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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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ROC curves showing the sensitivity and specificity of SN tumor diameter and penetrative depth as predictors of non-SN involvement. The larger the area below the curve, the more accurate the prediction of non-SN involvement (P < 0.001).
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Fig4: ROC curves showing the sensitivity and specificity of SN tumor diameter and penetrative depth as predictors of non-SN involvement. The larger the area below the curve, the more accurate the prediction of non-SN involvement (P < 0.001).

Mentions: The microanatomic localization of SN metastatic deposits correlated with non-SN involvement. Patients with subcapsular (N = 167), combined subcapsular and parenchymal (N = 40), parenchymal (N = 11) and extensive (N = 139) tumor deposits showed non-SN involvement in 25%, 42%, 27%, and 54% of cases, respectively (Table 3). Morphometrically assessed penetrative depth of SN metastases was also associated with non-SN involvement. Frequency of non-SN metastases in patients with a SN tumor penetrative depth <0.155 mm (N = 29), 0.155–2.7 mm (N = 181) and >2.7 mm (N = 147) was 10%, 28%, and 56%, respectively (P < 0.001, Table 5). In ROC analysis, diameter (AUC = 0.686) and the penetrative depth (AUC = 0.680) of the SN tumor deposit had comparable discriminative value (Fig. 4).TABLE 5.


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)

ROC curves showing the sensitivity and specificity of SN tumor diameter and penetrative depth as predictors of non-SN involvement. The larger the area below the curve, the more accurate the prediction of non-SN involvement (P < 0.001).
© Copyright Policy
Related In: Results  -  Collection

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

Fig4: ROC curves showing the sensitivity and specificity of SN tumor diameter and penetrative depth as predictors of non-SN involvement. The larger the area below the curve, the more accurate the prediction of non-SN involvement (P < 0.001).
Mentions: The microanatomic localization of SN metastatic deposits correlated with non-SN involvement. Patients with subcapsular (N = 167), combined subcapsular and parenchymal (N = 40), parenchymal (N = 11) and extensive (N = 139) tumor deposits showed non-SN involvement in 25%, 42%, 27%, and 54% of cases, respectively (Table 3). Morphometrically assessed penetrative depth of SN metastases was also associated with non-SN involvement. Frequency of non-SN metastases in patients with a SN tumor penetrative depth <0.155 mm (N = 29), 0.155–2.7 mm (N = 181) and >2.7 mm (N = 147) was 10%, 28%, and 56%, respectively (P < 0.001, Table 5). In ROC analysis, diameter (AUC = 0.686) and the penetrative depth (AUC = 0.680) of the SN tumor deposit had comparable discriminative value (Fig. 4).TABLE 5.

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