Predicting the status of the nonsentinel axillary nodes

A multicenter study

Sandra L. Wong, Michael J. Edwards, Celia Chao, Todd M. Tuttle, R. Dirk Noyes, Claudine Woo, Patricia B. Cerrito, Kelly M. McMasters

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Background: Sentinel lymph node (SLN) biopsy is a minimally invasive procedure that provides accurate nodal staging information. The need for completion axillary dissection after finding a positive SLN for breast cancer has been questioned. Hypothesis: The presence of nonsentinel node (NSN) metastases in the axillary dissection specimen correlates with tumor size, the number of SLNs removed, and the number of positive SLNs. Design: Prospective, multi-institutional study. Participants and Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a nationwide study involving 148 surgeons. All patients underwent SLN biopsy, followed by level I/II axillary dissection. All SLNs were evaluated histologically at a minimum of 2-mm intervals. Immunohistochemical analysis using antibodies for cytokeratin was performed at the discretion of each participating institution. All NSNs were evaluated by routine histologic examination. Results: An SLN was identified in 1268 (90%) of 1415 patients. Increasing tumor size was significantly correlated with increasing likelihood of positive NSNs: T1a, 14%; T1b, 22%; T1c, 30%; T2, 45%; and T3, 57% (P=.002, X2 test): The presence of positive NSNs was not significantly associated with the number of SLNs removed. Patients with more than 1 positive SLN were more likely to have positive NSNs than those with only 1 positive SLN (50% vs 32%; P < .001, X2 test). Increasing tumor size and the presence of multiple positive SLNs were also associated with the presence 4 or more positive axillary nodes. Multivariate analysis confirmed that tumor size and the number of positive SLNs were independent factors predicting the presence of positive NSNs. Conclusions: The likelihood of positive NSNs correlates with increasing tumor size and the presence of multiple positive SLNs. However, even patients with small primary tumors have a substantial risk of residual axillary nodal disease after SLN biopsy. These data will be helpful in counseling patients regarding the need for completion axillary dissection after a positive SLN is identified.

Original languageEnglish (US)
Pages (from-to)563-568
Number of pages6
JournalArchives of Surgery
Volume136
Issue number5
StatePublished - 2001
Externally publishedYes

Fingerprint

Multicenter Studies
Sentinel Lymph Node Biopsy
Dissection
Neoplasms
Breast Neoplasms
Keratins
Sentinel Lymph Node
Counseling
Multivariate Analysis
Neoplasm Metastasis
Antibodies

ASJC Scopus subject areas

  • Surgery

Cite this

Wong, S. L., Edwards, M. J., Chao, C., Tuttle, T. M., Noyes, R. D., Woo, C., ... McMasters, K. M. (2001). Predicting the status of the nonsentinel axillary nodes: A multicenter study. Archives of Surgery, 136(5), 563-568.

Predicting the status of the nonsentinel axillary nodes : A multicenter study. / Wong, Sandra L.; Edwards, Michael J.; Chao, Celia; Tuttle, Todd M.; Noyes, R. Dirk; Woo, Claudine; Cerrito, Patricia B.; McMasters, Kelly M.

In: Archives of Surgery, Vol. 136, No. 5, 2001, p. 563-568.

Research output: Contribution to journalArticle

Wong, SL, Edwards, MJ, Chao, C, Tuttle, TM, Noyes, RD, Woo, C, Cerrito, PB & McMasters, KM 2001, 'Predicting the status of the nonsentinel axillary nodes: A multicenter study', Archives of Surgery, vol. 136, no. 5, pp. 563-568.
Wong SL, Edwards MJ, Chao C, Tuttle TM, Noyes RD, Woo C et al. Predicting the status of the nonsentinel axillary nodes: A multicenter study. Archives of Surgery. 2001;136(5):563-568.
Wong, Sandra L. ; Edwards, Michael J. ; Chao, Celia ; Tuttle, Todd M. ; Noyes, R. Dirk ; Woo, Claudine ; Cerrito, Patricia B. ; McMasters, Kelly M. / Predicting the status of the nonsentinel axillary nodes : A multicenter study. In: Archives of Surgery. 2001 ; Vol. 136, No. 5. pp. 563-568.
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abstract = "Background: Sentinel lymph node (SLN) biopsy is a minimally invasive procedure that provides accurate nodal staging information. The need for completion axillary dissection after finding a positive SLN for breast cancer has been questioned. Hypothesis: The presence of nonsentinel node (NSN) metastases in the axillary dissection specimen correlates with tumor size, the number of SLNs removed, and the number of positive SLNs. Design: Prospective, multi-institutional study. Participants and Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a nationwide study involving 148 surgeons. All patients underwent SLN biopsy, followed by level I/II axillary dissection. All SLNs were evaluated histologically at a minimum of 2-mm intervals. Immunohistochemical analysis using antibodies for cytokeratin was performed at the discretion of each participating institution. All NSNs were evaluated by routine histologic examination. Results: An SLN was identified in 1268 (90{\%}) of 1415 patients. Increasing tumor size was significantly correlated with increasing likelihood of positive NSNs: T1a, 14{\%}; T1b, 22{\%}; T1c, 30{\%}; T2, 45{\%}; and T3, 57{\%} (P=.002, X2 test): The presence of positive NSNs was not significantly associated with the number of SLNs removed. Patients with more than 1 positive SLN were more likely to have positive NSNs than those with only 1 positive SLN (50{\%} vs 32{\%}; P < .001, X2 test). Increasing tumor size and the presence of multiple positive SLNs were also associated with the presence 4 or more positive axillary nodes. Multivariate analysis confirmed that tumor size and the number of positive SLNs were independent factors predicting the presence of positive NSNs. Conclusions: The likelihood of positive NSNs correlates with increasing tumor size and the presence of multiple positive SLNs. However, even patients with small primary tumors have a substantial risk of residual axillary nodal disease after SLN biopsy. These data will be helpful in counseling patients regarding the need for completion axillary dissection after a positive SLN is identified.",
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T2 - A multicenter study

