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25-04-2024 | Metastasis | Clinical trial

Characteristics and risk factors of axillary lymph node metastasis of microinvasive breast cancer

Authors: Soo-Young Lee, Tae-Kyung Yoo, Jisun Kim, Il Yong Chung, Beom Seok Ko, Hee Jeong Kim, Jong Won Lee, Byung Ho Son, Sae Byul Lee

Published in: Breast Cancer Research and Treatment

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Abstract

Purpose

To select patients who would benefit most from sentinel lymph node biopsy (SLNB) by investigating the characteristics and risk factors of axillary lymph node metastasis (ALNM) in microinvasive breast cancer (MIBC).

Methods

This retrospective study included 1688 patients with MIBC who underwent breast surgery with axillary staging at the Asan Medical Center from 1995 to 2020.

Results

Most patients underwent SLNB alone (83.5%). Seventy (4.1%) patients were node-positive, and the majority had positive lymph nodes < 10 mm, with micro-metastases occurring frequently (n = 37; 55%). Node-positive patients underwent total mastectomy and axillary lymph node dissection (ALND) more than breast-conserving surgery (BCS) and SLNB compared with node-negative patients (p < 0.001). In the multivariate analysis, independent predictors of ALNM included young age [odds ratio (OR) 0.959; 95% confidence interval (CI) 0.927–0.993; p = 0.019], ALND (OR 11.486; 95% CI 5.767–22.877; p < 0.001), number of lymph nodes harvested (≥ 5) (OR 3.184; 95% CI 1.555–6.522; p < 0.001), lymphovascular invasion (OR 6.831; 95% CI 2.386–19.557; p < 0.001), presence of multiple microinvasion foci (OR 2.771; 95% CI 1.329–5.779; p = 0.007), prominent lymph nodes in preoperative imaging (OR 2.675; 95% CI 1.362–5.253; p = 0.004), and hormone receptor positivity (OR 2.491; 95% CI 1.230–5.046; p = 0.011).

