NDLI: Characteristics of the Sentinel Lymph Node in Breast Cancer Predict Further Involvement of Higher-Echelon Nodes in the Axilla: A Study to Evaluate the Need for Complete Axillary Lymph Node Dissection

Content Provider	JAMA Network
Author	Kamath, Vidyulata J. Giuliano, Rosemary Dauway, Emilia L. Cantor, Alan Berman, Claudia Ku, Ni Ni Cox, Charles E. Reintgen, Douglas S.
Copyright Year	2001
Abstract	Background: Sentinel lymph node ( SLN) biopsy techniques provide accurate nodal staging for breast cancer. In the past, complete lymph node dissection ( CLND) (levels 1 and 2) was performed for breast cancer staging, although the therapeutic benefit of this more extensive procedure has remained controversial. Hypothesis: It has been demonstrated that if the axillary SLN has no evidence of micrometastases, the nonsentinel lymph nodes ( NSLNs) are unlikely to have metastases. Objective: To determine which variables predict the probability of NSLN involvement in patients with primary breast carcinoma and SLN metastases. Methods: An analysis of 101 women with SLN metastases and subsequent CLND was performed. Variables included size of the primary tumor, tumor volume in the SLN, staining techniques used to initially identify the micrometastases (cytokeratin immunohistochemical vs hematoxylin-eosin), number of SLNs harvested, and number of NSLNs involved with the metastases. Tumor size was determined by the invasive component of the primary tumor. Patients with ductal carcinoma in situ who were upstaged with cytokeratin staining were considered to have stage T1a tumors. Results: Sentinel lymph node micrometastases (<2 mm) detected initially by cytokeratin staining were associated with a 7.6% (2/26) incidence of positive CLND compared with a 25% (5/20) incidence when micrometastases were detected initially by routine hematoxylin-eosin staining. Sentinel lymph node micrometastases, regardless of identification technique, inferred a risk of 15.2% (7/46) for NSLN involvement. As the volume of tumor in the SLN increased (ie, <2 mm, >2 mm, grossly visible tumor), so did the risk of NSLN metastases ( P<.001). Conclusions: Our study demonstrated that patients with micrometastases detected initially by cytokeratin staining had low-volume disease in the SLN with a small chance of having metastases in higher-echelon nodes in the regional basin other than the SLN. Characteristics of the SLN can provide information to determine the need for a complete axillary CLND. Complete lymph node dissection may not be necessary in patients with micrometastases detected initially by cytokeratin staining since the disease is confined to the SLN 92.4% of the time. However, the therapeutic value of CLND in breast cancer remains to be determined by further investigation.
Ending Page	692
Starting Page	688
Page Count	5
File Format	PDF HTM / HTML
ISSN	00040010
DOI	10.1001/archsurg.136.6.688
Issue Number	6
Journal	Archives of Surgery
Volume Number	136
Language	English
Publisher	American Medical Association
Publisher Date	2001-06-01
Access Restriction	Open
Subject Keyword	axilla eosine yellowish-(ys) hematoxylin keratins neoplasm metastasis lymph nodes breast cancer micrometastasis sentinel lymph node tumor size axillary lymph node dissection breast carcinoma neoplasms lymph node dissection biopsy ductal carcinoma in situ tumor volume tnm breast tumor staging
Content Type	Text
Resource Type	Article
Subject	Surgery

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