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The prognostic value of lymph node cross-sectional cancer area in node-positive breast cancer: a comparison with N stage and lymph node ratio.

Li Y, Holmes E, Shah K, Albuquerque K, Szpaderska A, Erşahin C - Patholog Res Int (2012)

Bottom Line: Statistical analyses of these three LN-related factors were performed by Kaplan-Meier method and multivariate Cox's regression model.Patients were divided into three groups based on the different LN CSCA (<50, 50-500, and >500 mm(2)), or LNR (<0.1, 0.1-0.65, and >0.65), or N stage (N1-N3).Multivariate analysis demonstrated LNR was the most significant LN-related survival predictor with hazard ratio (HR) 25.0 (P = 0.001), compared to the metLN (HR 0.09, P = 0.052) and CSCA (HR 2.24, P = 0.323).

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Loyola University Medical Center, 2160 S First Avenue, Maywood, IL 60153, USA.

ABSTRACT
The number of positive axillary lymph nodes (LNs) is the only node-related factor for prognostic evaluation of breast cancer recognized by AJCC (TNM staging). However, N staging may not completely reflect LN tumor involvement due to the erroneous count of LNs in the presence of matted LNs and different tumor volume in LNs. Additionally, the positive/total LN ratio (LNR) has been shown to outperform N staging in survival prediction. In our study, to better quantify the tumor involvement of axillary LNs, we measured the cross-sectional cancer area (CSCA) of the positive LNs in 292 breast cancer patients diagnosed between 1998 and 2000 in our institution and compared its prognostic value to that of number of positive LNs (metLN)/N stage and LNR. Statistical analyses of these three LN-related factors were performed by Kaplan-Meier method and multivariate Cox's regression model. Patients were divided into three groups based on the different LN CSCA (<50, 50-500, and >500 mm(2)), or LNR (<0.1, 0.1-0.65, and >0.65), or N stage (N1-N3). Multivariate analysis demonstrated LNR was the most significant LN-related survival predictor with hazard ratio (HR) 25.0 (P = 0.001), compared to the metLN (HR 0.09, P = 0.052) and CSCA (HR 2.24, P = 0.323).

No MeSH data available.


Related in: MedlinePlus

Comparison of the number of positive LNs (metLN) and total LNs examined in the three methods N stage, LN CSCA, and LNR. ∗Statistically different with P < 0.05.
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fig3: Comparison of the number of positive LNs (metLN) and total LNs examined in the three methods N stage, LN CSCA, and LNR. ∗Statistically different with P < 0.05.

Mentions: The surgical reports and the medical records of 292 breast cancer patients diagnosed between 1998 and 2000 in our institution were retrospectively analyzed. The time frame of 1998–2000 is selected in that it allows at least a 10-year followup of the survival data. Information gathered for each patient includes age, tumor characteristics such as histologic grade, tumor size, T stage, metLN, N stage, total number of LNs examined, estrogen (ER) and progesterone receptor (PR) expression of tumors by immunohistochemical stains, and ECE of positive LNs. All the tumors were graded according to the Nottingham combined histologic grade. All the LNs are either bisected or serially sectioned into 2 mm thickness and submitted for histologic examination. ECE is defined by the clear penetration of cancer cells through the capsule of the LNs. The extent of metastatic cancer involving LNs was quantified in mm2 by measuring the area of cancer in these LNs (using Software Imaging System Olympus, MicroSuite 5, Pathology Edition). A screenshot of the cancer area measurement on a cross-section of an LN using the software is demonstrated in Figure 1. The contour of the cancer areas was outlined by a “pencil” tool in the program. If there were multiple foci of the metastatic tumor in a cross-section, the program calculated the individual contoured areas and then automatically summed all of them to calculate the total area. For positive LNs that were sectioned into multiple pieces, the measurement was selectively performed in one representative cross-section of the LN with the largest cancer area. If there are multiple positive LNs identified, the sum of CSCA in all positive LNs is obtained. Among 127 node-positive patients, 107 patients had available histologic slides for assessing the LN CSCA. These patients were divided into 3 groups based on the measured LN cancer areas: (1) <50 mm2, (2) 50–500 mm2, and (3) >500 mm2. The distribution of CSCA is illustrated in a scatter plot with mean ± SEM shown (Figure 2). The LNR was expressed as the ratio of metLN to total LNs examined. 127 node-positive patients were divided into three groups based on LNR: (1) 0.1, (2) 0.1–0.65, and (3) >0.65. metLN and total numbers of LNs are compared among different groups of N stage, LN cancer area, and LNR (Figure 3).


