Sentinel and non-sentinel lymph node metastases in patients with microinvasive breast cancer: a nationwide study
To determine the incidence and risk factors of sentinel lymph node (SN) and non-SN metastases in patients with microinvasive breast cancer (MIBC, T1mic). This to identify MIBC patients in whom axillary staging can be safely omitted.
The Danish Breast Cancer Group database was used to identify a total of 409 women with breast cancer ≤ 1 mm who underwent sentinel lymph node biopsy (SLNB) between 2002 and 2015. After validation, 233 patients were eligible for the analysis. The incidence rates of SN and non-SN metastases were determined. The associations between clinicopathological variables and a positive SN [pN1, pN1mi, or pN0(i+)] were analyzed using univariate and multivariate designs.
Of 233 patients with MIBC, only 9 (3.9%) had SN macrometastases. An additional 18 (7.7%) and 23 (9.9%) had SN micrometastases and isolated tumor cells (ITCs), respectively. Of patients with SN macrometastases, two (22.2%) had non-SN macrometastases. In the adjusted analysis, a positive SN was associated with younger age (P = 0.0001) and a positive human epidermal growth factor 2 receptor (HER2) status (P = 0.03).
The low incidence of SN macrometastases < 4% suggests omission of axillary staging in MIBC patients without staging at primary surgery, especially in older (≥ 50 years) HER2− patients. Still, the relatively high proportion of patients with non-SN macrometastases indicates that axillary treatment might be considered in SN positive patients, especially in younger HER2+ MIBC patients.
KeywordsEarly-stage breast cancer Microinvasive breast cancer Sentinel lymph node Sentinel lymph node biopsy Sentinel lymph node metastases Axillary lymph node metastases Axillary management Axillary surgery
This study was supported by the Danish Cancer Society (Knæk Cancer-midlerne), Denmark (Grant Number R130-A8152-15-S38), and by the Research Fund of Rigshospitalet, (Copenhagen University Hospital), Denmark (Grant Number E-22335-01).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
The register-based study was approved by the Data Protection Agency (J. No. RH-2015-262) and the Danish Patient Safety Authority (J. No. 3-3013-1443/1/). Approvals from Ethical Committees are not needed for registry-based research in Denmark.
The Danish Breast Cancer Group administering the Danish Breast Cancer Database is approved by the National Health Data Authorities (J. No. 14/915974.). The Central Denmark Region holds permission to collect, store, and process data in the Danish Breast Cancer Database on all persons diagnosed with cancer in Denmark without obtaining individual consent (J. No. KPU-2001-04-2001-54-0277). In Denmark, informed consent is not required for register-based research that does not involve contact with study participants or biological samples.
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