scholarly journals Predictive Value of Tumor Load in Breast Cancer Sentinel Lymph Nodes for Second Echelon Lymph Node Metastases

2007 ◽  
Vol 29 (6) ◽  
pp. 497-505
Author(s):  
C. H. M. van Deurzen ◽  
R. van Hillegersberg ◽  
M. G. G. Hobbelink ◽  
C. A. Seldenrijk ◽  
R. Koelemij ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Invasive Breast Cancer ◽  
Primary Tumor ◽  
Lymph Node Involvement ◽  
Consecutive Series ◽  
Axillary Lymph ◽  
Tumor Load ◽  
Node Involvement

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.

Primary Tumor Site, Size, Patients Age and Axillary Lymph Nodes in Breast Cancers

1986 ◽  
Vol 72 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Salvatore Toma ◽  
Stefano Bonassi ◽  
Riccardo Puntoni ◽  
Guido Nicolò
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Lymph Node Involvement ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Primary Tumor Site ◽  
Primary Tumors ◽  
Node Involvement

This study considers the correlations between some characteristics of the primary tumor and level of lymph node involvement in 185 primary breast cancers. The average number of lymph nodes was higher in N + women than in N— women. Primary tumors with a diameter of more than 4 cm yielded the highest mean number of lymph nodes (17.5). The risk of developing lymph node metastases was fourfold in tumors with a diameter greater than 2 cm when compared to those with a diameter less than or equal to 2 cm. The most commonly metastasized lymph node level, in both large and small tumors, was the first; however, one-fifth of the patients had simultaneous lymph node metastasis in all three axillary levels. Although the left breast was the most affected (58.9 %), there was no evidence of a different risk of metastasis between the two breasts; 34.1 % of the tumors were multifocal. Lymph node involvement was higher in women under 50 years of age with a primary tumor larger than 2 cm.

scholarly journals Evaluating the Effect of Axillary Lymph Node Involvement and Dissection in the Development of Post-Mastectomy Lymphedema

2019 ◽  
Vol 1 (1) ◽  
pp. 14-21
Author(s):  
Ahmed Abdulnabi ◽  
Issam Merdan
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Dissection ◽  
Disease Process ◽  
Radical Mastectomy ◽  
Lymph Node Involvement ◽  
Breast Cancer Surgery ◽  
Axillary Lymph ◽  
Node Involvement

Background: Lymphedema of the upper extremity is a serious consequence of breast cancer surgery. Postmastectomy lymphedema of the upper limb is usually related to many risk factors, like axillary surgery, radiotherapy, venous obstruction, obesity, and infection. In the current study, the objective was to identify the relationship between the extent of lymph node involvement and axillary dissection on the development of lymphedema. Patients and methods: One hundred and seventy patients managed by modified radical mastectomy with axillary dissection for mammary-invasive adenocarcinoma between January 2009 and December 2016 in Al-Fayhaa Teaching Hospital. The patients were divided into three groups according to the number of lymph nodes involvd, by pathology. The patients had been followed up for at least two years and assessed by standard lymphedema assessment, then categorized into three groups, according to the severity of lymphedema. Results: After the analysis of patient parameters, the highest age group was 36–45 years. More than 60% of the patients had 4–9 lymph nodes involved. Forty-one patients from the 170 developed lymphedema postoperatively. Forty patients had seroma and twenty-one patients had wound infection postoperatively. Conclusion: Post-mastectomy lymphedema is a sequelae of disease process related to the extent of lymph-node involvement and resection rather than operative fault. Key words: breast cancer, mastectomy, lymphedema.

Risk stratification by hormonal receptor (ER, PgR) and HER2 status in small (≤1cm) invasive breast cancer: Who might be a possible candidate for adjuvant treatment?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 564-564
Author(s):  
Y. Park ◽  
S. Kim ◽  
O. Ok ◽  
H. Baek ◽  
J. Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Invasive Breast Cancer ◽  
Axillary Lymph Node ◽  
Lymph Node Involvement ◽  
Axillary Lymph ◽  
Positive Group ◽  
Node Involvement ◽  
Her 2 ◽  
Axillary Lymph Node Involvement

564 Background: With the increasing use of screening mammography, the proportion of ≤ 1 cm invasive breast cancer is increasing. Identification of breast cancer molecular subtypes has resulted in a better appreciation of the biologic heterogeneity, which is not fully explained by clinicopathologic features including staging system. The aims of this study were: 1) to identify the risk factors of systemic metastases in patients with ≤ 1 cm invasive breast cancer and 2) to investigate the patients group at greatest risk of such failure even in these small tumors. Method: Data were collected retrospectively in the breast cancer registry of our institution for patients with invasive breast cancer from October 1994 to December 2004. Results: Of 4,036 patients who received curative breast cancer surgery, 466 patients who had T1a or T1b breast cancer were identified. 39 patients who received neoadjuvant chemotherapy were excluded in this study. Ipsilateral axillary lymph node involvement was found in 13% (57/427) at the time of surgery. Axillary lymph node involvement was much more common in HER-2 positive group (33% vs 11%, p < 0.0001) and triple negative (TN) group (24% vs 11%, p = 0.002) than in hormone receptor positive group. During median 61 months of follow-up, overall 10 year estimated distant relapse-free survival (DRFS) and overall survival (OS) were 95% and 92%, respectively. Multivariate analysis was conducted in 370 (T1aN0, T1bN0) patients, who had no lymph node involvement. In Cox-regression model, HER-2 positivity and triple negativity were identified as independent prognostic factors to predict DRFS [Hazard ratio (HR) 8.8, p = 0.003 for HER-2 positive group; HR 5.1, p = 0.026 for TN group] and OS (HR 5.0, p = 0.067 for HER-2 positive group; HR 11.1, p = 0.017 for TN group) in T1bN0 tumors. Limiting to T1aN0 tumors, statistical significance was not maintained. Conclusions: Even though T1aN0 and T1bN0 tumors have been known to have a relative low risk of systemic failure, anti-HER-2 directed therapy for HER-2 positive group and new innovative adjuvant systemic treatment for TN group in patients with T1bN0 tumor should be considered. Prospective adjuvant trials should be warranted in these subgroups of patients. No significant financial relationships to disclose.

scholarly journals Role of clinical and morphological data in prediction of regional lymph node involvement in early-stage breast cancer

2019 ◽  
Vol 15 (1) ◽  
pp. 29-34
Author(s):  
Yu. S. Shatova ◽  
L. N. Vashchenko ◽  
E. S. Bosenko ◽  
S. M. Bakulina ◽  
V. N. Kasyanenko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Primary Tumor ◽  
Regional Lymph Node ◽  
Lymph Node Involvement ◽  
Morphological Data ◽  
Significant Prognostic Factor ◽  
Axillary Lymph ◽  
Regional Lymph Node Involvement ◽  
Node Involvement

Objective:to evaluate the frequency of axillary lymph node metastasis (detected at routine pathomorphological examination) in order to determine the group of patients who do not require lymph node surgery.Materials and methods.We analyzed medical records of 485 patients with breast cancer and no signs (either clinical or instrumental) of regional lymph node involvement who underwent surgery at the first stage of their treatment.Results and conclusion.In patients with cN0 cancer, only the size of primary tumor ≤1 cm was found to be a significant factor indicating that regional lymph nodes are not involved (in addition to palpation, ultrasound, mammography, and spiral x-ray computed tomography of the chest). In patients with сТ1c cancer, the majority of standard immunohistochemical markers cannot yet be used as predictors of regional lymph node involvement. However, tumor differentiation grade G1 is rather an exclusion, which in combination with the size of the primary tumor сТ1c can also be considered as a significant prognostic factor.

Outcome of Small Invasive Breast Cancer with No Axillary Lymph Node Involvement

2010 ◽  
Vol 17 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Alfonso Sánchez-Muñoz ◽  
Elisabeth Pérez-Ruiz ◽  
Jose Manuel Jurado ◽  
Nuria Ribelles ◽  
Antonia Márquez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Invasive Breast Cancer ◽  
Axillary Lymph Node ◽  
Lymph Node Involvement ◽  
Axillary Lymph ◽  
Node Involvement ◽  
Axillary Lymph Node Involvement

scholarly journals Influence of Covariates on Involved Lymph Nodes in Primary Breast Cancer Patients: Mixture Distribution Zero-Inflated Modeling Methodological Framework

2020 ◽  
Author(s):  
Madiha Liaqat ◽  
Shahid Kamal ◽  
Florian Fischer ◽  
Nadeem Zia
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Primary Breast Cancer ◽  
Negative Binomial ◽  
Lymph Node Involvement ◽  
Breast Cancer Patients ◽  
Node Involvement ◽  
Study Population

Abstract Background: Involvement of lymph nodes has been an integral part of breast cancer prognosis and survival. This study aimed to explore factors influencing on the number of auxiliary lymph nodes in women diagnosed with primary breast cancer by choosing an efficient model to assess excess of zeros and over-dispersion presented in the study population. Methods: The study is based on a retrospective analysis of hospital records among 5,196 female breast cancer patients in Pakistan. Zero-inflated Poisson and zero-inflated negative binomial modeling techniques are used to assess the association between under-study factors and the number of involved lymph nodes in breast cancer patients. Results: The most common breast cancer was invasive ductal carcinoma (54.5%). Patients median age was 48 years, from which women aged 46 years and above are the majority of the study population (64.8%). Examination of tumors revealed that over 2,662 (51.2%) women were ER-positive, 2,652 (51.0%) PR-positive, and 2,754 (53.0%) were Her2.neu-positive. The mean tumor size was 3.06 cm and histological grade 1 (n=2021, 38.9%) was most common in this sample. The model performance was best in the zero-inflated negative binomial model. Findings indicate that most factors related to breast cancer have a significant impact on the number of involved lymph nodes. Age is not contributed to lymph node status. Women having a larger tumor size suffered from greater number of involved lymph nodes. Tumor grades 11 and 111 contributed to higher numbers of positive lymph node.Conclusions: Zero-inflated models have successfully demonstrated the advantage of fitting count nodal data when both “at-harm” (lymph node involvement) and “not-at-harm” (no lymph node involvement) groups are important in predicting disease on set and disease progression. Our analysis showed that ZINB is the best model for predicting and describing the number of involved nodes in primary breast cancer, when overdispersion arises due to a large number of patients with no lymph node involvement. This is important for accurate prediction both for therapy and prognosis of breast cancer patients.

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