Risk Stratification of Patients With Early Breast Cancer |
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| Affiliation: | 1. Department of Neurology, Yeungnam University College of Medicine, Daegu, Republic of Korea;2. Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea;3. Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea;4. Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea;5. Department of Neurology, Daegu Fatima Hospital, Republic of Korea;1. Division of Radiation Oncology, National Cancer Centre Singapore, Singapore;2. Unit of Health Services Research, Singapore General Hospital, Singapore;3. Department of Pathology, Singapore General Hospital, Singapore;1. Department of Oncology–Pathology, Radiumhemmet, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden;2. Department of Oncology, Central Hospital Karlstad, Karlstad, Sweden;3. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden;4. Department of Economics and Statistics, Karlstad University, Karlstad, Sweden;5. Department of Surgery, Uppsala University, Uppsala, Sweden;6. Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden;7. Department of Surgery, Uppsala University Hospital, Uppsala, Sweden;1. Department of Computer Engineering, Firat University, 23119 Elazig, Turkey;2. Department of Computer Science, University of Calgary, Calgary, AB, Canada;3. Department of Computer Science, Global University, Beirut, Lebanon;1. Division of Medical Senology, European Institute of Oncology, Milan, Italy;2. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy;3. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy;4. Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Italy;5. Integrated Breast Surgery Unit, European Institute of Oncology and University of Milan, Italy;6. Division of Senology, European Institute of Oncology, Milan, Italy;7. Division of Radiation Oncology, European Institute of Oncology, Milan, Italy;8. Department of Medicine, European Institute of Oncology, Milan, Italy |
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| Abstract: | BackgroundSentinel lymph node biopsy (SLNB) is the standard procedure performed to stage the axillae, and axillary node clearance (ANC) or radiotherapy is the treatment for nodal involvement. The aims of this study were to assess (1) the role of preoperative axillary ultrasonography (US), (2) the number of positive lymph nodes on ANC after either positive SLNB results or preoperative ultrasonographically guided nodal biopsy, and (3) the role of ANC in patients with node-positive breast cancer.Patients and MethodsAll patients with invasive breast cancer and axillary node involvement (but clinically negative nodes on presentation) who underwent ANC between January 2008 and December 2009 were identified, and information regarding clinicopathologic parameters and the nodal yield was collected. ANC was performed for 3 groups: patients with micrometastasis seen in SLNB specimens, macrometastasis seen in SLNB specimens, and positive axillary nodes detected on US biopsy.ResultsANC was performed 141 times over the 2-year period. Forty-two percent of axillary node involvement was diagnosed by biopsy or preoperative US, and 40% of these patients received neoadjuvant chemotherapy. The remainder of cases were diagnosed by SLNB: 30% had micrometastases and 70% had macrometastases. Fifty percent of cancers with an ultrasonographic diagnosis of lymph node involvement were high grade and 56% had 4 or more positive nodes on ANC; this was significantly higher than in patients with positive SLNB results (P = .0001). Only 20% of patients with macrometastases on SLNB had 4 or more positive nodes in comparison with 56% with positive axillary lymph nodes by US (P < .0001).ConclusionThe routine use of preoperative axillary US and biopsy of abnormal nodes helps in identifying high-risk patients and thus aids in planning treatment. |
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| Keywords: | Axillary node clearance Axillary ultrasonography Breast cancer Macrometastasis Micrometastasis Sentinel lymph node biopsy |
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