Association of Level III Axillary Lymph Node Positivity with Clinicopathological Characteristics in Breast Cancer
DOI:
https://doi.org/10.30683/1927-7229.2024.13.03Keywords:
Axillary Lymph Nodes, Level III Lymph Node Dissection, Breast Cancer, ALND, level III, MastectomyAbstract
Management of breast cancer has gradually shifted from era of radical surgery to present days of multi-modality management and conservatism. While complete axillary dissection is common for node-positive cases, less invasive approaches like sentinel node biopsy are often sufficient for clinically node-negative cases. However, these findings may not apply to all populations, particularly in India where advanced disease presentation is common. The objective of this study is to assess Level III Axillary Lymph Node Positivity with clinicopathological characteristics in Breast cancer.
This was a hospital based retrospective observational study on breast cancer patients conducted in single institute from 2016 to 2022. A total of 70 patients with operable breast cancers, who underwent primary tumour resection and complete axillary lymph node dissection, including level III were included in the study. Patients with inoperable and metastatic disease were excluded. Final histopathological examination data was collected and analysed.
Most patients (92.9%) underwent Modified Radical Mastectomy, with Infiltrating Ductal Carcinoma (IDC) being the most common histology (90%). Factors significantly associated with level III lymph node positivity included tumour size >4.5cm, nuclear grade III, pathological N3 stage and extra nodal extension. The study found no significant correlation with other factors like age, tumour laterality, location, hormone receptor status, HER2 status, or LVSI. These findings may help predict level III lymph node involvement in breast cancer patients. All these predictive factors should be considered during the axillary dissection.
References
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries Sung H, Ferlay J, Siegel RL , Laversanne M, Soerjomataram I, Jemal A, Bray F. CA: A Cancer Journal for Clinicians 2021; 71(3). https://doi.org/10.3322/caac.21660
Varughese AA , Poothiode U, Manjula VD. Descriptive study on selected risk factors and histopathology of breast carcinoma in a tertiary care centre in Kerala, India with special reference to women under 40 years old. Asian Pacific Journal Of Cancer Prevention: APJCP 2015; 16(1). https://doi.org/10.7314/APJCP.2015.16.1.181
Gogia A, Raina V, Deo SVS, Shukla NK, Mohanti BK. Young breast cancer: A single center experience. Indian Journal of Cancer 2014; 51(4). https://doi.org/10.4103/0019-509X.175332
Tfayli A, Temraz S, Abou Mrad R, Shamseddine. Breast cancer in low- and middle-income countries: an emerging and challenging epidemic. A Journal of Oncology 2010; 2010. https://doi.org/10.1155/2010/490631
Fisher B, Montague E, Redmond C, et al. Comparison of radical mastectomy with alternative treatments for primary breast cancer. A first report of results from a prospective randomized clinical trial. Cancer 1977; 39(suppl 6): 2827-2839. https://doi.org/10.1002/1097-0142(197706)39:6<2827::AID-CNCR2820390671>3.0.CO;2-I
Parmar V, Hawaldar R, Nair NS, et al. Sentinel node biopsy versus low axillary sampling in women with clinically node negative operable breast cancer. Breast 2013; 22: 1081-1086. https://doi.org/10.1016/j.breast.2013.06.006
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: Overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11: 927-933. https://doi.org/10.1016/S1470-2045(10)70207-2
Pesek S, Ashikaga T, Krag LE, et al. The false-negative rate of sentinel node biopsy in patients with breast cancer: A meta-analysis. World J Surg 2012; 36: 2239-2251. https://doi.org/10.1007/s00268-012-1623-z
Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 2010; 102: 111-118. https://doi.org/10.1002/jso.21535
National Comprehensive Cancer Network: NCCN Guidelines for the Treatment of Breast Cancer 2017 https://www.nccn. org/professionals/physician_gls/pdf/breast.pdf
Kiricuta CI, Tausch J. A mathematical model of axillary lymphnode involvement based on 1446 complete axillary dissections in patients with breast carcinoma. Cancer 1992; 69: 2496-2501. https://doi.org/10.1002/1097-0142(19920515)69:10<2496::AID-CNCR2820691018>3.0.CO;2-T
Aslan S: Level III lymph node involvement in breast carcinoma. Turkish Journal of Cancer 2007; 37: 109-113.
Fisher B, Wolmark N, Redmond C, et al. Findings from NSABP Protocol No. B-04: Comparison of radical mastectomy with alternative treatments. II. The clinical and biologic significance of medial-central breast cancers. Cancer 1981; 48: 1863-1872. https://doi.org/10.1002/1097-0142(19811015)48:8<1863::AID-CNCR2820480825>3.0.CO;2-U
Orr RK: The impact of prophylactic axillary node dissection on breast cancer survival--A Bayesian meta-analysis. Ann Surg Oncol 6: 109-116, 1999. https://doi.org/10.1007/s10434-999-0109-1
EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, TaylorC, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: Meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014; 383: 2127-2135. https://doi.org/10.1016/S0140-6736(14)60488-8
Bromham N, Schmidt-Hansen M, Astin M, et al. Axillary treatment for operable primary breast cancer. Cochrane Database Syst Rev 2017; 1: CD004561. https://doi.org/10.1002/14651858.CD004561.pub3
Khafagy M, Mostafa A, Fakhr I, et al. Distribution of axillary lymph node metastases in different levels and groups in breast cancer: A pathological study. J Egypt Natl Canc Inst 2011; 23: 25-30. https://doi.org/10.1016/j.jnci.2011.07.004
Veronesi U, Rilke F, Luini A, et al. Distribution of axillary node metastases by level of invasion. An analysis of 539 cases. Cancer 1987; 59: 682-687. https://doi.org/10.1002/1097-0142(19870215)59:4<682::AID-CNCR2820590403>3.0.CO;2-Z
Rosen PP, Lesser ML, Kinne DW, et al. Discontinuous or “skip” metastases in breast carcinoma. Analysis of 1228 axillary dissections. Ann Surg 1983; 197: 276-283. https://doi.org/10.1097/00000658-198303000-00006
Chua B, Ung O, Taylor R, et al. Is there a role for axillary dissection for patients with operable breast cancer in this era of conservatism? ANZ J Surg 2002; 72: 786-792. https://doi.org/10.1046/j.1445-2197.2002.02576.x
Fan Z, Li J, Wang T, et al. Level III axillary lymph nodes involvement in node positive breast cancer received neoadjuvant chemotherapy. Breast 2013; 22: 1161-1165. https://doi.org/10.1016/j.breast.2013.08.004
Bale A, Gardner B, Shende M, et al. Can interpectoral nodes be sentinel nodes? Am J Surg 1999; 178: 360-361. https://doi.org/10.1016/S0002-9610(99)00199-3
Joshi S, Noronha J, Hawaldar R, et al. Merits of Level III Axillary Dissection in Node-Positive Breast Cancer: A Prospective, Single-Institution Study from India J Glob Oncol 2019; 5. https://doi.org/10.1200/JGO.18.00165
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