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James J, Law M, Sengupta S, Saunders C. Assessment of the axilla in women with early-stage breast cancer undergoing primary surgery: a review. World J Surg Oncol 2024; 22:127. [PMID: 38725006 PMCID: PMC11084006 DOI: 10.1186/s12957-024-03394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
Sentinel node biopsy (SNB) is routinely performed in people with node-negative early breast cancer to assess the axilla. SNB has no proven therapeutic benefit. Nodal status information obtained from SNB helps in prognostication and can influence adjuvant systemic and locoregional treatment choices. However, the redundancy of the nodal status information is becoming increasingly apparent. The accuracy of radiological assessment of the axilla, combined with the strong influence of tumour biology on systemic and locoregional therapy requirements, has prompted many to consider alternative options for SNB. SNB contributes significantly to decreased quality of life in early breast cancer patients. Substantial improvements in workflow and cost could accrue by removing SNB from early breast cancer treatment. We review the current viewpoints and ideas for alternative options for assessing and managing a clinically negative axilla in patients with early breast cancer (EBC). Omitting SNB in selected cases or replacing SNB with a non-invasive predictive model appear to be viable options based on current literature.
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Affiliation(s)
- Justin James
- Eastern Health, Melbourne, Australia.
- Monash University, Melbourne, Australia.
- Department of Breast and Endocrine Surgery, Maroondah Hospital, Davey Drive, Ringwood East, Melbourne, VIC, 3135, Australia.
| | - Michael Law
- Eastern Health, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Eastern Health, Melbourne, Australia
- Monash University, Melbourne, Australia
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Zhang P, Song X, Sun L, Li C, Liu X, Bao J, Tian Z, Wang X, Yu Z. A novel nomogram model of breast cancer-based imaging for predicting the status of axillary lymph nodes after neoadjuvant therapy. Sci Rep 2023; 13:5952. [PMID: 37045864 PMCID: PMC10097686 DOI: 10.1038/s41598-023-29967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/14/2023] [Indexed: 04/14/2023] Open
Abstract
This study is aimed to develop and validate a novel nomogram model that can preoperatively predict axillary lymph node pathological complete response (pCR) after NAT and avoid unnecessary axillary lymph node dissection (ALND) for breast cancer patients. A total of 410 patients who underwent NAT and were pathologically confirmed to be axillary lymph node positive after breast cancer surgery were included. They were divided into two groups: patients with axillary lymph node pCR and patients with residual node lesions after NAT. Then the nomogram prediction model was constructed by univariate and multivariate logistic regression. The result of multivariate logistic regression analysis showed that molecular subtypes, molybdenum target (MG) breast, computerized tomography (CT) breast, ultrasound (US) axilla, magnetic resonance imaging (MRI) axilla, and CT axilla (all p < 0.001) had a significant impact on the evaluation of axillary lymph node status after NAT. The nomogram score appeared that AUC was 0.832 (95% CI 0.786-0.878) in the training cohort and 0.947 (95% CI 0.906-0.988) in the validation cohort, respectively. The decision curve represented that the nomogram has a positive predictive ability, indicating its potential as a practical clinical tool.
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Affiliation(s)
- Pengyu Zhang
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiang Song
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Luhao Sun
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chao Li
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaoyu Liu
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiaying Bao
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhaokun Tian
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xinzhao Wang
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
- REMEGEN, LTD, 58 Middle Beijing Road, Yantai Economic & Technological Development Area, Yantai, Shandong, China.
| | - Zhiyong Yu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
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Dwivedi AK. How to write statistical analysis section in medical research. J Investig Med 2022; 70:1759-1770. [PMID: 35710142 DOI: 10.1136/jim-2022-002479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 12/15/2022]
Abstract
Reporting of statistical analysis is essential in any clinical and translational research study. However, medical research studies sometimes report statistical analysis that is either inappropriate or insufficient to attest to the accuracy and validity of findings and conclusions. Published works involving inaccurate statistical analyses and insufficient reporting influence the conduct of future scientific studies, including meta-analyses and medical decisions. Although the biostatistical practice has been improved over the years due to the involvement of statistical reviewers and collaborators in research studies, there remain areas of improvement for transparent reporting of the statistical analysis section in a study. Evidence-based biostatistics practice throughout the research is useful for generating reliable data and translating meaningful data to meaningful interpretation and decisions in medical research. Most existing research reporting guidelines do not provide guidance for reporting methods in the statistical analysis section that helps in evaluating the quality of findings and data interpretation. In this report, we highlight the global and critical steps to be reported in the statistical analysis of grants and research articles. We provide clarity and the importance of understanding study objective types, data generation process, effect size use, evidence-based biostatistical methods use, and development of statistical models through several thematic frameworks. We also provide published examples of adherence or non-adherence to methodological standards related to each step in the statistical analysis and their implications. We believe the suggestions provided in this report can have far-reaching implications for education and strengthening the quality of statistical reporting and biostatistical practice in medical research.
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Affiliation(s)
- Alok Kumar Dwivedi
- Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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He L, Liang P, Zeng H, Huang G, Wu J, Zhang Y, Cui Y, Huang W. A Predictive Model for Nonsentinel Node Status after Sentinel Lymph Node Biopsy in Sentinel Lymph Node-Positive Chinese Women with Early Breast Cancer. JOURNAL OF ONCOLOGY 2022; 2022:7704686. [PMID: 35251176 PMCID: PMC8894031 DOI: 10.1155/2022/7704686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/11/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Axial lymph node dissection (ALND) is needed in patients with positive sentinel lymph node (SLN). ALND is easy to cause upper limb edema. Therefore, accurate prediction of nonsentinel lymph nodes (non-SLN) which may not need ALND can avoid excessive dissection and reduce complications. We constructed a new prognostic model to predict the non-SLN metastasis of Chinese breast cancer patients. METHODS We enrolled 736 patients who underwent sentinel lymph node biopsy (SLNB); 228 (30.98%) were diagnosed with SLNB metastasis which was determined by intraoperative pathological detection and further accepted ALND. We constructed a prediction model by univariate analysis, multivariate analysis, "R" language, and binary logistic regression in the abovementioned 228 patients and verified this prediction model in 60 patients. RESULTS Based on univariate analysis using α = 0.05 as the significance level for type I error, we found that age (P=0.045), tumor size (P=0.006), multifocality (P=0.011), lymphovascular invasion (P=0.003), positive SLN number (P=0.009), and negative SLN number (P=0.034) were statistically significant. Age was excluded in multivariate analysis, and we constructed a predictive equation to assess the risk of non-SLN metastasis: Logit(P)=Ln(P/1 - P)=0.267∗a+1.443∗b+1.078∗c+0.471∗d - 0.618∗e - 2.541 (where "a" represents tumor size, "b" represents multifocality, "c" represents lymphovascular invasion, "d" represents the number of metastasis of SLN, and "e" represents the number of SLNs without metastasis). AUCs for the training group and validation group were 0.715 and 0.744, respectively. When setting the risk value below 22.3%, as per the prediction equation's low-risk interval, our model predicted that about 4% of patients could avoid ALND. CONCLUSIONS This study established a model which demonstrated good prognostic performance in assessing the risk of non-SLN metastasis in Chinese patients with positive SLNs.
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Affiliation(s)
- Lifang He
- Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Peide Liang
- Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
- Department of Thyroid and Breast Surgery, Dongguan Houjie Hospital, Dongguan 523000, Guangdong Province, China
| | - Huancheng Zeng
- Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Guangsheng Huang
- Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Jundong Wu
- Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Yiwen Zhang
- Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Yukun Cui
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Wenhe Huang
- Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, No. 2000, Xiang'an East Road, Xiamen 361101, Fujian Province, China
- Key Laboratory for Endocrine-Related Cancer Precision Medicine of Xiamen, Xiamen 361101, Fujian Province, China
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Kittaka N, Nakajima S, Hatano T, Seto Y, Kusama H, Matsui S, Nishio M, Fujisawa F, Honma K, Nakayama T, Tamaki Y. Axillary management based on American college of surgeons oncology group Z0011 criteria makes it possible to omit intraoperative diagnosis of sentinel lymph nodes in early breast cancer patients. Breast J 2021; 27:804-810. [PMID: 34558164 DOI: 10.1111/tbj.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
The ACOSOG Z0011 trial has resulted in the omission of axillary lymph node dissection (ALND) in early breast cancer patients with one or two metastatic sentinel lymph nodes (SLNs). There has been increasing interest in the necessity of intraoperative assessment of SLNs in patients treated based on the Z0011 criteria. We evaluated the utility of intraoperative assessment in these eligible patients. A total of 1396 patients were treated following the Z0011 criteria from April 2012 to December 2019. We examined the proportion and clinicopathological features of patients who underwent ALND due to three or more metastatic SLNs and the sensitivity of intraoperative assessment. Only 16 (1.1%) patients had three or more metastatic SLNs diagnosed by intraoperative assessment, and they immediately underwent ALND. Of the clinicopathological factors, high clinical tumor stage (p = 0.002) and high Ki-67 labeling index value (p = 0.056) were more likely to be associated with the presence of three or more metastatic SLNs. The major independent risk factor for three or more metastatic SLNs was high clinical tumor stage (OR 3.94 [95% CI 1.42-11.0]; p = 0.009). Intraoperative assessment had low sensitivity (70.5%) and a high false-negative rate (29.5%) in detecting SLN metastases. The main finding of our study was the small proportion of patients who required ALND due to three or more metastatic SLNs according to the Z0011 criteria. The Z0011 strategy enables intraoperative assessment of SLNs to be omitted in early breast cancer patients.
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Affiliation(s)
- Nobuyoshi Kittaka
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Satomi Nakajima
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takaaki Hatano
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yukiko Seto
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroki Kusama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Saki Matsui
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Minako Nishio
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Fumie Fujisawa
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuhiro Tamaki
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
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Isheden G, Czene K, Humphreys K. Random effects models of lymph node metastases in breast cancer: quantifying the roles of covariates and screening using a continuous growth model. Biometrics 2021; 78:376-387. [PMID: 33501643 DOI: 10.1111/biom.13430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 11/27/2022]
Abstract
We recently described a joint model of breast cancer tumor size and number of affected lymph nodes, which conditions on screening history, mammographic density, and mode of detection, and can be used to infer growth rates, time to symptomatic detection, screening sensitivity, and rates of lymph node spread. The model of lymph node spread can be estimated in isolation from measurements of tumor volume and number of affected lymph nodes, giving inference identical to the joint model. Here, we extend our model to include covariate effects. We also derive theoretical results in order to study the role of screening on lymph node metastases at diagnosis. We analyze the association between hormone replacement therapy (HRT) and breast cancer lymph node spread, using data from a case-control study designed specifically to study the effects of HRT on breast cancer. Using our method, we estimate that women using HRT at time of diagnosis have a 36% lower rate of lymph node spread than nonusers (95% confidence interval [CI] =(8%,58%)). This can be contrasted with the effect of HRT on the tumor growth rate, estimated here to be 15% slower in HRT users (95% CI = (-34%,+7%)). For screen-detected cancers, we illustrate how lead time can relate to lymph node spread; and using symptomatic cancers, we illustrate the potential consequences of false negative screens in terms of lymph node spread.
