Sentinel Lymph Node Biopsy in Breast Cancer: Predictors of Axillary and Non-Sentinel Lymph Node Involvement

Abstract

Background: Sentinel lymph node biopsy is a standard method for the evaluation of axillary status in patients with T1-2N0M0 breast cancers. Aims: To determine the prognostic significance of primary tumour-related clinico-histopathological factors on axillary and non-sentinel lymph node involvement of patients who underwent sentinel lymph node biopsy. Study design: Retrospective clinical study. Methods: In the present study, 157 sentinel lymph node biopsies were performed in 151 consecutive patients with early stage breast cancer between June 2008 and December 2011. Results: Successful lymphatic mapping was obtained in 157 of 158 procedures (99.4%). The incidence of larger tumour size (2.543±1.21 vs. 1.974±1.04), lymphatic vessel invasion (70.6% vs. 29.4%), blood vessel invasion (84.2% vs. 15.8%), and invasive lobular carcinoma subtype (72.7% vs. 27.3%) were statistically significantly higher in patients with positive SLNs. Logistic stepwise regression analysis disclosed tumour size (odds ratio: 1.51, p=0.0021) and lymphatic vessel invasion (odds ratio: 4.68, p=0.001) as significant primary tumour-related prognostic determinants of SLN metastasis. Conclusion: A close relationship was identified between tumour size and lymphatic vessel invasion of the primary tumour and axillary lymph node involvement. However, the positive predictive value of these two independent variables is low and there is no compelling evidence to recommend their use in routine clinical practice. Turkish Başlık:Meme Kanserinde Bekçi Lenf Nodu Biyopsisi; Aksiller ve Bekçi Dışı Lenf Nodu Tutulumunun Belirleyicileri Anahtar Kelimeler:Meme neoplazmları, lenfatik metastaz, bekçi lenf nodu biyopsisi Arkaplan: Bekçi lenf nodu biopsisi (BLNB), T1-2N0M0 meme kanserli hastalarda aksilla durumunun değerlendirmesi için standart bir yöntemdir. Amaç: BLNB yapılan hastalarda, aksiller ve bekçi dışı lenf nodu tutulumu üzerinde birincil tümör ile ilgili klinik-histopatolojik faktörlerin prognostik önemini belirlemektir. Çalışma Tasarımı: Geriye dönük (retrospektif) klinik çalışma Yöntemler: Bu çalışmada, Haziran 2008 ve Aralık 2011 tarihleri arasında erken evre meme kanseri olan ardışık 151 hastaya 157 BLNB uygulandı. Bulgular: Yüz elli sekiz prosedürün 157'sinde başarılı lenfatik haritalama elde edildi. BLN tutulumu olan hastalarda büyük tümör boyutu (2.543±1.21'e karşı 1.974±1.04), lenf damar invazyonu (LDİ) (%70.6'e karşı %29.4), kan damar invazyonu (KDİ) (%84.2'e karşı %15.8) ve invaziv lobüler karsinom alt tipi (%72.7'e karşı %27.3) istatistiksel olarak anlamlı derecede yüksek bulundu. Lojistik aşamalı regresyon analizinde, birincil tümör ile ilgilibu dört prognostik belirleyicilerden LDİ (Odds Ratio: 4.68, p=0.001) ve tümör boyutu (Odds Ratio: 1.51, p=0.0021) BLN metastazı üzerinde en belirgin etkiye sahipti. Sonuç: Tümör boyutu ve birincil tümörün lenf damar invazyonu ile aksiller lenf nodu tutulumu arasında yakın bir ilişki tespit edilmiştir. Ancak bu iki bağımsız değişkenin pozitif öngörü değeri düşük olup rutin klinik uygulamada kullanımını önermek için hiçbir zorlayıcı kanıt mevcut değildir.

Keywords

• Breast neoplasms, lymphatic metastasis, sentinel lymph node biopsy.

Sentinel Lymph Node Biopsy in Breast Cancer: Predictors of Axillary and Non-Sentinel Lymph Node Involvement

Abstract

References

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