Are Clinically Node-Negative Patients with a Positive Preoperative Axillary Lymph Node Biopsy Appropriate Candidates for Sentinel Lymph Node Biopsy?

Axilla Breast cancer Clinically node-negative Early-stage breast cancer Needle biopsy Sentinel lymph node biopsy

Journal

Annals of surgical oncology

ISSN: 1534-4681

Titre abrégé: Ann Surg Oncol

Pays: United States

ID NLM: 9420840

Informations de publication

Date de publication:
12 Oct 2024

Historique:

received: 05 08 2024

accepted: 19 09 2024

medline: 12 10 2024

pubmed: 12 10 2024

entrez: 11 10 2024

Statut: aheadofprint

Résumé

Whether cN0 patients with image-detected nodal metastases are appropriate for sentinel lymph node biopsy (SLNB) or should proceed directly to axillary lymph node dissection (ALND) or neoadjuvant chemotherapy (NAC) is controversial. We sought to determine how often ALND is needed with upfront surgery and to identify factors associated with ≥ 3 positive SLNs after a positive preoperative lymph node (LN) biopsy. Patients with cT1-2N0 breast cancer and a positive LN biopsy treated from 2014 to 2022 were identified from a prospective database. Patients who received NAC were excluded. Clinicopathologic characteristics were compared between women with 1-2 positive SLNs and ≥ 3 positive SLNs. Of 90 eligible patients, 66 (73%) had 1-2 positive SLNs and 24 (27%) had ≥ 3 positive SLNs. The median patient age was 62 years, median tumor size was 2.2 cm, and 16 women (18%) received a mastectomy. There was no difference in body mass index, tumor size, histology, grade, multifocality, presence of lymphovascular invasion, and receptor status between groups. On multivariable analysis, having ≥ 3 positive SLNs was associated with > 1 abnormal LN on preoperative imaging (odds ratio [OR] 4.36, 95% confidence interval [CI] 1.47-14.0; p = 0.01), microscopic extracapsular extension in the SLNs (OR 3.83, 95% CI 1.25-13.7; p = 0.025), and a higher median number of SLNs removed (OR 1.42, 95% CI 1.10-1.88; p = 0.01). More than 70% of women with cT1-2 breast cancer with image-detected nodal metastases had < 3 positive SLNs and did not require ALND. To avoid multiple trips to the operating room, frozen section can be considered in women with multiple abnormal LNs on imaging.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Patients with cT1-2N0 breast cancer and a positive LN biopsy treated from 2014 to 2022 were identified from a prospective database. Patients who received NAC were excluded. Clinicopathologic characteristics were compared between women with 1-2 positive SLNs and ≥ 3 positive SLNs.

RESULTS RESULTS

Of 90 eligible patients, 66 (73%) had 1-2 positive SLNs and 24 (27%) had ≥ 3 positive SLNs. The median patient age was 62 years, median tumor size was 2.2 cm, and 16 women (18%) received a mastectomy. There was no difference in body mass index, tumor size, histology, grade, multifocality, presence of lymphovascular invasion, and receptor status between groups. On multivariable analysis, having ≥ 3 positive SLNs was associated with > 1 abnormal LN on preoperative imaging (odds ratio [OR] 4.36, 95% confidence interval [CI] 1.47-14.0; p = 0.01), microscopic extracapsular extension in the SLNs (OR 3.83, 95% CI 1.25-13.7; p = 0.025), and a higher median number of SLNs removed (OR 1.42, 95% CI 1.10-1.88; p = 0.01).

CONCLUSIONS CONCLUSIONS

More than 70% of women with cT1-2 breast cancer with image-detected nodal metastases had < 3 positive SLNs and did not require ALND. To avoid multiple trips to the operating room, frozen section can be considered in women with multiple abnormal LNs on imaging.

Identifiants

DOI: 10.1245/s10434-024-16321-6 PMID: 39394489

pubmed: 39394489

doi: 10.1245/s10434-024-16321-6

pii: 10.1245/s10434-024-16321-6

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Subventions

Organisme : NIH/NCI Cancer Center Support Grant

ID : P30CA008748

Informations de copyright

Références

Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111–8.

doi: 10.1002/jso.21535 pubmed: 20648579 pmcid: 3072246

Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33.

doi: 10.1016/S1470-2045(10)70207-2 pubmed: 20863759 pmcid: 3041644

Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599–609.

doi: 10.1093/jnci/djj158 pubmed: 16670385

Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017;318(10):918–26.

doi: 10.1001/jama.2017.11470 pubmed: 28898379 pmcid: 5672806

Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.

doi: 10.1001/jama.2011.90 pubmed: 21304082 pmcid: 5389857

Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426–32.

doi: 10.1097/SLA.0b013e3181f08f32 pubmed: 20739842

Bartels SAL, Donker M, Poncet C, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981–22023 AMAROS trial. J Clin Oncol. 2023;41(12):2159–65.

doi: 10.1200/JCO.22.01565 pubmed: 36383926

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.

doi: 10.1016/S1470-2045(14)70460-7 pubmed: 25439688 pmcid: 4291166

Sávolt Á, Péley G, Polgár C, et al. Eight-year follow up result of the OTOASOR trial: The optimal treatment of the axilla - surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: a randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol. 2017;43(4):672–9.

doi: 10.1016/j.ejso.2016.12.011 pubmed: 28139362

Pilewskie M, Jochelson M, Gooch JC, Patil S, Stempel M, Morrow M. Is preoperative axillary imaging beneficial in identifying clinically node-negative patients requiring axillary lymph node dissection? J Am Coll Surg. 2016;222(2):138–45.

doi: 10.1016/j.jamcollsurg.2015.11.013 pubmed: 26711795

Attieh M, Jamali F, Berjawi G, Saadeldine M, Boulos F. Shortcomings of ultrasound-guided fine needle aspiration in the axillary management of women with breast cancer. World J Surg Oncol. 2019;17(1):208.

doi: 10.1186/s12957-019-1753-y pubmed: 31801564 pmcid: 6894218

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.

doi: 10.1245/s10434-014-3813-4 pubmed: 24859939

Harris CK, Tran HT, Lee K, et al. Positive ultrasound-guided lymph node needle biopsy in breast cancer may not mandate axillary lymph node dissection. Ann Surg Oncol. 2017;24(10):3004–10.

doi: 10.1245/s10434-017-5935-y pubmed: 28766210

Pilewskie M, Mautner SK, Stempel M, Eaton A, Morrow M. Does a positive axillary lymph node needle biopsy result predict the need for an axillary lymph node dissection in clinically node-negative breast cancer patients in the ACOSOG Z0011 era? Ann Surg Oncol. 2016;23(4):1123–8.

doi: 10.1245/s10434-015-4944-y pubmed: 26553439

Yoo TK, Kang BJ, Kim SH, et al. Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis. Breast Cancer Res Treat. 2020;181(2):403–9.

doi: 10.1007/s10549-020-05636-z pubmed: 32328848

National Comprehensive Cancer Network. NCCN guidelines version 2.2024. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf Accessed March 20, 2024.

American Society of Breast Surgeons (ASBrS). ASBrS consensus statement on axillary management for patients with in-situ and invasive breast cancer: a concise overview. https://www.breastsurgeons.org/docs/statements/management-of-the-axilla.pdf Accessed March 26, 2024.

de Boniface J, Filtenborg Tvedskov T, Rydén L, et al. Omitting axillary dissection in breast cancer with sentinel-node metastases. N Engl J Med. 2024;390(13):1163–75.

doi: 10.1056/NEJMoa2313487 pubmed: 38598571

Tinterri C, Gentile D, Gatzemeier W, et al. Preservation of axillary lymph nodes compared with complete dissection in T1–2 breast cancer patients presenting one or two metastatic sentinel lymph nodes: the SINODAR-ONE multicenter randomized clinical trial. Ann Surg Oncol. 2022;29(9):5732–44.

doi: 10.1245/s10434-022-11866-w pubmed: 35552930

Jiang K, Ma C, Yang Y, et al. Axillary ultrasonography for early-stage invasive breast cancer. Am J Surg. 2024;231:86–90.

doi: 10.1016/j.amjsurg.2024.03.011 pubmed: 38490879

Gooch J, King TA, Eaton A, et al. The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1–T2 breast cancer. Ann Surg Oncol. 2014;21(9):2897–903.

doi: 10.1245/s10434-014-3752-0 pubmed: 24777858 pmcid: 4346337

Vane MLG, Willemsen MA, van Roozendaal LM, et al. Extracapsular extension in the positive sentinel lymph node: a marker of poor prognosis in cT1-2N0 breast cancer patients? Breast Cancer Res Treat. 2019;174(3):711–8.

doi: 10.1007/s10549-018-05074-y pubmed: 30610488

Nottegar A, Veronese N, Senthil M, et al. Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: a systematic review and an exploratory meta-analysis. Eur J Surg Oncol. 2016;42(7):919–25.

doi: 10.1016/j.ejso.2016.02.259 pubmed: 27005805

Barrio AV, Downs-Canner S, Edelweiss M, et al. Microscopic extracapsular extension in sentinel lymph nodes does not mandate axillary dissection in Z0011-eligible patients. Ann Surg Oncol. 2020;27(5):1617–24.

doi: 10.1245/s10434-019-08104-1 pubmed: 31820212

Kim WH, Kim HJ, Lee SM, et al. Prediction of high nodal burden with ultrasound and magnetic resonance imaging in clinically node-negative breast cancer patients. Cancer Imaging. 2019;19(1):4.

doi: 10.1186/s40644-019-0191-y pubmed: 30709369 pmcid: 6359788

Lim GH, Upadhyaya VS, Acosta HA, Lim JMA, Allen JC Jr, Leong LCH. Preoperative predictors of high and low axillary nodal burden in Z0011 eligible breast cancer patients with a positive lymph node needle biopsy result. Eur J Surg Oncol. 2018;44(7):945–50.

doi: 10.1016/j.ejso.2018.04.003 pubmed: 29705286

Man V, Luk WP, Fung LH, Kwong A. The role of pre-operative axillary ultrasound in assessment of axillary tumor burden in breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat. 2022;196(2):245–54.

doi: 10.1007/s10549-022-06699-w pubmed: 36138294

Morrow M, Van Zee KJ, Patil S, et al. Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers: a prospective validation study of 793 patients. Ann Surg. 2017;266(3):457.

doi: 10.1097/SLA.0000000000002354 pubmed: 28650355