title: Prognostic role of micrometastases in sentinel lymph node in patients with invasive breast cancer.
abstract: OBJECTIVE
  Axillary lymph node status at the time of diagnosis remains one of the most important prognostic factors in women with breast cancer. Sentinel lymph node biopsy (SLNB) proved to be a reliable method for the evaluation of axillary nodal status in early-stage invasive breast cancer. The prognostic value and potential therapeutic consequences of SLN micrometastases remains a matter of great debate.
  
  
  METHODS
  From January 1998 to March 2011, 1,976 consecutive patients with non-metastatic invasive breast cancer underwent surgical treatment; 1,080 of them (54.6%) underwent SLNB. We collected data regarding demography, preoperative lymphoscintigraphy, type of surgery, histopathologic and immunohistochemical features and adjuvant treatment.
  
  
  RESULTS
  A mean number of 2.1 ± 1.4 (range 1-13) SLN per patient were collected, a total of 2,294 nodes. SLNs were macrometastatic in 16.7% of patients and micrometastatic in 3.3%. Among the patients with positive SLN 93.6% underwent complete ALND. The overall survival (OS) and disease-free survival (DFS) of 72 patients with micrometastases in SLN at 60 months was 100%, similar to patients with negative SLN (98.7%), quite different from the DFS of N1-N3 patients (85.8%). Statistically significant differences in OS and DFS were observed between patients with N1mi and the group with N1-N3 sentinel node (p < 0.001 and p = 0.04) and also between patients with negative SLN and those with macrometastatic SLN (p < 0.001 for both).
  
  
  CONCLUSIONS
  SLN micrometastases could represents an epiphenomenon of peritumoral lymphovascular invasion which impacts independently on the survival of patients with invasive breast cancer.
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy; Senology Research Center, University of Insubria, Varese, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovera
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy; Senology Research Center, University of Insubria, Varese, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fachinetti
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy; Senology Research Center, University of Insubria, Varese, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Chiappa
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy; Senology Research Center, University of Insubria, Varese, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lavazza
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy; Senology Research Center, University of Insubria, Varese, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Arlant
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy; Senology Research Center, University of Insubria, Varese, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Marelli
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.affiliation: Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy
keywords: Axillary dissection; Breast cancer; Micrometastases; Sentinel lymph node biopsy; prognostic factors