Top

Published in:

01-10-2010 | Breast Oncology

Axillary Recurrence in Breast Cancer Patients with Isolated Tumor Cells in the Sentinel Lymph Node [AJCC N0(i+)]

Authors: Amy C. Degnim, MD, Shaheen Zakaria, MD, Judy C. Boughey, MD, Nicole Sookhan, MD, Carol Reynolds, MD, John H. Donohue, MD, David R. Farley, MD, Clive S. Grant, MD, Tanya Hoskin, MS

Published in: Annals of Surgical Oncology | Issue 10/2010

Abstract

Background

Completion axillary lymph node dissection (CALND) is controversial in patients with sentinel lymph node (SLN) metastases ≤ 0.2 mm [N0 (i+)]. Our goal was to characterize patients with SLN isolated tumor cells regarding surgical management and axillary recurrence.

Materials and Methods

An Institutional Review Board (IRB)-approved retrospective chart review identified 677 consecutive patients with positive SLN biopsy for breast cancer between October 1997 and June 2004, and N0(i+) patients were identified. Clinicopathologic characteristics, predicted probability of nonsentinel node disease, axillary surgery, and recurrences were recorded.

Results

Of 81 patients with SLN N0(i+) metastasis, 31 underwent CALND and 50 did not. The two groups of patients showed no statistical differences in tumor size, stage, grade, number of SLNs removed, and number of positive SLNs. Predicted probability of additional axillary metastasis was somewhat higher among those who underwent CALND compared with those who did not. Patients undergoing CALND were significantly younger than those who did not (mean age 50 vs. 57, P = 0.01). Of the 31 patients with CALND, 4 (12.9%) had additional nodal metastases. Radiation to nodal fields was administered to 8 patients in the CALND group (25.8%) and to 7 in the group without axillary dissection (14.0%, P = 0.44). No axillary recurrences were noted at a median follow-up of 38 months.

Conclusion

Among breast cancer patients with SLN isolated tumor cells, a small percentage have additional metastasis in other axillary nodes. However, the risk of axillary recurrence appears low in those who do not undergo CALND.

Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. American Joint Committee on cancer staging manual. 6th ed. Chicago: American Joint Committee on Cancer; 2002.

de Mascarel I, MacGrogan G, Debled M, Brouste V, Mauriac L. Distinction between isolated tumor cells and micrometastases in breast cancer: is it reliable and useful? Cancer. 2008;112:1672–8.CrossRefPubMed

Cox CE, Kiluk JV, Riker AL, Cox JM, Allred N, Ramos DC, et al. Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg. 2008;206:261–8.CrossRefPubMed

Viale G, Maiorano E, Mazzarol G, Zurrida S, Galimberti V, Luini A, et al. Histologic detection and clinical implications of micrometastases in axillary sentinel lymph nodes for patients with breast carcinoma. Cancer. 2001;92:1378–84.CrossRefPubMed

International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet. 1990;335:1565–8.

Van Rijk MC, Peterse JL, Nieweg OE, Oldenburg HS, Rutgers EJ, Kroon BB. Additional axillary metastases and stage migration in breast cancer patients with micrometastases or submicrometastases in sentinel lymph nodes. Cancer. 2006;107:467–71.CrossRefPubMed

Rutgers E. Sentinel node biopsy: interpretation and management of patients with immunohistochemistry-positive sentinel nodes and those with micrometastases. J Clin Oncol. 2008;26:698–702.CrossRefPubMed

Alran S, De Rycke Y, Fourchette V, Charitansky H, Laki F, Falcou MC, et al. Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node involvement after positive sentinel node biopsy. Ann Surg Oncol. 2007;14:2195–201.CrossRefPubMed

Herbert GS, Sohn VY, Brown TA. The impact of nodal isolated tumor cells on survival of breast cancer patients. Am J Surg. 2007;193:571–4.CrossRefPubMed

10.

Dowlatshahi K, Fan M, Bloom KJ, Spitz DJ, Patel S, Snider HC Jr. Occult metastases in the sentinel lymph nodes of patients with early stage breast carcinoma: a preliminary study. Cancer. 1999;86:990–6.CrossRefPubMed

11.

van Deurzen CH, de Boer M, Monninkhof EM, Bult P, van der Wall E, Tjan-Heijnen VC, et al. Non-sentinel lymph node metastases associated with isolated breast cancer cells in the sentinel node. J Natl Cancer Inst. 2008;100:1574–80.CrossRefPubMed

12.

Reed J, Rosman M, Verbanac KM, Mannie A, Cheng Z, Tafra L. Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg. 2009;208:333–40.CrossRefPubMed

13.

Fisher B, Montague E, Redmond C, Barton B, Borland D, Fisher ER, et al. Comparison of radical mastectomy with alternative treatments for primary breast cancer: a first report of results from a prospective randomized clinical trial. Cancer. 1977;39:2827–39.CrossRefPubMed

14.

Louis-Sylvestre C, Clough K, Asselain B, Vilcoq JR, Salmon RJ, Campana F, et al. Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow up. J Clin Oncol. 2004;22:97–101.CrossRefPubMed

15.

Langer I, Marti WR, Guller U, Moch H, Harder F, Oertli D, et al. Axillary recurrence rate in breast cancer patients with negative sentinel lymph node (SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg. 2005;241:152–8.PubMed

16.

Fournier K, Schiller A, Perry RR, Laronga C. Micrometastasis in the sentinel lymph node of breast cancer does not mandate completion axillary dissection. Ann Surg. 2004;239:859–63.CrossRefPubMed

17.

Naik AM, Fey J, Gemignani M, Heerdt A, Montgomery L, Petrek J, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240:462–8.CrossRefPubMed

18.

White RL, Wilke LG. Update on the NSABP and ACOSOG breast cancer sentinel node trials. Am Surg. 2004;70:420–4.PubMed

Title: Axillary Recurrence in Breast Cancer Patients with Isolated Tumor Cells in the Sentinel Lymph Node [AJCC N0(i+)]
Authors: Amy C. Degnim, MD
Shaheen Zakaria, MD
Judy C. Boughey, MD
Nicole Sookhan, MD
Carol Reynolds, MD
John H. Donohue, MD
David R. Farley, MD
Clive S. Grant, MD
Tanya Hoskin, MS
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 10/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1062-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Axillary Recurrence in Breast Cancer Patients with Isolated Tumor Cells in the Sentinel Lymph Node [AJCC N0(i+)]

Abstract

Background

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2010

Impact of US Surveillance on Detection of Clinically Occult Locoregional Recurrence after Mastectomy for Breast Cancer

Factors Determining the Sensitivity of Intraoperative Ultrasonography in Detecting Colorectal Liver Metastases in the Modern Era

Prognostic Significance of Free Peritoneal Tumor Cells in the Peritoneal Cavity Before and After Neoadjuvant Chemotherapy in Patients with Gastric Carcinoma Undergoing Potentially Curative Resection

Overexpression of Endothelial Cell Specific Molecule-1 (ESM-1) in Gastric Cancer

Predictors of Extrahepatic Recurrence After Curative Hepatectomy for Hepatocellular Carcinoma

Prospective Assessment of Postoperative Complications and Associated Costs Following Inguinal Lymph Node Dissection (ILND) in Melanoma Patients