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Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study

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Pathology & Oncology Research

Abstract

Sentinel lymph node (SLN) biopsy has become the preferred method for the nodal staging of early breast cancer, but controversy exists regarding its universal use and consequences in small tumors. 2929 cases of breast carcinomas not larger than 15 mm and staged with SLN biopsy with or without axillary dissection were collected from the authors′ institutions. The pathology of the SLNs included multilevel hematoxylin and eosin (HE) staining. Cytokeratin immunohistochemistry (IHC) was commonly used for cases negative with HE staining. Variables influencing SLN involvement and non-SLN involvement were studied with logistic regression. Factors that influenced SLN involvement included tumor size, multifocality, grade and age. Small tumors up to 4 mm (including in situ and microinvasive carcinomas) seem to have SLN involvement in less than 10%. Non-SLN metastases were associated with tumor grade, the ratio of involved SLNs and SLN involvement type. Isolated tumor cells were not likely to be associated with further nodal load, whereas micrometastases had some subsets with low risk of non-SLN involvement and subsets with higher proportion of further nodal spread. In situ and microinvasive carcinomas have a very low risk of SLN involvement, therefore, these tumors might not need SLN biopsy for staging, and this may be the approach used for very small invasive carcinomas. If an SLN is involved, isolated tumor cells are rarely if ever associated with non-SLN metastases, and subsets of micrometastatic SLN involvement may be approached similarly. With macrometastases the risk of non-SLN involvement increases, and further axillary treatment should be generally indicated.

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Abbreviations

ALND:

axillary lymph node dissection

DCIS:

ductal carcinoma in situ

ITC:

isolated tumor cells

LVI:

lymphovascular invasion

SLN:

sentinel lymph node

SLNB:

sentinel lymph node biopsy

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Authors and Affiliations

  1. Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    Gábor Cserni MD, PhD & Rita Bori

  2. Department of Human Pathology and Oncology, University of Florence, Florence, Italy

    Simonetta Bianchi & Vania Vezzosi

  3. Department of Pathology, Sant’Anna Hospital, Turin, Italy

    Riccardo Arisio

  4. Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Johannes L. Peterse

  5. Department of Biological Science and Human Oncology, University of Turin, Turin, Italy

    Anna Sapino & Isabella Castellano

  6. Pathologische Ontleedkunde, University Hospitals Leuven, Leuven, Belgium

    Maria Drijkoningen

  7. 2nd Department of Pathology, Semmelweis University, Budapest, Hungary

    Janina Kulka

  8. Sezione Anatomia Patologica M. Malpighi, Universita di Bologna, Ospedale Bellaria, Bologna, Italy

    Vincenzo Eusebi & Maria P. Foschini

  9. Service d’ Anatomie Pathologique, Hopital de Hautepierre, Strasbourg, France

    Jean-Pierre Bellocq & Cristi Marin

  10. Department of Pathology and Cytology, Kalmar Hospital, Kalmar, Sweden

    Sten Thorstenson

  11. Instituto de Patologia e Imunologia da Universidade do Porto (IPATIMUP) and Hospital de S. João, Porto, Portugal

    Isabel Amendoeira

  12. Institute of Pathology, Donauspital, Wien, Austria

    Angelika Reiner-Concin

  13. Gerhard-Domagk Institut fur Pathologie, Universitat von Munster, Munster, Germany

    Thomas Decker

  14. Laboratorio De Histopatologica, Centro Regional De Oncologia De Coimbra, Coimbra, Portugal

    Manuela Lacerda & Paulo Figueiredo

  15. Department of Informatics, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    Gábor Fejes

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  1. Gábor Cserni MD, PhD
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  2. Simonetta Bianchi
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  3. Vania Vezzosi
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  4. Riccardo Arisio
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  5. Rita Bori
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  14. Cristi Marin
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  15. Sten Thorstenson
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  16. Isabel Amendoeira
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  17. Angelika Reiner-Concin
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  18. Thomas Decker
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  19. Manuela Lacerda
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  20. Paulo Figueiredo
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  21. Gábor Fejes
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Correspondence to Gábor Cserni MD, PhD.

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Cserni, G., Bianchi, S., Vezzosi, V. et al. Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study. Pathol. Oncol. Res. 13, 5–14 (2007). https://doi.org/10.1007/BF02893435

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  • DOI: https://doi.org/10.1007/BF02893435

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