Conclusion

Low ALNM rate (4.1%) suggests that routine SLNB for patients with MIBC is unnecessary but can be valuable for patients with specific risk factors. Ongoing trials for omitting SLNB in early breast cancer, and further subanalyses focusing on rare populations with MIBC are necessary.
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Literature
6.
go back to reference Poodt IG, Spronk PE, Vugts G, van Dalen T, Peeters MV, Rots ML, Schipper RJ et al (2018) Trends on axillary surgery in nondistant metastatic breast cancer patients treated between 2011 and 2015: a Dutch population-based study in the ACOSOG-Z0011 and AMAROS era. Ann Surg 268(6):1084–1090CrossRefPubMed Poodt IG, Spronk PE, Vugts G, van Dalen T, Peeters MV, Rots ML, Schipper RJ et al (2018) Trends on axillary surgery in nondistant metastatic breast cancer patients treated between 2011 and 2015: a Dutch population-based study in the ACOSOG-Z0011 and AMAROS era. Ann Surg 268(6):1084–1090CrossRefPubMed
8.
go back to reference Choi B, Jegatheeswaran L, Nakhoul M, Haria P, Srivastava R, Karki S, Babu E et al (2021) Axillary staging in ductal carcinoma in situ with microinvasion: a meta-analysis. Surg Oncol 37:101557CrossRefPubMed Choi B, Jegatheeswaran L, Nakhoul M, Haria P, Srivastava R, Karki S, Babu E et al (2021) Axillary staging in ductal carcinoma in situ with microinvasion: a meta-analysis. Surg Oncol 37:101557CrossRefPubMed
9.
go back to reference Magnoni F, Massari G, Santomauro G, Bagnardi V, Pagan E, Peruzzotti G, Sacchini VS et al (2019) Sentinel lymph node biopsy in microinvasive ductal carcinoma in situ. J Br Surg 106(4):375–383CrossRef Magnoni F, Massari G, Santomauro G, Bagnardi V, Pagan E, Peruzzotti G, Sacchini VS et al (2019) Sentinel lymph node biopsy in microinvasive ductal carcinoma in situ. J Br Surg 106(4):375–383CrossRef
11.
go back to reference Holm-Rasmussen EV, Jensen MB, Balslev E, Kroman N, Tvedskov TF (2019) Sentinel and non-sentinel lymph node metastases in patients with microinvasive breast cancer: a nationwide study. Breast Cancer Res Treat 175:713–719CrossRefPubMed Holm-Rasmussen EV, Jensen MB, Balslev E, Kroman N, Tvedskov TF (2019) Sentinel and non-sentinel lymph node metastases in patients with microinvasive breast cancer: a nationwide study. Breast Cancer Res Treat 175:713–719CrossRefPubMed
12.
go back to reference Paik PS, Paik NS, Lee ES, Choi JE, Jeong J, Youn HJ, Yoo TK et al (2022) Low incidence of lymph node metastasis in patients with microinvasive breast cancer: a Korean nationwide study. Ann Surg Treat Res 102(6):306–312CrossRefPubMedPubMedCentral Paik PS, Paik NS, Lee ES, Choi JE, Jeong J, Youn HJ, Yoo TK et al (2022) Low incidence of lymph node metastasis in patients with microinvasive breast cancer: a Korean nationwide study. Ann Surg Treat Res 102(6):306–312CrossRefPubMedPubMedCentral
14.
go back to reference Chen J, Luo B, Gao M, Cai G, Luo X, Zhang-Cai Y, Chen Y (2022) Regional lymph node metastasis and axillary surgery of microinvasive breast cancer: a population-based study. Diagnostics 12(5):1049CrossRefPubMedPubMedCentral Chen J, Luo B, Gao M, Cai G, Luo X, Zhang-Cai Y, Chen Y (2022) Regional lymph node metastasis and axillary surgery of microinvasive breast cancer: a population-based study. Diagnostics 12(5):1049CrossRefPubMedPubMedCentral
15.
go back to reference Phantana-Angkool A, Voci AE, Warren YE, Livasy CA, Beasley LM, Robinson MM, White RL et al (2019) Ductal carcinoma in situ with microinvasion on core biopsy: evaluating tumor upstaging rate, lymph node metastasis rate, and associated predictive variables. Ann Surg Oncol 26:3874–3882CrossRefPubMed Phantana-Angkool A, Voci AE, Warren YE, Livasy CA, Beasley LM, Robinson MM, White RL et al (2019) Ductal carcinoma in situ with microinvasion on core biopsy: evaluating tumor upstaging rate, lymph node metastasis rate, and associated predictive variables. Ann Surg Oncol 26:3874–3882CrossRefPubMed
16.
go back to reference Flanagan MR, Stempel M, Brogi E, Morrow M, Cody HS (2019) Is sentinel lymph node biopsy required for a core biopsy diagnosis of ductal carcinoma in situ with microinvasion? Ann Surg Oncol 26:2738–2746CrossRefPubMedPubMedCentral Flanagan MR, Stempel M, Brogi E, Morrow M, Cody HS (2019) Is sentinel lymph node biopsy required for a core biopsy diagnosis of ductal carcinoma in situ with microinvasion? Ann Surg Oncol 26:2738–2746CrossRefPubMedPubMedCentral
17.
go back to reference Ko BS, Lim WS, Kim HJ, Yu JH, Lee JW, Kwan SB, Ahn SH et al (2012) Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol 19:212–216CrossRefPubMed Ko BS, Lim WS, Kim HJ, Yu JH, Lee JW, Kwan SB, Ahn SH et al (2012) Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol 19:212–216CrossRefPubMed
18.
