A predictive factor for axillary lymph node metastasis in invasive ductal breast cancer: the value of tumor and breast volume ratio

Mehmet Kubat; Soykan Dinç

doi:10.18203/2349-2902.isj20185464

Authors

Mehmet Kubat Department of General Surgery, Alanya Education and Research Hospital, Antalya, Turkey
Soykan Dinç Department of General Surgery, Bozok University Faculty of Medicine, Yozgat, Turkey

DOI:

https://doi.org/10.18203/2349-2902.isj20185464

Keywords:

Axilla, Breast cancer, Lymphatic metastasis, Organ volume, Tumor volume

Abstract

Background: The objective of this study was to witness the effect of tumor volume/breast volume ratio on the presence of axillary lymph node metastasis and to examine the strategy in surgical treatment approach for patients.

Methods: This study was carried out prospectively by examining the patients undergoing modified radical mastectomy surgery due to breast cancer (n=99). Breast volumes were measured through liquid overflow method in graduated bowl tumor volume was measured according to ellipsoid volume formula with diameters determined by pathological specimen, ultrasonography or MRI.

Results: Axillary lymph node metastasis (ALNM) was positive in 64.6% of them (n=64). Average breast volume was found to be 693.89cm³ in the measurement of mastectomy materials. Average tumor volume was found to be 9.58cm³. In line with these results, average tumor volume/breast volume (vTm/vMm) ratio was: 0.0176. Author found axillary lymph node metastasis possibility significantly higher in patients with vTm/vMm ratio>0.016 (Odds ratio 9.437, p-value 0.007).

Conclusions: The presence of ALNM is the most important factor in indicating the prognosis of patients with invasive breast cancer and planning the treatment. Thus, knowing whether there exists an ALNM or not during preoperative period draws the attention of both the doctors performing treatment and patients. In this study efficiencies of largest tumor diameter, tumor volume and tumor volume (vTm)/Breast volume (vMm) ratio in indicating ALNM presence in cases with T2 invasive ductal breast cancer were evaluated. It was found that vTm/vMm ratio was a recent and effective prognostic criterion in determining ALNM.

Metrics

Metrics Loading ...

References

Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol. 2005;16(3):481-8.

Sakorafas GH. Breast cancer surgery-historical evolution, current status and future perspectives. Acta Oncol. 2001;40(1):5-18.

Recht A, Houlihan MJ. Axillary lymph nodes and breast cancer. A review. Cancer. 1995;76:1491-512.

Barth RJ, Danforth DN, Venzon DJ, Straus KL, d'Angelo T, Merino MJ, et al. Level of axillary involvement by lymph node metastases from breast cancer is not an independent predictor of survival. Arch Surg. 1991;126(5):574-7.

Sener SF, Lee L. Staging of breast cancer. In: Singletory SE, Robb GL, eds. Advanced Therapy of Breast Disease; 2000:113-9.

Singletary SE, Connolly JL. Breast cancer staging: working with the sixth edition of the AJCC cancer staging manual. CA: Cancer J Clin. 2006;56:37-47.

Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer Basic Clin Res. 2011:5-43.

Wapnir IL, Wartenberg DE, Greco RS. Three-dimensional staging of breast cancer. Breast Cancer Res Treatment. 1996;41(1):15-9.

Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63(1):181-7.

Clamp A, Danson S, Clemons M. Hormonal and genetic risk factors for breast cancer. Surg. 2003;1(1):23-31.

Tavassoli FA, Schnitt SJ. Pathology of the breast. In: Stamford, eds. CT: Appleton & Lange; 1999.

Memorial Sloan-Kettering Cancer Center. Breast Cancer Nomogram: Sentinel Lymph Node Metastasis, 2014. Available at: http://nomograms.mskcc.org/breast/BreastSLNodeMetastasisPage.aspx. Accessed 5 November 2013.

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8(10):881-8.

Carmichael AR, Aparanji K, Nightingale P, Boparai R, Stonelake PS. A clinicopathological scoring system to select breast cancer patients for sentinel node biopsy. (EJSO). 2006;32(10):1170-4.

Barranger E, Coutant C, Flahault A, Delpech Y, Darai E, Uzan S. An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treatment. 2005;91(2):113-9.

Martić K, Vlajčić Z, Rudman F, Lambaša S, Tomasović-Lončarić Č, Stanec Z. Tumor and breast volume ratio as a predictive factor for axillary lymph node metastases in T1c ductal invasive breast cancer: prospective observational clinico-pathological study. Japan J Clin Oncol. 2011;41(12):1322-6.

Fein DA, Fowble BL, Hanlon AL, Hooks MA, Hoffman JP, Sigurdson ER, et al. Identification of women with T1‐T2 breast cancer at low risk of positive axillary nodes. J Surg Oncol. 1997;65(1):34-9.

Chao C, Edwards MJ, Abell T, Wong SL, Simpson D, McMasters KM. Palpable breast carcinomas: a hypothesis for clinically relevant lymphatic drainage in sentinel lymph node biopsy. Breast J. 2003;9(1):26-32.

Cunningham JE, Jurj AL, Oman L, Stonerock AE, Nitcheva DK, Cupples TE. Is risk of axillary lymph node metastasis associated with proximity of breast cancer to the skin?. Breast Cancer Res Treatment. 2006;100(3):319-28.

Ansari B, Morton MJ, Adamczyk DL, Jones KN, Brodt JK, Degnim AC, et al. Distance of breast cancer from the skin and nipple impacts axillary nodal metastases. Ann Surg Oncol. 2011;18(11):3174-80.

Torstenson T, Shah-Khan MG, Hoskin TL, Morton MJ, Adamczyk DL, Jones KN, et al. Novel factors to improve prediction of nodal positivity in patients with clinical T1/T2 breast cancers. Ann Surg Oncol. 2013;20(10):3286-93.