Extracapsular extension in the positive sentinel lymph node: a marker of poor prognosis in cT1-2N0 breast cancer patients?

  • Marissa L. G. VaneEmail author
  • Maria A. Willemsen
  • Lori M. van Roozendaal
  • Sander M. J. van Kuijk
  • Loes F. S. Kooreman
  • Sabine Siesling
  • Hans H. W. de Wilt
  • Marjolein L. Smidt
Clinical trial



This study aims to evaluate whether extracapsular extension (ECE) in the sentinel lymph node (SLN) is associated with involvement of ≥ 4 lymph node metastases at completion axillary lymph node dissection (ALND) and the effect on 5-year disease-free survival (DFS) and 10-year overall survival (OS).

Summary background data

ECE in a SLN is usually a contraindication for omitting completion ALND in cT1-2N0 breast cancer patients treated with breast-conserving therapy and 1–2 positive SLN(s).


All cT1-2N0 breast cancer patients with 1–3 positive SLN(s) who underwent ALND between 2005 and 2008 were selected from the Netherlands Cancer Registry. Logistic regression analysis was used to determine the association between ECE and ≥ 4 lymph node metastases. Five-year DFS and 10-year OS were analyzed using Kaplan–Meier survival analysis. Cox regression analysis was performed to correct for other prognostic factors.


A total of 3502 patients were included. Information on ECE was available for 2111 (60.3%) patients, consisting of 741 (35.1%) patients with and 1370 (64.9%) without ECE. The incidence of ≥ 4 lymph node metastases was 116 (15.7%) in the ECE group vs. 80 (5.8%) in the group without ECE (p < 0.001). Five-year DFS rate was 86.4% in the ECE group compared to 88.8% in the group without ECE (p = 0.085). 10-year OS rate was 78.6% compared to 83.0% (p = 0.018), respectively. Cox regression analysis showed that ECE was not an independent prognostic factor for both DFS and OS.


ECE was significantly associated with involvement of ≥ 4 lymph node metastases in the completion ALND group. ECE was not an independent prognostic factor for both DFS and OS.


Breast cancer Sentinel lymph node Axillary lymph node dissection Extracapsular extension Disease-free survival Overall survival 



Axillary lymph node dissection


Breast-conserving therapy


Disease-free survival


Distant metastasis


Extracapsular extension


Hazard ratio


Comprehensive Cancer Organisation the Netherlands


Local recurrence


Netherlands Cancer Registry


Overall survival


Pathological Anatomical National Automated Archive


Regional recurrence


Sentinel lymph node


Sentinel lymph node biopsy



The authors thank the Netherlands Cancer Registry and Pathological Anatomical National Automated Archive for providing the clinical and histopathological data.


The research reported in this article was supported by CZ funds. This study was not funded. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

None of the authors reported have a conflict of interest related to the outcomes of this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Supplementary material

10549_2018_5074_MOESM1_ESM.docx (2 mb)
Supplementary material 1 (DOCX 2091 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Marissa L. G. Vane
    • 1
    • 2
    Email author
  • Maria A. Willemsen
    • 1
  • Lori M. van Roozendaal
    • 3
  • Sander M. J. van Kuijk
    • 4
  • Loes F. S. Kooreman
    • 2
    • 5
  • Sabine Siesling
    • 6
    • 7
  • Hans H. W. de Wilt
    • 8
  • Marjolein L. Smidt
    • 1
    • 2
  1. 1.Department of Surgical OncologyMaastricht University Medical CentreMaastrichtThe Netherlands
  2. 2.GROW - School for Oncology and Developmental BiologyMaastricht University Medical CentreMaastrichtThe Netherlands
  3. 3.Department of SurgeryZuyderland Medical CentreHeerlenThe Netherlands
  4. 4.Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CentreMaastrichtThe Netherlands
  5. 5.Department of PathologyMaastricht University Medical CentreMaastrichtThe Netherlands
  6. 6.Department of ResearchNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
  7. 7.Department of Health Technology and Services Research, MIRA Institute for Biomedical Science and Technical MedicineUniversity of TwenteEnschedeThe Netherlands
  8. 8.Department of Surgical OncologyRadboud University Medical CentreNijmegenThe Netherlands

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