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Affiliation(s)
- Gabriel Isheden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Chen W, Wang C, Fu F, Yang B, Chen C, Sun Y. A Model to Predict the Risk of Lymph Node Metastasis in Breast Cancer Based on Clinicopathological Characteristics. Cancer Manag Res 2020; 12:10439-10447. [PMID: 33122943 PMCID: PMC7588670 DOI: 10.2147/cmar.s272420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) may cause lymphatic and nervous system side effects in patients with breast cancer. It is imperative to develop a model to evaluate the risk of sentinel lymph node metastasis to avoid unnecessary operation. Patients and Methods A total of 2705 cases of female breast cancer patients enrolled in this retrospective study. We divided into the training group (SLNB group) and the validation group (ALND group) to analyze the relathionship between lymph node metastasis and clinical-pathological factors. Logistic regression analysis was performed to verify the variables which involved in ALN metastasis and established a prediction model. ROC curves were employed to evaluate the predictive ability of the model. Results In the SLNB group, 9 variables, including pathological type, histological grade, tumor size, hormone receptor, HER-2, Ki-67, multifocality, and molecular subtypes, were related to breast cancer ALN metastasis. Clinically negative lymph nodes, favorable histologic type, tumor size <2 cm, and Ki-67 <15% were at very low risk for lymph node metastasis. The AUC of the validation group was 0.786. Conclusion We successfully establish a mathematics model to predict lymph node metastasis of breast cancer. Axillary surgery should be individual with preoperative clinical characteristics, especially for patients with a longer life expectancy.
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Affiliation(s)
- Wenxin Chen
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian Province 365001, People's Republic of China
| | - Chuan Wang
- Breast Surgery Ward, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, People's Republic of China
| | - Fangmeng Fu
- Breast Surgery Ward, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, People's Republic of China
| | - Binglin Yang
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian Province 365001, People's Republic of China
| | - Changming Chen
- Department of Pathology, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian Province 365001, People's Republic of China
| | - Yingming Sun
- Department of Radiation and Medical Oncology, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian Province 365001, People's Republic of China
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Liang Y, Chen X, Tong Y, Zhan W, Zhu Y, Wu J, Huang O, He J, Zhu L, Li Y, Chen W, Shen K. Higher axillary lymph node metastasis burden in breast cancer patients with positive preoperative node biopsy: may not be appropriate to receive sentinel lymph node biopsy in the post-ACOSOG Z0011 trial era. World J Surg Oncol 2019; 17:37. [PMID: 30786903 PMCID: PMC6383227 DOI: 10.1186/s12957-019-1582-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer patients with suspicious axillary lymph node (ALN) at ultrasound and positive fine-needle aspiration (FNA) results were required to receive ALN dissection (ALND), which was not certain in the post-ACOSOG Z0011 era. We aim to evaluate the ALN metastasis burden in these patients, thus to illustrate whether they can follow the ACOSOG Z0011 trial procedure. METHODS Clinically, T1-2 N0 breast cancer patients with positive preoperative ALN biopsy (FNA group) or 1-2 positive sentinel nodes (SLNB group) were retrospectively analyzed. ALN metastasis burden was compared between the two groups, which were further analyzed in certain subtypes. An association between clinicopathological factors and ≥ 3 ALN metastasis was also analyzed. RESULTS A total of 388 patients were included: 202 in the FNA group and 186 in the SLNB group. The FNA group had a significantly higher number of positive ALN (5.18 vs. 1.77, P < 0.001) and a larger proportion of patients with ≥ 3 ALN metastasis (58.42% vs. 11.83%, P < 0.001) than the SLNB group, which was not influenced by different tumor size stage and molecular subtypes. ALN metastasis identified by FNA was independently associated with a high rate of ≥ 3 ALN metastasis (OR = 6.98, 95% CI 1.95-25.02, P = 0.003). CONCLUSIONS Patients with positive preoperative ALN biopsy had a higher ALN metastasis burden than patients with 1-2 positive SLNs, which was also the strongest factor associated with ≥ 3 ALN metastasis, indicating that these patients are not appropriate to receive SLNB in the post-ACOSOG Z0011 trial era.
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Affiliation(s)
- Yue Liang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Yiwei Tong
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Weiwei Zhan
- Department of Ultrasound Imaging, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Zhu
- Department of Ultrasound Imaging, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Ou Huang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Jianrong He
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Yafen Li
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Weiguo Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025 China
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Azmil A, Bansal GJ. Can Nomograms Predict Preoperative Axillary Lymph Node Metastasis in Patients With Breast Cancer to Guide Second Look Ultrasonography? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1447-1453. [PMID: 29152824 DOI: 10.1002/jum.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The low sensitivity of ultrasonography (US) for diagnosing axillary lymph node metastasis in patients with breast cancer has led to the development of multiple tools in an attempt to increase preoperative sensitivity, including second-look US. We compared axillary lymph node metastasis predictor scores with postsurgical findings, using the Memorial Sloan Kettering Cancer Center (MSKCC; New York, NY) and Evidencio (www.evidencio.com) nomograms: 2 freely available online predictor tools. METHODS We retrospectively evaluated 450 patients with breast cancer and analyzed data from 194 patients. Sonograms were evaluated to measure lymph node cortical thickness, transverse diameter, and hilum status. Patients were divided into 3 groups: namely 0, 1, and 2 based on the number of postoperative positive nodes (0, 1 and ≥2, respectively). One-way analysis of variance was used to analyze the differences in mean scores across the 3 nodal groups for both nomograms. P < .05 was considered statistically significant. RESULTS There were significant differences in mean scores across the 3 nodal groups when using MSKCC (P < .001) as well as Evidencio (P < .001). However, there was an overlap of scores across the 3 groups; thus, mutually exclusive values were not obtained. A strong positive correlation was found between MSKCC and Evidencio (P < 0.001). Tumor size and the presence of lymphovascular invasion were significantly associated with axillary nodal disease (P < .001; P = .003, respectively). CONCLUSIONS The use of nomograms to predict axillary nodal involvement in patients with breast cancer can guide discussions, but in their present state, these scores cannot guide clinical decisions or direct second-look US of axilla.
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Affiliation(s)
- Ameerah Azmil
- Breast Center, University Hospital of Llandough, Penarth, Wales
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Ha R, Mango V, Al-Khalili R, Mema E, Friedlander L, Desperito E, Wynn RT. Evaluation of association between degree of background parenchymal enhancement on MRI and breast cancer subtype. Clin Imaging 2018; 51:307-310. [PMID: 29945057 DOI: 10.1016/j.clinimag.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Evaluate possible association between BPE and breast cancer tumor type/prognostic markers. METHODS IRB approved retrospective study from 1/2010-1/2014 identified 328 patients who had breast MRI and available clinical/pathology data. BPE was categorized according to BI-RADS. The association between BPE and breast cancer molecular subtype/prognostic factors was evaluated. RESULTS No significant association was present between high BPE and the following: HER2+ tumors, basal tumors, tumors with axillary nodal disease, high nuclear grade tumors, high Ki-67 index tumors or larger tumors. CONCLUSION Patients with high BPE may be at increased risk for breast cancer but not necessarily for those cancer subtypes with a poor prognosis.
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Affiliation(s)
- Richard Ha
- Columbia University Medical Center, Breast Imaging Section, Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY 10032, United States.
| | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 300 East 66th Street, New York, NY 10065, United States
| | - Rend Al-Khalili
- Department of Radiology, Georgetown University School of Medicine, CCC Building, 3800 Reservoir Road, N.W., Washington, DC 20007-2113, United states
| | - Eralda Mema
- Columbia University Medical Center, Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY 10032, United States
| | - Lauren Friedlander
- Columbia University Medical Center, Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY 10032, United States
| | - Elise Desperito
- Columbia University Medical Center, Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY 10032, United States
| | - Ralph T Wynn
- Columbia University Medical Center, Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY 10032, United States
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Cetintaş SK, Kurt M, Ozkan L, Engin K, Gökgöz S, Taşdelen I. Factors Influencing Axillary Node Metastasis in Breast Cancer. TUMORI JOURNAL 2018; 92:416-22. [PMID: 17168435 DOI: 10.1177/030089160609200509] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background The status of the axillary lymph nodes at the time of diagnosis has been accepted as one of the most important prognostic factors for the overall and disease-free survival of patients with breast cancer. The aim of our study was to determine which factors influence axillary node involvement in invasive breast cancer. Methods The data presented here were obtained from 344 patients who were treated for invasive breast cancer at the Department of Radiation Oncology, Uludag University Medical College, Bursa, Turkey. Possible prognostic factors were categorized as patient related and tumor related. The Mann-Whitney U test was used for univariate analysis and logistic regression was used for multivariate analysis. Results In univariate analysis, a familial cancer history (P = 0.0042), age <40 years (P = 0.0276), higher T stage (P <0.0000), nipple involvement (P = 0.0345), skin involvement (P = 0.0270), perineural invasion (P = 0.0231), and lymphatic vessel invasion (P <0.0000) were correlated with increased axillary node involvement. A higher incidence of ≥4 involved lymph nodes was associated with higher T stage (P = 0.0004), nipple involvement (P = 0.0292), presence of an extensive intraductal component (P = 0.0023), skin involvement (P = 0.0008), perineural invasion (P = 0.0523), and lymphatic vessel invasion (P <0.0000) in univariate analysis. In multivariate analysis, age <40 years (P = 0.0454), cancer history within the family (P = 0.0024), higher T stage (P = 0.0339), lymphatic vessel invasion (P = 0.0003), and perineural invasion (P = 0.0408) were found to be independent factors for axillary lymph node positivity. Age <40 years (P = 0.0221), perineural invasion (P = 0.0408), and an extensive intraductal component (P = 0.0132) were associated with an increased incidence of ≥4 involved nodes in the logistic regression analysis. In patients with breast cancer, the incidence of axillary lymph node involvement was independently influenced by age <40 years, presence of cancer history within the family, higher T stage, lymphatic vessel invasion, and perineural invasion. Conclusions In conclusion, absence of familial cancer history, presence of lymphatic vessel invasion, higher T stage, and age below 40 years independently increased the risk of axillary node involvement. Presence of perineural invasion and lymphatic vessel invasion, age below 40, and an extensive intraductal component of more than 25% independently affected the risk of having ≥4 nodes involved. Patients characterized by these factors may be classified into a higher risk group for nodal involvement, but more data are needed to define factors that can help in the decision-making regarding the omission of axillary treatment.
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Martínez-Iglesias O, Olmeda D, Alonso-Merino E, Gómez-Rey S, González-López AM, Luengo E, Soengas MS, Palacios J, Regadera J, Aranda A. The nuclear corepressor 1 and the thyroid hormone receptor β suppress breast tumor lymphangiogenesis. Oncotarget 2018; 7:78971-78984. [PMID: 27806339 PMCID: PMC5346691 DOI: 10.18632/oncotarget.12978] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/22/2016] [Indexed: 12/20/2022] Open
Abstract
Vascular Endotelial Growth Factors C and D (VEGF-C and VEGF-D) are crucial regulators of lymphangiogenesis, a main event in the metastatic spread of breast cancer tumors. Although inhibition of lymphangiogenic gene expression might be a useful therapeutic strategy to restrict the progression of cancer, the factors involved in the transcriptional repression of these genes are still unknown. We have previously shown that Nuclear Receptor Corepressor 1 (NCoR) and the thyroid hormone receptor β1 (TRβ) inhibit tumor invasion. Here we show that these molecules repress VEGF-C and VEGF-D gene transcription in breast cancer cells, reducing lymphatic vessel density and sentinel lymph node invasion in tumor xenografts. The clinical significance of these results is stressed by the finding that NCoR and TRβ transcripts correlate negatively with those of the lymphangiogenic genes and the lymphatic vessel marker LYVE-1 in human breast tumors. Our results point to the use of NCoR and TRβ as potential biomarkers for diagnosis or prognosis in breast cancer and suggest that further studies of these molecules as potential targets for anti-lymphangiogenic therapy are warranted.
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Affiliation(s)
- Olaia Martínez-Iglesias
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Spain
| | - David Olmeda
- Molecular Oncology Programme, Centro Nacional de Investigaciones Oncológicas, Universidad Autónoma de Madrid, Spain
| | - Elvira Alonso-Merino
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Spain
| | - Sara Gómez-Rey
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Spain
| | - Ana M González-López
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Spain
| | - Enrique Luengo
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Spain
| | - María S Soengas
- Molecular Oncology Programme, Centro Nacional de Investigaciones Oncológicas, Universidad Autónoma de Madrid, Spain
| | - José Palacios
- Departamento de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Universidad de Alcalá, Spain
| | - Javier Regadera
- Departamento de Anatomía, Histología y Neurociencia, Facultad de Medicina, Universidad Autónoma de Madrid, Spain
| | - Ana Aranda
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Spain
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Kondov B, Isijanovska R, Milenkovikj Z, Petrusevska G, Jovanovski-Srceva M, Bogdanovska-Todorovska M, Kondov G. Impact of Size of the Tumour, Persistence of Estrogen Receptors, Progesterone Receptors, HER2Neu Receptors and Ki67 Values on Positivity of Axillary Lymph Nodes in Patients with Early Breast Cancer with Clinically Negative Axillary Examination. Open Access Maced J Med Sci 2017; 5:825-830. [PMID: 29362604 PMCID: PMC5771280 DOI: 10.3889/oamjms.2017.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/22/2022] Open
Abstract
AIM: The study aimed to identify factors that influence the positivity of axillary lymph nodes in patients with early breast cancer and clinically negative axillary lymph nodes, who were subjected for modified radical mastectomy and axillary lymphadenectomy. MATERIAL AND METHODS: This study included 81 surgically treated, early breast cancer patients during the period from 08-2015 to 05-2017. All the cases have been analysed by standard histological analysis including macroscopic and microscopic examination by routine H&E staining. For determination of molecular receptors, immunostaining by PT LINK immunoperoxidase has been done for HER2neu, ER, PR, p53 and Ki67. RESULTS: Patients age ranged between 31-73 years, an average of 56.86 years. The mean size of a primary tumour in the surgically treated patient was 20.33 ± 6.0 mm. Axillary dissection revealed from 5 to 32 lymph nodes, with an average of 14. Metastases have been found in 1 to 7 lymph nodes, with an average 0.7. Only 26 (32.1%) of the patients showed metastases in the axillary lymph nodes. The univariant regression analysis showed that the size of a tumour and presence of HER2neu receptors on cancer cells influence the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors have no influence on the positivity for metastatic deposits of lymph nodes. Multivariant model and logistic regression analysis as significant independent factors or predictors of positivity of the axillary lymph nodes are influenced by the tumour size only. CONCLUSION: Our study showed that the metastatic involvement of the axillary lymph nodes is mainly influenced by the size of a tumour and presence of HER2neu receptors in the univariant analysis. This point to the important influence of positivity of the axillary lymph nodes but, in multi-variant regressive analysis the lymph node status correlates with the tumour size only.
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Affiliation(s)
- Borislav Kondov
- University Clinic for Thoracic and Vascular Surgery, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Rosalinda Isijanovska
- Institute for Epidemiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Zvonko Milenkovikj
- University Clinic for Infective Diseases and Febrile Conditions, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Gordana Petrusevska
- Institute for Pathology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Marija Jovanovski-Srceva
- University Clinic for Anesthesia and Reanimation, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | | | - Goran Kondov
- University Clinic for Thoracic and Vascular Surgery, Clinical Centre "Mother Theresa", Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Chakraborty A, Bose CK, Basak J, Sen AN, Mishra R, Mukhopadhyay A. Determinants of lymph node status in women with breast cancer: A hospital based study from eastern India. Indian J Med Res 2017; 143:S45-S51. [PMID: 27748277 PMCID: PMC5080928 DOI: 10.4103/0971-5916.191761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background & objectives: Number of metastatic lymph nodes has a strong prognostic value in the course of breast cancer treatment, morbidity and mortality. This study was undertaken to determine the association between axillary lymph node metastasis and several variables such as age, tumour size, grade, lymphovascular invasion, oestrogen and progesterone receptor expression and HER2/neu status in patients with breast cancer. Methods: In this study 426 (with complete information on study variables) patients with breast cancer on treatment during March 2010 to December 2013, were analyzed. TNM (tumour node matastasis) staging was evaluated. The histological grading of tumours was done according to modified Bloom-Richardson Grading System. The immunophenotype of the tumour was determined as the expression of oestrogen (ER) and progesterone (PR) receptors and HER2/neu status. Univariate and multivariate analyses were carried out to determine the independent predictors of metastatic lymph node. Results: Among the studied patients, 44.36 per cent (189 of 426) of the patients had nodal metastases. Tumour histology, tumour grade, size and lympho-vascular invasion were related with node positivity. On univariate analysis, age, menopause, hormone receptor status did not relate with the node metastasis. Age, tumour grade, tumour size, lympho-vascular invasion and HER2/neu expression was likely to be associated with the number of lymph node metastasis. Interpretation & conclusions: The lymph node status was associated with clinical stage, tumour grade, tumour histology and HER2/neu status. These factors may be used for better management of such patients.
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Affiliation(s)
- Abhijit Chakraborty
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Chinmoy Kumar Bose
- Department of Gynecological Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Jayasri Basak
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Aditya Narayan Sen
- Department of Surgical Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Raghwendra Mishra
- Department of Physiology, Ananda Mohan College, University of Calcutta, Kolkata, India
| | - Ashis Mukhopadhyay
- Department of Medical Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
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Kondov B, Kondov G, Spirovski Z, Milenkovikj Z, Colanceski R, Petrusevska G, Pesevska M. Prognostic Factors on the Positivity for Metastases of the Axillary Lymph Nodes from Primary Breast Cancer. ACTA ACUST UNITED AC 2017; 38:81-90. [PMID: 28593885 DOI: 10.1515/prilozi-2017-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM The aim of the study was to identify the impact of T stage, the presence of estrogen, progesterone, HER2neu receptors and the values of the Ki67 on the positivity for metastases of the axillary lymph nodes, from primary breast cancer. MATERIAL AND METHODS 290 surgically treated patients for breast cancer were included in the study. All cases have been analyzed by standard histological analysis including microscopic analysis on standard H&E staining. For determining the molecular receptors - HER2neu, ER, PR, p53 and Ki67, immunostaining by PT LINK immunoperoxidase has been done. RESULTS Patients age was ranged between 18-90 years, average of 57.6+11.9. The mean size of the primary tumor in the surgically treated patient was 30.27 + 18.3 mm. On dissection from the axillary pits 8 to 39 lymph nodes were taken out, an average of 13.81+5.56. Metastases have been found in 1 to 23 lymph nodes, an average 3.14+4.71. In 59% of the patients there have been found metastases in the axillary lymph nodes. The univariate regression analysis showed that the location, size of tumor, differentiation of the tumor, stage, the value of the Ki67 and presence of lymphovascular invasion influence on the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors and HER2neu receptors showed that they do not have influence on the positivity for metastatic deposits in axillary lymph nodes. The multivariate model and the logistic regression analysis as independent significant factors or predictors of positivity of the axillary lymph nodes are influenced by the tumor size and the positive lymphovascular invasion. CONCLUSION Our study showed that the involving of the axillary lymph nodes is mainly influenced by the size of the tumor and the presence of lymphovascular invasion in the tumor. Ki67 determined proliferative index in the univariate analysis points the important influence of positivity in the axillary lymph nodes, but not in the multivariate regressive analysis.
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Affiliation(s)
- Borislav Kondov
- University Clinic for Thoracic and Vascular Surgery, Skopje, Majka Tereza 17, 1000 Skopje
| | - Goran Kondov
- University Clinic for Thoracic and Vascular Surgery - Medical Faculty Skopje
| | - Zoran Spirovski
- University Clinic for Thoracic and Vascular Surgery - Medical Faculty Skopje
| | - Zvonko Milenkovikj
- University Clinic for Infective Disease and Febrile Conditions - Medical Faculty Skopje
| | - Risto Colanceski
- University Clinic for Thoracic and Vascular Surgery - Medical Faculty Skopje
| | | | - Meri Pesevska
- University Clinic for Oncology and Radiotherapy- Medical Faculty Skopje
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Moorman AM, Bourez RLJH, de Leeuw DM, Kouwenhoven EA. Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention? ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2842-2848. [PMID: 26259889 DOI: 10.1016/j.ultrasmedbio.2015.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/02/2015] [Accepted: 06/16/2015] [Indexed: 06/04/2023]
Abstract
A non-invasive and widely available method for pre-operative evaluation of the axilla is axillary ultrasonography (US). The purpose of this study was to evaluate the diagnostic accuracy of axillary US and fine-needle aspiration cytology in a large cohort of breast cancer patients. The sensitivity and specificity of US and fine-needle aspiration cytology in our cohort of 1124 patients were 42.2% and 97.1%, respectively. As the number of axillary nodes increased, sensitivity increased. The percentage of false-negative US results was 18.9%; patients in this subgroup were significantly younger, had larger tumors, more often had lymph vascular invasion and were more likely to have estrogen receptor-positive tumors. Ultrasonography in combination with fine-needle aspiration cytology is useful in the pre-operative workup of breast cancer patients, especially patients with three or more nodal metastases. Special attention should be paid to younger women with larger tumors in whom a larger percentage of false-negative results are obtained.
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Affiliation(s)
- A M Moorman
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands.
| | - R L J H Bourez
- Department of Radiology, Hospital Group Twente, Almelo, The Netherlands
| | - D M de Leeuw
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - E A Kouwenhoven
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
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Predictive factors for additional non-sentinel lymph node involvement in breast cancer patients with one positive sentinel node. TUMORI JOURNAL 2015; 101:78-83. [PMID: 25702658 DOI: 10.5301/tj.5000220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to identify a subgroup of breast cancer patients in whom it is possible to avoid axillary lymph node dissection (ALND) when the sentinel lymph node (SLN) is positive. METHODS A series of 292 patients treated with breast-conserving surgery or mastectomy underwent ALND after positive SLN detection. To correlate SLN metastasis with the chances of finding additional metastasis in non-SLNs we evaluated the main clinicopathological characteristics. No patients received adjuvant radiotherapy to the axillary region. RESULTS Fifty-six patients (35.4%) with positive SLNs for macrometastases (n = 158) had additional metastases upon completion ALND compared with 7 patients (5.2%) with micrometastases in the SLN (n = 132). Cases with a higher number of positive axillary lymph nodes tended to have higher pT stage (p = 0.004). In multivariate analysis, pT was confirmed as an independent predictor of non-SLN metastases (OR = 2.40; 95% CI = 1.16-4.99). No patients with micrometastases in SLN and cancer lt;10 mm had additional positive non-SLNs. CONCLUSIONS Our results, in agreement with the major published studies, suggest that ALND can be avoided in selected patients without the need for additional treatment to the axillary region.
