Top

Published in:

02-07-2022 | Metastasis | Original Article

Predictive Factors for Unnecessary Axillary Dissection According to SLN Metastasis in T1, T2 Stage Breast Cancer

Authors: Sami Benli, Süleyman Özkan Aksoy, Ali İbrahim Sevinç, Merih Güray Durak, Caner Baysan

Published in: Indian Journal of Surgical Oncology | Issue 4/2022

Abstract

The axillary nodes’ status is essential in determining the treatment algorithm according to complete clinical staging. Unnecessary axillary lymph node dissection (ALND) has been prevented after sentinel lymph node biopsy (SLNB) has occurred in current practice. However, approximately half of patients with positive SLNB do not have axillary metastatic lymph nodes. Our study aims to predict unnecessary ALND in patients with SLN metastases by evaluating the patients’ clinicopathological data. In total, 221 patients with macrometastasis in SLNB who underwent completion ALND were evaluated retrospectively. Patients were divided into two groups: patients with metastases only in the sentinel lymph node and additional axillary lymph nodes. Univariate and multivariate logistic regression analyses were used to analyze the correlation between SLN metastasis and axillary lymph node metastasis; clinicopathological characteristics, including patient age, menopause status, tumor size and grade, receptor status proliferative marker status, and molecular subtypes of the tumor. In the evaluation of T1–2, cN0 breast cancer patients with SLNB in the form of macrometastasis, only SLNB metastasis was found in 118 (53.4%) patients. In 103 (46.6%) patients, additional axillary node metastasis was observed. The risk of additional nodal spread correlated with patient age older than fertility age (age of 49) (p = 0.015, OR: 1.96, 95% CI: 1.14–3.39) and the number of increased metastatic sentinel nodes (p < 0.001). In line with the data shown by our study, the rate of axillary metastases increases in patients over the age of fertility and as the number of metastatic SLNs increases.

Krag DN, Weaver DL, Alex JC, Fairmont JT (1993) Surgical resection and radio localisation of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 2:335–340. https://doi.org/10.1016/0960-7404(93)90064-6CrossRef

Bergkvist L, de Boniface J, Jonsson PE et al (2008) Axillary recurrence rate after negative sentinel node biopsy in breast cancer: three-year follow-up of the Swedish Multicenter Cohort Study. Ann Surg 247(1):150–156CrossRef

Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349(6):546–553CrossRef

Giuliano AE, Ballman KV, McCall L et al (2017) Effect of axillary dissection versus no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA 318(10):918–926CrossRef

Donker M, van Tienhoven G, Straver ME et al (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15(12):1303–1310CrossRef

National Comprehensive Cancer Network (NCCN) Clinical practice guidelines in oncology: breast, version 1.2012. http://www.nccn.org/ professionals/physician_gls/pdf/breast.pdf. Accessed 30 Jun 2017. 3

Morrow M, Jagsi R, McLeod MC et al (2018) Surgeon attitudes toward the omission of axillary dissection in early breast cancer. JAMA Oncol 4:1511–1516CrossRef

Zhang X (2018) Ying Wang A survey of current surgical treatment of early stage breast cancer in China. Oncoscience 5:239–247CrossRef

Giuliano AE, Haigh PI, Brennan MB et al (2000) Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 18(13):2553–2559CrossRef

10.

Lucci A, McCall LM, Beitsch PD et al (2007) American College of Surgeons Oncology Group Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 25(24):3657–3663CrossRef

11.

Zurrida S, Veronesi U (2015) Milestones in breast cancer treatment. Breast J 21(1):3–12. https://doi.org/10.1111/tbj.12361CrossRef

12.

Krag DN, Weaver DL, Alex JC et al (1993) Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using agamma probe. Surg Oncol 2:335–339CrossRef

13.

Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553CrossRef

14.

Kamath VJ, Giuliano R, Dauway EL et al (2001) Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection. Arch Surg 136(6):688–692CrossRef

15.

Turner RR, Chu KU, Qi K et al (2000) Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node. Cancer 89(3):574–581CrossRef

16.

Coutant C, Olivier C, Lambaudie E et al (2009) Comparison of models to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a prospective multicenter study. J Clin Oncol 27(17):2800–2808CrossRef

17.

Dong LF, Xu SY, Long JP, Wan F, Chen YD (2018) Role of number of sentinel nodes in predicting non-sentinel node metastasis in breast cancer. J Int Med Res 46(2):828–835. https://doi.org/10.1177/0300060517729589CrossRef

18.

Ding J, Jiang L, Wu W (2017) Predictive value of clinicopathological characteristics for sentinel lymph node metastasis in early breast cancer. Med Sci Monit 25(23):4102–4108. https://doi.org/10.12659/msm.902795CrossRef

19.

Gann PH, Colilla SA, Gapstur SM (1999) Winchester DJ andWinchester DP: Factors associated with axillary lymph nodemetastasis from breast carcinoma: descriptive and predictiveanalyses. Cancer 86:1511–1519CrossRef

20.

Gajdos C, Tartter PI, Bleiweiss IJ (1999) Lymphatic invasion, tumor size, and age are independent predictors of axillary lymphnode metastases in women with T1 breast cancers. Ann Surg 230:692–696CrossRef

21.

Holmberg L, Ponten J, Adami HO (1989) The biology and natural history of breast cancer from the screening perspective. World J Surg 13:25–30CrossRef

22.

Jin ML, Gong Y, Pei YC, Ji P, Hu X, Shao ZM (2020) Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems. Breast 49:93–100. https://doi.org/10.1016/j.breast.2019.11.003CrossRef

23.

Soran A, Ozmen T, Salamat A, Soybir G, Johnson R (2019) Lymph node ratio (LNR): predicting prognosis after neoadjuvant chemotherapy (NAC) in breast cancer patients. Eur J Breast Health 15(4):249–255. https://doi.org/10.5152/ejbh.2019.4848CrossRef

24.

Hung M, Xu J, Nielson D, Bounsanga J, Gu Y, Hansen AR, Voss MW (2018) Evaluating the prediction of breast cancer survival using lymph node ratio. J Breast Cancer 21(3):315–320. https://doi.org/10.4048/jbc.2018.21.e35CrossRef

25.

Tonellotto F, Bergmann A, de Souza Abrahão K, de Aguiar SS, Bello MA, Thuler LCS (2019) Impact of number of positive lymph nodes and lymph node ratio on survival of women with node-positive breast cancer. Eur J Breast Health. 15(2):76–84. https://doi.org/10.5152/ejbh.2019.4414CrossRef

26.

Orsaria P, Caredda E, Genova F, Materazzo M, Capuano I, Vanni G, Granai AV, De Majo A, Portarena I, Sileri P, Petrella G, Palombi L, Buonomo OC (2018) Additional nodal disease prediction in breast cancer with sentinel lymph node metastasis based on clinicopathological features. Anticancer Res 38(4):2109–2117. https://doi.org/10.21873/anticanres.12451CrossRef

27.

Wo JY, Chen K, Neville BA, Lin NU, Punglia RS (2011) Effect ofvery small tumor size on cancer-specific mortality in nodepositive breast cancer. J Clin Oncol 29:2619–2627CrossRef

Title: Predictive Factors for Unnecessary Axillary Dissection According to SLN Metastasis in T1, T2 Stage Breast Cancer
Authors: Sami Benli
Süleyman Özkan Aksoy
Ali İbrahim Sevinç
Merih Güray Durak
Caner Baysan
Publication date: 02-07-2022
Publisher: Springer India
Keywords: Metastasis
Breast Cancer
Breast Cancer
Published in: Indian Journal of Surgical Oncology / Issue 4/2022
Print ISSN: 0975-7651
Electronic ISSN: 0976-6952
DOI: https://doi.org/10.1007/s13193-022-01580-0

At a glance: The STEP trials

Springer Medicine

Predictive Factors for Unnecessary Axillary Dissection According to SLN Metastasis in T1, T2 Stage Breast Cancer

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2022

A Tribute to the “Naughty” Follicular Epithelium

Low-Grade Serous Ovarian Carcinoma: a Retrospective Study from a Tertiary Cancer Institute

Solid Pseudopapillary Neoplasm — Case Series and Review of Literature

The Impact of Narrow and Infiltrated Distal Margin After Proctectomy for Rectal Cancer on Patients’ Outcomes: a Systematic Review and Meta-analysis

Multi-quadrant Robotic-Assisted Surgery for Synchronous Tumours Involving the Genitourinary System — Our Experience

Pharyngocutaneous Fistula Following Primary Total Laryngectomy: a Meta-analysis