, or, a combination of the two techniques are used for sentinel node biopsy (SNB) in breast cancer. This study reviews the effectiveness of the SNB technique using BDA by measuring the node identification rate and comparing the cohort node positivity with expected rates from established nomograms. A consecutive case series was examined from the database. This included the learning experience of six surgeons. Patients with unifocal tumors estimated at less than 31 mm were eligible. The tumor and axillary nodal histology was recorded. Published data were then used to calculate and predict node positivity rates in the study according to the size and grade of the tumors. There were 332 SNB procedures from 2001 to 2008. BDA successfully identified nodes in 94.6% (314/332) of the cases. The identification rate improved with experience. In patients with invasive cancer, 28.4% (85/299) of SNB were found to be positive for metastases or micrometastases. The node identification rate and the node positivity rate were found to be within published predicted ranges for the size and grade of the study tumors. The SNB with BDA was found to be effective in identifying sentinel nodes (SLN) in breast cancer. Surgeon experience was a factor in the success of the technique. Rates of detecting metastases were consistent with internationally published data, suggesting that BDA may perform as well as other techniques in experienced hands.
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