Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer.

dc.contributor.author

Ye, Linda

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Rünger, Dennis

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Angarita, Stephanie A

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Hadaya, Joseph

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Baker, Jennifer L

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Lee, Minna K

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Thompson, Carlie K

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Attai, Deanna J

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DiNome, Maggie L

dc.date.accessioned

2022-04-10T22:11:22Z

dc.date.available

2022-04-10T22:11:22Z

dc.date.issued

2022-04-07

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2022-04-10T22:11:21Z

dc.description.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.
dc.identifier

10.1007/s10549-022-06581-9

dc.identifier.issn

0167-6806

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1573-7217

dc.identifier.uri

https://hdl.handle.net/10161/24788

dc.language

eng

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Springer Science and Business Media LLC

dc.relation.ispartof

Breast cancer research and treatment

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10.1007/s10549-022-06581-9

dc.subject

Axillary lymph node dissection

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Breast cancer

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Clinically node-positive

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Nodal stage

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Palpable adenopathy

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Sentinel node biopsy

dc.title

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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Journal article

duke.contributor.orcid

DiNome, Maggie L|0000-0002-1926-292X

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Duke

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School of Medicine

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Clinical Science Departments

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Institutes and Centers

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Surgery

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Duke Cancer Institute

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Surgical Oncology

pubs.publication-status

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