Axillary node metastasis from T1N0M0 breast cancer: possible avoidance of dissection in a subgroup |
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Authors: | Iwasaki Y; Fukutomi T; Akashi-Tanaka S; Nanasawa T; Tsuda H |
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Institution: | Department of Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan. |
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Abstract: | BACKGROUND: Axillary lymph node dissection is now no longer considered to
be the standard treatment in all patients with invasive breast cancer. We
have attempted to identify a sub-group of patients with invasive breast
carcinoma who may not need to undergo axillary lymph node dissection.
METHODS: Patients (n = 823) with T1 N0M0 invasive breast cancer treated at
our hospital between 1970 and 1994 were studied. We investigated the
relationship between positive axillary lymph nodes and the following
clinico-pathological factors: patient age, menopausal status, contralateral
breast cancer (synchronous or asynchronous), tumor location, tumor size
(T:cm), histopathology, histological grade, presence or absence of
malignant microcalcification or spiculation on mammography and estrogen
receptor status. RESULTS: The incidence of axillary lymph node metastases
in patients with T1N0M0 invasive breast cancer was 25% (208/823). The
node-negative group was significantly older than the node-positive group.
Premenopausal patients had a higher rate of lymph node metastases although
this was not significant. The frequency of nodal metastases when related to
the tumor size was as follows: T< or =1.0 cm, 17%; T< or =1.5 cm,
25%; T< or =2.0 cm, 29%. Mammography revealed that patients with
malignant calcification or spiculation had a significantly higher rate of
nodal metastases than those without these findings. Certain tumor types
(medullary, mucinous and tubular carcinomas) had lower positive rates for
lymph node involvement. With regard to the histological grade, lymph node
positivity increased significantly with high-grade tumors. No correlation
was observed between any other factors and the presence or absence of lymph
node metastases. CONCLUSIONS: It may be possible to avoid axillary lymph
node dissection in postmenopausal patients (50 years or older) where the
histological type is favorable when the tumor diameter is < or =1.0 cm
and when microcalcification or spiculation is absent on mammography.
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