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Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

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Abstract

Background

The survival benefit of a completion axillary lymph node dissection (ALND) in patients after removal of a metastatic sentinel lymph node (SLN) is uncertain and is under study in ongoing clinical trials. The completion ALND remains necessary, however, for the identification of cases with at least four metastatic lymph nodes, in which extended-field locoregional and/or postmastectomy radiation will be recommended. Our goal was evaluate clinicopathologic features that might serve as surrogates for determining which patients with a positive SLN are likely or unlikely to belong to this high-risk subset.

Methods

Records were reviewed for 285 patients from 2 comprehensive cancer centers who underwent completion ALND after resection of a metastatic SLN from 1995 to 2002. Clinicopathologic features were analyzed by univariate and multivariate logistic regression. Forty-one cases (14%) were found to have at least four positive nodes after ALND.

Results

Fisher’s exact test revealed the following features to be significantly (P < .05) associated with having four or more nodal metastases: tumor size >2 cm, lymphovascular invasion, an increasing ratio of positive SLNs to the total number of resected SLNs, extranodal extension, and the size of the SLN metastasis. Patients whose largest SLN metastasis was <2 mm had only a 1.4% risk of having four or more metastatic nodes (P < .0001).

Conclusions

We conclude that patients with SLN micrometastases face an extremely low likelihood of having extensive nodal disease on completion ALND. Patients with larger primary tumors, lymphovascular invasion, and extranodal extension are more likely to have ALND findings that will affect their cancer management.

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Acknowledgment

The authors gratefully acknowledge support for this study from the Ruth Glancy Breast Cancer Research Fund.

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Authors and Affiliations

  1. Department of Surgery, St. Joseph’s Hospital and Medical Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109

    Aeisha K. Rivers MD

  2. Department of Biostatistics, University of Michigan Comprehensive Cancer Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109

    Aeisha K. Rivers MD & Kent A. Griffith MS, MPH

  3. Department of Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030

    Kelly K. Hunt MD

  4. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905

    Amy C. Degnim MD

  5. Department of Surgery, University of Michigan Comprehensive Cancer Center, 1500 E. Medical Center Drive, 3308 Cancer Center, Ann Arbor, Michigan, 48109-0932

    Michael S. Sabel MD, Kathleen M. Diehl MD, Vincent M. Cimmino MD, Alfred E. Chang MD & Lisa A. Newman MD, MPH, FACS

  6. Department of Pathology, University of Michigan Comprehensive Cancer Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109

    Peter C. Lucas MD

Authors
  1. Aeisha K. Rivers MD
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  2. Kent A. Griffith MS, MPH
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  3. Kelly K. Hunt MD
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  4. Amy C. Degnim MD
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  5. Michael S. Sabel MD
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  6. Kathleen M. Diehl MD
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  7. Vincent M. Cimmino MD
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  8. Alfred E. Chang MD
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  9. Peter C. Lucas MD
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  10. Lisa A. Newman MD, MPH, FACS
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Corresponding author

Correspondence to Lisa A. Newman MD, MPH, FACS.

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Rivers, A.K., Griffith, K.A., Hunt, K.K. et al. Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node. Ann Surg Oncol 13, 36–44 (2006). https://doi.org/10.1245/ASO.2006.03.080

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  • DOI: https://doi.org/10.1245/ASO.2006.03.080

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