RT Journal Article
SR Electronic
T1 Predictive Factors of Non-sentinel Lymph Node Involvement in Patients with Invasive Breast Cancer and Sentinel Node Micrometastases
JF Anticancer Research
JO Anticancer Res
FD International Institute of Anticancer Research
SP 4509
OP 4514
VO 33
IS 10
A1 FRIEDMAN, DANIELE
A1 GIPPONI, MARCO
A1 MURELLI, FEDERICA
A1 MESZAROS, PAOLO
A1 SOLARI, NICOLA
A1 MASSA, MICHELA
A1 DEPAOLI, FRANCESCA
A1 BACCINI, PAOLA
A1 CARLI, FRANCA
A1 GALLO, MAURIZIO
A1 CAFIERO, FERDINANDO
YR 2013
UL http://ar.iiarjournals.org/content/33/10/4509.abstract
AB Patient-related, tumor-related, and sentinel node (SN)-related factors have been identified with the aim of predicting non-SN status in patients with SN micrometastases. According to our previous experience, primary tumor size (p=0.005) and the presence of lymphovascular invasion (LVI) (p=0.000) significantly predicted non-SN status in patients with SN micrometastasis; moreover, non-SN metastases were never detected in patients with pT1a-1b, G1, and no LVI. A prospective assessment was undertaken in a validation set of 126 patients to confirm these findings. Univariate analysis indicated that primary tumor size (p=0.05), Scarff-Bloom-Richardson (SBR) grade (p=0.008), LVI (p=0.001), and the number of mitoses/mm2 (p=0.01) were significant predictors of non-SN status. By logistic regression analysis, tumor size (p=0.03), LVI (p=0.001), grade (p=0.003) and the number of mitoses/mm2 (p=0.01) were the only variables remaining in the model. Three subsets of patients were identified: i) 18.3% of patients (pT1, G1, and no LVI) had tumor-negative non-SN (no risk group); ii) 37.3% of patients (number of mitoses/mm2 <10, SBR grade II-III) had a rate of tumor-positive non-SN <15% (intermediate risk); iii) 44.4% of patients had a mean rate of non-SN involvement of 46% (high risk). By these parameters, more than 50% of patients could be selectively spared unnecessary axillary lymph node dissection without staging or therapeutic benefit, especially in patients with well-differentiated pT1 tumors without LVI.