Triple-negative breast cancer and likelihood of nodal metastates.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 50-50
Author(s):  
Alexandra Gangi ◽  
James Mirocha ◽  
Trista Leong ◽  
Armando E. Giuliano
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Triple Negative Breast Cancer ◽  
Tumor Size ◽  
Axillary Lymph Node ◽  
Triple Negative ◽  
Axillary Lymph ◽  
Luminal A ◽  
Axillary Lymph Node Metastases ◽  
Luminal B

50 Background: Axillary lymph node metastases are a prognostic indicator for breast cancer. Studies suggest that breast cancer subtypes are associated with the presence of lymph node (LN) metastases. The purpose of this study was to determine if patients with triple negative breast cancer (TNBC) have a higher risk of LN metastases than those with non-TNBC. Methods: Prospective database review identified 2,967 female patients with invasive breast cancer treated with mastectomy or breast conserving surgery (BCS) between January 2000 and May 2012. Only patients who underwent sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND) were included. Those receiving neoadjuvant therapy were excluded. Patient and tumor characteristics evaluated included age, race, tumor size, grade, stage, histologic subtype, presence of lymphovascular invasion (LVI), estrogen (ER), progesterone (PR), and human epidermal growth factor receptor 2 (HER2) status. Results: BCS was performed in 1,889 and mastectomy in 1,078 patients. Breakdown by subtype included 2,201 (74%) patients with Luminal A, 344 (12%) with Luminal B, 144 (5%) with HER2, and 278 (9%) with TNBC. SNB was performed in 1,094 (37%), ALND in 756 (25%), and 1,117 (38%) patients had both. LN metastases were detected in 1050 (35%) patients. The LN positivity rate varied across subtypes with 734/2,201 (33%) in Luminal A, 143/344 (42%) in Luminal B, 108/278 (39%) in TNBC, and 65/144 (45%) in HER-2 (p = 0.0007). However, on multivariable analysis, there was no difference in LN positivity among subtypes (p=0.24). Only age < 50 (HR 1.5, CI 1.3 to 1.8), grade 2 or 3 tumors (HR 1.8, CI 1.4 to 2.5), size greater than 2cm (HR 3.2, CI 2.7 to 3.9), and presence of LVI (HR 3.9, CI 2.4 to 6.3) were significant predictors of LN positivity. Four or more involved nodes were seen most commonly in the HER2 (28/144; 19%) and Luminal B (47/344; 14%) subtypes, but not TNBC (26/278; 9%) or Luminal A (199/2201; 9%) (p < 0.0001). Conclusions: Predictors of LN metastases include younger age, higher grade, larger tumor size, and presence of LVI. Patients with TNBC are not more likely to have involved nodes than those with non-TNBC.

Relationship of Ki67 to tumor size and lymph node metastasis in breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21076-e21076
Author(s):  
Ioana Bonta ◽  
Dacian Bonta ◽  
Michelle Marie Loch ◽  
Ann Eapen ◽  
Rita A. Blanchard
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Axillary Lymph Node ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph ◽  
Ki67 Index ◽  
Axillary Lymph Node Metastases ◽  
Node Metastasis

e21076 Background: Ki67, a tumor proliferation marker, has demonstrated usefulness in breast cancer prognosis. Prior work with BrdU labeling for cell proliferation in breast cancer has not settled the question whether cell proliferation labeling is independent of other tumor features like tumor size and presence of axillary metastases, see Rew (1992) vs. Thor et al (1999). Methods: We analyzed retrospectively our database of 379 patients for correlation between the and tumor size, presence of axillary lymph node metastases and the percentage of Ki67 positve cells. We used linear and parabolic regression to correlate tumor size with the Ki67 index and receiver operator characteristics curve to correlate the presence of axillary lymph node metastases with the Ki67 index. Results: A very weak linear relationship was detected between tumor size and Ki67 index. The R-squared coefficient was 0.03, indicating that tumor size explained only 3% of the variability in measured Ki67 indexes. The ROC analysis, looking at the correlation between Ki67 and lymph node metastasis, yielded an area under the curve (Az) of 0.53. This indicates a very weak correlation. No relationship between axillary lymph node metastasis would yield an Az of 0.5 and a perfect correlation would yield an Az of 1. Conclusions: Tumor size and axillary lymph node metastasis explain less than 10% of observed Ki67 index variability. Therefore, in breast cancer, the prognostic value of Ki67 is additive to that of tumor size and lymph node involvement.

Evaluating One Day versus Two Days Preoperative Lymphoscintigraphy Protocols for Sentinel Lymph Node Biopsy in Breast Cancer

2015 ◽  
Vol 81 (5) ◽  
pp. 454-457 ◽  
Author(s):  
Michael G. Mount ◽  
Nicholas R. White ◽  
Christophe L. Nguyen ◽  
Richard K. Orr ◽  
Robert B. Hird
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Axillary Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Node Biopsy ◽  
Node Negative Breast Cancer

Sentinel lymph node biopsy (SLNB) is used to detect axillary lymph node metastases in breast cancer. Preoperative radiocolloid injection with lymphoscintigraphy (PL) is performed before SLNB. Few comparisons between 1- and 2-day PL protocols exist. Opponents of a 2-day protocol have expressed concerns of radiotracer washout to nonsentinel nodes. Proponents cite lack of scheduling conflicts between PL and surgery. A total of 387 consecutive patients with clinically node-negative breast cancer underwent SLNB with PL. Lymphoscintigraphy images were obtained within 30 minutes of radio-colloid injection. Axillary lymph node dissection was performed if the sentinel lymph node (SLN) could not be identified. Data were collected regarding PL technique and results. In all, 212 patients were included in the 2-day PL group and 175 patients in the 1-day PL group. Lymphoscintigraphy identified an axillary sentinel node in 143/212 (67.5%) of patients in the 2-day group and 127/175 (72.5%) in the 1-day group ( P = 0.28). SLN was identified at surgery in 209/212 (98.6%) patients in the 2-day group and 174/175 (99.4%) in the 1-day group ( P = 0.41). An average of 3 SLN was found at surgery in the 2-day group compared with 3.15 in the 1-day group ( P = 0.43). SLN was positive for metastatic disease in 54/212 (25.5%) patients in the 2-day group compared with 40/175 (22.9%) in the 1-day group ( P = 0.55). A 2-day lymphoscintigraphy protocol allows reliable detection of the SLN, of positive SLN and equivalent SLN harvest compared with a 1-day protocol. The timing of radiocolloid injection before SLNB can be left at the discretion of the surgeon.

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