Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma
Identifieur interne : 003D82 ( Pmc/Curation ); précédent : 003D81; suivant : 003D83Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma
Auteurs : Sibel Yenidunya [Turquie] ; Reyhan Bayrak [Turquie] ; Hacer Haltas [Turquie]Source :
- Diagnostic Pathology [ 1746-1596 ] ; 2011.
Abstract
While several prognostic factors have been identified in breast carcinoma, the clinical outcome remains hard to predict for individual patients. Better predictive markers are needed to help guide difficult treatment decisions. Axillary lymph node metastasis (ALNM) is one of the most important prognostic determinants in breast carcinoma; however, the reasons why tumors vary in their capability to result in axillary metastasis remain unclear. Identifying breast carcinoma patients at risk for ALNM would improve treatment planning. This study aimed to identify the factors associated with ALNM in breast carcinoma, with particular emphasis on basal-like phenotype.
Breast carcinoma patients (n = 210) who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy were included in this study. Pathological and immunohistochemical data including individual receptor/gene status was collected for analysis. The basal phenotype status was ascertained using the basal cytokeratin markers CK5, CK14, CK17 and EGFR.
ALNM was found in 55% (n = 116) of the patients. On univariate analysis, multicentric disease, large tumor size (>2 cm), vascular and lymphatic invasion, epithelial hyperplasia, necrosis, in situ carcinoma and perineural invasion were associated with higher risk for ALNM, whereas CK5, CK14, EGFR positivity and basal-like tumor type were associated with lower risk. On multivariate analysis, CK5 positivity (OR 0.003, 95%CI 0.000-0.23, p = 0.009) and lymphatic/vascular invasion (OR 17.94, 95%CI 4.78-67.30, p < 0.001) were found to be independent predictors.
Although the value of complete ALND has been questioned in invasive breast cancer patients, treatment decisions for breast carcinoma have been influenced by many parameters, including lymph node status. Since histopathologic characteristics and expression of biological markers varies among the same histologic subtypes of breast carcinoma, specific clinical and histopathologic features of the primary tumor and ALN status like sentinel node might be used to tailor the loco-regional and systemic treatment in different clinical settings.
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DOI: 10.1186/1746-1596-6-18
PubMed: 21396129
PubMed Central: 3068936
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma</title><author><name sortKey="Yenidunya, Sibel" sort="Yenidunya, Sibel" uniqKey="Yenidunya S" first="Sibel" last="Yenidunya">Sibel Yenidunya</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Pathology, Fatih University Hospital, Ankara, Turkey</nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Department of Pathology, Fatih University Hospital, Ankara</wicri:regionArea></affiliation></author><author><name sortKey="Bayrak, Reyhan" sort="Bayrak, Reyhan" uniqKey="Bayrak R" first="Reyhan" last="Bayrak">Reyhan Bayrak</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Pathology, Fatih University Hospital, Ankara, Turkey</nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Department of Pathology, Fatih University Hospital, Ankara</wicri:regionArea></affiliation></author><author><name sortKey="Haltas, Hacer" sort="Haltas, Hacer" uniqKey="Haltas H" first="Hacer" last="Haltas">Hacer Haltas</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Pathology, Fatih University Hospital, Ankara, Turkey</nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Department of Pathology, Fatih University Hospital, Ankara</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21396129</idno><idno type="pmc">3068936</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068936</idno><idno type="RBID">PMC:3068936</idno><idno type="doi">10.1186/1746-1596-6-18</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">003D83</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003D83</idno><idno type="wicri:Area/Pmc/Curation">003D82</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003D82</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma</title><author><name sortKey="Yenidunya, Sibel" sort="Yenidunya, Sibel" uniqKey="Yenidunya S" first="Sibel" last="Yenidunya">Sibel Yenidunya</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Pathology, Fatih University Hospital, Ankara, Turkey</nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Department of Pathology, Fatih University Hospital, Ankara</wicri:regionArea></affiliation></author><author><name sortKey="Bayrak, Reyhan" sort="Bayrak, Reyhan" uniqKey="Bayrak R" first="Reyhan" last="Bayrak">Reyhan Bayrak</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Pathology, Fatih University Hospital, Ankara, Turkey</nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Department of Pathology, Fatih University Hospital, Ankara</wicri:regionArea></affiliation></author><author><name sortKey="Haltas, Hacer" sort="Haltas, Hacer" uniqKey="Haltas H" first="Hacer" last="Haltas">Hacer Haltas</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Pathology, Fatih University Hospital, Ankara, Turkey</nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Department of Pathology, Fatih University Hospital, Ankara</wicri:regionArea></affiliation></author></analytic><series><title level="j">Diagnostic Pathology</title><idno type="eISSN">1746-1596</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background/Objective</title><p>While several prognostic factors have been identified in breast carcinoma, the clinical outcome remains hard to predict for individual patients. Better predictive markers are needed to help guide difficult treatment decisions. Axillary lymph node metastasis (ALNM) is one of the most important prognostic determinants in breast carcinoma; however, the reasons why tumors vary in their capability to result in axillary metastasis remain unclear. Identifying breast carcinoma patients at risk for ALNM would improve treatment planning. This study aimed to identify the factors associated with ALNM in breast carcinoma, with particular emphasis on basal-like phenotype.</p></sec><sec><title>Methods</title><p>Breast carcinoma patients (n = 210) who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy were included in this study. Pathological and immunohistochemical data including individual receptor/gene status was collected for analysis. The basal phenotype status was ascertained using the basal cytokeratin markers CK5, CK14, CK17 and EGFR.</p></sec><sec><title>Results</title><p>ALNM was found in 55% (n = 116) of the patients. On univariate analysis, multicentric disease, large tumor size (>2 cm), vascular and lymphatic invasion, epithelial hyperplasia, necrosis, in situ carcinoma and perineural invasion were associated with higher risk for ALNM, whereas CK5, CK14, EGFR positivity and basal-like tumor type were associated with lower risk. On multivariate analysis, CK5 positivity (OR 0.003, 95%CI 0.000-0.23, p = 0.009) and lymphatic/vascular invasion (OR 17.94, 95%CI 4.78-67.30, p < 0.001) were found to be independent predictors.</p></sec><sec><title>Conclusions</title><p>Although the value of complete ALND has been questioned in invasive breast cancer patients, treatment decisions for breast carcinoma have been influenced by many parameters, including lymph node status. Since histopathologic characteristics and expression of biological markers varies among the same histologic subtypes of breast carcinoma, specific clinical and histopathologic features of the primary tumor and ALN status like sentinel node might be used to tailor the loco-regional and systemic treatment in different clinical settings.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Rosen, Pp" uniqKey="Rosen P">PP Rosen</name></author><author><name sortKey="Groshen, S" uniqKey="Groshen S">S Groshen</name></author><author><name sortKey="Kinne, Dw" uniqKey="Kinne D">DW Kinne</name></author><author><name sortKey="Norton, L" uniqKey="Norton L">L Norton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Greenlee, Rt" uniqKey="Greenlee R">RT Greenlee</name></author><author><name sortKey="Hill Harmon, Mb" uniqKey="Hill Harmon M">MB Hill-Harmon</name></author><author><name sortKey="Murray, T" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Diagn Pathol</journal-id><journal-title-group><journal-title>Diagnostic Pathology</journal-title></journal-title-group><issn pub-type="epub">1746-1596</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21396129</article-id><article-id pub-id-type="pmc">3068936</article-id><article-id pub-id-type="publisher-id">1746-1596-6-18</article-id><article-id pub-id-type="doi">10.1186/1746-1596-6-18</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Yenidunya</surname><given-names>Sibel</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>sibelyn@yahoo.com</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Bayrak</surname><given-names>Reyhan</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>bayrakreyhan@yahoo.com</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Haltas</surname><given-names>Hacer</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>hhaltas@hotmail.com</email></contrib></contrib-group><aff id="I1"><label>1</label>Department of Pathology, Fatih University Hospital, Ankara, Turkey</aff><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>13</day><month>3</month><year>2011</year></pub-date><volume>6</volume><fpage>18</fpage><lpage>18</lpage><history><date date-type="received"><day>16</day><month>2</month><year>2011</year></date><date date-type="accepted"><day>13</day><month>3</month><year>2011</year></date></history><permissions><copyright-statement>Copyright ©2011 Yenidunya et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2011</copyright-year><copyright-holder>Yenidunya et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.diagnosticpathology.org/content/6/1/18"></self-uri><abstract><sec><title>Background/Objective</title><p>While several prognostic factors have been identified in breast carcinoma, the clinical outcome remains hard to predict for individual patients. Better predictive markers are needed to help guide difficult treatment decisions. Axillary lymph node metastasis (ALNM) is one of the most important prognostic determinants in breast carcinoma; however, the reasons why tumors vary in their capability to result in axillary metastasis remain unclear. Identifying breast carcinoma patients at risk for ALNM would improve treatment planning. This study aimed to identify the factors associated with ALNM in breast carcinoma, with particular emphasis on basal-like phenotype.</p></sec><sec><title>Methods</title><p>Breast carcinoma patients (n = 210) who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy were included in this study. Pathological and immunohistochemical data including individual receptor/gene status was collected for analysis. The basal phenotype status was ascertained using the basal cytokeratin markers CK5, CK14, CK17 and EGFR.</p></sec><sec><title>Results</title><p>ALNM was found in 55% (n = 116) of the patients. On univariate analysis, multicentric disease, large tumor size (>2 cm), vascular and lymphatic invasion, epithelial hyperplasia, necrosis, in situ carcinoma and perineural invasion were associated with higher risk for ALNM, whereas CK5, CK14, EGFR positivity and basal-like tumor type were associated with lower risk. On multivariate analysis, CK5 positivity (OR 0.003, 95%CI 0.000-0.23, p = 0.009) and lymphatic/vascular invasion (OR 17.94, 95%CI 4.78-67.30, p < 0.001) were found to be independent predictors.</p></sec><sec><title>Conclusions</title><p>Although the value of complete ALND has been questioned in invasive breast cancer patients, treatment decisions for breast carcinoma have been influenced by many parameters, including lymph node status. Since histopathologic characteristics and expression of biological markers varies among the same histologic subtypes of breast carcinoma, specific clinical and histopathologic features of the primary tumor and ALN status like sentinel node might be used to tailor the loco-regional and systemic treatment in different clinical settings.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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