DOI: http://dx.doi.org/10.18203/2349-2902.isj20191512

The predictors and the prognostic significance of axillary lymph nodes involvement in breast cancer

Amine Mohammed Bakkour, Mohammed Hillu Surriah, Amir Naif Kadum Al-Imari, Riad Rahman Jallod Al-Asadi

Abstract


Background: Breast cancer is the most common cancer among women worldwide. The presence of axillary lymph node metastases in breast cancer is an important factor in assessing prognosis and determines management after surgery. The study aimed at identification of the factors that predict axillary lymph node involvement in CA breast. Addressing the prognostic effect of axillary lymph node involvement in turn of predicting the recurrence of CA breast.

Methods: This is a prospective review of one hundred cases of Ca breast who have underwent modified radical mastectomy and axillary clearance at Al-Karama Teaching Hospital during the period from January 2014 to December 2018.

Results: Positive axillary involvement was found in (74/100, 74%). The highest occurrence of positive axilla was found in (less than 30 and 30-39 years) age groups (27/74, 36%) with the outer quadrants (upper and lower) constituting the majority (50/74, 68%). Positive axillary involvement was mostly notified in tumor grade T4 (39/74, 53%) and in poorly differentiated lesions (47/74, 64%). The highest recurrence rate was found in patients with positive axillary metastases (12/74, 16%), nodal involvement of ten or more nodes (9/41, 22%), nodes with extracapsular extension (10/51, 20%) and in patients who have not taken and/or completed their chemo-radiation sessions (9/11, 82%).

Conclusions: Positive axillary lymph node involvement was seen mostly in: young age patients, outer quadrant lesions, tumors with skin involvement, and poorly differentiated lesions.


Keywords


Axillary lymph nodes, Breast cancer, Prognosis

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References


Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre MF, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505-27.

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. The Lancet Oncol. 2007;8(10):881-8.

Sainsbury J. Bailey and Love's short practice of surgery: Oxford University Press, USA; 2004.

Billiar T, Andersen D, Hunter J, Brunicardi F, Dunn D, Pollock RE. Schwartz's principles of surgery: McGraw-Hill Professional; 2004.

Lyman GH, Giuliano AE, Somerfield MR, Benson III AB, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703-20.

Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, et al. Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol. 2002;20(17):3628-36.

Zurrida S, Bassi F, Arnone P, Martella S, Del Castillo A, Ribeiro Martini R, et al. The changing face of mastectomy (from mutilation to aid to breast reconstruction). Int J Surg Oncol. 2011;2011:980158.

Zimmerman K, Montague E, Fletcher G. Frequency, anatomical distribution and management of local recurrences after definitive therapy for breast cancer. Cancer. 1966;19(1):67-74.

Group EBCTC. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. The Lancet. 2005;366(9503):2087-106.

Langstein HN, Cheng M-H, Singletary SE, Robb GL, Hoy E, Smith TL, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance. Plastic Reconst Surg. 2003;111(2):712-22.

Scott S, Morrow M. Breast cancer: Making the diagnosis. Surgical Clin N Am. 1999;79(5):991-1005.

Fisher B, Wolmark N. Limited surgical management for primary breast cancer: a commentary on the NSABP reports. World J Surg. 1985;9(5):682-91.

Patey D, Dyson W. The prognosis of carcinoma of the breast in relation to the type of operation performed. British J Cancer. 1948;2(1):7.

Tan L, Tan Y, Heng D, Chan M. Predictors of axillary lymph node metastases in women with early breast cancer in Singapore. Singapore Med J. 2005;46(12):693.

Cutuli B, Velten M, Martin C. Assessment of axillary lymph node involvement in small breast cancer: analysis of 893 cases. Clin Breast Cancer. 2001;2(1):59-65.

Contesso G, Rouesse J, Genin J. Local and regional lymph node invasion in breast cancer. Bulletin du Cancer. 1975;62(4):359-72.

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 Surgical Oncol. 1997;65(1):34-9.

Yiangou C, Shousha S, Sinnett H. Primary tumour characteristics and axillary lymph node status in breast cancer. Br J Cancer. 1999;80(12):1974.

Chua B, Ung O, Taylor R, Boyages J. Frequency and predictors of axillary lymph node metastases in invasive breast cancer. ANZ J Surg. 2001;71(12):723-8.

Barth A, Craig PH, Silverstein MJ. Predictors of axillary lymph node metastases in patients with T1 breast carcinoma. Cancer: Interdisciplinary Int J the Am Cancer Society. 1997;79(10):1918-22.

Adami H, Graffman S, Johansson H, Rimsten Å. Survival and recurrences five years after selective treatment for breast carcinoma. British J Cancer. 1978;38(5):624.

Arriagada R, Le M, Contesso G, Guinebretiere J, Rochard F, Spielmann M. Predictive factors for local recurrence in 2006 patients with surgically resected small breast cancer. Ann Oncol. 2002;13(9):1404-13.

Arvold ND, Taghian AG, Niemierko A, Raad RFA, Sreedhara M, Nguyen PL, et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 2011;29(29):3885.

Arriagada R, Lê MG. Adjuvant radiotherapy in breast cancer: The treatment of lymph node areas. Acta Oncologica. 2000;39(3):295-305.

Vinh-Hung V, Cserni G, Burzykowski T, Van de Steene J, Voordeckers M, Storme G. Effect of the number of uninvolved nodes on survival in early breast cancer. Oncol Reports. 2003;10(2):363-8.

Ilknur GB, Hilmi A, Tülay C, Oguz Ç, Selma S, Serdar S, et al. The importance of extracapsular extension of axillary lymph node metastases in breast cancer. Tumori J. 2004;90(1):107-11.

Coles CE, Griffin CL, Kirby AM, Titley J, Agrawal RK, Alhasso A, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. The Lancet. 2017;390(10099):1048-60.