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Sawaki M, Idota A, Ichikawa M, Gondo N, Horio A, Kondo N, Hattori M, Fujita T, Yatabe Y, Iwata H. Impact of intrinsic subtype on predicting axillary lymph node metastasis in breast cancer. Oncol Lett 2014; 8:1707-1712. [PMID: 25202396 PMCID: PMC4156270 DOI: 10.3892/ol.2014.2333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 06/12/2014] [Indexed: 11/19/2022] Open
Abstract
Axillary lymph node (LN) metastasis is one of the most important prognostic factors for the survival of breast cancer. The correlation between LN metastasis and the tumor (T) category has previously been investigated in certain case series. At present, the initial treatment approach is to define the intrinsic subtype, as it is significant in determining medical treatments, as well as being a prognostic factor. However, the intrinsic subtype is not known to predict the frequency of LN metastasis. The aim of the present study was to evaluate the frequency of LN metastasis with regard to tumor size according to the intrinsic subtype. In total, 654 patients with primary breast cancer were evaluated who underwent surgical resection between 2010 and 2011 at the Aichi Cancer Center Hospital (Nagoya, Aichi). The clinical and pathological data were analyzed for patients who underwent an axillary LN dissection or a sentinel LN biopsy for primary breast cancer. The intrinsic subtype of the primary tumors was classified using immunohistochemical staining of thin, paraffin-embedded sections. In total, 157 (24.0%) of the 654 patients exhibited LN metastasis, and according to the primary tumor category, a larger tumor size was found to correlate with a higher proportion of LN positivity, as well as with the luminal A subtypes (n=364). In luminal B subtypes (n=110), T1a (n=2), T1b (n=12), T1c (n=55), T2 (n=34), and T3 (n=2) exhibited 50, 8.3, 38.2, 55.9 and 50% LN positivity, respectively. In luminal-human epidermal growth factor receptor 2 (HER2) subtypes (n=46), T1c (n=17), T2 (n=10), and T3 (n=1) exhibited 40.1, 60 and 100% LN positivity, respectively. In HER2 subtypes (n=53), T1a (n=6), T1b (n=4), T1c (n=15), and T2 (n=10) exhibited 16.7, 25, 46.7 and 60% LN positivity, respectively. In triple-negative subtypes (n=81), T1b (n=15), T1c (n=29), T2 (n=20), and T3 (n=2) exhibited 26.7, 24.1, 50 and 50% LN positivity, respectively. In conclusion, the intrinsic subtype is significant in predicting the frequency of LN metastasis with regard to tumor size.
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Affiliation(s)
- Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Ai Idota
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Mari Ichikawa
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Naomi Gondo
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Akiyo Horio
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Naoto Kondo
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Takashi Fujita
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
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Tseng HS, Chen LS, Kuo SJ, Chen ST, Wang YF, Chen DR. Tumor characteristics of breast cancer in predicting axillary lymph node metastasis. Med Sci Monit 2014; 20:1155-61. [PMID: 24998473 PMCID: PMC4099209 DOI: 10.12659/msm.890491] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Tumor characteristics was sought to be related to axillary lymph node metastasis (ALNM), the paramount prognostic factor in patients with invasive breast cancer. This study was aimed to identify the ALNM-associated tumor characteristics and to determine the predictive clinical pathway. Material/Methods Data from 1325 patients diagnosed with invasive breast cancer between January 2004 and January 2010 were retrospectively reviewed. The structure equation model (SEM) was used to build the predictive clinical pathway. Results Among the factors found in the final model, the status of human epidermal growth factor receptor 2 is the primary influence on ALNM through histology grade (β=0.18), followed by tumor size (β=0.16). Tumor size was highly relevant to lymphovascular invasion (LVI) and influenced ALNM through LVI (β=0.26), the strongest predictor of ALNM in the final model (β=0.46) and the highest risk of ALNM (odds ratio=9.282; 95% confidence interval: 7.218–11.936). Conclusions The structure equation model presented the relation of these important predictors, and might help physicians to assess axillary nodal condition and appropriate surgical procedures.
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Affiliation(s)
- Hsin-Shun Tseng
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shou-Jen Kuo
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Fen Wang
- Department of Medical Research, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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Wu JL, Tseng HS, Yang LH, Wu HK, Kuo SJ, Chen ST, Chen DR. Prediction of axillary lymph node metastases in breast cancer patients based on pathologic information of the primary tumor. Med Sci Monit 2014; 20:577-81. [PMID: 24714517 PMCID: PMC3989944 DOI: 10.12659/msm.890345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Axillary lymph nodes (ALN) are the most commonly involved site of disease in breast cancer that has spread outside the primary lesion. Although sentinel node biopsy is a reliable way to manage ALN, there are still no good methods of predicting ALN status before surgery. Since morbidity in breast cancer surgery is predominantly related to ALN dissection, predictive models for lymph node involvement may provide a way to alert the surgeon in subgroups of patients. MATERIAL AND METHODS A total of 1325 invasive breast cancer patients were analyzed using tumor biological parameters that included age, tumor size, grade, estrogen receptor, progesterone receptor, lymphovascular invasion, and HER2, to test their ability to predict ALN involvement. A support vector machine (SVM) was used as a classification model. The SVM is a machine-learning system developed using statistical learning theories to classify data points into 2 classes. Notably, SVM models have been applied in bioinformatics. RESULTS The SVM model correctly predicted ALN metastases in 74.7% of patients using tumor biological parameters. The predictive ability of luminal A, luminal B, triple negative, and HER2 subtypes using subgroup analysis showed no difference, and this predictive performance was inferior, with only 60% accuracy. CONCLUSIONS With an SVM model based on clinical pathologic parameters obtained in the primary tumor, it is possible to predict ALN status in order to alert the surgeon about breast cancer counseling and in decision-making for ALN management.
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Affiliation(s)
- Jia-Long Wu
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-Shun Tseng
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Li-Heng Yang
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hwa-Koon Wu
- Department of Medical Imaging, Changhua Christian Hospital, Changhua County, Taiwan
| | - Shou-Jen Kuo
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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Mohamed OO, Neary PM, Fiuza-Castineira C, O'Donoghue GT. Questioning the role of axillary node dissection in sentinel node positive early stage breast cancer in the South Eastern Cancer Centre. Ir J Med Sci 2014; 184:189-94. [PMID: 24585071 DOI: 10.1007/s11845-014-1085-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/08/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Axillary node status is a predictor of breast cancer survival. Axillary node dissection (ALND) following positive sentinel node biopsy (SLNB) is challenged by the American College of Surgeons Z0011 trial, where clinically/radiologically node-negative, SLNB positive early stage patients failed to derive therapeutic benefit from ALND at 6 years. AIMS To quantify the rates of non-sentinel lymph node positivity after ALND in all breast cancer stages. To assess Z0011 trial result application to an Irish patient population. METHODS Retrospective review of a prospectively maintained database of clinically node-negative patients undergoing breast conserving surgery and ALND for a positive SLNB from January 2011 to January 2012. RESULTS Of 174 new breast cancers diagnosed, 144 underwent surgery of which 127 patients were clinically/radiologically node-negative; 46 patients were SLNB positive; 34 (73.9 %) proceeded to ALND. Of 9 T1 tumours, 3 (33.3 %) had further positive nodes on ALND. Of 24 T2 tumours, 11 (45.8 %) had further positive nodes on ALND. All 3 (100 %) T3/T4 tumours had further positive nodes on ALND. Mean numbers of sentinel and axillary nodes harvested were 2.3 and 15.2, respectively. In the SLNB positive, ALND negative group, 12 of 18 (66.7 %) patients were <60 years versus 14 of 17 (82.4 %) in the SLNB positive, ALND positive group. This may be indicative that younger women have a trend toward node positivity following ALND for a positive SLNB. CONCLUSION These data suggest that a significant proportion (41.9 %) of T1/T2 tumours undergoing ALND following positive SLNB have further positive nodes. It may be premature to exclude ALND in patients with T1/T2 tumours following a positive SLNB.
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Affiliation(s)
- O O Mohamed
- South Eastern Cancer Centre, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland
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Greer LT, Rosman M, Charles Mylander W, Liang W, Buras RR, Chagpar AB, Edwards MJ, Tafra L. A prediction model for the presence of axillary lymph node involvement in women with invasive breast cancer: a focus on older women. Breast J 2014; 20:147-53. [PMID: 24475876 DOI: 10.1111/tbj.12233] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Axillary lymph node (ALN) status at diagnosis is the most powerful prognostic indicator for patients with breast cancer. Our aim is to examine the contribution of variables that lead to ALN metastases in a large dataset with a high proportion of patients greater than 70 years old. Using the data from two multicenter prospective studies, a retrospective review was performed on 2,812 patients diagnosed with clinically node-negative invasive breast cancer from 1996 to 2005 and who underwent ALN sampling. Univariate and multivariate logistic regression were used to identify variables that were strongly associated with axillary metastases, and an equation was developed to estimate risk of ALN metastases. Of the 2,812 patients with invasive breast cancer, 18% had ALN metastases at diagnosis. Based on univariate analysis, tumor size, lymphovascular invasion (LVI), tumor grade, age at diagnosis, menopausal status, race, tumor location, tumor type, and estrogen and progesterone receptor status were statistically significant. The relationship between age and involvement of axillary metastases was nonlinear. In multivariate analysis, LVI, tumor size and menopausal status were the most significant factors associated with ALN metastases. Age, however, was not a significant contributing factor for axillary metastases. Tumor size, LVI, and menopausal status are strongly associated with ALN metastases. We believe that age may have been a strong factor in previous analyses because there was not an adequate representation of women in older age groups and because of the violation of the assumption of linearity in their multivariate analyses.
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Affiliation(s)
- Lauren T Greer
- General Surgery Service, Walter Reed National Military Medical Center, Bethesda, Maryland
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Fan Z, Li J, Wang T, Xie Y, Fan T, Lin B, Ouyang T. Level III axillary lymph nodes involvement in node positive breast cancer received neoadjuvant chemotherapy. Breast 2013; 22:1161-5. [PMID: 24080493 DOI: 10.1016/j.breast.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 06/05/2013] [Accepted: 08/16/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate the incidence, associated factors and prognosis of level III node involvement for breast cancer with positive axillary lymph nodes after neoadjuvant chemotherapy. METHODS A consecutive series of 521 node positive T0-2 invasive breast cancer cases were included in this retrospective study. Axillary node metastases were proved by ultrasound guided needle biopsy (NB) if ultrasonographic abnormal node was detected or by sentinel node biopsy (SNB) if no abnormal node was detected. After 4 to 8 cycles of neoadjuvant chemotherapy (NCT), axillary lymph nodes dissection included level III lymph nodes were completed for each case. RESULTS The pathologic complete response rate of axillary nodes was 31.1% (90/289) in NB positive subgroup. The incidence of residual positive level III lymph nodes were 9.0% (47/521). Multivariate analysis showed that node NB positivity (OR = 2.212, 95% CI: 1.022-4.787, P = 0.044), clinical tumor size >2 cm before NCT (OR = 2.672, 95% CI: 1.170-6.098, P = 0.020), and primary tumor non-response to neoadjuvant chemotherapy (OR = 1.718, 95% CI: 1.232-2.396, P = 0.001) were independent predictors of level III lymph nodes positivity. At median follow-up time of 30 months, the distant disease-free survival (DDFS) rate of level III node positive group was much lower than that of level III negative group (p = 0.011). CONCLUSIONS About 9% of node positive T0-2 breast cancer will have residual positive node in level III region after neoadjuvant chemotherapy. Node positivity proved by NB, large tumor size, and primary tumor non-response to neoadjuvant chemotherapy are independent predictors of level III lymph nodes positivity.
