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The microanatomic location of metastatic breast cancer in sentinel lymph nodes predicts nonsentinel lymph node involvement.

van Deurzen CH, Seldenrijk CA, Koelemij R, van Hillegersberg R, Hobbelink MG, van Diest PJ - Ann. Surg. Oncol. (2008)

Bottom Line: Non-SN metastases were found in 136/357 cases (38%).Microanatomic location and penetrative depth of SN metastases were significant predictors for non-SN involvement (<0.001); limited penetrative depth was associated with a low frequency of non-SN involvement with a minimal of 10%.However, based on these features no subgroup of patients could be selected with less than 10% non-SN involvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, St Antonius Hospital, Nieuwegein, The Netherlands.

ABSTRACT

Background: The majority of sentinel node (SN) positive breast cancer patients do not have additional non-SN involvement and may not benefit from axillary lymph node dissection (ALND). Previous studies in melanoma have suggested that microanatomic localization of SN metastases may predict non-SN involvement. The present study was designed to assess whether these criteria might also be used to be more restrictive in selecting breast cancer patients who would benefit from an ALND.

Methods: A consecutive series of 357 patients with invasive breast cancer and a tumor-positive axillary SN, followed by an ALND, was reviewed. Microanatomic SN tumor features (subcapsular, combined subcapsular and parenchymal, parenchymal, extensive localization, multifocality, and the penetrative depth from the SN capsule) were evaluated for their predictive value for non-SN involvement.

Results: Non-SN metastases were found in 136/357 cases (38%). Microanatomic location and penetrative depth of SN metastases were significant predictors for non-SN involvement (<0.001); limited penetrative depth was associated with a low frequency of non-SN involvement with a minimal of 10%.

Conclusions: Microanatomic location and penetrative depth of breast cancer SN metastases predict non-SN involvement. However, based on these features no subgroup of patients could be selected with less than 10% non-SN involvement.

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Related in: MedlinePlus

Pattern of distribution of metastatic breast cancer deposits in SNs.
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Fig1: Pattern of distribution of metastatic breast cancer deposits in SNs.

Mentions: The microanatomic location of metastatic deposits within each SN was classified as subcapsular, combined subcapsular and parenchymal, parenchymal or extensive. Extensive SN involvement, as defined in the study of Ruiter et al.,21 was a deposit >5 mm in diameter (Fig. 1). The centripetal depth was, according to Starz et al.,11 defined as the maximal depth at which tumor cells have infiltrated the SN, as measured from the inner margin of the capsule (Fig. 2), further denoted tumor penetrative depth according to the proposal of Scolyer et al.12 Multifocality was defined as two or more separated metastatic deposits at some distance from each other. All measurements were calculated microscopically in the plane of the tissue sections using interactive video morphometry systems (Q-PRODIT, Leica, Cambridge, UK or Research Video Assistant, Baarn, The Netherlands).FIG. 1.


The microanatomic location of metastatic breast cancer in sentinel lymph nodes predicts nonsentinel lymph node involvement.

van Deurzen CH, Seldenrijk CA, Koelemij R, van Hillegersberg R, Hobbelink MG, van Diest PJ - Ann. Surg. Oncol. (2008)

Pattern of distribution of metastatic breast cancer deposits in SNs.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2277442&req=5

Fig1: Pattern of distribution of metastatic breast cancer deposits in SNs.
Mentions: The microanatomic location of metastatic deposits within each SN was classified as subcapsular, combined subcapsular and parenchymal, parenchymal or extensive. Extensive SN involvement, as defined in the study of Ruiter et al.,21 was a deposit >5 mm in diameter (Fig. 1). The centripetal depth was, according to Starz et al.,11 defined as the maximal depth at which tumor cells have infiltrated the SN, as measured from the inner margin of the capsule (Fig. 2), further denoted tumor penetrative depth according to the proposal of Scolyer et al.12 Multifocality was defined as two or more separated metastatic deposits at some distance from each other. All measurements were calculated microscopically in the plane of the tissue sections using interactive video morphometry systems (Q-PRODIT, Leica, Cambridge, UK or Research Video Assistant, Baarn, The Netherlands).FIG. 1.

Bottom Line: Non-SN metastases were found in 136/357 cases (38%).Microanatomic location and penetrative depth of SN metastases were significant predictors for non-SN involvement (<0.001); limited penetrative depth was associated with a low frequency of non-SN involvement with a minimal of 10%.However, based on these features no subgroup of patients could be selected with less than 10% non-SN involvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, St Antonius Hospital, Nieuwegein, The Netherlands.

ABSTRACT

Background: The majority of sentinel node (SN) positive breast cancer patients do not have additional non-SN involvement and may not benefit from axillary lymph node dissection (ALND). Previous studies in melanoma have suggested that microanatomic localization of SN metastases may predict non-SN involvement. The present study was designed to assess whether these criteria might also be used to be more restrictive in selecting breast cancer patients who would benefit from an ALND.

Methods: A consecutive series of 357 patients with invasive breast cancer and a tumor-positive axillary SN, followed by an ALND, was reviewed. Microanatomic SN tumor features (subcapsular, combined subcapsular and parenchymal, parenchymal, extensive localization, multifocality, and the penetrative depth from the SN capsule) were evaluated for their predictive value for non-SN involvement.

Results: Non-SN metastases were found in 136/357 cases (38%). Microanatomic location and penetrative depth of SN metastases were significant predictors for non-SN involvement (<0.001); limited penetrative depth was associated with a low frequency of non-SN involvement with a minimal of 10%.

Conclusions: Microanatomic location and penetrative depth of breast cancer SN metastases predict non-SN involvement. However, based on these features no subgroup of patients could be selected with less than 10% non-SN involvement.

Show MeSH
Related in: MedlinePlus