Lymph node features may indicate breast cancer metastasis risk

Certain pathological features appear to be associated with metastasis in non-sentinel lymph nodes in breast cancer patients, according to results of a new meta-analysis. Ultimately, the findings may help reduce the need for complete axillary node dissections when a sentinel node is positive.

As lead investigator Dr. Amy C. Degnim told Reuters Health, “This study provides the groundwork for developing a way to predict which breast cancer patients with a positive sentinel node have more axillary lymph nodes containing cancer.”Dr. Degnim of the Mayo Clinic, Rochester, Minnesota and colleagues examined pooled results of 11 studies of patients with a positive sentinel lymph node. The number of patients in each study who went on to completion axillary lymph node dissection ranged from 60 to 389. The investigators report in the December 1st issue of Cancer that despite methodologic differences among studies, there was a “remarkably similar” correlation between positive non-sentinal lymph nodes and certain characteristics.Among the features with the highest likelihood of non-sentinal lymph node metastasis, were sentinel node metastasis greater than 2 mm in size, extranodal extension in the sentinel node, a tumor size of more than 2 cm and more than 1 positive sentinel node.The researchers suggest that such features should be routinely evaluated in sentinel node specimens, and be “included in prospective databases for the development of a predictive model.”Thus, Dr. Degnim concluded, “for patients determined to have a very low chance of additional positive lymph nodes, axillary dissection and the associated risk of lymphedema could be avoided.”(Source: Cancer 2003;98:2307-2315: Reuters Health: David Douglas: December 23, 2003: Oncolink)