Predictors of Non-sentinel Lymph Node Metastasis in Breast Cancer

Yang Hee Kim; Min Suk Kim; Nam Sun Paik; Nan Mo Moon; Woo Chul Noh

doi:10.4048/jbc.2007.10.1.95

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Kim, Kim, Paik, Moon, and Noh: Predictors of Non-sentinel Lymph Node Metastasis in Breast Cancer

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2007; 10(1): 95-100.

Published online: 31 March 2007

DOI: https://doi.org/10.4048/jbc.2007.10.1.95

Predictors of Non-sentinel Lymph Node Metastasis in Breast Cancer

Yang Hee Kim, Min Suk Kim¹, Nam Sun Paik, Nan Mo Moon, Woo Chul Noh

Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea.

¹Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea.

nohwoo@kcch.re.kr

Received 25 January 2007 Accepted 10 March 2007

Abstract

Purpose

Sentinel lymph node (SLN) biopsy has been shown to be accurate in axillary node staging in early breast cancer. If any SLN is positive, the standard care remains completion axillary node dissection (ALND). However over 50% of the patients with metastatic SLNs do not show other non-SLN metastasis. The purpose of this study was to identify predictors of non-SLN tumor involvement in patients with metastatic SLNs.

Methods

We reviewed 387 breast cancer patients in whom an SLN biopsy was successfully performed using a subareolar injection of ^99mTc-Tin colloid.

Results

Among the reviewed patients, 83 patients showed positive SLNs, and subsequently underwent ALND. In 47 of 83 patients (56.6%), SLNs were the only metastatic nodes. The following factors were assessed for predictors of non-SLN metastasis: age of the patient, size, grade, histologic type, multicentricity of the primary tumor, number of SLNs removed, number of positive SLNs, number of negative SLNs, size of the SLN metastasis, percentage of SLNs replaced by metastasis, and extracapsular extension (ECE). By multi-variate analysis, the size of SLN metastasis (<2 mm), absence of ECE, and the percent replacement (≦10%) were negative predictors of non-SLN metastasis. Among 18 cases in which micrometastasis were found in the SLNs, additional metastasis in non-SLN has been found in 3 cases. This result suggests that micro-metastasis in a SLN is not a sufficient condition for not performing ALND. However, in 9 cases, in which all of three factors (micrometastasis, absence of ECE, no more than 10% replacement of SLNs by tumor cells) were present, additional metastasis had not been found in the non-SLNs.

Conclusion

Although further study is needed to verify the result, it would seem that the presence of all three factors (micrometastasis, absence of ECE, no more than 10% replace-ment of SLNs by tumor cells) in combination might be sufficient to safely omit ALND.

Keywords: Breast, Carcinoma, Sentinel lymph node, Metastasis, Predictor

Figures and Tables

Fig 1

Micrometastasis in SLNs without metastasis in NSLNs. (A) Micrometastasis with less than 10% replacement, without ECE was observed in SLNs (arrow, H&E stain, ×40), (B) No metastasis was found axillary NSLNs (H&E stain, ×10).

Fig 2

Micrometastasis in SLN with metastasis in NSLN. (A) Micrometastasis with ECE was observed in SLN (H&E stain,×100). (B) Macrometastasis larger than 2 mm was found in one of NSLNs of the same patient (H&E stain, ×40).

Table 1

Clinicopathological characteristics of patients who underwent axillary clearance and predictors of non-sentinel node metastasis

SLN=sentinel lymph node; NSLN=non sentinel lymph node; ECE=extracapsular extension.

Table 2

Patients with micrometastasis in SLNs

SLN=sentinel lymph node; NSLN=non sentinel lymph node; ECE=extracapsular extension.

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