Predictors of Sentinel Lymph Node Metastasis in Postoperatively Upgraded Invasive Breast Carcinoma Patients
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Image-Guided Core Needle Biopsy Procedure
2.3. Radiologic Features of Tumor
2.4. Surgical Procedure
2.5. Pathological Assessment
2.6. Statistical Analysis
3. Results
3.1. Clinical Data
3.2. Radiologic Features
3.3. Final Pathological Findings
3.4. Evaluation of Axillary Lymph Node Status
3.5. Predictors of Sentinel Lymph Node Metastasis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | No. of Cases | % |
---|---|---|
Age (years), median (IQR) | 53 (16) | |
Lesion location | ||
Left breast | 180 | 57.0 |
Right breast | 136 | 43.0 |
First-degree family history of breast cancer | ||
Yes | 31 | 9.8 |
No | 285 | 90.2 |
Palpability | ||
Palpable | 174 | 55.1 |
Non-palpable | 142 | 44.9 |
Lesion-detecting imaging modality | ||
Ultrasonography only | 44 | 13.9 |
Mammography only | 36 | 11.4 |
Detected by both ultrasonography and mammography | 236 | 74.7 |
Radiologic morphology | ||
Mass with calcifications | 164 | 51.9 |
Mass without calcifications | 85 | 26.9 |
Non-mass | 67 | 21.2 |
Parenchymal density | ||
Entirely fatty | 11 | 3.5 |
Scattered fibroglandular | 52 | 16.5 |
Heterogeneously dense | 179 | 56.6 |
Extremely dense | 74 | 23.4 |
MMG-BI-RADS category | ||
0 | 49 | 15.5 |
1 | 6 | 1.9 |
2 | 26 | 8.2 |
4a | 50 | 15.8 |
4b | 71 | 22.5 |
4c | 78 | 24.7 |
5 | 36 | 11.4 |
Ultrasound-BI-RADS category | ||
1 | 15 | 4.7 |
2 | 10 | 3.2 |
3 | 10 | 3.2 |
4a | 82 | 25.9 |
4b | 72 | 22.8 |
4c | 75 | 23.7 |
5 | 52 | 16.5 |
Image-guided procedure | ||
Ultrasound-guided | 275 | 87.0 |
MMG-guided | 41 | 13.0 |
Needle gauge | ||
7/10 | 38 | 12.0 |
14/16/18 | 278 | 88.0 |
Operation type | ||
Mastectomy | 191 | 60.4 |
BCS | 125 | 39.6 |
DCIS tumor size (cm), median (IQR) | 3.3 (2.6) | |
Tumor necrosis area | ||
None | 36 | 11.4 |
Focal | 178 | 56.3 |
Large | 102 | 32.3 |
DCIS tumor grading | ||
Low | 34 | 10.7 |
Intermediate | 144 | 45.6 |
High | 138 | 43.7 |
DCIS architecture pattern | ||
Comedo | 122 | 38.6 |
Non-comedo | 194 | 61.4 |
Lymphovascular invasion | ||
Present | 11 | 3.5 |
Absent | 305 | 96.5 |
IDC area | ||
Multifocal/multicentric | 142 | 44.9 |
Unifocal | 174 | 55.1 |
IDC a | ||
T1mi | 101 | 32.0 |
T1a | 92 | 29.1 |
T1b | 50 | 15.8 |
T1c | 47 | 14.9 |
T2 | 26 | 8.2 |
IDC tumor grading | ||
1 | 81 | 25.6 |
2 | 133 | 42.1 |
3 | 44 | 13.9 |
Unknown | 58 | 18.4 |
Estrogen receptor status | ||
Positive | 197 | 62.3 |
Negative | 119 | 37.7 |
Progesterone receptor status | ||
Positive | 176 | 55.7 |
Negative | 140 | 44.3 |
HER2 status | ||
Positive | 110 | 34.8 |
Negative | 206 | 65.2 |
Ki-67 | ||
<20 | 221 | 69.9 |
≥20 | 70 | 22.2 |
Unknown | 25 | 7.9 |
Age (yrs) | Radiologic Morphology | Surgery Type | Final Pathology | |||||||
---|---|---|---|---|---|---|---|---|---|---|
LVI | DCIS (mm) | IDC (mm) | Molecular Subtype | No. of SLNs a | pN by SLNB b | No. of LN by ALND c | Final TNM Stage b | |||
50 | non-mass | Mast. | present | 26 | 9 | HER2 positive | 1/1 | pN1 | 1/17 | pT1bN1aM0 |
38 | mass without calcifications | Mast. | absent | 37 | 9 | Luminal A | 1/1 | pN1mi | 0/39 | pT1bN1miM0 |
54 | mass without calcifications | BCS | absent | 11 | 7 | Luminal A | 1/1 | pN1 | 0/20 | pT1bN1M0 |
55 | mass with calcifications | Mast. | absent | 70 | <1 | HER2 positive | 1/2 | pN1 | 0/12 | pT1miN1aM0 |
42 | mass with calcifications | Mast. | present | 56 | 12 | Luminal B/HER2 positive | 1/2 | pN1mi | 0/20 | pT1cN1miM0 |
69 | mass with calcifications | Mast. | present | 10 | 35 | Luminal A | 1/2 | pN1 | 0/10 | pT2N1aM0 |
41 | mass with calcifications | Mast. | present | 42 | 32 | Luminal A | 1/1 | pN1 | 1/16 | pT2N1aM0 |
41 | mass with calcifications | Mast. | absent | 6 | 8 | Triple negative | 1/1 | pN1mi | NP | pT1bN1miM0 |
68 | mass without calcifications | Mast. | absent | 52 | <1 | Luminal A | 1/5 | pN0(i+) | NP | pT1miN0(i+)M0 |
59 | mass without calcifications | BCS | absent | 47 | 2.5 | Triple negative | 1/1 | pN1 | 0/20 | pT1aN1aM0 |
53 | mass without calcifications | Mast. | absent | 46 | 12 | HER2 positive | 1/1 | pN1 | 0/44 | pT1cN1aM0 |
42 | mass without calcifications | Mast. | absent | 60 | 19 | Luminal A | 1/1 | pN1 | NP | pT1cN1aM0 |
65 | mass without calcifications | Mast. | absent | 48 | 20 | Luminal A | 2/2 | pN1 | 0/14 | pT1cN1aM0 |
64 | mass without calcifications | Mast. | present | 25 | 45 | Luminal A | 1/2 | pN1 | 1/28 | pT2N1aM0 |
47 | non-mass | Mast. | present | 109 | 12 | HER2 positive | 1/2 | pN1 | 0/20 | pT1cN1aM0 |
74 | mass with calcifications | Mast. | present | 38 | <1 | HER2 positive | 1/2 | pN1 | 1/18 | pT1miN1aM0 |
57 | mass with calcifications | Mast. | absent | 50 | 17 | Luminal B HER2 negative | 1/2 | pN1mi | NP | pT1cN1miM0 |
37 | mass with calcifications | BCS | absent | 18 | 18 | Luminal B/HER2 negative | 1/2 | pN1mi | NP | pT1cN1miM0 |
39 | mass with calcifications | Mast. | present | 47 | 39 | Luminal B/HER2 negative | 3/3 | pN1 | 3/12 | pT2N2aM0 |
42 | mass with calcifications | BCS | absent | 40 | 31 | Luminal B/HER2 negative | 2/3 | pN1 | 11/27 | pT2N3aM0 |
67 | mass without calcifications | Mast. | absent | 45 | 5 | Luminal A | 1/2 | pN1mi | 0/11 | pT1aN1miM0 |
44 | non-mass | Mast. | absent | 47 | 1.6 | Luminal B/HER2 negative | 1/2 | pN1 | 0/17 | pT1aN1aM0 |
55 | non-mass | BCS | absent | 34 | 32 | Luminal A | 1/1 | pN1mi | NP | pT2N1miM0 |
Variable | Lymph Node | p Value | |
---|---|---|---|
Negative (n = 293) | Positive (n = 23) | ||
Age (years), median (IQR) | 53.0 (16.0) | 53.0 (22.0) | |
Lesion location | 0.965 | ||
Left breast | 167 (57.0) | 13 (56.5) | |
Right breast | 126 (43.0) | 10 (43.5) | |
1st degree family history of breast cancer | 0.146 | ||
Yes | 31 (10.6) | 0 | |
No | 262 (89.4) | 23 (100.0) | |
Palpability | 0.059 | ||
Palpable | 157 (53.6) | 17 (73.9) | |
Non-palpable | 136 (46.4) | 6 (26.1) | |
Lesion-detecting imaging modality | 0.652 | ||
Ultrasonography only | 42 (14.3) | 2 (8.7) | |
Mammography only | 34 (11.6) | 2 (8.7) | |
Detected by both ultrasonography and mammography | 217 (74.1) | 19 (82.6) | |
Radiologic morphology | 0.389 | ||
Mass with calcifications | 154 (52.6) | 10 (43.5) | |
Mass without calcifications | 76 (25.9) | 9 (39.1) | |
Non-mass with calcifications | 63 (21.5) | 4 (17.4) | |
Parenchymal density | 0.070 | ||
Entirely fatty | 8 (2.7) | 3 (13.0) | |
Scattered fibroglandular | 49 (16.7) | 3 (13.0) | |
