title: Breast cancer patients with pN0(i+) and pN1(mi) sentinel nodes have high rate of nonsentinel node metastases.
abstract: BACKGROUND
  The recent American Joint Committee on Cancer revision of the staging system for breast cancer classifies sentinel node metastases < 0.2 mm (pN0[i+]) as node negative and those > 0.2 mm but < 2 mm are designated pN1(mi). We examined the association between size of sentinel node metastases and rate of nonsentinel node metastases, specifically in the subgroup of patients with micrometastases.
  
  
  METHODS
  We examined the nonsentinel nodes of 124 patients with positive sentinel nodes and correlated the likelihood of nonsentinel node involvement with the size of the metastasis in the sentinel node and primary tumor characteristics.
  
  
  RESULTS
  Nonsentinel node metastases were found in 19% (6 of 31) of patients with sentinel node metastases <or= 0.2 mm, 20% (6 of 30) of patients with metastases 0.2 mm to 2 mm, and 46% (29 of 63) of patients with metastases > 2 mm. Multivariate analysis found that involvement of the majority of sentinel nodes (p = 0.01) and sentinel metastases > 2 mm (p = 0.001) were significantly related to presence of metastases in nonsentinel nodes. Age, tumor size, pathology, multifocality, satellites, and lymphovascular invasion were not significantly related to nonsentinel node metastases in multivariate analysis.
  
  
  CONCLUSIONS
  These findings indicate that frequency of nonsentinel node metastases with sentinel node metastases <or= 0.2 mm is comparable to the frequency when sentinel metastases are > 0.2 to 2 mm. Omitting complete axillary dissection in pN1(mi) and pN0(i+) patients may leave residual disease in up to 20% of these patients.
authors.affiliation: Department of Surgery, St Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Tehillah S
authors.initials: TS
authors.lastname: Menes
authors.forename: Paul Ian
authors.initials: PI
authors.lastname: Tartter
authors.forename: Howard
authors.initials: H
authors.lastname: Mizrachi
authors.forename: Jonnel
authors.initials: J
authors.lastname: Constantino
authors.forename: Alison
authors.initials: A
authors.lastname: Estabrook
authors.forename: Sharon Rosenbaum
authors.initials: SR
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary*; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid