Effects of the number of removed lymph nodes on survival outcome in patients with sentinel node-negative breast cancer

Abstract Background Sentinel lymph node biopsy is the gold standard surgical technique for axillary staging in patients with clinically node-negative. However, it is still uncertain what is the optimal number of sentinel lymph nodes (SLNs) to be removed to reduce the false-negative rate. The aim of this study was to investigate whether patients with a single negative SLN have a worse prognosis than those with two or more negative SLNs. Methods A retrospective review was conducted on a large series of SLN-negative breast cancer patients. Survival outcomes and regional recurrence rate were evaluated according to the number of removed SLNs. Secondly, the contribution of different adjuvant therapies on disease-free survival was explored. Statistical analysis included the chi-square, Wilcoxon–Mann–Whitney test, and Kaplan–Meier survival analysis. Results A total of 1080 patients were included in the study. A first group consisted of 328 patients in whom a single SLN was retrieved, and a second group consisted of 752 patients in whom two or more SLNs were retrieved. There was no relevant difference in median DFS (64.9 vs 41.4) for SLN = 1 vs SLN > 1 groups (HR 0.76, CI 95% 0.39–1.46; p = 0.38). A statistically significant difference in mDFS was showed only for HT-treated patients who were SLN = 1 if compared to SLN > 1 (100.6 months versus 35.3 months). Conclusions There is likely a relationship between the number of resected SNL and mDFS. Our results, however, showed no relevant difference in median DFS for SLN = 1 vs SLN > 1 group, except for a subset of the patients treated with hormone therapy.

Download Full-text

Effects of the Number of Removed Lymph Nodes on Survival Outcome in Patients With Sentinel Node-negative Breast Cancer.

10.21203/rs.3.rs-565693/v1 ◽

2021 ◽

Author(s):

Calogero Cipolla ◽

Antonio Galvano ◽

Salvatore Vieni ◽

Federica Saputo ◽

Simona Lupo ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

False Negative ◽

False Negative Rate ◽

Optimal Number ◽

Breast Cancer Patients ◽

Chi Square ◽

Relevant Difference ◽

Kaplan Meier ◽

Significant Difference

Abstract Background It is still uncertain what is the optimal number of sentinel lymph nodes (SLN) to be removed to reduce the false negative rate. The aim of this study was to investigate whether patients with a single negative SLN have a worse prognosis than those with two or more negative SLNs.Methods A retrospective review was conducted on a large series of SLN-negative breast cancer patients. Survival outcomes were evaluated according to the number of removed SLNs. Statistical analysis included Chi-square, Wilcoxon Mann Whitney test and Kaplan–Meier survival analysis.Results There was no relevant difference in median DFS (64.9 vs 41.4) for SLN=1 vs SLN>1 groups (HR 0.76, CI 95% 0.39 – 1.46; p = 0.38). A statistically significant difference in mDFS was showed only for HT treated patients who were SLN= 1 if compared to SLN>1 (100.6 months versus 35.3 months). Conclusions Our results showed no relevant difference in median DFS for SLN=1 vs SLN>1 group, except for a subset of the patients treated with hormone therapy.

Download Full-text

A prospective study to evaluate the accuracy of axillary staging using ultrasound and USG-guided fine needle aspiration cytology in early breast cancer patients in a high-volume center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e12060 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e12060-e12060

Author(s):

Rashpal Singh ◽

Ekta Dhamija ◽

SVS Deo ◽

Sandeep Mathur ◽

Sanjay Thulkar

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Early Breast Cancer ◽

False Negative ◽

False Negative Rate ◽

High Volume ◽

Axillary Staging ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Developing Nation

