nach oben

Erschienen in:

06.09.2024 | Breast Oncology

Incidence of Pathologic Nodal Disease in Clinically Node-Negative, Microinvasive or T1a Breast Cancers

verfasst von: Pranam Dey, MD, MBA, Madhav Kc, PhD, MPH, Ellie M. Proussaloglou, MD, Jasmine A. Khubchandani, MD, MHS, Leah Kim, MD, Gregory Zanieski, MD, Tristen Park, MD, Melanie Lynch, MD, Alyssa Gillego, MD, Monica Valero, MD, Eric Schneider, PhD, Mehra Golshan, MD, MBA, Rachel A. Greenup, MD, MPH, Elizabeth R. Berger, MD, MS

Erschienen in: Annals of Surgical Oncology | Ausgabe 13/2024

Einloggen, um Zugang zu erhalten

Abstract

Background

Axillary staging in early-stage breast cancer can impact adjuvant treatment options but also has associated morbidity. The incidence of pathologic nodal positivity (pN+) in patients with microinvasive or T1a disease is poorly characterized and the value of sentinel node biopsy remains controversial.

Methods

Women with cN0 and pathologic microinvasive or T1a cancer who underwent upfront surgery were identified from the National Cancer Database. Pathologic nodal stage at the time of surgery was the primary outcome. Multivariable logistic modeling was used to assess predictors of pN+.

Results

Overall, 141,840 women were included; 139,206 had pathologic node-negative (pN0) disease and 2634 had pN+ disease. Rates of pN+ disease differed by receptor status, with the highest rates in hormone receptor-negative/human epidermal growth factor receptor 2-positive (HR−/HER2+) disease compared with triple-negative breast cancer (TNBC), HR-positive/HER2-negative (HR+/HER2−), and triple positive breast cancer. Rates of pN+ were also higher with lobular histology compared with ductal histology. Multivariable analysis demonstrated that compared with White women, Black women had higher odds of pN+ disease, and compared with women <50 years of age, women >70 years of age had higher odds of pN+ disease. Compared with women with HR+/HER2− disease, women with TNBC, triple-positive breast cancer, and HR−/HER2+ all had lower odds, and women with invasive lobular disease had higher odds compared with women with invasive ductal disease. Women with significant comorbidities also had higher odds of node positivity.

Conclusion

Over 90% of patients with clinically node-negative, microinvasive and T1a breast cancer remain pathologically node-negative following axillary staging. However, higher rates of nodal disease were found among Black patients, older patients, and patients with lobular cancer and significant comorbidities.

Mann GB, Port ER, Rizza C, Tan LK, Borgen PI, Van Zee KJ. Six-year follow-up of patients with microinvasive, T1a, and T1b breast carcinoma. Ann Surg Oncol. 1999;6(6):591–8. https://doi.org/10.1007/s10434-999-0591-5.CrossRefPubMed

NIH consensus conference. Treatment of early-stage breast cancer. JAMA 1991;265(3):391–5. https://www.ncbi.nlm.nih.gov/pubmed/1984541.

Jatoi I, Benson JR, Toi M. De-escalation of axillary surgery in early breast cancer. Lancet Oncol. 2016;17(10):e430–41. https://doi.org/10.1016/S1470-2045(16)30311-4.CrossRefPubMed

Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8(10):881–8. https://doi.org/10.1016/S1470-2045(07)70278-4.CrossRefPubMed

Rao R, Euhus D, Mayo HG, Balch C. Axillary node interventions in breast cancer: a systematic review. JAMA. 2013;310(13):1385–94. https://doi.org/10.1001/jama.2013.277804.CrossRefPubMed

Özkurt E, Wong S, Rhei E, Golshan M, Brock J, Barbie TU. Omission of surgical axillary lymph node staging in patients with tubular breast cancer. Ann Surg Oncol. 2021;28(5):2589–98. https://doi.org/10.1245/s10434-020-09223-w.CrossRefPubMed

McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213–9. https://doi.org/10.1200/JCO.2008.16.3725.CrossRefPubMedPubMedCentral

Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ. Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol. 2010;17(12):3278–86. https://doi.org/10.1245/s10434-010-1155-4.CrossRefPubMed

Barth A, Craig PH, Silverstein MJ. Predictors of axillary lymph node metastases in patients with T1 breast carcinoma. Cancer. 1997;79(10):1918–22.CrossRefPubMed

10.

Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel lymph node biopsy for patients with early-stage breast cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35(5):561–4. https://doi.org/10.1200/JCO.2016.71.0947.CrossRefPubMed

11.

Gentilini OD, Botteri E, Sangalli C, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023. https://doi.org/10.1001/jamaoncol.2023.3759.CrossRefPubMedPubMedCentral

12.

Choosing Wisely: Society of Surgical Oncology. Five things physicians and patients should question. Available at: https://www.surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf. Accessed 15 May 2024.

13.

Wang T, Baskin AS, Dossett LA. Deimplementation of the choosing wisely recommendations for low-value breast cancer surgery: a systematic review. JAMA Surgery. 2020;155(8):759–70. https://doi.org/10.1001/jamasurg.2020.0322.CrossRefPubMedPubMedCentral

14.

Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31(19):2382–7. https://doi.org/10.1200/JCO.2012.45.2615.CrossRefPubMedPubMedCentral

15.

Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the american college of surgeons oncology group (alliance) ACOSOG Z0011 randomized trial. Ann Surg. 2016;264(3):413–20. https://doi.org/10.1097/SLA.0000000000001863.CrossRefPubMed

16.

Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10. https://doi.org/10.1016/S1470-2045(14)70460-7.CrossRefPubMedPubMedCentral

17.

Kalinsky K, Barlow WE, Gralow JR, et al. 21-Gene assay to inform chemotherapy benefit in node-positive breast cancer. N Engl J Med. 2021;385(25):2336–47. https://doi.org/10.1056/NEJMoa2108873.CrossRefPubMedPubMedCentral

18.

Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379(2):111–21. https://doi.org/10.1056/NEJMoa1804710.CrossRefPubMedPubMedCentral

19.

Valente SA, Levine GM, Silverstein MJ, et al. Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging. Ann Surg Oncol. 2012;19(6):1825–30. https://doi.org/10.1245/s10434-011-2200-7.CrossRefPubMed

20.

Almerey T, Villacreses D, Li Z, et al. Value of axillary ultrasound after negative axillary MRI for evaluating nodal status in high-risk breast cancer. J Am Coll Surg. 2019;228(5):792–7. https://doi.org/10.1016/j.jamcollsurg.2019.01.022.CrossRefPubMed

21.

Schipper RJ, van Roozendaal LM, de Vries B, et al. Axillary ultrasound for preoperative nodal staging in breast cancer patients: is it of added value? Breast. 2013;22(6):1108–13. https://doi.org/10.1016/j.breast.2013.09.002.CrossRefPubMed

22.

Nori J, Vanzi E, Bazzocchi M, et al. Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy. Am J Surg. 2007;193(1):16–20. https://doi.org/10.1016/j.amjsurg.2006.02.021.CrossRefPubMed

23.

Park SH, Kim MJ, Park BW, Moon HJ, Kwak JY, Kim EK. Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol. 2011;18(3):738–44. https://doi.org/10.1245/s10434-010-1347-y.CrossRefPubMed

24.

Sun S, Mutasa S, Liu MZ, et al. Deep learning prediction of axillary lymph node status using ultrasound images. Comput Biol Med. 2022;143:105250. https://doi.org/10.1016/j.compbiomed.2022.105250.CrossRefPubMed

25.

Caudle AS, Kuerer HM, Le-Petross HT, et al. Predicting the extent of nodal disease in early-stage breast cancer. Ann Surg Oncol. 2014;21(11):3440–7. https://doi.org/10.1245/s10434-014-3813-4.CrossRefPubMed

26.

Angarita S, Ye L, Runger D, et al. Assessing the burden of nodal disease for breast cancer patients with clinically positive nodes: hope for more limited axillary surgery. Ann Surg Oncol. 2021;28(5):2609–18. https://doi.org/10.1245/s10434-020-09228-5.CrossRefPubMed

27.

