The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?
Identifieur interne : 000A90 ( Istex/Corpus ); précédent : 000A89; suivant : 000A91The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?
Auteurs : Julia S. Wong ; Anne O Eill ; Abram Recht ; Stuart J. Schnitt ; James L. Connolly ; Barbara Silver ; Jay R. HarrisSource :
- International Journal of Radiation Oncology, Biology, Physics [ 0360-3016 ] ; 2000.
English descriptors
Abstract
Purpose: Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0–3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field. Methods and Materials: In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor. Results: LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0–3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4 or more positive nodes was 3.9 (95% CI, 2.0–7.6). Conclusion: For patients with clinical T1–2, N0, infiltrating ductal carcinomas, the presence of LVI is predictive of having 4 or more positive axillary nodes. Only 3% of patients with clinical T1–2, N0, LVI-negative breast cancers had 4 or more positive nodes on axillary dissection. Such patients may be reasonable candidates for treatment with tangential radiation fields in the absence of axillary dissection.
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DOI: 10.1016/S0360-3016(00)00605-2
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</title><author><name sortKey="Wong, Julia S" sort="Wong, Julia S" uniqKey="Wong J" first="Julia S" last="Wong">Julia S. Wong</name><affiliation><mods:affiliation>E-mail: wong@jcrt.harvard.edu</mods:affiliation></affiliation><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="O Eill, Anne" sort="O Eill, Anne" uniqKey="O Eill A" first="Anne" last="O Eill">Anne O Eill</name><affiliation><mods:affiliation>Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="Recht, Abram" sort="Recht, Abram" uniqKey="Recht A" first="Abram" last="Recht">Abram Recht</name><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="Schnitt, Stuart J" sort="Schnitt, Stuart J" uniqKey="Schnitt S" first="Stuart J" last="Schnitt">Stuart J. Schnitt</name><affiliation><mods:affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</mods:affiliation></affiliation></author><author><name sortKey="Connolly, James L" sort="Connolly, James L" uniqKey="Connolly J" first="James L" last="Connolly">James L. Connolly</name><affiliation><mods:affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</mods:affiliation></affiliation></author><author><name sortKey="Silver, Barbara" sort="Silver, Barbara" uniqKey="Silver B" first="Barbara" last="Silver">Barbara Silver</name><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="Harris, Jay R" sort="Harris, Jay R" uniqKey="Harris J" first="Jay R" last="Harris">Jay R. Harris</name><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:17809DB8489F734A203CBC2CA96325993688F7FB</idno><date when="2000" year="2000">2000</date><idno type="doi">10.1016/S0360-3016(00)00605-2</idno><idno type="url">https://api.istex.fr/document/17809DB8489F734A203CBC2CA96325993688F7FB/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000A90</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000A90</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</title><author><name sortKey="Wong, Julia S" sort="Wong, Julia S" uniqKey="Wong J" first="Julia S" last="Wong">Julia S. Wong</name><affiliation><mods:affiliation>E-mail: wong@jcrt.harvard.edu</mods:affiliation></affiliation><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="O Eill, Anne" sort="O Eill, Anne" uniqKey="O Eill A" first="Anne" last="O Eill">Anne O Eill</name><affiliation><mods:affiliation>Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="Recht, Abram" sort="Recht, Abram" uniqKey="Recht A" first="Abram" last="Recht">Abram Recht</name><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="Schnitt, Stuart J" sort="Schnitt, Stuart J" uniqKey="Schnitt S" first="Stuart J" last="Schnitt">Stuart J. Schnitt</name><affiliation><mods:affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</mods:affiliation></affiliation></author><author><name sortKey="Connolly, James L" sort="Connolly, James L" uniqKey="Connolly J" first="James L" last="Connolly">James L. Connolly</name><affiliation><mods:affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</mods:affiliation></affiliation></author><author><name sortKey="Silver, Barbara" sort="Silver, Barbara" uniqKey="Silver B" first="Barbara" last="Silver">Barbara Silver</name><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author><author><name sortKey="Harris, Jay R" sort="Harris, Jay R" uniqKey="Harris J" first="Jay R" last="Harris">Jay R. Harris</name><affiliation><mods:affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">International Journal of Radiation Oncology, Biology, Physics</title><title level="j" type="abbrev">ROB</title><idno type="ISSN">0360-3016</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2000">2000</date><biblScope unit="volume">48</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="133">133</biblScope><biblScope unit="page" to="137">137</biblScope></imprint><idno