Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance. Issue 12 (1st December 2002)

• Record Type: Journal Article
• Authors: den Bakker, M A; van Weeszenberg, A; de Kanter, A Y; Beverdam, F H; Pritchard, C; van der Kwast, Th H; Menke-Pluymers, M
• Is Part Of: Journal of clinical pathology. Volume 55:Issue 12(2002)
• Page Start: 932
• Page End: 935
• Publication Date: 2002-12-01
• Subjects: sentinel node -- micrometastasis -- breast cancer -- pathological staging; CI, confidence interval -- H&E, haematoxylin and eosin -- IHC, immunohistochemistry -- ITC, isolated tumour cell -- LN, lymph node -- n-SLN, non-sentinel lymph node -- OR, odds ratio -- SLN, sentinel lymph node; Pathology -- Periodicals; Pathology, Molecular -- Periodicals; 616.0705
• DOI: 10.1136/jcp.55.12.932
• Languages: English
• ISSNs: 0021-9746

Abstract

Abstract : Aims: It has been suggested that patients with T1–2 breast tumours and sentinel node (SLN) micrometastases, defined as foci of tumour cells smaller than 2 mm, may be spared completion axillary lymph node dissection because of the low incidence of further metastatic disease. To gain insight into the extent of non-sentinel lymph node (n-SLN) involvement, SLNs and complementary axillary clearance specimens in patients with SLN micrometastases were examined. Methods: A set of 32 patients with SLN micrometastases was selected on the basis of pathology reports and review of SLNs. Five hundred and thirteen n-SLNs from the axillary clearance specimens were serially sectioned and analysed by means of immunohistochemistry for metastatic disease. Lymph node metastases were grouped as macrometastases (> 2 mm), and micrometastases (< 2 mm), and further subdivided as isolated tumour cells (ITCs) or clusters. Results: In 11 of 32 patients, one or more n-SLN was involved. Grade 3 tumours and tumours > 2 cm (T2–3 v T1) were significantly associated with n-SLN micrometastases as clusters (grade: odds ratio (OR), 8.3; 95% confidence interval (CI), 1.4 to 50.0; size: T2–3 tumours v T1: OR, 15; 95% CI, 2.18 to 103.0). However, no subgroup of tumours with regard to size and grade was identified that did not have n-SLN metastases. Conclusions: In patients with breast cancer and SLN micrometastases, n-SLN involvement is relatively common. The incidence of metastatic clusters in n-SLN is greatly increased in patients with T2–3 tumours and grade 3 tumours. Therefore, axillary lymph node dissection is especially warranted in these patients. However, because n-SLN metastases also occur in T1 and low grade tumours, even these should be subjected to routine axillary dissection to achieve local control.