e12060 Background: In breast cancer, axillary lymph node involvement directly impacts the patient survival and prognosis.Sentinel lymph node biopsy (SLNB) is a procedure of choice for axillary staging in early breast cancer. Currently, management options for axilla management are ALND & SLNB in node positive & in node negative respectively. In developing nation like India,where resource constraints, logistics issues and over burden health institutes create difficulty in managing patients, our study address this issue by implementing USG and USG-FNAC in early breast cancer patients in developing nation. Methods: All early breast cancer patients were screend by ultrasound axilla to categorise the nodes as suspicious or non suspicious. Suspicious nodes underwent USG & FNAC using vascualr pedicle based nodal mapping for node targeted on USG-FNAC, if node found to be positive, patient underwent ALND & negative node patients underwent SLNB.All non-suspicious nodes patient underwent SLNB. Final histopathology was taken as gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value, accuacy and false negative rate calculated for USG & USG-FNAC. Results: Total 100 patients included in which 58 were non-suspicious and 42 suspicious nodes on USG. Among suspicious group, 24 were positive on USG-FNAC & 18 were negative.In non suspicious SLNB done in all. False negative rate of USG & USG-FNAC was 38% and 17% respectively. Conclusions: Our study indicates the feasibility of USG & USG-FNAC in a high volume centre with good accuracy of around 70- 80%.Overall, 24 % of total patients can be taken up for ALND without performing SLNB.This study can guide us to utilize ultrasound and ultrasound-guided FNAC as a routine evaluation tool in the pre operative assessment of axillary lymph nodes in early breast cancer. Our study showed good and acceptable result (75%) in isolating and retrieving the targeted node by just following the Vascular pedicle based node mapping of axilla to locate the suspicious node without using any tagging or marking of node from where FNAC was performed. This finding can act as a good practicing tool in a busy high volume, logistics issue and and resource constraint hospitals.[Table: see text]

Download Full-text

The analyses of disease free survival and overall survival in premenopausal and postmenopausal axillary node negative breast cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10757 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10757-10757

Author(s):

N. D. Bajic ◽

D. D. Scepanovic

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Disease Free Survival ◽

Axillary Node ◽

Breast Cancer Patients ◽

Free Survival ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Significant Difference

10757 Background: The aim of this study was to analyse in which order known traditional prognostic factors predict disease free survival (DFS) and overall survival (OS) in breast cancer patients (pts) who are patohystologicaly axillary node negative. Methods: From 1998 till 2004, 258 patients were treated of axillary node negative breast cancer. We analysed 3 and 5 years (yrs) DFS and 3 and 5 yrs OS for all patients as well as for premenopausal (96 pts, 37%) and postmenopausal (162 pts, 63%). The mean follow-up time for DFS was 60 months (mo) (min 30, max 136 mo) and for OS was 66 mo (min 36, max 140 mo). As prognostic factors for DFS and OS, age, tumour size, HG as well as adjuvant treatment (locoregional and systemic) were analysed accordingly. Fifty two patients (20%) were HG1 while 190 pts (74%), were HG2 & 3; 30 pts (11%) had tumour up to 1cm and 157 pts (61%) had tumours up to 3cm and 71 pts (28%) above 3cm. Radical mastectomy was performed in 92 pts (36%) while conservative surgery were performed in 166 pts (64%). Systemic therapy was applied in 224 pts (87% of which 57% were treated with hormonotherapy). Results: 3 yrs DFS for 258 treated pts were 87% - there was no statistically significant difference among pre- and postmenopausal pts; 5 yrs DFS were 73% with no statistically significant difference among pre- and postmenopausal group of pts (p > 0.05). 3 yrs overall survival were 94% and 5 yrs 80% with no statistically significant difference among pre- and postmenopausal pts (p > 0.05). There were statistically different DFS and OS among those pts treated with adjuvant radiotherapy as well as for those with adjuvant systemic therapy in both group of pts (p < 0.001). Also as independent prognostic factor for DFS and OS were HG (Cox regression model). Conclusions: Although, HG and adjuvant therapy are the most important prognostic factors for DFS and OS in premenopausal and postmenopausal patients, we found that there is no statistically significant difference between the groups respectively. However, life-expectancy for premenopausal patients is longer. Therefore further adjuvant therapy research is needed to achieve better DFS and OS in this group of pts. No significant financial relationships to disclose.

