scholarly journals Tumor Size and Lobular Histology Predict for Higher Pathologic Nodal Stage Regardless of Clinical Presentation of Nodal Disease in Patients With Breast Cancer

2021 ◽  
Author(s):  
Linda Ye ◽  
Dennis Rünger ◽  
Stephanie A. Angarita ◽  
Joseph Hadaya ◽  
Jennifer L. Baker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Retrospective Chart Review ◽  
Low Grade ◽  
Axillary Lymph ◽  
Tumor Characteristics ◽  
Node Positive ◽  
Nodal Stage ◽  
Lobular Histology

Abstract Purpose: Omission of axillary lymph node dissection (ALND) is considered for patients with sentinel lymph node-positive (SLN+) breast cancer, but ALND remains the standard of care for clinically node-positive (cN+) patients treated with surgery first. Here, we evaluate differences in patient and tumor characteristics and pathologic nodal stage in patients with positive lymph nodes who underwent ALND. Methods: Retrospective chart review from 2010-2019 identified three groups of patients who underwent ALND for positive nodes: SLN+ (positive node identified at SLN biopsy), cNUS (abnormal preoperative US and biopsy), and cNpalp (palpable adenopathy). Patients who received neoadjuvant chemotherapy or presented with axillary recurrence were excluded. Results: Of 218 patients, 107 were SLN+, 43 were cNUS, and 68 were cNpalp. SLN+ patients compared with cNpalp were more likely to be younger (56 vs 64,p<.01), pre-menopausal (39%vs15%,p<.01), and white (62%vs37%,p<.01) with more tumors that were progesterone receptor-positive (6%vs21%,p=.02), low grade (35%vs6%,p<.01) and without lymphovascular invasion (11%vs27%,p=.02). SLN+ patients had more pN1 disease than cNUS and cNpalp (67.3% vs 39.5% vs 42.6%, p<.01). Greater tumor size and lobular histology were significantly associated with higher nodal stage in univariable regression analysis of SLN+ patients as well as a pooled analysis of the three clinical groups.Conclusion: Patient and tumor characteristics differ on either end of the nodal spectrum, with cNpalp patients having higher risk features than SLN+ patients. These higher risk features have historically resulted in ALND for patients with clinically positive nodes. However, only tumor size and histology are associated with higher pathologic nodal stage.

The elderly breast cancer patient: Association of age, tumor size, and grade with sentinel lymph node status.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 15-15
Author(s):  
Meaghan Working O'Malley ◽  
Kent A. Griffith ◽  
Michael S. Sabel ◽  
Lisa A. Newman ◽  
Tara M. Breslin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Cancer Patient ◽  
Breast Cancer Patient ◽  
Tumor Size ◽  
The Elderly ◽  
Lymph Node Status ◽  
Low Grade ◽  
Tumor Characteristics

15 Background: Nodal evaluation of the elderly breast cancer patient remains controversial, and some have suggested that selected older women with breast cancer may not require sentinel lymph node biopsy (SLNB). Methods: An IRB-approved database was queried for patients undergoing SLNB for invasive breast cancer from 2000-2006. We compared 8 cohorts: age <40 years, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, and >70 years. Logistic regression and chi-square test were used. Results: Procedure success rate was above 95% for all groups in a total sample size of 1268 patients. Patients >70 years had lower grade tumors than patients <40 years (Grade 1: 25% vs. 7%; Grade 2: 53% vs. 47%; Grade 3: 17% vs. 40%, p<0.0001) and higher ER expression (ER+: 83% vs. 59%, p<0.0005). Patients <40 years also had a higher proportion of multifocal disease (21% vs. 9%, p<0.002), lymphovascular invasion (20% vs. 10%, p<0.007), and number of positive sentinel lymph nodes (PSLN) removed (mean: 3.7 vs. 2.7, p<0.028). Upon multivariate analysis, the odds of a PSLN decrease 9% for every 5-year increase in age (OR 0.91, p<0.003), but increase significantly with certain tumor characteristics (ER+ vs. ER-: OR 1.7, p=0.002), larger size (0.5 cm increase: OR 1.26, p<0.0001), and higher grade (Grades 2-3: OR 1.99, p<0.0007). The predicted probability of a PSLN for patients age 35, 55, and 70 years is 27%, 22%, and 16%, assuming each had a ER+, low grade, 2 cm tumor. Conclusions: Older breast cancer patients have more favorable pathology, and the chance of a PSLN decreases as age increases. However, the odds of a PSLN are significantly higher in patients with certain tumor characteristics, which are known prior to definitive surgery. Given recent reports that older patients are less likely to receive standard treatment for breast cancer and prognosis may worsen as a result, tumor size and characteristics rather than age should dictate the decision to perform SLNB, and we should continue appropriate, aggressive staging of the older breast cancer patient.

Histologic Grade Remains a Prognostic Factor for Breast Cancer Regardless of the Number of Positive Lymph Nodes and Tumor Size: A Study of 161 708 Cases of Breast Cancer From the SEER Program

2014 ◽  
Vol 138 (8) ◽  
pp. 1048-1052 ◽  
Author(s):  
Arnold M. Schwartz ◽  
Donald Earl Henson ◽  
Dechang Chen ◽  
Sivasankari Rajamarthandan
Keyword(s):  
Breast Cancer ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Tumor Size ◽  
Nodal Status ◽  
Histologic Grade ◽  
Axillary Lymph Nodes ◽  
Low Grade ◽  
Axillary Lymph ◽  
Data Set

Context.—The appropriate staging of breast cancers includes an evaluation of tumor size and nodal status. Histologic grade in breast cancer, though important and assessed for all tumors, is not integrated within tumor staging. Objective.—To determine whether the histologic grade remains a prognostic factor for breast cancer regardless of tumor size and the number of involved axillary lymph nodes. Design.—By using a new clustering algorithm, the 10-year survival for every combination of T, N, and the histologic grade was determined for cases of breast cancer obtained from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. There were 36 combinations of TN, defined according to the American Joint Committee on Cancer, and grade. Results.—For each combination of T and N, a categorical increase in the histologic grade was associated with a progressive decrease in 10-year survival regardless of the number of involved axillary lymph nodes or size of the primary tumor. Absolute survival differences between high and low grade persisted despite larger tumor sizes and greater nodal involvement, though trends were apparent with increasing breast cancer stage. Statistical significance depended on the number of cases for each combination. Conclusions.—Histologic grade continues to be of prognostic importance for overall survival despite tumor size and nodal status. Furthermore, these results seem to indicate that the assignment of the histologic grade has been consistent among pathologists when evaluated in a large data set of patients with breast cancer. The incorporation of histologic grade in TNM staging for breast cancer provides important prognostic information.

scholarly journals Axillary lymph node dissection in node-positive breast cancer: are ten nodes adequate and when is enough, enough?

2019 ◽  
Vol 179 (3) ◽  
pp. 661-670 ◽  
Author(s):  
Laura H. Rosenberger ◽  
Yi Ren ◽  
Samantha M. Thomas ◽  
Rachel A. Greenup ◽  
Oluwadamilola M. Fayanju ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Positive ◽  
Positive Breast Cancer

The Association of Body Mass Index and Adverse Clinico-Pathological Characteristics of Non-Metastatic Breast Cancer Among Patients from Saudi Arabia

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 8-8
Author(s):  
Bashayer Alghamdi ◽  
Reema Alghamdi ◽  
Raghad Khallaf ◽  
Konooz faisal ◽  
Raghad Bishnaq ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Mass Index ◽  
Saudi Arabia ◽  
Lymph Node ◽  
Body Mass ◽  
Tumor Size ◽  
P Value ◽  
Axillary Lymph ◽  
Receptor Status ◽  
The Mean

Background: Obesity is a global health problem, especially in the Arab region, the prevalence of obesity is increasing. High body mass index (BMI) is a risk factor for many diseases, including cancer. Noticeably, breast cancer (BC) cases in Saudi Arabia occur at a younger age than western countries and different life style behaviours such as maintaining healthy body weight and physical activity may play a role in this. In this study, we aimed to investigate the association between BMI and BC clinicopathological features. Methods: This retrospective study was conducted by reviewing the records of females diagnosed with non-metastatic BC over four years. The association between BMI and patients’ demographics, BC histological type, receptor status, differentiation grade, tumor size, involvement of axillary lymph node, and performed procedures was analysed. Result: We studied 315 patients with non-metastatic BC. The mean age at the time of diagnosis was 52.43 years ±11.63. The mean BMI was 30.21±5.77. The mean tumor size was 3.19 cm ± 3.52. We found that the mean age of diagnosis is significantly greater in obese women than other BMI groups with a P-value = 0.025. A significant relationship was observed between BMI classification and tumor size in obese female patients aged ⩾ 40 years with P-value=0.022 Conclusion: The relationship between BMI and BC is still not clear, in this study we found an association with age at diagnosis and tumor size in older patients, characteristics as histological types, receptor status, lymph node involvement, and grade were not statistically significant.