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Affiliation(s)
- Zhaoqing Fan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Center, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, 100142 Beijing, China
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Leenders M, Richir M, Broeders M, Moormann G, Mollema R, Lopes Cardozo A, Meijer S, Schreurs H. Axillary staging by ultrasound-guided fine-needle aspiration cytology in breast cancer patients. Still up to date? Breast J 2013; 19:637-42. [PMID: 24011125 DOI: 10.1111/tbj.12176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To investigate whether clinicopathological features of breast cancer patients could predict the likelihood of lymph node metastases and the likelihood of false-negative results of ultrasound-guided fine-needle aspiration cytology of suspicious lymph nodes (US+FNAC). Between 2004 and 2009, US+FNAC was performed in 1,150 axillae (18 bilateral breast carcinomas). Based on final histologic diagnosis, the true- and false-negative group of US+FNAC were defined. Subsequently, 11 clinicopathological factors were compared between these two groups. These factors were also compared between patients with and patients without lymph node metastases. Of 1,150 axillae, 429 had lymph node metastases at final histology. US+FNAC indicated metastases in 107 axillae. 1,043 axillae were negative by US+FNAC. Final histology showed metastases in 323 of these 1,043 axillae, resulting in a false-negative group of US+FNAC of 31%. Both age <60 years and a cT2/cT3 breast carcinoma were significantly associated with lymph node metastases and with false-negative results of US+FNAC. Lymph node metastases were found in 59.6% of patients <60 years with a cT2/cT3 breast carcinoma. In these patients, 52.3% of the negative US+FNAC results were falsely negative. In patients <60 years with a cT2/cT3 breast carcinoma, we recommend to omit US+FNAC preoperatively and perform a SNB directly, because lymph node metastases were found in 59.6% of these patients and 52.3% of negative US+FNAC results were falsely negative.
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Affiliation(s)
- Martijn Leenders
- Department of Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
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25
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The feasibility of a randomised controlled trial for the axillary management of a select group of invasive breast cancer patients: SLNB vs. no-SLNB. Breast Cancer 2013; 22:343-9. [PMID: 23846682 DOI: 10.1007/s12282-013-0484-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/19/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The results of ZOO11 have shaken our thinking and approach for the axillary management of small invasive breast cancers where the incidence and burden of axillary metastasis would be much less than that of ZOO11 population. The traditional approach of sentinel lymph node biopsy (SLNB) for "all invasive cancers" is challenged because of the diminishing role of axillary lymph nodes (ALNs) status in guiding the adjuvant systemic therapy. Certainly this raises the question of whether SLNB can be avoided in a select group of patients without compromising clinical outcomes. The aim of this study was to identify such a group of patients in whom SLNB is no longer required. METHOD Patients with breast cancers ≤2 cm in size and clinically negative axilla who underwent breast conserving surgery (BCS) and SLNB were identified. Patients were divided into different groups; incidence of ALNs metastasis, further non-SLNs metastasis and a total number of tumour positive ALNs of ≥4 were determined. RESULTS A total of 194 patients met the criteria; incidence of tumour positive SLNs, further non-SLNs metastasis and a total number of tumour positive ALNs of ≥4 varied between different groups and was 9.3-15.5 %, 0-35 % and 0-2.6 %, respectively. Patients with T1b, grade 1-2 tumours had less than 5 % risk of ALNs macrometastasis. CONCLUSION It is possible to identify a group of patients whose burden of axillary disease is acceptably low enough that SLNB can be avoided. Feasibility of a non-inferiority randomised controlled trial (RCT) in a select group of patients with or without SLNB has been explored to compare the distant disease free, disease free and overall survival and axillary relapse rate (ARR).
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Vaysse C, Sroussi J, Mallon P, Feron JG, Rivain AL, Ngo C, Belichard C, Lasry S, Pierga JY, Couturaud B, Fitoussi A, Laki F, Fourchotte V, Alran S, Kirova Y, Vincent-Salomon A, Sastre-Garau X, Sigal-Zafrani B, Rouzier R, Reyal F. Prediction of axillary lymph node status in male breast carcinoma. Ann Oncol 2013; 24:370-376. [PMID: 23051951 DOI: 10.1093/annonc/mds283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND To evaluate whether predictive factors of axillary lymph node metastasis in female breast cancer (BC) are similar in male BC. PATIENTS AND METHODS From January 1994 to May 2011, we recorded 80 non-metastatic male BC treated at Institut Curie (IC). We analysed the calibration and discrimination performance of two nomograms [IC, Memorian Sloan-Kettering Cancer Center (MSKCC)] originally designed to predict axillary lymph node metastases in female BC. RESULTS About 55% and 24% of the tumours were pT1 and pT4, respectively. Nearly 46% demonstrated axillary lymph node metastasis. About 99% were oestrogen receptor positive and 94% HER2 negative. Lymph node status was the only significant prognostic factor of overall survival (P = 0.012). The area under curve (AUC) of IC and MSKCC nomograms were 0.66 (95% CI 0.54-0.79) and 0.64 (95% CI 0.52-0.76), respectively. The calibration of these two models was inadequate. CONCLUSIONS Multi-variate models designed to predict axillary lymph node metastases for female BC were not effective in our male BC series. Our results may be explained by (i) small sample size (ii) different biological determinants influencing axillary metastasis in male BC compared with female BC.
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Ngô C, Mouttet D, De Rycke Y, Reyal F, Fourchotte V, Hugonnet F, Falcou MC, Bidard FC, Vincent-Salomon A, Fourquet A, Alran S. Validation over time of a nomogram including HER2 status to predict the sentinel node positivity in early breast carcinoma. Eur J Surg Oncol 2012; 38:1211-7. [PMID: 22954526 DOI: 10.1016/j.ejso.2012.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 08/03/2012] [Accepted: 08/16/2012] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The molecular subtypes of breast cancer have different axillary status. A nomogram including the interaction covariate between estrogen receptor (ER) and HER2 has been recently published (Reyal et al. PLOS One, May 2011) and allows to identify the patients with a high risk of positive sentinel lymph node (SLN). The purpose of our study was to validate this model on an independent population. METHODS We studied 755 consecutive patients treated at Institut Curie for operable breast cancer with sentinel node biopsies in 2009. The multivariate model, including age, tumor size, lymphovascular invasion and interaction covariate between ER and HER2 status, was used to calculate the theoretical risk of positive sentinel lymph node (SLN) for all patients. The performance of the model on our population was then evaluated in terms of discrimination (area under the curve AUC) and of calibration (Hosmer-Lemeshow HL test). RESULTS our population was significantly different from the training population for the following variables: median tumor size in mm, lymphovascular invasion, positive ER and age. The nomogram showed similar results in our population than in the training population in terms of discrimination (AUC=0.72 [0.68-0.76] versus 0.73 [0.7-0.75] and calibration (HL p=0.4 versus p=0.35). CONCLUSIONS Despite significant differences between the two populations concerning variables which are part of the nomogram, the model was validated in our population. This nomogram is robust over time to predict the likelihood of positive SLN according to molecular subtypes defined by surrogate markers ER and HER2 determined by immunohistochemistry in clinical practice.
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Affiliation(s)
- C Ngô
- Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
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Xie F, Yang H, Wang S, Zhou B, Tong F, Yang D, Zhang J. A logistic regression model for predicting axillary lymph node metastases in early breast carcinoma patients. SENSORS (BASEL, SWITZERLAND) 2012; 12:9936-50. [PMID: 23012578 PMCID: PMC3444135 DOI: 10.3390/s120709936] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 01/17/2023]
Abstract
Nodal staging in breast cancer is a key predictor of prognosis. This paper presents the results of potential clinicopathological predictors of axillary lymph node involvement and develops an efficient prediction model to assist in predicting axillary lymph node metastases. Seventy patients with primary early breast cancer who underwent axillary dissection were evaluated. Univariate and multivariate logistic regression were performed to evaluate the association between clinicopathological factors and lymph node metastatic status. A logistic regression predictive model was built from 50 randomly selected patients; the model was also applied to the remaining 20 patients to assess its validity. Univariate analysis showed a significant relationship between lymph node involvement and absence of nm-23 (p = 0.010) and Kiss-1 (p = 0.001) expression. Absence of Kiss-1 remained significantly associated with positive axillary node status in the multivariate analysis (p = 0.018). Seven clinicopathological factors were involved in the multivariate logistic regression model: menopausal status, tumor size, ER, PR, HER2, nm-23 and Kiss-1. The model was accurate and discriminating, with an area under the receiver operating characteristic curve of 0.702 when applied to the validation group. Moreover, there is a need discover more specific candidate proteins and molecular biology tools to select more variables which should improve predictive accuracy.
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Affiliation(s)
| | | | - Shu Wang
- Breast Disease Center, Peking University, People's Hospital, Beijing 100044, China; E-Mails: (F.X.); (H.Y.); (B.Z.); (F.T.); (D.Y.); (J.Z.)
| | - Bo Zhou
- Breast Disease Center, Peking University, People's Hospital, Beijing 100044, China; E-Mails: (F.X.); (H.Y.); (B.Z.); (F.T.); (D.Y.); (J.Z.)
| | - Fuzhong Tong
- Breast Disease Center, Peking University, People's Hospital, Beijing 100044, China; E-Mails: (F.X.); (H.Y.); (B.Z.); (F.T.); (D.Y.); (J.Z.)
| | - Deqi Yang
- Breast Disease Center, Peking University, People's Hospital, Beijing 100044, China; E-Mails: (F.X.); (H.Y.); (B.Z.); (F.T.); (D.Y.); (J.Z.)
| | - Jiaqing Zhang
- Breast Disease Center, Peking University, People's Hospital, Beijing 100044, China; E-Mails: (F.X.); (H.Y.); (B.Z.); (F.T.); (D.Y.); (J.Z.)
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Toussaint A, Nogaret JM, Veys I, Hertens D, Noterman D, De Neubourg F, Larsimont D, Bourgeois P. Axillary recurrence rate in breast cancer patients with negative sentinel lymph node biopsy or containing micrometastases and without further lymphadenectomy: a monocentric review of 8 years and 481 cases. Breast J 2011; 17:337-42. [PMID: 21752137 DOI: 10.1111/j.1524-4741.2011.01113.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node biopsy (SLNB) has almost completely replaced complete axillary lymph node dissection (CALND) as the first-line axillary procedure for clinically node-negative early stage breast cancer. We assessed the incidence of axillary relapse in patients with negative SLNB who had no additional CALND (group 1, n = 481) and in patients whose SLNB contained micrometastases and had no further CALND (group 2, n = 45). All patients were operated on between November 1997 and December 2005 and followed at the Jules Bordet Institute. The median follow-up was 48 months. A mean of 2.2 sentinel lymph nodes was removed per patient. Axillary relapse was observed in only one patient (0.2%) in group 1 and in none of the patients in group 2. This study confirms that the axillary recurrence rate after long-term follow-up of patients with a negative sentinel lymph node is very rare, provided that the selection criteria are judicious.