Download Full-text

The comparison of surgeon performed axillary ultrasound with pathologic status of sentinel lymph nodes in clinically node-negative breast cancer patients: a single surgeon’s experience

The Breast ◽

10.1016/s0960-9776(17)30363-6 ◽

2017 ◽

Vol 32 ◽

pp. S115

Author(s):

G. Karadeniz Cakmak ◽

A. Ugur Emre ◽

H. Engin ◽

B. Dogan Gun ◽

T. Eray Sever

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

Sentinel Lymph Nodes ◽

Breast Cancer Patients ◽

Axillary Ultrasound ◽

Node Negative ◽

Node Negative Breast Cancer

Download Full-text

Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer

Journal of International Medical Research ◽

10.1177/0300060519827413 ◽

2019 ◽

Vol 47 (10) ◽

pp. 4841-4853 ◽

Cited By ~ 1

Author(s):

Huang Li ◽

Zhang Jun ◽

Ge Zhi-Cheng ◽

Qu Xiang

Keyword(s):

Breast Cancer ◽

Methylene Blue ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

False Negative ◽

False Negative Rate ◽

Blue Dye ◽

Methylene Blue Dye ◽

Clinicopathological Factors

Objective This study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer. Methods A total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB. Results The identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively. Conclusions SLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.

Download Full-text

Two months of doxorubicin-cyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B-15.

Journal of Clinical Oncology ◽

10.1200/jco.1990.8.9.1483 ◽

1990 ◽

Vol 8 (9) ◽

pp. 1483-1496 ◽

Cited By ~ 436

Author(s):

B Fisher ◽

A M Brown ◽

N V Dimitrov ◽

R Poisson ◽

C Redmond ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Disease Free Survival ◽

Positive Node ◽

Breast Cancer Patients ◽

Free Survival ◽

National Surgical Adjuvant Breast ◽

Significant Difference ◽

Bowel Project ◽

Disease Free

The National Surgical Adjuvant Breast and Bowel Project (NSABP) implemented protocol B-15 to compare 2 months of Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) and cyclophosphamide (AC) with 6 months of conventional cyclophosphamide, methotrexate, and fluorouracil (CMF) in patients with breast cancer nonresponsive to tamoxifen (TAM, T). A second aim was to determine whether AC followed in 6 months by intravenous (IV) CMF was more effective than AC without reinduction therapy. Through 3 years of follow-up, findings from 2,194 patients indicate no significant difference in disease-free survival (DFS, P = .5), distant disease-free survival (DDFS, P = .5) or survival (S, P = .8) among the three groups. Since the outcome from AC and CMF was almost identical, the issue arises concerning which regimen is more appropriate for the treatment of breast cancer patients. AC seems preferable since, following total mastectomy, AC was completed on day 63 versus day 154 for conventional CMF; patients visited health professionals three times as often for conventional CMF as for AC; women on AC received therapy on each of 4 days versus on each of 84 days for conventional CMF; and nausea-control medication was given for about 84 days to conventional CMF patients versus for about 12 days to patients on AC. The difference in the amount of alopecia between the two treatment groups was less than anticipated. While alopecia was almost universally observed following AC therapy, 71% of the CMF patients also had hair loss and, in 41%, the loss was greater than 50%. This study and NSABP B-16, which evaluates the worth of AC therapy in TAM-responsive patients, indicate the merit of 2 months of AC therapy for all positive-node breast cancer patients.

Download Full-text

Abstract P2-01-32: Comparison between positive and false-negative sentinel lymph nodes in breast cancer patients

10.1158/1538-7445.sabcs14-p2-01-32 ◽

2015 ◽

Author(s):

Eriko Abe ◽

Naoki Hayashi ◽

Toshinao Onoda ◽

Yang Yang ◽

Mieko Uno ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

False Negative ◽

Sentinel Lymph Nodes ◽

Breast Cancer Patients

Download Full-text

Randomized cooperative study of perioperative chemotherapy in breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.11.2712 ◽

1995 ◽

Vol 13 (11) ◽

pp. 2712-2721 ◽

Cited By ~ 22

Author(s):