type="ISSN">0360-3016</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0360-3016</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Axillary lymph nodes</term><term>Breast cancer</term><term>Lymphatic vessel invasion</term><term>Radiotherapy</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Purpose: Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0–3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field. Methods and Materials: In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor. Results: LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0–3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4 or more positive nodes was 3.9 (95% CI, 2.0–7.6). Conclusion: For patients with clinical T1–2, N0, infiltrating ductal carcinomas, the presence of LVI is predictive of having 4 or more positive axillary nodes. Only 3% of patients with clinical T1–2, N0, LVI-negative breast cancers had 4 or more positive nodes on axillary dissection. Such patients may be reasonable candidates for treatment with tangential radiation fields in the absence of axillary dissection.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>node</json:string><json:string>axillary</json:string><json:string>nodal</json:string><json:string>axillary dissection</json:string><json:string>breast cancer</json:string><json:string>oncol</json:string><json:string>positive nodes</json:string><json:string>radiotherapy</json:string><json:string>lymphatic</json:string><json:string>biol</json:string><json:string>eld</json:string><json:string>phys</json:string><json:string>lymphatic vessel invasion</json:string><json:string>oncology</json:string><json:string>nodal involvement</json:string><json:string>tumor size</json:string><json:string>axilla</json:string><json:string>radiat</json:string><json:string>surg</json:string><json:string>radiat oncol biol phys</json:string><json:string>pathologic</json:string><json:string>tangential</json:string><json:string>radiation therapy</json:string><json:string>axillary nodes</json:string><json:string>dissection</json:string><json:string>pathologic nodal status</json:string><json:string>breast carcinoma</json:string><json:string>extensive axillary involvement</json:string><json:string>lymph nodes</json:string><json:string>carcinoma</json:string><json:string>lymph</json:string><json:string>nodal status</json:string><json:string>median number</json:string><json:string>primary tumor</json:string><json:string>axillary involvement</json:string><json:string>conservative surgery</json:string><json:string>radiation oncology</json:string><json:string>nodal positivity</json:string><json:string>logistic regression model</json:string><json:string>negative axillary nodes</json:string><json:string>axillary lymph nodes</json:string><json:string>tumor location</json:string><json:string>tangential radiotherapy</json:string><json:string>axillary nodal involvement</json:string><json:string>pathologic factors</json:string><json:string>positive axillary nodes</json:string><json:string>lower axilla</json:string><json:string>tangential radiation therapy</json:string><json:string>surg oncol</json:string><json:string>treatment outcome</json:string><json:string>axillary lymph node metastases</json:string><json:string>univariate analysis</json:string><json:string>acta oncol</json:string></teeft></keywords><author><json:item><name>Julia S Wong M.D.</name><affiliations><json:string>E-mail: wong@jcrt.harvard.edu</json:string><json:string>Joint Center for Radiation Therapy, Boston, MA, USA</json:string></affiliations></json:item><json:item><name>Anne O’Neill M.S.</name><affiliations><json:string>Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA</json:string></affiliations></json:item><json:item><name>Abram Recht M.D.</name><affiliations><json:string>Joint Center for Radiation Therapy, Boston, MA, USA</json:string></affiliations></json:item><json:item><name>Stuart J Schnitt M.D.</name><affiliations><json:string>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</json:string></affiliations></json:item><json:item><name>James L Connolly M.D.</name><affiliations><json:string>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</json:string></affiliations></json:item><json:item><name>Barbara Silver B.A.</name><affiliations><json:string>Joint Center for Radiation Therapy, Boston, MA, USA</json:string></affiliations></json:item><json:item><name>Jay R Harris M.D.</name><affiliations><json:string>Joint Center for Radiation Therapy, Boston, MA, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Clinical investigation: Breast</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Breast cancer</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Lymphatic vessel invasion</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Axillary lymph nodes</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Radiotherapy</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Purpose: Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0–3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field. Methods and Materials: In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor. Results: LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0–3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4 or more positive nodes was 3.9 (95% CI, 2.0–7.6). Conclusion: For patients with clinical T1–2, N0, infiltrating ductal carcinomas, the presence of LVI is predictive of having 4 or more positive axillary nodes. Only 3% of patients with clinical T1–2, N0, LVI-negative breast cancers had 4 or more positive nodes on axillary dissection. Such patients may be reasonable candidates for treatment with tangential radiation fields in the absence of axillary dissection.</abstract><qualityIndicators><score>6.783</score><pdfVersion>1.2</pdfVersion><pdfPageSize>586 x 785 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>2462</abstractCharCount><pdfWordCount>3783</pdfWordCount><pdfCharCount>23307</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>361</abstractWordCount></qualityIndicators><title>The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</title><pii><json:string>S0360-3016(00)00605-2</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>International Journal of Radiation Oncology, Biology, Physics</title><language><json:string>unknown</json:string></language><publicationDate>2000</publicationDate><issn><json:string>0360-3016</json:string></issn><pii><json:string>S0360-3016(00)X0085-5</json:string></pii><volume>48</volume><issue>1</issue><pages><first>133</first><last>137</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>radiology, nuclear medicine & medical imaging</json:string><json:string>oncology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>oncology & carcinogenesis</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>2000</publicationDate><copyrightDate>2000</copyrightDate><doi><json:string>10.1016/S0360-3016(00)00605-2</json:string></doi><id>17809DB8489F734A203CBC2CA96325993688F7FB</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/17809DB8489F734A203CBC2CA96325993688F7FB/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/17809DB8489F734A203CBC2CA96325993688F7FB/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/17809DB8489F734A203CBC2CA96325993688F7FB/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©2000 Elsevier Science Inc.</p></availability><date>2000</date></publicationStmt><notesStmt><note type="content">Section title: Clinical investigation: Breast</note><note type="content">Table 1: Relationship of clinical and pathologic variables to pathologic axillary nodal status: Univariate analysislegend</note><note type="content">Table 2: Relationship of tumor size and lymphatic vessel invasion (LVI) considered jointly with pathologic axillary nodal status</note><note type="content">Table 3: Full logistic regression model to predict for extensive axillary involvement (≥4 positive vs. 0–3 positive nodes)</note><note type="content">Table 4: Logistic regression model restricted to significant terms</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</title><author xml:id="author-0000"><persName><forename type="first">Julia S</forename><surname>Wong</surname></persName><roleName type="degree">M.D.</roleName><email>wong@jcrt.harvard.edu</email><note type="biography">Reprint requests to: Dr. Julia S. Wong, Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, 44 Binney St. Level L2, Boston, MA 02115</note><affiliation>Reprint requests to: Dr. Julia S. Wong, Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, 44 Binney St. Level L2, Boston, MA 02115</affiliation><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Anne</forename><surname>O’Neill</surname></persName><roleName type="degree">M.S.</roleName><affiliation>Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Abram</forename><surname>Recht</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Stuart J</forename><surname>Schnitt</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</affiliation></author><author xml:id="author-0004"><persName><forename type="first">James L</forename><surname>Connolly</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Barbara</forename><surname>Silver</surname></persName><roleName type="degree">B.A.</roleName><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Jay R</forename><surname>Harris</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation></author><idno type="istex">17809DB8489F734A203CBC2CA96325993688F7FB</idno><idno type="DOI">10.1016/S0360-3016(00)00605-2</idno><idno type="PII">S0360-3016(00)00605-2</idno></analytic><monogr><title level="j">International Journal of Radiation Oncology, Biology, Physics</title><title level="j" type="abbrev">ROB</title><idno type="pISSN">0360-3016</idno><idno type="PII">S0360-3016(00)X0085-5</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2000"></date><biblScope unit="volume">48</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="133">133</biblScope><biblScope unit="page" to="137">137</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2000</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Purpose: Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0–3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field. Methods and Materials: In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor. Results: LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0–3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4 or more positive nodes was 3.9 (95% CI, 2.0–7.6). Conclusion: For patients with clinical T1–2, N0, infiltrating ductal carcinomas, the presence of LVI is predictive of having 4 or more positive axillary nodes. Only 3% of patients with clinical T1–2, N0, LVI-negative breast cancers had 4 or more positive nodes on axillary dissection. Such patients may be reasonable candidates for treatment with tangential radiation fields in the absence of axillary dissection.</p></abstract><textClass><keywords scheme="keyword"><list><head>article-category</head><item><term>Clinical investigation: Breast</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Breast cancer</term></item><item><term>Lymphatic vessel invasion</term></item><item><term>Axillary lymph nodes</term></item><item><term>Radiotherapy</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2000">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/17809DB8489F734A203CBC2CA96325993688F7FB/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>ROB</jid><aid>7076</aid><ce:pii>S0360-3016(00)00605-2</ce:pii><ce:doi>10.1016/S0360-3016(00)00605-2</ce:doi><ce:copyright type="full-transfer" year="2000">Elsevier Science Inc.</ce:copyright><ce:doctopics><ce:doctopic><ce:text>Clinical investigation: Breast</ce:text></ce:doctopic></ce:doctopics></item-info><head><ce:dochead><ce:textfn>Clinical investigation: Breast</ce:textfn></ce:dochead><ce:title>The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</ce:title><ce:presented>Presented in part at the 40th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Phoenix, Arizona, October 25–29, 1998.</ce:presented><ce:author-group><ce:author><ce:given-name>Julia S</ce:given-name><ce:surname>Wong</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1">∗</ce:cross-ref><ce:cross-ref refid="AFF2"><ce:sup>†</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF3"><ce:sup>‡</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF4"><ce:sup>∥</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF5"><ce:sup>g</ce:sup></ce:cross-ref><ce:cross-ref refid="CORR1">*</ce:cross-ref><ce:e-address>wong@jcrt.harvard.edu</ce:e-address></ce:author><ce:author><ce:given-name>Anne</ce:given-name><ce:surname>O’Neill</ce:surname><ce:degrees>M.S.</ce:degrees><ce:cross-ref refid="AFF6"><ce:sup>¶</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF5"><ce:sup>g</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Abram</ce:given-name><ce:surname>Recht</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1">∗</ce:cross-ref><ce:cross-ref refid="AFF3"><ce:sup>‡</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF5"><ce:sup>g</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Stuart J</ce:given-name><ce:surname>Schnitt</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF7"><ce:sup>§</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF5"><ce:sup>g</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>James L</ce:given-name><ce:surname>Connolly</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF7"><ce:sup>§</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF5"><ce:sup>g</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Barbara</ce:given-name><ce:surname>Silver</ce:surname><ce:degrees>B.A.</ce:degrees><ce:cross-ref refid="AFF1">∗</ce:cross-ref><ce:cross-ref refid="AFF5"><ce:sup>g</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Jay R</ce:given-name><ce:surname>Harris</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="AFF1">∗</ce:cross-ref><ce:cross-ref refid="AFF4"><ce:sup>∥</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF5"><ce:sup>g</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>∗</ce:label><ce:textfn>Joint Center for Radiation Therapy, Boston, MA, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>†</ce:label><ce:textfn>Department of Radiation Oncology, MetroWest Medical Center, Framingham, MA, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>‡</ce:label><ce:textfn>Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF7"><ce:label>§</ce:label><ce:textfn>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</ce:textfn></ce:affiliation><ce:affiliation id="AFF4"><ce:label>∥</ce:label><ce:textfn>Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF6"><ce:label>¶</ce:label><ce:textfn>Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF5"><ce:label>g</ce:label><ce:textfn>Harvard Medical School, Boston, MA, USA</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Reprint requests to: Dr. Julia S. Wong, Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, 44 Binney St. Level L2, Boston, MA 02115</ce:text></ce:correspondence></ce:author-group><ce:date-accepted day="17" month="11" year="1999"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>Purpose: Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0–3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field.</ce:simple-para><ce:simple-para>Methods and Materials: In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor.</ce:simple-para><ce:simple-para>Results: LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0–3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4 or more positive nodes was 3.9 (95% CI, 2.0–7.6).