AU - Wong, Sandra L.

AU - Edwards, Michael J.

AU - Chao, Celia

AU - Tuttle, Todd M.

AU - Noyes, R. Dirk

AU - Woo, Claudine

AU - Cerrito, Patricia B.

AU - McMasters, Kelly M.

PY - 2001

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N2 - Background: Sentinel lymph node (SLN) biopsy is a minimally invasive procedure that provides accurate nodal staging information. The need for completion axillary dissection after finding a positive SLN for breast cancer has been questioned. Hypothesis: The presence of nonsentinel node (NSN) metastases in the axillary dissection specimen correlates with tumor size, the number of SLNs removed, and the number of positive SLNs. Design: Prospective, multi-institutional study. Participants and Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a nationwide study involving 148 surgeons. All patients underwent SLN biopsy, followed by level I/II axillary dissection. All SLNs were evaluated histologically at a minimum of 2-mm intervals. Immunohistochemical analysis using antibodies for cytokeratin was performed at the discretion of each participating institution. All NSNs were evaluated by routine histologic examination. Results: An SLN was identified in 1268 (90%) of 1415 patients. Increasing tumor size was significantly correlated with increasing likelihood of positive NSNs: T1a, 14%; T1b, 22%; T1c, 30%; T2, 45%; and T3, 57% (P=.002, X2 test): The presence of positive NSNs was not significantly associated with the number of SLNs removed. Patients with more than 1 positive SLN were more likely to have positive NSNs than those with only 1 positive SLN (50% vs 32%; P < .001, X2 test). Increasing tumor size and the presence of multiple positive SLNs were also associated with the presence 4 or more positive axillary nodes. Multivariate analysis confirmed that tumor size and the number of positive SLNs were independent factors predicting the presence of positive NSNs. Conclusions: The likelihood of positive NSNs correlates with increasing tumor size and the presence of multiple positive SLNs. However, even patients with small primary tumors have a substantial risk of residual axillary nodal disease after SLN biopsy. These data will be helpful in counseling patients regarding the need for completion axillary dissection after a positive SLN is identified.

AB - Background: Sentinel lymph node (SLN) biopsy is a minimally invasive procedure that provides accurate nodal staging information. The need for completion axillary dissection after finding a positive SLN for breast cancer has been questioned. Hypothesis: The presence of nonsentinel node (NSN) metastases in the axillary dissection specimen correlates with tumor size, the number of SLNs removed, and the number of positive SLNs. Design: Prospective, multi-institutional study. Participants and Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a nationwide study involving 148 surgeons. All patients underwent SLN biopsy, followed by level I/II axillary dissection. All SLNs were evaluated histologically at a minimum of 2-mm intervals. Immunohistochemical analysis using antibodies for cytokeratin was performed at the discretion of each participating institution. All NSNs were evaluated by routine histologic examination. Results: An SLN was identified in 1268 (90%) of 1415 patients. Increasing tumor size was significantly correlated with increasing likelihood of positive NSNs: T1a, 14%; T1b, 22%; T1c, 30%; T2, 45%; and T3, 57% (P=.002, X2 test): The presence of positive NSNs was not significantly associated with the number of SLNs removed. Patients with more than 1 positive SLN were more likely to have positive NSNs than those with only 1 positive SLN (50% vs 32%; P < .001, X2 test). Increasing tumor size and the presence of multiple positive SLNs were also associated with the presence 4 or more positive axillary nodes. Multivariate analysis confirmed that tumor size and the number of positive SLNs were independent factors predicting the presence of positive NSNs. Conclusions: The likelihood of positive NSNs correlates with increasing tumor size and the presence of multiple positive SLNs. However, even patients with small primary tumors have a substantial risk of residual axillary nodal disease after SLN biopsy. These data will be helpful in counseling patients regarding the need for completion axillary dissection after a positive SLN is identified.

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