title: Localization of metastasis within the sentinel lymph node biopsies: a predictor of additional axillary spread of breast cancer?
abstract: OBJECTIVE
  To explore the relationship between morphological characteristics and histologic localization of metastasis within sentinel lymph nodes (SLN) and axillary spread in women with breast cancer.
  
  
  METHODS
  We selected 119 patients with positive SLN submitted to complete axillary lymph node dissection from July 2002 to March 2007. We retrieved the age of patients and the primary tumor size. In the primary tumor, we evaluated histologic and nuclear grade, and peritumoral vascular invasion (PVI). In SLNs we evaluated the size of metastasis, their localization in the lymph node, number of foci, number of involved lymph nodes, and extranodal extension.
  
  
  RESULTS
  Fifty-one (42.8%) patients had confirmed additional metastasis in non-sentinel lymph nodes (NLSN). High histologic grade, PVI, intraparenchymatous metastasis, extranodal neoplastic extension and size of metastasis were associated with positive NLSN. SLN metastasis affecting the capsule were associated to low risk incidence of additional metastasis. After multivariate analysis, PVI and metastasis size in the SLN remained as the most important risk factors for additional metastasis.
  
  
  CONCLUSIONS
  The risk of additional involvement of NSLN is higher in patients with PVI and it increases progressively according the histologic localization in the lymph node, from capsule, where the afferent lymphatic channel arrives, to the opposite side of capsule promoting the extranodal extension. Size of metastasis greater than 6.0 mm presents higher risk of additional lymph node metastasis.
authors.forename: César Augusto
authors.initials: CA
authors.lastname: Alvarenga
authors.forename: César Cabello
authors.initials: CC
authors.lastname: dos Santos
authors.forename: Marcelo
authors.initials: M
authors.lastname: Alvarenga
authors.forename: Paula Itagyba
authors.initials: PI
authors.lastname: Paravidino
authors.forename: Sirlei Siani
authors.initials: SS
authors.lastname: Morais
authors.forename: Henrique Benedito
authors.initials: HB
authors.lastname: Brenelli
authors.forename: Filomena Marino
authors.initials: FM
authors.lastname: de Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy