BACKGROUND: Whether extracapsular extension (ECE) of tumor in the sentinel lymph node (SLN) is an indication for axillary lymph node dissection (ALND) in patients managed by American College of Surgeons Oncology Group Z0011 criteria is controversial. Here we examine the correlation between ECE in the SLN and disease burden in the axilla. METHODS: Patients meeting Z0011 clinicopathologic criteria (pT1-2, cN0 with <3 positive SLNs) were selected from a prospectively maintained database (2006-2013). Chart review documented the presence and extent of ECE. Neoadjuvant chemotherapy patients were excluded. Comparisons were made by presence and extent (≤2 vs. >2 mm) of ECE. RESULTS: Of 11,730 patients, 778 were pT1-2, cN0 with <3 positive SLNs without ECE, and 331 (2.8 %) had ECE. Of these, 180 had ≤2 mm and 151 had >2 mm of ECE. Patients with ECE were older (57 vs. 54 years; p = 0.001) and had larger (2.0 vs. 1.7 cm; p < 0.0001), multifocal (p = 0.006), hormone receptor-positive tumors (p = 0.0164) with lymphovascular invasion (p < 0.0001). Presence and extent of ECE were associated with greater axillary disease burden; 20 and 3 % of patients with and without ECE, respectively, had ≥4 additional positive nodes at completion ALND (p < 0.0001), and 33 % of patients with >2 mm ECE had ≥4 additional positive nodes at completion ALND, compared with 9 % in the <2 mm group (p < 0.0001). On multivariate analysis, >2 mm of ECE was the strongest predictor of ≥4 positive nodes at completion ALND (odds ratio 14.2). CONCLUSIONS: Presence and extent of ECE were significantly correlated with nodal tumor burden at completion ALND, thus suggesting that >2 mm of ECE may be an indication for ALND or radiotherapy when applying Z0011 criteria to patients with metastases in <3 SLNs. ECE reporting should be standardized to facilitate future studies.
BACKGROUND: Whether extracapsular extension (ECE) of tumor in the sentinel lymph node (SLN) is an indication for axillary lymph node dissection (ALND) in patients managed by American College of Surgeons Oncology Group Z0011 criteria is controversial. Here we examine the correlation between ECE in the SLN and disease burden in the axilla. METHODS:Patients meeting Z0011 clinicopathologic criteria (pT1-2, cN0 with <3 positive SLNs) were selected from a prospectively maintained database (2006-2013). Chart review documented the presence and extent of ECE. Neoadjuvant chemotherapy patients were excluded. Comparisons were made by presence and extent (≤2 vs. >2 mm) of ECE. RESULTS: Of 11,730 patients, 778 were pT1-2, cN0 with <3 positive SLNs without ECE, and 331 (2.8 %) had ECE. Of these, 180 had ≤2 mm and 151 had >2 mm of ECE. Patients with ECE were older (57 vs. 54 years; p = 0.001) and had larger (2.0 vs. 1.7 cm; p < 0.0001), multifocal (p = 0.006), hormone receptor-positive tumors (p = 0.0164) with lymphovascular invasion (p < 0.0001). Presence and extent of ECE were associated with greater axillary disease burden; 20 and 3 % of patients with and without ECE, respectively, had ≥4 additional positive nodes at completion ALND (p < 0.0001), and 33 % of patients with >2 mm ECE had ≥4 additional positive nodes at completion ALND, compared with 9 % in the <2 mm group (p < 0.0001). On multivariate analysis, >2 mm of ECE was the strongest predictor of ≥4 positive nodes at completion ALND (odds ratio 14.2). CONCLUSIONS: Presence and extent of ECE were significantly correlated with nodal tumor burden at completion ALND, thus suggesting that >2 mm of ECE may be an indication for ALND or radiotherapy when applying Z0011 criteria to patients with metastases in <3 SLNs. ECE reporting should be standardized to facilitate future studies.
Authors: Elizabeth A Mittendorf; Kelly K Hunt; Judy C Boughey; Roland Bassett; Amy C Degnim; Robyn Harrell; Min Yi; Funda Meric-Bernstam; Merrick I Ross; Gildy V Babiera; Henry M Kuerer; Rosa F Hwang Journal: Ann Surg Date: 2012-01 Impact factor: 12.969
Authors: Aeisha K Rivers; Kent A Griffith; Kelly K Hunt; Amy C Degnim; Michael S Sabel; Kathleen M Diehl; Vincent M Cimmino; Alfred E Chang; Peter C Lucas; Lisa A Newman Journal: Ann Surg Oncol Date: 2006-01-01 Impact factor: 5.344
Authors: Eric A Strom; Wendy A Woodward; Angela Katz; Thomas A Buchholz; George H Perkins; Anuja Jhingran; Richard Theriault; Eva Singletary; Aysegul Sahin; Marsha D McNeese Journal: Int J Radiat Oncol Biol Phys Date: 2005-09-19 Impact factor: 7.038
Authors: J A Bucci; C W Kennedy; J Burn; D J Gillett; H L Carmalt; M J Donnellan; M G Joseph; S C Pendlebury Journal: Breast Date: 2001-06 Impact factor: 4.380
Authors: T Reimer; A Stachs; V Nekljudova; S Loibl; S Hartmann; K Wolter; G Hildebrandt; B Gerber Journal: Geburtshilfe Frauenheilkd Date: 2017-02 Impact factor: 2.915
Authors: Andrea V Barrio; Stephanie Downs-Canner; Marcia Edelweiss; Kimberly J Van Zee; Hiram S Cody; Mary L Gemignani; Melissa L Pilewskie; George Plitas; Mahmoud El-Tamer; Laurie Kirstein; Deborah Capko; Sujata Patil; Monica Morrow Journal: Ann Surg Oncol Date: 2019-12-09 Impact factor: 5.344