Risk of additional axillary metastases after micrometastases in sentinel lymph node in a Western Australian population

Introduction. Sentinel lymph node biopsy (SLNB) in patients with pure ductal carcinoma in situ (DCIS) has been a matter of debate due to very low rate of axillary metastases. We therefore aimed to identify factors in a single institutional series to select patients who may benefit from SLNB. Material and Methods. Patients, diagnosed with pure DCIS () between July 2000 and March 2011, were reviewed. All the sentinel lymph nodes were examined by serial sectioning (50 μm) of the entire lymph node and H&E staining, and by cytokeratin immunostaining in suspicious cases. Results. Median age was 51 (range, 30–79). Of 63 patients, 40 cases (63.5%) with pure DCIS underwent SLN, and 2 of them had a positive SLN (5%). In both 2 cases with SLN metastases, only one sentinel lymph node was involved with tumor cells. Patients who underwent SLNB were more likely to have a tumor size >30 mm or DCIS with intermediate and high nuclear grade or a mastectomy in univariate and multivariate analyses. Conclusion. In our series, we found a slightly higher rate of SLNB positivity in patients with pure DCIS than the large series reported elsewhere. This may either be due to the meticulous examination of SLNs by serial sectioning technique or due to our patient selection criteria or both.

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4. Sentinel lymph node metastasis burden in breast cancer patients predicts risk of further axillary metastases following analysis using one-step nucleic acid amplification: A prospective cohort study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.02.194 ◽

2014 ◽

Vol 40 (5) ◽

pp. 601

Author(s):

Thomas Milner ◽

Simon de Lusignan ◽

Simon Jones ◽

Peter Jackson ◽

Graham Layer ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Node Metastasis ◽

Nucleic Acid Amplification ◽

Breast Cancer Patients ◽

Axillary Metastases ◽

Node Metastasis ◽

One Step

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Predicting the Risk for Additional Axillary Metastases in Patients With Breast Carcinoma and Positive Sentinel Lymph Node Biopsy

Annals of Surgery ◽

10.1097/01.sla.0000150255.30665.52 ◽

2005 ◽

Vol 241 (2) ◽

pp. 319-325 ◽

Cited By ~ 191

Author(s):

Giuseppe Viale ◽

Eugenio Maiorano ◽

Giancarlo Pruneri ◽

Mauro G. Mastropasqua ◽

Stefano Valentini ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Breast Carcinoma ◽

Positive Sentinel Lymph Node ◽

Lymph Node Biopsy ◽

Axillary Metastases ◽

Node Biopsy

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4–31 Feasibility and Accuracy of Sentinel Lymph Node Biopsy After Preoperative Chemotherapy in Breast Cancer Patients With Documented Axillary Metastases

Breast Diseases A Year Book Quarterly ◽

10.1016/s1043-321x(07)80412-7 ◽

2008 ◽

Vol 18 (4) ◽

pp. 378-379

Author(s):

R. Nair ◽

C. Laronga

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Cancer Patients ◽

Preoperative Chemotherapy ◽

Lymph Node Biopsy ◽

Breast Cancer Patients ◽

Axillary Metastases ◽

Node Biopsy

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Prediction of occult axillary metastases in treatment-naïve patients with breast cancer: A transSENTINA analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.566 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 566-566

Author(s):

Cornelia Kolberg-Liedtke ◽

Hans-Christian Kolberg ◽

Ingo Bauerfeind ◽

Tanja N. Fehm ◽

Barbara Fleige ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Regression Models ◽

Her2 Status ◽

Tumor Diameter ◽

Tumor Type ◽

Biological Parameters ◽

Axillary Metastases ◽

Treatment Naïve ◽

Systemic Therapies

566 Background: Prediction of occult axillary metastases through clinical / biological parameters may allow reduction of axillary staging. This is particularly important, as systemic therapies have become more efficient. We have conducted a systematic analysis among patients undergoing axillary sentinel lymph-node biopsy (SLNB) before initiation of primary systemic therapy as part of a clinical trial (SENTINA) with the goal to identify predictors of sentinel lymph node status in a well-defined patient cohort. Methods: Patients with a clinically negative axillary status who underwent SLNB as part of the prospective SENTINA trial were included. Univariate and multivariate analyses were carried out to identify clinical / pathological parameters associated with SLN status, using logistic regression models. Model performance was assessed by ROC analyses. Calculations were performed using R version 3.5.2. Results: Arms A and B of the SENTINA study contained 1022 patients. Among 805 cN0 patients, all parameters considered relevant for this analysis were available. 527 and 278 patients presented with negative and positive lymph nodes upon SLN biopsy, respectively. Univariate regression models identified largest tumor diameter (odds ratio (OR) 1.016, p-value 0.0041), tumor type (ductal vs. lobular, OR 2.004, p 0.00234), tumor grading (low vs. high, OR 0.537, p < 0.001), hormone receptor (HR) status (negative vs. positive, OR 2.668, p < 0.001), HER2 status (negative vs. positive, OR 1.462, p 0.0158) as being associated with SLN status with an a < 0.1. Multivariate analysis resulted in tumor diameter, HR status, HER2 status and tumor type being independently associated. These parameters were combined using stepwise (backward and forward) selection into a prediction model. This model predicted SLN status with an AUC of only 0.65. Conclusions: Using data obtained as part of the SENTINA trial we were able to build a prediction model that was able to predict SLN metastases in treatment naïve cN0 patients with limited accuracy. Additional (biological) parameters, such as response to systemic therapies (i.e. axillary conversion through PST) may be more appropriate to predict presence of occult sentinel lymph node metastases among patients with breast cancer.

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