Plichta JK, Rushing CN, Lewis HC, et al. Implications of missing data on reported breast cancer mortality. Breast Cancer Res Treat. 2023;197(1):177–87. https://doi.org/10.1007/s10549-022-06764-4.CrossRefPubMed

Titel: Incidence of Pathologic Nodal Disease in Clinically Node-Negative, Microinvasive or T1a Breast Cancers
verfasst von: Pranam Dey, MD, MBA
Madhav Kc, PhD, MPH
Ellie M. Proussaloglou, MD
Jasmine A. Khubchandani, MD, MHS
Leah Kim, MD
Gregory Zanieski, MD
Tristen Park, MD
Melanie Lynch, MD
Alyssa Gillego, MD
Monica Valero, MD
Eric Schneider, PhD
Mehra Golshan, MD, MBA
Rachel A. Greenup, MD, MPH
Elizabeth R. Berger, MD, MS
Publikationsdatum: 06.09.2024
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 13/2024
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-16124-9

ASO Author Reflections: Are Common Risk Calculators Able to Predict Morbidity and Mortality Outcomes for Patients with Primary Retroperitoneal Sarcoma? A Multicentric Retrospective Analysis

ASO Author Reflections

The Association Between Breast Cancer Predisposing Genetic Variants and Multifocal, Multicentric Breast Cancer

Breast Oncology

Anatomic Versus Non-anatomic Liver Resection for Intrahepatic Cholangiocarcinoma: A Systematic Review and Patient-Level Meta-Analysis

Hepatobiliary Tumors

Changes in Skeletal Muscle Mass in the First 3 Months Following Gastrointestinal Cancer Surgery: A Prospective Study

Open Access
Translational Research

Cytoreduction and Heated Intraperitoneal Chemotherapy in Gastric Peritoneal Carcinomatosis: Selection is Key

Peritoneal Surface Malignancy

ASO Author Reflections: Ampulla of Vater Carcinoma with Advanced Pancreatic Invasion Imply Advanced Tumor Progression to Systemic Disease

ASO Author Reflections

Neu im Fachgebiet Chirurgie

Mit Lidocain kommt der Darm nicht schneller in Schwung

13.01.2025
Kolektomie
Nachrichten

Verzögertes Wiederanspringen der Darmfunktion ist ein Hauptfaktor dafür, wenn Patientinnen und Patienten nach einer Kolonresektion länger als geplant im Krankenhaus bleiben müssen. Ob man diesem Problem mit Lidocain vorbeugen kann, war Thema einer Studie.

Kein Unterschied bei inadäquaten Schocks zwischen ICD-Typen

24.12.2024
Implantierbarer Kardioverter-Defibrillator
Nachrichten

Inadäquate Schockabgaben sind ein unerwünschter Effekt der Therapie mit implantierbaren Kardioverter-Defibrillatoren. Subkutanen Geräten haftet dabei der Ruf an, dafür besonders anfällig zu sein. Die PRAETORIAN-Forschungsgruppe ist dem nachgegangen.

DCIS: Ist ein Verzicht auf eine Operation möglich?

Mammakarzinom
Nachrichten

Die COMET-Studie zeigt, dass aktives Monitoring bei Patientinnen mit duktalem Carcinoma in situ (DCIS) hinsichtlich der kumulativen Zwei-Jahres-Rate an ipsilateralen invasiven Karzinomen der leitliniengerechten Standardbehandlung nicht unterlegen ist. Dennoch wird von einem Verzicht auf eine Operation abgeraten, wie in einem begleitenden Editorial betont wird.

Soll man bei Cholezystektomie routinemäßig cholangiografieren?

18.12.2024
Cholezystektomie
Nachrichten

Eine US-Studie scheint den Befürwortern einer routinemäßigen intraoperativen Cholangiografie im Rahmen einer Cholezystektomie Recht zu geben. Die Studienkommentatoren in JAMA Surgery sparen jedoch nicht mit Kritik.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Incidence of Pathologic Nodal Disease in Clinically Node-Negative, Microinvasive or T1a Breast Cancers