Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer.
Abstract
<h4>Introduction</h4>Studies support omission of axillary lymph node dissection (ALND)
for patients with sentinel node-positive disease, with ALND recommended for patients
who present with clinically positive nodes. Here, we evaluate patient and tumor characteristics
and pathologic nodal stage of patients with estrogen receptor-positive (ER +) breast
cancer who undergo ALND to determine if differences exist based on nodal presentation.<h4>Materials
and methods</h4>Retrospective chart review from 2010 to 2019 defined three groups
of patients with ER + breast cancer who underwent ALND for positive nodes: SLN + (positive
node identified at SLN biopsy), cNUS (abnormal preoperative US and biopsy), and cNpalp
(palpable adenopathy). Patients who received neoadjuvant chemotherapy or presented
with axillary recurrence were excluded.<h4>Results</h4>Of 191 patients, 94 were SLN + ,
40 were cNUS, and 57 were cNpalp. Patients with SLN + compared with cNpalp were younger
(56 vs 64 years, p < 0.01), more often pre-menopausal (41% vs 14%, p < 0.01), and
White (65% vs 39%, p = 0.01) with more tumors that were low-grade (36% vs 8%, p < 0.01).
Rates of PR + (p = 0.16), levels of Ki67 expression (p = 0.07) and LVI (p = 0.06)
did not differ significantly among groups. Of patients with SLN + disease, 64% had
pN1 disease compared to 38% of cNUS (p = 0.1) and 40% of cNpalp (p = 0.01). On univariable
analysis, tumor size (p = 0.01) and histology (p = 0.04) were significantly associated
with pN1 disease, with size remaining an independent predictor on multivariable analysis
(p = 0.02).<h4>Conclusion</h4>Historically, higher risk features have been attributed
to patients with clinically positive nodes precluding omission of ALND, but when restricting
evaluation to patients with ER + breast cancer, only tumor size is associated with
higher nodal stage.
Type
Journal articleSubject
Axillary lymph node dissectionBreast cancer
Clinically node-positive
Nodal stage
Palpable adenopathy
Sentinel node biopsy
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https://hdl.handle.net/10161/24788Published Version (Please cite this version)
10.1007/s10549-022-06581-9Publication Info
Ye, Linda; Rünger, Dennis; Angarita, Stephanie A; Hadaya, Joseph; Baker, Jennifer
L; Lee, Minna K; ... DiNome, Maggie L (2022). Higher risk tumor features are not associated with higher nodal stage in patients
with estrogen receptor-positive, node-positive breast cancer. Breast cancer research and treatment. 10.1007/s10549-022-06581-9. Retrieved from https://hdl.handle.net/10161/24788.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Maggie L DiNome
Professor of Surgery
I am a faculty member at Duke in the department of surgery, division of surgical oncology.
I am a surgical breast oncologist whose clinical research interests focus on the de-escalation
of axillary surgery for patients with lymph node positive breast cancer. My translational
research interests focus on epigenetic modifications in breast cancer. I have returned
to Duke (Medical School 1994), having spent the past 20 years in Los Angeles, most
recently at UCLA where I served as Chief of Breast Sur

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