title: Primary tumor characteristics predict sentinel lymph node macrometastasis in breast cancer.
abstract: Selective sentinel lymphadenectomy (SSL) is rapidly becoming the standard of care in the surgical management of patients with early breast cancer. Sentinel lymph node macrometastasis has been well documented in the literature to have a higher risk of nonsentinel node tumor involvement when compared to micrometastasis. The aim of our study was to determine the primary tumor characteristics associated with sentinel node macrometastasis that will allow us to preoperatively determine this subgroup of patients at risk. This study was a retrospective review of 644 patients who underwent successful SSL as part of their surgical treatment of breast cancer at the University of California San Francisco Carol Franc Buck Breast Care Center from November 1997 to August 2003. All patients underwent preoperative lymphoscintigraphy followed by wide excision or mastectomy and sentinel lymphadenectomy with or without axillary lymph node dissection. One hundred twenty-two patients had positive sentinel nodes on histology. Micrometastasis was present in 43 of these patients and macrometastasis in the remaining 79. Statistical analysis showed that a tumor size greater than 15 mm, poor tubule formation by the tumor cells, and lymphovascular invasion were significantly associated with sentinel node macrometastasis. A high mitotic count showed a trend but was not significant in our study. Patients with a tumor size greater than 15 mm, poor tubule formation, and lymphovascular invasion are at risk of having sentinel node macrometastasis. These patients can be identified preoperatively based on imaging and biopsy criteria, allowing the option of selective intraoperative pathologic evaluation of the sentinel node and immediate completion axillary dissection as necessary.
authors.affiliation: Department of Surgery, UCSF Medical Center at Mount Zion, San Francisco, California, USA.
authors.forename: Yah-Yuen
authors.initials: YY
authors.lastname: Tan
authors.forename: Chen-Teng
authors.initials: CT
authors.lastname: Wu
authors.forename: Yang-Guo
authors.initials: YG
authors.lastname: Fan
authors.forename: Shelley
authors.initials: S
authors.lastname: Hwang
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ewing
authors.forename: Karen
authors.initials: K
authors.lastname: Lane
authors.forename: Laura
authors.initials: L
authors.lastname: Esserman
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Patrick
authors.initials: P
authors.lastname: Treseler
authors.forename: Eugene
authors.initials: E
authors.lastname: Morita
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis