Predictors for nonsentinel node involvement in breast cancer patients with micrometastases in the sentinel lymph node
Identifieur interne : 003E79 ( Pmc/Checkpoint ); précédent : 003E78; suivant : 003E80Predictors for nonsentinel node involvement in breast cancer patients with micrometastases in the sentinel lymph node
Auteurs : Archana Ganaraj ; Joseph A. Kuhn ; Ronald C. Jones ; Michael D. Grant ; Valerie R. Andrews ; Sally M. Knox ; Georges J. Netto ; Basel Altrabulsi ; Sheryl A. Livingston ; Todd M. MccartySource :
- Proceedings (Baylor University. Medical Center) [ 0899-8280 ] ; 2003.
Abstract
Sentinel lymph node (SLN) biopsy in breast cancer allows for a more thorough pathologic assessment with serial sectioning and cytokeratin staining. This has resulted in increased detection of micrometastatic disease (tumor size <2 mm) in the SLN. Unfortunately, the value of completion axillary dissection after finding micrometastatic disease in the SLN remains poorly defined. Over a 2-year period, a prospective database of 305 patients who underwent SLN biopsy for breast cancer at Baylor University Medical Center was reviewed. Eighty-four (27.5%) of the patients had evidence of metastatic disease in the SLN. Twenty-four of the 41 patients identified as having micrometastatic disease in the SLN underwent completion axillary lymph node dissection. In these patients, all nonsentinel nodes were further studied by serial sectioning and im-munohistochemistry. The median age of these 24 patients was 52 years (range, 34–83). Their primary tumor stages were T,a andT,b (n = 5), T,c (n = 15), and T2 (n = 4). A total of 328 nonsentinel lymph nodes were examined, including 225 from patients with infiltrating ductal carcinoma (n = 17) and 103 from patients with infiltrating lobular carcinoma (n = 7). In the patients with infiltrating ductal carcinoma, no additional nodal metastases were identified, while in those with infiltrating lobular carcinoma, additional nodal disease was found in 5 lymph nodes (2 of 12 patients, 17%). Primary tumor characteristics were not predictive of additional nodal disease. These data suggest that patients with micro-metastasis in the SLN from infiltrating lobular carcinoma have a significant risk of harboring additional nodal disease and should undergo completion axillary dissection. However, those with micrometastatic disease from infiltrating ductal carcinoma have a very low incidence of additional metastasis and may not need completion axillary dissection.
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PubMed: 16278715
PubMed Central: 1200802
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<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
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<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
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<author><name sortKey="Jones, Ronald C" sort="Jones, Ronald C" uniqKey="Jones R" first="Ronald C." last="Jones">Ronald C. Jones</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
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<author><name sortKey="Grant, Michael D" sort="Grant, Michael D" uniqKey="Grant M" first="Michael D." last="Grant">Michael D. Grant</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Netto, Georges J" sort="Netto, Georges J" uniqKey="Netto G" first="Georges J." last="Netto">Georges J. Netto</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Livingston, Sheryl A" sort="Livingston, Sheryl A" uniqKey="Livingston S" first="Sheryl A." last="Livingston">Sheryl A. Livingston</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predictors for nonsentinel node involvement in breast cancer patients with micrometastases in the sentinel lymph node</title>
<author><name sortKey="Ganaraj, Archana" sort="Ganaraj, Archana" uniqKey="Ganaraj A" first="Archana" last="Ganaraj">Archana Ganaraj</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Kuhn, Joseph A" sort="Kuhn, Joseph A" uniqKey="Kuhn J" first="Joseph A." last="Kuhn">Joseph A. Kuhn</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Jones, Ronald C" sort="Jones, Ronald C" uniqKey="Jones R" first="Ronald C." last="Jones">Ronald C. Jones</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Grant, Michael D" sort="Grant, Michael D" uniqKey="Grant M" first="Michael D." last="Grant">Michael D. Grant</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Andrews, Valerie R" sort="Andrews, Valerie R" uniqKey="Andrews V" first="Valerie R." last="Andrews">Valerie R. Andrews</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Knox, Sally M" sort="Knox, Sally M" uniqKey="Knox S" first="Sally M." last="Knox">Sally M. Knox</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Netto, Georges J" sort="Netto, Georges J" uniqKey="Netto G" first="Georges J." last="Netto">Georges J. Netto</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Altrabulsi, Basel" sort="Altrabulsi, Basel" uniqKey="Altrabulsi B" first="Basel" last="Altrabulsi">Basel Altrabulsi</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<author><name sortKey="Livingston, Sheryl A" sort="Livingston, Sheryl A" uniqKey="Livingston S" first="Sheryl A." last="Livingston">Sheryl A. Livingston</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
</affiliation>
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<author><name sortKey="Mccarty, Todd M" sort="Mccarty, Todd M" uniqKey="Mccarty T" first="Todd M." last="Mccarty">Todd M. Mccarty</name>
<affiliation><nlm:aff id="aff1">From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</nlm:aff>
<wicri:noCountry code="subfield">Texas.</wicri:noCountry>
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<front><div type="abstract" xml:lang="en"><p>Sentinel lymph node (SLN) biopsy in breast cancer allows for a more thorough pathologic assessment with serial sectioning and cytokeratin staining. This has resulted in increased detection of micrometastatic disease (tumor size <2 mm) in the SLN. Unfortunately, the value of completion axillary dissection after finding micrometastatic disease in the SLN remains poorly defined. Over a 2-year period, a prospective database of 305 patients who underwent SLN biopsy for breast cancer at Baylor University Medical Center was reviewed. Eighty-four (27.5%) of the patients had evidence of metastatic disease in the SLN. Twenty-four of the 41 patients identified as having micrometastatic disease in the SLN underwent completion axillary lymph node dissection. In these patients, all nonsentinel nodes were further studied by serial sectioning and im-munohistochemistry. The median age of these 24 patients was 52 years (range, 34–83). Their primary tumor stages were T,a andT,b (n = 5), T,c (n = 15), and T2 (n = 4). A total of 328 nonsentinel lymph nodes were examined, including 225 from patients with infiltrating ductal carcinoma (n = 17) and 103 from patients with infiltrating lobular carcinoma (n = 7). In the patients with infiltrating ductal carcinoma, no additional nodal metastases were identified, while in those with infiltrating lobular carcinoma, additional nodal disease was found in 5 lymph nodes (2 of 12 patients, 17%). Primary tumor characteristics were not predictive of additional nodal disease. These data suggest that patients with micro-metastasis in the SLN from infiltrating lobular carcinoma have a significant risk of harboring additional nodal disease and should undergo completion axillary dissection. However, those with micrometastatic disease from infiltrating ductal carcinoma have a very low incidence of additional metastasis and may not need completion axillary dissection.</p>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Proc (Bayl Univ Med Cent)</journal-id>
<journal-id journal-id-type="publisher-id">bumc</journal-id>
<journal-title>Proceedings (Baylor University. Medical Center)</journal-title>
<issn pub-type="ppub">0899-8280</issn>
<publisher><publisher-name>Baylor Health Care System</publisher-name>
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<article-id pub-id-type="publisher-id">bumc0016-0003</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Articles</subject>
</subj-group>
</article-categories>
<title-group><article-title>Predictors for nonsentinel node involvement in breast cancer patients with micrometastases in the sentinel lymph node</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name><surname>Ganaraj</surname>
<given-names>Archana</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Kuhn</surname>
<given-names>Joseph A.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Jones</surname>
<given-names>Ronald C.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Grant</surname>
<given-names>Michael D.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Andrews</surname>
<given-names>Valerie R.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Knox</surname>
<given-names>Sally M.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Netto</surname>
<given-names>Georges J.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Altrabulsi</surname>
<given-names>Basel</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name><surname>Livingston</surname>
<given-names>Sheryl A.</given-names>
</name>
<degrees>RN, MSN</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple" corresp="yes"><name><surname>Mccarty</surname>
<given-names>Todd M.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label>
From the Departments of Surgery (Ganaraj, Kuhn, Jones, Grant, Andrews, Knox, Livingston, McCarty) and Pathology (Netto, Altrabulsi), Baylor University Medical Center, Dallas, Texas.</aff>
<author-notes><corresp><bold>Corresponding author:</bold>
Todd M. McCarty, MD, 3409 Worth Street, Suite 420, Dallas, Texas 75246.</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>1</month>
<year>2003</year>
</pub-date>
<volume>16</volume>
<issue>1</issue>
<fpage>3</fpage>
<lpage>6</lpage>
<ext-link xlink:href="http://www.BaylorHealth.com/Proceedings" ext-link-type="uri">http://www.BaylorHealth.com/Proceedings</ext-link>
<copyright-statement>Copyright © 2003, Baylor University Medical Center</copyright-statement>
<copyright-year>2003</copyright-year>
<abstract><p>Sentinel lymph node (SLN) biopsy in breast cancer allows for a more thorough pathologic assessment with serial sectioning and cytokeratin staining. This has resulted in increased detection of micrometastatic disease (tumor size <2 mm) in the SLN. Unfortunately, the value of completion axillary dissection after finding micrometastatic disease in the SLN remains poorly defined. Over a 2-year period, a prospective database of 305 patients who underwent SLN biopsy for breast cancer at Baylor University Medical Center was reviewed. Eighty-four (27.5%) of the patients had evidence of metastatic disease in the SLN. Twenty-four of the 41 patients identified as having micrometastatic disease in the SLN underwent completion axillary lymph node dissection. In these patients, all nonsentinel nodes were further studied by serial sectioning and im-munohistochemistry. The median age of these 24 patients was 52 years (range, 34–83). Their primary tumor stages were T,a andT,b (n = 5), T,c (n = 15), and T2 (n = 4). A total of 328 nonsentinel lymph nodes were examined, including 225 from patients with infiltrating ductal carcinoma (n = 17) and 103 from patients with infiltrating lobular carcinoma (n = 7). In the patients with infiltrating ductal carcinoma, no additional nodal metastases were identified, while in those with infiltrating lobular carcinoma, additional nodal disease was found in 5 lymph nodes (2 of 12 patients, 17%). Primary tumor characteristics were not predictive of additional nodal disease. These data suggest that patients with micro-metastasis in the SLN from infiltrating lobular carcinoma have a significant risk of harboring additional nodal disease and should undergo completion axillary dissection. However, those with micrometastatic disease from infiltrating ductal carcinoma have a very low incidence of additional metastasis and may not need completion axillary dissection.</p>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations><list></list>
<tree><noCountry><name sortKey="Altrabulsi, Basel" sort="Altrabulsi, Basel" uniqKey="Altrabulsi B" first="Basel" last="Altrabulsi">Basel Altrabulsi</name>
<name sortKey="Andrews, Valerie R" sort="Andrews, Valerie R" uniqKey="Andrews V" first="Valerie R." last="Andrews">Valerie R. Andrews</name>
<name sortKey="Ganaraj, Archana" sort="Ganaraj, Archana" uniqKey="Ganaraj A" first="Archana" last="Ganaraj">Archana Ganaraj</name>
<name sortKey="Grant, Michael D" sort="Grant, Michael D" uniqKey="Grant M" first="Michael D." last="Grant">Michael D. Grant</name>
<name sortKey="Jones, Ronald C" sort="Jones, Ronald C" uniqKey="Jones R" first="Ronald C." last="Jones">Ronald C. Jones</name>
<name sortKey="Knox, Sally M" sort="Knox, Sally M" uniqKey="Knox S" first="Sally M." last="Knox">Sally M. Knox</name>
<name sortKey="Kuhn, Joseph A" sort="Kuhn, Joseph A" uniqKey="Kuhn J" first="Joseph A." last="Kuhn">Joseph A. Kuhn</name>
<name sortKey="Livingston, Sheryl A" sort="Livingston, Sheryl A" uniqKey="Livingston S" first="Sheryl A." last="Livingston">Sheryl A. Livingston</name>
<name sortKey="Mccarty, Todd M" sort="Mccarty, Todd M" uniqKey="Mccarty T" first="Todd M." last="Mccarty">Todd M. Mccarty</name>
<name sortKey="Netto, Georges J" sort="Netto, Georges J" uniqKey="Netto G" first="Georges J." last="Netto">Georges J. Netto</name>
</noCountry>
</tree>
</affiliations>
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