The prognostic value of lymph node cross-sectional cancer area in node-positive breast cancer: a comparison with N stage and lymph node ratio.

Li Y, Holmes E, Shah K, Albuquerque K, Szpaderska A, Erşahin C - Patholog Res Int (2012)

Comparison of the number of positive LNs (metLN) and total LNs examined in the three methods N stage, LN CSCA, and LNR. ∗Statistically different with P < 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3472529&req=5

fig3: Comparison of the number of positive LNs (metLN) and total LNs examined in the three methods N stage, LN CSCA, and LNR. ∗Statistically different with P < 0.05.
Mentions: The surgical reports and the medical records of 292 breast cancer patients diagnosed between 1998 and 2000 in our institution were retrospectively analyzed. The time frame of 1998–2000 is selected in that it allows at least a 10-year followup of the survival data. Information gathered for each patient includes age, tumor characteristics such as histologic grade, tumor size, T stage, metLN, N stage, total number of LNs examined, estrogen (ER) and progesterone receptor (PR) expression of tumors by immunohistochemical stains, and ECE of positive LNs. All the tumors were graded according to the Nottingham combined histologic grade. All the LNs are either bisected or serially sectioned into 2 mm thickness and submitted for histologic examination. ECE is defined by the clear penetration of cancer cells through the capsule of the LNs. The extent of metastatic cancer involving LNs was quantified in mm2 by measuring the area of cancer in these LNs (using Software Imaging System Olympus, MicroSuite 5, Pathology Edition). A screenshot of the cancer area measurement on a cross-section of an LN using the software is demonstrated in Figure 1. The contour of the cancer areas was outlined by a “pencil” tool in the program. If there were multiple foci of the metastatic tumor in a cross-section, the program calculated the individual contoured areas and then automatically summed all of them to calculate the total area. For positive LNs that were sectioned into multiple pieces, the measurement was selectively performed in one representative cross-section of the LN with the largest cancer area. If there are multiple positive LNs identified, the sum of CSCA in all positive LNs is obtained. Among 127 node-positive patients, 107 patients had available histologic slides for assessing the LN CSCA. These patients were divided into 3 groups based on the measured LN cancer areas: (1) <50 mm2, (2) 50–500 mm2, and (3) >500 mm2. The distribution of CSCA is illustrated in a scatter plot with mean ± SEM shown (Figure 2). The LNR was expressed as the ratio of metLN to total LNs examined. 127 node-positive patients were divided into three groups based on LNR: (1) 0.1, (2) 0.1–0.65, and (3) >0.65. metLN and total numbers of LNs are compared among different groups of N stage, LN cancer area, and LNR (Figure 3).

Bottom Line: Statistical analyses of these three LN-related factors were performed by Kaplan-Meier method and multivariate Cox's regression model.Patients were divided into three groups based on the different LN CSCA (<50, 50-500, and >500 mm(2)), or LNR (<0.1, 0.1-0.65, and >0.65), or N stage (N1-N3).Multivariate analysis demonstrated LNR was the most significant LN-related survival predictor with hazard ratio (HR) 25.0 (P = 0.001), compared to the metLN (HR 0.09, P = 0.052) and CSCA (HR 2.24, P = 0.323).

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Loyola University Medical Center, 2160 S First Avenue, Maywood, IL 60153, USA.

ABSTRACT
The number of positive axillary lymph nodes (LNs) is the only node-related factor for prognostic evaluation of breast cancer recognized by AJCC (TNM staging). However, N staging may not completely reflect LN tumor involvement due to the erroneous count of LNs in the presence of matted LNs and different tumor volume in LNs. Additionally, the positive/total LN ratio (LNR) has been shown to outperform N staging in survival prediction. In our study, to better quantify the tumor involvement of axillary LNs, we measured the cross-sectional cancer area (CSCA) of the positive LNs in 292 breast cancer patients diagnosed between 1998 and 2000 in our institution and compared its prognostic value to that of number of positive LNs (metLN)/N stage and LNR. Statistical analyses of these three LN-related factors were performed by Kaplan-Meier method and multivariate Cox's regression model. Patients were divided into three groups based on the different LN CSCA (<50, 50-500, and >500 mm(2)), or LNR (<0.1, 0.1-0.65, and >0.65), or N stage (N1-N3). Multivariate analysis demonstrated LNR was the most significant LN-related survival predictor with hazard ratio (HR) 25.0 (P = 0.001), compared to the metLN (HR 0.09, P = 0.052) and CSCA (HR 2.24, P = 0.323).

No MeSH data available.


Related in: MedlinePlus