</ce:simple-para><ce:simple-para>Conclusion: For patients with clinical T1–2, N0, infiltrating ductal carcinomas, the presence of LVI is predictive of having 4 or more positive axillary nodes. Only 3% of patients with clinical T1–2, N0, LVI-negative breast cancers had 4 or more positive nodes on axillary dissection. Such patients may be reasonable candidates for treatment with tangential radiation fields in the absence of axillary dissection.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Breast cancer</ce:text></ce:keyword><ce:keyword><ce:text>Lymphatic vessel invasion</ce:text></ce:keyword><ce:keyword><ce:text>Axillary lymph nodes</ce:text></ce:keyword><ce:keyword><ce:text>Radiotherapy</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>The relationship between lymphatic vessell invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?</title></titleInfo><name type="personal"><namePart type="given">Julia S</namePart><namePart type="family">Wong</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>E-mail: wong@jcrt.harvard.edu</affiliation><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation><description>Reprint requests to: Dr. Julia S. Wong, Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, 44 Binney St. Level L2, Boston, MA 02115</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anne</namePart><namePart type="family">O’Neill</namePart><namePart type="termsOfAddress">M.S.</namePart><affiliation>Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Abram</namePart><namePart type="family">Recht</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stuart J</namePart><namePart type="family">Schnitt</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">James L</namePart><namePart type="family">Connolly</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MAUSA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Barbara</namePart><namePart type="family">Silver</namePart><namePart type="termsOfAddress">B.A.</namePart><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jay R</namePart><namePart type="family">Harris</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Joint Center for Radiation Therapy, Boston, MA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2000</dateIssued><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Purpose: Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0–3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field. Methods and Materials: In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor. Results: LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0–3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4 or more positive nodes was 3.9 (95% CI, 2.0–7.6). Conclusion: For patients with clinical T1–2, N0, infiltrating ductal carcinomas, the presence of LVI is predictive of having 4 or more positive axillary nodes. Only 3% of patients with clinical T1–2, N0, LVI-negative breast cancers had 4 or more positive nodes on axillary dissection. Such patients may be reasonable candidates for treatment with tangential radiation fields in the absence of axillary dissection.</abstract><note type="content">Section title: Clinical investigation: Breast</note><note type="content">Table 1: Relationship of clinical and pathologic variables to pathologic axillary nodal status: Univariate analysislegend</note><note type="content">Table 2: Relationship of tumor size and lymphatic vessel invasion (LVI) considered jointly with pathologic axillary nodal status</note><note type="content">Table 3: Full logistic regression model to predict for extensive axillary involvement (≥4 positive vs. 0–3 positive nodes)</note><note type="content">Table 4: Logistic regression model restricted to significant terms</note><subject><genre>article-category</genre><topic>Clinical investigation: Breast</topic></subject><subject lang="en"><genre>Keywords</genre><topic>Breast cancer</topic><topic>Lymphatic vessel invasion</topic><topic>Axillary lymph nodes</topic><topic>Radiotherapy</topic></subject><relatedItem type="host"><titleInfo><title>International Journal of Radiation Oncology, Biology, Physics</title></titleInfo><titleInfo type="abbreviated"><title>ROB</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">20000801</dateIssued></originInfo><identifier type="ISSN">0360-3016</identifier><identifier type="PII">S0360-3016(00)X0085-5</identifier><part><date>20000801</date><detail type="volume"><number>48</number><caption>vol.</caption></detail><detail type="issue"><number>1</number><caption>no.</caption></detail><extent unit="issue pages"><start>1</start><end>314</end></extent><extent unit="pages"><start>133</start><end>137</end></extent></part></relatedItem><identifier type="istex">17809DB8489F734A203CBC2CA96325993688F7FB</identifier><identifier type="DOI">10.1016/S0360-3016(00)00605-2</identifier><identifier type="PII">S0360-3016(00)00605-2</identifier><accessCondition type="use and reproduction" contentType="copyright">©2000 Elsevier Science Inc.</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Science Inc., ©2000</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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