M R Sertoli ◽

P Bruzzi ◽

P Pronzato ◽

P Queirolo ◽

D Amoroso ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Preliminary Evidence ◽

Breast Cancer Patients ◽

Free Survival ◽

Node Negative ◽

Significant Survival ◽

Significant Difference ◽

Estrogen Receptor Negative

PURPOSE The aim of this multicentric randomized trial was to determine whether reducing the interval between surgery and chemotherapy improves the outcome of breast cancer patients. PATIENTS AND METHODS Between June 1985 and July 1992, 600 breast cancer patients, clinical stages T1-3A,N0-2,M0 were randomly assigned to a perioperative cycle (PC) of cyclophosphamide 600 mg/m2, epidoxorubicin 60 mg/m2, and fluorouracil 600 mg/m2 (CEF). Node-negative (N-) patients did not receive any further treatment. Node positive (N+) patients received 11 cycles if previously given PC, or 12 cycles of CEF alternated with cyclophosphamide 600 mg/m2, methotrexate 40 mg/m2, and fluorouracil 600 mg/m2 (CMF). In addition, N+ patients received concomitant or sequential 5-year tamoxifen therapy. RESULTS At a median follow-up duration of 5.7 years, no significant difference in survival (88% v 84%, P = .3) between the two treatment arms was seen. However, a difference of borderline significance in relapse-free survival (RFS; 76% v 70%, P = .053) was evident. A significant survival advantage for the PC arm was detected only in the estrogen receptor-negative (ER-) patients (P = .003). RFS was significantly improved in N- patients, postmenopausal patients, and ER- patients. Multivariate analyses show that pathologic tumor size, nodal status, receptor status, and treatment (only in ER- patients) are significantly correlated with survival and RFS. PC toxicity did not influence wound healing. CONCLUSION This study provides preliminary evidence that PC positively affects relapse rate and survival in some subgroups, namely, ER- patients.

Download Full-text

Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.6.2329 ◽

1997 ◽

Vol 15 (6) ◽

pp. 2329-2337 ◽

Cited By ~ 49

Author(s):

R Heimann ◽

D Ferguson ◽

C Powers ◽

D Suri ◽

R R Weichselbaum ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Racial Differences ◽

Multivariable Analysis ◽

Disease Free Survival ◽

Similar Proportion ◽

Significant Variable ◽

Breast Cancer Patients ◽

Node Negative

PURPOSE To compare the outcome of African American (AA) and Caucasian (C) breast cancer patients who had equivalent disease extent and were similarly treated. PATIENTS AND METHODS We compared prognostic characteristics, treatment, and outcome of 1,037 C and 481 AA breast cancer patients treated with mastectomy between 1946 and 1987. The median follow-up duration was 15.6 years. RESULTS During the study period, there was a successive increase in the percent of patients who presented with early breast cancer. Between 1980 and 1987, 35.1% AA versus 47.6% C patients had < or = 2-cm tumors and 50.0% AA versus 61.9% C patients were node-negative, while between 1946 and 1959, 27.7% AA and 31.3% C had < or = 2-cm tumors and 41.5% AA versus 40.4% C patients were node-negative. The treatments were similar during the study period. The 20-year disease-free survival (DFS) rate of AA compared with C patients with node-negative < or = 2-cm, 2.1- to 4-cm, and greater than 4-cm tumors and of patients with one to three and > or = four positive nodes was not significantly different. Equal-size tumors had similar proportion of positive axillary nodes in AA compared with C patients. The DFS for AA patients compared with C patients was similar in the periods 1946 to 1959, 1960 to 1969, and 1970 to 1979, but was lower between 1980 and 1987 (P = .02). In multivariable analysis, race was not a significant variable. CONCLUSION In this large group of uniformly treated breast cancer patients, race was not an independent factor that influenced outcome. The racial differences seen between 1980 and 1987 are likely because of a larger percent of greater than 2-cm and node-positive tumors in AA patients. Education and access to early diagnosis should reduce or eliminate the racial differences seen.

Download Full-text