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Affiliation(s)
- Arnaud Toussaint
- Department of Mammo-Pelvic Surgery, Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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The molecular subtype classification is a determinant of sentinel node positivity in early breast carcinoma. PLoS One 2011; 6:e20297. [PMID: 21655258 PMCID: PMC3105053 DOI: 10.1371/journal.pone.0020297] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/25/2011] [Indexed: 11/30/2022] Open
Abstract
Introduction Several authors have underscored a strong relation between the molecular subtypes and the axillary status of breast cancer patients. The aim of our work was to decipher the interaction between this classification and the probability of a positive sentinel node biopsy. Materials and Methods Our dataset consisted of a total number of 2654 early-stage breast cancer patients. Patients treated at first by conservative breast surgery plus sentinel node biopsies were selected. A multivariate logistic regression model was trained and validated. Interaction covariate between ER and HER2 markers was a forced input of this model. The performance of the multivariate model in the training and the two validation sets was analyzed in terms of discrimination and calibration. Probability of axillary metastasis was detailed for each molecular subtype. Results The interaction covariate between ER and HER2 status was a stronger predictor (p = 0.0031) of positive sentinel node biopsy than the ER status by itself (p = 0.016). A multivariate model to determine the probability of sentinel node positivity was defined with the following variables; tumour size, lympho-vascular invasion, molecular subtypes and age at diagnosis. This model showed similar results in terms of discrimination (AUC = 0.72/0.73/0.72) and calibration (HL p = 0.28/0.05/0.11) in the training and validation sets. The interaction between molecular subtypes, tumour size and sentinel nodes status was approximated. Discussion We showed that biologically-driven analyses are able to build new models with higher performance in terms of breast cancer axillary status prediction. The molecular subtype classification strongly interacts with the axillary and distant metastasis process.
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Does Lymphovascular Invasion Predict Regional Nodal Failure in Breast Cancer Patients With Zero to Three Positive Lymph Nodes Treated With Conserving Surgery and Radiotherapy? Implications for Regional Radiation. Int J Radiat Oncol Biol Phys 2010; 78:793-8. [DOI: 10.1016/j.ijrobp.2009.08.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 08/19/2009] [Accepted: 08/20/2009] [Indexed: 11/17/2022]
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Jaka RC, Zaveri SS, Somashekhar SP, Sureshchandra, Parameswaran RV. Value of frozen section and primary tumor factors in determining sentinel lymph node spread in early breast carcinoma. Indian J Surg Oncol 2010; 1:27-36. [PMID: 22930615 DOI: 10.1007/s13193-010-0008-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 07/18/2009] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) is the standard of care to assess the metastasis in breast carcinoma. Accuracy of intraoperative frozen section examination to evaluate SLN in detecting metastasis is important as it determines the further management of axilla. Primary tumor characteristics determining the metastasis to the lymph node will help in predicting the probability of spread and to determine the nature of disease. It also helps in refining selection of patients for SLNB. We evaluated all these criteria on Indian patients for the better management. MATERIALS AND METHODS Between January 2005 and April 2009, 114 consecutive patients of all age group of both sex, with cytology or biopsy proven carcinoma breast, clinical stage T1/T2 N0 M0 at Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore were subjected to SLNB and introperative frozen examination. First 75 cases had complete axillary clearance irrespective of SLNB result and subsequently, positive cases underwent axillary lymph node dissection (ALND). Age of the patient and primary tumor characteristics like size, grade, lymphovascular invasion (LVI), perineural invasion, ER/PR status, Her2-neu status and histological sub-types were evaluated for predicting the SLN metastasis. Feasibility of SLNB in previously treated patient is also evaluated. RESULTS The age of the patient ranged from 23 to 87 years and its association with SLN spread is not significant. Frozen section examination had accuracy of 97.37% in determining metastatic sentinel node with sensitivity of 96.15% and specificity of 100% with value P < 0.001. SLN remained significant indicator of the status of rest of axilla with value P < 0.001. Primary tumor characteristics like histological subtypes, grade (P = 0.353), ER/PR status (P = 0.839), Her2-neu status (P =0.296) were not significantly associated with SLN metastasis. Size of the primary tumor (P = 0.002), LVI (P < 0.001), perineural invasion (P = 0.084+) were significant factors determining the SLN metastasis. SLNB evaluation had no false negative values in previously treated breast. CONCLUSION SLNB is a valuable method of determining the axillary nodal metastasis. Intraoperative frozen section examination is highly ac-curate in detecting nodal metastasis. Primary tumor characteristics like size, LVI and perineural invasion are significant in predicting SLN metastasis. SLNB remains an important method of predicting axillary metastasis even in previously treated breast carcinomas.
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Affiliation(s)
- Rajshekhar C Jaka
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, HAL Airport Road, Bangalore, 560 017 India
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Dwivedi AK, Dwivedi SN, Deo S, Shukla R, Kopras E. Statistical models for predicting number of involved nodes in breast cancer patients. Health (London) 2010; 2:641-651. [PMID: 21720569 DOI: 10.4236/health.2010.27098] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinicians need to predict the number of involved nodes in breast cancer patients in order to ascertain severity, prognosis, and design subsequent treatment. The distribution of involved nodes often displays over-dispersion-a larger variability than expected. Until now, the negative binomial model has been used to describe this distribution assuming that over-dispersion is only due to unobserved heterogeneity. The distribution of involved nodes contains a large proportion of excess zeros (negative nodes), which can lead to over-dispersion. In this situation, alternative models may better account for over-dispersion due to excess zeros. This study examines data from 1152 patients who underwent axillary dissections in a tertiary hospital in India during January 1993-January 2005. We fit and compare various count models to test model abilities to predict the number of involved nodes. We also argue for using zero inflated models in such populations where all the excess zeros come from those who have at some risk of the outcome of interest. The negative binomial regression model fits the data better than the Poisson, zero hurdle/inflated Poisson regression models. However, zero hurdle/inflated negative binomial regression models predicted the number of involved nodes much more accurately than the negative binomial model. This suggests that the number of involved nodes displays excess variability not only due to unobserved heterogeneity but also due to excess negative nodes in the data set. In this analysis, only skin changes and primary site were associated with negative nodes whereas parity, skin changes, primary site and size of tumor were associated with a greater number of involved nodes. In case of near equal performances, the zero inflated negative binomial model should be preferred over the hurdle model in describing the nodal frequency because it provides an estimate of negative nodes that are at "high-risk" of nodal involvement.
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Affiliation(s)
- Alok Kumar Dwivedi
- Center for Biostatistical Services, Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, USA
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Roses RE, Kumar R, Alavi A, Czerniecki BJ. The Role of Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Staging of Breast Cancer. PET Clin 2009; 4:265-76. [PMID: 27157099 DOI: 10.1016/j.cpet.2009.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The widespread application of sentinel lymph node biopsy in the evaluation of patients with breast cancer has allowed for the more limited, selective treatment of regional lymph nodes and decreased the number of complete regional dissections performed in patients without nodal metastases. Surgical excision and pathologic evaluation of nodes for metastases allow for reliable staging and prediction of additional lymph node metastases. Sentinel lymph node biopsy also enables a meticulous histologic evaluation of multiple sections augmented by immunohistochemical staining. The current role of sentinel lymph node biopsy in the staging of breast cancer and ongoing controversies relating to the procedure are discussed.
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Affiliation(s)
- Robert E Roses
- Department of Surgery, University of Pennsylvania School of Medicine, 4 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abass Alavi
- Department Section, Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Brian J Czerniecki
- Department of Surgery, University of Pennsylvania School of Medicine, 4 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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The value of level III clearance in patients with axillary and sentinel node positive breast cancer. Ann Surg 2009; 249:834-9. [PMID: 19387317 DOI: 10.1097/sla.0b013e3181a40821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The value of level III axillary clearance is contentious, with great variance worldwide in the extent and levels of clearance performed. OBJECTIVE To determine rates of level III positivity in patients undergoing level I-III axillary clearance, and identify which patients are at highest risk of involved level III nodes. METHODS From a database of 2850 patients derived from symptomatic and population-based screening service, 1179 patients who underwent level I-III clearance between the years 1999-2007 were identified. The pathology, surgical details, and prior sentinel nodes biopsies of patients were recorded. RESULTS Eleven hundred seventy nine patients had level I-III axillary clearance. Of the patients, 63% (n = 747) were node positive. Of patients with node positive disease, 23% (n = 168) were level II positive and 19% (n = 141) were level III positive. Two hundred fifty patients had positive sentinel node biopsies prior to axillary clearance. Of these, 12% (n = 30) and 9% (n = 22) were level II and level III positive, respectively. On multivariate analysis, factors predictive of level III involvement in patients with node positive disease were tumor size (P < 0.001, OR = 1.36; 95% CI: 1.2-1.5), invasive lobular disease (P < 0.001, OR = 3.6; 95% CI: 1.9-6.95), extranodal extension (P < 0.001, OR = 0.27; 95% CI: 0.18-0.4), and lymphovascular invasion (P = 0.04, OR = 0.58; 95% CI: 0.35-1). Lobular invasive disease (P = 0.049, OR = 4.1; 95% CI: 1-16.8), extranodal spread (P = 0.003, OR = 0.18; 95% CI: 0.06-0.57), and having more than one positive sentinel node (P = 0.009, OR = 4.9; 95% CI: 1.5-16.1) were predictive of level III involvement in patients with sentinel node positive disease. CONCLUSION Level III clearance has a selective but definite role to play in patients who have node positive breast carcinoma. Pathological characteristics of the primary tumor are of particular use in identifying those who are at various risk of level III nodal involvement.
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Floyd SR, Taghian AG. Post-mastectomy radiation in large node-negative breast tumors: does size really matter? Radiother Oncol 2009; 91:33-7. [PMID: 19201501 DOI: 10.1016/j.radonc.2008.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 09/15/2008] [Accepted: 09/19/2008] [Indexed: 11/29/2022]
Abstract
Treatment decisions regarding local control can be particularly challenging for T3N0 breast tumors because of difficulty in estimating rates of local failure after mastectomy. Reports in the literature detailing the rates of local failure vary widely, likely owing to the uncommon incidence of this clinical situation. The literature regarding this clinical scenario is reviewed, including recent reports that specifically address the issue of local failure rates after mastectomy in the absence of radiation for large node-negative breast tumors.
