307 - Study on micrometastasis in sentinel lymph node of patients with breast cancer

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Breast Cancer
Pathology/Molecular Biology
Presenter David Pérez Callejo
Authors D. Pérez Callejo1, E. Almagro Casado2, B. Cantos2, C. González-Lois3, A. Ruiz-Valdepeñas2, M. Palka2, Á. Ortiz3, C. Maximiano2, M. Méndez García2, M. Provencio Pulla4
  • 1Hospital Universitario Puerta de Hierro Majadahonda, 28222 - Madrid/ES
  • 2Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 - Madrid/ES
  • 3Anatomical Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid/ES
  • 4Oncology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 - Madrid/ES

Abstract

Introduction

The nodal ratio it's the most important factor when delivering a prognosis in breast cancer, and survival is clearly related with the number of affected nodes. During the last few years the technique of the sentinel lymph node (SLN) has demonstrated to be a useful tool to predict the nodal status, being necessary until today to evaluate if a lymphadenectomy is needed when this node is affected. Due to the doubtful prognosis in these particular cases relating micrometastasis (NMIC) with a needed axillary lymph node dissection (ALND), in our Hospital we analyze the SLNs evaluated.

Methods

We perform a descriptive retrospective study in 216 patients of the Hospital Universitario Puerta de Hierro who have gone through a SLN biopsy (SLNB) of breast carcinoma between January 2010 and March 2012, being introduced the OSNA technique in May 2011. We analyze the following factors: histology, processing method of the SLN, number of SLNs, intraoperative and definitive diagnosis, performance of ALND, number of nodes dissected along the procedure and total number of affected nodes.

Results

Among 216 patients treated with SLNB, 26.8% (58) showed a positive SLN, subdivided in Nmic 8.8% (19 patients) and metastasis 18%, (39 patients). Out of the total number of nodes, 57% of them were processed with the OSNA method and the other 43% with histopathological (HP) examination. The specificity of the HP technique in these series was of a 100%, with a sensitivity of 73.33%. Out of the 58 SLN that presented SLN positive, 96.6% (56) received an ALND. Out of the 19 SLN with Nmic, 17 cases had an ALND, and 3 cases were affected again later. The other two SLNs, processed by histopathology, presented a negative intraoperative diagnosis for infiltration, and therefore it was decided not to proceed with a delayed lymphadenectomy.

Conclusions

Although we still don't know the impact of the persistence of tumoral disease in nodes with disease free survival and overall survival, with the data gathered in our study and given that more than the 15% of the nodes removed were positive, we conclude that lymphadenectomy should not be dismissed after detecting Nmic in the SLN. It is necessary to carry out studies with a larger number of patients, under a long-term monitoring, to determine the real impact on survival.

Disclosure

All authors have declared no conflicts of interest.