title: Risk of non-sentinel node metastases in patients with symptomatic cancers compared to screen-detected breast cancers.
abstract: BACKGROUND
  Symptomatic breast cancers may be more aggressive as compared to screen-detected breast cancers. This could favor axillary lymph node dissection (ALND) in patients with symptomatic breast cancer and positive sentinel nodes.
  
  
  METHODS
  We identified 955 patients registered in the Danish Breast Cancer Cooperative Group (DBCG) Database in 2008 - 2010 with micrometastases (773) or isolated tumor cells (ITC) (182) in the sentinel node. Patients were cross-checked in the Danish Quality Database of Mammography Screening and 481 patients were identified as screen-detected cancers. The remaining 474 patients were considered as having symptomatic cancers. Multivariate analyses of the risk of non-sentinel node metastases were performed including known risk factors for non-sentinel node metastases as well as method of detection.
  
  
  RESULTS
  18% of the patients had metastases in non-sentinel nodes. This was evenly distributed between patients with symptomatic and screen-detected cancers; 18.5% vs 17.5% (OR 1.07; 95% CI 0.77-1.49; p = 0.69). In patients with micrometastases 21% had non-sentinel node metastases in the group with symptomatic cancers compared to 19% of patients with screen-detected cancers. This difference was not significant (OR 1.16; 95% CI 0.81-1.65, p = 0.43). Neither the multivariate analysis showed an increased risk of non-sentinel node metastases in patients with symptomatic cancers compared to screen-detected cancers (OR 1.12, CI 0.77-1.62, p = 0.55). In patients with ITCs 8% of patients with symptomatic cancers had non-sentinel node metastases compared to 13% of patients with screen-detected cancers. This difference was not significant (OR 0.58; 95% CI 0.22-1.54, p = 0.27). In the multivariate analysis, the risk of non-sentinel node metastases was still not significantly increased in patients with symptomatic cancers compared to screen-detected cancers (OR 0.45; 95% CI 0.16-1.27, p = 0.13).
  
  
  CONCLUSIONS
  We did not find any clinically relevant difference in the risk of non-sentinel node metastases between patients with symptomatic and screen-detected cancers with micrometastases or ITC in the sentinel node.
authors.affiliation: a Department of Breast Surgery , Copenhagen University Hospital , Copenhagen , Denmark .
authors.forename: Tove F
authors.initials: TF
authors.lastname: Tvedskov
authors.affiliation: b Danish Breast Cancer Cooperative Group , Copenhagen University Hospital , Copenhagen , Denmark .
authors.forename: Maj-Britt
authors.initials: MB
authors.lastname: Jensen
authors.affiliation: c Department of Pathology , Herlev Hospital , Copenhagen , Denmark .
authors.forename: Eva
authors.initials: E
authors.lastname: Balslev
authors.affiliation: d Department of Breast Surgery , Ringsted Hospital , Ringsted , Denmark .
authors.forename: Jens P
authors.initials: JP
authors.lastname: Garne
authors.affiliation: e Department of Radiology , Copenhagen University Hospital , Copenhagen , Denmark .
authors.forename: Ilse
authors.initials: I
authors.lastname: Vejborg
authors.affiliation: f Department of Surgery, Breast Surgery Unit , Aarhus University Hospital/Randers Regional Hospital , Aarhus , Denmark , and.
authors.forename: Peer
authors.initials: P
authors.lastname: Christiansen
authors.affiliation: b Danish Breast Cancer Cooperative Group , Copenhagen University Hospital , Copenhagen , Denmark .|g Department of Clinical Oncology , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Ejlertsen
authors.affiliation: a Department of Breast Surgery , Copenhagen University Hospital , Copenhagen , Denmark .
authors.forename: N
authors.initials: N
authors.lastname: Kroman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003718:Denmark; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008327:Mammography; D008875:Middle Aged; D061206:Neoplasm Micrometastasis / Q000473:pathology; D012307:Risk Factors; D000071036:Sentinel Lymph Node / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy