Predictive Value of Tumor Load in Breast Cancer Sentinel Lymph Nodes for Second Echelon Lymph Node MetastasesReport as inadecuate




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Cellular Oncology - Volume 29 2007, Issue 6, Pages 497-505



Department of Pathology, University Medical Center Utrecht, The Netherlands

Department of Surgery, University Medical Center Utrecht, The Netherlands

Department of Nuclear Medicine, University Medical Center Utrecht, The Netherlands

Department of Pathology, St. Antonius Hospital, Nieuwegein, The Netherlands

Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands



Copyright © 2007 Hindawi Publishing Corporation and the authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The need for routine axillary lymph node dissection ALND in patients with invasive breast cancer and low-volume sentinel node SN involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND.

Methods: A consecutive series of 317 patients with invasive breast cancer and a tumor positive axillary SN followed by ALND was reviewed. Clinicopathologic features of the primary tumor and the SN were assessed as possible predictors of second echelon lymph node involvement.

Results: Second echelon metastases were found in 116-317 cases 36.6%. Frequency of second echelon lymph node involvement in patients with isolated tumor cells ITC, N = 23, micro- N = 101 and macrometastases N = 193 was 13%, 20% and 48%, respectively p < 0.001. Based on the area % of SN occupied by tumor no subgroup of patients could be selected with less than 20% second echelon lymph node involvement. However, none of the patients with SN ITC or micrometastases and a primary tumor size ≤1 cm N = 12, 3.8% had second echelon lymph node involvement.

Conclusions: Accurately measured SN tumor load predicts second echelon lymph node involvement. However, even in patients with ITC, the second echelon lymph nodes are involved in 13% justifying ALND.





Author: C. H. M. van Deurzen, R. van Hillegersberg, M. G. G. Hobbelink, C. A. Seldenrijk, R. Koelemij, and P. J. van Diest

Source: https://www.hindawi.com/



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