go back to reference Kapoor NS, Shamonki J, Sim MS, Chung CT, Giuliano AE (2013) Impact of multifocality and lymph node metastasis on the prognosis and management of microinvasive breast cancer. Ann Surg Oncol 20:2576–2581CrossRefPubMed Kapoor NS, Shamonki J, Sim MS, Chung CT, Giuliano AE (2013) Impact of multifocality and lymph node metastasis on the prognosis and management of microinvasive breast cancer. Ann Surg Oncol 20:2576–2581CrossRefPubMed
20.
go back to reference Orzalesi L, Casella D, Criscenti V, Gjondedaj U, Bianchi S, Vezzosi V, Nori J, Cecconi L, Meattini I, Livi L, Bernini M (2016) Microinvasive breast cancer: pathological parameters, cancer subtypes distribution, and correlation with axillary lymph nodes invasion: results of a large single-institution series. Breast cancer (Tokyo, Jpn) 23(4):640–648. https://doi.org/10.1007/s12282-015-0616-9CrossRef Orzalesi L, Casella D, Criscenti V, Gjondedaj U, Bianchi S, Vezzosi V, Nori J, Cecconi L, Meattini I, Livi L, Bernini M (2016) Microinvasive breast cancer: pathological parameters, cancer subtypes distribution, and correlation with axillary lymph nodes invasion: results of a large single-institution series. Breast cancer (Tokyo, Jpn) 23(4):640–648. https://​doi.​org/​10.​1007/​s12282-015-0616-9CrossRef
22.
go back to reference Pimiento JM, Lee MC, Esposito NN, Kiluk JV, Khakpour N, Carter WB, Han G, Laronga C (2011) Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Practe 7(5):309–313CrossRef Pimiento JM, Lee MC, Esposito NN, Kiluk JV, Khakpour N, Carter WB, Han G, Laronga C (2011) Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Practe 7(5):309–313CrossRef
23.
go back to reference Wang W, Zhu W, Du F, Luo Y, Xu B (2017) The demographic features, clinicopathological characteristics and cancer-specific outcomes for patients with microinvasive breast cancer: a SEER database analysis. Sci Rep 7(1):42045CrossRefPubMedPubMedCentral Wang W, Zhu W, Du F, Luo Y, Xu B (2017) The demographic features, clinicopathological characteristics and cancer-specific outcomes for patients with microinvasive breast cancer: a SEER database analysis. Sci Rep 7(1):42045CrossRefPubMedPubMedCentral
24.
go back to reference Chen C, Huang S, Huang A, Jia Y, Wang J, Zhang Z, Mao M, Wang L, Zhou J (2018) Risk factors for lymph node metastasis and the impact of adjuvant chemotherapy on ductal carcinoma in situ with microinvasion: a population-based study. OncoTargets therapy 18:9071–9080CrossRef Chen C, Huang S, Huang A, Jia Y, Wang J, Zhang Z, Mao M, Wang L, Zhou J (2018) Risk factors for lymph node metastasis and the impact of adjuvant chemotherapy on ductal carcinoma in situ with microinvasion: a population-based study. OncoTargets therapy 18:9071–9080CrossRef
27.
go back to reference Daidone MG, Coradini D, Martelli G, Veneroni S (2003) Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol 45(3):313–325CrossRefPubMed Daidone MG, Coradini D, Martelli G, Veneroni S (2003) Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol 45(3):313–325CrossRefPubMed
28.
go back to reference Wildiers H, Van Calster B, van de Poll-Franse LV, Hendrickx W, Røislien J, Smeets A et al (2009) Relationship between age and axillary lymph node involvement in women with breast cancer. J Clin Oncol 27(18):2931–2937CrossRefPubMed Wildiers H, Van Calster B, van de Poll-Franse LV, Hendrickx W, Røislien J, Smeets A et al (2009) Relationship between age and axillary lymph node involvement in women with breast cancer. J Clin Oncol 27(18):2931–2937CrossRefPubMed
32.
go back to reference Dihge L, Bendahl PO, Rydén L (2017) Nomograms for preoperative prediction of axillary nodal status in breast cancer. J Br Surg 104(11):1494–1505CrossRef Dihge L, Bendahl PO, Rydén L (2017) Nomograms for preoperative prediction of axillary nodal status in breast cancer. J Br Surg 104(11):1494–1505CrossRef
35.
go back to reference Liu Y, Ye F, Wang Y, Zheng X, Huang Y, Zhou J (2022) Elaboration and validation of a nomogram based on axillary ultrasound and tumor clinicopathological features to predict axillary lymph node metastasis in patients with breast cancer. Front Oncol 12:845334CrossRefPubMedPubMedCentral Liu Y, Ye F, Wang Y, Zheng X, Huang Y, Zhou J (2022) Elaboration and validation of a nomogram based on axillary ultrasound and tumor clinicopathological features to predict axillary lymph node metastasis in patients with breast cancer. Front Oncol 12:845334CrossRefPubMedPubMedCentral
Metadata
Title
Characteristics and risk factors of axillary lymph node metastasis of microinvasive breast cancer
Authors
Soo-Young Lee
Tae-Kyung Yoo
Jisun Kim
Il Yong Chung
Beom Seok Ko
Hee Jeong Kim
Jong Won Lee
Byung Ho Son
Sae Byul Lee
Publication date
25-04-2024
Publisher
Springer US
Published in
Breast Cancer Research and Treatment
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-024-07305-x
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