Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study
Tóm tắt
Sentinel lymph node (SLN) biopsy has become the preferred method for the nodal staging of early breast cancer, but controversy exists regarding its universal use and consequences in small tumors. 2929 cases of breast carcinomas not larger than 15 mm and staged with SLN biopsy with or without axillary dissection were collected from the authors′ institutions. The pathology of the SLNs included multilevel hematoxylin and eosin (HE) staining. Cytokeratin immunohistochemistry (IHC) was commonly used for cases negative with HE staining. Variables influencing SLN involvement and non-SLN involvement were studied with logistic regression. Factors that influenced SLN involvement included tumor size, multifocality, grade and age. Small tumors up to 4 mm (including in situ and microinvasive carcinomas) seem to have SLN involvement in less than 10%. Non-SLN metastases were associated with tumor grade, the ratio of involved SLNs and SLN involvement type. Isolated tumor cells were not likely to be associated with further nodal load, whereas micrometastases had some subsets with low risk of non-SLN involvement and subsets with higher proportion of further nodal spread. In situ and microinvasive carcinomas have a very low risk of SLN involvement, therefore, these tumors might not need SLN biopsy for staging, and this may be the approach used for very small invasive carcinomas. If an SLN is involved, isolated tumor cells are rarely if ever associated with non-SLN metastases, and subsets of micrometastatic SLN involvement may be approached similarly. With macrometastases the risk of non-SLN involvement increases, and further axillary treatment should be generally indicated.
Tài liệu tham khảo
Moore MP, Kinne DW: Axillary lymphadenectomy: a diagnostic and therapeutic procedure. J Surg Oncol 66: 2–6, 1997
Fisher B: Laboratory and clinical research in breast cancer — a personal adventure: the David A. Karnofsky memorial lecture. Cancer Res 40: 3863–3874, 1980
Forrest AP, Stewart HJ, Roberts MM, et al: Simple mastectomy and axillary node sampling (pectoral node biopsy) in the management of primary breast cancer. Ann Surg 196: 371–378, 1982
Ahlgren J, Holmberg L, Bergh J, et al: Five-node biopsy of the axilla: an alternative to axillary dissection of levels I-II in operable breast cancer. Eur J Surg Oncol 28:97–102, 2002
Sato K, Tamaki K, Takeuchi H, et al: Management of the axilla in breast cancer: a comparative study between sentinel lymph node biopsy and four-node sampling procedure. Jpn J Clin Oncol 31: 318–321, 2001
Krag DN, Weaver DL, Alex JC, et al: Surgical resection and radiolocalization of sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 2: 335–340, 1993
Giuliano AE, Kirgan DM, Guenther JM, et al: Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220: 391–398, 1994
Albertini JJ, Lyman GH, Cox C, et al: Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 276: 1818–1822, 1996
Al-Hilaly M, Willsher PC, Robertson JFR, et al: Audit of a conservative management policy of the axilla in elderly patients with operable breast cancer. Eur J Surg Oncol 23: 339–340, 1997
Ragaz J, Jackson SM, Le N, et al: Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337: 956–962, 1997
Overgaard M, Hansen PS, Overgaard J, et al: Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337: 949–955, 1997
Overgaard M, Jensen MB, Overgaard J, et al: Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353: 1641–1648, 1999
Vinh-Hung V, Verschraegen C: Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 96: 115–121, 2004
Orr RK: The impact of prophylactic axillary node dissection on breast cancer survival -a Bayesian meta-analysis. Ann Surg Oncol 6: 109–116, 1999
Early Breast Cancer Trialists’ Collaborative Group: Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366: 2087–2106, 2005
Silverstein MJ, Lagios MD, Recht A, et al: Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg 201: 586–597, 2005
Schwartz GF, Giuliano AE, Veronesi U, et al: Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, Pennsylvania. Cancer 94: 2542–2551, 2002
Pendas S, Dauway E, Giuliano R, et al: Sentinel node biopsy in ductal carcinoma in situ patients. Ann Surg Oncol 7: 15–20, 2000
Klauber-DeMore N, Tan LK, Liberman L, 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 7: 636–642, 2000
Cox CE, Nguyen K, Gray RJ, et al: Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg 67: 513–521, 2001
Intra M, Zurrida S, Maffini F, et al: Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol 10: 1160–1165, 2003
Degnim AC, Griffith KA, Sabel MS, etal: Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients. Cancer 98: 2307–2315, 2003
Cserni G, Gregori D, Merletti F, et al: Non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer: metaanalysis of 25 studies. Br J Surg 91: 1245–1252, 2004
Schrenk P, Konstantiniuk P, Wolfl S, et al: Prediction of non-sentinel lymph node status in breast cancer with a micrometastatic sentinel node. Br J Surg 92: 707–713, 2005
Houvenaeghel G, Nos C, Mignotte H, et al: Micrometastases in sentinel lymph node in a multicentric study: predictive factors of nonsentinel lymph node involvement—Groupe des Chirurgiens de la Federation des Centres de Lutte Contre le Cancer. J Clin Oncol 24: 1814–1822, 2006
Van Zee KJ, Manasseh DM, Bevilacqua JL, et al: A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 10: 1140–1151, 2003
Lambert LA, Ayers GD, Hwang RF, et al: Validation of a breast cancer nomogram for predicting nonsentinel lymph node metastases after a positive sentinel node biopsy. Ann Surg Oncol 13: 310–320, 2006
Smidt ML, Kuster DM, van der Wilt GJ, et al: Can the Memorial Sloan-Kettering Cancer Center nomogram predict the likelihood of nonsentinel lymph node metastases in breast cancer patients in the Netherlands? Ann Surg Oncol 12: 1066–1072, 2005
Kocsis L, Svébis M, Boross G, et al: Use and limitations of a nomogram predicting the likelihood of non-sentinel node involvement after a positive sentinel node biopsy in breast cancer patients. Am Surg 70: 1019–1024, 2004
Degnim AC, Reynolds C, Pantvaidya G, et al: Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram. Am J Surg 190: 543–550, 2005
Cserni G: Comparison of different validation studies on the use of the Memorial-Sloan Kettering Cancer Center nomogram predicting nonsentinel node involvement in sentinel node positive breast cancer patients. Am J Surg (in press)
Cserni G, Amendoeira I, Apostolikas N, et al: Pathological workup of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines. Eur J Cancer 39: 1654–1667, 2003
Cserni G, Amendoeira I, Apostolikas N, et al: Discrepancies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire-based survey by the European Working Group for Breast Screening Pathology. J Clin Pathol 57: 695–701, 2004
Cserni G, Bianchi S, Boecker W, et al: Improving the reproducibility of diagnosing micrometastases and isolated tumor cells. Cancer 103: 358–367, 2005
Cserni G, Bianchi S, Vezzosi V, et al: The value of cytokeratin immunohistochemistry in the evaluation of axillary sentinel lymph nodes in patients with lobular breast carcinoma. J Clin Pathol 59: 518–522, 2006
Perry N, Broeders M, de Wolf C, et al (Eds): European Guidelines for Breast Screening and Diagnosis. European Communities, Luxemburg, 2006
Sobin LH andWittekind C (Eds): UICC TNM Classification of Malignant Tumors, 6th edition. John Wiley and Sons, Inc., New-York, 2002
Ellis IO, Pinder SE, Bobrow L, et al: Pathology reporting of breast disease, http://www.cancerscreening.nhs.uk/breastscreen/publications/nhsbsp58-low-resolution.pdf. (Last assessed: 11 November 2006)
Tavassoli FA, Devilee P (Eds): World Health Organization: Tumors of the Breast and Female Genital Organs, 4th edition, IARC Press, Lyon, 2003
Greene FL, Page DL, Fleming ID, et al (Eds): AJCC Cancer Staging Handbook — TNM Classification of Malignant Tumors, 6th edition. Springer Verlag, New York, 2002
Hermanek P, Hutter RVP, Sobin LH, et al: Classification of isolated tumor cells and micrometastasis. Cancer 86: 2668–2673, 1999
Cserni G, Sapino A, Decker T: Discriminating between micrometastases and isolated tumor cells in a regional and institutional setting. Breast 15: 347–354, 2006
Miller WG: OpenStat. http://www.statpages.org/miller/openstat/OpenStathtm (Last assessed: 15 August 2006)
Cserni G, Burzykowski T, Vinh-Hung V, et al: Axillary sentinel node and tumor-related factors associated with non-sentinel node involvement in breast cancer. Jpn J Clin Oncol 34: 519–524, 2004
Woodward WA, Vinh-Hung V, Ueno NT, et al: Prognostic value of nodal ratios in node-positive breast cancer. J Clin Oncol 24: 2910–2916, 2006
Cady B: New era in breast cancer. Impact of screening on disease presentation. Surg Oncol Clin N Am 6: 195–202, 1997
McMasters KM, Chao C, Wong SL, et al: Sentinel lymph node biopsy in patients with ductal carcinoma in situ: a proposal. Cancer 95: 15–20, 2002
Holloway C: Surgery for ductal carcinoma in situ. Curr Probl Cancer 24: 141–162, 2000
Lagios MD, Silverstein MJ: Sentinel node biopsy for patients with DCIS: a dangerous and unwarranted direction. Ann Surg Oncol 8: 275–277, 2001
Intra M, Veronesi P, Mazzarol G, et al: Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg 138: 309–313, 2003
Trisal V, Qian D, Wagman LD: Axillary recurrence in DCIS: is axillary lymphadenectomy warranted? Am Surg 70: 876–880, 2004
Leidenius M, Salmenkivi K, von Smitten K, et al: Tumor-positive sentinel node findings in patients with ductal carcinoma in situ. J Surg Oncol 94: 380–384, 2006
Cserni G, Boross G, Maráz R, et al: Sentinel lymph node biopsy for in situ carcinoma of the breast. Experience at the Bacs-Kiskun County Hospital and review of the literature [In Hungarian]. Magy Seb 59: 164–172, 2006
Török K, Péley G, Mátrai Z, et al: The role of sentinel lymph node biopsy for staging patients with ductal carcinoma in situ of the breast. [In Hungarian] Magy Seb 59: 173–178, 2006
Damiani S, Ludvikova M, Tomasic G, et al: Myoepithelial cells and basal lamina in poorly differentiated in situ duct carcinoma of the breast. An immunocytochemical study. Virchows Arch 434: 227–234, 1999
Moran CJ, Kell MR, Kerin MJ: The role of sentinel lymph node biopsy in ductal carcinoma in situ. EJSO 31: 1105–1111, 2005
Silverstein MJ, Rosser RJ, Gierson ED, et al: Axillary lymph node dissection for intraductal breast carcinoma — is it indicated? Cancer 59: 1819–1824, 1987
Arisio R, Sapino A, Cassoni P, et al: What modifies the relation between tumor size and lymph node metastases in Tl breast carcinomas? J Clin Pathol 53: 846–850, 2000
Delia Rovere GQ, Bonomi R, Ashley S, et al: Axillary staging in women with small invasive breast tumors. EJSO 32: 733–737, 2006
Diaz LK, Wiley EL, Venta LA: Are malignant cells displaced by large-gauge needle core biopsy of the breast? Am J Roentgenol 173: 1303–1313, 1999
Diaz NM, Mayes JR, Vrcel V: Breast epithelial cells in dermal angiolymphatic spaces: a manifestation of benign mechanical transport. Hum Pathol 36: 310–313, 2005
Nagi C, Bleiweiss I, Jaffer S: Epithelial displacement in breast lesions: a papillary phenomenon. Arch Pathol Lab Med 129: 1465–1469, 2005
Bleiweiss IJ, Nagi CS, Jaffer S: Axillary sentinel lymph nodes can be falsely positive due to iatrogenic displacement and transport of benign epithelial cells in patients with breast carcinoma. J Clin Oncol 24: 2013–2018, 2006
Bleiweiss IJ: Sentinel lymph nodes in breast cancer after 10 years: rethinking basic principles. Lancet Oncol 7: 686–692, 2006
Viale G, Zurrida S, Maiorano E, et al: Predicting the status of axillary sentinel lymph nodes in 4351 patients with invasive breast carcinoma treated in a single institution. Cancer 103: 492–500, 2005
Vinh-Hung V, Verschraegen C, Promish DI, et al: Ratios of involved nodes in early breast cancer. Breast Cancer Res 6: R680–688, 2004
Calhoun KE, Hansen NM, Turner RR, et al: Nonsentinel node metastases in breast cancer patients with isolated tumor cells in the sentinel node: implications for completion axillary node dissection. Am J Surg 190: 588–591, 2005
van Rijk MC, Peterse JL, Nieweg OE, et al: Additional axillary metastases and stage migration in breast cancer patients with micrometastases or submicrometastases in sentinel lymph nodes. Cancer 107: 467–471, 2006