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Affiliation(s)
- Scott R Floyd
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
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Axillary lymph node status of operable breast cancers by combined steroid receptor and HER-2 status: triple positive tumours are more likely lymph node positive. Breast Cancer Res Treat 2008; 113:181-7. [DOI: 10.1007/s10549-008-9914-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 01/22/2008] [Indexed: 01/24/2023]
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Bevilacqua JLB, Kattan MW, Fey JV, Cody HS, Borgen PI, Van Zee KJ. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol 2007; 25:3670-9. [PMID: 17664461 DOI: 10.1200/jco.2006.08.8013] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lymph node metastasis is a multifactorial event. Several variables have been described as predictors of lymph node metastasis in breast cancer. However, it is difficult to apply these data-usually expressed as odds ratios-to calculate the probability of sentinel lymph node (SLN) metastasis for a specific patient. We developed a user-friendly prediction model (nomogram) based on a large data set to assist in predicting the presence of SLN metastasis. PATIENTS AND METHODS Clinical and pathologic features of 3,786 sequential SLN biopsy procedures were assessed with multivariable logistic regression to predict the presence of SLN metastasis in breast cancer. The model was subsequently applied to 1,545 sequential SLN biopsies. A nomogram was created from the logistic regression model. A computerized version of the nomogram was developed and is available on the Memorial Sloan-Kettering Cancer Center (New York, NY) Web site. RESULTS Age, tumor size, tumor type, lymphovascular invasion, tumor location, multifocality, and estrogen and progesterone receptors were associated with SLN metastasis in multivariate analysis. The nomogram was accurate and discriminating, with an area under the receiver operating characteristic curve of 0.754 when applied to the validation group. CONCLUSION Newly diagnosed breast cancer patients are increasingly interested in information about their disease. This nomogram is a useful tool that helps physicians and patients to accurately predict the likelihood of SLN metastasis.
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Affiliation(s)
- José Luiz B Bevilacqua
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, MRI 1026, New York, NY 10021, USA
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Patani NR, Dwek MV, Douek M. Predictors of axillary lymph node metastasis in breast cancer: A systematic review. Eur J Surg Oncol 2007; 33:409-19. [PMID: 17125963 DOI: 10.1016/j.ejso.2006.09.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 09/06/2006] [Indexed: 11/21/2022] Open
Abstract
AIMS To review the established and emerging techniques in axillary lymph node prediction and explore their potential impact on clinical practice. To reliably identify patients in whom axillary lymph node surgery, including SLNB, can be safely omitted. METHODS Searches of PubMed were made using the search terms "axilla" (or "axillary"), "lymph", "node" and "predictor" (or "prediction"). Articles from abstracts and reports from meetings were included only when they related directly to previously published work. FINDINGS There are numerous studies in which the predictive utility of biomarkers as determinants of axillary lymph node status have been investigated. Few of these have specifically addressed the attributes of the primary tumour which could offer much potential for the prediction of tumour metastasis to the axillary lymph nodes. CONCLUSIONS Currently, no single marker is sufficiently accurate to obviate the need for formal axillary staging using SLNB or axillary clearance.
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Affiliation(s)
- N R Patani
- Department of Surgery, Royal Free and University College Medical School, The Medical School Building, 74 Huntley Street, University College London, London WC1E 6AU, UK
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Abstract
Axillary dissection aims at local tumor control and staging. Among breast cancer, malignant melanoma and other solid malignancies, the nodal status is still the most important predictive and prognostic factor. Today, because of its morbidity, axillary lymphadenectomy is indicated only when the sentinel lymph node is involved by metastasis after histopathologic investigation. The surgical technique of axillary dissection is presented, complications and oncologic outcomes are summarised after dissection for breast carcinoma and malignant melanoma, respectively.
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Affiliation(s)
- D Oertli
- Departement Chirurgie, Universitätsspital Basel, Spitalstrasse 21, 4031 Basel, Schweiz.
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Filardo EJ, Graeber CT, Quinn JA, Resnick MB, Giri D, DeLellis RA, Steinhoff MM, Sabo E. Distribution of GPR30, a seven membrane-spanning estrogen receptor, in primary breast cancer and its association with clinicopathologic determinants of tumor progression. Clin Cancer Res 2006; 12:6359-66. [PMID: 17085646 DOI: 10.1158/1078-0432.ccr-06-0860] [Citation(s) in RCA: 274] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The seven transmembrane receptor, GPR30, is linked to estrogen binding and heparan-bound epidermal growth factor release. Here, the significance of GPR30 in human breast cancer was evaluated by comparing its relationship to steroid hormone receptor expression and tumor progression variables. EXPERIMENTAL DESIGN Immunohistochemical analysis of a National Cancer Institute-sponsored tumor collection comprised of 361 breast carcinomas obtained at first diagnosis (321 invasive and 40 intraductal tumors). Biopsies from 12 reduction mammoplasties served as controls. The distribution pattern of GPR30, estrogen receptor (ER), and progesterone receptor (PR) was correlated with clinicopathologic variables obtained at diagnosis. RESULTS GPR30, ER, and PR were positive in all 12 normal controls. In contrast, GPR30 expression varied in breast tumors, in which 62% (199 of 321) of invasive tumors and 42% (17 of 40) of intraductal tumors were positive. Codistribution of ER and GPR30 was measured in 43% (139 of 321) of invasive breast tumors, whereas both receptors were lacking (ER-GPR30-) in 19% (61 of 321) of the tumors analyzed, indicating a significant association between ER and GPR30 (P<0.05). The coexpression of PR and ER did not influence GPR30 expression, yet coexpression of GPR30 and ER was linked to PR positivity. Unlike ER, which varied inversely with HER-2/neu and tumor size, GPR30 positively associated with HER-2/neu and tumor size. In addition, GPR30 showed a positive association with metastasis (P=0.014; odds ratio, 1.9). CONCLUSIONS GPR30 and ER exhibited distinct patterns of association with breast tumor progression variables, including HER-2/neu, tumor size, and metastatic disease. Thus, these results support the hypothesis that GPR30 and ER have an independent influence on estrogen responsiveness in breast carcinoma.
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Affiliation(s)
- Edward J Filardo
- Department of Medicine, Rhode Island Hospital, and Department of Pathology, Brown University School of Medicine, Providence, Rhode Island 02903, USA.
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Demicheli R, Biganzoli E, Boracchi P, Greco M, Hrushesky WJM, Retsky MW. Allometric Scaling Law Questions the Traditional Mechanical Model for Axillary Lymph Node Involvement in Breast Cancer. J Clin Oncol 2006; 24:4391-6. [PMID: 16926222 DOI: 10.1200/jco.2006.05.5988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To find a quantitative relationship between tumor size and frequency of axillary lymph node involvement. Patients and Methods The frequency of axillary node involvement versus primary tumor volume was analyzed in 10 selected series of patients incorporating a total of 57,244 women with resectable breast cancer. The average number of events per unit volume resulting in tumor spread to axillary lymph nodes before tumor surgical removal Θ(V)/V, was estimated under simple probabilistic assumptions. Results The allometric scaling law Θ(V)/V = 0.0586V−0.7457 was estimated on the data, fitting the proportion of lymph node involvement on tumor volume V (in microliters). The estimate 0.7457 (95% CI, 0.7200 to 0.7713) suggests that the true scaling exponent, under the assumed model, may be the fractional value, which characterizes scaling relationships for a wide variety of biologic variables at both the whole organism level and organ level. Conclusion Results suggest that the phenomenon should be related to some internal structural trait of the tumor. The vascular network seems to be the best candidate. This result does not support a mere mechanical model of lymphatic tumor spread. A more complex biology-based model of lymphohematogenous spread is suggested, in which the axillary nodes draining the lymph from the primary tumor may become activated by factors produced by both tumor cells and tumor stroma, thus favoring cell-selective homing of otherwise circulating tumor cells. The success of fractal features related to the internal architecture brings additional support to the consideration of primary breast cancer as an organ-like structure.
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Affiliation(s)
- Romano Demicheli
- Department of Medical Oncology, Istituto Nazionale Tumori, Milano, Italy.
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Factors correlating with lymph node metastases in patients with T1 ductal invasive breast cancer. ARCHIVE OF ONCOLOGY 2006. [DOI: 10.2298/aoo0602019i] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Identification of reliable predictors of axillary lymph node metastases (ALNM) may be useful in selecting appropriate management for patients with T1-size breast cancer. This study was undertaken to determine the association between ALNM and several variables, including age, tumor size, grade, estrogen receptor status, progesterone receptor status, p53 and c-erbB2 protein expression, and Ki-67 proliferative index. METHODS: In a retrospective study, 74 patients with pT1b and pT1c ductal invasive breast carcinoma and with known nodal status were analyzed. The size of the infiltrating tumor was microscopically evaluated. The histological grading was performed using the modified criteria of Bloom and Richardson, as described by Elston and Ellis. The immunophenotype of the tumor was determined as: the expression of estrogen (ER) and progesterone (PR) receptors, p53, c-erbB2 and Ki-67. The patients were grouped by age as follows: <50, 50-70, and >70 years old. RESULTS: Twenty six patients (35%) were node positive. Tumor size was related directly to nodal positivity. Nodal positivity was significantly related to negative PR status, p53 protein overexpression and high Ki-67 index (p<0.05). No significant association was found between nodal positivity and patient age, tumor grade, ER status, and c-erbB2 expression. CONCLUSION: These data suggest that PR status, Ki-67 proliferation index, and p53 protein expression might provide additional information to the lymph node status in T1 ductal breast carcinomas.
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Cabioglu N, Yazici MS, Arun B, Broglio KR, Hortobagyi GN, Price JE, Sahin A. CCR7 and CXCR4 as novel biomarkers predicting axillary lymph node metastasis in T1 breast cancer. Clin Cancer Res 2005; 11:5686-93. [PMID: 16115904 DOI: 10.1158/1078-0432.ccr-05-0014] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The chemokine receptors CCR7 and CXCR4 have been shown to play an important role in cancer metastasis. We therefore studied the differential expression of CCR7 and CXCR4, along with that of the biomarker HER2-neu, to evaluate whether these biomarkers could predict axillary lymph node metastasis in breast cancer. EXPERIMENTAL DESIGN Biomarker expression levels were evaluated using paraffin-embedded tissue sections of lymph node-negative (n = 99) and lymph node-positive (n = 98) T1 breast cancer by immunohistochemical staining. RESULTS Lymph node-positive tumors showed higher rates of high cytoplasmic CCR7 staining (21.5% versus 8.5%, P = 0.013) and HER2-neu overexpression (21.5% versus 9.3%, P = 0.019) than did lymph node-negative tumors. Similarly, high cytoplasmic CXCR4 expression occurred more commonly in lymph node-positive tumors (11.2% versus 5.1%, P = 0.113). In contrast, predominantly nuclear CXCR4 staining was more likely to be found in lymph node-negative tumors (54.5% versus 37.8%, P = 0.018). Furthermore, cytoplasmic CXCR4 coexpressed with HER2-neu was the only factor associated with involvement of four or more lymph nodes (16.7% versus 1.2%, P = 0.04) among lymph node-positive tumors. When all three biomarkers (CCR7, CXCR4, HER2-neu) were utilized together, 50.0% of lymph node-positive tumors highly expressed one of these biomarkers compared with 18.8% of the lymph node-negative tumors (P < 0.0001). CONCLUSIONS Our results suggest that the chemokine receptor CCR7 is a novel biomarker that can predict lymph node metastases in breast cancer. Utilization of additional markers, such as CXCR4 and HER2-neu, further improves the prediction of the presence and extent of lymph node involvement.
