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Category: Volume 05 Issue 11 November 2017
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Title: Predictors of Axillary Lymph Node Status in Early Breast Cancer: A Single Center Analysis of 81 patients at a Tertiary Care Hospital in North-East India

Authors: Sapam Opendro Singh, Verma Nityanand, Lalsangzuala Tochhawng, Rina Tomeru, Longjam Anil Singh, Th Sudhir Chandra Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.157

Abstract

Breast cancer is the most common site specific cancer in women. Mastectomy with axillary lymph node dissection (ALND) is the gold standard in determining the prognosis, adjuvant therapy and loco-regional control and improves the survival rate among the node positive group. But, those patients who do not have axillary metastasis may not benefit from ALND instead they may suffer from its complications. Therefore, it may be overtreatment to perform ALND in this subgroup of patients. This study was done to find out the predictors of axillary lymph node metastases in early breast cancer which will help in selecting patients in whom ALND can be avoided. 81 early breast cancer patients who were operated between January 2010 to March 2017 were included in this study. 25 patients (30.9%) showed axillary metastasis. On statistical analysis, tumor size (p=0.045), hormonal status (p=0.023) and histological type of the tumor (p=0.038) were found to be significant. Whereas Other variables like age of the patient, histological grading of the tumor, side of the breast involved, lymphovascular invasion and perineural spread were not found to be associated with axillary lymph node metastasis in early breast cancer.In conclusion, we have found that size of the tumor, hormonal status and histological type of the tumor can predict the axillary metastasis in early breast cancer which can be taken into consideration before going for ALND in node negative patients.

Keywords: Breast cancer, axillary lymph node dissection (ALND), histopathological type, lymphovascular invasion, perineural spread, immunohistochemistry

References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA cancer J Clin. 2013;63:11-30.
  2. Murthy NS, Juneja A, Sehgal A, Parbhakar AK, Luthra UK. Cancer projection by the turn of the country- Indian Scene. Ind J Cancer 1990;27:74-82.
  3. Cianfrocca M, Goldstein LJ. Prognostic and Predictive factors in Early-Stage Breast Cancer. The Oncologist 2004;9: 606-16.
  4. Hoe Al, Iven D, Royle GT. Incidence of arm swelling following axillary clearance for breast cancer. Br J Surg 1992;79:261-62.
  5. Jatoi I. Management of the axilla in primary breast cancer. SurgClin North Am 1999;79:1061-73.
  6. Naik AM, Fey j, Gemignani M. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection. A follow-up study of 4008 procedures. Ann Surg 2004;240:462-71.
  7. Jeruss JS, Winchester DJ. Axillary recurrence after Sentinel Node Biopsy. Ann Surgoncol 2005;12:34-40.
  8. Purushotham AD, Upponi S, Klevesath MB, Bobrow L, Millar K, Myles JP et al. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J ClinOncol. 2005;19:4312-21.
  9. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T 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. LanOncol. 2007;10:881-8.
  10. Murthy NS, Chaudhry K, Nadayil D, Agarwal UK, Saxena S. Changing trends in incidence of breast cancer: Indian scenario. Indian J Cancer 2009;46:73–4.
  11. Moore MP, Kinne DW. Axillary lympha-denectomy: a diagnostic and therapeutic procedure. Surgoncol 1997;66:2-6.
  12. Carter CL, Allen C, Henson DE. Relation of tumors size,lymph node status and survival in 24,740 breast cancer cases. Cancer 1989;63:181–87.
  13. Newman LA, Kuerer HM. Advances in breast conservation therapy. J ClinOncol 2005;23:1685-97.
  14. Woon YY, Chan MYP. Breast conserva-tion surgery- the surgeon’s factor. Breast 2005;14;131-35.
  15. Alastair M, Thompson. Axillary node clearance for breastcancer. J R CollSurgEdinb1999;44:111–17.
  16. Krag D, Weaver D, Ashikaga T. The sentinel node in breast cancer: A multicenter validation study. New Engl J Med 1998;339:941-46.
  17. Noguchi M, Motomura K, Imoto S. A multicenter validation study of sentinel lymph node biopsy by the JapaneseBreast Cancer Society. Breast Cancer Res Treat 2000;63:31-40.
  18. Veronesi U,Cascinelli N, Greco M. Prognosis of breastcancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 1985;202:702-07.
  19. Noguchi M, Ohta N, Koyasaki N. Reappraisal of internal mammary node metastases as a prognostic factor in patients with breast cancer. Cancer 1991;68:1918-25.
  20. O'Hea BJ, Hill ADK, El-Shirbiny AM. Sentinel lymphnode biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am CollSurg 1998;186:423-27.
  21. Jatoi I. Management of the axilla in primary breast cancer.SurgClin N Am 1999;79:1061-73.
  22. Nixon AJ, Neuberg D, Hayes DF. Relationship of patientage to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J ClinOncol 1994;12:888-94.
  23. Albain KS, Allred DC, Clark GM. Breast cancer outcome andpredictors of outcome: are there age differentials? J Natl Cancer Inst Mongr 1994;16:35-42.
  24. Yiangou C, Shousha S, Sinnett HD. Primary tumour characteristicsand axillary lymph node status in breast cancer. Br J Cancer 1999;80:1974-8.
  25. Chua B, Ung O, Taylor R. Frequency and predictors ofaxillary lymph node metastases in invasive breast cancer. ANZ JSurg 2001;71:723-8.
  26. Olivotto IA, Jackson JS, Mates D. Prediction of axillarylymph node involvement of women with invasive breast carcinoma:a multivariate analysis. Cancer 1998;83:948-55.
  27. Rosen PP, Groshen S, Kinne. Factors influencingprognosis in node-negative breast carcinoma: analysis of 767T1N0M0/T2N0M0 patients with long-term follow-up. J ClinOncol 1993;11: 2090-2100.
  28. Tan LGL, Tan YY, Heng D, Chan MY. Predictors ofaxillary lymph nodemeta-stases in women with early breast cancerin Singapore. Singapore Med J 2005;46(12): 693–97.
  29. Henson DE. Histological grading of breast cancer: Significance of grade on recurrence and mortality. Arch PatholLab Med 1988;112:1091–96.
  30. Hapton DS,Thorogood J, Clayden AD. Histologicalgrading of breast cancer: significance of grade on recurrence andmortality. Eur J SurgOncol 1989;15:25–31.
  31. Hlgreno J, Tal L, Estman G, Nesson L-G. Prediction of axillary lymph node meta-stases in screened breast cancerpopulation. ActaOncol1994;33(6):603–08.
  32. Borg A, Tandon AK, Sigurdsson H. HER-2/neuamplificationpredicts poor survival in node-positive breast cancer. Cancer Res 1990;50:4322-27.
  33. Winstanley J, Cooke T, Murray GD. The long term prognosticsignificance of c-erb-2 in primary breast cancer. Br J Cancer 1991;63:447-50.
  34. Paterson MC, Dietrich KD, Danyluk J. Correlationbetween c-erb-2 amplification and risk of recurrent disease innode-negative breast cancer. Cancer Res 1991;51:566-67.
  35. Clark GM, McGuire WL. Follow-up study of HER-2/neuamplification in primary breast cancer. Cancer Res 1991;51:944-48.
  36. Lauria R, Perrone F, Carlomagno C. The prognostic value oflymphatic and blood vessel invasion in operable breast cancer. Cancer 1995;76:1772-78.

Corresponding Author

Verma Nityanand

Post-graduate trainees, Department of Surgery, Regional Institute of Medical Sciences,

Imphal, Manipur, India

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