Sentinel and non-sentinel lymph node metastases in patients with microinvasive breast cancer: a nationwide study

TY - JOUR

T1 - Sentinel and non-sentinel lymph node metastases in patients with microinvasive breast cancer

T2 - a nationwide study

AU - Holm-Rasmussen, Emil Villiam

AU - Jensen, Maj Britt

AU - Balslev, Eva

AU - Kroman, Niels

AU - Tvedskov, Tove Filtenborg

PY - 2019/6

Y1 - 2019/6

N2 - Purpose: To determine the incidence and risk factors of sentinel lymph node (SN) and non-SN metastases in patients with microinvasive breast cancer (MIBC, T1 mic ). This to identify MIBC patients in whom axillary staging can be safely omitted. Methods: The Danish Breast Cancer Group database was used to identify a total of 409 women with breast cancer ≤ 1 mm who underwent sentinel lymph node biopsy (SLNB) between 2002 and 2015. After validation, 233 patients were eligible for the analysis. The incidence rates of SN and non-SN metastases were determined. The associations between clinicopathological variables and a positive SN [pN1, pN1mi, or pN0(i+)] were analyzed using univariate and multivariate designs. Results: Of 233 patients with MIBC, only 9 (3.9%) had SN macrometastases. An additional 18 (7.7%) and 23 (9.9%) had SN micrometastases and isolated tumor cells (ITCs), respectively. Of patients with SN macrometastases, two (22.2%) had non-SN macrometastases. In the adjusted analysis, a positive SN was associated with younger age (P = 0.0001) and a positive human epidermal growth factor 2 receptor (HER2) status (P = 0.03). Conclusions: The low incidence of SN macrometastases < 4% suggests omission of axillary staging in MIBC patients without staging at primary surgery, especially in older (≥ 50 years) HER2 − patients. Still, the relatively high proportion of patients with non-SN macrometastases indicates that axillary treatment might be considered in SN positive patients, especially in younger HER2 + MIBC patients.

AB - Purpose: To determine the incidence and risk factors of sentinel lymph node (SN) and non-SN metastases in patients with microinvasive breast cancer (MIBC, T1 mic ). This to identify MIBC patients in whom axillary staging can be safely omitted. Methods: The Danish Breast Cancer Group database was used to identify a total of 409 women with breast cancer ≤ 1 mm who underwent sentinel lymph node biopsy (SLNB) between 2002 and 2015. After validation, 233 patients were eligible for the analysis. The incidence rates of SN and non-SN metastases were determined. The associations between clinicopathological variables and a positive SN [pN1, pN1mi, or pN0(i+)] were analyzed using univariate and multivariate designs. Results: Of 233 patients with MIBC, only 9 (3.9%) had SN macrometastases. An additional 18 (7.7%) and 23 (9.9%) had SN micrometastases and isolated tumor cells (ITCs), respectively. Of patients with SN macrometastases, two (22.2%) had non-SN macrometastases. In the adjusted analysis, a positive SN was associated with younger age (P = 0.0001) and a positive human epidermal growth factor 2 receptor (HER2) status (P = 0.03). Conclusions: The low incidence of SN macrometastases < 4% suggests omission of axillary staging in MIBC patients without staging at primary surgery, especially in older (≥ 50 years) HER2 − patients. Still, the relatively high proportion of patients with non-SN macrometastases indicates that axillary treatment might be considered in SN positive patients, especially in younger HER2 + MIBC patients.

KW - Axillary lymphnode metastases

KW - Axillary management

KW - Axillary surgery

KW - Early-stage breast cancer

KW - Microinvasive breast cancer

KW - Sentinel lymph node

KW - Sentinel lymph node biopsy

KW - Sentinel lymph node metastases

U2 - 10.1007/s10549-019-05200-4

DO - 10.1007/s10549-019-05200-4

M3 - Journal article

C2 - 30877405

AN - SCOPUS:85063031310

SN - 0167-6806

VL - 175

SP - 713

EP - 719

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

ER -