Published in:
01-01-2007
Risk Factors for Non-Sentinel Lymph Node Metastases in Patients with Breast Cancer. The Outcome of a Multi-institutional Study
Authors:
Marieke J. Bolster, Petronella G. M. Peer, Peter Bult, Frederik B. J. M. Thunnissen, René F. M. Schapers, Jos W. R. Meijer, Luc J. A. Strobbe, Charles L. H. van Berlo, Jean H. G. Klinkenbijl, Louk V. A. M. Beex, Theo Wobbes, Vivianne C. G. Tjan-Heijnen
Published in:
Annals of Surgical Oncology
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Issue 1/2007
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ABSTRACT
Background
In this multi-institutional prospective study, we evaluated whether we could identify risk factors predictive for non-sentinel lymph node (non-SN) metastases in breast cancer patients with a positive sentinel lymph node (SN).
Methods
In this multi-institutional study, 541 eligible breast cancer patients were included prospectively.
Results
The occurrence of non-SN metastases was related to the size of the SN metastasis (P = .02), primary tumor size (P = .001), and lymphovascular invasion (P = .07). The adjusted odds ratio was 3.1 for SN micro-metastasis compared with SN isolated tumor cells, 4.0 for SN macro-metastasis versus SN isolated tumor cells, 3.1 for tumor size (>3.0 cm compared with ≤3.0 cm), and 2.0 for lymphovascular invasion (yes versus no). There were no positive non-SNs when the primary tumor size was ≤1.0 cm (n = 24) [95% confidence interval (95% CI) 0%–14.0%]. The proportion of positive non-SNs ranged in a prognostic logistic regression model from 9.7% (95% CI 4.0%–23.0%) for patients with SN isolated tumor cells, tumor size of 1.1–3.0 cm, and without vessel invasion, to 72.6% (95% CI 47.0%–89.0%) for patients with SN macro-metastasis, tumor size >3.0 cm, and with vessel invasion.
Conclusion
We identified three predictive factors for non-SN metastases in breast cancer patients with a positive SN: size of the SN metastasis; primary tumor size; and vessel invasion. We were not able to identify a specific group of patients with a positive SN in whom the risk for non-SN metastases was less than 5%.