Skip to main content
Erschienen in: Annals of Surgical Oncology 1/2012

01.01.2012 | Breast Oncology

Risk Factor for Axillary Lymph Node Metastases in Microinvasive Breast Cancer

verfasst von: Beom Seok Ko, Woo Sung Lim, Hee Jeong Kim, Jong Han Yu, Jong Won Lee, Su Bum Kwan, Yu Mi Lee, Byung Ho Son, Gyung Yup Gong, Sei Hyun Ahn, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ (DCIS) was controversial. Usually we did not do a SLN biopsy when we performed conserving operations with small-sized DCIS. However, sometimes we find DCIS with microinvasive breast cancer (MIC) after the operation. Must reoperations be performed in all patients? The incidence of axillary metastases in microinvasive breast cancer (MIC) has not been extensively studied. We determined the incidence of positive axillary lymph node (ALN) in patients with MIC and the predictive factors of ALN metastases in these patients.

Methods

Between July 1989 and December 2008, 9635 patients had operation on invasive breast cancer in Asan Medical Center. Among these patients, 319 patients had MIC. The research conducted on the 293 patients (excluded were 26 who did not receive axillary lymph node dissection or SLN biopsy). We retrospectively checked clinical and pathologic variables.

Results

There were 22 cases of ALN metastases identified in this group of patients (7.5%). Lymphatic invasion (P < .001) and positive estrogen receptor status (P = 03) were independent significant predictors of axillary metastases.

Conclusions

Microinvasive breast cancer is associated with a low rate of lymph node metastases. Some breast cancer patients with MIC at low likelihood of lymph node metastases may be spared lymph node evaluation.
Literatur
1.
Zurück zum Zitat Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL et al. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin. 2006;56:168–83.PubMedCrossRef Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL et al. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin. 2006;56:168–83.PubMedCrossRef
2.
Zurück zum Zitat Adamovich TL, Simmons RM. Ductal carcinoma in situ with microinvasion. Am J Surg. 2003;186:112–6.PubMedCrossRef Adamovich TL, Simmons RM. Ductal carcinoma in situ with microinvasion. Am J Surg. 2003;186:112–6.PubMedCrossRef
3.
Zurück zum Zitat Klauber-DeMore N, Tan LK, Liberman L, Kaptain S, Fey J, Borgen P, et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann Surg Oncol. 2000;7:636–42.PubMedCrossRef Klauber-DeMore N, Tan LK, Liberman L, Kaptain S, Fey J, Borgen P, et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann Surg Oncol. 2000;7:636–42.PubMedCrossRef
4.
Zurück zum Zitat Cox CE, Nguyen K, Gray RJ, Salud C, Ku NN, Dupont E, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg. 2001;67:513–9; discussion 519–21.PubMed Cox CE, Nguyen K, Gray RJ, Salud C, Ku NN, Dupont E, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg. 2001;67:513–9; discussion 519–21.PubMed
5.
Zurück zum Zitat Wong SL, Chao C, Edwards MJ, Carlson DJ, Laidley A, Noyes RD, et al. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg. 2002;184:492–8; discussion 498.PubMedCrossRef Wong SL, Chao C, Edwards MJ, Carlson DJ, Laidley A, Noyes RD, et al. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg. 2002;184:492–8; discussion 498.PubMedCrossRef
6.
Zurück zum Zitat de Mascarel I, MacGrogan G, Mathoulin-Pelissier S, Soubeyran I, Picot V, Coindre JM. Breast ductal carcinoma in situ with microinvasion: a definition supported by a long-term study of 1248 serially sectioned ductal carcinomas. Cancer. 2002;94:2134–42.PubMedCrossRef de Mascarel I, MacGrogan G, Mathoulin-Pelissier S, Soubeyran I, Picot V, Coindre JM. Breast ductal carcinoma in situ with microinvasion: a definition supported by a long-term study of 1248 serially sectioned ductal carcinomas. Cancer. 2002;94:2134–42.PubMedCrossRef
7.
Zurück zum Zitat Wasserberg N, Morgenstern S, Schachter J, Fenig E, Lelcuk S, Gutman H. Risk factors for lymph node metastases in breast ductal carcinoma in situ with minimal invasive component. Arch Surg. 2002;137:1249–52.PubMedCrossRef Wasserberg N, Morgenstern S, Schachter J, Fenig E, Lelcuk S, Gutman H. Risk factors for lymph node metastases in breast ductal carcinoma in situ with minimal invasive component. Arch Surg. 2002;137:1249–52.PubMedCrossRef
8.
Zurück zum Zitat Intra M, Zurrida S, Maffini F, Sonzogni A, Trifirò G, Gennari R et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol. 2003;10:1160–5.PubMedCrossRef Intra M, Zurrida S, Maffini F, Sonzogni A, Trifirò G, Gennari R et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol. 2003;10:1160–5.PubMedCrossRef
9.
Zurück zum Zitat Yang M, Moriya T, Oguma M, De La Cruz C, Endoh M, Ishida T, et al. Microinvasive ductal carcinoma (T1mic) of the breast. The clinicopathological profile and immunohistochemical features of 28 cases. Pathol Int. 2003;53:422–8.PubMedCrossRef Yang M, Moriya T, Oguma M, De La Cruz C, Endoh M, Ishida T, et al. Microinvasive ductal carcinoma (T1mic) of the breast. The clinicopathological profile and immunohistochemical features of 28 cases. Pathol Int. 2003;53:422–8.PubMedCrossRef
10.
Zurück zum Zitat Gray RJ, Mulheron B, Pockaj BA, Degnim A, Smith SL. The optimal management of the axillae of patients with microinvasive breast cancer in the sentinel lymph node era. Am J Surg. 2007;194:845–8; discussion 848–9.PubMedCrossRef Gray RJ, Mulheron B, Pockaj BA, Degnim A, Smith SL. The optimal management of the axillae of patients with microinvasive breast cancer in the sentinel lymph node era. Am J Surg. 2007;194:845–8; discussion 848–9.PubMedCrossRef
11.
Zurück zum Zitat Fortunato L, Santoni M, Drago S, Gucciardo G, Farina M, Cesarini C, et al. Sentinel lymph node biopsy in women with pT1a or “microinvasive” breast cancer. Breast. 2008;17:395–400.PubMedCrossRef Fortunato L, Santoni M, Drago S, Gucciardo G, Farina M, Cesarini C, et al. Sentinel lymph node biopsy in women with pT1a or “microinvasive” breast cancer. Breast. 2008;17:395–400.PubMedCrossRef
12.
Zurück zum Zitat Sakr R, Barranger E, Antoine M, Prugnolle H, Daraï E, Uzan S. Ductal carcinoma in situ: value of sentinel lymph node biopsy. J Surg Oncol. 2006;94:426–30.PubMedCrossRef Sakr R, Barranger E, Antoine M, Prugnolle H, Daraï E, Uzan S. Ductal carcinoma in situ: value of sentinel lymph node biopsy. J Surg Oncol. 2006;94:426–30.PubMedCrossRef
13.
Zurück zum Zitat van la Parra RF, Ernst MF, Barneveld PC, Broekman JM, Rutten MJ, Bosscha K. The value of sentinel lymph node biopsy in ductal carcinoma in situ (DCIS) and DCIS with microinvasion of the breast. Eur J Surg Oncol. 2008;34:631–5.CrossRef van la Parra RF, Ernst MF, Barneveld PC, Broekman JM, Rutten MJ, Bosscha K. The value of sentinel lymph node biopsy in ductal carcinoma in situ (DCIS) and DCIS with microinvasion of the breast. Eur J Surg Oncol. 2008;34:631–5.CrossRef
14.
Zurück zum Zitat Sakr R, Bezu C, Raoust I, Antoine M, Ettore F, Darcourt J, et al. The sentinel lymph node procedure for patients with preoperative diagnosis of ductal carcinoma in situ: risk factors for unsuspected invasive disease and for metastatic sentinel lymph nodes. Int J Clin Pract. 2008;62:1730–5.PubMedCrossRef Sakr R, Bezu C, Raoust I, Antoine M, Ettore F, Darcourt J, et al. The sentinel lymph node procedure for patients with preoperative diagnosis of ductal carcinoma in situ: risk factors for unsuspected invasive disease and for metastatic sentinel lymph nodes. Int J Clin Pract. 2008;62:1730–5.PubMedCrossRef
15.
Zurück zum Zitat Guth AA, Mercado C, Roses DF, Darvishian F, Singh B, Cangiarella JF. Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature. Breast J. 2008;14:335–9.PubMedCrossRef Guth AA, Mercado C, Roses DF, Darvishian F, Singh B, Cangiarella JF. Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature. Breast J. 2008;14:335–9.PubMedCrossRef
16.
Zurück zum Zitat Zavagno G, Belardinelli V, Marconato R, Carcoforo P, Franchini Z, Scalco G, et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast. 2007;16:146–51.PubMedCrossRef Zavagno G, Belardinelli V, Marconato R, Carcoforo P, Franchini Z, Scalco G, et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast. 2007;16:146–51.PubMedCrossRef
17.
Zurück zum Zitat Wilkie C, White L, Dupont E, Cantor A, Cox CE. An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am J Surg. 2005;190:563–6.PubMedCrossRef Wilkie C, White L, Dupont E, Cantor A, Cox CE. An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am J Surg. 2005;190:563–6.PubMedCrossRef
18.
Zurück zum Zitat Katz A, Gage I, Evans S, Shaffer M, Fleury T, Smith FP, et al. Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2006;191:761–6.PubMedCrossRef Katz A, Gage I, Evans S, Shaffer M, Fleury T, Smith FP, et al. Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2006;191:761–6.PubMedCrossRef
19.
Zurück zum Zitat Maffuz A, Barroso-Bravo S, Najera I, Zarco G, Alvarado-Cabrero I, Rodriguez-Cuevas SA. Tumor size as predictor of microinvasion, invasion, and axillary metastasis in ductal carcinoma in situ. J Exp Clin Cancer Res. 2006;25:223–7.PubMed Maffuz A, Barroso-Bravo S, Najera I, Zarco G, Alvarado-Cabrero I, Rodriguez-Cuevas SA. Tumor size as predictor of microinvasion, invasion, and axillary metastasis in ductal carcinoma in situ. J Exp Clin Cancer Res. 2006;25:223–7.PubMed
Metadaten
Titel
Risk Factor for Axillary Lymph Node Metastases in Microinvasive Breast Cancer
verfasst von
Beom Seok Ko
Woo Sung Lim
Hee Jeong Kim
Jong Han Yu
Jong Won Lee
Su Bum Kwan
Yu Mi Lee
Byung Ho Son
Gyung Yup Gong
Sei Hyun Ahn, MD, PhD
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 1/2012
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1812-2

Weitere Artikel der Ausgabe 1/2012

Annals of Surgical Oncology 1/2012 Zur Ausgabe

Update Chirurgie

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

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.