Michael Co1, Ava Kwong. 1. Department of Surgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong, mcth@hotmail.co.uk.
Abstract
BACKGROUND: In patients with negative sentinel lymph node biopsy (SLNB), axillary dissection (AD) can be avoided to reduce morbidities. However, there is only limited data on the rate of positive non-SLN (NSLN) in those who have micrometastasis and isolated tumor cells (ITC) in the literature. METHODS: We did a retrospective review of all clinically node-negative breast cancer patients with SLNB done at our unit from January 2001 to June 2011. Multivariate analysis was adopted to evaluate the risk factors for NSLN metastasis. Difference in 5-year disease-free survival (DFS) was evaluated with log-rank test. RESULTS: Five-hundred and thirty-seven patients underwent SLNB; 161 (30%) had positive SLN on frozen section (FS), 50 of these patients (31%) had NSLN metastasis, 25 patients had negative SLN on FS but were found to have micrometastasis on histopathology, and only 1 (4%) of them had NSLN metastasis, while 14 patients were found to have ITC in SLN; none of them had NSLN metastasis. Multivariate analysis found that the number of SLN harboring micrometastasis is the only independent risk factor for NSLN metastasis in patients with micrometastasis (p value = 0.008). On the contrary; tumor size, grade, and biology were not associated with NSLN metastasis. 5-year DFS in patients with macrometastasis in SLN was 94.2%, while that in patients with micrometastasis and ITC was 100% (p value <0.001). CONCLUSION: NSLN metastasis in those who only have micrometastasis and ITC is rare, and 5-year DFS is significantly better in this group of patients as well. It is therefore a routine practice in our unit to omit AD in patients with micrometastasis and ITC on SLN.
BACKGROUND: In patients with negative sentinel lymph node biopsy (SLNB), axillary dissection (AD) can be avoided to reduce morbidities. However, there is only limited data on the rate of positive non-SLN (NSLN) in those who have micrometastasis and isolated tumor cells (ITC) in the literature. METHODS: We did a retrospective review of all clinically node-negative breast cancerpatients with SLNB done at our unit from January 2001 to June 2011. Multivariate analysis was adopted to evaluate the risk factors for NSLN metastasis. Difference in 5-year disease-free survival (DFS) was evaluated with log-rank test. RESULTS: Five-hundred and thirty-seven patients underwent SLNB; 161 (30%) had positive SLN on frozen section (FS), 50 of these patients (31%) had NSLN metastasis, 25 patients had negative SLN on FS but were found to have micrometastasis on histopathology, and only 1 (4%) of them had NSLN metastasis, while 14 patients were found to have ITC in SLN; none of them had NSLN metastasis. Multivariate analysis found that the number of SLN harboring micrometastasis is the only independent risk factor for NSLN metastasis in patients with micrometastasis (p value = 0.008). On the contrary; tumor size, grade, and biology were not associated with NSLN metastasis. 5-year DFS in patients with macrometastasis in SLN was 94.2%, while that in patients with micrometastasis and ITC was 100% (p value <0.001). CONCLUSION: NSLN metastasis in those who only have micrometastasis and ITC is rare, and 5-year DFS is significantly better in this group of patients as well. It is therefore a routine practice in our unit to omit AD in patients with micrometastasis and ITC on SLN.
Authors: Allan W Silberman; Carie McVay; Jason S Cohen; Jack F Altura; Sandra Brackert; Gregory P Sarna; Daphne Palmer; Albert Ko; Leslie Memsic Journal: Ann Surg Date: 2004-07 Impact factor: 12.969
Authors: Igor Langer; Ulrich Guller; Gilles Berclaz; Ossi R Koechli; Gabriel Schaer; Mathias K Fehr; Thomas Hess; Daniel Oertli; Lucio Bronz; Beate Schnarwyler; Edward Wight; Urs Uehlinger; Eduard Infanger; Daniel Burger; Markus Zuber Journal: Ann Surg Date: 2007-03 Impact factor: 12.969
Authors: Funda Meric; Thomas A Buchholz; Nadeem Q Mirza; Georges Vlastos; Frederick C Ames; Merrick I Ross; Raphael E Pollock; S Eva Singletary; Barry W Feig; Henry M Kuerer; Lisa A Newman; George H Perkins; Eric A Strom; Marsha D McNeese; Gabriel N Hortobagyi; Kelly K Hunt Journal: Ann Surg Oncol Date: 2002-07 Impact factor: 5.344
Authors: Maaike de Boer; Carolien H M van Deurzen; Jos A A M van Dijck; George F Borm; Paul J van Diest; Eddy M M Adang; Johan W R Nortier; Emiel J T Rutgers; Caroline Seynaeve; Marian B E Menke-Pluymers; Peter Bult; Vivianne C G Tjan-Heijnen Journal: N Engl J Med Date: 2009-08-13 Impact factor: 91.245
Authors: Karl Y Bilimoria; David J Bentrem; Nora M Hansen; Kevin P Bethke; Alfred W Rademaker; Clifford Y Ko; David P Winchester; David J Winchester Journal: J Clin Oncol Date: 2009-04-13 Impact factor: 44.544