title: Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients With Clinically Node-Negative Ipsilateral Multiple Breast Cancer Treated With Total Mastectomy.
abstract: BACKGROUND
  Recent clinical trials have shown that axillary lymph node dissection can be omitted even with positive sentinel nodes (SN) unless the patient undergoes total mastectomy without irradiation. The aim of our study was to identify predictive factors for non-SN metastasis among patients with solitary or multiple breast cancer treated with total mastectomy.
  
  
  METHODS
  Clinically node-negative breast cancer patients with pathologically node-positive disease treated with total mastectomy and axillary dissection after SN biopsy were retrospectively analyzed. Significant pathologic predictive factors for positive non-SN metastasis were also examined.
  
  
  RESULTS
  There were 47 multiple and 143 solitary breast cancer patients. Pathologic diagnosis demonstrated that smaller invasion size but larger tumor size, including adjacent noninvasive cancer, was observed in multiple breast cancer. The number of involved SNs and the rate of non-SN metastasis were similar between the multiple and solitary groups. Regarding predictive factors for non-SN metastasis, lymphatic invasion and SN macrometastasis were significant factors in the solitary group, and pathologic invasion size > 2 cm was the only significant factor in the multiple group.
  
  
  CONCLUSIONS
  Larger pathologic invasion size was important for predicting non-SN metastasis in multiple breast cancer.
authors.affiliation: Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan. Electronic address: soasaga@ncc.go.jp.
authors.forename: Sota
authors.initials: S
authors.lastname: Asaga
authors.affiliation: Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kinoshita
authors.affiliation: Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hojo
authors.affiliation: Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Jimbo
authors.affiliation: Department of Pathology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D015409:Mastectomy, Radical / Q000706:statistics & numerical data; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D047368:Tumor Burden
keywords: Multiple breast cancer; Non–sentinel node metastasis; Predictive factor; Sentinel node metastasis; Total mastectomy