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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 3/2017

Open Access 01-10-2017 | Clinical trial

Different outcome in node-positive breast cancer patients found by axillary ultrasound or sentinel node procedure

Authors: Nicole C. Verheuvel, Adri C. Voogd, Vivianne C. G. Tjan-Heijnen, S. Siesling, Rudi M. H. Roumen

Published in: Breast Cancer Research and Treatment | Issue 3/2017

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Abstract

Background

The Z0011 trial initiated a paradigm shift in the axillary treatment of breast cancer patients with a positive sentinel lymph node biopsy (SLNB), disregarding patients with a positive ultrasound-guided lymph node biopsy (UGLNB). We examined whether relevant differences exist between these patients to determine if the conclusions of the ACOSOG Z0011 trial are applicable to UGLNB-positive patients.

Methods

Patients diagnosed with invasive breast cancer in the Netherlands between January 2008 and December 2014 were selected from the Netherlands Cancer Registry.

Results

A total of 11,820 cases were included: 9149 cases in the SLNB group and 2671 in the UGLNB group. Multivariate analyses showed that UGLNB-positive patients were older (p < 0.001), more likely to have a poorly differentiated tumor (p < 0.001), had a negative hormone receptor status (p < 0.001), and more often had extensive nodal involvement (p < 0.001). However, they were less likely to undergo adjuvant radiation (p = 0.004) or systemic therapy (p < 0.001). Even after adjusting for these factors, UGLNB-positive patients had a worse overall survival (HR = 1.38; 95% CI 1.23–1.56) than SLNB-positive patients.

Conclusion

This nationwide retrospective study shows that young patients found positive by UGLNB have less favorable disease characteristics and a worse prognosis compared to patients with a positive SLNB. Selection by ultrasound plays an important role when axillary treatment strategies are considered. Hence, the conclusions of the Z0011 trial cannot unconditionally be applied to patients with a positive UGLNB.
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Metadata
Title
Different outcome in node-positive breast cancer patients found by axillary ultrasound or sentinel node procedure
Authors
Nicole C. Verheuvel
Adri C. Voogd
Vivianne C. G. Tjan-Heijnen
S. Siesling
Rudi M. H. Roumen
Publication date
01-10-2017
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 3/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-017-4342-1

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