The prognostic value of nodal ratios in node-positive breast cancer: AUBMC experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21072-21072
Author(s):  
A. Shamseddine ◽  
H. Hatoum ◽  
Z. Salem ◽  
Z. Abdel Khalek ◽  
N. El Saghir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Disease Free Survival ◽  
Axillary Lymph ◽  
Node Positive ◽  
The Impact ◽  
Positive Breast Cancer

21072 Background: Axillary lymph node metastasis has proven to be the most important factor affecting overall survival (OS) and disease free survival (DFS) in patients with breast cancer. Recent evidence suggests that axillary lymph node ratio (LNR) may be at least as important as absolute number of involved lymph nodes in predicting OS and DFS. The aim of this retrospective study is to evaluate the impact of axillary nodal ratios in node-positive breast cancer as a prognostic factor for survival. Methods: Data from 1181 patients with stage I, II and III breast cancer diagnosed at AUBMC between 1990 and 2001 were studied. The median age at diagnosis was 50 years (23 - 88); the median number of lymph nodes dissected was 17 (0 - 49). Survival was compared in 737 patients with node-positive disease according to a LNR below or more than 0.25 (defined as number of involved lymph nodes divided by total dissected axillary lymph nodes). Results: Patients with LNR = 0.25 had a median follow-up of 30 months (1.2–156) and a median DFS of 26 months (1–156). The 5-year survival was 26.2% (94/358) and the 5-year DFS was 22.9% (82/358). Patients with LNR <0.25 had a median follow-up of 36 months (1.2–157) and a median DFS of 36 months (1–157). The 5-year survival of 33.2% (245/737) and the 5-year DFS was 29.8 % (220/737). LNR showed significance as a continuous variable and a categorical variable (0, < 0.25, and = 0.25) with a p < 0.001 Conclusions: LNR significantly predicts OS and DFS in node-positive primary breast cancer. No significant financial relationships to disclose.

Predicting the extent of nodal disease in early breast cancer.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 95-95
Author(s):  
Abigail Suzanne Caudle ◽  
Henry Mark Kuerer ◽  
Huong T. Le-Petross ◽  
Wei Tse Yang ◽  
Isabelle Bedrosian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Group Versus ◽  
Receptor Subtype ◽  
Axillary Lymph ◽  
Imaging Features ◽  
Nodal Involvement ◽  
Node Dissection ◽  
Lobular Histology

95 Background: In early-stage breast cancer patients, the number of positive lymph nodes (LN) is considered in decisions regarding surgery and radiation. The goal of this study was to characterize the extent of axillary nodal involvement based on clinicopathologic and imaging features. Methods: A prospective database was used to identify T1-2 patients who underwent regional nodal ultrasound (US) and axillary lymph node dissection (ALND) from 2002-2012. Patients who received neoadjuvant chemotherapy or had extra-axillary LN metastases were excluded. Subjects were grouped by whether axillary metastases (AxM) were identified by US confirmed by needle biopsy or by sentinel lymph node dissection (SLND) after a negative US, then compared using X2 and Rank-Sum tests as appropriate. Results: AxM were identified by US in 190 patients and SLND in 518 patients. When compared to US-detected patients, SLND patients had fewer positive nodes (2.2 vs. 4.1, p < 0.0001), smaller metastases (5.3 vs. 13.8 mm, p < 0.0001), and a lower incidence of extranodal extension (ENE) (24% vs. 53%, p < 0.0001). Limiting analyses to patients with ≤ 2 abnormal LN on US, US-detected patients still had more positive LN (3.6, p < 0.001), larger metastases (13.4 mm, p < 0.0001), and a higher incidence of ENE (50%, p < 0.001) with more than 2 positive LN found in 45% of the US group versus 19% of the SLND group (p < 0.001). In patients with lobular histology there were no differences in number of positive LN (4 in SLND vs. 3.6 in US, p = 0.36), or ENE (34% SLND vs. 36% US, p = 0.9). Positive non-SLN were found in 23% (96/415) of patients with ductal tumors and 36% (21/59) of those with lobular tumors. In multivariate analysis, having metastases found by US (OR 4.01, 95% CI 2.75-5.84) and lobular histology (OR 1.77, 95% CI 1.06-2.95) predicted having > 2 positive LN adjusting for tumor size, receptor subtype, and histology. Conclusions: Patients with AxM found by US have more positive nodes, larger metastases, and higher risk of ENE, even if ≤ 2 suspicious LN are seen on US compared to patients with SLND-detected AxM. Tumor histology also predicts nodal burden. Clinicians can use imaging and clinicopathologic features to predict extent of nodal involvement and appropriately counsel patients regarding treatment decisions.

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