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Affiliation(s)
- Neslihan Cabioglu
- Department of Cancer Biology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Okamoto T, Yamazaki K, Kanbe M, Kodama H, Omi Y, Kawamata A, Suzuki R, Igari Y, Tanaka R, Iihara M, Ito Y, Sawada T, Nishikawa T, Maki M, Kusakabe K, Mitsuhashi N, Obara T. Probability of axillary lymph node metastasis when sentinel lymph node biopsy is negative in women with clinically node negative breast cancer: a Bayesian approach. Breast Cancer 2005; 12:203-10. [PMID: 16110290 DOI: 10.2325/jbcs.12.203] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although sentinel lymph node biopsy(SLNB)is highly accurate in predicting axillary nodal status in patients with breast cancer, it has been shown that the procedure is associated with a few false negative results. The risk of leaving metastatic nodes behind in the axillary basin when SLNB is negative should be estimated for an individual patient if SLNB is performed to avoid conventional axillary lymph node dissection(ALND). METHODS A retrospective analysis of 512 women with T1-3N0M0 breast cancer was conducted to derive a prevalence of nodal metastasis by T category as a pre-test(i.e., before SLNB)probability and to examine potential confounders on the relationship between T category and axillary nodal involvement. Probability of nodal metastasis when SLNB was negative was estimated by means of Bayes' theorem which incorporated the pre-test probability and sensitivity and specificity of SLNB. RESULTS Axillary nodal metastasis was observed in 6.1% of T1a-b, 25.1% of T1c, 28.7% of T2, 35.0% of T3 tumors. Point estimates for the probability of nodal involvement when SLNB was negative ranged from 0.3-1.3% for T1a-b, 1.6-6.3% for T1c, 2.0-7.5% for T2, and 2.6-9.7% for T3 tumors with representative sensitivities of 80%, 85%, 90% and 95%, respectively. The risk may be higher when the tumor involves the upper outer quadrant of the breast, while it may be lower for an underweight woman. CONCLUSIONS The probability of axillary lymph node metastasis when SLNB is negative can be estimated using a Bayesian approach. Presenting the probability to the patient may guide the decision of surgery without conventional ALND.
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Affiliation(s)
- Takahiro Okamoto
- Department of Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Martelli G, Boracchi P, De Palo M, Pilotti S, Oriana S, Zucali R, Daidone MG, De Palo G. A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up. Ann Surg 2005; 242:1-6; discussion 7-9. [PMID: 15973094 PMCID: PMC1357697 DOI: 10.1097/01.sla.0000167759.15670.14] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SUMMARY BACKGROUND DATA Axillary dissection, an invasive procedure that may adversely affect quality of life, used to obtain prognostic information in breast cancer, is being supplanted by sentinel node biopsy. In older women with early breast cancer and no palpable axillary nodes, it may be safe to give no axillary treatment. We addressed this issue in a randomized trial comparing axillary dissection with no axillary dissection in older patients with T1N0 breast cancer. METHODS From 1996 to 2000, 219 women, 65 to 80 years of age, with early breast cancer and clinically negative axillary nodes were randomized to conservative breast surgery with or without axillary dissection. Tamoxifen was prescribed to all patients for 5 years. The primary endpoints were axillary events in the no axillary dissection arm, comparison of overall mortality (by log rank test), breast cancer mortality, and breast events (by Gray test). RESULTS Considering a follow-up of 60 months, there were no significant differences in overall or breast cancer mortality, or crude cumulative incidence of breast events, between the 2 groups. Only 2 patients in the no axillary dissection arm (8 and 40 months after surgery) developed overt axillary involvement during follow-up. CONCLUSIONS Older patients with T1N0 breast cancer can be treated by conservative breast surgery and no axillary dissection without adversely affecting breast cancer mortality or overall survival. The very low cumulative incidence of axillary events suggests that even sentinel node biopsy is unnecessary in these patients. Axillary dissection should be reserved for the small proportion of patients who later develop overt axillary disease.
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Affiliation(s)
- Gabriele Martelli
- Unit of Diagnostic Oncology and Out-Patient Clinic, Istituto Nazionale Tumori, Milan, Italy.
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Viale G, Zurrida S, Maiorano E, Mazzarol G, Pruneri G, Paganelli G, Maisonneuve P, Veronesi U. Predicting the status of axillary sentinel lymph nodes in 4351 patients with invasive breast carcinoma treated in a single institution. Cancer 2005; 103:492-500. [PMID: 15612028 DOI: 10.1002/cncr.20809] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Reliable predictors of metastatic involvement would enable a better selection of candidate patients for sentinel lymph node biopsy (SLNB) and possibly allow identification of patients with such a low risk of axillary sentinel lymph node (SLN) involvement to be even spared SLNB. METHODS The authors evaluated 4351 consecutive patients surgically treated for breast carcinoma who also underwent SLNB. Clinicopathologic features significantly associated with SLN metastases by univariate analysis were included in a multivariate model. RESULTS By multivariate analysis, the prevalence of SLN metastases was associated directly with tumor size, multifocality, and with the occurrence of peritumoral vascular invasion (PVI; all P < 0.0001), and was associated inversely with a favorable histotype (P = 0.0007) and lack of progesterone receptors (P = 0.004). A predictive model based on the features more closely associated with SLN status documented that the patients with a favorable tumor type </= 1 cm in size and without PVI (n = 178 [4% of the population]) had the lowest risk of SLN metastases (9.5%) whereas patients with tumors > 2 cm and with PVI (n = 250 [5.7% of the population]) had the highest risk (77.2%) of SLN involvement. CONCLUSIONS Tumor size and PVI emerged as the most powerful independent predictors of SLN metastases. Although no combination of features identified patients with a < 9.5% risk of SLN metastases, the current data may be used to tailor the management of patients with breast carcinoma with the aim of minimizing as much as possible the diagnostic and therapeutic procedures, thus improving the quality of life of the patients without any adverse effect on their survival rates.
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Affiliation(s)
- Giuseppe Viale
- Department of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Milan, Italy.
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Fujimoto N, Amemiya A, Kondo M, Takeda A, Shigematsu N. Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection. Cancer 2004; 101:2155-63. [PMID: 15476272 DOI: 10.1002/cncr.20650] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of axillary lymph node dissection (AxD) for patients with breast carcinoma who have clinically negative lymph nodes (cN0) and undergo breast-conserving therapy has been controversial. If patients do not undergo AxD, then it is uncertain whether specific lymph node irradiation should be given. The authors compared the results obtained from patients w ho underwent AxD with the results from patients who received axillary irradiation (AxR) using one of two radiotherapy techniques. METHODS Patients with T1-T2cN0 breast carcinoma were treated from 1983 to 2002 with either AxD (80 patients) or AxR (1134 patients received tangential-field [2-field] irradiation, and 303 patients received 3-field irradiation). The median follow-up was 161 months for the AxD group and 66 months for the AxR group (55 months for patients who received tangential-field irradiation, and 122 months for patients who received 3-field irradiation). RESULTS One patient in the AxD group and 35 patients in the AxR group had axillary recurrences. The 10-year cumulative axillary recurrence rates were 1.3% and 4.6% for the AxD group and the AxR group, respectively (P = 0.21). For patients with T1 tumors, the 10-year overall survival rates for the two groups were 94.7% and 92.7%, respectively (P = 0.34); and, for patients with T2 tumors, the 10-year overall survival rates were 92.5% and 89.1%, respectively (P = 0.34). In the AxR group, the 5-year axillary recurrence rates were 2.5% for patients who received tangential-field irradiation and 1.7% for patients who received 3-field irradiation (P = 0.18), and the 5-year regional recurrence rates for the two groups were 4.8% and 2.4%, respectively (P = 0.048). On multivariate analysis, positive lymphovascular invasion, outer tumor location, and larger tumor size were significant risk factors for regional failure. CONCLUSIONS For patients with cN0 breast carcinoma, AxD and AxR yielded the same overall survival rates. Most patients can be treated safely with tangential-field irradiation alone. Patients who are at increased risk of regional failure may benefit from three-field irradiation.
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Affiliation(s)
- Naoko Fujimoto
- Department of Surgery, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
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Chao TC, Chen MF, Wang CS, Jan YY, Hwang TL, Chen SC. Small invasive breast carcinomas in Taiwanese women. Ann Surg Oncol 2003; 10:740-7. [PMID: 12900364 DOI: 10.1245/aso.2003.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Female Taiwanese breast cancer patients are younger than their Western counterparts. This study examined the predictors of axillary lymph node metastases in Taiwanese women with T1 breast cancer. METHODS Data from 394 Taiwanese women with T1 invasive breast carcinoma were retrospectively reviewed. RESULTS The data contained 6 T1a, 51 T1b, and 337 T1c breast tumors. The patients' ages ranged from 23 to 82 years (mean +/- SD, 48.2 +/- 11.4 years; median, 46.4 years). Axillary nodal metastases were present in 38.3% of the patients (16.7% in T1a, 35.3% in T1b, and 39.2% in T1c tumors). The patients with nodal metastases had significantly greater body weights and S-phase fractions than those without nodal metastases. Univariate analysis revealed that unfavorable pathology, lymphovascular invasion, S-phase fraction >7%, and nondiploid DNA ploidy were significantly associated with lymph node metastases. Lymphovascular invasion was the only significant variable as the independent predictor in the multiple logistic regression analysis. In the Cox proportional hazards regression analysis, axillary nodal status and lymphovascular invasion were significantly associated with survival. CONCLUSIONS Taiwanese women with small breast cancer displayed a relatively higher incidence of axillary lymph node metastases than Western women. Axillary lymph node dissection or sentinel lymph node biopsy should be conducted on Taiwanese patients with small invasive breast carcinomas, particularly when risk factors exist.
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Affiliation(s)
- Tzu-Chieh Chao
- Division of General Surgery, Department of Surgery, Chang Gung University College of Medicine, Keelung, Taiwan.
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Martelli G, Miceli R, De Palo G, Coradini D, Salvadori B, Zucali R, Galante E, Marubini E. Is axillary lymph node dissection necessary in elderly patients with breast carcinoma who have a clinically uninvolved axilla? Cancer 2003; 97:1156-63. [PMID: 12599220 DOI: 10.1002/cncr.11173] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Axillary dissection in elderly patients with early-stage breast carcinoma who do not have palpable axillary lymph nodes is controversial because of the associated morbidity of the surgery, reduced life expectancy of the patients, and efficacy of hormone therapy in preventing recurrences and axillary events. METHODS The authors performed a retrospective analysis of 671 consecutive patients with breast carcinoma who were age >or= 70 years and who underwent conservative breast surgery with axillary dissection (172 patients) or without axillary dissection (499 patients). Tamoxifen always was given. The effects of axillary dissection compared with no axillary dissection on breast carcinoma mortality and distant metastasis were analyzed using multiple proportional-hazards regression models. Because the assignment to axillary treatment was nonrandom, covariate adjustments were made for baseline variables that influenced the decision to perform axillary dissection and for prognostic factors. RESULTS The crude cumulative incidence curves for breast carcinoma mortality and distant metastasis did not appear to differ significantly between the two groups (P = 0.530 and P = 0.840, respectively). The crude cumulative incidences of axillary lymph node occurrence at 5 years and 10 years were 4.4% and 5.9%, respectively (3.1% and 4.1%, respectively, for patients with pT1 tumors). CONCLUSIONS Elderly patients with breast carcinoma who have no evidence of axillary lymph node involvement may be treated effectively with conservative surgery and tamoxifen. Immediate axillary dissection is not necessary but should be performed in the small percentage of patients who later develop overt axillary lymph node involvement.
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MESH Headings
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Axilla
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Female
- Humans
- Lymph Node Excision
- Lymphatic Metastasis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Retrospective Studies
- Survival Rate
- Tamoxifen/therapeutic use
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Affiliation(s)
- Gabriele Martelli
- Unit of Diagnostic Oncology and Outpatient Clinic, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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