Localization of metastasis within the sentinel lymph node biopsies: a predictor of additional axillary spread of breast cancer?

• Published in: Revista Brasileira de ginecologia e obstetrícia Vol. 35; no. 11; pp. 483 - 499
• Main Authors: Alvarenga, César Augusto, dos Santos, César Cabello, Alvarenga, Marcelo, Paravidino, Paula Itagyba, Morais, Sirlei Siani, Brenelli, Henrique Benedito, de Carvalho, Filomena Marino
• Format: Journal Article
• Language: English
• Published: Brazil Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 01-11-2013
• Subjects: Adult; Aged; Aged, 80 and over; Axilla; Breast neoplasms; Breast Neoplasms - pathology; Female; Humans; Lymph nodes; Middle Aged; Neoplasm Metastasis; OBSTETRICS & GYNECOLOGY; Predictive Value of Tests; Retrospective Studies; Sentinel Lymph Node Biopsy; Metástase neoplásica; Linfonodos; Sentinel lymph node biopsy; Neoplasias da mama; Breast neoplasms; Biopsia de linfonodo sentinela; Neoplasm metastasis; Lymph nodes
• ISSN: 0100-7203; 1806-9339; 1806-9339
• DOI: 10.1590/S0100-72032013001100002

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.
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.
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.
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.