More tumor‐affected lymph nodes because of the sentinel lymph node procedure but no stage migration,because the 2002 TNM classifies small tumor deposits as pathologic N0 breast cancer |
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| Authors: | Marieke J Bolster MD Peter Bult MD Carla A P Wauters MD Luc J A Strobbe MD PhD Petronella G M Peer PhD Theo Wobbes MD PhD Vivianne C G Tjan‐Heijnen MD PhD |
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| Institution: | 1. Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands;2. Fax: (011) 31‐24‐3540501;3. Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands;4. Department of Pathology, Canisius‐Wilhelmina Hospital, Nijmegen, the Netherlands;5. Department of Surgery, Canisius‐Wilhelmina Hospital, Nijmegen, the Netherlands;6. Department of Epidemiology and Biostatistics, Radboud University Nijmegen, Nijmegen, the Netherlands;7. Department of Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands |
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| Abstract: | BACKGROUND: Intensified examination of the sentinel lymph node (SN) may result in increased detection of tumor‐affected lymph nodes. The authors of this report hypothesized that the introduction of the SN procedure has led to stage migration because of the intensified workup of SNs by pathologists. METHODS: After the introduction of the SN procedure, 360 patients with operable breast cancer were included prospectively from 2 large hospitals (Hospital A and Hospital B). The prospectively included patients (the “SN era” group) were compared with 88 historic controls from the year 1994 who were diagnosed with primary breast cancer before introduction of the SN procedure. RESULTS: After correcting for classic clinical and pathologic prognostic factors in a multiple logistic regression analysis, the detection frequency of lymph node involvement was significantly higher in the SN era group compared with historic controls (P = .04). However, when using the 2002 TNM classification, in which isolated tumor cells (≤0.2 mm) were categorized as lymph node‐negative disease, no stage migration was observed (P = .98). Also, when analyzing both hospitals (Hospital A vs Hospital B) separately with respect to lymph node involvement, there was no difference, between the SN era and the historic controls (P = .79 and P = .69, respectively). This remained nonsignificant after the analysis was corrected for patient and primary tumor characteristics (P = .85 and P = .66, respectively). CONCLUSIONS: Introduction of the SN procedure has led to the detection of more tumor‐affected lymph nodes because of the intensified workup of SNs by pathologists. However, stage migration did not occur when tumor deposits of ≤0.2 mm were categorized as lymph node‐negative disease, according to the 2002 TNM classification. Cancer 2009. © 2009 American Cancer Society. |
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| Keywords: | breast cancer sentinel lymph node micrometastasis stage migration TNM classification |
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