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Annals of Surgical Oncology 8:145-149 (2001)
© 2001 Society of Surgical Oncology

ORIGINAL ARTICLES

Lymphovascular Invasion Enhances the Prediction of Non-Sentinel Node Metastases in Breast Cancer Patients With Positive Sentinel Nodes

Martin R. Weiser, MD, Leslie L. Montgomery, MD, Lee K. Tan, MD, Barbara Susnik, MD, Denis Y. H. Leung, PhD, Patrick I. Borgen, MD and Hiram S. Cody III, MD

From The Breast Service, Department of Surgery (MRW, LLM, PIB, HSC), the Department of Pathology (LKT, BS), and the Department of Biostatistics (DYHL), Memorial Sloan-Kettering Cancer Center, New York, New York.

Correspondence: Address correspondence and reprint requests to: Dr. Hiram S. Cody III, The Breast Service, Dept. of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021; Fax: 212-794-5812; E-mail: codyh{at}mskcc.org

Background: Fifty percent of patients with sentinel lymph node (SLN) metastases have no metastatic disease in non-SLNs on axillary lymph node dissection (ALND). The goal of this study is to determine which patients have metastatic disease limited to the SLN, and, therefore, may not require completion ALND.

Methods: Of the first 1000 patients undergoing SLN biopsy at Memorial Sloan-Kettering Cancer Center, using a combined blue dye and isotope technique, 231 (26%) had positive SLN. Of these, 206 underwent completion ALND. They are the study group for this report.

Results: The likelihood of non-SLN metastasis was inversely related to three clinicopathologic variables: tumor size <= 1.0 cm; absence of lymphovascular invasion (LVI); and SLN micrometastases (<= 2 mm). None of 24 patients with all three predictive factors had non-SLN metastases, whereas 58% of patients with none of the factors had disease in the non-SLN.

Conclusion: Patients with small breast cancers, no LVI, and SLN micrometastases have a low risk of non-SLN metastases, and may not require completion ALND.

Key Words: Breast cancer • Lymph node metastasis • Sentinel node




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