Heterogeneously dense | 166 (56.7) | 13 (56.5) | |
Extremely dense | 70 (23.9) | 4 (17.4) | |
MMG-BI-RADS category | 0.492 | ||
0 | 43 (14.7) | 6 (26.1) | |
1 | 5 (1.7) | 1 (4.3) | |
2 | 25 (8.5) | 1 (4.3) | |
4a | 49 (16.7) | 1 (4.3) | |
4b | 65 (22.2) | 6 (26.1) | |
4c | 72 (24.6) | 6 (26.1) | |
5 | 34 (11.6) | 2 (8.7) | |
Ultrasound-BI-RADS category | 0.080 | ||
1 | 14 (4.8) | 1 (4.3) | |
2 | 10 (3.4) | 0 | |
3 | 10 (3.4) | 0 | |
4a | 80 (27.3) | 2 (8.7) | |
4b | 62 (21.2) | 10 (43.5) | |
4c | 67 (22.9) | 8 (34.8) | |
5 | 50 (17.1) | 2 (8.7) | |
Image-guided procedure | 0.751 | ||
Ultrasound-guided | 254 (86.7) | 21 (91.3) | |
MMG-guided | 39 (13.3) | 2 (8.7) | |
Needle gauge | >0.999 | ||
7/10 | 36 (12.3) | 2 (8.7) | |
14/16/18 | 257 (87.7) | 21 (91.3) | |
Operation type | 0.070 | ||
Mastectomy | 173 (59.0) | 18 (78.3) | |
BCS | 120 (41.0) | 5 (21.7) | |
DCIS tumor size (cm), median (IQR) | 3.3 (2.6) | 4.5 (2.4) | 0.117 |
DCIS tumor grading | 0.797 | ||
Low | 32 (10.9) | 2 (8.7) | |
Intermediate | 132 (45.1) | 12 (52.2) | |
High | 129 (44.0) | 9 (39.1) | |
DCIS architecture pattern | 0.084 | ||
Comedo | 117 (39.9) | 5 (21.7) | |
Non-comedo | 176 (60.1) | 18 (78.3) | |
Tumor necrosis area | 0.912 | ||
None | 33 (11.3) | 3 (13.0) | |
Focal | 166 (56.7) | 12 (52.2) | |
Large | 94 (32.1) | 8 (34.8) | |
IDC area | 0.884 | ||
Multiple | 132 (45.1) | 10 (43.5) | |
Single | 161 (54.9) | 13 (56.5) | |
IDC tumor size (cm) | <0.001 | ||
≦0.5 | 187 (63.8) | 6 (26.1) | |
>0.5 | 106 (36.2) | 17 (73.9) | |
IDC tumor grading | 0.165 | ||
1 | 78 (26.6) | 3 (13.0) | |
2 | 119 (40.6) | 14 (60.9) | |
3 | 40 (13.7) | 4 (17.4) | |
Unknown | 56 (19.1) | 2 (8.7) | |
Lymphovascular invasion | <0.0001 | ||
Present | 3 (1.0) | 8 (34.8) | |
Absent | 290 (99.0) | 15 (65.2) | |
Estrogen receptor status | 0.458 | ||
Positive | 181 (61.8) | 16 (69.6) | |
Negative | 112 (38.2) | 7 (30.4) | |
Progesterone receptor status | 0.340 | ||
Positive | 161 (54.9) | 15 (65.2) | |
Negative | 132 (45.1) | 8 (34.8) | |
HER2 status | 0.647 | ||
Positive | 103 (35.2) | 7 (30.4) | |
Negative | 190 (64.8) | 16 (69.6) | |
Ki-67 | 0.873 | ||
<20 | 206 (70.3) | 15 (65.2) | |
≧20 | 64 (21.8) | 6 (26.1) | |
Unknown | 23 (7.8) | 2 (8.7) |
Variable | Odds Ratio | 95% Confidence Interval of Odds | p Value |
---|---|---|---|
IDC tumor size (cm) | |||
≤0.5 | 1 | ||
>0.5 | 3.11 | 1.09–8.81 | 0.033 |
Lymphovascular invasion | |||
Present | 32.85 | 7.56–142.80 | <0.0001 |
Absent | 1 |
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Yu, C.-C.; Cheung, Y.-C.; Hsueh, C.; Chen, S.-C. Predictors of Sentinel Lymph Node Metastasis in Postoperatively Upgraded Invasive Breast Carcinoma Patients. Cancers 2021, 13, 4099. https://doi.org/10.3390/cancers13164099
Yu C-C, Cheung Y-C, Hsueh C, Chen S-C. Predictors of Sentinel Lymph Node Metastasis in Postoperatively Upgraded Invasive Breast Carcinoma Patients. Cancers. 2021; 13(16):4099. https://doi.org/10.3390/cancers13164099
Chicago/Turabian StyleYu, Chi-Chang, Yun-Chung Cheung, Chuen Hsueh, and Shin-Cheh Chen. 2021. "Predictors of Sentinel Lymph Node Metastasis in Postoperatively Upgraded Invasive Breast Carcinoma Patients" Cancers 13, no. 16: 4099. https://doi.org/10.3390/cancers13164099