Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer.
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2022-04-07
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Abstract
Introduction
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.Materials and methods
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.Results
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).Conclusion
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
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Ye, Linda, Dennis Rünger, Stephanie A Angarita, Joseph Hadaya, Jennifer L Baker, Minna K Lee, Carlie K Thompson, Deanna J Attai, et al. (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.
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Maggie L DiNome
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 Surgery and Director of Breast Health for the UCLA Health System. I am honored to have joined the Duke faculty and am eager to grow the program in Wake County as the medical director of breast cancer services.
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