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Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery.

Publication ,  Journal Article
Angarita, S; Ye, L; Rünger, D; Hadaya, J; Baker, JL; Dawson, N; Thompson, CK; Lee, MK; Attai, DJ; DiNome, ML
Published in: Ann Surg Oncol
May 2021

BACKGROUND: Omission of axillary lymph node dissection (ALND) is accepted for patients with one or two positive sentinel nodes, and studies are focusing on clinically node-positive patients who have been downstaged with neoadjuvant chemotherapy (NAC). Evidence is lacking for patients with positive nodes who undergo surgery upfront. These patients are assumed to have a higher burden of nodal disease such that ALND remains the standard of care. METHODS: Patients who underwent ALND for breast cancer between 2010 and 2019 at the authors' institution were retrospectively identified. Those with clinical N1 disease were included in the study. Patients who received NAC and those who had surgery for sentinel node positive disease or axillary recurrence were excluded. Clinical and pathologic factors associated with nodal stage were evaluated. RESULTS: Of 111 patients who met the inclusion criteria, 61.3% had a palpable node on exam, and 41.4% ultimately had pN1 disease. Most of the tumors were estrogen receptor (ER)-positive (91.5%), and 21.7% of the tumors were invasive lobular cancers. Lobular histology, tumor size, and metastasis size were associated with higher nodal stage. In the multivariable analysis, the patients with nodal metastasis larger than 10 mm had significantly lower odds of having pN1 disease (odds ratio 0.12; 95% confidence interval 0.02-0.69; p = 0.02). In a subset analysis of patients with palpable nodes, tumor size and histology remained significantly associated with nodal stage. CONCLUSION: More than 40% of breast cancer patients with clinically positive nodes had minimal nodal disease (pN1) at surgery. Additionally, palpable nodes on exam did not predict higher nodal stage. A subset of patients with clinically positive nodes may be identified who can potentially be spared the morbidity of ALND.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

May 2021

Volume

28

Issue

5

Start / End Page

2609 / 2618

Location

United States

Related Subject Headings

  • Sentinel Lymph Node Biopsy
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Lymph Nodes
  • Lymph Node Excision
  • Humans
  • Breast Neoplasms
  • Axilla
  • 3211 Oncology and carcinogenesis
 

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Angarita, S., Ye, L., Rünger, D., Hadaya, J., Baker, J. L., Dawson, N., … DiNome, M. L. (2021). Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery. Ann Surg Oncol, 28(5), 2609–2618. https://doi.org/10.1245/s10434-020-09228-5
Angarita, Stephanie, Linda Ye, Dennis Rünger, Joseph Hadaya, Jennifer L. Baker, Nicole Dawson, Carlie K. Thompson, Minna K. Lee, Deanna J. Attai, and Maggie L. DiNome. “Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery.Ann Surg Oncol 28, no. 5 (May 2021): 2609–18. https://doi.org/10.1245/s10434-020-09228-5.
Angarita S, Ye L, Rünger D, Hadaya J, Baker JL, Dawson N, et al. Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery. Ann Surg Oncol. 2021 May;28(5):2609–18.
Angarita, Stephanie, et al. “Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery.Ann Surg Oncol, vol. 28, no. 5, May 2021, pp. 2609–18. Pubmed, doi:10.1245/s10434-020-09228-5.
Angarita S, Ye L, Rünger D, Hadaya J, Baker JL, Dawson N, Thompson CK, Lee MK, Attai DJ, DiNome ML. Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery. Ann Surg Oncol. 2021 May;28(5):2609–2618.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

May 2021

Volume

28

Issue

5

Start / End Page

2609 / 2618

Location

United States

Related Subject Headings

  • Sentinel Lymph Node Biopsy
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Lymph Nodes
  • Lymph Node Excision
  • Humans
  • Breast Neoplasms
  • Axilla
  • 3211 Oncology and carcinogenesis