Cancer Res Treat.  2010 Mar;42(1):30-36.

Predictors of Axillary Lymph Node Metastases (ALNM) in a Korean Population with T1-2 Breast Carcinoma: Triple Negative Breast Cancer has a High Incidence of ALNM Irrespective of the Tumor Size

• Lee JH
• Kim SH
• Suh YJ
• Shim BY
• Kim HK

Abstract

PURPOSE
We estimated the likelihood of breast cancer patients having axillary lymph node metastases (ALNM) based on a variety of clinical and pathologic factors. MATERIALS AND METHODS: Three hundred sixty-one breast cancer patients without distant metastases and who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy (MRM) were identified, and we retrospectively reviewed their pathology records and treatment charts. RESULTS: Positive axillary lymph nodes were detected in 104 patients for an overall incidence of 28.8%: 2 patients (5%) with T1a tumor, 5 (9.2%) with T1b tumor, 24 (21.8%) with T1c tumor and 73 (44.2%) with T2 tumor. On the multivariate analysis, an increased tumor size (adjusted OR=11.87, p=0.02), the presence of lymphovascular invasion (adjusted OR=7.41, p<0.01), a triple negative profile (ER/PR-, Her2-) (adjusted OR=2.09, p=0.04) and a palpable mass at the time of diagnosis (adjusted OR=2.31, p=0.03) were all significant independent factors for positive ALNM. CONCLUSION: In our study, the tumor size, the presence of lymphovascular invasion, a triple negative profile and a palpable mass were the independent predictive factors for ALNM. The tumor size was the strongest predictor of ALNM. Thus, the exact estimation of the extent of tumor is necessary for clinicians to optimize the patients' care. Patients with a triple negative profile have a high incidence of ALNM irrespective of the tumor size.

Keyword

Axillary lymph node; Breast neoplasms; Predictor

MeSH Terms

Breast
Breast Neoplasms
Humans
Incidence
Lymph Node Excision
Lymph Nodes
Mastectomy, Modified Radical
Mastectomy, Segmental
Multivariate Analysis
Neoplasm Metastasis
Retrospective Studies

Figure

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  Fig. 1 The frequency of nodal positivity according to the tumor size. Positive axillary lymph nodes were detected in 104 patients for an overall incidence of 28.8%: 2 patients (5%) with T1a; 5 (9.2%) with T1b; 24 (21.8%) with T1c; and 73 (44.2%) with T2. As the tumor size increased, the frequency of positive axillary nodes were also increased (p<0.001).

• 

  Fig. 2 The frequency of the tumor subtypes according to the ER, PR and Her2 statuses. The ER/PR+,Her2- profile was the most common subtype (n=189). Patients with triple negative (ER/PR-,Her2-) profile have a significantly increased probability of ALNM than patients with ER/PR+,Her2- profile (p=0.006).

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