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06-09-2024 | Breast Cancer | Breast Oncology

Incidence of Pathologic Nodal Disease in Clinically Node-Negative, Microinvasive or T1a Breast Cancers

Authors: Pranam Dey, MD, MBA, Madhav Kc, PhD, MPH, Ellie M. Proussaloglou, MD, Jasmine A. Khubchandani, MD, MHS, Leah Kim, MD, Gregory Zanieski, MD, Tristen Park, MD, Melanie Lynch, MD, Alyssa Gillego, MD, Monica Valero, MD, Eric Schneider, PhD, Mehra Golshan, MD, MBA, Rachel A. Greenup, MD, MPH, Elizabeth R. Berger, MD, MS

Published in: Annals of Surgical Oncology

Abstract

Background

Axillary staging in early-stage breast cancer can impact adjuvant treatment options but also has associated morbidity. The incidence of pathologic nodal positivity (pN+) in patients with microinvasive or T1a disease is poorly characterized and the value of sentinel node biopsy remains controversial.

Methods

Women with cN0 and pathologic microinvasive or T1a cancer who underwent upfront surgery were identified from the National Cancer Database. Pathologic nodal stage at the time of surgery was the primary outcome. Multivariable logistic modeling was used to assess predictors of pN+.

Results

Overall, 141,840 women were included; 139,206 had pathologic node-negative (pN0) disease and 2634 had pN+ disease. Rates of pN+ disease differed by receptor status, with the highest rates in hormone receptor-negative/human epidermal growth factor receptor 2-positive (HR−/HER2+) disease compared with triple-negative breast cancer (TNBC), HR-positive/HER2-negative (HR+/HER2−), and triple positive breast cancer. Rates of pN+ were also higher with lobular histology compared with ductal histology. Multivariable analysis demonstrated that compared with White women, Black women had higher odds of pN+ disease, and compared with women <50 years of age, women >70 years of age had higher odds of pN+ disease. Compared with women with HR+/HER2− disease, women with TNBC, triple-positive breast cancer, and HR−/HER2+ all had lower odds, and women with invasive lobular disease had higher odds compared with women with invasive ductal disease. Women with significant comorbidities also had higher odds of node positivity.

Conclusion

Over 90% of patients with clinically node-negative, microinvasive and T1a breast cancer remain pathologically node-negative following axillary staging. However, higher rates of nodal disease were found among Black patients, older patients, and patients with lobular cancer and significant comorbidities.

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Title: Incidence of Pathologic Nodal Disease in Clinically Node-Negative, Microinvasive or T1a Breast Cancers
Authors: Pranam Dey, MD, MBA
Madhav Kc, PhD, MPH
Ellie M. Proussaloglou, MD
Jasmine A. Khubchandani, MD, MHS
Leah Kim, MD
Gregory Zanieski, MD
Tristen Park, MD
Melanie Lynch, MD
Alyssa Gillego, MD
Monica Valero, MD
Eric Schneider, PhD
Mehra Golshan, MD, MBA
Rachel A. Greenup, MD, MPH
Elizabeth R. Berger, MD, MS
Publication date: 06-09-2024
Publisher: Springer International Publishing
Keywords: Breast Cancer
Breast Cancer
Published in: Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-16124-9

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Webinar | 06-02-2024 | 20:00 (CET)

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

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Springer Medicine

Incidence of Pathologic Nodal Disease in Clinically Node-Negative, Microinvasive or T1a Breast Cancers

Abstract

Background

Methods

Results

Conclusion

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions